California Family Physician (Fall 2013)

California

FAMILY PHYSICIAN VOL . 64 NO.4 Fall 2013

CAFP TACKLES COVERED CALIFORNIA

17

JACK CHOU ELECTED TO AAFP BOARD OF DIRECTORS

18

4 -&(*4-"5*7& 5)&.&4 "$"

IMPLEMENTATION AND SCOPE, SCOPE, SCOPE 19 130$&%63"- 53"*/*/( */ '".*-: .&%*$*/& RESIDENCY 20

Jack Chou, MD, New AAFP Director

CALIFORNIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION 1520 PACIFIC AVE SAN FRANCISCO, CA 94109 -2627

Little Rock, AR Permit No. 2437

U.S. POSTAGE PAID Presorted Standard

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A N O R C A L G R O U P C O M PA N Y

N O R C A L M U T U A L .C O M

California Family Physician Fall 2013

REGISTER BY 12/1: SAVE UP TO $70 SKIN DISEASE DISEAS EDUCATION FOUNDATION’s NDATION’s

38th Annual

Earn Up to o 37.5 CME E Credits

February F ebr 16-21, 2014 014 4 HILTON WAIKOLOA HOTEL HIL THE BIG ISLAND, HI APPROVED FOR AMA CATEGORY 1 CREDITS™ AND NURSING AMA PRA CAT NG CREDITS AAFP CREDITS PENDING CONFERENCE CHAIRS:

MEDICAL DERMATOLOGY Joseph F. Fowler, Jr, MD, University of Louisville

AESTHETIC AND PROCEDURAL DERMATOLOGY Christopher B. Zachary, FRCP, University of California, Irvine SESSION CHAIRS:

AESTHETIC MEDICINE Michael S. Kaminer, MD, Yale Medical School

PEDIATRIC DERMATOLOGY Lawrence F. Eichenfield, MD, University of San Diego

PSORIASIS Craig L. Leonardi, MD, Saint Louis University Medical School Linda F. Stein Gold, MD, Henry Ford Hospital

MELANOMA/CUTANEOUS ONCOLOGY Allan C. Halpern, MD, Memorial Sloan-Kettering Cancer Center

Self-Assessment Program Approved by the ABD

MOC-D Erik J. Stratman, MD, University of Wisconsin – Marshfield

WWW.GLOBALACADEMYCME.COM/SDEF

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in affiliation with

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California Family Physician Fall 2013 3

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California FAMILY PHYSICIAN Q Quarterly publication of the California Academy o of Family Physicians

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Student, Resident and Social Media Manager

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4

California Family Physician Fall 2013

P R O C E D U R E TA L K 18 Jack Chou Elected to AAFP Board!

19 2013’s Legislative Themes: ACA Implementation and Scope, Scope, Scope

Adam Francis

25 Procedural Training in Family Medicine Residency 26 Hungry for Procedures?

27 Reproductive Health Training in Residency

Peter Broderick, MD, MMEd Tipu V. Khan, MD

ȱȱ

Nathan Hitzeman, MD

28 Highlighting Dermoscopy: Early Melanoma Diagnosis Saves Lives

Michael Van Buskirk MD

ȱLauren M. Simon, MD, MPH

29 Performing Procedures Provides Whole Person Care

6

Editorial

Future of Procedures in Family Medicine Needs All Hands on Deck

8

Presidents Message

Family Medicine and Trivial Pursuit: What Is the Link?

9

Student News

Students Are Building Bridges in California

Michelle Quiogue, MD Mark Dressner, MD

Matthew Varallo and Lauran Doan

10 Foundation News

2013 FM Summit

12 PCMH Corner

Petaluma Health Center’s Journey to PCMH

15 Political Pulse

California Legislature Is Running Out of Time

30 Executive Vice President’s Forum

CAFP Can Help You Help Your Patients Get Health Coverage

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Kelly Pfeifer, MD and Kathie Powell, CEO Ashby Wolfe, MD, MPP, MPH

ȱȱȱȱȱȱȱȱȱ

Susan Hogeland, CAE

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For the upcoming CME calendar go to www.familydocs.org California Family Physician Fall 2013 5

EDITORIAL

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In training and long into their careers, family physicians ;&WƐͿ ĚŝƐƟŶŐƵŝƐŚ ƚŚĞŵƐĞůǀĞƐ ĨƌŽŵ ŽƚŚĞƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐƉĞĐŝĂůƟĞƐ ďLJ ƚŚĞŝƌ ƉƌŽĐůŝǀŝƟĞƐ ĨŽƌ ƉƌŽĐĞĚƵƌĞƐ͘ /Ŷ ϮϬϭϮ͕ ƚŚĞ &W ƌĞƉŽƌƚĞĚ ƚŚĂƚ͕ ĂĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ ϮϬϭϭ WƌĂĐƟĐĞ WƌŽĮůĞ ƐƵƌǀĞLJ͕ ƚŚĞ ŵĂũŽƌŝƚLJ ŽĨ &WƐ ƉĞƌĨŽƌŵ ƐŬŝŶ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ŝŶũĞĐƟŽŶƐ ŝŶ ƚŚĞ ŽĸĐĞ͘ ůŵŽƐƚ Ă ƚŚŝƌĚ ƉĞƌĨŽƌŵ ĐŽůƉŽƐĐŽƉLJ Žƌ ĐŝƌĐƵŵĐŝƐŝŽŶƐ ŝŶ ƚŚĞ ŽĸĐĞ͖ ĂŶĚ ŽĨ ƚŚŽƐĞ ƚŚĂƚ ĚŽ ŶŽƚ͕ ƚŚĞ ƌĞĂƐŽŶƐ ĐŝƚĞĚ ǁĞƌĞ ůĂĐŬ ŽĨ ĚĞƐŝƌĞ͕ ŶŽƚ ůĂĐŬ ŽĨ ƚƌĂŝŶŝŶŐ͘ DŽƌĞ ƚŚĂŶ ŚĂůĨ ƌĞƉŽƌƚĞĚ ŵĂŝŶƚĂŝŶŝŶŐ ƉƌŝǀŝůĞŐĞƐ ƚŽ ƉƌŽǀŝĚĞ ƉĞĚŝĂƚƌŝĐ ĂŶĚ ŶĞǁďŽƌŶ ĐĂƌĞ͘ ďŽƵƚ Ă ƚŚŝƌĚ ƐƉĞŶĚ Ă ƉŽƌƟŽŶ ŽĨ ƚŚĞŝƌ ǁŽƌŬ ŝŶ / h͕ h ĂŶĚͬŽƌ Z ƐĞƫŶŐƐ͘ EĞĂƌůLJ ŽŶĞͲƐŝdžƚŚ ŽĨ &WƐ ƉƌĂĐƟĐĞ ŽďƐƚĞƚƌŝĐƐ͕ ǁŝƚŚ ŶĞĂƌůLJ Ă ƋƵĂƌƚĞƌ ŽĨ ŶĞǁ ƉŚLJƐŝĐŝĂŶƐ ;ĨĞǁĞƌ ƚŚĂŶ ƐĞǀĞŶ LJĞĂƌƐ ŽƵƚ ŽĨ ƌĞƐŝĚĞŶĐLJͿ ƌĞƉŽƌƟŶŐ ŽďƐƚĞƚƌŝĐƐ ŝŶ ƚŚĞŝƌ ƉƌĂĐƟĐĞ͘ /Ŷ ƐŚŽƌƚ͕ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚĂŝůŽƌ ƚŚĞŝƌ ĐĂƌĞĞƌƐ ƚŽ ŵĞĞƚ ƚŚĞŝƌ ƉĞƌƐŽŶĂů ŝŶƚĞƌĞƐƚƐ ĂŶĚ ƐŬŝůůƐ͘ /Ŷ ĨĂĐƚ͕ ƚŚĞ ĚŝǀĞƌƐŝƚLJ ŽĨ ǁŚĂƚ ŝƚ ŵĞĂŶƐ ƚŽ ďĞ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ŝƐ ǁŚĂƚ ĚƌĂǁƐ ŵĂŶLJ ƚŽ ƚŚĞ ƐƉĞĐŝĂůƚLJ͘ DĂŶLJ ŶĞǁ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ƚĞĐŚŶŝƋƵĞƐ ĂƌĞ ďĞŝŶŐ ĚĞǀĞůŽƉĞĚ ƚŽ ĂŝĚ ŝŶ ƚŚĞ ĐĂƌĞ ŽĨ ƉĂƟĞŶƚƐ͕ ĂŶĚ ŵĂŶLJ ŽĨ ƚŚĞƐĞ ƉƌŽĐĞĚƵƌĞƐͬƚĞĐŚŶŝƋƵĞƐ ĂƌĞ ƉĞƌƟŶĞŶƚ ƚŽ ƚŚĞ ƉƌĂĐƟĐĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ dŚĞ &W ƐƚƌŽŶŐůLJ ďĞůŝĞǀĞƐ ƚŚĂƚ ƚŚĞ ŐƌĂŶƟŶŐ ŽĨ ƉƌŝǀŝůĞŐĞƐ ĨŽƌ ŶĞǁ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ƚĞĐŚŶŝƋƵĞƐ ĨŽƌ Ăůů ƉŚLJƐŝĐŝĂŶƐ ƐŚŽƵůĚ ďĞ ŵĂĚĞ ŽŶ ƚŚĞ ďĂƐŝƐ ŽĨ ĞĂĐŚ ƉŚLJƐŝĐŝĂŶ͛Ɛ ĚŽĐƵŵĞŶƚĞĚ ƚƌĂŝŶŝŶŐ ĂŶĚͬŽƌ ĞdžƉĞƌŝĞŶĐĞ͕ ĚĞŵŽŶƐƚƌĂƚĞĚ ĂďŝůŝƟĞƐ ĂŶĚ ĐƵƌƌĞŶƚ ĐŽŵƉĞƚĞŶĐĞ͘ dŚĞ &W ĨƵƌƚŚĞƌ ďĞůŝĞǀĞƐ ƚŚĂƚ ĐŽƵƌƐĞƐ ƚŽ ƚĞĂĐŚ ŶĞǁ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ƚĞĐŚŶŝƋƵĞƐ ƐŚŽƵůĚ ďĞ ĂǀĂŝůĂďůĞ ƚŽ Ăůů ƉŚLJƐŝĐŝĂŶƐ͕ ƌĞŐĂƌĚůĞƐƐ ŽĨ ƐƉĞĐŝĂůƚLJ͘ ^ŝŶĐĞ ŵĂŶLJ ŽĨ ƚŚĞ ŶĞǁ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ƚĞĐŚŶŝƋƵĞƐ ĂƌĞ ǀĞƌLJ ŝŵƉŽƌƚĂŶƚ ƚŽ ƚŚĞ ƉƌĂĐƟĐĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ƚŚĞ &W ǁŝůů ǁŽƌŬ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ ƐƵĐŚ ĐŽƵƌƐĞƐ ǁŝůů ďĞ ŵĂĚĞ ĂǀĂŝůĂďůĞ ƚŽ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ /ŶĐůƵĚŝŶŐ Ă ďƌŽĂĚ ƐƉĞĐƚƌƵŵ ŽĨ ƉƌŽĐĞĚƵƌĞƐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚƌĂŝŶŝŶŐ ŚĂƐ ďĞĞŶ ƐŚŽǁŶ ƚŽ ŝŶĐƌĞĂƐĞ ĞĂƌŶŝŶŐ ƉŽƚĞŶƟĂů ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐŝĞƐ͘ KƚŚĞƌ ƐƚƵĚŝĞƐ ŚĂǀĞ ƐŚŽǁŶ ƚŚĂƚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ƉĞƌĨŽƌŵ ŵŽƌĞ

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California Family Physician Fall 2013

ƉƌŽĐĞĚƵƌĞƐ ŚĂǀĞ ŚŝŐŚĞƌ ũŽď ƐĂƟƐĨĂĐƟŽŶ ĂŶĚ ďĞƩĞƌ ĮŶĂŶĐŝĂů ĐŽŵƉĞŶƐĂƟŽŶ͘ KŶĞ ƐƚƵĚLJ ŶŽƚĞĚ ƚŚĂƚ ƌĞƐŝĚĞŶĐŝĞƐ ǁŚĞƌĞ Ă ĨƵůů ĐŽŵƉŽŶĞŶƚ ŽĨ ƉƌŽĐĞĚƵƌĞƐ ǁĂƐ ƚĂƵŐŚƚ ďLJ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŚĂĚ ŚŝŐŚĞƌ Įůů ƌĂƚĞƐ ŝŶ ƚŚĞ DĂƚĐŚ͘ dŚŝƐ LJĞĂƌ͕ ŝŶ ĨĂĐƚ͕ ŵĂƌŬĞĚ ƚŚĞ ĮŌŚ ĐŽŶƐĞĐƵƟǀĞ LJĞĂƌ ƚŚĂƚ ƚŚĞ ŶƵŵďĞƌ ŽĨ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĐŚŽŽƐŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶĐƌĞĂƐĞĚ͘ ƵƌƌĞŶƚ ĂŶĂůLJƐƚƐ ĞdžƉĞĐƚ ƚŚĞ ĚĞŵĂŶĚ ĂŶĚ ĞŶƐƵŝŶŐ ĐŽŵƉĞƟƟŽŶ ĨŽƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ďĞĐŽŵĞ ĞǀĞŶ ŐƌĞĂƚĞƌ ĂƐ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƌĞĨŽƌŵ ůĂǁ ĞdžƚĞŶĚƐ ĐŽǀĞƌĂŐĞ ƚŽ ŵŝůůŝŽŶƐ ŵŽƌĞ ƉĞŽƉůĞ ĚƵƌŝŶŐ ƚŚĞ ŶĞdžƚ ĨĞǁ LJĞĂƌƐ͘ ^Ž ƉƵƚ LJŽƵƌ ŐůŽǀĞƐ ŽŶ͖ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ƉƌŽĐĞĚƵƌĞƐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŶĞĞĚƐ Ăůů ŚĂŶĚƐ ŽŶ ĚĞĐŬ͘ W^͗ / ŚĂĚ ƚŚĞ ƉƌŝǀŝůĞŐĞ ƚŽ ŵĞĞƚ ƐŽŵĞ ŽĨ ƚŚĞ ĨƵƚƵƌĞ ĨĂĐĞƐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ Ăƚ ƚŚĞ &W &ĂŵŝůLJ DĞĚŝĐŝŶĞ ^Ƶŵŵŝƚ ŚĞůĚ ^ĞƉƚĞŵďĞƌ ϳ͕ ϮϬϭϯ ŝŶ >ŽƐ ŶŐĞůĞƐ͘ dŚŝƐ ŐĞŶĞƌĂƟŽŶ ŽĨ ĞdžƉĞƌŝĞŶĐĞĚ ĂĚǀŽĐĂƚĞƐ ďƌŝŶŐƐ ĚŝǀĞƌƐĞ ĞĚƵĐĂƟŽŶĂů ďĂĐŬŐƌŽƵŶĚƐ͕ ƚĂůĞŶƚƐ ĂŶĚ ŝŶƚĞƌĞƐƚƐ͘ DLJ ƐĞŶƐĞ ǁĂƐ ƚŚĂƚ ƚŚĞƐĞ LJŽƵŶŐĞƌ ƉŚLJƐŝĐŝĂŶƐ ĐŚŽŽƐŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶ ƚŚĞ ĐƵƌƌĞŶƚ ĞŶǀŝƌŽŶŵĞŶƚ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞƌĞ ǁŝůů ďĞ ĐŚĂůůĞŶŐĞƐ ʹŝŶ ĨĂĐƚ͕ ƚŚĞLJ ĞdžƉĞĐƚ ƚŽ ďĞ ƉĂƌƚ ŽĨ ƚŚĞ ƐŽůƵƟŽŶ͘ ZĞĨĞƌĞŶĐĞƐ ŚƩƉ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂďŽƵƚͬƚŚĞͲĂĂĨƉͬĨĂŵŝůLJͲŵĞĚŝĐŝŶĞͲĨĂĐƚƐͬƚĂďůĞͲϭϮ͘Śƚŵů ŚƩƉ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂďŽƵƚͬƚŚĞͲĂĂĨƉͬĨĂŵŝůLJͲŵĞĚŝĐŝŶĞͲĨĂĐƚƐͬƚĂďůĞͲϭϳ͘Śƚŵů ZŽĚŶĞLJ tD͕ ,ĂŚŶ Z ͘ /ŵƉĂĐƚ ŽĨ ƚŚĞ ůŝŵŝƚĞĚ ŐĞŶĞƌĂůŝƐƚ ;ŶŽ ŚŽƐƉŝƚĂů͕ ŶŽ ƉƌŽĐĞĚƵƌĞƐͿ ŵŽĚĞů ŽŶ ƚŚĞ ǀŝĂďŝůŝƚLJ ŽĨ ĨĂŵŝůLJ ƉƌĂĐƟĐĞ ƚƌĂŝŶŝŶŐ͘ : ŵ ŽĂƌĚ &Ăŵ WƌĂĐƚ ϮϬϬϮ͖ϭϱ͗ϭϵϭͲϮϬϬ͘ >ĂƌŝŵŽƌĞ t>͕ ^ĂƉŽůƐŬLJ ^͘ DĂƚĞƌŶŝƚLJ ĐĂƌĞ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͗ ĞĐŽŶŽŵŝĐƐ ĂŶĚ ŵĂůƉƌĂĐƟĐĞ͘ : &Ăŵ WƌĂĐƚ ϭϵϵϱ͖ϰϬ͗ϭϱϯͲϲϬ͘ DĂƌƚnj t ͘ ,Žǁ ƚŽ Ɛƚ LJŽƵƌ ďŽƩŽŵ ůŝŶĞ ǁŝƚŚ ĂŶ ŽĸĐĞ ƉƌŽĐĞĚƵƌĞ͘ &Ăŵ WƌĂĐƚ DĂŶĂŐ ϮϬϬϯ͖ϭϬ͗ϯϴͲϰϬ͘ ,ĂƌƉĞƌ D ͕ DĂLJĞĂƵdž :͕ WŽƉĞ : ͕ 'ŽĞů Z͘ WƌŽĐĞĚƵƌĂů ƚƌĂŝŶŝŶŐ ŝŶ ĨĂŵŝůLJ ƉƌĂĐƟĐĞ ƌĞƐŝĚĞŶĐŝĞƐ͗ ĐƵƌƌĞŶƚ ƐƚĂƚƵƐ ĂŶĚ ŝŵƉĂĐƚ ŽŶ ƌĞƐŝĚĞŶƚ ƌĞĐƌƵŝƚŵĞŶƚ͘ : ŵ ŽĂƌĚ &Ăŵ WƌĂĐƚ ϭϵϵϱ͖ϴ͗ϭϴϵͲϵϰ͘

Nearly 100 years ago, Nobel Prize-winning scientist August Krogh and his wife Marie embarked on a journey to revolutionize diabetes care, driven by her needs as a diabetes patient. Today, Novo Nordisk still takes a deeply human approach to everything we do. As a world leader in diabetes care, we are in a position of great responsibility. We must continue to combine drug discovery and technology to turn science into treatment. We must prioritize research, education, and partnership around the world to make diabetes a global priority. We must conduct our business responsibly in every way. And most importantly, we can never lose sight of the patientcentric approach that has driven our vision of innovation since our inception.

Together, we can defeat diabetes in our lifetime.

For more about us, visit novonordisk-us.com

Š2011 Novo Nordisk 141928 June 2011

California Family Physician Fall 2013 7

PRESIDENT’S MESSAGE

ȱ ǰȱ

¢ȱ ȱ ȱ ȱ DZȱȱ ȱ ȱ ȱ ǵ My Sports/Game stories continue this issue with the linking ƉĂƟĞŶƚƐ ƚŚĂŶ ǁŚĂƚ ǁĞ ĚŽ ŝŶ ƚŚĞ ĞdžĂŵ ƌŽŽŵ͘ / ŐĞƚ ƚŽ ŵĞĞƚ ƌĞŐƵůĂƌůLJ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ƚŚĞ ŽŶĐĞ ǀĞƌLJ ƉŽƉƵůĂƌ ŐĂŵĞ ͞dƌŝǀŝĂů ǁŝƚŚ ĂŵĂnjŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŚƌŽƵŐŚŽƵƚ ƚŚĞ ƐƚĂƚĞ ǁŚŽ ůĞĂǀĞ ŵĞ ŝŶ Pursuit.” /ƚ͛Ɛ ƚƌƵĞ ͙ / ǁŽŶ ƚŚĞ ǀĞƌLJ ĮƌƐƚ ƟŵĞ / ƉůĂLJĞĚ dƌŝǀŝĂů ĂǁĞ ĂƐ ǁĞ ǁŽƌŬ ƚŽ ďĞƩĞƌ ŽƵƌ ƐƉĞĐŝĂůƚLJ ĂŶĚ ĐĂƌĞ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ͘ KŚ͕ WƵƌƐƵŝƚ͊ ;/ ŵĞĂŶ ƌĞĂůůLJ͕ ǁŚŽ ĚŽĞƐ ŶŽƚ ŬŶŽǁ ǁŚĂƚ ǁĂƌ ŝŶǀŽůǀĞĚ ƚŚĞ ĂŶĚ ǁŽƌŬ ǁŝƚŚ &W ƐƚĂī ŝƐŶ͛ƚ ƚŽŽ ƐŚĂďďLJ ĞŝƚŚĞƌ͘ dŚŝƐ ǁŽƌŬ ĂůǁĂLJƐ dĂƌůĞƚŽŶ ƚǁŝŶƐ͍Ϳ DLJ ĨĞůůŽǁ ŵĞĚ ƐĐŚŽŽů ĐůĂƐƐŵĂƚĞƐ ŶĞǀĞƌ ƉůĂLJĞĚ ǁŝƚŚ ŝŶǀŝŐŽƌĂƚĞƐ ŵĞ ĂƐ / ĐŽŵĞ ďĂĐŬ ƚŽ ƐĞĞ ŵLJ ƉĂƟĞŶƚƐ͘ ŵĞ ĂŐĂŝŶ͘ ůů / ĐĂŶ ƐĂLJ ǁĂƐ ƚŚĂŶŬ ŐŽŽĚŶĞƐƐ ƚŚĞ ͞ƐƉŽƌƚƐ ĂŶĚ ůĞŝƐƵƌĞ͟ Category Four: WƌŽĐĞĚƵƌĞƐ ʹ Ɛ ƋƵĞƐƟŽŶ / ŐŽƚ ǁĂƐ ĂďŽƵƚ ďŽĂƌĚ ƚŚŝƐ ŝƐƐƵĞ ŚŝŐŚůŝŐŚƚƐ͕ ŝŶƚĞŐƌĂƟŶŐ ŐĂŵĞƐ ĂŶĚ ŶŽƚ ƌĞĂů ƐƉŽƌƚƐ͘ / ĚŝŐƌĞƐƐ͕ ƉƌŽĐĞĚƵƌĞƐ ŝŶƚŽ ƉƌĂĐƟĐĞ ĐĂŶ ƐŽ ŽŶ ƚŽ ƚŚŝƐ ŝƐƐƵĞ͛Ɛ ĐŽůƵŵŶ͖ ŚŽǁ ŝƐ ĐĞƌƚĂŝŶůLJ ďƌĞĂŬ ĚĂŝůLJ ƌŽƵƟŶĞ͕ ŽīĞƌ ¢ȱ ȱ ȱ ȱ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ůŝŬĞ dƌŝǀŝĂů WƵƌƐƵŝƚƐ͍ Ă ĨƵŶ ďƌĞĂŬ ĂŶĚ ƐĞƌǀŝĐĞ ƚŽ ƉĂƟĞŶƚƐ dŚŝŶŬ ĂďŽƵƚ ƚŚĞ ĐĂƚĞŐŽƌŝĞƐ ͙ ĂŶĚ͕ ŚŽƉĞĨƵůůLJ͕ ĂĚĚ ƌĞǀĞŶƵĞ͘ ƵƌŝŶŐ ¢ȱ ȱ ȱ ȱ ŵLJ ĮƌƐƚ ƚŚƌĞĞ LJĞĂƌƐ ŝŶ ƉƌĂĐƟĐĞ͕ &ĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŚĂƐ ƐŽ ŵĂŶLJ ȃ ȱ Ȅȱ ȱ ¡ ǯȱȱ / ƌĞͲƚƌĂŝŶĞĚ ƚŽ ĚŽ ŇĞdž ƐŝŐƐ ĂŶĚ ĚŝīĞƌĞŶƚ ĂǀĞŶƵĞƐ Žƌ ͞ŐĂŵĞ ƚƌĞĂĚŵŝůůƐ͘ / ĚŝĚ ŇĞdž ƐŝŐƐ ŽŶĞ ŚĂůĨͲ ȱ ȱ ȱ ȱ ĐĂƚĞŐŽƌŝĞƐ͟ ƚŽ ĞdžƉůŽƌĞ͘ dŚŝƐ ŝƐƐƵĞ ŽĨ ĚĂLJ ĞĂĐŚ ǁĞĞŬ ĂŶĚ ŽŶĞͲŚĂůĨ ĚĂLJ ŽĨ ĂůŝĨŽƌŶŝĂ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ ĚŝƐĐƵƐƐĞƐ ƚƌĞĂĚŵŝůůƐ ĨŽƌ ĂŶLJ ĚŽĐƐ ŝŶ ƚŚĞ ƐƚĂī ¢ȱ ¢ ȱ ȱ ŝŶĐŽƌƉŽƌĂƟŶŐ ƉƌŽĐĞĚƵƌĞƐ ŝŶƚŽ ŵŽĚĞů ,DK͕ ǁŚĞƌĞ / ƚŚĞŶ ǁŽƌŬĞĚ͘ ȱ ȱ ƉƌĂĐƟĐĞ͕ Ă ŚŝŐŚůŝŐŚƚ ŽĨ ƉƌĂĐƟĐŝŶŐ / ůŽǀĞĚ ƚŚĞ ǀĂƌŝĞƚLJ ƚŚĂƚ ƉƌŽĐĞĚƵƌĞƐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ ^Ž͕ ǁŚĂƚ ŚĂǀĞ / ĂĚĚĞĚ ƚŽ ƚŚĞ ŵŝdž ŽĨ ŵLJ ĚĂLJƐ͘ ȱ ǰȱ ȱ ȱ ȱ ĚŽŶĞ ĂŶĚ͕ ĞƋƵĂůůLJ ŝŵƉŽƌƚĂŶƚ͕ ǁŚĂƚ ĐĂŶ LJŽƵ ĚŽ͍ ĂƚĞŐŽƌLJ &ŝǀĞ͗ dĞĂĐŚŝŶŐ ʹ /Ĩ LJŽƵ ȱ ¢ȱ ǯȱȱ ĐĂŶ ƐǁŝŶŐ ŝƚ͕ ǀŽůƵŶƚĞĞƌ Ă ŚĂůĨͲ ǰȱ ȱ ȱ ȱ ȱ ǰȱ Category One: 'ƌŽƵƉ sŝƐŝƚƐ ʹ &Žƌ ĚĂLJ Ă ǁĞĞŬ Žƌ ĞǀĞƌLJ ŽƚŚĞƌ ǁĞĞŬ ƚŚƌĞĞ LJĞĂƌƐ / ƌĂŶ ŵŽŶƚŚůLJ ĚŝĂďĞƚĞƐ ƚŽ ƉƌĞĐĞƉƚ Ăƚ Ă ůŽĐĂů ƌĞƐŝĚĞŶĐLJ ¢ȱ ǰȱ ȱ ȱ ŐƌŽƵƉ ǀŝƐŝƚƐ͘ tŝƚŚ ƚŚĞ ŚĞůƉ ŽĨ ƉƌŽŐƌĂŵ͘ /ƚ͛ůů ŵĂŬĞ LJŽƵ Ă ŵƵĐŚ ¢ ȱ ǵ ĐŽůůĞĂŐƵĞƐ ĂŶĚ͕ ŵŽƐƚ ŽĨ Ăůů͕ ŵLJ ďĞƩĞƌ ĚŽĐƚŽƌ ĂƐ LJŽƵ ƚƌLJ ƚŽ ƐƚĂLJ ƉĂƟĞŶƚƐ / ůĞĂƌŶĞĚ ƐŽ ŵƵĐŚ ĂŶĚ ĂŚĞĂĚ ŽĨ ƚŚĞ ƌĞƐŝĚĞŶƚƐ͘ ƉƌŽǀŝĚĞĚ ŵƵĐŚ ďĞƩĞƌ ĐĂƌĞ͘ dǁĞůǀĞ ŽĨ ŵLJ ƉĂƟĞŶƚƐ͕ ǀĂƌŝŽƵƐ ŽƚŚĞƌƐ ĂŶĚ / Category Six: :ŽŝŶ Ă ŽŵŵŝƩĞĞ ƐƉĞŶƚ Ă ǀĂůƵĂďůĞ ĂŶĚ ĨƵŶ ƚǁŽ ŚŽƵƌƐ ʹ >ĞĂƌŶŝŶŐ ŚŽǁ ĚĞĐŝƐŝŽŶƐ ĂƌĞ ŵĂĚĞ ƚŽŐĞƚŚĞƌ͘ /ƚ ǁĂƐ ŽŌĞŶ ƚŚĞ ŚŝŐŚůŝŐŚƚ ŽĨ ĂŶĚ ďĞŝŶŐ ƉĂƌƚ ŽĨ ƚŚĞ ƉƌŽĐĞƐƐ ŽŶ ƚŚŽƐĞ ǁĞĞŬƐ͘ WĂƟĞŶƚƐ ĞŶũŽLJĞĚ ƚŚĞŝƌ ĚŽĐƚŽƌ ǀŝƐŝƚƐ ŵŽƌĞ͘ DLJ ƉĂƟĞŶƚƐ͛ ƚŚĞ ƉŚĂƌŵĂĐLJ ĂŶĚ ƚŚĞƌĂƉĞƵƟĐƐ ĐŽŵŵŝƩĞĞ͕ ƚŚĞ ƵƟůŝnjĂƟŽŶ ƌĞǀŝĞǁ ŚĞŵŽŐůŽďŝŶ ϭ Ɛ ǁĞƌĞ ŶĞǀĞƌ ďĞƩĞƌ ĂŶĚ / ŶĞǀĞƌ ŚĂĚ Ă ďŝŐŐĞƌ ĨĂŶ ĐůƵď͘ ĐŽŵŵŝƩĞĞ ĂŶĚ ĞƐƉĞĐŝĂůůLJ ƚŚĞ ŚŽƐƉŝƚĂů ĞƚŚŝĐƐ ĐŽŵŵŝƩĞĞ ĐĂŶ ƌĞĂůůLJ ůŝǀĞŶ LJŽƵƌ ĚĂLJ͘ ĂƚĞŐŽƌLJ dǁŽ͗ /ŶƚĞƌŶĂƟŽŶĂů ,ĞĂůƚŚ ʹ ^ŝŶĐĞ ϭϵϵϮ͕ / ŚĂǀĞ ďĞĞŶ ŽŶ ϭϰ ŵĞĚŝĐĂů ďƌŝŐĂĚĞƐ ƚŽ ,ŽŶĚƵƌĂƐ ĂŶĚ ƚǁŽ ƚŽ ƌĂnjŝů͘ dŚĞƐĞ ĂƌĞ ŵLJ E yd hW͗ dŚĞ ZĞůĂLJ ZĂĐĞ͘ / Ăŵ ƐŽ ƉƌŽƵĚ ƚŚĂƚ &W ŚĂƐ ďĞĞŶ ƵůƟŵĂƚĞ ǀĂĐĂƟŽŶƐ͖ ǁĞ ǁŽƌŬ ƟƌĞůĞƐƐůLJ͕ ďƵƚ ĞŶƚĞƌ Ă ĐƵůƚƵƌĞ ŝŶ Ă ǁĂLJ ĂǁĂƌĚĞĚ ĂŶ Ψϴϲϱ͕ϬϬϬ ŐƌĂŶƚ ƚŽ ƚĞĂĐŚ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƚŚĞŝƌ ƉƌĂĐƟĐĞ ƚŚĂƚ ǁĞ ǁŽƵůĚ ŶĞǀĞƌ ďĞ ĂďůĞ ƚŽ ŝŶ ĂŶLJ ŽƚŚĞƌ ƉƌŽĨĞƐƐŝŽŶ͘ tĞ ŐĞƚ ƚŽ ƚĞĂŵƐ ĂďŽƵƚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͘ dŚĞ ďĂƚŽŶ ŚĂƐ ďĞĞŶ ƉĂƐƐĞĚ ƚŽ ƵƐ͘ ŬŶŽǁ ƚŚĞ ƉĞŽƉůĞ ĂŶĚ ƚŚĞŝƌ ůŝǀĞƐ ǀĞƌLJ ŝŶƟŵĂƚĞůLJ ŝŶ Ă ǀĞƌLJ ƐŚŽƌƚ ƟŵĞ͘ tĞ ǁŝůů ƉĂƐƐ ƚŚĞ ďĂƚŽŶ ƚŽ ŽƵƌ ĐŽůůĞĂŐƵĞƐ͘ dŚĞLJ ǁŝůů ƉĂƐƐ ƚŚĞ ďĂƚŽŶ ƚŽ ŶĚ͕ ƚŚĞƐĞ ďƌŝŐĂĚĞƐ ŚĂǀĞ ďĞĐŽŵĞ Ă ĨĂŵŝůLJ ĂīĂŝƌ͕ ǁŝƚŚ ŵLJ ŵŽƚŚĞƌ ĂŶĚ ƚŚĞŝƌ ƐƚĂīƐ ĂŶĚ ƉĂƟĞŶƚƐ͘ tĞ ǁŝůů Ăůů ǁŝŶ ŝŶ ƚŚŝƐ ŚĞĂůƚŚ ĐĂƌĞ ĐŽǀĞƌĂŐĞ ƐŽŶ ŝŶ ƚŽǁ͕ ǀŝƐŝƟŶŐ ƉĂƟĞŶƚƐ͕ ƐĐŚŽŽů ĂŶĚ ƚŚĞ ĐůŝŶŝĐ͘ / ŐĂŝŶ ƐŽ ŵƵĐŚ ŵŽƌĞ ĂŶĚ ĚĞůŝǀĞƌLJ ŐĂŵĞ͘ tĞ ǁŝůů Ăůů ǁŽƌŬ ƚŽŐĞƚŚĞƌ ǁŝƚŚ ŽƵƌ ƉĂƌƚŶĞƌƐ ŽŶ ƚŚĂŶ / ŐŝǀĞ͘ ƚŚŝƐ ŝŶŝƟĂƟǀĞ͘ &W ŝƐ ůĞĂĚŝŶŐ ƚŚĞ ǁĂLJ͊ ĂƚĞŐŽƌLJ dŚƌĞĞ͗ KƌŐĂŶŝnjĞĚ DĞĚŝĐŝŶĞ ʹ dŚĞ ŚŝŐŚůŝŐŚƚ ŽĨ ŵLJ ĐĂƌĞĞƌ ŚĂƐ ƚƌƵůLJ ďĞĞŶ ŵLJ ŝŶǀŽůǀĞŵĞŶƚ ǁŝƚŚ &W͘ dŚŝƐ ƐŽ ĐŽŵƉůĞŵĞŶƚƐ ǁŚĂƚ ǁĞ ĚŽ ŝŶ ƚŚĞ ŽĸĐĞ ĂŶĚ͕ ŝŶ ŵĂŶLJ ǁĂLJƐ͕ ŵĂLJ ĚŽ ŵŽƌĞ ĨŽƌ ŽƵƌ

8

California Family Physician Fall 2013

KŚ LJĞƐ͕ ƚŚŽƐĞ ƉĞƐŬLJ dĂƌůĞƚŽŶ ƚǁŝŶƐ ʹ ƚŚĞLJ ǁĞƌĞ ŝŶǀŽůǀĞĚ ŝŶ ƚŚĞ ŝǀŝů tĂƌ ĐŽƵƌƟŶŐ DŝƐƐ ^ĐĂƌůĞƩ Ăƚ ƚŚĞ ďĞŐŝŶŶŝŶŐ ŽĨ 'ŽŶĞ ǁŝƚŚ ƚŚĞ tŝŶĚ͘ ZŝƐŬ ĂŶĚ DŽŶŽƉŽůLJ ʹ ƌŝŶŐ ŝƚ ŽŶ͊

