Next
The
Is Your Name in Here? Vaccine and Screen
n o i t a r e n e G
Valley Fever on the Central Coast
SUMMER 2017
I’ve been cancer free for 10 years.
O take piano lessons O play soccer with my friends O become class president
O spend time with my family O beat Cancer!
CCMC cares for over 14,000 children a year in our Acute Pediatrics Unit, Neonatal and Pediatric ICU’s, the emergency department, pediatric trauma center, and eight specialized outpatient clinics. 2
CENTRAL COAST PHYSICIANS
When Isa was just two years-old, she was diagnosed with leukemia. From her initial hospital stay, to treatments and follow-up appointments, Isa and her family always felt a special bond with the staff at Cottage Children’s Medical Center.
Dreams Made Real. Summer 2017
VOLUME 2, NUMBER 2 • SUMMER 2017
8 11 12 20 30 Summer 2017
{FEATURES} VACCINE AND SCREEN
PHYSICIAN OF THE YEAR NOMINATIONS OPEN
CCMA/CMA MEMBERS
{DEPARTMENTS} 6
RISK TIP: MEDICAL SCRIBES
32 MEN’S HEALTH: ED 34 PUBLIC HEALTH: VALLEY FEVER 36 NEW MEMBERS 38 IN MEMORIAM
DOCTOR IN TRAINING
THE LIFECYCLE OF LEGISLATION
CENTRAL COAST PHYSICIANS
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Letter from the CEO
THANK YOU Thank you to the members of the Central Coast Medical Association and California Medical Association. Without your support, we would not be able to continuously defend MICRA, advocate for specialty scope of practice that protects patients, and lead public health efforts, including the tobacco tax and passing a landmark immunization law. DANA GOBA
You are ensuring we have a strong membership foundation to keep us a dominant force in health care. We will continue working with Congress and the Trump Administration to develop a plan that ensures patients can access doctors to receive high-quality and affordable health care. Your membership also provides you with access an online health law library that contains nearly 5,000 pages of valuable information for physicians and their staff. In addition, you can speak with highly trained economic advocates with expertise in physician reimbursement and medical business issues are available to provide one-on-one help to improve your bottom line. If you are not part of CCMA/CMA, become a member at www.cmanet.org/join or by calling 800.786.4262. Together, we are stronger.
PRESIDENT David Dodson, MD PRESIDENT ELECT Jennifer Hone, MD SECRETARY Daniel Berger, MD TREASURER Joseph Schwartz, MD IMMEDIATE PAST PRESIDENT Charity Dean, MD, MPH DIRECTORS Jonathan Berkowitz, MD, PhD; Philip Delio, MD; Joseph Freeman, MD; Douglas Jacobson, MD; Bindu Kamal, MD; Samira Kayumi-Rashti, MD; Douglas Murphy, MD; and Juan Reynoso, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sam Ahmad, MD; Sharon Basham, MD; Ned Bentley, MD; Charity Dean, MD, MPH; David Dodson, MD; Jennifer Hone, MD; Chris Lumsdaine, MD; Doug Murphy, MD; Jenni Nix, MD; John Sawyer, MD; Joe Schwartz, MD; Steven Yao, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR David Dodson, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Penny Borenstein, MD, MPH; David Dodson, MD; Dana Goba, MBA; Jeffrey A Gold, MD; Katherine V Row, Elizabeth Schwyzer CONTRIBUTING PHOTOGRAPHERS American Cancer Society, County of San Luis Obispo, Elizabeth Schwyzer 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.
Best,
PLEASE DIRECT EDITORIAL INQUIRIES AND SUBMISSIONS TO: Central Coast Physicians 100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 T 805.683.5333 • F 805.364.5431 • E magazine@sbmed.org
Dana Goba Chief Executive Officer Central Coast Medical Association
ADVERTISING rates and information sent upon request. Acceptance of advertising in Central Coast Physicians in 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@sbmed.org.
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CENTRAL COAST PHYSICIANS
Summer 2017
TAKE NOTE
The widespread adoption of electronic health records (EHRs) has led to a number of unintended consequences— particularly a negative effect on doctor satisfaction and practice workf low. Medical practices have tried many different solutions to help alleviate the burden, and one of the most common solutions is the adoption of medical scribes. How does this affect the delivery of care? A number of studies suggest that scribes can enhance physician efficiency, improve physician satisfaction, and increase billing in a variety of clinical settings. Patient satisfaction can also increase, due to improved physician-patient interactions during office visits.
BY JEFFREY A GOLD, MD, PROFESSOR OF MEDICINE, DIRECTOR OF SIMULATION, OREGON HEALTH AND SCIENCE UNIVERSITY
A LACK OF TRAINING AND STANDARDIZATION
In spite of the rapid growth and potential benefits of scribes, the healthcare community has generated very little regulation or standardization for scribe training, and researchers haven’t conducted any assessment of scribes’ ability to safely interface with the EHR. Dedicated scribe organizations, which provide scribes for individual practices and healthcare organizations, may train recruits on basic medical terminology, note structure, documentation, and EHR basics. Other scribes may receive on-the-job training from the doctor who is their employer. There is no licensure requirement for scribes.
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CENTRAL COAST PHYSICIANS
Summer 2017
SURVEY SHOWS VARIABLE ROLES AND FUNCTIONS
To better understand the role and functionality of scribes, The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, and Oregon Health and Science University (OHSU) conducted a national survey of The Doctors Company’s members. This survey, with 335 respondents, suggested that scribes are supplied from different sources, have disparate backgrounds, and their training is highly variable:
• 55 PERCENT OF SCRIBES ARE TRAINED BY THE DOCTOR.
• 44 PERCENT OF SCRIBES HAVE HAD NO PRIOR EXPERIENCE.
• ONLY 22 PERCENT OF SCRIBES HAVE HAD ANY FORM OF CERTIFICATION.
• AROUND 24 PERCENT OF PRACTICES THAT USE SCRIBES HIRE THEM AS EMPLOYEES.
• NEARLY 13 PERCENT OF PRACTICES USE SCRIBE STAFFING AGENCIES.
The study also revealed wide variability in the tasks scribes are performing, including pure note writing, data entry (such as updating allergies), data extraction (such helping the doctor find information in the EHR), and order entry.
THE RISK OF ‘FUNCTIONAL CREEP’ The combination of rapid growth in scribe use, lack of standardized training, variability in scribe experience, and variability in both EHR exposure and EHR workflows raises the concern that scribes may introduce potential negative unintended consequences to either workflow or documentation.
Center, program director of the Pulmonary Critical Care and Critical Care Fellowships, and associate director of the Adult Cystic Fibrosis Center at OHSU. Contributed by The Doctors Company (thedoctors.com)
In addition to concern over the wide variance in scribe activities, healthcare providers are worried about “functional creep”—scribes being granted the authority to perform more complex functions in the EHR over time. Given the already large number of negative safety issues associated with these complex EHR functions, it’s imperative that the healthcare community create methodology to ensure scribes can be effectively trained and their competency assessed for safe and effective use of the EHR. Dr. Gold is director of the OHSU Simulation
Summer 2017
CENTRAL COAST PHYSICIANS
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CENTRAL COAST PHYSICIANS
Summer 2017
American Cancer Society Urges Simple PCP Plan BY KATHERINE V ROW, AMERICAN CANCER SOCIETY
KATHERINE materials V ROW, AMERICANcall CANCER SOCIETY For more information andBYpatient 800-227-2345 or visit cancer.org.
Primary care practices are uniquely positioned to counter spiraling rates of head and neck cancers and prevent many colon cancers. Collective action is needed.
HPV Vaccination Adolescent HPV vaccines prevent most cervical, vaginal, vulvar, and anal cancers, and are expected to prevent most penile and oropharyngeal cancers, yet rates of several of these cancers are increasing. It is not often we can prevent multiple cancers with a single tool. Concerted efforts are needed to increase vaccination so this opportunity is not lost. While other adolescent vaccine coverage in the US increased from 2007-2014, HPV vaccination rates did not, despite overwhelming evidence of safety and effectiveness. Only 1-in-3 girls and 1-in-5 boys in the US are fully vaccinated, compared to 70+% in Australia, Canada, and the United Kingdom and 97% in Rwanda. In October 2016, the CDC reduced the recommended number of doses from three to two for ages 9 to 14. Ages 15 to 26 still require three doses for full protection. If the 84% of unvaccinated girls who received at least one other vaccination at/after age 11 received concurrent HPV vaccine, coverage for at least 1 dose would have been over 91%.
