2008 May/June

MAY / JUNE 2008 | Volume 14: Number 3

THE GENERALISTSPECIALIST TENSION WITHIN AMERICAN MEDICINE

INSIDE:

THE RETAINER MODEL OR SINGLE PAYER — WHAT WILL SAVE PRIMARY CARE?

EXTRA! New Discount Announced for Workers’ Compensation Insurance! For SCCMA Members!

We are pleased to announce a new enhancement to the sponsored Santa Clara County Medical Association/ CMA Workers’ Compensation program, underwritten by Employers Compensation Insurance Company (rated “A -” by A.M. Best Company). Members are now eligible to receive a rate of $1.13 per $100 of annual payroll.

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• Employers will provide members insured with Blue Cross on a group (2 – 250 employees) basis an additional discount on their workers’ compensation premium.

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SCCMA the

bulletin

Santa Clara County Medical Association Bulletin

Table of Contents

the Editor’s Desk 4 From Joseph S. Andresen, MD

Know? Mandated Standardized Written Information for Patients 5 DidAtulYou S. Sheth, MD

6 The Generalist-Specialist Tension Within American Medicine Stephen Jackson, MD

Retainer Model or Single Payer—What Will Save Primary Care?

8 The Robert M. Centor, MD and Charles P. Vega, MD

12 SCCMA and CMA Continue to Protect MICRA 14 2007 AMGA Physician Compensation Survey 16 How Organic Farming Mitigates Climate Change 17 2008 Directory Corrections 18 SCCMA Discount Ticket Program Day 20 Memorial Richard Mahrer, MD 22 Good Bets for Free and Low-Cost CME 24 2008-2009 Committee Sign-Up Sheet 26 MEDICO NEWS Hospital Update 28 Stanford Bryan Bohman, MD 29 Workers’ Compensation Update, New Members / In Memoriam Officers

President Atul S. Sheth, MD President-Elect Jerry A. Hanson, MD Past President Donald J. Prolo, MD VP-Community Health Martin D. Fenstersheib, MD VP-External Affairs William Lewis, MD VP-Member Services Howard Sutkin, MD VP-Professional Conduct Michael Hirschklau, MD Secretary Thomas M. Dailey, MD Treasurer Martin L. Fishman, MD

Executive Director

William C. Parrish, Jr.

House Officer Representative

Jacob Ballon, MD

AMA Trustees - SCCMA Donald J. Prolo, MD John D. Longwell, MD (Alternate)

SCCMA/CMA Delegation Chair

Tanya W. Spirtos, MD

CMA Trustees - SCCMA

Martin L. Fishman, MD (District VII) Susan R. Hansen, MD (Solo/Small Group Physician) James G. Hinsdale, MD (District VII) John D. Longwell, MD (Hospital Based Physician)

Editor

Joseph S. Andresen, MD

Managing Editor Pam Jensen

Councilors

Printed in U.S.A. Opinions expressed by authors are their own, and not necessarily those of The Bulletin or the Santa Clara County Medical Association.

Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by the Santa Clara County Medical Association of products or services advertised.

Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org Copyright 2008 by the Santa Clara County Medical Association.

Community Hospital of Los Gatos:

Judith Dethlefs, MD El Camino Hospital:

Editorial Board

Michael Curtis, MD Good Samaritan Hospital:

John Rashkis, MD Kaiser Permanente Hospital:

Allison Schwanda, MD O’Connor Hospital:

Jay Raju, MD Regional Medical Center of San Jose:

Hossein Habibi, MD Saint Louise Regional Hospital:

Joseph Andresen, MD Stephen Jackson, MD George Lundberg, MD Atul Sheth, MD

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John Saranto, MD Santa Teresa Community Hospital:

Efren Rosas, MD Stanford Univ. Medical Center:

Bryan Bohman, MD Santa Clara Valley Med. Center:

Phuong H. Nguyen, MD

MAY / JUNE 2008

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From the

Editor’s

Desk…

Standing atop the steps of the Lincoln Memorial, one can imagine the immense challenges that a young president such as Lincoln faced.

On a sunlit day, a solemn procession of young and old gathered along a walkway facing a black granite slab. Families with young children, seniors, and tourists paused to find the name of a beloved one or read a note left by a young relative who never would have the opportunity to meet their uncle, father, or grandfather. Here, all eyes peered at the engraved names of those who gave their lives for our country during the Vietnam War.

and Vega weigh in with their analysis entitled “The Retainer Model or Single Payer – What Will Save Primary Care?” The 2007 Physician Compensation Survey by the American Medical Group Association (AMGA) shares the latest numbers. Dr. Bryan Bohman, SCCMA Councilor and representative of Stanford University Medical Center brings us an update related to his medical community and hospital. Are you in need of CME credits, but don’t have the time or money to travel? Learn now about CME resources that are available free or for little cost.

Standing atop the steps of the Lincoln Memorial, one can imagine the immense challenges that a

Finally, I would like to share an update regarding

young president such as Lincoln faced. It was the

our bimonthly SCCMA Bulletin. Drs. Sheth, Jackson,

time of a nation deeply divided and on the brink

and I met this past month to discuss how we can

of civil war. Over a century later, this was the place

continue to improve our publication. We have

where Martin Luther King, Jr. spoke to our nation,

elected to form an editorial board to better identify

hoping for a healing of our nation’s racial divide. On

and address topics that concern our physician

that historic day, hundreds of thousands gathered

membership and medical community. After Dr.

and faced these same steps to hear his message.

George Lundberg’s lecture and visit this past fall, we have the good fortune of his support and advice

It was this recent trip to Washington, D.C. that

as a member of our editorial board. If you have an

provided my daughter and me the opportunity to

interest in participating, please contact our office. As

visit our historic monuments. Now a high school

always, your contribution and participation are what

senior, a recent student of U.S. history and a veteran

make our medical association great.

of her eighth grade field trip, she was my tour guide.

It was only after our visit and my first trip to our

Respectfully submitted,

nation’s capitol, that I had a chance to reflect on this

Joseph Andresen, MD | Editor

experience. If history is our best teacher, I am now confident that our next generation will have the wisdom to handle our future while avoiding the pitfalls of our past.

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This month’s SCCMA Bulletin attempts to shed some light on several historically challenging

MAY / JUNE 2008

issues. Dr. Stephen Jackson’s

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Medicine,” is an excellent overview

article, entitled “The GeneralistSpecialist Tension Within American of this important topic. Drs. Centor

DID YOU KNOW?

Mandated

Standardized Written

Information for Patients

By Atul S. Sheth, MD, 2007-2008 SCCMA President • The Paul Gann Blood Safety Act requires physicians to provide risks and benefits of blood transfusions before patients are scheduled for any surgical procedures.

You may want to consider giving an informational pamphlet and having the patient acknowledge its receipt. This will comply with Health & Safety (H&S) Code §1645 Blood Safety Act. A tri-fold pamphlet is available in English and Spanish in bundles of 50, up to 300 copies per order (includes masters), at no charge. Available online: www.mbc.ca.gov/publications.htm. Fax requests to the Medical Board of California at 916/263-2479.

• H&S Code §109278 requires any physicians providing annual well woman care to offer information to women regarding the descriptions, symptoms, and methods of detecting gynecological cancers.

A quad-fold pamphlet is available

• The Grant H. Kenyon Prostate Cancer Detection Act (B&P Code §2248, H&S Code §109280) requires men to be provided with available options for the diagnosis of prostate cancer.

Detailed booklets are available in English and Spanish in bundles of 25, up to two cases (140 per case) per order, at no charge. Available online: www.mbc.ca.gov/publications.htm. Fax requests to 916/263-2479. (Rev. 04/08) • H&S §109275 requires primary care physicians and surgeons to provide a summary discussing alternative breast cancer treatments and their risks and benefits to women upon diagnosis of breast cancer or, if the physician chooses, prior to a biopsy.

Booklets are available in English and Spanish in bundles of 25, up to two cases (250 per case) per order, at no charge. Masters are available in Chinese, Korean, Russian, and Thai. Available online: www.mbc.ca.gov/publications.htm. Fax requests to 916/263-2479.

BENEFIT SPOTLIGHT Do you have questions about medical-legal or other information of importance to physicians? Take advantage of California Medical Association’s online library, CMA ON-CALL. (Look for the complete index of topics in your new 2008 SCCMA Membership Directory.) Members have full access to the resource, which includes most of the Center for Legal Affair’s annual publication, the California Physician’s Legal Handbook (CPLH), as well as more specialized information on peer review and other topics, including information from the CMA’s Center for Medical Policy and Economics.

These documents are available free to members at the members-only website, www.cmanet.org/ member and click “CMA On-Call” on the upper right side of the screen.

If you have questions about particular documents, call the CMA Legal Department at 916/551-2872.

in English, Spanish, Armenian, Chinese, Cambodian, Farsi, Hmong, Korean, Russian and Vietnamese in single printed sets at no charge.

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Available online: www.mbc.ca.gov/ publications.htm. Please contact the Department of Health Care Services, Office of Women’s Health by phone at 916/440-7626 or fax, 916/440-7636, or email at OWHmail@dhs.ca.gov.

MAY / JUNE 2008

5

One might argue that if generalists were able to perform all of these beneficial functions concomitantly, then “unnecessary” testing, procedures, and consultations would be contracted, and therein minimize health care costs.

featured article

The Generalist-Specialist Tension Within American Medicine

By Stephen Jackson, MD Within our American health care sector, the base of primary care/generalist (family practice, internal medicine, and pediatrics) practice has eroded so substantially that it now comprises merely one-quarter of our physicians, despite the ongoing efforts by our health policy wonks and medical school deans to reverse this trend. In stark contrast, most European countries have a long history of a generalist foundation that accounts for about three-quarters of practicing physicians.

The benefits to society of a generalist-predominated health service are alleged to include better access to health services; improved preventive care; expanded “specialist” services by generalists who purportedly afford equivalent quality, efficiency, and effectiveness in evaluating and managing complex co-morbidities; and enhanced continuity and personalization of care. One might argue that if generalists were able to perform all of these beneficial functions concomitantly, then “unnecessary” testing, procedures, and consultations would be contracted, and therein minimize health care costs. Our nation’s current compensation schemes, it is claimed, have driven up costs by incentivizing procedures and technical interventions, that is, encouraging the deployment of specialty services.

Regrettably, reimbursement for generalists is approximately half (or less) of that of specialists.

This economic reality cannot but significantly influence the decision making process of a young

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physician (many of whom, upon completing medical school, already are in six-digit debt) to choose to pursue a higher compensated specialty. Moreover, there also are non-economic and quasi-economic

MAY / JUNE 2008

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factors that have contributed to this diminishing output of generalists: increased administrative expectations related to quality improvement initiatives; intensified record keeping demands; status deprivation; professional dissatisfaction;

lifestyle and quality of life preferences; difficulty in remaining thoroughly competent in the face of an expanding knowledge base across the broad spectrum of internal medicine and pediatrics; and the usual liability issues plaguing all of medicine. It is indeed startling to note that only one-tenth of first year internal medicine residents remain in general internal medicine!

