Department of Medicine
We are looking for physicians with unusual skills and adaptability to join us in return for a generous compensation package including the potential for loan repayment assistance.
If you are looking for a position as a member of a department of academic excellence, allied with a world renowned teaching institution, where you can practice in a surrounding supported by a group of peers at the pinnacle of their research careers, then read no further. This is not for you.
What we seek instead are skilled, adventurous, dedicated and idealistic physicians who can think on their feet. Physicians who can learn to practice beyond their comfort zone a great deal of the time. Those who understand that accomplishment lies not in having the answer to known problems, but the skill to devise solutions to the unknown and unforseen. Physicians whose greatest satisfaction is a truly expressed “thank you” from a grateful patient and who thrill at being able to test their skills to their limit. Those who really remember they went into this so they could be “Doctors" rather than "employees."
We are offering a position in a truly spectacular setting in the western Pacific, on a remote group of small islands that is still US territory. Where there are daily challenges never covered in training. Where making a difference is not a trite mission statement.
It is not for everyone. We are a long way from family, consultants, and conveniences we had taken for granted. We are surrounded by cultures and languages we never knew existed. It is a singular adventure, unlike anything we have ever encountered before. We have to “improvise, modify, adapt, and overcome” every single day. But, if you think you have what it takes to join us, and the courage to take a chance, contact one of us.
It is how we all got here.
David S. Grauman MD FACP
Department of Emergency Medicine
After my residency, I worked in a typical US ED: 3+ patients per hour, languishing psychiatric admissions, quarterly productivity reports, infection control perpetually on the hunt for my open coffee container. I liked my job, but it felt like a job; I had my set of responsibilities, the nurse had his, the tech has hers, the unit clerk had his. For a STEMI we called the cath lab, for a stroke the 24/7 neurologist read the CT, for the high cervical fracture I’d call neurosurgery to open the OR.
Here on Saipan, I have to make the decision about whether or not to lyse that STEMI, our CT radiologist keeps banker’s hours and lives on a different island, and for that cervical fracture I might be the doctor accompanying the patient on a flight to Korea or the Philippines to get him to definitive care. In our hospital, we are compelled to do more with less, and with less volume than the typical mainland ER, we have the time to really care for each patient. For those ER doctors who take joy in being the ultimate non-specialist specialty, this really is a lovely place.
And outside of the hospital, the adventure continues. The community here is tightly knit and supportive, the outdoor activities and water sports are world-class, it’s easy and cheap to take trips throughout Asia and Oceania. Whether it's a weekend tooling around Hong Kong, 6 weeks exploring southeast Asia, or just a trip back to the mainland, the medical staff prioritizes life outside the hospital walls. It is a daily gratification knowing that I am doing something different with my clinical training and free time outside of work.
If you’re an ER physician for whom this all sounds appealing, I can assure you that you’d be joining one of the finest little collections of ER docs I’ve known. Please feel free to contact me with further questions.
Nicholas Villalon, MD
If You Remember Me or Someone Like Me
Elizabeth A. Kohnen, MD, FACP, MPH
I’d like to tell you about the job I’m doing now as part of a recruiting effort to get other experienced physicians here. I have been in Saipan since August 2014 - don’t worry, I had to look up where and what Saipan was as well. It is a commonwealth of the United States in the Pacific down near Guam and near the Philippines. We are a tropical island 12 miles long x 5 miles wide. Our average temperature is between 80 and 85°. My house looks out on the Pacific ocean, I have coconuts, dragon fruit, pineapples, lots of citrus etc. growing in my yard, and access to the best SCUBA diving in the world. The island has Pacific Islanders including local Chamorro and Carolinians, neighboring Chukese, Yaps, Pohnepeians, Palauans, etc. There is also a large population of Filipinos and other Asians. The island is poor although we have a large population of tourists from Japan, China, Korea. We are still rebuilding from a recent typhoon. English is the lingua franca. We use the dollar. We have US passports, zip codes, telephone numbers and legal system. It is officially a part of the United States, but with ample difference to make it fascinating
After concluding training in Rochester I joined the U.S. Public Health Service in bush Alaska. I served for 2 years in Bethel which at that time had a population of 4000 people - 2000 of whom were Alaskan natives. I worked in Bethel and made visits out to smaller villages. The job came with resource limitations and I had the opportunity to work with a group of really great and dedicated PHS physicians. Nevertheless, the overall experience was just not that good. We felt that we were victims of "friendly fire"; not getting the support from Anchorage that we needed, and not always being appreciated by the locals.
From there, I moved to Fairbanks Alaska where I married, adopted and raised a daughter from China, earned a masters in public health, and was in private practice for 25 years. Like many of the doctors these days, I tired of all the rules, being an employer, billing, coding, but more than that, I got tired of finding myself limited to care of the worried-well. I was one more physician tweaking wellness issues and sometimes feeling like the life was being sucked out of me by neurotic patients, while “real” medicine was fragmented into the system and out of my care.
Because of this series of what now I see as somewhat miraculous circumstances, within 3 months of hearing about the opportunity here, my husband and I closed our out practice and started practice at the Commonwealth Health Care Corporation Hospital, the publicly funded (and only) hospital in the Northern Mariana Islands. We are salaried, more or less government employees, with no production bonuses. We work hard because there is a lot of need, and the spark of idealism that US medicine almost managed to kill has flared back to life. It is a rare physician who’s been here for more than 20 years. There is a handful of those who’ve been here 5-10. There is a moderate population of people just out of training getting their national health services score loan repayment benefits. There is also a group that is here because, perhaps like us, they have been gone from the “real” America too long to be able to reassimilate into what mainstream US medicine has become. There are many who worked here, left, and returned, realizing this is a pretty good deal.
