Issuu

FALL 2020

SANTA BARBARA COUNTY Henning Ansorg, MD

Physicians of the

SAN LUIS OBISPO COUNTY Penny E. Borenstein, MD, MPH

YEAR

AB 890 • Protecting Physician Practices • Personal Protective Equipment Fall 2020

CENTRAL COAST PHYSICIANS

Dr. Marc Zerey, General Surgeon, Chief of Staff, Santa Barbara Cottage Hospital

Open and ready to provide safe care. We are prepared to protect your health. If you need medical care, donâ€™t delay.

Your health is essential. Seek help if you need it.

cottagehealth.org 2 CENTRAL COAST PHYSICIANS

Fall 2020

VOLUME 5, NUMBER 3 â€¢ FALL 2020

{FEATURES}

6 8 11 18 20 28 34 Fall 2020

{DEPARTMENTS} PROTECTING PHYSICIAN PRACTICES

12 RISK TIP

AB 890

16 CENCAL HEALTH NEWS

NEW LEADERSHIP AT PLANNED PARENTHOOD MASKED AND MIGHTY

24 PHYSICIAN WELLNESS 32 CLASSIFIEDS 36 NEW MEMBERS 38 IN MEMORIAM

ANNUAL MEMBERSHIP CELEBRATION PPE RECAP TELE-ER

CENTRAL COAST PHYSICIANS

Letter from the CEO

CELEBRATING PHYSICIANS Last month we held our Annual Membership Celebration where we virtually gathered with physicians on the Central Coast. With all that is going on in the world, it was a nice break to have an uplifting evening. The highlight of the event was honoring our local public health officers Drs. Henning Ansorg and Penny Borenstein as our Physicians of the Year. These amazing physicians DANA GOBA rose to the challenge of the pandemic, and we are lucky to have them in our community. We asked local leaders to share a message about our honorees, and the response was overwhelming. If you missed the event, you can watch it on our website at www.ccmahealth.org. While we hope our event was uplifting, we have been hearing about doctors struggling with burnout, especially since the pandemic began. Clinicians who are on the frontlines of this crisis are facing unprecedented stress, risks to their physical safety, significant disruptions in social support, moral dilemmas, systemic racism, and emotional distress.

PRESIDENT Kevin Casey, MD PRESIDENT ELECT Priti Gagneja, MD TREASURER Samira Kayumi-Rashti, MD SECRETARY Julie Fallon, MD IMMEDIATE PAST PRESIDENT Jennifer Hone, MD DIRECTORS Eric Amador, MD; Daniel Berger, MD; Jeffrey Gauvin, MD; Thomas Hale, MD; Bindu Kamal, MD; Rachel May, MD; Rahim Raoufi, MD; Joseph Schwartz, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sharon Basham, MD; Edward Bentley, MD; Kevin Casey, MD; David Dodson, MD; Priti Gagneja, MD; Jennifer Hone, MD; Samira Kayumi-Rashti, MD; Christopher Lumsdaine, MD; Douglas Murphy, MD; Grace Park, MD; Joseph Schwartz, MD CMA DISTRICT V TRUSTEE Rene’ Bravo, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Kevin Casey, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Bill Fleming; California Medical Association; CenCal Health; County of Santa Barbara;

In response, CMA launched Care 4 Caregivers Now (C4CN) to help manage the emotional burnout health care workers have endured. C4CN provides peer coaching that is free, confidential (no mandated reporting requirement) and virtual. Caregivers receive one-on-one emotional support from trained medical practitioners who understand the rigors and emotional stresses of the profession, and who know the value of a safe, confidential, and non-judgmental space. Interested caregivers can sign up to receive support at care4caregiversnow.org.

Douglas P Murphy, MD; Planned Parenthood California Central Coast; and Tenet Health Central Coast CONTRIBUTING PHOTOGRAPHERS CenCal Health and Tenet Health Central Coast SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are welcome. Opinions expressed by authors are their own and not necessarily those of the CCMA. CCMA reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. PLEASE DIRECT EDITORIAL INQUIRIES AND SUBMISSIONS TO: Central Coast Physicians

Sincerely,

100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 T 805.683.5333 • F 805.364.5431 E magazine@ccmahealth.org ADVERTISING rates and information sent upon request. Acceptance of advertising in Central Coast Physicians in

Dana Goba Chief Executive Officer Central Coast Medical Association

no way constitutes approval or endorsement by CCMA of products or services advertised. CCMA reserves the right to reject any advertising. All advertising inquiries can be sent to magazine@ccmahealth.org.

A COMPONENT OF THE

CENTRAL COAST PHYSICIANS

Fall 2020

CENTRAL COAST PHYSICIANS

PROTECTING PHYSICIAN PRACTICES DURING COVID-19 COVID-19 is having a profound impact on physician practices across the state. The California Medical Association (CMA) continues to advocate on all fronts during the COVID-19 pandemic to ensure that the interests of physicians and their patients are considered as local, state and federal governments respond to the rapidly evolving public health emergency. From ensuring physician payments in the Paycheck Protection Program (PPP) to expanding the use of telehealth services, CMA’s advocacy has directly helped thousands of physician practices across California.

CMA also has a wide array of resources and programs to help physicians during the public health emergency: PPE RELIEF: As physician practices continue to struggle to secure the personal protective equipment (PPE) they need to keep themselves and their patients safe, CMA distributed millions of pieces of PPE – including masks, shields, gowns, gloves and hand sanitizer – free to qualifying practices. Practices with 50 or fewer providers were eligible to receive a 60-day supply to ensure they could see patients with proper safety precautions in place. VIRTUAL GRAND ROUNDS: CMA is partnering with the California Health and Human Services Agency and academic medical centers across the state to host California COVID-19 Clinical Updates, a regular series of virtual grand rounds for the state’s clinicians on the evolving understanding and management of COVID-19 patients. Participants earn free continuing medical education (CME). TOOLKITS FOR MEDICAL PRACTICES: CMA understands that things are changing rapidly – sometimes daily – during the COVID-19 pandemic. Our team of experts is distilling the information into easy-to-read toolkits that are updated regularly to keep you informed on the changing policy and regulatory landscape. COVID-19 WEBINAR SERIES: Since the beginning of the public health emergency, CMA has been hosting free COVID-19 webinars to keep California physicians informed on critical topics – from telehealth and reimbursement to legal and employment issues. REOPENING GUIDELINES: Many physician practices have had to close or reduce operating hours amid the COVID emergency. A CMA-convened taskforce of practicing physicians from different parts of the state, different sized practices and various specialties helped the state develop guidelines and recommendations for reopening the health care system.