But, the generalist surgeon also seems to have become an endangered species. Each year, about 1,000 general surgeons complete their residencies, a number that has remained stable since the early 1970s. However, only 30% continue to practice as general surgeons, the remainder entering the surgical subspecialties. As with internal medicine, these are ominous figures, especially so for small urban and rural hospitals that rely on well-rounded general surgeons for trauma, surgical emergencies, and a broad spectrum of operative procedures.

Imagine the typical hospital of a decade from now: largely a giant ICU with in-house intensivists and hospitalists managing the medical side, and in-house general/trauma surgeons managing the surgical aspects of patient care.

Yet, today, even in this country, we are challenged, not just by the shortage of generalists, but by a dearth of specialists as well. In many communities, it is increasingly difficult for hospitals and medical staffs to provide comprehensive panels of specialists on-call at all times. Why, despite an apparent surfeit of these specialists, is this the case? Well, there are many reasons, and, once again, not strictly limited to economics. Certainly, as specialists age, they reach a point in their lives where night and weekend call responsibilities come to exceed their ability, motivation, or willingness to continue with an “on-call” life style. Younger physicians these days are demanding a more reasonable, less stressful,

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POINT / COUNTERPOINT

The Retainer Model or Single Payer What Will Save Primary Care?

Point: The Retainer Model May Stimulate a Rebirth of Outpatient Internal Medicine

By Robert M. Centor, MD, Professor and Director, General Internal Medicine, University of Alabama at Birmingham Outpatient internal medicine has joined the endangered species list, or at least so many commentators have opined.

Fewer internal medicine residents are opting for outpatient jobs. Many outpatient internists are leaving practice, either for fellowships or for hospitalist jobs.

As I consider the medical student’s choice of internal medicine for his or her career, I note that the fascination with internal medicine usually results from the complexity of the field. Internists champion the care of complex patients. We love diagnostic and management puzzles.

In the 1970s and 1980s, many internists embraced a definition of primary care that the Institute of Medicine (IOM) codified: “A set of attributes, as in the 1978 IOM definition—care that is accessible, comprehensive, coordinated, continuous, and accountable—or as defined by Starfield (1992)—care that is characterized by first contact, accessibility, longitudinality, and comprehensiveness.”1 Training programs produced internists who could care for complex disease and also handle a wide variety of clinical issues, including episodic care and preventive medicine. Over the following 30 years, our society apparently has redefined primary care to a definition that degrades the original concept. The American Heritage Dictionary in 2006 provides this definition for primary care: “The medical care a patient receives upon first contact with the health care system, before referral elsewhere within the system.”

I believe that most insurers and other physicians no longer consider comprehensiveness when they think of primary care. I would argue that internists do not want and are not trained to do this limited conceptualization of primary care as defined by the American Heritage Dictionary; rather, we are trained to add primary care services to our comprehensive care. Such distinctions underlie the angst of many practicing internists. We have trained a generation

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of internists to provide comprehensive care, including episodic and preventive care, and yet insurers and, especially, health maintenance organizations complain that internists are not good at providing quick, efficient primary care. Family physicians are in a similar situation. We have a problem of semantics and, thus, our discussions about primary care remain confused.

Our reimbursement system also does not pay internists sufficiently to provide high-quality comprehensive care, although our patients are too complex and require more time than what insurers believe constitutes a standard office visit. Specifically, patients need various levels of intensity. A 30-year-old mother with a sore throat has different physician needs than a 55-year-old man with chronic obstructive pulmonary disease, heart failure, and type II diabetes mellitus. Clearly, the latter patient will need longer and more frequent visits. Moreover, our current system does not reimburse out-of-office continuity. We have no reimbursement for telephone calls or emails, although patients often have questions for their physicians. They would like to call their physician for advice, or to discuss a possible new symptom. And, conversely, we would often like to check on our patients to find out, for example, how they are responding to a new treatment.

Our current arrangements are slowly killing the outpatient practice of internal medicine. With this backdrop, some enterprising physicians re-created the retainer model. They imagined a practice and created a model that would both satisfy patient desires and improve physician satisfaction.

The idea is simple. The patient pays a fee for physician access, which allows same day appointments, telephone access, and email access.

Physicians regularly call these patients and even make house calls when necessary. The physician’s panel size has a much lower limit than most internists currently have. Although the retainer model has variations, the above principles represent the core concepts.

When interviewed, retainer physicians emphasize their professional satisfaction with this arrangement. They can spend enough time with each patient because they no longer have the pressure to see 20 or 25 patients each day. Patients apparently love this model. They want convenient access and are willing to pay for that access. Despite retainer fees, which generally range from $1,000 per year to $4,000 per year, approximately 90% of patients renew their contracts each year.

POINT / COUNTERPOINT Many have criticized these practices on ethical grounds and on the

Retainer practices may

assumption that primary care physicians should care for a large panel

improve health care for the

of patients. I believe that retainer medicine may save outpatient

individual patient, but is it

internal medicine. I doubt that all patients will enter a retainer practice,

justifiable to have a larger

but I do suspect that increasing numbers will join such practices

proportion of our shrinking

because patients recognize the value of access to their health care.

supply of quality primary care

Perhaps these practices, if they continue to flourish, will stimulate

physicians devoted to these

a resurgence of outpatient internal medicine. We will be able to continue to train internists who understand the spectrum and complexity of disease, because the retainer model provides an option for those who prefer the outpatient setting, but also want complexity and comprehensiveness. Whereas many critics are concerned with the finances of this model and worry about inequities, supporters emphasize the retainer physician’s ability to provide the level of care and attention that patients deserve.

The retainer model originated and is succeeding because of classic market forces. Physicians and patients find our current arrangements undesirable, thus this new alternative model gives them an interesting choice. Perhaps it will save outpatient internal medicine.

Counterpoint: But Will the Retainer Model Improve Health Care?

Charles P. Vega, MD, Associate Professor, Residency Director, Department of Family Medicine, University of California, Irvine Dr. Centor should be commended for making salient points about the state of primary care. He is absolutely correct that the current model of primary care is unsatisfactory to both provider and patient. In fact, as Dr. Centor suggests, this model may not be sustainable in the long term. Physicians may continue to choose careers in medical and surgical specialties, which are more lucrative financially in our current system of health care.

The concept of retainer practices is a logical response to this dilemma.

practices? As noted in an essay by Needell and Kenyon, physicians have “a responsibility to support the health of the entire community. [Retainer fee medical practice] does little to advance this cause except that by optimizing the conditions under which their own private patients receive health care, they call attention to shortcomings in prevailing public health care policies, which by comparison fall short of that standard.”2 Primary care physicians are the means for creating this standard. We are the physicians focused on the well-being, not just the treatment of disease, of the whole patient. We are the best instruments for providing high-quality and cost-effective healthcare.3 Primary care is now facing its significant moment in history. At this critical juncture, should we allow insurance companies to dictate the way we care for patients? Retainer practices represent a retreat from expanding health care access and quality to our American community at-large. With the closing of each general primary care practice in favor of a retainer practice, medicine loses a bit of its soul, and it would be naive to believe that there will not be a reckoning when we as a profession deviate from our responsibility to society.

How do we then fulfill this responsibility? Be advocates for change.

Have a voice in how health care is delivered in this country, from issues as basic as reimbursement for preventive services to compensation for health counseling and the greater use of technology in routine medical practice. Our nation needs us, and we urgently need to respond.

Responses

Retainer practices can solve some of primary care’s most difficult

Point Response: Robert M. Centor, MD

challenges, including the following:

I appreciate Dr. Vega’s concerns about “the health care of our

•

Greater access to physicians? Check.

country.” He opines that retainer practices would decrease access to

•

Improved patient-physician relationships, with a chance to focus

primary care physicians. Moreover, he raises the interesting point that

on the biopsychosocial model of health care? Check.

physicians have “a responsibility to support the health of the entire

•

More time for preventive care and patient counseling? Check.

community.” He finishes his impassioned essay with a plea for us to

•

The chance to make this nirvana of medical practice financially

advocate for change. He wants to change reimbursement and improve

feasible, if not highly profitable? Check.

compensation for health counseling.

Improving the health care of our country? Well...

I believe that I can convince Dr. Vega that the retainer medicine model

•

It is inspiring that health care is back on the national agenda. Each

can satisfy all these needs.

presidential candidate has staked out a position on health care reform,

As I stated originally, the current primary care model receives little

and regardless of party affiliation, the call has been for increased

respect and poor payment (a more accurate term than reimbursement).

access to care. Such care will emphasize preventive medicine, quality,

Thus, it attracts fewer and fewer students and residents. We

and evidence-based management of chronic disease.

in the South often say, “If it ain’t broke, don’t fix it.” Well, our

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�

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POINT / COUNTERPOINT : The Retainer Model or Single Payer current primary care model is broken, and, thus, we must develop a

But the adoption of this practice on a wide scale would be a disaster

better model.

for health care in the United States. These practices are exclusionary by

Dr. Vega represents the mainstream primary care idea: if only we

their very nature: physicians open these practices to lower the number

tinkered with the payment system, everything would work well. My position is that the current system has such major problems that we should consider a better one.

Given no monetary constraints, patients would all prefer to have a retainer physician. We all want access to our main physician. We want him or her to have enough time to provide care. We do not want any incentive for our physician to speed through our appointment, or fail to provide email communication, or make it nigh impossible to talk on the phone.

When I think about the advantages of retainer medicine, I imagine a revolution in primary care. Physicians can provide reasonable cost retainer medicine; it does not have to carry a huge fee. For example, if a primary care physician could restrict their practice to 1,000 patients and charge $50 per month, the numbers may well work. In such a practice, overhead would be minimal, because the physician would not need a cadre of billing and insurance experts.

I believe such practices would attract both patients and physicians.

Given this more desirable profession, more physicians would choose to enter such practices and more physicians would continue providing care. Retainer medicine could increase the attractiveness of outpatient generalist careers.

Although I understand Dr. Vega’s objections, I assert that the dynamics of a new model could improve access to generalist physicians.

Each physician has a primary responsibility to provide the best possible care to his or her patients. When we see too many patients, all of our patients suffer. When we consult subspecialists because we do not have time to spend with our patients, health care suffers. When we order imaging studies rather than spend more time interviewing and examining the patient, health care suffers.

We cannot be satisfied with a primary care system, unless we provide outstanding primary care. Our current payment system actually discourages primary care physicians from devoting our most precious resources to our patients. Of course, our most precious resource is time. Our patients deserve our time, and we deserve fair payment for all our time.

of patients they see. The annual “membership” fees for these practices cost thousands of dollars, and many of these practices exclude all but the most lucrative health insurance plans. Moreover, many retainer practices charge fees for physician visits, adding to the cost burden overall. And, for all of these costs, there is little evidence that these practices deliver superior health outcomes.