The job is not without its frustrations. The hospital is poor and resources are limited. You sometimes have to go down the hall and around the corner to find a printer that is filled with toner. Staffing issues are a common problem. There are frequent shortages, stressors, new challenging circumstances to deal with. Although we have good general services such as medicine, surgery, OB/GYN, Pediatrics, and anesthesia, we have very few specialty services....nephrology, orthopedics, ENT and oncology are it... and frequent practice outside of our comfort zone is a fact of life.
We don’t have a dedicated air ambulance service. If a patient needs an urgent referral, such as if we have placed a temporary pacemaker needing implantation of a permanent unit with minimal delay, medical evacuation is done on a stretcher in the back of a commercial airliner with one of us as an escort.
But going directly to the bottom line - the patients are lovely and we do great medicine. There is a lot of noncompliance but there is also a lot of appreciation, respect, gratitude. Circumstances may set the bar low, but not a day goes by that we are not made to feel like a hero.
We do get paid reasonably well for this job (and a 90% US Federal Income taxes rebate on island-earned income helps a lot) and for me at least, it’s a job I’ve been looking for my whole life. We have often said to one another, “if you want to make a difference and help a health system to grow, this is a target rich environment.” The job is not an easy one but it feels like being a real doctor. I put in many other volunteer hours trying to improve the health care system. This recruiting is part of that.
For me, this work on Saipan has become "A path with a Heart." I don’t know where you are in your lives. I hope you have found a position that lets you feel productive and appreciated and it has a good balance with your personal life. You may not be wanting to make a transition like this, but perhaps you are at least a bit curious or know someone who is a little bit restless and willing to take a chance to find challenge and adventure. This would be that.
Elizabeth A. Kohnen, MD, FACP, MPH
Adult Outpatient Services
I’ve been The Oncologist Of Saipan (TOOS) for nearly 4 years now, and I plan to stay until I can’t anymore. I’ve been a practicing oncologist now for 32 years, and absolutely, totally, 100% for sure, this has been the best job I’ve ever had. It’s also a really fun, interesting place to live. But is this place for most people? No.
Here’s the perspective of one specialist.
First, why is this job NOT right for most specialists?
Because we’re at least 6000 miles from the mainland US, and you mostly lose contact with your former colleagues. The time zone is so different, it’s hard to reach people in the mainland unless you get up really early or stay up really late. You’re really on your own here. You have to feel very confident in your training, your level of experience, and your clinical skills. There’s essentially no back-up, and the buck stops with you. I worked in the past in two multi-specialty medical groups, and we had university medical centers nearby. We had tumor board discussions, and if something was really complicated, you could send the patient for another opinion or treatment, or at least discuss cases. Can’t really do that here. Many patients here will have a hard time leaving the island at all for anything. Everyone depends on you here, so you have to already be skilled, and you really have to keep up on your continuing learning.
You’re stretched to provide care to the limit of your ability. In the mainland, we would often send a patient with AML to a university for care. But since many patients here can’t leave the island, you just have to do the best you can for these patients. For patients with cancer, we don’t have radiation or complex cancer surgery available in the Northern Mariana Islands. We don’t have an MRI machine. Many times, we have to rely on pushing the limits of systemic cancer treatment since that’s the best and only care that we have available.
You can make twice as much money somewhere in the mainland. That certainly may matter to you!
But why is this job WONDERFUL for some specialists?
Because you can do SO MUCH to help your patients, and you realize every day that few other specialists are both willing and able to do what you’re doing. You’re incredibly needed. If not unique, you know there are few like you. When I worked in the mainland, I always knew there were over a hundred oncologists within a hundred miles of me. I was a specialist, but maybe not that special.
Here you’re helping an incredibly vulnerable and under-served population in a resource-limited area. Many don’t have the financial resources or legal standing to leave the islands for any reason, even if it’s a matter of life and death. Many of the people who live in the Northern Mariana Islands accept this, but it’s still tragic. This is America, and the people here (like everywhere) of course deserve good medical care. And it’s incredibly rewarding to provide good care, also knowing that few others would do this for the people here. The patients also know this, and they’re incredibly grateful that you’re here helping them. Many tell me that it’s “a blessing” that I’m here to help them.
Patients don’t bring internet printouts to their office visits! Patients have every right to ask you questions about their care, and I always encourage questions and discussion about care, but here patients don’t trust Dr. Google more than they trust you. Most don’t even use Google.
Your colleagues here are collegial. They go out of their way to help you. And there’s certainly no competition. The primary care providers, the surgeons, the gynecologists, ENT, the radiologists, the hospitalists, and the ER providers especially help you out a lot. We all know we’re all in this together.
Your salary is not linked to production! To me, this is very important. I’m committed to seeing and caring for all patients in the Northern Mariana Islands who need cancer care. I work for the local government hospital, which provides a modest salary (and the income tax rate is very low here). And no one watches to make sure I see a certain number of patients per hour (I can see patients at the appropriate pace that allows for real care). I can focus on the care, not on pay. That’s not so true in the mainland anymore, as everybody knows.
Besides work, though, it's key that you have to enjoy living here. You’re not working all the time, of course. This IS a tropical island paradise. Every day I have to remind myself that I’m not dreaming, that this paradise is real. I absolutely love living here as well as working here. My wife barely puts up with it, though; she’d rather be living in California. You’ll just have to see and decide for yourself.
Peter Brett, MD