Central Valley Physicians

Summer 2016

PAVING THE PATH

FOR FUTURE

DOCTORS Celebrating USCF Fresno Graduates Intern Arambula Goes On-Call New-To-Practice Physicians Friends Beyond Medicine

Success.

It’s what California’s finest physicians strive for... and what CAP can help you achieve.

Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand the realities of running a medical practice, and are committed to supporting you with a range of valuable programs and services. These include a 24-hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.

Protect Your Online Reputation With CAP’s Free Physician’s Action Guide!

The Physician’s Online Reputation Action Guide can help you build a strong and positive reputation.

Learn how to: • Encourage patients to post positive reviews.

• Appropriately respond to negative reviews.

• Optimize social media to establish your credibility.

Request your free electronic or hard copy today!

800-356-5672 | CAPphysicians.com/ReputationPro 2

CENTRAL VALLEY PHYSICIANS

Summer 2016

VOLUME 1, NUMBER 3 • SUMMER 2016

22 24 28 34 36

{FEATURES}

{DEPARTMENTS}

NEW-TO-PRACTICE PHYSICIANS

14 IN THE NEWS

INTERN ARAMBULA GOES ON-CALL

New faces and Announcements

46 LEAVING A LEGACY 48 PUBLIC HEALTH UPDATE:

Climate Change

PAVING THE PATH FOR FUTURE DOCTORS

50 OFFICE MANAGER’S FORUM:

FRIENDS BEYOND MEDICINE

53 HOBBIES AT A GLANCE

USCF FRESNO GRADUATES

Summer 2016

Committed to Improving Quality Health Care

51 IN MEMORIAM 54 NEW & RENEWING MEMBERS

CENTRAL VALLEY PHYSICIANS

3

Letter From The Executive Director

FIRST YEAR AT FRESNO MADERA MEDICAL SOCIETY CHECK Yep, yesterday was my one year anniversary at Fresno Madera Medical Society and I celebrated by working a 12-hour day that included four NICOLE BUTLER meetings, a working lunch with a dozen doctors, and a Scholarship Foundation dinner meeting where we gave $25,000 to medical students from the Central Valley. Okay, I know that is a normal work day for most doctors, and I am not complaining one bit. In fact, I feel lucky to be part of such a great organization.

We are working on so many things right now I don’t even know where to begin. Membership is still a priority—even though we are half way through the year new members can still join at a prorated rate. This is a great way to try our services and member benefits, so now is the time to give it chance if you are still on the fence.

Current membership growth—drum roll please...is at 15percent, so we exceeded our goal of 13 percent. I am thrilled to share that we have never had this many members in the history of Fresno Madera Medical Society. Never! In addition, our growth of new members is second in the state behind the San Francisco Medical Society. Those that know me know that I would much rather be in first, so we will continue working with doctors to educate them about membership benefits and the importance of being a member of the medical society.

Our next big project is our Summer Meltdown fundraiser. This event is going to be held on Friday, August 12, at Clovis Veterans Hospital and ZDoggMD will be the entertainment for the evening. For those of you who don’t know him—no worries, I didn’t either—he is really a doctor and he’s from the Central Valley. He grew up in Clovis and graduated from Clovis West High School, and went on to UC Berkeley—which he completed in three years—and attended medical school UC San Francisco. He is currently practicing medicine in Las Vegas and an is an internet celebrity known for his music videos, parodies, and comedy sketches about contemporary medical issues and working in the medical field. Take a look at some of his YouTube videos; he’s hysterical! We haven’t had this type of event in a long time, so please come join us for a fun evening and support the Scholarship Foundation and Fresno Madera Medical Society.

Honestly, I can’t believe it has already been a year!

Thank you,

PRESIDENT Hemant Dhingra, MD PRESIDENT-ELECT Alan Kelton, MD VICE PRESIDENT Trilok Puniani, MD SECRETARY-TREASURER Cesar A. Vazquez, MD PAST-PRESIDENT A.M. Aminian, MD BOARD OF GOVERNORS Christine Almon, MD, Alan Birnbaum, MD, Jennifer Davies, MD, Joseph Duflot, MD, William Ebbeling, MD, Don Gaede, MD, David Hadden, MD, Christina Maser, MD, Ranjit Rajpal, MD, Oscar Sablan, MD, Katayoon Shahinfar, MD, Roydon Steinke, MD, Jessica Lee, MD CENTRAL VALLEY PHYSICIANS EDITOR Alan Birnbaum, MD MANAGING EDITOR Nicole Butler EDITORIAL COMMITTEE Alan Birnbaum, MD - Chair, Don Gaede, MD - Associate Editor, Virgil Airola, MD, Hemant Dhingra, MD, Roydon Steinke, MD, Cesar Vazquez, MD, Nicole Butler CREATIVE DIRECTOR Sherry Lavone Williamson www.sherrylavonedesign.com CONTRIBUTING WRITERS Alan Birnbaum, MD, Erin Kennendy, Nicole Butler, Millie Thao, Ronald Morton, MD CONTRIBUTING PHOTOGRAPHERS Nicole Butler, Mike Steenburgh CENTRAL VALLEY PHYSICIANS is produced by Fresno Madera Medical Society PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: Central Valley Physicians 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720 Phone: 559-224-4224 • Fax: 559-224-0276 Email Address: nbutler@fmms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9 a.m. to 5 p.m.

Closed from 12 to 1 p.m.

MEDICAL SOCIETY STAFF Nicole Butler - Executive Director Alissa Fowler - Marketing Manager and Becky Gentry - Receptionist CMA HOUSE OF DELEGATES REPRESENTATIVES Hemant Dhingra, MD*, A.M. Aminian, MD, Patrick Golden, MD, Brent Kane, MD, Ranjit Rajpal, MD, Oscar Sablan, MD, Roydon Steinke, MD, Toussaint Streat, MD ALTERNATES Alan Kelton, MD*, Naeem Akhtar, MD, Praveen Buddiga, MD, William Carveth, MD, Trilok Puniani, MD, Swarnpal Sekhon, MD *Automatic Delegate

Nicole Butler Executive Director Fresno Madera Medical Society

4

CENTRAL VALLEY PHYSICIANS

Summer 2016

A+ Medical Suite Available at Civic Center Square

The Place to be in Downtown Fresno

(

• A campus-like, lushly landscaped urban setting in the heart of Fresno’s Central Business District with easy access to all freeways. Just minutes from Community Medical Center

Call Today

• Convenient parking in adjacent parking structure.

• Starbucks, restaurants, banks and other retail services conveniently within easy walking distance.

(559) 485-4700 Visit us online

Contact Jaime McLelan for more information or to schedule a tour jaime@civiccentersquare.com

A message from our Editor > Alan M. Birnbaum, MD

Tithing Tobacco

ABOUT THE AUTHOR ­ Alan M. Birnbaum, MD, is boardcertified in Adult Neurology and is with Spruce Multispecialty Group. Dr. Birnbaum is currently Medical Director of the Saint Agnes Medical Center Stroke Program and a Board Member of Fresno Madera Medical Society.

6

CENTRAL VALLEY PHYSICIANS

Preliminary polls encouragingly indicate that Californians substantially favor this November’s California Medical Societysponsored tobacco tax ballot measure. California physicians need to work actively to ensure that this year’s version does not lose by the narrow margin a similar ballot measure suffered in 2010. The current Fresno Madera Medical Society (FMMS) Board of Governors supports this measure by an overwhelming majority. The measure’s authors and advocates prominently include the California Medical Association (CMA) Chief Executive Officer, Dustin Corcoran, whom many heard during our recent FMMS Healthcare CEO Forum.

As the over one million signatures submitted on May 16 have not yet been confirmed to the minimum needed number of 585,407, the measure has no number as of press deadline. “The California Healthcare, Research and Prevention Tobacco Tax Amendment (2016),” the official

title for (#15-0081A1), on the November 8 ballot would be the “Cigarette Tax to Fund Healthcare, Tobacco Use Prevention, Research, and Law Enforcement. Initiative Constitutional Amendment and Statute.” The official ballot summary explains that it: “Increases cigarette tax by $2.00 per pack, with equivalent increase on other tobacco products and electronic cigarettes containing nicotine. Allocates revenues primarily to increase funding for existing healthcare programs; also for tobacco use prevention/ control programs, tobaccorelated disease research and law enforcement, University of California physician training, dental disease prevention programs, and administration. Excludes these revenues from Proposition 98 funding requirements. If tax causes decreased tobacco consumption, transfers tax revenues to offset decreases to existing tobaccofunded programs and sales tax revenues. Requires biennial audit.

Summer 2016

The California Legislative Analyst and Director of something else. $4.3 billion results from hospital care, $2.1 Finance calculate that the measure’s financial impact billion is ambulatory care, nursing home care $1.5 billion, includes: $1.1 billion for prescription drugs, and $800 million for “Net increase in excise tax revenues in the range of home health care. Of the $8.3 billion in lost productivity, $1.1 billion to $1.6 billion annually by 2017-18, with 80% of that sadly represents preventable premature deaths. revenues decreasing slightly in subsequent years. The So, if the additional cost of healthcare approximates $9.8 majority of funds would be used for payments to health billion, then surely at least $3 billion of that represents care providers. The remaining funds would be used for a extra costs to the state Medi-Cal program. Once the variety of specified purposes, including tobacco-related additional tobacco tax initiative passes and starts sending prevention and cessation programs, law enforcement funds to improve provider reimbursements and with that programs, medical research on tobacco-related diseases, and early childhood development If a primary purpose of the new tax is to offset tobacco generated programs.” costs, one can easily see that $2 actually does not come close to What the more extensive wording indicates is that 82% that goal!, Many would argue that the tax should be not $2 but of the new proceeds would $4 to $5 a pack, or even more. underwrite increased health provider reimbursements in our chronically and woefully underfunded Medi-Cal program, around $1.1 billion much better true access to care, the new tax revenue will, annually. actually and sadly, only offset a fraction of the tobaccoA tax of $2 a pack barely tithes what tobacco costs our related true cost. This situation has been aggravated by the state. If we compare what the new taxes would bring from Affordable Care Act (ACA) driven Medi-Cal enrollment the approximately 900 million packs of cigarettes and increment of 7.9 million in 2013 to the 14.1 million other tobacco products sold in California every year, it projected for 2017. actually only represents 7.5% of the $18.1 billion yearly If a primary purpose of the new tax is to offset tobacco tobacco-generated costs to our state in increased health generated costs, one can easily see that $2 actually does costs and loss of productivity. These, and related figures, not come close to that goal!, Many would argue that the tax should be not $2 but $4 to $5 a pack, or even By contrast Medi-Cal typically allows about $25. So the shortfall more. Halfway around the world “down under,” that creates our continuing access roadblock comes to around there is a drive to increase cigarette taxes to $20 a $35 per office visit, NO calculus or differential equations pack, based on the adverse required! If dedicated simply to this core need, the new tax would health impact smoking bring around 39,000,000 office visits from the current Medi-Cal continues to have, particularly, on the Maori, rate up to the dual-eligible rate.

Native New Zealanders, in a similar fashion to what this country has seen come from a 2014 study by Professor Wendy Max, PhD, for our own Native Americans.

UC San Francisco School of Nursing, and her extensive But let us return to the challenge of improving Medi-Cal team of epidemiologists and statisticians. Professor Max is reimbursements, most critically at the level of office-based also the Director of the UCSF Institute for Health & Aging primary care, but also impacting specialty and surgical and studies Health Economics. care, and facility cost reimbursement in a close third place About 54.4% of these costs represent direct health for priority. Since the passage of the ACA, our state has expenses—dollars spent that could have been used for seen major expansion of individual coverage through

Summer 2016

CENTRAL VALLEY PHYSICIANS

7

Now Enrolling

Certified Medical Coder Classes Certified Course and Exam Certification validates your achievement and demonstrates superior knowledge as an advanced coding professional.

Consecutive Wednesdays for 5 weeks August 24, 31, September 7, 14, 21, 2016 REGISTER TODAY $975 FMMS Members $1250 Non-Members For more information call (559)224-4224 ext 110 or visit www.FMMS,org

$100 OFF

Register by July 15, 2016

In today’s complex practice environment, certified coders are in high demand. More physicians need Certified Medical Coders who are capable of understanding the complexities of the reimbursement process. Improve your practice’s financial health. Your certification will help limit audit liability and decrease claim denials.

• Certification demonstrates to auditors, compliance officers, employees and peers that you have taken steps to attain advanced knowledge and skills.

• Certified Medical Coders are employed in thousands of medical practices across the country. The CMC certification is recognized by CMS and leading healthcare groups nationwide.

• Certification will help you communicate with improved confidence with physicians, third-party payers, patients and business associates.

This program includes classroom instruction, course manual, homework exercises, exam preparation handbook, and certification exam. Participants may take up to six hours to complete the CMC exam. A passing score of 70% or better will confer with CMC certification.

Fresno Madera Medical Society Board Room 1040 E. Herndon, Suite 101 Fresno, CA 93720 8:30 am - 4:30 pm (lunch will be provided)

Recognition: PMI is recognized by the Centers for Medicare and Medicaid Services (CMS) as an example coding certification source for its Intermediary Provider Customer Service Program.1 This recognition by CMS and hundreds of other healthcare organizations reinforces PMI’s position as a leading provider of certification for medical office staff.

8

CENTRAL VALLEY PHYSICIANS

Summer 2016

A message from our Editor > Alan M. Birnbaum, MD

Exchange plans, but especially the Medi-Cal program. the emergency room. Too many well-designed and staffed At the same time however, inadequate Exchange ERs now have to deal with far too numerous ESI Class 4 reimbursements and totally deficient Medi-Cal managed and Class 5 patients. Those who know ER lingo recognize care reimbursements—the latter often as low as 35 cents the latter as non-emergency patients by any reasonable on the dollar—continue to make it essentially impossible criteria, versus the Level 1, 2, and 3 patients for whom our for any quality-conscious office-based practitioner to see patients under either Alas, the emergency room. Too many well-designed and program, but especially MediCal. Efforts over the years to staffed ERs now have to deal with far too numerous ESI point out this cause and effect Class 4 and Class 5 patients. conundrum to California’s Governor Jerry Brown, an otherwise knowledgeable administrator, have failed. high tech and capable ERs were really intended.

