Fall 2017

VO L . 68 N O. 4 Fa l l 201 7

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ϭϱϮϬ WĂĐŝĮĐ ǀĞŶƵĞ • ^ĂŶ &ƌĂŶĐŝƐĐŽ͕ ĂůŝĨŽƌŶŝĂ ϵϰϭϬϵ • ǁǁǁ͘ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐ WŚŽŶĞ ;ϰϭϱͿ ϯϰϱͲϴϲϲϳ • &Ădž ;ϰϭϱͿ ϯϰϱͲϴϲϲϴ • ͲŵĂŝů͗ ĐĂĨƉΛĨĂŵŝůLJĚŽĐƐ͘ŽƌŐ

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Nathan Hitzeman, MD, Editor Shelly Rodrigues, CAE, Managing Editor The California Family Physician is published quarterly by the California Academy of Family Physicians. Opinions are those of the authors and not necessarily those of the members and staff of the CAFP. Non-member subscriptions are $35 per year.

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California Family Physician Fall 2017

California

FAMILY PHYSICIAN s tron g

m edi ci ne

fo r

Cal i for ni a

features Kimberly Duir, MD; Emily Ebert, MD

14 Generational Voices 16 Are You Protected? Tips for CyberSecurity 18 Must Have Apps for Family Physicians

William O. Woo, MD Tipu V. Khan, MD, FAAFP

20 Looking Back at the Meaningful Use EHR Incentive Program

Conrad Amenta

24 Telemedicine and Telehealth in 2017: Innovation, Disruption, and Transformation

Chris Flores, MD and Maricela Fernandez, JD

26 Online Education: Is It Really the Future of learning?

Carol Havens, MD and Shelly Rodrigues, CAE

28 Why You Need to Be on Social Media

Alex Mroszczyk-McDonald, MD

departments 6

Editorial

All Things Digital

8

President’s Message

Count to Three Alligators!

Nathan Hitzeman, MD Michelle Quiogue, MD, FAAFP

10 Political Pulse

CAFP-Supported Bills are Sitting on the Threshold

Carla Kakutani, MD

12 Membership News

You Are the Best Part of Membership

Shannon Goecke

38 EVP Forum

What Does the Future Hold for ACA?

Susan Hogeland, CAE

&Žƌ ƵƉĐŽŵŝŶŐ D ĂĐƟǀŝƟĞƐ ǀŝƐŝƚ ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬĐŵĞ California Family Family Physician Physician Fall Fall 2017 ϮϬϭϳ California

5

editorial

Nathan Hitzeman, MD

All Things Digital We recognize the heresy of having you read your paper copy of California Family Physician given that our theme is cyber medicine and all things digital. But doesn’t the paper feel ŐŽŽĚ ĂŐĂŝŶƐƚ LJŽƵƌ ĨŝŶŐĞƌƚŝƉƐ͍ 'Ž ĂŚĞĂĚ͘ ZƵƐƚůĞ ŝƚ͘ ŐŝƚĂƚĞ it a bit. Feel the texture. This is something real. Like a boil erupting pus onto your lab coat or a placenta leaking into the edge of your shoe. Some things can only be appreciated Old School.

But like the statistic about spiders, I’m sure that your ĞůĞĐƚƌŽŶŝĐ ĚĞǀŝĐĞ ŝƐ ǁŝƚŚŝŶ ƐĞǀĞƌĂů ĨĞĞƚ ŽĨ LJŽƵ͕ ŶŽ͍ What kinds of apps are ŽŶ ƚŚĞƌĞ͍ ŝĚ LJŽƵƌ ŬŝĚƐ ůŽĂĚ ƐŽŵĞ ƚŽŽ͍ ŝĚ LJŽƵ remember to do that ƋƵŝĨĂdž ƚŚŝŶŐ͍ KŚ͕ ůĞƚ ŵĞ see if I can set up that account. “Kids, do your ŚŽŵĞǁŽƌŬ ƉůĞĂƐĞ͊͟ KŚ ǁĂŝƚ͕ EĂŶŶĂ ũƵƐƚ sŝďĞƌĞĚ me about her dog Sparky learning to roll over.

Then there’s a text from DŝĐŚĞůůĞ ĚŽǁŶ ƚŚĞ ƐƚƌĞĞƚ ǁŽŶĚĞƌŝŶŐ ŝĨ ǁĞ ĐĂŶ ĚŽ a play date soon. What’s ƚŚŝƐ ŶĞǁƐ ĨůĂƐŚ ĂďŽƵƚ ƚŚĞ ĨĂƚďƵƌŐ ŝŶ >ŽŶĚŽŶ͍ ŽŶŐĞĂůĞĚ ĨĂƚ ĂŶĚ ĚŝĂƉĞƌ ǁŝƉĞƐ ĐůŽŐŐŝŶŐ ƐĞǀĞƌĂů ďůŽĐŬƐ ŽĨ ƐĞǁĂŐĞ ůŝŶĞ͍ zƵĐŬ͕ / ďĞƚƚĞƌ ƐƚŽƉ ĨůƵƐŚŝŶŐ ƚŚŽƐĞ ƚŚŝŶŐƐ͘ ͞<ŝĚƐ͕ ŚŽŵĞǁŽƌŬ͊​͊​͊͟ ŶŽƚŝĐĞ ƚŽ ƵƉŐƌĂĚĞ ŵLJ ƐŽĨƚǁĂƌĞ͘ ŝĚŶ͛ƚ / ĚŽ ƚŚŝƐ ůĂƐƚ ǁĞĞŬ͍ hŚ ŽŚ͕ ƉŽǁĞƌ͛Ɛ ŐĞƚƚŝŶŐ ůŽǁ͘ ĞƚƚĞƌ ƌĞĐŚĂƌŐĞ͘ EŽǁ ǁŚLJ ĚŝĚ / ŐĞƚ ŽŶ ŵLJ ƉŚŽŶĞ ĂŐĂŝŶ͍ KŚ LJĞĂŚ͕ ƋƵŝĨĂdž͘ /͛ůů do it later.

increasingly complex digital processes, codes and algorithms. tĞ ĂůŵŽƐƚ ƚĂŬĞ ƚŚĞŵ ĨŽƌ ŐƌĂŶƚĞĚ Žƌ ĂĐĐĞƉƚ ƚŚĂƚ ƚŚĞLJ ǁŝůů be there like the hard ground beneath our next foot fall — that is, until they’re not. dĞĐŚŶŽůŽŐLJ ŝŶ ŵĞĚŝĐŝŶĞ ŚĂƐ ĂůǁĂLJƐ ďĞĞŶ ĞƐƉĞĐŝĂůůLJ ĐůƵŵƐLJ͘ When the product is hands-on care and compassion, three ŝŶ ƚŚĞ ƌŽŽŵ ŽĨƚĞŶ ďĞĐŽŵĞƐ Ă ĐƌŽǁĚ͘ /Ŷ ĨĂĐƚ͕ ƚŚĞ ĐŽŵƉƵƚĞƌ ŝŶ ĐůŝŶŝĐ ŚĂƐ ďĞĐŽŵĞ ƐŽ ƐLJŶŽŶLJŵŽƵƐ ǁŝƚŚ ƉĂƚŝĞŶƚ ĐĂƌĞ͕ ƚŚĂƚ ǁŚĞŶ ƌĞƐŝĚĞŶƚƐ ƉƌĞƐĞŶƚ Ă ĐĂƐĞ ƚŽ ŵĞ ŝŶ ƚŚĞ ƉƌĞĐĞƉƚŽƌ room, they often look at the computer screen – even if nothing’s on it – as if that ǁĞƌĞ ƚŚĞ ƉĂƚŝĞŶƚ ǁĞ͛ƌĞ ƚĂůŬŝŶŐ about. Hey, my eyes are over ŚĞƌĞ͕ ƵĚĚLJ͊ ; dt͕ / ůŽǀĞ ŽƵƌ residents.)

Depending on your generational affiliation, you probably use technology to different degrees and for ĚŝĨĨĞƌĞŶƚ ƉƵƌƉŽƐĞƐ͘ DLJ ǁŝĨĞ ǁŽƵůĚŶ͛ƚ ŚĂǀĞ ƚĞdžƚĞĚ ŽŶ ŚĞƌ ƉŚŽŶĞ ǁŚĞŶ ƉƵƐŚŝŶŐ ŽƵƚ ŽƵƌ ĚĂƵŐŚƚĞƌƐ͕ ďƵƚ ŝƚ ǁĂƐ ŽŬ ĨŽƌ ŵLJ ϭϳͲLJĞĂƌͲŽůĚ K ƉĂƚŝĞŶƚ yesterday. My dad can spend ŚŽƵƌƐ ǁĂƚĐŚŝŶŐ ƌĞŐƵůĂƌ ds ǁŚŝĐŚ ŝƐ ŚĂůĨ ĐŽŵŵĞƌĐŝĂůƐ͕ ďƵƚ / ǁŽŶ͛ƚ ǁĂƚĐŚ Ă ƐŚŽǁ ƵŶůĞƐƐ / ĐĂŶ ĨĂƐƚ ĨŽƌǁĂƌĚ ƚŚƌŽƵŐŚ ƚŚĂƚ ƐƚƵĨĨ͘ ,Žǁ ŝŶƚŝŵĂƚĞ ĂƌĞ LJŽƵ ǁŝƚŚ LJŽƵƌ ĚĞǀŝĐĞƐ ĂŶĚ ŚĂǀĞ LJŽƵ ďĞĞŶ ƚĞƐƚĞĚ ůĂƚĞůLJ͍

tĞ ŚŽƉĞ ƚŚŝƐ ŝƐƐƵĞ ǁŝůů ŵĂŬĞ LJŽƵ ƚŚŝŶŬ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ technology that you use, or could use or shouldn’t be using, ĂŶĚ ŚŽǁ LJŽƵ ĐĂŶ ŬĞĞƉ LJŽƵƌ ƚĞĐŚŶŽůŽŐŝĐĂů ŐŽŽĚŝĞƐ ŽƵƚ ŽĨ dĞĐŚŶŽůŽŐLJ ŝƐ ƵƐĞĨƵů͕ ĂŶĚ ŶŽŝƐLJ͘ ,Žǁ ĐĂŶ ǁĞ ŚĂƌŶĞƐƐ ŝƚ͕ ƚŚĞ ƌĞĂĐŚ ŽĨ ĐLJďĞƌƚŚŝĞǀĞƐ͕ ƚƌŽůůĞƌƐ͕ ďŝƚĐŽŝŶ ƉŝƌĂƚĞƐ͕ ĚĂƌŬ ǁĞď ƌĞŐƵůĂƚĞ ŝƚ͕ ŵĂŬĞ ŝƚ ǁŽƌŬ ĨŽƌ ƵƐ ĂŶĚ ŶŽƚ ĂŐĂŝŶƐƚ ƵƐ͍ dŚŝƐ ŝƐ ƚŚĞ ŵŽŶƐƚĞƌƐ͕ ĞƚĐ͘ dĞƌƌŽƌ ŝƐ ŶŽƚ ƚŚĂƚ ĚĞƌĂŶŐĞĚ ĐůŽǁŶ ŝŶ ƚŚĞ ƐƚŽƌŵ ƐƚƌƵŐŐůĞ ŽĨ ϮϭƐƚ ĞŶƚƵƌLJ ŚƵŵĂŶŝƚLJ͘ &Žƌ ĞǀĞƌLJ ϭ͕ϬϬϬ ƉĞŽƉůĞ ĚƌĂŝŶ͘ /ƚ͛Ɛ ƚŚĂƚ ĞdžƚƌĂ ƐǁŝƉĞ ŽĨ ƚŚĞ ƐĐƌĞĞŶ Žƌ ĐůŝĐŬ ŽĨ ƚŚĞ ŵŽƵƐĞ ǁŽƌŬŝŶŐ ŽŶ ŵĂŬŝŶŐ LJŽƵƌ ĐĂƌ ƐĞůĨͲĚƌŝǀŝŶŐ͕ ƚŚĞƌĞ͛Ɛ ƉƌŽďĂďůLJ ŽŶĞ ƚŚĂƚ LJŽƵ ƐŚŽƵůĚŶ͛ƚ ŚĂǀĞ ƚĂŬĞŶ͘ zŽƵƌ ŽŶƚƌŽů ƉŽǁĞƌ ŽŶůLJ ƉůĂŶŶŝŶŐ ŚŽǁ ƚŽ ŚŝũĂĐŬ ƚŚĞ ƉƌŽŐƌĂŵŵŝŶŐ ĂŶĚ ŵĂŬĞ LJŽƵ ĐƌĂƐŚ ŐŽĞƐ ƐŽ ĨĂƌ͊ ŝŶƚŽ Ă ĐƌŽǁĚ͘ tŚĂƚ ĚŽ ǁĞ ĚŽ ŝĨ ƚŚĞ ƉŽǁĞƌ ŐŽĞƐ ŽƵƚ͍ tŚĂƚ ŝĨ ůĂƌŐĞƐƚ ƐŽůĂƌ ĨůĂƌĞ ŝŶ ƌĞĐŽƌĚĞĚ ŚŝƐƚŽƌLJ ŽĨ ϭϴϱϵ Śŝƚ ĂŐĂŝŶ ŝŶ Ok, enough about technology. There’s a reason editors can’t ϮϬϱϵ͍ ůŵŽƐƚ ĞǀĞƌLJƚŚŝŶŐ ǁĞ ĚŽ ĂŶĚ ƚŽƵĐŚ ŝƐ ŶŽǁ ƚŝĞĚ ƚŽ ǁƌŝƚĞ ŵŽƌĞ ƚŚĂŶ ŽŶĞ ƉĂŐĞ͘ /͛ŵ ŐŽŝŶŐ ƉŚŝƐŚŝŶŐ͊

6

California Family Physician Fall 2017

Seeking Family Medicine Physician (Bilingual-Spanish) at our Novato, California clinic location 32-40 hours per week doing Primary Care, generous benefits, including CME and Sabbatical Program.

PHYSICIANS

Marin Community Clinics is a Federally Qualified Health Center (FQHC), the largest in Marin County.

We serve 35,000 patients annually. We offer a multi-clinic network with a wide array of primary care and specialty services. Our mission is to improve the health of our patients and community by providing high quality, cost-effective, culturally sensitive, patient-centered health care.

For more information visit:

www.marinclinics.org

California Family Physician Fall 2017

7

p r e s i d e n t ’s m e s s a g e

Michelle Quiogue, MD, FAAFP

Count to Three Alligators! /Ŷ ŽƵƌ ǁŽƌůĚ ŽĨ ƌĂƉŝĚůLJ ĐŚĂŶŐŝŶŐ ƚĞĐŚŶŽůŽŐŝĞƐ͕ ǁĞ ŽŌĞŶ ĨŽƌŐĞƚ ŚŽǁ ďƌŝĞĨ ŽƵƌ ƟŵĞ ǁŝƚŚ ƉĞƌƐŽŶĂů ŵŽďŝůĞ ĐŽŵƉƵƚĞƌƐ ŚĂƐ ďĞĞŶ͘ ǀĞŶ ƚŚŽƵŐŚ / ŬŶŽǁ ƚŚĞ ĨĞĞů ŽĨ ĚŝĂůŝŶŐ Ă ƌŽƚĂƌLJ ƉŚŽŶĞ ďĞŶĞĂƚŚ ŵLJ ĮŶŐĞƌƟƉ ĂŶĚ ƚŚĞ ďƵnjnjͲĐƌĂƐŚͲďƵnjnj ŽĨ ĚŝĂůͲƵƉ ŝŶƚĞƌŶĞƚ͕ / ƐƟůů ŐĞƚ ƋƵŝĐŬůLJ ĨƌƵƐƚƌĂƚĞĚ ǁŚĞŶ ŵLJ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚ ; ,ZͿ ƐƚĂůůƐ ĨŽƌ ƚŚƌĞĞ ƐĞĐŽŶĚƐ͘ Ɛ Ă ŵŽŵĞŶƚ ŽĨ ŵĞĚŝƚĂƟŽŶ͕ / ŚĂǀĞ begun to replace my habit of repeatedly clicking the mouse ǁŚĞŶ ƚŚŝƐ ŚĂƉƉĞŶƐ ĂŶĚ͕ ŝŶƐƚĞĂĚ͕ ƉƵƚ Ă ƉŽƐŝƟǀĞ ƐƉŝŶ ŽŶ ƚŚŝƐ ŝŶĐŽŶǀĞŶŝĞŶĐĞ ďLJ ĐŽƵŶƟŶŐ ŵLJ ďƌĞĂƚŚ͘ Ɛ / ŝŶŚĂůĞ ĂŶĚ ĞdžŚĂůĞ͕ / ƌĂƌĞůLJ ĐŽƵŶƚ ƚŽ ƚŚƌĞĞ ĂůůŝŐĂƚŽƌƐ ůĞƚ ĂůŽŶĞ ĐŽŵƉůĞƚĞ Ă ǁŚŽůĞ ďƌĞĂƚŚ ĐLJĐůĞ͘ ,Žǁ ĐŽƵůĚ ŝƚ ďĞ ƚŚĂƚ ƐƵĐŚ Ă ďƌŝĞĨ ƉĂƵƐĞ ĐŽƵůĚ ĨĞĞů ůŝŬĞ ĞŶĚůĞƐƐ ǁĂƐƚĞĚ ƟŵĞ ĂŶĚ ƉƵƐŚ ŵĞ ƚŽ ƚŚĞ ǀĞƌŐĞ ŽĨ ƚŚƌŽǁŝŶŐ ƐŽŵĞƚŚŝŶŐ Ăƚ ƚŚĞ ĐŽŵƉƵƚĞƌ͍ dŚŝƐ ĐŚĂŶĐĞ ƚŽ ƌĞĐĂůŝďƌĂƚĞ ĞdžƉĞĐƚĂƟŽŶƐ ŝƐ Ă ŐŝŌ͘ ƚ ƚŚĞ &W ŶŶƵĂů ŚĂƉƚĞƌ >ĞĂĚĞƌƐ &ŽƌƵŵ ; >&Ϳ ŝŶ <ĂŶƐĂƐ ŝƚLJ ƚŚŝƐ LJĞĂƌ͕ ůŝĨ <ŶŝŐŚƚ͕ D ͕ W ͕ & &W͕ ^ĞŶŝŽƌ sŝĐĞ WƌĞƐŝĚĞŶƚ ĨŽƌ ĚƵĐĂƟŽŶ͕ ŐĂǀĞ ŵĞ ƚŚŝƐ ŐŝŌ ĚƵƌŝŶŐ ŚŝƐ ƐĞƐƐŝŽŶ ĂďŽƵƚ ƉŚLJƐŝĐŝĂŶ ǁĞůůŶĞƐƐ͘ /Ŷ ĚĞƐĐƌŝďŝŶŐ ƚŚĞ ŶĞŐĂƟǀĞ ŝŵƉĂĐƚ ŽĨ ,ZƐ ŽŶ ƉƌŽĨĞƐƐŝŽŶĂů ƐĂƟƐĨĂĐƟŽŶ ĂŶĚ ƌŝƐŬ ŽĨ ďƵƌŶŽƵƚ͕ ŚĞ ƐŚŽǁĞĚ ƵƐ Ă ƐůŝĚĞ ŽĨ ƚŚĞ ĞĂƌůLJ ĐĞůůƉŚŽŶĞƐ͘ ,Ğ ƌĞŵŝŶĚĞĚ ƵƐ ƚŚĂƚ ǁĞ ĂƌĞ ůŝǀŝŶŐ ƚŚƌŽƵŐŚ ƚŚĞ early adolescence of EHRs. dŚĂƚ ĂǁŬǁĂƌĚ ƉĞƌŝŽĚ ďĞƚǁĞĞŶ ĐĞůůƉŚŽŶĞƐ ;ƚŚĞ ĮƌƐƚ ŝWŚŽŶĞ ǁĂƐ ƌĞůĞĂƐĞĚ ŽŶůLJ ϭϬ LJĞĂƌƐ ĂŐŽͿ ĂŶĚ ƚŚĞ ŝŶƚĞƌŶĞƚ ĂƐ ǁĞ ŬŶŽǁ ŝƚ today happened during my adolescence and years of medical ƚƌĂŝŶŝŶŐ͘ WĞƌŚĂƉƐ ƚŚĂƚ ĞdžƉůĂŝŶƐ ƚŚĞ ĞdžƉĞĐƚĂƟŽŶ / ŚĂǀĞ ĨŽƌ ĂŶ ŝŶƚƵŝƟǀĞ ŝŶƚĞƌĨĂĐĞ ĂŶĚ ĨŽƌ ƐĞĂŵůĞƐƐ ĂƵƚŽŵĂƟŽŶ ŽĨ ŵLJ ĚĂŝůLJ ŵĞĚŝĐĂů ǁŽƌŬ͘ hŶĨŽƌƚƵŶĂƚĞůLJ͕ ƚŚĞ ƐŝŐŶŝĮĐĂŶƚ ĚŝīĞƌĞŶĐĞ ďĞƚǁĞĞŶ ƚŚĞ ĞǀŽůƵƟŽŶ ŽĨ ƉĞƌƐŽŶĂů ĐŽŵƉƵƚĞƌƐ ĂŶĚ ŽĨ ,ZƐ ŝƐ ƚŚĞ ĂďƐĞŶĐĞ ŽĨ ĞŶĚ ƵƐĞƌƐ͕ ĂŬĂ ƉŚLJƐŝĐŝĂŶƐ͕ ŝŶ ďĞƚĂ ƚĞƐƟŶŐ ĂŶĚ ĨĞĞĚďĂĐŬ ĂďŽƵƚ ĚĞƐŝŐŶ ĂƐ ŝƚ ƌĞůĂƚĞƐ ƚŽ ƚŚĞ ĐƌŝƟĐĂů ĂƐƉĞĐƚ ŽĨ ŵĞĚŝĐŝŶĞ͗ ďƵŝůĚŝŶŐ ƌĞůĂƟŽŶƐŚŝƉƐ͘ Today’s EHRs are designed for coding and billing because those ĨŽůŬƐ ƐĂƚ Ăƚ ƚŚĞ ĚƌĂǁŝŶŐ ƚĂďůĞ ǁŚŝůĞ ƉŚLJƐŝĐŝĂŶƐ ǁĞƌĞ ĨŽƌ ƚŚĞ ŵŽƐƚ ƉĂƌƚ ĂďƐĞŶƚ ƵŶƟů ŶŽǁ͘ tĞ ĂƌĞ Ăƚ ƚŚĞ ďƌŝŶŬ ŽĨ ĂŶŽƚŚĞƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞǀŽůƵƟŽŶ͘ /Ŷ :ƵŶĞ͕ / ƌĞĐĞŝǀĞĚ ĂŶŽƚŚĞƌ ŐŝŌ ǁŚĞŶ / ĂƩĞŶĚĞĚ ĂŶ ,Z ƚƌĂŝŶŝŶŐ ƐƉŽŶƐŽƌĞĚ ďLJ ŵLJ ŵĞĚŝĐĂů ŐƌŽƵƉ͕ ^ WD'͘ /ƚ ǁĂƐ ƵŶůŝŬĞ ĂŶLJ other EHR training I had experienced in the past. Instead of

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California Family Physician Fall 2017

non-medical or peripherally medical IT folks, the leaders of this ƚƌĂŝŶŝŶŐ ǁĞƌĞ ĨƌŽŶƚ ůŝŶĞ ĨĂŵŝůLJ ĚŽĐƐ͘ ĂĐŚ ŽĨ ƚŚĞŵ ďƌŽƵŐŚƚ ƚŚĞŝƌ ĚŝǀĞƌƐĞ ĞdžƉĞƌŝĞŶĐĞƐ͕ ŝĚĞŶƟƟĞƐ͕ ƐŬŝůůƐ ĂŶĚ ƚĂůĞŶƚƐ ƚŽ ƚŚĞ ƐĞƌǀŝĐĞ ŽĨ ƚŚĞŝƌ ĐŽůůĞĂŐƵĞƐ͘ KŶĞ ĨĂŵŝůLJ ĚŽĐ ŝŶ ƉĂƌƟĐƵůĂƌ ƐƚĂŶĚƐ ŽƵƚ ĞŶŽƵŐŚ ƚŽ ŚŝŐŚůŝŐŚƚ͘ ĞĨŽƌĞ ŚĞ ǁĞŶƚ ƚŽ ŵĞĚŝĐĂů ƐĐŚŽŽů͕ ŚĞ ǁĂƐ Ă ĐŽŵƉƵƚĞƌ ƉƌŽŐƌĂŵŵĞƌ͘ tŝƚŚ ƚŚŝƐ ďĂĐŬŐƌŽƵŶĚ͕ ŚĞ ǁĂƐ ĂďůĞ ƚŽ ǁƌŝƚĞ Ă ƉƌŽŐƌĂŵ ƚŚĂƚ ƌƵŶƐ ĂůŽŶŐƐŝĚĞ ƚŚĞ ,Z͘ &ŝƌƐƚ͕ ŚĞ ƌĞĐŽƌĚĞĚ Ăůů ŽĨ ƚŚĞ ĐůŝĐŬƐ ŶĞĞĚĞĚ ƚŽ ĐŽŵƉůĞƚĞ Ăůů ŽĨ ƚŚĞ ƚĂƐŬƐ ƚŚĂƚ ǁĞ ĚŽ ŚƵŶĚƌĞĚƐ ŽĨ ƟŵĞƐ ĞǀĞƌLJ ĚĂLJ͘ dŚĞŶ͕ ŚĞ ĂƵƚŽŵĂƚĞĚ ƚŚŽƐĞ ƚĂƐŬƐ͘ ĂĐŚ ŝƚĞƌĂƟŽŶ ŽĨ ƚŚŝƐ ƉƌŽŐƌĂŵ ŐĞƚƐ ďĞƩĞƌ ĂŶĚ ďĞƩĞƌ ǁŝƚŚ ƚŚĞ input from dozens of other physician super users. Another ŐĞŶŝƵƐ ĨĂŵŝůLJ ĚŽĐ ŚĂƐ ĂĐƚƵĂůůLJ ĂƵƚŽŵĂƚĞĚ ĮůůŝŶŐ ŽƵƚ ĨŽƌŵƐ͊ dŚĞ ,Z ƐƟůů ŚĂƐ ŝƚƐ ĚĞĮĐŝĞŶĐŝĞƐ͕ ďƵƚ ƚŚĞƐĞ ĨĂŵŝůLJ ĚŽĐƐ ŚĂǀĞ ĐƌĞĂƚĞĚ Ă ǁĂLJ ƚŽ ƌĞŵŽǀĞ ƚŚŽƵƐĂŶĚƐ ŽĨ ĐůŝĐŬƐ ĂŶĚ ŵŝŶƵƚĞƐ ŽĨ ĚƌƵĚŐĞƌLJ ƚŽ ŐŝǀĞ ƵƐ ďĂĐŬ ƚŚŽƐĞ ƉƌĞĐŝŽƵƐ ŵŽŵĞŶƚƐ ĨŽƌ ĐŽŶŶĞĐƟŽŶ ĂŶĚ ƌĞŇĞĐƟŽŶ͘ ^ŽŵĞ ǁŚŽ ŚĂǀĞ ĂƩĞŶĚĞĚ ƚŚŝƐ ƚƌĂŝŶŝŶŐ ŚĂǀĞ ĞǀĞŶ ƉƌŽĨĞƐƐĞĚ ƚŚĂƚ ƚŚŝƐ ƉŚLJƐŝĐŝĂŶͲĐĞŶƚĞƌĞĚ ĂƵƚŽŵĂƟŽŶ and intelligent design has literally saved their careers, their marriages and, in some cases, their lives.

While not the only factor in the rise of physician burnout, redesigning EHRs to be physician-centered could turn the ƟĚĞ ŝŶ ĨĂǀŽƌ ŽĨ ŝŵƉƌŽǀĞĚ ǁŽƌŬ ůŝĨĞ ďĂůĂŶĐĞ ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂů ƐĂƟƐĨĂĐƟŽŶ͘ >ĞƐƐ ƚĞĚŝƵŵ ǁŽƵůĚ ĂůůŽǁ ƵƐ ƚŽ ĨŽĐƵƐ ŵŽƌĞ ŽŶ ĐĂƌŝŶŐ ĂŶĚ ƚŽ ĨĞĞů ŐƌĂƟƚƵĚĞ ĨŽƌ ƚŚĞ ŐŝŌƐ ŽĨ ŚĞĂůŝŶŐ͘ / ĨĞůů ŝŶ ůŽǀĞ ǁŝƚŚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĚƵƌŝŶŐ ŵĞĚŝĐĂů ƐĐŚŽŽů ǁŚĞŶ / ůĞĂƌŶĞĚ ƚŽ ƐĞĞ Ă ďĞĂƵƟĨƵů ƐƚŽƌLJ ŝŶ ĂůŵŽƐƚ ĞǀĞƌLJ ĞdžĂŵ ƌŽŽŵ͗ ƚŚĞ ĞŶĚƵƌŝŶŐ love of an elderly couple, the faith of those facing a grave ĚŝĂŐŶŽƐŝƐ͕ ƚŚĞ ƵŶŝǀĞƌƐĂů ƚƌĂŶƐŝƟŽŶƐ ŽĨ ůŝĨĞ͘ /Ĩ LJŽƵ ĂƌĞ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ǁŝƚŚ ƚŚĞ ƐŬŝůůƐ ĂŶĚ ďĂĐŬŐƌŽƵŶĚ ƚŽ create meaningful change, please consider yourself called to ůĞĂĚ LJŽƵƌ ŵĞĚŝĐĂů ŐƌŽƵƉ͘ ^ŚŽǁ ƚŚĞŵ ŚŽǁ ŝƚ ĐŽƵůĚ ďĞ͘ ^ŽŵĞƚŚŝŶŐ ďĞƩĞƌ ŝƐ ŽƵƚ ƚŚĞƌĞ͘ dŚĞ ǁĂLJ ĨŽƌǁĂƌĚ ƌĞůŝĞƐ ŽŶ ƚŚĞ ƉƌĞƐĞŶĐĞ ŽĨ Ăůů ƐƚĂŬĞŚŽůĚĞƌƐ Ăƚ ƚŚĞ ĚƌĂǁŝŶŐ ďŽĂƌĚ͘ zŽƵƌ ƵŶŝƋƵĞ ĞdžƉĞƌŝĞŶĐĞ͕ ŝĚĞŶƟƚLJ͕ ƐŬŝůůƐ ĂŶĚ ƚĂůĞŶƚƐ ĂƌĞ ŶŽƚ ŽŶůLJ ŶĞĞĚĞĚ ƚŽ ŚĞĂů LJŽƵƌ ƉĂƟĞŶƚƐ ďƵƚ ĂůƐŽ ƚŽ ŚĞĂů ĂŶĚ η ĞdŚĞ ŚĂŶŐĞ ĨŽƌ LJŽƵƌ ĐŽůůĞĂŐƵĞƐ ĂŶĚ LJŽƵƌ ƉƌŽĨĞƐƐŝŽŶ͘ dŚĞ ŶĂƌƌĂƟǀĞ ŽĨ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ ŝƐ ŝŶĐŽŵƉůĞƚĞ ǁŝƚŚŽƵƚ LJŽƵƌ ƐƚŽƌLJ͘ dŽŐĞƚŚĞƌ͕ ǁĞ ĐĂŶ ĐŚĂŶŐĞ ƚŚĞ ƐƚŽƌLJ ŽĨ ƉŚLJƐŝĐŝĂŶ ďƵƌŶŽƵƚ͘ dŽŐĞƚŚĞƌ͕ ǁĞ ĐĂŶ ŐĞƚ ƚŚƌŽƵŐŚ ƚŚŝƐ ĂǁŬǁĂƌĚ ĂĚŽůĞƐĐĞŶĐĞ͘

Leading the future of health care.

ADULT & FAMILY MEDICINE PHYSICIAN OPPORTUNITIES Northern & Central California

The Permanente Medical Group, Inc. (TPMG) is one of the largest medical groups in the nation with over 9,000 physicians, 22 medical centers, numerous clinics throughout Northern and Central California and a 70 year tradition of providing quality medical care.

WE OFFER • Physician-led organization–career growth and leadership • Professional freedom • State-of-the-art facilities • Multi-specialty collaboration and integration • Technology driven • Mission driven, patient care-centered and one of the largest progressive medical groups in the nation!

EXTRAORDINARY BENEFITS • Shareholder track • Unparalleled stability–70 years strong • Shared call • Moving allowance • No cost medical and dental • Home loan assistance (approval required) • Malpractice and tail insurance • Three retirement plans, including pension • Paid holidays, sick leave, education leave (with generous stipend)

FORGIVABLE LOAN PROGRAM $150,000-$275,000 (based on experience)

Nos apasiona nuestro trabajo.

En Kaiser Permanente, a nosostros los médicos nos encanta nuestro trabajo. Nuestra misión es servir a nuestros pacientes. Innovar, avanzar, ser inclusivos. Intégrate a nuestro equipo de atención de la salud, en apoyo a la comunidad.

LA SALUD PERMANENTE

At The Permanente Medical Group, Inc., we practice a multi-lingual, culturally inclusive approach to care that celebrates the diversity of our patients and physicians. By developing medical programs that are in tune with every aspect of our patients’ lives—from the language they speak to the heritage they embrace—we are actively investing in initiatives and services that reflect the diversity of our member community.

Here, our bilingual physicians can act as true advocates for their patients, delivering care that’s as medically advanced as it is culturally sensitive.

FAMILY MEDICINE OPPORTUNITIES: Contact Aileen Ludlow at: Aileen.M.Ludlow@kp.org | (800) 777-4912 INTERNAL MEDICINE OPPORTUNITIES: Contact Bianca Davis at: Bianca.X.Davis@kp.org | (800) 777-4912 http://physiciancareers-ncal.kp.org

We are an EOE/AA/M/F/D/V Employer.

VEVRAA Federal Contractor.

California Family Physician Fall 2017

political pulse

Carla Kakutani, MD

CAFP-Supported Bills are Sitting on the Threshold dŽ ĚĂƚĞ͕ ǁĞ ƐƵĐĐĞƐƐĨƵůůLJ ƉƌŽƚĞĐƚĞĚ ŽƵƌ ŚĂƌĚͲǁŽŶ ΨϭϬϬ ŵŝůůŝŽŶ ƚŚƌĞĞͲLJĞĂƌ ƐƚĂƚĞ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WŚLJƐŝĐŝĂŶ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ ;ǁŚŝĐŚ ĨƵŶĚƐ ƉƌŝŵĂƌLJ ĐĂƌĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ŝŶ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂƐ ƚŚĂƚ ƉƌŽǀŝĚĞ ĐĂƌĞ ĨŽƌ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶƐͿ͘ tĞ ĂůƐŽ ŚĂǀĞ ĞŶƐƵƌĞĚ ƚŚĂƚ Ă ƐŝŐŶŝĮĐĂŶƚ ƉŽƌƟŽŶ ŽĨ ƚŚĞ ƌĞǀĞŶƵĞ ĨƌŽŵ ƚŚĞ ƌĞĐĞŶƚůLJ ƉĂƐƐĞĚ WƌŽƉŽƐŝƟŽŶ ϱϲ ;ƚŽďĂĐĐŽ ƚĂdžͿ ŝƐ ƐƉĞŶƚ ŽŶ DĞĚŝͲ Ăů ƉƌŽǀŝĚĞƌ ƉĂLJŵĞŶƚ ;ŵŽƌĞ ƚŚĂŶ Ψϭ ďŝůůŝŽŶ ǁŚĞŶ ŵĂƚĐŚĞĚ ǁŝƚŚ ĨĞĚĞƌĂů ĨƵŶĚƐͿ ĂŶĚ ƉƌŝŵĂƌLJ ĐĂƌĞ ƌĞƐŝĚĞŶĐLJ ƚƌĂŝŶŝŶŐ ;ΨϰϬ million annually). Ɛ ŽĨ ƚŚŝƐ ǁƌŝƟŶŐ͕ ƐĞǀĞƌĂů &WͲƐƵƉƉŽƌƚĞĚ ĂŶĚ ĐŽͲƐƉŽŶƐŽƌĞĚ ďŝůůƐ ĂƌĞ ŽŶ ƚŚĞ ǀĞƌŐĞ ŽĨ ŵĂŬŝŶŐ ŝƚ ƚŽ ƚŚĞ 'ŽǀĞƌŶŽƌ͛Ɛ ĚĞƐŬ͕ ŝŶĐůƵĚŝŶŐ͗ ϰϬ ;^ĂŶƟĂŐŽͿ hZ ^ ĚĂƚĂďĂƐĞ͗ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ƚĞĐŚŶŽůŽŐLJ ƐLJƐƚĞŵ dŚŝƐ ďŝůů ĂůůŽǁƐ ƋƵĂůŝĮĞĚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ƚĞĐŚŶŽůŽŐLJ ƐLJƐƚĞŵƐ͕ ƐƵĐŚ ĂƐ ,ZƐ͕ ƚŽ ĐŽŶŶĞĐƚ ƚŽ ƚŚĞ ŽŶƚƌŽůůĞĚ ^ƵďƐƚĂŶĐĞ hƟůŝnjĂƟŽŶ ZĞǀŝĞǁ ĂŶĚ ǀĂůƵĂƟŽŶ ^LJƐƚĞŵ ; hZ ^Ϳ ĚĂƚĂďĂƐĞ ƚŽ ĞŶĂďůĞ ĚŝƌĞĐƚ ŝŵƉŽƌƚĂƟŽŶ ŽĨ hZ ^ ĚĂƚĂ ŝŶƚŽ ƉĂƟĞŶƚ ƌĞĐŽƌĚƐ͘

ŶĂŵĞ ĚƌƵŐƐ ĂŶĚ ƐƉĞĐŝĂůƚLJ ĚƌƵŐƐ͘ dŚĞ ƐƚĂƚĞ ŐŽǀĞƌŶŵĞŶƚ ǁŝůů ĐŽŵƉŝůĞ ƚŚĞ ŝŶĨŽƌŵĂƟŽŶ ŝŶ Ă ƌĞƉŽƌƚ ĨŽƌ ƚŚĞ ƉƵďůŝĐ ĂŶĚ ůĞŐŝƐůĂƚŽƌƐ that demonstrates the overall impact of drug costs on health care premiums. The bill also requires health plans to disclose ŝŶĨŽƌŵĂƟŽŶ ƌĞŐĂƌĚŝŶŐ ƚŚĞ ƌĞůĂƟŽŶ ŽĨ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ĐŽƐƚƐ ƚŽ plan or insurer spending and premium charges. Finally, the bill ƌĞƋƵŝƌĞƐ Ă ŵĂŶƵĨĂĐƚƵƌĞƌ ŽĨ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ǁŝƚŚ Ă ǁŚŽůĞƐĂůĞ ĂĐƋƵŝƐŝƟŽŶ ĐŽƐƚ ŽĨ ŵŽƌĞ ƚŚĂŶ ΨϰϬ ƚŽ ŶŽƟĨLJ ƉƵƌĐŚĂƐĞƌƐ ŽĨ ĂŶ ŝŶĐƌĞĂƐĞ ŝŶ ƚŚĞ ǁŚŽůĞƐĂůĞ ĂĐƋƵŝƐŝƟŽŶ ĐŽƐƚ ŽĨ Ă ƉƌĞƐĐƌŝƉƟŽŶ͘

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To date, we successfully protected our hard-won $100 million three-year state investment in the Song-Brown Physician Training Program.