STUDENT NEWS

Ĵ ȱ ȱ ȱ ȱ ȱ

ȱ ȱ ȱ ȱ ȱ tĞ ŚĂǀĞ ƚŚĞ ŚŽŶŽƌ ŽĨ ƌĞƉƌĞƐĞŶƟŶŐ ŽƵƌ ĨĞůůŽǁ ƐƚƵĚĞŶƚƐ ĂƐ ƚŚŝƐ year’s Student Council Co-Chairs for the California Academy of Family Physicians (CAFP). tĞ ďĞůŝĞǀĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝƐ Ă ĐĂůůŝŶŐ͕ ĂŶĚ ǁĞ ĂƌĞ ĐŽŵŵŝƩĞĚ ƚŽ ŝŶƐƉŝƌŝŶŐ ƚŚĞ ĨƵƚƵƌĞ ůĞĂĚĞƌƐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ /ƚ ŝƐ ǁŝƚŚ ŐƌĞĂƚ ĞdžĐŝƚĞŵĞŶƚ ƚŚĂƚ ǁĞ ĂŶŶŽƵŶĐĞ ƚŚĞ ƚŚĞŵĞ ĨŽƌ ƚŚŝƐ LJĞĂƌ͛Ɛ ĐŽƵŶĐŝů͗ Building Bridges͘ KƵƌ ŐŽĂů ĨŽƌ ƚŚĞ LJĞĂƌ ŝƐ ƚŽ ďƌŝŶŐ ƚŽŐĞƚŚĞƌ ĞǀĞƌLJŽŶĞ ǁŚŽ ŚĂƐ Ă ƉĂƐƐŝŽŶ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ tĞ ǁŝůů ŝŶŝƟĂƚĞ ƉƌŽŐƌĂŵƐ ƚŽ ĐŽŶŶĞĐƚ ƚŚĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŽĨ ƚŽŵŽƌƌŽǁ͕ ďŽƚŚ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ͕ ǁŝƚŚ ƚŚĞŝƌ ůŽĐĂů &W ĐŚĂƉƚĞƌƐ ĂŶĚ ƉƌĂĐƟĐŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ĨŽƐƚĞƌ ŵĞŶƚŽƌƐŚŝƉ ĂŶĚ ĞŶĐŽƵƌĂŐĞ ĐŽůůĂďŽƌĂƟŽŶ ƚŚƌŽƵŐŚŽƵƚ ƚŚĞ ĚŝīĞƌĞŶƚ ƐƚĂŐĞƐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚƌĂŝŶŝŶŐ ĂŶĚ ƉƌĂĐƟĐĞ͘ tŝƚŚ ƚŚĞƐĞ ƉĂƌƚŶĞƌƐŚŝƉƐ͕ ǁĞ ŚŽƉĞ ƚŽ ƉƌŽŵŽƚĞ ŝŶǀŽůǀĞŵĞŶƚ ŝŶ ůŽĐĂů͕ ƐƚĂƚĞǁŝĚĞ ĂŶĚ ŶĂƟŽŶĂů ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĞǀĞŶƚƐ ďLJ ŚĂǀŝŶŐ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ͗ ͻ ^ĞƌǀĞ ĂƐ ƌĞŐŝŽŶĂů ůŝĂŝƐŽŶƐ ƚŽ ƌĞƉƌĞƐĞŶƚ ƚŚĞŝƌ ŽƌŐĂŶŝnjĂƟŽŶƐ Ăƚ &W ĂŶĚ &W ĞǀĞŶƚƐ͘ ͻ ƐƐŝƐƚ ŝŶ ƉůĂŶŶŝŶŐ ĐŽŶĨĞƌĞŶĐĞƐ ƐƵĐŚ ĂƐ ƚŚĞ ƵƉĐŽŵŝŶŐ ^ƚƵĚĞŶƚ ĂŶĚ ZĞƐŝĚĞŶƚ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ^Ƶŵŵŝƚ͘ ͻ ŶŐĂŐĞ ŝŶ ĂĚǀŽĐĂĐLJ ĞīŽƌƚƐ ǁŝƚŚ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ WŽůŝƟĐĂů ĐƟŽŶ ŽŵŵŝƩĞĞ͘

dŽ ĚŽ ƚŚŝƐ͕ ǁĞ ǁŝůů ƉĞƌƐŽŶĂůůLJ ĐŽŶƚĂĐƚ ĞǀĞƌLJ &ĂŵŝůLJ DĞĚŝĐŝŶĞ /ŶƚĞƌĞƐƚ 'ƌŽƵƉ͕ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵ ĚŝƌĞĐƚŽƌ ĂŶĚ ůŽĐĂů &W ĐŚĂƉƚĞƌ͘ tĞ ŚŽƉĞ ƚŚĞ ůŽĐĂů ĐŚĂƉƚĞƌƐ ǁŝůů ůĞŶĚ ƵƐ ƚŚĞŝƌ ƐƵƉƉŽƌƚ ďLJ ǁĞůĐŽŵŝŶŐ ĂŶ ŝŶĐƌĞĂƐĞ ŝŶ ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ŝŶǀŽůǀĞŵĞŶƚ͘ dŽĚĂLJ͕ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ ĨĂĐĞƐ ƚŚĞ ĂĚǀĞŶƚ ŽĨ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ͕ ƚŚĞ ŝŵƉůĞŵĞŶƚĂƟŽŶ ŽĨ ĞůĞĐƚƌŽŶŝĐ ŵĞĚŝĐĂů ƌĞĐŽƌĚƐ ĂŶĚ ůĞŐŝƐůĂƟŽŶ ƚŚĂƚ ƚŚƌĞĂƚĞŶƐ ƚŚĞ ƐĂĨĞƚLJ ŽĨ ŽƵƌ ƉĂƟĞŶƚƐ͘ tŝƚŚ Ăůů ŽĨ ƚŚĞ ĐŚĂŶŐĞ ĂŶĚ ƚƵƌŵŽŝů ŝŶ ŵĞĚŝĐŝŶĞ͕ ŝƚ ŝƐ ŶŽǁ ŵŽƌĞ ŝŵƉŽƌƚĂŶƚ ƚŚĂŶ ĞǀĞƌ ƚŚĂƚ ǁĞ Build Bridges ĂŶĚ ĞŶĐŽƵƌĂŐĞ ĞǀĞƌLJŽŶĞ ǁŚŽ ďĞůŝĞǀĞƐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚŽ ƵŶŝƚĞ ǁŝƚŚ ŽŶĞ ǀŽŝĐĞ ĂŶĚ ĂĚǀŽĐĂƚĞ ĨŽƌ ŽƵƌ ĐŽŶƐƟƚƵĞŶĐLJ͘ ŽŶŶĞĐƟŶŐ ĨƵƚƵƌĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŝƚŚ ƚŚĞŝƌ ůŽĐĂů ĐŚĂƉƚĞƌƐ ǁŝůů ďĞ ƚŚĞ ĮƌƐƚ ŽĨ ŵĂŶLJ ƐƚĞƉƐ ƚŽ ďŽůƐƚĞƌ ƉƵďůŝĐ ĂǁĂƌĞŶĞƐƐ ŽĨ ƚŚĞ ůĞŐŝƐůĂƟǀĞ ŝƐƐƵĞƐ ĂīĞĐƟŶŐ ŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ƉƌŽĨĞƐƐŝŽŶ͘ DŽƐƚ ŝŵƉŽƌƚĂŶƚůLJ͕ ƚŚƌŽƵŐŚ ƚŚĞƐĞ ŝŶŝƟĂƟǀĞƐ͕ ǁĞ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ĐƌĞĂƚĞ ŐĞŶĞƌĂƟŽŶƐ ŽĨ ŵŽƟǀĂƚĞĚ ĂŶĚ ĞŶƚŚƵƐŝĂƐƟĐ ůĞĂĚĞƌƐ ƚŽ ĚƌŝǀĞ ƚŚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞǀŽůƵƟŽŶ ĨŽƌǁĂƌĚ͘ WůĞĂƐĞ ũŽŝŶ ƵƐ ĂƐ ǁĞ Build Bridges ƚŽǁĂƌĚ Ă ďƌŝŐŚƚĞƌ ĨƵƚƵƌĞ͊

California Family Physician Fall 2013 9

FOUNDATION NEWS

ŘŖŗřȱ ȱ dŚĞ ĮŌŚ ĂŶŶƵĂů &ĂŵŝůLJ DĞĚŝĐŝŶĞ ^Ƶŵŵŝƚ ǁĂƐ a smashing success, due in no small part to the incredible students, residents and faculty ŝŶ ĂƩĞŶĚĂŶĐĞ͘ dŚĞ ^Ƶŵŵŝƚ ŽƌŝŐŝŶĂƚĞĚ ĂƐ ƚǁŽ ĚŝīĞƌĞŶƚ ĞǀĞŶƚƐ͕ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ĐŽŶĨĞƌĞŶĐĞ ĂŶĚ Ă ŵĞĚŝĐĂů ůĞĂĚĞƌƐŚŝƉ ĐŽŶĨĞƌĞŶĐĞ͕ ĂŶĚ ŵĞƌŐĞĚ ŝŶƚŽ ŽŶĞ ĞǀĞŶƚ ŝŶ ϮϬϭϭ ĨŽƌ Ă ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĞdžƚƌĂǀĂŐĂŶnjĂ͘ dŚĞ ^Ƶŵŵŝƚ ǁĂƐ ĚĞƐŝŐŶĞĚ ƚŽ ďƌŝŶŐ ƚŽŐĞƚŚĞƌ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͕ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚƐ͕ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵ ĨĂĐƵůƚLJ ĂŶĚ ĐĂĚĞŵLJ ůĞĂĚĞƌƐ ĨŽƌ ĂŶ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĞŶŐĂŐĞ ŝŶ ƐĞƐƐŝŽŶƐ ŽŶ ŚĞĂůƚŚ ƉŽůŝĐLJ͕ ĂĚǀŽĐĂĐLJ ĂŶĚ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ <ĞLJŶŽƟŶŐ ƚŚĞ ĞǀĞŶƚ ǁĂƐ &W͛Ɛ ŽǁŶ ϮϬϭϯ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ ŽĨ ƚŚĞ zĞĂƌ͕ DŝĐŚĞůůĞ YƵŝŽŐƵĞ͕ D ͘ /Ŷ ĂĚĚŝƟŽŶ ƚŽ ďĞŝŶŐ ĂŶ ŝŶƐƉŝƌŝŶŐ ůĞĂĚĞƌ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ƌ͘ YƵŝŽŐƵĞ ŝƐ ĂůƐŽ Ă ƌĞĂůŝƐƚ͘ dŚĞ ďŝŐŐĞƐƚ ĂƉƉůĂƵƐĞ ŽĨ ƚŚĞ ĚĂLJ ĐĂŵĞ ŶŽƚ ĚƵƌŝŶŐ Ă ŵŽŵĞŶƚ ĚŝƐĐƵƐƐŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ďƵƚ ǁŚĞŶ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ĂƐŬĞĚ ƌ͘ YƵŝŽŐƵĞ ŚŽǁ ƐŚĞ ďĂůĂŶĐĞƐ ƌĞŐƵůĂƌ ůŝĨĞ͕ ŚĞƌ ĨĂŵŝůLJ ĂŶĚ ďĞŝŶŐ ŝŶĐƌĞĚŝďůLJ ŝŶǀŽůǀĞĚ ǁŝƚŚ &W͘ ,Ğƌ ĂŶƐǁĞƌ͍ ^ŚĞ ĚŽĞƐŶ͛ƚͶŚĞƌ ŚŽƵƐĞ

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California Family Physician Fall 2013

2013 Family Physician of the h Y Yea ear Mich Mich Mi chel elle lle le Q Qui uiiio u oggue o e, MD MD add drre esse ssed ed student tu nts ntts and ressi side den nts at nts nt a thi hiss ye year ar’s ’s SSum u m um miit. t ǁĂƐ Ă ĚŝƐĂƐƚĞƌ ĂŶĚ ƐŚĞ ǁĂƐ K< ǁŝƚŚ ƚŚĂƚ͘ hŶĚĞƌƐƚĂŶĚŝŶŐ ƚŚĂƚ ŝƚ ǁĂƐ K<͕ ĞǀĞŶ ĞƐƐĞŶƟĂů͕ ƚŽ ůĞƚ ƐŽŵĞ ŝŶĐŽŶƐĞƋƵĞŶƟĂů ƚŚŝŶŐƐ ŝŶ LJŽƵƌ ůŝĨĞ ŐŽ ƚŽ ĨŽĐƵƐ ŽŶ ƚŚĞ ƐŽƵůͲĨƵůĮůůŝŶŐ ƐƚƵī ŝƐ ŽŶĞ ŽĨ ƚŚĞ ďĞƐƚ ůĞƐƐŽŶƐ Ă ŵĞŶƚŽƌ ĐŽƵůĚ ƚĞĂĐŚ LJŽƵ͕ ĂŶĚ ũƵƐƚ ŽŶĞ ŽĨ ƚŚĞ ŵĂŶLJ ƌĞĂƐŽŶƐ ƌ͘ YƵŝŽŐƵĞ ŝƐ Ă ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŚĞƌŽ͘ ^ƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ǁĞƌĞ ƚƌĞĂƚĞĚ ƚŽ ƉƌŽĐĞĚƵƌĂů ǁŽƌŬƐŚŽƉƐ ŽŶ ƚƌŝŐŐĞƌ ƉŽŝŶƚ ŝŶũĞĐƟŽŶƐ ĂŶĚ /h ŝŶƐĞƌƟŽŶ͘ ^ƉĞĐŝĂů ƐĞƐƐŝŽŶƐ ŽŶ ŐĞƫŶŐ ŝŶƚŽ ƌĞƐŝĚĞŶĐLJ ĂŶĚ Ă ŐƌŽƵƉ ƐƚƌĂƚĞŐŝĐ ƉůĂŶŶŝŶŐ ƐĞƐƐŝŽŶ ĨŽƌ ƌĞƐŝĚĞŶĐLJ ĞĚƵĐĂƟŽŶ ǁĞƌĞ ŐƌĞĂƚ ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ĂůŝŬĞ ƚŽ ĐŽŶŶĞĐƚ ǁŝƚŚ ƉĞĞƌƐ ĂŶĚ ĨƵƚƵƌĞ ƉƌŽŐƌĂŵ

ĚŝƌĞĐƚŽƌƐ ĂŶĚ ůĞĂƌŶ ƚŚĞ ƟƉƐ ĂŶĚ ƚƌŝĐŬƐ ĨŽƌ ƐƵĐĐĞĞĚŝŶŐ ĂƐ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͘ ŌĞƌ Ă ĚĂLJ ŽĨ ƉƌĞƐĞŶƚĂƟŽŶƐ͕ ƚŚĞ ZĞƐŝĚĞŶĐLJ &Ăŝƌ ŽƉĞŶĞĚ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϰϬ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ƉĂƌƟĐŝƉĂƟŶŐ͘ ĂĐŚ ƉƌŽŐƌĂŵ ŚĂĚ Ă ƚĂďůĞ ƚŽƉ ĞdžŚŝďŝƚ ĂŶĚ ƵƐĞĚ ƚŚĞ ĂŌĞƌŶŽŽŶ ĂƐ ĂŶ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĐŚĂƚ ǁŝƚŚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂďŽƵƚ ƚŚĞŝƌ ƉƌŽŐƌĂŵƐ͕ ĨĂĐƵůƟĞƐ͕ ƐĞƌǀŝĐĞƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ͘ &W WƌĞƐŝĚĞŶƚ͕ DĂƌŬ ƌĞƐƐŶĞƌ͕ D ƐĂŝĚ͕ ͞dŚĞ ĞŶĞƌŐLJ ŝŶ ƚŚŝƐ ƌŽŽŵ ŵĂŬĞƐ ŵĞ ĐŽŶĮĚĞŶƚ ĂďŽƵƚ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͖ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ ŝƐ ŝŶ ŐŽŽĚ ŚĂŶĚƐ͘͟

There’s a bright future waiting for you on California’s beautiful Central Coast.

California’s breathtaking natural attractions are not the only stars on the Central Coast. Equally impressive are the top-trained medical professionals at Natividad Medical Center (Natividad), a 172-bed acute care medical center owned and operated by Monterey County. Affiliated with the University of California at San Francisco School of Medicine since 1974, we are located near Big Sur, Carmel and Monterey. We offer an excellent family practice residency program and enjoy a Joint Commission ranking in the top percentile of hospitals nationwide.

FAMILY MEDICINE PHYSICIAN Well-known West Coast Family Medicine Residency Program seeks a strong faculty member with interest in academics. Natividad Medical Center Family Medicine Residency Program has been in existence since 1975, and provides care for a largely Medicaid/underserved population in the Salinas Valley. Our program has an emphasis on Obstetrics and Inpatient Medicine, and we are expanding our resident cohort from 24 to 30 spots. We look to expand the number of faculty members over the next two years, but are looking to fill one full-time position at this time. This position also involves supervising Residents and Medical Students in the Family Medicine Residency clinic, on the Inpatient Units and while on call (call is approximately 3 times/month).

The ideal candidate will be a Board-Certified Family Physician with an interest in academics as well as general family medicine. Training and experience in Sports Medicine or Geriatrics is a plus, but not required. Faculty development, up to and including the UCSF faculty development year-long course and NIPDD training, may be available for the selected candidate.

Natividad offers a competitive salary and benefits package, and the opportunity to live, work and play in one of the most beautiful areas in the world. Please visit our website at www.natividad.com. For consideration email your CV to: ramirezcl@natividad.com. EOE/M/F/H/V

Unique views on the Central Coast.

MED7 has been providing urgent care services in the Greater Sacramento area since 1987 Urgent care clinics are located in Roseville, Carmichael, Folsom & North Sacramento. Board Certified or Board Eligible in family practice or emergency medicine.

All shifts 9am to 9pm. Full time is 13 shifts per month. We offer our full time physicians the following: full malpractice coverage, medical & dental coverage at no cost for the physician & any dependents, disability policy & we have a simple IRA you can contribute to with 3% matching. Part time is 6 to 8 shifts per month. There is no call. There is no tail coverage that needs to be purchased should you leave our employment. We have a single policy that continues on after you leave.

If something were to arise here after you left our employment, you would be covered.

For more information about MED7 and our clinics please visit our website: www.med7.com We offer an attractive compensation package.

Contact Merl O’Brien,MD, at: (916) 483-5400, ext.111; or email CV to: sherry@med7atwork.com.

California Family Physician Fall 2013 11

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PCMH CORNER

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dŚĞ ƌĞŝŐŶŝŶŐ ǁŽƌĚ ǁŚĞŶ / ũŽŝŶĞĚ WĞƚĂůƵŵĂ ,ĞĂůƚŚ ĞŶƚĞƌ ;W, Ϳ ŝŶ ϮϬϬϬ ǁĂƐ ͞ĐŚĂŽƐ͘͟ W, ƐĞƌǀĞĚ ĞǀĞƌLJŽŶĞ͕ ŝŶĐůƵĚŝŶŐ ŚŽŵĞůĞƐƐ ĂŶĚ ƵŶĚŽĐƵŵĞŶƚĞĚ ŝŵŵŝŐƌĂŶƚƐ ĂŶĚ ĨĂŵŝůŝĞƐ͘ /ƚ ǁĂƐ ǁŚĂƚ / ĞdžƉĞĐƚĞĚ ŽĨ Ă ƐĂĨĞƚLJ ŶĞƚ ĐůŝŶŝĐ͗ ĐƌĂnjLJ ĚĂLJƐ͕ ůŽŶŐ ǁĂŝƚ ƟŵĞƐ ĂŶĚ ůŽƚƐ ŽĨ ƉĂƚŚŽůŽŐLJ ĚƵĞ ƚŽ ĚŝƐĞĂƐĞ͕ ƉŽǀĞƌƚLJ ĂŶĚ ;ƚŽ ďĞ ŚŽŶĞƐƚͿ ŽƵƌ ŽǁŶ ĚŝƐŽƌŐĂŶŝnjĂƟŽŶ͘ tĞ ǁĞƌĞ ŵŝƐƐŝŽŶͲĚƌŝǀĞŶ ƉĞŽƉůĞ ƚƌLJŝŶŐ ƚŽ ĚŽ ƚŚĞ ƌŝŐŚƚ ƚŚŝŶŐ͘ KƵƌ ƉĂƟĞŶƚƐ ŚĂĚ ŶŽǁŚĞƌĞ ĞůƐĞ ƚŽ ŐŽ͕ ĂŶĚ ƚŚĞLJ ƐĞĞŵĞĚ ŐƌĂƚĞĨƵů͕ ƐŽ ǁĞ ĚŝĚ ŶŽƚ ĨĞĞů Ă ŶĞĞĚ ƚŽ ĐŚĂŶŐĞ͘ dŚĞŶ ĐĂŵĞ ƐĞǀĞƌĂů ǁĂŬĞͲƵƉ ĐĂůůƐ͗ Ă ĨĞĚĞƌĂů ƌĞǀŝĞǁĞƌ ĐĂŵĞ ŝŶ ĂŶĚ ƚŽůĚ ƵƐ ƚŽ ĐůŽƐĞ Ă ŵŝůůŝŽŶͲĚŽůůĂƌ ŚŽůĞ ŝŶ ŽƵƌ ŽŶŐŽŝŶŐ ŽƉĞƌĂƟŽŶĂů ďƵĚŐĞƚ Žƌ ǁĞ ǁŽƵůĚ ůŽƐĞ Ă ŐƌĂŶƚ ƚŚĂƚ ŬĞƉƚ ƵƐ ĂŇŽĂƚ͖ ǁĞ ůŽƐƚ ƚŚƌĞĞ ĚŽĐƚŽƌƐ ŝŶ ƚŚƌĞĞ ŵŽŶƚŚƐ͕ Ăůů ŽĨ ǁŚŽŵ ƐĂŝĚ͕ ͞/ ĐĂŶ͛ƚ ƚĂŬĞ ƚŚĞ ƉĂŝŶ ƉĂƟĞŶƚƐ ĂŶLJŵŽƌĞ͖͟ ŵŽƌĂůĞ ǁĂƐ ƚĂŶŬŝŶŐ͘ tĞ ŚĂĚ ƐŽŵĞ ďĂĚ ŽƵƚĐŽŵĞƐ ĨƌŽŵ ƐĐŚĞĚƵůĞ ĚĞůĂLJƐ͘ DLJ ƉĂƟĞŶƚƐ ǁŽƵůĚ ƐĂLJ͕ ͞zKh ĂƌĞ ŐƌĞĂƚ͕ ďƵƚ ƚŚĞ ǁĂŝƚ ƟŵĞƐ ĂƌĞ ŚŽƌƌŝĮĐ͊͟ / ǁŽŬĞ ƵƉ ƚŽ ƚŚĞ ĨĂĐƚ ƚŚĂƚ͕ ĂƐ ŵĞĚŝĐĂů ĚŝƌĞĐƚŽƌ͕ / ĐŽƵůĚ ŶŽƚ ďůĂŵĞ ͞ƚŚĞ ƐLJƐƚĞŵ͟ ʹ / ǁĂƐ ƚŚĞ ƐLJƐƚĞŵ͘ ^Ž͕ ƚŽŐĞƚŚĞƌ͕ ǁĞ ƚƵƌŶĞĚ ĞǀĞƌLJƚŚŝŶŐ ĂƌŽƵŶĚ͕ ŽŶĞ ƉƌŽďůĞŵ Ăƚ Ă ƟŵĞ͕ ŽŶĞ ŝŶŝƟĂƟǀĞ Ăƚ Ă ƟŵĞ͘ tĞ ŚĂĚ ƚǁŽ ŵĂŶƚƌĂƐ͗ Ăůů ĚĞĐŝƐŝŽŶƐ ŚĂĚ ƚŽ ďĞ ͞ƉĂƟĞŶƚͲĐĞŶƚĞƌĞĚ͕͟ ĂŶĚ ǁĞ ŚĂĚ ƚŽ ƌƵŶ ƚŚĞ ŽƌŐĂŶŝnjĂƟŽŶ ůŝŬĞ Ă ďƵƐŝŶĞƐƐ͘

WĞƚĂůƵŵĂ ,ĞĂůƚŚ ĞŶƚĞƌ ŝƐ Ă EĂƟŽŶĂů ŽŵŵŝƩĞĞ ĨŽƌ YƵĂůŝƚLJ /ŶƐƵƌĂŶĐĞ ;E Y Ϳ ůĞǀĞůͲϯ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ͕ ĂŶĚ ƚŚŝƐ ŝƐ ƚŚĞ ƐƚŽƌLJ ŽĨ ŝƚƐ ƚƌĂŶƐĨŽƌŵĂƟŽŶ͘ dŚĞ ƐƚŽƌLJ ŝƐ ǁƌŝƩĞŶ ĨƌŽŵ ƚŚĞ ƉĞƌƐƉĞĐƟǀĞ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ĂŶĚ CAFP member Kelly Pfeifer, MD, but in true, team-based fashion, Dr. Pfeifer relied on the ǀĂůƵĂďůĞ ŝŶƉƵƚ ŽĨ ƚŚĞ ,ĞĂůƚŚ ĞŶƚĞƌ͛Ɛ K͕ Kathie Powell. CAFP thanks both Dr. Pfeifer and DƐ͘ WŽǁĞůů ĨŽƌ ƚŚĞŝƌ ŝŶƐƉŝƌŝŶŐ ƐƚŽƌLJ͘ ƌ͘ WĮĞĨĞƌ ŝƐ ŶŽǁ ƚŚĞ ŚŝĞĨ DĞĚŝĐĂů KĸĐĞƌ ĨŽƌ ƚŚĞ ^ĂŶ &ƌĂŶĐŝƐĐŽ ,ĞĂůƚŚ WůĂŶ ĂŶĚ ĐĂŶ ďĞ ƌĞĂĐŚĞĚ Ăƚ <ƉĨĞŝĨĞƌΛƐĬƉ͘ŽƌŐ Žƌ ;ϰϭϱͿ ϲϭϱͲϰϮϯϮ͘

<ĂƚŚ <Ă ŚŝĞ Ğ W WŽǁ ŽǁĞů Žǁ Ğ ů͕ Ğů ů͕ K K ;;ůĞ ů Ō ŌͿͿ < <Ğů ĞůůLJ ů W WĨĞ ĨĞŝĨĨĞƌ Ğ ;;ƌŝ ƌŝŐŚƚͿͿ Ś ƌŝŐ ŚĞůůƉĞ ƉĞĚ Ě ůĞ ůĞĂĚ ĞĂĚ ƚŚĞ Ś W W D D, , ƚƌ ƚƌĂŶ Ă ƐĨ ĂŶ ƐĨŽƌ ŽƌŵĂ Žƌ ŽƌŵĂ ŵĂƟŽŶ ƟŽ ŽŶ ͘ &ŝƌƐƚ͕ ǁĞ ŚĂĚ ƚŽ ĐŚĂŶŐĞ ŚŽǁ ǁĞ ĨƵŶĐƟŽŶĞĚ ĂƐ Ă ůĞĂĚĞƌƐŚŝƉ ƚĞĂŵ͘ tĞ ůĞĂƌŶĞĚ ĨƌŽŵ ƚŚĞ YƵĂůŝƚLJ ƵůƚƵƌĞ ^ĞƌŝĞƐ͕ Ă ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ ;Y/Ϳ ƚƌĂŝŶŝŶŐ ƉƌŽŐƌĂŵ͕ ĂŶĚ ŵĂŶĂŐĞŵĞŶƚ ŬƐ ;>ĞŶĐŝŽŶŝ͛Ɛ &ŝǀĞ LJƐĨƵŶĐƟŽŶƐ ŽĨ Ă dĞĂŵ ĂŶĚ ĞĂƚŚ ďLJ DĞĞƟŶŐͿ͘ tĞ ĐŽŶƐĐŝŽƵƐůLJ ďƵŝůƚ ƐƚƌŽŶŐ ƚĞĂŵƐ ĂŶĚ ůĞĂƌŶĞĚ ŚŽǁ ƚŽ ƌƵŶ ĞīĞĐƟǀĞ ŵĞĞƟŶŐƐ͘ tĞ ĐŽŵŵŝƩĞĚ ŶĞǀĞƌ ĂŐĂŝŶ ƚŽ ŚŝƌĞ ĨƌŽŵ ĚĞƐƉĞƌĂƟŽŶ ĂŶĚ ŽŶůLJ ďƌŝŶŐ ŽŶ ͞ƐƚĂƌƐ͟ Ăƚ ĞǀĞƌLJ ůĞǀĞů͘ tĞ ŵĂĚĞ ƐŽŵĞ ƉĂŝŶĨƵů ĚĞĐŝƐŝŽŶƐ ĂďŽƵƚ ǁŚŽ ǁĂƐ ƚŚĞ ƌŝŐŚƚ Įƚ ĨŽƌ ŽƵƌ ĐŚĂŶŐŝŶŐ ĐƵůƚƵƌĞ͘ tĞ ŵŽǀĞĚ ƉĂƐƚ ŽƵƌ ĐƵƐƚŽŵĂƌLJ ƌŽůĞƐ ĂŶĚ ĐŽŵŵŝƩĞĚ ƚŽ ĨŽĐƵƐŝŶŐ ŽŶ ǁŚĂƚ ǁĂƐ ďĞƐƚ ĨŽƌ ƚŚĞ ŽƌŐĂŶŝnjĂƟŽŶ͘ / ƌĞŵĞŵďĞƌ ĐůĞĂƌůLJ ŽŶĞ ƉĂƌƟĐƵůĂƌůLJ ĐůĂƌŝĨLJŝŶŐ ŵŽŵĞŶƚ͘ / ǁĂƐ ƚƌLJŝŶŐ ƚŽ ĂĚǀŽĐĂƚĞ ĨŽƌ ŵLJ ůĂƚĞƐƚ ŝŵƉƌŽǀĞŵĞŶƚ ŝĚĞĂ͘ ͞tĞ ŚĂǀĞ ƚŽ ĚŽ ƚŚŝƐ ŶĞǁ ƉƌŽũĞĐƚ͊ WĂƟĞŶƚƐ ĂƌĞ ĚLJŝŶŐ͊͟ DLJ K ƌĞƐƉŽŶĚĞĚ͕ ͞tŚŽ ĚŽ LJŽƵ ǁĂŶƚ ŵĞ ƚŽ ĮƌĞ ƚŽ ĚŽ ƚŚŝƐ ƚŚŝŶŐ͍͟ / ƌĞŐƌŽƵƉĞĚ͘ / ůĞĂƌŶĞĚ ƚŽ ƐƚƌƵĐƚƵƌĞ ŶĞǁ ŝĚĞĂƐ ĂƐ ďƵƐŝŶĞƐƐ ƉůĂŶƐ ĂŶĚ ƉƌŝŽƌŝƟnjĞ ŝŵƉƌŽǀĞŵĞŶƚ ŝĚĞĂƐ ƚŚĂƚ ĐŽƵůĚ ůŽǁĞƌ ĐŽƐƚƐ ĂŶĚ ďƌŝŶŐ ŝŶ ƌĞǀĞŶƵĞ͘ ŶĚ͕ ŶŽ ƐƵƌƉƌŝƐĞ͕ ŵLJ K ǁŽƵůĚ ŚĞĂƌ ŵĞ ĂŶĚ ƌĞƐƉŽŶĚ͘ /ƚ ŶŽ ůŽŶŐĞƌ ǁĂƐ ƚŚĞ K͛Ɛ ũŽď ƚŽ ƉƵƐŚ ƉƌŽĚƵĐƟǀŝƚLJ ĂŶĚ ĞǀĞƌLJŽŶĞ ĞůƐĞ͛Ɛ ũŽď ƚŽ ƌĞƐŝƐƚ͘ /ƚ ďĞĐĂŵĞ >> ŽĨ ŽƵƌ ũŽďƐ ƚŽ ĮŶĚ ĞǀĞƌLJ ƉŽƐƐŝďůĞ ǁĂLJ ƚŽ ƐĂǀĞ ŵŽŶĞLJ ;Ğ͘Ő͕͘ ďLJ ďĞŝŶŐ ŵŽƌĞ ĞĸĐŝĞŶƚ͕ ƐŝŵƉůŝĨLJŝŶŐ ƐƵƉƉůŝĞƐ͕ ĐŽŶƐŽůŝĚĂƟŶŐ ƌŽůĞƐ͕ ĐŚĂŶŐŝŶŐ ƐĐŚĞĚƵůĞƐ͕ ďĞŝŶŐ ǁŝůůŝŶŐ ƚŽ ƐĞĞ ŵŽƌĞ ƉĂƟĞŶƚƐ ŝŶ ĞdžĐŚĂŶŐĞ ĨŽƌ ŵŽƌĞ ŚĞůƉͿ͘ tĞ Ăůů ĮŶĂůůLJ ǁŽŬĞ ƵƉ ƚŽ ƚŚĞ ĨĂĐƚ ƚŚĂƚ ǁĞ ǁŽƵůĚ ŚĂǀĞ ƚŽ ƐŝŶŬ Žƌ Ɛǁŝŵ ƚŽŐĞƚŚĞƌ͘

ŽŶƚŝŶƵĞĚ ŽŶ ƉĂŐĞ ϭϰ 12

California Family Physician Fall 2013

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California Family Physician Fall 2013 13

PCMH CORNER ƐĞĞŬ ĂŶ ĂƉƉŽŝŶƚŵĞŶƚ͘ KƵƌ ŵĂŶƚƌĂ͗ ͞^ĞĞ ƚŚĞŵ ŶŽǁ͕ ĂŶĚ ĚŽ ŶŽƚ ŵĂŬĞ ƚŚĞŵ ǁĂŝƚ͘͟

ȱ ȱ ǰȱ ȱ ¢ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ǯȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ǯȱȱ ȱ ¢ȱ ǰȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯ

tĞ ůĞĂƌŶĞĚ ŚŽǁ ĐŚĂŶŐĞ ŚĂƉƉĞŶƐ͘ tĞ Ăůů ǁĂŶƚ ƚŽ ũƵƐƚ ǁƌŝƚĞ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĂŶĚ ͞ƉŽŽĨ͟ ʹ ƐĞĞ ƚŚŝŶŐƐ ŐĞƚ ďĞƩĞƌ͘ Ƶƚ ǁĞ ůĞĂƌŶĞĚ ƚŚĂƚ ƌĞĂů ĐŚĂŶŐĞ ƚĂŬĞƐ ƚĞĂŵƐ͕ ƐŵĂůů ƚĞƐƚƐ ŽĨ ĐŚĂŶŐĞ͕ ŵĞĂƐƵƌĞŵĞŶƚ ĂŶĚ ǁƌŝƩĞŶ ƐLJƐƚĞŵƐ ƚŽ ƐƵƐƚĂŝŶ ǁŚĂƚ ǁŽƌŬƐ͘ tĞ ĚĞǀĞůŽƉĞĚ Ă ƐŚĂƌĞĚ ŐŽǀĞƌŶĂŶĐĞ ŵŽĚĞů ǁŝƚŚ ƐĞǀĞƌĂů ĂƐƐŽĐŝĂƚĞ ŵĞĚŝĐĂů ĚŝƌĞĐƚŽƌƐ͕ ƚĞĂŵ ůĞĂĚƐ ĂŶĚ ƉƌŽũĞĐƚ ůĞĂĚƐ͘ dŚŝƐ ŵĞĂŶƚ ƚŚĂƚ ŽŶĞ ůĞĂĚĞƌ ǁĂƐ ŶŽ ůŽŶŐĞƌ ƚŚĞ ƌĂƚĞͲ ůŝŵŝƟŶŐ ƐƚĞƉ͖ ƉƌŽũĞĐƚ ůĞĂĚĞƌƐŚŝƉ ǁĂƐ ƐƉƌĞĂĚ ŽƵƚ ĂŵŽŶŐ ƉƌŽǀŝĚĞƌƐ ĂŶĚ ƐƚĂī ĂŶĚ ĐŚĂŶŐĞ ďĞŐĂŶ ƚŽ ĂĐĐĞůĞƌĂƚĞ ĞdžƉŽŶĞŶƟĂůůLJ͘ tĞ ƚŽůĚ ŽƵƌƐĞůǀĞƐ͕ ĂŶĚ ĂŶLJŽŶĞ ǁŚŽ ǁŽƵůĚ ůŝƐƚĞŶ͕ ƚŚĂƚ ǁĞ ǁĞƌĞ ŐŽŝŶŐ ƚŽ ďĞĐŽŵĞ ƚŚĞ ďĞƐƚ ŚĞĂůƚŚ ĐĞŶƚĞƌ ŝŶ ƚŚĞ ĐŽƵŶƚƌLJ͘ /ƚ ǁĂƐ ŶŽƚ ůŽŶŐ ďĞĨŽƌĞ ǁĞ ďĞŐĂŶ ƚŽ ďĞůŝĞǀĞ ŽƵƌƐĞůǀĞƐ͕ ĂŶĚ ŽƚŚĞƌ ƉĞŽƉůĞ ĚŝĚ ƚŽŽ͘ ůŽĐŬ ďLJ ďůŽĐŬ͕ ǁĞ ďƵŝůƚ Ă ŵĞĚŝĐĂů ŚŽŵĞ͕ ĂŶĚ ƐƚĂī ƚŽŽŬ ŐƌĞĂƚ ƉƌŝĚĞ ŝŶ ƚŚŝƐ͘ ;^ĞĞ ϭϬ ďƵŝůĚŝŶŐ ďůŽĐŬƐ ŽĨ ŚŝŐŚͲƉĞƌĨŽƌŵŝŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ͕ dŽŵ ŽĚĞŶŚĞŝŵĞƌΎ͘Ϳ tĞ ĞŵƉĂŶĞůůĞĚ Ăůů ŽĨ ŽƵƌ ƉĂƟĞŶƚƐ͕ ĐĂůĐƵůĂƚĞĚ ƌĂƟŽŶĂů ƉĂŶĞů ƐŝnjĞƐ͕ ƌĞĚƵĐĞĚ ďĂĐŬůŽŐ ĂŶĚ ŝŵƉůĞŵĞŶƚĞĚ ĂĚǀĂŶĐĞĚ ĂĐĐĞƐƐ͘ &Žƌ ƚŚĞ ƉĂƐƚ ƐĞǀĞŶ LJĞĂƌƐ͕ ƚŚĞ ĐůŝŶŝĐ ŚĂƐ ĞŶƐƵƌĞĚ ƚŚĂƚ ƉĂƟĞŶƚƐ ƐĞĞ ƚŚĞŝƌ ŽǁŶ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌŽǀŝĚĞƌ ;W WͿ ǁŚĞŶ ƚŚĞLJ ŶĞĞĚ ƚŽ͕ ƵƐƵĂůůLJ ŽŶ ƚŚĞ ƐĂŵĞ ĚĂLJ ƚŚĂƚ ƚŚĞLJ 14

