November 2015

official publication of SDCMS November 2015

Farewell,

TOM

“Physicians United for a Healthy San Diego”

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november

Contents

Volume 102, Number 11

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: Sherry L. Franklin, MD • James Santiago Grisolía, MD • Theodore M. Mazer, MD • Robert E. Peters, MD, PhD • David M. Priver, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: William T-C Tseng, MD, MPH (CMA Trustee) President-elect: Mihir Y. Parikh, MD Secretary: Mark W. Sornson, MD Treasurer: David E. J. Bazzo, MD, FAAFP Immediate Past President: J. Steven Poceta, MD GEOGRAPHIC and GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD (Alt.) • Jay P. Mongiardo, MD • Alexandra E. Page, MD • Venu Prabaker, MD Hillcrest: Gregory M. Balourdas, MD • Kyle P. Edmonds, MD (Alt.) • Thomas C. Lian, MD Kearny Mesa: Sergio R. Flores, MD • John G. Lane, MD • Anthony E. Magit, MD (Alt.) • Eileen R. Quintela, MD (Alt.) La Jolla: Geva E. Mannor, MD, MPH • Marc M. Sedwitz, MD, FACS • Wayne C. Sun, MD (Alt.) North County: Neelima V. Chu, MD (Alt.) • Michael A. Lobatz, MD • Eileen S. Natuzzi, MD • Patrick A. Tellez, MD South Bay: Elizabeth Lozada-Pastorio, MD (Alt.) • Reno D. Tiangco, MD • Michael H. Verdolin, MD

features

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Godspeed, Fair Winds, and Following Seas

BY TOM GEHRING

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departments

hank You for Your 14 Years of T Dedication to SDCMS, Tom!

BY SDCMS STAFF

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Tom, We Wish You Farewell!

BY SAN DIEGO’S HEALTHCARE COMMUNITY

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Briefly Noted: Calendar • Volunteer Opportunities • In Memoriam • Directory Errata • Physician Socials • And More …

6 Puzzles, Mysteries, and the Unknownable Unknown

BY DANIEL J. BRESSLER, MD, FACP

AT-LARGE and AT-LARGE ALTERNATE DIRECTORS Lase A. Ajayi, MD • Karrar H. Ali DO, MPH • Steven L-W. Chen, MD, FACS, MBA (Alt.) • Stephen R. Hayden, MD • Phil Kumar, MD (Alt.) • Vimal I. Nanavati, MD, FACC, FSCAI (Alt.) • Robert E. Peters, MD, PhD (Alt.) (Delegation Chair) • Carl A. Powell, DO (Alt.) • Peter O. Raudaskoski, MD • Kosala Samarasinghe, MD • Thomas J. Savides, MD • James H. Schultz Jr., MD, MBA, FAAFP (Board Rep) • Karl E. Steinberg, MD, FAAFP (Alt.) • Erin L. Whitaker, MD (Alt.) • Marci M. Wilson, MD (Alt.) • Holly B. Yang, MD (Board Rep) OTHER VOTING MEMBERS Communications Chair: Sherry L. Franklin, MD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Michael C. Hann, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: Sandeep Prabhu OTHER NONVOTING MEMBERS Young Physician Alternate Director: Heidi M. Meyer, MD Resident Physician Alternate Director: Quinn C. Meisinger, MD Retired Physician Alternate Director: Mitsuo Tomita, MD SDCMS Foundation President: Albert Ray, MD (At-large AMA Delegate) CMA Speaker: Theodore M. Mazer, MD (At-large AMA Alternate Delegate) CMA Past Presidents: James T. Hay, MD (AMA Delegate) • Robert E. Hertzka, MD (Legislative Committee Chair, At-large AMA Delegate) • Ralph R. Ocampo, MD, FACS CMA Trustee: Bob E. Wailes, MD AMA Alternate Delegate: Lisa S. Miller, MD

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ooking a Gift Horse in the Mouth: L How to Deal With Holiday Gifts

BY HEIDI KOCHER, ESQ.

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Let’s All Start “Retirement” Today!