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dŚĂŶŬƐ ƚŽ ŽƵƌ ŵĞŵďĞƌƐ͕ <ĞLJ ŽŶƚĂĐƚƐ ĂŶĚ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƟŽŶƐ team, CAFP has already had one of its most successful advocacy LJĞĂƌƐ ĞǀĞƌ͘ ŶĚ͕ ĂƐ ǁĞ ǁƌĂƉ ƵƉ ƚŚĞ ĮƌƐƚ LJĞĂƌ ŽĨ ƚŚĞ ϮϬϭϳͲϭϴ >ĞŐŝƐůĂƟǀĞ ^ĞƐƐŝŽŶ͕ ǁĞ ŚĂǀĞ ƐĞǀĞƌĂů ǁŝŶƐ ƐƟůů ŝŶ ƉůĂLJ͘

ϯϭϱ ;tŽŽĚͿ WŚĂƌŵĂĐLJ ďĞŶĞĮƚƐ ŵĂŶĂŐĞŵĞŶƚ ƚƌĂŶƐƉĂƌĞŶĐLJ dŚŝƐ ďŝůů ĞŶƐƵƌĞƐ ƚŚĂƚ Ăůů ƉƌĞƐĐƌŝƉƟŽŶ ƉƵƌĐŚĂƐĞƌƐ͕ ƌĞŐĂƌĚůĞƐƐ ŽĨ ƚŚĞŝƌ ƐŝnjĞ͕ ƌĞĐĞŝǀĞ ƐƚĂŶĚĂƌĚ ŝŶĨŽƌŵĂƟŽŶ ĨƌŽŵ ƉŚĂƌŵĂĐLJ ďĞŶĞĮƚƐ ŵĂŶĂŐĞƌƐ ;W DͿ ƚŽ ĂƐƐŝƐƚ ƚŚĞ ƉƵƌĐŚĂƐĞƌ ŝŶ ƉƌŽƉĞƌůLJ ĞǀĂůƵĂƟŶŐ ǁŚĞƚŚĞƌ ƚŚĞ W D͛Ɛ ƐĞƌǀŝĐĞƐ ĂƌĞ ĚĞůŝǀĞƌŝŶŐ ƉƌŽŵŝƐĞĚ ƐĂǀŝŶŐƐ͘ W DƐ ƉůĂLJ Ă ŵĂũŽƌ ƌŽůĞ ŝŶ ŶĞŐŽƟĂƟŶŐ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ƉƌŝĐĞƐ͕ ĐƌĞĂƟŶŐ ĂŶĚ ŵĂŶĂŐŝŶŐ ĨŽƌŵƵůĂƌŝĞƐ ĂŶĚ ƐĞǀĞƌĂů ŽƚŚĞƌ ĨƵŶĐƟŽŶƐ ŬĞLJ ƚŽ ƚŚĞ ŵĂŶĂŐĞŵĞŶƚ ŽĨ ƉŚĂƌŵĂĐLJ ďĞŶĞĮƚƐ ĨŽƌ ŵŝůůŝŽŶƐ ŽĨ ĂůŝĨŽƌŶŝĂŶƐ͘ sĞƌLJ ůŝƩůĞ ŝƐ ŬŶŽǁŶ͕ ŚŽǁĞǀĞƌ͕ ĂďŽƵƚ ƚŚĞ ĚŝƐĐŽƵŶƚƐ ĂŶĚ ƉƌŝĐŝŶŐ ĂŐƌĞĞŵĞŶƚƐ W DƐ ŵĂŬĞ ǁŝƚŚ ĚƌƵŐ ŵĂŶƵĨĂĐƚƵƌĞƌƐ͕ ŚĞĂůƚŚ ƉůĂŶƐ ĂŶĚ ƉŚĂƌŵĂĐŝĞƐ͘ dŚŝƐ ďŝůů ƐŚŝŶĞƐ Ă ůŝŐŚƚ ŽŶ ƚŚĞŝƌ ĮŶĂŶĐŝĂů ĂƌƌĂŶŐĞŵĞŶƚƐ ĂŶĚ ĚĞƚĞƌŵŝŶĞ ǁŚĞƚŚĞƌ ƉĂƟĞŶƚƐ ĂĐƚƵĂůůLJ ďĞŶĞĮƚ ĨƌŽŵ W DƐ͛ ĂĐƟǀŝƟĞƐ͘

^ ϮϮϯ ; ƚŬŝŶƐͿ ,ĞĂůƚŚ ĐĂƌĞ ůĂŶŐƵĂŐĞ ĂƐƐŝƐƚĂŶĐĞ ƐĞƌǀŝĐĞƐ dŚŝƐ ďŝůů ĞŶƐƵƌĞƐ Ăůů ĂůŝĨŽƌŶŝĂŶ ƉĂƟĞŶƚƐ ƌĞĐĞŝǀĞ ĞƋƵĂů ĂĐĐĞƐƐ ƚŽ ůĂŶŐƵĂŐĞ ĂƐƐŝƐƚĂŶĐĞ ĂŶĚ ĐůĞĂƌ ŶŽƟĮĐĂƟŽŶ ŽĨ ƚŚĞŝƌ ƌŝŐŚƚƐ ƚŽ ƌĞĐĞŝǀĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŝƚŚŽƵƚ ĚŝƐĐƌŝŵŝŶĂƟŽŶ͕ ƌĞŐĂƌĚůĞƐƐ ŽĨ ĨĞĚĞƌĂů ĐŚĂŶŐĞƐ͘

^ ϭϳ ;,ĞƌŶĂŶĚĞnjͿ ,ĞĂůƚŚ ĐĂƌĞ͗ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ĐŽƐƚƐ dŚŝƐ ďŝůů ƌĞƋƵŝƌĞƐ ŚĞĂůƚŚ ƉůĂŶƐ ƚŽ ƌĞƉŽƌƚ ĐŽƐƚ ŝŶĨŽƌŵĂƟŽŶ ƌĞŐĂƌĚŝŶŐ ĐŽǀĞƌĞĚ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐƐ͕ ŝŶĐůƵĚŝŶŐ ŐĞŶĞƌŝĐ ĚƌƵŐƐ͕ ďƌĂŶĚ

ƌ͘ <ĂŬƵƚĂŶŝ ŝƐ ŚĂŝƌ ŽĨ ƚŚĞ >ĞŐŝƐůĂƟǀĞ īĂŝƌƐ ŽŵŵŝƩĞĞ ĂŶĚ WƌĞƐŝĚĞŶƚ ŽĨ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ WŽůŝƟĐĂů ĐƟŽŶ ŽŵŵŝƩĞĞ ;&WͲW Ϳ͘

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California Family Physician Fall 2017

We cannot thank enough all the Key Contacts, CAFP members, &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐLJ WƌŽŐƌĂŵƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƐƚƵĚĞŶƚƐ ǁŚŽ ƚŽŽŬ ĂĐƟŽŶ ƚŽ ŵĂŬĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͛Ɛ ǀŽŝĐĞ ŚĞĂƌĚ ĂŶĚ ƉƵƐŚ ĨŽƌ &W͛Ɛ ƉƌŝŽƌŝƟĞƐ͘ WůĞĂƐĞ ĐŽŶƚĂĐƚ LJŽƵƌ ůĞŐŝƐůĂƚŽƌƐ ĂŶĚ ƚŚĂŶŬ ƚŚĞŵ ĨŽƌ their support of primary care. ŶĚ͕ ŽĨ ĐŽƵƌƐĞ͕ ƚŚĂŶŬ LJŽƵ ƚŽ Ăůů ŽƵƌ ŵĞŵďĞƌƐ ǁŚŽ ĮŐŚƚ ŽŶ ďĞŚĂůĨ ŽĨ ƉĂƟĞŶƚƐ ĂŶĚ Ăůů ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĞǀĞƌLJ ĚĂLJ͊

FOR SOME OF OUR MOST ELITE SOLDIERS, THE EXAMINATION ROOM IS THE FRONT LINE. Becoming a family medicine physician and officer on the U.S. Army health care team is an opportunity like no other. You will provide the highest quality health care to Soldiers, family members, retirees and others, as well as conduct medical research of military importance. With this elite team, you will be a leader – not just of Soldiers, but in family health care.

See the benefits of being an Army medical professional at healthcare.goarmy.com/hb76 To learn more about the U.S. Army health care team, call 310-216-4433.

©2016. Paid for by the United States Army. All rights reserved.

California Family Physician Fall 2017

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Shannon Goecke Director, Membership and Member Services

membership news

You Are the Best Part of Membership dŚĞ ďĞƐƚ ƉĂƌƚ ŽĨ ŵĞŵďĞƌƐŚŝƉ ŝŶ ĂŶLJ ƉƌŽĨĞƐƐŝŽŶĂů ĂƐƐŽĐŝĂƟŽŶ ŝƐ ƚŚĞ ĐŽŵŵƵŶŝƚLJ͘ DĞŵďĞƌƐ ĐŽŵĞ ĨƌŽŵ ŵĂŶLJ ĚŝīĞƌĞŶƚ ďĂĐŬŐƌŽƵŶĚƐ ĂŶĚ ǁŽƌŬ ƐĞƫŶŐƐ ĂŶĚ ŚĂǀĞ ĚŝīĞƌĞŶƚ ŶĞĞĚƐ ŝŶ ƚŚĞŝƌ ĞǀĞƌLJĚĂLJ ƉƌĂĐƟĐĞ ůŝǀĞƐ͘ KŶĞ ƚŚŝŶŐ ŵĞŵďĞƌƐŚŝƉ ƉƌŽǀŝĚĞƐ͕ ǁŚŝĐŚ ďĞŶĞĮƚƐ ĞǀĞƌLJŽŶĞ͕ ŝƐ Ă ƐĞŶƐĞ ŽĨ ĐŽŶŶĞĐƟŽŶ ĂŶĚ ƐŚĂƌĞĚ ƉƵƌƉŽƐĞ ǁŝƚŚ ŽŶĞ͛Ɛ ƉĞĞƌƐ͘ tĞ strive to provide that experience to all CAFP members. Community has certainly been the best part of my membership in my ƉƌŽĨĞƐƐŝŽŶĂů ƐŽĐŝĞƚLJ͕ ƚŚĞ ŵĞƌŝĐĂŶ ƐƐŽĐŝĂƟŽŶ ŽĨ DĞĚŝĐĂů ^ŽĐŝĞƚLJ džĞĐƵƟǀĞƐ ; D^ Ϳ͘ DLJ ŵĞŵďĞƌƐŚŝƉ ŚĂƐ ůĞƚ ŵĞ ĐŽŶŶĞĐƚ ǁŝƚŚ ĂŶĚ ůĞĂƌŶ ĨƌŽŵ ĂŵĂnjŝŶŐ ƉĞŽƉůĞ / ŽƚŚĞƌǁŝƐĞ ŶĞǀĞƌ ǁŽƵůĚ ŚĂǀĞ ŵĞƚ͕ ĂŶĚ / ŶŽǁ ůŽŽŬ ĨŽƌǁĂƌĚ ƚŽ ƐĞĞŝŶŐ ƚŚĞŵ ĞǀĞƌLJ LJĞĂƌ͘ D^ ǁĂƐ ĨŽƌŵĞĚ ŝŶ ϭϵϰϲ ĂƐ ƚŚĞ DĞĚŝĐĂů ^ŽĐŝĞƚLJ džĞĐƵƟǀĞ ŽŶĨĞƌĞŶĐĞ ƚŽ ƉŽƐŝƟŽŶ ŵĞĚŝĐĂů ƐŽĐŝĞƚLJ ĞdžĞĐƵƟǀĞƐ͕ ƚŚĞŝƌ ŽƌŐĂŶŝnjĂƟŽŶƐ ĂŶĚ ƚŚĞ ƉŚLJƐŝĐŝĂŶƐ ƚŚĞLJ ƐĞƌǀĞ ƚŽ ĞdžĐĞů ŝŶ ƚŚĞ ĮĞůĚ ŽĨ organized medicine. AAMSE produces professional development ƌĞƐŽƵƌĐĞƐ ĂŶĚ ĂĐƟǀŝƟĞƐ ĨŽƌ Ă ŵĞŵďĞƌƐŚŝƉ ŽĨ ŵŽƌĞ ƚŚĂŶ ϭ͕ϯϬϬ ŵĞĚŝĐĂů ƐŽĐŝĞƚLJ ĞdžĞĐƵƟǀĞƐ ĂŶĚ ƐƚĂī ƐƉĞĐŝĂůŝƐƚƐ͘ KŶĞ ŽĨ ƚŚŽƐĞ ĂĐƟǀŝƟĞƐ ŝƐ ƚŚĞ ŶŶƵĂů ŽŶĨĞƌĞŶĐĞ͕ ŚĞůĚ ĞĂĐŚ ƐƵŵŵĞƌ͘ dŚŝƐ ƉĂƐƚ :ƵůLJ͕ / ĂƩĞŶĚĞĚ ƚŚĞ ŵĞĞƟŶŐ ŝŶ DŝŶŶĞĂƉŽůŝƐ ǁŝƚŚ ŵLJ ĐŽůůĞĂŐƵĞƐ͕ &W ĞƉƵƚLJ sW ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ͕ ĂŶĚ ŽŵŵƵŶŝĐĂƟŽŶƐ DĂŶĂŐĞƌ >ŝnjnjLJ >ƵŬƌŝĐŚ͘ tĞ ĞŶũŽLJĞĚ ƚŚƌĞĞ ĚĂLJƐ ŽĨ ĞĚƵĐĂƟŽŶĂů ƉƌŽŐƌĂŵŵŝŶŐ ŽŶ ƚŽƉŝĐƐ ŝŶĐůƵĚŝŶŐ ŵĞŵďĞƌƐŚŝƉ engagement, strategic planning, MACRA, storytelling, and much ŵŽƌĞ͘ tĞ ĂůƐŽ ŚĞĂƌĚ ƚǁŽ ĐŽŵƉĞůůŝŶŐ ŬĞLJŶŽƚĞƐ͕ ƉĂƌƟĐŝƉĂƚĞĚ ŝŶ ƚŚĞ ĂǁĂƌĚƐ ĐĞƌĞŵŽŶLJ ĂŶĚ ĨĞůůŽǁƐ͛ ĐŽŶǀŽĐĂƟŽŶ͕ ĂŶĚ ĞŶũŽLJĞĚ ƐŽĐŝĂů ĂĐƟǀŝƟĞƐ͘ ^ŽƵŶĚ ĨĂŵŝůŝĂƌ͍

^ƵƐĂŶ ,ŽŐĞůĂŶĚ͕ &W͛Ɛ džĞĐƵƟǀĞ sŝĐĞ WƌĞƐŝĚĞŶƚ͕ ĂŶĚ ^ŚĞůůLJ ŚĂǀĞ ďĞĞŶ ŝŶǀŽůǀĞĚ ǁŝƚŚ D^ ĨŽƌ ŵĂŶLJ LJĞĂƌƐ͖ ^ŚĞůůLJ ǁĂƐ D^ ƉƌĞƐŝĚĞŶƚ ŝŶ ϮϬϬϬͲϮϬϬϭ͘ dŚŝƐ ǁĂƐ >ŝnjnjLJ͛Ɛ ĮƌƐƚ ŵĞĞƟŶŐ͕ ďƵƚ ƐŚĞ ŐĂŵĞůLJ ĂŐƌĞĞĚ ƚŽ ũŽŝŶ ŵĞ ŝŶ ůĞĂĚŝŶŐ ĂŶ ĞĚƵĐĂƟŽŶĂů ƐĞƐƐŝŽŶ ŽŶ ŵĞŵďĞƌ ƉĞƌƐŽŶĂƐ ĂŶĚ ƚĂƌŐĞƚĞĚ ŵĂƌŬĞƟŶŐ͘ tĞ ƉƌĞƐĞŶƚĞĚ ƚŽ Ă ƉĂĐŬĞĚ ƌŽŽŵ ĂŶĚ ƌĞĐĞŝǀĞĚ ŵĂŶLJ ĐŽŵƉůŝŵĞŶƚƐ͕ ǁŚŝĐŚ ŵĞĂŶƚ ƐŽ much coming from our esteemed peers. ŶŽƚŚĞƌ ŚŝŐŚůŝŐŚƚ ǁĂƐ ƚŚĞ ĂǁĂƌĚƐ ůƵŶĐŚĞŽŶ ĚƵƌŝŶŐ ǁŚŝĐŚ D^ ƌĞĐŽŐŶŝnjĞƐ ƐŵĂůů ĂŶĚ ůĂƌŐĞ ŵĞĚŝĐĂů ƐŽĐŝĞƟĞƐ ĨŽƌ ƚŚĞŝƌ ĂĐĐŽŵƉůŝƐŚŵĞŶƚƐ ŝŶ ŵĞŵďĞƌƐŚŝƉ͕ ĐŽŵŵƵŶŝĐĂƟŽŶƐ͕ ĂĚǀŽĐĂĐLJ͕ ĞĚƵĐĂƟŽŶ ĂŶĚ ůĞĂĚĞƌƐŚŝƉ͘ zŽƵƌ ĐĂĚĞŵLJ ǁĂůŬĞĚ ĂǁĂLJ ǁŝƚŚ ƚǁŽ ĂǁĂƌĚƐ ŝŶ ƚŚĞ ůĂƌŐĞ ĂƐƐŽĐŝĂƟŽŶ ĐĂƚĞŐŽƌLJ ʹ ƚŚĞ ĞĚƵĐĂƟŽŶ ĂǁĂƌĚ ĨŽƌ ŽƵƌ ǁŽƌŬ ŽŶ ƚŚĞ ŶĚͲŽĨͲ>ŝĨĞ ŽŶǀĞƌƐĂƟŽŶƐ WƌŽũĞĐƚ ĂŶĚ ƚŚĞ ĂĚǀŽĐĂĐLJ ĂǁĂƌĚ ĨŽƌ ŽƵƌ ǁŽƌŬ ƐĞĐƵƌŝŶŐ ƚŚĞ ΨϭϬϬ ŵŝůůŝŽŶ ďƵĚŐĞƚ ĂƉƉƌŽƉƌŝĂƟŽŶ ƚŽ ĨƵŶĚ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ residency programs. / ĐĂŵĞ ŚŽŵĞ ĨƌŽŵ DŝŶŶĞĂƉŽůŝƐ ǁŝƚŚ ŶĞǁ ƐŬŝůůƐ ĂŶĚ ŝĚĞĂƐ ƚŚĂƚ ǁŝůů ƚƌĂŶƐůĂƚĞ ĚŝƌĞĐƚůLJ ƚŽ ŵLJ ǁŽƌŬ ĂƐ LJŽƵƌ &W ŵĞŵďĞƌƐŚŝƉ ĚŝƌĞĐƚŽƌ͕ ĂŶĚ / ŚĂĚ Ă ǁŽŶĚĞƌĨƵů ƟŵĞ ƌĞĐŽŶŶĞĐƟŶŐ ǁŝƚŚ ŵĞŵďĞƌƐ ŽĨ ŵLJ ͞ƚƌŝďĞ͘͟ KƚŚĞƌ ƵƐŝŶĞƐƐ LJ ƚŚĞ ƟŵĞ ƚŚŝƐ ŝƐƐƵĞ ŝƐ ƉƵďůŝƐŚĞĚ͕ ŵĞŵďĞƌƐ ǁŝůů ďĞ ĂďůĞ ƚŽ ƌĞŶĞǁ ĨŽƌ ϮϬϭϴ Ăƚ ĂĂĨƉ͘ŽƌŐͬĐŚĞĐŬŵLJĚƵĞƐ͘ dŚĞ ĮƌƐƚ ŚĂƌĚ ĐŽƉLJ ŝŶǀŽŝĐĞƐ ǁŝůů ŐŽ ŽƵƚ ƚŚŝƐ ŵŽŶƚŚ͘ ZĞŶĞǁ ĞĂƌůLJ ĂŶĚ ĐƌŽƐƐ ŝƚ Žī LJŽƵƌ ůŝƐƚ ʹ LJŽƵ ĐĂŶ ĞǀĞŶ ƐŝŐŶ ƵƉ ĨŽƌ ĞĂƐLJ ŵŽŶƚŚůLJ ŝŶƐƚĂůůŵĞŶƚ ƉĂLJŵĞŶƚƐ ĂŶĚͬŽƌ ĂƵƚŽͲ ƌĞŶĞǁĂů ʹ ƉƌĞǀĞŶƟŶŐ ĂŶ ŝŶƚĞƌƌƵƉƟŽŶ ŝŶ LJŽƵƌ ŵĞŵďĞƌƐŚŝƉ ďĞŶĞĮƚƐ͕ ĂŶĚ ĂůůŽǁŝŶŐ &W ƐƚĂī ƚŽ ƐƉĞŶĚ ůĞƐƐ ƟŵĞ ŽŶ ƌĞŶĞǁĂů ƌĞŵŝŶĚĞƌƐ ĂŶĚ ŵŽƌĞ ƟŵĞ ŽŶ ƉƌŽǀŝĚŝŶŐ Ă ŵŝůůŝŽŶͲĚŽůůĂƌ ŵĞŵďĞƌƐŚŝƉ ĞdžƉĞƌŝĞŶĐĞ LJĞĂƌͲƌŽƵŶĚ͊ &W ŝƐ ĂůƐŽ ĞŶƚĞƌŝŶŐ ŝƚƐ ŶĞdžƚ ƐƚƌĂƚĞŐŝĐ ƉůĂŶŶŝŶŐ ĐLJĐůĞ͖ ƚŽ ŚĞůƉ ƵƐ ďĞƐƚ ƐĞƌǀĞ ƚŚĞ ĐŚĂŶŐŝŶŐ ŶĞĞĚƐ ŽĨ ŽƵƌ ĚŝǀĞƌƐĞ ŵĞŵďĞƌƐŚŝƉ͕ ǁĞ ŶĞĞĚ ƚŽ ŬŶŽǁ ŵŽƌĞ ĂďŽƵƚ LJŽƵ͘ /Ĩ LJŽƵ ŚĂǀĞ ŶŽƚ ĂůƌĞĂĚLJ ĐŽŵƉůĞƚĞĚ the CAFP demographic survey and the AAFP Census survey, please ƚĂŬĞ Ă ŵŽŵĞŶƚ ƚŽ ĚŽ ƐŽ ŝŶ ƚŚĞ ŶĞdžƚ ĐŽƵƉůĞ ŽĨ ǁĞĞŬƐ͘ ŽŶƚĂĐƚ ŵĞ Ăƚ &W Ăƚ ;ϰϭϱͿ ϯϰϱͲϴϲϲϳ Žƌ ƐŐŽĞĐŬĞΛĨĂŵŝůLJĚŽĐƐ͘ŽƌŐ ŝĨ LJŽƵ ŶĞĞĚ ĂƐƐŝƐƚĂŶĐĞ͕ ĂŶĚ ĂŶLJ ƟŵĞ LJŽƵ ŚĂǀĞ ƋƵĞƐƟŽŶƐ Žƌ ĨĞĞĚďĂĐŬ ĂďŽƵƚ your CAFP membership.

>ŝnjnjLJ >ƵŬƌŝĐŚ͕ ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ͕ ĂŶĚ ^ŚĂŶŶŽŶ 'ŽĞĐŬĞ ĂĐĐĞƉƚ &W ĂǁĂƌĚƐ Ăƚ D^ :ƵůLJ ϮϬϭϳ͘

12

California Family Physician Fall 2017

DƐ͘ 'ŽĞĐŬĞ ŝƐ ƚŚĞ ŝƐ ŝƌĞĐƚŽƌ DĞŵďĞƌƐŚŝƉ ĂŶĚ DĂƌŬĞƟŶŐ͘

Adventist Health offers full- and part-time physician careers all along the West Coast and Hawaii. We offer a comprehensive employment package:

•Competitive salary •Generous benefits including 401k match •Opportunity to work where you play Join 5,000 other providers who chose to provide care where passion meets mission.

phyjobs@ah.org • 916-865-1905 • physiciancareers.ah.org

Physician Opportunity’s Santa Barbara, CA

PHYSICIAN OPPORTUNITIES • Open 8 to 8 every day • Flexible schedules, no call • Guaranteed $240,000 averaging 4 shif hiftts a weekk • Ad Addi dititition di onall bon onus us payy basedd on p od pr oduc ductitivivitity ty • Ma Malp lpra ract ctiice ice co cove vera rage g ge • Me Medi dica call an ca a d de dentall for phy dent hysiicician ian and ddeepeend nden entsts at no cos ostt • Lo L ng ng ter e m dissabi sabi bililility ty insur nsur ns u an a ce • RReeti etitire r me m nt n plan with withh mat atch chhin chin ingg fund funds ndds Contact Merl O’Brien, MD, at: (916) 791-1300, ext.11111; or email CV to:sherry@med7atwork.com.

Based in Santa Barbara, Sansum Clinic is the oldest and largest non-profit, multi-specialty group between San Francisco and Los Angeles with over 200 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine. Sansum Clinic has garnered recognition, accreditation and awards from national and state agencies.

Our current openings are Family Medicine Urgent Care Occupational Medicine Geriatrician/Palliative Care

For More Information Contact: Shawneen Flanders-Clark Physician Recruiter sflander@sansumclinic.org 805-689-8256 www.sansumclinic.org

Benefits Free Medical/Dental/Vision CME Stipend 1 MA Per Provider

Malpractice Insurance Disability Retirement: 401K & Profit Sharing

Annual Leave Licensure/DEA Fees Board Exam Fee

generational voices

Kimberly Duir, MD; Emily Ebert, MD

little plastic onboard pen and a special secret alphabet for Ăůů ĚĂƚĂ ĞŶƚƌLJ ƚŚĂƚ ƚƵƌŶĞĚ ŵLJ ƐĐƌĂǁů ŝŶƚŽ ƚLJƉĞĨĂĐĞ͘ dŚĞ WĂůŵ WŝůŽƚ ĂůůŽǁĞĚ ŵĞ ƚŽ ŵĂŶĂŐĞ ŵLJ ƐĐŚĞĚƵůĞ ĂŶĚ ŵLJ ĐŽŶƚĂĐƚƐ ĂŶĚ ŵLJ ƚŽͲĚŽ ůŝƐƚ Ăůů ŝŶ ŽŶĞ ƉůĂĐĞ E ŬĞĞƉ ŝƚ ŝŶ ŵLJ ƉŽĐŬĞƚ͊ ĚŵŝƚƚĞĚůLJ ƚŚĞ ĐŽŵďŝŶĞĚ ǁĞŝŐŚƚ ŽĨ ƚŚĞ WĂůŵ WŝůŽƚ ĂŶĚ ŵLJ ƉĂŐĞƌ ĂŶĚ ĂŶ ĞĂƌůLJ ĐĞůů ƉŚŽŶĞ ǁĂƐ Ă ĐŚĂůůĞŶŐĞ ĨŽƌ ŬĞĞƉŝŶŐ ŵLJ ǁĂŝƐƚďĂŶĚ ŝŶ ƉůĂĐĞ ďƵƚ Ɛƚŝůů͕ ǁŚĂƚ ĂŶ ĂĚǀĂŶĐĞ͊ EŽǁĂĚĂLJƐ͕ ŽĨ ĐŽƵƌƐĞ͕ ǁĞ ŚĂǀĞ Ă ƐŝŶŐůĞ ƐůĞĞŬ ĚĞǀŝĐĞ ƚŚĂƚ does all that and so much more. I can access the National Library of Medicine from my pocket, not to mention check the dosage of that medication I don’t use very often, find an evidence based recommendation for treatment or diagnosis or preventive care, use a calculator to assess the need for ƚŚĂƚ yͲƌĂLJ Žƌ ƚŚĂƚ ƐƚĂƚŝŶ ƌŝŐŚƚ ŝŶ ƚŚĞ ƌŽŽŵ ǁŝƚŚ ŵLJ ƉĂƚŝĞŶƚ͘ When younger colleagues approach my grey-haired self for ĐůŝŶŝĐĂů ĂĚǀŝĐĞ͕ / ĚŽŶ͛ƚ ŚĂǀĞ ƚŽ ĨĂŬĞ ŝƚ ĂŶĚ ŚŽƉĞ ƚŚĞ ĂŶƐǁĞƌ hasn’t changed since the last time I looked it up. I can invite ƚŚĞŵ ƚŽ ůŽŽŬ ŝƚ ƵƉ ǁŝƚŚ ŵĞ͕ ͞LJŽƵƌ ĚĞǀŝĐĞ Žƌ ŵŝŶĞ͍͟ ĂŶĚ ǁĞ ĐĂŶ ĚŝƐĐƵƐƐ ŚŽǁ ĐƵƌƌĞŶƚ ĞǀŝĚĞŶĐĞ ĐĂŶ ďĞƐƚ ďĞ ƚĂŝůŽƌĞĚ ĨŽƌ this particular patient. ŶĚ ƚŚĞƌĞ ŝƐ ĂůǁĂLJƐ 'ŽŽŐůĞ ƚŽ ĨŝŶĚ ƚŚĞ ŶĂŵĞ ŽĨ ƚŚĂƚ ƉĞƐŬLJ 'ĞƌŵĂŶ ĚŽĐƚŽƌ͛Ɛ ƉĞƚ ĚŝƐĞĂƐĞ ǁŚĞŶ / ĐĂŶ͛ƚ ŚĂƵů ŝƚ ƵƉ ĨƌŽŵ ŵLJ ĂŐŝŶŐ ŶĞƵƌŽŶĂů ƉĂƚŚǁĂLJƐ͊

Emily Ebert, MD Kimberly Duir, MD

A Registry Is Not So Much a Thing, as an Idea

The Baby Boomer Doctor and her Exogenous Brain

dĞĐŚŶŽůŽŐLJ ŝŶ ŵĞĚŝĐŝŶĞ ĂŶĚ ůŝĨĞ͕ ǁŚĂƚ ĚŽ ǁĞ ƌĞĂůůLJ ŵĞĂŶ ďLJ ƚŚŝƐ ƚĞƌŵ͍ dŚƌŽƵŐŚ ǁŽŶĚĞƌĨƵů ŚĂŶĚͲŚĞůĚ ĐŽŵƉƵƚĞƌƐ͕ ǁĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂĐĐĞƐƐ ĂŵĂnjŝŶŐ ŝŶĨŽƌŵĂƚŝŽŶ Ăƚ ŽƵƌ fingertips right at the point of care. We use these machines ƚŽ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ ŽƵƌ ƉĂƚŝĞŶƚƐ ǁŝƚŚŽƵƚ ďĞŝŶŐ ŝŶ ƚŚĞ ƐĂŵĞ ƌŽŽŵ͘ tĞ ŚĂƌŶĞƐƐ ƚŚĞŝƌ ƉŽǁĞƌ ƚŽ ŵĂdžŝŵŝnjĞ ƉĂƚŝĞŶƚ education leading patients to a deeper understanding of ƚŚĞŝƌ ŽǁŶ ďŽĚŝĞƐ ĂŶĚ ĐŽŶĚŝƚŝŽŶƐ͘ ƌĞĂƚŝŶŐ ĚĂƚĂ ďĂƐĞƐ͕ ǁĞ can automatically provide reminders for our health care delivery systems and our patients to ensure the maximum number of people get certain proven care components best suited to their age, gender, risk factors and health conditions. For those of us old enough to remember care before this transition, it is almost magical.

>ŝŬĞ ŵĂŶLJ ŽĨ LJŽƵ͕ / ŚĂǀĞ ĂůǁĂLJƐ ŚĂĚ Ă ƉƌĞƚƚLJ ŐŽŽĚ ŵĞŵŽƌLJ͕ reliable for regurgitating facts on a board exam and remembering the names of those obscure diseases that ƐŽŵĞ 'ĞƌŵĂŶ ĚĞĐŝĚĞĚ ƚŽ ŶĂŵĞ ĂĨƚĞƌ ŚŝŵƐĞůĨ͘ dŚĞŶ ĐĂŵĞ menopause, then came age-related cognitive decline and ŶŽǁ ŵLJ ĨƌŝĞŶĚƐ ĂŶĚ / ũŽŬĞ ƚŚĂƚ ŝƚ ͞ƚĂŬĞƐ Ă ǀŝůůĂŐĞ ƚŽ ĨŝŶŝƐŚ Ă ƐĞŶƚĞŶĐĞ͘͟ ǀĞƌLJ ĚĂLJ / ƚŚĂŶŬ ǁŚĂƚĞǀĞƌ ƉŽǁĞƌƐ Žƌ ^ŝůŝĐŽŶ sĂůůĞLJ ŵLJƐƚĞƌŝĞƐ ĐĂƵƐĞĚ ĐŽŵƉƵƚĞƌƐ ƚŽ ďĞ ĚĞǀĞůŽƉĞĚ ƌŝŐŚƚ ĂƌŽƵŶĚ ƚŚĞ ƚŝŵĞ / ǁĂƐ ƐƚĂƌƚŝŶŐ ƚŽ ůŽƐĞ ŵLJ ŵŝŶĚ͘ / ǁĂƐ ĂŶ ĞĂƌůLJ ĂĚŽƉƚĞƌ ǁŝƚŚ ƚŚĞ WĂůŵ WŝůŽƚ͕ ǁŚŝĐŚ ǁĂƐ ĂĐĐĞƐƐŝďůĞ ƚŽ ƚŚŽƐĞ ŽĨ ƵƐ ǁŝƚŚ ŶŽ ŬĞLJďŽĂƌĚŝŶŐ ƐŬŝůůƐ ǀŝĂ ƚŚĞ

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California Family Physician Fall 2017

to be intuitive and simple. I pleaded that medical assistants ŚĂĚ ƚŽ ͞ǁĂŶƚ ƚŽ͟ ƌƵŶ ƌĞƉŽƌƚƐ ƉƵƐŚŝŶŐ ƚŚĞŝƌ ƉƌŽǀŝĚĞƌƐ ĨŽƌǁĂƌĚ in the pursuit of improved health outcomes. He tried to ĞdžƉůĂŝŶ ŚŽǁ ƉƌŽŐƌĂŵŝŶŐ ǁŽƌŬƐ ĂŶĚ ǁŚLJ ŝƚ ǁĂƐ ƐŽ ŝŵƉŽƌƚĂŶƚ ƚŽ ŬŶŽǁ ǁŚĞƌĞ ĂŶĚ ŝŶ ǁŚĂƚ ůĂŶŐƵĂŐĞ ƚŚĞ ĚĂƚĂ ǁĂƐ ƐƚŽƌĞĚ͘ ,Ğ ƐƵĨĨĞƌĞĚ ƚŚƌŽƵŐŚ ǁƌŝƚŝŶŐ ĂŶĚ ƌĞǁƌŝƚŝŶŐ ĐŽŵŵĂŶĚƐ ďĞĐĂƵƐĞ ǁĞ ĐŽƵůĚŶ͛ƚ ĂĚĞƋƵĂƚĞůLJ ĞdžƉůĂŝŶ ǁŚĂƚ ǁĞ ǁĂŶƚĞĚ Žƌ ďĞĐĂƵƐĞ ǁĞ ǁŽƵůĚ ĐŚĂŶŐĞ ŽƵƌ ŵŝŶĚƐ ĂĨƚĞƌ ǁĞ ƐĂǁ ƚŚĞ data. We brought in other members of the health care team – nurses, medical assistants, and other physicians. We also brought analysts and other IT specialists to help translate.

We really did not understand one another, so these interpreters had a huge job.