The real cost of our failure in establishing a better health care system goes far beyond disgruntled patients and physicians, or even the loss of the primary care specialties. Relatively speaking, these are selfish concerns. The inequities and problems in health care in the United States cost individuals their health and, too often, their lives.

I, too, would call for a revolution in the way that physicians practice in this country. Certainly we should advocate for a greater overall focus on prevention and the maintenance of well-being, as opposed to the treatment of disease, for the whole patient. Patients want an empathetic physician who understands their needs. These are areas in which primary care physicians excel.

But those concepts in and of themselves are hardly revolutionary. Dr. Centor is perfectly right in saying that we need a new way forward that can sustain a better physician-patient interaction. Imagine a system in which primary care physicians are reimbursed fairly for the good work that we do. In this scenario, strong patient relationships and improved health outcomes are incentivized so that we all have a stake in better health. Best yet, this system is completely inclusive, guaranteeing access to basic health care for all.

An impossible dream? Not to every major industrialized country on the planet. This plan is called single-payer. You might have heard of it, perhaps when it’s being disparaged by insurance and pharmaceutical companies.

There are many controversial issues related to a single-payer health care system, but it is time for all of the stakeholders in medical care to realize that the consequences of our current quagmire of a health care antisystem are too important to remain intransigent to change. The work will be hard, and some sacrifices will have to be accepted on all sides. However, in the end, we will have a system that is not only fair and efficient, but caring and personal as well.

We should examine the retainer medicine movement carefully. This movement focuses on the highest-quality care. I believe we should

References

reinvent our payment system to make such care the expectation, rather

1. Starfield B. Primary Care: Concept, Evaluation, and Policy. New

than the exception.

York, NY: Oxford University Press; 1992.

2. Needell MH, Kenyon JS. Ethical evaluation of “retainer fee”

Counterpoint Response: Charles P. Vega, MD Dr. Centor again does an excellent job of describing real challenges for primary care and for medicine in general in the United States. It is clear that no one is satisfied with the inefficient and unjust system at hand, and retainer practices can certainly be attractive for physicians.

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medical practice. J Clin Ethics. 2005;16:72-84.

3. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457-502.

Reprinted with permission of Medscape Family Medicine. ©2008 Medscape (www.medscape.com)

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Today, MICRA saves the health care system billions of dollars each year and increases patients’ access to health care by keeping doctors, nurses, and other health care providers in practice, and hospitals and clinics open.

SCCMA and CMA Continue to Protect MICRA For more than three decades, the Medical Injury

defendant introduces such evidence, the claimant

Compensation Reform Act of 1975 (MICRA) has

may also introduce evidence of the cost of the

been California’s landmark model professional

premiums for such personal insurance.

liability law. MICRA works by compensating injured patients and keeping premiums stable. Both the

Limits on Attorney Contingency Fees

Santa Clara County Medical Association and the

In an action against a health care provider for

California Medical Association protect MICRA from

professional negligence, an attorney’s contingency

trial attorneys that try to undo the Act every year.

fee is limited to 40% of the first $50,000 recovered; 33 1/3% of the next $50,000; 25% of the next

The Californians Allied for Patient Protection

$500,000, and 15% of any amount exceeding

(CAPP) state that MICRA is a critical component of

$600,000.

California’s safety net for access to health care. It was enacted in 1975 by overwhelming bipartisan

Advance Notice of a Claim

support in response to a crisis of runaway medical

To further the public policy of resolving meritorious

liability costs and the resulting shortage of health

claims outside of the court system, MICRA requires

care providers, most predominantly in high-risk

a claimant to give a 90-day notice of an intention to

specialties.

bring a suit for alleged professional negligence. If the notice is given within 90 days of the expiration

According to CAPP, since MICRA’s enactment,

of the statute of limitations, the statute is extended

medical liability premiums have increased by 420%

90 days from the date of the notice.

nationwide, compared to just 168% in California.

Today, MICRA saves the health care system billions

Statute of Limitations

of dollars each year and increases patients’ access

In California, a claim for alleged medical negligence

to health care by keeping doctors, nurses, and other

must be brought within one year from the discovery

health care providers in practice, and hospitals and

of an injury and its negligent cause, or within three

clinics open.

years from injury.

The following are the seven basic provisions of MICRA:

Periodic Payments of Future Damages

Limits on Non-Economic Damages

claimant’s future economic damages, if over $50,000,

Non-economic damages in a claim against a health

in periodic amounts. This avoids a claimant’s

care provider for medical negligence are limited

wasting of an award prior to actual need.

A health care professional may elect to pay a

to $250,000 (sometimes called pain and suffering

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awards). Economic damages, such as lost earnings,

Binding Arbitration of Disputes

medical care, and rehabilitation costs, are not

Patients and their health care providers may agree

limited by statute.

that any future dispute may be resolved through binding arbitration. California statute requires

MAY / JUNE 2008

12

Evidence of Collateral Source Payments

specific language for such contracts and also

A defendant in a medical liability action may

provides that all such contracts be revocable within

introduce evidence of collateral source payments

30 days.

(such as from personal health insurance) as they relate to damages sought by the claimant. If a

MICRA: 69,039 REASONS WHY DR. JOHN IS AN SCCMA/CMA MEMBER Since 1975, MICRA has been California’s model professional liability law. MICRA works by compensating injured patients and keeping our premiums stable. Every year, the trial attorneys try to undo MICRA. Every year SCCMA/CMA protects MICRA.

Santa Clara physicians are saving an average of $69,039 this year.

2008 Santa Clara County Medical Association MICRA Savings Chart

Specialty

Allergy Anesthesiology Cardiology (Invasive) Cardiovascular Surgery Dermatology (Lipo/Cosmetic) Emergency Medicine Family Practice (Non-Surgical) General Surgery Internal Medicine (Non-Invasive) Neurosurgery OB/GYN Ophthalmology (LASIK/Cosmetic) Orthopaedics Otolaryngology (Cosmetic) Pathology Pediatrics (Non-Surgical) Plastic Surgery Proctology Psychiatry (Non-Shock) Radiology (Non-Invasive) Thoracic Surgery Urology Average - All Specialties *

Santa Clara County $3,283 $8,641 $9,857 $24,899 $23,031 $14,163 $8,284 $23,031 $6,869 $42,902 $30,463 $6,869 $23,031 $23,031 $4,781 $6,869 $23,031 $23,031 $4,781 $6,869 $24,899 $9,857 $16,021

Dade County, FL $26,871 $53,743 $105,566 $191,938 $60,460 $105,566 $49,904 $222,648 $55,662 $276,390 $222,648 $55,662 $172,744 $67,178 $61,420 $42,747 $105,566 $76,775 $26,871 $105,566 $191,938 $67,178 $106,593

Long Island New York $9,265 $32,223 $40,738 $100,550 $31,472 $48,737 $22,948 $150,824 $31,472 $275,289 $167,812 $31,179 $125,004 $97,378 $22,311 $22,948 $97,378 $55,005 $9,264 $50,496 $100,500 $55,005 $71,718

Wayne County, MI $16,909 $41,697 $66,711 $174,918 $23,797 $87,121 $33,893 $143,445 $34,350 $201,512 $135,935 $37,955 $144,667 $81,556 $19,524 $28,928 $91,565 $53,751 $17,853 $45,293 $154,089 $55,655 $76,869

Are you an SCCMA/CMA member?

* This is not a weighted average.

Note: Comparison reflects mature annual premium costs for $1 million maximum per case/$3 million maximum for all cases in a given year. Wayne County, MI rates are for $1 million/$4 million, coverage levels typically made available at no extra charge to the Michigan policyholders of American Physicians Assurance Corporation.

Sources: NORCAL Mutual Insurance Co. (San Francisco, CA) effective 1/1/2008; First Professionals Insurance Company (Dade County, FL) - effective 2/2/2008 - includes both FIGA assessments totaling 3.61%; Medical Liability Mutual Insurance Company (Long Island, NY) - policy year ends June 30, 2008. American Physicians Assurance Corporation (Wayne County, MI) - Rates effective through December 31, 2007.

FL-NY-MI Average $17,682 $42,554 $71,005 $155,802 $38,576 $80,475 $35,582 $172,306 $40,495 $251,064 $175,465 $41,599 $147,472 $82,037 $34,418 $31,541 $98,170 $61,844 $17,996 $67,118 $148,842 $59,279 $85,060

MICRA Savings

$14,399 $33,913 $61,148 $130,903 $15,545 $66,312 $27,298 $149,275 $33,626 $208,162 $145,002 $34,730 $124,441 $59,006 $29,637 $24,672 $75,139 $38,813 $13,215 $60,249 $123,943 $49,422 $69,039

Physician Compensation Data 2007 Physician Compensation Survey By the American Medical Group Association (AMGA) The American Medical Group Association, which has been conducting this survey since 1986, represents the interests of medical groups nationwide, including some of the nation’s largest, most prestigious integrated health care delivery systems. AMGA advocates for the multi-specialty group practice model of health care delivery and for the patients served by medical groups through innovation, information sharing, benchmarking, and continuous striving to improve patient care. The members of AMGA deliver health care to more than 50 million patients in 40 states, including 15 million capitated lives. The average AMGA member group has 272 physicians and 13 satellite locations. Headquartered in Alexandria, VA, AMGA is the strategic partner for medical groups providing a comprehensive

Specialty Allergy and Immunology Anesthesiology Cardiac & Thoracic Surgery Cardiology Colon & Rectal Surgery Critical Care Medicine Dermatology Diagnostic Radiology - Interventional Diagnostic Radiology - NonInterventional Emergency Care Endocrinology Family Medicine Family Medicine - with Obstetrics Gastroenterology General Surgery Geriatrics Gynecological Oncology Gynecology Gynecology & Obstetrics Hematology & Medical Oncology Hospitalist Hypertension & Nephrology Infectious Disease Intensivist Internal Medicine Neonatology

14

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MAY / JUNE 2008

package of benefits, including political advocacy, educational and networking programs and publications, benchmarking data services, and financial and operations assistance.

This survey was sent to 2,600 medical groups representing 35,000 physicians from all over the country. The bulk of respondents were multi-specialty groups (84%). A partial list of states surveyed in the North include: CT, DC, RI, and PA; in the West: CA, AZ, CO, and NV; in the South: AL, AK, FL, and GA; and in the East: IL, IN, OH, and WI. To order the full report, you may contact the American Medical Group Association at 703/838-0033 or by visiting the organization’s website at www.amga.org.

All .

