official publication of the san diego county medical society November 2012
every physician’s voice matters!
“Physicians United For A Healthy San Diego”
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S A N D I E G O P HY S I CI A N .or g O c tob e r 2011
Octo ber 2011 SAN DIEGO P HY SIC I A N. o rg
this month Volume 99, Number 11
Managing Editor: Kyle Lewis Editorial Board: Van L. Cheng, 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
INFLUENCING LEGISLATION 20 Political Advocacy: Who Cares? What Difference Does It Make? Why Bother? BY TOM GEHRING 22 One Must Imagine Sisyphus Happy: CMA’s 2012 Legislative Wrap-up BY JODI HICKS 26 CMA’s Legislative Hot List and Regulations Quick List BY CMA 28 You’re Either at the Table or You’re on the Menu: 10 Pretty Good Rules BY TOM GEHRING
30 Success in a New Era: CALPAC Continues to Thrive Under State’s New Election Policies BY RICHARD THORP, MD
SDCMS Board of Directors Officers President: Sherry L. Franklin, MD (CMA TRUSTEE) President-elect: Robert E. Peters, PhD, MD Treasurer: J. Steven Poceta, MD Secretary: William T-C Tseng, MD, MPH Immediate Past President: Robert E. Wailes, MD (CMA TRUSTEE) geographic and geographic alternate Directors East County: Alexandra E. Page, MD, Venu Prabaker, MD Hillcrest: Theodore S. Thomas, MD (A: Gregory M. Balourdas, MD) Kearny Mesa: John G. Lane, MD, Jason P. Lujan, MD (A: Sergio R. Flores, MD) La Jolla: Geva E. Mannor, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County: Niren Angle, MD, Douglas Fenton, MD, James H. Schultz, MD (A: Anthony H. Sacks, MD) South Bay: Vimal I. Nanavati, MD, Michael H. Verdolin, MD (A: Andres Smith, MD)
At-large Directors Karrar H. Ali, MD, David E.J. Bazzo, MD, Jeffrey O. Leach, MD (DELEGATION CHAIR), Mihir Y. Parikh, MD (EXECUTIVE COMMITTEE BOARD REP), Peter O. Raudaskoski, MD, Kosala Samarasinghe, MD, Suman Sinha, MD, Mark W. Sornson, MD (EXECUTIVE COMMITTEE BOARD REP) At-large ALTERNATE Directors James E. Bush, MD, Theresa L. Currier, MD, Thomas V. McAfee, MD, Carl A. Powell, DO, Elaine J. Watkins, DO, Samuel H. Wood, MD, Holly Beke Yang, MD, Carol L. Young, MD other voting members Communications Chair: Theodore M. Mazer, MD (CMA SPEAKER) Young Physician Director: Van L. Cheng, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: Suraj Kedarisetty
OTHER NONVOTING MEMBERS Young Physician Alternate Director: Renjit A. Sundharadas, MD Retired Physician Alternate Director: Mitsuo Tomita, MD
4 Briefly Noted
SDCMS Foundation President: Stuart A. Cohen, MD, MPH CMA Past Presidents: James T. Hay, MD (AMA DELEGATE), Robert E. Hertzka, MD (LEGISLATIVE COMMITTEE CHAIR, AMA DELEGATE), Ralph R. Ocampo, MD CMA Trustee: Albert Ray, MD (AMA ALTERNATE DELEGATE) CMA Trustee (OTHER): Catherine D. Moore, MD CMA SSGPF Delegates: James W. Ochi, MD, Marc M. Sedwitz, MD CMA SSGPF Alternate Delegates: Dan I. Giurgiu MD, Ritvik Prakash Mehta, MD
Calendar • Legislator Birthdays • New / Rejoining Members • And More …
8 Stopping Time and Seeing Through a New Lens by DANIEL J. BRESSLER, MD
0.125 in 10 Windows 8: Window Dressing or Game Changer? by OFER SHIMRAT
14 November Is National COPD Awareness Month by LYNN GODWARD
16 The Power of Perspective
by Helane Fronek, MD, FACP, FACPh
34 Physician Marketplace Classifieds
36 Featured Member: Bruce Potenza, MD by michelle brubaker
2 novem b er 2012
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.]
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 • firstname.lastname@example.org apply online at: bbvacompass.com/mortgages/byaninek
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8.4375x11_SMF Physicians AD.indd 1
11/17/11 11:59 AM
brieflynoted calendar SDCMS Seminars, Webinars & Events SDCMS.org/event
For further information or to register for any of the following SDCMS seminars, webinars, and events, visit SDCMS.org/event or contact Rhonda Weckback at (858) 300-2779 or at Rhonda. Weckback@SDCMS.org. 2012: A Critical Year for Changes in Tax Law (seminar/ webinar) NOV 8 • 11:30am–1:00pm
Understanding the CBAS Transition for Dual Eligibles NOV 28 • 12:15pm–1:15pm Essentials for ICD-10-CM: Part 1 NOV 29 • 7:45am–8:45am or 12:15pm–1:15pm California: A Physician Melting Pot NOV 29 • 12:15pm–1:15pm Impact of ICD-10 DEC 5 • 12:15pm–1:45pm Essentials for ICD-10-CM: Part 2 DEC 6 • 7:45am–8:45am or 12:15pm–1:15pm Successful Medi-Cal Provider Enrollment DEC 12 • 12:15pm–1:45pm
The (Physician) Leader’s Toolbox (workshop) NOV 10 (8:00am–4:00pm) and NOV 11 (8:00am–12:00pm)
Essentials for ICD-10-CM: Part 3 DEC 13 • 7:45am–8:45am or 12:15pm–1:15pm
Top 10 Patient Safety Issues for Office Practice (seminar/webinar) NOV 15 • 11:30am–12:30pm
Community Healthcare Calendar
Advocacy Training (workshop) DEC 1 • 8:00am–12:00pm
Understanding ARC and CARC Revenue Codes NOV 7 • 12:15pm–1:15pm 2013 Updates to Meaningful Use NOV 8 • 12:15pm–1:15pm State Disability Insurance Online for Your Patients and You NOV 14 • 12:15pm–1:15pm Successful Medi-Cal Provider Enrollment NOV 15 • 12:15pm–1:45pm
To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. Events should be physician-focused and should take place in or near San Diego County. Aces for Health Golf Tournament FEB 28 • Del Mar Country Club • Benefitting the SDCMS Foundation’s Project Access • (858) 565-7930 RCMA’s “Cruisin Thru CME” — French Waterways: Highlights of Burgundy & Provence JUL 1–13, 2013 • Call RCMA at (800) 472-6204
One way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday! BIRTHDAY: NOVEMBER 11 U.S. Senator Barbara Boxer E: (via website) boxer.senate.gov Washington, DC, Office: T: (202) 224-3553 • F: (202) 228-3863 San Diego Office: 600 B St., Ste. 2240, San Diego, CA 92101 T: (619) 239-3884
BIRTHDAY: NOVEMBER 24 State Assemblyman Kevin Jeffries (District 66) E: (via website) arc.asm.ca.gov/member/66 E: email@example.com Sacramento Office: State Assembly, Sacramento, CA 95814 T: (916) 319-2066 • F: (916) 319-2166 Murrieta Office: 41391 Kalmia St., Ste. 220, Murrieta, CA 92562 T: (951) 894-1232 • F: (951) 894-5053
SDCMS Member Physicians:
If you are interested in learning more about possibly joining the San Diego Physician editorial board, please email Editor@SDCMS.org.
Sometimes our light goes out but is blown into flame by another human being. Each of us owes deepest thanks to those who have rekindled this light.”
4 novem b er 2012
— Albert Schweitzer (1875–1965)
get in touch
Welcome Our New and Rejoining SDCMS-CMA Members! New Members Joanna E. Adamczak, MD Maternal and Fetal Medicine San Diego • (858) 966-8567 Julie S. Block, MD Pediatrics Encinitas • (760) 753-7143 Elion Brace, MD Hospital Medicine San Diego • (619) 499-2600 Holly L. Casele, MD Maternal and Fetal Medicine San Diego • (858) 541-6880 Chunjai P. Clarkson, MD Obstetrics and Gynecology Vista • (760) 630-5487 Christine Clotfelter, DO Family Practice (and OMT) Encinitas • (760) 942-0118 Jill S. Cottel, MD Internal Medicine Poway • (858) 312-1672 Michelle S. Dern, MD Pediatrics Encinitas • (760) 753-7143 Guia-Lynn P. Escuro, MD Pediatrics Encinitas • (760) 753-7143 Frederick M. Frumin, MD Pediatrics Encinitas • (760) 753-7143
Gary P. Gross, MD Pediatric Hematology-Oncology Encinitas • (760) 753-7143
Richard C. Smith, MD Infectious Disease Vista • (760) 806-9263
Nona L. Hanson, MD Family Medicine Vista • (760) 630-5487
Neha A. Trivedi, MD Obstetrics and Gynecology San Diego • (858) 966-8567
Pha C. Le, DO Emergency Medicine Escondido
Masami C. Wood, MD Pediatrics Encinitas • (760) 753-7143
Nicholas B. Levy, MD Pediatrics Encinitas • (760) 753-7143
Victoria K. Young, MD Obstetrics and Gynecology San Diego • (858) 618-1156
Patrick M. McGinty, MD Internal Medicine Encinitas • (760) 944-7300
Gordon C. Zink-Brody, MD Diagnostic Radiology San Diego • (858) 658-6500
Diego Mendez, MD Obstetrics and Gynecology San Diego • (858) 268-0300
Martin M. Nielsen, MD Pulmonary Disease Oceanside • (760) 758-7474 Kevin P. O’Leary, MD Pediatrics Encinitas • (760) 753-7143 Airisha P. Ramirez, MD Family Medicine San Diego • (619) 499-2600 Lauren A. Robertson, MD Obstetrics and Gynecologic Surgery San Diego • (858) 455-7520 Rajiv Roy, MD Endocrinology, Diabetes, and Metabolism Chula Vista
Enrique Espinosa-Melendez, MD Nephrology National City • (619) 477-7779 Diana E. Hoppe, MD Obstetrics and Gynecology Encinitas • (760) 635-5600 Valerie P. Rubin, MD Pediatrics Encinitas • (760) 753-7143 Vernon M. White, MD Family Medicine Chula Vista • (619) 498-1100
Your SDCMS and SDCMSF Support Teams Are Here to Help!