ŵŝůLJ ďĞƌƚ͕ D ŝŶ ƚŚĞ ĐĞŶƚĞƌ͘

Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ŚŽǁĞǀĞƌ͕ ƚŚĞ ƚĞĐŚŶŽůŽŐLJ ŝƐ ŶŽƚ ǁŚĂƚ ƌĞƐŽŶĂƚĞƐ ǁŝƚŚ ƵƐ ŝƐ ŝƚ͍ dŽ ƵƐ ŝƚ ŝƐ ƚŚĞ ŝŶƚĞƌĂĐƚŝŽŶ ďĞƚǁĞĞŶ ƚŚĞ ƚĞĐŚŶŽůŽŐLJ ĂŶĚ ƚŚĞ ƉĞŽƉůĞ͕ ǁŚŝĐŚ ŝƐ ǁŚLJ / ĐŚŽƐĞ ƚŽ tell the story of our disease management and health ŵĂŝŶƚĞŶĂŶĐĞͲƉƌŽŵŽƚŝŶŐ ƌĞŐŝƐƚƌLJ͘ /Ŷ ϮϬϭϬ ŽƵƌ ƉƌĂĐƚŝĐĞ͕ ǁŚŝĐŚ ŝƐ Ă ŐƌŽƵƉ ŽĨ ƚŚƌĞĞ ĨĂŵŝůLJ ŚĞĂůƚŚ ĐĞŶƚĞƌƐ ƐĞƌǀŝŶŐ ĂƐ ƚŚĞ ƉƌĂĐƚŝĐĞ ƐŝƚĞ ĨŽƌ ŽƵƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵ͕ ǁĂƐ ĞdžƉĞƌŝŵĞŶƚŝŶŐ ǁŝƚŚ ĂŶ ĞůĞĐƚƌŽŶŝĐ ŵĞĚŝĐĂů ƌĞĐŽƌĚ͘ tĞ ĂƌĞ part of the public hospital in San Bernardino County. Like ŵŽƐƚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉƌĂĐƚŝĐĞƐ͕ ǁĞ ǁĞƌĞ ŵŽǀŝŶŐ ƚŽǁĂƌĚ the patient centered medical home model. Our electronic ŚĞĂůƚŚ ƌĞĐŽƌĚ ; ,ZͿ ǁĂƐ ŶŽƚ ĨƵůůLJ ŝŵƉůĞŵĞŶƚĞĚ ĂĐƌŽƐƐ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ĐŽŶƚŝŶƵƵŵ ĂŶĚ ĚĞƐƉŝƚĞ ǁŚĂƚ ƐŽŵĞ ŽĨ ƚŚĞ salespeople said, it did not really have a registry function. ůƐŽ͕ ĂƐ Ă ƉƵďůŝĐ ŝŶƐƚŝƚƵƚŝŽŶ͕ ƌĞƐŽƵƌĐĞƐ ĂƌĞ ĂůǁĂLJƐ ƐĐĂƌĐĞ͘ WƵƌĐŚĂƐŝŶŐ ĂŶ ŽĨĨͲƚŚĞͲƐŚĞůĨ ƌĞŐŝƐƚƌLJ ǁĂƐ ũƵƐƚ ŶŽƚ ŝŶ ƚŚĞ ĐĂƌĚƐ͘ /ŶƐƚĞĂĚ͕ ůĞĂĚĞƌƐŚŝƉ ƐĂŝĚ͕ ͞ ƵŝůĚ LJŽƵƌ ŽǁŶ ŝĨ LJŽƵ ǁĂŶƚ ŽŶĞ͘͟ ŶƚĞƌ ŽŶĞ ĐƌĂnjLJ ƉŚLJƐŝĐŝĂŶ͕ ŵĞ͕ ĂŶĚ ŽŶĞ ƐŵĂƌƚ ĂŶĚ talented programmer, Mr. Ledbetter. Challenges immediately ƐƵƌĨĂĐĞĚ͗ ϭ͘ Ϯ͘ 3. ϰ͘ 5.

Both of us had day jobs and building the registry had ƚŽ ŽĐĐƵƌ ĚƵƌŝŶŐ ĚŽǁŶ ƚŝŵĞƐ͘ We spoke different languages.

KƵƌ ďĂĐŬŐƌŽƵŶĚƐ ǁĞƌĞ ƐŽ ĚŝĨĨĞƌĞŶƚ͖ ǁĞ ůŽŽŬĞĚ Ăƚ nothing in a similar fashion.

Neither of us had ever used a registry. tĞ ǁĞƌĞ ďƵŝůĚŝŶŐ Ă ƚŽŽů ĨŽƌ Ă ŐƌŽƵƉ ŽĨ ƉĞŽƉůĞ ƚŚĂƚ ŚĂĚ not particularly requested to use one.

KǀĞƌ ƚŚĞ ŶĞdžƚ ĨŽƵƌ LJĞĂƌƐ͕ ǁĞ ŵĞƚ ĂůŵŽƐƚ ĞǀĞƌLJ ǁĞĞŬ ĨŽƌ ŽŶĞ ƚŽ ƚǁŽ ŚŽƵƌƐ͘ / ŚĂŵŵĞƌĞĚ ŽŶ ŚŽǁ ƚŚĞ ƌĞƉŽƌƚ ǁƌŝƚŝŶŐ ŚĂĚ

dǁŽ LJĞĂƌƐ ŝŶƚŽ ƚŚĞ ƉƌŽũĞĐƚ͕ ƚŚĞ ƚŚƌĞĞ ĨĂŵŝůLJ ŚĞĂůƚŚ ĐĞŶƚĞƌƐ joined other public health care systems in California led by the Safety Net Institute arm of the California Association of Public Hospitals to aggressively increase the percentage of ǁŽŵĞŶ ǁŚŽ ƌĞĐĞŝǀĞĚ ĂƉƉƌŽƉƌŝĂƚĞ ďƌĞĂƐƚ ĐĂŶĐĞƌ ƐĐƌĞĞŶŝŶŐ͘ hƐŝŶŐ ŵƵůƚŝƉůĞ ƉůĂŶͲĚŽͲƐƚƵĚLJͲĂĐƚ ;W ^ Ϳ ĐLJĐůĞƐ ĂŶĚ ƐŽŵĞ ŐŽŽĚ ŶĂƚƵƌĞĚ ĐŽŵƉĞƚŝƚŝǀĞ ĞdžƉĞƌŝŵĞŶƚĂƚŝŽŶ ďĞƚǁĞĞŶ ƚŚĞ different physician-medical assistant groups, the practice ǁĂƐ ĂďůĞ ƚŽ ĂĐŚŝĞǀĞ ϴϯ ƉĞƌĐĞŶƚ ĐŽŵƉůŝĂŶĐĞ͕ ǁŚŝĐŚ ŝƐ ŽǀĞƌ ƚŚĞ ϵϬƚŚ ƉĞƌĐĞŶƚŝůĞ ĂŵŽŶŐ DĞĚŝĐĂŝĚ ƉŽƉƵůĂƚŝŽŶƐ͘ &ŽƵƌ LJĞĂƌƐ into the project, I turned the lead physician role over to Dr. DĞůĞŶĚĞnj͘ ,Ğƌ ƚĞĐŚŶŽůŽŐLJ ƉƌŽǁĞƐƐ ĨĂƌ ƐƵƌƉĂƐƐĞƐ ŵŝŶĞ͘ ^ŚĞ ĐŽŶƚŝŶƵĞƐ ƚŽ ǁŽƌŬ ǁŝƚŚ Dƌ͘ >ĞĚďĞƚƚĞƌ ĂŶĚ ƚŚĞ ƌĞŐŝƐƚƌLJ ŚĂƐ improved exponentially. >ĞƐƐŽŶƐ ůĞĂƌŶĞĚ͗ ϭ͘ A registry is not so much a thing as an idea. The ǀĂůƵĞ ŝƐ ŝŶ ƚŚĞ ǁĂLJ ŝŶ ǁŚŝĐŚ ƚŚĞ ƉŚLJƐŝĐŝĂŶ ĂŶĚ ŽƚŚĞƌ ŵĞŵďĞƌƐ ŽĨ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƚĞĂŵ ĐŚĂŶŐĞ ŚŽǁ ƚŚĞLJ ǀŝĞǁ ŚĞĂůƚŚ ĐĂƌĞ͘ /ƚ ŝƐ ŶŽƚ Ă ůĂď ƚĞƐƚ ƚŚĂƚ ŐŝǀĞƐ LJŽƵ ŝŶĨŽƌŵĂƚŝŽŶ ĂďŽƵƚ Ă ƉĂƚŝĞŶƚ ƚŚĂƚ ĚĂLJ͖ ŝƚ ŝƐ ŵŽƌĞ ůŝŬĞ using the science of laboratory medicine to improve the health of your patient population. Ϯ͘ /d ƉƌŽĨĞƐƐŝŽŶĂůƐ ƐĂǀĞ ůŝǀĞƐ ƚŽŽ͘ hƐĞ ŽĨ Ă ƌĞŐŝƐƚƌLJ ĂůůŽǁƐ the health care team to identify and address health ĐĂƌĞ ŶĞĞĚƐ ƚŚĂƚ ǁŽƵůĚ ŶŽƚ ďĞ ŶŽƚŝĐĞĚ ŽŶ ĞƉŝƐŽĚŝĐ visits.

3. ^ŽĐŝĞƚLJ ǁĂŶƚƐ ƚŽ ƐƚŽƉ ƉĂLJŝŶŐ ƵƐ ĨŽƌ ƚŚĞ ŶƵŵďĞƌ ŽĨ visits, tests, procedures and hospitalizations and instead pay us for improved health outcome results ǁĞ ĐĂŶ ƉƌŽǀĞ͘ ZĞŐŝƐƚƌŝĞƐ ĨĂĐŝůŝƚĂƚĞ ƚŚŝƐ͘ ϰ͘ The registry is never actually finished. It is asymptomatic. The people in the practice ĐŽŶƚŝŶƵĞ ƚŽ ŝŶƚĞƌĂĐƚ ǁŝƚŚ ŝƚ͕ ĂĚĚŝŶŐ ŵĞĂƐƵƌĞƐ ĂŶĚ features that continue to push the envelope on quality improvement.

California Family Physician Fall 2017

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cyber world and medicine

William O. Woo, MD

Are You Protected?

Tips for CyberSecurity tĂƐ ƉƌŽƚĞĐƟŶŐ LJŽƵƌ ƉƌĂĐƟĐĞ ĨƌŽŵ ŚĂĐŬŝŶŐ ĐŽǀĞƌĞĚ ŝŶ LJŽƵƌ ŵĞĚŝĐĂů ƐĐŚŽŽů Žƌ ƌĞƐŝĚĞŶĐLJ ĐƵƌƌŝĐƵůƵŵ͍ /ƚ ǁĂƐŶ͛ƚ ŝŶ ŵŝŶĞ͕ ďƵƚ ŝƚ͛Ɛ ŶŽƚ ƚŽŽ ůĂƚĞ͘ >ĞĂƌŶŝŶŐ ĂďŽƵƚ ƚŚĞ ŵŽƟǀĂƟŽŶ ŽĨ ĐLJďĞƌ ĐƌŝŵŝŶĂůƐ ĂŶĚ ƚŚĞŝƌ ŵŽƐƚ ĐŽŵŵŽŶ ĐLJďĞƌͲĂƩĂĐŬƐ ǁŝůů ŐŽ Ă ůŽŶŐ ǁĂLJ ƚŽ ƉƌĞǀĞŶƚ ƐƵĐŚ ĂƩĂĐŬƐ ĂŐĂŝŶƐƚ LJŽƵƌ ƉƌĂĐƟĐĞ͘

/ŶŚĞƌĞŶƚ ǁĞĂŬŶĞƐƐĞƐ ŝŶ ŽƵƌ /d ƐLJƐƚĞŵƐ ĂŶĚ ƚŚĞ ĞĂƐLJ ďƵĐŬ ƚŽ ďĞ ŵĂĚĞ ŽŶ ƉƌŽƚĞĐƚĞĚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ;W,/Ϳ ĞdžƉůĂŝŶƐ ƚŚĞ ŝŶĐƌĞĂƐŝŶŐ ƌĂƚĞ ŽĨ ĂƩĂĐŬƐ ŽŶ ƚŚĞ ŵĞĚŝĐĂů ƐĞĐƚŽƌ͕ ďƵƚ ŚŽǁ ĂƌĞ ƚŚĞ ĐƌŝŵŝŶĂůƐ ƉƵůůŝŶŐ Žī ƚŚĞŝƌ ĂƩĂĐŬƐ͍ dŚĞ ƚŚƌĞĞ ŵŽƐƚ ĐŽŵŵŽŶ ƐĐŚĞŵĞƐ ĨŽƌ ĂƩĂĐŬ ŝŶĐůƵĚĞ͗ ƉŚŝƐŚŝŶŐ ƐĐŚĞŵĞƐ͕ ĚŝƌĞĐƚ ƉŚLJƐŝĐĂů ĂƩĂĐŬƐ͕ ĂŶĚ ƌĂŶƐŽŵǁĂƌĞ͘

^ŝŶĐĞ ƚŚĞ ŝŶǀĞŶƟŽŶ ŽĨ ƚŚĞ ůĞĐƚƌŽŶŝĐ ,ĞĂůƚŚ ZĞĐŽƌĚ ; ,ZͿ ĐLJďĞƌ ĐƌŝŵŝŶĂůƐ ŚĂǀĞ ďĞĞŶ ĂƩĂĐŬŝŶŐ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐĞĐƚŽƌ Ăƚ ĂŶ ŝŶĐƌĞĂƐŝŶŐůLJ ĂůĂƌŵŝŶŐ ƌĂƚĞ͕ ƐƚĞĂůŝŶŐ ƉĂƟĞŶƚ ŝŶĨŽƌŵĂƟŽŶ ĨŽƌ ƐƵďƐĞƋƵĞŶƚ ƐĂůĞ ŽŶ ƚŚĞ ďůĂĐŬ ŵĂƌŬĞƚ ĂŶĚ ĞdžƚŽƌƟŶŐ ŵŽŶĞLJ ĚŝƌĞĐƚůLJ ĨƌŽŵ ŚĞĂůƚŚ ĐĂƌĞ ŽƌŐĂŶŝnjĂƟŽŶƐ͘ /Ŷ ϮϬϬϵ͕ ŽŶĞ ŽĨ ƚŚĞ ůĂƌŐĞƐƚ ĚĂƚĂ ďƌĞĂĐŚĞƐ ĞdžƉŽƐŝŶŐ ƉĂƟĞŶƚ ŝŶĨŽƌŵĂƟŽŶ ŝŶǀŽůǀĞĚ ůƵĞ ƌŽƐƐ н ůƵĞ ^ŚŝĞůĚ dE͕ ĂīĞĐƟŶŐ ĂƉƉƌŽdžŝŵĂƚĞůLJ ŽŶĞ ŵŝůůŝŽŶ ƉĂƟĞŶƚƐ͘ dŚĞ ĞdžƉŽŶĞŶƟĂů ŐƌŽǁƚŚ ŝŶ ƉĂƟĞŶƚ ĚĂƚĂ ƚŚĞŌ ĐƵůŵŝŶĂƚĞĚ ŝŶ ϮϬϭϱ ǁŝƚŚ Ă ďƌĞĂĐŚ ĂŐĂŝŶƐƚ ŶƚŚĞŵ ǁŚŝĐŚ ĂīĞĐƚĞĚ ϴϬ ŵŝůůŝŽŶ ƉĂƟĞŶƚ ƌĞĐŽƌĚƐ͘

WŚŝƐŚŝŶŐ ƐĐŚĞŵĞƐ͗ ƩĂĐŬƐ ĚĞƐŝŐŶĞĚ ƚŽ ƚƌŝĐŬ ƉĞŽƉůĞ ŝŶƚŽ ĚŽŝŶŐ ƚŚŝŶŐƐ ůŝŬĞ ŐŝǀŝŶŐ ƵƉ ƐĞŶƐŝƟǀĞ ŝŶĨŽƌŵĂƟŽŶ Žƌ ŽƉĞŶŝŶŐ ĞŵĂŝů ĂƩĂĐŚŵĞŶƚƐ ǁŚŝĐŚ ĐŽŶƚĂŝŶ ŵĂůŝĐŝŽƵƐ ƐŽŌǁĂƌĞ͘ WŚŝƐŚŝŶŐ ƐĐŚĞŵĞƐ ƉƌĞĚĂƚĞ ƚŚĞ ĞůĞĐƚƌŽŶŝĐ ĞƌĂ ĂŶĚ ƉƌĞǀŝŽƵƐůLJ ŝŶĐůƵĚĞĚ ŵĂŝůĞĚ ůĞƩĞƌƐ ǁŚŝĐŚ ĂƩĞŵƉƚĞĚ ƚŽ ƐŽůŝĐŝƚ ŝŶĨŽƌŵĂƟŽŶ ƵŶĚĞƌ ĨĂůƐĞ ƉƌĞƚĞŶƐĞƐ͘ /Ŷ ƚŚĞ ƐĂŵĞ ǁĂLJ͕ ĞŵĂŝůƐ ĂŶĚ ĨĂŬĞ ǁĞďƐŝƚĞƐ ĂƌĞ ŶŽǁ ƵƐĞĚ ƚŽ ƐŽůŝĐŝƚ ƐƵĐŚ ŝŶĨŽƌŵĂƟŽŶ͘ LJďĞƌĐƌŝŵŝŶĂůƐ ŚĂǀĞ ĞǀŽůǀĞĚ ĂŶĚ ďĞĐŽŵĞ ŵŽƌĞ ƐŽƉŚŝƐƟĐĂƚĞĚ͕ ĂŶĚ ŶŽǁ ĂƌĞ ƵƐŝŶŐ ƐŽĐŝĂů ĞŶŐŝŶĞĞƌŝŶŐ ƚŽ ďĂŝƚ ƉĞŽƉůĞ ŝŶƚŽ ŐŝǀŝŶŐ ƵƉ ŝŶĨŽƌŵĂƟŽŶ Žƌ ŽƉĞŶŝŶŐ ƚŚĞŝƌ ƐLJƐƚĞŵƐ ƚŽ ĂƩĂĐŬ͘ ,ĞƌĞ ĂƌĞ Ă ĨĞǁ ĞdžĂŵƉůĞƐ͗ • &ĂŬĞ ĞŵĂŝůƐ ĨƌŽŵ ǁŚĂƚ ĂƉƉĞĂƌƐ ƚŽ ďĞ ĂŶ ŽĸĐŝĂů ǁĞďƐŝƚĞͬ ŝŶƐƟƚƵƟŽŶ ƐƚĂƟŶŐ LJŽƵƌ ĂĐĐŽƵŶƚ ŚĂƐ ďĞĞŶ ĐŽŵƉƌŽŵŝƐĞĚ͘ hƐĞƌƐ ĂƌĞ ĂƐŬĞĚ ƚŽ ĐůŝĐŬ ŽŶ Ă ůŝŶŬ ƚŽ ƌĞƐĞƚ ƚŚĞ ƉĂƐƐǁŽƌĚ͘ dŚĞ ůŝŶŬ ƚĂŬĞƐ ƚŚĞ ƉĞƌƐŽŶ ƚŽ ĂŶ ŽĸĐŝĂů ůŽŽŬŝŶŐ ǁĞďƐŝƚĞ ǁŚĞƌĞ ƚŚĞLJ ĞŶƚĞƌ ƐĞŶƐŝƟǀĞ ŝŶĨŽƌŵĂƟŽŶ ǁŚŝĐŚ ŝƐ ƚŚĞŶ ƐƚŽůĞŶ͘ • ŵĂŝůƐ ǁŝƚŚ ĂŶ ŽīĞƌ ƚŽŽ ŐŽŽĚ ƚŽ ďĞ ƚƌƵĞ͘ dŚĞ ĮƌƐƚ ŝƚĞƌĂƟŽŶ ŽĨ ƚŚŝƐ ƐĐŚĞŵĞ ŝŶǀŽůǀĞĚ ƚŚĞ ƌŝĐŚ EŝŐĞƌŝĂŶ ƉƌŝŶĐĞ ǁŚŽ ƉĂƐƐĞĚ ĂǁĂLJ ĂŶĚ ůĞŌ LJŽƵ ŵŽŶĞLJ͘ tŝƚŚ ƐŽĐŝĂů ĞŶŐŝŶĞĞƌŝŶŐ͕ ĐLJďĞƌ ĐƌŝŵŝŶĂůƐ ůĞĂƌŶ ĂďŽƵƚ LJŽƵƌ ŵŽƟǀĂƟŽŶƐ ;ƉĞƌŚĂƉƐ ƚŚƌŽƵŐŚ LJŽƵƌ ƐŽĐŝĂů ŵĞĚŝĂ ƉŽƐƚƐͿ ƚŽ ƚĂŝůŽƌ ĂŶ ĞŶƟĐŝŶŐ ĞŵĂŝů͘ • ŵĂŝůƐ ƚŚĂƚ ƐĞĞŵ ƚŽ ďĞ ĨƌŽŵ ƉĞŽƉůĞ LJŽƵ ŬŶŽǁ ĂƐŬŝŶŐ ĨŽƌ ŝŶĨŽƌŵĂƟŽŶ Žƌ ĨŽƌ ĂĐƟŽŶ͘ Ŷ ĞdžĂŵƉůĞ ĐŽƵůĚ ŝŶĐůƵĚĞ Ă ĨĂŬĞ email from the head physician of a medical group asking the ŽĸĐĞ ŵĂŶĂŐĞƌ ƚŽ ĐƵƚ Ă ĐŚĞĐŬ ƚŽ ƉĂLJ ĨŽƌ ĂŶ ĞdžƉĞŶƐĞ͘

ƋƵĂůůLJ ĂƐ ĚŝƐƚƵƌďŝŶŐ ŝƐ ƚŚĞ ƚƌĞŶĚ ƚŽǁĂƌĚ ĞdžƚŽƌƟŶŐ ŵŽŶĞLJ ĨƌŽŵ ŚĞĂůƚŚ ĐĂƌĞ ŝŶƐƟƚƵƟŽŶƐ ďLJ ĞŶĐƌLJƉƟŶŐ ĂŶĚ ůŽĐŬŝŶŐ ĚŽǁŶ ƚŚĞŝƌ /d ƐLJƐƚĞŵƐ ĂŶĚ ŚŽůĚŝŶŐ ƚŚĞŵ ĨŽƌ ƌĂŶƐŽŵ͘ /Ŷ DĂLJ ϮϬϭϳ͕ ƚŚĞ ŶŽƚŽƌŝŽƵƐ tĂŶŶĂ ƌLJ ƌĂŶƐŽŵǁĂƌĞ ĂƩĂĐŬ ƐŚƵƚ ĚŽǁŶ ϰϳ EĂƟŽŶĂů ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ;E,^Ϳ ŽƌŐĂŶŝnjĂƟŽŶƐ ŝŶ ƚŚĞ hŶŝƚĞĚ <ŝŶŐĚŽŵ͕ ŐƌŝŶĚŝŶŐ ŚĞĂůƚŚ care delivery in England to a halt for several days. These trends ĂīĞĐƚ ƉŚLJƐŝĐŝĂŶƐ Ăƚ Ăůů ůĞǀĞůƐ ͙ ƐŵĂůů ƉƌĂĐƟĐĞ͕ ůĂƌŐĞ ŐƌŽƵƉ ĂŶĚ hospital based. ^ƵĐĐĞƐƐĨƵů ƉŚLJƐŝĐŝĂŶƐ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͛ ŵŽƟǀĂƟŽŶƐ ĂŶĚ ƵƐĞ ƚŚĂƚ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ƚŽ ďĞƐƚ ŐƵŝĚĞ ƉĂƟĞŶƚ ĐĂƌĞ͘ /Ŷ ŵƵĐŚ ƚŚĞ ƐĂŵĞ ǁĂLJ͕ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ƚŚĞ ŵŽƟǀĂƟŽŶ ŽĨ ŚĂĐŬĞƌƐ ĂŶĚ ĐLJďĞƌ ĐƌŝŵŝŶĂůƐ ŝŶ ƚŚĞ ĐŽŶƚĞdžƚ ŽĨ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ ŐŽĞƐ Ă ůŽŶŐ ǁĂLJ ƚŽǁĂƌĚ ƉƌŽƚĞĐƟŶŐ LJŽƵƌ ƉƌĂĐƟĐĞ ĨƌŽŵ ǀŝƌƚƵĂů ŝŶƚƌƵƐŝŽŶƐ͘ dŚĞ ŵĂŝŶ ŵŽƟǀĂƚŽƌ ĨŽƌ ŚĂĐŬĞƌƐ ƚŽ ƐƚĞĂů ƉĂƟĞŶƚ ƌĞĐŽƌĚƐ ŝƐ ŵŽŶĞƚĂƌLJ ŐĂŝŶ͘ ,ĞĂůƚŚ ĐĂƌĞ ƌĞĐŽƌĚƐ ĐĂŶ ďĞ ƐŽůĚ ŽŶ ƚŚĞ ĚĂƌŬ ǁĞď ;ďůĂĐŬ ŵĂƌŬĞƚ ŽĨ ƚŚĞ ŝŶƚĞƌŶĞƚͿ ĨŽƌ ƵƉǁĂƌĚ ŽĨ ΨϱϬϬ ƉĞƌ ƌĞĐŽƌĚ͘ ĐŽŵƉůĞƚĞ ƉĂƟĞŶƚ ƌĞĐŽƌĚ ŝƐ ŽŌĞŶ more valuable than a stolen credit card. What makes the health ĐĂƌĞ ĮĞůĚ Ă ƉĂƌƟĐƵůĂƌůLJ ĞĂƐLJ ƚĂƌŐĞƚ ŝƐ ƚŚĂƚ ĐLJďĞƌƐĞĐƵƌŝƚLJ ŝŶ ƚŚĞ ŚĞĂůƚŚ care industry lags behind other sectors – and it is not a high priority, ĞƐƉĞĐŝĂůůLJ ŝŶ ƐŵĂůů ƉƌĂĐƟĐĞƐ͘ Ŷ ĂĚĚŝƟŽŶĂů ǀƵůŶĞƌĂďŝůŝƚLJ ŝƐ ƚŚĞ ŝĚĞĂ ƚŚĂƚ /d ƐLJƐƚĞŵƐ ĂƌĞ ŽŌĞŶ ĐĞŶƚƌĂůͬĐƌŝƟĐĂů ƚŽ ƉĂƟĞŶƚ ĐĂƌĞ ďƵƚ ĂƌĞ ŶŽƚ ĂůǁĂLJƐ ŬĞƉƚ ƵƉͲƚŽͲĚĂƚĞ ǁŝƚŚ ƚŚĞ ůĂƚĞƐƚ ƐŽŌǁĂƌĞ͘ ŽŶƐĞƋƵĞŶƟĂůůLJ ŚĞĂůƚŚ ĐĂƌĞ ŽƌŐĂŶŝnjĂƟŽŶƐ ĂƌĞ ǁŝůůŝŶŐ ƚŽ ƉĂLJ ůĂƌŐĞ ĂŵŽƵŶƚƐ ŽĨ ŵŽŶĞLJ ǁŚĞŶ ƚŚĞƐĞ ƐLJƐƚĞŵƐ ĂƌĞ ƚŚƌĞĂƚĞŶĞĚ͘ 16

California Family Physician Fall 2017

ŝƌĞĐƚ ƉŚLJƐŝĐĂů ĂƩĂĐŬ͗ /ŶǀŽůǀĞƐ Ă ĐƌŝŵŝŶĂů Žƌ ŝŶƐŝĚĞ ŵĂŶ ǁŚŽ ĂĐƚƵĂůůLJ ŐŽĞƐ ŽŶ ƉƌĞŵŝƐĞƐ ƚŽ ƐƚĞĂů ŝŶĨŽƌŵĂƟŽŶ͘ ĐŽŵŵŽŶ ǁĂLJ ƚŽ ĂĐŚŝĞǀĞ ƚŚŝƐ ŝƐ ďLJ ŚĂǀŝŶŐ Ă ǀŝƌƵƐͬŵĂůǁĂƌĞ ŽŶ Ă h^ ƐƟĐŬ ĂŶĚ ŝŶƐĞƌƟŶŐ ŝƚ ŝŶƚŽ Ă ĐŽŵƉƵƚĞƌ ŽŶ ƚŚĞ ŶĞƚǁŽƌŬ͘ dŚŝƐ ĐĂŶ ďĞ ĚŽŶĞ ŬŶŽǁŝŶŐůLJ Žƌ ŝŶĂĚǀĞƌƚĞŶƚůLJ͘ ĚĚŝƟŽŶĂůůLJ͕ ŚĂĐŬĞƌƐ ĐĂŶ ƐŽŵĞƟŵĞƐ ŐĂŝŶ ĂĐĐĞƐƐ ƚŽ ĐŽŵƉƵƚĞƌƐ ŽŶ ƐŝƚĞ ǀŝĂ ƚŚĞ ǁŝƌĞůĞƐƐ ŶĞƚǁŽƌŬ͕ ĞƐƉĞĐŝĂůůLJ ŝĨ ŶŽ ĞŶĐƌLJƉƟŽŶ is used to secure the Wi-Fi. ZĂŶƐŽŵǁĂƌĞ͗ DĂůŝĐŝŽƵƐ ƐŽŌǁĂƌĞ ƚŚĂƚ ĞŶĐƌLJƉƚƐ ĐŽŵƉƵƚĞƌƐ ŽŶ ƚŚĞ ŶĞƚǁŽƌŬ ŵĂŬŝŶŐ ƚŚĞŵ ƵƐĞůĞƐƐ ƵŶƟů Ă ƌĂŶƐŽŵ ŝƐ ƉĂŝĚ͘ dŚŝƐ ƚĞĐŚŶŝƋƵĞ ŝƐ ŽŌĞŶ ĞŵƉůŽLJĞĚ ƚŚƌŽƵŐŚ ƚŚĞ ƵƐĞ ŽĨ Ă ƉŚŝƐŚŝŶŐ ƐĐŚĞŵĞ͘ hƐĞƌƐ ĂƌĞ ďĂŝƚĞĚ ŝŶƚŽ ĐůŝĐŬŝŶŐ ŽŶ Ă ůŝŶŬ ŝŶ ĂŶ ĞŵĂŝů͕ ŽƉĞŶŝŶŐ ĂŶ ĞŵĂŝů ĂƩĂĐŚŵĞŶƚ͕ Žƌ ĐůŝĐŬŝŶŐ Ă ůŝŶŬ ŽŶ Ă ǁĞďƐŝƚĞ ǁŚŝĐŚ ůŽĂĚƐ ƚŚĞ ƌĂŶƐŽŵǁĂƌĞ ŽŶƚŽ ƚŚĞ ƐLJƐƚĞŵ͘ dŚĞ ƐŽŌǁĂƌĞ ƚƌĂǀĞůƐ ƚŚƌŽƵŐŚ Ăůů ŽĨ ƚŚĞ ĐŽŵƉƵƚĞƌƐ ŽŶ ƚŚĞ ŶĞƚǁŽƌŬ ĞŶĐƌLJƉƟŶŐ Ăůů ƚŚĞ ĮůĞƐ ŵĂŬŝŶŐ ƚŚĞŵ ƵŶƵƐĂďůĞ͘ dŚĞ ŵŽƐƚ ǀƵůŶĞƌĂďůĞ ƐLJƐƚĞŵƐ ĂƌĞ ƚŚŽƐĞ ǁŝƚŚ ƵŶƉĂƚĐŚĞĚ Žƌ ŽƵƚĚĂƚĞĚ ƐŽŌǁĂƌĞ ƐLJƐƚĞŵƐ ǁŚŝĐŚ ĂůůŽǁ ĂŶ ĂƩĂĐŬĞƌ ƚŽ ŐĂŝŶ unauthorized access.

>ŽŽŬŝŶŐ ĨŽƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ͍ • ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂŶĚ ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ ʹ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ZĂŶƐŽŵǁĂƌĞ͗ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ŚŚƐ͘ŐŽǀͬƐŝƚĞƐͬĚĞĨĂƵůƚͬĮůĞƐͬ ZĂŶƐŽŵǁĂƌĞ&ĂĐƚ^ŚĞĞƚ͘ƉĚĨ • h^ ŽŵƉƵƚĞƌ ŵĞƌŐĞŶĐLJ ZĞĂĚŝŶĞƐƐ dĞĂŵ ;h^Ͳ ZdͿ ʹ ǀŽŝĚŝŶŐ ^ŽĐŝĂů ŶŐŝŶĞĞƌŝŶŐ ĂŶĚ WŚŝƐŚŝŶŐ ƩĂĐŬƐ͗ ŚƩƉƐ͗ͬ​ͬ ǁǁǁ͘ƵƐͲĐĞƌƚ͘ŐŽǀͬŶĐĂƐͬƟƉƐͬ^dϬϰͲϬϭϰ • ĞƉĂƌƚŵĞŶƚ ŽĨ :ƵƐƟĐĞ LJďĞƌƐĞĐƵƌŝƚLJ hŶŝƚ ʹ ĞƐƚ WƌĂĐƟĐĞƐ ĨŽƌ sŝĐƟŵ ZĞƐƉŽŶƐĞ ĂŶĚ ZĞƉŽƌƟŶŐ ŽĨ LJďĞƌ /ŶĐŝĚĞŶƚƐ͗ ŚƩƉ͗ͬ​ͬǁǁǁ͘ũƵƐƟĐĞ͘ŐŽǀͬƐŝƚĞƐͬĚĞĨĂƵůƚͬĮůĞƐͬŽƉĂͬƐƉĞĞĐŚĞƐͬ ĂƩĂĐŚŵĞŶƚƐͬϮϬϭϱͬϬϰͬϮϵͬĐƌŝŵŝŶĂůͺĚŝǀŝƐŝŽŶͺŐƵŝĚĂŶĐĞͺŽŶͺ ďĞƐƚͺƉƌĂĐƟĐĞƐͺĨŽƌͺǀŝĐƟŵͺƌĞƐƉŽŶƐĞͺĂŶĚͺƌĞƉŽƌƟŶŐͺĐLJďĞƌͺ incidents.pdf • ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂŶĚ ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ͕ KĸĐĞ ĨŽƌ ŝǀŝů ZŝŐŚƚƐ Ͳ ,/W ^ĞĐƵƌŝƚLJ ZƵůĞ ĂŶĚ 'ƵŝĚĂŶĐĞ ŝŶĨŽƌŵĂƟŽŶ͗ ŚƩƉ͗ͬ​ͬǁǁǁ͘ŚŚƐ͘ŐŽǀͬŚŝƉĂĂͬĨŽƌͲƉƌŽĨĞƐƐŝŽŶĂůƐͬƐĞĐƵƌŝƚLJͬ ŐƵŝĚĂŶĐĞͬŝŶĚĞdž͘Śƚŵů

ƌ͘ tŽŽ ƉƌĂĐƟĐĞƐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ Ăƚ <ĂŝƐĞƌ WĞƌŵĂŶĞŶƚĞ͕

EŽǁ ƚŚĂƚ LJŽƵ ŬŶŽǁ ǁŚLJ ĐLJďĞƌ ĐƌŝŵŝŶĂůƐ ĂŶĚ ŚĂĐŬĞƌƐ ĚŽ ǁŚĂƚ ƚŚĞLJ KƌĂŶŐĞ ĂŶĚ ŝƐ Ă ŵĞŵďĞƌ ŽĨ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ ĚŽ ĂŶĚ ŚŽǁ ƚŚĞLJ ĚŽ ŝƚ͕ ŚĂůĨ ŽĨ ƚŚĞ ďĂƩůĞ ŝƐ ǁŽŶ͘ hŶĨŽƌƚƵŶĂƚĞůLJ͕ ƐŚŽƵůĚ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ͘ LJŽƵ Žƌ LJŽƵƌ ŽƌŐĂŶŝnjĂƟŽŶ ĨĂůů ǀŝĐƟŵ ƚŽ Ă ŚĂĐŬĞƌ͕ ŝƚ ŝƐ LJŽƵƌ ƌĞƐƉŽŶƐŝďŝůŝƚLJ ƚŽ ƉƌŽǀĞ ƚŚĂƚ W,/ ǁĂƐ ŶŽƚ ƐƚŽůĞŶ Žƌ LJŽƵ ĐŽƵůĚ ďĞ ĮŶĞĚ͘ ,ĞƌĞ ĂƌĞ ƐŽŵĞ ƐŝŵƉůĞ ƟƉƐ ŽŶ ŚŽǁ LJŽƵ ĐĂŶ ŚĞůƉ ƚŽ ƉƌŽƚĞĐƚ LJŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ƉƌĂĐƟĐĞ͗ • ,ĂǀĞ Ă ĚĞĚŝĐĂƚĞĚ W ĨŽƌ ǁŽƌŬ ʹ ǁŝƚŚ Ă ^dZKE' ƉĂƐƐǁŽƌĚ͘ <ĞĞƉ ƚŚĞ ĐŽŵƉƵƚĞƌ locked unless using it.

• hƐĞ ĞŶĐƌLJƉƟŽŶ ƚĞĐŚŶŽůŽŐLJ ŽŶ LJŽƵƌ ŚĂƌĚ ĚƌŝǀĞƐ͖ ƚŚŝƐ ĐĂŶ ŵŝƟŐĂƚĞ ůŽƐƐ ŽĨ W,/ ĚƵƌŝŶŐ ĂŶ ĂƩĂĐŬ͘ • Ž ŶŽƚ ŽƉĞŶ ĞŵĂŝůƐ Žƌ ĐůŝĐŬ ŽŶ ůŝŶŬƐͬ ĂƩĂĐŚŵĞŶƚƐ ĨƌŽŵ ƉĞŽƉůĞ LJŽƵ ĚŽ ŶŽƚ ŬŶŽǁ Žƌ LJŽƵ ǁĞƌĞ ŶŽƚ ĞdžƉĞĐƟŶŐ͘ DĂŬĞ sure to look at the email addresses The UCSF Fresno Medical Education Program and Central California Faculty Medical Group (CCFMG) are recruiting for a physician to join the teaching faculty. The successful applicant must ǀĞƌLJ ĐĂƌĞĨƵůůLJ͘ /Ĩ ŝŶ ĚŽƵďƚ ĐĂůů͊ be board certified in Family Medicine, have a license to practice medicine in the United States, • <ĞĞƉ LJŽƵƌ ŽƉĞƌĂƟŶŐ ƐLJƐƚĞŵƐ ĂŶĚ and be eligible to obtain a California medical license at the time of hire. This position provides an ďƌŽǁƐĞƌƐ ƵƉͲƚŽͲĚĂƚĞ͘ ŽŵƉĂŶŝĞƐ opportunity for teaching, clinical research, and community practice. Proficiency in OB optional. ƐƵĐŚ ĂƐ DŝĐƌŽƐŽŌ ŽŌĞŶ ƐĞŶĚ ŽƵƚ Administrative/leadership opportunities are available. A competitive salary is offered. updates that protect against the latest ǀƵůŶĞƌĂďŝůŝƟĞƐ ĂŶĚ ƚŚƌĞĂƚƐ͘ The program is based in Fresno, California, which offers a high standard of living combined with a • ŶƐƵƌĞ Ăůů ƐƚĂī ĂƌĞ ƚƌĂŝŶĞĚ ƌĞŐƵůĂƌůLJ low cost of living. The result is a quality of life uniquely Californian, yet surprisingly affordable. ŽŶ ,/W ͬ,/d , ĂƐ ǁĞůů ĂƐ Fresno is a vibrant, growing city located in Central California. There is much to see and do in phishing techniques.