BY HELANE FRONEK, MD, FACP, FACPH

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26 Physician Marketplace: Classifieds 28

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2015 CMA House of Delegates

november 2015

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.]

Rents are rising. See how some of our clients are taking back control.

Fourth Avenue Medical Plaza

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71 72 71 72 73 74 75 41 42 43 44 45 41 19 42 43 44 45 44 45 46 16 2043 17 18 20 16 17 1841 1942 17 18 19 20 16 17 18 1916 20 Our recent medical office sales transactions: 76 77 76 77 78 46 47 48 49 50 46 47 48 49 5021 2522 51 49 50 21 2548 22 23 24 21 22 2346 2447 23 24 25 21 25 22 23 24 1. Undisclosed healthcare provider – 20,076 SF in Hillcrest 51 52 53 54 55 51 55 52 53 54 55 54 56 26 3053 27 28 29 30 27in Kearny 2851Mesa2952 26 30 27 28 29 30 26 27 28 29 2. The Super Dentists – 26 27,239 SF 56 57 58 59 60 3. Mission Bay Office Group, – 27,395 SF in Mission 56 57 58 59 6031 3532 59 60 61 31 Bay/PB 32 33 34 31 LLC32 3356 3457 3558 33 34 35 31 35 32 33 34 4. Kevin Herold,61 DDS – 2,773 SF in Sorrento Mesa 62 63 64 61 65 62 63 64 65 61 65 64 66 36 4063 37 38 39 40 37in Del 38 3962 36 40 37 38 39 40 36 37 38 39 5. The Super Dentists – 36 34,600 SF Mar Heights 66 67 68 69 70 66 67 68 69 7041 4542 67 69 70 71 6. Coastal Pain & Spinal41 Diagnostics Carlsbad 41 4568 42 43 44 42 – 2,795 4366SF in44 43 44 45 41 45 42 43 44 71 72 73 74 75 7. Packard Dental – 3,915 SF in Carlsbad 71 75 72 73 74 75 74 76 46 5073 47 48 49 50 46 47 4871 4972 46 50 47 48 49 50 46 47 48 49 8. Ehsan Nasery, DDS – 3,656 SF in San Marcos 76 77 78 76 77 78 51 5578 52 53 54 5376 Ranch 5477 9. Anthony Scoma, DDS51 – 5,000 52 SF in Scripps 53 54 55 51 55 52 53 5451 5552 10. CHP Partners, LP – 33,680 SF in Chula Vista

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Take a look at how we help our clients by visiting www.sdmedicalrealestate.com

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Paul Braun 71 +1 858 410 6388 paul.braun@am.jll.com 76

Chris Ross +172 858 410736377 7471 chris.ross@am.jll.com 76 77 78

Sales ▪ Leases ▪ Renewals ▪ Investments

Kelly Moriarty 736359 74 7572858 410 71 75 72 +1 kelly.moriarty@am.jll.com 77 78 76 77

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/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// giving back

VOLUNTEER OPPORTUNITIES Email Your Physician Volunteer Opportunities to Editor@SDCMS.org

calendar Community Healthcare Calendar

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.

Evaluations of Healthcare Professionals: From Screening to Full Assessment and Fitness for Duty Reports DEC 5 in Los Angeles at the Los Angeles County/USC Medical Center Update in Rheumatology: Highlights From the ACR and EULAR Meetings DEC 5 at the UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences San Diego Pulmonary, Critical Care, and Sleep Medicine Case Conference & Clinical Updates (sleep medicine content) DEC 7 at the VA San Diego (sjamil@ucsd. edu) Musculoskeletal Ultrasound in Hemophilia DEC 16–18 at the UC San Diego Hemophilia & Thrombosis Treatment Center

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SDCMS Foundation Project Access: Volunteer specialty physicians are needed for the following specialties: gynecology, pulmonology, urology, general surgery, ENT or head and neck, ophthalmology, GI, rheumatology, and endocrinology. We are seeking these specialists throughout all regions of San Diego. Commitment can vary by practice. The mission of the SDCMS Foundation’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Help us help the most vulnerable population seek care. For more information, please call Barbara Mandel at (858) 300-2780 or email Barbara.Mandel@SDCMS.org, or visit our website at www.SDCMSF.org.