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 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 DIRECTOR OF ENGAGEMENT Jennipher Ohmstede at (858) 300-2781 or JOhmstede@SDCMS.org DIRECTOR OF MEMBERSHIP SUPPORT • PHYSICIAN ADVOCATE Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org DIRECTOR OF RECRUITING AND RETENTION Brian R. Gerwe at (858) 300-2782 or at Brian.Gerwe@SDCMS.org DIRECTOR OF MEMBERSHIP OPERATIONS Brandon Ethridge at (858) 300-2778 or at Brandon.Ethridge@SDCMS.org DIRECTOR OF COMMUNICATIONS AND MARKETING • MANAGING EDITOR Kyle Lewis at (858) 300-2784 or KLewis@SDCMS.org OFFICE MANAGER • DIRECTOR OF FIRST IMPRESSIONS Betty Matthews at (858) 565-8888 or Betty.Matthews@SDCMS.org 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 Francesca Mueller, MPH, at (858) 565-8161 or Francesca.Mueller@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 RESOURCE DEVELOPMENT DIRECTOR Nicole Hmielewski at (858) 565-7930 or Nicole.Hmielewski@SDCMS.org IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org IT PROJECT MANAGER Victor Bloomberg at (619) 252-6716 or Victor.Bloomberg@SDCMS.org
SAN DI EGO PHYSICIAN .org 5
brieflynoted risk management
Telemedicine Creates Efficiencies, Requires Caution
By SDCMS-endorsed The Doctors Company (www.thedoctors.com/patientsafety)
The adoption of telemedicine is growing as physicians seek innovative ways to provide clinical healthcare to patients who are at a distance, have a disability, or face other barriers that can impede access to quality care. Telemedicine can improve efficiencies, but security and confidentiality must be addressed. The Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, has identified Health Professional Shortage Areas (HPSAs), i.e., geographic regions with an inadequate number of primary care physicians. Physicians who practice in 6 novem b er 2012
these areas can meet the rising demand for care from a vast patient population by taking advantage of affordable technology, the convenience of webcams and web-based portals like Skype, secure internet connections, and high-speed links via satellite. Physicians who are not located in HPSAs are incorporating this technology into their practices to help manage increasing patient volume. The Centers for Medicare and Medicaid Services (CMS) reimburses physicians and hospitals that offer telemedicine to patients in HPSAs, remote sites, and rural areas. Last year, CMS also amended the Medicare
Conditions of Participation for hospitals and critical access hospitals, updating the process that facilities can use for credentialing and granting privileges to practitioners who deliver care through telemedicine. In addition, many payers are reimbursing physicians who offer virtual consultations. While the benefits of telemedicine are vast, its use and adoption must be tempered with caution. Physicians must be aware of the risks associated with access, such as patient and staff privacy, inaccuracies in self-reporting, and symptoms that may only be caught in person. Additional legal considerations for online interactions, such as licensure compliance, must be addressed for the protection of the physician and the patient. According to the Federation of State Medical Boards, only 10 states have provided special-purpose licenses to allow for cross-border telemedicine, while most states require complete licensing if the patient is in their jurisdiction. Additional considerations include: • Employing secure computer network systems with approved security codes designated under HIPAA compliance. • Clearly defining proper protocols for webcams and web-based portals. • Using mechanisms to protect the privacy of individuals who do not want to be seen on camera (including staff members, other patients, or patients’ families). • Understanding how web-based portals send encryption keys so that hackers can’t access the stream and decrypt the conversation. • Developing a method to ensure that the person you are communicating with is not an impersonator. • Considering the effects that telemedicine may have on your relationship with your patients and developing strategies to ensure they feel valued.
SAN DI EGO PHYSICIAN .org 7
Poetry and Medicine
is really about. Honesty catalyzes change. The purpose of art, paraphrasing Rilke, is to change your life. San Diego Physician magazine has been kind enough to set aside some space in to publish a series of poems that have grown from poemseeds over the past few years. I will introduce them with a few lines relating them to my practice and life, and hopefully also to yours.
Stopping Time and Seeing Through a New Lens An Introduction to the “Poetry and Medicine” Series by Daniel J. Bressler, MD
I don’t know about you, but my days go by in a blur. When I take my white coat off for the last time in the evening, but also when I raise a glass of champagne to celebrate the turning of a year, or when I sing “Happy Birthday” to a family member, I feel bewilderment along with satisfaction and joy. Where did it go, this day, this year, this decade? (And with the quiet, unspoken addenda, this career, this life?) During my working day as a primary care doctor, I dictate office visits and other clinical notes on a pocket recorder that is transcribed and inserted into the electronic health record. I also carry around a second pocket recorder that I use to capture snippets of my day, some phrase that strikes me as profound or funny, some seemingly new or original thought that pops into my head. At home I jot down the entries from the second recorder. Sometimes it contains little nuggets I call 8 novem b er 2012
“poemseeds.” These I put in a journal. Sometimes they germinate. Poetry, like all art, provides a provocation that can do more than merely amuse. There’s nothing wrong with amusement. It is a form of soothing. It can be a wonderful diversion and certainly it can break tension. But poetry “as art” can — beyond relief — actually change how we see the world. It can even change who we are. It is an attempt, through words, to help us see new things. Moreover, it guides us to see things that were always there but somehow previously overlooked. Poetry can give us a new lens with which to take in the world. Just as the microscope revealed a new world of the tiny and the telescope revealed the world of the cosmic, the poetic lens offers the possibility of perceptual and emotional revelation. Art can pull from the blur of time an honest snapshot of who you really are and what your life
Time and Heat Waves As a practicing doctor, time in both its cyclical/seasonal aspects and its linear/projective aspects affects how I look at the world. The time of year determines the likelihood of certain (especially infectious) diseases. The number of years a person has accumulated dramatically affects the differential diagnosis of a presenting complaint. Chest pain means something very different if you’re 60 than if you’re 20. In my own life, this past summer was especially poignant. My son turned 18 and left for college, the last by a year or two in the cohort of friends on our little cul-de-sac with whom he grew up. The street is now much quieter. With heat waves, I often awake early and sit in the dining room, luxuriating in the pre-dawn coolness. Before the business of the day begins, this dark, still time provides a context for me to reflect on the last year and the last 20. Where did they go? Asking imponderables is, I suppose, one form of therapy for my “early morning awakening.” Sometimes, I even get a poem out of it. Here’s one of them, called “September Song.” September Song The gardenias are floating in water The water’s suspended in air The air is supporting my porcelain cup The floorboards supporting my chair I hear it’s the summer from crickets I feel it’s the summer from sweat I hope in my dreams I’ll be wicked With the mermaids who swim in my head The street that I live on’s grown quiet The children have all moved away If the past was for sale I would buy it And release just a minute a day
you take care of the san diego communit y ’s health. But August has turned to September As summer is fading to fall Sunday dissolves into Monday Like it never existed at all
we take care of san diego’s
healthcare communit y.
I look toward the past and can’t find it Like the scent of a trail that’s grown cold I take yesterday’s snapshot and grind it To a mixture of strychnine and gold
3 income Tax Planning
The summer is too quick forgotten Like all of the seasons before The gardenia blooms have gone rotten And the screeching chair scratches the floor
3 Profitability Reviews
3 Wealth Management 3 employee Benefit Plans 3 outsourced Professional services (CFo, Controller)
It seems like a misapprehension To expect any season to stay Or to hope that the kids remain children For more than a year and a day
3 organizational and Compensation structure 3 succession Planning
The moral’s not clear from this story Though I rub my eyes open to see If my dreams brought some new allegory Like an overnight package for me
3 Practice Valuations 3 internal Control Review and Risk Assessment
But the porch has no new gift upon it Old toys in the bin gather dust What’s this worn jump rope worth if I pawn it? Seems the basketball hoop’s gone to rust Ah well, take a breath and release it Ah well, take a shower and shave The day like the autumn is coming Like a rising tide, wave upon wave Time takes all things and all creatures All children, all toys and all streets And haphazardly changes their features Till their transformation completes The future awaits on my doorstep Respectful, its hat in its hand But as soon as I venture one more step This future assumes its command The future’s a mystery waiting Tomorrow’s a mist and a fog And if you insist on more detail You may as well talk to my dog Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and a longtime contributing writer to San Diego Physician.
akt A KT LLP, CPAs and Business Consu LTAnTs CARL SBAD
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“think SDCMS FIRST!” Start by contacting SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.
