December 2011

official publication of the san diego county medical society December 2011

Reaching

8,500 Physicians

life after

Every Month

medicine

“Physicians United For A Healthy San Diego”

“A” (ExcEllEnt) RAting

renewal rate

in a row of a.M. Best

of last

95

28

years

totAl DiviDEnDs DEclARED

$425M

or very satisfied

total years deClared dividend

Customers satisfied

32 34

93%

To make a calculated decision on medical liability insurance, you need to see how the numbers stack up—and there’s nothing average about NORCAL Mutual’s recent numbers above. We could go on: NORCAL Mutual won 86% of its trials in 2010, compared to an industry average of about 80%; and we paid settlements or jury awards on only 12% of the claims we closed, compared to an industry average of about 30%.* Bottom line? You can count on us. *Source: Physician Insurers Association of America Claim Trend Analysis: 2010 Edition.

strenghten your Practice at norcalMutual.coM Proud to support the San Diego County Medical Society.

B

S A N D I E G O P HY S I CI A N .or g O c tob e r 2011

Our passion protects your practice

Octo ber 2011 SAN DIEGO P HY SIC I A N. o rg

1

this month Volume 98, Number 12

Managing Editor Kyle Lewis

features

Editorial Board Van L. Cheng, MD, Adam F. Dorin, MD, Kimberly M. Lovett, MD, Theodore M. Mazer, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager Jennifer Rohr Sales Director Dari Pebdani Art Director Lisa Williams Copy Editor Adam Elder

LIFE AFTER MEDICINE 18 Are You the Retiring Type?

by Rosemarie Marshall Johnson, MD

20 Practicing Medicine Longer: The Impact of Aging on Physician Clinical Performance and Quality of Care

by Rosemarie Marshall Johnson, MD

21 SDCMS Would Like to Thank Our Retired Member Physicians!

24 Successful Retirement for Physicians

by Dilip V. Jeste, MD, and Alana Iglewicz, MD

28 What Have You Been Doing Since Retiring? Four Vignettes …

by Ralph R. Ocampo, MD, Ronald Reinsch, MD, Tomás E. Romero, MD, and William L. Sperling, MD

4 Briefly Noted

Featured Member SDCMS and CMA Seminars, Webinars, and Events And More …

6 Your Monthly Benefits Check-up Q&A With SDCMS-endorsed AKT Wealth Advisors And More …

geographic and geographic alternate Directors East County William T-C Tseng, MD, Heywood “Woody” Zeidman,

MD, Kimberly M. Lovett, MD (A:Venu Prabaker, MD) Hillcrest Theodore S. Thomas, MD, Steven A. Ornish, MD, Jason P. Lujan, MD (A:Gregory M. Balourdas, MD) Kearny Mesa John G. Lane, MD (A:Marvalyn E. DeCambre, MD, Sergio R. Flores, MD) La Jolla Gregory I. Ostrow, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County James H. Schultz, MD, Douglas Fenton, MD, Niren Angle, MD (A: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Mike H. Verdolin, MD (A: Andres Smith, MD) At-large and At-large alternate Directors Jeffrey O. Leach, MD, Bing S. Pao, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD, Peter O. Raudaskoski, MD, Mihir Y. Parikh, MD, Suman Sinha, MD (A: Carol L. Young, MD, Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Samuel H. Wood, MD, Elaine J. Watkins, DO, Carl A. Powell, DO, Theresa L. Currier, MD)

departments

SDCMS Board of Directors Officers President Robert E. Wailes, MD (CMA Trustee) President-elect Sherry L. Franklin, MD (CMA Trustee) Treasurer Robert E. Peters, PhD, MD Secretary J. Steven Poceta, MD Immediate Past President Susan Kaweski, MD

other voting members Communications Chair Theodore M. Mazer, MD (CMA Vice Speaker) Young Physician Director Van L. Cheng, MD Resident Physician Director Steve H. Koh, MD Retired Physician Director Rosemarie M. Johnson, MD

Medical Student Director Beth P. Griffiths

OTHER NONVOTING MEMBERS Young Physician Alternate Director Renjit A. Sundharadas, MD

10 San Diego County’s “Outstanding Medical Office Manager for 2011” 12 When Texting, HIPAA Is the Acronym to Know

12

Resident Physician Alternate Director Christina Pagano, MD Retired Physician Alternate Director Mitsuo Tomita, MD CMA President-elect James T. Hay, MD CMA Past Presidents Robert E. Hertzka, MD (Legislative Committee Chair), Ralph R. Ocampo, MD CMA Trustee Albert Ray, MD CMA Trustee (OTHER) Catherine D. Moore, MD CMA SSGPF Delegates James W. Ochi, MD, Ritvik Prakash Mehta, MD CMA SSGPF Alternate Delegates Dan I. Giurgiu MD, Ashish K. Wadhwa, MD

by The Doctors Company

14 The Hoffman Society

by Clifford L. Graves

16 From Toxic to Healthy: A Productive Exchange

by Steven P. Dinkin, Esq., and Pamela K. Steele, PhD

34 Physician Marketplace

Classifieds

36 Happy Holidays From Your SDCMS and SDCMS Foundation Support Teams!

14 2 SAN DIEGO PHYSICIAN .org decem ber 2011

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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sept August ember 2011 SAN DIEGO P HY SIC SICII A A N. N. .org o rg rg 3 decem b er 2011 SAN DIEGO PHYSICIAN Octo ber 2011 SAN DIEGO P HY o

brieflynoted calendar SDCMS SEMINARS & WEBINARS SDCMS.org/event

Workplace Harmony JAN 18 • 11:30am–1:00pm Legislative Advocacy Training (workshop) JAN 21 • 8:00am–12:00pm Electronic Health Records: Best Practices JAN 25 • 6:30pm–7:30pm Electronic Health Records: Best Practices JAN 26 • 11:30am–12:30pm Certified Medical Coder Course JAN 27, FEB 3, 10, 17, 24 • 8:00am–4:00pm HIPAA 5010 FEB 9 • 11:30am–1:00pm Tax Time FEB 16 • 11:30am–1:00pm

COMMUNITY HEALTHCARE CALENDAR 9th Annual Natural Supplements: An Evidencebased Update JAN 19–22 • Hilton San Diego Bayfront

Brain Tumors: 2nd Annual Collaborative Care Conference JAN 21 • Catamaran Resort Hotel, San Diego • cme.ucsd.edu/ braintumors

featured member

Rosemarie Marshal Johnson, MD

Dr. Rosemarie Marshall Johnson, who has been a member of SDCMS-CMA since 1978 and who currently represents retired physicians on SDCMS’ board of directors, serves the SDCMS Foundation as its medical community liaison for Project Access San Diego. PASD has recruited more than 600 physician specialists to volunteer their time and skills in this unique program for adult uninsured San Diegans.

At the 2010 SDCMS and SDCMS Foundation White Coat Gala, Dr. Johnson received the 2010 Presidential Recognition Award for her work on behalf of SDCMS physicians. In March 2010, Dr. Johnson was also honored by LEAD San Diego and Channel 10 for her volunteer contributions throughout San Diego.

Congratulations, Dr. Johnson!

Timmy Global Health Mission Trip to Ecuador MAR 10–17 • Clinics seeing approximately 40 patients per provider per day. • www. timmyglobalhealth.org Topics and Advances in Internal Medicine MAR 12–16 • Catamaran Resort Hotel, San Diego • cme.ucsd.edu/ internalmed Prescription Opioid Misuse Academy: The Dark Side of Prescription Opioids MAR 15 • Catamaran Resort Hotel, San Diego • www.acmt.net Topics and Advances in Pulmonary and Critical Care Medicine MAR 17–18 • Catamaran Resort Hotel, San Diego • cme.ucsd.edu/ internalmed California Orthopaedic Association Annual Meeting APR 19–22 • Park Hyatt Resort in Carlsbad • www.coa.org/coaannual-meeting.html Sharon’s Ride Run Walk for Epilepsy 2012!

APR 25 • De Anza Cove, Mission Bay Park • $25 Individuals/$50 Family/Phil’s BBQ Lunch included • 7:30am-1:00pm • sharonsride2012.kintera.org 13th Annual Science and Clinical Application of Integrative Holistic Medicine NOV 2 • Hilton San Diego Resort

history of medicine

legislator birthdays

One way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday!

BIRTHDAY: DEC. 31 State Assemblyman Nathan Fletcher (District 75) E: (via website) arc.asm.ca.gov/member/75 E: assemblymember.fletcher@assembly.ca.gov Sacramento Office: California State Capitol, Rm. 2111, Sacramento, CA 95814 T: (916) 319-2075 • F: (916) 319-2175 San Diego Office: 9909 Mira Mesa Blvd., Ste. 130, San Diego, CA 92131 T: (858) 689-6290 • F: (858) 689-6296

The David Hoffman Society

By Ralph R. Ocampo, MD, Retired SDCMS-CMA Member

The David Hoffman Society, working with and through the San Diego County Medical Society Foundation, was originally founded in 1965 by Clifford Greaves and Fred Frye (see page 14 for details). Over the years, the David Hoffman Society has presented medical historians such as Loyal Davis and Sarah Wangenstein to its membership. It has taken 43 oral histories of physicians in their specialties and is currently videographing the oral histories of early East County physicians. Our physicians, including UC San Diego Health System, are the inheritors of high-quality practices that went before. This is why all of us, old and young, should participate in documenting this trajectory in San Diego. Photo taken during the Oct. 3, 2011, “History of the Medical Staff of the Grossmont District Hospital” meeting of the David Hoffman Society. Left to right: Ken Stone, editor of the La Mesa Patch, Ralph Ocampo, MD, Dan Smith, MD, and Bill Pogue, MD (David Hoffman Society members).

4 SAN DIEGO PHYSICIAN .org decem ber 2011

you take care of the san diego communit y ’s health. we take care of san diego’s

healthcare communit y.

get in touch

3 income Tax Planning 3 Wealth Management

Your SDCMS and SDCMSF Support Teams Are Here to Help!

3 employee Benefit Plans 3 Profitability Reviews

SDCMS Contact Information

5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org

3 outsourced Professional services (CFo, Controller) 3 organizational and Compensation structure

CEO/Executive Director Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO/CFO James Beaubeaux at (858) 300-2788 or James.Beaubeaux@SDCMS.org

3 succession Planning

Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or Janet.Lockett@SDCMS.org

3 Practice Valuations 3 internal Control Review and Risk Assessment

Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org Director of Engagement Jennipher Ohmstede at (858) 300-2781 or JOhmstede@SDCMS.org

akt

Director of Communications and Marketing Kyle Lewis at (858) 300-2784 or KLewis@SDCMS.org administrative assistant Betty Matthews at (858) 565-8888 or Betty.Matthews@SDCMS.org

A KT LLP, CPAs and Business Consu LTAnTs

LETTERS TO THE EDITOR Editor@SDCMS.org GENERAL SUGGESTIONS SuggestionBox@SDCMS.org

SDCMSF Contact Information

5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 300-2777 F (858) 560-0179 (general) W SDCMSF.org EXECUTIVE DIRECTOR Barbara Mandel at (858) 300-2780 or Barbara.Mandel@SDCMS.org project access PROGRAM DIRECTOR Tanya Rovira at (858) 565-8161 or Tanya.Rovira@SDCMS.org RESOURCE DEVELOPMENT DIRECTOR Lauren Banfe at (858) 565-7930 or Lauren.Banfe@SDCMS.org Patient Care Manager Rebecca Valenzuela at (858) 300-2785 or Rebecca.Valenzuela@SDCMS.org Patient Care Manager Elizabeth Terrazas at (858) 565-8156 or Elizabeth.Terrazas@SDCMS.org

IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org

CARL SBAD

ESCONDIDO

760-431-8440

S A N DIEGO

W W W.AKTCPA.COM ron mitchell, cpa director of health services

RMITCHELL@AKTCPA.COM

Give Us 5 Minutes and We’ll Give You a Benefits Check-up!

Call SDCMS at (858) 565-8888 to schedule a time Today!

decem b er 2011 SAN DIEGO PHYSICIAN .org 5

Your Monthly Benefits

check-up Put Your SDCMS-CMA Membership to Work!