Medicare allows about $75 for CPT 99213, the most The much larger numbers of patients in our ERs these common office service code, and actually paying 80% days are the Class 4 and 5 patients, virtually all of whom of that. In fact, that’s all that the physician receives for should be getting their care in clinics or in a private office “dual eligible” patients (Medicare plus Medical). A setting. Imagine the difference in true access that would strong argument can be made that this level represents rapidly develop once these patients found themselves the absolute minimum payment given today’s cost of welcomed at privately-based medical offices. running a medical office, the finite number of patients that In 2010, the tobacco industry—through its lobbyists— a physician can see in a day, and other factors. In contrast, spent an estimated $100 million to defeat a proposition to Medi-Cal typically allows about $25 for the same billing raise the tax per pack. We can assume that they will spend code. So the shortfall that creates our continuing access it again this year, with massive media buys. CMA, the roadblock comes to around $35 per office visit, no calculus American Cancer Society, and others likely will not have or differential equations required! If dedicated simply to the same financial resources. But they will have their own this core need, the new tax would bring around 39 million capable and articulate lobbyists, hundreds of thousands of them, who can—and hopefully will—speak to California voters These In 2010 the tobacco industry through its lobbyists spent an lobbyists also known as estimated $100 million to defeat a proposition to raise the tax per patients.

CMA and the rest of the pack. We can assume that they will spend it again this year, with coalition have you, the California physician. Do massive media buys. not hesitate to talk to your patients. They are the voters.

Your patients, their families, office visits from the current Medi-Cal rate up to the dualtheir friends, and really all Californians stand to benefit eligible rate. As the Medi-Cal program now has about 9.4 in so many ways, once the tobacco tax revenues start to million enrollees with no other funding, the increment improve the patterns of real health care access. would support around four basic office visits a year. That is As November approaches, be both a doctor and the not enough, but it would be a meaningful start. lobbyist!

Where does a newly “carded” healthcare consumer currently go if they lack a primary care physician? Alas, Partial source: https://ballotpedia.org/California_Healthcare,_Research_and_Prevention_Tobacco_Tax_ Amendment_(2016)

Summer 2016

CENTRAL VALLEY PHYSICIANS

9

Guest Editorial > Dr. Ronald Morton

Unqualified and Under-prepared

ABOUT THE AUTHOR ­ Dr. Ronald Morton is a board-certified ophthalmologist who practiced in Bakersfield for over 30 years and is a past president of the Kern County Medical Society. He is currently retired and enjoys traveling with his wife of 46 years, Ingrid.

10

CENTRAL VALLEY PHYSICIANS

We rely on our eyes almost every moment of our waking hours.

Unfortunately, a dangerous piece of legislation in Sacramento, Senate Bill 622, would allow optometrists across California to perform surgical procedures on the eye and surrounding tissues with a trivial amount of training and a handful of practice procedures — procedures that should be reserved for those with proper education and experience.

Having undergone the intensive training and years of experience required to become a medical doctor that specializes in and performs surgery on the eye, the skill to perform these procedures is not something that can be achieved in a matter of hours as proposed by our optometric colleagues.

Don’t let the bill’s supporters try to fool you by labeling what they are asking for as “minor.”

Using lasers (to treat, among other things, glaucoma) and scalpels (to remove tumors) is indeed doing surgery, plain and simple.

Unexpected complications, including misdiagnoses of lesions that are actually cancers, cannot be properly appreciated and prepared for by doing a handful of training cases. Allowing optometrists such privileges with embarrassingly inadequate training would put Californians at risk of irreparable damage to their health and vision.

Steph Curry – the reigning NBA MVP from the Golden State Warriors – didn’t become the league’s best shooter by practicing just a few shots before game time, and no one would have expected him to. He rose to the top by hitting the courts for years, learning from the best and training relentlessly, a regimen optometrists would be smart to

Summer 2016

adopt.

The comparison is not meant to belittle the ramifications of care by unqualified and under-

reported to have suffered vision loss. These veterans were harmed because optometrists failed to refer glaucoma patients to ophthalmologists as they were required to do by facility policy.

Those optometrists were Don’t let the bill’s supporters try to fool you by labeling supposedly “fully trained” to determine that such vision loss what they are asking for as “minor.” Using lasers (to treat, was occurring. Yet, they failed among other things, glaucoma) and scalpels (to remove to do so until it was too late, and as a result some of those tumors) is indeed doing surgery, plain and simple. veterans were reported to have gone blind -- circumstances that likely weighed heavily on a prepared professionals; possibly losing one’s eyesight recent decision by the VA to renew a national directive is far more consequential and life-altering than losing preventing optometrists from doing the very laser a game. However, it seems that optometrists hoping to surgeries on veterans that they would be able to do on practice “advanced procedures” view delivering these California citizens under SB 622.

Put simply, if we allow ourselves to ignore the very real consequences of lowering training and standards, we risk the health and vision of Californians, particularly those who are less well off financially and may find themselves “limited” to lesser trained providers. eye treatments to Californians as a game to be played – Put simply, if we allow ourselves to ignore the taking a half-court shot with a promise to patients and very real consequences of lowering training and the state that the shot will go in. standards, we risk the health and vision of Californians, I am not willing to take that shot. Although recently particularly those who are less well-off financially retired, I could certainly resume practice if I wanted and may find themselves “limited” to lesser trained to. But, having not done surgery for nearly two years, I wouldn’t Fortunately, the state legislature has rejected this bill and dream of stepping back into the surgeon’s chair without extensive others like it time and time again. Given the failure of its retraining – including being proponents to acknowledge the need for far more training proctored – just as Steph Curry wouldn’t start the season without than SB 622 requires, policy makers would be wise to vote extensive advance practice and down this dangerous bill once again. coaching.

Yet, despite decades of prior experience which should make “relearning” that much easier, even if I were now to providers. complete the training the optometrists have proposed, Fortunately, the state legislature has rejected this bill I would not feel comfortable returning to the surgeon’s and others like it time and time again. Given the failure chair. It is not enough to re-qualify me, let alone qualify of its proponents to acknowledge the need for far more them. training than SB 622 requires, policy makers would be Recall several years ago when veterans at the Palo wise to vote down this dangerous bill once again.

Alto Veterans Affairs Health Care System were

Summer 2016

CENTRAL VALLEY PHYSICIANS

11

N O R C A L

G R OU P

OF

COMPANIES

GUIDE GUARD ADVOCATE

MEDICAL PROFESSIONAL LIABILITY INSURANCE

PHYSICIANS DESERVE Offering top-tier educational resources essential to reducing risk, providing versatile coverage solutions to safeguard your practice and serving as a staunch advocate on behalf of the medical community.

Talk to an agent/broker about NORCAL Mutual today. © 2015 NORCAL Mutual Insurance Company. nm0607

NORCALMUTUAL.COM | 844.4NORCAL

NORCAL MUTUAL RISK MANAGEMENT INSIGHT

4 Tips for Safeguarding Your Digital Practice The common factor in 90% of all data breaches is people being careless or behaving badly, including losing unsecured laptops and thumb drives, clicking malicious email links, downloading viruses and malware, and other errors.16 Through user training, communication, and common sense policies, you can build a culture of security in your practice.

1.

2.

3.

4.

Secure Connected Medical Devices: Internet-connected devices like health monitoring devices, radiology imaging systems and video conferencing systems are easily hacked since attackers can obtain default device passwords on the Web. Once on your network, attackers can then steal user passwords for other systems, install malware and steal financial and patient records.13 Secure connected devices with custom user names and passwords.

Lock Down Your Systems and Data: Advanced security measures can help protect your systems and sensitive data. Consider enabling login verification (with security cards or fingerprint scans), timed user log outs and user lockout after failed login attempts. Also, encrypting emails, text messages and patient health information (PHI) helps protect sensitive data after a breach and may prevent the need for a HIPAA notification.12 Actively Monitor Your Data: A data activity monitoring system monitors your systems for unusual or suspect activity and alerts system administrators to potential security threats. This can help you identify threats and possibly avoid a breach. The HHS OCR HIPAA Audit Protocol is a good place to start for determining monitoring protocols.14 Develop a Breach Response Plan: You likely have response plans in place for medical emergencies or severe weather events.

Take this same care and develop a plan for how to respond to a data breach with staff roles and communication protocols clearly defined. In short, expect a breach and plan accordingly.15

For the full report visit data-theft.norcalmutual.com.

Numbered references available at data-theft.norcalmutual.com

Copyright Š2015 NORCAL Mutual Insurance Company. All rights reserved.

In The News

IN THE

NEWS

Providing physicians, office staff, and healthcare executives with relevant and up-to-date information

• FRESNO • Bonna RogersNeufeld, MD, FACR, Excellence in Patient Care Award Congratulations to Radiologist Bonna Rogers-Neufeld, MD, FACR, for being honored with the Excellence in Patient Care Award from the Medical Bonna Rogers-Neufeld, MD and Executive Committee! Dr. Saint Agnes Medical Staff President, Dalpinder Sandhu, MD Rogers-Neufeld was chosen for her work in establishing a follow-up plan-of-care for patients presenting to the ER with breast masses. This new protocol has already helped three women.

Teresa Daniele, M.D., Physician of the Year Award

Teresa Daniele, M.D.

Congratulations to Teresa Daniele, M.D., for receiving the Physician of the Year Award from the American Heart Association at the 2016 Central Valley Heart Ball. Dr. Daniele is part of UCSF Fresno Cardiology and University Cardiovascular Center.

Rob Joneja, MD, MRO Internal Medicine, Occupational Health Dr. S. Rob Joneja, an Internal Medicine Specialist, comes to Saint Agnes Medical Providers (SAMP) from Indiana, where he served at

14

CENTRAL VALLEY PHYSICIANS

St. Joseph’s Regional Medical Center, another Trinity Health hospital. Dr. Joneja brings his experience in occupational medicine to the SAMP multispecialty physician group.

Dr. Joneja earned his Medical Degree from St. George’s University, School of Medicine in Grenada, West Indies. He completed his internal medicine Rob Joneja, MD, MRO residency at St. Joseph’s Regional Medical Center in New Jersey.

Certified as a Medical Review Officer (MRO) and National Registry Medical Examiner, Dr. Joneja formerly served as Medical Director and MRO at the Center for Industrial Medicine in New Mexico.

Recognized for his excellent bedside manner and diagnostic skills, Dr. Joneja looks forward to serving occupational health patients at Saint Agnes Wellness Center – Northwest.

Joseph Shen, M.D., PhD Assistant Clinical Professor, UCSF Pediatrics and Genetics Joseph Shen, M.D., PhD, is boardcertified in Pediatrics and Medical Genetics. He earned his Medical Degree from Case Western Reserve University School of Medicine. There he also received

Joseph Shen, M.D., PhD

Summer 2016

his PhD from the Department of Human Genetics. His residency in Pediatrics and his fellowship in Medical Genetics were completed at Baylor College of Medicine.

Dr. Joseph Shen looks forward to serving patients at University Pediatric Specialists in Fresno.

Renee Kinman, M.D., PhD Associate Clinical Professor, UCSF Pediatric Endocrinology Renee Kinman, M.D., PhD, is board-certified in Pediatrics and Pediatric Endocrinology.

She earned her Medical Degree at Case Western University.

She completed a residency in Internal Medicine and Pediatrics at University Hospitals of Cleveland/Rainbow Babies and Children’s Hospital. Her fellowship in Pediatric Endocrinology was also completed at Rainbow Babies and Children’s Hospital.

Renee Kinman, M.D., PhD

Dr. Renee Kinman is currently an Associate Program Director for the Fresno Pediatric Residency Program, University of California, San Francisco. She is also an Associate Clinical Professor for University of California, San Francisco. She has extensive experience instructing at other institutions including University of Southern California School of Medicine and West Los Angeles Community College.

Dr. Renee Kinman looks forward to serving patients at University Pediatric Specialists in Fresno.

Cynthia Myers, M.D. Associate Professor, UCSF Pediatric Cardiology Dr. Cynthia Myers, is boardcertified in Pediatrics and Pediatric Cardiology. She is joining University Pediatric Specialists.

She is currently an Assistant Professor for University of Cynthia Myers, M.D. California San Francisco in the UCSF Fresno Department of Pediatrics. She has held Instructor positions at Children’s Hospital Colorado and Children’s Hospital of Philadelphia.

Outstanding Patient Experience Award Clovis Community Medical Center and Fresno Heart & Surgical Hospital both earned Healthgrades® Outstanding Patient Experience Award™ for delivering care in a way that patients consistently say is amazing. The recognition puts the two Community Medical Centers’ hospitals in the top 10 percent in the nation for patient experience.

This is the ninth consecutive year that Fresno Heart & Surgical has received Healthgrades Outstanding Patient Experience Award.

Valley Children’s Hospital Receives National Accreditation for Pediatric Residency Program Valley Children’s Hospital now has a nationally-accredited pediatric residency program. The Accreditation Council for Graduate Medical Education (ACGME) notified Valley Children’s Hospital of its decision this week to grant accreditation to the Valley Children’s Hospital’s Pediatric Residency Program, affiliated with Stanford University School of Medicine. The ACGME is a nonprofit council that oversees graduate medical training programs in hospitals throughout the country.

HAVE SOMETHING TO SHARE? We welcome submissions to our In the News section from our community healthcare partners. We prefer Word files and .jpg images and may edit for space restrictions. Send your files to nbutler@fmms.org one month prior to publication (September 1 for the Fall issue, and December 1 for the Winter issue).

Summer 2016

CENTRAL VALLEY PHYSICIANS

15

In The News

IN THE

NEWS

Providing physicians, office staff, and healthcare executives with relevant and up-to-date information

The accreditation process took more than a year to complete. Valley Children’s Hospital’s pediatric residency team began working with the ACGME in January 2015, when Valley Children’s Hospital announced the creation of its own hospital-based pediatric residency program. The ACGME reviewed Valley Children’s Hospital proposed residency program curriculum, performed site visits and interviewed physicians and staff members.

Visalia, Mercy Medical Center in Merced, and Clinica Sierra Vista in Fresno.

The Valley Children’s Hospital ‘s Pediatric Residency Program, Affiliated with Stanford University School of Medicine will begin interviewing medical students this fall, with the inaugural class of residents arriving in Madera in July 2017. Stanford residents will begin rotations through Valley Children’s Hospital’s Emergency Department this summer.

The center will be designed to serve the entire Community Medical Centers system and patients throughout the Valley – combining services and expertise provided in multiple locations including Community Regional Medical Center in downtown Fresno, the California Cancer Center in north Fresno, and Clovis Community Medical Center.

In addition to Valley Children’s Hospital’s affiliation with Stanford University School of Medicine, the Pediatric Residency Program also features partnerships with hospitals and medical groups throughout the area.

Valley Children’s Hospital residents will have the opportunity for rotations at partner locations, including Kaiser Permanente, Saint Agnes Medical Center in Fresno, Dignity Health and local pediatricians’ offices.

The envisioned center will be located on the Clovis Community campus, adjacent to Highway 168. The facility will be three stories tall and nearly 100,000 square feet, at an estimated cost of $65 million.

Valley Children’s Hospital continues to serve as a teaching site for more than 190 residents and medical students in a dozen other programs, including those based at Kaweah Delta Health Care District in

16

CENTRAL VALLEY PHYSICIANS

Design Work Begins for $65 Million Cancer Center Community Medical Center’s Board of Trustees authorized architectural design and other preconstruction work for a regional cancer treatment and research center — the first of its kind in the San Joaquin Valley.