SAN DI EGO PHYSICIAN .org 9
Window Dressing or Game Changer? by Ofer Shimrat
Metro, Azure, Mountain Lion, Snow Leopard, Honeycomb, and Jellybean … you would think these were the latest color schemes, window dressing, or drink names in trendy restaurants at the most chic downtown hangouts. In fact, they are code names for operating systems (OSs) and platforms from the likes of Microsoft, Apple, and Google, respectively. Mountain Lion came out for Apple on July 25, 2012. Not to be outdone, the newest Microsoft OS, called Windows 8, debuted on Oct. 26, 2012. 10 novem b er 2012
Windows 8 and its new Metro desktop interface, just recently renamed Modern (but we will keep calling it Metro), represent the most radical departure for an OS built by Microsoft since the paradigm shift of Windows 95. That system was launched back in 1995 with The Rolling Stones’ “Start Me Up” — remember? Incidentally, the current theme song for the Windows 8 launch is “I Only Want You” by the Eagles of Death Metal — don’t ask. Windows 8 has a totally revamped look and feel, and it pushes the technology envelope through the use of touch-centric tiles on any device built to support it: desktops, tablet computers, smartphones, car navigation systems, kiosks, wide panels, laptops, refrigerators … you name it — both on the local device and in the cloud, synchronized with the Microsoft platform called Azure. Microsoft is acutely cognizant of the consumerization trend in IT. For the last three to four years, consumers and businesses have acclimated themselves to the whole “touch” paradigm, coupled with internet access anywhere, everywhere, and on any device. This “experience” has transformed hardware and software technologies, and manufacturers have succumbed to the demands of this market that just five short years ago did not exist. As a matter of fact, the Pew Research Center recently indicated that half of American adults have mobile internet access via a tablet or smartphone. You could successfully argue that Microsoft has been behind the times in those form factors. To its great detriment, the OSs on the vast majority of those devices have not been Windows but rather Apple iOS or Google Android instead. So if Microsoft has its way, Windows 8, subsets thereof, and the tiled Metro interface, will become the new standard in OSs across all devices. To support that message, it is spending well over $1 billion on an ag-
gressive marketing campaign — launched as we speak — that attempts to drastically shift all things mobile in its favor. A bevy of new devices and form factors is due to be released fourth quarter 2012 into first quarter 2013 by hardware manufacturers featuring the new Windows 8 OS or subsets thereof — some of that hardware, surprisingly, directly from Microsoft. Among the notables: • business-ready Microsoft Surface tablets with built-in physical keyboards • Windows mobile phones by most smartphone manufacturers on most phone carriers • ultrathin laptops that wirelessly extend video signal to secondary monitors nearby • all-in-one desk or wall-mounted monitors with built-in computers with touch • sync functionality for the entire line of Ford cars and trucks that feature navigation • Xbox and Kinect functionality built-in and redesigned for touch And that is just the start: Later in 2013 we will see the advent of very large touch presentation plasma screens, retail kiosks, projection systems, airline reservations,
financial dashboards, gaming applications, industrial controls, embedded logic systems, medical devices, paper-thin Mylar displays, etc. — all loaded with Windows 8 or subsets thereof. All in an attempt to once again regain the market share that Microsoft used to enjoy in the mobile space before the arrival in 2010 of Apple iPhones, iPads, and, subsequently, Google Android devices. The new tiled interface and user interaction across all devices will make dissimilar hardware look and feel consistent. Navigating a standard graphical user interface across laptops, desktops, smartphones, and tablets will accelerate adoption of Windows 8 and reduce the learning curve to use them. Strategically, Microsoft views Windows 8 and the ensuing Windows-based ecosystem as strengthening its position in the OS market for desktops and laptops — already a robust 70% share according to WikiMedia. Combining the desktop OS segment with the huge potential gains in the mobile and tablet markets will, if the company’s tactics pan out, place Microsoft back at the top of overall OS markets for a
decade or more. For Microsoft, this is a game changer and a huge risk for a company that has had previous dominance in the desktop, laptop, server OSs and Office productivity suites — hence the massive marketing campaign to tap into all your senses. In addition, Windows 8 is optimized to work seamlessly with cloud services on any device. Microsoft, and for that matter Apple, Google, et al, want consumers and businesses to work and play in the cloud. The convergence of local hardware devices with cloud services represents the holygrail for Microsoft — and the technology world overall — for continued growth of their revenue stream based on cloud-based perpetual subscription licensing models. So what does Windows 8 do, and why should your medical practice follow its release? For the purposes of this article, it would be impossible to delve deeply into all the new features of Windows 8. So, besides the aforementioned items, we list
Half of American adults have mobile Internet access via a tablet or smartphone.
SAN DI EGO PHYSICIAN.org 11
Technology Matters “Privileged to Provide Care and Clinical Research Since 1975”
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the most notable features, improvements each with a short description: • Windows 8 Is Faster: On same recent hardware Windows 8 boots faster, works faster, transfers files faster, hibernates faster, wakes up faster, and shuts down faster as compared to Windows 7, Vista, and Windows XP. • Cloud Services: Tight integration with all types of cloud services from Microsoft and other cloud vendors with offerings like Office 365, Skydrive, and X-Box. • File Explorer: Formerly known as Windows Explorer, improves on and incorporates the same consistent ribbon interface present in Office 2010 and soon-to-be-released Office 2013. New functions include the ability to mount ISO files, virtual machines, preview panes on document formats, pause and resume file copy while viewing multiple operations at once. • Powerful Search Function: Search for anything across all document formats, files, folders, emails, email attachments, and media files with preview panes.
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2475 South Avenue A, Suite A, Yuma AZ 85364 * New address effective November 4, 2011
619.287.9730 Michael I. Keller, M.D., Director Puja Chitkara, M.D. Ara H. Dikranian, M.D. Oleg Gavrilyuk, M.D. Mahmood Pazirandeh, M.D. Soumya Rao, M.D. Timothy F. Lazarek, N.P. Kevin Delgadillo, P.A. Jennifer Lincoln, P.A.
www.SanDiegoArthritis.com 12 novem b er 2012
• File History: Present in previous versions of Windows but underutilized, this function is now at the forefront of the OS. Incremental backups are automatically created and stored on a pre-designated backup target such as an external hard drive, network share, or online service. • Multiple Wired and Wireless Monitor Support: Taskbar can be shown on multiple displays, and each display can have its own customized taskbar, Metro interface, wallpaper, Charms Bar, Menu Bar, or Application assigned. • New Lock Screen: Allows access back to system through touch “gestures,” fourdigit pin, text, or picture. It includes a date and time as well as the ability to display tiled notifications from any application while “locked.” • Internet Explorer 10: Completely optimized for touch, full screen, drag-anddrop, flip ahead, and Flash integration within the browser on the local device and the cloud. • Windows To Go on a USB Flash Drive: With Windows 8 Enterprise, this new feature allows users to create a bootable flash drive that includes their own applications, programs, profiles, settings, and files, and use it anywhere on any other recent machine. • Windows Store: A secure and high-quality vetted digital distribution platform built into the OS, similar to Apple’s App Store and Google Play.
Navigating a standard graphical user interface across laptops, desktops, smartphones, and tablets will accelerate adoption of Windows 8 and reduce the learning curve to use them. • Built-in Virtualization: The ability to spin up a whole new virtual machine within the physical machine is now included in Windows 8 through the use of Microsoft Hyper-V technology. The possibilities and applications are endless for a development, production environment, and legacy applications, such as EMR software, billing, and scheduling applications.
The Bottom Line As we approach the holiday season, tablets will be the first to quickly adopt the new OS. Anticipating demand, Microsoft is
manufacturing about 4 million Surface tablets pre-loaded with Windows 8 and built-in keyboards to be sold in fourth quarter 2012. If all those millions of tablets sell out in the fourth quarter, Microsoft will have an instant hit on its hands, as they are priced less than Apple’s iPad offering and are more powerful. Timing is of the essence as, for the first time, consumers and businesses will have real choices between a native Windows tablet with Word, Excel, Outlook, PowerPoint, et al, and all other tablet offerings with other OSs from Apple and Google. On the mobile front, phone carriers will be dovetailing their Windows Mobile 8 smartphone marketing strategies with Microsoft’s campaign. I know, as soon as it releases, I will quickly be swapping my two-year old Motorola Droid Pro for the new Nokia Lumia 1000 running Windows Mobile 8.
However, it is expected that the demand for desktops and laptops with Windows 8 in medical practices and other businesses will grow less quickly. Offices will transition away from legacy Windows XP and Vista, skip over Windows 7, and more methodically embrace Windows 8 on new hardware that supports touch. As we welcome 2013, more and more EMR offerings will start supporting Windows 8 and design their interfaces to be more productive by incorporating the touch features. By summer 2013 we will have apprised ourselves of the real-world business impact of Windows 8. By then it will be clear whether the Metro interface was window dressing, or a game changer worth the risk that Microsoft is taking. Until then, always follow the best-practices IT rule: The recommended requirements of your line-of-business software or EMR application initially determine the ensuing
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November Is National COPD Awareness Month by Lynn Godward
Known by many names, COPD (chronic obstructive pulmonary disease) is a serious lung disease that is now the third leading cause of death in the United States. It is, according to the COPD Foundation, one of the nation’s largest healthcare concerns and is severely under-diagnosed and undertreated. More than 12 million people are currently diagnosed with COPD, and it is estimated that another 12 million may have COPD but not realize it. And, according to the CDC, in 2005 COPD caused an estimated 126,005 U.S. deaths in people older than 25. 14 Novem b er 2012
role. Some of those occupational exposures are to chemical fumes, gases, vapors, and dust. If your patient works with this type of lung irritant, suggest they talk to their supervisor about the best ways to protect themselves, such as wearing a mask. A simple Spirometry test can be used to measure pulmonary function and detect COPD in current and former smokers 45 years and older and to anyone with breathing problems due to environmental exposure to smoke or occupational pollutants. By taking steps now and talking with your patient about smoking cessation, treatment options, and symptoms such as coughing or wheezing, many of these conditions can be treated with medications. If your patients have respiratory infections, they should be treated with antibiotics, if appropriate. Antibiotics are not recommended except for use in the treatment of bacterial infections. COPD prevention begins with reducing or eliminating smoking initiation among teens and young adults, and encouraging cessation among current smokers. Approximately 75% of COPD cases are attributed to cigarette smoking. You can take an active role in talking to your patients about smoking cessation and provide them with resources to help them: the California Smokers Helpline at www.nobutts.org/ Information/p.shtml or at 1 (800) NOBUTTS, where they will be connected with a person to counsel them on cessation options. Although tobacco use is a key factor in the development and progression of COPD, asthma, exposure to air pollutants in the home and workplace, as well as genetic factors and respiratory infections also play a
RESOURCES • For more information, go to the CMA Foundation’s website at www.aware.md/ PatientsAndConsumers/EdMaterials. aspx • The COPD Foundation has a handy pocket guide for diagnosing and managing COPD available at www.copdfoundation.org/Resources/EducationalMaterials/COPDPocketConsultantGuide.aspx. • The CDC website has a list of estimated prevalence by industry at www2a.cdc. gov/drds/WorldReportData/FigureTableDetails.asp?FigureTableID=950&GroupRe fNumber=T10-03. Ms. Godward is senior project coordinator for the CMA Foundation.
CMA Foundation Publishes 2013 AWARE Provider Toolkit
The CMA Foundation’s Alliance Working for Antibiotic Resistance Education (AWARE) project has published its sixth annual antibiotic awareness toolkit for physicians and other clinicians. The toolkit contains an array of clinical resources and patient education materials to help reduce inappropriate antibiotic use. The 2013 toolkits were mailed to 28,000 providers. Physicians are encouraged to utilize the toolkit to educate patients about antibiotic resistance. The toolkit can also be downloaded at www.aware.md. Physicians are also encouraged to take a brief survey to let us know what we can do to improve future versions of the toolkit: www.zoomerang.com/ Survey/WEB22GHRJXVCQ4.