This Month:

✓✓ Q&A With Your Physician Advocate ✓✓ Q&A With SDCMS-endorsed AKT Wealth Advisors ✓✓ Upcoming Seminars & Webinars ✓✓ AMA Secures a Two-year Delay of Revalidation Effort ✓✓ Deadlines & Reminders ✓✓ Welcome SDCMS’ New Members for December

6 SAN DIEGO PHYSICIAN .org decem ber 2011

Q&A WITH YOUR PHYSICIAN ADVOCATE

By Marisol Gonzalez, Your SDCMS Physician Advocate SDCMS member physicians are encouraged to contact Marisol with any practice or membership questions at (858) 300-2783 or at MGonzalez@SDCMS.org.

Question: I received a revalidation request from Palmetto, and I thought CMS delayed this process by two years. Can I ignore this letter? Submitted by a family practice physician.

Answer: No. If you’ve received a revalidation request letter from Palmetto, you must respond. Physicians who have already received revalidation notifications from Palmetto should fill out the form and return it to Palmetto per the instructions in the notice. SDCMS and CMA will keep members updated on the next round of revalidation notifications once they become available.

UPCOMING SDCMS & CMA SEMINARS/WEBINARS Don’t Forget: SDCMS members and their staffs attend, free of charge, all SDCMS and CMA seminars and webinars.

See page 4 for a listing of our January and February 2012 seminars and webinars.

Your

Q&A With SDCMS-endorsed AKT Wealth Advisors QUESTION: There are new fee disclosure rules going into effect in 2012 for retirement plans. What is the timeline on this, and what should I be doing as a physician to prepare for this?

Mon l y Benetfh s check-it up

Answer: This fee disclosure information is required to be provided to each eligible participant (not just those who have an account balance) either before or on the day they become eligible to participate in the plan, and quarterly thereafter. All plan participants will likely get their first round of disclosures for the quarter ending March 31, 2012. Physicians who are sponsoring a retirement plan should consult with their plan provider(s) to determine how this information is going to be disseminated.

QUESTION: What do I need to know to ensure compliance and avoid penalty issues?

Answer: The responsibility for these disclosures rests on the plan administrator, usually the plan sponsor. It is important that you understand the requirements and the timing of these new disclosures, and that you work with your plan provider to ensure compliance. You may also want to consult with an attorney who specializes in ERISA law.

SDCMS-endorsed AKT Wealth Advisors helps its clients protect their financial assets for tomorrow by enabling them to make smart financial decisions today. Its professionals provide strategic wealth management, financial planning, and retirement plan services for businesses, individuals, families, and organizations. AKT Wealth Advisors offers the experience, expertise, and resources of a global investment firm, with the personalized attention and client service of local professionals. For further information, contact Marisol Gonzalez, your SDCMS physician advocate, at (858) 300-2783 or at MGonzalez@SDCMS.org.

From the Nov. 4, 2011, Issue of SDCMS’ E-newsletter, “News You Can Use”:

AMA Secures a Two-year Delay of Revalidation Effort CMS recently launched an effort to revalidate the enrollment of every provider and supplier

by March 23, 2013, pursuant to the program integrity screening provisions of the Affordable Care Act (ACA). In response to AMA advocacy, the revalidation effort will be pushed back through 2015, and physicians will be among the last to revalidate. As well, CMS announced numerous, significant improvements to the online Medicare Provider Enrollment, Chain, and Ownership (PECOS) system that should make revalidation less onerous for physicians. The changes physicians can expect to see in place by the end of 2012 include: • e-signatures • electronic document upload • batch upload capability • seamless password reset • enhancements for authorized officials • reassignment reports • new “my enrollments page” and “fast track view” screens • fewer duplicative document submission requirements CMS has stated that these improvements to PECOS will be implemented before most physicians are asked to revalidate. AMA staff will work to ensure that these improvements are working for physicians and that the revalidation effort progresses as smoothly as possible.

If you are not currently receiving SDCMS’ “News You Can Use,” please email Kyle Lewis at SDCMS at KLewis@SDCMS.org to sign up.

decem b er 2011 SAN DIEGO PHYSICIAN .org 7

r u o Y y Monthl

s Benefkit -up

chec

WELCOME SDCMS’ NEW MEMBERS FOR DECEMBER! Wilfredo R. Abesamis, MD Internal Medicine (619) 229-5050 San Diego

• ONGOING: TDC-insured SDCMS member physicians MUST satisfy their participation requirement ONCE EVERY TWO YEARS in order to continue receiving their TDC medical professional liability insurance premium credit. Contact Janet Lockett at SDCMS at (858) 300-2778 or at Janet.Lockett@ SDCMS.org.

• DEC. 31: Reporting year ends for eligible professionals (eRx).

• JAN. 1: $100 Three-year Commitment SDCMS-CMA Dues Discount Deadline • JAN. 1: SDCMS-CMA Membership Dues Deadline • JAN. 1: On Jan. 1, 2012, the HIPAA 5010 “implementation guide” standard will go into effect. This affects all of the HIPAA Standard Transactions, including the following pertinent transactions for most medical practices: electronic claims; electronic remittance advices; electronic requests for eligibility and benefit verification and the responses; electronic referral authorizations; and electronic claims status. The last major change was in October 2003, when the HIPAA transactions and code sets rule took effect. The 5010 changes reduce ambiguity in many of the transactions and provide for some very important new codes such as ICD-10. They also eliminate many of the situational codes while implementing requirements such as taxonomy codes on all claims. Medical practices should be preparing now for this change by ensuring your vendors (billing software, billing services, and clearinghouses) are ready and that your software is capable of generating a 5010 transaction. If your practice management systems are not compliant with HIPAA Version 5010 standards by Jan. 1, 2012, you will risk not getting electronic payments from Medicare or private insurers.

• FEB. 29: Last day for eligible professionals to register and attest to receive incentive payment for calendar year 2011 (eHR).

8 SAN DIEGO PHYSICIAN .org decem ber 2011

Roger Oen, MD Family Medicine (619) 255-4765 Coronado

James Hwang, MD Emergency Medicine La Jolla

Sunanda M. Pejavar, MD Radiation Oncology (619) 460-2770 La Mesa

Dilip V. Jeste, MD Geriatric Psychiatry (858) 534-4020 La Jolla

Mark L. Rabe, MD Integrative Holistic Medicine San Diego

Randall G. Browning, MD Medical Toxicology Oceanside

Setareh S. Jones, MD Pediatrics (858) 495-0500 San Diego

Gurinder K. Dabhia, MD Pediatrics (760) 547-1010 Oceanside

Paul D. Kim, MD Spine Surgery (619) 265-7912 San Diego

Anuradha S. Rode, MD Obstetrics and Gynecology (760) 658-6101 Escondido

Dennis Dass, MD Plastic Surgery (619) 697-0227 La Mesa

Saul D. Levine, MD Emergency Medicine San Diego

Saskia Boisot, MD Anatomic Pathology and Clinical Pathology Escondido

PRACTICE MANAGEMENT AND MEMBERSHIP DEADLINES & REMINDERS

Stephen R. Hayden, MD Undersea and Hyperbaric Medicine 619) 543-8254 San Diego

Elise S. Brown, MD Obstetrics and Gynecology (619) 229-6585 San Diego

Jon G. Ellison, MD Radiology (619) 460-2770 La Mesa Julie A. Ellner, MD Surgery (619) 286-7866 San Diego Michael H. Forman, MD Emergency Medicine (760) 439-1963 Oceanside Roger M. Galindo, MD Surgery (619) 532-7577 San Diego Darin S. Garner, MD Emergency Medicine (760) 439-1963 Oceanside Bradley W. Greider, MD Ophthalmology (760) 758-2020 Vista

Sepi Mahooti, MD Cytopathology (858) 552-8585 San Diego James R. Malinak, MD Rheumatology (619) 460-4050 La Mesa Douglas N. Mellinger, DO Cardiothoracic Surgery (858) 455-6330 La Jolla Michael Moon, MD Pain Medicine (858) 202-1546 San Diego Gregory M. Mundis, MD Spine Surgery (858) 678-0610 La Jolla Michael T. Naumann, MD Radiology (619) 460-2770 La Mesa

Amber P. Sanchez, MD Nephrology (619) 471-0753 San Diego Hai Shao, MD Infectious Disease 619) 267-0200 National City Wendy B. Shelly, MD Reproductive Endocrinology and Fertility (858) 505-5500 San Diego Henry Showah, MD Emergency Medicine (760) 931-5339 Oceanside Joel J. Smith, MD Orthopedic Surgery (858) 278-8110 San Diego Ryan S. Smith, DO Emergency Medicine Oceanside William G. Wang, MD Cardiothoracic Surgery (858) 455-6330 La Jolla John R. Wilkinson, MD Hematology (619) 255-1754 San Diego

Join SDCMS-CMA Online at SDCMS.org!

Special Mortgage Financing for Physicians Our special home financing program is designed to meet your needs as a physician for the purchase, refinance or construction of your primary residence.

• Financing for single family homes available with low down payment up to $1,750,000. Refinances with high loan-to-values are also available • Private mortgage insurance is not required • One-Time Close Construction Loan - one application, one approval and one closing for both construction and permanent loans.

For information on this special home financing program from BBVA Compass, give us a call today.

Bryan Yaninek, NMLS #392774 Mortgage Banking Officer 719-499-9000 • bryan.yaninek@bbvacompass.com apply online at: bbvacompass.com/mortgages/byaninek

1-800-COMPASS • bbvacompass.com

All loans subject to approval, including credit approval. Eligible properties must be located in Alabama, Arizona, California, Colorado, Central Florida, North Florida, New Mexico or Texas where BBVA Compass has a market presence. BBVA Compass is a trade name of Compass Bank, Member FDIC.

8.4375x11_SMF Physicians AD.indd 1

11/17/11 11:59 AM

Office Manager AdvocaCy

San Diego County’s Outstanding Medical Office Manager for 2011 Robert O’Meara — Nominated by Irwin Goldstein, MD, SDCMS Member Since 2007

Dr. Irwin Goldstein’s staff celebrating Robert’s award. L-R: Shalaine Corbilla, Sally Morgan, Dr. Rose Hartzell, Dr. Goldstein, Robert O’Meara, Sue Goldstein, Dr. Sandra Arroyo, Priscilla Santiago, Claudia Carranza, Olga Johnson.

I would like to nominate Robert O’Meara as outstanding medical office manager. He took over from a practice administrator who, due to personal issues, had become dysfunctional, leaving us not only with inadequate financial records but a great deal of stress in the office, promoting a disconnect between our clinical unit and our research unit.

When Bob came he knew we needed help, but he went beyond that. He went back through our finances since our inception in 2007, reconciling bank statements with our financial records for the first time.

He worked with our front office staff so that they would respect him but also feel comfortable working with him. He helped to promote the clinical trial program in our office and became determined to figure out a way that clinical and research staff would 10 SAN DIEGO PHYSICIAN.org decem ber 2011

become supportive of each other.

He came up with a bonus system whereby all staff would be bonused quarterly based on total profits so that clinical and research supported each other, because, in the end, all would win. He rewards initiative and development of good ideas that help the practice with gift cards from Starbucks. He meets with management regularly not only to update us but also to try to develop new ideas to both increase business and improve productivity. He has taken us from the dark ages to the 21st century.

To read more about Dr. Goldstein and San Diego Sexual Medicine, his multi-disciplinary facility treating men and women from around the country and the world who suffer from sexual dysfunctions, visit SDCMS.org.

Message From 2010’s Outstanding Medical Office Manager

By Susan Rose, Office Manager for David J. Bodkin, SDCMS-CMA Member Since 1990

It was such a tremendous honor when I was chosen as the 2010 “Outstanding Office Manager” by SDCMS. The letter of recommendation submitted to SDCMS by one of my physicians at the Cancer Center Oncology Medical Group brought tears to my eyes as well as my colleagues’. I have been working in the medical field since the ’70s, but I found my true passion when I took a position in oncology in 1985. When I relocated from New York to San Diego in 2000, I wasn’t sure I’d have the opportunity to continue working in this specialty that I love so much.

Since accepting my current position in 2007, I’ve been able to assemble a winning team of employees. In these difficult times it is the power of teamwork that defines your success.

Without the commitment and hard work of this team, our organization wouldn’t be one of the top oncology practices in San Diego.

Our Cancer Center has strong leadership in all of its departments. We encourage communication and input from all our employees, so monthly department meetings are always held. We consider continuing education crucial to staying at the forefront of

oncology; therefore, all employees are invited to participate in lunchtime and after-work dinner programs. They are also encouraged to take outside courses to advance their positions.