Summer 2017
Increased vaccination can reduce racial and socioeconomic disparities in cervical and other HPV-associated cancers: Vaccination rates are lowest where cervical cancer rates are highest, in Appalachia, Southern and Mexican border states. Black and Hispanic women have higher cervical cancer incidence and mortality rates. African American, American Indian/Alaska Native, and low-income girls are least likely to complete the multiple-dose vaccine series. Increasing HPV vaccine uptake requires leadership and collaboration of the cancer, immunization and primary care communities. Successes in other countries and parts of the US, including Rhode Island and Philadelphia, indicate that increasing vaccine uptake is achievable. Consistent messaging during every well-child visits about the vaccine’s safety and efficacy, and the long-term protection against multiple cancers is needed. >>
CENTRAL COAST PHYSICIANS
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Understand the power of your recommendation as a primary care physician. The American Cancer Society’s five things PCP/healthcare providers can do: 1. Recommend colorectal cancer screening to patients ages 50 and older and younger patients at increased risk. 2. Measure the colorectal cancer screening rate in your practice, it may not be as high as you think. 3. U se evidence-based practice changes to systematize screening in your office. More screening doesn’t have to mean more work for you. 4. Understand colorectal cancer screening options. Educate your patients and staff on the various, often less expensive testing options. 5. M ake sure patients and staff understand that most insurance companies and Medicare are required to cover colorectal cancer screening.
Colorectal Cancer Screening
Colorectal cancer is the third most common cancer in the US and the second deadliest, yet it is one of the most preventable, when precancerous polyps are detected and removed during regular screening. The number of colorectal cancer cases is dropping thanks to screening, but we can prevent more: About 1 in 3 adults between 50-75 years old – some 23 million people – are not getting screened. Risk for colorectal cancer increases with age, nearly 90% of cases diagnosed are in adults age 50 years or older. For those at average risk, screening should begin at 50. African Americans are at highest risk with increased rates among Alaska natives, some American Indians and Ashkenazi Jews. Those with a first-degree family history of colon cancer, a personal history of inflammatory bowel disease and polyps are at increased risk. “My doctor never talked to me about it” is a leading patient-reported reason for procrastinating. Low awareness of colorectal cancer as a personal health threat and of the screening benefits are common. Many procrastinators are unaware of screening options, basing decisions to delay on fears of colonoscopy with its onerous prep, discomfort, and assault on modesty. Primary care physicians play a key role in ensuring adults age 50 and older are regularly screened for colorectal cancer with reminders during annual checkups. Recommended screening test options include colonoscopy, stool tests (FOBT), guaiac fecal occult blood test and (FIT) fecal immunochemical test, and sigmoidoscopy. Screening saves lives, but only if people get screened. The best test is the one that gets done!
Bench Staff Openings
®
William Sansum Diabetes Center, a major diabetes research institute, invites interested physicians to join our bench staff for upcoming studies and clinical trials in Santa Barbara. Experience with diabetes devices preferred. Contact Laura Lindsey 805.682.7640 ext. 221 llindsey@sansum.org
Gynecologic Health
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CENTRAL COAST PHYSICIANS
MLTU-QTAD-A-R 1
www.sansum.org 2219 Bath Street, Santa Barbara, CA 93105
Summer 2017
We’ve moved!
Central Coast Medical Association 100 N Hope Ave, Ste 14 Santa Barbara, CA 93110
Summer 2017
T 805.683.5333 F 805.364.5431 E sbcms@sbmed.org www.CCMAHealth.org
CENTRAL COAST PHYSICIANS
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The Central Coast Medical Association and California Medical Association
thank the following physicians for membership and support to protect physicians’ profession and patients.
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CENTRAL COAST PHYSICIANS
Summer 2017
Membership list as of May 9, 2017: Mark Abate, MD
Steven Niels Benaron, MD
Leanne Renee Buckner, MD
David Abbott, MD
Jeoffrey P Benson, MD
Roman Platon Bukachevsky, MD
Rushdi Abdul-Cader, MD
Edward Bentley, MD
Daryl Burgess, DO
Shields Brewster Abernathy, MD
James Benzian, MD
William E Buys, DO
Adam David Abroms, MD, FAAO
Lurleen Benzian, MD
David Alan Canvasser, MD
Mitchell Adler, MD
Daniel Berger, MD
Thomas Caruso, MD
Thomas Aguirre, MD
Jonathan L Berkowitz, MD, PhD
Kevin Michael Casey, MD
Sam Hosam Ahmad, MD
Michael Bernstein, MD
Alessandro A Castellarin, MD
Eric Michael Alltucker, MD
Julia Billington, MD
Kristin Nicole Castorino, DO
Thomas Allyn, MD
David L Birken, MD
Julie Adele Chacko, MD
Eric Rey Amador, MD
Scott Edward Bisheff, MD
Jinny Ei Chang, MD
Gilbert O Andersen, MD
Jerold Black, MD
Therese Eden Chan-McNabb, MD
Seth Eli Anderson, Jr, MD
Cindy Blifeld, MD
John G Chapple, MD
Thomas G Anderson, MD
Laurel Bliss, MD
Linda Sian Chen, MD
Thomas Robert Anderson, MD
Jeffrey Martin Bloom, MD
George C Cheng, MD
John Onssy Anis, MD
Lindsay Blount, MD
Dugald D Chisholm, MD
Andrew Martin Anthony, MD
Gary M Blum, MD
Dugald Donald Chisholm, MD
Joseph Aragon, Jr, MD
Mark C Bocchicchio, MD
Rosa Choi, MD
Robert L Avery, MD
Claudio Bonometti, MD
Bernard Chow, MD
Matthew Wayne Backer, MD
Michael Bordofsky, MD
Nicole Christiano, MD
Bruce R Bailey, MD
Penny Borenstein, MD, MPH
Katherine Chung, MD
Rollin C Bailey, MD
Allan Bosko, MD
Richard Y Chung, MD
Dennis Baker, MD
Jason Boyatt, MD
Paul Cisek, MD
Polly Baldwin, MD
Gary Bradley, MD
Eduardo Enrique Clark, MD
Steven Colin Barkley, MD
Rabindra Braganza, MD
Ramona Clark, MD
H Richard Barthel, MD
Sushila L Braganza, MD
Gregory Alexander Cogert, MD
Sharon L Basham, MD
Joel H Brandt, MD
Kevin Francis Colton, MD
Thomas Beamer, MD
Stuart Braverman, MD
Shauna Sunita Conry, MD
David L Bearman, MD
Rene Henry Bravo, MD
William H Coulter, MD
J Kevin Beckmen, DO
Daniel Brennan, MD
Stephen Couvillion, MD
Michael J Behrman, MD
James Brewer, MD
Carin Craig, MD
Richard A Belkin, MD
Jessica Brown, MD
Daniel F Craviotto, Jr, MD
If your name is not on this list, please contact CCMA as soon as possible regarding membership benefits and resources at 805.683.5333 or sbcms@sbmed.org. Summer 2017
CENTRAL COAST PHYSICIANS
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Daniel Edward Culhane, MD
Todd Michael Erickson, MD
Robert Lawrence Gong, MD
David Cumes, MD
Douglas Etsell, MD
Frank D Gonzales, MD
Daniel Curhan, MD