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The Power of Perspective Giving Ourselves Choice by Helane Fronek, MD, FACP, FACPh
In their enthusiasm to raise nonviolent children, many parents refuse to purchase toy weapons for their kids. To their dismay, a stick, a piece of cardboard, even a sandwich bitten into the shape of a gun can be wielded as their imaginative child shouts, “pow, pow, pow!” What children do so naturally is see possibilities. Somewhere along the way, however, we forget we have this capacity. We view each situation as immutable and allow others to define the limits of our lives. “That’s just the way it is,” we say. But what if we returned to the expansive thinking we had as children and considered what else might be possible? The easiest gate to that path lies in changing our perspective. 16 novem b er 2012
We show we are capable of changing our perspective when we see a situation through another’s eyes. We might feel frustrated when our patient hasn’t taken his medication as we suggested, but we can understand that the cost, side-effects, or inconvenience impact his adherence. When we feel “stuck” in situations in our own lives, considering other perspectives can be just the grease to get us going again. A busy OB-GYN felt burdened as she attempted to guide her residents toward completing their research projects. Not having done research at this institution, she felt as if she was a tourist lost without a map. No wonder she didn’t know how to begin! By examining the task from the perspective of an explorer, many ideas suddenly seemed possible, and she was able to easily construct a plan to achieve her goal. What would it be like to see your difficult situation through the lens of an explorer? What possibilities open up? Several years ago I was asked to plan a symposium on work-life balance for a group of physician leaders. I wanted the program to be meaningful and practical so that the attendees would gain the tools to make a difference in their lives. What would be the perfect combination of experiences to achieve that goal? Not knowing the personal goals or situations of the individuals or the culture of the institution, I felt as though I was looking for a needle in a haystack. As I thought about the program, my gaze settled on two white double doors. A door! I realized that I could be a door for them — I could show them ways of finding their “true north” and introduce them to strategies to eliminate or reduce those aspects of their life that didn’t serve or fulfill them. It was then up to them whether they decided to walk through the door, into a more balanced life. Planning
for their unique approach to our life’s dilemmas. The trick is to first consider what that person or object represents to us, then view our situation through that lens. My grandfather was a risk-averse person who valued integrity above all else. Looking at a situation from his perspective would give me different ideas than if I saw it from the perspective of our dog, Elvis, who was loyal, extremely social, and eager to engage in any activity we were doing. To Elvis, life was all about relationship and fun. And what if I used a pizza perspective? Pizza is made of a bland, flat base with different, tasty items placed on top. It suggests that the solution to my situation might be to look for a stable
Perspectives can come from loved ones, people who inspire us, or from nature. Even inanimate objects can be tapped for their unique approach to our life’s dilemmas. The trick is to first consider what that person or object represents to us, then view our situation through that lens. the seminar became exciting, and the participants had many enthusiastic comments about the program. We physicians often feel responsible for everything and everyone in our lives. How much more invigorated would you feel if your role was to open a door so others could see new ideas or information rather than being responsible for their actions or realizations? Perspectives can come from loved ones, people who inspire us, or from nature. Even inanimate objects can be tapped Project4:Layout 1
foundation with some variety added in smaller doses. Once you’ve considered several perspectives, decide which one feels most energizing or “right,” and see what ideas come to mind. Usually, you will immediately find a few that will at least get you started moving in a more satisfying direction. As a coach, I am always impressed by the power of changing my clients’ perspectives. Although playful and at times silly, it’s a fun exercise that engages our creativity and allows us to see possibilities where none appeared before. It gives us choice in our life, and the result is always a life that is more uniquely ours. Dr. Fronek, SDCMS-CMA member since 2010, is a certified physician development coach, certified professional co-active coach, and assistant clinical professor of medicine at the UC San Diego School of Medicine. You can read her blog at helanefronekmd.wordpress.com.
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Advocacy As physicians
Who Cares? What Difference Does It Make? Why Bother? B y T o m G e h r ing
20 novem b er 2012
struggle with the day-to-day challenges of healing patients and running a business, it’s tough to remember that advocacy really matters. After all, advocacy is something someone else does, and physicians almost never see the results today. We want to remind you that advocacy matters to every physician — and it matters a lot! First, the results are often hidden. In his short story “Silver Blaze,” Sherlock Holmes speaks of the guard dog that didn’t bark as the clue to solving a murder. Often, the “dog that didn’t bark” is the bad legislation that wasn’t enacted, the poor decision that was stopped, and the awful ruling that was never made. We all see the affirmative successes, but we seldom see the averted disasters. Second, advocacy results often take years to show themselves. Consider that every candidate for state and national office from San Diego County is interviewed, educated, and contacted in a way that, as candidates, they understand physician issues, and, as office
holders, they are frequently reminded. They may not always agree with every position we have, but they sure as heck understand the issues and their impacts. Third, advocacy is not an arena where everything goes your way. So while a particular issue may not go exactly the way one would like, sometimes organized medicine has to compromise. Remember: It’s not the operating room where the doctor has the final say! Fourth, when you speak, the politicians listen. When you are quiet, the voices of our opponents win. So when we ask you to call your congressional representative or U.S. senators, to fax your California assemblymember or senator, or to contribute to a campaign, your participation matters, and your failure to participate is noticed. Fifth, rarely does legislation get passed the first time. So our “batting average” may look low, but remember that we often have to build consensus and support over years to change bad behavior or to implement good ideas. Last, we need you, all of you! Advocacy is the voice of one or two, but with a chorus behind them. That chorus is physician membership. It is the power of one to speak for many. Absent the many, we who do this all the time are just empty voices. We need your membership, we need your contributions to CALPAC, and we need you to get involved when we ask you to. Contact me anytime on my cell at (619) 206-8282 or email me at Gehring@SDCMS. org to discuss how you can get involved! Mr. Gehring is CEO and executive director of the San Diego County Medical Society.
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imagine Sisyphus Happy In years past,
CMA’s 2012 Legislative Wrap-up B y J o di H ic k s , Vic e P r e sid e nt , C M A G o v e r n m e nt R e lati o ns
22 Novem b er 2012
CMA has defended physicians in battles waged by hospitals, health plans, and midlevel practitioners, but this year we initiated a few fights of our own. CMA did what physicians do best: We fought to protect patients. CMA fought to keep patients out of the middle of billing disputes, to educate parents about immunizations, to require mandatory flu vaccinations for healthcare workers, to remove sugared beverages from schools, to create a physician health program, to expand residency programs, and a last-minute effort to save the Healthy Families Program. Sponsoring legislation is the equivalent of pushing rocks up a hill … or, rather, big, righteous boulders. CMA’s Government Relations team
struggled to push those rocks up the legislative hill while fighting off the enemies trying to get in the way, and at the same time stopping the many other rocks being thrown down at physicians. Sounds dramatic, but by all accounts it was a crazy, precarious, contentious, hazardous, and dramatic pathway to the finish line. We ended with some big wins, and, although we lost a few along the way, CMA fought for physicians and their patients until the very end. CMA came out of the gate swinging in January. We introduced AB 1742 (Pan), which would have enabled patients to assign their benefits directly to the provider furnishing medical services. Sounds simple enough, but the bill soon came under attack from the health plans and culminated in what was described on one blog as the “juiciest” health committee hearings of the year. After much back and forth, the bill came up one vote short before reaching a legislative deadline to move the bill. That same week, CMA battled the unions, championing a bill through both a health and labor committee that would mandate flu vaccines for healthcare providers in hospitals. Against all odds and much opposition, SB 1318 (Wolk) moved through the Senate in a decisive win for public health. Though CMA was able to maneuver this contentious bill all the way through the Legislature, it was subsequently vetoed by the governor. CMA also joined a large coalition of healthcare providers in a valiant attempt to create a physician health program in California. The coalition worked tirelessly to address the opposition’s concerns sur-
rounding funding, oversight, and standards. The bill made it all the way through both committee hearings and was on its way to the floor when it stalled. Despite the coalition’s diligence, the overwhelming demands of the opposition damaged the bill beyond repair before the last legislative deadline. Despite an end to this bill, we are confident that the conversation can continue, and this will be an issue CMA will look to advance next year. And then came Rob Schneider. CMA, along with the American Academy of Pediatrics, the Health Officers Association of California, and the California Immunization Coalition, sponsored AB 2109 (Pan) in an attempt to decrease the number of parents exempting their children from being vaccinated before entering public schools. Hundreds of anti-vaccine activists flooded the committee hearings to oppose the measure and eventually were joined by Saturday Night Live alum Rob Schneider. Now armed with “celebrity” status, the opposition was able to secure public rallies, television time, and social media to oppose our efforts. Despite attempts at negative media attention by the opposition, Governor Brown signed AB 2109 into law hours before the deadline. The year wouldn’t be complete without CMA’s revisiting some oldies but goodies, physical therapy and MICRA being no exceptions. Unfinished business from 2011, SB 924 (Steinberg/Price) would have fixed the ambiguity in law as to whether or not medical corporations can legally employ physical therapists, but it would also have allowed patients to directly access
physical therapy treatment for 30 business days, at which time a physician would have to sign off on a physical therapy treatment plan. CMA had an official “Oppose Unless Amended” position on the bill, asking for amendments that would have required a medical diagnosis after 30 days of direct treatment. The Assembly Appropriations Committee passed the bill, adding in medical diagnosis as a requirement for direct access. The California Physical Therapy Association again amended the bill on the floor, changing the language so that instead of requiring a diagnosis it would require an examination or a diagnosis … and as the semantics game wore on, the bill was quickly sent to Assembly Rules Committee, where it stayed until its demise. Two bills that would have weakened MICRA protections, SB 1528 (Steinberg) and AB 1062 (Dickenson), were amended the last week of session, adding to the flurry of the chaos in the final days. The provider community strongly opposed both bills, and, thanks to letters and phone calls from physicians across the state, they were ultimately killed with astoundingly low vote counts. The legislative session officially ended early Saturday morning, Sept. 1, 2012, and CMA’s Government Relations team was at the Capitol until the very end. In the waning hours of the 2011–12 Legislative Session, CMA successfully negotiated key amendments into the workers’ compensation bill and proudly fought to reinstate the Healthy Families program as part of a multipart deal that died sometime after 1 a.m. Despite bipartisan support for our efforts, the Healthy Fam-
ilies program became collateral damage to partisan politics. CMA continues to work with stakeholders on the transition of kids to Medi-Cal. More to come on this issue … Albert Camus’ The Myth of Sisyphus tells us that toil is not futile and that hard work can be noble. CMA toiled throughout the year for physicians, honoring the labor physicians do for their patients every day. The struggle to push those legislative rocks up the hill was performed with pride, and, as the essay reads, “The struggle itself toward the heights is enough to fill a man’s heart. One must imagine Sisyphus happy.” Of course, Sisyphus was not pushing the rock while simultaneously fighting labor lobbyists or Rob Schneider, but I still imagine him happy. Below are details on the major bills that CMA followed this year. Legislation Sponsored by CMA Despite bipartisan support for our efforts (AB 826 and SB 301), the Healthy Families program became collateral damage to partisan politics. CMA continues to work with stakeholders on the transition of kids to Medi-Cal. More to come on this issue … CMA introduced AB 1742 to enable patients to assign their benefits directly to the provider furnishing medical services. Sounds simple enough, but the bill soon came under attack from the health plans and culminated in what was described on one blog as the “juiciest” health committee hearings of the year. After much back and forth, the bill came up one vote short before reaching a legislative deadline to move the bill.