Having a happy and appreciated staff overflows to the patients, who feel that love and compassion. Our staff fights for the needs of our patients on a daily basis. Whether dealing with insurance plans or helping those patients with little or no insurance, our group of dedicated professionals goes above and beyond to ensure

our patients get the care they need and deserve.

Our physicians and physician assistants are key to our success and my ability to manage their practice. Their willingness to listen to suggestions and help implement ideas discussed at our management meetings demonstrates to the staff the respect the doctors have for them and the wonderful job they are doing.

As I reflect on the past year, I realize how blessed I am to be in my position here at the Cancer Center. We have truly become a family and I know our patients benefit from that every time they step into our office.

KolAH lAw HelPS ClientS meet the growing challenges oF tHe HeAltHCAre inDuStry.

We take the time to understand your legal issues, values and goals, and offer a variety of legal options to protect your interests while promoting success in your practice. We advise and represent clients in a range of health care legal areas including:

AnAheetA Z. KolAh

• Lobbying for the Healthcare Industry, State & Federal • Compliance • Regulations • Reimbursement • Business Transactions • Corporate Governance • Alternate Dispute Resolution • Patient Care • Estate Planning / Asset Protection

4370 la Jolla Village Drive Ste 400 San Diego, CA, 92122 Phone: (858) 546-4480 Fax: (858) 546-4482 kolahlaw@lawfirmofsandiego.com www.lawfirmofsandiego.com

MAS in HeAltH lAw

TODAY’S HEALTHCARE ATTORNEY FOR TOMORROW’S HEALTHCARE PROFESSIONAL.

Give Us 5 Minutes and We’ll Give You a Benefits Check-up!

Call SDCMS at (858) 565-8888 to schedule a time Today!

decem b er 2011 SAN DIEGO PHYSICIAN .org 11

Risk Management

When Texting …

HIPAA Is the

Acronym to Know

by The Doctors Company

It’s immediate, useful, and direct. It makes pagers seem as outdated as carrier pigeons.

But expedient as it is, texting colleagues may be a HIPAA violation.

With more than 85 percent of physicians using smartphones — more than twice the rate of the general public — physicians are smartphone “superusers.” Smartphones can pack libraries full of information into your pocket, instantly provide you with drug labeling alerts and CME (such as PDR.net), reduce time wasted waiting for colleagues to return calls, and facilitate the timely routing of patient care orders, critical lab results, and other patient data.

A few keystrokes and a click may be convenient, but may not be safe and legal. Texting raises HIPAA issues with significant consequences. Although a text message may start out without any protected health information (PHI), it can expand to include specific patient

information, turning a simple text into a cause for legal concern. Texting PHI that is not properly safeguarded by using encryption is a violation of federal privacy and security rules.

Is a text the same as a verbal order? No. The Joint Commission noted on Nov. 10 that because texting provides no method for recipients to verify the sender’s identity, and also no reasonable method for preserving or incorporating the original message into the medical record, texting is not the same as a verbal order. As with any communication over a network, be aware that text messages could also be discoverable in case of a malpractice claim.

Since texting represents potential risk, consider taking the following steps to protect your practice: • Enable encryption on your device.

• Install auto lock and remote wiping programs to prevent lost phones from becoming data breaches.

A few keystrokes and a click may be convenient, but may not be safe and legal.

12 SAN DIEGO PHYSICIAN.org decem ber 2011

• Know your recipient and double-check the “send” field to prevent sending confidential information to the wrong person.

• Avoid identifying details in texts.

• Assume that your text can be viewed by anyone in the room with you.

• Before using text orders, make sure that the order can be placed into the electronic record without using transcription.

• Ensure that your system has a secure method to verify provider authorization.

• When conducting your HIPAA risk analysis, include text message content and capability.

SDCMS-endorsed The Doctors Company provides CyberGuard® as part of its core coverage, which protects members against regulatory and liability claims arising from the theft, loss, or accidental transmission of confidential patient or financial information, as well as the cost of data recovery. More information on other electronic tools can be found at www.thedoctors.com/erisk.

For the health of our community, we thank you.

First Citizens is proud to serve the medical professionals and healthcare practices of our community.

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History of Medicine

Left: Horton’s Hall, located on the southeast corner of Sixth Avenue and F Street, was the first meeting place of the San Diego County Medical Society. It had shops downstairs and a meeting hall above when it opened around Christmas in 1869. It burned in 1897 and was torn down shortly thereafter.

The Hoffman Society

Originally Published in the June 1967 Issue of San Diego Physician, Then Known as the Bulletin

by Clifford L. Graves

14 SAN DIEGO PHYSICIAN .org decem ber 2011

The David Hoffman Society for the Study of Medical History brings together the doctors in San Diego with an interest in medical history. The society is named for Dr. David Bancroft Hoffman, the first doctor to settle in San Diego.

We do not know much about Dr. Hoffman because his diary is lost. We do know that he was born in the state of New York in 1827. In 1851 he arrived in San Francisco with a medical diploma in his pocket and very little else. At the time, the gold rush held people in its grip. But Dr. Hoffman was not after that kind of gold. He wanted a place where he could live and work and be useful. To find it, he took a job as ship’s surgeon with the Pacific Mail Steamship Company. For two years he cruised up and down the coast. Then he made up his mind! San Diego.

For us who live in San Diego today, it is difficult to visualize what the town looked like in 1853. From all we can gather, it was not good. A few ramshackle buildings stood where Old Town plaza is now; dusty or muddy depending on the season. The population, when it was in view, consisted of several hundred penniless Mexicans, an equal number of ditto Indians, a small garrison, and a sprinkling of Yankee settlers.

This was the town that moved Lt. George Derby to write: “I can assure you that an exile in this dreary and desolate little place, with nothing to do and all day to do it in, is about the most disagreeable duty I could have drawn.”

Lt. Derby might have been discouraged, but Dr. Hoffman was not. Setting up an office in a vacant room above Lyon’s variety store, he was confronted with his first emergency before he had unpacked his bags. It was a patient with smallpox.

The last time anybody in San Diego had been vaccinated was 25 years earlier, when

a fabulous character named James Ohio Pattie stumbled on the scene. Without hesitation, Dr. Hoffman boarded the first steamer for San Francisco, picked up a supply of vaccine, and hurried back. Now he let it be known that he was ready to vaccinate the entire population — free of charge, if necessary. The people could see that this man was truly interested in their welfare.

Dr. Hoffman was a worker. Besides carrying on a busy practice, he found time to be coroner in 1855, to pass the bar examination in 1856, to be town trustee in 1857, to be married in 1858, to be district attorney in 1859, assemblyman in 1862, trustee of the school board in 1865, presidential elector in 1868, and collector of the port in 1869. During all these years he was also surgeon of the garrison. In this capacity, he wrote the first sanitary report to come from San Diego. It was published in the San Francisco Medical Press in 1864, and it remains good reading today. In 1870, Dr.

Hoffman founded the County Medical Society and became its first president.

He also gave the push for what eventually became the county hospital. One day in 1868, as he was crossing the plaza, he was accosted by a vagrant. Instead of brushing the man aside, he took a close look, noticed flushed cheeks, and immediately suspected enteric fever. We call it typhoid today. The disease is highly contagious, and Dr. Hoffman knew this. He put the patient in the infirmary at his own expense, kept him isolated, and warned the town council of the health hazard. The council promptly voted funds.

When Dr. Hoffman died in 1888 at the age of 61, he was truly the beloved physician. His office on the corner of Seventh and G was never idle. His patients revered him, and his colleagues admired him. It seemed that he had earned his place in the annals of San Diego.

But people forget quickly. Before long, he was only a name on some parchment. His

children scattered, his office vanished, his friends died, and his writings dissolved in the mist of time. The doctors of San Diego were too busy with the present to bother with the past.

Then, in 1965, some of these doctors formed a historical society, and in a gesture of esteem, they called it the David Hoffman Society. By this time, not much of Dr. Hoffman remained: his medical bag, a brass plaque, some yellowing papers — and an old photograph. It was this photograph that became the inspiration for a noteworthy portrait of Dr. Hoffman by local artist Barbara Roy. In keeping with its great interest in the traditions of the medical profession, the woman’s auxiliary of the County Medical Society paid the not inconsiderable fee for the painting. Today the portrait hangs in the library of the County-University Hospital.

The David Hoffman Society is proud to hand the memory of this stouthearted pioneer on to the generations of the future.

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decem b er 2011 SAN DIEGO PHYSICIAN .org 15

Practice Management

From Toxic to Healthy A Productive Exchange

by Steven P. Dinkin, Esq., and Pamela K. Steele, PhD

16 SAN DIEGO PHYSICIAN.org Decem ber 2011

Sometimes, walking through the corridors, it hits you. Tension. It’s in the air. It’s in the body language. It’s in the tone of voice.

Its impact gets expressed in many ways: • A domineering, controlling administrator criticizes others in public settings. Outcome? A crippling of creative thinking. Why bother?

• Nurses argue about protocol at the bedside of a dying patient. Outcome?

Increased anxiety about the end of life for the patient, loss of confidence by the family, fractured treatment.

• A physician assistant leaves incomplete notes in the patient’s chart. Outcome?

Potential patient harm; increased exposure to malpractice liability; extra time, effort, and frustration required to provide the best care.

• Members of a surgical team don’t communicate — clearly or at all. Outcome?

Compromised patient care.

One Key to High-quality Care The healthcare industry is currently under a microscope. As if the pressure and demands of new technology, sicker patients, fewer employees, and growing bureaucracy are not enough, everyone has become an instant expert on how to “fix”

Take a look at the following descriptors. How would you assess the climate in your work group?

TOXIC ENVIRONMENT • sarcasm, mixed messages, guessing games • time wasters such as backroom gossip • redundant efforts or working at cross-purposes • competitive people who need to be right • avoidance or passive-aggressive behavior

HEALTHY ENVIRONMENT • clear communication • highly productive • very efficient, focused efforts • collaborative teamwork • open and honest

OUTCOMES • cynicism, frustration, stress, burnout • higher than average turnover = $$$$ • inconsistent focus on patient-centered care

OUTCOMES • positive-attitude energy; sustained support • staffing stability, skills and experience • consistent focus on patient-centered care

The Impact of Personal Style Toxic environments are often fueled by our own, often unconscious, personal style of dealing with conflict. How do you address conflict?

• Turn a blind eye. Deny its existence.

• Hope it just goes away.

• Procrastinate. Push it to a lower priority.

• Use your position of power to mandate a solution.

• Empower those involved to discuss the issues and reach a mutually agreeable solution.

Choosing Healthy Habits Over Crisis

the system. It’s no surprise that healthcare workers may be feeling more tension or experiencing more conflicts. The system is changing.

One critical difference, however, between providers who consistently deliver highquality care with high ratings for patient safety and those who don’t is how quickly and how effectively they acknowledge problems or conflicts and how they choose to address them. If not addressed early and productively, the outcome of these ignored conflicts can be detrimental — to physicians, staff, patients, families, and the organization.

Resolving conflicts, whether personal or professional, takes time. But just like dealing with wounds, the earlier you do what it takes to start the healing process, the less the likelihood of infection. Acknowledge the problem, identify the issues, and solve it while it’s manageable. The longer you wait to address a conflict, the larger it gets, the more difficult it is to unravel, and the more time and effort it requires.

A Team Approach Resolving interpersonal conflicts is similar to diagnosing and treating medical problems. When working with patients, you ask about their symptoms, the effects on their body, their quality of life, etc. You may run tests or talk to others in the family to understand what they are witnessing. Once you’ve collected “sufficient” information,

you talk with the patient about appropriate next steps. If you recognize that your knowledge and experience is not sufficient to address the patient’s needs, you might seek advice or counsel from a respected colleague. The same is true of resolving conflicts.

Mr. Dinkin is president of the National Conflict Resolution Center. Dr. Steele is a crisis communication and mediation consultant.

Sign up to Attend SDCMS’ Jan. 18 “Workplace Harmony” Seminar/Webinar This seminar/webinar will take place from 11:30 a.m. to 1 p.m. on Wednesday, Jan. 18. For further information or to sign up, please contact Serena Sauerheber at SDCMS at (858) 300-2779 or Serena.

Sauerheber@SDCMS.org.

