The doctor for this practice and be focused on non-invasive or come in as an interventional cardiologist. There is an option to build our structural heart program too. All candidates should be comfortable with doing outreach times 4 times a month as this is the practice builder. A candidate that aspires for a leadership role will have that option here.
Our long time cardiologist, Dr. McGowen considers himself an interventional cardiologist that has a full spectrum practice including all non-invasive diagnostic testing with Nuclear and TEE, which are being done by anesthesiologists at the hospital For echo’s, we share staff with the hospital allowing us to do echo’s in clinic and at the hospital. This is an established practice where Dr. McGowan will assist you in building your practice in whatever way you may need help. Within two years of your arrival, he plans to step back from full-time practice to work part time, probably in locums.
Dr. McGowen has been in Kearney for 25 years. He covers a service area of 300K. The program was built by doing a lot of outreach. Dr. McGowen does 9 outreach clinics a month. Outreach will continue to be the practice builder in the future as it represents close to 70% of all procedures performed in our 3 cath labs. Our APPs have been assisting in covering the outreach until our new providers arrive.
Market-To the west to Grand Island and North Platte up into South Dakota and down into northern Kansas (4 sites). The Bryan hospital covers more to the east and south.
Hastings and Grand Island Hospital is covered by one cardiologist and then visiting cardiologists from Lincoln. CHI has a Grand Island cardiology practice, that is not as busy as ours. In Kozad, Dr. McGowen averages 25-30 patients in a half day clinic. Outreach-Hansworth, Bassett, Atkinson-he is the only cardiologist going there.
Dr. McGowin does Pacemakers and will mentor you if you want to do them too. Dr. McGowen sees a lot of heart failure patients and will take care of them up until the point they need a BiV. He refers out the BiV, but does the ICD and pacers. The hospital is open to developing a heart failure clinic upon the arrival of another cardiologist. Dr. McGowen follows close to 400 devices. We have a visiting EP doctor, that sees patients twice a month in town and performs 50 ablations a year on our patients in Lincoln. There is an option to read our Cardiac MRI work as nobody does that and we send that out. We are not doing CTA now but are getting that module in the near future.
The peripheral vascular service is covered by Dr. Murphy 15 days a month, when he is on hospital call. The other 15 days, when he is in clinic/performing procedures, the PV is referred out. Our CTS, Dr. Pankaj Kulshrestha, and IR doctors do not do PV. An interventional cardiologist that wants to develop PV as part of their practice will be supported by Dr. Murphy and Dr. McGowen.
We have a program doing TAVRs in Lincoln and Dr. McGowen refers out 20-40 cases a year. The other hospital south of town does about 7 TAVR cases a year. Dr. McGowen believes there is enough volume to build a structural heart practice. We have a new $5M Siemens hybrid suite with plenty of time available for procedures. A structural heart physician will need to also perform interventional cases and see our non-invasive patients.
The local patients are split between the two hospitals. We have 6 primary care (5 FM/1 IM) doctors, and the other hospital at Bryan-Platte Valley Medical Clinic has 3 FM doctors and 2 APPs and 2 IM and 2 APPs. They have one full time cardiologist and 6 APPs. There is a private primary care group, Family Practice Associates, https://www.kearneyfpa.com/ that has 10 FM or FMOB doctors and 7 APPs that refer patients to both programs.
Your clinic has 12 exam rooms, and you are in the same hallway as our CTS. We use McKesson PACS and Epic EMR. We have 2 experienced device technicians that check on the device prior to the doctor’s visit. We also have a nurse triage team to assist in patient management.
We have 3 APP’s and will be hiring a fourth. As additional cardiologists join the practice, we will hire another APP. The APPs help with rounds, consults on the floor and observe stress tests at the hospital. They help manage patients coming through the ED and will do the initial assessment if the doctor is doing a procedure. We save the new patients for the cardiologists, but our APPs do a lot of the returns and post hospital follow ups. They also help in our outreach clinics.
Cath Lab
Dr. McGowen is the medical director of the Cath Lab and gives the staff high marks for their skill set and experience in handling acute cases. We will replace our 3 Cath labs with 3 new GE labs up and running by the end of 2025. We will have 2 GE 5 labs and one GE 7 lab. Dr. McGowen and our Cath Lab APP, Stephanie, mentioned the Cath Lab staff is experienced and ready to work efficiently to provide a high level of patient care. We have experience with INARI and EKOS in the Cath Lab.
History of Cardiology
The other Kearney hospital was built in the early 2000’s. The group over there also is doing outreach. But Dr. McGowen has a great reputation in the region and should be able to transition his outreach, and others, to the new doctors. Our outreach locations are critical access hospitals that refer their patients to us.
The cardiologists at the other hospital were Dr. McGowen’s previous partners. He was involved in setting up the hospital but never practiced there. That group competes with us in the outreach areas to help direct cases to their practice. However, the practice of cardiology over there is a step below ours. It appears that there has been turnover within cardiology with doctors that have moved around a lot prior to coming to Kearney. In Cardiothoracic surgery, they have had 4 CTS in the last four years. Dr. McGowen considers his competitors’ skill set to be pretty good. But he enjoys the competition and believes there is plenty of work in the region for everyone.
Our CTS, Dr. Kulshrestha takes on a lot of high-risk cases, that others turn down. His outcomes are very good. In the late 1990’s we did close to 300 hearts, but it has come down a lot due to the lack of cardiologists. With the addition of two more cardiologists, Dr. McGowen believes our open-heart volume would begin to go up within 6 months of a new cardiologist joining our practice.
Dr. Murphy and Dr. McGowen have a good relationship. Dr. McGowen will do the renal artery stenting, but most of his PV is on his patients. Dr. Murphy is approachable and always willing to help. Our IR does not do PV, nor does our CTS. Dr. Murphy gets most of the PV, but is in agreement, and supports, a new Interventional Cardiologist will be able to do PV too.
CHI-Kearney is part of the largest hospital system in the state. We have been one of the systems’ top performing hospitals for several years. We have a level 2 trauma center with an average daily census of 100-110 patients. We have a 16 bed and 8 bed ICU that runs full most of the time.
Our hospitalists admit to the ICU and round on those patients as we are an open ICU. The hospitalists also run the codes and have a respiratory therapist and ICU nurse on that team. The ventilator management is done by the intensivists who are in house during the day, M-F. After hours and on the weekend, we have eICU support to assist in patient care. A cardiologist has the option to manage their ICU patients. We have Cardiac Rehabilitation and that is moderately busy. That is due to the majority of our patients come from outreach locations, and they have their rehabilitation done at those critical access hospitals.
We have a 3T MR and PET/CT that supports our cancer center.
The hospital has a team approach to care delivery. We are located in central Nebraska in an affluent college town. There are several wealthy benefactors that have donated millions of dollars to the community as well as the hospital. Our $5M hybrid suite came from a donation from one of those families.
Call
Dr. McGowen does not take weekend call. He does take 2-3 days of call during the week when he is in town. The new cardiologist will be on call one weekend a month and take weekday call. The contract will require 10 days of call per month. For weekday call, you will round with an APP. For weekend rounding you will average from 3-10 patients per day. Hospitalists are good at assessing and admitting patients. They may call you 1-2 times a night, where you will be consulted and just do the procedure in the morning. In a typical year, Dr. McGowen will come in less than 10 times after hours to do a procedure, like a temporary pacer, a balloon pump or an acute. Dr. Waters, our locums may come in more, since he is not as familiar with the patient as Dr. McGowen.