The center would also conduct cancer research in partnership with the University of California, San Francisco Medical Center, with the goal of becoming a “Designated Cancer Center” by the National Cancer Institute. Ten such centers exist in California, but none in the San Joaquin Valley.

Projections for the Valley show a nearly 30% increase in the need for cancer surgeries and radiation treatments within the next decade,

said Paul Ortiz, Community’s vice president of cancer services.

The preconstruction and design phase for the project is expected to take 6 to 10 months.

Community Medical Center’s Board of Trustees would then authorize the actual construction expenditure and timeline.

Saint Agnes Medical Center grants $13,000 in scholarships Saint Agnes Medical Center, along with the Saint Agnes Service Guild, Saint Agnes Medical Staff, and the Saladino Family Foundation, has gifted 10 high school students a total of $13,000 in scholarship funds.

Three students were awarded $2,000 scholarships and seven were awarded $1,000 scholarships at the annual awards banquet on May 25. Funds also come from Junior Volunteer fundraising efforts.

The Saint Agnes Junior Volunteer program gives teens, ages 14-18, the opportunity to provide support to staff, physicians, and visitors in a health care setting. There are approximately 220 active Junior Volunteers at Saint Agnes.

The scholarship recipients, Kaila Webb of Clovis West, Sarah Jackson of Clovis North, and Dwight Lewis of Clovis High, had to meet the criteria of volunteering at Saint Agnes for at least 60 hours per year while maintaining a 3.0 grade point average.

Summer 2016

that families could comprehend. Dr. Wright believed such patient- and family-centered satisfaction affected clinical outcomes and the timely, efficient delivery of quality healthcare.

Saint Agnes Men’s Club Past-President Ryan De Young, Saint Agnes Medical Center President and CEO Nancy Hollingsworth and President Brian King.

Saint Agnes Medical Center receives over $208,000 for programs and services Saint Agnes Medical Center was gifted over $208,000 by the Saint Agnes Men’s Club to benefit the advancement of 16 hospital programs and services impacting patients and the community.

Saint Agnes President and CEO Nancy Hollingsworth, RN, accepted the donation on behalf of the Medical Center at the Men’s Club MercedesBenz of Fresno Casino Night fundraiser on May 21. The gift is a result of the club’s 2015 fundraising efforts.

The donation will provide new equipment, additional funding for community benefit and outreach programs, more supplies and resource materials for patients and their family members, and funds for hospital expansion and renovation projects.

Dr. Kenneth Rouillard Wins Inaugural Patient Satisfaction Award Dr. Dowain Wright always had a penchant for patient and customer satisfaction. That showed in all aspects of his work, from how he cared for kids within Valley Children’s Healthcare as one of California’s renowned Pediatric Rheumatologists to how he translated information into a way

Dr. Wright passed away unexpectedly in January, but his work and memory live on at Valley Children’s Hospital through physicians who share his deeply rooted desire for patient satisfaction. That is why Valley Children’s Hospital decided to honor one physician each year as the recipient of the Dowain Wright Patient Satisfaction Award.

Dr. Kenneth Rouillard

“Medical staff decided to establish an award that focused on patient experience,” Chief of Staff Dr. Fred Laningham, a Valley Children’s Hospital Pediatric Radiologist, said. “We measure a lot of things, and one of the things is patient satisfaction. For years and years, Dr. Dowain Wright was the pinnacle of providing great patient experience.”

The first award of its kind was presented to pediatric cardiologist Dr. Kenneth Rouillard.

“To be recognized with Dr. Wright, he’s definitely left a legacy here in this community, so it’s a great, tremendous honor,” Dr. Rouillard said. “It’s incredible for me to receive this.”

Saint Agnes Opens Second Wellness Location Recently Saint Agnes celebrated the opening of its second Saint Agnes Wellness Center, Avecinia, at Shaw and Fowler avenues. The acquisition of Avecinia allows Saint Agnes to advance its strategy around population health.

Saint Agnes Wellness Center – Avecinia is located at 2006 Shaw Ave., in Clovis. Services include family practice and aesthetic services. Additional services are coming soon. For more information, please call 559-450SAMP (7267).

• KINGS • Family Healthcare Network Opens Clinic in Traver On April 28th, local government leaders, community members, and the board and staff of Family HealthCare Network (FHCN) gathered to celebrate the official grand opening of the organization’s newest Community Health Center in Traver, CA. Joined by Assemblyman Devon Mathis, County of Tulare Supervisor Steve Worthley, Field Representative for Congressman Devin Nunes Anneka Sweeney, and

Summer 2016

Local government leaders, community members, and the board and staff of Family HealthCare Network (FHCN)

CENTRAL VALLEY PHYSICIANS

17

In The News

IN THE

NEWS Traver Joint School District Superintendent Steve Ramirez. The event included an official ribbon cutting, performances by students of Traver Elementary School’s band and folkloric dance team, and guided tours of the new health center. Offering comprehensive family medicine and pediatric services, the Traver Health Center is open Monday through Friday, 9 am to 6 pm.

• KERN • Recognizing Kern County Medical Managers Three outstanding Kern County Medical Managers were awarded $250 each and were recognized for their contributions to our medical community. Dr. Vinod Kumar’s office, Vascular and Leg Center, awarded Carey Wagner, Medical Manager at California Cardiac Surgeons, and Michelle Hammond, Medical Manager at Dr. Bradford Anderson’s office, the Gupta Award. Dr. J.R. Grandhe awarded Peg Board, Medical Manager at San Dimas Medical Group the Central Valley Pain Management Award. Congratulations to these hardworking managers.

Kern County Medical Society - 30 Years of Service

Kathy Hughes

18

Kathy Hughes, Administrative Assistant and Membership Secretary for Kern County Medical Society, celebrated 30 years of service on May 19, 2016. She has been the familiar face of the society and has provided outstanding support. We thank Kathy for her dedication to the medical society and the physicians we serve.

CENTRAL VALLEY PHYSICIANS

Providing physicians, office staff, and healthcare executives with relevant and up-to-date information

Builders group wins award for Memorial Hospital’s Hope House Kern County Builders’ Exchange, Inc. has won the Chairman’s Award at this year’s Beautiful Bakersfield Awards in celebration of its work on a four-bedroom house its members built for families of patients receiving treatment at Dignity Health Memorial Hospital.

Nearly 80 business and individual members of the builders group donated time, labor, and materials to build Hope House on the campus of the 420-bed medical center.

“It’s providing a place of comfort and solace to families while their loved ones are being cared for at Memorial for generations to come,” said farmer Steve Murray, who, as Chairman of the Greater Bakersfield Chamber of Commerce, selected Kern County Builders’ Exchange for the award.

Hope House contains a full kitchen, 2-1/2 bathrooms, a living room and a laundry facility. Conceived in 2009, it was built between March and August of last year before being donated to the hospital. The house began operation in October.

Memorial’s Vice President of Philanthropy, Sue Benham, said the hospital was thrilled by the generosity the Builders Exchange demonstrated.

“It has proven to be a wonderful amenity for our patients’ families,” she said. “And we think [the Builders Exchange] is very deserving of the award.”

Summer 2016

Fresno Madera Medical Society Presents

D M g r g e o i D nn Z y l t h

Slig

FRIDAY

AUG

12

Summer 2016

Fu

n a h T ty l Socie

esno ting Fr i f e n e B

Medica Madera

o b e lac

P

MMS on & F

Sc

dati ip Foun h s r a l ho

Cocktails - 6 pm Dinner - 7 pm ZDoggMD - 8 pm

Clovis Veterans Memorial Building 808 4th St, Clovis, CA 93612 For information or tickets call (559) 224-4224 or visit www.FMMS.org Sponsorship packages are available

CENTRAL VALLEY PHYSICIANS

19

In The News

Great Owner/User Opportunity FOR SALE - FULLY IMPROVED MEDICAL CONDO

IN THE

NEWS 1290 E. SPRUCE #103, FRESNO, CA 2,309 square feet SALE PRICE: $695,000 • Prominent location near St. Agnes & Clovis Community Hospitals • Convenient proximity to Freeways 41 & 168 • Excellent floor plan • East Herndon Location CONTACT: Michael Schuh

MOB 559 281 6112 MAIN 559 221 1271 michael.schuh@colliers.com BRE License #01195311

Providing physicians, office staff, and healthcare executives with relevant and up-to-date information

7485 N Palm Ave. #110 Fresno, CA 93711

www.colliers.com/fresno Central California Available Medical Office BAKERSFIELD - David A Williams, Jason Alexander & Cameron Mahoney 10000 Stockdale Hwy. #102 Bakersfield, CA 93311 | Ph 661 631 3800 For Sale 1921 18th Street - 5,826 sf 820 34th Street - ±33,000 sf Lease 820 34th Street - 20,298 sf 9330 Stockdale Hwy. - 2,665 sf 2019 21st - 2,856 sf 3535 San Dimas - up to 12,000 sf 3941 San Dimas #103 - 3,759 sf 3850 Riverlakes Drive - 3,355 sf FRESNO - Bobby Fena, Michael Schuh & Beau Plumlee 7485. N Palm Ave. #110 | Fresno, CA 93711 Ph 559 221 1271 For Sale 1920 E. Spruce #103 - 2,309 sf For Lease 560 E. Herndon - up to 15,247 sf 1360 E. Herndon - 16,475 rsf

Tehachapi Valley Health Care District Passes Vote The ballot measure to bring the Tehachapi Valley Health Care District under the operation of Adventist Health passed in a community vote by almost 90 percent (89.02) on Tuesday, June 8, 2016, allowing Adventist Health to assume management of the hospital under a long-term lease beginning July 1, 2016.

In addition to the operation and management of the current hospital, Adventist Health will provide funding to complete construction of the new hospital and supply ongoing resources to create sustainable and high-quality services.

The new 25-bed critical access hospital will serve the Tehachapi Valley and Southeast Kern County. The key service areas include emergency services, inpatient, swing bed, laboratory, imaging, inpatient pharmacy, and dietary services. Adventist Health also will operate and manage three rural health clinics located in Tehachapi, Mojave, and California City.

Completion of construction is expected by December 2016, and the new hospital plans to open its doors to patients in February 2017.

www.colliers.com

20

CENTRAL VALLEY PHYSICIANS

Summer 2016

Understanding Pain The healthcare community in Central Valley has seen an increase in problems arising from the use of prescription pain management medications.

The Central Valley Opioid Safety Coalition has planned a lecture series that will raise the level of understanding of this critical issue. The 3-part lecture series includes topics about Understanding Pain, the Management of Chronic Pain, and Safe Prescribing.

September 21, 2016 - Understanding Pain November 9, 2016 - Management of Chronic Pain January 18, 2017 - Safe Prescribing September 21, 2016 Speakers

Ming-Chih Kao, PhD, MD

Pain specialist, General musculoskeletal physiatrist Clinical Assistant Professor, Orthopaedic Surgery, Clinical Assistant Professor, Anesthesiology, Perioperative & Pain Medicine, Associate Division Chief of Operations at Stanford Pain Management, Stanford Health Care

Scott Pritzlaff, MD

Pain specialist, Anesthesiologist Clinical Instructor, Anesthesiology, Perioperative and Pain Medicine, Stanford Health Care

CME Dinner Event

46

2.0 Applied for - Invitation to Follow

September 21, 2016 - 6 PM to 9 PM Fort Washington Country Club 10272 N Millbrook Ave., Fresno, CA

Summer 2016

the number of people who die everyday from prescription opioid overdose

Preregistration is required - No charge Please register online at www.fmms.org or by calling (559) 224-4224. Registration must be received by September 16 to be a guarentee participant.

CENTRAL VALLEY PHYSICIANS

21

John Telles, MD, and son Connor Telles, MD

New Physicians > A Brave New World

THE BRAVE NEW WORLD OF THE

NEW-TO-PRACTICE

PHYSI CIA N Story By Carole A. Lambert • Vice President Practice Optimization and Residents Program Director • Cooperative of American Physicians, Inc.

As I meet with physicians completing their residencies and beginning practice, I think of Miranda in Shakespeare’s The Tempest and her exclamation: “Oh, wonder! How many goodly creatures are there here! How beauteous mankind is! O brave new world, That has such people in’t!” However, the new-topractice physician can quickly run out of wonder at her or his new circumstance as the many, often competing, pressures of professional practice come to bear.

To quote Phyllis Maguire, Executive Editor at Today’s Hospitalist, “Being the lone decision-maker is a particular eye-opener when physicians have to navigate the business and socio-economic worlds of medicine, fraught with payer denials and family demands, by themselves.”

We cannot underestimate the impact of the change in professional role. The physician goes, almost overnight, from student to clinician, from novice to expert with the demand for knowledge, skill, and expertise to meet patients’ and families’ expectations. Then there are the changes on the personal level from an internal focus to an external focus: breadwinner, life on the go, obligations to others. In addition, Dr. Selene Parekh, from Duke University, on his blog identified changes facing physicians in the new and evolving healthcare environment: payer mix and methodologies, technology, reimbursement moving from volume to value, the physician-patient relationship; and the great unknown.

A large part of navigating the business world of medicine is negotiating contracts and knowing what questions to ask. General principles would include: don’t enter into a relationship lightly; contracts should be a two-way street between you and the other person or business entity. Try to keep your present and future goals in mind, even under pressure to “sign.” When in doubt, contact an attorney—legal review of a contract before you sign is always

22

CENTRAL VALLEY PHYSICIANS

recommended. Whatever your role—employer or employee, vendor or purchaser—clarify and have in writing your shared expectations and responsibilities, compensation, and termination.

As you explore contractual relationships, you may discover your non-negotiables or deal-breakers—recognize the importance of acknowledging them to yourself and your prospective partner.

In the seven years Cooperative of American Physicians, Inc. has been meeting with residents throughout the state, we have never yet met a physician who went into medicine to become a Human Resources expert. If your goal is private practice, finding and keeping the staff you need will depend on a variety of factors, beginning with your vision of how you want your practice to operate and grow. The range of options for practice management is broad, from a family member to a professional practice administrator. Having a clear idea about staffing needs to begin with and getting professional HR help if you feel inexperienced in this area can help you make good decisions and avoid frustration and disappointment.

In 1998, B. Joseph Pine II and James HHH. Gilmore wrote in the Harvard Business Review, “Welcome to the Experience Economy.” Physicians today know that knowledgeable and discriminating patients and families have rising expectations of the physician, the staff, and the environment. In conversations with physicians, the goals of patient safety, physician safety, and organizational safety are constant themes.