Interested in Becoming a Preceptor for Osteopathic Medical Students? Midwestern/AZCOM osteopathic medical school in Phoenix has thirdand fourth-year medical students in San Diego looking for clinical rotations, particularly in pediatrics, psychiatry, general surgery, and OB/GYN. Requirements: Either MD or DO; physicians interested must commit to minimum one four-week rotation per year/or more as desired (2–3 preferable) and to FT hands-on training for each student as is reasonable for the duration of the rotation. Compensation and CME provided. If interested, please contact Dr. Kevin Considine at kconsidine@sbcglobal.net for more information.

Humanitarian Teams Need Medical Volunteers for Haiti: We are looking for physicians and midlevel providers for one-week primary care medical clinics in rural Haiti in February and June 2016. This is a rewarding opportunity to work with the people of Haiti and provide care in a very austere environment in a medically underserved area. Seattle-King County Disaster Team — a U.S.-based nonprofit — has been operating these clinics since 1998. We coordinate all in-country travel and logistics. Please contact Bob Downey at (619) 905-7157 or at labboy@ earthlink.net if you are interested in applying. Visit www.skcdteam.org for further information.

Physician Volunteer Opportunity: Established in 2011, Flying Samaritans of SDSU provides free healthcare to the underserved community of Ejido Matamoros, Mexico (15 minutes away from the border), through monthly medical and dental clinics (every second Saturday of the month), seeing 60–80 patients/medical clinic and 10/ dental clinic. Email FlyingSamaritansSDSU@gmail.com.

in memoriam

SDCMS extends our deepest sympathies to the families of Drs. Medina, Greisman, Sereda, and Weiss …

Ben Medina, MD, 36-year member of SDCMS-CMA, passed away on October 14, 2015.

John J. Greisman, MD, 26-year member of SDCMS-CMA, passed away on October 11, 2015.

William M. Sereda, MD, 11-year member of SDCMS-CMA, passed away on October 1, 2015.

Jack L. Weiss, MD, 26-year member of SDCMS-CMA, passed away on August 29, 2015.

directory ERRATA Please update the following physician listings in your copy of SDCMS’s 2016 San Diego County All Physician Directory, aka, The Little Purple Book.

Delete Listing for the Following Physician: • Mia Hosaka, DO Update Listings for the Following Physicians: • Corrections for Leo J. Murphy, MD »» Address Suite = 102 »» Telephone = (619) 800-7942 »» Fax = (619) 800-7385 • Correct photo for Steven George Pratt, MD

• Corrections for Erin J. Vance, MD »» Address = 4405 Vandever Ave., San Diego 92130 »» Telephone = (800) 290-5000 • Corrections for Cameron W. Wilson, MD »» Address = 8851 Center Drive, Suite 208, La Mesa 91942 »» Telephone = (619) 828-1000 »» Fax = (619) 828-1001

/////////////////////////////////////////////////////////////////////////////////////////////////// PHYSICIAN SOCIALS

A Good Time Was Had by All! More than 60 San Diego County doctors and their guests joined SDCMS on Friday evening, October 23, for a physician networking opportunity and mixer at the Rock Bottom Brewery in La Jolla.

A big thank you to our event sponsor, TriNet, which provides HR solutions to small and midsize practices! SDCMS organizes these quarterly socials to give doctors an opportunity to mingle and network with their colleagues in a festive environment — all free of charge.

Save the date for our next social, which we’ll be holding on Thursday, February 4, at the Handlery Hotel in Mission Valley — email Jen at JOhmstede@SDCMS.org for details or to RSVP today!

