The Expansions of HOAF in 2023: Growing to Serve Our Community  

Dr. Vaughn:
Thank you, listening audience, and hope everyone had a wonderful and restful holiday season. I thought
it would be a great idea to start the new year with a podcast highlighting the exciting growth and
expansion that’s going to be taking place here at HOAF and discuss our practice plans going forward in
2023 and how we hope to continue to make enhancements and best support our patients and the
community going forward.
Fortunately, I think because of the continued growth and patient needs, we’ve been able to hire two
wonderful new physicians to the HOAF team. So during this podcast, we really want to highlight them
and how they’re going to make HOAF a better place. So I’d like to welcome Dr. Nanda, Dr. An, and also
Dr. Menachery’s here to really highlight the expansion that that’s going to happen in 2023. So, thank you
all for participating in our first podcast of 2023.

And I thought it’d be a great idea to start Dr. Nanda, if we could start with you, our patients and our listeners can get an idea about your background and your journey in medicine. So I open the floor to let you just discuss how you got to HOAF.

Dr. Nanda:

Yeah, yeah. Thank you for having me on this, and thank you for the nice introduction.

In terms of my journey to HOAF, I started off actually doing my med school back in India, and then came to the US to do my residency, which actually happened in Detroit, and following which I was able to get into a fellowship, which I completed at UAB in Birmingham, Alabama.

After completing fellowship, I stayed back at the university and was fortunate to be part of their GU program, which is focusing on cancers of the bladder, prostate, kidney, et cetera. And in the final few years where I was there, I was actually leading the program there in GU cancers, including running clinical trials.

But I think end of the day, my calling was still to serve in a community-based practice. I believe my true passion is in having good patient interactions, providing good clinical care, be it in the clinic or on the bedside, and providing high-quality care and the latest updates in care wherever I might be.

And that brings me to HOAF. I think when I interviewed here, I loved the people. The people I interviewed with had the same passion and zeal that I would want to have going forward and which I strive for. So I’ve been here since July 2022, so it’s been six months, and I have truly loved it.

Dr. Vaughn:

I mean, it seems like you’ve acclimated well here, Dr. Nanda, but what was the biggest change coming from an academic center? I know, and it’s been now almost 15 years for me, but I was always a little concerned leaving academia that we may not have the specialists we need, but I was thoroughly impressed when I joined the Fredericksburg community, and just want to get your thoughts on coming from academia and have you been able to acclimate? Are you surprised by, I really think the medical expertise here is quite astounding.

Dr. Nanda:

Yes, as I said, I think the important thing in oncology is the quality of care is not just driven by one individual. It comes from a team process. You need to have multiple disciplines, be it surgery, radiation, oncology, radiology, pathology. So all of us have to play a part at various times in the patients’ cancer journey.

What I have been very impressed about is the fact that if you go to any of our tumor board discussions, they are of pretty much the highest quality that you could see, even sometimes surprising what you see in a university-based setting. And not to mention, I think the biggest change I saw in transitioning to a community practice is that you are more focused on the patient and their families. You’re more patient-centric and you’re trying to get things done in a timely manner, which I think is often more, I guess, feasible in a community practice.

In the university, I think your attention is diverted in other directions, be it research projects or other administrative tasks which do take away some of your time and energy. But in the community setting, I think you’re really fully focused on the patient in front of you. And I think that really translates to efficient and high-quality care.

Dr. Vaughn:

That’s always been the foundation of HOAF is just our culture of the patient is center and then we move outward from there. I’m glad that that’s kind of the culture we try to create. Brilliant. I’m glad you’ve noticed that right as you started here. That’s important.

Dr. Nanda:

Yes, yes. I think for that to happen, you need to have a good support staff infrastructure, and the other things that are so much required for a patient care journey. It’s not just me being a good doctor. You need to have the other people in place where the patient is in contact with at various aspects, be it just someone checking in or the person drawing the lab. I think all of those pieces need to be in place and that’s what has impressed me so much that it’s a very well-run and awesome place to work.

Dr. Vaughn:

Dr. An, who also has joined us, a little different pathway to HOAF. Dr. An, I would love to have you talk about your experience in medicine and what brought you down to Fredericksburg.

Dr. An:

My name is Dr. An. Nice to be here in this practice. I am 47-years-old. I served in the Army for 24 years. I retired, joined this practice after working here on the weekends while I was in the Army, providing some coverage and I enjoyed working with the patients and the staff members, so I decided to join the group.

I actually grew up here in Fairfax. I came over with my parents at age 40. So I immigrated to us at age 10 and grew up in Fairfax County. I went to college and after college, to gain some medical experience, I joined the US Army, worked as a combat medic for four years, and that’s when I decided to become a physician to treat the soldiers and their family members.

