Clinical Component

Navigating the Clinical Component

Relationship-Based Medicine Across Multiple Care Settings

Your clinical practice will unfold across eight carefully selected assisted living facilities, where you'll develop deep, meaningful relationships with residents who come to know and trust you as their primary physician. Unlike the revolving door of hospital medicine or the time constraints of traditional clinic practice, you'll have the opportunity to truly understand each patient's story, managing complex cases that span everything from Parkinson's disease and stroke recovery to dementia care and pulmonary hypertension. Each day brings variety as you travel between two facilities, seeing 5–10 patients who benefit from your unhurried, comprehensive approach to care – a refreshing contrast to the volume-driven models that lead to physician burnout elsewhere.

The patient population reflects the full spectrum of geriatric complexity, with particular emphasis on those requiring sophisticated medication management and behavioral health integration. Two of your facilities specifically house residents with dual diagnoses of mental health conditions alongside their medical comorbidities, allowing you to utilize the full scope of your geriatric training. Your practice will encompass acute care management for COPD exacerbations, careful titration of Parkinson's medications, post-stroke rehabilitation oversight, heart failure management, fracture care coordination, and addressing the myriad GI issues that affect the elderly. You'll also play a vital role in goals-of-care discussions, helping families navigate difficult decisions with compassion and expertise.

  • Patient volume: 5–10 visits daily across two facilities – averaging 6–7 patients, allowing for thorough 30–45 minute encounters
  • Comprehensive case mix: heart disease, Parkinson's, dementia, stroke, pulmonary hypertension, behavioral health conditions, fracture management, and complex polypharmacy
  • Team-based care model: shared patient panel of 240 (growing to 320) managed collaboratively with PA Ken Donahue
  • Extensive care coordination: family meetings, specialist referrals within Augusta Health network, and transition management
  • Call schedule: 1:9 (soon 1:10) covering hospice and palliative care – approximately 3–4 weekday calls monthly plus one weekend every 9–10 weeks
  • Hospice coverage: 2–4 patient census at Augusta Health's inpatient unit with 4 beds total – primarily phone management for medication refills and symptom control
  • EMR transition: moving to unified Meditech Advance platform – eliminating current fragmentation where each facility has different systems
  • Integrated behavioral health: services for dual-diagnosis patients requiring psychiatric expertise alongside medical management
  • No SNF responsibilities: focus maintained on assisted living and transitional care
  • Innovation: opportunity to develop "curbside" virtual consultation program for enhanced care coordination
  • Teaching opportunities: Internal Medicine residents rotating through geriatric service

The beauty of this practice model lies in its sustainable pace and meaningful impact – Dr. Kokanovich specifically notes the absence of burnout thanks to varied, intellectually stimulating cases and the ability to form genuine bonds with residents, making this "old school medicine" in the best possible way where relationships and comprehensive care take precedence over productivity metrics.

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