Visit cmadocs.org/covid-19 for more information on any of these resources. 6

CENTRAL COAST PHYSICIANS

Fall 2020

ADDITIONAL MEMBER BENEFITS CMA members gain access to valuable members-only services, including: LEGAL RESOURCES Free access to CMA’s online health law library with 5,000+ pages of information and resources.

PROFESSIONAL DEVELOPMENT Grow your leadership skills with tools, resources and opportunities for growth.

REIMBURSEMENT ASSISTANCE CMA physicians have recouped more than $3 million in the past 11 years with the help of CMA’s reimbursement experts.

GROUP-BUYING DISCOUNTS Our extensive network of benefit partners makes it so that your membership can easily pay for itself.

PRACTICE SUSTAINABILITY CMA’s Physician Services Organization ensures that California physicians can practice in the modality of their choosing, armed with bestin-class tools and technologies.

LEGISLATIVE ADVOCACY Learn how to use your voice as a trusted and powerful tool to protect your patients and the practice of medicine.

We Are Here for You Your membership makes these programs and resources possible. CMA and its county medical societies have represented California’s physicians for more than 160 years as the recognized voice of the house of medicine. Become a member of CMA today to help strengthen the political voice of the house of medicine, and get the services you need to help your practice adapt during these turbulent times. Together we stand taller, our combined voices stronger, fighting for the future of medicine and our noble profession.

Become a Member Today Visit cmadocs.org/join or contact CMA’s member resource center at (800) 786-4262 or memberservice@cmadocs.org.

Fall 2020

Rev. 9.30.20

CENTRAL COAST PHYSICIANS

Assembly Bill (AB) 890: Talking Points for Physicians

Background: AB 890 authorizes two newly created types of nurse practitioners (NPs) who would be allowed to perform certain functions without standardized procedures. The law specifies the education, training, testing, regulatory and governance requirements for these new NPs, including the circumstances in which an NP must consult with or refer patients to a physician. Key provisions of AB 890 are ambiguous, and will require clarification and guidance from regulators. Though the law will be enacted in the fall of 2020, full implementation and training of these new categories of nurse practitioners will not happen until the required regulations and guidance are approved by state regulators. Implementation of the law now moves to the Board of Registered Nursing, which will be responsible for establishing guidelines for these new categories of nurse practitioners. The Medical Board of California may also have a role to play in the bill’s implementation. The California Medical Association (CMA) will be closely involved in the implementation of AB 890, monitoring and advocating during the regulatory process at the Board of Registered Nursing and at the Medical Board of California, as necessary.

AB 890 Does Not End Physician Supervision The bill does not prohibit the supervision of NPs – including the two new categories created under AB 890 – or otherwise seek to regulate or modify the operative law regarding the governance of nurse practitioners who do not receive additional training. Current arrangements regarding the practice and supervision of NPs are not regulated or changed by AB 890.

AB 890 Requires Consultation and/or Referral AB 890 requires “Section 103'NPs to refer cases beyond their training and education to a physician. It also requires “Section 104” NPs, who are practicing in facilities that may not have a physician on site, to consult with and refer patients to a physician in specified circumstances.

AB 890 Explicitly Protects the “Corporate Bar” AB 890 specifies that the corporate bar applies to Section 103 and Section 104 NPs. That means entities including hospitals may not hire, employ or otherwise control the Section 103 and Section 104 NPs unless one of the existing exceptions to the corporate bar applies.

CENTRAL COAST PHYSICIANS

Fall 2020

AB 890: AN OVERVIEW FOR PHYSICIANS

Additional Guidance Is Needed from State Regulators AB 890 does not prohibit physician supervision of nurse practitioners, and implies a continuing role for physicians in the care of patients who are treated by Section 103 or 104 nurse practitioners. Additional guidance from the Board of Registered Nursing and the California Medical Board is necessary to determine what degree of physician involvement is required. Guidance from the Medical Board of California as to how it views the role of physicians under the AB 890 NP structure is necessary to better understand physicians' liability risks created by AB 890.

CMA Will Continue to Advocate to Regulators for the Right of All All Patients to Be Treated by a Physician We have a lot of work to do to ensure AB 890 is implemented in a way that protects patients. The law is clear that AB 890 does not prohibit physician supervision or modify existing arrangements with medical systems or physicians and nurse practitioners, and applies the prohibition on the corporate practice of medicine to these new categories of nurse practitioner. CMA will continue to advocate for the highest quality health care for all Californians and ensure that medical decisions are made by highly trained medical professionals, and not by those who are more concerned with the bottom line than with patient well-being.

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CENTRAL COAST PHYSICIANS

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CENTRAL COAST PHYSICIANS

Fall 2020

California Central Coast New Vice President of Medical Affairs

Planned Parenthood California Central Coast (PPCCC) is honored to announce the appointment of Dr. Maryam Guiahi as their Vice President of Medical Affairs. The position oversees medical programs and services for PPCCC’s five tri-county health care centers. Dr. Maryam Guiahi is an Iranian immigrant who grew up on Long Island, NY. She completed her undergraduate education at Cornell University and attended Loyola University Stritch School of Medicine, where she completed obstetrics and gynecology residency training at Loyola University Medical Center. During her time at Loyola University Medical Center she was introduced to religious restrictions to care based on the institution’s Catholic principles, an experience that fueled her passion for comprehensive reproductive care including abortion. Dr. Guiahi completed a Fellowship in Family Planning at Columbia University Medical Center and received a Master’s in Epidemiology from the Columbia Mailman School of Public Health. “Dr. Guiahi’s appointment comes at a time when our state and country are facing a public health crisis and access to affordable reproductive health care is under attack. Access to sexual and reproductive health care is crucial for our patients and

Fall 2020

Dr. Maryam Guiahi communities, now more than ever,” said Jenna Tosh, president and CEO of PPCCC. “We are thrilled to welcome Dr. Guiahi to the team and are eager to work alongside her to improve and expand our ability to connect patients to care — no matter what.” Dr. Guiahi joins PPCCC after serving as an Associate Professor at University of Colorado School of Medicine, where she taught for nine years. She has over 50 peer-reviewed publications, many specific to the implications of institutional religious restrictions to care on women’s health services and OB-GYN residency training.

