Photo: Regional Clinic physicians gather for a photo. Pictured, back row, from left: Dr. Ken Davenport, MD, FACS, General Surgery; Bart Clapp, DNP, CRNP; Wil Mullins, CRNP; Dr. Ramesh Chellamuthu, MD, MBA, Nephrology; Dr. Nicolas Bordas, MD, Infectious Disease; Dr. F. Duncan Scott, MD, Nephrology; Dr. Faris Al-Faris, MD, Critical Care/Nephrology. Pictured, front row, from left: Cody Gray, CRNP; Josh McCamy, CRNP; Dr. Lindsay Frederick, MD, Gynecology; Justin Ford, DNP, CRNP; Dr. Krishna Keri, MD, Nephrology. (Courtesy of Regional Clinic)
By Emma Kirkemier, News Editor
Local healthcare practitioners have joined together at Regional Clinic with the same vision in mind: forming the area’s first multispecialty clinic and prioritizing interdisciplinary patient care.
“It’s nice to be part of medicine as a whole,” said Dr. Ken Davenport, MD, FACS, the clinic’s general surgeon. “I think it’s probably good for your medical practice to be around other specialties, to be around people who may see the patient differently than you do because they’ve taken care of different systems.”
Supported by the clinic’s five experienced nurse practitioners and many staff members are its seven doctors: Dr. Ramesh Chellamuthu, MD, MBA; Dr. Krishna Keri, MD; Dr. F. Duncan Scott, MD; Dr. Faris-Al Faris, MD; Dr. Nicolas Bordas, MD; Davenport and Dr. Lindsay Frederick, MD.
Chellamuthu, Keri and Scott are practicing nephrologists, while Al-Faris is dual-certified in critical care and nephrology. Bordas, who became the first non-nephrology addition to the clinic in 2020, specializes in infectious disease. Davenport is a general surgeon, and Frederick is a gynecologist — in fact the only female gynecologist currently practicing in the area.
“It’s unusual,” Davenport said. “It’s only a recent thing where they have multispecialty practices. It really just makes sense, because no one is each other’s boss, but we all have the same viewpoint about how we want to take care of patients. You have a great office, you have a great staff and you’re able to practice the way you want to practice.”
“It’s definitely new in this area,” Keri said. “If you go to really big cities, there are physicians who work well together and form a single group, but it’s not that common.”
Regional Clinic has seen patients flock to its six locations in recent years to take advantage of its various specialties.
“The growth is mainly because there is need,” Keri said. “Once the patients realize there is a (specialized) physician locally available and they don’t have to travel to Birmingham or Chattanooga, they kind of start to come to you, and that has fueled about 20 to 25 percent of our growth. We keep the patients local, so they don’t have to travel too far.”
Keri sees the bulk of his nephrology patients in the Gadsden and Boaz offices, as well as covering local hospitals including Gadsden Regional Medical Center, Encompass Rehabilitation Hospital of Gadsden, Riverview Regional Medical Center and Marshall Medical Center South.
“This was one of the practices that I found which had an opportunity to serve the community, and that was why I decided to move to Gadsden and start working at Regional Clinic,” Keri said.
Keri worked in small towns in Wisconsin and Tennessee before coming to Alabama, realizing along the way that he prefers rural to urban healthcare settings.
“Come summer, I get a lot of tomatoes and bell peppers and all this stuff that patients bring to me,” Keri said. “They bring their backyard vegetables, some of them. It is personal in a way; you get to know them really well.”
According to Regional Clinic practitioners, relationships fostered in the practice are strengthened by the small-town setting.
“I think overall in Gadsden, there’s a great collegial atmosphere amongst the physicians and medical staff, and that’s something I have loved and valued the whole time I’ve been here,” said Frederick, who has been practicing obstetrics and gynecology in Gadsden for 11 years. “I feel so lucky that I came here and have had nothing but wonderful people to work with.”
Several doctors also attested to the fact that the interdisciplinary setup makes it much easier to seek consultation.
“I don’t need to go through the complicated system of paging or finding a different practice that provides the service, which puts a lot of delay into it,” Al-Faris said. “If you need a different specialty from a different clinic, it might take a day to get the consult, versus I’ll just reach out to my buddy who is across the hall from me, and I’ll get an answer in 10 minutes.”