According to the Beryl Institute, the patient experience is “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Sue Ter Maat, Communications Manager at the American College of Osteopathic Physicians, has said that, “the patient experience —focusing on care coordination, communication with caregivers and staff responsiveness—is about protocols designed to reduce

Summer 2016

patient stress.” pressure, is the physician and his or her to extremes. Self-reliance draws on our From the perspective of a small ability to stay true to their vision of what learned skills. Authenticity shows our selfbusiness owner, the physician wants to be being a physician means to them and to acceptance and strength. the provider and place of choice—to be manage their own physical and mental Finally, what about the tools or known for quality and safety. The patient’s well-being. Research has shown that behaviors or actions that will equip us and family’s perception of quality and a physician’s well-being is associated for the known challenges we face and safety most often rests on the perception with fewer medical errors, enhanced for the unknown beyond our current of service: responsiveness, competence, satisfaction, and a positive environment view? To quote Dr. Leonard again, “the accuracy, reliability, predictability, in the workplace. The physician is the people who are going to win are those and consistency. The physician, staff, resource whose knowledge, skill, and who do the basics correctly every time.” patient, and family are co-creators expertise must be allocated and utilized I believe that our most dependable of the extraordinary experience that wisely. So much advice and direction tells allies are within us: respect, clarity, and engages and activates and satisfies and us to search for work-life balance: work collegiality in communication; reliability, rewards all participants. Accuracy and is bad – life is good. Life happens when predictability, and consistency in action; consistency help the practice get paid and we’re not at work. This implicitly demotes precision, accuracy, and timeliness in keep the money. Satisfied patients stay. the importance of work and loads nondocumentation; and honesty, humor, and Enthusiastic patients bring their families worktime with unrealistic expectations. humility in relationships. and friends. Colleagues refer patients A more achievable and sustainable The physicians leaving residency and because they respect and appreciate the goal is resilience—the capacity to live bringing their dedication to patient, work. Staff stays because it is a good place life to the fullest and face adversity, family, and community health evoke to work. change, and challenge with purpose from the healthcare community the same The mention of colleagues referring and determination. Purpose gets us up wonder that Miranda spoke of: “O brave patients brings to mind the observation by in the morning. Perseverance sees us new world, That has such people in’t!”

Dr. Michael Leonard of Safe and Reliable through. Equanimity keeps us from going Care that “hand-offs are dangerous.”

Being alert to the risks associated with patients moving from one practitioner or setting to another is vital to recognizing the dangers Assisted Living • Memory Care inherent in transitions of care. Dr. Linda Aiken and her colleagues at the University of Pennsylvania define transitions of care as, “a broad range of time-limited services designed to ensure health care continuity, avoid preventable poor outcomes among at-risk populations, and promote the safe and timely transfer of patients from one level of care to another or from one type of setting to another.”

Resident focused care that you will be proud to recommend.

Literature reviews identify 46 articles describing 24 handoff Personalized care plan • Incontinence Program mnemonics published since 1987, Medication management including injections • Purposeful activity programs most since 2006. Our job is to identify the at-risk populations we Nurse on-site 7 days a week • Diabetic Wellness Program encounter and the information, tools, and behaviors we need 5605 N Gates Ave • Fresno, CA 93722 to mobilize to seal the cracks and effectively transfer patient 559-682-3114 information among the members of oakmontoffresno.com the patient’s healthcare team.

RCFE #107206882 TOURS AVAILABLE DAILY! At the center of all the competing

Premier Senior Living

Summer 2016

CENTRAL VALLEY PHYSICIANS

23

Intern Ara Goes On-

ambula -Call

On May 6, Central Valley Physician Editor Alan Birnbaum, MD, interviewed newly elected California Assemblyman Joaquin Arambula, MD, about a broad range of topic, following his first three weeks in office to complete an abbreviated term of six months. His new local office on the Mariposa Mall still had former Assemblyman Henry T. Perea’s brass door nameplate. Inside, his staff was busy interviewing potential staff and negotiating upgraded Internet access. >>

Arambula > Goes On-Call

Critical to the work of the Legislature are committees which screen thousands of bills every year, selecting a relatively few for action, including discussion, modification, and—for some— forwarding for floor votes. During the April Walk With A Doc, the Assemblyman mentioned that he especially wanted seats on the Water and the Health Committees. Predictably, given his very low seniority, he has had to settle for half a dozen others, including Rules, Veteran Affairs, Human Services, Joint Legislative Audit, Joint Committee on Fairs, Allocation and Classification, and Environmental Safety and Toxic Materials.

He advises that after the close of session, there might be opportunity to change committee assignments.

Dr. Armabula has already met Governor Brown, and has been extremely impressed by his breadth of knowledge and insight into State affairs, while emphasizing there remain some differences in their relative priorities. He has asked Governor Brown for two budget items: The first is $200,000 for improved collection of data from MediCal. Currently, demographics are assumed by last name and zip code. He proposes self-identification for better data analysis.

He also asked for seed money for medical translators. 40 percent of Californians speak a language other than English.

6 percent of physicians speak Spanish. There is a need for increased interpreters. Based on his experience in practice, he finds it inadequate and inappropriate to use family members to translate. This will also create more jobs for the community. He believes that Federal matching funds can also be accessed.

The Assemblyman relates that his long term focus is on the District. He sees a need to improve Medi-Cal and DentiCal reimbursement because it will increase access. Increased coverage is not the same as increased access. Physicians commonly find the low reimbursement a barrier to allowing Medi-Cal patients into their practice. Dr. Arambula sees as one of his continuing challenges getting Governor Brown to understand this issue.

[Editor’s Note: Medi-Cal currently pays a physician $24 for a CPT 99213 revisit, compared to the $76 paid by Medi-Care. With the cost of running a higher volume office practice, nearly $100 an hour, what’s left after overhead for physicians would be an amount that often would violate the $15 an hour minimum wage recently signed by the Governor!]

Assemblyman Arambula strongly supports the proposed $2 tax increase on cigarettes and e-cigarettes this year, either by legislation or by proposition, which would raise $1.5 to $2 billion per year. “Like others states, I want this money to fund healthcare. In New York the tax is $4.35, in California the

26

CENTRAL VALLEY PHYSICIANS

current tax is [20% of that] at 0.87 cents.” The increase, in part, would decrease the amount of people smoking. In the last three years, e-cigarettes and vaping have tripled. This tax will help discourage the younger population from smoking. Years ago, California was the most aggressive state in taxing cigarettes, but there have been no tax increases in many years. Early polls show nearly 70 percent of the population support the proposition.

When a similar proposition was introduced circa 2010, tobacco companies spent $90 million in opposition and defeated it. Dr. Arambula understands he is taking on a special interest, but allows he is unconcerned about “drawing a line in the sand,” and making an enemy.

[Editor’s note: Support for the increase among physicians likely exceeds 80 percent. One former FMMS President, expressed concern that prior “sin taxes” were diverted to the General Fund rather than health care funding. This Editor sees a parallel need to deter cigarette smuggling and untaxed sales on “sovereign” Native American reservations and casinos.]

Dr. Arambula seems to see forces moving healthcare delivery onto the path to single payor, but does not support any immediate conversion. “We need to build a collaborative approach by bringing key stakeholders in. I don’t pretend to have all of the answers. I will look at other nations of similar size

Summer 2016

and economics that are comparative.

He is not “xenocentric.” “ I don’t believe we have the best health care system. We have a 2.2 year lifespan shorter than other nations.

What can we learn from their systems?

I’m in the collection of data phase.

We need to fix physician to patient ratios. The short term goal is to find a funding stream. In the long term, we need a medical school. We need to train people from our Valley to treat people in our Valley. UC Merced has an inside track, so I suspect the medical school program would be there.” The Assemblyman concurs that diabetes is one of the largest public health issues we are seeing in our area. “It is going to take a multifaceted approach. Keep it simple. Our body is our temple. Start with prevention. Every child needs to be insured so that they can combat obesity before it becomes diabetes.”

Summer 2016

The novitiate politician, when asked about the national stage this year, responded that, “I’m not impressed with the GOP nominee. I don’t think he is aware of what he is saying. I’m concerned of him in the Oval Office, and I’m terrified of the thought of him making healthcare wonderful.” On the other hand, he understands his appeal to many. “ This shows the nation’s anti-establishment [feelings.] There is a disconnect between government and everyday people. This is a powerful reminder to all elected officials that the need to stay grounded to their constituents.”

Dr. Arambula sees the California Legislature as having the opportunity to be more dynamic than the national Congress. “ I don’t spend much time on national politics because I find them dysfunctional. It is my belief, as the most progressive state in the nation, we need to lead healthcare and set an example that other states will follow.” He finds it distasteful that, “there have been more than 60 attempts for Congress to repeal the Accountable Care Act.” By his count, Dr. Arambula is the eighth son of a parent who also served in a legislative capacity. As to what he has learned, “My father served three terms in the Assembly. He told me, it is easy to get lost in Sacramento. People have their own interest and want to steer you in their direction. My father’s advice is Biblical. He said, don’t place your feet in shifting sand. Place your feet in bedrock. Stay grounded. Stay true to who you are.”

Explaining what his own medical career has taught him, “I spent nine years in the Emergency Department.

I’ve taken a 75% reduction in pay to become an Assemblyman. I’ve ‘right-sized’ my life. I try not to say down-size. I view it as a public service.

I believe in serving my community.

The skills I learned in the emergency department have prepared me well to deal with a hectic pace and environment. It has helped me with the ability to meet demands, the ability to compartmentalize, work efficiently, and work effectively. I do miss wearing scrubs to work! I plan to take a hiatus from medicine for the next decide.

My goal downstream is to train future doctors, volunteer my time and possibly take part in travel medicine. For now, I believe I can do more in the state legislature to improve health than I can as a physician. With large brushstrokes you can help people on a grander scale. I feel I’ve been given a new toolset to help my patients.”

Dr. Arambula warns his medical colleagues, “that if you don’t have a seat at the table, you are on the menu.

It is our responsibility to advocate on our profession. Healthcare should be improved. Those who practice medicine have the starting vantage point to review healthcare and drive to fix it.” As he enters the Legislature, “I’m having to learn patience. As an emergency department physician, I’m used to kicking open the doors and treating patients immediately. The state legislature is deliberately incremental, which has been challenging. I encourage the medical community to engage with me to make improvements to the health delivery model. We need to make fundamental changes in healthcare and it must be methodical in approach.”

Central Valley Physician plans to meet again with the Assemblyman after he finishes his current term to get his perspectives on the term completed and his plans for the future. FresnoMadera Medical Society supports Dr. Arambula’s bid for re-election this November.

CENTRAL VALLEY PHYSICIANS

27

PAVING THE PATH

FOR FUTURE

DOCTORS B Y E R I N M . K E N N E DY

At just $1,000, it didn’t seem like much given the total cost of an Ivy League education, but the scholarship money from back home meant Carlos Paz could buy brand new textbooks instead of having to borrow them from the Harvard Medical School library.

The small annual scholarships from the Fresno Madera Medical Society, it turns out, also served a greater purpose. They gave a psychological boost to the son of farm laborers from Parlier. It felt like a vote of confidence to him.

Dr. Paz saw some of the world after finishing medical school, but it turns out that scholarship money played one final role in his life: nudging him back home in 2013. “Maybe not overtly,

but subconsciously, because of the scholarship, I felt I owed something to the Valley,” said Dr. Paz, who now has a dermatology practice in Fresno and Visalia.

That’s exactly what the Fresno Madera Medical Society’s Scholarship Foundation intended when it began handing out help to medical students 55 years ago. “We’re trying to encourage people with ties to the community who might go into the medical profession. We hope they come back to a region that’s not f lush with extra doctors,” said Charles Touton, M.D., a Fresno orthopedic surgeon and president of the Scholarship Foundation for the past six years. >>

Home-Grown Doctors > Alejandro Ochoa III

Carlos Paz, MD is a board-certified dermatologist and fellowship-trained dermatologic surgeon, with offices in Fresno and Visalia, Ca.

“Knowing that Fresno is number two in the country in terms of the need for dermatologists made my decision (to return) easier,” said Dr. Paz. “I could go back to Fresno County and really make a difference. There is just a huge need in the Valley for doctors.”

The Central San Joaquin Valley has one of the lowest doctor-to-patient ratios in the state, with shortages in primary care and all specialties. Fresno and Madera counties also have huge healthcare challenges with high rates of poverty, asthma, diabetes, and obesity, and a large population that doesn’t speak English.

It’s exactly the kind of community this year’s scholarship recipient Alejandro Ochoa III hopes to serve when he becomes a doctor. “I want to be in a position where I can help take away that language barrier and build that trust,” said the Spanish-speaking Ochoa.

His parents immigrated from Mexico and Guatemala as teenagers and didn’t have a chance to perfect their English

30

CENTRAL VALLEY PHYSICIANS

or go far with their education. “I remember some of the interactions we’d have when we went to the doctor and even though I was young, I saw it was difficult for my mother to talk to the physicians and for them to talk to her,” described Ochoa, the oldest of four. “I want to be that culturally competent physician.”

Ochoa, a third-year medical student at University of California, Los Angeles, is part of the exclusive UCLA Prime program for those who have experience working with and are committed to serving diverse, medically-disadvantaged populations. Eighteen students are chosen each year for the five-year, double-degree program, which leads to an MD and a Master’s and requires a public-service project in an underserved community. Ochoa starts his clinical rotations this year and is hoping to finish with a Master’s in public health with an emphasis in bio-statistics. He said he’s particularly interested in population health His route to UCLA medical school was circuitous, so at

Summer 2016

30 he’s a bit older than many of his classmates. He had the good recommendations from their colleges, and good grades and test scores to qualify for a University of California transcripts. We also look for those who have demonstrated campus right after high school, but wasn’t sure he was ready efforts to volunteer. And we look at financial need too. With to leave home or that he could afford it. He did his first year the cost of medical school these days though, everyone is of college commuting to California State University, Fresno, needy.” and then realized that the easier, less expensive route to a UC “At this point, any amount is a help,” agreed Ochoa, who was via community college. After completing prerequisites has relied on scholarships, financial aid, part-time jobs, and at a community college, he transferred to University of loans to pay for his $55,000 a year education. “I’m grateful.

Southern California where he graduated with a Bachelor’s in This pays for a month’s rent,” he said.

Public Health, specializing in Health Promotion and Disease Since that first scholarship – $250 given away in 1961 Prevention.

Ochoa knew he wanted to go to medical school, but “We look for people with ties to the community, good took the next three years, to recommendations from their colleges and good transcripts. We build his resume and study to make sure his MCAT scores also look for those who have demonstrated efforts to volunteer. would get him to his dream And we look at financial need too. With the cost of medical school, UCLA. During those three years Ochoa worked as school these days though, everyone is needy.” an academic advisor in the Anaheim School District with first-generation immigrant high school students. to an Arnold Peters – the Society’s Foundation has given “I helped guide students through the process to college. I away more than $400,000. Dr. Wilfred Derksen, the second wanted to do for them what I wished someone would’ve done scholarship recipient, returned to Fresno to become a for me,” he said. “I’m the first in my entire family to go to pediatrician after receiving $2,550 in scholarships over four college. I knew I wanted to go, but I didn’t know how to do it. years. He also joined the Fresno Madera Medical Society I didn’t even know what the SAT was.” to help raise funding to encourage the next crop of local Ochoa loved being able to make the route to college doctors.