California Family Physician Fall 2013

tĞ ŝŵƉůĞŵĞŶƚĞĚ Ă ƚƌƵĞ ŝŶƚĞŐƌĂƚĞĚ ďĞŚĂǀŝŽƌĂů ŚĞĂůƚŚ ŵŽĚĞů͕ ǁŚŝĐŚ ŵĞĂŶƚ ƐŽŵĞ ƚŽƵŐŚ͕ ĐƵůƚƵƌĞ ƐŚŝŌƐ ʹ ǁĂƌŵ ŚĂŶĚͲ ŽīƐ͕ ŝŶƚĞƌƌƵƉƟďůĞ ϭϱͲ ƚŽ ϯϬͲŵŝŶƵƚĞ ǀŝƐŝƚƐ ĂŶĚ ůŝŵŝƚĞĚ ůĞŶŐƚŚƐ ŽĨ ƚƌĞĂƚŵĞŶƚ͘ ŬĞLJ ĨĂĐƚŽƌ ǁĂƐ ƚŚĞ K͛Ɛ ďĞůŝĞĨ ƚŚĂƚ ƚĞĂŵͲďĂƐĞĚ ĐĂƌĞ ŵĞĂŶƚ ŝŶǀĞƐƟŶŐ ŝŶ ƐƵƉƉŽƌƚ ƐƚĂī͘ tĞ ƚƌĂŶƐĨŽƌŵĞĚ ŵĞĚŝĐĂů ĂƐƐŝƐƚĂŶƚƐ ;D ƐͿ ĨƌŽŵ ͞ƌŽŽŵĞƌƐ ĂŶĚ ƐƚŽĐŬĞƌƐ͟ ƚŽ ĞŵƉŽǁĞƌĞĚ ŵĞŵďĞƌƐ ŽĨ ƚŚĞ ĐĂƌĞ ƚĞĂŵ͘ tĞ ŝŵƉůĞŵĞŶƚĞĚ ƚŚĞ ƌŽůĞ ŽĨ ƚŚĞ ƚĂĐƟĐĂů ŶƵƌƐĞ͕ ƐŽ ƌĞĮůůƐ ĂŶĚ ůĂď ƌĞƐƵůƚƐ ĐŽƵůĚ ďĞ ŵĂŶĂŐĞĚ ďLJ ƚŚĞ ƚĞĂŵ͕ ŶŽƚ ũƵƐƚ ƚŚĞ W W͘ tĞ ǁŚŽůĞͲŚĞĂƌƚĞĚůLJ ƚŽŽŬ ŽŶ ƉĂŶĞů ŵĂŶĂŐĞŵĞŶƚ ĂŶĚ ŚĞůĚ ŽƵƌƐĞůǀĞƐ ĂĐĐŽƵŶƚĂďůĞ ƚŽ ĞŶƐƵƌĞ ƉĂƟĞŶƚƐ ŐŽƚ ƚŚĞ ƌŝŐŚƚ ĐĂƌĞ Ăƚ ƚŚĞ ƌŝŐŚƚ ƟŵĞ͘ / ƌĞŵĞŵďĞƌ ŵLJ ĮƌƐƚ ĚŝĂďĞƚĞƐ ƌĞŐŝƐƚƌLJ ƌĞƉŽƌƚ͘ DLJ ĐŽĐŬŝŶĞƐƐ ǁĂƐ ƌĞǁĂƌĚĞĚ ďLJ Ă ƐŚŽĐŬ͗ / ŚĂĚ ƚŚĞ ǁŽƌƐƚ ƐĐŽƌĞƐ ŝŶ ƚŚĞ ĐůŝŶŝĐ ĨŽƌ ĞLJĞ ĞdžĂŵƐ͘ ŌĞƌ Ă ƚLJƉŝĐĂů ĚŽĐƚŽƌ ƌĞĂĐƟŽŶ ;Ğ͘Ő͕͘ ĚĞŶŝĂů͕ ďĂƌŐĂŝŶŝŶŐ ĂŶĚ ĚĞƐƉĂŝƌͿ͕ / ǁĞŶƚ ƚŽ ƚŚĞ ŚŝŐŚ ƉĞƌĨŽƌŵĞƌƐ͕ ĮŐƵƌĞĚ ŽƵƚ ǁŚĂƚ ƚŚĞLJ ĚŝĚ ĂŶĚ ĐŽƉŝĞĚ ƚŚĞŵ͘ / ůĞŌ W, ĮǀĞ LJĞĂƌƐ ĂŐŽ͕ ďƵƚ ƐƟůů ǀŽůƵŶƚĞĞƌ ƚŚĞƌĞ͘ EŽǁ ĂŶ E Y ůĞǀĞůͲϯ ŵĞĚŝĐĂů ŚŽŵĞ͕ W, ŚĂƐ ŝŶƚĞŐƌĂƚĞĚ ŚĞĂůƚŚ ĐĂƌĞ ǁŝƚŚ ĂĐƵƉƵŶĐƚƵƌĞ͕ ŐƌŽƵƉ ĞdžĞƌĐŝƐĞ ĐůĂƐƐĞƐ͕ ŚĞĂůƚŚ ĞĚƵĐĂƟŽŶ ĂŶĚ ŵŽƌĞ͘ dŚĞLJ ŚĂǀĞ Ă ŚŝŐŚ ƌĞƚĞŶƟŽŶ ƌĂƚĞ ĨŽƌ ƉƌŽǀŝĚĞƌƐ ĂŶĚ ƐƚĂī ĂŶĚ ĂƌĞ ƌĞĐŽŐŶŝnjĞĚ ĂƐ ŽŶĞ ŽĨ ƚŚĞ ďĞƐƚ ƉůĂĐĞƐ ƚŽ ǁŽƌŬ ŝŶ ƚŚĞ EŽƌƚŚ ĂLJ͘ dŚĞLJ ŚĂǀĞ ŚŝŐŚ ƋƵĂůŝƚLJ ƐĐŽƌĞƐ ĂŶĚ ŚŝŐŚ ƉĂƟĞŶƚͲƐĂƟƐĨĂĐƟŽŶ͘ dŚĞLJ ŚĂǀĞ Ă ƌĂƟŽŶĂů ƉĂŝŶ ŵĂŶĂŐĞŵĞŶƚ ƉŽůŝĐLJ͘ / ůŽǀĞ ƉƌĂĐƟĐŝŶŐ ƚŚĞƌĞ͘ /Ŷ Ă ƌĞĐĞŶƚ ĞdžĂŵƉůĞ͕ ďĞĨŽƌĞ / ƐĂǁ ŵLJ ĮƌƐƚ ƉĂƟĞŶƚ͕ ƚŚĞ D ŚĂĚ ĚŽŶĞ ŵŽƐƚ ŽĨ ͞ŵLJ͟ ǁŽƌŬ ďLJ ƐƚĂŶĚŝŶŐ ŽƌĚĞƌ ;Ğ͘Ő͕͘ ϭĐ ĂŶĚ > > ŽƌĚĞƌĞĚ͕ ŇƵ ƐŚŽƚ ŐŝǀĞŶ͕ ƉĂƉ ƐŵĞĂƌ ƐĐŚĞĚƵůĞĚ ĂŶĚ ƌĞĨĞƌƌĂů ŝŶ ƉůĂĐĞ ĨŽƌ ĂŶ ĞLJĞ ĞdžĂŵͿ͘ EŽƚ ŽŶůLJ ƚŚĂƚ͕ / ĂůƌĞĂĚLJ ŬŶĞǁ ŵLJ ƉĂƟĞŶƚ ǁĂƐ ŶŽƚ ĚĞƉƌĞƐƐĞĚ ;W,YϮͿ͕ ŝƐ Ă ŚĞĂǀLJ ƐŵŽŬĞƌ ĂŶĚ ŝƐ ƚŚŝŶŬŝŶŐ ĂďŽƵƚ ƋƵŝƫŶŐ͘ / ƚŚĂŶŬĞĚ ƚŚĞ D ĂŶĚ ŚĞƌ ƌĞƐƉŽŶƐĞ ǁĂƐ ͞ĚŽŶ͛ƚ ǁŽƌƌLJ ĂďŽƵƚ ŝƚ͖ ǁĞ ĂƌĞ ŚĞƌĞ ƚŽ ŚĞůƉ ĞĂĐŚ ŽƚŚĞƌ͊͟ dŚĂƚ ǁĂƐ ǁŚĞŶ / ƌĞĂůŝnjĞĚ / ŚĂĚ ĞdžƉĞƌŝĞŶĐĞĚ Ă ƚƌƵĞ ĐƵůƚƵƌĞ ĐŚĂŶŐĞ͘ DLJ ũŽď ǁĂƐ ƚŽ ŚĞůƉ ƚŚĞ D ͕ ŚĞƌ ũŽď ǁĂƐ ƚŽ ŚĞůƉ ŵĞ͕ ĂŶĚ Ăůů ŽĨ ƵƐ ǁĞƌĞ ŚĞƌĞ ƚŽ ŵĂŬĞ ƐƵƌĞ ƚŚĞ ƌŝŐŚƚ ƚŚŝŶŐ ŚĂƉƉĞŶĞĚ Ăƚ ƚŚĞ ƌŝŐŚƚ ƟŵĞ͘ / ƚŚŝŶŬ ƚŚĞƌĞ ǁŽƵůĚ ďĞ ůĞƐƐ ďƵƌŶͲŽƵƚ ŝŶ ƉƌŝŵĂƌLJ ĐĂƌĞ ŝĨ Ăůů Ɖ ĚŽĐƚŽƌƐ ƉƌĂĐƟĐĞĚ ůŝŬĞ ƚŚŝƐ͘

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POLITICAL PULSE

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ȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱ /Ĩ LJŽƵ ĂƌĞ ůŝŬĞ ŵĞ͕ LJŽƵ ĂƌĞ ĂŶƟĐŝƉĂƟŶŐ ƚŚĞ ŝŵƉůĞŵĞŶƚĂƟŽŶ ŽĨ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ ǁŝƚŚ ĞdžĐŝƚĞŵĞŶƚ͕ ŽƉƟŵŝƐŵ ĂŶĚ Ă ŚĞĂůƚŚLJ ĚŽƐĞ ŽĨ ĂƉƉƌĞŚĞŶƐŝŽŶ͘ 'ŝǀĞŶ ƚŚĞ bills the Legislature passed this year, and those they failed ƚŽ ƉĂƐƐ͕ ƵƌŐĞŶƚ ĂĐƟŽŶ ǁŝůů ůŝŬĞůLJ ďĞ ŶĞĞĚĞĚ ĞĂƌůLJ ŶĞdžƚ LJĞĂƌ to bolster primary care and the health care workforce in general. &W ĚŝĚ ŝƚƐ ƉĂƌƚ ĚƵƌŝŶŐ ƚŚŝƐ ůĞŐŝƐůĂƟǀĞ LJĞĂƌ͘ tĞ ƐƵƉƉŽƌƚĞĚ ŝŶĐƌĞĂƐĞĚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ƚŚƌŽƵŐŚ ŽƵƌ ĂĚǀŽĐĂĐLJ ĞīŽƌƚƐ ŽŶ džϭ ϭ;WĠƌĞnjͿ ĂŶĚ ^ džϭ ϭ ;,ĞƌŶĂŶĚĞnjͿ͕ ǁŚŝĐŚ ǁĞƌĞ ƐŝŐŶĞĚ ďLJ ƚŚĞ ŐŽǀĞƌŶŽƌ ĞĂƌůŝĞƌ ƚŚŝƐ LJĞĂƌ͘ dŚĞƐĞ ďŝůůƐ ŝ Ě ď ƚŚ ůŝ ƚŚŝ dŚ ďŝůů ĂƵƚŚŽƌŝnjĞĚ ƚŚĞ DĞĚŝĐĂŝĚ ĞůŝŐŝďŝůŝƚLJ ĞdžƉĂŶƐŝŽŶ ĐŽŶƚĂŝŶĞĚ ŝŶ ƚŚĞ ͘ dŚĞ ŐŽǀĞƌŶŽƌ ĂůƐŽ ƐŝŐŶĞĚ &WͲƐƵƉƉŽƌƚĞĚ Ϯ džϭ ;WĂŶͿ ĂŶĚ ^ Ϯ džϭ ;,ĞƌŶĂŶĚĞnjͿ͕ ǁŚŝĐŚ ƉƌŽŚŝďŝƚ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ĐŽŵƉĂŶŝĞƐ ĨƌŽŵ ĚĞŶLJŝŶŐ ƉĞŽƉůĞ ĐŽǀĞƌĂŐĞ ďĂƐĞĚ ŽŶ ƉƌĞĞdžŝƐƟŶŐ ŚĞĂůƚŚ ĐĂƌĞ ĐŽŶĚŝƟŽŶƐ͕ ůŝŵŝƟŶŐ ƚŚĞ ĨĂĐƚŽƌƐ ƚŚĂƚ ĐĂŶ ďĞ ƵƐĞĚ ƚŽ ĚĞƚĞƌŵŝŶĞ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ƉƌĞŵŝƵŵƐ ƚŽ ĂŐĞ͕ ŐĞŽŐƌĂƉŚLJ ĂŶĚ ĨĂŵŝůLJ ƐŝnjĞ͘ /Ŷ ĂĚĚŝƟŽŶ͕ &W ƐƉŽŶƐŽƌĞĚ ϭϭϳϲ ; ŽĐĂŶĞŐƌĂ ĂŶĚ ŽŶƚĂͿ͕ ǁŚŝĐŚ ǁŽƵůĚ ŚĂǀĞ ƌĞƋƵŝƌĞĚ ĞǀĞƌLJ ƉƌŝǀĂƚĞ ŝŶƐƵƌĞƌ Žƌ ƉůĂŶ ƚŚĂƚ ƉƌŽǀŝĚĞƐ ŚĞĂůƚŚ ĐĂƌĞ ĐŽǀĞƌĂŐĞ ŝŶ ĂůŝĨŽƌŶŝĂ ƚŽ ƉĂLJ ĂŶ ĂŶŶƵĂů ĨĞĞ ŽĨ ĮǀĞ ĚŽůůĂƌƐ ƉĞƌ ĐŽǀĞƌĞĚ ůŝĨĞ ŝŶƚŽ Ă 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ;'D Ϳ &ƵŶĚ͘ dŚĞ &ƵŶĚ ǁŽƵůĚ ĚŝƐƚƌŝďƵƚĞ ŵŽŶĞLJ ƚŽ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ͕ ŐŝǀŝŶŐ ƉƌŝŽƌŝƚLJ ƚŽ ƉƌŽŐƌĂŵƐ ůŽĐĂƚĞĚ ŝŶ ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂƐ͕ ŚĂǀĞ Ă ƉƌŽǀĞŶ ƌĞĐŽƌĚ ŽĨ ƉůĂĐŝŶŐ ŐƌĂĚƵĂƚĞƐ ŝŶ ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂƐ ĂŶĚͬŽƌ ƉůĂĐĞ ĂŶ ĞŵƉŚĂƐŝƐ ŽŶ ƚƌĂŝŶŝŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ĂŶĚ ŽƚŚĞƌ ƉŚLJƐŝĐŝĂŶ ƐƉĞĐŝĂůƟĞƐ ƚŚĂƚ ĂƌĞ ŵŽƐƚ ŶĞĞĚĞĚ ŝŶ ƚŚĞ ĐŽŵŵƵŶŝƚLJ ŝŶ ǁŚŝĐŚ ƚŚĞ ƉƌŽŐƌĂŵ ŝƐ ůŽĐĂƚĞĚ͘ &W ĂůƐŽ ƐƉŽŶƐŽƌĞĚ ϭϮϬϴ ;WĂŶͿ ƚŽ ĚĞĮŶĞ ĂŶĚ ĞŶĐŽƵƌĂŐĞ ƚŚĞ ĂĚŽƉƟŽŶ ŽĨ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞƐ ŝŶ ĂůŝĨŽƌŶŝĂ͘ tŚŝůĞ ŽƵƌ ƐƉŽŶƐŽƌĞĚ ďŝůůƐ ǁĞƌĞ ƵůƟŵĂƚĞůLJ ƵŶƐƵĐĐĞƐƐĨƵů ƚŚŝƐ LJĞĂƌ͕ ǁĞ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ĮŐŚƚ ĨŽƌ ƚŚĞƐĞ ŝƐƐƵĞƐ ǁŚĞŶ ƚŚĞ >ĞŐŝƐůĂƚƵƌĞ ƌĞĐŽŶǀĞŶĞƐ ŝŶ :ĂŶƵĂƌLJ͘

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ĞůŽǁ ĂƌĞ ƐŽŵĞ &WͲƐƵƉƉŽƌƚĞĚ ďŝůůƐ ƚŚĂƚ͕ ĂƐ ŽĨ ƚŚŝƐ ǁƌŝƟŶŐ͕ Ɛŝƚ ŽŶ ƚŚĞ ŐŽǀĞƌŶŽƌ͛Ɛ ĚĞƐŬ͕ ĂǁĂŝƟŶŐ ŚŝƐ ƐŝŐŶĂƚƵƌĞ Žƌ ǀĞƚŽ͗ ͻ ϭϵϭ ; ŽĐĂŶĞŐƌĂͿ ǁŽƵůĚ ŵĂŬĞ ŚŽƵƐĞŚŽůĚƐ ǁŝƚŚ Ăƚ ͻ ůĞĂƐƚ ŽŶĞ DĞĚŝͲ Ăů ƌĞĐŝƉŝĞŶƚ ĐĂƚĞŐŽƌŝĐĂůůLJ ĞůŝŐŝďůĞ ĨŽƌ Ăů&ƌĞƐŚ ; ĂůŝĨŽƌŶŝĂ͛Ɛ ĨŽŽĚ ƐƚĂŵƉ ƉƌŽŐƌĂŵͿ ďLJ ƌĂŝƐŝŶŐ ƚŚĞ Ăů&ƌĞƐŚ ŐƌŽƐƐ ŝŶĐŽŵĞ ƚĞƐƚ ĨŽƌ ƚŚĞƐĞ ŚŽƵƐĞŚŽůĚƐ ƚŽ ϮϬϬ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ &ĞĚĞƌĂů WŽǀĞƌƚLJ >ĞǀĞů ;&W>Ϳ͘ dŚŝƐ ǁŝůů ĞŶƐƵƌĞ ƚŚĂƚ ƚŚĞ ĐƵƌƌĞŶƚ ŐƌŽƐƐ ŝŶĐŽŵĞ ƚĞƐƚ ŽĨ ϭϯϬ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ &W> ĚŽĞƐ ŶŽƚ ƉƌĞǀĞŶƚ ŚŝŐŚͲŶĞĞĚ ŚŽƵƐĞŚŽůĚƐ ǁŝƚŚ Ă DĞĚŝͲ Ăů ƌĞĐŝƉŝĞŶƚ ǁŚŽ ĂƌĞ ŽƚŚĞƌǁŝƐĞ ĞůŝŐŝďůĞ ĨŽƌ ͻ Ăů&ƌĞƐŚ ĨƌŽŵ ĂƉƉůLJŝŶŐ͘ ͻ ϰϭϭ ;WĂŶͿ ǁŽƵůĚ ƌĞƋƵŝƌĞ Ăůů DĞĚŝͲ Ăů ŵĂŶĂŐĞĚ ĐĂƌĞ ƉůĂŶƐ ƚŽ ĂŶĂůLJnjĞ ƚŚĞŝƌ ,ĞĂůƚŚĐĂƌĞ īĞĐƟǀĞŶĞƐƐ ĂƚĂ ĂŶĚ /ŶĨŽƌŵĂƟŽŶ ^Ğƚ ;, /^Ϳ ŵĞĂƐƵƌĞƐ Žƌ ƚŚĞŝƌ džƚĞƌŶĂů

ĐĐŽƵŶƚĂďŝůŝƚLJ ^Ğƚ

Ğ ;; Ğƚ ^Ϳ ^ ŵĞĂ ^Ϳ ŵ ŵĞĂĂƐƵ ƵƌĞƐ ďLJ ďLJLJ ƌƌĂĐ ď ĂĐĞ͕ Ğ͕ Ğ ĞĞƚŚŶŝ ŶŝĐŝ ĐŝƚLJ ƚLJ ĂŶĚ Ɖƌ Ɖ ŝŵ Ɖƌ ŝŵĂƌ ĂƌLJLJ ůĂ Ăƌ ůĂŶŐƵĂŐĞ ŐĞ ĂĂŶĚ ŐĞ Ŷ ƚ ƚŽ Ž ŝŵ ŵƉů Ɖ Ğŵ ĞŵĞĞŶƚ Ŷƚ Ɛƚ ƐƚƌĂ ƌ ƚĞŐŝĞƐ ƚŽ ƌĞĚƵ ƌĞ Ě ĐĞĞ Ě ĚŝƐƉĂ ƉĂƌŝ ƌŝƟĞ Ɵ Ɛ Ɛ ŝŶ ŝŶ Ŷ ƚ ƚŚŽ ŽƐĞĞ Đ Ăƚ Ă ĞŐ ĞŐŽ ŽƌŝĞƐ ŽƌŝĞ Žƌ ŝĞĞƐ͘ Ɛ͘ dŚĞ ďŝůů ů ůǁŽƵů Ɛ͘ d ǁŽ ŽƵů Ƶ Ě Ě ĂůƐŽ Ăů ƐŽ Ž ƌĞƋ ƌƌĞƋ ĞƋƵŝ Ƶ ƌĞ ƌĞ ƚ ƚŚĂ ƚ ŚĂƚ ŚĂ ƚ ƚŚ ƚ ƚŚĞƐ Ğ Ğ ĞƐ Ğ ĂŶ ŶĂů ĂůLJƐ LJƐĞƐ LJƐ ĞƐ ď ĞƐ ď ďĞ Ğ ƌĞ ƌĞĞƉ ƌĞƉŽ ƉŽ ŽƌƌƚƚĞĚ Ě ƚƚŽ ƚŚ Ž ƚŚ ƚ Ğ Ğ ĞƉĂƌƚŵĞ ŵĞŶƚ Ŷƚƚ Ž ŽĨ Ĩ ,Ğ Ĩ ,ĞĂů ĂůƚŚ ƚ ĂƌƌĞ Ğ ^Ğ ^ ƌǀ ƌǀŝŝĐĞƐ ŝĐĞƐ ; ; , , , ^ ^Ϳ ĂŶ Ϳ ĂŶ ŶŶƵ ŶƵĂů ĂůůLJ ůLJ ĂŶĚ Ě ďĞ ďĞ ŵĂĚ ŵĂĚĞ Ăǀ ĂǀĂŝ ĂŝůĂ ůĂďů ďůĞ Ğ ƚŽ ƚ ƚŚĞ ƚŚĞ ƉƵď ďůŝůĐ ǀŝĂ ƚŚĞ , ^͛Ɛ ǁĞďƐŝƚĞ͘ ϱϲϱ ;^ĂůĂƐͿ ǁŽƵůĚ ƌĞƋƵŝƌĞ ƚŚĞ ŐƵŝĚĞůŝŶĞƐ ĨŽƌ ƚŚĞ ƐĞůĞĐƟŽŶ ĂŶĚ ƉůĂĐĞŵĞŶƚ ŽĨ ĂůŝĨŽƌŶŝĂ WŚLJƐŝĐŝĂŶ ŽƌƉƐ W WƌŽŐƌĂŵ ĂƉƉůŝĐĂŶƚƐ ƚŽ ŝŶĐůƵĚĞ ĐƌŝƚĞƌŝĂ ƚŚĂƚ ǁŽƵůĚ ŐŝǀĞ ůŝ ƚ ƚ ŝ ů Ě ŝƚ ŝ ƚŚ ƚ ůĚ ŝ ƉƌŝŽƌŝƚLJ ĐŽŶƐŝĚĞƌĂƟŽŶ ƚŽ ĂƉƉůŝĐĂŶƚƐ ǁŚŽ ŚĂǀĞ ƚŚƌĞĞ LJĞĂƌƐ ŽĨ ĞdžƉĞƌŝĞŶĐĞ ƉƌŽǀŝĚŝŶŐ ŚĞĂůƚŚ ĐĂƌĞ ƐĞƌǀŝĐĞƐ ƚŽ ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶƐ ŝŶ Ă ĨĞĚĞƌĂůůLJ ĚĞƐŝŐŶĂƚĞĚ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂů ƐŚŽƌƚĂŐĞ ĂƌĞĂ Žƌ ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂ ĂŶĚ ǁŚŽ ĂŐƌĞĞ ƚŽ ƉƌĂĐƟĐĞ ŝŶ ƚŚŽƐĞ ĂƌĞĂƐ ĂŶĚ ƐĞƌǀĞ Ă ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶ͘ ϭϮϴϴ ;s͘D͘ WĠƌĞnjͿ ǁŽƵůĚ ƌĞƋƵŝƌĞ ƚŚĞ DĞĚŝĐĂů ŽĂƌĚ ŽĨ ĂůŝĨŽƌŶŝĂ ĂŶĚ ƚŚĞ KƐƚĞŽƉĂƚŚŝĐ DĞĚŝĐĂů ŽĂƌĚ ŽĨ ĂůŝĨŽƌŶŝĂ ƚŽ ĚĞǀĞůŽƉ Ă ƉƌŽĐĞƐƐ ƚŽ ŐŝǀĞ ƉƌŝŽƌŝƚLJ ƌĞǀŝĞǁ ƐƚĂƚƵƐ ƚŽ ĂŶ ĂƉƉůŝĐĂŶƚ ĨŽƌ Ă ŵĞĚŝĐĂů ůŝĐĞŶƐĞ ǁŚŽ ĐĂŶ ĚĞŵŽŶƐƚƌĂƚĞ ŚŝƐ Žƌ ŚĞƌ ŝŶƚĞŶƚ ƚŽ ƉƌĂĐƟĐĞ ŝŶ Ă ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂ Žƌ ƚƌĞĂƚ Ă ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶ͘ ^ Ϯϭ ;ZŽƚŚͿ ƌĞƋƵĞƐƚƐ ƚŚĞ ^ĐŚŽŽů ŽĨ DĞĚŝĐŝŶĞ Ăƚ ƚŚĞ hŶŝǀĞƌƐŝƚLJ ŽĨ ĂůŝĨŽƌŶŝĂ͕ ZŝǀĞƌƐŝĚĞ ƚŽ ĚĞǀĞůŽƉ Ă ƉƌŽŐƌĂŵ ƚŽ ĂƐƐŝƐƚ ŵĞĚŝĐĂů ƌĞƐŝĚĞŶƚƐ ŝŶ ĂƉƉůLJŝŶŐ ĨŽƌ ƉŚLJƐŝĐŝĂŶ ƌĞƚĞŶƟŽŶ ƉƌŽŐƌĂŵƐ͕ ŝŶĐůƵĚŝŶŐ͕ ďƵƚ ŶŽƚ ůŝŵŝƚĞĚ ƚŽ͕ ƚŚĞ ^ƚĞǀĞŶ D͘ dŚŽŵƉƐŽŶ WŚLJƐŝĐŝĂŶ ŽƌƉƐ >ŽĂŶ ZĞƉĂLJŵĞŶƚ WƌŽŐƌĂŵ͘ ^ ϱϯ ; Ğ >ĞſŶͿ ǁŽƵůĚ ĐƌĞĂƚĞ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ĂŵŵƵŶŝƟŽŶ ƌĞŐƵůĂƟŽŶƐ ƚŚĂƚ ĞŶƐƵƌĞ ƚŚĂƚ ĐƌŝŵŝŶĂůƐ ĂŶĚ ŽƚŚĞƌ ĚĂŶŐĞƌŽƵƐ ŝŶĚŝǀŝĚƵĂůƐ ĐĂŶŶŽƚ ƉƵƌĐŚĂƐĞ ĂŵŵƵŶŝƟŽŶ͘ /ƚ ǁŽƵůĚ ĂůƐŽ ƌĞƋƵŝƌĞ ĂŵŵƵŶŝƟŽŶ ǀĞŶĚŽƌƐ ƚŽ ďĞ ůŝĐĞŶƐĞĚ͕ ǁŚŝĐŚ ǁŽƵůĚ ĂůůŽǁ ƚŚĞ ƐƚĂƚĞ ƚŽ ƚƌĂĐŬ ƚŚĞ ƐĂůĞ ŽĨ ĂŵŵƵŶŝƟŽŶ͘ dŚŝƐ ďŝůů ĂůƐŽ ƌĞƋƵŝƌĞƐ ƉƵƌĐŚĂƐĞƌƐ ƚŽ ƉĂƐƐ Ă ďĂĐŬŐƌŽƵŶĚ ĐŚĞĐŬ ƚŽ ďƵLJ ĂŵŵƵŶŝƟŽŶ͘ ^ ϯϱϮ ;WĂǀůĞLJͿ ǁŽƵůĚ ǁĂŝǀĞ ƚŚĞ ƌĞƋƵŝƌĞŵĞŶƚ ƚŚĂƚ Ă ƉŚLJƐŝĐŝĂŶ ďĞ ĚŝƌĞĐƚůLJ ŽŶƐŝƚĞͿ ƚŽ ƐƵƉĞƌǀŝƐĞ ƚŚĞ ŵĞĚŝĐĂů ĂƐƐŝƐƚĂŶƚ ;ƉŚLJƐŝĐŝĂŶ ĂƐƐŝƐƚĂŶƚ͕ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌ Žƌ ŶƵƌƐĞͲŵŝĚǁŝĨĞͿ ǁŽƌŬŝŶŐ ĂƐ ƉĂƌƚ ŽĨ ƚŚĞ ƚĞĂŵ͘ dŚĞ ďŝůů ǁŽƵůĚ ǁĂŝǀĞ ƚŚŝƐ ƌĞƋƵŝƌĞŵĞŶƚ ŝŶ Ăůů ŵĞĚŝĐĂů ŽĸĐĞ ƐĞƫŶŐƐ͕ ŝŶƐƚĞĂĚ ŽĨ ŝŶ ĐŽŵŵƵŶŝƚLJ ĐůŝŶŝĐƐ ĂŶĚ ĨƌĞĞ ĐůŝŶŝĐƐ ŽŶůLJ͕ ǁŚĞƌĞ ŝƚ ŝƐ ĐƵƌƌĞŶƚůLJ ƉĞƌŵŝƩĞĚ͘ ^ ϯϳϰ ;^ƚĞŝŶďĞƌŐͿ Ͳ dŚŝƐ ďŝůů ǁŽƵůĚ ƉƌŽŚŝďŝƚ ƚŚĞ ĨƵƚƵƌĞ ƐĂůĞ͕ ƉƵƌĐŚĂƐĞ͕ ŵĂŶƵĨĂĐƚƵƌĞ͕ ŝŵƉŽƌƚĂƟŽŶ Žƌ ƚƌĂŶƐĨĞƌ ŝŶ ĂůŝĨŽƌŶŝĂ ŽĨ ƐĞŵŝͲĂƵƚŽŵĂƟĐ ƌŝŇĞƐ ƚŚĂƚ ĐĂŶ ĂĐĐĞƉƚ ĚĞƚĂĐŚĂďůĞ ŵĂŐĂnjŝŶĞƐ͘ ^ƉĞĐŝĮĐĂůůLJ͕ ƚŚŝƐ ďŝůů ǁŝůů ĂŵĞŶĚ ƚŚĞ ĐƵƌƌĞŶƚ ĚĞĮŶŝƟŽŶ ŽĨ ŝůůĞŐĂů ͞ĂƐƐĂƵůƚ ǁĞĂƉŽŶ͟ ƚŽ California Family Physician Fall 2013 15

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ŝŶĐůƵĚĞ Ă ƐĞŵŝĂƵƚŽŵĂƟĐ͕ ƌŝŵĮƌĞ Žƌ ĐĞŶƚĞƌĮƌĞ ƌŝŇĞ ƚŚĂƚ ĚŽĞƐ ŶŽƚ ŚĂǀĞ Ă ĮdžĞĚ ŵĂŐĂnjŝŶĞ ǁŝƚŚ ƚŚĞ ĐĂƉĂĐŝƚLJ ƚŽ ĂĐĐĞƉƚ ƚĞŶ Žƌ ĨĞǁĞƌ ƌŽƵŶĚƐ͘ ^ ϰϬϮ ; Ğ >ĞſŶͿ ǁŽƵůĚ ƌĞƋƵŝƌĞ Ăůů ŐĞŶĞƌĂů ĂĐƵƚĞ ĐĂƌĞ ŚŽƐƉŝƚĂůƐ ĂŶĚ ƐƉĞĐŝĂů ŚŽƐƉŝƚĂůƐ ƚŚĂƚ ŚĂǀĞ Ă ƉĞƌŝŶĂƚĂů ƵŶŝƚ ƚŽ ĂĚŽƉƚ ƚŚĞ ͞dĞŶ ^ƚĞƉƐ ƚŽ ^ƵĐĐĞƐƐĨƵů ƌĞĂƐƞĞĞĚŝŶŐ͟ ĂƐ ĂĚŽƉƚĞĚ ďLJ ĂďLJ &ƌŝĞŶĚůLJ h^ ͕ ƉĞƌ ƚŚĞ ĂďLJͲ &ƌŝĞŶĚůLJ ,ŽƐƉŝƚĂů /ŶŝƟĂƟǀĞ Žƌ ĂŶ ĞƋƵŝǀĂůĞŶƚ ƉƌŽĐĞƐƐ ƌĞĐŽŐŶŝnjĞĚ ďLJ ƚŚĞ ^ƚĂƚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ͘ dŚĞ dĞŶ ^ƚĞƉƐ ĂƌĞ ĞŶĚŽƌƐĞĚ ĂŶĚ ƉƌŽŵŽƚĞĚ ďLJ ƚŚĞ ŵĂũŽƌ ŵĂƚĞƌŶĂů ĂŶĚ ĐŚŝůĚ ŚĞĂůƚŚ ĂƵƚŚŽƌŝƟĞƐ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ͕ ŝŶĐůƵĚŝŶŐ ƚŚĞ &W͘ ^ ϳϱϱ ;tŽůŬͿ ĂĚĚƐ ƐƉĞĐŝĮĞĚ ŽīĞŶƐĞƐ ƚŽ ƚŚĞ ůŝƐƚ ŽĨ ŵŝƐĚĞŵĞĂŶŽƌƐ ƚŚĂƚ ƌĞƐƵůƚ ŝŶ Ă ϭϬͲLJĞĂƌ ƉƌŽŚŝďŝƟŽŶ ŽŶ ĮƌĞĂƌŵƐ ĂŶĚ ĂŵŵƵŶŝƟŽŶ ƉŽƐƐĞƐƐŝŽŶ ŝŶĐůƵĚŝŶŐ ƌĞĐĞŝǀŝŶŐ ƚǁŽ Žƌ ŵŽƌĞ ĐŽŶǀŝĐƟŽŶƐ ŽĨ ĚƌƵŐ Žƌ ĂůĐŽŚŽů ŽīĞŶƐĞƐ ŝŶ Ă ƚŚƌĞĞͲLJĞĂƌ ƉĞƌŝŽĚ͕ ƚĂŬŝŶŐ Ă ĮƌĞĂƌŵ Žƌ ǁĞĂƉŽŶ ĨƌŽŵ Ă ƉŽůŝĐĞ ŽĸĐĞƌ͕ ƚŚƌĞĂƚĞŶŝŶŐ ĂŶ ŽĸĐĞƌ͕ ƐĞǀĞƌĂů ŐĂŶŐ ƌĞůĂƚĞĚ ŽīĞŶƐĞƐ ĂŶĚ ŽƚŚĞƌƐ͘ /ƚ ĂůƐŽ ƉƌŽŚŝďŝƚƐ Ă ƉĞƌƐŽŶ ŽƌĚĞƌĞĚ ŝŶƚŽ ŽƵƚƉĂƟĞŶƚ ƚƌĞĂƚŵĞŶƚ ĚƵĞ ƚŽ ŵĞŶƚĂů ŝůůŶĞƐƐ ĨƌŽŵ ƉŽƐƐĞƐƐŝŶŐ Ă ĮƌĞĂƌŵ ǁŚŝůĞ ƐƵďũĞĐƚ ƚŽ ĂƐƐŝƐƚĞĚ ŽƵƚƉĂƟĞŶƚ ƚƌĞĂƚŵĞŶƚ͘ ^ ϴϬϵ ; Ğ^ĂƵůŶŝĞƌͿ ǁŽƵůĚ ƌĂŝƐĞ ŵŽŶĞLJ ƚŽ ƐƵƉƉŽƌƚ ƚŚĞ ŽŶƚƌŽůůĞĚ ^ƵďƐƚĂŶĐĞ hƟůŝnjĂƟŽŶ ZĞǀŝĞǁ ĂŶĚ ǀĂůƵĂƟŽŶ ^LJƐƚĞŵ ; hZ ^Ϳ͕ ǁŚŝĐŚ ŝƐ ƵƐĞĚ ƚŽ ŵŽŶŝƚŽƌ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ƵƐĞ͘ dŚĞ ĨƵŶĚŝŶŐ ǁŽƵůĚ ĐŽŵĞ ĨƌŽŵ Ă Ψϲ ĂŶŶƵĂů ĨĞĞ ŽŶ ĂůŵŽƐƚ Ăůů ůŝĐĞŶƐĞĚ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ͕ ǁŚŽůĞƐĂůĞƌƐ ŽĨ ĚĂŶŐĞƌŽƵƐ ĚƌƵŐƐ͕ ĐůŝŶŝĐƐ ĂŶĚ ƉŚĂƌŵĂĐŝĞƐ͘ /ƚ ǁŽƵůĚ ĂůƐŽ ƌĞƋƵŝƌĞ Ăůů ƉƌĞƐĐƌŝďĞƌƐ ƚŽ ƌĞŐŝƐƚĞƌ ǁŝƚŚ hZ ^͘

tĞ ůŽŽŬ ĨŽƌǁĂƌĚ ƚŽ ƉƌĞƉĂƌŝŶŐ ĨŽƌ ƚŚĞ ƵƉĐŽŵŝŶŐ ůĞŐŝƐůĂƟǀĞ ƐĞƐƐŝŽŶ͕ ĞĂŐĞƌ ƚŽ ǁŽƌŬ ŽŶ ďĞŚĂůĨ ŽĨ &W ƚŽ ĐŽŶƟŶƵĞ ƚŽ ƉƌŽŵŽƚĞ ƚŚĞ ŝŶƚĞƌĞƐƚƐ ŽĨ ŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ ƌ͘ tŽůĨĞ ŝƐ ŚĂŝƌ͕ &W >ĞŐŝƐůĂƟǀĞ īĂŝƌƐ ŽŵŵŝƩĞĞ͘

16

California Family Physician Fall 2013

Voted one of the “Best Places to Work in LA & Orange County” HEALTHCARE PARTNERS MEDICAL GROUP, a division of DaVita HealthCare Partners, Inc. (DVA: NYSE), is a top-rated southern-California medical group and is widely recognized for its achievements in clinical excellence and patient satisfaction.