Julie Cecilia Fallon, MD
Liana Gonzalez, MD
David d’Ablaing, MD
Ryan James Fante, MD
Vishal Goyal, MD
Gustavo A Dascanio, MD
Todd Fearer, MD
Gregory Greaney, MD
Karen B DaSilva, MD
Edwin Feliciano, MD
Daniel Greenwald, MD
Kenneth Daughters, MD
Charles C Fenzi, MD
Howard Gregersen, MD
Thomas Daughters, Jr, MD
Kevin L Ferguson, MD
Howard Gross, MD
Bret Davis, MD
Yvonne Ferguson, MD
Khawar Gul, MD
Charity Dean, MD,MPH
Mary Elina Ferris, MD
Mukul Gupta, MD
Carol Del Ciello, MD
Michael Fisher, MD
Cory Gusland, MD
Julia Delgado, MD
David Fisk, MD
Gloria Hadsall, MD
Philip Delio, MD
Cary J Fitchmun, MD
Jeffrey Hadsall, MD
Vincent DeRosa, MD
Christopher Flynn, MD
William Hahn, MD
Kamlesh M Desai, MD
Peter Ford, MD
Thomas Walter Hale, MD
Robert Dichmann, MD
Daniel Fox, MD
Saida Hamdani, MD
Benjamin Diener, MD
P Joseph Frawley, MD
Van Hamilton, II, MD
Benjamin N Dirkx, DO
Joseph Dreyfuss Freeman, MD
Richard E Hammond, MD
David Charles Dodson, MD
Jeffrey Charles Fried, MD
Jeffrey Hankoff, MD
C Christopher Donner, MD
Robert W Fry, MD
Laurel Hansch, MD
Steven E Dosch, MD
Gregory John Frye, MD
George Robert Hansen, MD
William H Dunbar, V, MD
Priti Gagneja, MD
Muhammad Salman Ul Haq, MD
James Dunn, MD
John Gainor, MD
Bilal Harake, MD
Sean Early, MD
J Gregory Gaitan, MD
Patrick Joseph Haran, MD
Raul Benjamin Easton-Carr,
Bryan Leigh Gammon, MD
Lawrence Phillip Harter, MD
MD, MPH
Karina Marie Garcia, MD
Steven Hartzman, MD
Margaret L Echt, MD
Joanne Garofalo, MD
Richard Allen Hendricks,
Mark Keith Eckert, MD
William H Gausman, Jr, MD
MD, FAAO
James Egan, MD
Jeffrey M Gauvin, MD
William J Heringer, MD
John Elder, MD
William James Gealy, Jr, MD
David Hernandez, MD
Bryan Christian Emmerson, MD
Andrew Gersoff, MD
Alan Hersh, MD
Duard Enoch, III, MD
Brett A Gidney, MD
Jeff Herten, MD
Philip Ente, MD
Michael Gill, MD
Stephen A Hilty, MD
Patricia Erbe, MD
Rebecca D Golgert, MD
Bryce Richard Holderness, MD
Lisa Ercolini-Bhatia, MD
William Golgert, MD
Glenn Hollingshead, MD
If your name is not on this list, please contact CCMA as soon as possible regarding membership benefits and resources at 805.683.5333 or sbcms@sbmed.org. 14
CENTRAL COAST PHYSICIANS
Summer 2017
Stephen Raymond Holtzman, MD
Sharon Min Joo Kim, MD
Arthur Lee, MD
Taylor James Holve, MD
Sylvia Kim, MD
Wonuk Lee, MD
Jennifer Hone, MD, FACE
Heather S Kirschner, DO
Kyle Lemon, MD
Bradley E Hope, MD
Phillip Kissel, MD
Susan Lemon, DO
Stephen Hosea, MD
Robin P Knauss, MD
Hollanda Leon, MD
Randall Howard, MD
Bradley C Knox, MD
Darryl Chuck Ngin Leong,
Barbara A Hrach, MD
Oma Christine Knox, MD
MD, FAAP, MPH
Richard Huffard, MD
Brian Koch, MD
Robert Leposavic, MD
Robert Michael Hullander, MD
Roger Kohn, MD
Winifred K Leung, MD
Graham R Hurvitz, MD
Robert A Kolarczyk, MD
Edward N Li, MD
Kimberly Hurvitz, MD
Garry R Kolb, MD
Lawrence Bon Yen Li, MD
Farooq Husayn, MD
Karen S Kolba, MD
Myron Israel Liebhaber, MD
James Ingersoll, MD
Ernest Kolendrianos, MD
Donald Lindblad, MD
Douglas R Jackson, MD
Li-Sheng Kong, MD
Anne Little, MD
Douglas W Jacobson, MD
Alex Koper, II, MD
Keith Llewellyn, MD
Lauren Elaine Jacobson, MD
Jennifer Backer Kosek, MD
Suresh C Lodha, MD
Eric Jahnke, MD
Kenneth S Kosik, MD
Mark Logan, MD
Matti Rose Jansen, MD
Brent Kovacs, MD
Adam D Lowenstein, MD
Ali Javanbakht, MD
Mark Gerald Kowall, MD
Miguel Angel Loya, DO
David Oscar Javitz, MD
Kenneth Dale Krone, MD
Gary Michael Lucchesi, MD
Helen Anita John-Kelly, MD
Sanjay Kumar, MD
Theresa Lueck, MD
Karen Johnson, MD
Bradley Shawn Kurgis, DO
Bryant Jay Lum, MD
Steven Craig Johnson, MD
Christopher Kuzminski, MD
George Philip Lum, MD
Thomas Jones, MD
James L Kwako, MD
Christopher Lumsdaine, MD
Darol D Joseff, MD
Cedric Kwon, MD
Leslie Pedersen Lundt, MD
Daniel L Jurewitz, MD
Pierre G Labrecque, MD
Tomas M Machin, MD
Richard Kahmann, MD
Francis P Lagattuta, MD
Douglas J Mackenzie, MD
Bindu Kamal, MD
Erica J Lambert, MD
Robin Elizabeth Malone, MD
Frederic Kass, MD
Roger I Lane, MD
David Mandel, MD
Douglas Katsev, MD
Vikki Lane, MD
Kari Mathison, MD
Samira Kayumi-Rashti, MD
David LaPatka, MD
Rachel May, MD
Kathleen April Kennedy, MD
Derek Brian Lauritzen, MD
David L McAninch, III, MD
Rachel Kernoff, MD
Randolph Schuyler Lawrence,
John McCaffery, MD
Tamir H Keshen, MD
MD, FACS
Stanley McLain, Jr, MD
Case H Ketting, MD
Ann Miehyung Lee, MD
Arnold Medved, MD
If your name is not on this list, please contact CCMA as soon as possible regarding membership benefits and resources at 805.683.5333 or sbcms@sbmed.org. Summer 2017
CENTRAL COAST PHYSICIANS
15
William Meller, MD
Michael Paveloff, MD
Brian Michael Roberts, MD
Andrew Mester, MD
Nancy A Pawlik, MD
Joseph Andrew Robinson, MD
Toni Meyers, MD
Steven Pearson, MD
Timothy Leigh Rodgers, MD
Randall G Michel, MD
Terry J Perkins, MD
Vance Douglas Rodgers, MD
Kelli Miller, MD
Timothy J Perrin, MD
Anne O`Meara Rodriguez, MD
James F Mitchell, Jr, MD
Kim L Peters, MD
Alexandra E Rogers, MD
Alan P Moelleken, MD
John Petrini, Jr, MD
Anthony Rogers, MD
James Moghtader, MD
Dan Pham, MD
Anthony C Romero, MD
Mark T Montgomery, MD
David Phreaner, MD
Thomas George Ronay, MD
Mark Francis Mooney, MD
Dante Pieramici, MD
Margot Roseman, MD
Erin Greenspun Moore, MD
Matthew Alan Pifer, MD
Barry J Ross, MD
Alexander Eduard Morf, MD
Jordan Eliot Pinsker, MD
Lynn A Rudman, MD
Ralph Mozingo, DO
Dennis Plesons, MD
Andria Ruth, MD
Jamil Suheil Muasher, MD
Kathleen Pojunas, MD
Robert M Ruth, MD
Douglas P Murphy, MD
Jeffrey R Polito, MD
Brian David Santacrose, MD
James J Murray, Jr, MD
Laura Polito, MD
John Michael Sawyer, MD
Ian Blair Murton, MD
Michael Polo, MD
Matthew Bennett Scales, MD
Mark Musicant, MD
Mark Pomerantz, MD
James Scheib, MD
Robert M Nagy, MD
Richard Ponce, MD
Carl Schlosser, MD
Ma’an Nasir, MD
Robert Poulin, MD
Wesley G Schooler, MD
Gregg Newman, MD
Christian Harrington Powell, MD
Joseph Alan Schwartz, MD
Joann Ng, MD
Liza Presser Belkin, MD
Mary-Louise Scully, MD
Diane Nguyen, MD
Christopher S Proctor, MD
Stuart Segal, MD
Peter Nickel, MD
Ralph Quijano, MD
Roberta Sengelmann, MD
David Nomeland, MD
Susanne L Ramos, MD
Colin David Shafer, MD
Joseph A Nunez, MD
Kurt Ransohoff, MD
Ayesha Shaikh, MD
William Kiernan O’Callaghan, MD
Rahim Ali Raoufi, MD
William A Shapiro, MD
Cecilia O’Dowd, MD
David Raphael, MD
Michael Mourad Shenoda, MD
Michael Jon Omlid, MD
Thomas Reaper, MD
Eric F Shepherd, MD
Richard Onishi, MD
Cinnamon Hampikian Redd, MD
Virginia Ann Siegfried, MD
Andrew Osburn, MD
Jason M Redd, MD
Michael D Silvas, MD
William Pace, MD
Katherine Lynn Remington, MD
Mark Silverberg, MD
Edwin Pai, MD
Juan Reynoso, MD
John Sim, MD
Grace Eunmi Park, MD
Mark G Richmond, MD
Clinton Andrew Slaughter, MD
David Howard Paul, MD, PhD
Jonathan Lee Riegler, MD
Margaux Kelly Snider, MD
If your name is not on this list, please contact CCMA as soon as possible regarding membership benefits and resources at 805.683.5333 or sbcms@sbmed.org.