CENTRAL COAST PHYSICIANS

RISK TIP

COVID-19 IS CHANGING

LIABILITY RISKS AND LITIGATION IN HEALTHCARE

BILL FLEMING, CHIEF OPERATING OFFICER, THE DOCTORS COMPANY

Across the spectrum of care, healthcare delivery is changing as the COVID-19 pandemic continues, creating additional pressures to maintain patient safety and shaping new liability risks for hospitals, group practices, and solo physicians. Understanding how these new risk exposures are unfolding—and how adverse events may be litigated in a courtroom environment also under strain—is the first step to taking protective measures. Mr. Fleming offers his expert insights:

CENTRAL COAST PHYSICIANS

Fall 2020

Q) WHAT KINDS OF LAWSUITS DO YOU EXPECT TO SEE LINKED TO THE COVID-19 PANDEMIC?

Q) AS YOU’VE SAID, PROVIDERS ARE DELIVERING CARE DIFFERENTLY DURING COVID-19. HOW DO THESE CHANGES DIMINISH OR INCREASE RISKS?

A) Extraordinary circumstances and a steady stream of directives (and revisions thereto) from state and local A) In the crush of managing a public health crisis, many governments have pressed physicians, practices, and hospitals hospitals and practices have had to take temporary measures to practice medicine in ways they never have before—or to that impact patient safety: Some of these measures mitigate not practice medicine, when certain elective forms of care have certain risks but may amplify others. been suspended by government action, often to conserve PPE and other resources. In spite of reasonable efforts under difficult conditions, it’s likely that some adverse events will be traced to this time. Moreover, circumstances have forced physicians to use It is important to note that “elective” in this context does not mean unnecessary or optional. It includes important screening and diagnostic procedures such as colonoscopies, some cancer and cardiac surgeries, and most dental procedures. Delay of elective procedures may be a source of increased litigation—many biopsies for cancer, for instance, have lately been delayed, and delay in diagnosis was already one of the most expensive areas of litigation pre-COVID19. Other delays in care many be linked to access issues. Telemedicine has been a lifesaver for many during this crisis, but some vulnerable patients may lack access. Infrastructure can also present a barrier to telemedicine care, as some do not have sufficient internet bandwidth for video visits. Moreover, circumstances have forced physicians to use telemedicine in ways they usually might not. Telemedicine is ideally an adjunct to in-person care, and therefore not the best option for a first visit with a new patient, but during peak infection risk, exceptions had to be made. Among our infrequent telemedicine claims pre-COVID-19, misdiagnosis of cancer was the top allegation, and I can’t imagine that risk of misdiagnosis has decreased, given the spike in telemedicine usage under nonoptimal conditions. Also, I anticipate that some COVID-19-related cases will focus on shortages of personal protective equipment (PPE)—those claims may come from patients or employees.

Fall 2020

telemedicine in ways they usually might not. Telemedicine is ideally an adjunct to in-person care, and therefore not the best option for a first visit with a new patient, but during peak infection risk, exceptions had to be made.

Healthcare providers in hard-hit areas are working longer hours, sometimes with insufficient PPE, sometimes in large tents put up in parking lots or other overflow sites. In surge locations, staff from other departments may be covering in the emergency department (ED) or intensive care unit (ICU)— this is could increase the risk of communication gaps. All of these resource-stretching measures, taken together, may add up to a risk profile that is more than the sum of their parts. While responding to health directives from state and local governments, as well as advisories from the Centers for Disease Control and Prevention (CDC) and other trusted sources, hospitals and practices will continue to experience unavoidable delays in treatment to all patients. Testing delays do not help. In addition, by patient preference, many routine checkups and tests have been delayed, not to mention routine procedures. Adverse events linked to these delays could affect physician liability.

CENTRAL COAST PHYSICIANS

Q) WHAT CAN PHYSICIANS AND PRACTICES DO TO PROTECT THEMSELVES DURING THE PANDEMIC? A) Conscientious documentation becomes a witness for the physician in the courtroom. In the COVID-19 era, practices may benefit from documenting not only individual patient interactions, but how the practice is following CDC infection control guidelines and recommendations from state and local health authorities at particular points in time. This could be as simple as jotting a daily note in an electronic calendar. Q) HOW ARE COURTROOM CHANGES DURING THE PANDEMIC CHALLENGING DEFENSE TEAMS? A) In a recent medical malpractice suit, a physician member of The Doctors Company, with assistance of counsel and The Doctors Company’s support, secured a defense verdict despite many changes in the courtroom environment that could have posed problems if we had not been prepared to adjust. We’ve seen firsthand how physicians facing a court hearing during COVID-19 need a legal team that is prepared for

We’ve seen firsthand how physicians facing a court hearing during COVID-19 need a legal team that is prepared for changes in depositions, jury selection, and the trial itself.

changes in depositions, jury selection, and the trial itself. For instance, depositions may be completed by video, with multiple screens for the attorneys, parties and exhibits, and jury selection may take place partly via written communication. During trial, showing evidence must be done differently, so defense teams need solid technology skills in settings where counsel can publish exhibits to the jury using large screens.