As part of our continued growth, we have opportunities for Family Practice Physicians in West Hills, CA and other locations throughout Southern California.

Qualified candidates will have a current California medical license. Ideal candidates are trained in Family Practice medicine. HealthCare Partners Medical Group has full-time and part-time Primary Care opportunities.

HealthCare Partners offers competitive salaries and a wide range of benefits to our full and parttime employees including medical, dental and vision insurance, 401(k), continuing education, tuition reimbursement, free Basic Life and AD&D, free long term disability coverage, a generous holiday schedule, paid time off and more.

For immediate consideration apply at www.healthcarepartners.com or email your CV to Linda Alvarado, Sr. Recruiter at lalvarado@healthcarepartners.com

Family Medicine Opportunities across Los Angeles!

Providence Health & Services operates dozens of hospitals and hundreds of primary and specialty care clinics across the West, including Los Angeles County. We also partner with private groups to recruit the best providers. We offer diverse communities, settings and practice models, including some with loan repayment and visa sponsorships.

LEARN MORE AT

www.providence.org/physicianopportunities or contact Rachelle Hobson rachelle.hobson@providence.org 503-215-1390

ȱ ȱ ȱ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ůĞĂĚĞƌƐ ĂƌĞ ŚĞƌĂůĚŝŶŐ ƚŚŝƐ ŵŽŶƚŚ͛Ɛ ůĂƵŶĐŚ ŽĨ ŽƉĞŶ ĞŶƌŽůůŵĞŶƚ Ăƚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͕ ƚŚĞ ƐƚĂƚĞ͛Ɛ ŶĞǁ ŚĞĂůƚŚ ďĞŶĞĮƚ ĞdžĐŚĂŶŐĞ͘ ͞dŽĚĂLJ ŵĂƌŬƐ ĂŶ ŚŝƐƚŽƌŝĐ ĞīŽƌƚ ƚŽ ŝŵƉƌŽǀĞ ĂůŝĨŽƌŶŝĂŶƐ͛ ŚĞĂůƚŚ ďLJ ŵĂŬŝŶŐ ĐŽǀĞƌĂŐĞ ŵŽƌĞ ĂīŽƌĚĂďůĞ ĂŶĚ ŵŽƌĞ ĞĂƐŝůLJ ĂǀĂŝůĂďůĞ͕͟ ƐĂŝĚ DĂƌŬ ƌĞƐƐŶĞƌ͕ D ͕ ƉƌĞƐŝĚĞŶƚ ŽĨ ƚŚĞ ĂůŝĨŽƌŶŝĂ ĐĂĚĞŵLJ ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ; &WͿ͘ ͞dŽĚĂLJ͕ ĂůŝĨŽƌŶŝĂ ĂŶĚ ŽƵƌ ĞŶƟƌĞ ŶĂƟŽŶ ŵŽǀĞ ƚŽǁĂƌĚ ďĞƩĞƌ ŝŶĚŝǀŝĚƵĂů ĂŶĚ ƉƵďůŝĐ ŚĞĂůƚŚ͕͟ ŚĞ ƐĂŝĚ͘ ͞/ƚ ďĞŐŝŶƐ ǁŚĞŶ ŶŽ ŽŶĞ ŐŽĞƐ ǁŝƚŚŽƵƚ ƚŚĞ ĐĂƌĞ ƚŚĞLJ ŶĞĞĚ͘ DŝůůŝŽŶƐ ŽĨ ƉĞŽƉůĞ ǁŚŽ͛ǀĞ ďĞĞŶ ƵŶĂďůĞ ƚŽ ĂīŽƌĚ ŚĞĂůƚŚ ĐŽǀĞƌĂŐĞ ŶŽǁ ƋƵĂůŝĨLJ ĨŽƌ ĨĞĚĞƌĂů ƐƵďƐŝĚŝĞƐ ĂŶĚ ƚŚĞ ĞdžƉĂŶĚĞĚ DĞĚŝͲ Ăů ;DĞĚŝĐĂŝĚͿ ƉƌŽŐƌĂŵ͘ īĞĐƟǀĞ :ĂŶƵĂƌLJ ϭ͕ ƚŚĞLJ ĐĂŶ ƐĞĞŬ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƚŚĞLJ ŶĞĞĚ͘͟ ͞dŚĞ ŚƵŵĂŶ ƚŽůů ŽĨ ďĞŝŶŐ ƵŶŝŶƐƵƌĞĚ ŝƐ ƐŽŵĞƟŵĞƐ ĚĞǀĂƐƚĂƟŶŐ ĂŶĚ ĂůǁĂLJƐ ƵŶĂĐĐĞƉƚĂďůĞ͕͟ ƌ͘ ƌĞƐƐŶĞƌ ƐĂŝĚ͘ ZĞƐĞĂƌĐŚ ƐŚŽǁƐ ƚŚĂƚ ƉĞŽƉůĞ ǁŝƚŚŽƵƚ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ŽŌĞŶ ƉŽƐƚƉŽŶĞ ƉƌĞǀĞŶƟǀĞ ĐĂƌĞ ƚŚĂƚ ĐŽƵůĚ ŬĞĞƉ ƚŚĞŵ ŚĞĂůƚŚLJ ĂŶĚ ŝŶƐƚĞĂĚ ǁĂŝƚ ƵŶƟů Ă ĐŽŶĚŝƟŽŶ ĚĞǀĞůŽƉƐ ĂŶĚ ǁŽƌƐĞŶƐ ďĞĨŽƌĞ ƐĞĞŬŝŶŐ ĐĂƌĞ͘ ͞ ǀĞŶ ǁŚĞŶ ƐŝĐŬ͕ ƉĞŽƉůĞ ǁŝƚŚŽƵƚ ĐŽǀĞƌĂŐĞ ĂƌĞ ŵŽƌĞ ůŝŬĞůLJ ƚŽ ƉŽƐƚƉŽŶĞ ĐĂƌĞ

CAFP, with support from its three partners, ǁŝůů ďĞ ŽīĞƌŝŶŐ Ă ͞ďƌŽǁŶ ďĂŐ͟ ǁĞďŝŶĂƌ ŽŶ EŽǀĞŵďĞƌ ϲ͕ ϮϬϭϮ ƌŽŵ ϭϮ͗ϯϬ Ɖŵ ƚŽ ϭ͗ϯϬ Ɖŵ͘ dŚĞ ŵĞĞƟŶŐ ǁŝůů ďĞ ĨĂĐŝůŝƚĂƚĞĚ ďLJ &W ƉƌĞƐŝĚĞŶƚ͕ DĂƌŬ ƌĞƐƐŶĞƌ͕ D ͘ dŚĞ ůƵŶĐŚƟŵĞ ǁĞďŝŶĂƌ ǁŝůů ƉƌŽǀŝĚĞ ĂŶ ŝŶƚƌŽĚƵĐƟŽŶ ƚŽ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͘ <ĞĞƉ ĂŶ ĞLJĞ ŽŶ ǁǁǁ͘ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬĐŽǀĞƌĞĚͲ ĐĂůŝĨŽƌŶŝĂ ĨŽƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ ĐŽŵŝŶŐ ƐŽŽŶ͊

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ DZ Ȋȱ ȱ ȱ ȱ ȱ

Ȋȱ ȱ ȱ Ȋȱ ȱ ȱ ȱ Ȋȱ ȱ ȱ ȱ Ȭ Ȭ ȱ

Ȋȱ ȱ ȱ ǰȱ ȱ Ƿ

ĂŶĚ ŐŽ ǁŝƚŚŽƵƚ ŵƵĐŚͲŶĞĞĚĞĚ ŵĞĚŝĐĂƟŽŶƐ͕͟ ŚĞ ƐĂŝĚ͘ ͞ Ɛ ŚĞĂůƚŚ ĐĂƌĞ ƌĞĨŽƌŵ ƌŽůůƐ ŽƵƚ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ŵŝůůŝŽŶƐ ŽĨ ƉĞŽƉůĞ ǁŝůů ďĞŶĞĮƚ͘͟ ĂůŝĨŽƌŶŝĂŶƐ ǁŚŽ ĚŽ ŶŽƚ ƋƵĂůŝĨLJ ĨŽƌ ƐƵďƐŝĚŝĞƐ ĂůƐŽ ǁŝůů ďĞ ĂďůĞ ƚŽ ƉƵƌĐŚĂƐĞ ŝŶƐƵƌĂŶĐĞ ƚŚƌŽƵŐŚ ƚŚĞ ĞdžĐŚĂŶŐĞ͕ ĂƐ ǁŝůů ƐŵĂůů ďƵƐŝŶĞƐƐ ŽǁŶĞƌƐ ƐĞĞŬŝŶŐ ĐŽǀĞƌĂŐĞ ĨŽƌ ĞŵƉůŽLJĞĞƐ͘ ͞dŚŝƐ ŝƐ ĂŶŽƚŚĞƌ ĐƌŝƟĐĂů ƐƚĞƉ ƚŽǁĂƌĚ ŵĂŬŝŶŐ ĐŽǀĞƌĂŐĞ ĂǀĂŝůĂďůĞ ƚŽ ĂůŝĨŽƌŶŝĂ͛Ɛ ŵŽƌĞ ƚŚĂŶ ƐĞǀĞŶ ŵŝůůŝŽŶ ƵŶŝŶƐƵƌĞĚ͕͟ ƌ͘ ƌĞƐƐŶĞƌ ƐĂŝĚ͘ dŽ ŚĞůƉ ƐƉƌĞĂĚ ƚŚĞ ǁŽƌĚ ĂďŽƵƚ ĐŽǀĞƌĂŐĞ ĂǀĂŝůĂďůĞ ƚŽ ƚŚĞ ƵŶŝŶƐƵƌĞĚ͕ &W ĂŶĚ ƚŚƌĞĞ ƉĂƌƚŶĞƌ ŽƌŐĂŶŝnjĂƟŽŶƐ ŚĂǀĞ ďĞĞŶ ĂǁĂƌĚĞĚ ĂŶ Ψϴϲϱ͕ϬϬϬ ŐƌĂŶƚ ďLJ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ƚŽ ƚƌĂŝŶ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ĂƐƐŝƐƚĂŶƚƐ ƚŽ ƚĂůŬ ǁŝƚŚ ƉĂƟĞŶƚƐ ĂďŽƵƚ ƚŚĞ ĞdžĐŚĂŶŐĞ͕ ƌ͘ ƌĞƐƐŶĞƌ ƐĂŝĚ͘ ͞&ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŝůů ďĞ Ă ůĂƌŐĞ ƉĂƌƚ ŽĨ ƚŚĞ ƚĞĂŵ ůĞĂĚŝŶŐ ƚŚĞ ĐŚĂƌŐĞ ĨŽƌ Ăůů ĐŝƟnjĞŶƐ ƚŽ ŚĂǀĞ ŚĞĂůƚŚĐĂƌĞ ǁŝƚŚ ƚŚŝƐ ŐƌĂŶƚ͕͟ ŚĞ ƐĂŝĚ͘ California Family Physician Fall 2013 17

C O N G R AT U L AT I O N S J A C K !

ȱ ȱ ȱ ȱ ȱ ȱ ȱ dŚĞ ĂůŝĨŽƌŶŝĂ ĐĂĚĞŵLJ ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ŝƐ ƉƌŽƵĚ ƚŽ ĂŶŶŽƵŶĐĞ ƚŚĂƚ ƐĞŶŝŽƌ &W ĞůĞŐĂƚĞ :ĂĐŬ ŚŽƵ was elected to the AAFP Board of Directors at last week’s Congress of Delegates in San Diego.

dŚĞ &W ŽŶŐƌĞƐƐ ŽĨ ĞůĞŐĂƚĞƐ͛ ƉŽůŝĐLJŵĂŬŝŶŐ ǁĂƐ ĚŝƐƉĂƚĐŚĞĚ ŝŶ ƌĞĐŽƌĚ ƟŵĞ ƚŚŝƐ LJĞĂƌ ʹǁŽƌŬ ŽŶ Ăůů ƌĞƐŽůƵƟŽŶƐ ǁĂƐ ĐŽŵƉůĞƚĞĚ ďLJ ƚŚĞ ĞŶĚ ŽĨ ƚŚĞ ĚĂLJ ŽŶ dƵĞƐĚĂLJ͕ ^ĞƉƚĞŵďĞƌ Ϯϰ͘ KƌĚŝŶĂƌŝůLJ͕ ƌĞĨĞƌĞŶĐĞ ĐŽŵŵŝƩĞĞ ƌĞƉŽƌƚƐ ĂƌĞ ƐƟůů ďĞŝŶŐ ŚĞĂƌĚ ŽŶ tĞĚŶĞƐĚĂLJ ŵŽƌŶŝŶŐ͘ ǀĞŶ ǁŚĂƚ ƉƌŽŵŝƐĞĚ ƚŽ ďĞ Ă ĐŽŶƚĞŶƟŽƵƐ ĚĞďĂƚĞ ŽŶ ƉŽůŝĐLJ ĂĚŽƉƚĞĚ ůĂƐƚ LJĞĂƌ ŝŶ ƐƵƉƉŽƌƚ ŽĨ ƐĂŵĞ ŐĞŶĚĞƌ ŵĂƌƌŝĂŐĞ ǁĂƐ ƌĞůĂƟǀĞůLJ ƚĂŵĞ͗ ƚŚĞ ZĞĨĞƌĞŶĐĞ ŽŵŵŝƩĞĞ ŽŶ ĚǀŽĐĂĐLJ ƌĞĐŽŵŵĞŶĚĞĚ Ă Ž EŽƚ ĚŽƉƚ ƉŽƐŝƟŽŶ ŽŶ Ă ƌĞƐŽůƵƟŽŶ ĐĂůůŝŶŐ ĨŽƌ &W ƚŽ ďĞ ŶĞƵƚƌĂů ŽŶ ƚŚŝƐ ƚŽƉŝĐ͖ ƚŚĞ ƌĞĨĞƌĞŶĐĞ ĐŽŵŵŝƩĞĞ͛Ɛ ƌĞĐŽŵŵĞŶĚĂƟŽŶ ǁĂƐ ĂĐĐĞƉƚĞĚ ŽŶ ƚŚĞ ŽŶƐĞŶƚ ĂůĞŶĚĂƌ͘

dŚĂŶŬƐ ŬƐƐ ƚŽ ĞǀĞƌƌLJŽ ŽŶĞ ǁ ǁŚŽ ƉĂƌƌƟĐ Ɵ ŝƉĂƚ ĂƚƚĞĚ Ě ŝŝŶ Ŷ ƚŚ ŚŝƐ ŝƐ ƐƵ ƵĐĐĐĞƐƐĨĨƵů Đ Ƶůů ĐĂŵ Ƶ ĐĐĂĂŵ ŵƉ ƉĂĂŝŐ ŝŐŶ͊ Ŷ :ĂĐŬ ŚĂƐ ƐĞƌǀĞĚ ŝŶ ĞǀĞƌLJ &W ĞůĞĐƚĞĚ ŽĸĐĞ ƐŝŶĐĞ ĮƌƐƚ ũŽŝŶŝŶŐ ƚŚĞ ĐĂĚĞŵLJ͛Ɛ ŽĂƌĚ ĂƐ Ă ƌĞƐŝĚĞŶƚ ĚŝƌĞĐƚŽƌ͘ ,Ğ ƚŽŽŬ ŚŝƐ ƐĞĂƚ ŽŶ ƚŚĞ &W ŽĂƌĚ ŝŵŵĞĚŝĂƚĞůLJ ĂůŽŶŐ ǁŝƚŚ ƚǁŽ ŽƚŚĞƌ ŵĞŵďĞƌƐ ŽĨ ŚŝƐ ĐůĂƐƐ͕ ZŽď >ĞĞ ŽĨ /ŽǁĂ ĂŶĚ DŝĐŚĂĞů DƵŶŐĞƌ ŽĨ <ĂŶƐĂƐ͘ &W ĞdžƚĞŶĚƐ ŝƚƐ ĐŽŶŐƌĂƚƵůĂƟŽŶƐ ƚŽ ƌ͘ ŚŽƵ ĂŶĚ ƚŚĂŶŬƐ ƚŽ ŚŝƐ ĐĂŵƉĂŝŐŶ ĐŽͲĐŚĂŝƌƐ͕ &W ĞůĞŐĂƚĞ ĂƌůĂ <ĂŬƵƚĂŶŝ ĂŶĚ ^ƉĞĂŬĞƌ ŽĨ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ :ĂLJ >ĞĞ͕ ĂƐ ǁĞůů ĂƐ ůƚĞƌŶĂƚĞ ĞůĞŐĂƚĞƐ :Ğī >ƵƚŚĞƌ ĂŶĚ ƌŝĐ ZĂŵŽƐ ĂŶĚ EĂƟŽŶĂů ĂƵĐƵƐ ŽĨ ^ƉĞĐŝĂů ŽŶƐƟƚƵĞŶƚƐ ĞůĞŐĂƚĞ DĂƌŝĞ ZĂŵĂƐ ĂŶĚ ůƚĞƌŶĂƚĞ ĞůĞŐĂƚĞ ^ĐŽƩ EĂƐƐ͘ &W WƌĞƐŝĚĞŶƚ DĂƌŬ ƌĞƐƐŶĞƌ ĂŶĚ WƌĞƐŝĚĞŶƚͲĞůĞĐƚ Ğů DŽƌƌŝƐ ǁĞƌĞ ĂůƐŽ ƚŚĞƌĞ ƚŽ ƐƵƉƉŽƌƚ ƚŚĞ ĐĂŵƉĂŝŐŶ ĂůŽŶŐ ǁŝƚŚ ŽĂƌĚ ŵĞŵďĞƌƐ tĂůƚ DŝůůƐ͕ WĂƚƌŝĐŝĂ DŽŽƌĞͲWŝĐŬĞƩ͕ :ĞĂŶŶŝŶĞ ZŽĚĞŵƐ͕ :ŽĂŶ ZƵďŝŶƐƚĞŝŶ͕ >ŝƐĂ tĂƌĚ ĂŶĚ ƐŚďLJ tŽůĨĞ͕ ǁŚŽ ĐĂŵĞ ũƵƐƚ ƚŽ ŚĞůƉ ǁŝƚŚ ƚŚĞ ĐĂŵƉĂŝŐŶ͕ ĞƐƉĞĐŝĂůůLJ ƚŚĞ ŚŽƐƉŝƚĂůŝƚLJ ĞǀĞŶƚ ŽŶ DŽŶĚĂLJ͕ ^ĞƉƚĞŵďĞƌ Ϯϯ͘ ŽĂƌĚ ŵĞŵďĞƌƐ ^ƚĞǀĞ 'ƌĞĞŶ ;/ŵŵĞĚŝĂƚĞ WĂƐƚ WƌĞƐŝĚĞŶƚͿ͕ >ĞĞ ZĂůƉŚ ;sŝĐĞ ^ƉĞĂŬĞƌͿ ĂŶĚ ĚŝƌĞĐƚŽƌ ĂǀŝĚ ĂnjnjŽ ĂůƐŽ ĐĂŵĞ ƚŽ ŚĞůƉ ŚŽƐƚ ƚŚĞ ŚŽƐƉŝƚĂůŝƚLJ ĞǀĞŶƚ ĂůŽŶŐ ǁŝƚŚ ĨĞůůŽǁ ^ĂŶ ŝĞŐĂŶƐ ^ĂďƌŝŶĂ ĂnjnjŽ͕ ĚĂ DĂƌŝŶ ĂŶĚ ZĂŶĚLJ ^ǁĂƌƚnj͘ DĞŵďĞƌ <ĂƌĞŶ :ĂĐŬƐŽŶ ĐĂŵĞ ĨƌŽŵ ^ĂŶ &ƌĂŶĐŝƐĐŽ ƚŽ ĂƐƐŝƐƚ ĂŶĚ DŝŬĞ ĂŶĚ ZŽƐŝĞ <ĂŬƵƚĂŶŝ ĂůŽŶŐ ǁŝƚŚ ^ƚĞǀĞ ƵƌŶƐ͕ WĂƚƌŝĐŝĂ DŽŽƌĞͲWŝĐŬĞƩ͛Ɛ ƐƉŽƵƐĞ͕ ĂůƐŽ ůĞŶƚ Ă ŚĂŶĚ͘ dŚĂŶŬƐ ƚŽ Ăůů͊

18

California Family Physician Fall 2013

&W͛Ɛ ƌĞƐŽůƵƟŽŶ ƚŽ ĞŶĚŽƌƐĞ ĂĐĐĞƐƐ ƚŽ ŽƌĂů ĐŽŶƚƌĂĐĞƉƟǀĞ ƉŝůůƐ ŽǀĞƌͲƚŚĞͲĐŽƵŶƚĞƌ ǁĂƐ ƌĞĨĞƌƌĞĚ ƚŽ ƚŚĞ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ͖ Ă ƐƵďƐƟƚƵƚĞ ĨŽƌ ŽƵƌ ƌĞƐŽůƵƟŽŶ ĂƐŬŝŶŐ &W ƚŽ ƐƵƉƉŽƌƚ ŽīĞƌŝŶŐ ŝŶƚƌĂƵƚĞƌŝŶĞ ĚĞǀŝĐĞƐ ĂƐ Ă ĮƌƐƚͲůŝŶĞ ĐŽŶƚƌĂĐĞƉƟǀĞ ŵĞƚŚŽĚ͕ ĞŶĐŽƵƌĂŐĞĚ ĂƐ ŽƉƟŽŶƐ ĨŽƌ ŵŽƐƚ ǁŽŵĞŶ ĂŶĚ ĞŶĐŽƵƌĂŐŝŶŐ ĞǀĞƌLJ h͘^͘ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵ ƚŽ ŝŶĐůƵĚĞ ĐŽƌĞ ĐƵƌƌŝĐƵůƵŵ͕ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ŝŶƚƌĂƵƚĞƌŝŶĞ ĚĞǀŝĐĞ ŝŶĚŝĐĂƟŽŶƐ ĂŶĚ ŚĂŶĚƐͲŽŶ ŝŶƐĞƌƟŽŶ ƚƌĂŝŶŝŶŐ ƚŽ ĐŽŵƉĞƚĞŶĐLJ ĂƐ ǁĞůů ĂƐ ĞŶĐŽƵƌĂŐŝŶŐ ĐŽŶƟŶƵŝŶŐ ƉƌŽĨĞƐƐŝŽŶĂů ĚĞǀĞůŽƉŵĞŶƚ ŽƉƉŽƌƚƵŶŝƟĞƐ ƌĞŐĂƌĚŝŶŐ ŝŶƚƌĂƵƚĞƌŝŶĞ ĚĞǀŝĐĞ ĞůŝŐŝďŝůŝƚLJ͕ ŝŶƐĞƌƟŽŶ ĂŶĚ ƌĞŵŽǀĂů ǁĂƐ ĂĚŽƉƚĞĚ ǁŝƚŚ ƚŚĞ ŝŶĐůƵƐŝŽŶ ŽĨ ͞ŽƚŚĞƌ ůŽŶŐͲĂĐƟŶŐ ƌĞǀĞƌƐŝďůĞ ĚĞǀŝĐĞƐ͘͟ dŚĞ ĮŶĂů ƌĞƐŽůƵƟŽŶ ĐŽŵďŝŶĞĚ Ă ƐŝŵŝůĂƌ ƌĞƐŽůƵƟŽŶ ĨƌŽŵ ƚŚĞ dĞdžĂƐ ĐĂĚĞŵLJ͘

ĂƌůĂ Ă <Ă <ĂŬƵ ŬƵ ƵƚĂ ƚĂŶŝ ĂŶŝ Ŷŝ ĂĂŶĚ ŶĚ ::Ğī > >Ƶ >Ƶƚ ƵƚŚĞ Ś ƌ ŚĞ ŚĞ Ś ĞůƉ Ɖ Ɖ ƉƌĞ ƉƌĞ ĞƉĂ ƉĂƌĞ ƌĞ ::ĂĂĐĐŬ ƌĞ ĨŽƌ ƚŚĞ ŚŽƐƉ ĨŽ Ɖŝƚ ŝ Ăů Ă ŝƚLJ Ğǀ Ğ ĞŶƚ

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ŘŖŗřȂ ȱ ȱ DZȱ ȱ ȱ ȱ ǰȱ ǰȱ tŚŝůĞ &W ĂŶĚ ŝƚƐ ŵĞŵďĞƌƐ ĨŽƵŐŚƚ ǀĂůŝĂŶƚůLJ ĚƵƌŝŶŐ ϮϬϭϯ ƚŽ ƉƌŽŵŽƚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͛Ɛ ƉƌŝŽƌŝƚŝĞƐ ŽĨ ƚŚĞ WĂƚŝĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ĂŶĚ ƚŚĞ ĚĞǀĞůŽƉŵĞŶƚ ŽĨ Ă ůĂƌŐĞƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ͕ ƚŚĞ >ĞŐŝƐůĂƚƵƌĞ ĂŶĚ &W ĂůƐŽ ƐƉĞŶƚ ĐŽŶƐŝĚĞƌĂďůĞ ƚŝŵĞ ŽŶ ŽƚŚĞƌ ŚŽƚ ďƵƚƚŽŶ ŝƐƐƵĞƐ͘ dŚĞ ĨŝƌƐƚ LJĞĂƌ ŽĨ ƚŚĞ ϮϬϭϯͲϮϬϭϰ >ĞŐŝƐůĂƚŝǀĞ ^ĞƐƐŝŽŶ ĨŽĐƵƐĞĚ ĞdžƚĞŶƐŝǀĞůLJ ŽŶ ŝŵƉůĞŵĞŶƚĂƚŝŽŶ ŽĨ ƚŚĞ ĨĨŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ ĂŶĚ ƚŚĞ ĞĨͲ ĨŽƌƚƐ ŽĨ ŽƉƚŽŵĞƚƌŝƐƚƐ͕ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ĂŶĚ ƉŚĂƌŵĂĐŝƐƚƐ ƚŽ ĞdžƉĂŶĚ ƚŚĞŝƌ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ͘ &W ǁĂƐ ƚŚĞƌĞ͕ ĞǀĞƌLJ ƐƚĞƉ ŽĨ ƚŚĞ ǁĂLJ͕ ĂĚǀŽĐĂƚŝŶŐ ĨŽƌ ƉĂƚŝĞŶƚƐ ĂŶĚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŽŶ ƚŚĞƐĞ ĐƌƵĐŝĂů ƚŽƉŝĐƐ͘ dŚĞƌĞ ŝƐ ŶŽ ĚŽƵďƚ ƚŚĂƚ ƚŚĞƐĞ ŝƐƐƵĞƐ ǁŝůů ĂĨĨĞĐƚ ŚĞĂůƚŚ ĐĂƌĞ ŝŶ ĂůŝĨŽƌŶŝĂ ĨŽƌ ƚŚĞ ĨŽƌĞƐĞĞĂďůĞ ĨƵƚƵƌĞ͘ Affordable Care Act Implementation in California ^ƚĂƚĞ ůĞĂĚĞƌƐ ŚĂǀĞ ƚĂŬĞŶ Ă ďƌŽĂĚ͕ ĐŽŶƐŽůŝĚĂƚŝŶŐ ĂƉƉƌŽĂĐŚ ƚŽ ŝŵƉůĞŵĞŶƚŝŶŐ ƚŚĞ ͘ dŚƌŽƵŐŚ ĂĐƚŝŽŶ ďƌŽƵŐŚƚ ĂďŽƵƚ ďLJ ůĂƐƚ LJĞĂƌ͛Ɛ ƐƚĂƚĞ ďƵĚŐĞƚ͕ ĂůŝĨŽƌŶŝĂ ŚĂƐ ĂƚƚĞŵƉƚĞĚ ƚŽ ŝŶĐůƵĚĞ ĂƐ ŵĂŶLJ ƐƚĂƚĞ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽŐƌĂŵƐ ĂƐ ƉŽƐƐŝďůĞ ŝŶƚŽ ƚŚĞ DĞĚŝͲ Ăů ƉƌŽŐƌĂŵ ĂŶĚ ƚƌĂŶƐŝƚŝŽŶ ĂůŵŽƐƚ Ăůů DĞĚŝͲ Ăů ďĞŶĞĨŝĐŝĂƌŝĞƐ ŝŶƚŽ ŵĂŶĂŐĞĚ ĐĂƌĞ͘ dŚŝƐ ƚƌĂŶƐŝƚŝŽŶ ŝŶĐůƵĚĞƐ ƚŚĞ ĨŽůůŽǁŝŶŐ ŐƌŽƵƉƐ͗ ͻ ^ĞŶŝŽƌƐ ĂŶĚ WĞƌƐŽŶƐ ǁŝƚŚ ŝƐĂďŝůŝƚLJ ;^W ^Ϳ͘ ͻ ĞŶĞĨŝĐŝĂƌŝĞƐ ĚƵĂůůLJ ĞůŝŐŝďůĞ ĨŽƌ DĞĚŝĐĂŝĚ ĂŶĚ DĞĚŝĐĂƌĞ ; ƵĂůƐͿ͘ ͻ ,ĞĂůƚŚLJ &ĂŵŝůŝĞƐ WƌŽŐƌĂŵ ;,&WͿ ĐŚŝůĚƌĞŶ͘ ͻ /ŶĚŝǀŝĚƵĂůƐ ƉĂƌƚŝĐŝƉĂƚŝŶŐ ŝŶ ƚŚĞ >Žǁ /ŶĐŽŵĞ ,ĞĂůƚŚ WƌŽŐƌĂŵ ;>/,WͿ͘ ͻ /ŶĚŝǀŝĚƵĂůƐ ǁŚŽ ǁŝůů ŐĂŝŶ ĐŽǀĞƌĂŐĞ ĂƐ Ă ƌĞƐƵůƚ ŽĨ ƚŚĞ DĞĚŝĐĂŝĚ ĞůŝŐŝďŝůŝƚLJ ĞdžƉĂŶƐŝŽŶ ŝŶĐůƵĚĞĚ ŝŶ ƚŚĞ ͕ ƌĞŶĚĞƌĞĚ ͞ŽƉƚŝŽŶĂů͟ ďLJ ƚŚĞ h^ ^ƵƉƌĞŵĞ ŽƵƌƚ ĚĞĐŝƐŝŽŶ ƵƉŚŽůĚŝŶŐ ƚŚĞ ͘

dŚĞƐĞ ƚƌĂŶƐŝƚŝŽŶƐ ĐŽŵĞ Ăƚ Ă ƚŝŵĞ ǁŚĞŶ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ŽƚŚĞƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ǁŝůů ƌĞĐĞŝǀĞ Ă ƐŝŐŶŝĨŝĐĂŶƚ ƉĂLJŵĞŶƚ ŝŶĐƌĞĂƐĞ͕ ďƌŝŶŐŝŶŐ DĞĚŝͲ Ăů ƉĂLJŵĞŶƚƐ ;ĐƵƌƌĞŶƚůLJ ĂŵŽŶŐ ƚŚĞ ůŽǁĞƐƚ DĞĚŝĐĂŝĚ ƌĂƚĞƐ ŝŶ ƚŚĞ ŶĂƚŝŽŶͿ ƵƉ ƚŽ DĞĚŝͲ ĐĂƌĞ ůĞǀĞůƐ ĨŽƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐĞƌǀŝĐĞƐ ƵŶƚŝů :ĂŶƵĂƌLJ ϮϬϭϱ͘ /Ĩ ƚŚŝƐ ǁĂƐ ŶŽƚ ĐŽŵƉůŝĐĂƚĞĚ ĞŶŽƵŐŚ͕ ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂƌĞ ^ĞƌǀŝĐĞƐ ;ƚŚĞ ĂŐĞŶĐLJ ŝŶ ĐŚĂƌŐĞ ŽĨ ĂĚŵŝŶŝƐƚĞƌŝŶŐ ƚŚĞ DĞĚŝͲ Ăů ƉƌŽŐƌĂŵͿ ǁŝůů ďĞ ĐƵƚƚŝŶŐ ĐĞƌƚĂŝŶ DĞĚŝͲ Ăů ƉƌŽǀŝĚͲ ĞƌƐ͛ ƉĂLJŵĞŶƚƐ ďLJ ϭϬ ƉĞƌĐĞŶƚ͕ ĐůĂǁŝŶŐ ďĂĐŬ Ă ƉĞƌĐĞŶƚĂŐĞ ŽĨ ƉĂLJŵĞŶƚ ĨŽƌ ƐĞƌǀŝĐĞƐ ƌĞŶĚĞƌĞĚ ƐŝŶĐĞ :ƵůLJ ϮϬϭϭ ƚŽ ƌĞĐŽƵƉ ƚŚĞ ϭϬ ƉĞƌĐĞŶƚ ;ĞdžĞŵƉƚŝŶŐ ƐƉĞĐŝĂůŝƐƚƐ ŝŶ ŵĂŶĂŐĞĚ ĐĂƌĞ ƐĞƚƚŝŶŐƐͿ͘ /Ĩ LJŽƵ͛ǀĞ ĨŽůůŽǁĞĚ Ăůů ŽĨ ƚŚĂƚ͕ LJŽƵ ĞŝƚŚĞƌ ǁŽƌŬ ŝŶ ƚŚĞ &W ŽĨĨŝĐĞ Žƌ LJŽƵ͛ǀĞ ďĞĞŶ ǀŝƐŝƚŝŶŐ ŽƵƌ ǁĞďƐŝƚĞ ŽĨƚĞŶ͊ Legislation to Expand Non-physician Scope of Practice /Ŷ ϮϬϭϮ͕ ŵĂŶLJ ƐƚĂƚĞ ĐŚĂƉƚĞƌƐ ŽĨ ƚŚĞ &W ƌĞƉŽƌƚĞĚ ƚŚĂƚ ŶŽŶͲƉŚLJƐŝĐŝĂŶ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ǁĞƌĞ ƵƐŝŶŐ ƚŚĞ ƉƌŽũĞĐƚĞĚ ƐŚŽƌƚĂŐĞ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ŝŶ ƚŚĞŝƌ ƐƚĂƚĞƐ ĂƐ ĂŶ

ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĞdžƉĂŶĚ ƚŚĞŝƌ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ ůĞŐŝƐůĂƚŝǀĞůLJ͕ ƉĂƌƚŝĐƵůĂƌůLJ ŝŶƚŽ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ /Ŷ ĂŶƚŝĐŝƉĂƚŝŽŶ ŽĨ ƐƵĐŚ Ă ŵŽǀĞ ŝŶ ŽƵƌ ƐƚĂƚĞ͕ &W ƚŽŽŬ ƐƚĞƉƐ ŝŶ ĞĂƌůLJ ϮϬϭϯ ƚŽ ƉƌĞƉĂƌĞ ĨŽƌ ƚŚĞ ĐŽŵŝŶŐ ŽŶƐůĂƵŐŚƚ͘ &W͛Ɛ ƉŽůŝĐLJ ŽŶ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ ŝƐ ŶŽƚ ƚŽ ŽƉƉŽƐĞ ĂŶLJ ĂŶĚ Ăůů ƐĐŽƉĞ ĞdžƉĂŶƐŝŽŶƐ͘ /ƚ ŝƐ ƚŚĂƚ ĂŶLJ ƉƌŽǀŝĚĞƌ ;ƉŚLJƐŝĐŝĂŶ Žƌ ŽƚŚĞƌǁŝƐĞͿ ǁŚŽ ǁĂŶƚƐ ƚŽ ƉƌŽǀŝĚĞ Ă ƉĂƌƚŝĐƵůĂƌ ƐĞƌǀŝĐĞ ƐŚŽƵůĚ ŚĂǀĞ ƐŝŐŶŝĨŝĐĂŶƚ ĂŶĚ ŵŽƌĞ ƚŚĂŶ ĂĚĞƋƵĂƚĞ ƚƌĂŝŶŝŶŐ ĂŶĚ ĞdžƉĞƌŝĞŶĐĞ ŝŶ ƚŚĂƚ ƐĞƌǀŝĐĞ͘ 'ŝǀĞŶ ƚŚĞ ĐƵƌƌĞŶƚ ĂŶĚ ƉƌŽũĞĐƚĞĚ ǁŽƌŬĨŽƌĐĞ ƐŚŽƌƚĂŐĞ Ăƚ Ăůů ůĞǀĞůƐ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ͕ &W ŚĂƐ ďĞĞŶ ĂĚǀŽĐĂƚŝŶŐ ĨŽƌ ŵƵůƚŝƉůĞ ƐŽůƵƚŝŽŶƐ͕ ŝŶĐůƵĚŝŶŐ ĂŶ ĂůůͲƉĂLJĞƌ 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƚŝŽŶ ĨƵŶĚ ƚŽ ŝŶĐƌĞĂƐĞ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƉƌŝŵĂƌLJ ƌĞƐŝĚĞŶĐLJ ƐůŽƚƐ ŝŶ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ƚŚĂƚ ƚƌĞĂƚ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƚŝŽŶƐ͘ ĞĨŽƌĞ ůĞŐŝƐůĂƚŝŽŶ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ͕ Ă &W Ě ,ŽĐ ^ĐŽƉĞ ŽŵŵŝƚƚĞĞ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁĂƐ ĐƌĞĂƚĞĚ ƚŽ ŵĂŬĞ ƌĞĐŽŵͲ ŵĞŶĚĂƚŝŽŶƐ ƚŽ ƚŚĞ &W >ĞŐŝƐůĂƚŝǀĞ ĨĨĂŝƌƐ ŽŵŵŝƚƚĞĞ ĂŶĚ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ ƌĞŐĂƌĚŝŶŐ ƉŽƐƐŝďůĞ ƐĐŽƉĞ ůĞŐŝƐůĂƚŝŽŶ͘ dŚĞ Ě ,ŽĐ ŽŵŵŝƚƚĞĞ ƌĞĐŽŐŶŝnjĞĚ ƚŚĂƚ͕ ǁŚŝůĞ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ ĨŽƌ ƉƌŽǀŝĚĞƌƐ ƐƵĐŚ ĂƐ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ŚĂƐ ŶŽƚ ŝŵƉƌŽǀĞĚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ŝŶ ƐƚĂƚĞƐ ƚŚĂƚ ĂůůŽǁ ŝƚ͕ ĂĐĐĞƐƐ͕ ƋƵĂůͲ ŝƚLJ ĂŶĚ ĐŽƐƚ ŚĂǀĞ ŝŵƉƌŽǀĞĚ ƐŝŐŶŝĨŝĐĂŶƚůLJ ŝŶ ƐƚĂƚĞƐ ƚŚĂƚ ŚĂǀĞ ĂĚŽƉƚĞĚ ƚĞĂŵͲďĂƐĞĚ ĐĂƌĞ ŵŽĚĞůƐ͕ ƐƵĐŚ ĂƐ ƚŚĞ WĂƚŝĞŶƚ ĞŶͲ ƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ͘ /Ŷ ĐŽŵďŝŶĂƚŝŽŶ ǁŝƚŚ &W͛Ɛ ĞdžŝƐƚŝŶŐ ƐĐŽƉĞ ƉŽůŝĐLJ ƌĞŐĂƌĚŝŶŐ ƚƌĂŝŶŝŶŐ ĂŶĚ ĞĚƵĐĂƚŝŽŶ͕ ƚŚŝƐ ƐĞƌǀĞĚ ĂƐ ƚŚĞ ďĂƐŝƐ ĨŽƌ Ă ƐĞƚ ŽĨ ƐĐŽƉĞ ƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐ ƚŚĂƚ ĂŝŵĞĚ ƚŽ ĐŚĂŶŐĞ Žƌ ĞdžƉĂŶĚ ĐƵƌƌĞŶƚ ůĂǁ ƚŽ ŝŵƉƌŽǀĞ ƚĞĂŵͲďĂƐĞĚ ĐĂƌĞ ǁŝƚŚŽƵƚ ƉƵƚƚŝŶŐ ƉĂƚŝĞŶƚƐ ŝŶ ŚĂƌŵ͛Ɛ ǁĂLJ͘ ĨƚĞƌ ŽĂƌĚ ĂƉƉƌŽǀͲ Ăů͕ &W͛Ɛ ĂĚǀŽĐĂĐLJ ƚĞĂŵ ƵƐĞĚ ƚŚĞƐĞ ŐƵŝĚŝŶŐ ƉƌŝŶĐŝƉůĞƐ ŝŶ ĚŝƐĐƵƐƐŝŽŶƐ ǁŝƚŚ ůĞŐŝƐůĂƚŽƌƐ ĂŶĚ ŶĞŐŽƚŝĂƚŝŽŶƐ ǁŝƚŚ ƚŚĞ ďŝůůƐ͛ ƉƌŽƉŽŶĞŶƚƐ͘ dŚŝƐ ĞĨĨŽƌƚ͕ ĐŽƵƉůĞĚ ǁŝƚŚ ƚŚĞ ŚŝŐŚůLJ ĞĨĨĞĐƚŝǀĞ ŐƌĂƐƐƌŽŽƚƐ ĂĐƚŝǀŝƚLJ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ŽƚŚĞƌƐ ĂĐƌŽƐƐ ƚŚĞ ƐƚĂƚĞ͕ ĂĐŚŝĞǀĞĚ ƐŝŐŶŝĨŝĐĂŶƚ ǀŝĐƚŽƌŝĞƐ͘ ^ ϰϵϭ ;,ĞƌŶĂŶĚĞnjͿ͕ Ă ďŝůů ƚŚĂƚ ǁŽƵůĚ ŐŝǀĞ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐͲ ƚŝĐĞ ƚŽ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ;EWƐͿ͕ ǁĂƐ ŚĞůĚ ŝŶ ƚŚĞ ƐƐĞŵďůLJ ƉƉƌŽƉƌŝĂƚŝŽŶƐ ŽŵŵŝƚƚĞĞ͘ &W ĂŶĚ ŝƚƐ ĂůůŝĞƐ ƉƌŽǀĞĚ ƚŽ ůĞŐŝƐůĂƚŽƌƐ ƚŚĂƚ Ă ƚĞĂŵͲďĂƐĞĚ ĂƉƉƌŽĂĐŚ ƚŽ ĐĂƌĞ͕ ǁŝƚŚ ƚĞĂŵ ŵĞŵďĞƌƐ ǁŽƌŬŝŶŐ ƚŽ ƚŚĞ ŚŝŐŚĞƐƚ ĞdžƚĞŶƚ ŽĨ ƚŚĞŝƌ ůŝĐĞŶƐĞƐ ĂŶĚ Ăƚ ůĞĂƐƚ ƐŽŵĞ ůĞǀĞů ŽĨ ƉŚLJƐŝĐŝĂŶ ŝŶǀŽůǀĞŵĞŶƚ͕ ŝƐ ƚŚĞ ďĞƐƚ ǁĂLJ ƚŽ ŝŶĐƌĞĂƐĞ ĂĐĐĞƐƐ͕ ŝŵƉƌŽǀĞ ƋƵĂůŝƚLJ ĂŶĚ ůŽǁĞƌ ĐŽƐƚƐ͘ ƌĞĂƚŝŶŐ ŶĞǁ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ǁŝůů ŽŶůLJ ĨƵƌƚŚĞƌ ĨƌĂŐŵĞŶƚ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ ĂŶĚ ŚƵƌƚ ĐĂƌĞ ĐŽŽƌĚŝŶĂƚŝŽŶ͘ &W ŚŽƉĞƐ ƚŽ ǁŽƌŬ ǁŝƚŚ ƚŚĞ ŽƌŐĂŶŝnjĂƚŝŽŶƐ ƌĞƉƌĞƐĞŶƚŝŶŐ EWƐ ďĞĨŽƌĞ ϮϬϭϰ ƚŽ ƌĞĂĐŚ Ă ĐŽŵƉƌŽŵŝƐĞ ƚŚĂƚ ĞŶƐƵƌĞƐ ƉĂƚŝĞŶƚƐ ƌĞĐĞŝǀĞ ƚĞĂŵͲďĂƐĞĚ ĐĂƌĞ͕ ǁŝƚŚ ƚĞĂŵ ŵĞŵďĞƌƐ ŵĂdžŝŵŝnjŝŶŐ ƚŚĞ ǀĂůƵĞ ƚŚĞLJ ďƌŝŶŐ ƚŽ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͘ ^ ϰϵϮ ;,ĞƌŶĂŶĚĞnjͿ͕ Ă ďŝůů ƚŚĂƚ ǁŽƵůĚ ŚĂǀĞ ŽƌŝŐŝŶĂůůLJ ĂůůŽǁĞĚ ŽƉƚŽŵĞƚƌŝƐƚƐ ƚŽ ƚĞƐƚ ĨŽƌ͕ ĚŝĂŐŶŽƐĞ ĂŶĚ ƚƌĞĂƚ ĂŶLJ ĐŽŶĚŝƚŝŽŶ California Family Physician Fall 2013 19

PHYSICIAN â&#x20AC;&#x201C; FAMILY MEDICINE Vista Community Clinic located in North San Diego County Ć&#x161;Ĺ&#x161;Ä&#x201A;Ć&#x161; Ĺ?Ĺś Ć?ŽžÄ&#x17E; Ć&#x2030;Ä&#x201A;Ć&#x152;Ć&#x161; ĹľÄ&#x201A;ĹśĹ?ĨÄ&#x17E;Ć?Ć&#x161;Ä&#x17E;Ä&#x161; Ĺ?Ĺś Ć&#x161;Ĺ&#x161;Ä&#x17E; Ä&#x17E;Ç&#x2021;Ä&#x17E; ÍžÄ&#x17E;Í&#x2DC;Ĺ?Í&#x2DC;Í&#x2022; / ^Í&#x2022; Ä&#x161;Ĺ?Ä&#x201A;Ä?Ä&#x17E;Ć&#x161;Ä&#x17E;Ć?Í&#x2022; Ä&#x17E;Ć&#x161;Ä?Í&#x2DC;ÍżÍ&#x2022; Ç Ä&#x201A;Ć? Ć?Ĺ?Ĺ?ĹśĹ?ĨĹ?Ä?Ä&#x201A;ĹśĆ&#x161;ĹŻÇ&#x2021; Ä&#x201A;ĹľÄ&#x17E;ĹśÄ&#x161;Ä&#x17E;Ä&#x161;Í&#x2022; Ä?ĆľĆ&#x161; Ć?Ć&#x161;Ĺ?ĹŻĹŻ Ć&#x152;Ä&#x201A;Ĺ?Ć?Ä&#x17E;Ä&#x161; Ć&#x2030;Ä&#x201A;Ć&#x161;Ĺ?Ä&#x17E;ĹśĆ&#x161; Ä?Ä&#x201A;Ć&#x152;Ä&#x17E; Ä?ŽŜÄ?Ä&#x17E;Ć&#x152;ĹśĆ? ĨŽĆ&#x152; &WÍ&#x2DC; dĹ&#x161;Ä&#x17E; ĨĹ?ĹśÄ&#x201A;ĹŻ Ç&#x20AC;Ä&#x17E;Ć&#x152;Ć?Ĺ?ŽŜ ŽĨ Ć&#x161;Ĺ&#x161;Ä&#x17E; Ä?Ĺ?ĹŻĹŻ Ç Ĺ˝ĆľĹŻÄ&#x161; Ĺ&#x161;Ä&#x201A;Ç&#x20AC;Ä&#x17E; Ä&#x201A;ĹŻĹŻĹ˝Ç Ä&#x17E;Ä&#x161; Ä&#x201A;Ĺś Ĺ˝Ć&#x2030;Ć&#x161;ŽžÄ&#x17E;Ć&#x161;Ć&#x152;Ĺ?Ć?Ć&#x161;Í&#x2022; Ç Ĺ?Ć&#x161;Ĺ&#x161; ĹŻĹ?Ć&#x161;Ć&#x161;ĹŻÄ&#x17E; Ĺ˝Ć&#x152; ŜŽ Ć&#x161;Ć&#x152;Ä&#x201A;Ĺ?ĹśĹ?ĹśĹ?Í&#x2022; Ć&#x161;Ĺ˝ Ć&#x161;Ä&#x17E;Ć?Ć&#x161; ĨŽĆ&#x152;Í&#x2022; Ä&#x161;Ĺ?Ä&#x201A;Ĺ?ŜŽĆ?Ä&#x17E; Ä&#x201A;ĹśÄ&#x161; Ć&#x161;Ć&#x152;Ä&#x17E;Ä&#x201A;Ć&#x161; Ä&#x161;Ĺ?Ä&#x201A;Ä?Ä&#x17E;Ć&#x161;Ä&#x17E;Ć?Í&#x2022; Ĺ&#x161;Ç&#x2021;Ć&#x2030;Ä&#x17E;Ć&#x152;Ć&#x161;Ä&#x17E;ĹśĆ?Ĺ?ŽŜ Ä&#x201A;ĹśÄ&#x161; Ĺ&#x161;Ç&#x2021;Ć&#x2030;Ä&#x17E;Ć&#x152;Ä?Ĺ&#x161;ŽůÄ&#x17E;Ć?Ć&#x161;Ä&#x17E;Ć&#x152;ŽůÄ&#x17E;ĹľĹ?Ä&#x201A;Í&#x2DC; &W Ä&#x201A;ĹśÄ&#x161; Ĺ?Ć&#x161;Ć? Ä&#x201A;ĹŻĹŻĹ?Ä&#x17E;Ć? Ĺ˝Ć&#x2030;Ć&#x2030;Ĺ˝Ć?Ä&#x17E;Ä&#x161; Ć&#x161;Ĺ&#x161;Ĺ?Ć? ĹľÄ&#x17E;Ä&#x201A;Ć?ĆľĆ&#x152;Ä&#x17E; Ć&#x161;Ĺ˝ Ć&#x161;Ĺ&#x161;Ä&#x17E; Ä&#x17E;ĹśÄ&#x161;Í&#x2022; Ć&#x2030;Ć&#x152;Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹśĆ&#x161;Ĺ?ĹśĹ? Ĺ?Ć&#x161; ĨĆ&#x152;Žž Ć&#x2030;Ä&#x201A;Ć?Ć?Ĺ?ĹśĹ? Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć?Ć?Ä&#x17E;ĹľÄ?ĹŻÇ&#x2021; ĆľĆ?Ĺ?ĹśÄ&#x17E;Ć?Ć?Í&#x2022; WĆ&#x152;ŽĨÄ&#x17E;Ć?Ć?Ĺ?ŽŜĆ? Ä&#x201A;ĹśÄ&#x161; ŽŜĆ?ƾžÄ&#x17E;Ć&#x152; WĆ&#x152;Ĺ˝Ć&#x161;Ä&#x17E;Ä?Ć&#x161;Ĺ?ŽŜ ŽžžĹ?Ć&#x161;Ć&#x161;Ä&#x17E;Ä&#x17E;Í&#x2DC; &W Ç Ĺ?ĹŻĹŻ Ä?Ä&#x17E; Ä&#x201A; Ć&#x2030;Ä&#x201A;Ć&#x152;Ć&#x161; ŽĨ Ć?Ć&#x161;Ä&#x201A;ĹŹÄ&#x17E;Ĺ&#x161;ŽůÄ&#x161;Ä&#x17E;Ć&#x152; ĹľÄ&#x17E;Ä&#x17E;Ć&#x161;Ĺ?ĹśĹ?Ć? Ä?Ä&#x17E;ĨŽĆ&#x152;Ä&#x17E; ĎŽĎŹĎ­Ď° Ć&#x161;Ĺ˝ Ć?Ä&#x17E;Ä&#x17E; Ĺ?Ĩ Ä&#x201A; Ä?ŽžĆ&#x2030;Ć&#x152;ŽžĹ?Ć?Ä&#x17E; Ä?Ä&#x201A;Ĺś Ä?Ä&#x17E; Ć&#x152;Ä&#x17E;Ä&#x201A;Ä?Ĺ&#x161;Ä&#x17E;Ä&#x161;Í&#x2DC;

Seeking: Full-time, part-time and per diem Family Medicine Physicians.

Requirements: California license, DEA license, CPR certiďŹ cation and board certiďŹ ed in family medicine.

Bilingual English/Spanish preferred.

Contact Us: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760-414-3702

We want to help you! Whether you're buying a practice, selling a practice, or just looking, Doctors Broker will eliminate all of the work and stress that comes with the brokering process.

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Adam Francis is the Deputy Director, Government Affairs.

20

California Family Physician Fall 2013

For details call (877)955-4447 or email: Info@DoctorsBroker.com

INSPIRE greatness

At Dignity Health Medical Foundation, we lead by example. By always striving to give our personal bestâ&#x20AC;&#x201D;and encouraging our patients and colleagues to do the sameâ&#x20AC;&#x201D;weâ&#x20AC;&#x2122;re able to achieve and do more than we ever imagined. If youâ&#x20AC;&#x2122;re ready to inspire greatness in yourself and others, join us today.

We currently have the following opportunities with our different medical groups throughout Northern & Central California:

&AMILY Practice:

s 2EDDING 3ACRAMENTO 3ANTA #RUZ 3TOCKTON

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Michelle Gilbert

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Our locations offer access to outstanding schools, exciting recreational opportunities and a wide variety of cultural events. Our physicians utilize leading edge technology, including EMR, and enjoy a collegial and supportive environment. We also offer a competitive compensation & benefits package which includes bonus potential and a very desirable retirement plan. &OR MORE INFORMATION PLEASE CONTACT 0HYSICIAN 2ECRUITMENT 0HONE %MAIL PROVIDERS DIGNITYHEALTH ORG WWW DIGNITYHEALTH ORG

PHYSICIAN â&#x20AC;&#x201C; OBSTETRICS AND GYNECOLOGY

Vista Community Clinic located in North San Diego County Seeking: Part-Time and per diem OB/GYN Physicians.

Requirements: California license, DEA license, CPR certiďŹ cation and board certiďŹ ed in obstetrics and gynecological medicine.

Bilingual English/Spanish preferred. Bilingual English/Spanish

Contact Us: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760-414-3702

health.org

West Coast

Family Medicine Opportunities

Northern, Central and Southern California, The Pacific Northwest and Hawaii

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Inpatient, Outpatient & Traditional Family Medicine options available

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Multiple employment models

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Full & Part-time possibilities

Visit physiciancareers.ah.org or confidentially contact Ryan Rasmusson, Director of Physician Recruitment, at 800.847.9840 to discover why top physicians choose to work with Adventist Health

phyjobs@ah.org y 800.847.9840 y physiciancareers.ah.org California Family Physician Fall 2013 21

PROVEN. LOW RATE OF HYPOGLYCEMIA

POWERFUL A1C REDUCTIONS -0.8% to -1.5%*

MAY PROVIDE ADDITIONAL BENEFIT OF WEIGHT LOSS†

For adult patients with type 2 diabetes, Victoza® offers these benefits and more.

Visit VictozaPro.com/Care to learn how the support program helps patients get started.

*Victoza® 1.2 mg and 1.8 mg when used alone or in combination with OADs. † Victoza® is not indicated for the management of obesity, and weight change was a secondary end point in clinical trials.

Indications and Usage Victoza® (liraglutide [rDNA origin] injection) is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Because of the uncertain relevance of the rodent thyroid C-cell tumor findings to humans, prescribe Victoza® only to patients for whom the potential benefits are considered to outweigh the potential risk.

Victoza® is not recommended as first-line therapy for patients who have inadequate glycemic control on diet and exercise.

Based on spontaneous postmarketing reports, acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis has been observed in patients treated with Victoza®. Victoza® has not been studied in patients with a history of pancreatitis. It is unknown whether patients with a history of pancreatitis are at increased risk for pancreatitis while using Victoza®. Other antidiabetic therapies should be considered in patients with a history of pancreatitis.

Victoza® is not a substitute for insulin. Victoza® should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings.

Victoza® has not been studied in combination with prandial insulin.

Important Safety Information

Liraglutide causes dose-dependent and treatment-durationdependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Victoza® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as human relevance could not be ruled out by clinical or nonclinical studies. Victoza® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Based on the findings in rodents, monitoring with serum calcitonin or thyroid ultrasound was performed during clinical trials, but this may have increased the number of unnecessary thyroid surgeries. It is unknown whether monitoring with serum calcitonin or thyroid ultrasound will mitigate human risk of thyroid C-cell tumors. Patients should be counseled regarding the risk and symptoms of thyroid tumors.

Victoza® is a registered trademark of Novo Nordisk A/S. © 2013 Novo Nordisk All rights reserved.

22

California Family Physician Fall 2013

Do not use in patients with a prior serious hypersensitivity reaction to Victoza® (liraglutide [rDNA origin] injection) or to any of the product components.

Postmarketing reports, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis. Discontinue promptly if pancreatitis is suspected. Do not restart if pancreatitis is confirmed. Consider other antidiabetic therapies in patients with a history of pancreatitis.

When Victoza® is used with an insulin secretagogue (e.g. a sulfonylurea) or insulin serious hypoglycemia can occur. Consider lowering the dose of the insulin secretagogue or insulin to reduce the risk of hypoglycemia.

Renal impairment has been reported postmarketing, usually in association with nausea, vomiting, diarrhea, or dehydration which may sometimes require hemodialysis. Use caution when initiating or escalating doses of Victoza® in patients with renal impairment.

Serious hypersensitivity reactions (e.g. anaphylaxis and angioedema) have been reported during postmarketing use of Victoza®. If symptoms of hypersensitivity reactions occur, patients must stop taking Victoza ® and seek medical advice promptly.

There have been no studies establishing conclusive evidence of macrovascular risk reduction with Victoza® or any other antidiabetic drug.

The most common adverse reactions, reported in ≥5% of patients treated with Victoza® and more commonly than in patients treated with placebo, are headache, nausea, diarrhea, dyspepsia, constipation and anti-liraglutide antibody formation. Immunogenicity-related events, including urticaria, were more common among Victoza®treated patients (0.8%) than among comparator-treated patients (0.4%) in clinical trials.

Victoza® has not been studied in type 2 diabetes patients below 18 years of age and is not recommended for use in pediatric patients.

There is limited data in patients with renal or hepatic impairment.

Please see brief summary of Prescribing Information on adjacent page.

0513-00015592-1

June 2013

Victoza® (liraglutide [rDNA origin] injection) Rx Only BRIEF SUMMARY. Please consult package insert for full prescribing information.

WARNING: RISK OF THYROID C-CELL TUMORS: Liraglutide causes dose-dependent and treatmentduration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Victoza® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as human relevance could not be ruled out by clinical or nonclinical studies.

Victoza® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Based on the findings in rodents, monitoring with serum calcitonin or thyroid ultrasound was performed during clinical trials, but this may have increased the number of unnecessary thyroid surgeries. It is unknown whether monitoring with serum calcitonin or thyroid ultrasound will mitigate human risk of thyroid C-cell tumors. Patients should be counseled regarding the risk and symptoms of thyroid tumors [see Contraindications and Warnings and Precautions].

INDICATIONS AND USAGE: Victoza® is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Important Limitations of Use: Because of the uncertain relevance of the rodent thyroid C-cell tumor findings to humans, prescribe Victoza® only to patients for whom the potential benefits are considered to outweigh the potential risk. Victoza® is not recommended as first-line therapy for patients who have inadequate glycemic control on diet and exercise. Based on spontaneous postmarketing reports, acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis has been observed in patients treated with Victoza®. Victoza® has not been studied in patients with a history of pancreatitis. It is unknown whether patients with a history of pancreatitis are at increased risk for pancreatitis while using Victoza®. Other antidiabetic therapies should be considered in patients with a history of pancreatitis. Victoza® is not a substitute for insulin. Victoza® should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings. The concurrent use of Victoza® and prandial insulin has not been studied.

CONTRAINDICATIONS: Do not use in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Do not use in patients with a prior serious hypersensitivity reaction to Victoza® or to any of the product components.

WARNINGS AND PRECAUTIONS: Risk of Thyroid C-cell Tumors: Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors (adenomas and/or carcinomas) at clinically relevant exposures in both genders of rats and mice. Malignant thyroid C-cell carcinomas were detected in rats and mice. A statistically significant increase in cancer was observed in rats receiving liraglutide at 8-times clinical exposure compared to controls. It is unknown whether Victoza® will cause thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors could not be determined by clinical or nonclinical studies. In the clinical trials, there have been 6 reported cases of thyroid C-cell hyperplasia among Victoza®-treated patients and 2 cases in comparator-treated patients (1.3 vs. 1.0 cases per 1000 patient-years). One comparator-treated patient with MTC had pre-treatment serum calcitonin concentrations >1000 ng/L suggesting pre-existing disease.

All of these cases were diagnosed after thyroidectomy, which was prompted by abnormal results on routine, protocol-specified measurements of serum calcitonin. Five of the six Victoza®-treated patients had elevated calcitonin concentrations at baseline and throughout the trial. One Victoza® and one non-Victoza®-treated patient developed elevated calcitonin concentrations while on treatment. Calcitonin, a biological marker of MTC, was measured throughout the clinical development program. The serum calcitonin assay used in the Victoza® clinical trials had a lower limit of quantification (LLOQ) of 0.7 ng/L and the upper limit of the reference range was 5.0 ng/L for women and 8.4 ng/L for men. At Weeks 26 and 52 in the clinical trials, adjusted mean serum calcitonin concentrations were higher in Victoza®-treated patients compared to placebo-treated patients but not compared to patients receiving active comparator. At these timepoints, the adjusted mean serum calcitonin values (~1.0 ng/L) were just above the LLOQ with between-group differences in adjusted mean serum calcitonin values of approximately 0.1 ng/L or less. Among patients with pre-treatment serum calcitonin below the upper limit of the reference range, shifts to above the upper limit of the reference range which persisted in subsequent measurements occurred most frequently among patients treated with Victoza® 1.8 mg/day. In trials with on-treatment serum calcitonin measurements out to 5-6 months, 1.9% of patients treated with Victoza® 1.8 mg/day developed new and persistent calcitonin elevations above the upper limit of the reference range compared to 0.8-1.1% of patients treated with control medication or the 0.6 and 1.2 mg doses of Victoza®. In trials with on-treatment serum calcitonin measurements out to 12 months, 1.3% of patients treated with Victoza® 1.8 mg/day had new and persistent elevations of calcitonin from below or within the reference range to above the upper limit of the reference range, compared to 0.6%, 0% and 1.0% of patients treated with Victoza® 1.2 mg, placebo and active control, respectively. Otherwise, Victoza® did not produce consistent dose-dependent or time-dependent increases in serum calcitonin.

Patients with MTC usually have calcitonin values >50 ng/L. In Victoza® clinical trials, among patients with pre-treatment serum calcitonin <50 ng/L, one Victoza®-treated patient and no comparator-treated patients developed serum calcitonin >50 ng/L. The Victoza®-treated patient who developed serum calcitonin >50 ng/L had an elevated pre-treatment serum calcitonin of 10.7 ng/L that increased to 30.7 ng/L at Week 12 and 53.5 ng/L at the end of the 6-month trial. Follow-up serum calcitonin was 22.3 ng/L more than 2.5 years after the last dose of Victoza®. The largest increase in serum calcitonin in a comparator-treated patient was seen with glimepiride in a patient whose serum calcitonin increased from 19.3 ng/L at baseline to 44.8 ng/L at Week 65 and 38.1 ng/L at Week 104. Among patients who began with serum calcitonin <20 ng/L, calcitonin elevations to >20 ng/L occurred in 0.7% of Victoza®-treated patients, 0.3% of placebo-treated patients, and 0.5% of active-comparator-treated patients, with an incidence of 1.1% among patients treated with 1.8 mg/day of Victoza®. The clinical significance of these findings is unknown. Counsel patients regarding the risk for MTC and the symptoms of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea or persistent hoarseness). It is unknown whether monitoring with serum calcitonin or thyroid ultrasound will mitigate the potential risk of MTC, and such monitoring may increase the risk of unnecessary procedures, due to low test specificity for serum calcitonin and a high background incidence of thyroid disease. Patients with thyroid nodules noted on physical examination or neck imaging obtained for other reasons should be referred to an endocrinologist for further evaluation. Although routine monitoring of serum calcitonin is of uncertain value in patients treated with Victoza®, if serum calcitonin is measured and found to be elevated, the patient should be referred to an endocrinologist for further evaluation. Pancreatitis: Based on spontaneous postmarketing reports, acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with Victoza®. After initiation of Victoza®, observe patients carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting). If pancreatitis is suspected, Victoza® should promptly be discontinued and appropriate management should be initiated. If pancreatitis is confirmed, Victoza® should not be restarted. Consider antidiabetic therapies other than Victoza® in patients with a history of pancreatitis. In clinical trials of Victoza®, there have been 13 cases of pancreatitis among Victoza®-treated patients and 1 case in a comparator (glimepiride) treated patient (2.7 vs. 0.5 cases per 1000 patient-years). Nine of the 13 cases with Victoza® were reported as acute pancreatitis and four were reported as chronic pancreatitis. In one case in a Victoza®-treated patient, pancreatitis, with necrosis, was observed and led to death; however clinical causal-

ity could not be established. Some patients had other risk factors for pancreatitis, such as a history of cholelithiasis or alcohol abuse. Use with Medications Known to Cause Hypoglycemia: Patients receiving Victoza® in combination with an insulin secretagogue (e.g., sulfonylurea) or insulin may have an increased risk of hypoglycemia. The risk of hypoglycemia may be lowered by a reduction in the dose of sulfonylurea (or other concomitantly administered insulin secretagogues) or insulin Renal Impairment: Victoza® has not been found to be directly nephrotoxic in animal studies or clinical trials. There have been postmarketing reports of acute renal failure and worsening of chronic renal failure, which may sometimes require hemodialysis in Victoza®-treated patients. Some of these events were reported in patients without known underlying renal disease. A majority of the reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. Some of the reported events occurred in patients receiving one or more medications known to affect renal function or hydration status. Altered renal function has been reversed in many of the reported cases with supportive treatment and discontinuation of potentially causative agents, including Victoza®. Use caution when initiating or escalating doses of Victoza® in patients with renal impairment. Hypersensitivity Reactions: There have been postmarketing reports of serious hypersensitivity reactions (e.g., anaphylactic reactions and angioedema) in patients treated with Victoza®. If a hypersensitivity reaction occurs, the patient should discontinue Victoza® and other suspect medications and promptly seek medical advice. Angioedema has also been reported with other GLP-1 receptor agonists. Use caution in a patient with a history of angioedema with another GLP-1 receptor agonist because it is unknown whether such patients will be predisposed to angioedema with Victoza®. Macrovascular Outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Victoza® or any other antidiabetic drug.

ADVERSE REACTIONS: Clinical Trials Experience: Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety of Victoza® has been evaluated in 8 clinical trials: A double-blind 52-week monotherapy trial compared Victoza® 1.2 mg daily, Victoza® 1.8 mg daily, and glimepiride 8 mg daily; A double-blind 26 week add-on to metformin trial compared Victoza® 0.6 mg once-daily, Victoza® 1.2 mg once-daily, Victoza® 1.8 mg once-daily, placebo, and glimepiride 4 mg once-daily; A double-blind 26 week add-on to glimepiride trial compared Victoza® 0.6 mg daily, Victoza® 1.2 mg once-daily, Victoza® 1.8 mg once-daily, placebo, and rosiglitazone 4 mg once-daily; A 26 week add-on to metformin + glimepiride trial, compared double-blind Victoza® 1.8 mg once-daily, double-blind placebo, and open-label insulin glargine once-daily; A doubleblind 26-week add-on to metformin + rosiglitazone trial compared Victoza® 1.2 mg once-daily, Victoza® 1.8 mg once-daily and placebo; An open-label 26-week add-on to metformin and/or sulfonylurea trial compared Victoza® 1.8 mg once-daily and exenatide 10 mcg twice-daily; An open-label 26-week add-on to metformin trial compared Victoza® 1.2 mg once-daily, Victoza® 1.8 mg once-daily, and sitagliptin 100 mg once-daily; An open-label 26-week trial compared insulin detemir as add-on to Victoza® 1.8 mg + metformin to continued treatment with Victoza® + metformin alone. Withdrawals: The incidence of withdrawal due to adverse events was 7.8% for Victoza®-treated patients and 3.4% for comparator-treated patients in the five double-blind controlled trials of 26 weeks duration or longer. This difference was driven by withdrawals due to gastrointestinal adverse reactions, which occurred in 5.0% of Victoza®-treated patients and 0.5% of comparator-treated patients. In these five trials, the most common adverse reactions leading to withdrawal for Victoza®-treated patients were nausea (2.8% versus 0% for comparator) and vomiting (1.5% versus 0.1% for comparator). Withdrawal due to gastrointestinal adverse events mainly occurred during the first 2-3 months of the trials. Common adverse reactions: Tables 1, 2, 3 and 4 summarize common adverse reactions (hypoglycemia is discussed separately) reported in seven of the eight controlled trials of 26 weeks duration or longer. Most of these adverse reactions were gastrointestinal in nature. In the five double-blind clinical trials of 26 weeks duration or longer, gastrointestinal adverse reactions were reported in 41% of Victoza®-treated patients and were dose-related. Gastrointestinal adverse reactions occurred in 17% of comparator-treated patients. Common adverse reactions that occurred at a higher incidence among Victoza®-treated patients included nausea, vomiting, diarrhea, dyspepsia and constipation. In the five double-blind and three open-label clinical trials of 26 weeks duration or longer, the percentage of patients who reported nausea declined over time. In the five double-blind trials approximately 13% of Victoza®-treated patients and 2% of comparator-treated patients reported nausea during the first 2 weeks of treatment. In the 26-week open-label trial comparing Victoza® to exenatide, both in combination with metformin and/or sulfonylurea, gastrointestinal adverse reactions were reported at a similar incidence in the Victoza® and exenatide treatment groups (Table 3). In the 26-week open-label trial comparing Victoza® 1.2 mg, Victoza® 1.8 mg and sitagliptin 100 mg, all in combination with metformin, gastrointestinal adverse reactions were reported at a higher incidence with Victoza® than sitagliptin (Table 4). In the remaining 26-week trial, all patients received Victoza® 1.8 mg + metformin during a 12-week run-in period. During the run-in period, 167 patients (17% of enrolled total) withdrew from the trial: 76 (46% of withdrawals) of these patients doing so because of gastrointestinal adverse reactions and 15 (9% of withdrawals) doing so due to other adverse events. Only those patients who completed the run-in period with inadequate glycemic control were randomized to 26 weeks of add-on therapy with insulin detemir or continued, unchanged treatment with Victoza® 1.8 mg + metformin. During this randomized 26-week period, diarrhea was the only adverse reaction reported in ≥5% of patients treated with Victoza® 1.8 mg + metformin + insulin detemir (11.7%) and greater than in patients treated with Victoza® 1.8 mg and metformin alone (6.9%).