Fresno and the city is ideally located for fast, convenient getaways to the scenic Central Coast as well as the majestic Sierra Nevada mountains. Fresno is the only major city in the country with • ^Ğƚ ƐĞĐƵƌŝƚLJͬƉƌŝǀĂĐLJ ĨŽƌ LJŽƵƌ close proximity to three national parks, including renowned Yosemite National Park. social media.

• ^ĞĐƵƌĞ LJŽƵƌ tŝͲ&ŝ ŶĞƚǁŽƌŬ ǁŝƚŚ Ă PLEASE APPLY ONLINE AT: https://aprecruit.ucsf.edu/apply/JPF01168 ƉĂƐƐǁŽƌĚͬĞŶĐƌLJƉƟŽŶ͘ Visit our websites: www.fresno.ucsf.edu | www.communitymedical.org • ZĞƉŽƌƚ ĂŶLJ ĂƩĂĐŬƐ Žƌ ƐƵƐƉĞĐƚĞĚ UC San Francisco seeks candidates whose experience, teaching, research, or community service that has prepared them to contribute to our commitment to diversity ĂƩĂĐŬƐ ƚŽ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ͘ and excellence. The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

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UCSF FRESNO FAMILY MEDICINE FACULTY OPPORTUNITY

California Family Physician Fall 2017

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Tipu V. Khan, MD, FAAFP

Must Have Apps for Family Physicians ǀĞƌLJ ĚĂLJ ŶĞǁ ĂƉƉůŝĐĂƟŽŶƐ ĂƌĞ ĚĞǀĞůŽƉĞĚ ĂŶĚ ƌĞůĞĂƐĞĚ ĨŽƌ ƐŵĂƌƚƉŚŽŶĞƐ͘ ^ŽŵĞ ĂƌĞ ĨƌĞĞ ĂŶĚ ƐŽŵĞ ƌĞƋƵŝƌĞ Ă ƐƵďƐĐƌŝƉƟŽŶ Žƌ ŽŶĞͲƟŵĞ ĨĞĞ͘ dŚĞ ŶƵŵďĞƌ ŽĨ ŵĞĚŝĐĂů ĂƉƉƐ ŝƐ ĂƐƚŽŶŝƐŚŝŶŐ ĂŶĚ ǀĂƌŝĞƐ ŐƌĞĂƚůLJ ďĂƐĞĚ ŽŶ ŶĞĞĚ͘ &Žƌ ĞdžĂŵƉůĞ͕ ǁŚĞŶ / ǁŽƌŬ ŝŶ ƚŚĞ ĞŵĞƌŐĞŶĐLJ ĚĞƉĂƌƚŵĞŶƚ͕ / ƵƐĞ Ă ƐƉĞĐŝĮĐ ƐĞƚ ŽĨ ĂƉƉƐ ĨŽƌ ƋƵŝĐŬ͕ ƉŽŝŶƚͲŽĨͲĐĂƌĞ ĚĞĐŝƐŝŽŶ ŵĂŬŝŶŐ ĂŶĚ ĂůŐŽƌŝƚŚŵ ƌĞǀŝĞǁ͘ tŚĞŶ /͚ŵ ŝŶ ĐůŝŶŝĐ Žƌ ŽŶ ƚŚĞ ǁĂƌĚƐ͕ ŚŽǁĞǀĞƌ͕ / ƵƐĞ ĚŝīĞƌĞŶƚ apps and calculators. tŚĞŶ / ĮƌƐƚ ďĞŐĂŶ ƵƐŝŶŐ ŵLJ ƐŵĂƌƚƉŚŽŶĞ ĂƐ Ă ŵĞĚŝĐĂů ƌĞƐŽƵƌĐĞ͕ / ĚŽǁŶůŽĂĚĞĚ ŚƵŶĚƌĞĚƐ ŽĨ ĂƉƉƐ ĂŶĚ ĨŽƵŶĚ ŵLJƐĞůĨ ƌĂƌĞůLJ ƵƐŝŶŐ ŵŽƐƚ͘ KǀĞƌ ƚŚĞ LJĞĂƌƐ͕ /͛ǀĞ ŚŽŶĞĚ ƚŚĂƚ ůŝƐƚ ĚŽǁŶ ƚŽ Ă ĨĞǁ ĐƌŝƟĐĂů ͞ŐŽ ƚŽ͟ ĂƉƉƐ / ĚŽŶ͛ƚ ŵŝŶĚ ƉĂLJŝŶŐ Ă ĨĞĞ ƚŽ ƵƐĞ͘ ^Ž͕ ŚĞƌĞ͛Ɛ ŵLJ ŚŝŐŚůŝŐŚƚ ŽĨ Ă ĨĞǁ ĂƉƉƐ ƉƌĂĐƟĐŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŵĂLJ ĮŶĚ ƵƐĞĨƵů ŽǀĞƌ ƚŚĞ ĐŽƵƌƐĞ ŽĨ Ă ƉƌĂĐƟĐĞ ĚĂLJ͘ DŽƐƚ ŽĨ ƚŚĞƐĞ ĂƉƉƐ ǁŝůů ŐŝǀĞ LJŽƵ Ă ĨƌĞĞ ƚƌŝĂů͕ ƐŽ ĚŽǁŶůŽĂĚ ĂŶĚ ŐŝǀĞ ƚŚĞŵ Ă ƐŚŽƚ͊

WŚĂƌŵĂĐŽƉĞŝĂƐ Ɛ ĨĂƌ ĂƐ ƉŚĂƌŵĂĐŽƉĞŝĂƐ ŐŽ͕ Ă ĨĞǁ ďŝŐ ŚŝƩĞƌƐ ĂƌĞ ĂǀĂŝůĂďůĞ͗ Epocrates, Tarascon, Lexicomp, and Micromedex. All ĨŽƵƌ ĂƌĞ ǁĞůů ŬŶŽǁŶ ĂŶĚ ƉƌŽǀŝĚĞ ĞƐƐĞŶƟĂůůLJ ƚŚĞ ƐĂŵĞ ŝŶĨŽƌŵĂƟŽŶ͘ / ŚĂǀĞ ďĞĞŶ ƵƐŝŶŐ ƉŽĐƌĂƚĞƐ ƐŝŶĐĞ / ǁĂƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ĂŶĚ Ăŵ ƋƵŝƚĞ ĨĂŵŝůŝĂƌ ǁŝƚŚ ŝƚƐ ŝŶƚĞƌĨĂĐĞ͘ dŚĞ ĚƌƵŐ ƌĞĨĞƌĞŶĐĞ ƉŽƌƟŽŶ ŽĨ ƚŚĞ ĂƉƉ ŝƐ ĨƌĞĞ͕ ďƵƚ / ŐůĂĚůLJ ĨŽƌŬ ŽǀĞƌ ƚŚĞ ĞdžƚƌĂ ĚŽůůĂƌƐ ĨŽƌ ƚŚĞ ƉƌĞŵŝƵŵ ǀĞƌƐŝŽŶ ǁŚŝĐŚ ƉƌŽǀŝĚĞƐ Ă ĚŝĂŐŶŽƐƟĐ ĂŶĚ ƚƌĞĂƚŵĞŶƚ ƌĞƐŽƵƌĐĞ ĂƐ ǁĞůů ʹ ƚŚƵƐ ĂůƐŽ ĨƵŶĐƟŽŶŝŶŐ ĂƐ Ă ŵĞĚŝĐĂů ĚŝƐĞĂƐĞ ƌĞĨĞƌĞŶĐĞ ŐƵŝĚĞ all in one app. This is by far my most used app and I open ƚŚŝƐ ĂƉƉ ŽŶ ĂǀĞƌĂŐĞ ϮϬ ƟŵĞƐ ƉĞƌ ĚĂLJ͘

ZĞĨĞƌĞŶĐĞ ƉƉƐ

UpToDate: DŽƐƚ ĐůŝŶŝĐŝĂŶƐ ŚĂǀĞ ƵƐĞĚ hƉdŽ ĂƚĞ ĚƵƌŝŶŐ ƚŚĞŝƌ ŵĞĚŝĐĂů ĐĂƌĞĞƌ͘ /Ĩ LJŽƵ ĮŶĚ LJŽƵƌƐĞůĨ ƐƵďƐĐƌŝďŝŶŐ ƚŽ hƉdŽ ĂƚĞ͕ LJŽƵ͛ůů ĮŶĚ ƚŚĞ ĂƉƉ ŚĂƐ Ăůů ƚŚĞ ŽŶůŝŶĞ ƌĞƐŽƵƌĐĞƐ available on your phone.

AHRQ ePSS: dŚŝƐ ĂƉƉ ŝƐ ƉŽǁĞƌĞĚ ďLJ ƚŚĞ ŐĞŶĐLJ ĨŽƌ ,ĞĂůƚŚĐĂƌĞ ZĞƐĞĂƌĐŚ ĂŶĚ YƵĂůŝƚLJ ; ,ZYͿ ĂŶĚ ƉƵůůƐ h^ WƌĞǀĞŶƟǀĞ ^ĞƌǀŝĐĞƐ dĂƐŬ &ŽƌĐĞ ;h^W^d&Ϳ ĚĂƚĂ͘ zŽƵ ƉůƵŐ ŝŶ LJŽƵƌ ƉĂƟĞŶƚ ŝŶĨŽ ;ĂŐĞ͕ ƐĞdž͕ ƌŝƐŬ ĨĂĐƚŽƌƐͿ ĂŶĚ LJŽƵ͛ůů ŐĞƚ h^W^d& ƐĐƌĞĞŶŝŶŐ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ͘ VisualDx: This is a great resource for dermatology. It has Ă ŶŝŌLJ ĚŝīĞƌĞŶƟĂů ĚŝĂŐŶŽƐŝƐ ďƵŝůĚĞƌ ƚŚĂƚ ĂůůŽǁƐ LJŽƵ ƚŽ ƉůƵŐ ŝŶ ƉĞƌƟŶĞŶƚ ĚĞƚĂŝůƐ ĂŶĚ ĚĞƐĐƌŝƉƟŽŶƐ ŽĨ ƚŚĞ ƌĂƐŚ ;ŚĂƐ ƉŝĐƚƵƌĞƐ ƚŽ ŚĞůƉ LJŽƵ ĐŚŽŽƐĞͿ ĂŶĚ ŝƚ ǁŝůů ŽƵƚƉƵƚ Ă ĚŝīĞƌĞŶƟĂů ĂůŽŶŐ ǁŝƚŚ ŽƚŚĞƌ ƌĞĨĞƌĞŶĐĞ ŝŶĨŽƌŵĂƟŽŶ ƐƵĐŚ ĂƐ ƚĞƐƟŶŐ͕ ƚƌĞĂƚŵĞŶƚ͕ ĨŽůůŽǁͲƵƉ ĂŶĚ ƚŽŶƐ ŽĨ ƉŝĐƚƵƌĞƐ͘ Recently they expanded to include other problem sets ƐƵĐŚ ĂƐ Ed͕ ŶĞƵƌŽůŽŐLJ͕ '/͕ ĞƚĐ͘ / ŚĂǀĞŶ͛ƚ ĨŽƵŶĚ ƚŚĞƐĞ other parts as useful but the dermatology part makes this ĞdžƉĞŶƐŝǀĞ ĂƉƉ ǁĞůů ǁŽƌƚŚ ƚŚĞ ƐƵďƐĐƌŝƉƟŽŶ͘ 18

California Family Physician Fall 2017

Southern California Permanente Medical Group

ĂůĐƵůĂƚŽƌƐ

Calculate by QxMD and MD Calc: These are both great calculators but I’ve found using only one is ŽŌĞŶ ŶŽƚ ĞŶŽƵŐŚ͘ &Žƌ ĞdžĂŵƉůĞ͕ YdžD ĚŽĞƐ ŶŽƚ ŚĂǀĞ Ă Kt^ ; ůŝŶŝĐĂů KƉŝĂƚĞ tŝƚŚĚƌĂǁĂů ^ĐŽƌĞͿ ďƵƚ MD Calc does. Therefore, I keep and use both apps. ^ s ZŝƐŬ ƐƟŵĂƚŽƌ͗ WůƵŐ ŝŶ LJŽƵƌ ƉĂƟĞŶƚ͛Ɛ ĚĂƚĂ ĂŶĚ ŝƚ ǁŝůů ŽƵƚƉƵƚ ƚŚĞ ^ s ƌŝƐŬ ĂƐ ǁĞůů ĂƐ recommended treatment per ACC guidelines.

KƚŚĞƌƐ

The Answer to Health Care in America

Family Medicine & Urgent Care Opportunities in Southern California

LactMed from NIH: This app provides detailed ŝŶĨŽƌŵĂƟŽŶ ĂďŽƵƚ ƚŚĞ ƐĂĨĞƚLJ ŽĨ ĚŝīĞƌĞŶƚ ŵĂƚĞƌŶĂů ŵĞĚŝĐĂƟŽŶƐ ĚƵƌŝŶŐ ůĂĐƚĂƟŽŶ ĂƐ ǁĞůů ĂƐ ƐĂĨĞ ĂůƚĞƌŶĂƟǀĞƐ ŝĨ Ă ƋƵĞƌŝĞĚ ŵĞĚŝĐĂƟŽŶ ŝƐ ŶŽƚ ƐĂĨĞ ĚƵƌŝŶŐ ďƌĞĂƐƞĞĞĚŝŶŐ͘

The future of health care is happening today at Kaiser Permanente Southern California. By pursuing new breakthroughs, promoting proactive care and employing innovative technologies, we’re giving our physicians the tools they need to create a healthier tomorrow for everyone. As part of our practice, you’ll be working in a progressive environment that encourages cross-specialty collaboration, professional autonomy and work-life balance.

Pedi Stat: ŵƵƐƚ ŚĂǀĞ ĨŽƌ ƚŚŽƐĞ ǁŽƌŬŝŶŐ ŝŶ ŵĞƌŐĞŶĐLJ ĂŶĚ hƌŐĞŶƚ ĂƌĞ ƐĞƫŶŐƐ͘ WƵƚ ŝŶ Ă ǁĞŝŐŚƚ͕ ĂŐĞ͕ Žƌ ƌŽƐĞůŽǁ ĐŽůŽƌ ĂŶĚ ƚŚĞ ĂƉƉ ǁŝůů ŽƵƚƉƵƚ ƐƉĞĐŝĮĐ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ ĨŽƌ ŚƵŶĚƌĞĚƐ ŽĨ ĐůŝŶŝĐĂů ƐĐĞŶĂƌŝŽƐ ĨƌŽŵ ĂŝƌǁĂLJ ŵĂŶĂŐĞŵĞŶƚ ƚŽ ĂƐƚŚŵĂ ŵĞĚŝĐĂƟŽŶƐ͘

• An organization that has served the communities of Southern California for more than 60 years

10 Second EM: ƋƵŝĐŬ ƌĞǀŝĞǁ ĨŽƌ ďĂƐŝĐ ĂŶĚ ĐŽŵŵŽŶ ĞŵĞƌŐĞŶĐLJ ƐŝƚƵĂƟŽŶƐ͘ / ŽŌĞŶ ƵƐĞ ƚŚŝƐ ǁŚĞŶ ǁŽƌŬŝŶŐ Ă ƐŚŝŌ ŝŶ ƚŚĞ ĞŵĞƌŐĞŶĐLJ ĚĞƉĂƌƚŵĞŶƚ͘ OB Wheel by Quartertone: dŽŶƐ ŽĨ K ǁŚĞĞůƐ ĂƌĞ on the market. The premium version of this app lets you enter ultrasound data plus other variables to ĐĂůĐƵůĂƚĞ LJŽƵƌ K ĚĂƚĞƐ ĂƐ ǁĞůů ĂƐ ŐĞƐƚĂƟŽŶĂů ĂŐĞ ƐƉĞĐŝĮĐ ƌĞĐŽŵŵĞŶĚĞĚ ƚĞƐƟŶŐͬƉƌĞŶĂƚĂů ĐĂƌĞ͘ Tiger Text: ^ĞĐƵƌĞ ,/W ͬ,/d , ĐŽŵƉůŝĂŶƚ ƚĞdžƚ ŵĞƐƐĂŐŝŶŐ ƉůĂƞŽƌŵ ƚŽ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ LJŽƵƌ ƐƚĂī and other providers. Remember, standard SMS is EKd ,/W ͬ,/d , ĐŽŵƉůŝĂŶƚ͘ Doximity: ƉƌŽĨĞƐƐŝŽŶĂů ƐŽĐŝĂů ŵĞĚŝĂ ƉůĂƞŽƌŵ ;ŽŶůLJ ůŝĐĞŶƐĞĚ ƉƌŽǀŝĚĞƌƐ ĐĂŶ ĐƌĞĂƚĞ ĂŶ ĂĐĐŽƵŶƚͿ ĂŶĚ Ă ǁĂLJ ƚŽ ŬĞĞƉ ŝŶ ƚŽƵĐŚ ǁŝƚŚ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ƐŚĂƌĞ ƉĂƟĞŶƚ ŝŶĨŽƌŵĂƟŽŶ ŝŶ Ă ,/W ͬ,/d , ĐŽŵƉůŝĂŶƚ ĨĂƐŚŝŽŶ͘ zŽƵ ĂůƐŽ ƌĞĐĞŝǀĞ Ă ĨƌĞĞ ĨĂdž ŶƵŵďĞƌ ƚŽ ƐĞŶĚ ĂŶĚ receive faxes electronically.

Kaiser SCPMG is proud to offer its physicians:

• A physician-led practice that equally emphasizes professional autonomy and cross-specialty collaboration • Comprehensive administrative support • An environment that promotes excellent service to patients • A fully implemented electronic medical record system • An excellent salary, comprehensive benefits and partnership eligibility after 3 years For consideration or to apply, please visit our website at http://scpmgphysiciancareers.com.

For questions or additional

information, please call (800) 541-7946.

We are an AAP/EEO employer.

Dr. Khan is the Core Faculty of Ventura County &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐLJ ĂŶĚ ƐƐŝƐƚĂŶƚ ůŝŶŝĐĂů WƌŽĨĞƐƐŽƌ ʹ h > ĂǀŝĚ 'ĞīĞŶ ^ĐŚŽŽů ŽĨ DĞĚŝĐŝŶĞ͘ California Family Physician Fall 2017

19

Conrad Amenta

Looking Back at the Meaningful Use EHR Incentive Program With the approval of the Medicare Access and CHIP ZĞĂƵƚŚŽƌŝnjĂƟŽŶ Đƚ ;D Z Ϳ ŝŶ ϮϬϭϱ͕ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ DĞĚŝĐĂƌĞ Θ DĞĚŝĐĂŝĚ ^ĞƌǀŝĐĞƐ͛ ; D^Ϳ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚ ; ,ZͿ ŝŶĐĞŶƟǀĞ ƉƌŽŐƌĂŵ͕ ŽŌĞŶ ĐĂůůĞĚ ͞DĞĂŶŝŶŐĨƵů hƐĞ͕͟ ;DhͿ ǁĂƐ ĐŚĂŶŐĞĚ ĨŽƌĞǀĞƌ͘ ĐƟǀŝƟĞƐ ŽŶĐĞ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ĂĐŚŝĞǀŝŶŐ ŵĞĂŶŝŶŐĨƵů ƵƐĞ ĂƌĞ ŶŽǁ ĐŽůůĞĐƚĞĚ ƵŶĚĞƌ D Z ͛Ɛ DĞƌŝƚͲ ĂƐĞĚ /ŶĐĞŶƟǀĞ WĂLJŵĞŶƚ ^LJƐƚĞŵ ;D/W^Ϳ͕ ǁŚŝĐŚ ŝƐ ĚĞƐŝŐŶĞĚ ƚŽ ƉĂLJ ƉŚLJƐŝĐŝĂŶƐ ŽŶ ƚŚĞ ďĂƐŝƐ ŽĨ ƚŚĞ ǀĂůƵĞ ƚŚĞLJ ƉƌŽĚƵĐĞ͘ hƐŝŶŐ ĂŶ ,Z ŝŶ Ă ŵĞĂŶŝŶŐĨƵů ǁĂLJ ŝƐ ĐŽĚŝĮĞĚ ŝŶ D/W^ ĂƐ ͞ ĚǀĂŶĐŝŶŐ ĂƌĞ /ŶĨŽƌŵĂƟŽŶ͘͟ DĞĂŶŝŶŐĨƵů hƐĞ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ŝŶ ϮϬϬϵ ǁŝƚŚ ƚŚĞ ƉĂƐƐĂŐĞ ŽĨ ƚŚĞ ,ĞĂůƚŚ /ŶĨŽƌŵĂƟŽŶ dĞĐŚŶŽůŽŐLJ for Economic and Clinical Health ;,/d ,Ϳ Đƚ͘ ůŽŶŐƐŝĚĞ dŚĞ ŵĞƌŝĐĂŶ ZĞŝŶǀĞƐƚŵĞŶƚ Θ ZĞĐŽǀĞƌLJ Đƚ ; ZZ Ϳ͕ ƚŚĞ ,/d , Đƚ ǁĂƐ designed to speed the recovery ŽĨ ƚŚĞ h^ ĞĐŽŶŽŵLJ ŝŶ ƚŚĞ ǁĂŬĞ ŽĨ ƚŚĞ ĮŶĂŶĐŝĂů ĐƌŝƐŝƐ ďLJ ŵŽĚĞƌŶŝnjŝŶŐ the health care industry.

DĞĂŶŝŶŐĨƵů hƐĞ͛Ɛ ƉƌŝĐĞ ƚĂŐ ǁĂƐ ŶŽƚ ŝŶƐŝŐŶŝĮĐĂŶƚ͖ ĂƐ ŽĨ ϮϬϭϱ͕ ƚŚĞ ĨĞĚĞƌĂů government has allocated $35 ďŝůůŝŽŶ ƚŽ ƚŚĞ ŝŶĐĞŶƟǀĞ ƉƌŽŐƌĂŵ͘ tĂƐ ŝƚ ǁŽƌƚŚ ŝƚ͍

“

ƉƌŽǀŝĚĞƌ ŽƌĚĞƌ ĞŶƚƌLJ ĂŶĚ ŵƵůƟĨƵŶĐƟŽŶĂů ŚĞĂůƚŚ /d ŝŶƚĞƌǀĞŶƟŽŶ͕ Ăůů ĨĂĐĞƚƐ ŽĨ DĞĂŶŝŶŐĨƵů hƐĞ͕ ŚĂǀĞ ƚŚĞ ŐƌĞĂƚĞƐƚ ƉŽƚĞŶƟĂů ƚŽ ƉƌŽĚƵĐĞ ƚŚĞƐĞ ŝŵƉƌŽǀĞŵĞŶƚƐ͘ /Ŷ ƚŚŝƐ ƌĞŐĂƌĚ͕ ŚŽǁĞǀĞƌ͕ ƚŚĞ ƌĞƐƵůƚƐ ŽĨ DĞĂŶŝŶŐĨƵů hƐĞ ŚĂǀĞ ďĞĞŶ ŵŽƌĞ ŝŶĐŽŶĐůƵƐŝǀĞ͘ Dh ďƌŝŐŚƚ ƐƉŽƚƐ͕ ĞƐƉĞĐŝĂůůLJ ĂŵŽŶŐ ƉŚLJƐŝĐŝĂŶƐ ƵƐŝŶŐ ĐŽƌĞ ĨƵŶĐƟŽŶƐ ƐƵĐŚ ĂƐ ƌĞĐŽƌĚŝŶŐ ƉĂƟĞŶƚ ŚŝƐƚŽƌLJ ĂŶĚ ĚĞŵŽŐƌĂƉŚŝĐ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ĞͲƉƌĞƐĐƌŝďŝŶŐ ĂƌĞ ŶŽƟĐĞĂďůĞ͘ ^ŚĂƌŝŶŐ ŝŶĨŽƌŵĂƟŽŶ ǁŝƚŚ ŝŵŵƵŶŝnjĂƟŽŶ ƌĞŐŝƐƚƌŝĞƐ Žƌ ƉƵďůŝĐ ŚĞĂůƚŚ ĚĂƚĂďĂƐĞƐ͕ ƚŚĞ ƉĂƟĞŶƚƐ͛ ĂďŝůŝƚLJ ƚŽ ĂĐĐĞƐƐ ƚŚĞŝƌ ŽǁŶ ŚĞĂůƚŚ ƌĞĐŽƌĚƐ Žƌ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ ƚŚĞŝƌ ƉŚLJƐŝĐŝĂŶƐ ĞůĞĐƚƌŽŶŝĐĂůůLJ ĂŶĚ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ĐůŝŶŝĐĂů decision support all remain ƌĞůĂƟǀĞůLJ ůŽǁ͕ ŚŽǁĞǀĞƌ͘ The biggest disappointments have been interoperability and the level of ƉŚLJƐŝĐŝĂŶ ƐĂƟƐĨĂĐƟŽŶ ǁŝƚŚ ,ZƐ͘ Ɛ ŽĨ ϮϬϭϱ͕ ŽŶůLJ Ϯϱ ƉĞƌĐĞŶƚ ŽĨ ĞůŝŐŝďůĞ medical providers and hospitals ĂƩĞƐƚĞĚ ƚŽ ĞǀĞŶ ŵŽĚĞƐƚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ĞdžĐŚĂŶŐĞ ƌĞƋƵŝƌĞŵĞŶƚƐ͘ And using EHRs has become a source ŽĨ ŵĂũŽƌ ĨƌƵƐƚƌĂƟŽŶ ĨŽƌ ƉŚLJƐŝĐŝĂŶƐ͕ ŝŶĐƌĞĂƐŝŶŐ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ ĂŶĚ ĚĞƚƌĂĐƟŶŐ ĨƌŽŵ ƚŚĞŝƌ ĂďŝůŝƚLJ ƚŽ ŝŶƚĞƌĂĐƚ ǁŝƚŚ ƉĂƟĞŶƚƐ͘ /ŵƉůĞŵĞŶƟŶŐ EHR systems has also been more ĐŽƐƚůLJ ƚŚĂŶ ĞdžƉĞĐƚĞĚ͕ ƌĂŶŐŝŶŐ ĂŶLJǁŚĞƌĞ ĨƌŽŵ Ψϭϱ͕ϬϬϬ ƚŽ ΨϳϬ͕ϬϬϬ per physician.

Family physicians truly do lead the way in the use of EHRs in medical practice.

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/Ĩ ǁĞ ƵƐĞ ĂĚŽƉƟŽŶ ŽĨ ,ZƐ ĂƐ Ă ƉƌŽdžLJ ĨŽƌ DĞĂŶŝŶŐĨƵů hƐĞ͕ ƚŚĞ ĂŶƐǁĞƌ might be ͞LJĞƐ͘͟ /Ŷ ϮϬϬϴ͕ ďĞĨŽƌĞ ƚŚĞ ,/d , Đƚ͕ ŽŶůLJ ϰϮ ƉĞƌĐĞŶƚ ŽĨ ŽĸĐĞͲďĂƐĞĚ ƉŚLJƐŝĐŝĂŶƐ ŚĂĚ ĂĚŽƉƚĞĚ ĂŶLJ ŬŝŶĚ ŽĨ ,Z͘ LJ ϮϬϭϱ͕ ƚŚĂƚ ŶƵŵďĞƌ ŚĂĚ ŵŽƌĞ ƚŚĂŶ ĚŽƵďůĞĚ͕ ƚŽ ϴϲ͘ϵ ƉĞƌĐĞŶƚ͘ dŚĞ ĂĚŽƉƟŽŶ ƌĂƚĞ ŝƐ ĞǀĞŶ ŵŽƌĞ ƉƌŽŶŽƵŶĐĞĚ ĂŵŽŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͗ ĂƐ ŽĨ ϮϬϭϲ͕ ϵϱ ƉĞƌĐĞŶƚ ŽĨ ƚŚŽƐĞ ƐƉĞĐŝĂůŝnjŝŶŐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂƌĞ ͞ůŝǀĞ͟ ŽŶ ĂŶ ,Z͕ ĂŶĚ ϴϮ ƉĞƌĐĞŶƚ ŚĂǀĞ ĚĞŵŽŶƐƚƌĂƚĞĚ ĂĚǀĂŶĐĞĚ ƵƐĞ ŽĨ ƚŚĞ ƚĞĐŚŶŽůŽŐLJ͘ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚƌƵůLJ ĚŽ ůĞĂĚ ƚŚĞ ǁĂLJ ŝŶ ƚŚĞ ƵƐĞ ŽĨ ,ZƐ ŝŶ ŵĞĚŝĐĂů ƉƌĂĐƟĐĞ͘

What has become clear is that meaningful use of EHRs should not be pursued as a standalone strategy. The health systems ĚĞŵŽŶƐƚƌĂƟŶŐ ƚŚĞ ŵŽƐƚ ĞīĞĐƟǀĞ ƵƐĞ ŽĨ ,ZƐ͕ ƐƵĐŚ ĂƐ <ĂŝƐĞƌ Permanente in California and Intermountain Healthcare ŝŶ hƚĂŚ͕ ĐŽŶƐŝĚĞƌ ,ZƐ ŽŶĞ ůĞŐ ŽĨ Ă ƚŚƌĞĞͲůĞŐŐĞĚ ƋƵĂůŝƚLJͲ ŝŵƉƌŽǀĞŵĞŶƚ ƐƚƌĂƚĞŐLJ͗ • &ŝƌƐƚ͕ ,ZƐ ŵĞĂƐƵƌĞ ǀĂƌŝĂƟŽŶƐ ŝŶ ƉƌĂĐƟĐĞ͘ DĞĂŶŝŶŐĨƵů hƐĞ ǁĂƐ ĚĞƐŝŐŶĞĚ ƚŽ ĂĐŚŝĞǀĞ ŵŽƌĞ ƚŚĂŶ ŵĞƌĞ • ^ĞĐŽŶĚ͕ ĐŽŶƐƚƌƵĐƟǀĞ ĐŽŶǀĞƌƐĂƟŽŶƐ ĂďŽƵƚ ǀĂƌŝĂƟŽŶ ƚĂŬĞ ĚŝŐŝƟnjĂƟŽŶ͘ dŚĞŽƌĞƟĐĂůůLJ͕ ŝŶƚƌŽĚƵĐŝŶŐ ,ZƐ ƉƌŽĚƵĐĞƐ ĚŽǁŶƐƚƌĞĂŵ place to improve care. ďĞŶĞĮƚƐ͕ ƐƵĐŚ ĂƐ ŝŶĐƌĞĂƐŝŶŐ ĞĸĐŝĞŶĐLJ͕ ƌĞĚƵĐŝŶŐ ĐŽƐƚƐ ĂŶĚ • dŚŝƌĚ͕ ŝŶŶŽǀĂƟǀĞ ƉĂLJŵĞŶƚ ŵŽĚĞůƐ ĞŶƐƵƌĞ ƚŚĞ ƉŚLJƐŝĐŝĂŶ ŝƐ ŝŵƉƌŽǀŝŶŐ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ĐĂƌĞ͘ ƐLJƐƚĞŵĂƟĐ ƌĞǀŝĞǁ ŽĨ ƚŚĞ free to think about quality and not about the sustainability literature reveals that clinical decision support, computerized ŽĨ ƚŚĞ ƉƌĂĐƟĐĞ͘ ĐŽŶƟŶƵĞĚ ŽŶ ƉĂŐĞ ϮϮ х 20

California Family Physician Fall 2017

Put Yourself on the Road to Continued Success!

Sports Medicine Essentials February 21-25, 2018 Sheraton San Diego Hotel & Marina San Diego, California USA

9th World Congress on

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May 29-June 2, 2018 Hyatt Regency Minneapolis/ Minneapolis Convention Center Minneapolis, Minnesota USA

Attend this interactive workshop to learn new perspectives in the orthopedic, primary care and emergency medicine aspects of sports medicine.

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FAIRMONT ORCHID KOHALA COAST, BIG ISLAND, HAWAII MARCH 5â&#x20AC;&#x201C;9, 2018 Optional Pre-Course Sessions: March 4, 2018

FAIRMONT ORCHID KOHALA COAST, BIG ISLAND, HAWAII MARCH 5â&#x20AC;&#x201C;9, 2018 CE.MAYO.EDU/PPMPC2018 Photo courtesy of the Fairmont Orchid

California Family Physician Fall 2017

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AHF LJ ŵĞƌŐŝŶŐ ƚŚĞ DĞĂŶŝŶŐĨƵů hƐĞ ƉƌŽŐƌĂŵ ǁŝƚŚ D/W^ ƵŶĚĞƌ D Z ͕ D^ ƚŽŽŬ Ă ǁĞůĐŽŵĞ ƐƚĞƉ ƚŽǁĂƌĚ reframing the discussion about ĂĚŽƉƟŶŐ ,ZƐ ĂƐ Ă ĚŝƐĐƵƐƐŝŽŶ ŽŶ ƉƌŽĚƵĐŝŶŐ ǀĂůƵĞ ĨŽƌ ƉĂƟĞŶƚƐ͘ ,ŝƐƚŽƌLJ ŵĂLJ ũƵĚŐĞ DĞĂŶŝŶŐĨƵů hƐĞ ĂƐ Ă ůĞƐƐͲƚŚĂŶͲƉĞƌĨĞĐƚ ƐŽůƵƟŽŶ ƚŽ a longstanding problem. Dr. Jack Wennberg pioneered the study of ƵŶǁĂƌƌĂŶƚĞĚ ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ǀĂƌŝĂƟŽŶ ĂƐ ĞĂƌůLJ ĂƐ ϭϵϲϳ͕ ĂŶĚ ĂƐ ŵƵĐŚ ĂƐ Ă ƚŚŝƌĚ ŽĨ ǁŚĂƚ ƚŚĞ h^ ƐƉĞŶĚƐ ĂŶŶƵĂůůLJ ŽŶ ŚĞĂůƚŚ ĐĂƌĞ ŵĂLJ ďĞ ǁĂƐƚĞĨƵů͘ dŚĞ ǁŝŶĚŽǁ ĨŽƌ ĂĐƟŽŶ ǁĂƐ ďƌŝĞĨ͗ ǁŚĂƚ ŵŝŐŚƚ ŚĂǀĞ ďĞĞŶ Ă ĚŝĸĐƵůƚ ŶĞŐŽƟĂƟŽŶ ŽŶ ŝƚƐ ŽǁŶ ĐŽƵůĚ ďĞ ŝŶĐůƵĚĞĚ ŝŶ ƚŚĞ ĨĞĚĞƌĂů ŐŽǀĞƌŶŵĞŶƚ͛Ɛ ƟŵĞůLJ ƌĞƐƉŽŶƐĞ ƚŽ ƚŚĞ ĮŶĂŶĐŝĂů ĐƌŝƐŝƐ͘ dŚŽƵŐŚƚ ŽĨ ƚŚĂƚ ǁĂLJ͕ ŝƚ͛Ɛ ƵŶƐƵƌƉƌŝƐŝŶŐ ƚŚĂƚ DĞĂŶŝŶŐĨƵů hƐĞ ƌĞƉƌĞƐĞŶƚƐ ƉĂŝŶĨƵůůLJͲĨŽƌĐĞĚ ŐƌŽǁƚŚ Ăƚ ŐƌĞĂƚ ĮŶĂŶĐŝĂů ĂŶĚ ƉĞƌƐŽŶĂů ĐŽƐƚ͘ Ƶƚ ŶĞĂƌůLJ ϭϬ LJĞĂƌƐ ůĂƚĞƌ͕ ŽŶĞ ĐĂŶ ƐĂLJ ƚŚĂƚ ŝƚ ǁĂƐ ŐƌŽǁƚŚ͕ ŶŽŶĞƚŚĞůĞƐƐ͕ ĂŶĚ ŵĞĚŝĐŝŶĞ may never be the same as a result.

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ŚƩƉƐ͗ͬ​ͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬƉĂŐĞƐͬ ƉŚLJƐŝĐŝĂŶͲĞŚƌͲĂĚŽƉƟŽŶͲƚƌĞŶĚƐ͘ƉŚƉ ŚƩƉƐ͗ͬ​ͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬƉĂŐĞƐͬ &/'ͲZ ͲWŚLJƐŝĐŝĂŶƐͲ>ŝǀĞͲDhͲ^ƉĞĐŝĂůŝƚLJ͘ƉŚƉ ŚƩƉƐ͗ͬ​ͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬƉĂŐĞƐͬ &/'Ͳ,ĞĂůƚŚͲ/dͲ>ŝƚĞƌĂƚƵƌĞͲZĞǀŝĞǁͲ^ƵŵŵĂƌLJͲŽĨͲ &ŝŶĚŝŶŐƐͲDĞĂŶŝŶŐĨƵůͲhƐĞͲ&ƵŶĐƟŽŶĂůŝƟĞƐͲŽŶͲ YƵĂůŝƚLJͲ^ĂĨĞƚLJͲĂŶĚͲ ĸĐŝĞŶĐLJ͘ƉŚƉ ŚƩƉ͗ͬ​ͬŚĞĂůƚŚĂīĂŝƌƐ͘ŽƌŐͬďůŽŐͬϮϬϭϱͬϬϯͬϬϰͬǁŚĞƌĞͲ ŝƐͲŚŝƚĞĐŚƐͲϯϱͲďŝůůŝŽŶͲĚŽůůĂƌͲŝŶǀĞƐƚŵĞŶƚͲŐŽŝŶŐͬ ŚƩƉƐ͗ͬ​ͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬ ƉĂŐĞƐͬ&/'ͲƉŚLJƐŝĐŝĂŶƐͲǁŝƚŚͲŵĞĂŶŝŶŐĨƵůͲƵƐĞͲ ĨƵŶĐƟŽŶĂůŝƟĞƐͲŝŶͲƚŚĞŝƌͲ ,Z͘ƉŚƉ ŚƩƉƐ͗ͬ​ͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬƉĂŐĞƐͬ &/'ͲWĞƌĐĞŶƚͲWŚLJƐŝĐŝĂŶƐͲĞZdžͲƚŚƌŽƵŐŚͲ ,Z͘ƉŚƉ

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Dƌ͘ ŵĞŶƚĂ ŝƐ &W͛Ɛ ŝƌĞĐƚŽƌ ŽĨ Health Policy.

AIDS HEALTHCARE F OU N DAT ION

AIDS Healthcare Foundation (AHF), was founded in 1987 and is the largest specialized provider of HIV/AIDS medical care in the nation. We provide cutting edge medicine & advocacy regardless of ability to pay.

