Dancing through the pain: physician executive launches new business to treat patients with chronic pain - Profile

Physician Executive, Jan-Feb, 2004 by Will Bunch

She learned that nerve blocks--a common procedure for treating pain--didn't work in the long run and that only two things were successful: Neuromuscular rehabilitation and cognitive behavioral therapy.

"What studies show is that treatment isn't working unless the patient can get back to a normal working lifestyle," she says. She explains that chronic pain is often the result of nerves learning to send the wrong signals over time. That means it's necessary to essentially re-educate the nerves to perform their original purpose, which often also means changing the habits of patients who've learned to avoid certain muscles and motions.

But just as Korevaar's philosophy of treating pain began to come together, she began to suffer a mid-career crisis. Her new dean at Penn was less supportive, but more importantly she was frustrated--as were many of her colleagues--with the changes resulting from the rise of managed care in the mid-1990s.

She found her methods of evaluating pain patients didn't always jibe with the insurance providers' ideas and she feared for her financial future. "In my mind," she says, "I thought maybe I could become a high school science teacher, that that would be more financially rewarding."

But she also looked into a job that would mark another change in direction for her--studying pain treatment for the local Independence Blue Cross to come up with better ideas of what works and what doesn't. That information could be used to control costs by avoiding unnecessary treatments.

The job Korevaar was looking at was for a "medical director," and Korevaar jokes that she didn't know what exactly a medical director was. Then somebody sent her a book from ACPE called: Medical Directors--What, Why, How?

She ultimately decided to seek a degree in medical management and says it was a career altering experience. "I met people from all over who were similar in age and who had a similar professional quandary, noting that things were changing and wanting to embrace the change rather than hang around."

Working with worker compensation

After earning her master's degree, Korevaar took on a very different career challenge, as medical director for employee liability for the city of Philadelphia. Much of her city job involves the evaluation of worker compensation claims. She said her experience with the municipal job also helped keep up her interest in alleviating pain, because "by and large most employees want to go back to work."

Korevaar believes that her work with MDance Clinic will allow her to help pain patients return to their jobs and the other activities that they once enjoyed. In addition to working with the Philadelphia employees, Korevaar says a lot of the motivation for opening the new clinic came from her own life.

"People are different in their 40s and 50s--they go through a fragile time," she says. "People put weight on and more people are going through their life cycle. They aren't biologically depressed but they aren't feeling good."

She says that as she focused on her posture through her dance lessons, "it made a huge difference in what foods I chose to eat and how happy I felt about it."