Table 1: Adverse reactions reported in ≥5% of Victoza®-treated patients in a 52-week monotherapy trial All Victoza® N = 497 Glimepiride N = 248 (%) (%) Adverse Reaction Nausea 28.4 8.5 Diarrhea 17.1 8.9 Vomiting 10.9 3.6 Constipation 9.9 4.8 Headache 9.1 9.3 Table 2: Adverse reactions reported in ≥5% of Victoza®-treated patients and occurring more frequently with Victoza® compared to placebo: 26-week combination therapy trials Add-on to Metformin Trial All Victoza® + Metformin Placebo + Metformin Glimepiride + Metformin N = 724 N = 121 N = 242 (%) (%) (%) Adverse Reaction Nausea 15.2 4.1 3.3 Diarrhea 10.9 4.1 3.7 Headache 9.0 6.6 9.5 Vomiting 6.5 0.8 0.4 Add-on to Glimepiride Trial ® Placebo + Glimepiride Rosiglitazone + All Victoza + Glimepiride N = 695 N = 114 Glimepiride N = 231 (%) (%) (%) Adverse Reaction Nausea 7.5 1.8 2.6 Diarrhea 7.2 1.8 2.2

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Constipation Dyspepsia

5.3 0.9 1.7 5.2 0.9 2.6 Add-on to Metformin + Glimepiride Victoza® 1.8 + Metformin Placebo + Metformin + Glargine + Metformin + + Glimepiride N = 230 Glimepiride N = 114 Glimepiride N = 232 (%) (%) (%) Adverse Reaction Nausea 13.9 3.5 1.3 Diarrhea 10.0 5.3 1.3 Headache 9.6 7.9 5.6 Dyspepsia 6.5 0.9 1.7 Vomiting 6.5 3.5 0.4 Add-on to Metformin + Rosiglitazone Placebo + Metformin + Rosiglitazone All Victoza® + Metformin + Rosiglitazone N = 355 N = 175 (%) (%) Adverse Reaction Nausea 34.6 8.6 Diarrhea 14.1 6.3 Vomiting 12.4 2.9 Headache 8.2 4.6 Constipation 5.1 1.1 Table 3: Adverse Reactions reported in ≥5% of Victoza®-treated patients in a 26-Week Open-Label Trial versus Exenatide Victoza® 1.8 mg once daily + Exenatide 10 mcg twice daily + metformin and/or sulfonylurea metformin and/or sulfonylurea N = 235 N = 232 (%) (%) Adverse Reaction Nausea 25.5 28.0 Diarrhea 12.3 12.1 Headache 8.9 10.3 Dyspepsia 8.9 4.7 Vomiting 6.0 9.9 Constipation 5.1 2.6 Table 4: Adverse Reactions in ≥5% of Victoza®-treated patients in a 26-Week Open-Label Trial versus Sitagliptin All Victoza® + metformin Sitagliptin 100 mg/day + N = 439 metformin N = 219 (%) (%) Adverse Reaction Nausea 23.9 4.6 Headache 10.3 10.0 Diarrhea 9.3 4.6 Vomiting 8.7 4.1 Immunogenicity: Consistent with the potentially immunogenic properties of protein and peptide pharmaceuticals, patients treated with Victoza® may develop anti-liraglutide antibodies. Approximately 50-70% of Victoza®-treated patients in the five double-blind clinical trials of 26 weeks duration or longer were tested for the presence of anti-liraglutide antibodies at the end of treatment. Low titers (concentrations not requiring dilution of serum) of anti-liraglutide antibodies were detected in 8.6% of these Victoza®-treated patients.

Sampling was not performed uniformly across all patients in the clinical trials, and this may have resulted in an underestimate of the actual percentage of patients who developed antibodies. Cross-reacting antiliraglutide antibodies to native glucagon-like peptide-1 (GLP-1) occurred in 6.9% of the Victoza®-treated patients in the double-blind 52-week monotherapy trial and in 4.8% of the Victoza®-treated patients in the double-blind 26-week add-on combination therapy trials. These cross-reacting antibodies were not tested for neutralizing effect against native GLP-1, and thus the potential for clinically significant neutralization of native GLP-1 was not assessed. Antibodies that had a neutralizing effect on liraglutide in an in vitro assay occurred in 2.3% of the Victoza®-treated patients in the double-blind 52-week monotherapy trial and in 1.0% of the Victoza®-treated patients in the double-blind 26-week add-on combination therapy trials.

Among Victoza®-treated patients who developed anti-liraglutide antibodies, the most common category of adverse events was that of infections, which occurred among 40% of these patients compared to 36%, 34% and 35% of antibody-negative Victoza®-treated, placebo-treated and active-control-treated patients, respectively. The specific infections which occurred with greater frequency among Victoza®-treated antibody-positive patients were primarily nonserious upper respiratory tract infections, which occurred among 11% of Victoza®-treated antibody-positive patients; and among 7%, 7% and 5% of antibody-negative Victoza®-treated, placebo-treated and active-control-treated patients, respectively. Among Victoza®-treated antibody-negative patients, the most common category of adverse events was that of gastrointestinal events, which occurred in 43%, 18% and 19% of antibody-negative Victoza®-treated, placebo-treated and active-control-treated patients, respectively. Antibody formation was not associated with reduced efficacy of Victoza® when comparing mean HbA1c of all antibody-positive and all antibody-negative patients. However, the 3 patients with the highest titers of anti-liraglutide antibodies had no reduction in HbA1c with Victoza® treatment. In the five double-blind clinical trials of Victoza®, events from a composite of adverse events potentially related to immunogenicity (e.g. urticaria, angioedema) occurred among 0.8% of Victoza®-treated patients and among 0.4% of comparator-treated patients. Urticaria accounted for approximately one-half of the events in this composite for Victoza®-treated patients. Patients who developed anti-liraglutide antibodies were not more likely to develop events from the immunogenicity events composite than were patients who did not develop anti-liraglutide antibodies. Injection site reactions: Injection site reactions (e.g., injection site rash, erythema) were reported in approximately 2% of Victoza®-treated patients in the five double-blind clinical trials of at least 26 weeks duration. Less than 0.2% of Victoza®-treated patients discontinued due to injection site reactions. Papillary thyroid carcinoma: In clinical trials of Victoza®, there were 7 reported cases of papillary thyroid carcinoma in patients treated with Victoza® and 1 case in a comparator-treated patient (1.5 vs. 0.5 cases per 1000 patient-years). Most of these papillary thyroid carcinomas were <1 cm in greatest diameter and were diagnosed in surgical pathology specimens after thyroidectomy prompted by findings on protocol-specified screening with serum calcitonin or thyroid ultrasound. Hypoglycemia: In the eight clinical trials of at least 26 weeks duration, hypoglycemia requiring the assistance of another person for treatment occurred in 11 Victoza®-treated patients (2.3 cases per 1000 patient-years) and in two exenatidetreated patients. Of these 11 Victoza®-treated patients, six patients were concomitantly using metformin and a sulfonylurea, one was concomitantly using a sulfonylurea, two were concomitantly using metformin (blood glucose values were 65 and 94 mg/dL) and two were using Victoza® as monotherapy (one of these patients was undergoing an intravenous glucose tolerance test and the other was receiving insulin as treatment during a hospital stay). For these two patients on Victoza® monotherapy, the insulin treatment was the likely explanation for the hypoglycemia. In the 26-week open-label trial comparing Victoza® to sitagliptin, 24

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the incidence of hypoglycemic events defined as symptoms accompanied by a fingerstick glucose <56 mg/ dL was comparable among the treatment groups (approximately 5%).

Table 5: Incidence (%) and Rate (episodes/patient year) of Hypoglycemia in the 52-Week Monotherapy Trial and in the 26-Week Combination Therapy Trials Victoza® Treatment Active Comparator Placebo Comparator None Monotherapy Victoza® (N = 497) Glimepiride (N = 248) Patient not able to 0 0 — self−treat Patient able to self−treat 9.7 (0.24) 25.0 (1.66) — Not classified 1.2 (0.03) 2.4 (0.04) — ® Glimepiride + Placebo + Metformin Add-on to Metformin Victoza + Metformin (N = 724) Metformin (N = 121) (N = 242) Patient not able to 0.1 (0.001) 0 0 self−treat Patient able to self−treat 3.6 (0.05) 22.3 (0.87) 2.5 (0.06) None Continued Victoza® Add-on to Victoza® + Insulin detemir + ® Metformin Victoza + Metformin + Metformin alone (N = 158*) (N = 163) Patient not able to 0 0 — self−treat Patient able to self−treat 9.2 (0.29) 1.3 (0.03) — Add-on to Victoza® + Glimepiride Rosiglitazone + Placebo + Glimepiride Glimepiride (N = 695) Glimepiride (N = 231) (N = 114) Patient not able to 0.1 (0.003) 0 0 self−treat Patient able to self−treat 7.5 (0.38) 4.3 (0.12) 2.6 (0.17) Not classified 0.9 (0.05) 0.9 (0.02) 0 ® Placebo + Metformin Add-on to Metformin Victoza + Metformin + Rosiglitazone None + Rosiglitazone + Rosiglitazone (N = 355) (N = 175) 0 — 0 Patient not able to self−treat Patient able to self−treat 7.9 (0.49) — 4.6 (0.15) Not classified 0.6 (0.01) — 1.1 (0.03) ® Add-on to Metformin Victoza + Metformin Insulin glargine Placebo + Metformin + Glimepiride + Metformin + + Glimepiride + Glimepiride (N = 230) Glimepiride (N = 232) (N = 114) Patient not able to 2.2 (0.06) 0 0 self−treat Patient able to self−treat 27.4 (1.16) 28.9 (1.29) 16.7 (0.95) Not classified 0 1.7 (0.04) 0 *One patient is an outlier and was excluded due to 25 hypoglycemic episodes that the patient was able to self-treat. This patient had a history of frequent hypoglycemia prior to the study.

In a pooled analysis of clinical trials, the incidence rate (per 1,000 patient-years) for malignant neoplasms (based on investigator-reported events, medical history, pathology reports, and surgical reports from both blinded and open-label study periods) was 10.9 for Victoza®, 6.3 for placebo, and 7.2 for active comparator.

After excluding papillary thyroid carcinoma events [see Adverse Reactions], no particular cancer cell type predominated. Seven malignant neoplasm events were reported beyond 1 year of exposure to study medication, six events among Victoza®-treated patients (4 colon, 1 prostate and 1 nasopharyngeal), no events with placebo and one event with active comparator (colon). Causality has not been established. Laboratory Tests: In the five clinical trials of at least 26 weeks duration, mildly elevated serum bilirubin concentrations (elevations to no more than twice the upper limit of the reference range) occurred in 4.0% of Victoza®treated patients, 2.1% of placebo-treated patients and 3.5% of active-comparator-treated patients. This finding was not accompanied by abnormalities in other liver tests. The significance of this isolated finding is unknown. Vital signs: Victoza® did not have adverse effects on blood pressure. Mean increases from baseline in heart rate of 2 to 3 beats per minute have been observed with Victoza® compared to placebo.

The long-term clinical effects of the increase in pulse rate have not been established. Post-Marketing Experience: The following additional adverse reactions have been reported during post-approval use of Victoza®. Because these events are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure: Dehydration resulting from nausea, vomiting and diarrhea; Increased serum creatinine, acute renal failure or worsening of chronic renal failure, sometimes requiring hemodialysis; Angioedema and anaphylactic reactions; Allergic reactions: rash and pruritus; Acute pancreatitis, hemorrhagic and necrotizing pancreatitis sometimes resulting in death.

OVERDOSAGE: Overdoses have been reported in clinical trials and post-marketing use of Victoza®. Effects have included severe nausea and severe vomiting. In the event of overdosage, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms.

More detailed information is available upon request.

For information about Victoza® contact: Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, NJ 08536, 1−877-484-2869 Date of Issue: April 16, 2013 Version: 6 Manufactured by: Novo Nordisk A/S, DK-2880 Bagsvaerd, Denmark Victoza® is covered by US Patent Nos. 6,268,343, 6,458,924, 7,235,627, 8,114,833 and other patents pending.

Victoza® Pen is covered by US Patent Nos. 6,004,297, RE 43,834, RE 41,956 and other patents pending. © 2010-2013 Novo Nordisk 0513-00015681-1 5/2013

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ȱ ȱ ȱ ¢ȱ ȱ ¢ȱ ȱ ¢ ƉƌŽŐƌĂŵƐ͕ ůŝŬĞ sĞŶƚƵƌĂ͕ ǁŝĚĞůLJ ŬŶŽǁŶ ŝŶ ƚŚĞ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ĐŽŵŵƵͲ ŶŝƚLJ ĂƐ Ă ͞ĐŽǁďŽLJ͟ ƌĞƐŝĚĞŶĐLJ ƚƌĂŝŶŝŶŐ ƉƌŽŐƌĂŵ͕ ƉƌĞƉĂƌĞ ƐƚƵĚĞŶƚƐ ĨŽƌ ƚŚĞ ƵŶŬŶŽǁŶ͗ ͞tĞ ƉƌŽǀŝĚĞ ƚƌĂŝŶŝŶŐ ŝŶ ĂĚǀĂŶĐĞĚ ƉƌŽĐĞĚƵƌĞƐ ďĞĐĂƵƐĞ ǁĞ ďĞůŝĞǀĞ ƚŚĂƚ ƉƌĂĐƟĐŝŶŐ ĨƵůů ƐƉĞĐƚƌƵŵ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝƐ Ă ŵŽƌĞ ƐĂƟƐĨLJŝŶŐ ǁĂLJ ƚŽ ƉƌŽǀŝĚĞ ĐĂƌĞ ƚŽ ƚŚĞ ƵŶĚĞƌƐĞƌǀĞĚ ŝŶ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ͘ zŽƵ ĐĂŶ ƉƌŽǀŝĚĞ ĐĂƌĞ ǁŝƚŚ ĐŽŶĮĚĞŶĐĞ because your training will support what your community ŶĞĞĚƐ͘ dŚĞƌĞ ŝƐ ŶŽ ďĞƩĞƌ ǁĂLJ ƚŽ ƉƌĞƉĂƌĞ LJŽƵƌƐĞůĨ ĨŽƌ ƚŚĞ ƵŶŬŶŽǁŶ ŽĨ ƌƵƌĂů Žƌ ŝŶƚĞƌŶĂƟŽŶĂů ŵĞĚŝĐŝŶĞ ƚŚĂŶ ƚŽ ĚĞǀĞůŽƉ ĂƐ ŵĂŶLJ ĂƌƌŽǁƐ ĂƐ ƉŽƐƐŝďůĞ ŝŶ LJŽƵƌ ƋƵŝǀĞƌ ǁŚŝůĞ ŝŶ ƚƌĂŝŶŝŶŐ͊͟ Ͳ ĂǀŝĚ ƌĂƵũŽ͕ D ͕ WƌŽŐƌĂŵ ŝƌĞĐƚŽƌ͕ sĞŶƚƵƌĂ &ĂŵŝůLJ Medicine Residency Program KƚŚĞƌ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ƚŚĂƚ ƚƌĂŝŶ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĨŽƌ ǁŽƌŬ ŝŶ ƚŚĞ ĂƌŵĞĚ ĨŽƌĐĞƐ ƐĞĞ ƚĞĂĐŚŝŶŐ ƉƌŽĐĞĚƵƌĞƐ ĂƐ Ă ŶĞĞĚĞĚ ƚŚƌŽǁďĂĐŬ ƚŽ ƚŚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŽĨ LJĞƐƚĞƌLJĞĂƌ͗

Peter Br Pe B od derickk, MD MM MEd suiits t up fo or a procedur ure ur e in Mod odessto to.

WƌŽĐĞĚƵƌĂů ƚƌĂŝŶŝŶŐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐŝĞƐ ŚĂƐ ďĞĞŶ Ă ŚŽƚ ƚŽƉŝĐ ŝŶ ƌĞĐĞŶƚ LJĞĂƌƐ͘ hŶůŝŬĞ ŵĂŶLJ ŽƚŚĞƌ ŵĞĚŝĐĂů ƐƉĞĐŝĂůƟĞƐ ǁŚĞƌĞ Ă ŶĂƌƌŽǁ ƐĐŽƉĞ ŽĨ ŵĂŶĚĂƚŽƌLJ ƉƌŽĐĞĚƵƌĞƐ ŝƐ ĚĞĮŶĞĚ͕ ƉƌŽĐĞĚƵƌĂů ƚƌĂŝŶŝŶŐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŚĂƐ ůĂƌŐĞůLJ ďĞĞŶ ůĞŌ ƚŽ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ƉƌŽŐƌĂŵ ƚŽ ĚĞĮŶĞ͘ Ɛ Ă ƌĞƐƵůƚ͕ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŐƌĂĚƵĂƚĞ ǁŝƚŚ ǀĂƌŝĞĚ ůĞǀĞůƐ ŽĨ ĐŽŵƉĞƚĞŶĐLJ ŝŶ ƉƌŽĐĞĚƵƌĂů ƐŬŝůůƐ͕ ĂŶĚ ƚŚĞ ƐĐŽƉĞ ŽĨ ƉƌŽĐĞĚƵƌĂů ƉƌĂĐƟĐĞ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝͲ ĐŝĂŶƐ ƌĞŵĂŝŶƐ ǁĞĂŬůLJ ĚĞĮŶĞĚ͘ ĂĐŚ ƉƌŽŐƌĂŵ ŵƵƐƚ ĐƌĞĂƚĞ Ă ƌĞƋƵŝƌĞĚ ĐŽŵƉĞƚĞŶĐLJ ƉƌŽĐĞĚƵƌĞ ůŝƐƚ ĂŶĚ ƚƌĂĐŬ ƚŚĞ ƉƌŽŐƌĞƐƐ ŽĨ ŝƚƐ ƌĞƐŝĚĞŶƚƐ͕ ďƵƚ ĞǀĞŶ ƚŚĞ ďĞƐƚ ƚƌĂĐŬŝŶŐ ƉƌŽĐĞĚƵƌĞƐ ĚŽ ŶŽƚ ĂůǁĂLJƐ ƐĂƟƐĨLJ ŚŽƐƉŝƚĂůͲƉƌŝǀŝͲ ůĞŐŝŶŐ ĐŽŵŵŝƩĞĞƐ͘ dŚĞ ǁŝĚĞ ǀĂƌŝĂƟŽŶ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚƌĂŝŶŝŶŐ ĂůƐŽ ĐŽŶƚƌŝďƵƚĞƐ ƚŽ ƚŚĞ ĚŝĸĐƵůƟĞƐ ŵĂŶLJ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŚĂǀĞ ǁŝƚŚ ŽďƚĂŝŶͲ ŝŶŐ ĂŶĚ ŵĂŝŶƚĂŝŶŝŶŐ ŚŽƐƉŝƚĂů ƉƌŝǀŝůĞŐĞƐ ĨŽƌ ĂĚǀĂŶĐĞĚ ƉƌŽĐĞĚƵƌĞƐ͘ &Žƌ ƌĞƐŝĚĞŶƚƐ ǁŚŽ ŚĂǀĞ ƚŚĞ ĂďŝůŝƚLJ ƚŽ ĂĐĐƵƌĂƚĞůLJ ƉƌĞĚŝĐƚ ǁŚĂƚ ƉƌŽĐĞͲ ĚƵƌĞƐ ƚŚĞLJ ǁŝůů ĂŶĚ ǁŽŶ͛ƚ ĐŽŵƉůĞƚĞ ƉŽƐƚͲƌĞƐŝĚĞŶĐLJ ƚƌĂŝŶŝŶŐ͕ ƚŚŝƐ ŵĂLJ ŶŽƚ ďĞ Ă ƉƌŽďůĞŵ͘ DĂŶLJ ƌĞƐŝĚĞŶƚƐ ĮŶĚ ƚŚĞŵƐĞůǀĞƐ ŝŶ ƉƌĂĐƟĐĞ ĞŶǀŝƌŽŶͲ ŵĞŶƚƐ ĚŝīĞƌĞŶƚ ĨƌŽŵ ǁŚĂƚ ƚŚĞLJ ĞŶǀŝƐŝŽŶĞĚ͕ Žƌ ŝŶ ƌƵƌĂů Žƌ ƵƌďĂŶ ĂƌĞĂƐ ǁŚĞƌĞ ĂĐĐĞƐƐ ƚŽ ƐƉĞĐŝĂůŝƐƚƐ ŝƐ ůŝŵŝƚĞĚ͕ ĂŶĚ ǁŚĞƌĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂƌĞ ŽŌĞŶ ƚŚĞ ƉƌŝŵĂƌLJ ƐŽƵƌĐĞ ŽĨ ĐĂƌĞ͕ ŚŽǁĞǀĞƌ͘ WĂƟĞŶƚƐ ŝŶ ƚŚĞƐĞ ĂƌĞĂƐ ŵĂLJ ŚĂǀĞ ĚŝĸĐƵůƚLJ ŽďƚĂŝŶŝŶŐ ŶĞĞĚĞĚ ŵĞĚŝĐĂů ƐĞƌǀŝĐĞƐ ŝĨ ƚƌĂŝŶĞĚ ĨĂŵŝůLJ ƉŚLJƐŝͲ ĐŝĂŶƐ ĚŽ ŶŽƚ ŚĂǀĞ ƉƌŝǀŝůĞŐĞƐ ƚŽ ƉĞƌĨŽƌŵ ĂĚǀĂŶĐĞĚ ƉƌŽĐĞĚƵƌĞƐ ƐƵĐŚ ĂƐ ĐĞƐĂƌĞĂŶ ĚĞůŝǀĞƌLJ Žƌ ĐŽůŽŶŽƐĐŽƉLJ͘ ,ĞƌĞ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϱϬ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚƌĂŝŶŝŶŐ ƉƌŽͲ ŐƌĂŵƐ͕ Ă ǀĂƌŝĞƚLJ ŽĨ ĞdžƉĞƌŝĞŶĐĞƐ ŝƐ ƉŽƐƐŝďůĞ ĨŽƌ ƚŚĞ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ŝŶƚĞƌĞƐƚĞĚ ŝŶ ůĞĂƌŶŝŶŐ ƉƌŽĐĞĚƵƌĞƐ ŝŶ ƌĞƐŝĚĞŶĐLJ ƚƌĂŝŶŝŶŐ͘ ^ŽŵĞ ƚƌĂŝŶŝŶŐ

͞tĞ ĚŽ ŽƵƌƐ ĨŽƌ ŽŶĞ ƐŝŵƉůĞ ƌĞĂƐŽŶͶ ĂƐ EĂǀLJ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ĂƌĞ ĐĂůůĞĚ ƚŽ ŐŽ ƚŽ Ă ǀĂƌŝĞƚLJ ŽĨ ĐĂƌĞ ƐĞƫŶŐƐ ĚƵƌŝŶŐ ŽƵƌ ĐĂƌĞĞƌƐ ĂŶĚ ŵĂLJ ďĞ ƚŚĞ ͞ŽŶůLJ ŐĂŵĞ ŝŶ ƚŽǁŶ͟ ǁŝƚŚ regard to doing these, so we are expected to be able to do ĂƐ ŵƵĐŚ ĂƐ ǁĞ ĐĂŶ͘ &ŝƚƐ ďĞĂƵƟĨƵůůLJ ǁŝƚŚ ǁŚĂƚ / ƌĞĨĞƌ ƚŽ ĂƐ ͛ŽůĚ ƟŵĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘͟Ͳ DĂƌŬ :͘ &ůLJŶŶ͕ D ͕ & &W͕ Wd D h^E͕ WƌŽŐƌĂŵ ŝƌĞĐƚŽƌ͕ EĂǀĂů ,ŽƐƉŝƚĂů ĂŵƉ WĞŶĚůĞƚŽŶ͕ Family Medicine Residency hŶĨŽƌƚƵŶĂƚĞůLJ͕ ũƵƐƚ ďĞĐĂƵƐĞ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ŝƐ ƚƌĂŝŶĞĚ ŝŶ ƉƌŽĐĞĚƵƌĞƐ ĚŽĞƐŶ͛ƚ ŵĞĂŶ ŚĞ Žƌ ƐŚĞ ĂƵƚŽŵĂƟĐĂůůLJ ǁŝůů ďĞ ĂďůĞ ƚŽ ƵƐĞ ƚŚŽƐĞ ƐŬŝůůƐ͕ ŽŌĞŶ ĚƵĞ ƚŽ ŚŽƐƉŝƚĂů ƉŽůŝƟĐƐ͘ WĞƚĞƌ ƌŽĚĞƌŝĐŬ͕ D DD Ě͕ &W͛Ɛ ϮϬϭϭ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ ŽĨ ƚŚĞ zĞĂƌ ĂŶĚ ĨŽƌŵĞƌ ƉƌŽŐƌĂŵ ĚŝƌĞĐƚŽƌ ŽĨ ƚŚĞ sĂůůĞLJ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐLJ ŝŶ DŽĚĞƐƚŽ ŬŶŽǁƐ ŚŽǁ ƉĂŝŶĨƵů ƚŚŝƐ ƉƌŽĐĞƐƐ ĐĂŶ ďĞ͘ ƌ͘ ƌŽĚĞƌŝĐŬ ǁĂƐ ƐƵĐĐĞƐƐĨƵů ŝŶ ŐĂŝŶŝŶŐ ƉƌŝǀŝůĞŐĞƐ ŝŶ ŚŝƐ ůŽĐĂů ŚĞĂůƚŚ ƐLJƐƚĞŵ ƚŽ ƉĞƌĨŽƌŵ '/ ƉƌŽĐĞĚƵƌĞƐ͕ ďƵƚ ŶŽƚ ďĞĨŽƌĞ ƌĞĐƌƵŝƟŶŐ Ă ůŽĐĂů ŐĂƐƚƌŽĞŶƚĞƌŽůŽŐŝƐƚ ƚŽ ŚĞůƉ Śŝŵ ŐĂŝŶ ĞŶŽƵŐŚ ƉƌŽĐĞĚƵƌĞƐ ƚŽ ďĞ ĚĞĞŵĞĚ ĐŽŵƉĞƚĞŶƚ ďLJ ƚŚĞ ŚĞĂůƚŚ ƐLJƐƚĞŵ͕ ĞǀĞŶ ĨŽƌŐŽŝŶŐ ƚŚĞ ƉƌŽĨĞƐͲ ƐŝŽŶĂů ĨĞĞƐ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ŚŝƐ ƚƌĂŝŶŝŶŐ ƉƌŽĐĞĚƵƌĞƐ ƚŽ ĂǀŽŝĚ ĐƌĞĂƟŶŐ ĂŶLJ ŶĞŐĂƟǀĞ ĞĐŽŶŽŵŝĐ ŝŵƉĂĐƚ ŽŶ ŚŝƐ ƉƌŽĐƚŽƌ͘ tŚĂƚĞǀĞƌ ƚŚĞ ƌĞĂƐŽŶŝŶŐ ďĞŚŝŶĚ ƚƌĂŝŶŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ĐŽŵƉĞͲ ƚĞŶĐĞ ŝŶ ƉƌŽĐĞĚƵƌĞƐ͕ ƚŚĞ ůŝŵŝƚĞĚ ŶƵŵďĞƌ ŽĨ ƐƵďͲƐƉĞĐŝĂůŝƐƚƐ ĂǀĂŝůĂďůĞ ƚŽ ƚƌĞĂƚ DĞĚŝͲ Ăů ƉĂƟĞŶƚƐ ĂŶĚ ƚŚĞ ŝŶĐƌĞĂƐĞĚ ŝŶƚĞƌĞƐƚ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŵĂŬĞ ŝƚ ůŝŬĞůLJ ƚŚĂƚ ƐƚƵĚĞŶƚƐ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ƐĞĞŬ ŽƉƉŽƌƚƵŶŝƟĞƐ ƚŽ ƉƌŽͲ ǀŝĚĞ ƋƵĂůŝƚLJ ĂŶĚ ĐŽŵƉĞƚĞŶƚ ĐĂƌĞ ĨŽƌ ƚŚĞŝƌ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞ ŵŽƐƚ ĞĸĐŝĞŶƚ ǁĂLJ ƉŽƐƐŝďůĞ ŝŶ ƚŚĞ ĐŽŵŝŶŐ LJĞĂƌƐ͘ /Ĩ LJŽƵ ĂƌĞ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ŝŶƚĞƌĞƐƚĞĚ ŝŶ ůĞĂƌŶŝŶŐ ĂďŽƵƚ ĂĚǀĂŶĐĞĚ ƉƌŽĐĞĚƵƌĂů ƚƌĂŝŶŝŶŐƐ ŽīĞƌĞĚ ďLJ ŽƚŚĞƌ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ͕ ƐŝŵƉůLJ ƵƐĞ &W͛Ɛ ŶĞǁ ZĞƐŝĚĞŶĐLJ WƌŽŐƌĂŵ WƌŽĮůĞƐ ŝƌĞĐƚŽƌLJ ĂŶĚ ĮůƚĞƌ ďLJ WƌŽŐƌĂŵ ŵƉŚĂƐŝƐ Žƌ ^ƉĞĐŝĂů ZŽƚĂƟŽŶƐ͘ ^Ƶŝƚ ƵƉ͊ California Family Physician Fall 2013 25

P R O C E D U R E TA L K

ȱ ǯȱ ǰȱ ǯ ǯ

¢ȱ ȱ ǵȱ Ɛ ƌĞƐŝĚĞŶƚƐ ǁĞ ŚƵŶŐĞƌĞĚ ĨŽƌ ƉƌŽĐĞĚƵƌĞƐ͘ tĞ ĂŐŐƌĞƐƐŝǀĞůLJ ƐŽƵŐŚƚ ŽƵƚ ĞǀĞƌLJƚŚŝŶŐ ĨƌŽŵ ƚŚŽƌĂĐĞŶƚĞƐŝƐ ĂŶĚ ĐĞŶƚƌĂů ůŝŶĞƐ ŝŶ ƚŚĞ ŚŽƐƉŝƚĂů ƚŽ ŇĞdžͲƐŝŐƐ ĂŶĚ ĐŝƌĐƵŵĐŝƐŝŽŶƐ ŝŶ ĐůŝŶŝĐ͘ tĞ ƉƌŝĚĞĚ ŽƵƌƐĞůǀĞƐ ŽŶ ŽƵƌ ĂďŝůŝƚLJ ƚŽ ďĞ ƚƌĂŝŶĞĞƐ ŝŶ Ă ĮĞůĚ ƚŚĂƚ ǁĂƐ ƵŶŝƋƵĞ ʹ ǁĞ ǁĞƌĞ ŚĂŶĚƐͲŽŶ E ƚŚŝŶŬĞƌƐ Ăƚ ƚŚĞ ƐĂŵĞ ƟŵĞ͘ tĞ ǁĞƌĞ ƉƌŽǀŝĚŝŶŐ ƚŚĞ ĚŝĂŐŶŽƐŝƐ͕ ŝŶƚĞƌǀĞŶƟŽŶ͕ ĐĂƌĞ ƉůĂŶ͕ ĨŽůůŽǁͲƵƉ ĂŶĚ ƉƌĞǀĞŶƟŽŶ ƐŝŵƵůƚĂŶĞŽƵƐůLJ͘ tĞ ŐƌĂĚƵĂƚĞĚ ĐŽŵƉĞƚĞŶƚ ŝŶ Ă ǀĂƌŝĞƚLJ ŽĨ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ůĞŌ ƚŚĞ ĂĐĂĚĞŵŝĐ ďƵďďůĞ ĨŽƌ ƚŚĞ ƌĞĂů ǁŽƌůĚ ƚŽ ĮŶĚ ŵĂŶLJ ĨĂĐƚŽƌƐ ƚŚĂƚ ůŝŵŝƚ ŽƵƌ ĂďŝůŝƚLJ ƚŽ ĐŽŶƟŶƵĞ ƚŚĞƐĞ ƉƌŽĐĞĚƵƌĞƐ͕ ƐƵĐŚ ĂƐ ƟŵĞ ŶĞĞĚĞĚ͕ ĐŽƐƚ ĨŽƌ ƐƵƉƉůŝĞƐ͕ ůĂĐŬ ŽĨ ĂĚĞƋƵĂƚĞ ƌĞŝŵďƵƌƐĞŵĞŶƚ͕ ůĂĐŬ ŽĨ /ŶĚĞƉĞŶĚĞŶƚ WƌĂĐƟĐĞ ƐƐŽĐŝĂƟŽŶͬŝŶƐƵƌĂŶĐĞ ĂƵƚŚŽƌŝnjĂƟŽŶ͕ ĂƉƉƌŽƉƌŝĂƚĞ ůŝĂďŝůŝƚLJ ŝŶƐƵƌĂŶĐĞ͕ ŶŽƚ ŚĂǀŝŶŐ ďĂĐŬƵƉ ĨŽƌ ƋƵĞƐƟŽŶƐͬĐŽŵƉůŝĐĂƟŽŶƐ ĂŶĚ ŵŽƌĞ͘ ǀĞŶ ŝĨ LJŽƵ ĐŚŽŽƐĞ ŶŽƚ ƚŽ ĚŽ ƉƌŽĐĞĚƵƌĞƐ ŝŶ LJŽƵƌ ƉƌĂĐƟĐĞ͕ ŬĞĞƉŝŶŐ LJŽƵƌƐĞůĨ ĂďƌĞĂƐƚ ŽĨ ĐŽŵŵŽŶ ƉƌŽĐĞĚƵƌĞƐ ǁŝůů ŵĂŬĞ LJŽƵ Ă ďĞƩĞƌ ƉŚLJƐŝĐŝĂŶ͕ ƐŝŶĐĞ ǁĞ ŽŌĞŶ ƐĞĞ ƉĂƟĞŶƚƐ ďĞĨŽƌĞ ĂŶĚ ĂŌĞƌ Ă ƉƌŽͲ ĐĞĚƵƌĞ ĨŽƌ ĐŽƵŶƐĞůŝŶŐ͕ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ƌĞƐƵůƚƐ ĂŶĚ ƉŽƐƚͲƉƌŽĐĞĚƵƌĞ ŵĂŶĂŐĞŵĞŶƚ͘ ^ŚŽƵůĚ LJŽƵ ďĞ ĚŽŝŶŐ ƉƌŽĐĞĚƵƌĞƐ͍ ,ĞƌĞ ĂƌĞ Ă ĨĞǁ ƋƵĞƐƟŽŶƐ ƚŽ ĂƐŬ LJŽƵƌƐĞůĨ͗