time per day, and prolongs the trial duration. Taking time out of a practice to participate in an extended trial can further stress a stretched practice. Q) LITIGATION STRESS PLACES A BURDEN ON PHYSICIANS AT ANY TIME. HOW IS THIS DIFFERENT DURING THE PANDEMIC? A) Individual trials are taking longer, compounding delays from the existing backlog. This keeps physicians in limbo— and could even affect their credentialing. As previously reported by RAND, pre-pandemic, on average, physicians were already spending more than 10 percent of their careers living under the shadow of an open malpractice claim. It is true that at any time, even the best of physicians could find themselves facing an unexpected lawsuit. And states around the country handle cases differently. That’s why our members are supported by legal teams with deep roots and expertise in members’ local venues. In addition, knowing that the stress of malpractice litigation affects physicians deeply, and knowing that preparation is the key to victory, we support our members through in-depth litigation preparation. Like the COVID-19 pandemic itself, pandemicrelated risk exposures are fluid. Physicians, practices, hospitals, and systems are facing rapid changes in liability exposures at the same time as the day-to-day business of healthcare is changing under their feet. The Doctors Company is prepared to assist our members through lawsuits during these unprecedented times so that, even with changes in the courtroom, members can present their best defense. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Some courts are taking 15-minute breaks every hour for better ventilation and cleaning. This breaks the momentum when an attorney is speaking with a witness, reduces the overall trial

CENTRAL COAST PHYSICIANS

Fall 2020

CCMA/CMA-Sponsored Insurance Programs

Your Membership Offers Additional Savings on Already Low Rates! CCMA members are eligible to save an additional 5%* on their Workers’ Compensation insurance because of their membership.

Central Coast Medical Association/CMA’s sponsored Workers’ Compensation program offers Savings, Service and Stability! CCMA and CMA partner with Mercer Health & Benefits Insurance Services LLC and Preferred Employers Insurance to provide best-in-class Workers’ Compensation insurance that includes outstanding customer service, risk management advice and an easy to navigate website in the event of a claim. CCMA members are eligible to save an additional 5%!* This program is already serving the needs of hundreds of California’s physicians. Have you considered the

Savings, Service and Stability offered to you through your membership?

Save today! It’s easy to get a quote: visit CountyCMAMemberInsurance.com and complete a premium request indication form, or call 800-842-3761 or email CMACounty.Insurance.service@mercer.com to work with a Client Advisor.

Sponsored by:

Underwritten by:

Programs administered by:

PREFERRED EMPLOYERS Insurance

| a Berkley Company

* Most practices will qualify for group pricing and receive the 5% discount; however some practices will need to be underwritten separately when they do not qualify for the special program terms and conditions. A minimum premium applies to very small payrolls.

Program Administered by Mercer Health & Benefits Insurance Services LLC

CA Insurance License #0G39709 • Copyright 2020 Mercer LLC. All rights reserved. 633 West 5th Street, Suite 1200, Los Angeles, CA 90071 • 800-842-3761 • CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com • 90761 (10/20) Fall 2020

CENTRAL COAST PHYSICIANS

CenCal Health NEWS HUB:

Welcome Back to Care: Local Providers Join CenCal Health in Advancing Public Health Message

Decrease in Immunizations, Cancer Screenings, Annual Physicals Seen on Central Coast Due to COVID Concerns This fall, top health professionals on the Central Coast joined CenCal Health, the local Medi-Cal health plan, in encouraging the public to return to their doctors, clinics and hospitals for vital health care services, especially immunizations, cancer screenings and other preventive care evaluations. A bilingual public awareness campaign began in September to persuade Central Coast residents to go back to regular medical care – care that has slowed up to 50% in some service categories since the national health emergency was declared in March. Disruptions occurred in routine preventive and other non-emergency care due to stay-at-home orders to reduce the spread of COVID-19, and public fear of coronavirus contagion.

CENTRAL COAST PHYSICIANS

“Now that we know more about preventing the spread, it’s time to welcome you back to care,” says Van Do-Reynoso, Ph.D., Director of Santa Barbara County Public Health Department in a new TV commercial produced by CenCal Health, airing in English and Spanish on local stations across Santa Barbara and San Luis Obispo counties. Other prominent participants in the public health message include Charles Fenzi, MD, CEO of Santa Barbara Neighborhood Clinics, Rocio Rodriguez Valencia, MD, of Community Health Centers of the Central Coast (CHC), and Sue Andersen, president and CEO of Marian Regional Medical Center. In the “Welcome Back to Care” TV spots, local medical professionals emphasize the safety of patients returning to care, outlining examples of protocols put in place in addition to mask wearing, temperature readings and disinfecting facilities. Central Coast medical staff are implementing measures like “turning cars into waiting rooms,” says Santa Maria pediatrician Robert Barry, MD, “and reducing the number of patients in our office at the same time,” offers Melvin Lopez, MD, of Marian Community Clinics. Paul Hennig, MD, Chief Medical Officer & Family Physician for American Indian Health & Services, states that they are “offering telemedicine, so some visits can be held through your smartphone.”

Fall 2020

According to the California Department of Public Health, vaccinations for children decreased by more than 40% in April 2020 compared to the same month the previous year. For March through May of this year, CenCal Health evaluated utilization trends among its members and found a 34% decrease in immunizations for adolescents in Santa Barbara County. The health plan also discovered a 50% decrease in cervical cancer screenings (ages 21-64) in Santa Barbara County, with a 40% decrease in the same category in San Luis Obispo County. There was a 35% decrease in preventive medicine evaluations (such as annual physicals) for adults in Santa Barbara County, and a 31% decrease in San Luis Obispo County. “An advantage of a publicly-sponsored health plan is that it works for the betterment of the community,” said Bob Freeman, CEO of CenCal Health. “We saw the opportunity to help by letting the public know of the many steps physicians and other providers are taking to provide care safely. It’s also important to encourage those who have lost their health insurance to explore their potential eligibility for Medi-Cal. Every one of the providers in our video serve Medi-Cal patients.” Other providers featured in the “Welcome Back to Care” TV campaign are Angela Halusic, MD, with FCPP Women’s Health; Richard Macias, MD, of Central Coast Pediatrics; Bryce Holderness, MD, with Sansum Clinic; Shaun Ehsani, MD, family physician with Jackson Medical Group; and Laura Lopez, phlebotomy technician at Quest Diagnostics. The public service announcement ends with the message “if you have lost your health insurance you may qualify for free coverage,” and offers a URL to learn more about applying for Medi-Cal. CenCal Health partners with over 1,500 local physicians, hospitals, and other providers in delivering patient care to nearly 190,000 members in two counties – about one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County. Established in 1983, it is the oldest managed care Medicaid plan of its kind in the nation.

Fall 2020

For more information and to view the commercial, visit cencalhealth.org.