Sean Snodgress, MD
Vincent C Tubiolo, MD
Marc Zerey, MD
Alex Soffici, MD
Jon R Uyesaka, MD
David Zisman, MD
William Svend Sogaard, MD
Gary Van Deventer, MD
James Zmolek, MD
Mark Ian Soll, MD
Thomas Van Meter, MD
Marta Sovilj, MD
John Vander Heide, MD
Timothy M Spiegel, MD
Stephen J Vara, MD
Kenneth Glenn Starr, MD
Fred Steve Vernacchia, MD
Nathan C Steinle, MD
David Vierra, Jr, MD
Nicole Gaye Stern, MD
Christian J Voge, MD
Robert G Stewart, MD
John Vowels, MD
Noah Stites-Hallett, MD
Takashi Wada, MD
Owen Stormo, MD
Thomas D Watson, MD
Gary Strachan, MD
Marc W Weise, MD
Cathy Straits, MD
Timothy William West, MD
David Strumpf, MD
J Patrick Wheelock, MD
Alan Mark Sugar, MD
Anne White, DO
Mark Wayne Surrey, MD
Richard Wikholm, MD
Gerald Svedlow, MD
Avery Wilmanns, MD
Sasha Lynn Szytel, MD
Brett Wilson, II, MD
Brian Taber, MD
Mark Wilson, MD
Victor A Tacconelli, MD
Jay Winner, MD
Julie Taguchi, MD
Stuart Robert Winthrop, MD
Reyna Maria Talanian, MD
Michelle Withee, MD, MBA
Stefan Robert Teitge, MD
John Dean Wrench, MD
Heather Terbell, MD
Robert Simpson Wright, MD
Pamela Thiene, MD
Edmund M Wroblewski, MD
Peter Alan Thom, MD
Wilson Wu, MD
David S Thoman, MD
Michael L Wyatt, MD
Caleb Daniel Thompson, MD
Steven Yao, MD, MS
Christopher John Thrash, MD
Jeffrey Yim, MD
Casey Toole, DO
John Yoon, MD
Mandana A Toole, DO
Hsien Young, MD
Michael Trambert, MD
Steven H Young, MD
Rachel Trautwein, MD
Alois Zauner, MD
Lloyd Leonard Trujillo, MD
Steven Zelko, MD
Resident Members Natalie Achamallah, MD, MA, MS Anthony Alexander Anagnostou, MD Farnaz Pirayesh Baqai, DO Emily Chen, DO Terry Chen, DO Nathaniel Collins, MD Calida Danko, MD Chelsea Dean, MD Erin Nicole Dizon, MD Susie Xi-Feng Fong, MD Aimee Elizabeth Gough, MD Gregory Joseph Hammett, DO Camille Hunter, MD Lindsay Blake Katona, DO, MPH Daisy Lankarani, MD Alice Wen Lin, DO Jenna Raye Martini, DO Samantha Mathews, MD Yuri Matusov, MD Jenni Lynne Nix, MD Michael John Paisley, MD Michelle Pham, MD Spencer E Price, MD Anita Rai, MD Sang-Gyou Rho, MD Jennifer Lynn Roberts-Kelly, DO Aaron Russell, MD
If your name is not on this list, please contact CCMA as soon as possible regarding membership benefits and resources at 805.683.5333 or sbcms@sbmed.org.
Brenda Anais Ruvalcaba, MD
Frank R Gamberdella, MD
Peter Morris, MD
Priyanka Saharan, MD
Donald Gillies, MD
Karen Moyes, MD
Cameron James Selent, MD
David S Gillon, MD
Ted B Newman, MD
Wing Sun Tam, MD
Stephen L Hansen, MD
Charles H Nicholson, MD
Erin Michele Thompson, MD
Robert Harbaugh, MD
Pierre Nizet, MD
Burgundy R Tyrrel, MD
Marvin Harrah, MD
Thomas Ochsner, MD
Behnam Vahdata Nia, DO
Robert A Harway, MD
Robert W Olson, MD
Andrea Isabela Zambrano
Robert Hawkins, MD
Kevin C Osburn, MD
Sequera, MD
John Hans Hirschberg, MD
Stanley Ostern, MD
David Hirt, MD
Theodore Polos, MD
Bruce Howard, MD
Elliot Prager, MD
Robert Jacoby, MD
George Primbs, MD
W Blake Jamison, MD
William Rack, MD
Karl Kassity, MD
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Retired Members John Ackerman, MD Walter Anderson, MD Vida Baron, MD Maria I Barrows, MD Robert K Baum, MD Christel Bejenke, MD David A Bernhardt, MD Andrew Binder, MD Ernest Blakey, MD Charles Bradley, III, MD Blaine Braniff, MD William K Brokken, MD James Cavins, MD Mary P M Cederberg, MD Cary Conyers, MD Barry Coughlin, MD P Kent Cullen, Jr, MD Olga Daiber, MD David Doner, Jr, MD Robert I Fishburn, MD Richard Fulton, MD
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REASONS REASONS TO JOIN CMA AND YOUR
TO JOIN CMA AND YO COUNTY MEDICAL SOCIETY COUNTY MEDICAL SO
TOGETHER WE ARE STRONGER HEAD SEAT AT POLICY TABLE TOGETHER WE ARE STRONGER HEAD SEAT AT POLICY TABL California Medial Association (CMA) and its county Through aggressive political and regulatory
California Medial Association (CMA) and its county Through aggressive political and regulatory medical societies have represented California’s advocacy, CMA and its county medical societies medical societies have represented California’s advocacy, CMA and its county medical societie physicians for 160 years as the recognized voice are positioned as one of the most influential physicians for 160 years as the recognized voice are positioned as one of the most influential of the house of medicine. Together we stand taller stakeholders in the development and implementation of the house of medicine. Together we stand taller stakeholders in the development and implemen and stronger as we fight to protect patients and of health policy. and stronger as we fight to protect patients and of health policy. improve the health of our communities. We are a improve the health of our communities. We are a COLLABORATE WITH dominant force in health care – but all the great work COLLABORATE WITH dominant force in health care – but all the great work COLLEAGUES we do wouldn’t be possible without the support of COLLEAGUES we do wouldn’t be possible without the support of CMA and its county medical societies bring together members like you. CMA and its county medical societies bring tog members like you. physicians from all regions, specialties and modes of physicians from all regions, specialties and mod SHAPE THE FUTURE OF practice through leadership, collaboration, social and SHAPE THE FUTURE OF practice through leadership, collaboration, soc MEDICINE educational events, and community service. MEDICINE educational events, and community service. Members receive direct access to our state and Members receive direct access to our state and PROMOTE PUBLIC HEALTH national legislative leaders to influence how medical PROMOTE PUBLIC HEALTH national legislative leaders to influence how medical From tobacco use and obesity to prescription drug care is provide today and in the future. From tobacco use and obesity to prescription care is provide today and in the future. abuse and vaccinations, your membership dollars abuse and vaccinations, your membership doll PROTECT THE PROFESSION support forward-thinking public health advocacy to PROTECT THE PROFESSION support forward-thinking public health advoca Your membership affirms your commitment to the improve the health of Californians. Your membership affirms your commitment to the improve the health of Californians. medical profession and ensures physicians remain in medical profession and ensures physicians remain in PROTECT MICRA control of the practice of medicine. PROTECT MICRA control of the practice of medicine. CMA staunchly defends the landmark Medical Injury CMA staunchly defends the landmark Medical GET PAID Compensation Reform Act (MICRA) year after GET PAID Compensation Reform Act (MICRA) year after Members receive one-on-one assistance from CMA’s year, saving each California physician an average of Members receive one-on-one assistance from CMA’s year, saving each California physician an averag reimbursement experts, who have recouped $13 $75,000 per year in professional liability insurance reimbursement experts, who have recouped $13 $75,000 per year in professional liability insura million from payors on behalf of CMA physicians in premiums. million from payors on behalf of CMA physicians in premiums. the past seven years. the past seven years.
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CMA and its county medical societies produce publications to keep you up to date on the latest CMA and its county medical societies provide many publications to keep you up to date on the late opportunities to get involved, including opportunities health care news and information affecting the opportunities to get involved, including opportunities health care news and information affecting the to volunteer, serve on a committee, council or board, practice of medicine in California. to volunteer, serve on a committee, council or board, practice of medicine in California. and shape the future of the medical profession. and shape the future of the medical profession.
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Questions? Contact our Member Service Center at (800) 786-4262 or memberservice@cmanet.org. Summer 2017 CENTRAL COAST PHYSICIANS 19 Questions? Contact our Member Service Center at (800) 786-4262 or memberservice@cm 01.23.2017
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Summer 2017
How Central Coast hospitals are preparing young physicians for the field BY ELIZABETH SCHWYZER
It’s no secret that the path to becoming a physician is long and arduous. Four years of undergraduate study lead to four notoriously rigorous years of medical school. Next come three to seven years spent in a medical residency that culminates in an exhaustive board examination. Many board certified physicians then go on to a fellowship of one or more years before launching into practice.
54%
of medical residents go on to practice in the same state
For med school graduates, the hope is to match into a residency program at a hospital that offers the right kind of medical environment and training opportunities. For hospitals, the goal is often to train physicians who will go on to serve the local community. Nationwide, about 54 percent of medical residents go on to practice in the same state where they completed residency. California boasts the highest percentage of all states, retaining more than 77 percent of its resident physicians, according to figures from the Association of American Medical Colleges (AAMC). Here on the Central Coast, there are four medical residencies: three at Santa Barbara Cottage Hospital (SBCH), and one at Santa Maria’s Marian Regional Medical Center. We took a close look at each program to learn how residents are being prepared for careers in region and beyond, as well as what value those residents bring to the patients and communities they serve.