ƐĞƚ ƵƉ ĂŶĚ Ă ůŝƐƚ ŽĨ ƐƵƉƉůŝĞƐ ĨŽƌ LJŽƵƌ ƐƚĂī ƚŽ ƌĞĨĞƌ ƚŽ͘ /Ŷ ƚŚĂƚ ďŝŶĚĞƌ ŚĂǀĞ Ă ůŝƐƚ ŽĨ ƚŚĞ ůĂďƐͬǀŝƚĂůƐ ŶĞĞĚĞĚ ĨŽƌ ƐƉĞĐŝĮĐ ƉƌŽĐĞĚƵƌĞƐ ;Ğ͘Ő͘ ͕ ŶĞŐĂƟǀĞ ƉƌĞŐŶĂŶĐLJ ƚĞƐƚ ĨŽƌ ĂŶ /h ŝŶƐĞƌƟŽŶͿ ĂŶĚ ŚĂǀĞ ŵĞĚŝͲ ĐĂů ĂƐƐŝƐƚĂŶƚƐ ;D ƐͿ ŽďƚĂŝŶ ƉĂƟĞŶƚ ĐŽŶƐĞŶƚ ƐŽ ĞǀĞƌLJƚŚŝŶŐ ŝƐ ƌĞĂĚLJ ƚŽ ŐŽ ǁŚĞŶ LJŽƵ ǁĂůŬ ŝŶ͘ ŵƉŽǁĞƌ LJŽƵƌ D Ɛ͘ Ž LJŽƵ ŚĂǀĞ Ă ďĂĐŬƵƉ ƉůĂŶ͍ ĮƌƐƚ ƐƚĞƉ ŝƐ ƚŽ ŚĂǀĞ ƐŽŵĞŽŶĞ ĞůƐĞ ŝŶ LJŽƵƌ ƉƌĂĐƟĐĞ ĂƐ Ă ƐĞĐŽŶĚ ƐĞƚ ŽĨ ĞLJĞƐ͘ /Ĩ ƚŚĞƌĞ ŝƐ Ă ĐŽŵƉůŝĐĂƟŽŶ͕ LJŽƵ ŵƵƐƚ ĞdžĞĐƵƚĞ LJŽƵƌ ďĂĐŬƵƉ ƉůĂŶ͘ &Žƌ ƚŚĞ ŵŽƐƚ ƉĂƌƚ͕ ƚŚŝƐ ĐĂŶ ďĞ Ă ŚŽƐƉŝƚĂůͬ Z ǁŚĞƌĞ LJŽƵ ĐĂŶ ƐĞŶĚ ƚŚĞ ƉĂƟĞŶƚ ĨŽƌ ƵƌŐĞŶƚ ĐĂƌĞ ĂŶĚ Ă ƐƉĞĐŝĂůŝƐƚ ƚŽ ǁŚŽŵ LJŽƵ ĐĂŶ ƌĞĨĞƌ ƚŚĞ ŶŽŶͲƵƌŐĞŶƚ ĐŽŵƉůŝĐĂƟŽŶƐ͘ DĂŬĞ ƐƵƌĞ ƚŽ ŚĂǀĞ Ăůů ƌŝƐŬƐ͕ ďĞŶĞĮƚƐ ĂŶĚ ƐŝŐŶƐͬƐLJŵƉƚŽŵƐ ŽĨ ĐŽŵͲ ƉůŝĐĂƟŽŶƐ ůŝƐƚĞĚ ŽŶ LJŽƵƌ ŝŶĨŽƌŵĞĚ ĐŽŶƐĞŶƚ ĨŽƌŵ ĂŶĚ ĚŽĐƵŵĞŶƚĞĚ ŝŶ ƚŚĞ ĐŚĂƌƚ͘ dŚŝŶŬ ƚŚƌŽƵŐŚ ƉŽƚĞŶƟĂů ĐŽŵƉůŝĐĂƟŽŶƐ ĂŶĚ ƉƌŽǀŝĚĞ ĂƉƉƌŽƉƌŝĂƚĞ ĨŽůůŽǁ ƵƉ͘ ŚŽŽƐŝŶŐ ƚŽ ŝŶƚĞŐƌĂƚĞ ƉƌŽĐĞĚƵƌĞƐ ŝŶ ĚĂŝůLJ ƉƌĂĐƟĐĞ ƉƌŽǀŝĚĞƐ ĂŶ ĞŶŽƌŵŽƵƐ ĂŵŽƵŶƚ ŽĨ ƐĂƟƐĨĂĐƟŽŶ ĨŽƌ ƚŚĞ ƉƌŽǀŝĚĞƌ ĂŶĚ ƉĂƟĞŶƚ ʹ ůĞŶĚŝŶŐ ƚƌƵĞ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,ͿͲƐƚLJůĞ ĨƵůů ƐƉĞĐƚƌƵŵ ƉƌŝŵĂƌLJ ĐĂƌĞ ʹ ďƵƚ LJŽƵ ŚĂǀĞ ƚŽ ďĞ ŚƵŶŐƌLJ ĨŽƌ ƉƌŽĐĞĚƵƌĞƐ͘

/Ɛ ŝƚ ǁŽƌƚŚ ŝƚ ĨŽƌ LJŽƵ͍ WĞƌƐŽŶĂůůLJ͕ / ĞŶũŽLJ ďĞŝŶŐ ŚĂŶĚƐͲŽŶ͕ ĂŶĚ / ĞŶũŽLJ ƚŚĞ ŝŶƐƚĂŶƚ ŐƌĂƟĮĐĂƟŽŶ ĞǀĞŶ ŵŽƌĞ͘ Ɛ ŝƐ ŽŌĞŶ ƚŚĞ ĐĂƐĞ ŝŶ ŽƵƌ ƐƉĞĐŝĂůƚLJ͕ ŽƵƌ ŽƵƚĐŽŵĞƐ ĂƌĞ ŵĞĂƐƵƌĞĚ ŽǀĞƌ ŵŽŶƚŚƐ ƚŽ LJĞĂƌƐ͘ tĞ ŵĂLJ ŶĞǀĞƌ ƐĞĞ ƚŚĞ ƉƌĞǀĞŶƚĂƟǀĞ ŽƵƚĐŽŵĞƐ ŽŶ ƉĂƟĞŶƚƐ ŝĨ ǁĞ ĂƌĞŶ͛ƚ ĨŽůůŽǁŝŶŐ ƚŚĞŵ ůŽŶŐ ĞŶŽƵŐŚ͘ /Ĩ ƐŽŵĞŽŶĞ ƉƌĞƐĞŶƚƐ ŝŶ ĐůŝŶŝĐ ǁŝƚŚ ĂŶ ŝŶĨĞĐƚĞĚ ĂŶĚ ƉĂŝŶĨƵů ƚŽĞŶĂŝů ĞĚŐĞ͕ Žƌ / ĂĚŵŝƚ Ă ĐŝƌƌŚŽƟĐ ĨŽƌ ƐŚŽƌƚͲ ŶĞƐƐ ŽĨ ďƌĞĂƚŚ ĂŶĚ ǁŽƌƐĞŶŝŶŐ ĂƐĐŝƚĞƐ͕ / ĐĂŶ ƉƌŽǀŝĚĞ Ă ƚƌĞĂƚŵĞŶƚ͘ ŌĞƌ ƌĞŵŽǀŝŶŐ ƚŚĞ ŶĂŝů͕ Žƌ ĨŽƵƌ ůŝƚĞƌƐ ŽĨ ĂƐĐŝƚĞƐ͕ / ĐĂŶ ǁĂůŬ ĂǁĂLJ ŬŶŽǁŝŶŐ ŵLJ ƉĂƟĞŶƚ ĨĞĞůƐ ďĞƩĞƌ ƌŝŐŚƚ ŶŽǁ͘ dŚĞ ŝŶƐƚĂŶƚ ŐƌĂƟĮĐĂƟŽŶ ĨŽƌ ďŽƚŚ ƉĂƟĞŶƚ ĂŶĚ ƉƌŽǀŝĚĞƌ ŝƐ Ă ŵĂũŽƌ ŵŽƟǀĂƟŶŐ ĨĂĐƚŽƌ ŝŶ ŵLJ ĐŚŽŝĐĞ ƚŽ ĐŽŶƟŶƵĞ ƉƌŽǀŝĚŝŶŐ ƉƌŽĐĞĚƵƌĞƐ͘ ĂŶ LJŽƵ ĂīŽƌĚ ŝƚ͍ /Ĩ LJŽƵ ŚĂǀĞ Ă ĚŝǀĞƌƐĞ ĂŶĚ ůĂƌŐĞ ĞŶŽƵŐŚ ƉƌĂĐƟĐĞ͕ ƚŚĞ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ƐƵƉƉůŝĞƐͬƚŽŽůƐ ǁŝůů LJŝĞůĚ ƉƌŽĮƚ ŝĨ LJŽƵ ĂƌĞ ďĞŝŶŐ ƉĂŝĚ ĨŽƌ ƚŚĞ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ĐĂŶ ĚŽ ĞŶŽƵŐŚ ŽĨ ƚŚĞŵ͘ Ğ ĐĂƌĞĨƵů ƚŚŽƵŐŚ͖ ƐŽŵĞ /W Ɛ ǁŝůů ŶŽƚ ĂůůŽǁ WƌŝŵĂƌLJ ĂƌĞ WƌŽǀŝĚĞƌƐ ;W WƐͿ ƚŽ ĚŽ ĐĞƌƚĂŝŶ ƉƌŽĐĞĚƵƌĞƐ͘ &Žƌ ĞdžĂŵƉůĞ͕ ŽŶĞ ŽĨ ƚŚĞ /W Ɛ ŵLJ ĐůŝŶŝĐ ŝƐ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ǁŝůů ŶŽƚ ƉĂLJ ŵĞ ĨŽƌ ĚŽŝŶŐ Ă ĐŽůƉŽƐĐŽƉLJ͕ ƌĞƋƵŝƌͲ ŝŶŐ ŵĞ ƚŽ ƌĞĨĞƌ ƚŚĂƚ ƉĂƟĞŶƚ ƚŽ Ă ŐLJŶĞĐŽůŽŐŝƐƚ͘ ZĞƐĞĂƌĐŚ ĂŶĚ ŬŶŽǁ ǁŚŝĐŚ ƉƌŽĐĞĚƵƌĞƐ LJŽƵ ĐĂŶ ďĞ ƉĂŝĚ ĨŽƌ ĂŶĚ ŚĂǀĞ ĂƉƉƌŽƉƌŝĂƚĞ ůŝĂďŝůŝƚLJ ŝŶƐƵƌĂŶĐĞ͘ Ž LJŽƵ ŚĂǀĞ ĞŶŽƵŐŚ ƟŵĞ͍ KƵƌ ƉƌĂĐƟĐĞ ŝŶƚĞŐƌĂƚĞƐ ƉƌŽĐĞĚƵƌĞƐ ǁŝƚŚ ƐƚĂŶĚĂƌĚ ƉĂƟĞŶƚ ĐĂƌĞ͕ ǁŚŝĐŚ ŵĂLJ ŶŽƚ ďĞ ĂƐ ĞĸĐŝĞŶƚ ĂƐ ƉƌŽĐĞĚƵƌĞͲ ŽŶůLJ ĚĂLJƐ͕ ďƵƚ ĚŽĞƐ ƉƌŽǀŝĚĞ ƉĂƟĞŶƚƐ ǁŝƚŚ ŵŽƌĞ ƐĐŚĞĚƵůŝŶŐ ŽƉƟŽŶƐ͘ ŽŶƐŝĚĞƌ ĚŽƵďůĞ ďŽŽŬŝŶŐ ůŽŶŐĞƌ ƉƌŽĐĞĚƵƌĞƐ ƐƵĐŚ ĂƐ ĐŝƌĐƵŵĐŝƐŝŽŶƐ͘ ,ĂǀŝŶŐ ǁĞůůͲƚƌĂŝŶĞĚ ƐƚĂī ŝƐ ĐƌƵĐŝĂů ŝŶ ƚŚŝƐ ŵŽĚĞů ƚŽ ƉƌĞǀĞŶƚ ďĂĐŬƵƉ ŝŶ ƉĂƟĞŶƚ ĐĂƌĞ͘ ƌĞĂƚĞ Ă ƉƌŽĐĞĚƵƌĞ ďŝŶĚĞƌ ǁŝƚŚ Ă ƉŝĐƚƵƌĞ ŽĨ ƚƌĂLJ 26

California Family Physician Fall 2013

dĂďůĞ ϭ͘ WƌŽĐĞĚƵƌĞƐ / ŝŶƚĞŐƌĂƚĞ ŝŶƚŽ ƉƌĂĐƚŝĐĞ͕ ǁŚĞƌĞ / perform them, and how I book them.

P R O C E D U R E TA L K

ȱ ĵ ǰȱ

ȱ ȱ ȱ ȱ ¢ȱȱ ďŽƌƟŽŶ ŝƐ ƐƟůů Ă ƐŽŵĞǁŚĂƚ ƚĂ ǁŽƌĚ ƚŽ ŵĞŶƟŽŶ ŝŶ ƉƌŝŶƚ͕ ďƵƚ ŝƚ ŝƐ ĂŶ ŝŵƉŽƌƚĂŶƚ ƐĞƌǀŝĐĞ͘ DĂŶLJ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŵĂLJ ŶŽƚ ŽƉƚ ƚŽ ďĞ ĚŝƌĞĐƚůLJ ŝŶǀŽůǀĞĚ ŝŶ ƚŚŝƐ ƉƌŽĐĞĚƵƌĞ͕ ďƵƚ ĂůŵŽƐƚ Ăůů ǁŝůů ďĞ ĂƐŬĞĚ ďLJ ƐŽŵĞ ŽĨ ƚŚĞŝƌ ƉĂƟĞŶƚƐ ĨŽƌ Ă ƌĞĨĞƌƌĂů ĨŽƌ ƚŚŝƐ ƐĞƌǀŝĐĞ͘ /ƚ ŝƐ ĞƐƟŵĂƚĞĚ ƚŚĂƚ ŽŶĞ ŝŶ ƚŚƌĞĞ ǁŽŵĞŶ ŚĂǀĞ ĂŶ ĂďŽƌƟŽŶ Ăƚ ƐŽŵĞ ƉŽŝŶƚ ŝŶ ƚŚĞŝƌ ůŝǀĞƐ͕ ĂŶĚ ǁŚŽ ďĞƩĞƌ ƚŚĂŶ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ƐĞĞ ƚŚĞŵ ƚŚƌŽƵŐŚ ƚŚŝƐ ĞŵŽƟŽŶĂůůLJ ƚĂdžŝŶŐ ƟŵĞ͍ dŚĞ ƉƌŽĐĞĚƵƌĞ ĐĂŶ ďĞ ĚŽŶĞ ĚŝƐĐƌĞƚĞůLJ ĂŶĚ ƐĂĨĞůLJ ŝŶ ĂŶ ŽĸĐĞͲďĂƐĞĚ ƐĞƫŶŐ͘

ƐŽŵĞ ŽĨ ŵLJ ĨĂǀŽƌŝƚĞ ƐƉĞĐŝĂůŝƐƚƐ͕ / ǁŽƵůĚ ŵƵĐŚ ƌĂƚŚĞƌ ƚĂŬĞ ĐĂƌĞ ŽĨ ƚŚĞŝƌ ŶĞĞĚƐ ƵŶĚĞƌ ƚŚĞ ƌŽŽĨ ŽĨ ƚŚĞŝƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ŵĞĚŝĐĂů ŚŽŵĞ͘

/ ĚŝĚ ŶŽƚ ƐĞĞ ŵLJƐĞůĨ ƉƌŽǀŝĚŝŶŐ ƚŚŝƐ ƐĞƌǀŝĐĞ ƵŶƟů ĞdžƉŽƐĞĚ ƚŽ ŝƚ ĚƵƌͲ ŝŶŐ ƌĞƐŝĚĞŶĐLJ͘ WĂƟĞŶƚƐ ǁŽƵůĚ ƉƌĞƐĞŶƚ ŝŶ ƐƚƌĞƐƐĨƵů ƐŝƚƵĂƟŽŶƐ ŽŌĞŶ ŝŶǀŽůǀŝŶŐ ĮŶĂŶĐŝĂů ŚĂƌĚƐŚŝƉƐ͕ ũƵƐƚ ƐƚĂƌƟŶŐ ĐŽůůĞŐĞ͕ ďĂƌĞůLJ ŐĞƫŶŐ ďLJ ĂƐ Ă ƐŝŶŐůĞ ƉĂƌĞŶƚ͕ ŚĂǀŝŶŐ ƚŚŽƵŐŚƚ ƚŚĞLJ ǁĞƌĞ ĚŽŶĞ ĐŚŝůĚďĞĂƌͲ ŝŶŐ͕ ĨĂŝůĞĚ ĐŽŶƚƌĂĐĞƉƟŽŶ ;Ğ͘Ő͕͘ ƚŽŽŬ ĂŶƟďŝŽƟĐƐ ĂŶĚ ƚŚĞŝƌ ƉŝůůƐ ĚŝĚŶ͛ƚ ǁŽƌŬͿ͕ ƌĂƉĞ͕ ŵĞŶƚĂů ŚĞĂůƚŚ ŝƐƐƵĞƐ Žƌ Ă ƐƚĂůŬĞƌ ďŽLJĨƌŝĞŶĚ ǁŝƚŚ ǁŚŽŵ ^ĞǀĞƌĂů ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ŝŶ ĂůŝĨŽƌŶŝĂ ŽīĞƌ ĂďŽƌͲ ƚŚĞLJ ǁĂŶƚĞĚ ŶŽ ŵŽƌĞ ƟĞƐ͘ Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ŽŌĞŶ ƐƚƌƵŐŐůĞ ƚŽ ƟŽŶ ƚƌĂŝŶŝŶŐ͕ ĂŶĚ ƚŚŝƐ ŝƐ ĨƌĞƋƵĞŶƚůLJ Ă ƐŬŝůů ŽĨ ŝŶƚĞƌĞƐƚ ĨŽƌ DĞĚŝĐĂů ^ƚƵͲ ĚŝƐĞŶƚĂŶŐůĞ ŽƵƌ ƉĂƟĞŶƚƐ ĨƌŽŵ ƚŚĞ ǁĞď ŽĨ ƚŚĞŝƌ ƉƐLJĐŚŽƐŽĐŝĂů ŵŽƌĂƐƐ͘ ĚĞŶƚƐ ĨŽƌ ŚŽŝĐĞ ǁŚŽ ĂƌĞ ůŽŽŬŝŶŐ ĨŽƌ ĨƵůů ƐĐŽƉĞ ƌĞƉƌŽĚƵĐƟǀĞ ƉƌĂĐƟĐĞ ,ĞƌĞ ŝƐ ŽŶĞ ƐŝƚƵĂƟŽŶ ǁŚĞƌĞ ǁĞ ĐĂŶ ĚĞĮŶŝƟǀĞůLJ ŽīĞƌ ŚĞůƉ͘ ĨŽƌ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͘ Ɛ ŽĨ Ɖƌŝů ϮϬϭϭ͕ ƚŚĞ ĞŶƚĞƌ ĨŽƌ ZĞƉƌŽĚƵĐƟǀĞ ,ĞĂůƚŚ ĚƵĐĂƟŽŶ ŝŶ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ŶŽƚĞĚ ƚŚĞ ĨŽůůŽǁŝŶŐ ƉƌŽŐƌĂŵƐ Ɛ ƐŽŵĞŽŶĞ ǁŚŽ ĚŽĞƐ ŽďƐƚĞƚƌŝĐĂů ĐĂƌĞ ĂƐ ǁĞůů͕ / ǁŽƌƌŝĞĚ ĂďŽƵƚ ůŝǀŝŶŐ ƚŚĂƚ ŚĂǀĞ ĨƵůůLJ ŝŶƚĞŐƌĂƚĞĚ ƚŚŝƐ ƚƌĂŝŶŝŶŐ͗ ŽŶƚƌĂ ŽƐƚĂ͕ EĂƟǀŝĚĂĚ͕ ^ĂŶ ŝŶ ĐŽŶƚƌĂĚŝĐƟŽŶƐ͘ Ƶƚ ƚŽ ŵLJ ƐƵƌƉƌŝƐĞ͕ ƉƌĂĐƟĐŝŶŐ ĂŶĚ ƚĞĂĐŚŝŶŐ ƚŚĞ ĨƵůů &ƌĂŶĐŝƐĐŽ͕ ^ƵƩĞƌ ^ĂŶƚĂ ZŽƐĂ ĂŶĚ ^ƵƩĞƌ ^ĂĐƌĂŵĞŶƚŽ͘ ƐƉĞĐƚƌƵŵ ŽĨ ƌĞƉƌŽĚƵĐƟǀĞ ŚĞĂůƚŚ ŝƐ ƌĞǁĂƌĚŝŶŐ ĂŶĚ ĂƉƉƌĞĐŝĂƚĞĚ ďLJ ƉĂƟĞŶƚƐ ĂŶĚ ůĞĂƌŶĞƌƐ͘ /ƚ ŚĞůƉƐ ĨƵůĮůů ǁŚĂƚ / ŵĞŶƟŽŶĞĚ ŝŶ ŵLJ ŵĞĚŝĐĂů ^ŽŵĞ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ŽŶůLJ ŽďƐĞƌǀĞ ƚŚĞ ƉƌŽĐĞĚƵƌĞ͘ ƐĐŚŽŽů ĂƉƉůŝĐĂƟŽŶ ʹ ͞ŚĞůƉŝŶŐ ƉĞŽƉůĞ͟ ʹ ŝŶ Ă ǁĂLJ ƚŚĂƚ ǁŽƌŬƐ ďĞƐƚ ĨŽƌ ^ŽŵĞ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ŽƉƟŽŶƐ ĐŽƵŶƐĞůŝŶŐ͕ ƵůƚƌĂƐŽƵŶĚ ĚĂƟŶŐ Žƌ ĞĂĐŚ ƉĂƟĞŶƚ͛Ɛ ŝŶĚŝǀŝĚƵĂů ĐŝƌĐƵŵƐƚĂŶĐĞƐ͘ ƉŽƐƚͲƉƌŽĐĞĚƵƌĞ /h ͬĞƚŽŶŽŐĞƐƚƌĞů ŝŵƉůĂŶƚ͘ ^ŽŵĞ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ǁŚŽůĞ ƉƌŽĐĞƐƐ͘ Ɛ Ă ŶŝĐĞ ďƌĂŶĐŚ Žī͕ ƚŚĞ ƐĂŵĞ ƉƌŽĐĞĚƵƌĞ ĐĂŶ ďĞ dŚĞ :ŽƵƌŶĂů ŽĨ ƚŚĞ ŵĞƌŝĐĂŶ ŽĂƌĚ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ŚĂƐ ĂŶ ĞdžĐĞůͲ ƵƐĞĚ ĨŽƌ ŵŝƐĐĂƌƌŝĂŐĞ ŵĂŶĂŐĞŵĞŶƚ͕ ǁŚŝĐŚ ĂĐĐŽƵŶƚƐ ĨŽƌ ĂďŽƵƚ ŽŶĞ ůĞŶƚ ƌĞǀŝĞǁ ĂƌƟĐůĞ ŽŶ ƚŚĞ ƐƚĞƉƐ ŽĨ ƉƌŽǀŝĚŝŶŐ ƚŚŝƐ ŽƵƚƉĂƟĞŶƚ ƉƌŽĐĞͲ ŽƵƚ ŽĨ ϭϬ ŽĨ ŽƵƌ ĂŶĚ Ɛ͘ Ɛ ŵƵĐŚ ĂƐ / ůŝŬĞ ƌĞĨĞƌƌŝŶŐ ƉĂƟĞŶƚƐ ƚŽ ĚƵƌĞ͗ ŚƩƉ͗ͬ​ͬǁǁǁ͘ũĂďĨŵ͘ŽƌŐͬĐŽŶƚĞŶƚͬϮϮͬϮͬϭϲϵ͘ĨƵůů͘ƉĚĨ͘

& D/>z WZ d/ KWWKZdhE/dz ƚĞĂŵ ŽĨ ŵŽƟǀĂƚĞĚ ƉƌŽĨĞƐƐŝŽŶĂůƐ Ăƚ Ă ŐƌŽǁŝŶŐ ŽŵŵƵŶŝƚLJ ,ĞĂůƚŚ ĞŶƚĞƌ ;ĐĐŚĐŝ͘ŽƌŐͿ ŝƐ ƐĞĞŬŝŶŐ Ă ͬ & D/>z WZ d/d/KE Z ƚŽ ĐŽŶƚƌŝďƵƚĞ ƚŽǁĂƌĚƐ ƚŚĞ ďƵŝůĚŝŶŐ ŽĨ Ă ƉƌŽŐƌĞƐƐŝǀĞ͕ ĮƌƐƚͲƌĂƚĞ ŵĞĚͲ ŝĐĂů ƉƌŽŐƌĂŵ ŝŶ ƚŚĞ ŵĞĚŝĐĂůůLJͲƵŶĚĞƌƐĞƌǀĞĚ ďŽƌĚĞƌ ƌĞŐŝŽŶ ŽĨ ƐŽƵƚŚĞĂƐƚĞƌŶ ƌŝnjŽŶĂ͘ &ŽĐƵƐ ŝƐ ŽŶ ƋƵĂůŝƚLJ͕ ŶŽƚ ƋƵĂŶƟƚLJ͘ ŽŵŵƵŶŝƚLJ ŽƵƚƌĞĂĐŚ͕ ƌĞƐĞĂƌĐŚ͕ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ͕ ĂŶĚ ƉƌŽŐƌĂŵ ŝŶŶŽǀĂͲ ƟŽŶ ŽƉƉŽƌƚƵŶŝƟĞƐ ĂƌĞ ĂǀĂŝůĂďůĞ ĂŶĚ ƐƵƉƉŽƌƚĞĚ͘ ŽŵƉĞƟƟǀĞ ƉĂLJͬďĞŶĞĮƚƐ͕ ǁŝƚŚ ŇĞdžŝďůĞ ǁŽƌŬ ŚŽƵƌƐͬĚĂLJƐ ĂŶ ŽƉƟŽŶ͖ ŶŽ ZͬŚŽƐƉŝƚĂů ĐŽǀĞƌĂŐĞͬĚĞůŝǀĞƌŝĞƐ ;ƵŶůĞƐƐ ĚĞƐŝƌĞĚͿ͘ &ƵůůͲ Žƌ ƉĂƌƚͲƟŵĞ ƉŽƐŝƟŽŶ;ƐͿ ĂǀĂŝůĂďůĞ͘ >ŽĂŶ ƌĞƉĂLJŵĞŶƚ͘ ĞƐŝƌĂďůĞ &d ůŝĂďŝůŝƚLJ ŝŶƐƵƌĂŶĐĞ ƉƌŽǀŝĚĞĚ͘ /ŶĐƌĞĚŝďůĞ ũŽď ŽƉƉŽƌƚƵŶŝƚLJ ĨŽƌ ƚŚĞ ƌŝŐŚƚ ƉĞƌƐŽŶ ŽŶƚĂĐƚ͗ :ŽŶĂƚŚĂŶ DĞůŬ D Ğůů͗ ϱϮϬ͘ϮϮϳ͘ϵϭϲϳ

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ȱ ¢DZȱ ¢ȱ ȱ ȱ ȱ ĞƌŵŽƐĐŽƉLJ ŝƐ ƉĞƌĨŽƌŵĞĚ ǁŝƚŚ Ă ŚĂŶĚ ŚĞůĚ ĚĞǀŝĐĞ ĐĂůůĞĚ Ă ĚĞƌŵĂƚŽƐĐŽƉĞ͘ /ƚ ƵƟůŝnjĞƐ ϭϬ ƉŽǁĞƌ ŵĂŐŶŝĮĐĂƟŽŶ ǁŝƚŚ ĐƌŽƐƐ ƉŽůĂƌŝnjĞĚ ůĞŶƐ ǁŝƚŚ ƚŚĞ ƵƐĞ ŽĨ ĂƉƉƌŽdžŝŵĂƚĞůLJ ϭϴϬϬ ĐĂŶĚůĞ ƉŽǁĞƌ ůŝŐŚƚ ƚŚĂƚ ĐĂŶ ƉĞŶĞƚƌĂƚĞ ƚŽ ƚŚĞ ĞƉŝĚĞƌŵŝƐ ĂŶĚ ĚŽǁŶ ƚŽ ƚŚĞ ƵƉƉĞƌ ĚĞƌŵŝƐ͕ ĂƌĞĂƐ ƚŚĂƚ ĐĂŶŶŽƚ ďĞ ƐĞĞŶ ǁŝƚŚ ƚŚĞ ĞLJĞ ĂůŽŶĞ͘ DĞůĂŶŽŵĂ ŝƐ ƚŚĞ ƐŝdžƚŚ ŵŽƐƚ ĐŽŵŵŽŶ ĐĂŶĐĞƌ ŝŶ ŵĞƌŝĐĂŶƐ͕ ƚŚĞ ŵŽƐƚ ĐŽŵŵŽŶ ĨĂƚĂů ŵĂůŝŐŶĂŶĐLJ ŝŶ LJŽƵŶŐ ĂĚƵůƚƐ͕ ĂŶĚ ƚŚĞ ŝŶĐŝĚĞŶĐĞ ŝƐ ƌŝƐŝŶŐ͘ dŚĞ ůŝĨĞƟŵĞ ŝŶĐŝĚĞŶĐĞ ŝŶ ϮϬϭϬ ǁĂƐ ϭͬϱϬ ǁŝƚŚ ϲϬ͕ϬϬϬ ŶĞǁ ĐĂƐĞƐ ŝŶ ϮϬϬϳ͘ /ƚ ĂĐĐŽƵŶƚƐ ĨŽƌ ϰ ƉĞƌĐĞŶƚ ŽĨ Ăůů ƐŬŝŶ ĐĂŶĐĞƌ ĂŶĚ ϳϳ ƉĞƌĐĞŶƚ ŽĨ ƐŬŝŶ ĐĂŶĐĞƌ ĚĞĂƚŚƐ͘ DĞůĂŶŽŵĂƐ ŝŶ ĐŚŝůĚƌĞŶ ĐĂŶ ƉƌĞƐĞŶƚ ǁŝƚŚ ŵŽƌĞ ĂĚǀĂŶĐĞĚ ůĞƐŝŽŶƐ ĂŶĚ ŵĂLJ ŚĂǀĞ Ă ƉŽŽƌĞƌ ƉƌŽŐŶŽƐŝƐ ďĞĐĂƵƐĞ ŽĨ ĚĞůĂLJ ŝŶ ĚŝĂŐŶŽƐŝƐ͘ tĞ ŚĂǀĞ ŵĂŶLJ ŽƉƉŽƌƚƵŶŝƟĞƐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚŽ ĚŝĂŐŶŽƐĞ Ă ŵĞůĂŶŽŵĂ͘ ŝĂŐŶŽƐŝƐ ŵĂLJ ŽĐĐƵƌ ǁŚĞŶ ƚŚĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ŚĂƐ ŚĞŝŐŚƚĞŶĞĚ ĂǁĂƌĞŶĞƐƐ ƚŽ ŵĞůĂŶŽŵĂ ĂŶĚ ĞƐƉĞĐŝĂůůLJ ŝĨ ĚĞƌŵŽƐĐŽƉLJͲ ƚƌĂŝŶĞĚ͘ ĞŝŶŐ ƚƌĂŝŶĞĚ ŝŶ ĚĞƌŵŽƐĐŽƉLJ ĐĂŶ ŝŵƉƌŽǀĞ ĚŝĂŐŶŽƐŝƐ ŽĨ

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California Family Physician Fall 2013

ŵĞůĂŶŽĐLJƟĐ ůĞƐŝŽŶƐ ĂŶĚ ĞƐƉĞĐŝĂůůLJ ůĞƐŝŽŶƐ ůĞƐƐ ƚŚĂŶ Žƌ ĞƋƵĂů ƚŽ ƚŚƌĞĞ ŵŝůůŝŵĞƚĞƌƐ ŝŶ ĚŝĂŵĞƚĞƌ͘ tŝƚŚ ƚŚĞ ŶĂŬĞĚ ĞLJĞ͕ ƐŵĂůů ůĞƐŝŽŶƐ ƐĞŶƐŝƟǀŝƚLJ ǁĂƐ ϰϯ ƉĞƌĐĞŶƚ ǀĞƌƐƵƐ ϴϴ ƉĞƌĐĞŶƚ ƵƐŝŶŐ ĚĞƌŵŽƐĐŽƉLJ ĂŶĚ ƚŚĞ DĞŶnjŝĞƐ ZƵůĞ͘ /ƚ ŝƐ ƵƐĞĨƵů ŝŶ ƚŚĞ ĚŝĂŐŶŽƐŝƐ ŽĨ ŶŽŶͲŵĞůĂŶŽĐLJƟĐ ůĞƐŝŽŶƐ͘ tŝƚŚ ƚŚĞ ĐŽŵŝŶŐ ŽĨ ĐĐŽƵŶƚĂďůĞ ĂƌĞ KƌŐĂŶŝnjĂƟŽŶƐ͕ ƚŚŝƐ ƉƌŽĐĞĚƵƌĞ ĚĞĐƌĞĂƐĞƐ ƚŚĞ ƌĂƟŽ ŽĨ ďĞŶŝŐŶ ƚŽ ŵĂůŝŐŶĂŶƚ ;ϭϮͲϭϴͿ ďŝŽƉƐŝĞƐ ƚŽ ĨŽƵƌ ƚŽ ŽŶĞ ŽǀĞƌ Ă ƚŚƌĞĞͲLJĞĂƌ ƉĞƌŝŽĚ͕ ƚŚƵƐ ĚĞĐƌĞĂƐŝŶŐ ĐŽƐƚƐ ĂŶĚ ƵŶŶĞĐĞƐƐĂƌLJ ƉƌŽĐĞĚƵƌĞƐ͘ >ĞĂƌŶ ĚĞƌŵŽƐĐŽƉLJ͊ / ǁŽƌŬ Ăƚ ^ĐƌŝƉƉƐ ůŝŶŝĐ DĞĚŝĐĂů 'ƌŽƵƉ ŝŶ ^ĂŶ ŝĞŐŽ ŽƵŶƚLJ͘ KƵƌ ĞŶƟƌĞ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ĞƉĂƌƚŵĞŶƚ ŚĂƐ ďĞĞŶ ƚƌĂŝŶĞĚ ŝŶ ĚĞƌŵŽƐĐŽƉLJ ĂŶĚ ǁĞ ĂƌĞ ďĞŶĞĮƟŶŐ ĨƌŽŵ ŽīĞƌŝŶŐ ƚŚŝƐ ƉƌŽĐĞĚƵƌĞ͘ tĞ ƉĞƌĨŽƌŵ ĚŝŐŝƚĂů ĚĞƌŵŽƐĐŽƉLJ ƉŚŽƚŽƐ ĂŶĚ ĐĂŶ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ ŽƵƌ ƉĂƚŚŽůŽŐŝƐƚƐ ƵƐŝŶŐ ĐůŝŶŝĐĂů ǀŝƐƵĂů ĐůƵĞƐ͘ KŶĞ ŽĨ ƚŚĞ ŵŽƐƚ ƌĞǁĂƌĚŝŶŐ ĞdžƉĞƌŝĞŶĐĞƐ ŝƐ ǁŚĞŶ LJŽƵ ĚŝĂŐŶŽƐĞ Ă ŵĞůĂŶŽŵĂ ŝŶ Ă ƉĂƟĞŶƚ ǁŚŽ ĐĂŵĞ ŝŶ ĨŽƌ Ă ĐŽŵƉůĞƚĞůLJ ĚŝīĞƌĞŶƚ ŝƐƐƵĞ͘ DĂŬŝŶŐ Ă ĚŝĂŐŶŽƐŝƐ ĞĂƌůLJ ĐĂŶ ƐĂǀĞ Ă ůŝĨĞ͘