CENTRAL COAST PHYSICIANS

An uncommon coalition of healthcare and education partners from across the county is joining forces to launch MASKED AND MIGHTY, a campaign to save lives, reduce the transmission of COVID-19, reopen more businesses and schools, and maintain access to vital healthcare. “We want to reach our communities with a positive, non-political message that will engage all parts of our county to work together on stopping COVID-19 in its tracks,” said Dr. Peggy Dodds, Deputy Health Officer, Santa Barbara County Public Health Department and retired pediatrician. “In addition to avoiding

CENTRAL COAST PHYSICIANS

Fall 2020

gatherings with people outside of your household,

Santa Barbara County Promotores Network

residents should practice good hygiene and

is engaging the Spanish and Mixtec speaking

observe social distancing of at least six feet.”

communities.

Geared for audiences of all ages and translated

•C ounty Board of Supervisors Resolution

into English and Spanish, the MASKED AND

recognizing the “MASKED AND MIGHTY”

MIGHTY campaign uses local imagery and people

countywide approach to improving health

to engage all communities with messages about

and the economy.

the importance of MASKS, and the MIGHTY powers that physical distancing, good hygiene and

•D iscussion Guide for Teachers to lead

other preventions can have to prevent community

conversations with students about the best

spread of the virus.

ways to protect against COVID-19. The guide is available on the MASKED AND MIGHTY

Components of the MASKED AND MIGHTY

website.

campaign include:

•W ebsite in English at maskedandmighty.org

their artwork on the campaign’s social media

and Spanish at enmascaradoypoderoso.org

•P aid advertising will run county-wide in print, radio, digital and outdoor outlets.

•C oloring pages for artists of all ages to share accounts.

• Social media: Facebook (www.facebook.com/maskedandmighty), Instagram (www.instagram.com/masked_

•L ighting Display to “POWER UP SANTA BARBARA COUNTY” from October 26 to

and_mighty_coalition), Custom Hashtag: #maskedandmighty

November 7, partners will come together to power up landmark buildings across the county with bright, multi-colored lights to demonstrate commitment to adhering to safety precautions to reduce transmission of COVID-19. The lighting display is a fun, safe

Coalition members include County of

alternative to Halloween trick-or-treating. Any

Santa Barbara, Sansum Clinic, Cottage

business or resident can participate or share

Health, CenCal Health, Central Coast

images on social media with the hashtag

Medical Association, Lompoc Valley

#maskedandmighty. The MASKED AND MIGHTY website lists some stores that stock colored light bulbs.

MASKED AND MIGHTY

•C ommunity video project to create a series of short videos in English and Spanish

Medical Center, Lompoc Valley Pediatric Care Center, Marian Regional Medical Center, Santa Barbara City College, Santa Barbara County Promotores

to encourage residents to follow safety

Network, Santa Barbara Neighborhood

guidelines to reduce the infection rate.

Clinics, Santa Barbara County Education

Members of the public will be encouraged to

Office, and School Districts throughout

create and share their own messages about why they are MASKED AND MIGHTY. The website includes examples and tips to help

Santa Barbara County, UC Santa Barbara, and Westmont College.

the public create their own message. The

Fall 2020

CENTRAL COAST PHYSICIANS

2020 Celebration Annual Membership

THE 2020 VIRTUAL ANNUAL MEMBERSHIP CELEBRATION WAS A ROUSING SUCCESS!

You can view it at www.ccmahealth.org

SAN LUIS OBISPO COUNTY â€¢ Penny E. Borenstein, MD, MPH

Physicians of the Year Chosen by their peers, the Physician of the Year is an honor bestowed to those who have gone above and beyond. Despite being the first pandemic in a century, two individuals rose to meet the challenges and have truly shown us all what it means to be a leader. They have been unwavering in their defense of science and facts. >>

CENTRAL COAST PHYSICIANS

Fall 2020

SANTA BARBARA COUNTY â€¢ Henning Ansorg, MD

Fall 2020

We were thrilled to recognize our local Public Health Officers, Drs. Henning Ansorg and Penny Borenstein as our 2020 Physicians of the Year. We reached out to local leaders asking if they would be willing to share a message about our honorees, and the response was overwhelming. You can watch their videos at www.ccmahealth.org.

CENTRAL COAST PHYSICIANS

Wine Tasting Grassini Family Vineyards led an interactive virtual wine tasting with three of their specialty wines: 2019 Happy Canyon Sauvignon Blanc, 2017 Articondo Proprietary Red, and 2017 Reserve Sauvignon Blanc. To purchase these or other wines, go to www.grassinifamilyvineyards.com.

Program Attendees were welcomed by CEO, Dana Goba; President Kevin Casey, MD, provided his remarks on the year and welcomed the incoming Board of Directors; and 2021 president, Priti Gagneja, MD, thanked Dr. Casey for his service. The highlight of the program was honoring our Physicians of the Year Drs. Henning Ansorg and Penny Borenstein.

Bingo After the program, president Kevin Casey, MD, led an exciting game of bingo. Prizes were gift certificates to local companies: Cowboy Cookie & Ice Cream, House of Bread, Jessica Foster Confections, and Santa Barbara Pistachios. Congratulations to our winners!

Sponsors Thank you to our event sponsors!

CENTRAL COAST PHYSICIANS

Fall 2020

Feel More Empowered in Just 30 Minutes Struggling to find balance in your work and personal life amid the pandemic? Frustrated, angry or anxious that public health guidelines are ignored while COVID-19 remains prevalent? Experiencing racial or social injustice? Worried about your financial stability? Feeling burned out, unable to sleep or wishing you could just talk to someone who understands? Did you have an emotional response as you read these questions? Itâ€™s okay. CMA Wellness understands.

The California Medical Associationâ€™s wellness initiative (CMA Wellness) supports the well-being of the stateâ€™s health care workers with free and confidential peer coaching. Through Care 4 Caregivers Now (C4CN), clinicians will: Partner with a trained peer coach for free and confidential virtual sessions (via Zoom) that are held weekly for 30 minutes (no mandated reporting requirement) Receive emotional support to feel calmer, more focused and in control Find clarity and peace to better plan for the future Our trained coaches are fellow clinicians who understand the rigors and emotional stresses of the profession and know the value of a safe, confidential and non-judgmental space. Coaching is available for physicians (M.D. and D.O.), physician assistants, nurse practitioners, registered nurses, certified respiratory therapists, registered respiratory therapists, residents/fellows, medical students, public health officers and medical reserve corps volunteers.