Physicians

Starting

Eastern

$233,318 $344,691 $460,000 $370,295 $357,262 $249,996 $316,473 $440,004

$161,858 $275,000 $350,000 $275,000 **** $207,180 $228,500 $350,000

$252,445 $312,292 $462,747 $299,670 $342,000 $237,886 $271,580 $367,267

$237,323 $343,810 $492,874 $361,205 $351,481 $313,850 $325,484 $433,085

$234,444 $333,035 $375,000 $417,395 **** **** $336,656 $538,318

$218,137 $349,991 $513,747 $388,786 $378,172 $249,996 $308,658 $440,004

$414,875

****

$371,308

$414,904

$397,393

$430,000

$255,530 $204,217 $185,740 $190,649 $356,388 $327,902 $177,392 $358,297 $225,182 $270,793 $280,339 $191,436 $240,145 $213,496 $252,055 $193,162 $255,524

$178,000 $150,000 $130,000 $139,375 $280,000 $220,000 **** **** **** $200,000 $220,000 $151,140 $175,000 $150,000 **** $135,000 $180,000

$224,373 $178,387 $159,639 $175,070 $325,647 $284,055 $175,000 $315,357 $204,008 $232,913 $244,478 $177,368 $213,245 $177,291 **** $176,642 $242,739

$260,175 $200,491 $198,415 $186,336 $370,095 $326,042 $172,614 $359,277 $217,586 $274,448 $298,779 $200,977 $262,687 $225,033 $252,619 $203,440 $284,588

$256,490 $196,892 $187,281 $165,290 $374,077 $320,000 **** **** $230,242 $288,815 $359,160 $199,450 $263,891 $173,883 **** $194,374 $226,453

$257,745 $211,494 $177,747 $199,357 $345,508 $356,463 $179,052 $379,995 $228,260 $274,561 $280,001 $181,175 $225,504 $215,001 **** $181,570 $250,131

Western Southern Northern

Specialty Neurological Surgery Neurology Nuclear Medicine (M.D. only) Obstetrics Occupational / Environmental Medicine Ophthalmology Oral Surgery Orthopedic Surgery Orthopedic-Medical Orthopedic Surgery - Joint Replacement Orthopedic Surgery - Hand Orthopedic Surgery - Pediatrics Orthopedic Surgery - Spine Otolaryngology Pathology (M.D. only) Pediatric Allergy Pediatric Cardiology Pediatric Endocrinology Pediatric Gastroenterology Pediatric Hematology / Oncology Pediatric Intensive Care Pediatric Nephrology Pediatric Neurology Pediatric Pulmonary Disease Pediatric Surgery Pediatrics & Adolescent Pediatric Infectious Disease Perinatology Physical Medicine & Rehabilitation Plastic & Reconstruction Psychiatry Psychiatry - Child Pulmonary Disease Radiation Therapy (M.D. only) Reproductive Endocrinology Rheumatologic Disease Sports Medicine Transplant Surgery - Kidney Transplant Surgery - Liver Trauma Surgery Urgent Care Urology Vascular Surgery

All   .

Physicians

Starting

Eastern

Western Southern Northern

$530,000 $222,998 $329,951 $297,887

$400,000 $177,500 **** ****

$457,641 $200,976 **** ****

$605,825 $233,221 $311,188 ****

$550,000 $226,986 **** $316,714

$530,000 $222,998 $421,762 $300,077

$203,159

$146,821

$209,103

$202,662

$182,350

$209,109

$295,510 $333,857 $436,481 $238,154

$205,510 $229,370 **** ****

$249,167 **** $390,000 ****

$284,526 **** $448,559 ****

$320,625 $275,879 $403,781 ****

$324,997 $361,500 $437,930 $198,830

$502,204

****

$496,639

****

****

$499,998

$413,148 $427,795 $579,400 $327,399 $247,506 $175,824 $218,331 $182,488 $221,667 $202,903 $214,547 $189,966 $203,000 $181,087 $353,682 $185,913 $182,742 $349,807 $219,991 $349,499 $200,871 $211,740 $265,907 $371,218 $299,620 $208,285 $240,475 $342,550 $423,418 $353,971 $198,646 $365,999 $365,882

**** **** **** $220,000 **** **** **** **** **** **** **** **** **** **** **** $125,000 **** $283,457 $170,000 $250,000 $160,000 **** $182,500 $275,000 **** $155,000 **** **** **** **** $140,000 $246,235 $260,100

$405,000 **** **** $295,844 $216,457 **** $191,668 **** $203,767 **** **** **** **** $173,129 $356,073 $176,938 **** $327,631 $199,808 $294,242 $176,300 $162,000 $233,520 $306,887 $249,722 $193,678 **** **** **** $295,164 $181,556 $317,392 $321,135

$393,308 **** $623,202 $326,556 **** **** $264,915 **** $238,870 $214,461 **** **** $216,139 **** $343,774 $187,154 **** $353,850 $218,338 $357,217 $214,681 $231,453 $277,535 $414,630 $330,361 $221,868 **** **** **** **** $201,887 $371,250 $378,973

**** **** **** $351,705 $259,819 **** $180,000 **** **** $206,160 $177,999 **** **** **** $377,036 $197,056 **** **** $218,852 $323,235 $181,097 **** $285,961 $357,634 **** $201,013 **** **** **** $455,323 $210,731 $358,100 $364,596

$441,645 **** $548,000 $339,085 $253,006 **** $249,996 $178,200 $228,227 $200,471 $212,909 $178,788 $203,000 **** $353,750 $183,642 $165,749 $349,725 $219,992 $382,450 $185,999 $181,716 $267,956 $386,990 **** $204,691 $234,538 $379,248 $431,750 $375,491 $198,944 $388,552 $356,164

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MAY / JUNE 2008

15

Monocultures that rely on limited highinput and high-cost technologies are more riskprone because they lack biodiversity.

Farmers using low-externalinput organic approaches are better able to adapt to climate change, as their farms are more resistant to extremes of droughts and floods.

How Organic Farming Mitigates Climate Change

By Pesticide Action Network North America (www.panna.org) The world won’t be saved by any one thing.

Fifty years ago, the “Green Revolution” promised to end hunger; today, corporations promise that genetically engineered crops will solve the climate crises. They won’t.

efficient in energy use per ton of produce than conventional farming. Greenhouse gas emissions are 48–66% lower per-hectare in organic farming systems in Europe.

In the U.S., it takes about two units of fossil fuel energy to harvest a unit of crop energy. Organic systems collect 180% more solar energy than conventional agriculture. This is the equivalent to

Yet recent studies demonstrate that organic

saving 64 gallons of fossil fuel per hectare.

agriculture, because it relies on diversity and

Oil-based industrial agriculture moves carbon

adaptability, because it works with rather than

out of the soil and into the atmosphere. Organic

against nature, offers one of the quickest, cheapest,

agriculture takes carbon from the air and puts it

and most effective means of mitigating climate

back in the soil. If 10,000 medium-sized U.S. farms

change. Farming that traps carbon in the soil, uses

converted to organic production, this would remove

fewer external inputs, and supports localized food

enough carbon from the air to equal removing

systems, has the potential to stop nearly 30% of

1,174,400 cars from the road. Halting the use of

global greenhouse gas emissions while saving one-

chemical fertilizers would increase soil carbon stores

sixth of global energy use.

by 734 billion pounds. Converting 160 million acres

Agriculture currently generates between 11–20%

of U.S. corn and soybeans to organic production

of greenhouse gasses worldwide. It contributes

would sequester enough carbon to meet 73% of

7.4% of U.S. greenhouse gas emissions, releasing

America’s CO2 reduction targets under the Kyoto

750 million tons of CO2 into the atmosphere each

Protocol.

year. Chemical- and energy-intensive “conventional”

Monocultures that rely on limited high-input and

agriculture is the main source of greenhouse

high-cost technologies are more risk-prone because

gasses, like methane and nitrous oxide, and a major

they lack biodiversity. Farmers using low-external-

consumer of fossil fuels.

input organic approaches are better able to adapt

Globalization feeds an artificial market that profits

to climate change, as their farms are more resistant

by moving food thousands of miles from the point

to extremes of droughts and floods. The secret to

of production to the point of consumption, burning

sustainable agriculture—historically and today—is

fossil fuel, and generating pollution every step of

diversity and resilience.

the way. Localized food systems tend to reduce both

Sources: “Mitigating Climate Change through

fuel consumption and the production of climate-

Organic Agriculture and Localized Food Systems,”

altering emissions.

The Institute of Science in Society (January 31,

The U.N. Food and Agriculture Organization reports

2008); “Organic Agriculture, Environment and Food

that “organic agriculture performs better than

Security,” FAO, Environment and Natural Resources

conventional agriculture on a per-hectare scale, both

Service Sustainable Development Department

with respect to direct energy consumption (fuel and

(Rome, 2002); International Conference on Organic

oil) and indirect consumption (synthetic fertilizers

Agriculture and Food Security (Rome, 2007);

MAY / JUNE 2008

and pesticides).”

“Organic Farming Combats Global Warming…Big

16

farms use 200% more energy than organic farms.

the bulletin

The Rodale Institute has found that conventional Organic farming in Britain is about 26% more

Time,” The Rodale Institute (2008).

Reprinted with permission of PAN Magazine ©2008

directory updates

2008 Membership Directory Updates Please cut and paste over the existing listing, or insert on the appropriate page, the following physician listing changes in your 2008 SCCMA Membership Directory.

Catherine A Collings, MD

Mandakini D Patel, MD

*IM *CD

*PD

University of Wisconsin Medical School 1987

Med College, Baroda University 1980

2490 Hospital Dr Ste 311 Mtn View 94040 650-962-4690

200 Jose Figueres Ave #340 San Jose 95116 408-729-1220

Fax: 650-962-4696 doccate@sbcglobal.net

Dominick A Curatola, MD *CD *IM *IC New York Univ School of Medicine 1979

Michael M Quach, MD P Stanford University School of Medicine 2001

2490 Hospital Dr Ste 311 Mtn View 94040 650-962-4690

200 Jose Figueres Ave Ste 210 San Jose 95116-1586 408-272-4400

Fax: 650-962-4696

Rashid Elahi, MD *NEP *IM Dow Medical College 1986

175 North Jackson Ave Ste 103 San Jose 95116 408-937-9009

Fax: 408-937-9002 dhanukapoor@sbcglobal.net

Dan D Hopner, MD *FP Medizinische Fakultatderuniv Zurich 1978

340 Dardanelli Ln Ste 24 Los Gatos 95032 408-378-8648

Fax: 408-378-9114

Dr. David Yeh is a neurosurgeon who has returned to his home town of San Jose. He practices general neurosurgery and has advanced training in spine and epilepsy surgery. He has expertise in:

Appoints & information: 2505 Samaritan Dr., #605 San Jose, CA 95124 Office: (408) 358‐0133 Fax: (408) 358‐8134 daveyeh@yahoo.com

• Minimally invasive surgery • Adv spinal instrumentation • Deformities and trauma • Degenerative disease • Spinal oncology • Stereotactic and image‐guided surgery • Neuro‐oncology • Epilespy surgery

Fax: 408-272-4422 mmquach@yahoo.com

Meena Sathappan, MD *PD Jipmer Medical College 1993

1569 Lexann Ave #230 San Jose 95128 408-274-9099

Fax: 408-274-9009 msathappan@gmail.com

David D Yeh, MD NS St. Louis University School of Medicine 1999

2505 Samaritan Dr #605 San Jose 95124 408-358-0133

Fax: 408-358-8134 daveyeh@yahoo.com

Retired Section Richard L Sogg, MD

19262 Hidden Hill Rd Los Gatos 95030 408-354-8758

rlsogg@yahoo.com

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MAY / JUNE 2008

17

2008 SCCMA DISCOUNT TICKET PROGRAM Regular Gate Price

Discounted Price

GILROY GARDENS (FORMERLY BONFANTE GARDENS) General Admission $41.99 $24.00 (Ages 3+) ~Season passes for this park are no longer available through SCCMA ~ GREAT AMERICA General Admission Season Pass (Includes parking all year long) Day Parking Pass Children ages 2 & under are free

$51.99 $69.99

$33.00 $61.00

$10.00

$ 5.00

MONTEREY BAY AQUARIUM Adult Senior (65+) Child (3-12 years) Student (13-17 years)

$24.95 $22.95 $15.95 $22.95

$22.00 $20.00 $13.00 $20.00

RAGING WATERS General Admission Season Pass

$29.99 $59.99

$23.00 $41.00

SIX FLAGS DISCOVERY KINGDOM (FORMERLY MARINE WORLD) General Admission $51.25 Children ages 2 & under are free SEE’S CANDIES 1 lb. Gift Certificate

$14.50

$27.00

$11.00

Discount coupon for Roaring Camp Railroads is available to SCCMA members.