Thank you to the sponsor of our Oct. 23 Social

Photos by Marisol Gonzalez, SDCMS Physician Advocate

“

quote of the month

The glory of friendship is not in the outstretched hand, nor the kindly smile, nor the joy of companionship; it is in the spiritual inspiration that comes to one when he discovers that someone else believes in him and is willing to trust him. — Ralph Waldo Emerson (1803–1882) SAN DIEGO PHYSICIAN.org

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Poetry and M edicine

Mystery Still Remains (Origins) The chanting is familiar Strange prayers learned by rote Memorized in childhood Both intimate and remote Simple myths and fables Displaced where science reigns Yet in these incantations A mystery still remains

Puzzles, Mysteries, and the Unknowable Unknown

by Daniel J. Bressler, MD, FACP

A puzzle is a challenge that poses an answerable question. Sudoku, crosswords, and labyrinths are examples. As physicians we deal with puzzles daily. Typically, they take the form of the who, what, when, where, how, and why format that we learned in elementary school.

Who was the index case for this outbreak?

How can we use radiation to best shrink this tumor?

What is causing her recurrent miscarriages?

When did the stroke begin?

Where was the entry point for this bacteremia?

What does this PET-CT image signify?

How should I place the incision to minimize scarring?

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A mystery is different from a puzzle. It is a situation that poses an unanswerable question. It may be unanswerable for a number of reasons. Our current level of knowledge may be insufficient. “How can we cure stage IV colon cancer?” is such a mystery. It is overwhelmingly likely that we will have an actionable answer to that question within the decade. The answer will draw from the realm of knowledge that can be called the “known unknown.”

We have some broad categories of frontier science — RNA interference, tyrosine kinase biology, and cancer stem cell dynamics — from which the answer will most likely come.

Other questions may be unanswerable because our level of necessary understanding is much more primitive. We cannot

(Birth) While you were in your mother’s womb We dreamed who you might be Perched upon a high chair Or climbing in a tree The fit of gene and chromosome Might evoke your limbs and brains But the unexampled child that’s born Proves mystery still remains (Love) A spec list of what pleased me My preferences of style Your form and features teased me Your voice and kiss beguile But apart from charming attributes What enlivens and sustains Is imperfectly predicted As a mystery still remains (Knowledge) The scope of science amplifies Its rules and models glisten The world speaks ever louder Using new techniques to listen But the giant global database Both questions and explains At the gaps and furthest boundaries Where mystery still remains (Death) I hoped that you’d be fast asleep Instead I found you gone Arrived too late to hold your hand As your consciousness moved on The long desire to catch your breath And to overcome your pains Was finally granted by your death But your mystery still remains

even say, with any level of reliability, that an answer will come from one or another field. Such a question is “How do we stop the process of aging?” Although there are certainly intriguing findings in genetics and endocrinology that suggest possible approaches, at this time there does not appear to be a compelling explanation or theory around which the question can be addressed. An answer, if it comes, will need insights and discoveries from a future knowledge base that can be called the “unknown unknown.”

Finally, there are mysteries that are even more inscrutable. These are the deepest of mysteries that pose questions most often asked by philosophers, theologians, or artists. Why is there something rather than nothing? What happens after we die?

How do I know that I’m not dreaming all this? These are examples of inquiry into the “unknowable unknown.” These questions were asked by our remote ancestors and will be asked, I expect, by our distant descendants.

Futurists tell us that information is growing exponentially with the doubling time of known facts decreasing from years to days to hours. The boundary between the known and the unknown seems to be constantly receding. Based on such dramatic claims, one might be tempted to imagine a scenario when all the puzzles are solved and the mysteries relegated to a tiny corner of the hall of knowledge. But I wouldn’t be so sure. One reason has to do with the issue of the unknown unknowns.

We just can’t say how much more there is to learn about the world. The other reason has to do with the questions that will most likely never be answered, the inquiries into the unknowable unknowns.

As doctors, we deal with all three categories of investigation. The standard of care calls upon us to skillfully answer the clinical puzzles we face. Humility demands that we acknowledge that there are mysteries we’ve yet to solve, which thus sets limits to even the most expert of care. Finally, it is our shared humanity that asks us to join with our patients in facing those other most intractable of mysteries with awe, with wonder, and with compassion.

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.