Physician Wellness: An Introduction

“ H ealthy citizens are the greatest asset any country can have.” Sir Winston Churchill BY DOUGLAS P MURPHY, MD

When the opportunity to write an article on physician wellness for CCMA’s Central Coast Physicians (CCP) for arose, I was immediately moved by the opportunity to further explore the issue knowing its importance in light of profound and ongoing changes in medicine now complicated immensely by a global pandemic. However, it became clear to me that the depth and breadth of the issue would not in my estimation permit a just presentation in a single article. Hence, this is the first of a series of articles for Central Coast Physicians magazine that will address the multifaceted, complex, and profoundly important issue physician health and wellness. The issue of physician wellness has grown immensely in importance over the last decade or more, and with the COVID-19 pandemic still raging internationally, perhaps even more so. This is due to wellness’ critical impact not only on the lives of physicians and their families, but also on the ability of healthcare systems to function optimally and provide the best possible care to patients. A growing body of research and international attention is mounting because of the belief amongst institutions and stakeholders that it takes a healthy doctor workforce for health systems to operate effectively in the service of providing high quality patients care.

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However, since the “Golden Era of Medicine”, a time when the medical profession and the institutions it controlled enjoyed especially high public regard, ended in the mid-late 20th century, physicians have sought to serve patients amidst a protracted and unprecedented transition effecting virtually every aspect of medicine. The necessity for this change has at its foundation unsustainably rising healthcare costs. In 1960, healthcare costs in the United States as a percentage of gross domestic product (GDP) were 5%; by 1980 these costs grew to 8.9% but by 1992 they had risen to 13.1% of GDP, respectively. The reasons for these increases are beyond the scope of this article. However, this growth in healthcare costs have broadly been recognized as unsustainable driving the need for change. Efforts at reforming the healthcare system began with the Clinton Administration’s efforts to pass health care reform legislation the early 1990’s which were largely unsuccessful. However, momentum from these efforts led to the “first wave” of healthcare reform and the advent of managed care. A burgeoning bureaucracy was created to manage the provision of medical care and spending and with it a significant portion of physicians’ freedom, autonomy and earnings shifted from doctors to the federal bureaucracy and private insurance administration. Yet costs did not decline nor did their increase slow. By 2008 healthcare spending was 16.3% of GDP and still growing. This was followed by the Affordable Care Act in 2010. So-called Obamacare created a new set of values, principles, and institutions, largely theoretical, with the novel goal to improve quality of healthcare while containing costs. This is recognized perhaps most singly in, “The Triple Aim: Care, health, and cost” (Berwick 2008). The Triple Aim stated, “Improving the US health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Basically, the goal was to get more with less through efficiencies derived from technology, economies of scale and better management of resources. Despite these efforts, healthcare costs continued to rise. By 2018, healthcare costs grew to 17.7% of GDP. During this protracted period of radical changes in healthcare, the practice of medicine was beset with shifting values and principles, goals and priorities, and overseen by changing sets of rules and institutions. Since the early 1990’s the practice of medicine had been pressed by powerful forces in efforts to more equitably manage medical care and more recently to implement

Fall 2020

Wellness Action Item

#1: Exercise Whether you are an experienced gym enthusiast, a runner or active in a healthy aerobic sport, there is no single act that one can commit to than voluntary physical exercise in support of personal health and wellness. Physical exercise has been described as the best antioxidant supplement in existence (Kravitz 2009, Ristow 2009). As you are well aware, the American Heart Association recommends, “Get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity (or a combination of both), preferably spread throughout the week” (AHA 2020). A helpful 1-page pdf handout may be downloaded for your practice to give to patients in AHA 2020 refernce-2, below. We know this. We teach this to our patients. But do we do this? If you are just beginning an exercise regimen, consider beginning by simply doing what you can. Try to identify distractions and resistances to “getting out there” and consider them in comparison to the emotional and physical benefits that await you upon embarking on a practical exercise regimen. Of course, always check with your own doctor first if there is any question

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psychological distress, necessarily have serious negative affects on the health-care systems and patient care. Hence, physician wellness has become a prominent worldwide healthcare issue because poor physician health and wellness has been shown to lead to state that undermines the goals of healthcare reform and the Triple Aim.

the Triple Aim. Meanwhile, doctors were seeing a decrease in their independence and autonomy while being progressively aggregated into systems of care that limited what they entered medicine to do: engage and provide excellent care for patients. Physicians as a group are at best a body of professionals selected to attain to the highest ethical and professional standards in medicine. Administrative burdens and the time spent engaging Electronic Medical Records became significant obstacles to engaging and providing quality care to patients, the heart and soul of the practice of medicine.

In 2014 Bodenheimer and Sinsky published their seminal article, “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider.” The authors posited the Quadruple Aim recommending that the Triple Aim be expanded by adding the goal of improving the work life of health care providers, including clinicians and staff (Bodenheimer 2014). Hence, physician wellness became a fundamental consideration in efforts to achieve healthcare reform and the goals of the Triple Aim. To succeed in developing a costeffective, high quality healthcare system, ensuring the health and wellness of physicians would be fundamental to process of succeeding in this goal. Finally, the state of physician’s wellness was seen as being to the benefit of the healthcare system and ultimately to patients.