P R O C E D U R E TA L K

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ȱ ȱ ȱ ȱȱȱ ȱ / ǁŽƌŬ ŝŶ Ă ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĨĂĐƵůƚLJ ŐƌŽƵƉ ƉƌĂĐƟĐĞ Ăƚ >ŽŵĂ >ŝŶĚĂ hŶŝǀĞƌƐŝƚLJ ŝŶ >ŽŵĂ >ŝŶĚĂ͕ ĂůŝĨŽƌŶŝĂ͕ ǁŚĞƌĞ ǁĞ ƐĞĞ Ăůů ĂŐĞƐ ŽĨ ƉĂƟĞŶƚƐ ǁŝƚŚ ŵƵůƟƉůĞ ƚLJƉĞƐ ŽĨ ŝŶƐƵƌĂŶĐĞ͘ / ĂůƐŽ ƐƵƉĞƌǀŝƐĞ ŽƵƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚƐ Ăƚ ŽƵƌ ĐŽŵŵƵŶŝƚLJ ĐůŝŶŝĐ͕ ^ŽĐŝĂů ĐƟŽŶ ŽŵŵƵŶŝƚLJ ,ĞĂůƚŚ ^LJƐƚĞŵ ;^ ,^Ϳ͕ ǁŚŝĐŚ ŝƐ Ă &ĞĚĞƌĂůůLJ YƵĂůŝĮĞĚ ,ĞĂůƚŚ ĞŶƚĞƌ ;&Y, Ϳ ŝŶ ^ĂŶ ĞƌŶĂƌĚŝŶŽ ǁŚĞƌĞ ǁĞ ĐĂƌĞ ĨŽƌ ƉĂƟĞŶƚƐ ǁŝƚŚ DĞĚŝͲ Ăů͕ ŵĂŶĂŐĞĚ ĐĂƌĞ DĞĚŝͲ Ăů ĂŶĚ ƐůŝĚŝŶŐ ĨĞĞ ƐĐĂůĞ͘ ƚ ƚŚĞ ƚǁŽ ĚŝīĞƌĞŶƚ ƐŝƚĞƐ͕ ǁĞ ŚĂǀĞ ƚŚĞ ĐĂƉĂĐŝƚLJ ƚŽ ƉĞƌĨŽƌŵ ĚŝīĞƌĞŶƚ ƉƌŽĐĞĚƵƌĞƐ͘ /Ŷ ŵLJ ĨĂĐƵůƚLJ ƉƌĂĐƟĐĞ͕ / ƉĞƌĨŽƌŵ ƐŬŝŶ͕ ũŽŝŶƚ ĂŶĚ ŵƵƐĐƵůŽƐŬĞůĞƚĂů͕ ŐLJŶĞĐŽůŽŐŝĐ ĂŶĚ ŽƚŚĞƌ ƉƌŽĐĞĚƵƌĞƐ͗ ͻ

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^ŬŝŶ ƉƌŽĐĞĚƵƌĞƐ͗ ƐŬŝŶ ďŝŽƉƐŝĞƐ ;ǀŝĂ ƐŚĂǀĞ͕ ƉƵŶĐŚ Žƌ ĞdžĐŝƐŝŽŶͿ͕ ůĞƐŝŽŶ ĞdžĐŝƐŝŽŶƐ͕ ƐŬŝŶ ĐƌLJŽƚŚĞƌĂƉLJ͕ ůĂĐĞƌĂƟŽŶ ƌĞƉĂŝƌƐ͕ ĨŽƌĞŝŐŶ ďŽĚLJ ƌĞŵŽǀĂů͕ ƚŽĞŶĂŝů ƌĞŵŽǀĂů ĂŶĚ ĐĂůůƵƐ ĚĞďƌŝĚĞŵĞŶƚ͘ DƵƐĐƵůŽƐŬĞůĞƚĂů ƉƌŽĐĞĚƵƌĞƐ͗ ĐĂƐƟŶŐ ĂŶĚ ƐƉůŝŶƟŶŐ͖ ũŽŝŶƚ ŝŶũĞĐƟŽŶƐ ĂŶĚ ĂƐƉŝƌĂƟŽŶƐ͕ ƚƌŝŐŐĞƌ ĮŶŐĞƌ ŝŶũĞĐƟŽŶƐ͘ 'LJŶĞĐŽůŽŐŝĐ ƉƌŽĐĞĚƵƌĞƐ͗ /ŶƚƌĂƵƚĞƌŝŶĞ ĚĞǀŝĐĞ ƉůĂĐĞŵĞŶƚͬƌĞŵŽǀĂů͖ E yW> EKE ŝŶƐĞƌƟŽŶ͕ ĚŝĂƉŚƌĂŐŵ ĮƫŶŐ͕ ĐŽůƉŽƐĐŽƉLJ͕ ĞŶĚŽŵĞƚƌŝĂů ďŝŽƉƐLJ ĂŶĚ ůŝŵŝƚĞĚ ŽďƐƚĞƚƌŝĐĂů ƵůƚƌĂƐŽƵŶĚ͘ KƚŚĞƌ ƉƌŽĐĞĚƵƌĞƐ͗ ƐŝŐŵŽŝĚŽƐĐŽƉLJ͕ ĂŶŽƐĐŽƉLJ͕ ŶĞǁďŽƌŶ ĐŝƌĐƵŵĐŝƐŝŽŶ ĂŶĚ ĞdžĞƌĐŝƐĞ ƚƌĞĂĚŵŝůů ƚĞƐƟŶŐ͘

/ ƉĞƌĨŽƌŵ ƉƌŽĐĞĚƵƌĞƐ ĨŽƌ ŵƵůƟƉůĞ ƌĞĂƐŽŶƐ͗ ĂƐ Ă ƐĞƌǀŝĐĞ ĂŶĚ ĐŽŶǀĞŶŝĞŶĐĞ ĨŽƌ ŵLJ ƉĂƟĞŶƚƐ͕ ĨŽƌ ǁŚŽůĞ ƉĞƌƐŽŶ ĐĂƌĞ ĂŶĚ ďĞĐĂƵƐĞ / ĞŶũŽLJ ǁŽƌŬŝŶŐ ǁŝƚŚ ŵLJ ŚĂŶĚƐ ĂŶĚ ƵƐŝŶŐ ŵLJ ƉƌŽĐĞĚƵƌĂů ƐŬŝůůƐ͘ WĞƌĨŽƌŵŝŶŐ ƉƌŽĐĞĚƵƌĞƐ͕ ŚŽǁĞǀĞƌ͕ ĐĂŶ ďĞ Ă ĚŽƵďůĞͲĞĚŐĞĚ ƐǁŽƌĚ ƚŽ ƌĞǀĞŶƵĞ͗ ŝĨ ƉĞƌĨŽƌŵĞĚ ĞĸĐŝĞŶƚůLJ͕ ƚŚĞLJ ŵĂLJ ĂĚĚ ƌĞǀĞŶƵĞ ƚŽ Ă ƉƌĂĐƟĐĞ͕ ďƵƚ ŝĨ ƚŚĞLJ ƚĂŬĞ ƚŽŽ ŵƵĐŚ ƟŵĞ ŝŶ ƚŚĞ ĐůŝŶŝĐ͕ ƚŚĞLJ ĐĂŶ ĂĐƚƵĂůůLJ ĚĞĐƌĞĂƐĞ ƌĞǀĞŶƵĞ͘ &Žƌ ĞdžĂŵƉůĞ͕ ŝĨ / Ăŵ ƌĞŵŽǀŝŶŐ Ă ĐLJƐƚ ĨƌŽŵ Ă ƉĂƟĞŶƚ͛Ɛ ďĂĐŬ ĂŶĚ͕ ŽŶĐĞ ƚŚĞ ƉƌŽĐĞĚƵƌĞ ƐƚĂƌƚƐ / ĮŶĚ ƚŚĞ ĐLJƐƚ ƚŽ ďĞ ĂĚŚĞƌĞŶƚ Žƌ ŵƵĐŚ ĚĞĞƉĞƌ ƚŚĂŶ ĂŶƟĐŝƉĂƚĞĚ͕ ŝƚ ŵĂLJ ƚĂŬĞ ŵƵĐŚ ůŽŶŐĞƌ ƚŽ ĐŽŵƉůĞƚĞ ƚŚĞ ƉƌŽĐĞĚƵƌĞ ĨŽƌ ƚŚĞ ƐĂŵĞ ƉĂLJŵĞŶƚ͘ ^ĞƌǀŝĐĞ ƚŽ ƉĂƟĞŶƚƐ͗ /ƚ ŝƐ ĐŽŶǀĞŶŝĞŶƚ ĨŽƌ ƉĂƟĞŶƚƐ ƚŽ ďĞ ĂďůĞ ƚŽ ŐĞƚ ƚŚĞŝƌ ƉƌŽĐĞĚƵƌĞƐ ĚŽŶĞ ŝŶ ƚŚĞ ƐĂŵĞ ƉůĂĐĞ ŝŶ ǁŚŝĐŚ ƚŚĞLJ ŐĞƚ ƚŚĞŝƌ ŵĞĚŝĐĂů ĐĂƌĞ ĂŶĚ ďLJ ƚŚĞ ƉŚLJƐŝĐŝĂŶͬĐůŝŶŝĐŝĂŶ ǁŚŽŵ ƚŚĞLJ ĂůƌĞĂĚLJ ŬŶŽǁ͘ /ƚ ŝƐ ƉĂƌƟĐƵůĂƌůLJ ƌĞǁĂƌĚŝŶŐ ƚŽ

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ďĞ ĂďůĞ ƚŽ ďŝŽƉƐLJ Žƌ ƌĞŵŽǀĞ Ă ƐƵƐƉŝĐŝŽƵƐ ůŽŽŬŝŶŐ ŵŽůĞ ŝŶ ĐůŝŶŝĐ ĂŶĚ ŐĞƚ Ă ƉƌŽŵƉƚ ĚŝĂŐŶŽƐŝƐ ƚŽ ĚŝƌĞĐƚ ĨƵƌƚŚĞƌ ƚƌĞĂƚŵĞŶƚ͘ / ǁŝůů ĂůǁĂLJƐ ƌĞŵĞŵďĞƌ ŶŽƟĐŝŶŐ Ă ͞ĨƵŶŶLJ ůŽŽŬŝŶŐ ĨƌĞĐŬůĞ͟ ŽŶ ŽŶĞ ŽĨ ŵLJ ƉĂƟĞŶƚƐ͕ ƌĞŵŽǀŝŶŐ ŝƚ ŝŶ ĐůŝŶŝĐ ŇŽǁ ĂŶĚ ĮŶĚŝŶŐ ŽƵƚ ŝƚ ǁĂƐ Ă ŵĞůĂŶŽŵĂ͘ / ĨĞĞů ƚŚĞ ĂďŝůŝƚLJ ƚŽ ĚŽ ďŝŽƉƐŝĞƐ ǁŝƚŚŽƵƚ ƚŚĞ ĚĞůĂLJ ĐĂƵƐĞĚ ďLJ ƐĞŶĚŝŶŐ ƉĂƟĞŶƚƐ ĞůƐĞǁŚĞƌĞ ĨŽƌ ƉƌŽĐĞĚƵƌĞƐ ;ĂŶĚ ŚŽƉŝŶŐ ƚŚĞLJ ŐĞƚ ƚŚĞŵ ĚŽŶĞ ŝŶ Ă ƟŵĞůLJ ŵĂŶŶĞƌͿ ŚĞůƉƐ ƚŽ ƌĞŵŽǀĞ ƐŽŵĞ ďĂƌƌŝĞƌƐ ƚŽ ŐŽŽĚ ĐĂƌĞ͘ Whole person care: &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŚĂǀĞ ŐƌĞĂƚ ŽƉƉŽƌƚƵŶŝƟĞƐ ƚŽ ƉƌŽǀŝĚĞ ǁŚŽůĞ ƉĞƌƐŽŶ ƉŚLJƐŝĐĂů͕ ƉƐLJĐŚŽƐŽĐŝĂů ĂŶĚ ƐƉŝƌŝƚƵĂů ĐĂƌĞ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ƚŚƌŽƵŐŚ ĐĂƌĞ ĐŽŶƟŶƵŝƚLJ͘ ŽŝŶŐ ƉƌŽĐĞĚƵƌĞƐ ŝƐ ĂŶŽƚŚĞƌ ǁĂLJ ƚŽ ƉƌŽŵŽƚĞ ƚŚĞ ŚĞĂůƚŚ ŽĨ ŽƵƌ ƉĂƟĞŶƚƐ͘ &Žƌ ĞdžĂŵƉůĞ͕ ŝĨ Ă ƉĂƟĞŶƚ ŐĞƚƐ ĂŶ ĂďŶŽƌŵĂů ƉĂƉ ƐŵĞĂƌ ƌĞƐƵůƚ ĂŶĚ ŚĂƐ Ă ůŽƚ ŽĨ ƋƵĞƐƟŽŶƐ ĂŶĚ ĐŽŶĐĞƌŶƐ͕ / ĐĂŶ ƐŚŽǁ ŚĞƌ ƚŚĞ ^ W ĂůŐŽƌŝƚŚŵƐ ; ^ W͘ŽƌŐͿ ĨŽƌ ŵĂŶĂŐĞŵĞŶƚ ĂŶĚ ĞĚƵĐĂƚĞ ŚĞƌ ĂďŽƵƚ ƚŚĞ ĚŝĂŐŶŽƐŝƐ͘ /Ĩ ƐŚĞ ŶĞĞĚƐ Ă ĐŽůƉŽƐĐŽƉLJ ĚŽŶĞ͕ / ĐĂŶ ĞdžƉůĂŝŶ ƚŚĞ ƉƌŽĐĞƐƐ ƚŽ ŚĞƌ ĂŶĚ ƉĞƌĨŽƌŵ ƚŚĞ ƉƌŽĐĞĚƵƌĞ͘ / ĐĂŶ ĂůƐŽ ĂƐƐĞƐƐ ĂŶĚ ĐŽƵŶƐĞů ŚĞƌ ŽŶ ƌĞůĂƚĞĚ ĨĂĐƚŽƌƐ ŝŶ ŚĞƌ ůŝĨĞ ƚŽ ƉƌŽŵŽƚĞ ŽƉƟŵĂů ŚĞĂůƚŚ͘ ŶũŽLJŵĞŶƚ ĂŶĚ ƐŬŝůůƐ͗ WƌŽĐĞĚƵƌĞƐ ĂƌĞ ĞŶũŽLJĂďůĞ ĂŶĚ ŚĂŶĚƐͲŽŶ͘ ĂƐƟŶŐͬƐƉůŝŶƟŶŐ͕ ũŽŝŶƚ ŝŶũĞĐƟŽŶƐ ĂŶĚ ĂƐƉŝƌĂƟŽŶƐ͕ ƐŬŝŶ ďŝŽƉƐŝĞƐ͕ ƐƵƚƵƌŝŶŐ͕ ŐLJŶĞĐŽůŽŐŝĐ ƉƌŽĐĞĚƵƌĞƐ͕ ĞƚĐ͕͘ Ăůů ŝŶǀŽůǀĞ ƐŽŵĞ ĚĞdžƚĞƌŝƚLJ ĂŶĚ ŚĞůƉ ƚŽ ĂĚĚ ǀĂƌŝĞƚLJ ƚŽ ƚŚĞ ŵŽƌĞ ĐŽŐŶŝƟǀĞ ĂƐƉĞĐƚƐ ŽĨ ƚƌĞĂƟŶŐ ƉĂƟĞŶƚƐ ŝŶ ŵLJ ĐůŝŶŝĐ͘ tŚĂƚ ĂƌĞ ƚŚĞ ďĞŶĞĮƚƐ ŽĨ ŽīĞƌŝŶŐ ƚŚĞƐĞ ƉƌŽĐĞĚƵƌĞƐ͍ ^ŽŵĞ ŽĨ ƚŚĞ ďĞŶĞĮƚƐ ŽĨ ŽīĞƌŝŶŐ ƚŚĞƐĞ ƉƌŽĐĞĚƵƌĞƐ ŝŶĐůƵĚĞ ĐŽŶǀĞŶŝĞŶĐĞ ĨŽƌ ƉĂƟĞŶƚƐ͕ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ŐĞƚ ƉƌŽŵƉƚ ĐĂƌĞ ƐƵĐŚ ĂƐ ƐŬŝŶ ďŝŽƉƐŝĞƐ͕ ũŽŝŶƚ ĂƐƉŝƌĂƟŽŶƐ ĂŶĚ ůĂĐĞƌĂƟŽŶ ƌĞƉĂŝƌ͕ ƉĂŝŶ ƌĞĚƵĐƟŽŶ ǁŝƚŚ ũŽŝŶƚ ŝŶũĞĐƟŽŶƐ͕ ƚŽĞŶĂŝů ĞdžĐŝƐŝŽŶƐ ĂŶĚ ƐƉůŝŶƟŶŐ͕ ƉƌŽǀŝĚŝŶŐ ŚĞĂůƚŚ ƐĐƌĞĞŶŝŶŐ ǁŝƚŚ ƐŝŐŵŽŝĚŽƐĐŽƉLJ ĂŶĚ ĞdžĞƌĐŝƐĞ ƐƚƌĞƐƐ ƚĞƐƚ ƉƌŽĐĞĚƵƌĞƐ͘

/ ŚŝŐŚůLJ ƌĞĐŽŵŵĞŶĚ ĚŽŝŶŐ ƉƌŽĐĞĚƵƌĞƐ ŝŶ LJŽƵƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉƌĂĐƟĐĞ͘ /Ĩ LJŽƵ ĂƌĞ ŶŽƚ ĂůƌĞĂĚLJ ĚŽŝŶŐ ƉƌŽĐĞĚƵƌĞƐ͕ / ƐƵŐŐĞƐƚ ƐƚĂƌƟŶŐ ǁŝƚŚ ƉƌŽĐĞĚƵƌĞƐ ůŝŬĞ ƐŬŝŶ ďŝŽƉƐŝĞƐ ƚŚĂƚ ĚŽ ŶŽƚ ƌĞƋƵŝƌĞ Ă ůŽƚ ŽĨ ŝŶƐƚƌƵŵĞŶƚƐ Žƌ ŽǀĞƌŚĞĂĚ͘ ĞŝŶŐ ĂďůĞ ƚŽ ƉƌŽǀŝĚĞ ƉƌŽĐĞĚƵƌĂů ĐĂƌĞ ĞdžƉĂŶĚƐ ƚŚĞ ƌĞůĂƟŽŶƐŚŝƉƐ LJŽƵ ŚĂǀĞ ǁŝƚŚ ƉĂƟĞŶƚƐ ĂŶĚ ŝƐ ĞŵŽƟŽŶĂůůLJ ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂůůLJ ƌĞǁĂƌĚŝŶŐ͘

California Family Physician Fall 2013 29

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EXECUTIVE VICE PRESIDENT’S FORUM

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ In the last issue of California Family Physician, I wrote ĂďŽƵƚ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ͕ ĂŶĚ ƐƵŐŐĞƐƚĞĚ that family physicians could play a larger role in ĞĚƵĐĂƟŶŐ ƚŚĞŝƌ ƉĂƟĞŶƚƐ ĂďŽƵƚ ŝƚ͘ &W ĂŶĚ &W ǁĞƌĞ ďŽƚŚ ƐƚƌŽŶŐ ĂĚǀŽĐĂƚĞƐ ĨŽƌ ŚĞĂůƚŚ ĐĂƌĞ ƌĞĨŽƌŵ͘ EŽǁ &W ĂŶĚ ƚŚƌĞĞ ƉĂƌƚŶĞƌƐ ; ŵĞƌŝĐĂŶ ŽůůĞŐĞ ŽĨ WŚLJƐŝĐŝĂŶƐ ʹ ĂůŝĨŽƌŶŝĂ ŚĂƉƚĞƌ͕ ƚŚĞ ĂůŝĨŽƌŶŝĂ ĐĂĚĞŵLJ ŽĨ WŚLJƐŝĐŝĂŶ ƐƐŝƐƚĂŶƚƐ ĂŶĚ ƚŚĞ KƐƚĞŽƉĂƚŚŝĐ WŚLJƐŝĐŝĂŶƐ ĂŶĚ ^ƵƌŐĞŽŶƐ ŽĨ ĂůŝĨŽƌŶŝĂͿ ŚĂǀĞ ďĞĞŶ ĂǁĂƌĚĞĚ ŽŶĞ ŽĨ ĨŽƵƌ WƌŽǀŝĚĞƌ ĚƵĐĂƟŽŶ 'ƌĂŶƚƐ ĨƌŽŵ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͕ ĂůŝĨŽƌŶŝĂ͛Ɛ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ĞdžĐŚĂŶŐĞ͘ dŚĞ ƉƵƌƉŽƐĞ ŽĨ ƚŚĞ ŐƌĂŶƚ ŝƐ ƚŽ ŚĞůƉ ŽƵƌ ƌĞƐƉĞĐƟǀĞ ŵĞŵďĞƌƐ ĞĚƵĐĂƚĞ ƚŚĞŝƌ ƋƵĂůŝĮĞĚ ƉĂƟĞŶƚƐ ƚŽ ƵŶĚĞƌƐƚĂŶĚ ĂŶĚ ƐĞůĞĐƚ ĂŵŽŶŐ ƚŚĞ ŝŶƐƵƌĂŶĐĞ ĐŽǀĞƌĂŐĞ ŽƉƟŽŶƐ ĂǀĂŝůĂďůĞ ƚŽ ƚŚĞŵ ƚŚƌŽƵŐŚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͘

ƉƌŽŐƌĂŵŵŝŶŐ͕ ǁĞ ƌĞƐĞĂƌĐŚĞĚ ŵĞŵďĞƌƐ͛ ŬŶŽǁůĞĚŐĞ ĂďŽƵƚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂͬƚŚĞ ĂŶĚ ƚŚĞŝƌ ŝŶƚĞƌĞƐƚ ŝŶ ĂŶĚ ǁŝůůŝŶŐŶĞƐƐ ƚŽ ŚĞůƉ ƉĂƟĞŶƚƐ ŶĂǀŝŐĂƚĞ ƚŚĞ ŶĞǁ ŝŶƐƵƌĂŶĐĞ ŽƉƟŽŶƐ ĂŶĚ ƐƵďƐŝĚŝĞƐ ĂǀĂŝůĂďůĞ ƚŽ ƚŚĞŵ͗ ŝŶ Ă :ƵůLJ ϮϬϭϯ ƐƵƌǀĞLJ ƐĞŶƚ ƚŽ ƚŚĞ ĨŽƵƌ ŽƌŐĂŶŝnjĂƟŽŶƐ͛ ŵĞŵďĞƌƐ͕ Ϯϯ͘ϴ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ϭ͕ϬϬϬ ƌĞƐƉŽŶĚĞŶƚƐ ƐĂŝĚ ƚŚĞLJ ǁĞƌĞ ŵŽĚĞƌĂƚĞůLJ ŬŶŽǁůĞĚŐĞĂďůĞ͖ ϱϬ͘ϱ ƉĞƌĐĞŶƚ ĂƐƐĞƐƐĞĚ ƚŚĞŝƌ ĐƵƌƌĞŶƚ ŬŶŽǁůĞĚŐĞ ĂƐ ŵĂƌŐŝŶĂů ĂŶĚ Ϯϯ ƉĞƌĐĞŶƚ ŝŶĚŝĐĂƚĞĚ ƚŚĞLJ ǁĞƌĞ ŶŽƚ Ăƚ Ăůů ŬŶŽǁůĞĚŐĞĂďůĞ ĂďŽƵƚ ŶĞǁ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ĐŽǀĞƌĂŐĞ ŽƉƟŽŶƐ ĂǀĂŝůĂďůĞ ƚŚƌŽƵŐŚ ƚŚĞ ĂŶĚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͘ ,ĂƉƉŝůLJ͕ ϲϯ͘ϱ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞƐĞ ƐĂŵĞ ƌĞƐƉŽŶĚĞŶƚƐ ŝŶĚŝĐĂƚĞĚ ƚŚĞLJ ǁŽƵůĚ ůŝŬĞ ƚŽ ďĞ ŚŝŐŚůLJ ŬŶŽǁůĞĚŐĞĂďůĞ ĂŶĚ ϯϭ͘ϵ ƉĞƌĐĞŶƚ ŝŶĚŝĐĂƚĞĚ ƚŚĞLJ ǁŽƵůĚ ůŝŬĞ ƚŽ ďĞ ŵŽĚĞƌĂƚĞůLJ ŬŶŽǁůĞĚŐĞĂďůĞ ʹ ĂŶ ŝŵƉƌĞƐƐŝǀĞ ϵϱ͘ϰ ƉĞƌĐĞŶƚ ŝŶ ƚŽƚĂů͘

ĂůŝĨŽƌŶŝĂ ŝƐ ĂŵŽŶŐ ƚŚĞ ŵŽƐƚ ƉƌĞƉĂƌĞĚ ŽĨ ƚŚĞ ƐƚĂƚĞƐ ƚŚĂƚ ŵŽǀĞĚ ƚŽ ĞƐƚĂďůŝƐŚ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ŵĂƌŬĞƚƉůĂĐĞƐ ƵŶĚĞƌ ƚŚĞ ͘ KŶ KĐƚŽďĞƌ ϭ͕ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ǁĞŶƚ ŽŶůŝŶĞ ǁŝƚŚ ŵĂƌŬĞƟŶŐ ĂŶĚ ƐĂůĞƐ ŽĨ ŚĞĂůƚŚ ĐŽǀĞƌĂŐĞ ƚŚƌŽƵŐŚ ƚǁĞůǀĞ ŚĞĂůƚŚ ƉůĂŶƐ ĨŽƌ ŝŶĚŝǀŝĚƵĂůƐ ĂŶĚ Ɛŝdž ĨŽƌ ƐŵĂůů ďƵƐŝŶĞƐƐ͕ ǁŝƚŚ ĐŽǀĞƌĂŐĞ ƚĂŬŝŶŐ ĞīĞĐƚ :ĂŶƵĂƌLJ ϭ͕ ϮϬϭϰ͘ ďŝŐ ĐŽŶƐƵŵĞƌͲŽƌŝĞŶƚĞĚ ŵĞĚŝĂͬWZ ĐĂŵƉĂŝŐŶ ďLJ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ŬŝĐŬĞĚ Žī ŝŶ ^ĞƉƚĞŵďĞƌ͘

tĞ ǁŝůů ĚĞůŝǀĞƌ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ŝŶ Ă ǀĂƌŝĞƚLJ ŽĨ ĨŽƌŵĂƚƐ ʹ ŽŶůŝŶĞ͕ ŚĂƌĚ ĐŽƉLJ͕ ŝŶͲƉĞƌƐŽŶ ŵĞĞƟŶŐƐ ;ŽƵƌ ŶŶƵĂů ^ĐŝĞŶƟĮĐ ƐƐĞŵďůLJ͕ ĐŽƵŶƚLJ ĐŚĂƉƚĞƌ ŵĞĞƟŶŐƐ͕ ĞƚĐ͘Ϳ͕ ƉŽƚĞŶƟĂů ƌĞŐŝŽŶĂů ŵĞĞƟŶŐƐ͕ ǁĞďŝŶĂƌƐͬĐŽŶĨĞƌĞŶĐĞ ĐĂůůƐ͕ ĞƚĐ͘ /Ĩ LJŽƵ ĐŚŽŽƐĞ ƚŽ ƉĂƌƟĐŝƉĂƚĞ͕ LJŽƵ ŵĂLJ ƐĞůĞĐƚ ǁŚĂƚ ǁŽƌŬƐ ďĞƐƚ ĨŽƌ LJŽƵ ĂŶĚ LJŽƵƌ ƐƚĂī ŵĞŵďĞƌƐ͘

tĞ ĂŶĚ ŽƵƌ ƉĂƌƚŶĞƌƐ͕ ĂƐ ǁĞůů ĂƐ ŽƚŚĞƌ ŐƌĂŶƚ ƌĞĐŝƉŝĞŶƚƐ ŝŶĐůƵĚŝŶŐ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ &ŽƵŶĚĂƟŽŶ͕ ǁŝůů ƌĞĐĞŝǀĞ Ă ŐƌĞĂƚ ĚĞĂů ŽĨ ƐƵƉƉŽƌƚ ĂƐ ǁĞ ĚĞǀĞůŽƉ ĞĚƵĐĂƟŽŶĂů ƉƌŽŐƌĂŵŵŝŶŐ ĂŶĚ ŵĂƚĞƌŝĂůƐ ĨŽƌ ŽƵƌ ŵĞŵďĞƌƐ͗ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ǁŝůů ŽīĞƌ ĐŽůůĂƚĞƌĂů ŵĂƚĞƌŝĂůƐ ƚŽ ŚĞůƉ ƉŚLJƐŝĐŝĂŶƐ͕ ƉŚLJƐŝĐŝĂŶ ĂƐƐŝƐƚĂŶƚƐ ĂŶĚ ŵĞĚŝĐĂů ŽĸĐĞ ƐƚĂīƐ ĂƐƐŝƐƚ ƉĂƟĞŶƚƐ ŝŶ ŐĞƫŶŐ ƚŚĞŝƌ ĂƌŵƐ ĂƌŽƵŶĚ ƚŚŝƐ ŶĞǁ ŵĂƌŬĞƚƉůĂĐĞ ĨŽƌ ƉƌŝǀĂƚĞ ŝŶƐƵƌĂŶĐĞ͕ ŝŶĐůƵĚŝŶŐ ƐƵďƐŝĚŝĞƐ ĨŽƌ ƚŚŽƐĞ ĞůŝŐŝďůĞ͕ ĂŶĚ ƐŽŵĞ ŶĞǁ ŽƉƟŽŶƐ ĨŽƌ ƚŚŽƐĞ ƋƵĂůŝĮĞĚ ĨŽƌ DĞĚŝͲ Ăů ĐŽǀĞƌĂŐĞ͘ &W ƐƚĂī ĂƩĞŶĚĞĚ Ă ϭ͘ϱ ĚĂLJ ƚƌĂŝŶŝŶŐ ƐƉŽŶƐŽƌĞĚ ďLJ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͘ tĞ ǁŝůů ďƌŝŶŐ ŽƵƌ ĐŽŶƐŝĚĞƌĂďůĞ ƐŬŝůůƐ ƚŽ ďĞĂƌ ŽŶ ƚŚĞ ĚĞůŝǀĞƌLJ ŽĨ ƚŚŝƐ ŝŶĨŽƌŵĂƟŽŶ ƚŽ ŽƵƌ ŵĞŵďĞƌƐ ŝŶ ŵƵĐŚ ƚŚĞ ƐĂŵĞ ǁĂLJ ǁĞ ĚĞǀĞůŽƉ ĂŶĚ ƉƌĞƐĞŶƚ ĐŽŶƟŶƵŝŶŐ ƉƌŽĨĞƐƐŝŽŶĂů ĞĚƵĐĂƟŽŶ ƉƌŽŐƌĂŵƐ ĂŶĚ ŚĞůƉ ŽƵƌ ŵĞŵďĞƌƐ ďĞƩĞƌ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ ĂďŽƵƚ ĐůŝŶŝĐĂů ŝƐƐƵĞƐ͘ Ɛ ǁĞ ĂůƐŽ ĚŽ ǁŝƚŚ ŽƵƌ ĐŽŶƟŶƵŝŶŐ ĞĚƵĐĂƟŽŶ

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California Family Physician Fall 2013

&ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƚŚĞ ŵĞŵďĞƌƐ ŽĨ ŽƵƌ ƉĂƌƚŶĞƌ ŽƌŐĂŶŝnjĂƟŽŶƐ͕ ŝŶƚĞƌŶŝƐƚƐ͕ ŽƐƚĞŽƉĂƚŚŝĐ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƐƵƌŐĞŽŶƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶƐ ĂƐƐŝƐƚĂŶƚƐ͕ ĂƌĞ ĂůƌĞĂĚLJ ƚƌƵƐƚĞĚ ƐŽƵƌĐĞƐ ŽĨ ŝŵƉŽƌƚĂŶƚ ŵĞĚŝĐĂů ŝŶĨŽƌŵĂƟŽŶ ĨŽƌ ƉĂƟĞŶƚƐ͘ WĂƟĞŶƚƐ ŬŶŽǁ LJŽƵ ŚĂǀĞ ƚŚĞŝƌ ďĞƐƚ ŝŶƚĞƌĞƐƚƐ Ăƚ ŚĞĂƌƚ ĂŶĚ ǁĂŶƚ ƚŽ ĞŶƐƵƌĞ ƚŚĞLJ ĂƌĞ ƉƌŽƚĞĐƚĞĚ ĨƌŽŵ ƚŚĞ ŚĞĂůƚŚ ĂŶĚ ĮŶĂŶĐŝĂů ŝŵƉĂĐƚ ŽĨ ďĞŝŶŐ ƵŶĚĞƌͲ Žƌ ƵŶŝŶƐƵƌĞĚ͘ ZĞĐĞŶƚ ƉƌĞƐƐ ƌĞƉŽƌƚƐ ŝŶĚŝĐĂƚĞ ƚŚĂƚ ĐŚĂƌůĂƚĂŶƐ ĂŶĚ ĐƌŝŵŝŶĂůƐ ĂƌĞ ŵŽǀŝŶŐ ŝŶ ƚŽ ƚĂŬĞ ĂĚǀĂŶƚĂŐĞ ŽĨ ƉĂƟĞŶƚƐ͛ ůĂĐŬ ŽĨ ŬŶŽǁůĞĚŐĞ͕ ǁŝƚŚ ƐŽŵĞ ƚĞůůŝŶŐ ƚŚĞŵ ƚŚĞLJ͛ůů ďĞ ũĂŝůĞĚ ŝĨ ƚŚĞLJ ĚŽŶ͛ƚ ďƵLJ ŝŶƐƵƌĂŶĐĞ ĂŶĚ ĐŚĂƌŐŝŶŐ ƚŚĞŵ ĨĂŬĞ ĨĞĞƐ͘ zŽƵ ĐĂŶ ďĞ Ă ĐƌƵĐŝĂů ĮƌĞǁĂůů ďĞƚǁĞĞŶ LJŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ƚŚŽƐĞ ǁŚŽ͛Ě ůŝŬĞ ƚŽ ŇĞĞĐĞ ƚŚĞŵ͘ zŽƵ ĐĂŶ ƉƌŽǀŝĚĞ ƚƌƵƐƚǁŽƌƚŚLJ ŝŶĨŽƌŵĂƟŽŶ ƚŚĂƚ ĚŝƌĞĐƚƐ ƚŚĞŵ ƚŽ ƌĞĂů ƉŽůŝĐŝĞƐ Ăƚ ĂīŽƌĚĂďůĞ ƉƌŝĐĞƐ͘ dŚĞ ƉƌŽǀŝƐŝŽŶƐ ĂƌĞ ĐŽŵƉůŝĐĂƚĞĚ͘ &W ĐĂŶ ŚĞůƉ LJŽƵ ƵŶĚĞƌƐƚĂŶĚ ǁŚĂƚ ƚŚĞ Đƚ ŵĞĂŶƐ ĨŽƌ LJŽƵƌ ƉĂƟĞŶƚƐ͕ ĂŶĚ ŚŽǁ LJŽƵ ĂŶĚ LJŽƵƌ ƐƚĂī ĐĂŶ ŚĞůƉ ƚŚĞŵ ĂĐĐĞƐƐ ŚĞĂůƚŚ ĐŽǀĞƌĂŐĞ͕ ŝĨ LJŽƵ ǁŝƐŚ ƚŽ͘ tĞ ŚŽƉĞ LJŽƵ ǁŝůů͘

physician’s office, a malfunctioning thermostat ruined $51,000 in refrigerated vaccine.

Make sure you’re covered.

In a Del Mar

For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner.

Call (800) 852-8872 today for a quote or a complimentary insurance assessment.

Q Q Q Q

Medical Malpractice Workers’ Compensation

Q

Health and Disability Property and General Liability

Q

CA License #0677182

Q

Q

Employment Practices Liability Directors and Officers/Management Liability Errors and Omissions Liability Billing Errors and Omissions Liability

www.thedoctors.com/TDCIS California Family Physician SƐƉƌŝŶŐ ϮϬϭϯ 31

“ As your MIEC Claims Representative, I will serve your professional liability needs with both steadfast advocacy and compassionate support.”

Senior Claims Representative Michael Anderson

Join the insurance company that always

puts policyholders first.

MIEC has never lost sight of its original mission, always putting policyholders (doctors like you) first. For over 30 years, MIEC has been steadfast in our protection of California physicians with conscientious Underwriting, Policyholder Dividend Ratio* excellent Claims management and 50% 47% hands-on Loss Prevention services.

41% 39% We’ve partnered with policyholders 40% 36% to keep premiums low.

30% 29% 30%

For more information or to apply: Q www.miec.com Q Call 800.227.4527 Q Email questions to underwriting@miec.com

20%

14%

10% 0%

6.4% 2.2% 2007

2008

5.2%

5.2% 2009

6.9%

2010

2011

8%

8%

2012

2013

DISTRIBUTED

Med Mal Industry (PIAA Composite)

MIEC

* (On premiums at $1/3 million limits. Future dividends cannot be guaranteed.)

MIEC 6250 Claremont Avenue, Oakland, California 94618 s 800-227-4527 s www.miec.com CalFamPhy_ad_09.04.13

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California Family Physician Fall 2013

MIEC

Owned by the policyholders we protect.