Seed money for the Scholarship Foundation came Since that first scholarship – $250 given away in 1961 to an from funds left over Arnold Peters – the society’s Foundation has given away more from Sunday polio vaccination clinics than $400,000. Dr. Wilfred Derksen, the second scholarship organized in the early recipient, returned to Fresno to become a pediatrician after 1960s by the Fresno Madera Medical receiving $2,550 in scholarships over four years. He also joined Society. The society the Fresno Madera Medical Society to help raise funding to joined the public effort to stamp out polio and encourage the next crop of local doctors. felt any excess funds should be used for a program that would easier for others like him. “And it just worked out that when have a permanent public health benefit to the community.

I applied to the Prime program in UCLA, that’s exactly the That early funding was augmented by a group of physicians kind of experience they were looking for,” he added. who had a Dixieland jazz band. “They would play gigs and It’s also the kind of experience the Fresno Madera put their earnings toward the foundation,” said Dr. Touton. scholarship committee was looking for, Dr. Touton Additional scholarship funding has been raised through explained, “We look for people with ties to the community, members’ contributions, memorial gifts, and fundraising

Summer 2016

CENTRAL VALLEY PHYSICIANS

31

CMA/FMMS/KCMS’s exclusive Workers’ Compensation program can help your practice save money!

Savings

CMA members qualify for an additional 5% discount* on top of Preferred Insurance’s already competitive rates. Preferred’s rates are set for long term consistency, and are managed by focusing on safety and injury prevention, fraud prevention and the control of medical costs for your practice by getting employees back to work as soon as practical.

Service Mercer’s team of insurance advisors is knowledgeable about the needs of physicians and is available to walk you through the application process. Preferred’s claims examiners are experts in helping members with an employee injury or illness claim. Plus Preferred’s payroll management and flexible payment plans help you manage your premiums in the way that works best for you and your practice’s cash-flow needs.

Safety In addition to mandatory CalOSHA information and videos on workplace safety, Preferred’s team of Risk Advisors are available for consultations when you need them. They also have a strong fraud prevention policy and as a California-based carrier, they know exactly what it takes to do business successfully in this State.

Stability Preferred Insurance prides itself on its stability, which includes maintaining some of the best and most consistent pricing available for CMA members. And because of its Medical Provider Network of credentialed medical professionals, claim costs can be closely monitored and managed while providing quality care to injured employees.

Call Mercer today at 800-842-3761 for a premium indication.

CMACounty.Insurance.service@mercer.com or www.CountyCMAMemberInsurance.com.

See how CMA/FMMS/KCMS’s Workers’ Compensation team can help you save!

Sponsored by:

Underwritten by:

Administered by:

Scan for info:

*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.

Mercer Health & Benefits Insurance Services LLC • CA Insurance License #0G39709 • Copyright 2016 Mercer LLC. All rights reserved.

74499 (7/16) • 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • www.CountyCMAMemberInsurance.com • CMACounty.Insurance.service@mercer.com 32

CENTRAL VALLEY PHYSICIANS

Summer 2016

Home-Grown Doctors > Alejandro Ochoa III

events, said Dr. Touton, who has been on the Scholarship Foundation’s 20-member board for the past 15 years.

This past year, $25,000 was split between more than a dozen medical students. “We’re pretty small in the amount we are able to give, but we figure every $1,000 helps,” said Dr. Tuoton. Once students earn a Fresno Madera Medical Society scholarship, they continue to get scholarship funding through the remainder of medical school.

Dr. Paz, a member of the scholarship selection committee, said his experience growing up underprivileged in the Valley helped him relate to many of the applicants. His background is similar to Ochoa’s as the youngest of seven children of immigrants to the Valley. While it was frustrating interactions with family physicians that propelled Ochoa to want to make a difference through medicine, for Dr. Paz it was his awe and respect for the doctors he saw while volunteering at a Parlier clinic after high school.

“What really sold me on the idea of medicine was when I saw a physician remove an ingrown toenail. I was so impressed at how someone could manipulate the human body and bring such relief to the patient,” Dr. Paz explained.

After Harvard medical school, residencies and internships at UC San Francisco and University of Chicago, a stint doing research in Mali, West Africa, and then a fellowship in Florida, Dr. Paz felt the pull of home. “Over the years I lived in pretty cool places – San Francisco, Chicago, and Miami – but every time I came back to the Valley I was excited to come back here. I was so familiar with the area and the culture.”

Ochoa knows he, too, will look for a place where his cultural heritage and language can best help patients.

He’s not sure yet if he’ll come back to the Valley when he finishes his residency. He’s not even sure yet what he might want to specialize in.

But Ochoa does know this: “I want to work with underserved populations. As a medical professional I’m in a privileged position to share patients’ stories. I’m able to listen, relate to them, and then put it all together and share it back. I want to practice medicine in a way that empowers the patient.”

With luck, the monetary encouragement from the Fresno Madera Medical Society will nudge Ochoa back to his roots to empower patients here in the Valley.

Summer 2016

“I want to work with underserved populations. As a medical professional I’m in a privileged position to share patients’ stories. I’m able to listen, relate to them and then put it all together and share it back. I want to practice medicine in a way that empowers the patient.”

CENTRAL VALLEY PHYSICIANS

33

Retired Physicians > FMMS Members

FRIENDS

Beyond Medicine

Story By Nicole Butler

There’s an old saying that friendships last a life time. That saying couldn’t be more true for a group of Central Valley doctors. In the spirit of camaraderie, twice a month a small group of physicians ranging in specialty from OB/GYN to ENT to Neurosurgery get together for lunch and talk… not about medicine, but about life. These doctors are all retired, well somewhat retired.

In early 2010, Drs. Morton Rosenstein and the late Robert Duerksen starting calling some colleagues to get together for lunch. Within a couple of months, dozens of retired doctors were showing up to talk about ... well, a lot of different topics.

Colleagues that are no longer with us, challenges in medicine today, grandchildren, and hobbies.

“Twenty-five percent of the time we talk about our frustration with electronics, cell phones, televisions, and computers,” Dr. Paul Madsen, retired GYN said with a smile.

“The rest of the time we talk about how good medicine used to be, and how happy we are to be retired” Madsen continued.

Although a lot of these doctors are “retired”, most are still very active in the medical community. In fact, most of them

34

CENTRAL VALLEY PHYSICIANS

still have jobs. Some work part-time, some volunteer, and all of them stay busy. Drs. Adams and Madsen currently serve as facility staff at University of California San Francisco Fresno.

At 83 years young, Dr. Beil, a founding partner of CCENT, still assists the current doctors in the group today. Dr. Boro, considered the “young one” in the group, stays busy as the Program Director for the Valley Fever Study and works with the California State Medical Board weekly. Dr. Adams has been traveling a lot this year doing talks about his dad, Ansel Adams, in celebration of the 100th Year of National Parks.

In listening to their conversations, it’s obvious that these doctors have been friends for years. Some friendships go all the way back to their residency at Fresno Community General

Summer 2016

Hospital, the former University Medical Center. “This represents a group of doctors that worked so well together, they continued to be friends,” said Dr. Rosenstein, retired OB/GYN. “We knew each other back in the 60’s before gray hair and no hair. We trained together and we stayed in town because of friendships,” Dr. Thomas Cole, retired pulmonologist continued.

Family is another frequent topic among the group, from Dr. Unguez saying how proud he is of his daughter, Pediatrition Dr. Carmela Sosa, to Dr. Smith boasting to the group about his newest granddaughter born just last week.

Of the 13 doctors that were at last week’s lunch, we counted a total of 52 grandchildren, and soon to be 53 when Dr. Hadden’s daughter delivers next week.

When asked what advice he would give a new physician just starting out, Dr. Boro stated “Enjoy the ride. Leverage the technology to improve care and personalize patient care as much as possible.”

All of the doctors present were long-time members of the Fresno-Madera Medical Society. We had four past presidents of the Medical Society, Dr. Knapp (1974), Dr. Beil (1977), Dr. Bonner(1985), and Dr. Hadden (2005). Honestly, Drs. Smith and Boro are still involved with the Medical Society serving as CoChairs of the Historical Committee.

It was a privilege talking with these doctors and getting to know them better.

I hope to be invited back again to hear some more stories on the history of medicine in Fresno.

 

Securies offered through Kestra Investment Services, LLC (Kestra IS), member FINRA/SIPC. Kestra IS is not affiliated with Fort Washington Financial & Insurance Services, Inc.

Summer 2016

Michael Adams, IM FMMS Member for 37 years Marvin Beil, ENT FMMS Member for 47 years John Bonner, MS FMMS Member for 44 years Herbert Boro, IM, ID FMMS Member for 37 years Thomas Cole, PUD FMMS Member for 35 years David Hadden, PTH FMMS Member for 44 years Donald Knapp, IM, GE FMMS Member for 42 years Leonard Lovalvo, CRS, GS FMMS Member for 48 years Paul Madsen, GYN FMMS Member for 39 years Morton Rosenstein, OBG FMMS Member for 48 years Roy Smith, NS FMMS Member for 55 years John Slater, NS FMMS Member for 48 years Frank Unguez, VS FMMS Member for 43 years

Financial management for physicians is more complex than ever. Working with an experienced advisor team that provides comprehensive financial services to hundreds of your peers is a good place to start. Think of us as your financial concierge. We understand the complexity of a medical professionals working life, the rapidly changing environment, the risks, and the potential rewards. From school debt analysis, retirement funding, to appropriate disability insurance and umbrella risk needs, and the ever growing financial burden of college education for your children, we have seen what works and what does not.

  

CENTRAL VALLEY PHYSICIANS

35

36

CENTRAL VALLEY PHYSICIANS

Summer 2016

42% OF UCSF FRESNO GRADUATES ARE STAYING IN THE CENTRAL VALLEY UCSF Fresno held its 41st graduation June 5, 2016. More than 100 physicians, including medical residents in eight specialties and fellows in 12 sub-specialties along with two oral and maxillofacial surgery dental residents, took part in the ceremony. Of the 108 graduates, over 40 percent are staying in the Central Valley to practice medicine. Some of which will join the faculty at UCSF Fresno to train the next generation of physicians. Others will continue medical training in fellowships with UCSF Fresno.

Some of this year’s graduates include Greg Gilmore, DO, who completed residency training

Summer 2016

in internal medicine and is staying to continue training at UCSF Fresno as one of two fellows in the new Hematology/Oncology Fellowship, which starts July 1. Â Dr. Gilmore was born and raised in the San Fernando Valley. He went to UC Irvine and attended Western University College of Osteopathic Medicine of the Pacific. Greg Gilmore, DO, is finishing residency training in internal medicine and will be staying at UCSF Fresno as one of the first two fellows in the new Hematology/Oncology Fellowship, which starts July 1. >>

CENTRAL VALLEY PHYSICIANS

37

2016 > Local Graduates

Pearl Ma, MD, who is originally from Iowa, completed fellowship training in minimally invasive surgery and bariatric surgery and is staying in Fresno to perform bariatrics and metabolic surgery at Advanced Laparoscopic Surgery Associates.

Mitul Patel, MD, who was born in Modesto and raised in Lodi, completed residency training in pediatrics and is staying in Fresno to provide care at Children’s Medical Centers.

HOUSESTAFF AWARDS Residents vote for members of the housestaff, faculty and non-physician staff who exemplify standards of teaching excellence deserving of special recognition. Outstanding first year resident Outstanding resident teacher Outstanding attending teacher Outstanding non-physician teacher

Outstanding first year residentTheodore Geissler, MD - Internal Medicine Outstanding resident teacherJonathan Kung, MD Gastroenterology

Outstanding attending teacherDeena Bengiamin, MD Emergency Medicine

Sarah Sifuentez, MD, is finishing residency training in emergency medicine. She will stay in Fresno to provide care at Kaiser Medical Center. Congratulations to all of the graduates and best wishes! Â A number of awards were be presented during the graduation ceremony, including honors for outstanding residents and teachers, Borba research awards, the UCSF Fresno Community Service Award, Kaiser Award for Excellence in Teaching, the ICare Award, the Leon S. Peters Resident of the Year Award and the Steven N. Parks Leadership Award.

BORBA HOUSESTAFF & FACULTY RESEARCH AWARD The Faculty Development and Scholarly Activity Committee reviews original research conducted by members of the faculty and housestaff. Awards are given to recognize creative research judged to be the most significant and meritorious during the academic year.

Crystal Ives Tallman, MD Emergency Medicine Arang Samim-Intventional, MD Cardiology Manmeet Singh, MD Cardiovascular Fellow Vipul Jain, MD Pulmonary, Internal Medicine

ICARE AWARD This award recognizes the resident who exemplifies the abilities to communicate effectively, lead treatment teams that foster a culture of safety and uses data effectively when making decisions.

Robert Ferdman, DO Internal Medicine

UCSF FRESNO COMMUNITY SERVICE AWARD This award, established by the Dizon family, recognizes the resident who best personifies the UCSF Fresno value of outstanding service to the community.

Aysun Azimi, DO - Pediatrics

Outstanding non-physician teacherGerald Willey, PA - Surgery PA

38

CENTRAL VALLEY PHYSICIANS

Summer 2016

LEON S. PETERS “RESIDENT OF THE YEAR” In December 2011, the “Leon S. Peters Resident/Fellow of the Year Award” was established through funding received from the Leon S. Peters foundation in support of the first UCSF Fresno Resident Council. The Resident Council has selected one resident/fellow, nominated by his/her peers, who has demonstrated an outstanding job in patient and family care, research project success, has volunteered in the community to provide medical assistance where needed, and is overall a well-rounded physician concerned about his/her patients, research and community.

Pearl Ma, MD – Surgery Fellow

STEVEN N. PARKS, MD, LEADERSHIP AWARD Steven N. Parks, MD was known for his vision, leadership and guidance, during his 35 years of practice in Fresno, Dr. Parks made many outstanding contributions to the medical community, the profession, the Fresno-Madera Medical Society and other professional organizations. His dedication and commitment to medicine continue through this leadership award, established by the medical society to recognize and encourage excellence in leadership development within organized medicine by residents and fellows and serves to stimulate similar efforts by other physicians in training.

Nicklaus Brandehoff, MD Emergency Medicine Fellow

EMERGENCY MEDICINE Nicklaus Brandehoff, MD University of California, San Francisco, School of Medicine Dr. Brandehoff will begin a Medical Toxicology Fellowship at The Rocky Mountain Poison and Drug Center in Denver, Colorado.

Jennifer Conti, MD University of Southern California Keck School of Medicine Dr. Conti has accepted a faculty position with Northern Nevada Emergency Physicians in Reno, Nevada.