Primary Care Practitioners Needed in California AHF is seeking dedicated full-time Family/Internal Medicine Practitioners (MD/DO/RNP) Hollywood, CA - https://careers-aidshealth.icims.com/jobs/6355/physician--hollywood/job

Experience/Educational Requirements: 1. Must possess a State Medical Board license MD/DO in Internal/Family Medicine. (without restrictions)

2.

3.

3+ years recent experience treating and diagnosing HIV/AIDS clients in an outpatient Primary Care Setting.

Candidates will be required to obtain DEA furnishing licenses.

4.

5.

Must obtain AAHIVM Certification within 18 months of hire.

Current CPR (Cardio Pulmonary Resuscitation) required.

(without restrictions)

Base Salary with Retention/Productivity Bonus, Relocation Assistance, On-Call Schedule 5 Weeks Per Year, 28 Days PTO Annually, CME Stipend, 401K, Liability Coverage and Comprehensive, Loan Repayment Plan. We sponsor H-1 Visas

Email: Miyoshi.LaFourche@aidshealth.org • Telephone: 310-999-6089

W H AT T O O K Y O U A L I F E T I M E TO LEARN CAN BE LOST IN MINUTES.

WITH A STROKE, TIME LOST IS BRAIN LOST.

Le arn the warning signs at StrokeAssociation.org or 1-888-4-STROKE.

©2004 American Heart Association Made possible in part by a generous grant from The Bugher Foundation.

22

California Family Physician Fall 2017

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California Family Physician Fall 2017

Chris Flores, MD and Maricela Fernandez, JD

Telemedicine and Telehealth in 2017: Innovation, Disruption, and Transformation ,ĂǀĞ LJŽƵ ŚĞĂƌĚ ŽĨ ĂŶ ͞Ğ/ h͍͟ Ŷ ĞŵĞƌŐĞŶĐLJ ƌŽŽŵ ƚĞůĞƐƚƌŽŬĞ ƉƌŽŐƌĂŵ͍ Kƌ͕ ǀŝƌƚƵĂů ƉĞĚŝĂƚƌŝĐ ĂŶĚ ͞ƚĞůĞŵĞŶƚĂů ŚĞĂůƚŚ͟ ƐĞƌǀŝĐĞƐ ƚŽ ŝŶĚŝǀŝĚƵĂůƐ ĚŝƐƉůĂĐĞĚ ĂŌĞƌ ,ƵƌƌŝĐĂŶĞƐ ,ĂƌǀĞLJ ĂŶĚ /ƌŵĂ͍ Everyone is talking about telehealth these days, but for the vast majority of physicians in primary care, this concept is ŶŽƚŚŝŶŐ ŵŽƌĞ ƚŚĂŶ Ă ŶĞǁƐ ŚĞĂĚůŝŶĞ Žƌ ďƌŝĞĨ ďůƵƌď ŵĞŶƟŽŶĞĚ ŝŶ ŚŽƐƉŝƚĂů Žƌ ŚĞĂůƚŚ ƉůĂŶ ŶĞǁƐůĞƩĞƌƐ͘ ůƚŚŽƵŐŚ ŵĂũŽƌ advances are happening in terms of telehealth technology and promising pilot programs, most family physicians have not ŝŶƚĞŐƌĂƚĞĚ ĂŶLJ ƚĞůĞŵĞĚŝĐŝŶĞ Žƌ ƚĞůĞŚĞĂůƚŚ ƐŽůƵƟŽŶƐ ŝŶƚŽ ƚŚĞŝƌ ĚĂŝůLJ ƉĂƟĞŶƚ ŇŽǁƐ͘ DĂŶLJ ĐŽůůĞĂŐƵĞƐ ǁĞ ƚĂůŬ ǁŝƚŚ ĂƌĞ ƚĂŬŝŶŐ Ă ͞ǁĂŝƚ ĂŶĚ ƐĞĞ͟ ĂƫƚƵĚĞ ĂŶĚ ŚĂǀĞ ŶŽƚ LJĞƚ ƐƚĂƌƚĞĚ ƉƌŽǀŝĚŝŶŐ ĂŶLJ telehealth services. /ƚ ŵĂLJ ďĞ ƟŵĞ ƚŽ ƌĞĐŽŶƐŝĚĞƌ ƚŚŝƐ ĂƉƉƌŽĂĐŚ͘ tĞ͕ ĂƐ ĨĂŵŝůLJ physicians, need to start looking seriously at all the changes ŐŽŝŶŐ ŽŶ ŝŶ ƚŚĞ ƚĞůĞŚĞĂůƚŚ ĐĂƌĞ ŵĂƌŬĞƚƉůĂĐĞ ůĞƐƚ ǁĞ ůŽƐĞ ƚŽƵĐŚ ǁŝƚŚ ƚŚĞ ͞ƐƚĂŶĚĂƌĚ ŽĨ ĐĂƌĞ͟ ŝŶ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ ďĞĨŽƌĞ ǁĞ ůŽƐĞ ŽƵƌ ƉĂƟĞŶƚƐ ƚŽ ǀŝƌƚƵĂů ŽŶͲůŝŶĞ ƉƌŽǀŝĚĞƌƐ͘ ƚ ĮƌƐƚ ďůƵƐŚ͕ ŝƚ ƐĞĞŵƐ ĂƐ ŝĨ ƐŽŵĞ ŽĨ ƚŚĞ ŵŽƌĞ ŝŶŶŽǀĂƟǀĞ ĂŶĚ ĚŝƐƌƵƉƟǀĞ ƚĞůĞŚĞĂůƚŚ ƉƌĂĐƟĐĞƐ ŚĂǀĞ ůŝƩůĞ ƚŽ ĚŽ ǁŝƚŚ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ tĞ ŚĞĂƌ ŵŽƌĞ ĂďŽƵƚ ƚĞůĞŚĞĂůƚŚ ĂƉƉůŝĐĂƟŽŶƐ ŝŶ ŚŽƐƉŝƚĂůͬ ƐƉĞĐŝĂůƚLJ ƐĞƫŶŐƐ͘ &Žƌ ĞdžĂŵƉůĞ͕ ƚŚĞ Ğ/ h͕ ĂůƚŚŽƵŐŚ Ă ŶĞǁ concept to some, is actually one of the more mature and ǀĂůŝĚĂƚĞĚ ƚĞůĞŚĞĂůƚŚ ĂƉƉůŝĐĂƟŽŶƐ ŝŶ ƵƐĞ͘ &ƌŽŵ Ă ĐĞŶƚƌĂůŝnjĞĚ ŚƵď or headquarters, a group of intensivist physicians and nurses ƵƐŝŶŐ ƚĞůĞŵĞĚŝĐŝŶĞ ĂŶĚ ŝŶƚĞƌŶĞƚ ĐŽŶŶĞĐƟŽŶ ƚŽŽůƐ ƚƌĞĂƚ ĂŶĚ ŵĂŶĂŐĞ / h ƉĂƟĞŶƚƐ ŚŽƵƐĞĚ ŝŶ ƐŵĂůů ƌƵƌĂů ŚŽƐƉŝƚĂůƐ ŚƵŶĚƌĞĚƐ ŽĨ ŵŝůĞƐ ĂǁĂLJ͘ DĞƌĐLJ sŝƌƚƵĂů ĂƌĞ ďĂƐĞĚ ŝŶ ^ƚ͘ >ŽƵŝƐ͕ DK ŝƐ ŽŶĞ of the most recognized and celebrated leaders in this area.

DĞƌĐLJ ŚĂƐ ďĞĞŶ ŵĂŶĂŐŝŶŐ ƚŚĞ ^ĂĨĞ tĂƚĐŚ ƌŝƟĐĂů ĂƌĞ WƌŽŐƌĂŵ ĨŽƌ ŵĂŶLJ LJĞĂƌƐ͘ Ɛ Ă ƌĞƐƵůƚ ŽĨ ƚŚŝƐ ƉƌŽŐƌĂŵ͕ ϯϮ ŚŽƐƉŝƚĂů / hƐ ŝŶ Ɛŝdž ĚŝīĞƌĞŶƚ ƐƚĂƚĞƐ ŚĂǀĞ ƐĞĞŶ Ă ϯϱ ƉĞƌĐĞŶƚ ĚĞĐƌĞĂƐĞ ŝŶ ůĞŶŐƚŚ ŽĨ ƐƚĂLJ ĂŶĚ Ă ϯϬ ƉĞƌĐĞŶƚ ĚĞĐƌĞĂƐĞ ŝŶ ŵŽƌƚĂůŝƚLJ͘ KďǀŝŽƵƐůLJ͕ ƚŚĞ ƉƌŽĨĞƐƐŝŽŶĂů ůŝĨĞ ĂŶĚ ǁŽƌŬŇŽǁ ŽĨ ƚŚĞ ƉŚLJƐŝĐŝĂŶƐ ŝŶǀŽůǀĞĚ ǁŝƚŚ ƚŚŝƐ ƉƌŽŐƌĂŵ ŚĂƐ ĐŚĂŶŐĞĚ ŝŵŵĞŶƐĞůLJ ʹ ŵŽƐƚůLJ ĨŽƌ ƚŚĞ ďĞƩĞƌ͘ ^ŝŵŝůĂƌůLJ͕ ŽƚŚĞƌ ŚŽƐƉŝƚĂůƐ ĂƌĞ ŝŵƉůĞŵĞŶƟŶŐ ƚĞůĞŚĞĂůƚŚ emergency room specialty consult programs.

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California Family Physician Fall 2017

DLJ ŚŽƐƉŝƚĂů͕ ŝƐĞŶŚŽǁĞƌ DĞĚŝĐĂů ĞŶƚĞƌ ŝŶ ZĂŶĐŚŽ DŝƌĂŐĞ͕ ŚĂƐ Ă ŶĞǁůLJ ŝŵƉůĞŵĞŶƚĞĚ ƚĞůĞƐƚƌŽŬĞ ƉƌŽŐƌĂŵ ǁŝƚŚ h ^ĂŶ ŝĞŐŽ͘ dƌĂĚŝƟŽŶĂůůLJ͕ ǁŚĞŶ Ă ƉĂƟĞŶƚ ǁŝƚŚ ĂĐƵƚĞ ƐƚƌŽŬĞ ĂƌƌŝǀĞĚ Ăƚ ŽƵƌ ĞŵĞƌŐĞŶĐLJ ĚĞƉĂƌƚŵĞŶƚ͕ ŽŶĞ ŽĨ ŽƵƌ ůŽĐĂů ƐƚĂī ŶĞƵƌŽůŽŐŝƐƚƐ ǁŽƵůĚ ďĞ ĐŽŶƐƵůƚĞĚ ĞŵĞƌŐĞŶƚůLJ ƚŽ ĞǀĂůƵĂƚĞ ĂŶĚ ŵĂŶĂŐĞ ƚŚĞ ƉĂƟĞŶƚ ĨĂĐĞͲƚŽͲĨĂĐĞ ŽŶ ƐŝƚĞ͘ WĂƟĞŶƚƐ ŶŽǁ have immediate access to a tele-neurologist. Although the ƉĂƟĞŶƚ ĂŶĚ ƚĞůĞͲŶĞƵƌŽůŽŐŝƐƚ ĂƌĞ ƐĞƉĂƌĂƚĞĚ ďLJ ϭϮϬ ŵŝůĞƐ͕ ƚŚĞLJ ŝŶƚĞƌĂĐƚ ĂŶĚ ĞŶŐĂŐĞ ǀŝĂ Ă ůŝǀĞ ƚǁŽͲǁĂLJ ǀŝĚĞŽ ĐŽŶŶĞĐƟŽŶ through the Internet. The tele-neurologist also has full access ƚŽ ƚŚĞ ƉĂƟĞŶƚ͛Ɛ ŝŵĂŐŝŶŐ͕ ůĂď ƚĞƐƚƐ ĂŶĚ ŽƚŚĞƌ ĞǀĂůƵĂƟŽŶƐ ĂŶĚ results. Published studies demonstrate improved outcomes and enhanced adherence to standard of care guidelines using telestroke services. The intended purpose of this program is ƚŚĂƚ ůŽĐĂů ƉĂƟĞŶƚƐ ǁŝůů ďĞŶĞĮƚ ĨƌŽŵ ƚŚŝƐ ŶĞǁ ƉƌŽŐƌĂŵ͘ dŚĞ ƵŶŝŶƚĞŶĚĞĚ ĐŽŶƐĞƋƵĞŶĐĞ͕ ŚŽǁĞǀĞƌ͕ ŝƐ ƚŚĂƚ ŝƚ ŝƐ ĂīĞĐƟŶŐ ƚŚĞ ǁŽƌŬůŽĂĚ ŽĨ ŽƵƌ ƐƚĂī ŶĞƵƌŽůŽŐŝƐƚƐ ʹ ŽƵƌ ůŽĐĂů ŶĞƵƌŽůŽŐŝƐƚƐ ǁŚŽ ŚĂĚ ƉƌĞǀŝŽƵƐůLJ ďĞĞŶ ŬĞƉƚ ďƵƐLJ ŽŶ ĐĂůů Ăƚ ƚŚĞ ŚŽƐƉŝƚĂů͕ ŵƵƐƚ ŶŽǁ ĮŶĚ ŽƚŚĞƌ ƉĂƟĞŶƚ ĐĂƌĞ ĂĐƟǀŝƟĞƐ ƚŽ Įůů ƚŚĞŝƌ ƟŵĞ͘ ůƚŚŽƵŐŚ͕ ƚŚĞƐĞ ĞdžĂŵƉůĞƐ ŵĂLJ ƐĞĞŵ ͞ƐƉĞĐŝĂůƚLJͲŽƌŝĞŶƚĞĚ͟ ĂŶĚ ŶŽƚ ƌĞůĞǀĂŶƚ ƚŽ ŽƵƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌĂĐƟĐĞƐ͕ ǁĞ ƐŚŽƵůĚ ŶŽƚ ďĞ lulled into a false sense of security. &Žƌ ƚŚŽƐĞ ŽĨ ƵƐ ǁŚŽ ƉƌĂĐƟĐĞ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ŝƚ ŝƐ ǀĞƌLJ ůŝŬĞůLJ ƚŚĂƚ ƐŽŵĞ ŽĨ ŽƵƌ ŽǁŶ ƉĂƟĞŶƚƐ ŚĂǀĞ ƵƐĞĚ ƚĞůĞŵĞĚŝĐŝŶĞ ƐĞƌǀŝĐĞƐ ǁŝƚŚŽƵƚ ŽƵƌ ŬŶŽǁůĞĚŐĞ Žƌ ĂĚǀŝĐĞ͘ ŽŵƉĂŶŝĞƐ ƐƵĐŚ ĂƐ dĞůĂĚŽĐ͕ Doctor on Demand, American Well and HealthTap are seeing ƌĂƉŝĚ ŐƌŽǁƚŚ ŝŶ ƚĞůĞŵĞĚŝĐŝŶĞ ĂƉƉŽŝŶƚŵĞŶƚƐ ĨŽƌ ƐƵĐŚ ƵƌŐĞŶƚ ĐĂƌĞ ĐŽŶĚŝƟŽŶƐ ĂƐ hZ/͕ hd/ ĂŶĚ ďĂĐŬ ƉĂŝŶ͕ ĞƐƉĞĐŝĂůůLJ ĂŵŽŶŐ young tech-savvy consumers. These companies are quickly ĞdžƉĂŶĚŝŶŐ ŝŶƚŽ ĐĂƌĞ ŽĨ ĐŚƌŽŶŝĐ ĐŽŶĚŝƟŽŶƐ ůŝŬĞ ĚŝĂďĞƚĞƐ ĂŶĚ ŚLJƉĞƌƚĞŶƐŝŽŶ͘ Ɛ ƚŚĞLJ ĐŽŶƟŶƵĞ ƚŽ ŐĂŝŶ ŵĂƌŬĞƚ ƐŚĂƌĞ͕ ĚĞŵŽŶƐƚƌĂƟŶŐ ǀĂůƵĞ ƚŽ ƉĂƟĞŶƚƐ͕ ĂŶĚ ŽƵƚĐŽŵĞƐ ƐƚƵĚŝĞƐ ĮŶĚ ďĞƩĞƌ Žƌ ĐŽŵƉĂƌĂďůĞ ƋƵĂůŝƚLJ ǀĞƌƐƵƐ ĨĂĐĞͲƚŽͲĨĂĐĞ ǀŝƐŝƚƐ͕ ƚƌĂĚŝƟŽŶĂů ďƌŝĐŬͲĂŶĚͲŵŽƌƚĂƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŝůů ĨĞĞů ĐŽŵƉĞƟƟŽŶ ĂŶĚ ĞƌŽƐŝŽŶ ŽĨ ƚŚĞŝƌ ƉƌĂĐƟĐĞ͕ ůŽƐŝŶŐ ƉĂƟĞŶƚƐ ƚŽ ǀŝƌƚƵĂů ŽŶͲůŝŶĞ ŚĞĂůƚŚ ƉƌŽǀŝĚĞƌƐ͘ /Ŷ ĨĂĐƚ͕ ŝŶƐƵƌĞƌƐ ǁŝůů ůŝŬĞůLJ ĚŝǀĞƌƚ ƉĂƟĞŶƚƐ ƚŽ ƚĞůĞŚĞĂůƚŚ ĐŽŵƉĂŶŝĞƐ ŝĨ ĐŽƐƚƐ ĂƌĞ ůŽǁĞƌ ĂŶĚ ŽƵƚĐŽŵĞƐ ĂƌĞ ĞƋƵŝǀĂůĞŶƚ Žƌ ďĞƩĞƌ͘

Ɛ ƚŚŝƐ ĂƌƟĐůĞ ǁĂƐ ǁƌŝƩĞŶ͕ ŵƵůƟƉůĞ ŚƵƌƌŝĐĂŶĞƐ ǁĞƌĞ ƉƵŵŵĞůŝŶŐ ŽƵƌ ĐŽƵŶƚƌLJ leaving thousands of people homeless ĂŶĚ ǁŝƚŚŽƵƚ ďĂƐŝĐ ŶĞĐĞƐƐŝƟĞƐ ůŝŬĞ ŵĞĚŝĐĂů ĐĂƌĞ͘ sĂƌŝŽƵƐ ƚĞůĞŵĞĚŝĐŝŶĞ companies are stepping in and ƉƌŽǀŝĚŝŶŐ ĨƌĞĞ ƌĞŵŽƚĞ ͞ǀŝƌƚƵĂů͟ ĐĂƌĞ ƚŽ ƚŚŽƐĞ ĚŝƐƉůĂĐĞĚ ďLJ ƚŚĞ ŇŽŽĚŝŶŐ ĂŶĚ ĚĞƐƚƌƵĐƟŽŶ͘ &Žƌ ŵĂŶLJ ŽĨ ƚŚĞƐĞ ƉĂƟĞŶƚƐ ŝƚ ǁŝůů ďĞ ƚŚĞŝƌ ǀĞƌLJ ĮƌƐƚ ŝŶƚƌŽĚƵĐƟŽŶ ƚŽ ƚĞůĞŵĞĚŝĐŝŶĞ ʹ Ă ŶĞǁ ǁĂLJ ƚŽ ĂĐĐĞƐƐ primary care and mental health ƐĞƌǀŝĐĞƐ͘ tŚĞŶ ƚŚĞLJ ƐĞĞ ŚŽǁ ŚĞůƉĨƵů͕ ĞĸĐŝĞŶƚ ĂŶĚ ůŽǁ ĐŽƐƚ ƚŚŝƐ ƐĞƌǀŝĐĞ ĐĂŶ ďĞ͕ ŝƚ ŝƐ ǀĞƌLJ ůŝŬĞůLJ ƚŚŝƐ ŝŶƚƌŽĚƵĐƟŽŶ ǁŝůů ĐƌĞĂƚĞ Ă ƉŽƐŝƟǀĞ ůĂƐƟŶŐ ŝŵƉƌĞƐƐŝŽŶ͕ ĂŶĚ ƚŚĞLJ ŵĂLJ ĞŶĚ ƵƉ ƐǁŝƚĐŚŝŶŐ ĚŽĐƚŽƌƐ because of it. &ƌĂŶŬůLJ͕ ƚŽ ƌĞŵĂŝŶ ǀŝĂďůĞ ŝŶ ƚŚŝƐ ŶĞǁ emerging health care marketplace, ǁĞ ĂƐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŵƵƐƚ ĂĚĂƉƚ ĂŶĚ ĞĚƵĐĂƚĞ ŽƵƌƐĞůǀĞƐ ĂďŽƵƚ ƉŽƚĞŶƟĂů ƚĞůĞŵĞĚŝĐŝŶĞ ƐŽůƵƟŽŶƐ ĨŽƌ ŽƵƌ ŽĸĐĞƐ͘ tĞ ĚŽ ŶŽƚ ǁĂŶƚ ƚŽ ďĞ ůĞŌ ďĞŚŝŶĚ ĂŶĚ ůĞŌ ŽƵƚ ŽĨ ŝŶƐƵƌĂŶĐĞ ŶĞƚǁŽƌŬƐ ĂƐ telehealth companies expand their ƐĞƌǀŝĐĞ ĂƌĞĂƐ͖ ĂŶĚ͕ ǁĞ ĚŽŶ͛ƚ ǁĂŶƚ ƚŽ ďĞĐŽŵĞ ŝƌƌĞůĞǀĂŶƚ ƚŽ ŽƵƌ ƉĂƟĞŶƚƐ͘

ƌ͘ &ůŽƌĞƐ ƉƌĂĐƟĐĞƐ ŝŶ ZĂŶĐŚŽ DŝƌĂŐĞ͖ DƐ͘ &ĞƌŶĂŶĚĞnj ŝƐ ƚŚĞ WƌĂĐƟĐĞ ĚŵŝŶŝƐƚƌĂƚŽƌͬKĸĐĞ DĂŶĂŐĞƌ͘ ,Ğ ŝƐ ĐŽͲĐŚĂŝƌ ŽĨ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ͘

INSPIRE greatness

At Dignity Health, we lead by example. By always striving to give our personal best-and encouraging our patients and colleagues to do the same-we're able to achieve and do more than we ever imagined. If you're ready to inspire greatness in yourself and others, join us today.

OUTPATIENT FAMILY MEDICINE PHYSICIANS Northern and Central California (Folsom, Grass Valley, Merced, Redding, Sacramento, Santa Cruz, & Stockton)

Practice Highlights: • Autonomy with administrative and clinical support

• Salary guarantee period and excellent earning potential based on productivity model

• An established, growing medical group OR an independent single specialty group practice

• Attractive bonus structure

• Full-time and part-time practice options

FAMILY MEDICINE/OB/GYN MEDICINE

Vista Community Clinic

With locations in Vista/No San Diego County, Lake Elsinore/So Riverside County and La Habra/Orange County Seeking: Full-time, part-time and per diem Family Medicine Physicians and OB/GYN Physicians.

Requirements: California license, DEA license, CPR certification and board certified in family medicine.

Bilingual English/Spanish preferred.

Contact c Us: Visitt our website at a ww www.vistacommunityclinic.org r Forward resume to hr@vistacommunityc t linic.org r or fax resume to 760-414-3702

• A Medical Foundation aligned with one of the largest health systems in the nation and the largest hospital system in California

• Sunny California locations with easy access to San Francisco, Napa, and Lake Tahoe

Please contact/send your CV to: Physician Recruitment providers@dignityhealth.org | 888-599-7787 www.dignityhealth.org/physician-careers

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Hello humankindness California Family Physician Fall 2017

25

Carol Havens, MD and Shelly Rodrigues, CAE

Online Education: Is It Really the Future of Learning? tŚĞƌĞ ĚŽ ƚŚĞ ŐĞŶĞƌĂƟŽŶƐ ŽĨ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƉƌĂĐƟĐŝŶŐ ƉŚLJƐŝĐŝĂŶƐ ĨĂůů ŝŶ ƚŚĞ ƐƉĞĐƚƌƵŵ ŽĨ ůĞĂƌŶŝŶŐ ƐƚLJůĞƐ ĂŶĚ ŝŶ ƉĂƌƟĐƵůĂƌ͕ ŽŶůŝŶĞ ůĞĂƌŶŝŶŐ͍͟ dŚĞ ĂŶƐǁĞƌ ŝƐ ͞Ăůů ŽǀĞƌ ƚŚĞ ƉůĂĐĞ͊͟ ŶĚ ǁŝƚŚ ŶŽ ŽŶĞ ƌŝŐŚƚ ĂŶƐǁĞƌ͕ ƚŚĞ ĮĞůĚ ŝƐ ǁŝĚĞ ŽƉĞŶ ĨŽƌ ĚŝƐĐƵƐƐŝŽŶ͘ dŚĞ ǁŝĚĞͲŽƉĞŶ ĮĞůĚ ŝƐ ŽƵƌ ĚŝůĞŵŵĂ ĂƐ ĂŶ ŽƌŐĂŶŝnjĂƟŽŶ ǁŝƚŚ Ă ƉƌŝŽƌŝƚLJ ƚŽ ƉƌŽǀŝĚĞ ŚŝŐŚ ƋƵĂůŝƚLJ͕ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ͕ ƉƌĂĐƟĐĂů ĂŶĚ ƌĞůĞǀĂŶƚ ĞĚƵĐĂƟŽŶ ƚŽ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͊ 'ĞŶĞƌĂƟŽŶĂů ůĞĂƌŶŝŶŐ ƐƚLJůĞ ƌĞƐĞĂƌĐŚ ƚĞůůƐ ƵƐ ƚŚĂƚ ƚŚĞ ^ŝůĞŶƚ 'ĞŶĞƌĂƟŽŶ ;ϭϵϮϱͲϭϵϰϱͿ ĂƌĞ ƉƌŽĐĞƐƐ ŽƌŝĞŶƚĞĚ͖ ƚŚĞLJ ůĞĂƌŶĞĚ ŝŶ Ă ƐĐŚŽŽů ƌŽŽŵ ǁŝƚŚ text books and tests. They may dive into some online learning for personal development, but are not really our online audience. ŽŽŵĞƌƐ ;ϭϵϰϲͲϭϵϲϰͿ ůĞĂƌŶĞĚ ŝŶ ŵƵĐŚ ƚŚĞ ƐĂŵĞ ǁĂLJ ĂƐ ƚŚĞ ^ŝůĞŶƚ 'ĞŶĞƌĂƟŽŶ͘ They tend to be dependent on educators, prefer the lecture format ;ƚŚŝŶŬ ŽĨ ƚŚŽƐĞ ƌƵŶŶŝŶŐ ĨƌŽŵ ƚŚĞ ƌŽŽŵ ǁŚĞŶ Ă ƐƉĞĂŬĞƌ ƐĂLJƐ ͞ǁĞ͛ƌĞ ŐŽŝŶŐ ƚŽ ƌŽůĞ ƉůĂLJ͟Ϳ ĂŶĚ ůŝŬĞ ĂĐƟǀŝƟĞƐ ƚŽ ďĞ ƐĐƌŝƉƚĞĚ͘ dŚĞLJ ĂůƐŽ ĂƌĞ ƵƐŝŶŐ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ͕ ƉĂƌƟĐƵůĂƌůLJ ƐŝƚĞƐ ůŝŬĞ DĞĚƐĐĂƉĞ͕ ďƵƚ ĂƌĞ ŶŽƚ ĚŝŐŝƚĂů ŶĂƟǀĞƐ͘ 'ĞŶy ;ϭϵϲϱͲϭϵϴϬͿ ĂƌĞ ŵƵĐŚ ŵŽƌĞ ĐŽŵĨŽƌƚĂďůĞ ǁŝƚŚ ŽŶůŝŶĞ ůĞĂƌŶŝŶŐ͕ ďƵƚ ƚŚĞLJ ĂƌĞ ĂůƐŽ ŝŶĚĞƉĞŶĚĞŶƚ͕ ĞǀĞŶ ƐŽůŽ͕ ůĞĂƌŶĞƌƐ͕ ǁŝƚŚ Ă ĚĞƐŝƌĞ ƚŽ ůĞĂƌŶ ŽŶ ƚŚĞ ũŽď͕ ƌĂƚŚĞƌ ƚŚĂŶ ŽŶůŝŶĞ͘ 'ĞŶyĞƌƐ ĂƌĞ ŽƵƚĐŽŵĞ ŽƌŝĞŶƚĞĚ͘ dŚĞ ŶĞdžƚ ŐĞŶĞƌĂƟŽŶ͕ DŝůůĞŶŶŝĂůƐ ;ϭϵϴϭͲϮϬϬϬͿ͕ ůŽŽŬ ĨŽƌ ƚĞĂŵͲďĂƐĞĚ ƚĞĐŚŶŽůŽŐLJ ĞŶĂďůĞĚ ͞ĞĚƵƚĂŝŶŵĞŶƚ͘͟ KŶůŝŶĞ ĞĚƵĐĂƟŽŶ ŵĞĞƚƐ ƚŚĞŝƌ ŶĞĞĚƐ ĨŽƌ ŬĞLJ ƉŽŝŶƚƐ ƌĂƚŚĞƌ ƚŚĂŶ ĞdžŚĂƵƐƟǀĞ ƌĞǀŝĞǁ ĂŶĚ ƚŚĞŝƌ ŐĞŶĞƌĂůůLJ ůŽǁ ƚŽůĞƌĂŶĐĞ ĨŽƌ ďŽƌĞĚŽŵ͘ dŚŝƐ ůĞĂĚƐ ƵƐ ƚŽ ƚŚĞ ŶĞdžƚ ŐĞŶĞƌĂƟŽŶ͕ ŽŶĞ ǁĞ ĂƌĞ ũƵƐƚ encountering. 'ĞŶ ;ǁŝƚŚ ŶŽ ĚĞĮŶŝƟǀĞ ƐƚĂƌƚͲĞŶĚ ďŝƌƚŚ ĚĂƚĞƐͿ ĂƌĞ ƚƌƵůLJ ĚŝŐŝƚĂů ŶĂƟǀĞƐ͕ ĨƵůůLJ ĨƵŶĐƟŽŶĂů ŝŶ ĂŶ ŽŶůŝŶĞ ǁŽƌůĚ͘ 'ĞŶ Ɛ ǁŝůů ĐƌĞĂƚĞ Ă document on their school computer, do research on their phone or ƚĂďůĞƚ͕ ǁŚŝůĞ ƚĂŬŝŶŐ ŶŽƚĞƐ ŽŶ Ă ŶŽƚĞƉĂĚ͕ ƚŚĞŶ ĮŶŝƐŚ ŝŶ ĨƌŽŶƚ ŽĨ ƚŚĞ ds ǁŝƚŚ Ă ůĂƉƚŽƉ͕ ǁŚŝůĞ ĨĂĐĞͲƟŵŝŶŐ Ă ĨƌŝĞŶĚ͘ DĞĚŝĐĂů ƐĐŚŽŽůƐ ĂƌĞ ŝŶĐƌĞĂƐŝŶŐůLJ ƌĞůLJŝŶŐ ŽŶ ƚĞĐŚŶŽůŽŐLJ ďĂƐĞĚ ƉůĂƞŽƌŵƐ ĨŽƌ ŬŶŽǁůĞĚŐĞ ĂĐƋƵŝƐŝƟŽŶ͘ dŚĞ hŶŝǀĞƌƐŝƚLJ ŽĨ sĞƌŵŽŶƚ ŵĞĚŝĐĂů ƐĐŚŽŽů ƌĞĐĞŶƚůLJ ĚĞĐŝĚĞĚ ƚŽ ŐŽ ͞ůĞĐƚƵƌĞ ĨƌĞĞ͟ ĐŽŵƉůĞƚĞůLJ͘ dŚŝƐ ƚƌĞŶĚ͕ ĐŽŵďŝŶĞĚ ǁŝƚŚ ŚĂŶĚƐ ŽŶ ŝŶƚĞƌĂĐƟǀĞ ĐĂƐĞͲďĂƐĞĚ ƉƌŽďůĞŵƐ ƚŽ ůĞĂƌŶ ŚŽǁ ƚŽ ĂƉƉůLJ ƚŚĂƚ ŬŶŽǁůĞĚŐĞ͕ ƐĞĞŵƐ ƚŽ ďĞ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ŵĞĚŝĐĂů ƐĐŚŽŽů͘ ZĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ŚĂǀĞ ŝŶĐŽƌƉŽƌĂƚĞĚ ŽŶůŝŶĞ ůĞĂƌŶŝŶŐ ƉůĂƞŽƌŵƐ ĂƐ ǁĞůů͘ &Žƌ ĞdžĂŵƉůĞ͕ ^ƚĂŶĨŽƌĚ hŶŝǀĞƌƐŝƚLJ͛Ɛ ^ƵĐĐĞƐƐĨƵů dƌĂŶƐŝƟŽŶ ƚŽ ŶĞƐƚŚĞƐŝĂ ZĞƐŝĚĞŶĐLJ dƌĂŝŶŝŶŐ ;^d ZdͿ ŝƐ Ă ϭϬͲŵŽŶƚŚ ŽŶůŝŶĞ ĐŽƵƌƐĞ ĮůůĞĚ ǁŝƚŚ ůĞĐƚƵƌĞƐ͕ ǀŝĚĞŽͲƉŽĚĐĂƐƚƐ͕ ŝŶƚĞƌĂĐƟǀĞ ŐƌŽƵƉ ƉƌŽũĞĐƚƐ͕ ǀŝƌƚƵĂů ĐůĂƐƐƌŽŽŵƐ ĂŶĚ ǀŝƌƚƵĂů ŵĞŶƚŽƌŝŶŐ͘ dŚŝƐ ďƌŝŶŐƐ ƵƐ ƚŽ ƉƌĂĐƟĐŝŶŐ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ǁŚĞƌĞ ƚŚĞLJ ůĂŶĚ ŝŶ ƚŚŝƐ ǁŽƌůĚ ŽĨ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ͕ ĂŶĚ ŝƚ ŽƉĞŶƐ ĨŽƌ &W Ă ĐŚĂůůĞŶŐŝŶŐ ĚŝĂůŽŐƵĞ ŽŶ ŚŽǁ ďĞƐƚ ƚŽ ƉƌŽǀŝĚĞ ŵĞĂŶŝŶŐĨƵů ĞĚƵĐĂƟŽŶĂů ĂĐƟǀŝƟĞƐ ƚŽ Ăůů ůĞǀĞůƐ ŽĨ ŵĞŵďĞƌƐŚŝƉ͘ /Ĩ ǁĞ ƚĂŬĞ Ă ƐƚĞƉ ďĂĐŬ͕ ůŽŽŬŝŶŐ Ăƚ ǁŚĂƚ͛Ɛ ŚĂƉƉĞŶŝŶŐ ŝŶ ŐĞŶĞƌĂů ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ͕ ƉĞƌŚĂƉƐ ǁĞ ĐĂŶ ŵĂŬĞ ĐŽƌƌĞůĂƟŽŶƐ ƚŚĂƚ ǁŝůů ŚĞůƉ ŐƵŝĚĞ ƵƐ ĂƐ 26

California Family Physician Fall 2017

ǁĞ ĞŶŐĂŐĞ ǁŝƚŚ ŽƵƌ ƉƌĂĐƟĐŝŶŐ ŵĞŵďĞƌƐ ʹ ƵƐŝŶŐ ƚŚĞ ďĞƐƚ ŽĨ ďŽƚŚ ŽŶůŝŶĞ ĂŶĚ ůŝǀĞ ǁŽƌůĚƐ͊ /Ŷ ƚŚĞ ƉĂƐƚ ĨĞǁ LJĞĂƌƐ͕ ŵŽƌĞ ƐƚƵĚĞŶƚƐ ĞŶƌŽůůĞĚ ŝŶ ŽŶůŝŶĞ ĐŽƵƌƐĞƐ͖ ŵŽƌĞ ŽƌŐĂŶŝnjĂƟŽŶƐ ŽīĞƌĞĚ ĂůƚĞƌŶĂƟǀĞ ĐƌĞĚĞŶƟĂůƐ ƐƵĐŚ ĂƐ ĚŝŐŝƚĂů ďĂĚŐĞƐ ĂŶĚ ŶĂŶŽĚĞŐƌĞĞƐ͖ ĂŶĚ ŵŽƌĞ ĞŵƉůŽLJĞƌƐ ĂĐĐĞƉƚĞĚ ŽŶůŝŶĞ ĚĞŐƌĞĞƐ ĨƌŽŵ ũŽď ĐĂŶĚŝĚĂƚĞƐ͘ 'Ž ŽŶƋƌ͛Ɛ ϮϬϭϳ KŶůŝŶĞ >ĞĂƌŶŝŶŐ ZĞƉŽƌƚ ŝĚĞŶƟĮĞĚ ƚŚƌĞĞ ƚƌĞŶĚƐ ƚŚĂƚ ŚŽůĚ ŝŶƐŝŐŚƚ ĨŽƌ &W ĂƐ ǁĞ ĚŝǀĞ ŝŶƚŽ ƚŚĞ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ ƉŽŽů͗ ŽůůĂďŽƌĂƟǀĞ >ĞĂƌŶŝŶŐ • ϳϵ ƉĞƌĐĞŶƚ ŽĨ ƚŚŽƐĞ ƐƵƌǀĞLJĞĚ ĐŚŽŽƐĞ ŶŽƚ ƚŽ ƐƚƵĚLJ ĐŽůůĂďŽƌĂƟǀĞůLJ ĞǀĞŶ ǁŚĞŶ ƚŚĞLJ ĂƌĞ ŽŶůŝŶĞ͘ • ZĞƐĞĂƌĐŚĞƌƐ ďĞůŝĞǀĞ ƚŚŝƐ ůĂĐŬ ŽĨ ŽŶůŝŶĞ ĐŽůůĂďŽƌĂƟŽŶ ŝƐ Ă ůĞŐĂĐLJ ŽĨ ƚƌĂĚŝƟŽŶĂů ůĞĂƌŶŝŶŐ ŵĞƚŚŽĚŽůŽŐŝĞƐ͘ • ƐƚĞĂĚLJ ŝŶĐƌĞĂƐĞ ŝŶ ŐƌŽƵƉ ĂĐƟǀŝƚLJ ŚĂƐ ŽĐĐƵƌƌĞĚ ƐƵŐŐĞƐƟŶŐ ƚŚĂƚ Ă ͞ĐƵůƚƵƌĂů ƐŚŝŌ ŝƐ ƵŶĚĞƌǁĂLJ ǁŚĞƌĞ ƚŚĞ ƉŽǁĞƌ ŽĨ ƐŽĐŝĂů ŶĞƚǁŽƌŬƐ ĨŽƌ ĞĚƵĐĂƟŽŶ͕ ĂŶĚ ŶŽƚ ũƵƐƚ ĞŶƚĞƌƚĂŝŶŵĞŶƚ͕ ŝƐ ďĞŝŶŐ ƌĞĐŽŐŶŝnjĞĚ͘͟ DŽďŝůĞ >ĞĂƌŶŝŶŐ • ^ƚƵĚŝĞƐ ĮŶĚ ƚŚĞ ŐƌŽǁƚŚ ƌĂƚĞ ĨŽƌ ŵŽďŝůĞ ŝƐ ŶŽƚ ĂƐ ĂĐĐĞůĞƌĂƚĞĚ ĂƐ ƚŚĞ ŐĞŶĞƌĂů ŵŽďŝůĞ ǁĞď ƵƐĂŐĞ ƚƌĞŶĚƐ͘ tŚĞŶ ĐŽŵƉĂƌĞĚ ƚŽ ŐůŽďĂů ŵŽďŝůĞ ƵƐĂŐĞ ƐƚĂƚƐ ŽĨ ϰϱ ƉĞƌĐĞŶƚ ŽĨ Ăůů ǁĞď ƚƌĂĸĐ͕ ŝƚ ďĞĐŽŵĞƐ ĞǀŝĚĞŶƚ ƚŚĂƚ ůĞĂƌŶŝŶŐ ŽŶ ĚĞǀŝĐĞƐ ͞ŝƐ ƐƟůů ŶŽƚ ĂƐ ƉƌĞǀĂůĞŶƚ ĂƐ ŐĞŶĞƌĂů ďƌŽǁƐŝŶŐ͘͟ ͞dŚĞƐĞ ĚĂƚĂ ƐƵŐŐĞƐƚ ƚŚĂƚ ůĞĂƌŶŝŶŐ ŝƐ ůŽǁĞƌ ĚŽǁŶ ƚŚĞ ůŝƐƚ ŽĨ ƉƌŝŽƌŝƟĞƐ ĨŽƌ ƵƐĞƌƐ ŽĨ ŵŽďŝůĞ ĚĞǀŝĐĞƐ͘͟ • WŚŽŶĞ ƵƐĂŐĞ ŝƐ ŝŶĐƌĞĂƐŝŶŐ ǁŝƚŚ Ɛŝdž ǀŝƐŝƚƐ ǀŝĂ Ă ŵŽďŝůĞ ƉŚŽŶĞ ĨŽƌ every one visit via a tablet.