However, in time it became understood that rapid and ongoing changes to the practice of medicine (e.g., increased administrative burdens and growing bureaucracy, the growth of electronic medical records, remuneration issues and conflicts between the needs systems and patients) are all potential threats to the health and wellness of physicians. Terms like “physician wellness” and “burnout” became widely discussed principles for the first time in the profession. A growing body of research is demonstrating that the result of physicians’ stress, fatigue, burnout, depression, and

What is physician wellness? What is burnout? Definitions abound and research on this subject is rife with a lack of consensus as to precisely what constitutes the construct of physician wellness. A conceptual definition of physician wellness has been proposed by Brady et al., “Physician wellness (well-being) is defined by quality of life, which includes the absence of ill-being and the presence of positive physical, mental, social, and integrated well-being experienced in connection with activities and environments that allow physicians to develop their full potentials across

References Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, health, and cost. Health Affairs. 2008 May/June; 27(3):759-769. Bodenheimer T and Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine November 2014, 12 (6) 573-576. Brady KJS, Trockel MT & Khan CT, et al. What do we mean by physician wellness? A systemic review of its definition and measurement. Academic Psychiatry, 2018 Feb;42(1):94-108. Connor KM, Davidson JRT. Developmentofanewresiliencescale:theConnor-DavidsonResilienceScale (CD-RISC). Depress Anxiety. 2003;18(2):76-82. Tait D. Shanafelt, MD; Sonja Boone, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of General Psychiatry. August 20, 2012. West CP, Dyrbye LN and Synsky C, et al. Resilience and Burnout Among Physicians and the General US Working Population. JAMA Netw Open. 2020;3(7):e209385. Further references are available upon request.

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persona and work-life domains” (Brady 2017). Closely linked to Physician Wellness is the opposing and widely recognized concept of burnout, and the health and wellness promoting concept of resilience. Burnout has been described as a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment (Tait 2012). Resilience is defined as the collection of personal qualities that enable a person to adapt well and even thrive in the face of adversity and stress (Connor 2003). Recently West et al have showed that “Resilience is inversely associated with burnout symptoms.” Hence, developing resilience is central to the development of physician wellness. These are theoretical and complex constructs which will require ongoing research and application to develop practical and actionable elements making it possible to optimize physician resilience and wellness and minimize burnout. If physicians are going to thrive in this new era of medicine, physician groups, institutions and healthcare systems will have to work together to optimize the attainment of health and wellness. Without this, the worthy goals of the Triple and Quadruple Aims will not be realized, and patient care will ultimately suffer. Future editions of this series will look at the history of health and wellness from ancient to modern conceptions, and the broad range of ideas related to the constructs of physician wellness, resilience, and burnout. The series will discuss major changes in the healthcare industry that positively and negatively effect physician health and wellness, highlighting those supporting improvement of physician wellness. It will explore consequences of extremes on the continuum of burnout, specific practices that can be employed for milder cases, resources available for moderate and interventions available for more severe cases. The series will explore how physicians can overcome denial (rampant on this issue among physicians) and recognize symptoms of burnout within themselves. Moreover, it will seek to identify practical and actionable lifestyle practices that may be of benefit to our physician readers in seeking to improve their own personal health and wellness. Finally, the series would be remiss if it didn’t address the overwhelming impact of the COVID-19 pandemic, with the resultant world shutdown and massive effect it has had on healthcare systems, and how this is and is expected to affect medical systems and the health and wellness of physician in the future. Thank you for your time in reading this article. It is my hope that as a whole this series will provide information and practical principles and tools that will aid our physician members in attaining their own personal optimal health and wellness.

Fall 2020

as to whether a health issue might limit you safely exercising. One way is to start with a 10-minute walk outside or your home once a day or as many times as you are able. Then begin to walk alternating between jogging gently and walking for 1-minute each or at whatever interval you are comfortable with. Increasing your walking to jogging ratio eases the intensity of the exercise. Emphasis should be on consistency – get out there – and on enjoying the experience. Notice how you feel afterwards. Better? I hope so. Overexerting is often a significant problem with beginning an exercise regimen. Our egos may get in the way here. When we begin an exercise regimen too quickly our deconditioned bodies are hit hard with oxygen debt leading to an overwhelming drive to breathe deeply associated with feeling of breathlessness. This feels terrible. At a subconscious level, it is the equivalent of giving your brain stem a “punch in the nose;” it is painful at a deep psychological level. It is no wonder many of us avoid exercise. I did for years. If we emphasize frequency and enjoyment of the experience over the intensity of the exercise, we feel better afterwards and are much more likely to want to persist and develop those weekly exercise habits that offer so much in the way of emotional and physical health. More on this in a future article.

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PPE RELIEF

CMA DISTRIBUTES T WO - MONTH S U P P LY O F F R E E P P E T O M O R E THAN 40K C ALIFORNIA PHYSICIANS BY JACO B GR EENS T EI N

Since the onset of the COVID-19 pandemic, lack of personal protective equipment (PPE) has compounded the hardships for medical practices and hindered their ability to provide care for Californians. To alleviate the strain on practices and improve patient access to care, the California Medical Association (CMA) mobilized with its local county medical societies, the state of California and Altais to bring more than 40 million pieces of PPE—including medical-grade masks, gloves and gowns—to physicians free of charge, so that they can safely provide care for California residents. From the beginning, the need was urgent, and the demand was clear. CMA jumped into action, reaching out to California’s Office of Emergency Services to see what it would take to quickly get PPE into the hands of physicians. The result was an unprecedented project—in both scale and complexity—requiring an exceptional level of logistical planning, execution and collaboration between CMA, local county medical societies and several logistical partners. This was an entirely new operation for CMA, setting up a statewide distribution system for essential equipment that the state of California was struggling to get into the hands of physicians who desperately needed it. The CMA team, led by Mike Steenburgh—vice president of membership, marketing and component relations—got to work, rallying county medical societies and reaching out to Pride Industries, a Roseville-based non-profit that specializes in supply-chain management. Together, they established a statewide distribution network that took materials from state warehouses, repackaged them into individual kits for medical practices and loaded the material on trucks to be distributed at dozens of drive-through events across the state—