SCCMA kindly accepts prepayment prior to ticket pick up in the form of VISA or MASTERCARD. Delivery of tickets on Fridays only, with surcharge of $5.00. Call Rachael Hernandez at 408/998-8850 ext. 3008 to order tickets today.

18

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MAY / JUNE 2008

Medical Dimensions Incorporated 3131 S. Bascom Avenue, Suite 120 Campbell, CA 95008 Phone: 408.377.9877 Fax: 408.377.9893 www.mdidocs.com

MDI is pleased to announce the addition of Joetta Cox, CMC, as our new Chief Operations Officer.

Joetta brings over 25 years of healthcare experience (12 years in Santa Clara County). She is a certified medical coder and has done numerous coding and health related seminars while employed as the Reimbursement Advocate for the Santa Clara County Medical Association. Her experience includes reimbursement expertise for commercial, Medicare, and Workers’ Comp.

Joetta’s duties include conducting seminars for MDI members and assisting them with healthcare issues. She will also continue to renegotiate reimbursement fee schedules for MDI physicians.

Medical Dimensions Incorporated (“MDI”) is the largest, non-capitated multi-specialty Independent Physician Association in Santa Clara County. MDI provides contracting services for PPO, EPO, POS and Worker’s Compensation products. MDI’s contract management department provides individual and group assistance with issues concerning reimbursement, and development of new product lines.

For information on plans, benefits or membership in MDI, please visit our website at www.mdidocs.com

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MAY / JUNE 2008

19

Memorial Day

By Richard A. Mahrer, MD

achieved a complete remission of her multiple sclerosis, but years later developed progressive bone necrosis and eventual death from

A time for remembering the fallen, as the final balmy spring-like

therapeutic side effects not predictable when treatment was first

days at the very end of May disappear forever and are scattered into

initiated.

the timeless void of cosmic dust. I have lived through too many wars and deeply respect those who have sacrificed so much. But, as I reflect on the reasons for celebrating this day, I note that I have also lived through, perhaps, too many decades of medicine, and remember all those who have departed, not from physical combat, but from combat while under my care against the myriads of ills which plague humanity, and which perils we as physicians have pledged ourselves to help eliminate.

Many battles, of course, do not always end in defeat, but sometimes we lose the ones we want to help the most, and often there is nothing to do but hold a patient’s hand when modern medicine fails, knowing that minimal physical contact is an important though fragile bridge connecting the heart of the healer with the heart of one beyond saving. I remember not long ago doing just that with an exceptional lady from Northern Africa. I visited her daily for six weeks in a small, quiet convalescent hospital room, which was to

It is fitting, therefore, an appropriate time to remember patients

be her final home, and we held hands—eventually without words,

we have lost, for reasons not necessarily related to our lack

but not without feelings. She was young, vibrant, newly married,

of professional skill—although our current level of scientific

but with terminal cancer which was ending her hopes, her dreams,

achievement will be considered archaic by future medical

her life. She bore her burden with dignity, courage, equanimity, and

generations. Although I haven’t kept an accurate accounting of the

a marvelous philosophy. Beyond pain relief, I could only offer my

mortality figures in 50-plus years of practice, the number for me is

hand. She understood and wanted me to keep returning, promising

certainly in the hundreds. It is not a subject for casual conversation

with a smile that when she was well, she would make my wife

with colleagues because the loss rate in our various practices,

(who also visited her) and me a fantastic chicken dinner cooked in a

although variable as well as inevitable, is not a record of pride or

special style created from an old family recipe.

satisfaction.

So, on this Memorial Day, hundreds of images come into focus,

Pondering those unhappy events where blame cannot always be

emerging from dark recesses and depths of this physician’s half-

ascribed to another’s inappropriateness, I remember a delightful

century medical practice. Many of the departed are lost in the haze

young woman in the 1950s who died, I feel unnecessarily, from

of receding memory, but the majority have obviously been helped as

complications of subendocardial bacterial endocarditis related to her

a result of medical magic, certainly mixed with the blessing of good

long-standing rheumatic heart disease, when my diagnosis was too

heredity and a generous portion of good luck. We in the profession

late. And she trusted and believed in me and my professional skills…

know very well how much we can assist and how much we can

Another, long ago in a primitive intensive care unit, whom I was

harm. Humility, rather than inflated self-image, must always be an

treating for an acute myocardial infarction, had a sudden cardiac

integral personal dynamic, as we face the daily crises in the pursuit

arrest as I was talking to him about going home to his wife and

of our medical careers.

family. He looked at me in horror with eyes pleading for help and, in

Professional advances are often met with powerful antagonists

that instant, I could not help.

attempting to overwhelm us, as well as our patients. We may never

A young, energetic lady with hemiplegic migraine, who was

reach that pinnacle in future time when there will be no more

reassured by my neurologic consultant and appropriate tests that the

need for memorial days, but that remains the perhaps elusive but

stroke-like symptoms accompanying her headaches would not lead

challenging goal of humanity, as we endeavor to overcome the

to real strokes (but they did), was paralyzed and died while under

sickness of war and the sickness that makes people become our

my care. Was there a small aneurysm that we missed? We never

patients. Remembering all those who have slipped beyond our

knew.

professional therapeutic grasp is important—and not just for one day

The beautiful woman from Denmark, who 45 years ago, after specialist failure and the apparent end of hope, I treated with massive corticosteroid dosage after reading about successful early, but experimental trials. After months and months of therapy, she

20

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MAY / JUNE 2008

a year. Death is also a learning tool and increases our awareness that every human life is precious, and that we have been blessed as physicians with responsibility and knowledge that should make us proud to be part of a profession that tries to make a difference.

The Generalist-Specialist Tension Within American Medicine. from page 6 and more normatively healthy quality of life, one in which personal

solution to ensure on-call coverage, but even what might seem to

and family needs are better addressed, and where deprivation

constitute a reasonable level of compensation may no longer be

(delayed gratification) of the routine amenities of a contented life

persuasive or attractive to specialists. Furthermore, most hospitals

no longer is acceptable or tolerable. Also, some specialists, after a

have a limited ability and a withering willingness to pay for specialty

variable number of years of practice, do not need the added income

coverage. After all, should hospitals be expected to expend their

from call because they have become well enough compensated by

own revenue to finance this element of our crumbling national

busy practices, often independent of hospital activities. Moreover,

health care sector? Understandably, the maxim “no margin, no

they don’t want to have these lucrative practices interrupted at

mission” applies to nonprofit hospitals as well as for-profits.

inconvenient or inopportune times by emergencies associated with being on-call. Furthermore, some specialists become so sub-

As a final point, let us contemplate where ethics and professionalism

specialized that at some point of their careers they simply no longer

fit within this simmering cauldron? Do specialists have an ethical

have retained the comprehensive skills of the “generalist” specialist.

obligation to service the emergency needs of the communities in which they live and/or work? Can medical professionalism survive

Inadequate compensation stemming from patients with no

our commercialized health care market?

insurance or government insurance degrades the payment mix needed to ensure adequate specialist back up staffing of emergency

Reprinted with permission of the CSA Bulletin © 2008 by California

departments. Then add the organized and illegal refusal of insurers

Society of Anesthesiologists

to pay non-contracted specialists fairly and reasonably for services rendered that otherwise would not have been available to their policy-holders (“balance billing” issues). Hospital stipends or other forms of financial support may provide a temporary patchwork

Living With Dignity REDEFINING

Hope™

Because each life is unique.

Care near the end of life should be unique as well.

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On Medscape right now, there are about 2,000 unique courses available to members,” divided among more than 30 medical specialties… (http://cme. medscape. com/cme/ familymedicine)

Good Bets for Free and Low-Cost CME Five general areas to check on when you’re in a crunch for credit.

By Chris Womack

groups to host events.”

Continuing medical education requirements are not so hard to fulfill, according to several sources interviewed for this article. Doctors can usually meet them by attending events sponsored by their hospitals or their specialty societies.

In addition to that major effort, the foundation’s

But even doctors with the most well-planned lives

2 Internet-Only CME

have unexpected emergencies, snafus, or visits to the in-laws that just happen to conflict with the year’s big society meeting. And not surprisingly, doctors might prefer to get CME credits for free.

“There are some programs that I pay for, for CME, because I value the programs and I like doing them, but if you’re looking to get good CME—25 units a year—you can do it for free. You don’t have to spend a dime,” says Samuel Fink, MD, an internal medicine specialist in Tarzana.

The Internet is a natural place to look for free and low-cost CME, but it’s a big, big place, and it’s not the only option. Here are several outlets you might want to check out, if you find yourself short of CME units and deadline time is nigh.

1 The California Medical Association Foundation The foundation is a great resource for doctors looking to get free CME, which it offers on obesity, antibiotic-resistant bacteria, and diabetes.

“We have an online childhood obesity CME that

antibiotic resistance CME course addresses topics, such as appropriate prescribing for MRSA, while its diabetes project offers free CME events on quality care in target counties, such as San Bernardino, Maulhardt says. See the CMA Foundation Web site at www.calmedfoundation.org.

There are several places to get free CME online, and everyone inevitably has favorites. “If [a state legislator’s] grandmother dies of kuru, and he [passes a law that] everybody should do five units of kuru, you can get it on Medscape.com,” Dr. Fink says.

“On Medscape right now, there are about 2,000 unique courses available to members,” divided among more than 30 medical specialties, says Steve Zatz, executive vice president of professional services at WebMD Health, which owns Medscape.

The service is quite popular: Doctors completed approximately 730,000 CME activities during the most recent quarter in 2007 for which the company has data.