“Working with other physicians within the clinic has been very useful,” Keri agreed. “Nephrologists depend a lot on surgeons for various procedures: putting in the dialysis catheters, removing them, infections related to them and all that. We have a surgeon who is in our group, so we can just talk to him about what to do. And with nephrology and catheters there are a lot of infection situations. We have an ID physician in the group who takes care of this stuff as well.”
“I have some patients that I’ve referred to Dr. Davenport, maybe for a breast mass or something like that,” Frederick said. “He is a great resource for me if I need a surgical consult or need to talk to him about a patient, especially because we both do robotic surgery, and he has really moved that along in this area.”
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Chellamuthu started the clinic in 2016 as a nephrology practice, but his expansions since then have been strategic and intentional. Chellamuthu recruited each doctor to the practice in turn.
“I don’t think that this hodgepodge of people came here randomly,” Bordas said. “This was not coincidental, and I have to give credence to Dr. Chellamuthu. I think he has a very good idea of what he’s doing, and I don’t think it’s a coincidence that we meld like we do.”
“This is such a great group,” Frederick said. “You go into places and you can feel an energy, and everyone here is happy to be at work. They’re friendly with patients, and regardless of what type of medicine we practice, I think that personal relationship with the patient is important to all of us.”
“I worked with most of them before I joined the practice, so I saw them in the hospital and saw how they talked to patients,” Davenport said. “I saw the courtesy they gave them and the respect they gave them. They’re very patient-forward; they’re kind. It’s wonderful to pour yourself into a practice that you know has those values.”
Most of the physicians worked with Chellamuthu and the nurse practitioners in a hospital setting prior to joining the practice, but those that did not still found themselves drawn to Chellamuthu’s ideas.
“When I was looking for a job (during residency), I found Regional Clinic,” Al-Faris said. “After the first phone conversation I had with Dr. Chellamuthu, we realized we had the same vision of what we want to do.”
According to Al-Faris, the clinic’s main attraction was the opportunity for him to use his full potential as a dual-certified physician.
“A lot of places will offer you either to work as a critical care physician or just a nephrologist,” Al-Faris said. “But Dr. Chellamuthu offered me the opportunity to practice integrated nephrology and critical care, the way it’s meant to be.”
Al-Faris was the first-ever fellow to specialize in critical care/nephrology at his program in Albany, New York.
“The critical care/nephrology specialty is very young,” he said. “There are few places around the country that offer training. It came out of necessity that nephrology is a specialty that’s heavy on physiology and how the body mechanics work. Understanding that helps you manage the most sick patients.”
Unlike most of their peers at Regional Clinic, Al-Faris and his partner Bart Clapp, DNP, CRNP, almost exclusively see patients in local hospitals.
“Whenever any patient in any specialty gets sick enough that there is a life-threatening condition — no matter what the illness was, whether it’s an infection or an organ failure like heart failure or kidney failure or a stroke — if that condition becomes life threatening, they need more attention and care,” Al-Faris explained. “And that’s when they become an ICU patient. You have to act quick, and you will see the result of that quick. When you have someone who’s not able to breathe, the next day you can have them sitting up saying, ‘Oh, I feel so much better.’ That is something you cannot do in regular internal medicine. That’s what critical care medicine can do.”
“We don’t see anybody in the clinic,” Clapp added. “[Al-Faris] might not be as widely known as some of the other physicians, just because he’s not in the community as much, but if you come to our hospital and you’re under Dr. Al-Faris’ care, it’s going to be A-plus.”
The mutual respect between practitioners was evident in their speech.
“Not every small community hospital has a specialist that’s this deeply specialized,” Al-Faris said about Bordas, who is certified through the American Association of HIV Medicine to deal with complex HIV/AIDS cases.
“AIDS patients are the most complex patients that I deal with, because they basically have no immune system at all,” Bordas said. “That’s actually AIDS: acquired immunodeficiency syndrome. When you start them on the medication and you take your proper precautions, in a matter of six months this patient that was deathly ill (is showing improvement). That is so gratifying.”
Bordas noted that being able to treat and educate patients with complex cases is rewarding work.
“It’s so pejorative to be diagnosed with AIDS,” he said. “It’s such a gut instinct of the reaction of the word. And then you realize that this is not a death sentence. You’re not a leper; you’re not going to die of this. We have ways of functionally curing. There’s always so much behind it, and then you bring it to light and say, ‘Listen, you shouldn’t see this as different than hypertension, or you shouldn’t see this as different than a broken bone. This is a medical condition.’”
According to Bordas, the “remarkable improvement” patients often exhibit as they recover from their disease is the best part of his job.