Decem b er 2011 SAN DIEGO PHYSICIAN .org 17

life

after medicine

Are You the Retiring

type?

By Rosemarie Marshall Johnson, MD

18 SAN DIEGO PHYSICIAN.org decem ber 2011

I

t used to be quite easy to plan retirement. The decisions centered around when, how much financing, what activities and relationships. Most of the practice arrangements were in your own hands.

Everyone was quietly respectful of the senior physician who left clinical medicine and started calling travel agencies and golf courses. Good physical and mental health for you and your spouse or partner was the basis for assessing contentment. For years, that and a solid relationship with a partner have been well correlated with positive responses when retired physicians are quizzed.

Today it is difficult to put all the usual retirement factors in one basket. We all recognize immediately the financial stress overshadowing all businesses, including the physician workplace, whether solo practice or group.

Can you afford to retire? What will be the impact on your practice and colleagues? Will you feel guilty of deserting the practice? Are your savings enough for you and your family? The sandwich generation often is providing for more than the number of family members originally planned. And as we live longer and competently, retirement grows further away in most physicians’ sights. This may lead to mandatory office rules.

Mandatory retirement, individually assessed or age-based, is another surprising and possibly uncomfortable imposition that limits the decision to step down. Who has the ability to test clinical skills, mental acuity, and general fitness to practice? In the past, the methods used were suspect and poorly regarded.

The conference “Practicing Medicine Longer,” recently held in San Diego, presented dramatic, credible, and useful information affecting senior physicians. The Coalition for Physician Enhancement (CPE) and the UC San Diego PACE Program invited speakers well known for their enlightening research and applicability for physician testing, remediation, and education. Such fields as neuropsychology and the study of neuroplasticity of the brain expand reliably our methods of assessing all physicians’ capabilities. Professor David Bazzo, MD (SDCMS-CMA member since 2005 and SDCMS board member), led a remarkable group of scientists who offer new ways to evaluate medical competency that open many novel paths to retirement for all physicians.

As we live longer and competently, retirement grows further away in most physicians’ sights.

decem b er 2011 SAN DIEGO PHYSICIAN .org 19

life

after medicine

Practicing Medicine

longer The Impact of Aging on

T

he Coalition for Physician Enhancement (CPE) recently presented an innovative and enlightening program, “Practicing Medicine Longer: The Impact of Aging on Physician Clinical Performance and Quality of Care,” which expands thinking about physicians and retirement and has academic and clinical implications. For many, especially physicians, aging is objectionable, but our professional responsibility to our patients and to the profession necessitates reliable methods of assessment and treatment of competency as aging occurs. One of the few but well-regarded programs in the United States that offers solutions to these problems is the UC San Diego Physician Assessment and Clinical Education (PACE) Program. In this conference, PACE and CPE have joined to review the current literature and research on aging and physician competence. Topics covered in this meeting, all dealing with physicians’ aging, included education, remediation, competency evaluations, fitness for duty evaluations, performance, impairment, aging, and leadership. International experts in medicine, law, and public policy were brought together to discuss this controversial area of healthcare: the multifaceted impact of aging on physician clinical performance and quality of care.

In order to consider the many topics relative to physician aging, it was necessary to lay out the demographic data. Peter Boal, associate director of the PACE Program, presented two credible sources: AMA’s Physician Master File and the U.S. Census.

20 SAN DIEGO PHYSICIAN.org Decem ber 2011

Physician Clinical Performance and Quality of Care

By Rosemarie Marshall Johnson, MD

AMA has been reporting and studying physician competence with aging since the 1980s and currently surveys one-third of the MD population annually as to major clinical activity and other nonclinical work. Both AMA and the U.S. Census agree that the general population is aging, as is the practicing physician population. Many studies also report that the growing over-65 population of physicians often coexists with a shortage of physicians overall.

Working professionals are continuing their careers well after the standard retirement age, and doctors are no exception. While an experienced physician is certainly prized, there are some risks concerning the optimal and safe delivery of care to the patient that are associated with aging. Currently, there are very few healthcare systems with age-based screening policies. However, some opponents of this grading might consider any age-based screening to be ageist and unethical. In one workshop session, Jill Silverman, president of CMA’s Institute for Medical Quality, took the side of the physicians and enumerated some of the challenges inherent in age-based screening — for instance, data collection relevant to aging and competency is often unreliable. The Honorable Steven Adler, California administrative law judge, argued for the public that there is ample evidence of in-

SDCMS Would Like to Thank Our Retired Member Physicians For Their Many Years of Unflagging Support of Organized Medicine!

creased risk of cognitive decline and health-related impairment with advancing age. Nevertheless, in the mid ’90s the Coalition for Physician Enhancement formed to study the concerns of the medical community about the relationship between competence and quality of care. Along with CPE, the PACE Program is dedicated to the education of physicians and other healthcare professionals; the detection, evaluation, and remediation of deficiencies in medical practice; and assisting the medical profession in its quest to deliver the highest quality of healthcare to the people of the United States.

This conference demonstrated the sophistication of study in the areas of physician quality of care and educational needs at any age. But the meeting focused on the measurement of aging, the various components of aging available to derive the most complete and valid picture of the aging physician.

For example, Dilip Jeste, MD (SDCMS-CMA member since 2011), distinguished professor of psychiatry

Working professionals are continuing their careers well after the standard retirement age, and doctors are no exception.

and neurosciences at UC San Diego Health System, presented the topic of “healthful” aging and strategies to improve the likelihood of successful aging in the physician population. He described current definitions of successful aging that include the concepts of wisdom, social cognition, and optimal decisionmaking, areas beyond general physical and mental health. He provided scientific data that demonstrated the neuroplasticity of the human brain, and gave evidence-based strategies for increasing the likelihood of aging successfully for all of us.

Another perspective was presented by William Perry, PhD, associate director of the neuropsychiatry

John Alan Aalbers, MD Parichehr Abadee, MD David B. Adams, MD Allan Adler, MD John H. Akhavan, MD Paul G. Alberton, MD Neil S. Alex, MD John T. Alexander, MD Maurice J. Alfaro, MD Albert Algazi-Cario, MD Yasar M. Alkar, MD John R. Amberg, MD Eric G. Anderson, MD Ralph D. Anderson, MD Robert M. Anderson, MD Robert F. Andrews, MD Robert O. Andrews, MD Habib Anwar, MD Douglas H. Arbon, MD Iluminada L. Arenas, MD Steven M. Arentz, MD Angelito M. Arias, MD David B. Arkin, MD Lantz E. Arnell, MD Krystyna Artymowska, MD Harold A. Askren, MD Victor V. Avedian, MD James W. Backhaus, MD J. Roland Barberio, MD Michael James Barker, MD David W. Barron, MD Fred A. Baughman, MD Gary A. Belfry, MD Robert A. Bennett, MD Wayne E. Bennett, MD S. Matthew Berge, MD Michael Dean Berger, MD David B. Bergman, MD Robert N. Berk, MD Jack W. Bills, MD Perry S. Binder, MD John A. Bishop, MD Barbara F. Blake, MD Gary D. Blake, MD Melvin A. Block, MD David H. Blount, MD Marc H. Blumberg, MD Kenneth J. Blunt, MD Robert C. Bock, MD William Ward Bock, MD Oscar H. Bolch, MD Joseph A. Bonanno, MD Michael L. Bonin, MD James Borden, MD Douglas G. Boyden, MD John L. Boyer, MD Mary Bradford, MD

Decem b er 2011 SAN DIEGO PHYSICIAN .org 21

life

after medicine

Garrett G. Bradt, MD Rudolph Bragg, MD Leland C. Brannon, MD George B. Brassington, MD Steven A. Brody, MD Donna L. Brooks, MD Robert P. Brouillard, MD Simon C. Brumbaugh, MD Daniel T. Brumfield, MD Theodore K. Bryson, MD Edward B. Buchner, MD John H. D. Buck, MD Thomas E. Bucknell, MD Leslie Buncher, MD George Burkhart, MD Harold Eugene Burt, MD Lionel G. Burton, MD Frederick Michael Busch, MD Joseph Cairncross, MD Thomas W. Callan, MD Robert M. Callicott, MD Frank B. Callipari, MD Timothy G. Canty, MD David B. Carmichael, MD Donna M. Carr, MD Cecilia O. Carrick, MD James M. Casey, MD George D. Cave, MD David L. Chadwick, MD

Donald C. Chapin, MD Jeng-Hsien Chen, MD Ying Chang Chen, MD James K. Chier, MD Christina Youngmo Chung, MD Charles E. Clark, MD G. Wesley Clark, MD Royce E. Clifford, MD George E. Coade, MD Norman L. Cobb, MD Gerald G. Cole, MD Jerry D. Colling, MD David L. Collins, MD Clifford W. Colwell, MD Don F. Compton, MD Roderick Comunale, MD Joseph F. Contasti, MD F. Richard Convery, MD Dwight E. Cook, MD C. Leroy Cooper, MD Lawrence R Cooperman, MD Fred A. Corey, MD John C. Country, MD Richard D. Coutts, MD Roger T. Crenshaw, MD Murray H. Crouse, MD Michael A. Crucitt, MD John T. Cudmore, MD Arthur S. Cummins, MD

Thomas L. Curtin, MD Olgard Dabbert, MD Stewart E. Dadmun, MD Brendan J. Daly, MD Erin M. David, MD Bernice H. Davidson, MD Douglas G. Davidson, MD Harold A. Davis, MD Ronald T. Davis, MD Steven J. Davis, MD Robert Louis Day, MD Tom J. De Cino, MD Daniel J. De La Vega, MD Daniel L. De Werd, MD Melvin H. Degooyer, MD Giacomo A. DeLaria, MD Robert C. Delbridge, MD Richard D. Della Penna, MD Edward K. Denison, MD James E. Denton, MD Victor J. Depratti, MD Frantz J. Derenoncourt, MD Pushpa Desai, MD Robert E. Detrich, MD Joseph B. Devin, MD Ellis R. Diamond, MD Gerald F. Dobel, MD Donald M. Dolgas, MD Kevin P. Donnelly, MD

and behavioral medicine service at UC San Diego Health System. He presented neuropsychological research linking aging to cognitive changes, and explored the link between cognition and occupational performance in physicians. Of great interest was his discussion of a well-supported theory that many older physicians draw from “crystallized knowledge” and rely more heavily on non-analytic cognitive processes in their clinical practice. Additionally, he explained the distinction between a neuropsychodiagnostic assessment and a fitness for duty evaluation, such as is offered at the PACE Program. He ended on a bright note by introducing the idea that doctors can accommodate to cognitive decline and how they can mitigate against the results of aging.

Stephen Miller, MD (retired SDCMS-CMA member), UC San Diego Health System clinical professor of plastic surgery and faculty in the PACE Program, showed the need for regular evaluations of clinical skills in the medical profession by comparing the aviation and medical fields, showing the differences between the regulatory standards for each. Besides describing areas where clinical competency would be beneficial, he noted that physicians endorse

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For many, especially physicians, aging is objectionable, but our professional responsibility to our patients and to the profession necessitates reliable methods of assessment and treatment of competency as aging occurs.

the old tenet of the profession that would require reporting an impaired colleague, but few have actually done so when it would have been appropriate. Dr. Miller ended by making a case for regular evaluations of mental and physical health throughout a physician’s life cycle, and suggested other important ways to ensure competency for physicians of all ages.

Finally Andre Jacques, MD, director of the Medical College of Quebec, and William McCauley, MD, president of CPE, described the differences in testing and treatment utilized in Quebec and Ontario, Canada, where systems are in place to assess all physicians as they age. This testing is run by the physician boards of each province, not by external sources as in the United States.

“Practicing Medicine Longer” is an eye-opening lesson in the close relationship between the individual physician’s abilities and quality of care. Many aspects of this ever-widening subject were presented

by world experts with convincing data and conclusions. There was an optimistic air throughout because of the quality of the work presented and the many intriguing and achievable solutions.

Physicians should be individually evaluated regularly and educated to remain in practice as long as safely possible.

Dr. Johnson, retired SDCMS-CMA member and former SDCMS president, is the medical community liaison for the SDCMS Foundation’s Project Access San Diego.

Acknowledgements: I am especially appreciative of the contributions of all the speakers, but I would like to recognize Dr. William Norcross and Dr. David Bazzo for their leadership in this exciting expansion of a field of medicine invaluable yet intimidating to physicians, and inseparable from dedication to high quality of care of the profession. For their help in educating me and guiding my writing, I am very grateful.