Another popular free CME Internet source is Discovery Health CME (http://discoveryhealthcme. discovery.com). The outfit’s CME programs also show on the Discovery Health cable TV station, with the option for e-mailed reminders for program times.

we’ve done in conjunction with WellPoint,” says

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22

Christine Maulhardt, director of the foundation’s

Other CME sources online include: AHC Media’s

Obesity Prevention project. “It’s 1.5 credits, and

www.freecme.com; and Oakstone Medical

it gives background on childhood obesity and

Publishing’s www.cmeonly.com; and Medical

practical tips for addressing it in office visits in a

Communications Media’s www.cmecorner.com. But

culturally competent way.” The foundation also

be sure to confirm that the CME provider has been

conducts live obesity CME events throughout the

accredited to award the units you need.

state focusing on both adults and children, and addressing community prevention efforts and

3 Government Agencies

clinical issues. “We’re always looking for medical

When you need CME in a particular area, try some

of the usual governmental suspects, such as the Centers for Disease Control and Prevention (www2. cdc.gov/ce/availableactivities.asp), the National Institutes of Health (www.nihandhopkinscme.org), the Office on Women’s Health (www.4women. gov/hearttruth/cme.cfm), the Office of Minority Health (https://cccm.thinkculturalhealth.org), and the Health Resources and Services Administration (www.hrsa.gov/healthliteracy/training.htm).

“Everything we offer at NIH that is CME is free,” says Joan Schwartz, assistant director of the NIH Office of Intramural Research. While most of the activities are held at East Coast locations, many of them include a Webcast, she says. The NIH is about to hand all of its CME activities over to Johns Hopkins University, which will add those activities to its own offerings, Schwartz says.

4 Specialty Societies “There are many different requirements for physicians, so I think one reason they do attend our meeting is that we offer a variety of CME,” says Diane Przepiorski, executive director of the California Orthopaedic Association. The organization has low membership dues and the fees for CME range, with the three-day annual meeting

CME Events More CME Events can be found online at www. cme.ucsf.edu/cme or http://cme.medscape.com/ cme/familymedicine (this page carries a wealth of CME activities and also provides access to Medscape’s other specialty sites that host CME activities).

costing $225, she says. “We do try to keep them real affordable, so that cost is never really an issue as to whether someone does or doesn’t attend.”

Naturally, the topics that each specialty society chooses to address are going to vary from group to group. The COA’s CME courses are a mix of clinical and socio-economic topics, and it offers qualified medical evaluator courses at its annual meeting as well, Przepiorski says.

5 Advocacy Groups Groups focused on particular medical conditions are often happy to provide free CME. Currently, the American Cancer Society offers few Web-based CME activities on its site, but it has plenty in print. “Most of our CME is journal-based, [from] our free journal, which is CA: A Cancer Journal for Clinicians,” says Ted Gansler, director of medical content for the American Cancer Society. “They are intended for a diverse group of clinicians,” and the society offers about 20 new courses a year, he says. The CME evaluation can be completed online. Find all of the society’s activities at http://cme.amcancersoc.org.

Reprinted with permission of the Southern California Physician (www.socalphys.com)

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This form goes on letterhead when published in the BULLETIN and/or faxed

2008-2009 SCCMA COMMITTEE RESPONSE FORM Listed below are the current SCCMA committees—all meet at the Medical Association building. Omitted are those where membership is by election (i.e. Council and Executive Committee), bylaw consideration, and/or existing protocol (i.e. Membership, Physicians’ Well-Being, and Professional Standards/Conduct).

SCCMA committees help recommend policies for the Association, standards for practice in Santa Clara County, and aid in the development of important relationships with governmental and public service organizations. Committee service commences on July 1, 2008. The majority of the committees will not meet during July and August, however.

In accordance with SCCMA bylaws, committee appointments are made each year by the President and state that, “The terms of office of the chairs and members of all committees shall be at the discretion of the President, and, in any event, shall end with the term of office of the President by whom they were appointed…” Therefore, the terms of fiscal 07-08 committee members and chairs, having been appointed by Atul Sheth, MD, will officially end with his term of office — June 30, 2008.

Name: (Please print) Specialty:

Phone:

Fax:

Members currently serving, who seek reappointment, are also asked to return this form.

Indicate first, second, & third choice:

24

❏ ❏

Awards (Yearly) To select and nominate to Council the prospective recipients of the Association’s annual awards.

❏ ❏

Environmental Health (Bi-monthly, dinner) To study and address environmental and occupational health concerns.

Bioethics (4 times a year, dinner) To educate its committee members regarding bioethical decision making and to discuss bioethical issues and cases.

External Affairs/Lunch With Legislators & Key Contacts (Lunchtime meetings, usually Fridays) To meet, interview, and serve as the Association’s liaison to the legislators. To influence legislation and regulations relating to the delivery of medical care and the public health.

❏

Leon P. Fox Medical History (Bi-monthly, 3rd Thursday, dinner) To identify, collect, and preserve archival material, memorabilia, and artifacts representing the medical history of Santa Clara County.

❏

Medical Review Advisory (Monthly, 3rd Thursday, dinner) To serve as a consultant to the attorneys for professional liability carriers by providing review and advice on malpractice claims.

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MAY / JUNE 2008

❏

Mini-Internship Committee To organize and coordinate an annual mini-internship program whereby community leaders “shadow” practicing physicians for a day in order to increase awareness and understanding of the medical profession in the community.

❏

Mini-Internship Mentor Members are encouraged to participate in the “Mini-Internship” by volunteering to be “shadowed” by an “intern” (lay community leader) for one day, then attending a follow-up dinner.

Check one: ❏ I’d like a “mini-intern” to shadow me. ❏ Please provide me with more information.

❏

Public Service (Dinner meeting, as needed) To evaluate and attempt to resolve disputes between physicians and patients.

FAX form to 408/289-1064 or mail to SCCMA by 8/15/08.

Santa Clara County Medical Association 700 Empey Way San Jose, CA 95128 Phone: 408/998-8850; Fax: 408/289-1064

✁

700 Empey Way, San Jose, CA 95128 (408) 998-8850 FAX (408) 289-1064

We proudly announce our 2008 member dividend. We set a higher standard. We ensure that members benefit from our strength. We embrace opportunities to recognize and reward physicians. We exceed expectations. We offer tangible benefits to those who join us. We stand behind the promises we make. We are The Doctors Company.

Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company

We are on a mission to relentlessly defend, protect, and reward doctors who advance the practice of good medicine.

We act with single-minded determination to reward our members and to ensure that they share in the company’s financial strength. In 2007, our members received a dividend of between 5 and 7.5 percent. For 2008, our members will receive a dividend distribution at the same level. That’s $44 million returned to members in two years. To learn more about our medical professional liability program, call The Doctors Insurance Agency at (415) 506-3030 or (800) 553-9293. You can also visit us at www.doctorsagency.com.

MEDICO NEWS

MEDICONEWS

HealthNet Agrees to Amend Contract to Comply With RICO Settlement

CMA and CMA member Richard Jones, MD, have successfully challenged a number of provisions in HealthNet’s standard physician contract that do not comply with the terms of the RICO settlement.

HealthNet is one of seven insurance companies that settled CMA’s class action civil racketeering (RICO) lawsuit against for-profit health plans. The settlement agreements required the health insurers to change their business practices to effect transparency and fairness in their relationships with physicians.

HealthNet’s physician contract conflicts with the settlement agreement in a number of ways.

Among other things, the contract’s definition of “medically necessary” is inconsistent with the definition agreed to in the settlement. The contract also requires contracting physicians to participate in all of HealthNet’s products, despite the fact that the plan agreed in the settlement not to require universal participation in its products. Additionally, the contract allows HealthNet to make unilateral changes to the contract without prior notification, despite agreeing in the settlement that it would provide at least 90-days’ advance notice of material adverse changes.

CMA and Dr. Jones filed a dispute with the settlement compliance dispute facilitator. As a result, HealthNet agreed to mail contract addendums—addressing these issues and others—to all contracting physicians with standard HealthNet contracts in California and six other states.

The addendum will be distributed within 90 days of its approval by regulators. We will let you know as soon as this date is known, so that you can be on the lookout for this important document.

CMA continues to have concerns with the HealthNet contract that do not fall under the RICO settlement. CMA is working with the insurer to resolve these issues.

For information about the insurers’ specific obligations under the settlements and what you can do if you believe that the insurers are violating the settlements, please refer to CMA ON-CALL document #0108, “RICO Settlements,” or call CMA’s Center for Economic Services, 888/401-5911.

Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.

(CMA Alert, April 14, 2008 issue)

Medical Board Changing CME Requirements The Medical Board of California is changing its continuing medical education (CME) requirements for physicians. Though it is unclear exactly when the new requirements will take effect, the medical board has announced that physicians will be required to complete 50 CME hours during every twoyear licensure period. Currently, physicians are required to complete 100 every four years.

We will let you know as soon as additional details are available.

The medical board has also clarified that CME are to be calculated based on the physician’s personal license renewal date (the last day of the month of your birthday), not the calendar year.

Contact: Paulette Richardson, 415/882-3387 or prichardson@imq.org.

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Physicians are reminded that CMA’s Institute for Medical Quality (IMQ) certifies physicians’ CME activity for credentialing purposes to the Medical Board of California, as well as to hospitals, health plans, specialty societies, and others. CME certification is $29 a year for members, $49 for nonmembers.

(CMA Alert, April 14, 2008 issue)

Most California Physicians Eligible for New Blues Settlement Another settlement has been reached in the racketeering lawsuit against the Blue Cross/ Blue Shield Association, which alleges that the insurers’ payment practices defrauded physicians out of payments for patient care.

Most California physicians will be eligible for this latest settlement, which was reached with Capital Blue Cross, Capital Advantage Insurance Company, and Keystone Health Plan Central.

The class includes all physicians who billed any of the Blues companies or their contracted intermediaries (capitated medical groups, IPAs, etc.) for services provided between May 22, 1999, and February 1, 2008. Most California physicians will only be entitled to one settlement share. Physicians who have treated a large number of out-ofstate Blues patients may be entitled to more.

The deadline to submit a claim is June 30. Physicians do not have to provide documentation for individual claims. If you wish to opt out of the settlement, you must do so by May 30.

The case, Rick Love, MD v. Blue Cross Blue Shield Association, was filed in May 2003 in federal district court in Miami. The suit accused the insurers of a pattern and practice of denying and delaying care, including intentionally programming computer billing databases to automatically downcode physician claims. The suit was filed under the federal civil racketeering (RICO) statutes.

Although CMA is not a plaintiff in the suit, the suit affects all physicians because of its class-action status.

More information, including a copy of the settlement notice and claim form, is available at http://www.cmaalert.org.