Leslie Crebassa, MD University of California, Davis, School of Medicine Dr. Crebassa will be doing per diem work in the Central Valley.

KERN MEDICAL CELEBRATES 2016 RESIDENT PHYSICIAN AND FELLOW GRADUATES AT 59TH ANNUAL GRADUATION CEREMONY Kern Medical celebrated its 2016 resident physician and fellow graduates in a graduation ceremony and reception at the Bakersfield Museum of Art on Thursday, June 9, 2016. A total of 31 resident physicians and fellows are graduating this year after three to five years of training at Kern Medical.

“As the only academic training hospital in the county, Kern Medical is proud to equip our residents and fellows with the education they need for a successful career in health care,” said Russell Judd, CEO of Kern Medical.

“Between services like Emergency Medicine, General Surgery, Internal Medicine, OB/GYN and Psychiatry, Kern Medical’s graduates are prepared to address health issues pertinent to our community and beyond.”

Each year, Kern Medical trains over 100 resident physicians and fellows in eight specialties, and nearly 140 medical students undergo their third and fourth year medical school rotations at the hospital and its clinics.

While Kern Medical says congratulations to one group, the hospital welcomes the new incoming class of resident physicians and fellows on June 28, 2016.

This year’s new class has 42 residents and fellows in practice areas including Emergency Medicine, Clinical Pharmacy, Internal Medicine, Obstetrics and Gynecology, General Surgery, Psychiatry, Rio Bravo Family Medicine, and Child & Adolescent Psychiatry.

EMERGENCY MEDICINE Babak Farivar, MD Sarah Gonzalez, MD Matthew Greer, MD Bryan Lembo, MD Mark Loewen, DO Khoa Tu, MD Continued on page 41

Summer 2016

CENTRAL VALLEY PHYSICIANS

39

2016 > Local Graduates

Dan Garrison, MD Rosalind Franklin University of Medicine and Science, Chicago Dr. Garrison has accepted an Emergency Medicine faculty position with Indiana University Health in Bloomington, Indiana.

Jove Graham, MD Tulane University School of Medicine Dr. Graham has accepted a North Sound Emergency Medicine faculty position with Providence Hospital in Everett, Washington.

Crystal Ives Tallman, MD University of Southern California Keck School of Medicine Dr. Ives Tallman has accepted an Emergency Medicine faculty position at UCSF Fresno in California.

Daniel Kwan, MD Washington University School of Medicine Dr. Kwan has accepted an Emergency Medicine faculty position with Good Samaritan Hospital in San Jose, California.

WILDERNESS MEDICINE FELLOWSHIP Derek Meyer, MD University of Illinois College of Medicine Dr. Meyer has accepted a faculty position with Adventist in Portland, Oregon.

Saint Louis University School of Medicine Dr. Storkan has accepted an Emergency Medicine faculty position at UCSF Fresno in California.

ORTHOPAEDIC SURGERY Samia Ghaffar, MD University of California, Irvine, College of Medicine Dr. Ghaffar will begin a Spine Fellowship at University of Washington / Harborview Medical Center in Seattle, Washington.

Nicole Wojtal, MD University of California, San Francisco, School of Medicine Dr. Wojtal will begin an Administrative Fellowship at Ronald Reagan UCLAAntelope Valley Hospital in Los Angeles.

40

CENTRAL VALLEY PHYSICIANS

Lake Erie College of Osteopathic Medicine at Erie, PA Dr. Sastry has accepted a position with Kaiser Permanente in Sacramento, California.

PEDIATRICS Janae Barker, DO Touro University College of Osteopathic Medicine at Vallejo, CA Dr. Barker will be a Chief Resident at Valley Children’s Hospital in Madera, California.

Anita Chadha MD Matthew Knedel, MD University of Southern California Keck School of Medicine Dr. Knedel will begin an Adult Reconstruction Fellowship at Rush University in Chicago, Illinois.

Edward Walker Gallego, MD University of Illinois College of Medicine Dr. Walker Gallego will begin an Orthopaedics, Sports Subspecialty Fellowship at Houston Methodist Hospital in Houston, Texas.

Philip Stalcup, MD Tulane University School of Medicine Dr. Stalcup has accepted an Emergency Medicine faculty position with Tulane University in New Orleans.

Touro University College of Osteopathic Medicine Henderson, Nevada Dr. Novack will join an Ob/Gyn practice in Montana.

Ragini Sastry, DO Michelle Storkan, MD

Sarah Sifuentez, MD Warren Alpert Medical School of Brown University Dr. Sifuentez has accepted an Emergency Medicine position with Kaiser Permanente in Fresno, Ca.

Mallory Novack, DO

OBSTETRICS/GYNECOLOGY Melissa Adrouny, MD Tulane University School of Medicine Dr. Adrouny will begin an Ob/Gyn private practice in the Bay Area.

Corinna Liu, DO College of Osteopathic Medicine of the Pacific at Pomona Dr. Liu has accepted a position with Omni Women’s Health in Fresno, California.

Ross University Dr. Chadha will begin a Neonatology Fellowship at Loma Linda University in California

Albert Chow, MD Medical College of Wisconsin Dr. Chow will begin a Rheumatology Fellowship at University of Washington in Seattle, Washington.

Anna Ekstrom, DO Touro University College of Osteopathic Medicine at Vallejo, CA Dr. Ekstrom will be going into private practice in Fresno.

Erica Mariel Gastelum, MD University of California, San Francisco, School of Medicine Dr. Gastelum will be a Chief Resident in Pediatrics at UCSF Fresno in California.

Alicia Hardcastle, DO Touro University College of Osteopathic Medicine at Vallejo, CA Dr. Hardcastle will be a Chief Resident in Pediatrics at UCSF Fresno in California.

Summer 2016

Jessica Lee, MD Ross University Dr. Lee will begin a Critical Care Fellowship at Loma Linda University in California.

Mitul Patel, MD Ross University Dr. Patel will join a Private Practice in Fresno and will work per diem at Children’s Health Clinic.

Elaine Peterson, DO Pacific Northwest University of Health Sciences College of Osteopathic Medicine Dr. Peterson will join a Private Practice in Washington.

Sonia Solomon, DO Philadelphia College of Osteopathic Medicine Dr. Solomon will begin a Pediatric Nephrology Fellowship at Montefiore Medical Center /Einstein in New York.

Jasmine Walker, MD Loma Linda University School of Medicine Dr. Walker has accepted a Pediatric faculty position with UCSF Fresno in California.

Vincent Whelan, MD University of California, Irvine, College of Medicine Dr. Whelan has accepted a hospitalist position as a bone marrow specialist at Stanford in Palo Alto, Ca.

Monica Zlotnicki, MD St. George’s University Dr. Zlotnicki will begin a Hematology/Oncology Fellowship at Children’s Hospital in Oakland, California.

PEDIATRIC COMMUNITY FELLOWSHIP Aysun Azimi, DO Touro University of College Osteopathic Medicine at Vallejo, CA Dr. Azimi will be joining Kaiser Permanente in Southern California.

Soniya Mehra, DO University of Missouri-Kansas City Dr. Mehra has accepted a Pediatric faculty position with UCSF Fresno in California.

FAMILY MEDICINE Shashmi Ghanpur Balakrishna, MD Harini Goli, MD Gayathri Kaushik, MD Liam Soe Kyan, MD Thaw Zin Thiha, MD GENERAL SURGERY Allan L. Capote, MD Amber Jones, DO, MPH INTERNAL MEDICINE David A. Aguirre, MD Boris Arutyunov, MD Nason Azizi, MD Si Chen, MD Bahareh Ghafarizadeh, MD Harsimran Singh Gill, MD Amanpreet Kaur Bath, MD Sukhpreet Sidhu, MD OBSTETRICS & GYNECOLOGY Kiran Kavipurapu, DO Michelle Sanchez, MD Neetu Sodhi, MD CLINICAL PHARMACY Pete Fowler, PharmD, MBA Jackie Ho, PharmD, MPH ADDICTION PSYCHIATRY FELLOWSHIP Sameer Hassamal, MD CHILD & ADOLESCENT PSYCHIATRY FELLOWSHIP Sadia Ghaffar, DO Matthew Louie, MD Thuong-Phuong Van Arvid Nguyen, MD PSYCHIATRY Japsharan Gill, MD

Summer 2016

CENTRAL VALLEY PHYSICIANS

41

2016 > Local Graduates

SURGERY Sara Higginson, MD Ohio State University College of Medicine Dr. Higginson will begin a Burn Fellowship at the University of North Carolina at Chapel Hill, North Carolina.

Amy Kohlbrenner, MD Saint Louis University School of Medicine Dr. Kohlbrenner will be joining a private practice in San Francisco, California.

MINIMALLY INVASIVE SURGERY FELLOWSHIP Pearl Ma, MD University of California, Davis, School of Medicine Dr. Ma has accepted a MIS Bariatric and General Surgeon faculty position with Advanced Laparoscopic Surgery Associates in Fresno, California.

Subhash Reddy, MD Mysore Medical College Dr. Reddy will join a private practice in California.

Carol Machado, MD University of California, San Diego, School of Medicine Dr. Machado will join a group practice in Fresno, California.

Jonathan Romanyshyn, MD Yale University School of Medicine Dr. Romanyshyn will join a group practice in Fresno, California.

Lexine Yurcho, MD Ross University Dr. Yurcho will begin a colon and rectal surgery Fellowship at Saint Vincent Hospital in Erie, Pa.

ACUTE CARE SURGERY FELLOWSHIP Shaina Schaetzel, MD University of North Dakota School of Medicine Dr. Schaetzel has accepted a Trauma Acute Care Surgery faculty position with The Everett Clinic in Everett, Washington.

42

CENTRAL VALLEY PHYSICIANS

Stanford University School of Medicine Dr. Arroyo will begin a Neurology Residency at Harvard University in Cambridge, Massachusetts.

Lynn Chang, DO College of Osteopathic Medicine of the Pacific at Pomona, CA Dr. Chang will begin a Physical Medicine and Rehabilitation Residency at UCLA/ VA Greater Los Angeles Healthcare Systems in Los Angeles, California

Ryan Fraiser, DO

Jordan Lilienstein, MD University of California, Davis, School of Medicine Dr. Lilienstein will begin a Surgical Critical Care Fellowship with Wake Forest Baptist Medical Center in WinstonSalem, North Carolina.

Sergio Arroyo, MD

ORAL & MAXILLOFACIAL SURGERY Niloofar Deyhim, DDS New York University College of Dentistry Dr. Deyhim will practice in California.

Touro University College of Osteopathic Medicine at Vallejo, CA Dr. Fraiser will begin a Physical Medicine and Rehabilitation Residency at Stanford University School of Medicine in Palo Alto, California.

Theodore Geissler, MD Jeffrey Garcia, DDS UCLA School of Dentistry Dr. Garcia plans to practice in Oregon.

PSYCHIATRY Mary Gable, MD Stanford University School of Medicine Dr. Gable will begin a Child & Adolescent Psychiatry Fellowship at UCLA in Los Angeles, California.

Sindhura Reddy, MD Touro University College of Osteopathic Medicine at Vallejo, CA Dr. Reddy has accepted an Outpatient Psychiatry position in Orange County, California.

University of California, Davis, School of Medicine Dr. Geissler will begin an Anesthesiology Residency at UC Davis in Sacramento, California.

Andrew Han, DO Touro University College of Osteopathic Medicine at Vallejo, CA Dr. Han will begin an Anesthesiology Residency at UC Davis in Sacramento, California.

Satinderpal Khera, MD Georgetown University School of Medicine Dr. Khera will begin a Radiology Residency at UC Davis in Sacramento, California.

Peter Kim, MD INTERNAL MEDICINE (PRELIMINARY) Sin Yeong An, MD University of California, San Francisco, School of Medicine Dr. An will begin an Anesthesiology Residency at UC Davis in Sacramento, California.

Drexel University College of Medicine Dr. Kim will begin a Neurology Residency at Yale University in New Haven, Connecticut.

Braden Lind, MD State University of New York Upstate Medical University Dr. Lind will begin a Radiology Residency at the University of Texas in Houston.

Summer 2016

Sabrina Young, DO

Raman Mattu, MD

Leonid Vydro, MD

University of North Texas Health Science Center College of Osteopathic Medicine Dr. Young will begin a Physical Medicine and Rehabilitation Residency at Baylor University Medical Center in Dallas, Texas.

Ross University Dr. Mattu has accepted a Primary Care position in Parlier, California.

Medical College of Wisconsin Dr. Vydro will begin an Endocrinology Fellowship at University of Illinois, Chicago.

INTERNAL MEDICINE (CATEGORICAL) Jennifer Akamine, MD Rosalind Franklin University of Medicine and Science, Chicago Medical School Dr. Akamine will practice Internal Medicine on the island of Oahu, Hawaii.

Nabil Baig, DO Touro University College of Osteopathic Medicine Henderson, NV Dr. Baig will be a Chief Resident in Internal Medicine at UCSF Fresno in California.

Robert Ferdman, DO Touro University College of Osteopathic Medicine Henderson, NV Dr. Ferdman has accepted a hospitalist position at Kaiser Permanente

Rebecca Flanagan, DO College of Osteopathic Medicine of the Pacific at Pomona, CA Dr. Flanagan has accepted a Hospitalist position in Vancouver, Washington.

Gregory Gilmore, DO College of Osteopathic Medicine of the Pacific at Pomona, CA Dr. Gilmore will begin a Hematology/ Oncology Fellowship at UCSF Fresno in California.

Shruti Joglekar, MD Mahatma Gandhi Mission’s Medical College Dr. Joglekar has accepted a faculty position at the VA hospital in Fresno, California.

Ashenafi Legesse, MD Addis Ababa University Dr. Legesse has accepted a Hospitalist position at Community Hospitalist Medical Group in Fresno, California.

Summer 2016

Jarae Ng, DO Arizona College of Osteopathic Medicine Dr. Ng will be a Chief Resident in Internal Medicine at UCSF Fresno in California.

INTERNAL MEDICINE (CHIEFS) Amir Najafi, DO

Ladoke Akintola University of Technology Dr. Oladimeji has accepted a Hospitalist position in Bakersfield, California.

Touro University College of Osteopathic Medicine Henderson, NV Dr. Najafi has accepted a position with the VA in Fresno, California.

Deanna Oliver, MD

Hau (Ken) Nguyen, MD

Lola Oladimeji, MD

American University of the Caribbean Dr. Oliver will be a Chief Resident in Internal Medicine at UCSF Fresno in California.

University of Wisconsin School of Medicine and Public Health Dr. Nguyen has accepted a faculty position with the VA in Fresno, California.

H. Kiran K. Reddy, MD

Reza Ronaghi, MD

St. George’s University Dr. Reddy will begin a Cardiology Fellowship at UCSF Fresno in California.

