I established cardiac electrophysiology (EP) here in 1991, and in 1993 moved to the Billings Clinic where support for the program has always been very high. This specialty is focused on treatment of heart rhythm problems rather than treatment of the vascular parts of the heart. It takes a couple decades to develop such a substantial program. We provide all electrophysiology services. Since 1991 the specialty has evolved enormously. Defibrillators once requiring an open surgical procedure to implant are now done simply like a pacemaker. Radiofrequency ablation has conquered electrical short circuits causing fast heartbeats, one after another. We are highly experienced in ablation of all tachycardias, such as atrial fibrillation, SVT, Wolff-Parkinson-White, atrial and ventricular tachycardia. We are experienced with defibrillator and pacemaker implantation and follow around 1800 devices. We perform chronic device lead extraction. We have 4 pacemaker nurses, 3 mid-level providers (PA's/Nurse Practitioners) all dedicated to EP, nurses, and extensive facilities newly built or being extensively remodeled and expanded. A service like this does not appear in a matter of a few years. No other EP program in the region has such an infrastructure. There is no other regional EP specialty practice remotely this capable and advanced. We recently upgraded the hospital EP laboratories, more than doubling our capacity with more room space and more state of the art equipment, due to heavy demand. In addition, a hybrid laboratory is available for those procedures requiring a cardiovascular surgeon. The Billings Clinic is focused on safety and was the #1 Hospital for Safety nationally in consumer reports in 2012. I am not pressured financially to do, or not to do procedures. I am not pressured to see too many patients in a short amount of time. The emphasis is on patient care rather than profits. Of course it's necessary for any business to stay solvent. But, unlike other hospitals run only by financial/managerial personnel, who's CEO is usually an MBA, our CEO is a physician and our board dominated by physicians. Therefore our "culture" is oriented towards patient care as a fact rather than a marketing slogan. This in turn attracts the right kinds of physicians to practice here. We do not allow technicians to insert catheters or sheaths for procedures. We allow plenty of time for our procedures, and if necessary will spend more time than expected to finish the job, rather than bringing the patient back later for another one (although the nature of the EP practices is such that this is sometimes still necessary). These approaches are different than many other EP-providing hospitals. In medical school at The University of Washington, an instructor once said "the secret to patient care is caring for the patient." While it can sound trite, it's actually the bedrock of a successful practice. Patients can tell that you are really trying to help them. But I can always learn what practice patterns are most appreciated. So I read my reviews on health grades and from elsewhere, and have in the past altered my practice as a result. It's likely I will do so again in the future.