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c o m p l i a n c e p r o g r a m s — 7 th i n a s e r i e s

the gift from the patient. However, depending on the nature of the gift, the practice should consider donating the gift to a suitable charity. For example, a quilted wall hanging may be accepted and displayed. A crocheted shawl might be donated to a charity. In the case of something that might be donated and to avoid hurting patient feelings if they don’t see their handiwork later, practice personnel should be appreciative and thank the patient but explain that the practice policy does not allow them to accept gifts of such value and that they will be donating it to an appropriate charity.

Looking a Gift Horse in the Mouth Or How to Deal With Holiday Gifts

by Heidi Kocher, Esq.

Last month we discussed performing audits in your practice. With the winter holidays just around the corner, we are going to take a detour from our process through establishing a compliance program. November, December, January, and February bring many holidays and parties.

These are usually an opportunity for happiness and cheer, but they can also present problems for physicians and practices.

Gifts of Food From Patients One of the biggest concerns this time of year is whether to give or receive gifts.

Many practices will receive gifts of food, such as cakes, cookies, or the ubiquitous

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popcorn tins. Some will come from grateful patients. Assuming these are of nominal value, it is fine to accept such perishable gifts from patients. However, it is a very good idea to share such food gifts from patients with the office or departmental staff.

Non-perishable Gifts From Patients Non-perishable gifts from patients present a bit more of a problem. Often these gifts are hand-made. But by their very nature they often can’t be shared by office personnel. And refusing such gifts would offend, insult, or disappoint the patients, who have sometimes spent considerable time and effort on the gifts. In such cases, it is permissible to accept

Gifts of Food or Perishables From Vendors, Suppliers, Other Healthcare Providers, or Third Parties Let me start this section by saying that any gifts from vendors, suppliers, other healthcare providers or entities, or third parties are more problematic than gifts from individual patients. Gifts from patients do not implicate the anti-kickback statute; gifts from vendors, suppliers, or other healthcare providers do. Remember that the antikickback statute prohibits giving, offering, accepting, or receiving any remuneration, whether in cash or in kind, in exchange for the referral of services or patients whose care may be reimbursed by federally funded programs such as Medicare. The antikickback statute has no exception for gifts of nominal value or for items such as cookies or cakes.

That said, no physician practice will be prosecuted solely for accepting a holiday gift of food items, provided certain guidelines are kept in mind. As with food gifts from patients, food gifts from non-patients should be of nominal value and should not be a routine event. The food item should be of nominal value. The food should be delivered to the office and not in the form of coupons or paid-for expensive meals at a fancy restaurant. Thus, a tin of popcorn or a platter of mixed cookies from a local deli might be acceptable.

Gifts of Non-perishable Items From Vendors, Suppliers, Other Healthcare Providers or Third Parties Gifts of non-perishable items should never be accepted. As noted above, there is no de minimis value of a “remuneration” that is acceptable. The history of anti-kickback statute cases is full of examples of “gifts” that were really meant to be payments for referrals. A number of years ago, I was involved in a case where a marketing rep for an ancillary healthcare provider meticulously documented the Christmas gifts purchased for physicians and nurses who referred to

Any gifts from vendors, suppliers, other healthcare providers or entities, or third parties are more problematic than gifts from individual patients. the ancillary care provider and submitted that documentation for reimbursement as a marketing expense. The gifts ranged from simple, small gift baskets of cosmetics to video-game units plus games to expensive jewelry for the female physicians or the male physicians’ wives. Unfortunately, the rep’s documentation also included explicit notes as to the expense of each gift and comments that the higher value gifts were for physicians and nurses who referred more business. Partially as a result of this documentation, the ancillary healthcare provider was forced to make a self-disclosure to the OIG and entered into a five-year corpo-

rate integrity agreement, in addition to refunding significant amounts of Medicare reimbursements.

Gifts Between Family Members Who May Be in a Referral Position Finally, a question that often arises is whether it is acceptable for an individual who is in a position to benefit from a physician’s referrals to give a gift to a family member who is a physician. This situation often arises with in-laws of physicians who are healthcare marketing personnel or ancillary or downstream healthcare providers, such as home health agencies or an imaging center. For example, a home healthcare agency owner may wish to give his brotherin-law — a physician — a gift. If the gift is within reasonable limits, is not excessive in kind or value, and is of the kind typically exchanged by family members, and there are no other indications of an improper business relationship, I find it hard to believe that the government would prosecute such an act. Thus a sweater is likely acceptable, but a new car is not.