With AB 1746, CMA tried to remove sugared beverages from schools. Unfortunately, it failed in committee. AB 1848 would have, among other things, authorized the state to discipline or deny licensure to physicians who offer deceptive or fraudulent expert witness testimony related to the practice of medicine. Unfortunately, it failed in committee. CMA attempted, with AB 2064, to require healthcare service plans or health insurers that provide coverage for childhood and adolescent immunizations to reimburse a physician or physician group in an amount not less than the actual cost of acquiring and administering the vaccine. Unfortunately, it failed in committee. Childhood Immunizations (AB 2109), which the governor signed into law, requires a parent or guardian seeking a personal belief exemption for their child to obtain a document signed by themselves and a licensed healthcare practitioner stating that the healthcare practitioner has informed the parent or guardian of the benefits and risks of the immunization, as well as the health risks of the diseases that a child could contract if left unvaccinated. CMA battled the unions, championing a bill (SB 1318) through both a health and labor committee that would mandate flu vaccines for healthcare providers in hospitals. Against all odds and much opposition, SB 1318 moved through the Senate in a decisive win for public health. Though
SAN DI EGO PHYSICIAN.org 23
We ended with some big wins, and, although we lost a few along the way, CMA fought for physicians and their patients until the very end
CMA was able to maneuver this contentious bill all the way through the Legislature, it was subsequently vetoed by the governor.
1062), which CMA killed, would have encouraged use of the elder abuse law to get around the MICRA cap and plaintiff attorney fee limits.
CMA attempted with SB 1416 to expand residency programs in the state, but the bill failed in committee.
Physical Therapists: Direct Access to Services / Professional Corporations (SB 924), which CMA killed, would have provided a framework where physical therapists might treat a patient directly without first seeing a physician. While CMA may wish to consider allowing a certain amount of treatment prior to diagnosis, there must be a diagnosis requirement at some point, and 30 business days is just too long.
CMA joined a large coalition of healthcare providers in a valiant attempt to create a physician health program in California (SB 1483). The coalition worked tirelessly to address the opposition’s concerns surrounding funding, oversight, and standards. The bill made it all the way through both committee hearings and was on its way to the floor when it stalled. Despite the coalition’s diligence, the overwhelming demands of the opposition damaged the bill beyond repair before the last legislative deadline. Despite an end to this bill, we are confident that the conversation can continue, and this will be an issue CMA will look to advance next year. Prior CMA-sponsored legislation now provides $1 million per year in funding for the Steve Thompson Loan Repayment Program, giving physicians up to $105,000 in loan repayment if they agree to practice in an underserved area for at least three years. Medical School Scholarships (AB 589), which the governor signed into law, mirrors the loan repayment program by creating the Steve Thompson Scholarship Program, providing scholarships to medical students who agree to practice in one of California’s medically underserved areas upon completion of residency.
Legislation Opposed by CMA Elder Abuse / MICRA (AB
24 novem b er 2012
Healthcare Coverage: Out-ofNetwork Coverage (SB 1373), which CMA killed, would have required a healthcare provider to inform an enrollee in writing, prior to providing out-of-network services, that the provider is out of network and that the health plan may not cover some of the services; to provide an estimate of the cost of the services; to direct the enrollee to contact the health plan for a list of contracted providers; and more! Damages: Medical Services (SB 1528), which CMA killed, would have allowed an injured party of medical services to be compensated based upon the reasonable value of services rather than the amount actually paid, thereby dramatically increasing economic damage awards in all personal injury cases.
cols for the treatment of pain. Healthcare Coverage: Cancer
Treatment (AB 1000), which CMA supported but the governor vetoed, would have helped ensure that cancer patients are not denied the most appropriate and effective treatment by putting costs above care. International Medical
Graduates (AB 1533), which CMA supported and the governor signed into law, will allow the UCLA International Medical Graduate program to create a five-year pilot for participants to engage in physician-supervised patient care activities as part of an approved and supervised clinical clerkship/rotation at UCLA, thereby increasing the number of licensed physicians practicing in the state. Workers’ Compensation (SB
863), which CMA supported and the governor signed into law, directs the state to adopt the Medicare fee schedule as well as establish Independent Medical Review and Independent Bill Review in an effort to utilize third-party processes, instead of the court system, to adjudicate treatment and billing disputes. CMA was able to secure many important changes to the bill, including medical provider network reforms, expanding categories of payment for physicians as well as increasing the entire funding allocation for physician services, and protecting physicians’ ability to own an ambulatory surgery center.
Bills of Interest Step Therapy Reform (AB
369), which CMA supported but the governor vetoed, would have limited a health plan’s or health insurer’s ability to use step therapy or “fail first” proto-
Nurse Practitioners (SB 1524), which the governor signed into law, deletes the statutory requirement that nurse practitioners complete at least six months of physician and surgeon supervised experience
in the furnishing or ordering of drugs and a course in pharmacology covering the drugs that will be furnished. CMA recommended accepted amendments that clarify that the physician may include a six-month (or longer) supervised experience requirement in the standardized protocol between the physician and the APRN. Mammograms (SB 1538),
which the governor signed into law, will require physicians to notify mammography patients with highly dense breasts about the density of their breast tissue. CMA took a neutral position after physician advocates were able to secure amendments.
Bills Impacting Healthcare Reform Medi-Cal Eligibility (AB
43), which failed in committee, would have required the Department of Health Care Services to establish, by Jan. 1, 2014, eligibility for Medi-Cal benefits for any person who meets these eligibility requirements to phase in coverage for those individuals. Essential Health Benefits (AB 1453, SB 951), which CMA supported and the governor signed into law, will establish a set of essential health benefits that insurers and health plans in California’s Health Benefit Exchange will be required to cover.
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Individual Market Reforms
(AB 1461, SB 961), which CMA supported but the governor vetoed, would have conformed state law to the ACA, establishing guaranteed issue, Exchange open and special enrollment periods, rating, and same regions as PERS. Deceptive Marketing (AB
1761), which CMA supported and the governor signed into law, will prohibit deceptive marketing by outlawing “copycats” from representing themselves as part of the California Health Benefit Exchange.
called for by the ACA, are private, consumer-governed, nonprofit health insurance plans that will be operated by its community beneficiaries. CalHEERS Horizontal Integration (SB 970), which CMA supported but the governor vetoed, would have added human services programs to those screened by the California Healthcare Eligibility, Enrollment, and Retention System, which will be used for California Health Benefit Exchange and Medi-Cal enrollment.
CO-OPs (AB 1846), which the governor signed into law, authorizes the insurance commissioner to issue a certificate of authority to CO-OPs, which,
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Sign up to Receive
Legislative Hot List Regulations Quick List
CMA produces a number of publications to keep members up to date on the latest healthcare news and information affecting the practice of medicine in California. Members can subscribe to any of these publications by visiting their account dashboard at www.cmanet.org. New users can create a free web account at www.cmanet. org to manage their subscriptions. CMA’s Legislative Hot List provides a summary and current status of CMA-sponsored bills, as well as the progress of other significant legislation followed by CMA’s Center for Government Relations. The Hot List represents only a small sampling of the hundreds of bills CMA follows every year.
CMA’s Regulations Quick List provides a summary and current status of significant regulations followed by CMA. The Quick List is circulated regularly on a monthly basis or more frequently, as needed. 26 novem b er 2012
CMA’s Other Publications CMA Alert: Biweekly e-newsletter to keep members up to date on critical issues affecting the practice of medicine in California. CMA Capitol Insight: Biweekly column reporting on the inner workings of the state Legislature. CMA Practice Resources (CPR): Monthly bulletin full of tips and tools to assist physicians and their office staff in improving their practice efficiency and viability. CMA Press Clips: Daily reports on healthcare policy and medicine from newspapers and magazines throughout California and around the nation. Legal Case List: Monthly summary / current status of litigation in which CMA is a party or has filed an amicus curiae brief. OMSS Advocate: Quarterly newsletter providing member medical staffs with updates on current events and issues. CMA Reform Essentials: Provides readers with the latest developments on California’s implementation of federal healthcare reform.
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SAN DI EGO PHYSICIAN.org 27
You’re Either at
Over the past 11 years as your executive director, I’ve had the pleasure of meeting and learning from many exceptional physicians and physician leaders. I want to share some of these pretty good rules about politics and advocacy, and start by thanking Drs. Bob Hertzka and Jim Hay, both past presidents of SDCMS and of CMA.
the Table or You’re 1 on the Menu
Look at politicians as either those who view physicians as part of the solution or those who view physicians as part of the problem. In the world of political parties, we are seduced into thinking that the party affiliation drives “goodness” or “badness.” Not so. We in the leadership team use a very simple litmus test: Does the decision maker trust physicians or not? If they do, it matters not whether they are a Republican or a Democrat.
Respect the truth ... always. This rule can’t get any easier, and more difficult to adhere to in the heat of the moment. Never, ever BS. Never, ever fudge. Your reputation, and that of your organization, can be destroyed in 30 seconds by being (even inadvertently) untruthful. And remember, few are more respected than those who say, “I don’t know, but I will find out,” and then actually find out and inform the legislator.
10 Pretty Good Rules B y T o m G e h r ing
28 novem b er 2012
The most powerful spokesperson for your cause is someone who has no direct stake in the outcome. When you speak to a decision maker, and you have a clear interest in the outcome, you will be politely listened to, but your words will be assessed in the context of a special
interest. When those same thoughts come from someone without a (perceived) conflict, those words become (magically) much more compelling. So, for example, when a family physician speaks to the lunacy of letting optometrists operate on the eye, that’s a powerful statement — much more so than from the ophthalmologist, who may in fact be making a much more fact-based argument (see rule No. 10).
Count your votes before the vote. Don’t find out you’re close (or behind) during the vote. Do everything in your power to find out who is with you and who isn’t, then lobby the heck out of the issue.
Focus on the persuadables. While actual percentages may vary, on any given issue, about 30% will be in full-throated support, and roughly 30% are stridently opposed. Focus 90% of your energy on the 40% who are convincible.