And then after medical school, where the US Army paid for my medical school, I did the residency and fellowship in hematology-oncology and then after hematology-oncology, I worked at Womack Army Medical Center as well as Fort Belvoir. When I was in Fort Belvoir, that’s when I had some opportunity to work in this practice to acquire some civilian experience so that when I retired from the US Army, the transition would be smooth.

I really enjoyed working here because of the great support and then also the patients I encounter here. This was considered one of those underserved areas, so I feel good taking care of patients here and working with others. I feel like I was providing benefit for the community in this place.

Dr. Vaughn:

So Dr. An, it’s interesting to have both of you guys from different kind of phases, but how has practicing, I guess you call it maybe civilian practice or in a non-military establishment, how is it different? I know Dr. Nanda, coming from academia, but you’re coming from the military. How is working in a private practice setting different, and what are some of the things you like about it?

Dr. An:

Well, in the Army we take soldiers when they’re young and the whole philosophy of military medicine is conserving the fighting strength by preventing condition and illnesses. And then as you get older, when you start having medical issues, then you get to retire, after serving 20 years in the Army.

When I was in the military, I think I encountered a little bit more healthy patients. As an oncologist, I saw more lymphoma and leukemia, but there were a lot less patients I have to see in the military. Whereas in a civilian sector, I think that being accessible is very important. When you have a cancer diagnosis, it’s important that you see the patient right away, within that day of the diagnosis or even the very next day. So there is a sense of urgency here, there’s a sense of accountability, and what I like most about civilian sector is that you get to have a relationship with the patient longer than two to three years, whereas in military, you move every two or three years so there is a lack of continuity of care.

I remember taking care of patients in the military and I’m moving every two or three years, so I don’t know what the patients that I treated, how he or she is doing right now. I missed that. And I really will enjoy developing a long-standing relationship with the patient in the community, in this place where it is a smaller community here compared to Fairfax or other bigger cities where you get to have a good, tight relationship with the patient. And I’m really looking forward to developing this in this community. I’m really looking forward to this. Thanks.

Dr. Vaughn:

That’s a good point. I think the relationships, I think, as oncologists we have with our patients is different and to only to have it for two or three years and then move on would be a bit of a challenge. It’s an interesting point you make there, Dr. An.

Well, I always feel it’s, I think, wonderful in general to have new physicians because it brings new ideas to HOAF and I always think it allows us to better ourselves. I think every time we’ve added someone, maybe new ideas have come in from where they’ve trained, what they’ve done, and it allows us to grow, and like I said, maybe change how we may practice in certain ways.

But Dr. Nanda, anything from your experience before and what you bring, anything? You mentioned specializing in GU and in clinical trials, but it’s interest to know what else, what you think we could continue to add to HOAF as we’re always looking to better ourselves?

Dr. Nanda:

Yeah. In terms of my experience, the four years I was an assistant professor there, I was doing clinical trials, I was also teaching residents and fellows.

So I think one important aspect about oncology care nowadays is the constant need to stay up to date with all the new cancer treatments that are getting approved, and also understanding the data in terms of how much it impacts a certain patient. I think part of it comes from experience, part of it from a critical review of the data. So definitely I think moving forward, I’m going to try to make sure we have the newest treatments available to our patients, making sure that they get the same, if not better, quality care than they would if they go to any other academic center even. I think that’s very much doable in the community.

I think in terms of trial access, of course a bigger university might have more resources and more trial options available, but outside of that, I believe we should still be able to focus on providing the latest and most up-to-date treatments for pretty much all our patients.

Dr. Vaughn:

Yeah. I know it’s something that we’re always trying to move the needle just as we have, I think, a pretty strong research department here, but always looking for the new trials, particularly your background in GU particularly maybe offers some specific options that we can narrow into.

Both of you, it’s great because it’s always fun to have you in the office. I think we have a nice collegial culture where we ask questions and run by cases and both Dr. Nanda and Dr. An have been easily approachable, they just troubleshoot ideas. It’s just almost like we have our tumor board every morning as we walk down the hallway. That’s what’s also wonderful and it’s so true that we have to be always constantly abreast of new information that comes out almost repeatedly every week, it sounds like. It’s always good to be able to talk through cases and questions we have with each of us.

Dr. Nanda:

I think I know eventually as the practice grows, it may be even possible that some of us might have our own small niches in particular cancers. If I were GU, then I think maybe you are seeing a lot of leukemia patients. So I think eventually, that might be something that could also help long-run.

But a major challenge nowadays in oncology is really making sure that we are providing the most up-to-date patient care for our patients in terms of treatment options. And that’s going to be a constant learning process for us and that’s also a challenge, but it also keeps us on our toes and is also grating in some ways, that something that may have been relevant a year ago is no longer right now.