Conclusion As with many subjects in this arena, intent is key. Accordingly, providers should have a policy in place that deals with gifts. If a practice chooses to accept gifts, a written policy incorporating the above aspects helps establish a lack of improper intent. It also provides staff members with cover when they refuse gifts. If this path is followed, all staff members will have a stress-free holiday season.

Ms. Kocher is counsel with the law firm of Liles Parker, which has hosted SDCMS’s Certified Medical Compliance Officer (CMCO) certification course. In addition to serving as a chief compliance officer and chief privacy officer, Ms. Kocher has nearly 20 years of experience advising and defending clients on legal and regulatory matters affecting providers of all sizes. Ms. Kocher can be reached at hkocher@ lilesparker.com or at (214) 952-5169.

SDCMS Physician Networking Opportunity and Mixer The November 18, 2015 mixer at Handlery Hotel has been rescheduled to February 4, 2016.

Save the Date!

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SAN DIEGO PHYSICIAN.org

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P e r s o n a l & P r o f e s s i o n a l D e v e lo p m e n t

Let’s All Start “Retirement” Today!

by Helane Fronek, MD, FACP, FACPh

My first reactions upon hearing of Tom Gehring’s retirement were sadness — and gratitude. Tom’s commitment to San Diego and its physicians has been unwavering. He consistently looked at issues from the perspective of our benefit and continually found new ways of supporting us during his tenure at SDCMS. Then my reaction turned to curiosity as I wondered what exciting things he would do next. Retirement is a phase of our life we hope to fill with activities we are passionate about — no more struggling with insurance companies, spending hours doing charts, or feeling frustrated with the difficulty of helping patients change their behaviors.

But why wait until retirement to fill our

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lives with our passions?

At a recent American Medical Women’s Association meeting of UC San Diego medical students, four doctors spoke of the passion they feel for their work and how they managed to sustain that through long careers, raising children, and career shifts.

They recalled seizing opportunities that came their way rather than insisting on following the path they had anticipated, and that these opportunities introduced new and interesting avenues of practice. A love of mentoring and developing younger physicians led one woman to direct the residency program at her institution, and the intrigue of problem-solving turned a transfusion medicine specialist’s every day

into as much fun as “playing Sudoku.” I discarded my plan to practice critical care medicine when I began to see patients with venous disorders. It quickly became my passion to bring modern evaluation and treatment to this large group of patients whose conditions were poorly understood and often trivialized.

The passions of many speakers at Sharp Rees-Stealy’s annual CME conference shone through in their talks — about chronic kidney disease, worldwide service, plant-based diets, or looking critically at the medical literature to see what is and isn’t actually proven by the data. Each of these physicians, originally primary care providers, found an area of medicine that spoke to their hearts and helped them feel that their efforts affected more than the single patients they saw each day.

Several years ago, a wonderful internal medicine physician attended a workshop I offered on work-life balance. Her career felt overbearing and uninspiring. Although she believed she was already working too hard, it was by adding an activity that she found the balance she was looking for. Recalling her passion for improving communication, she spearheaded a program to help trainees improve their communication skills. Her career feels refreshed and meaningful.

So, as Tom sets off into that time of following one’s passions, let’s all take a moment and consider what would bring one of our passions into our own life. Is there an aspect of medical care that would thrill you to dive into? An adventure on your bucket list you could plan this coming year?

Would a book club — possibly centered on a theme that touches you, such as biography, spirituality, humanitarianism — bring inspiration and connection that you’ve been longing for? Why wait until retirement?

Let’s intentionally bring our passions into our lives, starting today.

Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.com.

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S D C M S L eadership

Godspeed, Fair Winds, and Following Seas

by Tom Gehring, Executive Director & CEO, SDCMS

❦ December 31 will be my last day at SDCMS. After more than 14 years as your CEO, I have chosen to retire at the top of my game. Following a welcome sabbatical, I intend to look for new, different opportunities to contribute.