No one bats 1.000 in advocacy. If you expect to win every issue, you’ve chosen the wrong avocation. It’s a game of percentages. Work for the long haul, and be patient.
It’s about the relationship, not about the issue. Variation: When it’s a core issue, then it is about the issue Corollary: Choose your core issues very, very carefully. There are a million issues. Choose the ones you’re willing “to die for” very carefully. So treasure the relationship. Those you lobby may not agree with you (see rule No. 8 below), but the value of the relation-
ship is that you get a fair and fast hearing. Being able to pick up the cell phone (and having the cell phone number) and calling a state legislature is incredibly useful.
Today’s opponent is tomorrow’s ally, and vice versa. Note, I did not say enemy ... I said opponent (see rule No. 9 below). Alliances come and go; accept that the greater good sometimes makes for strange bedfellows. Therefore, never, ever personalize a disagreement because you may be looking for a partner someday soon!
Respect the elected officials, their staffs, and your adversaries. You haven’t run for office. You haven’t had to fly to Sacramento or Washington, DC, every week. You haven’t spent interminable hours in meetings listening to ... well, let’s just say that our legislators work incredibly hard, and every move they make is scrutinized, criticized, and second-guessed. Respect them for what they do and who they are. The staff are just as, and sometimes more, important as the elected official. Never, ever, ever treat the staff with anything but respect. They may be young, they may be underpaid, they may work under very challenging conditions, but they have the ear of the decision maker. Make them your allies, even your advocates! Badmouthing your opponents (or worse, not respecting the truth) will invariably cause you to be ineffective. And the word gets around. Quickly!
It’s 90% on the politics, only 10% on the merits. Corollary: You don’t get to the merits until after you deal with the politics. Deal with (and understand) the politics before you speak to the merits. Those of us educated in deterministic, objective, and data-driven disciplines (engineering in my case, medicine in my spouse’s) are resolutely convinced that the merits of any argument will always prevail. Sadly, in the world of politics and advocacy, that is rarely the case. In fact, many decisions are made in the absence of, or even contravention of, the facts. Decision makers have to do things, e.g., their party leadership may demand a vote, maybe they need to vote against something we like that is passing easily but they have a constituency to appease, the list goes on. Get over it! That’s the world we live in. So who cares about advocacy and politics anyway? You do. If SDCMS and CMA are not building those relationships, making the case for physicians, walking the halls of power, then a nonphysician will tell you how to practice medicine and reach into your pockets — and directly affect your ability to provide patient care. Which brings me to the last and most important rule (with apologies to the famous line from the 1992 presidential campaign): It’s the patient care, stupid. Everything we do as advocates for physicians has to focus on the ultimate goal of healing the sick. Honestly framed as a patient care issue, it’s hard to lose an argument!
If SDCMS and CMA are not building those relationships, making the case for physicians, walking the halls of power, then a nonphysician will tell you how to practice medicine and reach into your pockets — and directly affect your ability to provide patient care.
Mr. Gehring is CEO and executive director of the San Diego County Medical Society. SAN DI EGO PHYSICIAN.org 29
Success in a
new era Thanks to
CALPAC Continues to Thrive Under State’s New Election Policies B y Richa r d T h o r p , M D
30 novem b er 2012
Proposition 11 (2008), district boundaries for the state Assembly and Senate were, for the first time in California’s history, drawn by a 14-member Citizens Redistricting Commission rather than members of the Legislature themselves. This historic shift meant that lawmakers were no longer able to protect one another through the creation of gerrymandered districts and socalled “safe seats” for their fellow incumbents. Adding to the chaos was the fact that the June primary was also the first to implement the top-two system as a result of Proposition 14 (2010). The new rule calls for the top two candidates with the most votes to move on to the November general election, regardless of party affiliation. Together, these changes created a myriad of outcomes that would have been unheard of under the previous rules. For the first time
in state history, it was imaginable that two Democrats could be facing off in a November contest to represent a district that, historically, had belonged to Republicans. Despite the shake-ups, one constant from previous years remained intact: CMA’s Political Action Committee (CALPAC) was incredibly successful in supporting candidates that will go on to uphold the efforts of organized medicine. In all, CALPAC engaged in a total of 32 contests. Of those, 30 races — or 94% of the contests we participated in — have CALPAC-supported candidates moving on to the November elections. Additionally, 13 CALPAC-supported candidates are moving on to the November general election as a prohibitive favorite in a safe seat. In short, these candidates are all strong favorites to be in the Capitol in 2013. Of the remaining CALPAC-backed candidates, 13 will be moving into a November contest against a member of their own party, while the remaining four will be facing a competitive race against a member of the opposing party. One interesting race to look for in November will be held in Los Angeles County’s Assembly District (AD) 49, where Dr. Matthew Lin (R), a past president of the Los Angeles County Medical Association and current CMA member, will be working to win over a district that tends to lean Democrat. Dr. Lin managed to pick up an impressive 52.1% of the vote in a three-way contest that featured two Democrats, but will need further support from CALPAC members to help translate this performance into a November victory. Further north, in Los Angeles’ AD 39, CALPAC-backed candidate Raul Bocanegra (D) put up an impressive perfor-
mance, finishing first in a six-way contest with 36.1% of the total vote. Bocanegra, the current chief of staff for Assemblymember Felipe Fuentes (DLos Angeles), has never run for public office but will be facing off against former Assemblymember and current Los Angeles City Council member Richard Alarcon (D), who pulled in roughly 26% of the June vote. To say that these two differ in their stance toward organized medicine would be a severe understatement. Bocanegra is part of an Assembly office that has historically supported the efforts of CMA, while Alarcon is backed by trial attorneys and staunchly opposes MICRA. In short, CALPAC will continue to involve itself in this contest and help ensure that Bocanegra is successful in November.
Successes such as these are certainly a cause for celebration, but it’s also important to remember that they don’t come easy. In order to make sure that our candidates are successful, CALPAC members must stay active and continue to support our efforts. Contributions can range in both size and frequency, but every dollar goes to help bolster the voice of organized medicine in Sacramento. In a year of many changes, CALPAC candidates continue to look strong on their own. But together, we are stronger. Dr. Thorp is chair of CALPAC, the California Medical Association’s Political Action Committee. CALPAC supports candidates and legislators who understand and embrace medicine’s agenda.
In order to make sure that our candidates are successful, CALPAC members must stay active and continue to support our efforts.
“think SDCMS FIRST!” Start by contacting SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.
SAN DI EGO PHYSICIAN.org 31
BE OUR HERO give access to healthcare for those without!
San Diego County Medical Society Foundation’s Mission Is To Improve Health, Access To Care, And Wellness For Patients And Physicians Through Engaged Volunteerism.
Volunteer for Project Access San Diego Through our flagship program, Project Access San Diego, we have been able to assist over 1.700 uninsured adults in our community to improve their health through access to specialty healthcare services. Join our more than 625 volunteer physicians to provide specialty healthcare services to those who most need our help. You decide how many patients a month or a year you are able to serve. We make your volunteer experience easier and more rewarding, and less taxing to your office staff with comprehensive patient care management, labs, imaging and other ancillary health services. Your consultations will be efficient for you and life-changing for your patients.
Volunteer in Your Pajamas Provide your primary care physician colleagues HIPAA-compliant, web-based patient consultations from the comfort of home or office. eConsultSD increases the capacity of primary care physicians at our community health centers to maintain care of their patients by receiving answers to clinical questions from volunteer specialists. eConsultSD is an easy way for specialist physicians to volunteer when they are not able to provide direct patient care.
Get Involved San Diego County Medical Society Foundation needs you! Attend an event, assist us to recruit fellow physicians, or provide educational opportunities for primary care physicians or medical students. Our first annual Golf Tournament is scheduled for Thursday, February 28, 2013 at Del Mar Country Club; we hope you can join us! Please consider making a contribution to SDCMS Foundation to support our efforts at www.sdcmsf.org, or call us at 858.300.2777.
5575 Ruffin Road, Suite 250, San Diego, California 92123 p: 858.300.2777 f: 858.569.1344 n
Lawrence Eisenhauer, MD HERO North County OBGYN Dr. Lawrence Eisenhauer has helped numerous Project Access female patients to regain their health over the years, and recently performed four much-needed surgeries -- three in one day! Dr. Eisenhauer’s dedication has helped women who have suffered for years with chronic conditions to improve their health, and get back to work and caring for their families. Elsa B said, “Dr. Eisenhauer was the light at the end of my tunnel. I didn’t know angels existed on earth!” Thank you to all our our more than 625 volunteer physicians -- you are all our heroes!!