Miguel Risco, MD University Peruana Cayetano Heredia Dr. Risco will be a Chief Resident in Internal Medicine at UCSF Fresno in Ca.

Jonathan Rosario, DO A.T. Still University School of Osteopathic Medicine in Arizona Dr. Rosario has accepted a Hospitalist position with Kaiser Permanente in Fresno, California.

Gary Rubiaco, MD Ross University Dr. Rubiaco has accepted a Hospitalist position in Bakersfield, California.

Artem Ryazantsev, DO College of Osteopathic Medicine of the Pacific at Pomona, CA Dr. Ryazantsev has accepted a Hospitalist position with Baystate Medical Center in Springfield, Ma.

Saba University Dr. Ronaghi will begin a Pulmonary and Critical Care Fellowship at University of Southern California in Los Angeles, California.

PULMONARY DISEASE/ CRITICAL CARE FELLOWSHIP Pradeep Doddamreddy, MD Ross University Dr. Doddamreddy will begin a Sleep Fellowship at Stanford University in Palo Alto, California.

Ali Rashidian, MD Ross University Dr. Rashidian has accepted a Pulmonary Critical Care faculty position with Clovis Heart in Fresno, Ca.

Gurpartap Sahota, MD Kasturba Medical College Dr. Sahota has accepted a Pulmonary Critical Care faculty position with Kaiser Permanente in Modesto, Ca.

Christopher Smith, MD Ross University Dr. Smith has accepted a position with CEP America in Montana.

CENTRAL VALLEY PHYSICIANS

43

2016 > Local Graduates

SLEEP MEDICINE FELLOWSHIP Kinjal Madhav, MD Ross University Dr. Madhav has accepted a Sleep Medicine and Primary Care position with Kaiser Permanente, Fresno, Ca.

Mohamed Saadi, MD Misr University for Science and Technology Dr. Saadi has accepted a Pulmonary, critical care and sleep medicine position with East Valley Pulmonary Associates in Tempe, Arizona.

CARDIOVASCULAR DISEASE

Interpreet Feudale, MD

Fellowship

St. George’s University Dr. Feudale has accepted a Family Medicine position in Phoenix, Arizona.

Tushar Acharya, MD Sri Devaraj Urs Medical College Dr. Acharya will begin an Advanced Cardiac Imaging Fellowship at National Institute of Health.

Kamil Muhyieddeen, MD University of Jordan Dr. Muhyieddeen will begin an Interventional Cardiology Fellowship at the University of Wisconsin.

Manmeet Singh, MD INFECTIOUS DISEASE FELLOWSHIP Ahlaam Alynbiawi, MD King Abdulaziz University Dr. Alynbiawi has accepted a position with King Faisal Specialist Hospital & Research Center in Saudi Arabia.

Ingrid Fernandes, MD Albert Szent-Gyorgyi Medical University Dr. Fernandes will join a private practice in Napa, California.

Medical University Pleven Dr. Singh will begin an Interventional Cardiology Fellowship at UCSF Fresno in California.

INTERVENTIONAL CARDIOLOGY FELLOWSHIP Arang Samim, MD Boston University School of Medicine Dr. Samim will be joining UCSF Fresno Faculty as an Interventional Cardiologist at the VA in Fresno, Ca.

Thwe Shein, MD University of Medicine 1 Dr. Shein will join a private practice in the Bay Area.

GASTROENTEROLOGY FELLOWSHIP Pradeep Atla, MD Armed Forces Medical College Dr. Atla will join Mid-Valley Gastroenterology in Corvallis, OR.

Dekey Lhewa, MD University of Washington School of Medicine Dr. Lhewa will begin a Transplant Hepatology Fellowship at University of Michigan in Ann Arbor, MI.

44

CENTRAL VALLEY PHYSICIANS

Ashlynn Gordon, DO College of Osteopathic Medicine of the Pacific at Pomona, CA Dr. Gordon has accepted a Family Medicine position with Twin Cities Hospital in Templeton, California.

Benjamin Huang, MD State University of New York at Buffalo School Dr. Huang has accepted a faculty position with Stanford Medical Center in Palo Alto, California.

Sebouh Krioghlian, DO College of Osteopathic Medicine of the Pacific at Pomona, CA Dr. Krioghlian has accepted a Family Medicine position with Kaiser Permanente in Fresno, California.

Liana Milanes, MD Ross University Dr. Milanes will join UCSF Fresno Family Medicine as Faculty.

Rashell Reynoso-Garza, MD FAMILY & COMMUNITY MEDICINE Bobby Aulakh, MD American University of Antigua College of Medicine Dr. Aulakh has accepted a Family Medicine faculty position with United Health Centers in Parlier, Ca.

Jose Buenrostro, MD Universidad Autonoma de Guadalajara Dr. Buenrostro has accepted a Family Medicine faculty position with Castle Family Health Center in Atwater, Ca.

Alice Chung, MD Boston University School of Medicine Dr. Chung has accepted a Family Medicine faculty position with Express Care/Stanford Health Care in Palo Alto, California.

University of Illinois College of Medicine Dr. Reynoso-Garza has accepted a Family Medicine position with United Health Centers in Parlier, California.

Jusel Ruelan, DO A.T. Still University School of Osteopathic Medicine in Arizona Dr. Ruelan will join UCSF Fresno Family Medicine as Faculty.

Satjit Sanghera, MD St. George’s University Dr. Sanghera has accepted a Family Medicine faculty position with Kaiser Permanente in Fresno, Ca.

Alejandro Soto, MD Universidad de Montermorelos Dr. Soto has accepted a Family Medicine faculty position with Borrego Health Centro Medico in Escondido, California.

Summer 2016

MATERNAL CHILD HEALTH FELLOWSHIP Erica Delsman, MD

SIERRA VISTA FAMILY MEDICINE Arvin Fuentes, MD

Boston University School of Medicine Dr. Delsman will join UCSF Fresno Family Medicine as faculty.

University of Santo Tomas, Faculty of Medicine and Surgery, Philippines Dr. Fuentes has accepted a Family Medicine position with Valley Health Team in Kingsburg, CA. He will also join the Sierra Vista Family Medicine Residency as part-time faculty at VHT in San Joaquin, California.

HOSPICE AND PALLIATIVE MEDICINE FELLOWSHIP Duc Chung, MD State University of New York at Buffalo School of Medicine Dr. Chung has accepted a position in Palliative Medicine with Kaiser in Fresno, California

Austin Sue, MD Ross University Dr. Sue has accepted a Hospice Medical Director Position in Northern California.

Diana Oviedo-Cavazos, MD Universidad Evangélica de El Salvador Facultad de Medicina, El Salvador Dr. Oviedo-Cavazos has accepted a Family Medicine position with Valley Health Team in Firebaugh, CA. She will also join the Sierra Vista Family Medicine Residency as part-time faculty at VHT in San Joaquin, California.

Tahmina Rahman, MD Chittagong Medical College University, Bangladesh Dr. Rahman has accepted a Family Medicine position with Kaiser Permanente-Ambulatory Care Center in Bakersfield, California.

M. Alejandra Jaimes, MD Universidad de Cartagena Facultad de Medicina, Colombia Dr. Jaimes has accepted a Family Medicine position with Valley Health Team in Kerman, CA. She will also join the Sierra Vista Family Medicine Residency as part-time faculty at VHT in San Joaquin, California.

The value of adopting the Triton PEO, Inc. Retirement Plan 

A low-cost solution to enhance your benefits package,

 Streamlined plan management with features and services typically available only to larger companies,  A dedication to plan health, powered by targeted communications and education,  A comprehensive variety of investment options,  Flexible plan design options,  A seamless installation process.



 

Summer 2016

CENTRAL VALLEY PHYSICIANS

45

IRA > Advantages

IRA ASSETS

Leaving a Legacy Beginning the year after attaining age 70 ½, you are required to withdraw a minimum annual amount from certain retirement accounts, including IRAs. This minimum amount is known as a Required Minimum Distribution (RMD). RMDs are calculated by taking the total of the applicable account balance(s) on December 31st of the preceding year and dividing it by the your life expenctancy.

IRA challenge: As a physician, you may have other sources of retirement income and may not need your IRA assets to meet your financial needs. The RMD rules, however, require you take a minimum distribution and pay income taxes on the withdrawal amount each year. For those of you with significant wealth, the IRA could also be subject to estate taxes.

These taxes can result in your heirs only receiving a fraction of your IRA account balance.

IRA strategy: If you do not need the IRA income and want to leave more after-tax wealth to your heirs, one planning strategy is to begin withdrawing IRA assets to fund a life insurance policy. To avoid early withdrawal penalties, distributions should generally not begin until after age 59 ½.

46

CENTRAL VALLEY PHYSICIANS

The policy can be personally owned or—if you believe you have estate tax exposure—owned inside an irrevocable trust.

Each distribution from the IRA is taxable, but the net proceeds are used to pay the premiums on a tax-free life insurance benefit. Upon your passing, your heirs receive a death benefit from the life insurance plus whatever is left inside the IRA. Advantages • On an after-tax basis, this may increase the overall amount your heirs receive.

• The IRA owner selects the amount of life insurance benefit that is to be paid to heirs.

Summer 2016

• Accelerating IRA distributions and paying some income tax early may help to avoid larger income tax payments in the future.

• The life insurance death benefit paid to heirs is generally income tax free.

• If properly structured, the life insurance death benefits can avoid federal estate taxes.

Considerations • Income tax on the IRA distributions may be accelerated from what would otherwise be paid if just taking standard RMDs. • You must qualify for life insurance.

Survivorship policies can also be used for married individuals. If purchasing a survivorship policy, the spouse should be named IRA beneficiary so the funds will be available to continue the life insurance premiums.

the wealth they transfer to the next generation.

Insurance products are issued by Principal National Life Insurance Company (except in New York), Principal Life Insurance Company, and the companies available through the Preferred Product Network, Inc. Securities and advisory products offered through Principal Securities, Inc. (800) 247-1737, member SIPC. Principal National, Principal Life, the Preferred Product Network and Principal Securities are members of the Principal Financial Group, Des Moines, IA 50392. Chris Fide, Jaisy Prem, Jonathan Holt Principal National and Principal Life Financial Representative, Principal Securities Registered Representative, Financial Advisor. t16060104a7

Jonathan Holt, Jaisy Prem, Chris Fide 1350 East Spruce Avenue, Fresno, CA (559) 261-2000 • email: prem.jaisy@principal.com This is a paid advetorial.

The subject matter in this communication is provided with the understanding that The Principal® is not rendering legal, accounting, or tax advice. You should consult with appropriate counsel or other advisors on all matters pertaining to legal, tax, or accounting obligations and requirements.

Tracy Zweig Associates INC.

• The IRA funds used to pay life insurance premiums will not be available to the IRA owner for income.

• If assets are transferred to a life insurance trust outside of the estate, they will generally not be available to the account owner.

In addition, gifting and transfer strategies will need to be utilized to fund the life insurance policy inside the trust.

Summary: This strategy is not for everyone. It is an alternative that should be considered for affluent individuals who do not need their IRA assets to address living expenses during retirement and who are looking to maximize

Summer 2016

A

REGISTRY

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners ~ Physician Assistants

Locum Tenens ~ Permanent Placement Voice: 800-919-9141 or 805-641-9141 FAX: 805-641-9143

tzweig@tracyzweig.com www.tracyzweig.com

CENTRAL VALLEY PHYSICIANS

47

Public Health

Update

“The new map is more accurate than the initial one,” says Thomas Scott, an entomologist at the University of California, Davis. “The distribution of the A. aegypti mosquito is much more restricted than the initial map showed.”

Counties where Aedes aegypti was reported between Jan. 1, 1995, and March 2016. Counties in yellow recorded one year of A. aegypti being present; those shown in orange recorded two years; and those shown in red, three or more years.

Map Provided by Centers for Disease Control and Prevention

Zika Mosquitoes

A few months ago, the Centers for Disease Control and Prevention published a startling map that showed the parts of the U.S. that could harbor mosquitoes capable of carrying Zika.

By Michaeleen Doucleff

Many readers, including myself, thought, “Zika could come to my town! It could come to Connecticut! To Ohio and Indiana! Or to northern California! Oh, goodness!”

The map made it look like a vast swath of the country was at risk for Zika, including New England and the Upper Midwest.

48

CENTRAL VALLEY PHYSICIANS

Well, not quite.

On Thursday, CDC scientists published another mosquito map for the U.S. And it paints a very different picture.

The new map shows counties in which scientists, over the past two decades, have collected Aedes aegypti mosquitoes

Summer 2016

— the type of insect thought to be spreading Zika in Latin American and the Caribbean.

“The new map is more accurate than the initial one,” says Thomas Scott, an entomologist at the University of California, Davis. “The distribution of the A. aegypti mosquito is much more restricted than the initial map showed.”

In the map, counties colored yellow reported A. aegypti mosquitoes during one year between 1995 to 2016, orange counties had the mosquitoes in two years, and red counties are the hotspots: Scientists there found A. aegypti mosquitoes during three or more years in the past two decades.

Many of the hot spots for this mosquito aren’t surprising. They’re places that we already knew are vulnerable to Zika, including counties in southern Florida, along the Gulf Coast and southern Texas. These places have had problems with a virus closely related to Zika, called dengue. They’re already on high alert for Zika.

This map represents “...the best knowledge of the current distribution of this mosquito based on collection records,” entomologist John-Paul Mutebi and his colleagues at the CDC wrote in the Journal of Medical Entomology.

Many of the hot spots for this mosquito aren’t surprising.

They’re places that we already knew are vulnerable to Zika, including counties in southern Florida, along the Gulf Coast, and southern Texas. These places have had problems with a virus closely related to Zika, called Dengue. They’re already on high alert for Zika.

But several hot spots are bit more unexpected — and concerning. “Perhaps the most concerning development for A. aegypti is its establishment in the Southwest, most recently in California in 2013,” Mutebi and his co-authors write.

Other surprises include parts of the Bay Area, greater Washington, D.C., and the Dallas-Fort Worth region, which all have established populations of A. aegypti, the map shows.

“The country is really a patchwork,” Scott says. “When you drill down into one particular state, you find that the mosquito isn’t found across the whole state. And when you drill down into a county, you find the same thing. The mosquito is found in just a small part.”

So why did the first map from the CDC make it look like such an extensive part of the country was at risk for Zika?

“The two maps show different things,” Mutebi tells Shots.

Summer 2016

“The first map showed where the climate is able to sustain populations of A. aegypti. This new map shows reports from counties where these mosquitoes were found in the last 20 years.” and the new map, Mutebi says, is not complete. “Not all counties have mosquito surveillance programs looking for mosquitoes,” he says. In places that do, they are often targeting the mosquito that causes West Nile virus, not A. aegypti.

“So just because a county hasn’t reported having any A. aegypti mosquitoes, doesn’t mean they’re not there,” Mutebi says.