(CMA Alert, April 28, 2008 issue)

MEDICO NEWS

U.S. House Passes Bill That Would Block Federal Medicaid Cuts, Bush Threatens Veto The U.S. House of Representatives has passed a bill (HR 5613) to delay implementation of a series of new Medicaid rules that would shift billions in health care costs to state and local governments. The rules, proposed by the Bush administration, would limit how much states could pay health care providers, ban the use of federal Medicaid money to train doctors, set new limits on Medicaid payments to hospitals and nursing homes operated by state and local governments, and limit Medicaid coverage of rehabilitation services for people with disabilities, including serious mental illnesses. Some estimates indicate that California alone would lose $12 billion over five years.

Senate Finance Committee Working on Legislation to Stop Medicare Cuts The U.S. Senate Finance Committee is currently developing legislation that would stop the 15% Medicare physician payment cuts scheduled over the next two years, and instead extend the current .5% increase through the end of 2008 and give doctors a 1.1% pay raise in 2009.

(CMA Alert, April 28, 2008 issue)

President Bush continues to threaten to veto any Medicare physician payment package that is financed by equalizing Medicare Advantage health plan rates with physician fee-for-service rates. Currently, Medicare Advantage plans receive an average of 12% to 20% more than fee-for-service physicians for providing the same services to Medicare beneficiaries. Bringing plan rates in line with fee-for-service physician rates could save over $50 billion.

UnitedHealthcare Cutting Physician Fees Without Notice or Opportunity to Terminate

Because of the urgency of this legislation and the President’s veto threat, the Senate package will likely be financed by increasing the cuts in 2010. Senate leaders have said that they will work with the new Administration to fix the physician payment formula before then.

Governors of both parties strongly objected to the new rules and asked Congress to stop implementation of the regulations, which could have a devastating effect on the nation’s health care system. For states already grappling with rising health care costs, the new rules would force them to consider cutbacks in services, leaving the most vulnerable Americans without access to health care and other vital services.

President Bush has threatened to veto the legislation. The bill passed by veto-proof margin of 349 – 62 in the House, but it is unclear whether the Senate will also pass the measure with a two-thirds margin.

Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.

CMA has asked the Department of Insurance to force UnitedHealthcare to comply with state law, which requires insurance companies to give contracted physicians 45 days’ notice of any material changes to their contracts. Currently, United makes significant changes to contracts— namely its fee schedules—under the guise of “routine maintenance,” without notifying physicians or giving them the opportunity to cancel their contracts.

United’s “progressive fee schedules” are developed using third-party data (such as Medicare’s relative value units). According to United, “routine maintenance” occurs when it “mechanically incorporates revised information created by a third party that is the source for a portion of the fee schedule.” CMA has learned that payments for some CPT codes were reduced by up to 9.5% as a result of United’s most recent fee schedule revision.

Affected physicians were not given prior notice of these fee reductions, nor were they given the opportunity to terminate as required by California law. Over 50% of physicians contracted with United Healthcare in California are on these so-called progressive fee schedules.

CMA has requested that DOI declare these contract provisions void, unlawful, and unenforceable.

More information, including a copy of CMA’s letter to Insurance Commissioner Steve Poizner on this issue, is available at http://www.cmaalert.org.

The Senate Medicare package may also include demonstration projects on primary care medical homes, comparative effectiveness, and a potential mandate on e-prescribing. The Senate is also considering a payment increase for primary care services.

Senate leaders hope to vote on the package as early as mid-May. Congressman Pete Stark, Chair of the House Ways and Means Subcommittee and one of the most powerful voices in Congress on Medicare policy, has also vowed that he will fight to include a geographic payment fix in the final Medicare payment package. Stay tuned for more information.

Contact: Elizabeth McNeil, 415/882-3176 or emcneil@cmanet.org.

(CMA Alert, April 28, 2008 issue)

Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.

(CMA Alert, April 28, 2008 issue)

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Stanford Hospital Update

By Bryan Bohman, MD, SCCMA Councilor & Stanford Hospital Representative

EMR system (Epic). The

Self-Governance

members have been required to spend considerable

We have recently instituted a major change in

personal time in training activities. While we are

medical staff governance at Stanford. Our system

all well aware of the many potential benefits of the

historically included a chief of staff, appointed by

EMR, at this point in the process, the costs are the

the dean of the School of Medicine and CEO of

more prominent feature. I hope we can report back

the hospital, who exercised most of the leadership

on a positive experience in several months.

hospital has invested huge resources in this project over the past few years and medical staff

prerogatives of the medical staff organization, and an elected president of the medical staff serving

I am concerned for physicians who are on the

in a mostly ceremonial role. The result was that

medical staffs of more than one hospital, each of

the medical staff was largely deprived of its right

which may soon have a different highly complex

(and obligation) to exercise quality oversight in

EMR system. And what of patients who move

the hospital through a self-governing medical staff

between institutions with varying EMR systems,

organization.

none of which can really communicate with each other? The potential for patient safety issues and

After considerable debate, punctuated by input

gross inefficiencies is great. This is an area which

from the Joint Commission, we have adopted a

cries out for regulatory intervention, but I gather

more standard model in which a single chief of staff

there is no rapid solution forthcoming.

is elected directly by the medical staff. Our chief

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28

is now the legitimate leader of the medical staff

Building Project

organization and also represents the medical staff on

Both the Hospital and School of Medicine at

the governing body of the hospital. Those of us who

Stanford are undertaking major new building

promoted these reforms are very hopeful that they

projects. The aim on the hospital side is to largely

will stimulate increased medical staff engagement

replace the entire facility over the next 10 to 15

in all manner of quality improvement efforts. If that

years (partly because of earthquake issues). There

all sounds a bit boring, I guess you had to be there;

are ambitious fundraising efforts in the works,

it wasn’t. Many thanks to the CMA and SCCMA,

as well as intense demands on current hospital

including our CEO Bill Parrish and former president

revenues to support building bonds. There will

Don Prolo, MD, for their advice and support during

of course be tensions regarding the allocation of

this process.

resources to the building project as opposed to ongoing clinical needs. If you, like so many of our

Electronic Medical Record (EMR)

SCCMA members, have spare millions you’d like to

As I write this, we are less than one week away

contribute to a worthy cause, that’s a 3 a.m. call I’d

from a “Big Bang” implementation (simultaneously

be happy to take!

throughout our entire inpatient environment) of an

MEMBER NEWS & HAPPENINGS new

members, in memoriam

Members Continue to Reduce Overhead Expenses Thanks to Membership SCCMA members renewing their workers’ compensation insurance

(ECIC), rated “A -” by the A.M. Best and Company. SCCMA members

this year don’t have very far to go to see how their membership can

insured through Marsh will receive the new discount on renewal.

help save them money. Not only are rates going down again this year, SCCMA members will enjoy a special member discount not

If you are not insured through the SCCMA-sponsored Workers’

previously available.

Compensation Program, call Marsh for information on how you can access your discount. And depending upon where you have your

The special member discount is only available through Marsh,

group health insurance, you may be entitled to even larger discounts.

SCCMA’s sponsored insurance program administrator. The program

See how, today, by calling Marsh at 800/842-3761.

is underwritten by Employers Compensation Insurance Company

New Members Name Venkat Aachi Mari Asakawa Catherine Berger-Dujmovic Anthony Debs Marketa Dolnik Robert Gordon Gordon Haddow Edward Karpman Divya Laxmikant

Specialty *PMR IM *OBG *AN *PM *CCM *CDS *TS *AN U IM

City Santa Clara Cupertino Santa Clara Santa Clara Santa Clara Santa Clara Santa Clara Mountain View Milpitas

Name Hon Lee Anna Li Lynn Ngo Mario Pompili Mary Rhee Leslie Sullivan Sergio Zendejas

Specialty City *CDS *TS Santa Clara OBG San Jose *IM San Jose *CDS *TS Santa Clara PD Milpitas *GS San Jose AN Santa Clara *Board Certified | US - Unspecified

In Memoriam…

Robert J. Gaspich, MD *Internal Medicine & Allergy 1/9/24 – 4/16/08 SCCMA member since 1957 Allen H. Johnson, MD *General Surgery 1/23/22 – 5/2/08 SCCMA member since 1956 Benjamin E. Kliger, MD Reproductive Endocrinology, Infertility & Gynecology 1/9/31 – 5/1/08 SCCMA member since 1984

Everett B. Viano, MD Family Practice 3/28/31 – 3/31/08 SCCMA member since 1960 Gene T. Yore, MD *General Surgery 12/10/26 – 4/8/08 SCCMA member since 1985

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MAY / JUNE 2008

29

Classified

ADS office space for rent/lease

MEDICAL SUITES • LOS GATOS – SARATOGA

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Two suites, ranging from 1,000 to 1,645 sq.

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Previous use was dental lab. Call Alice Teng for more information: 408/282-3808. www.colliersparrish.com/ateng.

30

the bulletin

MAY / JUNE 2008

ateng.

MEDICAL SUITES • GILROY First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Time-share also available. Call Betty at 408/848-2525.

MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA

OFFICE SPACE FOR SUBLEASE • MTN VIEW Two exam rooms and one doctor’s office, five days a week, shared waiting room, in Mountain View, on South Drive. Call 650/967-7471.

OFFICE FOR RENT • SAN JOSE

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www.colliersparrish.com/josefigueres.

MEDICAL OFFICE SUITE FOR RENT • SAN JOSE Medical office suite for rent at 93 N. 14th St. San Jose 95112. Contact Dr. Sajjadi at 408/294-1825 or 408/867-1111.

OFFICE FOR LEASE • MORGAN HILL Ten minutes from San Jose. 1,100 sq. ft.

EMPLOYMENT OPPORTUNITY MEDICAL PRACTITIONER WANTED

Regional Medical Center of San Jose.

OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer a challenging environment with minimal

Physicians, Physician Assistants, or

stress, without weekend, evening, or “on

Registered Nurses needed for contract

call” coverage. We are currently looking

positions at the San Jose Military Entrance

for several knowledgeable and progressive

Processing Station, 546 Vernon Ave.

primary care and specialty physicians

Mountain View. Medical Practitioners will

(orthopedist and physiatrist) interested

conduct medical qualifications examinations

in joining our team of professionals in

of applicants for all branches of Armed

providing high quality occupational medical

Forces. Must hold a current unrestricted

services to Silicon Valley firms and their

license. Practitioners will be subject to

injured employees. We can provide either

credentials approval by the Headquarters

IM/FP/GP. Primary care practice for sale,

an employment relationship including

U.S. Military Entrance Processing Command

including inventory and equipment. Close to

full benefits or an independent contractor

prior to employment. Excellent opportunity

O’Connor Hospital. If interested, please call

relationship. Please contact Dan R. Azar

for someone looking for a flexible, part-time

Stacy at 408/297-2910.

MD, MPH at 408/790-2907 or e-mail

work schedule from 1-2 days per week to

dazar@allianceoccmed.com for additional

as little as a few hours per month. If you

information.

Next to two primary care offices and Quest Lab. $2,000/month, water/sewer provided.

No net. Call 408/779-7348.