FIRST GOLF TOURNAMENT
Our first annual golf tournament, benefitting Project Access San Diego, is set for Thursday, February 28, 2013 at Del Mar Country Club. Golfer fees, including cart, lunch and post-golf reception is $250. To register or for more information, go to sdcmsf.org/ golf/
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classifieds PHYSICIAN POSITIONS AVAILABLE FULL- OR PART-TIME PSYCHIATRIST NEEDED: Psychiatric Office Management, LLC, looking for a part-time or full-time psychiatrist to fill immediate occupancy. This person(s) will be a part of a busy, professional and friendly office in Santee. Enjoy a spacious office, friendly office staff, an answering service, booking and referrals for a small rental fee of 20% of money received. Office consists of independent practitioners. Please call Connie Dawson at (619) 258-6730 or Paul Liederman, MD, at (619) 8719250.  CHIEF, MATERNAL AND CHILD HEALTH: The County of San Diego Health and Human Services Agency is seeking a qualified medical doctor to fill the position of chief, Maternal, Child, and Family Health Services (MCFHS) branch. The chief is responsible for the management and administration of public health programs that improve the health of mothers, children, and their families. For more information on the position, including minimum requirements and how to apply, please visit www.sdcounty. ca.gov.  Adult Psychiatrist — Part Time: The County of San Diego’s Health and Human Services Agency is seeking a psychiatrist for 10-hour weekdays, part-time shifts for adult outpatient clinic work. Our psychiatrists work with a dynamic team of medical and nursing professionals to provide outpatient treatment, telepsychiatry, inpatient and emergency services, and crisis intervention. More information about psychiatrist positions can be found at www.sdcounty.ca.gov/hr. Interested candidates may contact Lita Santos at (619) 563-2782 or email a CV to lita. firstname.lastname@example.org.  ADULT PSYCHIATRISTS: County of San Diego’s Health & Human Services Agency seeks FT/PT psychiatrists for key components in the Behavioral Health Division’s continuum of care. Our psychiatrists work with a dynamic team of medical and nursing professionals to provide outpatient treatment, telepsychiatry, inpatient and emergency services, and crisis intervention. More information about psychiatrist positions can be found at www.sdcounty.ca.gov/hr. Interested candidates can contact Gloria Brown at (858) 505-6525 or email CV and cover letter to email@example.com, and Marshall Lewis, MD, Behavioral Health clinical director, at firstname.lastname@example.org. Please specify clinical area of interest.  FAMILY PRACTICE PHYSICIAN: For a busy federally qualified health center. MHCS (www.mtnhealth.org) is a mission-driven organization that serves both rural and urban residents of San Diego County. We have been in business for over 35 years and offer a competitive salary, medical benefits, vacation, paid holidays, sick time, malpractice, life, AD&D, long-term disability, long-term care, monthly incentive, CME / license reimbursement, plus a sign-on bonus. Board certified and bilingual English/ Spanish preferred. Send CV to email@example.com or (619) 478-9164. You may contact HR directly at (619) 4785254, ext 30.  SENIOR PHYSICIAN: The County of San Diego, Health and Human Services Agency’s HIV/STD/Hepatitis clinic has an immediate opening for a licensed physician with at least three (3) years of recent post-internship training or experience in internal medicine or as a general practitioner to manage a team responsible for planning and directing clinic services. Must be available to work flexible schedules at multiple sites, including some evenings is expected. Please read more about the senior physician job description, benefits, and application process at www. sdcounty.ca.gov/hr. Please include a copy of your CV along with your online application. For questions, please contact Gloria Brown, human resources analyst, at (858) 505-6525 or at firstname.lastname@example.org.  PHYSICIAN TO STAFF VARIOUS SAN DIEGO DETENTION FACILITIES: The Department of Emergency Medicine (http://emergencymed.ucsd.edu) at UC San Diego, committed to academic excellence and diversity within
the faculty, staff, and student body, is initiating a search for a physician to staff various San Diego detention facilities. The applicant must have a background in family medicine, internal medicine, or emergency medicine and be eligible for a California medical license. Appointment level in the academic series will be commensurate with experience and qualifications, with salary based upon established UCSD salary scale. UCSD is an affirmative action / equal opportunity employer with a strong institutional commitment to excellence through diversity. Interested individuals should send their CV, a reference list, and separate statement summarizing their experience to email@example.com.  PHYSICIAN AND PSYCHIATRIST NEEDED FOR AMBULATORY CLINIC: Southern Indian Health Council is seeking a FT board-certified physician Mon–Fri, 8:00am– 4:30pm, as well as a PT psychiatrist. Must have current CA medical license, DEA license, ACLS, BLS. We offer a competitive salary, health benefits, vacation, holidays, sick, CME and license reimburse, and malpractice coverage. Forward resume to firstname.lastname@example.org or fax to (619) 659-3145 or website at www.sihc.org. Contact email@example.com or HR phone (619) 445-1188, ext. 308 or ext. 307.  OPPORTUNITY KNOCKS FOR BC/BE DERMATOLOGISTS: Live in one of the country’s most desirable locations and practice with a premier San Diego multispecialty medical group! Sharp Rees-Stealy Medical Group is looking for BC/BE dermatologists. Competitive first-year compensation guarantee, excellent benefits, and shareholder eligibility after two years. Unique opportunity for professional and personal fulfillment while living in a vacation destination. Please send CV to Physician Services, 2001 Fourth Avenue, San Diego, CA 92101. Fax: (619) 233-4730. Email: Lori.Miller@sharp.com.  RESEARCH PHYSICIAN / PRINCIPAL INVESTIGATOR: Profil Institute for Clinical Research is looking for a research physician / principal investigator. Requirements: three years MD experience in clinical adult medicine + unrestricted California MD license. Research experience not necessary. Responsibilities: Serve as sub-investigator or principal investigator on studies. Perform medical histories, physical exams, admit, discharge, and monitor subjects, including reviewing labs results, EKGs and telemetry as part of clinical research trials. Weekday shift hours + limited on-call hours and strong benefits plan. Interested parties please apply online at www.profilinstitute.com under “Career Opportunities.” If you have further questions, please contact Robyn Nielsen, recruitment manager, at (619) 419-2048.  SUPERB INTERNAL MEDICINE PRACTICE OPPORTUNITY: The position is available in August of 2013. You will be joining one of the premier internal medicine groups in North County San Diego. No hospital work or ER call. Competitive salary including benefits plus the opportunity to begin a partnership track if desired. Beautiful office building, excellent staff, ideal for either first year in practice or for an experienced practitioner. Contact Jon LeLevier, MD, at (760) 310-2237 or Jeff Leach, MD, at (760) 8460464 for more information.  SEEKING A FAMILY PRACTICE PHYSICIAN: To join a small but growing group in North County San Diego, CA. The perfect doctor for the position will be one who has strong communication skills and great bedside manner. The physician should have a good background in procedures (dermatologic, orthopedic, etc.). I am looking for a physician who will take personal pride in the growth of this unique practice. We emphasize quality of time with the patients rather than the number of patients seen. Hours will be 8–5 Monday–Friday with no hospital call. Once hired you will be provided with an LVN/scribe for all EMR notes and to assist in procedures. We are inviting you to join an extraordinary clinic in a beautiful location with a fantastic staff. Salary will be competitive for the region along with bonuses for exquisite performance. Please email me at firstname.lastname@example.org.  CONTRAST SUPERVISING PHYSICIAN NEEDED: Independent diagnostic imaging facility seeks physicians to
monitor patient examinations requiring contrast. We are looking for physicians to work various Saturday/Sunday shifts scheduled from 8am to 5pm on a per diem basis. Shifts are available on an ongoing basis. Please contact Eva Miranda at (858) 658-6589 for more information.  MEDICAL DIRECTOR: The County Psychiatric Hospital needs a full-time medical director. This is a key leadership role in our very physician-friendly, dynamic Behavioral Health system. Facility includes an inpatient unit and a very busy psychiatric emergency unit. Medical director does limited direct clinical care. Required: three years of psychiatrist experience, including one year of managing a psychiatric hospital or multi-disciplinary medical and mental health facility. Competitive salary and excellent County employee benefit package offered. San Diego combines the lifestyle of a resort community and the amenities of a big city. The hospital is centrally located, minutes from many recreational opportunities and great residential communities with wonderful year-round weather. CV can be submitted online at www.sdcounty.ca.gov/hr. For questions, please contact Darah Frondarina, human resources specialist, at (858) 505-6534 or Darah.Frondarina@sdcounty.ca.gov.  SOUTHERN CALIF REGIONAL MEDICAL DIRECTOR (RMD): Your Neighborhood Urgent Care (YNUC) is recruiting two RMDs for its 10 urgent care clinic network in Orange County and San Diego County. BC in emergency medicine or in family practice, internal medicine with urgent care experience required. Management/administrative experience in previous healthcare positions very desirable. Independent Contractor for two years, then equity available. Position is based at the MSO and is 20 hours per week clinical and 20 hours per week quality improvement. Very attractive hourly. Contact ramster@ ynuc.us now!  SUPERVISING CHILD PSYCHIATRIST, COUNTY OF SAN DIEGO: BC child psychiatrist to serve as supervising child psychiatrist for Child, Youth and Families (CYF) Behavioral Health and as deputy to the clinical director of the Behavioral Health Division of County of San Diego Health & Human Services Agency (HHSA). Significant administrative/managerial experience required; to provide clinical supervision in a variety of CYF County-operated programs. Applications and CVs must be submitted online at www.sdcounty.ca.gov/hr. For further information please email Marshall Lewis, MD, Clinical Director, at marshall. email@example.com or call (619) 563-2771, or email Katie Astor, Assistant Deputy Director, at firstname.lastname@example.org, or email Lita Santos, Human Resources, at email@example.com.  PHYSICIAN NEEDED — FULL- OR PART-TIME SCHEDULES AVAILABLE: Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. Since 1970, our mission has been to provide caring, affordable, high-quality healthcare and supportive services to everyone, with a special commitment to uninsured, low-income, and medically underserved persons. Every member of our team plays an important role in improving the health of our patients and community. We offer an excellent comprehensive benefits package that includes: malpractice coverage; NHSC loan repay eligibility; and much, much more! For more information, please call Anna Jameson at (619) 9064591 or email firstname.lastname@example.org. If you would like to fax your CV, fax it to (619) 876-4426. To apply, visit our website and apply online at www.fhcsd.jobs.  PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com ) is a fast-growing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 279-1212 or email CV to email@example.com.  PHYSICIANS WANTED: Vista Community Clinic, a private, nonprofit clinic serving the communities of North San Diego County, has openings for part-time and perdiem positions. Five locations in Vista and Oceanside.
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 novem b er 2012
Family medicine, OB/GYN medicine, pediatric medicine. Requirements: California license, DEA license, CPR, board certified, one (1) year post-graduate clinic experience. Bilingual English/Spanish preferred. Benefits: malpractice coverage. Email resume to firstname.lastname@example.org or fax to (760) 414-3702. Visit website at www.vistacommunityclinic.org. EOE/M/F/D/V  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 eighthour 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 email@example.com. Salary $ 102–108,000 annually (equal to $130–135,000 full-time).  PRACTICE WANTED WE BUY URGENT CARE OR READY MED-CLINIC: We are interested in purchasing a preexisting urgent care or ready med-clinic anywhere in San Diego County. Please contact Lyda at (619) 417-9766. 
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 the Surgery Center. Receptionist help provided if needed. Contact Stephanie at (760) 753-8413.  LUXURIOUS / BEAUTIFULLY DECORATED DOCTOR’S OFFICE NEXT TO SHARP HOSPITAL FOR SUB-LEASE OR FULL LEASE: The office is conveniently located just at the opening of Highway 163 and Genesee Avenue. Lease price if very reasonable and appropriate for ENT, plastic surgeons, OB/GYN, psychologists, research laboratories, etc. Please contact Mia at (858) 279-8111 or at (619) 823-8111. Thank you.  POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467 sqft furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease / satellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at firstname.lastname@example.org.  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 with OB/GYN. Call (619) 463-7775 or fax letter of interest to La Mesa OB/GYN at (619) 463-4181. 