A. aegypti mosquitoes are nasty critters. They chase down people so they can feed on their blood, says virologist Scott Weaver at the University of Texas Medical Branch in Galveston.

“A. aegypti lives in close association with people, feeds almost exclusively on people — not animals — and even comes into people’s home,” he says. “Its behavior and its ecology are almost ideal for a mosquito to transmit a human virus.”

Michaeleen Doucleff is a digital editor for NPR’s Science Desk. She is the deputy host for the global health and development blog, Goats and Soda, and she reports for the Web and radio on disease outbreaks and trends in global health.

As a science journalist, Doucleff has reported on a broad range of topics, from vaccination fears and the microbiome to beer biophysics and dog psychology.

Before coming to NPR in 2012, Doucleff was an editor at the journal Cell, where she wrote about the science behind pop culture. Doucleff has a doctorate in chemistry from the University of Berkeley, California, and a master’s degree in viticulture and enology from the University of California, Davis.

CENTRAL VALLEY PHYSICIANS

49

Office Manager’s Forum Free to FMMS/CMA Members!

THE OFFICE MANAGER’S FORUM EMPOWERS PHYSICIANS AND THEIR MEDICAL STAFF WITH VALUABLE TOOLS VIA EXPERT LED EDUCATIONAL SESSIONS FROM INDUSTRY PROFESSIONALS WHO ARE COMMITTED TO DELIVERING QUALITY HEALTH CARE. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($20 thereafter). Registration required.

For more information, contact Nicole Butler at 559-224-4224 or nbutler@fmms.org.

WEDNESDAY, SEPTEMBER 28, 2016 NOON - 1:30 PM SENIOR HEALTH PLANS CHANGES ARE COMING IN 2017 In 2017 there will be changes to senior health plans that you need to know. What you can and cannot advise your patients about Medicare Insurance Plans. Medicare Advantage vs. Medigap -Medicare Supplements. Medicare Plan eliminations and new 2017 plans. How a person can get the best part D Drug plan for 2017.

Susan Hatch (PHIAS- Professional Health Insurance of Advanced Studies) is an objective advocate, analyst & talk radio guest expert on Medicare Supplements. A renowned specialist on CA Medicare Supplement laws & speaker at the National Medicare Supplement Insurance Conference. Susan is a licensed, independent insurance agent who represents ALL Supplement plan types. Awarded the #1 Medicare Supplement agent in California & The Soaring Eagle Award from NAHU. Accredited with the BBB, member of the Congress of California Seniors & The National Committee to preserve Social Security & Medicare.

In Memoriam

In Memoriam Robert N. Kammen, MD • Roger Abie Franz, MD

ROBERT N. KAMMEN, MD September 21, 1919 – March 31, 2016

Robert Kammen MD was born to Abraham and Fannie Kammen on September 21, 1919. He passed away peacefully on March 31, 2016. He received his Medical Degree from Indiana University and practiced Urology in Fresno for many years. He loved his family, friends, golfing, bridge, traveling, and the practice of medicine. He was preceded in death by his parents and brother, Leo. He is survived by Pepper, his loving wife of 70 years; daughters, Pamela and Karen; four grandchildren; and many nieces and nephews.

Dr. Robert N. Kammen was a member of the Fresno Madera Medical Society for 39 years.

ROGER ABIE FRANZ, MD January 2, 1936 – September 13, 2015

Dr. Roger Abie Franz was born to George and Mary Wiens Franz in Henderson, NE. He attended kindergarten through twelfth grade in Enid, OK; Tabor College in Hillsboro, KS; Phillips University in Enid, OK. He also attended Oklahoma University School of Medicine, where he received his doctorate degree in 1961. His Internship was in the Panama Canal Zone, and Surgery Residency in Bakersfield, CA He practiced family medicine for 39 fulfilling years in Sanger, CA. He was a member of the Christian Medical & Dental Society, Fresno Madera Medical Society, Fellow with the American Academy of Family Physicians, and served for a time as Chief of Staff for Sanger Hospital.

He married his high school sweetheart, LaWanda Franz, in Buhler, KS, on September 7, 1958, and was a loving husband. He enjoyed attending Butler Church, served as choir tenor, deacon, and council member. He volunteered as a camp doctor for Hume Lake and also held clinics on mission trips in the San Blas Islands and Mexico.

He valued education, establishing scholarships, giving physicals to high school sports teams, and cheering on the Sanger Apaches, Fresno Pacific University Sunbirds, and Fresno State University Bulldogs. He was a member of the Senior Professionals group at Fresno Pacific University as well as a 35 – year member of the President’s Circle. He could often be heard encouraging his children and grandchildren at their own sporting events and other activities.

Dr. Roger Abie Franz was a member of the Fresno Madera Medical Society for 47 years.

Summer 2016

CENTRAL VALLEY PHYSICIANS

51

Do you know What, When and How to Report Child Abuse?

FREE ONLINE COURSE! Course developed by the Child Abuse Prevention Center



Approved for 1.25 AMA PRA Category 1 Credits™





Approved for 1.25 CE credits 

Course available 24/7

Pre-register NOW at: 52

CENTRAL VALLEY PHYSICIANS

http://www.imq.org/education/caprrc.aspx Summer 2016

Hobbies > At a Glance

Hobbies

Local Physician Authors Book Story by Millie Thao

W

ith thirty years of experience as an internal medicine physician, Shelly Kruse, MD, was very familiar with treating patients, researching diseases, and forming treatment plans. Yet after her mother was diagnosed with Alzheimer’s disease, she found herself searching for information that wasn’t readily available. There were countless questions and no answers. Dr. Kruse decided it was time for that to change. Three years after the loss of her mother, she wrote Walking with Alzheimer’s to share her experience and journey.

“Writing the book was part therapy” said Dr. Kruse. She says it provided an outlet to recollect, share her experience and provide personal insight. “It is not a medical textbook. This book is intended to be a guidebook for patients and families of Alzheimer’s patients.”

The 124-page book is wellorganized with a table of contents that walks the reader through the difficult disease, with chapter titles like “Walking into the Doctor’s Office,” “Walking

Summer 2016

into Assisted Living,” “Walking into Hospice,” and so forth. It outlines everything a caregiver would need to know including medication and diet, state and federal disability laws, power of attorney, and more. Dr. Kruse simplifies the medical language and verbiage to a level that a caretaker and family member can understand.

According to Dr Kruse, Walking with Alzheimer’s has been out for a little more than a month. “So far, I’ve received a great response.” She says she is eager to hear back from her peers who are reviewing the book. Dr. Kruse recommends the book to family practice physicians, internal medicine physicians, caregivers, and families of those with Alzheimer’s.

Dr. Kruse graduated from Pomona College in Claremont, California, with a Bachelor’s Degree in Psychology after completing pre-med. She earned a Masters of Art in psychology from California State University, San Francisco. She received her Medical Degree from Oral Roberts University in Tulsa,

Oklahoma. She completed her residency in Internal Medicine in Southern California, and has been practicing medicine in Central California for 25 years.

Walking with Alzheimer’s can be purchased on Amazon.com in both traditional and eBook formats. Dr. Kruse will be hosting book signings in the near future.

CENTRAL VALLEY PHYSICIANS

53

Fresno Madera Medial society

2016 Pictorial Directory SuPPlement

new/renewing MeMbers between FebrUary 1 - May 31, 2016 ATTWILL, Francis

FISCHER, Barton

MASOOD, Sheikh

BAYARDO, Carlos

GABRIEL, San

MITROO, Pradnya

BIRD, Kenneth

HEROPOULOS, Angelos

MOJADADDI, Humaira

CASTLE, Brent

HSU, George

NARAIN, Gurinder

DOMINIC, Susan

JACKSON, Jason

PALAV, Swapna

FAYED, Ali

KIM, Vivian

PERRY, Victor

FELTON, Patricia

MARTINEZ, Gregory

PETKAR, Animesh

EM California Emergency Physicians Medical Group 1250 E. Almond Ave. Madera 93637 657-5555

FP California Emergency Physicians Medical Group 372 W. Cypress Ave. Reedley 93654 638-8155

CCM 1221 Fulton Mall Fresno 93721 488-2866 / FAX: 488-3298

EM California Emergency Physicians Medical Group 2755 Herndon Ave. Clovis 9-3611 324-4040 / FAX: 324-3979

IM 7780 N. Fresno St. Fresno 93720 493-5760 / FAX: 493-5292

IM 2335 E. Kashian Lane #270 Fresno 93701 445-1251 / FAX: 445-0683

OBG/Hormone Therapy 9493 N. Ft. Washington Rd, #103 Fresno 93730 365-1818 U of Michigan ’77

AN 2626 S. Mooney Blvd.

Visalia 93277 733-1250

IM California Emergency Physicians Medical Group 3152 N. Millbrook Ave., Suite C Fresno 93703 884-5540

IM California Emergency Physicians Medical Group 1141 Rose Ave. Selma 93662 891-1000

OTO Central California Ear, Nose, and Throat (CCENT) 1351 E. Spruce Ave. Fresno 93720 432-3303 / FAX: 432-1468

EM California Emergency Physicians Medical Group 1141 Rose Ave. Selma 93662 891-1000

OPH 7145 N. Chestnut Ave. #108 Fresno 93720 702-1212 / FAX: 209-546-6064

NEP The Nephrology Med Grp, Inc. 568 E. Herndon Ave. #201 Fresno 93720-2989 228-6600 / FAX: 226-3709

NEP 508 E. Almond Ave. Madera 93637 661-1965

GE Digestive Disease Consultants 1187 E. Herndon Ave. #101 Fresno 93720 440-0450 / FAX: 440-0253

IM California Emergency Physicians Medical Group 1250 E. Almond Ave. Madera 93637 675-5555

IM California Emergency Physicians Medical Group 800 N Street Sanger 93657 875-5545

FP California Emergency Physicians Medical Group 1141 Rose Ave. Selma 93662 891-1000

NS 7887 N. Cedar Ave. Fresno 93720 437-1000 / FAX: 437-3870

Eye-Q 7075 N. Sharon Ave. Fresno 93720 486-2000 / FAX: 256-8595

RAO, Ravi

SIDHU, Rabinder

THAMPY, Anila

RASHIDIAN, Ali

SILVEIRA, William

THISTLE, Richard

SCHILLING, Thomas

SIMONS, Matthew

THOMAS, Jeffrey

SCOTT-TOMLINSON, Tasha

SMITH, David

TONKINSON, Brien

SHANKERMAN, Robert

SMITH, John Charles

UTTAM, Jai

SHEIKH, Muhammad

SOOD, Pawan Kumar

VISVESHWARA, Nadarsa

cCare 7130 N. Millbrook Ave. #100 Fresno 93720 447-4949 / FAX: 447-4925

PCC California Emergency Physicians Medical Group 155 N. Fresno St. Fresno 93701 499-6520

EM California Emergency Physicians Medical Group 1141 Rose Ave. Selma 93662 891-1000

FP California Emergency Physicians Medical Group 224 W. Lacey Blvd.

Hanford 93230 583-8913

IM 650 Zediker Ave., Building 3 Parlier 93648 646-6618

GE CCFMG 2625 E. Divisadero Fresno 93721 326-1010 / FAX: 326-1020

SHERMAN, Susan

MFM 9300 Valley Children’s Place Madera 93636 353-8038 / FAX: 353-5580

AI 7151 N. Cedar Ave. #103 Fresno 93720-3311 325-7775 / FAX: 325-7505

California Cancer Center 7257 N. Fresno St. Fresno 93720 447-4050

ORS Sierra Pacific Orthopedics 1630 E. Herndon Ave. Fresno 93720 256-5200

GS California Emergency Physicians Medical Group 1250 E. Almond Ave. Madera 93637 675-5555

PDR Wishon Radiological Medical Group Inc. 5765 N. Fresno St., Suite 105 Fresno 93710 432-7442 / FAX: 485-6994

IM California Emergency Physicians Medical Group 7035 N. Chestnut Ave. Fresno 93720 323-0600

SOSA, Carmela

PD 9300 Valley Children’s Place Madera 93636 353-8038 / FAX: 353-5580

PD 7105 N. Chestnut Ave. #102 Fresno 93720 437-9024 / FAX: 437-9024

EM California Emergency Physicians Medical Group 1250 E. Almond Ave. Madera 93637 675-5555

OBG Central Valley OB/ GYN Medical Group 722 Med Center Drive E. #105 Clovis 93611 299-6300

OTO Central California Ear, Nose, and Throat (CCENT) 1351 E. Spruce Ave. Fresno 93720 432-3303 / FAX: 432-1468

AN 1180 E. Shaw, Suite 101 Fresno 93710 375-3340

NPM 9300 Valley Children’s Place Madera 93636 353-8038 / FAX: 353-5580

ZAMORA, Jose

GS Jose U Zamora II MD AMC 7125 N. Chestnut Ave. #103 Fresno 93720 765-4868 / FAX: 797-4674

Fresno Madera Medical Society 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 30 Fresno, CA

State of the Heart

We believe actions SAINT AGNES CARDIOLOGY SYMPOSIUM 2016 speak louder than words.

Saturday, April 23 • 8 a.m.-2 p.m.

Saint Agnes Medical Center, Shehadey Pavilion 1303 East Herndon Avenue • Fresno, California This symposium focuses on cardiovascular disease management and emerging paradigms in treating coronary and structural heart disease.

It will address practice gaps in disease management and provide education to improve patient outcomes.

Speakers Paradigms of Revascularization for Chronic Coronary Artery Disease Verghese Mathew, MD, FACC, FSCAI Consultant, Division of Cardiovascular Diseases and Department of Radiology Professor of Medicine, Mayo Clinic College of Medicine Protected PCI: Treating Complex Coronary Artery Disease in 2016 Anthony A. Hilliard, MD Assistant Professor of Medicine Director, Adult Cardiovascular Lab Loma Linda University International Heart Institute Invasive Management of Intractable Angina Gurpreet S. Sandhu MD, PhD Director, Dr. Earl Wood Cardiac Cath Lab, Mayo Clinic Transcatheter Mitral Valve Therapies Oluseun Alli, isMD Saint Agnes MedicalO. Center proud to be the only local hospital that Assistant Professor of Medicine publicly reports its heart surgery outcomes to the Society of Thoracic University of Alabama at Birmingham School of Medicine Surgery (STS) for online publishing. When comparing this data with hospitals across the country, Saint Agnes received a 3-star rating – denoting the highest category of quality possible – for its Preregistration is required • No charge performance in Coronary Artery Bypass Grafting Surgery.

Please register online at www.samc.com. Registration must be received by April 16, 2016,

Many hospitals will tell you they provide outstanding heart care, to be guaranteed a participant syllabus. If you have questions or problems registering online, but we’re willing to show you. www.samc.com

email medicaleducation@samc.com or call (559) 450-7566.

Registration at the door is dependent on space availability.

TM

5 AMA PRA Category 1 Credits to be awarded