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sponsored by health care services company Altais. The demand for the product was overwhelming. Within days of reaching out to physicians across the state, nearly 10,000 physician practices signed up to secure free PPE. To fulfill these requests, CMA and its component medical societies embarked on a three-week-long series of traveling distribution events to put PPE directly into the hands of physicians. On Monday, July 27, 2020, the PPE distribution events kicked off at the Rose Bowl in Pasadena. Staff arrived just after sunrise to scope out, plan and unload the dozens of pallets of PPE and equipment necessary to ensure a safe and effective drive-through event. Soon after, volunteers began to arrive onsite to help complete set up. Hours before the events even began, cars started lining up by the dozens as physicians who had been up against insurmountable supply chain issues could hardly believe there would be enough PPE to fulfill the need. Each box distributed included 1,600 nitrile examination gloves, 320 N95 respirators, 90 isolation gowns, 40 face shields and 800 surgical masks. In addition to a box of PPE, physicians were given a 20-bottle case of 500ml hand sanitizers, when available. Although the thousands of PPE kits will not permanently solve PPE issues for medical practices, the infusion of a roughly two-month supply of masks, gloves and gowns was welcome relief for thousands of physicians who simply could not secure the equipment they needed through traditional channels. Between July 27 and August 13, CMA and county society staff and over 1,000 volunteers from networks of friends, family, and local schools and universities came together to execute a campaign that had a profound impact on physicians and patients across the state. Nearly 10,000 boxes of PPE were handed out at drive-through distribution events, and more than 6,600 boxes were directly shipped to practices who needed equipment but could not attend their local events. Event teams worked tirelessly in an assembly-

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PPE RELIEF AT A GLANCE E V E N T S : 3 6 O V E R 15 D AY S

P R A C T I C E S R E A C H E D : 15 , 0 0 0 P H Y S I C I A N S S E R V E D : 4 0 , 5 70

B O X E S D I S T R I B U T E D : 15 , 8 0 0 9,10 0 I N P E R S O N 6,70 0 BY MAIL PPE DISTRIBUTED: 40 MILLION PIECES

15 M I L L I O N E X A M I N AT I O N G L O V E S

6 . 5 M I L L I O N N 9 5 R E S P I R AT O R S

1. 4 M I L L I O N I S O L AT I O N G O W N S

1. 5 M I L L I O N FA C E S H I E L D S

15 M I L L I O N S U R G I C A L M A S K S

70 0,0 0 0 BOT TLE S OF HAND SANITIZER ITE MS PE R BOX: 1, 6 0 0 N I T R I L E E X A M I N AT I O N G L O V E S 3 2 0 N 9 5 R E S P I R AT O R S 9 0 I S O L AT I O N G O W N S 4 0 FA C E S H I E L D S 800 SURGICAL MASKS 20 BOT TLES OF HAND SANITIZER VA L U E O F P P E D I S T R I B U T E D : T O TA L : $ 8 0 . 6 M I L L I O N

PE R BOX: $5,000

I N D I V I D U A L B O X W E I G H T: 4 5 P O U N D S V O L U N T E E R S : M O R E T H A N 1, 0 0 0 * D I S T R I B U T I O N I S O N G O I N G , A N D T H E S E N U M B E R S A R E A C C U R AT E A S O F S E P T E M B E R 1, 2 0 2 0 .

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line fashion checking reservations, guiding traffic, loading PPE, and thanking physicians for their hard work. At roughly 45 lb. for a box of PPE, volunteers loaded nearly half a million pounds into physicians’ cars over three weeks, sometimes loading for a near full eight-hour day in 100+ degree weather. When asked what this means to them, time and time again physicians relayed the hardship of trying to scour the internet for PPE, often paying exorbitant prices for miniscule amounts, if they can even find it, just to keep enough on hand to stay open on a day-to-day basis. “Amazing,” “necessary” and “grateful” were among the words that resounded from event to event. In San Luis Obispo and Santa Barbara counties alone, the Central Coast Medical Association distributed 220 boxes of PPE, reaching nearly 200 practices. That means more than $1 million worth of PPE was given to Central Coast physicians, at no charge to them, to jumpstart and restart efforts to provide care to the residents of the San Luis Obispo County and Santa Barbara County communities. CMA and its component medical societies continue to advocate for more resources for our state’s physicians. “To say that physicians and health care are essential at this time is an understatement, and PPE is an essential part of their ability to administer care,” said CMA President Peter N. Bretan, Jr, MD, “CMA and its county medical societies are proud to work with the state to ensure that physicians of California can keep their practices open, and keep themselves and their patients safe.” CMA and its component medical societies remain committed to distributing PPE across the state. Remaining surplus is being shared with medical groups who did not qualify under the parameters of the initial program—which was limited to practices with fewer than 50 providers—and are struggling with securing adequate PPE supplies or experiencing financial hardship because of the increasing costs of PPE. Interested groups can contact CMA at memberservices@cmadocs.org to learn more.

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I SI N T R E V D A

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CENTRAL COAST PHYSICIANS

F I S IE S A

OFFICE SPACE AVAILABLE GROUND-LEVEL UNIT at 2420 Castillo St, Suite 200, approx. 1800 square feet. Dr. Di Bartolomeo (Suite 100) will collaborate to restore the entire suite to the requirements of the new tenant (current ADA code, plans submitted by the tenant, ready to occupy, at no cost to them). Call 805.689.1222.

POSITIONS AVAILABLE The COUNTY OF SAN LUIS OBISPO is committed to serving the community with pride to enhance the economic, environmental, and social quality of life in San Luis Obispo County. Physician openings can be found at www.slocounty.ca.gov. The COUNTY OF SANTA BARBARA delivers exceptional services so Santa Barbara Countyâ€™s communities can enjoy a safe, healthy, and prosperous life. Physician openings can be found at www.sbcountyjobs.com.

DIGNITY HEALTH is a mission-driven, not-for-profit organization of more than 40 hospitals and care centers across California, Arizona, and Nevada. Physician openings can be found at dignityphysiciancareers.org. SANSUM CLINIC is the largest and oldest multi-specialty group between San Francisco and Los Angeles with over 180 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine. Physician openings can be found at www.sansumclinic.org/physician-provider-jobopportunities. Whether you are interested in employment, relocating your practice or joining the staff of one of our urgent care centers, TENET HEALTH most likely has an opportunity thatâ€™s right for you. Physician openings can be found at www.tenethealth.com/for-physicians/physician-careers.

If you would like to submit a listing to our Classifieds, contact ccma@ccmahealth.org. Listings are free for members with reasonable rates for nonmembers. 32

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Learn more about this valuable plan today! Mercer Health & Benefits Insurance Services LLC can provide you with free information, including features, costs, eligibility, renewability, limitations and exclusions.

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Visit www.CountyCMAMemberInsurance.com for a brochure and application, email CMACounty.Insurance.service@mercer.com or call 800-842-3761 to speak with a Client Advisor.