PRIVATE PRACTICE for sale PRIVATE PRACTICE FOR SALE

PRIVATE PRACTICE FOR SALE Established/Active Internal Medicine/ Primary care practice for sale. Work/live in Coastal California. Enjoy best of everything.

If interested, please call 831/345-9696.

are searching for this unique opportunity, contact Ms. Veronica Knight at 650/603-8236

FAMILY PHYSICIAN NEEDED

to become part of our team.

MD or DO wanted. F/P in Santa Clara.

Phone: 408/515-2222; Fax: 408/556-6773.

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MAY / JUNE 2008

31

classified ads, FROM PAGE 27 PEDIATRIC PRACTICE OPPORTUNITY

408/567-0510, or email: rosalyn_chan@wvm.

formulating and maintaining policies

edu.

and procedures, controls, and reporting systems for the effective administration and

Busy Pediatrician in an established

DIRECTOR OF PUBLIC HEALTH

group practice in San Jose is looking

The Santa Clara Valley Health and Hospital

enforcement of applicable Federal, State,

for a partner to practice-share or work

System (SCVHHS), County of Santa Clara,

and County laws, and regulations governing

part-time. Excellent call rotation and

is seeking an innovative, dynamic Director

public health protection and functions;

hospitalist coverage. Great opportunity

of Public Health. The Public Health

developing and recommending the annual

for someone looking for work-life

Department (PH) has a long history of

budget and capital improvement programs,

balance. Email: pedmd@yahoo.com.

leadership and creativity in improving the

and may assist in presenting these to

community’s health.

the Board of Supervisors; representing

The Director of Public Health is an

the County before boards, commissions,

Executive Management position which may

political bodies, and the general

A growing private practice in San Jose seeks

be filled by a physician or non physician.

public; establishing and maintaining

board certified physician to work part-time

Management responsibilities include

cooperative and effective relationships with

(16 hours) per week. Email C.V. to skale.

providing vision and leadership to help the

professionals in the health community,

md@gmail.com.

Department further innovate; planning,

consumer and community groups,

organizing, directing, and evaluating the

administrators, and officials of State and

operations, activities, and programs of the

Federal health and related agencies; and

Public Health Department; establishing

selecting personnel and evaluating their

and maintaining goals, objectives, and

performance in meeting program and

plans for carrying out functions of the

individual goals and objectives.

Department, consistent with over-all County

Candidates should possess considerable

and SCVHHS goals and community needs;

knowledge and managerial or administrative

FAMILY PHYSICIAN NEEDED

COLLEGE HEALTH PHYSICIAN • MISSION COLLEGE, SANTA CLARA Physician needed (part-time, 4-5 hours/1-2 weeks/regular semesters). CA medical/ active DEA license. Immediate opening.

Call 408/855-5141, fax CV/resume to

implementation of services; managing the

THE DIABETES SOCIETY IS THE ANSWER TO EFFECTIVELY MANAGING BLOOD GLUCOSE LEVELS IN YOUR DIABETIC PATIENTS The Diabetes Society is an independent non-profit organization founded in San Jose as a one-stop shop for diabetes education and support in the communities you serve!

Services Offered: • ADA certified 3-step diabetes self-management program • Nutrition education and counseling • Free meters and instruction • Group classes (English and Spanish) • Support Groups (English and Spanish) • Insulin start appointments and pump training • Weight loss consultation and carb counting • Children’s diabetes camps throughout California Easy referral process with a variety of fee options including most insurance plans, Medicare and local IPA’s

> If you never thought about us for your patients, now is the time < For more information or brochures: 1165 Lincoln Avenue, Suite 300, San Jose, CA 95125 (408) 287-3785 Fax: (408) 287-2701 Email: info@thediabetessociety.org

32

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MAY / JUNE 2008

PHYSICIAN VOLUNTEERS NEEDED San Jose Rotacare Adult Free Clinic needs physician volunteers.

Time: Wednesday nights from 6-9 p.m.

Where: Washington Elementary School ((in the clinic building on Edwards between Almaden and First, a residential neighborhood about a mile from the Fairmont).

Patient mix: uninsured, many workers, many diabetics, many Hispanics. Small free medicine dispensary.

condo rentals CONDO RENTAL • ON THE BEACH AT MONTEREY BAY Vacation respite at Pajaro Dunes on Monterey Bay, smack dab on the beach, with full ocean view from 2nd level.

Shorebirds section, one bedroom, fireplace, fully equipped, tennis courts on the property, $250 per night, two-night minimum. Contact Robert Weinmann or Marie Barry at 408/292-0802.

Need: Gyn, General Medicine.

FOR SALE

Malpractice insurance and evening snack provided. Can you help out once a month?

Email: henrylew9@aol.com. Message phone: 408/715-3088.

This Free Clinic has been open since 1991, but physician turnover prompts

MEDICAL OFFICE EQUIPMENT Retiring. Office and medical equipment for sale, available now. Call 408/374-9900 for information.

this plea. experience, which demonstrates possession and application of the knowledge and abilities. Candidates must have a degree from an accredited college or university with major work in public health, public administration, human services, or a closely related field. Possession of a master’s degree may substitute for one year of the required experience.

Please visit www.sccjobs.org for more information. Questions: 408/299-5897.

MISCELLANEOUS PEAK MEDICAL BILLING LLC Professional medical billing for improved cash flow and faster, unauthorized reimbursement. Ask about our low fees and ongoing promotions. Call us today 925/321-0632 or email aknierieme@

A+ TRANSCRIPTION SERVICE Providing Clinicians Quality Medical Transcription Since 1995 � Dictation Using 800 Phone System or Your Hand-Held Recorder � 24-Hr. TAT - STAT 2-Hrs. � HIPAA Compliant Testimonials “ A+ Transcription makes us feel like we are their only client. Great work in terms of accuracy and rapid turnaround time.”

Wendy Perston, Administrator – Cardiovascular Institute of Southern Oregon “A+ Transcription has provided my Physiatry and Pain Medicine practice with prompt, accurate transcription for many years. I strongly recommend this service to any clinician.” Mark J. Sontag, M.D.

peakmedicalbillingllc.com.

AMBULATORY SURGERY CENTER FACILITY IS LOOKING FOR ASSOCIATES Jeunederm Surgery Center is a two OR fully staffed facility located at downtown Mountain View, ready to be shared for immediate surgical and procedural needs

“Transition was seamless, prompt, accurate and very easy to work with. All my doctors are completely satisfied with A+ Transcription Service!” Ilona Garton, Administrator – Altos Oaks Medical Group

of your practice. Facility is best suited for endoscopic procedures & minor

Pajaro Dunes Beachfront Condo Shorebirds #58 2 Bedroom -- 2 Bath Top Level -- Great Ocean View Great for Families Owners Bill & Debbi Ricks 408-354-5613

Rental Agent Pajaro Dunes Company 1-800-564-1771

surgeries. Currently is being utilized as a Cosmetic Surgery Center. Flexible scheduling and privileging is available to meet your needs.

Please contact 650/967-7007 for

“A+ Transcription Service has good turnaround time. Their team is accurate in transcribing what we dictate and most importantly, A+ is reliable!”Anthony DuBose, M.D. – Director, Workforce Medical Center A+ Transcription Service 888 589-8283 e-mail: apluspat@aol.com

further details.

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MAY / JUNE 2008

33

TRACY ZWEIG ASSOCIATES, INC. Physicians Physician Assistants Nurse Practitioners LOCUM TENENS PERMANENT PLACEMENT

VOICE: (800) 919-9141 or (805) 641-9141 FAX: (805) 641-9143 E-Mail: tzweig@tracyzweig.com Website: www.tracyzweig.com

Thinking about electronic medical records?

What about your paper records?

If you are planning going to do with all those records into records to a CD alternative:

to move to an electronic medical record system, what are you your paper patient charts and billing files? Consider scanning a digital database with deliverExchange™. Let us scan your or DVD, and realize the benefits of this cost-effective

Safe secure storage that you control • Records are accessible 24/7 Files can be printed out or electronically transmitted • Save time spent filing and retrieving records • Eliminate lost or misfiled records • Save space and storage costs • Keep a copy for backup, security •

•

We pick up your records, scan them at our imaging unit in San Jose, produce quality images on CDs or DVDs, and handle the destruction of the paper records.

2054 Zanker Road San Jose, CA 95131 Contact: Liz Allan phone 408.436.1701 ext.131 fax 408.436.1625

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the bulletin

MAY / JUNE 2008

You may not know our name, but if you practice in Santa Clara county you know our service. For over 30 years, SOURCECORP Deliverex has been the vendor of choice for record management in the Bay Area.

California pacific Medical Center’s vascular institute

Most physicians treat patients with everyday vascular issues. But more intricate vascular problems may be harder to handle.

Do you have patients: n

With debilitating short distance claudication or other sequelae of lower extremity arterial insufficiency?

n

With thoracic aortic pathologies (aneurysm, dissection, penetrating ulcers)?

n With a DVT who you feel may benefit from vascular consultation for thrombolysis? n

Who are female and complain of pelvic pain, urinary frequency or heavy bleeding with periods?

n

In liver failure and awaiting a transplant?

n

With renovascular hypertension or mesenteric ischemia?

n

With swelling of an extremity or signs of arterial emboli?

California Pacific Medical Center’s Vascular Institute offers a wide variety of leading-edge services provided by a unique, multi-disciplinary team of Vascular Surgeons, Radiologists and Cardiologists treating the complex biology of vascular pathologies. Physicians merge and improve skill sets while patients and families benefit from the efficient evaluation and completeness of our integrated approach. From risk factor modification to the latest in minimally invasive procedures, patients greatly benefit from the collegial relationships of the specialists in the Vascular Institute. Our experienced team currently performs over 5500 various procedures per year. And our team’s experience includes performing over 350 AAA repairs.

For more information, to find a specialist or schedule a patient transfer, please call 888-637-2762.

Pictured, members of the Vascular Institute Team (from left to right): Anna Michael, R.N., Nurse Coordinator; Myron Marx, M.D., Interventional Radiologist; Jon P. Wack, M.D., Interventional Radiologist; Daniel Nathanson, M.D., Vascular Surgeon/Interventional Radiologist; Edward L. Baker, M.D., Interventional Radiologist; Bruce N. Brent, M.D., Interventional Cardiologist; John Rhee, M.D., Interventional Radiologist; John B. Long, M.D., Vascular Surgeon

www.cpmc.org

partnership

whatdrivesyou?

A commitment to excellence.

A passion for the art of medicine.

A basic desire to heal.

Whatever it is that sustains you through the daily challenges of your profession, know that you have an ally in NORCAL.

(800) 652-1051 l www.norcalmutual.com

NORCAL is proud to be endorsed by the Santa Clara County Medical Association as the preferred professional liability insurer for its members.

THE

BULLETIN

A PUBLICATION OF THE SANTA CLARA COUNTY MEDICAL ASSOCIATION

700 Empey Way, San Jose, CA 95128-4705

Address service requested

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