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decem b er 2011 SAN DIEGO PHYSICIAN .org 23

life

after medicine

Successful

Retirement

for Physicians

By Dilip V. Jeste, MD, and Alana Iglewicz, MD

24 SAN DIEGO PHYSICIAN .org Decem ber 2011

studies, including some we have done at UC San Diego’s Stein Institute for Research on Aging, suggest that for most older adults, subjective quality of life is more important. There is a paradox of aging: Whereas physical health and some aspects of cognitive function (for instance, memory for names and faces) decline, aging is generally associated with greater happiness, better mental health, and better management of interpersonal relationships. Researchers have found that new learning is possible in later life, and older adults continue to exhibit new forms of adaptive capacity. Older people make greater use of higher-order reasoning schemes that include multiple perspectives, compromises, and recognizing limits of knowledge.

Social reasoning seems to improve with age despite decline in certain memory functions. Indeed, for decisions that require experience and an ability to use that experience optimally, older adults are better decisionmakers than their younger counterparts.

When the first author (Dr. Jeste) went to medical school, he was taught that most of the growth and development of the brain occurred early in life and that after 60 years of age, it was all a downhill course with progressive and unavoidable shrinkage of the brain. Yet one of the most exciting findings in neuroscience research during the past 20 years has been that of the neuroplasticity of aging, i.e., the fact that brain growth and development continue into old age. Interestingly, such a positive outcome is related not so much to the genes we inherit from our parents but to our own behavior, attitude, and environment. Research shows that older individuals who keep their bodies and brains active are happier and more productive than those who do not. How can an aging brain improve its function and structure?

One mechanism relates to “compensation,” which involves increased recruitment and more efficient utilization of brain networks. Even more interestingly, new synapses, and in some areas of the brain new neurons, form in older brains if stimulated by living in an enriched environment.

General strategies for successful aging include calorie restriction (e.g., through intermittent fasting

Whereas physical health and some aspects of cognitive function decline, aging is generally associated with greater happiness, better mental health, and better management of interpersonal relationships.

I

f you Google the word “retirement,” you will mostly find links to financial planning. Yet retirement is surely more than saving dollars and pennies. While some physicians look forward to their retirement from jobs that have become increasingly stressful for them, others feel restless and depressed with the mere thought of retirement.

At the same time, many older and retired people are happier and have a better quality of life compared to when they were younger adults. Old age is not necessarily the age for retirement from work — and certainly not from life — but can be a time for second careers and new ventures.

How should we define this successful aging?

Traditional objective definitions have emphasized absence of physical and cognitive disabilities. Recent

Margaret F. Farrow, MD Laurence DeKanter Favrot, MD Jerry E. Fein, MD Elena G. Feldman, MD Vincent J. Felitti, MD Michael Fenn, MD Ernesto Fernandez, MD Myron D. Fessler, MD Seymour J. Filman, MD Lawrence M. Fine, MD Robert N. Fiorentino, MD Jack C. Fisher, MD Charles T. Fitch, MD David A. Fitz, MD Jane C. Fitz, MD Robert J. Fleischaker, MD Donald J. Fleischli, MD Arnold L. Flick, MD Larry Dean Flickinger, MD Frank B. Flint, MD Ruben G. Flores, MD Vincent J. Flynn, MD John R. Ford, MD Harvey R. Forester, MD Stanley Foster, MD Philip R. Franklin, MD Robert H. Franks, MD Milton E. Fredericksen, MD Harriet J. Fremland, MD Joseph C. Fremont, MD William E. Friedel, MD Barry A. Friedman, MD Herman F. Froeb, MD Frederick A. Frye, MD Charles E. Fuerst, MD Henry W. Fulhorst, MD Edwin B. Fuller, MD Roger Fuller, MD Wayne A. Funk, MD Edwin S. Gardiner, MD A. Garofolo, MD Charles M. Garrett, MD Sander Garrie, MD Phillips L. Gausewitz, MD Anne B. Geiger, MD Philip J. Gelber, MD Louis H. Gessay, MD James A. Gibbons, MD Joel C. Giese, MD Ludwig F. Ginkel, MD Alexander S. Giritsky, MD Richard A. Gladden, MD Franklin S. Glanz, MD Leonard W. Glass, MD Edwin L. Glazener, MD Matthew C. Gleason, MD Stuart J. Goldstone, MD Melvin G. Goldzband, MD Glenn Paul Goltz, MD Robert W. Goltz, MD Bernard Goodhead, MD Nancy J. Goodman, MD Bernard Goott, MD Stephen Peter Gormican, MD Stephen L. Gottlieb, MD Frank Grabarits, MD Francisco Gracia, MD Nancy M. Green, MD Thomas J. Green, MD

Decem b er 2011 SAN DIEGO PHYSICIAN .org 25

life

after medicine

Physicians obviously constitute a unique group of individuals: highly educated, self-disciplined in most ways, and well respected by society. At the same time, ours is a constantly demanding profession with a very low margin for error, leading to a stressful life.

with plenty of water), physical exercise (especially aerobic), stopping smoking and substance use, eating the so-called “super foods” rich in antioxidants (e.g., broccoli, cabbage, cauliflower, spinach, berries, vitamin E, curcumin), and ensuring appropriate healthcare.

Equally important are cognitive and psychosocial strategies such as developing a positive attitude and resilience, acquiring new skills (e.g., speaking another language, learning new technology), engaging in activities that are stimulating without being too stressful, focusing on new hobbies (art, music, photography), optimizing stress, mentoring children and younger adults, seeking and giving social support, and coping proactively, i.e., anticipating stressors and preparing for them positively. An important principle to remember is that it is never too early nor too late to

Martin M. Greenberg, MD Gilbert Greenspan, MD Thomas E. Grier, MD William H. Grier, MD Richard H. Grimmett, MD Stephen E. Groban, MD Jay R. Grossman, MD Lawrence L. Grove, MD Donald I. Guttman, MD David A. Haaland, MD Frederick S. Hammill, MD Sharon W. S. Han, MD William P. Haney, MD Galen H. Hansen, MD Kenneth G. Hanson, MD Brian P. Harney, MD Fredrick E. Harrison, MD Nathan J. Harrison, MD Carol Ann Harter, MD Clarence A. Harvey, MD Frank W. Hattox, MD John S. Hattox, MD William Haubrich, MD Max H. Hauser, MD Donald O. Hayen, MD William E. Hayes, MD John F. Healy, MD

start on the path to successful cognitive and emotional aging.

Physicians obviously constitute a unique group of individuals: highly educated, self-disciplined in most ways, and well respected by society.

At the same time, ours is a constantly demanding profession with a very low margin for error, leading to a stressful life. Accordingly, we need to personalize our own strategies for successful aging. There is no one size that fits all. A variety of role models exist of successfully aging physicians. Some continue to do what they have done during most of their professional life, i.e., they do not retire from their work.

Dr. Aaron Beck (1921–) is emeritus professor of psychiatry at the University of Pennsylvania. The father of cognitive behavior therapy and winner of the 2006 Lasker Clinical Medical Research Award, he continues to write and obtain grants. He recently published a new book with his daughter and

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will be a featured speaker at the May 2012 annual meeting of the American Psychiatric Association.

Some physicians continue their clinical work.

Dr. Michael DeBakey (1909–2008), a pioneering heart surgeon who was called by some “the greatest surgeon of the 20th century,” performed more than 60,000 heart surgeries before putting down his scalpel at age 90. He said that his secret to successful aging was constant intellectual challenge, good salads, and four to five hours of sleep at night.

Some physicians turn to community service. Dr. Shigeaki Hinohara (1911–), a centenarian, chairs the board of trustees of an international hospital and a nursing school in Tokyo. He has published several books since his 75th birthday, including Living Long, Living Good, which has sold more than a million copies. He founded the New Elderly Movement. He does voluntary work 18 hours a day, seven days a week. His advice to others: Contribute to society.

Finally, there are inspiring examples of physicians who fought physical and mental illnesses and yet became creative artists and writers in their later life. Dr. William Carlos Williams (1883–1963) was a pediatrician from Rutherford, N.J., who loved to write

poetry. Throughout his career as a pediatrician, he struggled with finding a balance between the time constraints inherent in his career as a physician and the resultant lack of time he had to write. He suffered from numerous major depressive episodes and later developed recurrent strokes that led to his retirement.

After retirement, Williams had more time to dedicate to writing poetry than he had earlier in his life. He went on to write his most mature, evocative poetry following retirement, for which he received the Pulitzer Prize, National Book Award, and Gold Medal for Poetry.

While aging of body tissues is inevitable, aging of the mind is not. A positive attitude, a rational mix of optimism and realism, resilience, engagement in stimulating physical and cognitive activities, and having a good time with friends and family — that is the prescription for a successful retirement. A glass of pinot noir is optional!

Dr. Jeste, SDCMS-CMA member since 2011, is boardcertified in psychiatry and geriatric psychiatry. Dr. Iglewicz, SDCMS-CMA member since 2011, is currently a research fellow in geriatric psychiatry.

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Jerome L. Heard, MD Peter S. Hein, MD Ralph A. Heising, MD Ronald J. Heller, MD Scott Whittaker Helmers, MD Eugene V. Helsel, MD Jerry R. Hemric, MD Laurel H. Herbst, MD Robert W. Herbst, MD Benjamin F. Hicks, MD William L. Higgins, MD H. Paul Hirshman, MD John G. Hockin, MD Heinz R. Hoenecke, MD John W. Holl, MD Robert S. Holt, MD Samuel C. Hon, MD Gerald E. Howe, MD Doris Howell, MD David R. Hubbard, MD Lee E. Human, MD Michael E. Humphrey, MD Leroy W. Hunsaker, MD E. Woodrow Hunt, MD Robert G. Hunt, MD Peter Hutchin, MD Leo Huzieff, MD Anthony P. Iagmin, MD

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life

after medicine

What Have You Been Doing Since

retiring?

Four vignettes

28 SAN DIEGO PHYSICIAN.org Decem ber 2011

Ralph R. Ocampo, MD

Retired SDCMS-CMA Member

I retired from general and vascular surgery in 2003 at the age of 72.

This culminated in a timeline after medical school of two years in the U.S. Air Force, five years as a house officer, and 36 years as a practicing surgeon. I enjoyed every single day of those 43 years. In order to keep myself mentally and physically alert, my wife, Bonnie, and I bought a small parcel in Blossom Valley that we call “the farm.” Shortly after retiring in 2003, Jack Fisher, Matt Gleason, and yours truly met to discuss other ways to stay involved and mentally alert. Jack Fisher, MD, is the retired chief of plastic surgery at UCSD and Matt Gleason, MD, is a retired plastic surgeon from private practice. Matt’s father, by coincidence, happened to be a good friend of my grandfather.

After a series of discussions in a hotel near the Medical Society, we hit upon oral histories of the specialties, local specialty societies, and local geographic enclaves of practice. In the subsequent five to six years, I have been able to complete 42 DVDs, each about 45 to 60 minutes long, on these topics.

In addition, as a member of the San Diego County Medical Society Foundation board of directors, I have been privileged to assist Jim Hay, MD, and Carol Young, MD, in putting together Project Access San Diego (PASD). At this year’s annual meeting of the California Medical Association, Dr. Hay and PASD were honored for the more than 1,000 needy patients served.

In summary, relevance after retirement is important to one’s mental health. I can think of no better way than continued involvement with the Medical Society and community health issues to achieve this end.

Ronald Reinsch, MD

Retired SDCMS-CMA Member

I did not want to retire.

Fortunately, I am working per diem after age-related mandatory retirement. Now I can still practice the same profession that has been so enjoyable, but at only 20 hours a week. I have more time to do volunteer work, teach, travel, and do things that make me happy. This means enjoying family, friends, and the wonderful things around me. Every day is a great day.

And it beats the alternative.

Tomás E. Romero, MD

Retired SDCMS-CMA Member

I retired from practice in 2008, after 20 years as chief of cardiology at Sharp Chula Vista Medical Center. Since my “retirement,” I have been involved in research projects sponsored by Fundacion Araucaria, a nonprofit foundation that I established in San Diego in 1995 that promotes initiatives for cardiovascular prevention. I do some clinical teaching at the UC San Diego School of Medicine on a voluntary basis as associate clinical professor in the Department of Cardiology. One of my hobbies, besides traveling, jogging, reading, and listening to good music, is to make wine: I may be one of the few, if not the only one that has made wine with grapes grown in Coronado, where we have lived since 1982. This is in a nutshell my past and present life in San Diego.

