the query for the grid should not include the image column as this will increase the network payload an greatly slow down the query. if the grid needs. thumbnail (probably not likely with medical cert), then a pre calculated thumbnail column should be added.
5000 rows is not too bad for query access, but a 5000 row html table, can have performance issues. you should use a javascript grid that supports virtual scrolling. if this is not an option, then you should use a paging grid.