Dr. Vaughn:

So question, Dr. An, I’ll throw this one at you. I’ve been amazed at what we’ve been able to create at HOAF. We have our own… Dr. Menachery is kind of director of our laboratory downstairs. So we have in-house flow cytometry, we have run a lot of our genetics, we have palliative care. Linda, who’s our nurse practitioner, runs the palliative care program through the office.

Has that been somewhat eye-opening a little bit to you that we can have this sort of center at HOAF, having all these services available to patients?

Dr. An:

I think that ability to order tumor testing or flow cytometry and all these resources is able to provide more information for the patient.

I think it’s also important that you order these tests and you follow up these tests, sometimes more information is not always better, but it does give us tools to improve the patient care because our patients, they want to have answers. When they come see us, there is a reason why they come see us. Of course, because they have cancer, but they want to get some answers and they want to get directions. And as a physician, it’s our job to… It’s actually a privilege and honor to provide those answers to the patients in this, could be a little bit underserved areas here.

So I’m very happy that we have a system here that has evolved over the years and be able to provide some in-house testing, for instance, in flow cytometry. Tumor testing is also much easier to obtain because I had a trouble ordering those tests while I was in the military. Whereas here, it’s standard care ordering a genetic and somatic testing for our patients who have the cancer. So I think this helps us better take care of patient and I feel good knowing that I could help the patient and to know that I could make a difference.

Dr. Vaughn:

I’m glad you bring that up because it leads me into, I think, what we’d also like to talk about next is because I think of the continued growth, I’m honored, I think, by how well we serve our community. There is still a demand for more and we’re going to expand into another office, and I wanted to have Dr. Menachery highlight that, talk about what that means and what the future lies, at least for 2023.

Dr. Menachery:

Yeah. Hey, good morning everybody. My name’s Sudeep Menachery and I’ve also been with the practice close to 16, 17 years and also want to take the chance to welcome Dr. Nanda and Dr. An to the practice. They’ve been great to work with and certainly appreciate a lot of the comments and collegiality that we’ve had so far in things like tumor board and discussing cases.

When I reflect and think about where the practice was when I joined, which was the fall of 2006, I want to say we were probably pushing maybe 20 employees, and now I think we’re closer to about 150 employees. And Chris, as you alluded to, we’re building out a new office, which is just adjacent to our main office here in Fredericksburg, on the same side of the street, but just down a little bit.

And what we really want to do is provide, with the growth that we’ve had at the main office and even in the Stafford office, provide the same care in another location just to accommodate for the growth that we’ve had. We want to not only see patients, but do the infusions that we need to, do the laboratory tests that we need to, biopsies should we need to, but be able to do everything that we’re doing in the main office at the other offices as well.

Dr. Vaughn:

Just a point there, all the services, just for our listers and patients who are listening to this, it is still the same services we’re providing here at the main building are going to be there just for some reassurance. Palliative care, surveillance, these same things we provide in the main building are going to be held over there too. Is that correct?

Dr. Menachery:

Correct. As always, I think we’re worried a little bit about some growing pains, but yeah, that’s exactly what we want to do.

Dr. Vaughn:

Yeah. Dr. Nanda, have you… I’m seeing this, I’ll just throw this question at you. I’m seeing a lot of people, maybe we’re expanding our network. I’m seeing a lot of patients from Culpeper, Northern Virginia coming down, maybe it’s… I’m not sure if it’s family-driven, but I think people are coming, I guess, from larger areas of where we used to be centered in Fredericksburg or maybe some spots in Stafford, I find our catchment area has grown quite a bit.

I also find the co-management with some of the tertiary centers, which has really been, I think, improved where we manage a lot with VCU in Virginia. So we’re seeing many more patients that may have stayed in one center, if that makes sense. I don’t know if you guys have seen that.

Dr. Nanda:

We do have patients who sometimes need to have some of the care at a higher center, for example, like a myeloma patient needing a transplant. So I have worked with folks at VCU, and folks at the UVA even. And yeah, I think we are always happy to collaborate and the important thing is we are able to provide the same quality of care and sometimes with a better delivery of care sometimes in the community.

I think we have patients who are maybe wanting to get their care locally. I think we are a great place to start and for always, if they had certain situations where they needed certain specific therapies that can only be brought at a higher center, we always make sure we have that accessible to our patients and we are able to collaborate with all these centers in this area.

So I think so far, my experience has been positive and I have been on the other end before. I was at an academic center before and used to have to collaborate with community physicians occasionally. And I think it all comes down to effective communication, making sure you have an open channel of communication and keep updating each other appropriately. And that always translates to better transitions of care and better delivery systems. So it’s been a very positive experience for me so far. Yeah.