• ŶĚƌŽŝĚ ĚŽŵŝŶĂƚĞƐ ŐůŽďĂůůLJ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϳϬ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ŵŽďŝůĞ ĐŽŶŶĞĐƟŽŶƐ ǀƐ͘ ϲϱ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ŵŽďŝůĞ ĐŽŶŶĞĐƟŽŶƐ ŝŶ ƚŚĞ h^ ǀŝĂ ŝK^͘ • DŽďŝůĞ ƵƐĞƌƐ ƉƌĞĨĞƌ ƚŽ ǀŝĞǁ ĐŽŶƚĞŶƚ ƌĂƚŚĞƌ ƚŚĂŶ ĐƌĞĂƚĞ ŝƚ ǀŝĂ ƚŚĞŝƌ ŵŽďŝůĞ ĚĞǀŝĐĞ͗ ĚĞƐŬƚŽƉ ƵƐĞƌƐ ƐƉĞŶĚ ŽŶ ĂǀĞƌĂŐĞ Ɛŝdž ŵŝŶƵƚĞƐ ĐƌĞĂƟŶŐ Ă ƌĞƐŽƵƌĐĞ͕ ǁŚŝůĞ ŽŶůLJ Ă ƐŵĂůů ƉƌŽƉŽƌƟŽŶ ŽĨ ƚŚŽƐĞ ƐƵƌǀĞLJĞĚ ĐƌĞĂƚĞ ƚŚĞŝƌ ŽǁŶ ĐŽŶƚĞŶƚ͖ ĂŶĚ ǁŚĞŶ ƚŚĞLJ ĚŽ͕ ƚŚĞLJ spend an average of three minutes. >ĞĂƌŶŝŶŐ ĂŶĚ dĞĂĐŚŝŶŐ ^ƚLJůĞƐ • dŚŽƐĞ ƐƵƌǀĞLJĞĚ ƚĞŶĚ ƚŽ ĨĂǀŽƌ ŝŶƚĞƌĂĐƟǀĞ ƌĞƐŽƵƌĐĞƐ ;ŵŝŶĚ ŵĂƉƐ͕ ŇĂƐŚĐĂƌĚƐ ĂŶĚ ƋƵŝnjnjĞƐͿ ŽǀĞƌ ƚƌĂĚŝƟŽŶĂů ŽŶĞƐ ;ŶŽƚĞƐ ĂŶĚ ƐůŝĚĞƐͿ ŝŶ Ă ƌĂƟŽ ŽĨ ĂďŽƵƚ ϴ͗ϭ͘ ŵŽŶŐ ƚŚĞ ĐŽŶƚĞŶƚ ĐƌĞĂƟŽŶ ƚŽŽůƐ ĂǀĂŝůĂďůĞ ƚŽ ůĞĂƌŶĞƌƐ͕ ƚŚĞ ŵŽƐƚ ƉŽƉƵůĂƌ ďLJ Ă ƐŝŐŶŝĮĐĂŶƚ ŵĂƌŐŝŶ ŝƐ ƚŚĞ DŝŶĚ DĂƉ ƚŽŽů͗ Ă ŚŝŐŚůLJ ǀŝƐƵĂů ƐƚƵĚLJ ƚŽŽů ŝŶ ǁŚŝĐŚ Ă ĐĞŶƚƌĂů ŝĚĞĂ Žƌ ƚŚĞŵĞ ŝƐ ĞdžƉůŽƌĞĚ ƚŚƌŽƵŐŚ ŝƚƐ ĐŽŶŶĞĐƟŽŶƐ ǁŝƚŚ Ă ƐĞƌŝĞƐ ŽĨ related ideas or topics.

Excellent Physician Opportunities Enjoy Work - Life Balance in the Gateway to the Sierras

• Short distance to hiking in 2 National Parks • Numerous lakes • Biking, Fishing, Hunting, Golf, as well as other outdoor activities available

• Close to International airport • Excellent schools • Low cost of living • High Quality Medical Care

Now Seeking: Family Medicine Physician • FNP Competitive compensation, signing bonus, annual physician bonus, malpractice coverage.

Ɛ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ ǁŽƌŬƐ ƚŽ ŵĞĞƚ LJŽƵƌ ĞĚƵĐĂƟŽŶĂů ŶĞĞĚƐ͕ ǁĞ ǁŝůů ĞdžƉůŽƌĞ ƚŚĞ ǀŝĂďŝůŝƚLJ ŽĨ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ͕ ůŽŽŬ Ăƚ ǁŚĞƌĞ ŝƚ ŵĂŬĞƐ ƐĞŶƐĞ ĂŶĚ ƐƵƉƉŽƌƚƐ ůĞĂƌŶŝŶŐ ƐƚLJůĞƐ͕ ŵĂƚĐŚ ŝƚ ǁŝƚŚ ƚŚĞ appropriate content and seek your input ĂŶĚ ĨĞĞĚďĂĐŬ͘ tĞ ǁŝůů ƐƚƵĚLJ ƚŚĞ ĨƌƵƐƚƌĂƟŽŶ ĐĂƵƐĞĚ ďLJ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚƐ ;ĨŽƌ ƚŚĞ ŵĞƌƐ͕ ďĞĐĂƵƐĞ ǁĞ ĐĂŶ͛ƚ ĮŐƵƌĞ ƚŚĞŵ ŽƵƚ and for Millennials, because they are not as ƌŽďƵƐƚ ĂƐ ƚŚĞLJ ǁĂŶƚͿ ƐŽ ǁĞ ĚŽŶ͛ƚ ƌĞͲĐƌĞĂƚĞ ƚŚĂƚ environment for your online experiences. Clearly ŽŶĞ ƐŝnjĞ ĚŽĞƐ ŶŽƚ Įƚ Ăůů͕ ďƵƚ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ ĚŽĞƐ ƉƌŽŵŝƐĞ ƚĞƌƌŝĮĐ ŶĞǁ ĞdžƉĞƌŝĞŶĐĞƐ ĨŽƌ ĞĂĐŚ ŽĨ ƵƐ ͙ ĨƌŽŵ ŽŽŵĞƌ ƚŽ 'ĞŶ ͊

Please send CV to CVIH HR: 2740 Herndon Ave., Clovis, CA 93611 or email to hr@cvih.org

Central Valley Indian Health, Inc.

Hiring in accordance with Indian Pref. Act.

Voted one of the “Best Places to Work in LA & Orange County” What’s the value of Facebook, LinkedIn, Snapchat, Instagram, Twitter, etc. for physicians? They may certainly serve a marketing niche and perhaps be a way to disseminate brief facts, but are they going to be education tools and resources? That question has yet to be fully explored or answered.

ŶĚ Ă &ŝŶĂů EŽƚĞ KĨ ĐŽƵƌƐĞ͕ ŽƵƌ ƉĂƟĞŶƚƐ ƐƉĂŶ ƚŚĞ ŐĞŶĞƌĂƟŽŶĂů ƐƉĞĐƚƌƵŵ ĂƐ ǁĞůů ʹ ĂŶĚ ŵĂŶLJ ĞdžƉĞĐƚ ƚŽ ďĞ ĂďůĞ ƚŽ ƐĞŶĚ ƐĞĐƵƌĞ ŵĞƐƐĂŐĞƐ ƚŽ ƚŚĞŝƌ ƉŚLJƐŝĐŝĂŶƐ͕ ƌĞǀŝĞǁ test results online, or schedule a telemedicine ĂƉƉŽŝŶƚŵĞŶƚ ĐŽŵƉůĞƚĞ ǁŝƚŚ ƉŚŽƚŽƐ ŽĨ Ă ƌĂƐŚ͕ for example. They expect technology assisted ĚŝĂŐŶŽƐƟĐ ĂŶĚ ƚŚĞƌĂƉĞƵƟĐ ŽƉƟŽŶƐ ĂŶĚ ĞĂƐLJ ĂĐĐĞƐƐ ƚŽ ŝŶĨŽƌŵĂƟŽŶ͕ ĂŶĚ ƚŚĞLJ ǁĂŶƚ ƚŚĞŝƌ ŚĞĂůƚŚ care team to be not only comfortable, but also ĨĂĐŝůĞ͕ ǁŝƚŚ ƚĞĐŚŶŽůŽŐLJ͘ dŚŝƐ ŝƐ &W͛Ɛ ĐŚĂůůĞŶŐĞ ĂƐ ǁĞůů͘ ^ƚĂLJ ƚƵŶĞĚ͗ LJŽƵ͛ůů ďĞ ŚĞĂƌŝŶŐ ŵƵĐŚ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ƚŽƉŝĐ ŽĨ ĂĚƵůƚ ĞĚƵĐĂƟŽŶ͕ ŝŶĐůƵĚŝŶŐ ĞŶŐĂŐŝŶŐ ŝŶ ƚŚĞ ĞͲǁŽƌůĚ ŽĨ ĞĚƵĐĂƟŽŶ͕ ŽǀĞƌ ƚŚĞ next several months.

ƌ͘ ,ĂǀĞŶƐ ŝƐ ŝƌĞĐƚŽƌ ŽĨ ůŝŶŝĐĂů ĚƵĐĂƟŽŶ for Northern California Kaiser Permanente ĂŶĚ ĐŽͲĐŚĂŝƌ ŽĨ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ͘ DƐ͘ ZŽĚƌŝŐƵĞƐ ŝƐ &W͛Ɛ ĞƉƵƚLJ sW͘

HealthCare Partners has immediate fulltime and part-time opportunities for Family Medicine Physicians throughout Los Angeles and North Orange County.

Ideal candidates will have at least one year of Family Medicine experience. H1B candidates are encouraged to apply.

We offer organizational stability, career growth, excellent compensation and benefits for a truly balanced professional/personal lifestyle.

To see a full list of available positions and to apply online visit us at: www.joindavitamedicalgroup.com or email your CV to: ClinicianApplicants@healthcarepartners.com

California Family Physician Fall 2017

27

Alex Mroszczyk-McDonald, MD

Why You Need to Be on Social Media tŚĂƚ ŝƐ ^ŽĐŝĂů DĞĚŝĂ͕ zŽƵ ƐŬ ͞^ŽĐŝĂů DĞĚŝĂ͟ ŝƐ Ă ďƌŽĂĚ ĂŶĚ ĐŽŶƐƚĂŶƚůLJ ĞǀŽůǀŝŶŐ ƚĞƌŵ͖ ŝƚ ĐĂŶ ŐĞŶĞƌĂůůLJ ďĞ ĚĞĮŶĞĚ ĂƐ ŝŶƚĞƌŶĞƚͲďĂƐĞĚ ƐLJƐƚĞŵƐ ƚŚĂƚ ĂůůŽǁ ŝŶĚŝǀŝĚƵĂůƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ ƚŽ ͞ŐĂƚŚĞƌ͟ ĂŶĚ ĐŽŵŵƵŶŝĐĂƚĞ͘ /Ŷ ďƌŽĂĚ ĐĂƚĞŐŽƌŝĞƐ͕ ƐŽĐŝĂů ŵĞĚŝĂ ĐŽŶƐŝƐƚƐ ŽĨ ƐŽĐŝĂů ŶĞƚǁŽƌŬŝŶŐ ƐŝƚĞƐ͕ ďůŽŐƐ͕ ŵŝĐƌŽďůŽŐƐ͕ ǁŝŬŝƐ͕ ŵĞĚŝĂͲƐŚĂƌŝŶŐ͕ ǀŝƌƚƵĂů ƌĞĂůŝƚLJ ĂŶĚ ŐĂŵŝŶŐ͘ ƵƌƌĞŶƚůLJ͕ ϴϭ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ h^ ĂĚƵůƚ ƉŽƉƵůĂƟŽŶ ŚĂƐ ƐŽŵĞ ŬŝŶĚ ŽĨ Ă ƐŽĐŝĂů ŵĞĚŝĂ ƉƌŽĮůĞ͘ tŽƌůĚǁŝĚĞ͕ ĂŶ ĞƐƟŵĂƚĞĚ Ϯ͘ϱ ďŝůůŝŽŶ ;ŐƌŽǁŝŶŐ ĚĂŝůLJͿ ƉĞŽƉůĞ ĂƌĞ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞƌƐ͘ dŚĞ ĨĂƐƚĞƐƚ ŐƌŽǁŝŶŐ ĚĞŵŽŐƌĂƉŚŝĐ ŝƐ ƉĞŽƉůĞ ĂŐĞƐ ϰϱͲϱϰ͘ dŚĞ ŵŽƐƚ ƉŽƉƵůĂƌ ƐŽĐŝĂů ŵĞĚŝĂ ƐŝƚĞƐ ĂƌĞ &ĂĐĞŬ͕ dǁŝƩĞƌ͕ /ŶƐƚĂŐƌĂŵ͕ zŽƵdƵďĞ ĂŶĚ >ŝŶŬĞĚŝŶ͘ Ͳ,ĞĂůƚŚ ŶǀŝƌŽŶŵĞŶƚ tĞ ůŝǀĞ ŝŶ ĂŶ ŝŶĐƌĞĂƐŝŶŐůLJ ĐŽŶŶĞĐƚĞĚ ĂŶĚ ŝŶƚĞƌŶĞƚͲďĂƐĞĚ ǁŽƌůĚ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ŝƐ ŶŽ ĞdžĐĞƉƟŽŶ͘ ŽĐƚŽƌƐ ůŝǀĞ͕ ƚĞĂĐŚ ĂŶĚ ƉƌĂĐƟĐĞ ŝŶ ĂŶ ͞ Ͳ,ĞĂůƚŚ͟ ǁŽƌůĚ͘ ŽŶŇŝĐƟŶŐ ĚĂƚĂ͕ ŚŽǁĞǀĞƌ͕ ƐĂLJ ĂŶLJǁŚĞƌĞ ĨƌŽŵ ϯϬͲϳϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ŚĂǀĞ ƐĞĂƌĐŚĞĚ ƚŚĞ ŝŶƚĞƌŶĞƚ ĨŽƌ ŵĞĚŝĐĂů ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ŵŽƌĞ ƚŚĂŶ ŚĂůĨ ŽĨ ƚŚŽƐĞ ĚŝƐĐƵƐƐĞĚ ƚŚŝƐ ŝŶĨŽƌŵĂƟŽŶ ǁŝƚŚ ƚŚĞŝƌ ĚŽĐƚŽƌ͘ dŚĞ ƉƵďůŝĐ ĂŶĚ ƉƌŽƐƉĞĐƟǀĞ ƉĂƟĞŶƚƐ ĂƌĞ ďĞĐŽŵŝŶŐ ŵŽƌĞ ƚĞĐŚ ƐĂǀǀLJ ĂŶĚ ǁĂŶƚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ŵĞĚŝĐĂů ĐĂƌĞ Ăƚ ƚŚĞŝƌ ĮŶŐĞƌƟƉƐ͘ DŽƌĞ ƚŚĂŶ Ϯϱ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ǁŝƚŚ ĐŚƌŽŶŝĐ ŵĞĚŝĐĂů ĐŽŶĚŝƟŽŶƐ ŚĂǀĞ ƵƐĞĚ ƐŽĐŝĂů ŵĞĚŝĂ Žƌ ƚŚĞ ŝŶƚĞƌŶĞƚ ƚŽ ĮŶĚ ĂŶĚ ĞŶŐĂŐĞ ŽƚŚĞƌƐ ǁŝƚŚ ƚŚĞ ƐĂŵĞ ŵĞĚŝĐĂů ĐŽŶĚŝƟŽŶƐ͘ ^ĐŝĞŶƟĮĐ ũŽƵƌŶĂůƐ ĂŶĚ ƉƵďůŝĐĂƟŽŶƐ ĂƌĞ ŝŶĐƌĞĂƐŝŶŐůLJ ĚŝƐƚƌŝďƵƟŶŐ ŝŶĨŽƌŵĂƟŽŶ ƵƐŝŶŐ ƐŽĐŝĂů ŵĞĚŝĂ ĂŶĚ ƐŽĐŝĂů ŵĞĚŝĂ ĐŝƚĂƟŽŶƐ ǁŝƚŚŝŶ ĂĐĂĚĞŵŝĐ ŵĞĚŝĐĂů ůŝƚĞƌĂƚƵƌĞ ĂƌĞ ŽŶ ƚŚĞ ƌŝƐĞ͘ ^ŽĐŝĂů ŵĞĚŝĂ ŽĐĐƵƉŝĞƐ Ă ƐƉĂĐĞ͕ Ăƚ ƚŚĞ ŝŶƚĞƌƐĞĐƟŽŶ ŽĨ ŵĞĚŝĐĂů ŝŶĨŽƌŵĂƟĐƐ͕ ƉƵďůŝĐ ŚĞĂůƚŚ ĂŶĚ ďƵƐŝŶĞƐƐ͕ ǁŚĞƌĞ ĂĚĚŝƟŽŶĂůůLJ͕ ƉŚLJƐŝĐŝĂŶƐ ŵƵƐƚ ǁŽƌŬ͘ dŚĞ ĂĚ ^ŽĐŝĂů ŵĞĚŝĂ ŝƐ Ă ƉŽǁĞƌĨƵů ƚŽŽů ĂŶĚ ĂƐ Ă ƌĞƐƵůƚ ŝƐ ĨƌĂƵŐŚƚ ǁŝƚŚ ƉŽƚĞŶƟĂů ƉŝƞĂůůƐ ĂŶĚ ƉƌŽďůĞŵƐ͘ WĞƌŚĂƉƐ ƚŚĞ ďŝŐŐĞƐƚ ĚŽǁŶƐŝĚĞ ŝƐ an individual’s message can be distorted, misinterpreted or even ĐŚĂŶŐĞĚ ŽǀĞƌ ŵƵůƟƉůĞ ŝƚĞƌĂƟŽŶƐ ĂŶĚ ƌĞƉĞĂƚĞĚ ƐŚĂƌŝŶŐ͕ ŵƵĐŚ ůŝŬĞ ƚŚĞ ŐĂŵĞ ŽĨ ͞ƚĞůĞƉŚŽŶĞ͟ ǁĞ ƉůĂLJĞĚ ĂƐ ĐŚŝůĚƌĞŶ͘ hŶůŝŬĞ ƉĞĞƌ ƌĞǀŝĞǁĞĚ ƌĞƐĞĂƌĐŚ͕ ŝŶĨŽƌŵĂƟŽŶ ĐĂŶ ďĞ ŝŶĐŽŵƉůĞƚĞ͕ ŽĨ ƉŽŽƌ ƋƵĂůŝƚLJ͕ ĂŶĞĐĚŽƚĂů͕ ƵŶƌĞĨĞƌĞŶĐĞĚ͕ ďŝĂƐĞĚ Žƌ ƐŝŵƉůLJ ŝŶĂĐĐƵƌĂƚĞ ĂŶĚ͕ ĂƐ ƐƵĐŚ͕ ŝŶĨŽƌŵĂƟŽŶ must be carefully analyzed. Ɛ ƉŚLJƐŝĐŝĂŶƐ͕ ŽƵƌ ƌĞƉƵƚĂƟŽŶƐ ĂƌĞ ĐƌŝƟĐĂů ƚŽ ĂĚĞƋƵĂƚĞůLJ ĐĂƌĞ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƚLJ͘ ĂƌĞůĞƐƐ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞ ĐĂŶ ĐĂƵƐĞ ƐŝŐŶŝĮĐĂŶƚ ĚĂŵĂŐĞ ƚŽ ƉĞƌƐŽŶĂů͕ ƉƌŽĨĞƐƐŝŽŶĂů Žƌ ŝŶƐƟƚƵƟŽŶĂů ƌĞƉƵƚĂƟŽŶ͘ ŶĞŐĂƟǀĞ ĮƌƐƚ ƐŽĐŝĂů ŵĞĚŝĂ ŝŵƉƌĞƐƐŝŽŶ ĐĂŶ ĚŽ ůĂƐƟŶŐ ĚĂŵĂŐĞ͘ ^ŽŵĞ ƐƚƵĚŝĞƐ ŚĂǀĞ ŶŽƚĞĚ ϳϵ ƉĞƌĐĞŶƚ ŽĨ ƉŽƚĞŶƟĂů ĞŵƉůŽLJĞƌƐ search social media accounts of a job applicant. Social media may 28

California Family Physician Fall 2017

ƌĞĚƵĐĞ ƉƌŝǀĂĐLJ ĂŶĚ ŚĂƐ ƚŚĞ ƉŽǁĞƌ ƚŽ ďůƵƌ ƚŚĞ ůŝŶĞƐ ďĞƚǁĞĞŶ ĂŶ ŝŶĚŝǀŝĚƵĂů͛Ɛ ƉĞƌƐŽŶĂů ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂů ůŝǀĞƐ ĂƐ ǁĞůů ĂƐ ƚŚĞ ĚŽĐƚŽƌͲ ƉĂƟĞŶƚ ƌĞůĂƟŽŶƐŚŝƉ͘ /ŶƐƟƚƵƟŽŶĂů ƉƌŝǀĂĐLJ ƌĞŐƵůĂƟŽŶƐ ĂŶĚͬŽƌ ƉĂƟĞŶƚ ƉƌŝǀĂĐLJͬ,/W ĐĂŶ ĞĂƐŝůLJ ďĞ ďƌĞĂĐŚĞĚ ǀŝŽůĂƚĞĚ ďLJ ƉŽŽƌ ƵƐĞ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ ƉůĂƞŽƌŵƐ͘ Lastly, and perhaps most concerning to some physicians, are the ŝƐƐƵĞƐ ŽĨ ůŝĐĞŶƐƵƌĞ ĂŶĚ ůĞŐĂů ůŝĂďŝůŝƚLJ͘ WŚLJƐŝĐŝĂŶƐ ŚĂǀĞ ďĞĞŶ ĮŶĞĚ Žƌ reprimanded by state medical boards for unprofessional behavior or ĐŽŶĚƵĐƚ ŽŶ ƐŽĐŝĂů ŵĞĚŝĂ͘ dŚĞ ĂĐƚ ŽĨ͕ Žƌ ĞǀĞŶ ƉĞƌĐĞƉƟŽŶ ŽĨ͕ ŵĞĚŝĐĂů care or advice through social media opens the door to medical liability. ^ŽĐŝĂů DĞĚŝĂ ŝŶ ,ĞĂůƚŚ ĂƌĞ ĂŶĚ DĞĚŝĐĂů ĚƵĐĂƟŽŶ DŽƌĞ ƚŚĂŶ ϵϬ ƉĞƌĐĞŶƚ ŽĨ ĚŽĐƚŽƌƐ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ŝŶ ƚŚĞŝƌ ƉƌŝǀĂƚĞ ůŝǀĞƐ ĂŶĚ ϲϱ ƉĞƌĐĞŶƚ ƵƐĞ ŝƚ ƉƌŽĨĞƐƐŝŽŶĂůůLJ͘ DĂŶLJ LJŽƵŶŐ ƉŚLJƐŝĐŝĂŶƐ͕ ƵƉ ƚŽ ϴϬ ƉĞƌĐĞŶƚ ŝŶ ƐŽŵĞ ƐƚƵĚŝĞƐ͕ ƌĞƉŽƌƚ ƚŚĞLJ ͞ĚŽ ŶŽƚ ǁŽƌƌLJ͟ Žƌ ͞ǁŽƌƌLJ ǀĞƌLJ ůŝƩůĞ͟ ĂďŽƵƚ ƉƌŝǀĂĐLJ ĂƐ ŝƚ ƉĞƌƚĂŝŶƐ ƚŽ ƚŚĞŝƌ ƵƐĞ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ͘ &ƵƌƚŚĞƌŵŽƌĞ͕ ϱϬ ƉĞƌĐĞŶƚ ƌĞƉŽƌƚ ƚŚĂƚ ĂƌĞ ͞ĂůŵŽƐƚ ĂůǁĂLJƐ ŽŶůŝŶĞ͘͟ ,ŽǁĞǀĞƌ͕ ƚŚĞƌĞ ĂƉƉĞĂƌƐ ƚŽ ďĞ Ă ĚŝƐĐŽŶŶĞĐƚ ʹ ϲϬ ƉĞƌĐĞŶƚ ŽĨ ŵĞĚŝĐĂů ƐĐŚŽŽů ĚĞĂŶƐ ƌĞƉŽƌƚ ƚŚĞLJ ŚĂǀĞ ŚĂĚ ƚŽ ĚĞĂů ǁŝƚŚ ŝŶĐŝĚĞŶƚƐ ŽĨ inappropriate social media use by medical students. Despite this, ǀĞƌLJ ĨĞǁ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ ĂƌĞ ƉƌŽǀŝĚŝŶŐ ĂŶLJ ƐŽĐŝĂů ŵĞĚŝĂ ĞĚƵĐĂƟŽŶ͘ >ĞĨĞďǀƌĞ Ğƚ͘ Ăů ƐƵŵŵĞĚ ŝƚ ƵƉ ǁĞůů͖ ͞DŝůůĞŶŶŝĂů ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ĂƉƉĞĂƌ ƚŽ ŚĂǀĞ Ă ƌĞůĂdžĞĚ ƐƚĂŶĐĞ ƚŽǁĂƌĚ ŝŶƚĞƌƉƌŽĨĞƐƐŝŽŶĂů ĚŝŐŝƚĂů ŶĞƚǁŽƌŬŝŶŐ ĂŶĚ ŵĂLJ ŶŽƚ ƌĞĐŽŐŶŝnjĞ ƚŚĞ ƉŽƚĞŶƟĂů ƌĂŵŝĮĐĂƟŽŶƐ ŽĨ ďůƵƌƌŝŶŐ ƚŚĞŝƌ ŝĚĞŶƟƟĞƐ ŽŶůŝŶĞ͘͟ tŝƚŚŝŶ ƚŚĞ ƐĂŵĞ ƐƚƵĚLJ͕ ĂŌĞƌ Ă ďƌŝĞĨ ƐŽĐŝĂů ŵĞĚŝĂ ĞĚƵĐĂƟŽŶ ŝŶƚĞƌǀĞŶƟŽŶ͕ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĚĞŵŽŶƐƚƌĂƚĞĚ ŝŵƉƌŽǀĞŵĞŶƚ ŝŶ ĚŝŐŝƚĂů ƉƌŽĨĞƐƐŝŽŶĂůŝƐŵ͕ ŬŶŽǁůĞĚŐĞ͕ ĂƫƚƵĚĞƐ ĂŶĚ ƐŽĐŝĂů ŵĞĚŝĂ ƐŬŝůůƐ͘ ^ŝŐŶŝĮĐĂŶƚ ŽƉƉŽƌƚƵŶŝƟĞƐ ƌĞŵĂŝŶ ĨŽƌ ƐŽĐŝĂů ŵĞĚŝĂ ĞĚƵĐĂƟŽŶ ǁŝƚŚŝŶ ŵĞĚŝĐĂů ƐĐŚŽŽů͕ ƉŽƐƚŐƌĂĚƵĂƚĞ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŶĚ ĐŽŶƟŶƵŝŶŐ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ͘ ^ƉĞĐŝĮĐ ĞĚƵĐĂƟŽŶ ƐŚŽƵůĚ ďĞ ĨŽĐƵƐĞĚ ŽŶ ƉĞƌƐŽŶĂů ĂŶĚ ƉĂƟĞŶƚ ƉƌŝǀĂĐLJ͕ ĚŝŐŝƚĂů ƉƌŽĨĞƐƐŝŽŶĂůŝƐŵ ĂƐ ǁĞůů ĂƐ ŬŶŽǁůĞĚŐĞ ŽĨ ĞdžŝƐƟŶŐ ŝŶƐƟƚƵƟŽŶĂů ƐŽĐŝĂů ŵĞĚŝĂů ƉŽůŝĐŝĞƐ͘ dŚĞ 'ŽŽĚ &Žƌ Ăůů ŝƚƐ ƉŽƚĞŶƟĂů ƉŝƞĂůůƐ ĂŶĚ ƉƌŽďůĞŵƐ͕ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞ ŚĂƐ ũƵƐƚ ĂƐ ŵĂŶLJ͕ ŝĨ ŶŽƚ ŵŽƌĞ͕ ƉŽƐŝƟǀĞ ĂƉƉůŝĐĂƟŽŶƐ͘ dŚĞ ƉŽƐŝƟǀĞ ƉŽǁĞƌ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞ ďLJ ƉŚLJƐŝĐŝĂŶƐ ĐĂŶ ďĞ ůĂƌŐĞůLJ ďƌŽŬĞŶ ŝŶƚŽ ĨŽƵƌ ĐĂƚĞŐŽƌŝĞƐ͖ ĞĚƵĐĂƟŽŶ͕ ƉƵďůŝĐ ŚĞĂůƚŚ͕ ĐŽŵŵƵŶŝƚLJ ĂŶĚ ĂĚǀŽĐĂĐLJ ͙ ƉůƵƐ ƵƐĞƐ LJĞƚ ƚŽ be imagined.

DĂŶLJ ƉŚLJƐŝĐŝĂŶƐ ĮŶĚ ǀĂůƵĂďůĞ ƐŽƵƌĐĞƐ ŽĨ ĐŽŶƟŶƵŝŶŐ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŝŵĞĚ Ăƚ Ăůů ƚLJƉĞƐ ŽĨ ƉƌĂĐƟĐĞ Žƌ ƐƉĞĐŝĂůƚLJ ǀŝĂ ǀĂƌŝŽƵƐ ƐŽĐŝĂů ŵĞĚŝĂ ƉůĂƞŽƌŵƐ͘ WŚLJƐŝĐŝĂŶƐ ĂůƐŽ ŚĂǀĞ ĂŵƉůĞ ƐŽĐŝĂů ŵĞĚŝĂ ŽƉƉŽƌƚƵŶŝƟĞƐ ƚŽ ĞŶŚĂŶĐĞ ƚŚĞŝƌ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ĐŽŵŵƵŶŝĐĂƟŽŶ͕ professionalism and medical ethics.

DĂŶLJ ƉŚLJƐŝĐŝĂŶƐ ĂůƐŽ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ƚŽ ĞĚƵĐĂƚĞ ƉĂƟĞŶƚƐ ĂŶĚ ƚŚĞ ƉƵďůŝĐ ďLJ ĚŝƐƚƌŝďƵƟŶŐ ĐƌĞĚŝďůĞ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ Žƌ ĐŽƌƌĞĐƟŶŐ ĐŽŵŵŽŶ ŵŝƐĐŽŶĐĞƉƟŽŶ͘ ^ŽŵĞ ĚŽĐƚŽƌƐ ĂŶĚ ŚĞĂůƚŚ ŐƌŽƵƉƐ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ƚŽ ƌĞĐƌƵŝƚ ƉĂƟĞŶƚƐ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƌĞƐĞĂƌĐŚ͘ ^ŽŵĞ ƉĂƟĞŶƚƐ ƌĞĐĞŝǀĞ ĮŶĂŶĐŝĂů ĂŶĚͬŽƌ ŵŽƌĂů ƐƵƉƉŽƌƚ ǀŝĂ ƐŽĐŝĂů ŵĞĚŝĂ ƉůĂƞŽƌŵƐ ƚŽ ŚĞůƉ ĐŽŶƚƌŽů ƚŚĞŝƌ ĐŚƌŽŶŝĐ ĚŝƐĞĂƐĞ Žƌ ƐĞƚ ŐŽĂůƐ ĂŶĚ ƚƌĂĐŬ ƉƌŽŐƌĞƐƐ ƚŽǁĂƌĚ achieving them. ^ŽĐŝĂů ŵĞĚŝĂ ĐĂŶ ĐƌĞĂƚĞ ǀŝƌƚƵĂů ĐŽŵŵƵŶŝƟĞƐ͕ some designed exclusively for physicians, ƐŽŵĞ ĨŽƌ ƉĂƟĞŶƚƐ ĂŶĚ ŽƚŚĞƌƐ ĨŽƌ ďŽƚŚ͘ DĂŶLJ ĚŽĐƚŽƌƐ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ƚŽ ŶĞƚǁŽƌŬ͕ ĐŽŶŶĞĐƚ ƉƌŽĨĞƐƐŝŽŶĂůůLJ Žƌ ďƵŝůĚ ƚŚĞŝƌ ĐĂƌĞĞƌƐ ǁŝƚŚŝŶ ǀĂƌŝŽƵƐ ƐƉĞĐŝĮĐ ĨŽƌƵŵƐ͘ ^ŽŵĞ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ƚŽ ĐƌŽǁĚƐŽƵƌĐĞ ĚŝĂŐŶŽƐĞƐ Žƌ ĂƐŬ ĨŽƌ ŐƵŝĚĂŶĐĞ ŽŶ ŚŽǁ ƚŽ ŵĂŶĂŐĞ ĐŚĂůůĞŶŐŝŶŐ ŵĞĚŝĐĂů ƉƌŽďůĞŵƐ Žƌ ƐƉĞĐŝĮĐ ĐĂƐĞƐ͘ KƚŚĞƌƐ ŚĂǀĞ ŽďƚĂŝŶĞĚ ĂĐĂĚĞŵŝĐ Žƌ ŝŶƐƟƚƵƟŽŶĂů ĂĚǀĂŶĐĞŵĞŶƚ͕ ĞŵƉůŽLJŵĞŶƚ Žƌ ŽƚŚĞƌ ůĞĂĚĞƌƐŚŝƉ ŽƉƉŽƌƚƵŶŝƟĞƐ ŝŶ ƉĂƌƚ ĚƵĞ ƚŽ their use of social media. ůƚŚŽƵŐŚ ƌĞĚƵĐŝŶŐ ďĂƌƌŝĞƌƐ ŚĂƐ ďĞĞŶ ŵĞŶƟŽŶĞĚ ĂƐ Ă ƉŽƚĞŶƟĂů ĚŽǁŶƐŝĚĞ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞ͕ ďLJ ƚŚĞ ƐĂŵĞ ƚŽŬĞŶ͕ ƵƐĞ ŽīĞƌƐ ŶƵŵĞƌŽƵƐ ďĞŶĞĮƚƐ͘ dŚĞ ĚŝƌĞĐƚ ůŝŶĞ ŽĨ ĐŽŵŵƵŶŝĐĂƟŽŶ ďĞƚǁĞĞŶ ƉƌŽĚƵĐĞƌƐ ŽĨ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ĐŽŶƐƵŵĞƌƐ ŵĞĂŶƐ ŝŶĨŽƌŵĂƟŽŶ ĐĂŶ ďĞ ƋƵŝĐŬůLJ ĂŶĚ ĂĐĐƵƌĂƚĞůLJ ĚŝƐƐĞŵŝŶĂƚĞĚ͕ ŽŌĞŶ ŝŶ ƌĞĂů ƟŵĞ͘ DĂŶLJ ƉŚLJƐŝĐŝĂŶƐ Žƌ ŚĞĂůƚŚ ƐLJƐƚĞŵƐ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ĨŽƌ ŵĂƌŬĞƟŶŐ ĂŶĚͬŽƌ ĐŽŵŵƵŶŝƚLJ ĞŶŐĂŐĞŵĞŶƚ͘ DŽƌĞ ƚŚĂŶ ϳϬ ƉĞƌĐĞŶƚ ŽĨ h^ ŚĞĂůƚŚ ĐĂƌĞ ŽƌŐĂŶŝnjĂƟŽŶƐ ƵƐĞ social media and perhaps more stunning, more ƚŚĂŶ ϴϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ĂƐƐĞƐƐ ƉŽƚĞŶƟĂů physicians via social media prior to their visit. dŚĞ ĚŽĐƚŽƌͲƉĂƟĞŶƚ͕ Žƌ ŚĞĂůƚŚ ƐLJƐƚĞŵͲƉĂƟĞŶƚ ĐŽŶǀĞƌƐĂƟŽŶ ĐĂŶ ďĞŐŝŶ ďĞĨŽƌĞ ĂŶĚ ĞdžƚĞŶĚ ĂŌĞƌ ƚŚĞ ƚLJƉŝĐĂů ŚĞĂůƚŚ ĞŶĐŽƵŶƚĞƌ͘ ŽĐƚŽƌƐ͕ ƉĂƟĞŶƚƐ ĂŶĚ ĨĂŵŝůŝĞƐ ĐĂŶ ƌĞĂĐŚ ĞĂĐŚ ŽƚŚĞƌ ŝŶ ŶĞǁ ĂŶĚ ŝŶŶŽǀĂƟǀĞ ǁĂLJƐ ƚŽ ŚĞůƉ ŝŵƉƌŽǀĞ ƚŚĞ ŚĞĂůƚŚ ŽĨ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ͘ ^ĐŝĞŶƟĮĐ ĐŽŵŵƵŶŝƟĞƐ Žƌ ŐŽǀĞƌŶŵĞŶƚ ŝŶƐƟƚƵƟŽŶƐ ĐĂŶ ƉƵďůŝƐŚ ĂŶĚ distribute research and policy more easily via social media.