“The reason why I chose infectious disease is it gives you the opportunity to heal or cure, which is something that in internal medicine is not very common,” Bordas said. “We treat a lot of things, but we tend to cure infections. And that is something that always attracted me.”
The ability to offer comfort and solutions in bad situations was something several doctors sited as the most valuable aspect of their work.
“It’s nice to have that connection with patients at a time that probably defines most people’s adult life, when you come in and tell them about them having cancer,” Davenport said. “I feel it’s a good situation to be able to be there for people when they need and to know that you have the skills to fix it. And it’s not just the fixing, it’s the following up with them and making sure you monitor them and keep them cancer-free for the rest of their lives.”
According to Frederick, education is a crucial piece in those conversations with patients.
“I think when you’re taking care of a patient, you want to empower them in their choices and give good recommendations, but you also can’t overwhelm them,” Frederick said. “You ultimately need to help them know this is the best recommendation.”
“In our day-to-day practice, one thing that we are proud of is doing what we call shared decision making, which is the way we practice medicine with the families and the patients being involved,” Al-Faris said. “In some of the tough decisions that are not easy to make or clear-cut, we always make sure that either the patient or, if they’re not able to answer for themselves, their immediate family members or whoever their healthcare proxy is, be involved in the decision making.”
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The doctors aim to empower their patients in their healthcare.
“That’s definitely one thing that’s been really nice about this practice: I’m very easily available to my patients, whether it’s for a routine visit or an emergency,” Frederick said. “Something that may seem routine to me is scary to someone who has never gone through it, and so being able to access your doctor and office staff and hear about things in a timely fashion is important.”
Frederick has been practicing gynecology and obstetrics in the Gadsden area for 12 years.
“This is the one place where women feel safe, and they can talk to you about anything,” she said. “Truly the best thing about my job is the relationships I get to form with women.”
Frederick has shifted to practicing gynecology only since her move to Regional Clinic, a change that she said has allowed her to provide even greater focus to her patients.
“Gynecology really is a broad scope of things,” she explained. “It involves education, contraception (and) infertility evaluation, but primarily the preventative care, pap smears, breast exams, mammograms and then of course any of the problems that may come along, problems with periods, with pelvic pain, with incontinence.”
Frederick said her patient base is just as varied as her practice.
“I love the opportunity to take care of and educate women throughout their lives, from being a teenager to all the way through your childbearing years up until the point of (menopause),” Frederick said. “I take care of a lot of older women, too, and I love that. Also, no day is ever the same. There’s office visits and office procedures and bigger surgeries, and no regular checkup is just a checkup.”
According to Keri, the team of nephrologists has been encouraging patients to take advantage of home dialysis.
“Dialysis is generally time-consuming for patients,” Keri said. “They have to dialyze for about 12 hours in a week, usually. They have to do four hours each time, so every other day they have to be in the dialysis unit. But we have been teaming up with local dialysis facilities to increase home dialysis. We have a way to do the home dialysis where we train them and let them do it at home.”
Keri claimed that home techniques are often underutilized, a norm that he and Chellamuthu are both interested in changing, as well as pushing preventative care.
“In a healthy community, in addition to understanding cancer and heart risks, we have to understand kidney risks,” he said. “You don’t feel anything. You have chest pain and you have more symptoms with other disorders that you do not have with kidneys, and that’s the problem. By the time these things are diagnosed, it’s too late for a lot of people.”
Lack of awareness and education, especially on diabetes and high blood pressure in communities, is partially to blame.
“The best way is everybody after age 40 should have primary care physicians, and they should follow up with them regularly, because any of these early disorders, be it heart, kidney, cancer, all of that, are caught in early stages in patients who have primary care doctors,” Keri said.
He also predicted that the clinic — and the local medical community — continuing to welcome new specialties will ease this plight.
“They’re all interlinked,” Keri said. “The need for a nephrology practice in an area like this is linked to the lack of resources available. The more specialties we have, it will be easier. We can see more endocrinology, that way we can help with diabetes better. In the community we don’t have enough rheumatology practices, so rheumatology, endocrinology. As it becomes more specialized, the community benefits; it will be easier on us and our patients as well.”
Clinicians are still looking forward to more growth on the horizon.
“We’re going to be bringing in ultrasound in the next month or so, which all of us will be able to us, which is fantastic,” Frederick said. “We’ll be doing pelvic ultrasounds, renal ultrasounds and hopefully some breast ultrasounds.”