77%
California retains more than 77 percent of its resident physicians
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These four programs vary in terms of size, duration, the fields of medicine they emphasize, and the methods they use to prepare residents. Yet they share in common a commitment to high-level clinical training, a solid track record of helping residents secure positions in California if not on the Central Coast, and a collegial culture where residents are respected and even championed as valued members of the medical team.
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ts n e ti a p t a th n w o h s e v a h “Studies ” ls a it p os h g in ch a te t a s e have better outcom COTTAGE: SURGERY
Surgery is scheduled to begin in 30 minutes, and the doors of the operating room swing open to reveal a scene of preparation. Darkened computer screens circle the operating table, and fluorescent light bounces off the gleaming floor. At the side of the room, a technician in blue scrubs leans over a tray, busily arranging surgical equipment. She hums along absentmindedly to the song playing over the room’s sound system: Sade’s “Smooth Operator.” Into this scene strides Dr. Jeffrey Gauvin, flanked by two younger surgeons. Ebullient, stocky, with a booming voice and a sharp wit, Gauvin serves as the director of surgical education at SBCH, overseeing the training of surgical residents. The five-year program is one of the longest running surgical residency programs in the Western United States. It’s one of three medical residencies based at Cottage, which also offers residencies in internal medicine and radiology. When Gauvin is with his residents, he’s aggressively jocular, peppering his subordinates with affectionate taunting and fast-paced banter. Yet back in his office,
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talking about the surgery residency, Gauvin plays it straight as he shares his pride in the program, his 14 residents, and the value they bring to the hospital and the larger community. “Studies have shown that patients have better outcomes at teaching hospitals,” he noted, adding that because his is the only surgical residency at Cottage, his residents get a more hands-on experience than their counterparts at larger academic hospitals. “Some residents don’t operate a lot; mine do,” he explained. “We don’t have fellows here, so the residents don’t ever have to play second string.” In addition to their work at SBCH, Gauvin and his residents spend one afternoon each week seeing patients at Santa Barbara Health Care Center, a clinic operated by the county’s public health department. “Many of these patients have never seen a doctor in their lives,” Gauvin explained. In cases where surgery is necessary, SBCH provides their care. Surgical residents are involved in these cases at every step, from pre-op to surgery to followup appointments. Although he acknowledged that some patients are
Summer 2017
initially leery about having a resident involved in their surgery, Gauvin pointed out that residents have far more medical training than the nurses or technicians who would otherwise assist during surgery. Furthermore, he pointed out, residents are never left to perform surgeries unattended. “Patients need to be better educated about what it means when a resident is involved in their care,” Gauvin said, adding that he’s happy to explain the benefits to his patients. “I’ve operated on thousands of people,” he concluded, “and only one patient has ever refused to have a resident involved.” Gauvin also made a point to mention the balance of men and women in his current pool of residents. According to 2015-2016 data from the AAMC, men make up a larger percentage of residents in surgery. “Currently, I have seven men and seven women,” Gauvin boasted. “Very few surgery residency programs in the country can say that.” Among those Gauvin supervises is first-year resident Dr. Caitlin Loseth. Born and raised in rural Washington state and trained at the University of Nebraska, Loseth assumed she would remain in a large university setting for residency. She was drawn to Cottage after meeting residents who “seemed happier, and seemed like they knew how to operate.” “At the end of my first year, I have double the cases I need,” she explained, adding, “I knew I was someone who’d need more experience in order to feel confident. The more you get into surgery, the more you realize there is to know.” After she completes her residency and a fellowship, Loseth plans to return to Washington. “There’s a real need for surgeons in that region,” she said. “Where I grew up, the closest hospital was two hours away.” Loseth’s fellow resident, Dr. Hassan Moghaddas, shared her assessment of the program as collegial and welcoming, and used medical terminology to describe the hospital’s culture. “The people here are nice; it’s not malignant like some programs,” said the fourth-year resident of Iranian descent who was born in Germany and completed his medical training in Sweden. “Some programs have a rougher culture towards residents, a more old-school hierarchy,” he added. “We’re comfortable calling our attending physicians.” Among his other reasons for choosing SBCH for residency, Moghaddas mentioned the opportunity to operate frequently and the hospital’s trend toward minimally invasive surgical procedures. “It’s also in California,” he concluded. “It’s nice to be here.”
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COTTAGE: RADIOLOGY
Tune in to job market news these days, and there’s a lot of talk about the march of technology making certain jobs obsolete. It’s generally understood that no computer can do the work of a physician -- but what about radiologists? Dr. Chow isn’t concerned. As the medical education director of the radiology residency at SBCH, Chow has seen both the benefits and the limits of technological advances. “Radiology is not just ‘Where’s Waldo,’” Chow explained, his even tone betraying just a hint of amusement. “It’s processing data, using reasoning to come up with the most likely diagnosis. Often times, disease processes are complicated. An experienced radiologist can think through what’s likely and what’s not in ways a computer just can’t.” The issue is one he enjoys discussing with his residents. The four-year program currently includes 15 residents: radiologists whose professional future hinges on such questions. For fourth-year resident Dr. Richard Koff, the very appeal of radiology was in the human applications of the field. Before medical school, “I did research in the pharmaceutical industry, which I didn’t really like,” he explained. “I never really knew how or even whether my research would be applied.” In radiology, by contrast, Koff sees direct medical applications on a daily basis. He’s confident that computers won’t replace the role of the radiologist any time soon.
t o n s i y g “Radiol o Waldo’” s ’ e r e h just ‘W 24
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“The more I learn about the computerized technology available, the more I believe it will enhance the field,” Koff noted. “In the near future, I think artificial intelligence will make radiologists more efficient, and more crucial as interpreters.” Training residents to be excellent interpreters of X-rays is certainly part of Chow’s job, but it’s not the only way he sees the work of the radiologist. “Radiologists are not just image interpreters,” he explained. “We do minimally invasive procedures. We do consultation. We speak to doctors, give a likelihood of disease. Our job is not binary; it’s much more complicated.” For a period of time, Chow noted, the popularity of radiology dipped, due in large part to these concerns. Today, the field is enjoying a resurgence of popularity. The radiology residency program at Cottage receives more than 300 applications each year for four available spots, a number that’s steadily increasing.
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And despite the relative dearth of radiology positions on the Central Coast in comparison to positions for internists, the majority of Chow’s residents go on to jobs somewhere in the state. Over the past decade, 20 of the program’s 27 graduates have secured a position in California.
opportunity he credits to the hospital’s small size and reputation.
First-year resident Dr. Ashutosh Shelat, however, plans to go elsewhere. Shelat holds an MBA, and brings a business orientation to his work in medicine. Part of the appeal of Cottage, he explained, was the combination of public funding and private practice. But when it comes to striking out in the field, he’ll likely leave California.
Like Gauvin, Chow feels strongly that residents raise the level of medical care at Cottage.
“I look for long-term growth,” he explained. “The financial burden of going in to medicine instead of business was to the tune of five million dollars in lifetime earnings. State taxes are high in California; Texas has a more favorable income tax scheme.” While he’s here, though, Shelat is taking advantage of Cottage’s connections to industry. He’s currently involved in research with IBM Watson Health, an
Summer 2017
“Here, unlike at many larger institutions, we can make changes as residents,” he concluded. “We’re treated equally.”
“I think you get better care when you have a number of opinions of a patient diagnosis,” he explained. “As a patient, you get twice the attention at a teaching hospital that you would elsewhere. You also get more expeditious care.” And while the public perception of residents might be summarized by the phrase, “They’re experimenting on me,” nothing could be farther from the truth, Chow said. “The ACGME strictly regulates how we supervise residents,” he explained. “First-year residents don’t get to do the same things that fourth-year residents do. We operate on a ‘see one, do one, teach one’ model.”
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MARIAN: FAMILY MEDICINE Modern medicine requires most physicians to become specialists in a particular discipline. Whether it’s gynecologic oncology, abdominal radiology, pediatric gastroenterology, or one of more than 100 other fields, the emphasis is on training doctors to focus deeply on a relatively narrow range of human ailments.
“What can we do well in this community, with these resources and these patients?” he recalled asking his colleagues. After a thorough analysis that included visits to other residency programs, the team settled on family medicine, confident that their hospital could produce highly trained, quality family doctors.
Not so for practitioners of family medicine.
Marian Regional Medical Center is smaller than SBCH – it has 191 beds as opposed to SBCH’s 450 – but it serves a similar role in its community. Built in 2012, the busy hospital attracts patients from the larger region, provides both general and specialized care, and sees a wide variety of cases.