Dr. Vaughn:

Dr. An, same with you as far as, I think also just not only acclimating with the communication with maybe some referers outside of the network, but just how about just with other specialists within the area? Tumor boards, I always find that we’re very collegial, I think, in general as far as our conferences, how we discuss cases. How have you adapted Dr. An?

Dr. An:

I think having open-ended communication is very important. Patients want to see doctors are communicating so that they don’t get conflicting information when they go see doctor to doctor.

So I think the initial, sometimes when patients have a rare diagnosis, I agree with Dr. Nanda, that patients sometimes need to be referred, but if there’s a way… Most patients want to be treated near their home because there’s a lot of support at home and they have families here and they have other things that motivate them to live here. And so I think that in order to provide and improve quality of lives for the patient, because our job as oncologist is not just to improve their survival but also improve their quality of lives, so when patients are treated near their home, they’re happier, they feel more comfortable because this is where the support is.

So in order to do that effectively, I think it’s important to show patients that we are communicating with other providers, that there is a good communication so that we could provide more complete care.

I like going to tumor board every week, Tuesday, Wednesday, Thursday. I didn’t do that in military. It was a lot less intense. But here, on Tuesday, Wednesday, Thursday, we have doctors and other medical providers discussing cases because we don’t know everything and it is to have a good communication with providers. So I really enjoy that, having the dialogue going to improve the care. And so I appreciate the opportunity to take place in this place and I think we are going to get better.

As we expand, I think it’s important to open the communication with each other and other providers so that the patient doesn’t have to go to different specialists. They could just come see us here and get all the information.

Dr. Vaughn:

And that’s, I guess, the critical point is I think it’s wonderful to see the growth and the demand in the area. I think it shows how we have been providing excellent quality care for our patients. And even if we are expanding, I think it’s important we’re going to maintain this level of quality, that’s not going to change. That’s at the foundation of what we do at HOAF.

So what is the timeline of this expansion?

Dr. Menachery:

We’re hoping, we’re aiming for the spring. We think April-May is what the build-out is gearing up towards right now. So yeah, it is coming along, barring any supply chain issues. And we’re really hoping in the springtime, April-May, that it’ll be a fully functioning office and we’ll start seeing patients there.

So yes, we’ll make sure we broadcast that loud and clear to all of our patients at the main office and at the Stafford office when we get that operational and when we’re up and running.

Dr. Vaughn:

And I know I’m not great on the social media spectrum, but hopefully we will definitely let our patients know well-ahead of time, for sure, and what our schedule is. And I’m sure there’s a lot of logistics that need to be done, but the plan is, at least like you say, in mid-spring.

Well, I thank you, everyone, for being on. Is there anything else anyone like to add? Dr. Nanda, Dr. An? Dr. Menachery, anything else? I think it’s been a great talk on welcoming you two new docs. You guys are doing great. It’s been wonderful having both of you here and we’re excited for 2023.

Dr. Menachery:

Yes.

Dr. Nanda:

Yeah, yeah. I think I had a great foster experience so far, the last six months. I loved it more than I expected to, so I think that goes to say how well the clinic is run and how well things have worked out for me. So I think thanks for having me.

Dr. An:

I think oncology care, whether in military or outside military, good quality care is the same. Showing compassion and caring and also having good communication with your patient. I look forward working here, learning from the other providers, and I think the last three months has been positive learning experience for me, even though I’m retired from the US Army.

When I see retired patients who served in the military here, I enjoy having that interaction because one day, I may come down here and live around here. So I look forward to working hard and having a long-lasting relationship with the patients, and not move every two to three years. I’ll stay here.

Dr. Menachery:

Welcome to the both of you guys. You guys have been great additions to the practice. We love having you here and working with you. So yeah, looking forward to that. I mean, we’ve had a lot of doctors here that stayed on and started and hopefully finishing their careers here, so yeah, we love it.

Dr. Vaughn:

Well, thank you, guys. It was wonderful.

Thank you again to Dr. Nanda, Dr. Menachery, and Dr. An. I’m thrilled to introduce our new physicians to the listening audience and to share our plans for the practice in the upcoming year.

We’ll be releasing episodes monthly in 2023, covering a range of topics including our 35th anniversary here at HOAF, Camp Lejeune, and exposures to environmental agents, the benefits of financial advocacy and assistance for our cancer patients because of the high cost of medications, and insurance changes that are happening annually. It’s important to us that we’re covering the topics our audience is interested in, so please make sure to like the HOAF Facebook page, and keep an eye out for an upcoming poll on podcast episode topics to weigh in on episodes later in the year.

Thank you for tuning in and happy New Year from Cancer Shop Talk.