ƚŚĞ ŝŶĐŝĚĞŶĐĞ ĂŶĚ ƐĞǀĞƌŝƚLJ ƚŚƌŽƵŐŚŽƵƚ ƚŚĞ ǁŝŶƚĞƌ͘ WŚLJƐŝĐŝĂŶƐ ĐĂŶ ĂůƐŽ ĞdžƉƌĞƐƐ ǀŝĞǁƐ ŽŶ ƉƌŽƉŽƐĞĚ ĐŚĂŶŐĞƐ ƚŽ ŚĞĂůƚŚ ƉŽůŝĐLJ ĂŶĚ ŚŽǁ ƚŚĞLJ ŵĂLJ ĂīĞĐƚ ƉƌĂĐƟĐĞ ĂŶĚ ƉĂƟĞŶƚƐ͘ ^ŽĐŝĂů ŵĞĚŝĂ ĂĚǀŽĐĂĐLJ ĨŽƌ ƉĂƟĞŶƚƐ͕ ĚŽĐƚŽƌƐ ĂŶĚ ĐŽŵŵƵŶŝƚLJ ŚĞĂůƚŚ has rapidly progressed over the past several years. Many physicians ĐŽŶƟŶƵĞĚ ŽŶ ŶĞdžƚ ƉĂŐĞ х

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Set off for a partnership track in Southern California Come and join a well established, multi-specialty medical group of 250+ providers, first established in 1945 with continued growth.

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Many people entrust their most valued possession — their good health — into the hands of our outstanding, committed physicians at Beaver Medical Group. We would like to extend a personal invitation to you to participate in a unique opportunity to combine professional excellence and camaraderie by joining us.

You will love our competitive compensation plan, generous benefit package, vacation time, partnership track after 2 years, professional business account • Sign on bonus • medical insurance for family with Beaver HMO option • Relocation • Life insurance & disability insurance

BMGRecruiting@epiclp.com 909.335.4189

dƌĂĚŝƟŽŶĂů ƉƵďůŝĐ ŚĞĂůƚŚ ĂŶĚ ƉŽůŝĐLJ ĚŝƐĐƵƐƐŝŽŶƐ ĐĂŶ ďĞŶĞĮƚ ĨƌŽŵ ƉŚLJƐŝĐŝĂŶƐ͛ ƉƌĞƐĞŶĐĞ ŽŶ ƐŽĐŝĂů ŵĞĚŝĂ͘ WƵďůŝĐ ŚĞĂůƚŚ ĞŶƟƟĞƐ ĐĂŶ ƋƵŝĐŬůLJ ĚŝƐƐĞŵŝŶĂƚĞ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ŵŽďŝůŝnjĞ ƐĞƌǀŝĐĞƐ during natural disasters or disease outbreaks, for ĞdžĂŵƉůĞ͕ ƚŚĞ ĞŶƚĞƌƐ ŽĨ ŝƐĞĂƐĞ ŽŶƚƌŽů ŽŌĞŶ ƵƐĞƐ ƚǁŝƩĞƌ ƚŽ ƉŽƐƚ ŽŶ ŝŶŇƵĞŶnjĂ ƚŽ ŵĞĂƐƵƌĞ California Family Physician Fall 2017

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Ä&#x201A;ĹśÄ&#x161; Ć&#x2030;Ĺ&#x161;Ç&#x2021;Ć?Ĺ?Ä?Ĺ?Ä&#x201A;Ĺś Ĺ?Ć&#x152;ŽƾĆ&#x2030;Ć? Ĺ&#x161;Ä&#x201A;Ç&#x20AC;Ä&#x17E; ĹľÄ&#x201A;Ä&#x161;Ä&#x17E; Ć?Ĺ?Ĺ?ĹśĹ?ÄŽÄ?Ä&#x201A;ĹśĆ&#x161; Ĺ?ĹľĆ&#x2030;Ä&#x201A;Ä?Ć&#x161; ŽŜ Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ć&#x2030;ŽůĹ?Ä?Ç&#x2021; Ä&#x201A;Ć&#x161; ĹŻĹ˝Ä?Ä&#x201A;ĹŻÍ&#x2022; Ć?Ć&#x161;Ä&#x201A;Ć&#x161;Ä&#x17E; Ä&#x201A;ĹśÄ&#x161; ĹśÄ&#x201A;Ć&#x;ŽŜÄ&#x201A;ĹŻ ĹŻÄ&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĆ? Ç Ĺ?Ć&#x161;Ĺ&#x161; Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ä?Ä&#x201A;ĹľĆ&#x2030;Ä&#x201A;Ĺ?Ĺ?ĹśĆ? Ä&#x201A;Ć? Ä&#x201A; Ć?Ć&#x161;Ć&#x152;Ä&#x201A;Ć&#x161;Ä&#x17E;Ĺ?Ç&#x2021;Í&#x2DC; ^Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ĺ&#x161;Ä&#x201A;Ć? Ć&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E;Ä&#x161; ĹśÄ&#x17E;Ç Ä&#x201A;ĹśÄ&#x161; ƾŜĆ&#x2030;Ć&#x152;Ä&#x17E;Ä?Ä&#x17E;Ä&#x161;Ä&#x17E;ĹśĆ&#x161;Ä&#x17E;Ä&#x161; Ä&#x201A;Ä?Ä?Ä&#x17E;Ć?Ć? Ć&#x161;Ĺ˝ Ä&#x17E;ĹŻÄ&#x17E;Ä?Ć&#x161;Ä&#x17E;Ä&#x161; ŽĸÄ?Ĺ?Ä&#x201A;ĹŻĆ? Ä&#x201A;ĹśÄ&#x161; Ĺ?Ć? Ä&#x201A; Ć&#x2030;Ĺ˝Ç Ä&#x17E;Ć&#x152;Ĩƾů Ć&#x161;ŽŽů ĨŽĆ&#x152; Ä?ŽžžƾŜĹ?Ć&#x161;Ç&#x2021; Ĺ˝Ć&#x152;Ĺ?Ä&#x201A;ĹśĹ?Ç&#x152;Ä&#x17E;Ć&#x152;Ć? Ĺ˝Ć&#x152; Ĺ?Ć&#x152;ŽƾĆ&#x2030;Ć? Ć&#x161;Ĺ˝ Ć?Ç Ä&#x201A;Ç&#x2021; Ć&#x2030;ĆľÄ?ĹŻĹ?Ä? Ĺ˝Ć&#x2030;Ĺ?ĹśĹ?ŽŜ ĨŽĆ&#x152; Ç&#x20AC;Ä&#x201A;Ć&#x152;Ĺ?ŽƾĆ? Ä?Ä&#x201A;ĹŻĹŻĹ˝Ć&#x161; Ĺ?ĹśĹ?Ć&#x;Ä&#x201A;Ć&#x;Ç&#x20AC;Ä&#x17E; Ĺ˝Ć&#x152; Ć&#x2030;ĆľÄ?ĹŻĹ?Ä? opinion. The sky is the limit for social media use.

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ĆľĹ?ĹŻÄ&#x161;Ĺ?ĹśĹ? Ä&#x201A; ^Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ DÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; &Ć&#x152;Ä&#x201A;ĹľÄ&#x17E;Ç Ĺ˝Ć&#x152;ĹŹ /Ĺś Ĺ˝Ć&#x152;Ä&#x161;Ä&#x17E;Ć&#x152; Ć&#x161;Ĺ˝ Ä&#x201A;Ç&#x20AC;Ĺ˝Ĺ?Ä&#x161; ĹľÄ&#x201A;ĹśÇ&#x2021; ŽĨ Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x2030;Ĺ?Ć&#x17E;Ä&#x201A;ĹŻĹŻĆ? ŽĨ Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ç Ĺ&#x161;Ĺ?ĹŻÄ&#x17E; Ĺ&#x161;Ä&#x201A;Ć&#x152;ĹśÄ&#x17E;Ć?Ć?Ĺ?ĹśĹ? Ĺ?Ć&#x161;Ć? Ć&#x2030;Ĺ˝Ç Ä&#x17E;Ć&#x152; Ĺ?Ć&#x161; Ĺ?Ć? Ä?Ć&#x152;Ĺ?Ć&#x;Ä?Ä&#x201A;ĹŻ Ć&#x161;Ĺ˝ Ä?ĆľĹ?ĹŻÄ&#x161; Ä&#x201A; ĨĆ&#x152;Ä&#x201A;ĹľÄ&#x17E;Ç Ĺ˝Ć&#x152;ĹŹ Ĺ˝Ć&#x152; Ĺ?ĆľÄ&#x201A;Ć&#x152;Ä&#x161;Ć&#x152;Ä&#x201A;Ĺ?ĹŻĆ? Ç Ĺ?Ć&#x161;Ĺ&#x161;Ĺ?Ĺś Ç Ĺ&#x161;Ĺ?Ä?Ĺ&#x161; Ć&#x161;Ĺ˝ Ç Ĺ˝Ć&#x152;ĹŹÍ&#x2DC; &Ĺ?Ć&#x152;Ć?Ć&#x161;Í&#x2022; Ä&#x17E;Ć?Ć&#x161;Ä&#x201A;Ä?ĹŻĹ?Ć?Ĺ&#x161; Ä&#x201A;ĹśÄ&#x161; maintain digital professionalism by acquiring Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ć&#x2030;Ć&#x152;ŽĎÄ?Ĺ?Ä&#x17E;ĹśÄ?Ç&#x2021;Í&#x2022; Ä?ĆľĹ?ĹŻÄ&#x161;Ĺ?ĹśĹ? 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Ä&#x201A;ĹśÄ&#x161; Ç&#x2021;Žƾ Ä?Ä&#x201A;Ĺś Ć&#x2030;ĆľĆ&#x152;Ć?ĆľÄ&#x17E; ĹľÄ&#x201A;ĹśÇ&#x2021; ŽĨ Ć&#x161;Ĺ&#x161;Ä&#x17E;Ĺľ Ä&#x201A;Ć&#x161; Ĺ&#x161;ĆŠĆ&#x2030;Í&#x2014;ÍŹÍŹ Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A;Ĺ?Ĺ˝Ç&#x20AC;Ä&#x17E;Ć&#x152;ĹśÄ&#x201A;ĹśÄ?Ä&#x17E;Í&#x2DC;Ä?Žž͏Ć&#x2030;ŽůĹ?Ä?Ĺ?Ä&#x17E;Ć?Í&#x2DC; / Ć&#x152;Ä&#x17E;Ä?ŽžžÄ&#x17E;ĹśÄ&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E; Í&#x17E;ĹśÄ&#x17E;Ç Ć?Ć&#x2030;Ä&#x201A;Ć&#x2030;Ä&#x17E;Ć&#x152; Ć&#x161;Ä&#x17E;Ć?Ć&#x161;Í&#x2022;Í&#x; Ĺ?Ĩ Ç&#x2021;Žƾ Ä&#x161;Ĺ˝ ŜŽĆ&#x161; Ç Ä&#x201A;ĹśĆ&#x161; Ĺ?Ć&#x161; ŽŜ Ć&#x161;Ĺ&#x161;Ä&#x17E; ĨĆ&#x152;ŽŜĆ&#x161; ĹśÄ&#x17E;Ç Ć? ŽĨ Ć&#x161;Ĺ&#x161;Ä&#x17E; ĹśÄ&#x17E;Ç Ć?Ć&#x2030;Ä&#x201A;Ć&#x2030;Ä&#x17E;Ć&#x152; Ć&#x161;ŽžŽĆ&#x152;Ć&#x152;Ĺ˝Ç ĹľĹ˝Ć&#x152;ĹśĹ?ĹśĹ?Í&#x2022; Ć&#x161;Ĺ&#x161;Ä&#x17E;Ĺś do not post it tonight. If you have the Ć?ĹŻĹ?Ĺ?Ĺ&#x161;Ć&#x161;Ä&#x17E;Ć?Ć&#x161; Ĺ&#x161;Ä&#x17E;Ć?Ĺ?Ć&#x161;Ä&#x201A;Ć&#x;ŽŜÍ&#x2022; Ć?Ä&#x201A;Ç&#x20AC;Ä&#x17E; Ä&#x201A; Ä&#x161;Ć&#x152;Ä&#x201A;Ĺ&#x152;Í&#x2022; Ć&#x152;Ä&#x17E;ͲÄ&#x17E;Ç&#x2020;Ä&#x201A;ĹľĹ?ĹśÄ&#x17E; Ĺ?Ć&#x161; Ĺ?ŜώϏ ĹľĹ?ŜƾĆ&#x161;Ä&#x17E;Ć?Í&#x2022; Ć&#x161;Ĺ&#x161;Ä&#x17E;Ĺś Ć&#x152;Ä&#x17E;Ä&#x201A;Ć?Ć?Ä&#x17E;Ć?Ć?Í&#x2DC; &Ĺ?ĹśÄ&#x201A;ĹŻĹŻÇ&#x2021;Í&#x2022; Ä&#x17E;Ä&#x161;ĆľÄ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ç&#x2021;ŽƾĆ&#x152;Ć?Ä&#x17E;ůĨ Ç Ĺ?Ć&#x161;Ĺ&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E; ĨŽƾĆ&#x152; Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ć?Í&#x2014; Ä&#x201A;Ç Ä&#x201A;Ć&#x152;Ä&#x17E;ĹśÄ&#x17E;Ć?Ć?Í&#x2022; Ä&#x201A;ĹŻĹ?Ĺ?ŜžÄ&#x17E;ĹśĆ&#x161;Í&#x2022; Ä&#x201A;Ć?Ć?Ä&#x17E;Ć?Ć?ĹľÄ&#x17E;ĹśĆ&#x161; and accountability. &ŽƾĆ&#x152; ZÄ&#x17E;Ä&#x201A;Ć?ŽŜĆ? Ć&#x161;Ĺ˝ :Ĺ˝Ĺ?Ĺś Ć&#x161;Ĺ&#x161;Ä&#x17E; ^Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ DÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ä&#x201A;ĹśÄ&#x161;Ç Ä&#x201A;Ĺ?ŽŜ ^Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ĺ?Ć? Ä&#x201A;Ĺś Í&#x17E;Ä&#x201A;ĆľĆ&#x161;Ĺ&#x161;Ä&#x17E;ĹśĆ&#x;Ä? Ç&#x20AC;Ĺ˝Ĺ?Ä?Ä&#x17E; ĨŽĆ&#x152; Ć&#x2030;Ä&#x201A;Ć&#x;Ä&#x17E;ĹśĆ&#x161;Ć? and health care professionals, building Ć&#x152;Ä&#x17E;ĹŻÄ&#x201A;Ć&#x;ŽŜĆ?Ĺ&#x161;Ĺ?Ć&#x2030;Ć? Ć&#x161;Ĺ&#x161;Ć&#x152;ŽƾĹ?Ĺ&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x152;Ä&#x17E;Ç&#x20AC;ŽůƾĆ&#x;ŽŜÄ&#x201A;Ć&#x152;Ç&#x2021; Ć&#x2030;Ĺ˝Ç Ä&#x17E;Ć&#x152; ŽĨ Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A;Í&#x2DC;Í&#x; ^Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ĺ?Ć? Ä&#x201A; Ć&#x2030;Ĺ˝Ç Ä&#x17E;Ć&#x152;Ĩƾů Ć&#x161;ŽŽů Ä&#x201A;ĹśÄ&#x161; ŽŜÄ&#x17E; Ć&#x161;Ĺ&#x161;Ä&#x201A;Ć&#x161; Ć?Ĺ&#x161;ŽƾůÄ&#x161; Ä?Ä&#x17E; Ĺ?Ĺś Ć&#x161;Ĺ&#x161;Ä&#x17E; Ç Ĺ&#x161;Ĺ?Ć&#x161;Ä&#x17E; Ä?Ĺ˝Ä&#x201A;Ć&#x161; Ć&#x2030;Ĺ˝Ä?ĹŹÄ&#x17E;Ć&#x161; ŽĨ Ä&#x17E;Ç&#x20AC;Ä&#x17E;Ć&#x152;Ç&#x2021; Ć&#x2030;Ĺ&#x161;Ç&#x2021;Ć?Ĺ?Ä?Ĺ?Ä&#x201A;ĹśÍ&#x2022; Ĺ&#x161;Ĺ˝Ç Ä&#x17E;Ç&#x20AC;Ä&#x17E;Ć&#x152;Í&#x2022; ĹŠĆľĆ?Ć&#x161; ĹŻĹ?ĹŹÄ&#x17E; Ć&#x161;Ĺ&#x161;Ä&#x17E; ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä?Ä&#x201A;Ć&#x;ŽŜĆ? Ç Ä&#x17E; Ć&#x2030;Ć&#x152;Ä&#x17E;Ć?Ä?Ć&#x152;Ĺ?Ä?Ä&#x17E;Í&#x2022; Ĺ?Ć&#x161; žƾĆ?Ć&#x161; Ä?Ä&#x17E; Ć&#x161;Ä&#x201A;ĹŹÄ&#x17E;Ĺś Ĺ?Ĺś Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x152;Ĺ?Ĺ?Ĺ&#x161;Ć&#x161; Ä?ŽŜĆ&#x161;Ä&#x17E;Ç&#x2020;Ć&#x161; Ä&#x201A;Ć&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x152;Ĺ?Ĺ?Ĺ&#x161;Ć&#x161; Ć&#x;ĹľÄ&#x17E; Ä&#x201A;ĹśÄ&#x161; Ä?Ä&#x17E; ĆľĆ?Ä&#x17E;Ä&#x161; Ä?Ç&#x2021; Ä&#x201A; Ć&#x2030;Ĺ&#x161;Ç&#x2021;Ć?Ĺ?Ä?Ĺ?Ä&#x201A;Ĺś Ä&#x201A;Ç Ä&#x201A;Ć&#x152;Ä&#x17E; ŽĨ Ĺ?Ć&#x161;Ć? Ć?Ĺ?Ä&#x161;Ä&#x17E; Ä&#x17E;ÄŤÄ&#x17E;Ä?Ć&#x161;Ć?Í&#x2DC; Ď­Í&#x2DC; DĹ˝Ć?Ć&#x161; Ć&#x2030;Ä&#x201A;Ć&#x;Ä&#x17E;ĹśĆ&#x161;Ć? Ä&#x201A;Ć&#x152;Ä&#x17E; ŽŜ Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ä&#x201A;ĹśÄ&#x161; Ç Ä&#x201A;ĹśĆ&#x161; Ć&#x161;Ĺ˝ Ĺ?ĹśĆ&#x161;Ä&#x17E;Ć&#x152;Ä&#x201A;Ä?Ć&#x161; Ç Ĺ?Ć&#x161;Ĺ&#x161; Ć&#x2030;Ĺ&#x161;Ç&#x2021;Ć?Ĺ?Ä?Ĺ?Ä&#x201A;Ĺś Ç Ĺ&#x161;Ĺ˝ use and understand social media. ĎŽÍ&#x2DC; ^Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ć&#x2030;Ć&#x152;ŽĨÄ&#x17E;Ć?Ć?Ĺ?ŽŜÄ&#x201A;ĹŻ Ä&#x17E;Ä&#x161;ĆľÄ?Ä&#x201A;Ć&#x;ŽŜÍ&#x2022; ĹľÄ&#x201A;Ć&#x152;ĹŹÄ&#x17E;Ć&#x;ĹśĹ?Í&#x2022; ĹśÄ&#x17E;Ć&#x161;Ç Ĺ˝Ć&#x152;ĹŹĹ?ĹśĹ? Ä&#x201A;ĹśÄ&#x161; 30

California Family Physician Fall 2017

BECOME AN INTEGRAL PART OF AN EXCITING YOUNG RESIDENCY PROGRAM!

Faculty, Family Medicine Residency Rancho Mirage, CA

'KUGPJQYGT /GFKECN %GPVGT KP 4CPEJQ /KTCIG %CNKHQTPKC TGEGPVN[ YGNEQOGF KVU Ć&#x201A; HVJ class of residents and has a full 10-year ACGME accreditation. Eisenhower Medical Associates, Inc., a California Professional Corporation, is seeking to enhance its team of employed physicians to serve as Family Medicine Residency faculty members for the Eisenhower Medical Center Residency Program. Options include outpatient-only, inpatient-only, or combined inpatient and outpatient care responsibilities. You may precept family medicine residents in our outpatient center and/or supervise residents on our family medicine inpatient service. You will have protected time for curriculum management, resident advising, and scholarly work. $QCTF EGTVKĆ&#x201A; ECVKQP KP (COKN[ /GFKEKPG KU TGSWKTGF (CEWNV[ CECFGOKE CRRQKPVOGPVU CTG EQPĆ&#x201A; TOGF HTQO C PWODGT QH NQECN WPKXGTUKVKGU DCUGF WRQP GZRGTKGPEG CPF SWCNKĆ&#x201A; ECVKQPU 'KUGPJQYGT /GFKECN #UUQEKCVGU UGGMU ECPFKFCVGU YJQUG GZRGTKGPEG teaching, research, and community service has prepared them to contribute to our commitment to serving the Coachella Valley.

3WCNKĆ&#x201A; GF CRRNKECPVU KPENWFKPI TGEGPV TGUKFGPE[ ITCFWCVGU CTG GPEQWTCIGF VQ apply. Candidates should submit an electronic CV and statement of interest to Anne Montgomery, MD, MBA, Program Director, at amontgomery@emc.org with a copy to tdunn@emc.org.

(QT SWGUVKQPU QT KPSWKT[ RNGCUG EQPVCEV /KEJGNNG *CTFKPI (/ 4GUKFGPE[ 2TQITCO Manager, at mharding@emc.org or 760-773-4504.

emc.org/GME

Social Media Do’s • Identify yourself and speak in the first person • Take responsibility and own your mistakes • Respect copyright • Be yourself • Add value and be accurate • Know your fellow SoMe individuals • Use best judgment • Be professional • Have Fun and learn

ϭ͘ Z͘ ,͘ ůůĂǁĂLJ͕ :͘ ŽƌĂů͕ ͘ dŽƉƉƐ͕ D͘ Topps - Exploring digital professionalism, WĂŐĞƐ ϴϰϰͲϴϰϵ ͮ WƵďůŝƐŚĞĚ ŽŶůŝŶĞ͗ Ϭϭ :ƵŶ ϮϬϭϱ͕ ŚƩƉ͗ͬ​ͬĚdž͘ĚŽŝ͘ŽƌŐͬϭϬ͘ϯϭϬϵͬϬϭϰϮϭϱ ϵy͘ϮϬϭϱ͘ϭϬϰϰϵϱϲ Ϯ͘ >ĞĨĞďǀƌĞ ͕ DĞƐŶĞƌ :͕ ^ƚŽƉLJƌĂ :͕ K͛EĞŝůů :͕ ,ƵƐĂŝŶ /͕ 'ĞĞƌ ͕ 'ĞƌĂŶĐŚĞƌ <͕ ƚŬŝŶƐŽŶ H, Harper E, Huang W, Cline DM, Social DĞĚŝĂ ŝŶ WƌŽĨĞƐƐŝŽŶĂů DĞĚŝĐŝŶĞ͗ EĞǁ ZĞƐŝĚĞŶƚ WĞƌĐĞƉƟŽŶƐ ĂŶĚ WƌĂĐƟĐĞƐ͕ : DĞĚ /ŶƚĞƌŶĞƚ ZĞƐ ϮϬϭϲ͖ϭϴ;ϲͿ͗Ğϭϭϵ͕ hZ>͗ ŚƩƉ͗ͬ​ͬ ǁǁǁ͘ũŵŝƌ͘ŽƌŐͬϮϬϭϲͬϲͬĞϭϭϵ 3. Social Media and Health Care WƌŽĨĞƐƐŝŽŶĂůƐ͗ ĞŶĞĮƚƐ͕ ZŝƐŬƐ͕ ĂŶĚ ĞƐƚ WƌĂĐƟĐĞƐ͕ ͘ >ĞĞ sĞŶƚŽůĂ͕ ƵƚŚŽƌ ŝŶĨŽƌŵĂƟŽŶ͕ ĐŽƉLJƌŝŐŚƚ ĂŶĚ >ŝĐĞŶƐĞ ŝŶĨŽƌŵĂƟŽŶ͕ ŽƉLJƌŝŐŚƚ Ξ ϮϬϭϰ͕ DĞĚŝDĞĚŝĂ h^ ͕ /ŶĐ͘ ϰ͘ W d͘ ϮϬϭϰ :Ƶů͖ ϯϵ;ϳͿ͗ ϰϵϭͲϰϵϵ͕ ϱϮϬ͘ WD / ͗ WD ϰϭϬϯϱϳϲ͕ ^ŽĐŝĂů DĞĚŝĂ ĂŶĚ ,ĞĂůƚŚ ĂƌĞ WƌŽĨĞƐƐŝŽŶĂůƐ͗ ĞŶĞĮƚƐ͕ ZŝƐŬƐ͕ ĂŶĚ ĞƐƚ WƌĂĐƟĐĞƐ͕ ͘ >ĞĞ sĞŶƚŽůĂ ϱ͘ ^ŽĐŝĂů DĞĚŝĂ hƐĞ ŝŶ DĞĚŝĐĂů ĚƵĐĂƟŽŶ͗ ^LJƐƚĞŵĂƟĐ ZĞǀŝĞǁ͕ ŚĞƐƚŽŶ͕ ŚƌŝƐƟŶĞ ͘ D ͖ &ůŝĐŬŝŶŐĞƌ͕ dĂďŽƌ ͘ D ͕ DW,͖ Chisolm, Margaret S. MD ϲ͘ ĐĂĚĞŵŝĐ DĞĚŝĐŝŶĞ͗ :ƵŶĞ ϮϬϭϯ Ͳ sŽůƵŵĞ ϴϴ Ͳ /ƐƐƵĞ ϲ Ͳ Ɖ ϴϵϯʹϵϬϭ͕ ĚŽŝ͗ ϭϬ͘ϭϬϵϳͬ D͘ϬďϬϭϯĞϯϭϴϮϴīĐϮϯ ϳ͘ ƐŽĐŝĂů ŵĞĚŝĂ ƉƌŝŵĞƌ ĨŽƌ ƉƌŽĨĞƐƐŝŽŶĂůƐ͗ digital dos and don’ts., Bernhardt JM, ůďĞƌ :͕ 'ŽůĚ Z^͕ ,ĞĂůƚŚ WƌŽŵŽƚ WƌĂĐƚ͘ ϮϬϭϰ DĂƌ͖ ϭϱ;ϮͿ͗ϭϲϴͲϳϮ͘

ƌ͘ DĐ ŽŶĂůĚ ƉƌĂĐƟĐĞƐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ Ăƚ <ĂŝƐĞƌ WĞƌŵĂŶĞŶƚĞ͕ &ŽŶƚĂŶĂ͘

JOIN OUR TEAM! AVAILABLE PROVIDEROPPORTUNITIES IN FAMILY MEDICINE WHAT WE HAVE TO OFFER: • Salary based on experience • Sign on bonus and relocation assistance • 5 days of CME, $3,000 CME reimbursement and 10 paid holidays • Quarterly bonuses SACRAMENTO based on quality and productivity SAN FRANCISCO YOSEMITE • Cap Exempt and Offering Visa FRESNO Sponsorship • National Health Service Corp Scholar and Loan Recruitment eligible • Organizational HPSA (Health Provider Shortage Area) score of 16 • Many sites within 1 hour of Yosemite National Park, 2 hours from the San Francsico Bay Area, and Monterey • 30 sites located throughout the central valley of California SAN JOAQUIN COUNTY

STANISLAUS COUNTY

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CONTACT ME TO DISCUSS OUR AMAZING OPPORTUNITIES: Joshua Skunca, Director of Provider Recruitment jskunca@gvhc.org | Office: 209.384.6489 | Cell: 209.291.9750

PLEASE VISIT US AT www.gvhc.org

California Family Physician Fall 2017

311

No-see, no-handle needle No reconstitution required No need to dial a dose 1,2

TrulicityÂŽ (dulaglutide) is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.

Limitations of Use: Not recommended as first-line therapy for patients inadequately controlled on diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans. Prescribe only if potential benefits outweigh potential risks. Has not been studied in patients with a history of pancreatitis; consider another antidiabetic therapy. Not for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Not a substitute for insulin. Has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis. Not for patients with pre-existing severe gastrointestinal disease.

Select Important Safety Information WARNING: RISK OF THYROID C-CELL TUMORS In male and female rats, dulaglutide causes a dose-related and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure.

It is unknown whether Trulicity causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of dulaglutide-induced rodent thyroid C-cell tumors has not been determined.

Trulicity is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC with the use of Trulicity and inform them of symptoms of thyroid tumors (eg, mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Trulicity.

Please see Important Safety Information for Trulicity, including Boxed Warning about possible thyroid tumors including thyroid cancer, on following pages and accompanying Brief Summary of Prescribing Information. Please see Instructions for Use included with the pen.

Preparation2 •

Check the pen to be sure it is not expired, damaged, cloudy, discolored, or has particles in it

•

Choose an area for injection (abdomen or thigh), being sure to choose a different site (even within area) each week

The key administration steps

Disposal2

2

•

1

2

3

Uncap the pen

Place and unlock

Press and hold

Dispose of the pen in a closable punctureresistant container and not in household trash

Please review the full Instructions for Use with your patients to ensure they understand how to properly administer Trulicity.

Select Important Safety Information • Trulicity is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia

syndrome type 2, and in patients with a prior serious hypersensitivity reaction to dulaglutide or to any of the product components.

• Cases of medullary thyroid carcinoma (MTC) in patients treated with liraglutide, another GLP-1 RA, have been reported in the postmarketing period; the data

in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 RA use in humans. If serum calcitonin is measured and found to be elevated or thyroid nodules are noted on physical examination or neck imaging, the patient should be further evaluated.

Yes, I think I can do this

*

In a study, 99% of patients reported that overall, the Trulicity Pen was easy or very easy to use3

•

Patients with type 2 diabetes who were naïve to self-injection and injecting others (n=214) participated in a phase 3b, multicenter, open-label, single-arm, outpatient study on the safe and effective use of the Trulicity single-dose pen

•

The primary objective was to achieve a final injection success rate (proportion of patients who successfully complete injection) significantly greater than 80%

•

Patients were trained at baseline on proper self-injection technique with the pen

•

Final injection (4th weekly injection) success was observed in 99.1% [95% CI: 96.6% to 99.7%] (n=209) of patients (primary objective met). Success determined by evaluation of patients’ ability to accurately complete each step in the sequence of drug administration

•

After the final self-injection, patients completed a 12-item ease of use module (secondary endpoint). 209 (99%) out of 210 patients reported that overall, the single dose pen was “easy” or “very easy” to use

To see how Trulicity can help your patients start injectable therapy, visit Trulicity.com/yesican

*Patient will need additional assistance from their healthcare professional as well as to review the full Instructions for Use included with the Trulicity Pen. Please see Important Safety Information for Trulicity, including Boxed Warning about possible thyroid tumors including thyroid cancer, on following pages and accompanying Brief Summary of Prescribing Information.

Please see Instructions for Use included with the pen.

Important Safety Information WARNING: RISK OF THYROID C-CELL TUMORS In male and female rats, dulaglutide causes a dose-related and treatmentduration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure. It is unknown whether Trulicity causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of dulaglutideinduced rodent thyroid C-cell tumors has not been determined.

Severe Gastrointestinal Disease: Use of Trulicity may be associated with gastrointestinal adverse reactions, sometimes severe. Trulicity has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis, and is therefore not recommended in these patients.

Trulicity is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC with use of Trulicity and inform them of symptoms of thyroid tumors (eg, mass in the neck, dysphagia, dyspnea, persistent hoarseness).

Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Trulicity.

The most common adverse reactions (excluding hypoglycemia) reported in ≥5% of Trulicity-treated patients in placebo-controlled trials (placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg) were nausea (5.3%,12.4%, 21.1%), diarrhea (6.7%, 8.9%,12.6%), vomiting (2.3%, 6.0%,12.7%), abdominal pain (4.9%, 6.5%, 9.4%), decreased appetite (1.6%, 4.9%, 8.6%), dyspepsia (2.3%, 4.1%, 5.8%), and fatigue (2.6%, 4.2%, 5.6%).

Trulicity is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2, and in patients with a prior serious hypersensitivity reaction to dulaglutide or any of the product components.

Risk of Thyroid C-cell Tumors: Cases of MTC in patients treated with liraglutide, another GLP-1 receptor agonist (GLP-1 RA), have been reported in the postmarketing period; the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 RA use in humans. If serum calcitonin is measured and found to be elevated or thyroid nodules are noted on physical examination or neck imaging, the patient should be further evaluated.

Pancreatitis: Has been reported in clinical trials. Observe patients for signs and symptoms including persistent severe abdominal pain. If pancreatitis is suspected, discontinue Trulicity promptly. Do not restart if pancreatitis is confirmed. Consider other antidiabetic therapies in patients with a history of pancreatitis.

Hypoglycemia: The risk of hypoglycemia is increased when Trulicity is used in combination with insulin secretagogues (eg, sulfonylureas) or insulin. Patients may require a lower dose of the sulfonylurea or insulin to reduce the risk of hypoglycemia.

Hypersensitivity Reactions: There have been postmarketing reports of serious hypersensitivity reactions (eg, anaphylactic reactions and angioedema) in patients treated with Trulicity. Instruct patients who experience symptoms to discontinue Trulicity and promptly seek medical advice. Use caution in a patient with a history of angioedema or anaphylaxis with another GLP-1 receptor agonist as it is unknown whether they will be predisposed to anaphylaxis with Trulicity.

Renal Impairment: In patients treated with GLP-1 RAs, there have been postmarketing reports of acute renal failure and worsening of chronic renal failure, sometimes requiring hemodialysis. A majority of reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration.

In patients with renal impairment, use caution when initiating or escalating doses of Trulicity and monitor renal function in patients experiencing severe adverse gastrointestinal reactions.

PP-DG-US-1091

09/2017

Macrovascular Outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Trulicity.

Gastric emptying is slowed by Trulicity, which may impact absorption of concomitantly administered oral medications. Use caution when oral medications are used with Trulicity. Drug levels of oral medications with a narrow therapeutic index should be adequately monitored when concomitantly administered with Trulicity. In clinical pharmacology studies, Trulicity did not affect the absorption of the tested, orally administered medications to a clinically relevant degree.

Pregnancy: Limited data with Trulicity in pregnant women are not sufficient to determine a drug-associated risk for major birth defects and miscarriage. Based on animal reproduction studies, there may be risks to the fetus from exposure to dulaglutide. Use only if potential benefit justifies the potential risk to the fetus.

Lactation: There are no data on the presence of dulaglutide in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Trulicity and any potential adverse effects on the breastfed infant from Trulicity or from the underlying maternal condition.

Pediatric Use: Safety and effectiveness of Trulicity have not been established and use is not recommended in patients less than 18 years of age.

Please see Brief Summary of Prescribing Information, including Boxed Warning about possible thyroid tumors including thyroid cancer, on following pages.

Please see Instructions for Use included with the pen.

DG HCP ISI 06FEB2017 Trulicity® is a registered trademark owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates.

Trulicity is available by prescription only.

Other product/company names mentioned herein are the trademarks of their respective owners.

References 1. Trulicity [Instructions for Use]. Indianapolis, IN: Lilly USA, LLC. 2. Trulicity [Prescribing Information]. Indianapolis, IN: Lilly USA, LLC. 3. Matfin G, Van Brunt K, Zimmermann AG, et al. Safe and effective use of the once weekly dulaglutide single-dose pen in injection-naïve patients with type 2 diabetes. J Diabetes Sci Technol.

2015;9(5):1071-1079.

©Lilly USA, LLC 2017. All rights reserved.

Trulicity® (dulaglutide) Brief Summary: Consult the package insert for complete prescribing information.

WARNING: RISK OF THYROID C-CELL TUMORS • In male and female rats, dulaglutide causes a dose-related and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure. It is unknown whether Trulicity causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of dulaglutide-induced rodent thyroid C-cell tumors has not been determined.

• Trulicity is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Counsel patients regarding the potential risk of MTC with use of Trulicity and inform them of symptoms of thyroid tumors (eg, mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Trulicity.

Trulicity and other suspected medications and promptly seek medical advice. Use caution in a patient with a history of angioedema or anaphylaxis with another GLP-1 receptor agonist because it is unknown whether such patients will be predisposed to anaphylaxis with Trulicity. Renal Impairment: In patients treated with GLP-1 receptor agonists, there have been postmarketing reports of acute renal failure and worsening of chronic renal failure, which may sometimes require hemodialysis. Some of these events were reported in patients without known underlying renal disease. A majority of reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. Because these reactions may worsen renal failure, use caution when initiating or escalating doses of Trulicity in patients with renal impairment. Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions. Severe Gastrointestinal Disease: Use of Trulicity may be associated with gastrointestinal adverse reactions, sometimes severe. Trulicity has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis, and is therefore not recommended in these patients. Macrovascular Outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Trulicity.