Ronald J. Ignelzi, MD Robert Ilko, MD Pascal John Imperato, MD Gene T. Izuno, MD J. Robert Jacobs, MD Charles R. Jacobson, MD Irving Jake Jacoby, MD James M. Jacquet, MD Edward A. Janon, MD Inge Johansen, MD D. Eugene Johnson, MD Kenneth C. Johnson, MD Nolan E. Johnson, MD Robert L. Johnson, MD Rosemarie M. Johnson, MD Clyde W. Jones, MD Donald A. Jones, MD James P. Jorgensen, MD Morton C. Jorgensen, MD Joseph W. Joyner, MD Richard L. Kahler, MD Henry M. Kankowski, MD Jahangir A. Kashani, MD Emanuel Kauder, MD Paul R. Keith, MD Leland E. Kellerhouse, MD Cyril F. Kellett, MD Huston G. Kellogg, MD James P. Kemp, MD Judith A. Kemp, DO Joseph F. Kennedy, MD Geves S. Kenny, MD Vern I. Kent, MD Seymour P. Kern, MD F. Bruce Kimball, MD Marion F. King, MD Robert J. King, MD Arvin J. Klein, MD Morton Kligerman, MD Ronald Kobayashi, MD Harold Martin Koenig, MD Jurgen W. Kogler, MD F. Stephen Kohl, MD Larry T. Konzen, MD Roman J. Kownacki, MD Kai Kristensen, MD Joel M. Kunin, MD James D. Kunzman, MD Michael D. Kurtz, MD Leonard A. Kutnik, MD William J. Kuzman, MD James E. Lasry, MD Ernest F. Latham, MD Donald F. Lathen, MD George W. Le Fevre, MD Dixon A. Lee, MD Michael Morgan Lee, MD Ronald G. Lehman, MD Quentin H. Lehmann, MD William A. Leovy, MD William R. Letsch, MD Ira D. Levine, MD Jerome Levy, MD Lawrence J. Levy, MD Edwin H. Lewis, MD Gordon M. Lillie, MD Charles V. Lindsay, MD Rabbe R. Lindstrom, MD Raymond J. Linovitz, MD

Decem b er 2011 SAN DIEGO PHYSICIAN .org 29

life

after medicine

Thomas Lohner, MD Michael T. Long, MD George F. Longstreth, MD John R. Lucas, MD Diane M. Ludwig, MD Austin MacDonald, MD Jack S. Madowitz, MD Henry F. Maguire, MD Thomas F. Maguire, MD Robert M. Malkus, MD Christopher I. Malloch, MD G. Dwight Malone, MD Calvin G. Maloney, MD Richard S. Marsh, MD Ben B. Martin, MD Noory H. Masliyah, MD Robert H. Masters, MD Ramona D. Matibag, MD John E. Mayo, MD John C. McCall, MD William McColl, MD Herbert I. McCoy, MD William C. McDade, MD Ann McGowan-Tuskes, MD Thomas M. McGreevy, MD Charles F. Medlin, MD John H. Mehnert, MD Christian W. Mende, MD Robert C. Meredith, MD Rose Ellis Merino, MD John C. Meyers, MD Melvyn J. Michaelian, MD Lewis D. Michaelson, MD Paul E. Michelson, MD John C. Miethke, MD Douglas G. Miller, MD Henry A. Miller, MD Larry Miller, MD Leroy A. Miller, MD Stephen H. Miller, MD Sandra Miner, MD James R. Moitoza, MD Charles J. Molnar, MD Ramon E. Moncada, MD Lee S. Monroe, MD Donald Montgomery, MD J. Lawrence Moodie, MD Douglas P. Mooney, MD Robert L. Moore, MD Jacob R. Morgan, MD James A. Morgan, MD Byron O. Mork, MD Martin L. Morris, MD John R. Morse, MD Thomas F. Mosher, MD George A. Mross, MD John Murphy, MD James W. Myers, MD Stanley M. Nadel, MD Alan M. Nahum, MD Leonard H. Naiman, MD Otto T. Nebel, MD Norman H. Needel, MD Jim W. Nelson, MD Robert L. Nelson, MD William L. Nelson, MD John B. Nevara, MD

Donald R. Newman, MD Lawrence P. Newman, MD Mark Charles Niblack, MD Lee T. Nordan, MD Martin M. Nosan, MD Nick S. Nurani, MD Ralph R. Ocampo, MD Monica P. Ormsby, MD Rodney D. Orth, MD Edward J. Ottenheimer, MD Philip M. W. Pailey, MD James D. Palmer, MD Lewis A. Palmer, MD Solon Palmer, MD Stanley J. Pappelbaum, MD Robert A. Peacock, MD John E. Pearson, MD David J. Peck, DO Francis J. Pedace, MD Carl M. Pedersen, MD Joseph W. Pennario, MD Roy F. Perkins, MD Gerard S. Petrone, MD Edward J. Pezanoski, MD Julie M. Phillips, MD Anthony J. Pierangelo, MD Joan L. Pirl, MD William L. Pogue, MD Andrew Polansky, MD Michael A. Pousti, MD David B. Preskill, MD William H. Quillin, MD Milagros Y. Quini, MD Romeo A. Quini, MD J. Harley Quint, MD Charles J. Rabiner, MD Julian L. Ragsdale, MD Diego Ramirez-Cardenas, MD Donald G. Ramras, MD Herman S. Rauch, MD Thomas A. Rauner, MD Marshall I. Ravden, MD Paul E. Reading, MD Harvey M. Reich, MD Robert T. Reid, MD Ronald Reinsch, MD Laurence S. Reisner, MD Russell J. Reit, MD Justin W. Renaudin, MD William A. Renert, MD George B. Ribble, MD Michael J. Rich, MD Irving M. Richman, MD Clyde S. Rights, MD John M. Riley, MD Laurence S. Rivkin, MD Craig W. Roe, MD Charles Roland, MD Tomas E. Romero, MD Dianne C. Rosenberg, MD Gerald A. Rosenberger, MD Charles M. Ross, MD Bernard M. Roth, MD Kenneth R. Roth, MD Melvin B. Rotner, MD Richard I. Rowen, MD Norman M. Rozansky, MD

30 SAN DIEGO PHYSICIAN.org Decem ber 2011

Robert A. Rubenstein, MD Stephen A. Russo, MD Andrew C. Sabey, MD George B. Sachs, MD Stephen L. Saltzman, MD Sidney L. Saltzstein, MD Bernard Samtoy, MD R. Edward Sanchez, MD Blossom A. Sanger, MD George M. Sanger, MD Brian S. Saunders, MD Max Savin, MD James R. Schaefer, MD Robert A. Schaffer, MD Edward L. Schechter, MD Jenkins L. Schley, MD Donald L. Schmidt, MD R. Larry Schmitt, MD Jerry A. Schneider, MD Robert D. Schroeder, MD David G. Schrunk, MD David G. Seay, MD John D. Segel, MD Allan B. Seid, MD Thomas W. Self, MD Melvin L. Selzer, MD Stephen R. Selzer, MD Richard Serwin, MD Marjorie E. Seybold, MD Ghazi S. Shaba, MD Chandrakant V. Shah, MD Jacob Sharp, MD Ernest W. Shaw, MD Wynton G. Shaw, MD Charles P. Sheehan, MD Phillips L. Sheffey, MD James W. Sherrill, MD Harold H. Shively, MD Earl H. Shultz, MD Alan E. Shumacher, MD Hano A. Siegel, MD Arthur W. Silver, MD Eunice M. Simmons, MD Morton A. Simmons, MD Robert B. Simons, MD Ronald J. Sisel, MD Richard A. Slawson, MD Daniel H. Slemmons, MD Cody L. Smith, MD Dan S. Smith, MD David A. Smith, MD Frederick W. Smith, MD John L. Smith, MD N. Ty Smith, MD Penelope C. Smith, MD Randall W. Smith, MD Robin Victor Smith, MD Anthony P. Solimine, MD Rodney D. Sornson, MD Alan R. Spector, MD Gerald M. Spector, MD William L. Sperling, MD Thomas F. Spethmann, MD Edward S. Spilkin, MD Raymond Joseph Splinter, MD Frederick W. Spong, MD Leland W. Sprinkle, MD

William L. Sperling, MD

Retired SDCMS-CMA Member

I retired at age 60 in 2001, after 27 years of practicing medicine. Prior to my retirement, I was an active member of SDCMS. Clyde Jones, MD, and I were some of the first Kaiser Permanente physicians to join the Medical Society in San Diego.

With the encouragement of Robert Penner, Jackie Trestrail, and Richard Butcher, I became active with SDCMS as a councilmember and a representative on the CMA delegation. I was also a member of several committees at the same time that my wife was president of the Auxiliary and active with the CMAA and the CMAA Foundation.

Since then many Permanente physicians have held major positions on the SDCMS board, including Al Ray, president, Jeff Krebs, chairman of the Young Physicians Section at SDCMS and CMA, and William Tseng, present councilmember.

My wife, Barbara, and I were both on the board of the Wellness Community, a cancer support network. We chaired the KPBS Wine Tasting Fundraiser for many years and worked together to eliminate cigarette smoking in restaurants and bars before it became a state law. I also enjoyed my teaching experience at UCSD hospital as a clinical professor of medicine. I attended in both outpatient and inpatient areas for the pulmonary division.

In 2001 when I retired, we looked at this opportunity as entering “Phase 2” of our lives. We traveled more in our motorcoach, visiting amazing places in our wonderful country. Because we did not have any time constraints, we also visited countries around the world that we could only previously read about. Hiking, biking, tennis, and golf became weekly activities. I also continued to teach medical students at the university campus school of medicine. I assisted in improving their history taking and physical diagnosis skills.

When we had the wildfires in 2003 and 2007, I volunteered my time to help set up a field hospital at Qualcomm Stadium’s club level. We treated many people who were overcome by smoke or who had complications from chronic medical problems. Many of these patients had to leave their homes without their medicines, and, with the help of volunteer pharmacists, we were able to help them through this crisis. Shortly after this, I started working with the Community Emergency Response Team (CERT), sponsored by the San Diego Fire-Rescue Department, and with other community members preparing our neighborhoods for future disasters. Becoming a

HAM operator has added another resource to my emergency preparedness.

Ralph Ocampo requested that I arrange for a panel of retired pulmonary physicians so that they can share their history of pulmonary medicine in San Diego. Tony Catanzarro, Tom Farrell, Kevin Glynn, Bob Sarlin, Dick Schillaci, Harry Kendall, Herman Froebe, and I met at the San Diego History Center and shared our thoughts while Ralph Ocampo recorded it on CD. We had a wonderful morning sharing our experiences, followed by a lovely lunch at the Prado in Balboa Park.

My hiking interest exposed me to Mission Trails Regional Park. I became a member of its foundation board, where I help raise funds and awareness for this outstanding regional park.

My other interests include photography, computers, reading, organizing a neighbors-on-watch program, and enjoying the local theater.

“Phase 2” has become just as rewarding as the first phase of my life. I highly recommend that when physicians retire they become involved in their community and continue to give back in this new and exciting way.