OFFICE SPACE / REAL ESTATE SPACE FOR SUBLEASE IN POOLE BUILDING ON SCRIPPS MEMORIAL LA JOLLA CAMPUS: Office on entry level facing main hospital, which is 50 yards away — BEST location on campus. Own consultation room and two shared exam rooms available at least two full days a week. Equipped for minor surgery / procedures. Receptionist and medical assistant help can be provided. Call Ilana at (858) 558-2272 for details. 
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 email@example.com or (619) 504-5830. 
NORTH COAST OFFICE SPACE TO SUBLEASE: North Coast Health Center, 477 El Camino Real, Encinitas, office space to sublease. Newly remodeled and beautiful office space available at the 477/D Building. Occupied by seasoned vascular and general surgeons. Great window views and location with all new equipment and furniture. New hardwood floors and exam tables. Full ultrasound lab and tech on site for extra convenience. Will sublease partial suite for two exam rooms and office work area or will consider subleasing the entire suite, totally furnished, if there is a larger group. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. 
NEW — EXTREMELY LOW RENTAL RATE INCENTIVE — EASTLAKE / RANCHO DEL REY: Two office/medical spaces for lease. From 1,004 to 1,381 SF available. (Adjacent to shared X-ray room.) This building’s rental rate is marketed at $1.70/SF + NNN; however, landlord now offering first-year incentive of $0.50/SF + NNN for qualified tenants and five-year term. $2.00/SF tenant improvement allowance available. Well parked and well kept garden courtyard professional building with lush landscaping. Desirable location near major thoroughfares and walkable retail amenities. Please contact listing agents Joshua Smith, ECP Commercial, at (619) 4429200, ext. 102. 
SHARE OFFICE SPACE IN PLASTIC & RECONSTRUCTIVE SURGERY CLINIC IN UTC: Office space and practice support for full- or part-time surgeon available immediately. Equipped with two operating rooms accredited by the AAAASF, private entrance, three exam rooms, two of them also consults rooms, two private bathrooms, and staff room with kitchen. Ideal for orthopedic, urologist, plastic or general surgeon. Surgical center contracted with Anthem Blue Cross, United Health Care, Aetna, and workers’ comp. Call (858) 457-8686 or email drsoltero@ solteromd.com. 
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. 
FULL- AND PART-TIME OFFICE SPACE IN UTC: in 8th floor suite with established neuropsychologists and psychiatrists in Class A office building. Features include private entrance, staff room with kitchen facilities, 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 parking. Contact Christine Saroian, MD, at (619) 682-6912.  CLAIREMONT MESA OFFICE SPACE FOR LEASE: Clairemont Mesa Medical Arts Center is a medical office building conveniently located in Kearny Mesa, close to the 15, 163, 52, and 805 freeways. Available for lease September 1, 2012. 520 square-foot suite, currently configured as three room (lobby, exam, and office), located on the second floor. Call Alex at (858) 268-1111, ext. 311, for inquiries and viewing. 
NONPHYSICIAN POSITIONS AVAILABLE Assistant Medical Services Administrator: The County of San Diego is seeking an assistant medical services administrator for the Edgemoor Distinct Part Skilled Nursing Facility, located in Santee, to provide administrative oversight and operational accountability, as well as being in charge in the absence of the hospital administrator. Bachelor’s or master’s degree in nursing, public health, business administration, public administration, or a closely related field; AND six (6) years of experience coordinating medical service delivery, three (3) years of which must have been in an institutional or in a community agency setting. Apply online at www.sdcounty.ca.gov.  MEDICAL ASSISTANT: Internal medicine practice looking to fill a full-time position for a busy internist in Poway. Position requires five-plus years experience in internal medicine, good communication skills, compassion toward seniors, electronic health record exposure a plus. Strong references. Please fax your resume to practice manager
at (858) 618-5976.  FULL-TIME NURSE PRACTITIONER: Busy internal medicine practice in Hillcrest seeking a full-time (Monday– Friday) licensed nurse practitioner. Minimum of one (1) year nurse practitioner experience preferred. Experience with EMR helpful. Qualified candidate should submit a current CV or resume to firstname.lastname@example.org. Salary based on knowledge and experience. No calls.  PHYSICIAN ASSISTANT / NURSE PRACTITIONER: Gastroenterology specialty practice located in North San Diego County is seeking a PA or NP for our five-physician group. The candidate will be dependable, detail-oriented, and a team player. We offer a competitive salary and benefits. PA or NP will be responsible for assessing patients, obtaining patient histories, and performing physical exams. They would order/perform routine diagnostic procedures, develop treatment plans, and monitor the effectiveness of therapeutic interventions as directed by the physicians. Physician Assistant: Certified California State Medical Board for Physician Assistants. Nurse Practitioner: Current licensure as RN in the State of California. Advanced practice degree. Email Javaid Shad at jshad@ ncgastro.com.  NURSE MANAGER: Seeking nurse manager for our AAAHC GI facility in Oceanside, California. The ideal candidate will be dependable, detail-oriented, and a team player. Competitive salary and benefits. NM is responsible for accountability of clinical care and productivity, including assessing, implementing, and evaluating processes, technology, personnel, and facility needs required to achieve patient outcomes safely. Is responsible for coordination and direction of patient care services and other service areas in the facility. Responsible for quality improvement, identifying opportunities to improve services, recommending and implementing actions to meet the goals of the facility. RN State of California. ACLS certification. Email Kathy Moore at email@example.com.  FRONT OFFICE RECEPTIONIST POSITION: Dermatologist in Hillcrest needs a special individual for computer billing, typing, front office, mature, experienced. Friendly environment. Email resume to eydiekornberg@ gmail.com.  NURSE PRACTITIONER WANTED: Nurse practitioner wanted for internal medicine and pediatrics practice in Coronado. Enthusiasm, dependability, and a love of learning are musts! Full-time with benefits. Experience preferred. Please send your resume to CoronadoMedPeds@ gmail.com.  PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician in Coachella Valley (Palm Springs / Palm Desert). Part time, flexible days/hours. Competitive compensation. Call (619) 992-5330. 
Place your advertisement here Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org
SAN DI EGO PHYSICIAN.org 35
Bruce Potenza, MD by michelle brubaker, UC San Diego Health Sciences
He is a tireless surgeon who brings gifts to patients who are hospitalized during the holidays; he holds the hands of mothers whose children are healing at UC San Diego Health System’s Regional Burn Center; and his life’s mission is to educate the public on burn injury prevention. These are just a few of the many reasons why Bruce Potenza, MD, FACS, director of the UC San Diego Health System Regional Burn Center, professor of surgery at UC San Diego School of Medicine, and SDCMSCMA member since 2005, was named a medical hero by the American Red Cross of San Diego/Imperial Counties during their 10th annual Heroes Breakfast on the USS Midway. More than 500 people attended the event, a community celebration honoring 11 individuals and organizations that have made a commitment to creating safer, stronger communities and providing help when disaster strikes. “It was truly an honor to be recognized by the American Red Cross for the work I love to do,” says Dr. Potenza. 36 novem b er 2012
“Dr. Potenza dedicates himself to educating the public on burn injuries, treatment options, and prevention,” says Janine Dubina, RN, nurse manager at UC San Diego Health System’s Regional Burn Center. “He is so deserving of this award. He treats every patient like they are a member of his family.” The UC San Diego Health System Regional Burn Center is an American Burn Association-verified burn pediatric and adult burn center and provides comprehensive burn services for San Diego and Imperial counties. It is internationally recognized for burn research and advanced practice in areas such as skin grafts. Deep burns require skin grafts for healing, and the best skin grafts come from the patient’s own unburned skin. These grafts are unlikely to be rejected from the patient and have a better cosmetic result. However, if the patient does not have enough healthy skin, there are skin substitutes and skin banks to provide temporary coverings to allow time for the patient to stabilize. “Burn surgery requires patience to ensure grafts remain in place, the willingness to undergo the tropical heat of the operating room, and the stamina of standing for eight to 12 hours in one place for the best patient outcome,” says Dr. Potenza. The promise of the future is in the world of biotechnology. Living skin cells may be taken from the burn patient and grown into new skin cells in sheets. The challenges of current technology are the fragility of the cells, cost, and time required to grow the cells. The advantages are the patient is less likely to reject the new covering. The center has an ICU, an intermediate unit, and a 24-hour clinic. As the only burn center in the region, it provides education and training to first responders and healthcare professionals, and hosts burn support services and activities for burn survivors and their families. Each year, approximately 450 burn victims are admitted and hundreds more are treated as outpatients in the burn clinics.
Dr. Potenza leads a multidisciplinary team that responds to complex patient burns and works with prevention efforts like the Baby Be Safe Program to reduce the number of burn injuries to children under the age of 4. “Our staff has the training and skill needed for seriously injured patients who are dealing with both physical and emotional challenges,” says Dr. Potenza, who performs more than 450 surgeries for burn injuries each year. The Burn Center team includes experts in plastic and reconstructive surgery, nutrition, social work, psychology, pain management, child life, and physical and occupational therapy. “Some of our patients are here for several months to a year and literally have to relearn how to eat, talk, and walk again after a burn injury,” said Dr. Potenza. “To see these patients transformed by our team is incredibly rewarding.” Dr. Potenza is known by his peers as an excellent instructor and mentor, specializing in general surgery, critical care, and burns. He has received numerous honors and awards from faculty and students, and is involved in community service and outreach programs to promote awareness and prevention surrounding burn injuries. “Watching Dr. Potenza at the bedside of every patient and teaching our team the latest techniques is what makes me want to come to work every day,” says Dubina. “I have learned so much from him over the years.” In addition to his busy schedule, Dr. Potenza is a captain in the United States Naval Reserve and has traveled across the nation presenting lectures related to trauma and burn treatment. “The Burn Center is committed to advancing our knowledge and awareness of burn injuries and prevention, and the American Red Cross award is a wonderful way to recognize the team that makes this happen every day,” says Dr. Potenza. To learn more about the UC San Diego Health System Regional Burn Center, please visit health.ucsd.edu/specialties/surgery/trauma-burn/burn-center.
We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.
800-252-7706 www.CAPphysicians.com San Diego orange LoS angeLeS PaLo aLTo SacramenTo
For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like Irvine internal medicine specialist James Strebig, 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 11,500 preferred California physicians already enjoying the benefits of CAP membership.
Superior Physicians. Superior Protection. 37
mayapril 2011 2012 SAN DIEGO P HY SICIA N. o rg 37 SAN DI EGO PHYSICIAN.org
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