ADVERSE REACTIONS

Risk of Thyroid C-cell Tumors: In male and female rats, dulaglutide causes a dose-related and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure. Glucagon-like peptide (GLP-1) receptor agonists have induced thyroid C-cell adenomas and carcinomas in mice and rats at clinically relevant exposures. It is unknown whether Trulicity will cause thyroid C-cell tumors, including MTC, in humans, as the human relevance of dulaglutide-induced rodent thyroid C-cell tumors has not been determined. One case of MTC was reported in a patient treated with Trulicity. This patient had pretreatment calcitonin levels approximately 8 times the upper limit of normal (ULN). Cases of MTC in patients treated with liraglutide, another GLP-1 receptor agonist, have been reported in the postmarketing period; the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 receptor agonist use in humans. Trulicity is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2. Counsel patients regarding the potential risk for MTC with the use of Trulicity and inform them of symptoms of thyroid tumors (eg, a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Trulicity. Such monitoring may increase the risk of unnecessary procedures, due to the low test specificity for serum calcitonin and a high background incidence of thyroid disease. Significantly elevated serum calcitonin value may indicate MTC and patients with MTC usually have calcitonin values >50 ng/L. If serum calcitonin is measured and found to be elevated, the patient should be further evaluated. Patients with thyroid nodules noted on physical examination or neck imaging should also be further evaluated. Pancreatitis: In Phase 2 and Phase 3 clinical studies, 12 (3.4 cases per 1000 patient years) pancreatitis-related adverse reactions were reported in patients exposed to Trulicity versus 3 in non-incretin comparators (2.7 cases per 1000 patient years). An analysis of adjudicated events revealed 5 cases of confirmed pancreatitis in patients exposed to Trulicity (1.4 cases per 1000 patient years) versus 1 case in non-incretin comparators (0.88 cases per 1000 patient years). After initiation of Trulicity, observe patients carefully for signs and symptoms of pancreatitis, including persistent severe abdominal pain. If pancreatitis is suspected, promptly discontinue Trulicity. If pancreatitis is confirmed, Trulicity should not be restarted. Trulicity has not been evaluated in patients with a prior history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin: The risk of hypoglycemia is increased when Trulicity is used in combination with insulin secretagogues (eg, sulfonylureas) or insulin. Patients may require a lower dose of sulfonylurea or insulin to reduce the risk of hypoglycemia in this setting. Hypersensitivity Reactions: There have been postmarketing reports of serious hypersensitivity reactions (e.g., anaphylactic reactions and angioedema) in patients treated with Trulicity. If a hypersensitivity reaction occurs, the patient should discontinue

Clinical Studies Experience: Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice. Pool of Placebo-controlled Trials: These data reflect exposure of 1670 patients to Trulicity and a mean duration of exposure to Trulicity of 23.8 weeks. Across the treatment arms, the mean age of patients was 56 years, 1% were 75 years or older and 53% were male. The population in these studies was 69% White, 7% Black or African American, 13% Asian; 30% were of Hispanic or Latino ethnicity. At baseline, the population had diabetes for an average of 8.0 years and had a mean HbA1c of 8.0%. At baseline, 2.5% of the population reported retinopathy. Baseline estimated renal function was normal or mildly impaired (eGFR ≥60mL/min/1.73 m2) in 96.0% of the pooled study populations.

Adverse Reactions in Placebo-Controlled Trials Reported in ≥5% of Trulicity-Treated Patients: Placebo (N=568), Trulicity 0.75mg (N=836), Trulicity 1.5 mg (N=834) (listed as placebo, 0.75 mg, 1.5 mg): nausea (5.3%, 12.4%, 21.1%), diarrheaa (6.7%, 8.9%, 12.6%), vomitingb (2.3%, 6.0%, 12.7%), abdominal painc (4.9%, 6.5%, 9.4%), decreased appetite (1.6%, 4.9%, 8.6%), dyspepsia (2.3%, 4.1%, 5.8%), fatigued (2.6%, 4.2%, 5.6%). (a Includes diarrhea, fecal volume increased, frequent bowel movements. b Includes retching, vomiting, vomiting projectile. c Includes abdominal discomfort, abdominal pain, abdominal pain lower, abdominal pain upper, abdominal tenderness, gastrointestinal pain. d Includes fatigue, asthenia, malaise.) Note: Percentages reflect the number of patients that reported at least 1 treatment-emergent occurrence of the adverse reaction. Gastrointestinal Adverse Reactions: In the pool of placebo-controlled trials, gastrointestinal adverse reactions occurred more frequently among patients receiving Trulicity than placebo (placebo 21.3%, 0.75 mg 31.6%, 1.5 mg 41.0%). More patients receiving Trulicity 0.75 mg (1.3%) and Trulicity 1.5 mg (3.5%) discontinued treatment due to gastrointestinal adverse reactions than patients receiving placebo (0.2%). Investigators graded the severity of gastrointestinal adverse reactions occurring on 0.75 mg and 1.5 mg of Trulicity as “mild” in 58% and 48% of cases, respectively, “moderate” in 35% and 42% of cases, respectively, or “severe” in 7% and 11% of cases, respectively. In addition to the adverse reactions ≥5% listed above, the following adverse reactions were reported more frequently in Trulicity-treated patients than placebo (frequencies listed, respectively, as: placebo; 0.75 mg; 1.5 mg): constipation (0.7%; 3.9%; 3.7%), flatulence (1.4%; 1.4%; 3.4%), abdominal distension (0.7%; 2.9%; 2.3%), gastroesophageal reflux disease (0.5%; 1.7%; 2.0%), and eructation (0.2%; 0.6%; 1.6%). Pool of Placebo- and Active-Controlled Trials: The occurrence of adverse reactions was also evaluated in a larger pool of patients with type 2 diabetes participating in 6 placebo- and active-controlled trials evaluating the use of Trulicity as monotherapy and add-on therapy to oral medications or insulin. In this pool, a total of 3342 patients with type 2 diabetes were treated with Trulicity for a mean duration 52 weeks. The mean age of patients was 56 years, 2% were 75 years or older and 51% were male. The population in these studies was 71% White, 7% Black or African American, 11% Asian; 32% were of Hispanic or Latino ethnicity. At baseline, the population had diabetes for an average of 8.2 years and had a mean HbA1c of 7.6-8.5%. At baseline, 5.2% of the population reported retinopathy. Baseline estimated renal function was normal or mildly impaired (eGFR ≥60 ml/min/1.73 m2) in 95.7% of the Trulicity population. In the pool of placebo- and active-controlled trials, the types and frequency of common adverse reactions, excluding hypoglycemia, were similar to those listed as ≥5% above. Other Adverse Reactions: Hypoglycemia: Incidence (%) of Documented Symptomatic (≤70 mg/dL Glucose Threshold) and Severe Hypoglycemia in Placebo-Controlled Trials: Add-on to Metformin at 26 weeks, Placebo (N=177), Trulicity 0.75 mg (N=302), Trulicity 1.5 mg (N=304), Documented symptomatic: Placebo: 1.1%, 0.75 mg: 2.6%, 1.5 mg: 5.6%; Severe: all 0. Add-on to Metformin + Pioglitazone at 26 weeks, Placebo (N=141), Trulicity 0.75 mg (N=280), Trulicity 1.5 mg (N=279), Documented symptomatic: Placebo: 1.4%, 0.75 mg: 4.6%, 1.5 mg: 5.0%; Severe: all 0. Add-on to Glimepiride at 24 weeks, Placebo (N=60), Trulicity 1.5 mg (N=239), Documented symptomatic: Placebo: 1.7%, 1.5 mg: 11.3%; Severe: all 0. Add-on to Insulin Glargine with or without Metformin at 28 weeks, Placebo (N=150), Trulicity 1.5 mg (N=150), Documented symptomatic: Placebo: 30.0% 1.5 mg: 35.3%; Severe: Placebo: 0% 1.5 mg: 0.7%. Hypoglycemia was more frequent when Trulicity was used in combination with a sulfonylurea or insulin. In a 78-week clinical trial documented symptomatic hypoglycemia occurred in 39% and 40% of patients when Trulicity 0.75 mg and 1.5 mg, respectively, was co-administered with a sulfonylurea. Severe hypoglycemia occurred in 0% and 0.7% of patients when Trulicity 0.75 mg and 1.5 mg, respectively, was co-administered with a sulfonylurea. Documented

Trulicity® (dulaglutide)

Trulicity® (dulaglutide)

INDICATIONS AND USAGE Trulicity® is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Limitations of Use: Not recommended as a first-line therapy for patients who have inadequate glycemic control on diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans. Prescribe Trulicity only to patients for whom the potential benefits outweigh the potential risk. Has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. It is not a substitute for insulin. Has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis. Not recommended in patients with pre-existing severe gastrointestinal disease.

CONTRAINDICATIONS Do not use in patients with a personal or family history of MTC or in patients with MEN 2.

Do not use in patients with a prior serious hypersensitivity reaction to dulaglutide or to any of the product components.

WARNINGS AND PRECAUTIONS

DG HCP BS 10FEB2017 7 x 9.5

DG HCP BS 10FEB2017 7 x 9.5

symptomatic hypoglycemia occurred in 85% and 80% of patients when Trulicity 0.75 mg and 1.5 mg, respectively, was co-administered with prandial insulin. Severe hypoglycemia occurred in 2.4% and 3.4% of patients when Trulicity 0.75 mg, and 1.5 mg, respectively, was co-administered with prandial insulin. Heart Rate Increase and Tachycardia Related Adverse Reactions: Trulicity 0.75 mg and 1.5 mg resulted in a mean increase in heart rate (HR) of 2-4 beats per minute (bpm). The long-term clinical effects of the increase in HR have not been established. Adverse reactions of sinus tachycardia were reported more frequently in patients exposed to Trulicity. Sinus tachycardia was reported in 3.0%, 2.8%, and 5.6% of patients treated with placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg, respectively.

Persistence of sinus tachycardia (reported at more than 2 visits) was reported in 0.2%, 0.4%, and 1.6% of patients treated with placebo, Trulicity 0.75 mg and Trulicity 1.5 mg, respectively. Episodes of sinus tachycardia, associated with a concomitant increase from baseline in heart rate of ≥15 beats per minute, were reported in 0.7%, 1.3%, and 2.2% of patients treated with placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg, respectively.

Immunogenicity: Across four Phase 2 and five Phase 3 clinical studies, 64 (1.6%) Trulicitytreated patients developed anti-drug antibodies (ADAs) to the active ingredient in Trulicity (ie, dulaglutide). Of the 64 dulaglutide-treated patients that developed dulaglutide ADAs, 34 patients (0.9% of the overall population) had dulaglutide-neutralizing antibodies, and 36 patients (0.9% of the overall population) developed antibodies against native GLP-1.

The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, the incidence of antibodies to dulaglutide cannot be directly compared with the incidence of antibodies of other products. Hypersensitivity: Systemic hypersensitivity adverse reactions sometimes severe (eg, severe urticaria, systemic rash, facial edema, lip swelling) occurred in 0.5% of patients on Trulicity in the four Phase 2 and Phase 3 studies. Injection-site Reactions: In the placebo-controlled studies, injection-site reactions (eg, injection-site rash, erythema) were reported in 0.5% of Trulicity-treated patients and in 0.0% of placebo-treated patients. PR Interval Prolongation and Adverse Reactions of First Degree Atrioventricular (AV) Block: A mean increase from baseline in PR interval of 2-3 milliseconds was observed in Trulicity-treated patients in contrast to a mean decrease of 0.9 millisecond in placebo-treated patients. The adverse reaction of first degree AV block occurred more frequently in patients treated with Trulicity than placebo (0.9%, 1.7%, and 2.3% for placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg, respectively). On electrocardiograms, a PR interval increase to at least 220 milliseconds was observed in 0.7%, 2.5%, and 3.2% of patients treated with placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg, respectively. Amylase and Lipase Increase: Patients exposed to Trulicity had mean increases from baseline in lipase and/or pancreatic amylase of 14% to 20%, while placebotreated patients had mean increases of up to 3%. Postmarketing Experience: Anaphylactic reactions have been reported during post-approval use of Trulicity. 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.

DRUG INTERACTIONS Trulicity slows gastric emptying and thus has the potential to reduce the rate of absorption of concomitantly administered oral medications. Caution should be exercised when oral medications are concomitantly administered with Trulicity. Drug levels of oral medications with a narrow therapeutic index should be adequately monitored when concomitantly administered with Trulicity. In clinical pharmacology studies, Trulicity did not affect the absorption of the tested, orally administered medications to any clinically relevant degree.

USE IN SPECIFIC POPULATIONS Pregnancy: Risk Summary Limited data with Trulicity in pregnant women are not sufficient to determine a drug associated risk for major birth defects and miscarriage. Based on animal reproduction studies, there may be risks to the fetus from exposure to dulaglutide during pregnancy. Trulicity should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. In pregnant rats administered dulaglutide during organogenesis, early embryonic deaths, fetal growth reductions, and fetal abnormalities occurred at systemic exposures at least 14-times human exposure at the maximum recommended human dose (MRHD) of 1.5 mg/week. In pregnant rabbits administered dulaglutide during organogenesis, major fetal abnormalities occurred at 13-times human exposure at the MRHD. Adverse embryo/fetal effects in animals occurred in association with decreased maternal weight and food consumption attributed to the pharmacology of dulaglutide.

Lactation: Risk Summary There are no data on the presence of dulaglutide in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Trulicity and any potential adverse effects on the breastfed infant from Trulicity or from the underlying maternal condition. Pediatric Use: Safety and effectiveness of Trulicity have not been established in pediatric patients. Trulicity is not recommended for use in pediatric patients younger than 18 years. Geriatric Use: In the pool of placebo- and active-controlled trials, 620 (18.6%) Trulicity-treated patients were 65 years of age and over and 65 Trulicity-treated patients (1.9%) were 75 years of age and over. No overall differences in safety or efficacy were detected between these patients and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Hepatic Impairment: There is limited clinical experience in patients with mild, moderate, or severe hepatic impairment. Therefore, Trulicity should be used with caution in these patient populations. In a clinical pharmacology study in subjects with Trulicity® (dulaglutide)

DG HCP BS 10FEB2017 7 x 9.5

varying degrees of hepatic impairment, no clinically relevant change in dulaglutide pharmacokinetics (PK) was observed. Renal Impairment: In the four Phase 2 and five Phase 3 randomized clinical studies, at baseline, 50 (1.2%) Trulicity-treated patients had mild renal impairment (eGFR ≥60 but <90 mL/min/1.73 m2), 171 (4.3%) Trulicity-treated patients had moderate renal impairment (eGFR ≥30 but <60 mL/min/1.73 m2) and no Trulicity-treated patients had severe renal impairment (eGFR <30 mL/min/1.73 m2).

No overall differences in safety or effectiveness were observed relative to patients with normal renal function, though conclusions are limited due to small numbers. In a clinical pharmacology study in subjects with renal impairment including end-stage renal disease (ESRD), no clinically relevant change in dulaglutide PK was observed. There is limited clinical experience in patients with severe renal impairment or ESRD. Trulicity should be used with caution, and if these patients experience adverse gastrointestinal side effects, renal function should be closely monitored. Gastroparesis: Dulaglutide slows gastric emptying. Trulicity has not been studied in patients with pre-existing gastroparesis.

OVERDOSAGE Overdoses have been reported in clinical studies. Effects associated with these overdoses were primarily mild or moderate gastrointestinal events (eg, nausea, vomiting) and non-severe hypoglycemia. In the event of overdose, appropriate supportive care (including frequent plasma glucose monitoring) should be initiated according to the patient’s clinical signs and symptoms.

PATIENT COUNSELING INFORMATION See FDA-approved Medication Guide • Inform patients that Trulicity causes benign and malignant thyroid C-cell tumors in rats and that the human relevance of this finding has not been determined. Counsel patients to report symptoms of thyroid tumors (eg, a lump in the neck, persistent hoarseness, dysphagia, or dyspnea) to their physician. • Inform patients that persistent severe abdominal pain, that may radiate to the back and which may (or may not) be accompanied by vomiting, is the hallmark symptom of acute pancreatitis. Instruct patients to discontinue Trulicity promptly, and to contact their physician, if persistent severe abdominal pain occurs.

• The risk of hypoglycemia may be increased when Trulicity is used in combination with a medicine that can cause hypoglycemia, such as a sulfonylurea or insulin. Review and reinforce instructions for hypoglycemia management when initiating Trulicity therapy, particularly when concomitantly administered with a sulfonylurea or insulin. • Patients treated with Trulicity should be advised of the potential risk of dehydration due to gastrointestinal adverse reactions and take precautions to avoid fluid depletion. Inform patients treated with Trulicity of the potential risk for worsening renal function and explain the associated signs and symptoms of renal impairment, as well as the possibility of dialysis as a medical intervention if renal failure occurs. • Inform patients that serious hypersensitivity reactions have been reported during postmarketing use of Trulicity and other GLP-1 receptor agonists. If symptoms of hypersensitivity reactions occur, patients must stop taking Trulicity and seek medical advice promptly. • Advise patients to inform their healthcare provider if they are pregnant or intend to become pregnant. • Prior to initiation of Trulicity, train patients on proper injection technique to ensure a full dose is delivered. Refer to the accompanying Instructions for Use for complete administration instructions with illustrations. • Inform patients of the potential risks and benefits of Trulicity and of alternative modes of therapy. Inform patients about the importance of adherence to dietary instructions, regular physical activity, periodic blood glucose monitoring and HbA1c testing, recognition and management of hypoglycemia and hyperglycemia, and assessment for diabetes complications. During periods of stress such as fever, trauma, infection, or surgery, medication requirements may change and advise patients to seek medical advice promptly. • Each weekly dose of Trulicity can be administered at any time of day, with or without food. The day of once-weekly administration can be changed if necessary, as long as the last dose was administered 3 or more days before. If a dose is missed and there are at least 3 days (72 hours) until the next scheduled dose, it should be administered as soon as possible. Thereafter, patients can resume their usual once-weekly dosing schedule. If a dose is missed and the next regularly scheduled dose is due in 1 or 2 days, the patient should not administer the missed dose and instead resume Trulicity with the next regularly scheduled dose. • Advise patients treated with Trulicity of the potential risk of gastrointestinal side effects. • Instruct patients to read the Medication Guide and the Instructions for Use before starting Trulicity therapy and review them each time the prescription is refilled. • Instruct patients to inform their doctor or pharmacist if they develop any unusual symptom, or if any known symptom persists or worsens. • Inform patients that response to all diabetic therapies should be monitored by periodic measurements of blood glucose and HbA1c levels, with a goal of decreasing these levels towards the normal range.

HbA1c is especially useful for evaluating long-term glycemic control.

Eli Lilly and Company, Indianapolis, IN 46285, USA US License Number 1891 Copyright © 2014, 2015, Eli Lilly and Company. All rights reserved.

Additional information can be found at www.trulicity.com DG HCP BS 10FEB2017 Trulicity® (dulaglutide)

DG HCP BS 10FEB2017 7 x 9.5

evp forum

Susan Hogeland, CAE

What Does the Future Hold for ACA? The theme of this issue of California Family Physician is the ĐLJďĞƌ ǁŽƌůĚ ŽĨ ŵĞĚŝĐŝŶĞ͕ ďƵƚ /͛ŵ ŶŽƚ ŐŽŝŶŐ ƚŽ ǁƌŝƚĞ ĂďŽƵƚ ƚŚĂƚ͘ KƚŚĞƌƐ ŵƵĐŚ ŵŽƌĞ ŬŶŽǁůĞĚŐĞĂďůĞ ĂďŽƵƚ ƚŚĞ ƚŽƉŝĐ ǁŝůů ŚĂŶĚůĞ ŝƚ ǀĞƌLJ ǁĞůů͘ dŚĞ ďƵƌŶŝŶŐ ƉůĂƞŽƌŵ ŝƐƐƵĞ ƚŽĚĂLJ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ͕ ŝŶĚĞĞĚ͕ ĨŽƌ ƚŚĞ ĐŽƵŶƚƌLJ͕ ŝƐ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ͘ /ƚ ŝƐ ŵLJ ƐƚƌŽŶŐ ŚŽƉĞ ŝƚ ƐƵƌǀŝǀĞƐ ůŽŶŐ ĞŶŽƵŐŚ ĨŽƌ ƚŚŝƐ ĂƌƟĐůĞ ƚŽ ĂƉƉĞĂƌ ŝŶ ƉƌŝŶƚ ďĞĐĂƵƐĞ͕ ĂƐ ǁĂƐ ƚŚĞ ĐĂƐĞ ǁŝƚŚ DĞĚŝĐĂƌĞ ŝŶ ƚŚĞ ƉĂƐƚ͕ ƚŚĞ ƉƵďůŝĐ ŽŶůLJ ƌĞĂůŝnjĞƐ ŝƚ ůŽǀĞƐ ƐŽŵĞƚŚŝŶŐ ǁŚĞŶ Ă ƚŚƌĞĂƚ ůŽŽŵƐ ƚŽ ƚĂŬĞ ŝƚ ĂǁĂLJ͘ Before the Republican-dominated House and Senate tried to ƌĞƉĞĂů ƚŚĞ ͕ ƉŽůůƐ ŝŶĚŝĐĂƚĞĚ Ă ŶĞĂƌůLJ ϱϬͲϱϬ ƐƉůŝƚ ďĞƚǁĞĞŶ ƚŚĞ ůŝŬĞ ŝƚͬůŽǀĞ ŝƚ ĨŽůŬƐ ĂŶĚ ƚŚĞ ŚĂƚĞ ŝƚͬƌĞƉĞĂů ŝƚ ĨŽůŬƐ͕ ǁŝƚŚ ƚŚĞ ůĂƩĞƌ ƐůŝŐŚƚůLJ ĂŚĞĂĚ ĨŽƌ Ă ƐĞǀĞƌĂů LJĞĂƌƐ͘ tŚŝůĞ ƚŚĞ ĨĂǀŽƌĂďůĞ ǀ͘ ƵŶĨĂǀŽƌĂďůĞ ǀŝĞǁ ƐƉůŝƚ ŶŽǁ ŝƐ ϱϮ ƉĞƌĐĞŶƚ ƚŽ ϯϵ ƉĞƌĐĞŶƚ͕ Ă <ĂŝƐĞƌ &ĂŵŝůLJ &ŽƵŶĚĂƟŽŶͲƌĞůĞĂƐĞĚ ƉŽůů ŝŶ ĞĂƌůLJ ƵŐƵƐƚ ĨŽƵŶĚ Ă ůĂƌŐĞ majority of the public, including half of Republicans and Trump ƐƵƉƉŽƌƚĞƌƐ͕ ƐĂLJ ƚŚĞ ĚŵŝŶŝƐƚƌĂƟŽŶ ŶŽǁ ƐŚŽƵůĚ ƚƌLJ ƚŽ ŵĂŬĞ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ǁŽƌŬ͘

ŬŶŽǁƐ ǁŚĂƚ ĂĚǀĞƌƐĞ ƐĞůĞĐƟŽŶ ŝƐ ĂŶĚ ŝƚƐ ĂīĞĐƚ ŽŶ Ă ŚĞĂůƚŚ ƉůĂŶ͕ ƵůƟŵĂƚĞůLJ͘ LJ ƚŚĞ ƐĂŵĞ ƚŽŬĞŶ͕ ŝĨ ƚŚĞ ĚŵŝŶŝƐƚƌĂƟŽŶ ĐŚŽŽƐĞƐ ƚŽ ŐŽ ƚŚĞ ͞ĚĞĂƚŚ ďLJ Ă ƚŚŽƵƐĂŶĚ ĐƵƚƐ͟ ƌŽƵƚĞ ĂŶĚ ĞůŝŵŝŶĂƚĞ ĐŽƐƚͲ sharing subsidies, remove various taxes that support the ACA, fail ƚŽ ĞŶĨŽƌĐĞ /Z^ ƌƵůĞƐ ŽŶ ƉĞŶĂůƟĞƐ ĨŽƌ ĨĂŝůŝŶŐ ƚŽ ƉƵƌĐŚĂƐĞ ĐŽǀĞƌĂŐĞ͕ ƐƚŽƉ ƉƌŽŵŽƟŶŐ ƐŝŐŶͲƵƉƐ Žƌ ĐŽŶƟŶƵĞ ƚŽ ƐĐĂƌĞ ƚŚĞ ĚĂLJůŝŐŚƚƐ ŽƵƚ of the health insurance industry, jeopardizing stability, the result may be the same – not just death of an industry, but literally ĚĞĂƚŚƐ ŽĨ ƚŚŽƵƐĂŶĚƐ ŽĨ ŵĞƌŝĐĂŶ ĐŝƟnjĞŶƐ ƵŶĂďůĞ ƚŽ ŽďƚĂŝŶ Žƌ ĂīŽƌĚ ŚĞĂůƚŚ ĐĂƌĞ ĐŽǀĞƌĂŐĞ͘ /Ŷ ŚŝƐ ƵŐƵƐƚ ͞/Ŷ ƚŚĞ dƌĞŶĐŚĞƐ͟ ďůŽŐ͕ &W ^ĞŶŝŽƌ sŝĐĞ WƌĞƐŝĚĞŶƚ͕ ĚǀŽĐĂĐLJ͕ WƌĂĐƟĐĞ ĚǀĂŶĐĞŵĞŶƚ ĂŶĚ WŽůŝĐLJ ^ŚĂǁŶ DĂƌƟŶ ƋƵŽƚĞĚ &W͛Ɛ ůĞƩĞƌ ƚŽ ^ĞŶĂƚĞ ůĞĂĚĞƌƐ DĐ ŽŶŶĞůů ĂŶĚ ^ĐŚƵŵĞƌ͗ ͞/ƚ ŝƐ ƟŵĞ ƚŽ ŵŽǀĞ ďĞLJŽŶĚ ŽƵƌ ĐƵƌƌĞŶƚ ŚĞĂůƚŚ ĐĂƌĞ ĚĞďĂƚĞ ƚŚĂƚ ŝƐ ĨŽĐƵƐĞĚ ŽŶ ƌĞƉĞĂůŝŶŐ ŵĂũŽƌ ƉŽƌƟŽŶƐ ŽĨ ĐƵƌƌĞŶƚ ůĂǁ ĂŶĚ ƐĞĞŬ ďŝƉĂƌƟƐĂŶ ƉŽůŝĐŝĞƐ ƚŚĂƚ ďƵŝůĚ ŽŶ ŽƵƌ ĐŽůůĞĐƟǀĞ ƐƵĐĐĞƐƐĞƐ͕ ĂĚĚƌĞƐƐ ongoing challenges, and improve our health care system for ĐƵƌƌĞŶƚ ĂŶĚ ĨƵƚƵƌĞ ĐŝƟnjĞŶƐ͘͟

dŚĞ ƐƵƌǀĞLJ ĞǀĞŶ ĨŽƵŶĚ ƚŚĂƚ ŵŽƐƚ ZĞƉƵďůŝĐĂŶƐ ĂƌĞ ͞ĚŝƐĂƉƉŽŝŶƚĞĚ͟ ďƵƚ ŶŽƚ ͞ĂŶŐƌLJ͟ ƚŚĂƚ ƌĞƉĞĂů ĂŶĚ ƌĞƉůĂĐĞ ůĞŐŝƐůĂƟŽŶ ĨĂŝůĞĚ͘ ŝŐŚƚ ŝŶ ϭϬ ŵĞƌŝĐĂŶƐ ;ϳϴ ƉĞƌĐĞŶƚͿ ƐĂLJ ƚŚĞ ĚŵŝŶŝƐƚƌĂƟŽŶ ƐŚŽƵůĚ ĚŽ ǁŚĂƚ ŝƚ ĐĂŶ ƚŽ ŵĂŬĞ ƚŚĞ ĐƵƌƌĞŶƚ ŚĞĂůƚŚ ĐĂƌĞ ůĂǁ ǁŽƌŬ͕ ŝŶĐůƵĚŝŶŐ ϱϮ ƉĞƌĐĞŶƚ ŽĨ ZĞƉƵďůŝĐĂŶƐ ĂŶĚ ϱϭ ƉĞƌĐĞŶƚ ŽĨ WƌĞƐŝĚĞŶƚ dƌƵŵƉ͛Ɛ ƐƵƉƉŽƌƚĞƌƐ͕ ĂůƚŚŽƵŐŚ ƚŚĞ ůĂƩĞƌ ƐƵƉƉŽƌƚ ͞ŚĂƌĚďĂůů͟ ŶĞŐŽƟĂƟŶŐ ƚĂĐƟĐƐ ƚŚĂƚ ĐŽƵůĚ ĨƵƌƚŚĞƌ ĚĞƐƚĂďŝůŝnjĞ ƚŚĞ ŝŶƐƵƌĂŶĐĞ ŝŶĚƵƐƚƌLJ͘ / Ăŵ ŚĂƉƉLJ ƚŽ ƐĂLJ ƐŽŵĞ ďŝƉĂƌƟƐĂŶ ĞīŽƌƚƐ ƚŽ ĂĚĚƌĞƐƐ ƚŚĞ ŇĂǁƐ ĂƌĞ ďĞŐŝŶŶŝŶŐ ƚŽ ƚĂŬĞ ƐŚĂƉĞ ŝŶ ƚŚĞ ^ĞŶĂƚĞ͘ WĂƌƟƐĂŶ ƌĂŶĐŽƌ ƉƌĞǀĞŶƚĞĚ ƐƵĐŚ ĞīŽƌƚƐ ĨƌŽŵ ďĞŝŶŐ ƵŶĚĞƌƚĂŬĞŶ ƉƌĞǀŝŽƵƐůLJ͕ ĂŶĚ͕ ŽĨ ĐŽƵƌƐĞ͕ ƚŚĞƌĞ͛Ɛ ŶŽ ŐƵĂƌĂŶƚĞĞ ƚŚĞLJ ǁŝůů ǁŽƌŬ ŶŽǁ͘

Dƌ͘ DĂƌƟŶ ĂĚĚĞĚ͗ ͞dŚĞ ƉƌŽƉŽƐĞĚ ƐĞƚ ŽĨ ƉŽůŝĐŝĞƐ ŽƵƚůŝŶĞĚ ŝŶ ŽƵƌ ůĞƩĞƌ ĂƌĞ ǁĞůůͲƉŽƐŝƟŽŶĞĚ ƚŽ ŝŶĐƌĞĂƐĞ ĂĐĐĞƐƐ ƚŽ ĂīŽƌĚĂďůĞ ĂŶĚ meaningful health care coverage for all Americans. They place ĂŶ ĞŵƉŚĂƐŝƐ ŽŶ ĞƐƚĂďůŝƐŚŝŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ ĂƐ ƚŚĞ ĨŽƵŶĚĂƟŽŶ ŽĨ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ Ăƚ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ĂŶĚ ƉŽƉƵůĂƟŽŶ ůĞǀĞůƐ͘ They promote increased payment for family physicians, especially in the public insurance programs. We also have been mindful ƚŽ ƉƌŽŵŽƚĞ ƉŽůŝĐŝĞƐ ƚŚĂƚ ďĞŐŝŶ ƚŽ ƌĞŵŽǀĞ ƚŚĞ ĮŶĂŶĐŝĂů ďĂƌƌŝĞƌƐ ŵĂŶLJ ŝŶƐƵƌĞĚ ŝŶĚŝǀŝĚƵĂůƐ ĞdžƉĞƌŝĞŶĐĞ ĚƵĞ ƚŽ ŚŝŐŚ ĚĞĚƵĐƟďůĞƐ ĂŶĚ ĐŽͲƉĂLJƐ͘ &ŝŶĂůůLJ͕ ǁĞ ŝŶƚƌŽĚƵĐĞĚ Ă ŶĞǁ ƉƌŽƉŽƐĂů ƚŚĂƚ ǁŽƵůĚ ĂůůŽǁ ŝŶĚŝǀŝĚƵĂůƐ ďĞƚǁĞĞŶ ƚŚĞ ĂŐĞƐ ŽĨ ϱϱ ĂŶĚ ϲϰ ǁŚŽ ƉƵƌĐŚĂƐĞ ƚŚĞŝƌ insurance on the individual market to purchase that coverage ƚŚƌŽƵŐŚ Ă DĞĚŝĐĂƌĞ ĚǀĂŶƚĂŐĞ ƉůĂŶ͘͟

dŚŝƐ ƉŽůů ĂŶĚ ŽƚŚĞƌƐ ůŝŬĞ ŝƚ ƐĞŶĚ Ă ĐůĞĂƌ ŵĞƐƐĂŐĞ͗ ŵĂŬĞ ƚŚĞ ǁŽƌŬ ĂŶĚ ůĞƚ͛Ɛ ŵŽǀĞ ŽŶ͘ Ɛ ƚŚĞ ĨĞůůŽǁ ŽŶ ^ĂƚƵƌĚĂLJ EŝŐŚƚ >ŝǀĞ ƵƐĞĚ ƚŽ ƐĂLJ ĂďŽƵƚ ƚŚĞ ĞĐŽŶŽŵLJ ĂŌĞƌ ƚŚĞ ϮϬϬϴ ƌĞĐĞƐƐŝŽŶ͗ ͞:ƵƐƚ &/y ŝƚ͊͟ /ƚ͛Ɛ ďĞĞŶ &W͛Ɛ͕ &W͛Ɛ ĂŶĚ ŵŽƐƚ ŽĨ ŽƌŐĂŶŝnjĞĚ ŵĞĚŝĐŝŶĞ͛Ɛ ƉŽƐŝƟŽŶ ƚŚĂƚ ƚŚĞ ŵĞƌŝƚĞĚ ƐƚƌŽŶŐ ƐƵƉƉŽƌƚ ďĞĐĂƵƐĞ ŝƚ ĚƌĂŵĂƟĐĂůůLJ ĞdžƉĂŶĚĞĚ ĂĐĐĞƐƐ͕ ďƵƚ ĚĞĮŶŝƚĞůLJ ŚĂĚ ŇĂǁƐ ƚŚĂƚ ŶĞĞĚĞĚ ƚŽ ďĞ ĂĚĚƌĞƐƐĞĚ͘ Ƶƚ ŚŽǁ ƚŚĞ ,ŽƵƐĞ ŽĨ ZĞƉƌĞƐĞŶƚĂƟǀĞƐ ŵĂũŽƌŝƚLJ ĐŽƵůĚ ŝŐŶŽƌĞ ƚŚĞ ďĂƐŝĐ ƉƌŝŶĐŝƉůĞƐ ŽĨ ĞĐŽŶŽŵŝĐƐ ǁŚĞƌĞ health insurance is concerned is beyond me. Every physician

dŚĞ ƉƵďůŝĐ ƐĞĞŵƐ ǁĞůů ĂǁĂƌĞ͕ ƚŽŽ͕ ŽĨ ƚŚĞ ŝŵƉůŝĐĂƟŽŶƐ ŽĨ ƉƌŽďůĞŵƐ ŝŶ ƚŚĞ ŝŶƐƵƌĂŶĐĞ ƉůĂŶ ŵĂƌŬĞƚ ĨŽƌ ƚŚĞŝƌ ŽǁŶ ĐŽǀĞƌĂŐĞ͕ ǁŚĞƚŚĞƌ ŝŶ Žƌ ŽƵƚ ŽĨ ĐŽǀĞƌĂŐĞ ʹ ϲϬ ƉĞƌĐĞŶƚ ƐĂLJ ͞ŝŶƐƵƌĞƌƐ͛ ĚĞĐŝƐŝŽŶƐ ŶŽƚ ƚŽ ƐĞůů ŝŶƐƵƌĂŶĐĞ ƉůĂŶƐ ŝŶ ĐĞƌƚĂŝŶ ŵĂƌŬĞƚƉůĂĐĞƐ ǁŝůů ĂīĞĐƚ ĞǀĞƌLJŽŶĞ ǁŝƚŚ ŝŶƐƵƌĂŶĐĞ͖ ϲϬ ƉĞƌĐĞŶƚ ĂůƐŽ ďĞůŝĞǀĞ ƚŚĂƚ ͞ƚŚĞŝƌ ĨĂŵŝůLJ ǁŝůů ďĞ ŶĞŐĂƟǀĞůLJ ĂīĞĐƚĞĚ ďLJ ƌŝƐŝŶŐ ƉƌĞŵŝƵŵƐ ŝŶ ƚŚĞ ŵĂƌŬĞƚƉůĂĐĞƐ͘͟ ƚ ǁŚŽŵ ǁŝůů ǀŽƚĞƌƐ ďĞ ĂŶŐƌLJ ŝŶ ϮϬϭϴ ŝĨ ƚŚŽƐĞ ĨĞĂƌƐ ĐŽŵĞ ƚƌƵĞ ŝŶ ƚŚĞ ĂďƐĞŶĐĞ ŽĨ ƌĞĂů ĞīŽƌƚƐ ƚŽ ŝŵƉƌŽǀĞ ƚŚĞ ͕ ƐƵĐŚ ĂƐ ǁŚĂƚ &W ŚĂƐ ƉƌŽƉŽƐĞĚ͍

38

California Family Physician Fall 2017

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Little Rock, AR Permit No. 2437

“ FFor more MIEC or m ore tthan han 440 0 yyears, ears, M IEC hhas as bbeen een a CAFP vvalued alued d ppartner artner ooff tthe he C AFP aand nd aan n iinvaluable nvaluable members” rresource esource ffor or oour ur m embers”

Toni Brayer, MD Board of Governors

MIEC has just announced $11 Million in dividends* to be distributed to policyholders in 2017

Committed to serving the Medical Professional Liability Needs of Physicians in California!

MIEC Mission: Provide our policyholders and local medical communities with the exemplary service and support they deserve! By providing vastly superior Professional Liability coverage to our members, coupled with unmatched service & support, MIEC has never lost sight of its mission and the associations that support the medical community. MIEC is proud to support physicians, and organized medicine in California!

MIEC has been proudly serving the Medical Professional Liability Insurance needs of physicians in California for more than 40 years.

Added value: Q Owned by the physicians we protect Q No profit motive, dividend policy* Q Specialized local claims staff Q Local Northern California claims office Q Supports organized medicine in California

For more information or to submit an application: www.miec.com Call 800.227.4527 Email underwriting@miec.com * On premiums at $1/3 million limits. Future dividends cannot be guaranteed.

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