This summer, Dignity Health’s Marian Regional Medical Center in Santa Maria will honor five young physicians who have reached the culmination of a three-year residency in family medicine. The ceremony will mark the program’s inaugural graduating class. Medical Education Director Dr. David Oates served as a full-time ER physician at the hospital for many years before transitioning to his current role. Long before launching the residency program, Oates began meeting with a multi-disciplinary committee to consider which medical disciplines the hospital was best equipped to teach.
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“Family medicine is broad spectrum: We address patients from birth to the end of life,” Oates explained. “You need a lot of patients for this type of training, and we have them here.” One of the primary concerns of the hospital was to train physicians who would remain in the region to serve its population. Of the five residents completing their
Summer 2017
n o i t a d n u o f e h t e r a s n ia c i s y h p y l i m “Fa ” y t i n u m m o c e h for healthcare in t training this summer, three will go on to jobs as family medicine practitioners at Pacific Central Coast Health Centers. Among these residents is Dr. Farnaz Pirayesh, who, like the majority of her fellow residents, is a doctor of osteopathic medicine, or D.O., rather than an M.D. Drawn to Marian after spending a rotation at the hospital during medical school, Pirayesh “wanted to be part of something new,” and said she hasn’t been disappointed. “I think all doctors are inherently educators,” she stated, adding that the faculty at Marian have been “excited to teach, and very respectful.” For Dr. Stephen Herrick, a second-year resident, the appeal of Marian was in the diversity of patients, and the fact that the family medicine residency stood unopposed by any other residency program. “We get to see almost everything that comes through the hospital,” he noted. “There’s a huge population this hospital serves. We’re seeing a population that is traditionally underserved and providing them with excellent medical care and facilities.” First-year resident Dr. Scott Piazza chose Marian for his residency in large part because he and his wife wanted to settle on the Central Coast. He, too, spoke of the hospital’s diverse patient population. “On the floor of the hospital at any given time, you might have a
Summer 2017
Mixtec-speaking patient, a Spanish-speaking patient, the owner of a prominent restaurant, and the CEO of a local business,” he explained. One of the most rewarding aspects of practicing family medicine, these residents agreed, was the ability to empower patients by helping them understand how to improve their wellbeing. Piazza spoke of the biopsychosocial aspect of family medicine: the way one person’s health concerns affects a larger social network. “Often, we’ll see a pathology that impacts more than just the patient – they may be the sole breadwinner for a large family, and their illness creates real financial strain on the family system,” he said. At the same time, Herrick noted, a positive healthcare experience can have ripple effects through a larger social group. “We might talk to one patient about addressing their diabetes through diet, and they’ll tell a cousin who will come in to see us the following week,” he explained. To Oates, who oversees everything from the screening of medical residency applicants to staying up-to-date on the regulations put out by the Accreditation Council for Graduate Medical Education or ACGME, this is what it’s really all about: the training of family doctors who can address the health of everyone. “Family physicians are the foundation for healthcare in the community,” Oates said. “No matter where these physicians go, they’ll be of great benefit.”
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COTTAGE: INTERNAL MEDICINE Name a handful of physicians practicing in Santa Barbara, and chances are at least one of them will have received all or part of their training at SBCH. That’s due in large part to the internal medicine residency program, founded in 1978. According to director Dr. Andrew Gersoff, who joined the program in 1981, there are about 75 graduates of the program currently working in southern Santa Barbara County, and even more in the larger region. Today, the internal medicine residency boasts 29 residents: eight in each year of three-year program, and five more who spend just one preliminary year in the program before transferring elsewhere for residency. Many of these residents are native Californians, and many intend to stay in the state or the region following their residency. Among them is Dr. Spencer Price, a first-year resident who grew up in Santa Barbara and did rotations at SBCH during medical school.
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“Medicine was always a comfortable setting for me,” Price said of his decision to go into the field. “My mother worked at Cottage and Sansum. I remember coming to the old wing of Cottage when my grandfather had a triple bypass.” As Price sees it, Cottage has the benefit of being a community hospital that “functions like an academic center.” “We see the same complicated cases here that you would at a larger hospital, and we get to be hands-on,” he explained. Third-year resident Dr. Anita Rai, also a Santa Barbara local, said she chose Cottage because of the relationships she saw being fostered between residents and faculty. “The faculty are interested in our education and happiness,” she explained. “We’re well taken care of. The way people treat each other here is wonderful. The relationships you build in smaller hospitals are different; you often see staff and patients out in the community, which I love.” Following graduation from residency this summer, Rai
Summer 2017
will join the Santa Barbara-based practice of Dr. Mara Sweeney, an internal medicine specialist who also completed her residency at SBCH. Internal Medicine faculty member Dr. Lynn Fitzgibbons, who also oversees the HIV and infectious disease clinic at the County Public Health Department, described the residency as focusing on “clinical instincts and the art of medicine.”
such a positive experience at the hospital that they choose to come back and practice in the area. That is a tremendous benefit to the hospital and our community.” In addition to the faculty and administrators at
“The patient and the case are more than numbers and physical findings,” she explained. “We provide patients with the humanistic side of medical care.” Like many of her colleagues, Fitzgibbons grew up in Santa Barbara and is now raising her own family here. The familial and communityoriented nature of the internal medicine residency program is a source of inspiration and satisfaction for its director.
“We who participate in medical ed have the best jobs in the worldu”cation
“We who participate in medical education have the best jobs in the world,” Gersoff said. “To mentor and guide new physicians is really a great privilege. You get to see that work come to fruition when people become medical leaders in the community.” Gersoff was hesitant to single out anyone in particular, but in the course of conversation mentioned Dr. Charity Dean, Health Officer with the County Public Health Department; Dr. Babji Mesipam, Chief Medical Quality Officer for Cottage Health; and Dr. Michael Bordofsky, Medical Director of Visiting Nurse and Hospice Care, all of whom received their training in the program. “What’s most important is that the residency program and the entire administrative structure of the hospital cares about the residents’ wellbeing and has a vested interest in seeing that they receive excellent training,” Gersoff explained. “You hear stories about large hospitals where staff can be almost working against residents. That’s just not the case here.” According to Dr. Ed Wroblewski, Chief Medical Officer for Cottage Health, residents often “have
Summer 2017
Cottage, Gersoff credited physicians in the larger community who serve the residency program as “volunteer faculty,” offering their time and expertise to residents. Another point of pride for Gersoff: For the past four years, the internal medicine program at Cottage has had a 100 percent first-time taker board pass rate. Only 16 other categorical internal medicine programs in the nation can boast such a figure, Gersoff noted. Like his colleagues in surgery and radiology, Gersoff had much to say about the value of residents to the larger hospital community and the patients they serve. “Residents are the physicians who have most recently been through medical school, and have been exposed to the latest ideas and techniques,” he said. “They ask really difficult questions of attending physicians. It’s stimulating to have extra brains involved, to have residents who are there to ask ‘why and how’ questions. It keeps everyone on their toes.”
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HOW A BILL BECOMES A LAW Change is happening, and change will always happen. CMA remains focused on the future and will act boldly to shape the world of health care to support physicians and patients.
BILL IS INTRODUCED
Ruth Haskins, MD, CMA PRESIDENT
COMMITTEE HEARINGS COMMITTEE HEARINGS IF PASSED (SENT TO OTHER HOUSE)
FLOOR ACTION
FLOOR ACTION RETURNED TO ORIGINAL HOUSE
IF PASSED WITH AMMENDMENTS IF PASSED WITHOUT AMMENDMENTS
BILL GOES TO GOVERNOR IF ORIGINAL HOUSE CONCURRS
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IF NOT VETOED
MOST BILLS BECOME LAW JAN. 1 OF THE NEXT YEAR
Summer 2017
THE LIFECYCLE OF
Legislation
FROM IDEA INTO LAW
The California Medical Association (CMA) is the largest, most influential medical organization in California, and an aggressive advocate for doctors and patients. CMA relies on the involvement of its members to communicate the physician vision of medical care to the public, to lawmakers and to the regulators who determine how medicine is practiced. An idea is born: Ideas for new health policy are born in a number of places. One of them is in the hearts and minds of the physicians of California. CMA members can directly influence the association’s health care advocacy agenda by submitting a resolution for consideration to the CMA House of Delegates. CMA policy is established: Resolutions are assigned to councils and subcommittees for study and development, then opened up for discussion by your physician colleagues before recommendations are developed for action by the CMA Board of Trustees. Many of CMA’s sponsored bills have their genesis in an idea submitted by our physician members. While not all CMA policies result in direct legislative action, they are used to guide CMA’s positions on the hundreds of health care bills that are introduced into the State Legislature each year. Bills are introduced: The California Legislature operates on a two‐year session. Each year, primarily in January and February, bills are introduced by lawmakers for consideration. The governor may also call a special session of the Legislature to deal with specific subjects. CMA takes a position: Each year, with physician input, CMA monitors more than 500 bills and takes a public position on around 200 bills. Those positions include watch, support, oppose,
support if amended and oppose unless amended. CMA also may choose to sponsor or co-sponsor legislation that is of critical importance to the physicians of California. Bills move through the process: If a bill is to become law, it must be passed out of one or more committees, approved by a simple majority of both houses, and signed by the governor. Laws ordinarily take effect on January 1 of the following year. Briefly, a bill progresses through the following steps: 1. A bill is introduced. 2. The bill is heard in one or more committees in its house of origin (either Senate or Assembly), including public testimony. 3. If the bill passes out of committee(s), it goes to the house floor for a vote. If it passes out of the house, it is sent to the other house for consideration following the same process described above. 4. If approved by both houses, the bill goes to the governor for signing. 5. The governor has three choices: sign the bill into law, allow it to become law without his or her signature, or veto it. A governor’s veto can be overridden by a two-thirds vote in both houses. CMA monitors and protects physician interests: CMA’s powerful government relations team works tirelessly with legislators to educate them on how legislation could enhance or threaten patients’ health or physicians’ ability to practice medicine. Their activities include reading and tracking bills and amendments, shaping bill language, meeting with legislators, testifying in committee, conducting research, and preparing policy papers and position letters. Every year, CMA not only supports and shapes the development of valuable health care policy, but the association also stops a number of harmful legislative proposals.