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Miles V. Stanich, MD Arthur A. W. Stanley, MD Sandra Stedinger, MD John F. Steel, MD David A. Stein, MD Lawrence S. Steinberg, MD Frank J. Stella, MD Charles M. Stephenson, MD John J. Stevens, MD Roger D. Stoike, MD James Stokos, MD Charles E. Stoopack, MD Stanley R. Sulkowski, MD John L. Sullivan, MD Peter M. Taft, MD Blake S. Talbot, MD Francis I. Tanaka, MD Bruce J. Tarzy, MD Marshall B. Taylor, MD William E. Temple, MD Edward A. Ten Eyck, MD Anita A. Tey, MD Merrill H. Thayer, MD Stephen G. Thein, MD Willie E. Thigpen, MD Blanche M. Thomas, MD David F. Thomas, MD Edgar E. Thomas, MD Oliver P. Thomas, MD Peter R. Thomas, MD

Wendell S. Thomas, MD Joseph M. Thompson, MD Lawrence C. Thum, MD Joel E. Tobiason, MD Sidney Tolchin, MD Mitsuo Tomita, MD Louis C. Towne, MD Richard T. Trackler, MD Ton D. Tran, MD Joseph H. Traxler, MD Mark A. Treger, MD Robert D. Trifunovic, MD Max J. Trummer, MD Rosemary T. Tu, MD John D. Turner, MD Searle W. Turner, MD Richard J. Ugoretz, MD James J. Underwood, MD Isadore R. Unger, MD John R. Utne, MD Bruce E. van Dam, MD Ronald F. Vandell, MD Demetrio J. Vazquez, MD John L. Verkleeren, MD Lee Vida, MD Richard Villalobos, MD Long T. Vu, MD Keith Jay Wahl, MD Udo Wahn, MD Frederick Douglas Walker, MD

Erwin N. Wallack, MD Ethel M. Waters, MD Michael L. Weber, MD Thomas C. Webster, MD Donald H. Weiss, MD Joseph B. Weiss, MD Stuart R. Weiss, MD John J. Wells, MD Fernald W. Wentzell, MD Floyd L. Wergeland, MD Elmer C. Werner, MD G. Richard Wheelock, MD Thomas S. Whitelock, MD Jean K. Wickersham, MD Stanley E. Willis, MD Cole B. Willoughby, MD Heston L. Wilson, MD James K. Wilson, MD Thomas E. Wilson, MD Richard T. Wold, MD Jay G. Wolf, MD Joseph H. Wood, MD Lawrence A. Wood, MD Vell R. Wyatt, MD William A. Yancey, MD Lawrence J. Zaino, MD Robert S. Zeiger, MD Philip Robert Ziring, MD Michael A. Zirpolo, MD George G. Zorn, MD

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Decem b er 2011 SAN DIEGO PHYSICIAN .org 31

Looking for a way to give back to the community?

The San Diego County Medical Society Foundation’s (SDCMSF) mission is to address the unmet San Diego healthcare needs of all patients and physicians through innovation, education, and service. SDCMSF is proud to partner with volunteer specialty physicians and nearly 100 community clinics in the county who provide primary care services for the medically uninsured and underserved. These clinics have little to no access to specialty care for their patients and need your help!

Opportunities for Physicians 1

Volunteer for Project Access San Diego:

If you are a specialist in private practice in San Diego, please consider joining more than 180 specialists in the county by seeing a limited number of uninsured adult community clinic patients in your office for free. Project Access coordinates all aspects of care so your volunteerism is hassle-free for you and your office staff.

2

Volunteer for eConsultSD:

eConsultSD allows primary care physicians from the community clinics in San Diego to articulate a clinical question to a specialist and receive a timely response in a HIPAA-compliant, web-based portal. eConsultSD is an easy way for busy specialist physicians to give back to the community who are not able to provide direct patient care.

3

Obtain a Volunteer or Paid Position at a Local Community Clinic: SDCMSF is happy to connect specialist physicians with a community clinic that needs your services on site. This opportunity involves traveling to a clinic within San Diego County as your schedule permits.

4

Make a Contribution:

SDCMSF needs your support to care for the medically underserved in our community. Please consider making a contribution of any size to support the Foundation’s efforts.

Contributions can be made online at SDCMSF.org or sent to the San Diego County Medical Society Foundation at 5575 Ruffin Road, Suite 250, San Diego, CA 92123.

Thank you for your support!

Thank you for your dedication to the medically underserved. If you are interested in any of the opportunities above, please contact Lauren Banfe, resource development director, at (858) 565-7930 or at Lauren.Banfe@SDCMS.org.

The San Diego County Medical Society Foundation is a 501(c)3 organization (Tax ID # 95-2568714).

Please visit SDCMSF.org for more information. Telephone: (858) 300-2777 or Fax: (858) 569-1334

SDCMSF was formed as a separate 501(c)3 in 2004 by the San Diego County Medical Society.

32 S AN D I E G O P HY S I CI A N. or g Au gu st 2011 32 SAN DIEGO PHYSICIAN.org decem ber 2011

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classifieds PHYSICIAN POSITIONS AVAILABLE PART- OR FULL-TIME PHYSICIAN OR PHYSICIAN ASSISTANT: Immediate opening for a part- or full-time physician or physician assistant in a busy internal medicine practice with two offices in La Mesa and El Cajon.

This office uses EHR with speech recognition. The candidate should be willing to see patients at hospitals and SNF as well. Efficient, hardworking team-player with compassion towards patient care is expected. Compensation is competitive and commensurate with experience. Interested candidates can email CV to vprabaker@ yahoo.com, attention to Venu Prabaker, MD. [999] XIMED HOSPITALISTS, INC., LA JOLLA, CA: Prestigious, 350-physician multi-specialty group seeks experienced full-time hospitalists to be part of an established hospitalists program at Scripps Memorial Hospital, La Jolla. Board-certified internal medicine physicians with superior clinical skills and willing to work in a team environment. Excellent communication skills a must. Outstanding salary, bonus, and benefits. Please email CV to Yvonne Montelius, XiMED Hospitalists, at ymontelius@ ximedinc.com or fax to (858) 587-1642. [997] NEUROLOGIST: This practice is seeking a qualified neurologist to join our practice here in beautiful La Jolla. We are a well-established neurology practice with four physicians. We are located on and provide on call for Scripps Memorial Hospital, La Jolla campus. We have a large referral base with two HMOs and contract with numerous insurance companies. There is outstanding earning potential, and the opportunity to expand into other areas is certainly a possibility. On-call ratio is 1:4. One of our physicians is the stroke director at Scripps Memorial Hospital. Our practice treats neurodegenerative diseases with emphasis on dementias. We treat a large number of movement disorder, stroke, and Botox treatment, as well as Parkinson’s disease. If you know anyone who would be interested in this excellent opportunity, please contact our office at or forward resumes to mrsbinx@ hotmail.com. [995] INTERNAL MEDICINE, PRIVATE PRACTICE PART TIME: LIFE/WORK BALANCE! Unusual and exceptionally attractive private practice IM opportunity in beautiful North San Diego County. Stable, long-term, part-time position available with flexible scheduling. Collegial, single-specialty group, exceptional office staff, and above all very high-quality patient care set this far apart from many other situations. Outpatient only, paperless office, easy access from anywhere in the county. Multiple scheduling options available, making this very attractive for any physician wanting part-time only work or wanting to combine with other job opportunities. Outstanding way to experience private practice. Email CV to portofino3@aol.com or call (619) 248-2324. [993] GENERAL CARDIOLOGIST: Recruiting for a general cardiologist for busy cardiology practice. Must perform diagnostic cath. Board eligible/certified. California license required. Must possess excellent education and training in the United States. Please send resume to SDCardioJobs@gmail.com. [989] INTERVENTIONAL CARDIOLOGIST: Recruiting for well-rounded interventional cardiologist interested in both an office-based practice and hospital procedures.

The individual should be well trained in all aspects of cardiology for diagnostic and therapeutic interventions, including cardiac, peripheral vascular disease, and renal vascular disease. Please send resume to SDCardioJobs@gmail.com. [990] BOARD-CERTIFIED FAMILY PRACTICE PHYSICIAN NEEDED: To cover hours at busy urgent care/family practice office in Carlsbad. Nights and weekend coverage needed, some day coverage available. Please fax CV to (760) 603-7719 or email CV to gcwakeman@sbcglobal.net. [985] BC FAMILY PRACTIONER MD/DO WANTED TO JOIN OUR PRACTICE IN BEAUTIFUL CORONADO: Seeking

FT family physician to join our practice before July 2012.

There would be a salary assistance guarantee through a leading local IPA for first year and also a buy-in opportunity as well. The ideal candidate would be willing to share practice with one FT FP and PT FP in practice together and share call and expenses. There would be additional earning opportunities for PT inpatient hospitalist at local hospital as well. Hospital work is optional however. We provide a full range of pediatric and adult family medicine (but no OB). Our practice is well known and has a reputation of personal excellence and service to a wonderful community in an ideal location. Also there is very good earning potential as well. If seriously interested in this unique opportunity, please send your CV and references to donalddill@sbcglobal.net, Attn: Gloria Rivera, or call (619) 435-3155 or fax (619) 435-3158. [968] PHYSICIANS: North County Health Services is a Joint Commission-accredited FQHC, celebrating 40 years of service and serving more than 60,000 patients in multiple locations in North San Diego County. We have opportunities for BC/BE physicians for both full-time and per-diem positions. Spanish communication skills are helpful but not required. Compensation includes attractive salary, great benefit and retirement programs, malpractice, reimbursement for CME and licensure.

This is an opportunity to make a difference in the lives of patients who are under or uninsured without having the expense of overhead or management concerns, and provides work-life balanced hours. NHSC loan repay may also be available. Email cynthia.bekdache@nchs-health. org or (fax) 760-736-8740. [966] PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private nonprofit outpatient clinic serving the communities of North San Diego County, has opening for part-time, per diem positions. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English/Spanish preferred. Forward resume to hr@vistacommunityclinic. org or fax to (760) 414-3702. Visit our website at www. vistacommunityclinic.org. EOE/MF/D/V [912] SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT FOUR-DAYS-PER-WEEK POSITION: Private practice in La Mesa seeks pediatrician four days per week on partnership track. Modern office setting with a reputation for outstanding patient satisfaction and retention for over 15 years. A dedicated triage and education nurse takes routine patient calls off your hands, and team of eight staff provides attentive support allowing you to focus on direct, quality patient care.

Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, rounding on newborns, and occasional admission, NO delivery standby or rushing out in the night.

Benefits include tail-covered liability insurance, paid holidays/vacation/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disability and life insurance. Please contact Venk at (619) 504-5830 or at venk@gpeds.sdcoxmail.com. Salary $ 102–108,000 annually (equal to $130–135,000 full-time). [778] PRACTICE FOR SALE INTERNAL MEDICINE PRACTICE FOR SALE IN NATIONAL CITY: $318,000 yearly average gross earnings for the past three years. Office-based busy practice of 31 years on the busiest street of the city. Option to add hospital practice to the office practice, with the nearest hospital 1.6 miles close. Two other nearby hospitals are less than 7 miles. Easily accessible location right between two freeways, I-5 and I-805. $89,000–$99,000. Terms negotiable. Financing if needed. Call (619) 948-4946 anytime or (619) 449-4318 7pm–2am. [945] INTERNAL MEDICINE PRACTICE FOR SALE: Beautiful beach weather, established 27 years with excellent reputation. Two exam rooms. Free-standing building. Main street corner location. Great visibility. Office shared with another physician. Patient parking. 2010 gross: $483K. Asking $245K. 100% financing available. Please contact ProMed at (888) 277-6633 or at info@promed-financial. com, or visit www.promed-financial.com. [906]

OFFICE SPACE / REAL ESTATE For sale or lease or lease-option: Coronado condo/office. California Plaza. 1001 B Ave., Ste. 100. Corner first floor, 900 sq. ft. Perfect doctor’s office. $344K. Owner will carry. Call (619) 997-3112. [002] TALMADGE OFFICE SPACE $995/$850: Easy access partially furnished office with parking. Previously a doctor’s office with 1,245 sq.ft. of space. Two 1/2 baths, reception area, lab, and six other rooms. We also have a 1,185 sq.ft. space behind this one. Could be medical, dental, or professional office. Located on the north end of Euclid Avenue near the Talmadge gates. Two entrances: one from the street and another from the parking lot.

Handicapped entrance off the parking lot. Commercial tenants may use the parking lot Monday–Fridays 8am– 6pm. Contact patwoodard@aol.com for more information or to view. [998] CLAIREMONT OFFICE SPACE TO SHARE: Currently occupied by two general internists. Great central location in Clairemont, halfway between Sharp Memorial and Scripps La Jolla hospitals. Office just recently remodeled. Free parking. Looking to share with specialty physician. Fully furnished. Terms negotiable. Please contact Gary at (858) 430-1651 for more details. [996] OFFICE SPACE TO SHARE: Currently occupied by orthopedic surgeon. Great location close to Scripps/Mercy and UCSD Hospital. Looking to share with part-time or fulltime physician. Fully furnished, fully equipped with fluoro machine and four exam rooms, and staff. (NEGOTIABLE) Please contact Rowena at (619) 299-3950. [804] FULL- AND PART-TIME OFFICE SPACE IN UTC: with 8th floor view in suite with established psychologists, marriage and family therapist, and psychiatrists in Class A office building. Features include private entrance, staff room with kitchenfacilities, active professional collegiality and informal consultation, private restroom, spacious penthouse exercise gym, storage closet with private lock in each office, soundproofing, common waiting room and abundant parking. Contact Christine Saroian, MD, at (619) 682-6912. [862] OFFICE SPACE TO SHARE: Office space to share in National City with a well-respected physician who has been in private practice for 30 years. Office is about 900 square feet with two exam rooms and an additional office/multipurpose space. Office is currently being used part-time, Monday through Wednesday, but hours are flexible to accommodate another part-time practice. If interested, please contact me at bpmedina@msn.com. [991a] TIME SHARES FOR SALE: 1 week / year at the Pono Kai in Kauai, Hawaii. Price $18,000. (2 bed / 2 bath). 2 weeks / year at the Summer Bay in Las Vegas. Price $14,000 (2 bed / 2 bath). Try before you buy. Both can be used at this time, 1 week for 2 $1,500. If interested, please contact me at bpmedina@msn. [991b] OFFICE SPACE IN ENCINITAS — 477 N. EL CAMINO REAL: 1,600 sq. ft. beautiful office occupied by a dermatologist. One or two rooms available. May have the space to yourself for a full day and some half days. Prime location in a multi-specialty four building complex with an outpatient surgery center. Close to Scripps Encinitas Hospital. Available immediately and staff available if needed. Great for solo physician or a small group seeking a presence in North County. Please contact Dana at (760) 436-8700. [987] PLEASE CONTACT IF YOU HAVE OFFICE SPACE AVAILABLE TO SUBLET: Will consider any area in greater San Diego but would specifically be interested in Poway, Escondido, Vista, North County, as well as East County/ La Mesa. Prefer situation where we can use existing office staff. Contact sundhmail@yahoo.com. [983] SCRIPPS ENCINITAS CONSULTATION ROOM/EXAM ROOMS: Available consultation room with two examination rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

34 SAN DIEGO PHYSICIAN.org decem ber 2011

the Surgery Center. Receptionist help provided if needed.

Contact Stephanie at (760) 753-8413. [703]

with OB/GYN. Call (619) 463-7775 or fax letter of interest to La Mesa OB/GYN at (619) 463-4181. [648]

MEDICAL OFFICE SPACE FOR LEASE, 1,215 SQ FT: Office has furnished waiting area, front and back stations for four staff members, two exam rooms, a break room, and doctor’s office. Office is updated and is ready for move-in. Located in a great medical/dental complex in Poway, close to Pomerado Hospital, on the border with Rancho Bernardo. Second floor. Elevator/stair access. Large, free patient parking area. Ideal for medical, complementary/alternative medicine, physical therapy, chiropractic, acupuncture, massage/body work, etc. Patients from Poway, Rancho Bernardo, Carmel Mountain, 4-S Ranch, Scripps Ranch, Escondido, Ramona, and surrounding areas. Affordable rent. Please contact Olga at (858) 485-8022. [980]

BUILD TO SUIT: Up to 1,900ft2 office space on University Avenue in vibrant La Mesa/East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable. Contact venk@cox.net or (619) 504-5830. [835]

CONSULTATION ROOM AVAILABLE: On the campus of Scripps Encinitas, close to 5 freeway. Private entry to wheelchair-accessible unit with soundproof walls, spacious waiting room shared with one doctor, BR with shower, reserved parking. Flexible sub-lease terms. To view the property (available now), please contact (760) 944-9263. [979] OFFICE SPACE TO SUBLEASE: At 754 Medical Center Court, Suite 101, Chula Vista, CA 91911. Close to Sharp Chula Vista Hospital. Includes one office and three exam rooms. If interested, please call (619) 994-4366. [978] SCRIPPS / XIMED BUILDING, LA JOLLA OFFICE SPACE TO SUBLEASE: Currently occupied by one fulltime and three part-time physicians. One office available plus one exam room. Receptionist space available for your employee. For more information, contact Mary at (858) 457-3270. [975] OFFICE FOR LEASE: Beautiful turnkey 1,800-squarefoot medical office space for sublease in Encinitas on El Camino Real with lighted signage and wall signage on El Camino Real. Ideal drive-by advertising. $80,000 worth of tenant improvements with in the last two years. Hardwood flooring, designer decorated and coordinated walls, cabinets, and counters. Five exam rooms and beautiful nursing and reception areas all perfectly appointed. Waiting room with leather couch matching designer furniture and credenza. Phone system, T-1 line, surround-sound muzac system, E-clinical version 9 EMR, new server, all offices fully furnished with new exam tables, computers, and Welch Allen oto/optho sets. 4,700 active primary care patients with healthy cash-based practice. Rent is currently $4,900 a month. Office hard assets and goodwill are negotiable. Physician could lease the space, buy the practice, or work as a guaranteed employee. Please contact Judith Rubin, MD, at judyr@nouveauhealth.net. [973] PATIENT INTERVIEW OFFICE: Patient interview office available on the campus of Scripps Encinitas Hospital, adjacent to Highway 5 Santa Fe exit. First floor, four office private suite, with two established psychiatrists, and one psychotherapist. Full- or part-time lease available. Use of front office staff negotiable. [971] MEDICAL OFFICE SPACES FOR RENT/PRE-LEASE, NEW CONSTRUCTION, VERY AFFORDABLE: Very close to Grossmont Hospital and highways 8 and 125.

New building being constructed at 5980 Severin Dr., La Mesa. Near corner of Severin Dr. and Amaya, just north of the Brigantine restaurant. Beautiful and functional design. Spaces from 950 to 1,500 sq. ft. available. Now leasing. Call Nathan at (619) 787-3422 or email hythams@att. net. [967] 3998 VISTA WAY, IN OCEANSIDE: Two medical office spaces approximately 2,000 sq. ft. available for lease.

Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground floor access. Lease price: $1.75 +NNN. Tenant improvement allowance. For further information, please contact Lucia Shamshoian at (760) 931-1134 or at shamshoian@coveycommercial.com. [965] SHARE OFFICE SPACE IN LA MESA: Available immediately. 1,400 square feet available to an additional doctor on Grossmont Hospital Campus. Separate receptionist area, physician’s own private office, three exam rooms, and administrative area. Ideal for a practice compatible

SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building.

Medicare certified ambulatory surgery center next door.

Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@SDCMS.org for more information. [867]

helpful but not required. Compensation includes attractive salary, great benefit and retirement programs, malpractice, reimbursement for CME and licensure. This is an opportunity to make a difference in the lives of patients who are under or uninsured without having the expense of overhead or management concerns, and provides work-life balanced hours. NHSC loan repay may also be available. Email cynthia.bekdache@nchs-health.org or fax (760) 736-8740. [984] PA/NP POSITION: PA/NP needed in busy neurosurgery private practice. Candidate needs to be highly interested and motivated, as well as caring and flexible. Will be asked to conduct patient clinics, hospital rounds, and assist in surgeries. If interested, please send email with CV and references to armonia01@me.com. [977] MEDICAL EQUIPMENT FOR SALE: Office equipment and supplies. Closing Poway office 12/31/2011. Dr. Dougherty (858) 748-2228. [994]

NONPHYSICIAN POSITIONS AVAILABLE FT Medical insurance biller wanted: Collections, A/R, with knowledge of full cycle billing.

Verification of insurance benefits, and be familiar with electronic and paper billing insurance claim follow-up.

Previous experience preferred. Send resume to mrsbinx@hotmail.com. [001] PART- OR FULL-TIME PHYSICIAN OR PHYSICIAN ASSISTANT: (see #999 under “PHYSICIAN POSITIONS AVAILABLE”) NURSE PRACTITIONER/PHYSICIAN ASSISTANT/ NURSE MIDWIFE: North County Health Services is a Joint Commission-accredited FQHC, celebrating 40 years of service and serving more than 60,000 patients in multiple locations in North San Diego County. We have opportunities for certified family nurse practitioners and physician assistants and nurse midwives for both full-time and per-diem positions. Spanish communication skills are

USED X-RAY PROCESSOR FOR SALE: Kodak RP XOMAT, model #M6B, 90 second processor. Works great.

Contact Lisa Sullivan at lisas@sdsm.net or by phone at (619) 229-3934. [992] ELECTRONIC TOUCH SCREEN MEDICAL CHECK IN SYSTEM FOR SALE: Eliminate staff interruptions and increase your office efficiency with this easy-to-use patient sign-in kiosk in your waiting room. The average signin time for patients with a Medical Check In touch-screen kiosk takes fewer than 10 seconds. With this reduction in interruptions and the clear, organized communication of patient information to your receptionist’s computer, Medical Check In will reduce the time for the patient sign in process, reduce congestion for your reception area and save you money. Compatible with all electronic health records. Still under warranty. Cost for new Medical Check In is $2,500. Great price for this at $995. For more information please see medicalcheckin.com. Email KLewis@ SDCMS.org. [982]

Increase Your Referral Business San Diego Physician is the only publication that is distributed to all 8,500 practicing physicians in San Diego County. Advertising is a cost-effective and profitable way to increase your referral business.

Contact Dari Pebdani at 858-231-1231 or at DPebdani@sdcms.org

decem b er 2011 SAN DIEGO PHYSICIAN.org 35

SDCMS

Happy Holidays!

From Your SDCMS and SDCMS Foundation Support Teams

Left to Right: Tom Gehring, CEO/Executive Director; Betty Matthews, Administrative Assistant; Tanya Rovira, Project Access Program Director, Foundation; Elizabeth Terrazas, Patient Care Manager, Foundation; Rebecca Valenzuela, Patient Care Manager, Foundation; Sonia Gonzales, Director of Medical Office Manager Support and Office Manager Advocate (Former); Jennipher Ohmstede, Director of Engagement; Janet Lockett, Director of Membership Development; Lauren Banfe, Resource Development Director, Foundation; Serena Sauerheber, Membership Administrative Assistant; Kyle Lewis, Director of Communications and Marketing; Marisol Gonzalez, Director of Membership Operations and Physician Advocate; James Beaubeaux, COO/CFO. Not Pictured: Barbara Mandel, Executive Director, Foundation; Rob Yeates, IT Project Manager, Foundation.

36 SAN DIEGO PHYSICIAN.org decem ber 2011

We Celebrate Excellence – Theodore M. Mazer, MD CAP member and tireless champion for access to quality health care, for those in need

800-252-7706 www.CAPphysicians.com San Diego orange LoS angeLeS PaLo aLTo SacramenTo

For over 30 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like San Diego otolaryngologist Theodore Mazer, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT).

Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.

CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best.

We invite you to join the more than 11,000 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection.

37

may 2011 SAN DIEGO P HY SICIA N. o rg 37 decem b er 2011 SAN DIEGO PHYSICIAN.org

$5.95 | www.SANDIEGOPHYSICIAN.org San diego County Medical Society 5575 RUFFIN ROAD, SUITE 250 SAN DIEGO, CA 92123 [ RETURN SERVICE REQUESTED ]

National power. Local clout.

No compromises.

The Doctors Company protects California members with both.

What does uncompromising protection look like? With 71,000 member physicians nationwide, we constantly monitor emerging trends and quickly respond with innovative solutions, like incorporating coverage for privacy breach and Medicare reviews into our core medical liability coverage.

In addition, our 20,000 California members benefit from the significant local clout provided by our long-standing relationships with the state’s leading attorneys and expert witnesses, plus litigation training tailored to California’s legal environment.

When it comes to your defense, don’t take half measures. Get protection on every front with The Doctors Company. This uncompromising approach, combined with our Tribute® Plan that has already earmarked over $106 million to California physicians, has made us the nation’s largest insurer of physician and surgeon medical liability.

The San Diego County Medical Society has exclusively endorsed our medical professional liability program since 2005. To learn more about our benefits for SDCMS members, call (800) 852-8872 or visit us at www.thedoctors.com.

Robert D. Francis Chief Operating Officer, The Doctors Company

We relentlessly defend, protect, and reward the practice of good medicine.

Exclusively Endorsed by

Any Tribute Plan projections shown here are not intended to be a forecast of future events or a guarantee of future balance amounts. For a more complete description of the Tribute Plan, see our Frequently Asked Questions at www.thedoctors.com/tributefaq.

38 SAN DIEGO PHYSICIAN.org decem ber 2011