For more information on CMA’s legislative advocacy, and how you can get involved, visit www.cmanet.org.
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MEN’S HEALTH
Erectile Dysfunction
BY DAVID DODSON, MD
ED has been much discussed these past 17 years or so since Viagra was introduced. Yes – 17 years. The patent is about to expire! Has anyone else had patients balk at the $40 plus per pill price tag?
Mercifully, that should change soon as the patent on Viagra is set to expire later this year and hopefully the price for PDE 5 inhibitors, including Viagra, Levitra, Cialis, and Stendra will fall from their current stratospheric heights. Compounding the problem is insurance companies that seldom cover these drugs, especially since the prices have skyrocketed. One work-around is that sildenafil is now available as Revatio, which is a 20 mg preparation indicated for pulmonary hypertension which sells
sexually is something the great majority of men have no problem relating to. My friend Dr. Abraham Morgentaler, a urologist whose Boston practice is called Men’s Health Boston, wrote a book called “The Viagra Myth”, which is that Viagra solves all men’s sexual problems. Obviously it does not. Other causes should always be looked for including pudendal neuropathy – an occupational hazard for professional cyclists, many of whom develop ED; drugs including diuretics, beta blockers, and other antihypertensives; poorly controlled diabetes; depression; and alcohol and other substance abuse. A complaint of ED should always result in a history and physical directed at these and other factors. Prime among these is the quality of the man’s relationship. Is there a willing partner? Is there mutual love, affection, and attraction? These are not so important for young men, but as men mature such factors become increasingly important. Nothing will kill a mature man’s sexual performance as quickly as the infamous 3 A’s: alcohol, anger, and ambivalence. What about the role of testosterone? In general, testosterone drives libido, not performance. A man who can perform but doesn’t care to often has low T, which a PDE5 won’t help. Think obesity, diabetes, sleep apnea – factors that lower testosterone. Guys who want to perform but cannot are more likely to benefit from PDE5 therapy, but they need help to control their vascular risk factors before even a PDE5 won’t help – hence the importance of taking ED seriously as an opportunity to intervene before atherosclerosis takes a more serious toll. As always, we invite input on this and other Men’s Health topics from our readers. Please submit correspondence to sbcms@sbmed.org.
“Nothing will kill a mature man’s sexual performance as quickly as the infamous 3 A’s: alcohol, anger, and ambivalence.” for about 90 cents per pill or even less. At this price, even taking 5 tabs to equal the 100 mg dose of Viagra would represent a huge savings, on the order of $35 dollars or so per dose. At that rate, very few men would refuse to pay, even without insurance coverage. Should we care about ED? Is it important? The answer is it can certainly be important because ED is well established as a potential harbinger of coronary artery disease, for the simple reason that the arteries responsible for erectile function are roughly 1/3 the caliber of the epicardial coronary arteries, and as a result, as atherosclerosis – the #1 killer – progresses, it may knock out erectile function several years before CAD rears its ugly and often fatal head. Thus eliciting a history of erectile dysfunction can be an opportunity to intervene in coronary risk factors such as systemic inflammation, smoking, diabetes, hypertension, and hyperlipidemia. In this way ED provides a potential to help patients make important, even life-saving improvements in their health. And while the distant risk of CAD may be too abstract for many patients to relate to in a way that results in their taking the steps necessary to prevent a heart attacks several years in the future, the immediate prospect of losing the ability to perform
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CENTRAL COAST PHYSICIANS
Summer 2017
2017 Physician of the Year call for nominations deadline: September 5, 2017 The Central Coast Medical Association (CCMA) is accepting nominations for a member physician(s) to receive the Physician of the Year Award. The award will be presented at the year-end annual membership meeting. The nominee must be a member physician who practices in San Luis Obispo or Santa Barbara County and who meets some or all of the following criteria: Exemplifies the principles of CCMA’s mission of promoting the science and art of medicine, the care and well-being of patients, the protection of the public health, and the betterment of the medical profession Has practiced for a reasonable period of time in this area Has participated in organized medicine Has worked to improve the quality of health care Has contributed to the education of other physicians Has engaged in community service and other activities outside of medicine Include in the submission Nominee’s name Reasons for nominating CCMA member submitting the nomination Send nomination to E sbcms@sbmed.org F 805.364.5431 M 100 N Hope Ave, Ste 14, Santa Barbara, CA 93111
Past Honorees 2016 Mark Soll, MD, San Luis Obispo County 2016 Ayesha Shaikh, MD, Santa Barbara County 2015 Fred S Vernacchia, MD, San Luis Obispo County 2015 Daniel Brennan, MD, Santa Barbara County 2014 Kurt Ransohoff, MD, Santa Barbara County 2013 Michael Bordofsky, MD, Santa Barbara County 2012 R Bruce McFadden, MD, Santa Barbara County 2011Summer Rollin C2017 Bailey, MD, Santa Barbara County
2010 Gilbert O Andersen, MD, Santa Barbara County 2009 Myron I Liebhaber, MD, Santa Barbara County 2008 Ralph Quijano, MD, Santa Barbara County 2007 Elliot Schulman, MD, Santa Barbara County 2006 Edward S Bentley, MD, Santa Barbara County 2005 Barry J Coughlin, MD, Santa Barbara County 2004 James V McNamara, MD, Santa Barbara County 2003 Robert A Reid, CENTRAL MD, SantaCOAST Barbara County PHYSICIANS 33
Public Health
Update
Learn More Valley Fever Center for Excellence http://vfce.arizona.edu Resources for physicians, including tutorials and CME. Order a printed copy of the Tutorial for Primary Care Professionals by emailing vfever@email.arizona.edu. Epidemiologic Profile of Coccidioidomycosis for San Luis Obispo County bit.ly/slo-valley-fever Local epidemiology Coccidioidomycosis among
Valley Fever on the Central Coast
Workers Constructing Solar Power Farms, California, USA, 2011–2014. https://dx.doi.org/10.3201/ eid2111.150129
Improving Early Diagnosis and Care
Local case study published in
By Penny Borenstein, MD, MPH, Health Officer/Public Health Director, County of San Luis Obispo
21(11).
Emerging Infectious Diseases,
Cough, weight loss, exhaustion: the symptoms of Valley Fever don’t loudly announce its presence. The main risk factor, exposure to soil and dust in endemic areas, could be present for nearly everyone we see here on the Central Coast. For physicians, that makes Valley Fever a disease we sometimes begin to suspect only after other likely possibilities are eliminated. For patients, that can mean uncomfortable tests, unnecessary medication, and weeks or months of anxiety as symptoms worsen. Valley Fever has a way of leaving everyone in the room frustrated and worried.
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CENTRAL COAST PHYSICIANS
Summer 2017
How can we improve the accurate, timely diagnosis of Valley Fever here on the Central Coast? I’d like to ask all physicians—especially those practicing in primary care, hospital, and emergency department settings—to be aware of the particular risk of Valley Fever in our region.
Valley Fever on the Central Coast The fungus that causes Valley Fever, Coccidioides, lives naturally in the soil. It is highly endemic in Arizona and some areas of California, including San Luis Obispo County, Monterey County, and the Central Valley region. When this soil is disturbed—by wind, construction, even gardening or cycling—people can breathe in the fungal spores and develop coccidioidomycosis, also known as cocci or Valley Fever. More than 60 percent of people who become infected do not experience any symptoms; around 30-40 percent develop flulike symptoms. Most people get well on their own within weeks. Between one and five percent experience a disseminated form of the disease that can cause lifelong complications or death. Expected Increase in 2017 Valley Fever appears to be on the rise in 2017. California’s extended drought followed by this year’s rainy winter have created conditions for Coccidioides to proliferate in the soil. As the soil dries and people spend more time outdoors, infections increase. We often see diagnoses peak in October, after patients experience prolonged illness and other causes have been ruled out. I encourage you to be vigilant this summer and throughout the year.
Early Diagnosis Matters With Valley Fever, the benefits of early diagnosis are profound. It means we are subjecting patients to fewer diagnostic tests, with the related costs, discomfort, and potential complications. We avoid providing therapies—such as antibiotics or corticosteroids—that can cause adverse effects. It means we’re able to recognize complications earlier, possibly limiting the most dangerous forms of dissemination. Early diagnosis also provides relief in the form of a clear answer. As Dr. John Galgiani for the Valley Fever Center for Excellence at The University of Arizona explains: “By giving an illness a specific name, it removes the patient’s fear of the unknown. Diagnosis has always been a major contribution by clinicians, and the value of diagnosis to patient satisfaction should not be underestimated.”
Summer 2017
Taking Action I appreciate the clear five-step approach suggested by the team at the Valley Fever Center for Excellence: C – Consider the diagnosis. In short, think Valley Fever. The resources below include suggestions for routine indications to test for Valley Fever. O – Order the right tests. This commonly begins with a serological test; if positive, the lab then performs a titer. Skin tests and chest X-rays indicate prior exposure but do not specify current infection. C – Check for risk factors. People experiencing immunosuppression, diabetes, or pregnancy appear to be at increased risk for complications. Men appear to experience more complications than women, older adults more than children, and people of African and Asian-Pacific descent more than other groups. C- Check for complications. Even in patients without these risk factors, the disease can disseminate to the lungs or other parts of the body. I – Initiate management. This includes monitoring the course of infection and determining if therapy is appropriate. For clinical specifics, I encourage you to consult the Tutorial for Primary Care Professionals and free CME from the Valley Fever Center for Excellence at http://vfce.arizona.edu.
Working Together Valley Fever is here to stay on the Central Coast. The way our medical community responds to this challenge will make a difference both for our patients and for our profession’s collective understanding of this serious and often-overlooked illness. As Health Officer, I’d be remiss if I didn’t remind you that prompt reporting of Valley Fever supports our efforts to understand the regional epidemiology of the disease and develop targeted interventions. I also encourage you to talk with your colleagues, share your experiences, and help us all do a better of job of recognizing and treating Valley Fever. Please feel free to contact me to discuss your experiences and needs as we take on this challenge.
CENTRAL COAST PHYSICIANS
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11 New
The Central Coast Medical Association welcomes the following physicians as members
...and even more on the way. Ryan Fante, MD Ophthalmology Sansum Clinic Santa Barbara 681.8950
Matthew Pifer, MD Orthopedic Surgery The Spine & Orthopedic Center Santa Barbara 563.3307
Nicole Stern, MD Urgent Care Sansum Clinic Santa Barbara 563.6110
Liana Gonzalez, MD Internal Medicine Sansum Clinic Santa Barbara 681.7500
Matthew Scales, MD Emergency Medicine French Hospital San Luis Obispo 543.5353
Timothy West, MD Neurology Sansum Clinic Santa Barbara 681.7500
Grace Park, MD Internal Medicine Sansum Clinic Santa Barbara 681.7500
Margaux Snider, MD Emergency Medicine Arroyo Grande Community Hospital Arroyo Grande 489.4261
Anne White, MD Internal Medicine Sansum Clinic Santa Barbara 563.6180
RESIDENTS Lindsay Katona, DO, MPH Internal Medicine Santa Barbara Cottage Hospital
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CENTRAL COAST PHYSICIANS
Yuri Matusov, MD Internal Medicine Santa Barbara Cottage Hospital
Spencer Price, MD Internal Medicine Santa Barbara Cottage Hospital
Summer 2017
Do you know What, When and How to Report Child Abuse?
FREE ONLINE ONLINE CME CME COURSE! COURSE! FREE Course can be offered in a group training using one log-in. Contact Leslie Iacopi at (415) 882-5167 for more details. Course developed by • Course developed by the Child Abuse Prevention Center Prevention Center
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ALL healthcare providers (MD, DO, RN, PhD, LCSW, MSW) are encouraged to take this valuable course! Register Register NOW NOW at: at: Register NOW at: http://www.imq.org/education/caprrc.aspx http://www.imq.org/education/caprrc.aspx http://www.imq.org/education/caprrc.aspx Summer 2017
CENTRAL COAST PHYSICIANS
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AB 72 What physicians need to know
July 1, 2017, AB 72 will take effect On July 1, 2017, a new law (AB 72) will take effect that will change the billing practices of non-contracted physicians providing non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law, signed in 2016, was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. CMA is aware of the potential adverse impacts of the new law on our physician members and has dedicated significant resources in order to achieve the best possible outcomes for physicians in light of the new billing restrictions.
AB 72 Resources • CMA FAQ: “A Physician’s Guide to AB 72: Questions and Answers” • Instructions and Sample Form for Obtaining Patient Consent Under California’s New Law on Billing and Payment for Out-of-Network Services at In-Network Facilities • Sample letter to appeal to the payor for additional reimbursement • Billing Requirements Under California’s New Law on Billing and Payment for Out-of-Network Services at In-Network Facilities • CMA On-Call Document #7508: “Non-Contracting Physicians” • On-Demand Webinar (5/17/17): Assembly Bill 72: What Physicians Need to Know About the New Law on Payment and Billing for Out-OfNetwork Services
Join Now!
These materials are exclusively designed for members of CMA and component medical societies. Call the CMA Member Resources line during normal business to join and have immediate access to this toolkit: (800) 786-4262. Ask about our new monthly payment plan for membership.
Call (800) 786-4262 for more information 38
CENTRAL COAST PHYSICIANS
Summer 2017
In Memoriam
Summer 2017
John Mark Richards, MD February 23, 1919 – February 16, 2017 John Mark Richards of Santa Barbara was born February 23, 1919 to George and Florence Richards in Stony Point, New York. John graduated from Blair Academy in NY, entered Cornell University in Ithaca, New York in 1936; received BA and MD degrees in 1940. Served his residency at the New York Eye and Ear Infirmary. He married his childhood sweetheart, Katherine Peck, on July 5, 1938. The family moved to Santa Barbara, CA in 1947 where he established his medical practice in eye surgery. He performed some of the first intraocular lens surgeries and YAG Laser treatments in Santa Barbara; held several eye-re-
lated patents, and built the professional center building at 1919 State Street in 1963. John died the morning of February 16, 2017 at the age of 97+ at his home in Santa Barbara. He was predeceased by his wife of 60+ years, Katherine Peck Richards, on October 11, 1999 and his son, Edward J. Richards, on March 22, 2014. He is survived by his daughter Jean L. Richards, son John P. Richards, daughterin-law Judi Richards, three granddaughters: Barbara (Richards) Minor of Bakersfield, CA; Madeleine (Richards) Myers of Susanville, CA; Susan (Richards) George of Janesville, CA; eight (8) great-grandchildren, and his brother George Douglas Richards of Laurel, New York. Originally published in the Santa Barbara News-Press.
Daniel Martin Joseph, MD March 16, 1933 – January 10, 2017 Dr. Daniel Martin Joseph passed away on January 10 peacefully at his home, in front of a warm fire being held by his family and dear friends. Dan was born on March 16, 1933 in West Haven, CT to Jenny and Philip Joseph. He attended Yale, graduating with a B.S. in Zoology in 1959. He attended New York Medical College from 1960-1964. He completed his residency in OB-GYN at Kaiser Permanente Hospital in LA from 1961-1964. Dan was in private practice in Santa Barbara with partners Drs. James Shipp and Robert Reid. He listened with great attention to his patients, respecting and caring for each as an individual. He was helpful at each stage of life, being on the forefront of openly discussing women’s issues, giving seminars on menopause, and treating with bioidentical hormones long before it was en vogue. After retiring and being diagnosed with
Parkinson’s disease, Dan began painting with encouragement and tutelage from his dear friend and local artist Kristena West. He found great satisfaction, calm and therapeutic release in putting paint on canvas. His art has been displayed and sold at Hospice of Santa Barbara and many other exhibits, including in his home. Many beautiful expressions of his creativity adorn the walls of he and his wife Sara’s home. As an incredible human being, physician, artist, husband and father, Dan always acted with honesty, generosity, dignity and heartfelt caring for others. Dan is survived by Sara Joseph, his wife and partner of 41 years; his brother and sister-inlaw Nate and Linda Joseph of North Haven, CT; children Danelle Joseph of Ojai, Philip and Caroline Joseph of San Diego, David and Jasmine Joseph of Brooklyn, NY, Chris Joseph and Leann Sgobba of Santa Ynez; and four grandsons Noah, Alec, Andrew and Dean. Originally published in the Santa Barbara Independent.
CENTRAL COAST PHYSICIANS
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Central Coast Medical Association 100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 CHANGE SERVICE REQUESTED
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