It has been a privilege to make a difference in the lives of San Diego physicians and the patients whom they serve. My mother taught her boys to always leave things better than when we found them, and I am proud of what we’ve improved at SDCMS since my first day on September 17, 2001.

• We have a compelling, unifying vision that we — as staff, as leadership, and as San Diego doctors — constantly strive for: “Physicians United for a Healthy San Diego.” It is about doctors, it is about being united, and it is ultimately about the patients — a healthy San Diego.

• In a time of shrinking organizational allegiance, we’ve increased membership from 1,900+ active members in 2001 to almost 2,900 in 2015. We have joined all of UCSD’s medical students and nearly all of San Diego’s approximately 1,200 residents and fellows.

• We’ve grown inclusively, across all modes of practice, all systems, and all ages. In 2013, the next seven likely presidents would hail from Scripps Clinic, from the Permanente Medical Group, from an independent solo practice, from Sharp Rees-Stealy, from UCSD, from a medium-sized practice, and from a Federally Qualified Health Center.

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• We’ve created so many critical legislative victories: ♦♦ In our finest hour, we held the line on medical malpractice rates — preserving MICRA — and turned Prop.

46 from a sure thing to a dead duck.

It lost in San Diego 72–28%. ♦♦ We positively addressed many, many real-world medical issues in the legislature, from eliminating loopholes in immunizations to temporary, if not yet permanent improvements in Medi-Cal payments and access. ♦♦ After a decade of struggle, we eliminated the absurd Geographic Practice Cost Index (GPCI) inequity — returning the almost unbelievable amount of $12,000+ on average to every doctor in the county. ♦♦ We contributed to eliminating the (un)Sustainable (non)Growth Rate (SGR) formula. ♦♦ We preserved the physician as the head of the care team by stopping dangerous scope of practice incursions.

• We have a local, state, and national reputation for organizational excellence and innovation. Just this year, every SDCMS member in San Diego will be able to access, on their cell phone, the database of all San Diego physicians to recruit, retain, and refer (R3) from that eponymous mobile application.

• Despite the vagaries of the stock market, we are financially healthy. In 2005, we sold the building near the top of the market and eliminated the

huge organizational risk of owning a crumbling building.

• We are the convener of choice on healthcare — an agnostic spokesperson for all docs. When Ebola threatened, it was SDCMS who gathered the community. In 2001, when anthrax and bioterrorism terrified, it was SDCMS who promulgated, in record time, a primer on bioterrorism to help the average physician — used far beyond San Diego.

• We created the SDCMS Foundation, which has facilitated more than $10 million of pro bono care by San Diego doctors.

• We are supremely relevant in the community; we have superb relationships with almost all local leaders and stakeholders.

Unsurprisingly, as with any self-aware organization, SDCMS has challenges: • Our membership penetration is still too low. We have to grow by organically re-

Three thank-you’s: • To my wife of 33 years and 30-year member of SDCMS, Catherine Moore, MD. I’ve known her since 1973, since before she decided to go to med school, so I have enjoyed a ringside seat of what it really means to be a doctor. She kept me grounded in what physicians want and need. Thanks, Dear.

• To my team: Betty, Jim, Jen, Brandon, Brian, Marisol, Kyle, and Barbara; you guys are absolutely the greatest! You embody the level-five organization of Tribal Leadership. It has been an honor to work with you.

• To the many dedicated leadership doctors who made serving a pleasure.

•

•

•

•

cruiting. Ask yourself this, dear reader: “Who have I signed up to be a member recently?” Ask yourself, dear nonmember reader: “Why aren’t I part of the solution — especially after Prop. 46?”

We must constantly focus on remaining relevant by delivering value at the county level — never forgetting that doctors are giving us $405 every year to do more than just annually send them a bill and cash their check.

We have to proactively seek relevance to the Generation Y doctors who are just now starting to enter the physician workforce.

We are not as diverse as we should be.

Our relevance to — and therefore our penetration among — minority physicians needs much work.

In light of the tectonic shift toward large and medium groups, the funding model for all physician membership organizations has to change. Annual dues based on a “dues per member” model

has to change, most likely to a “dues per organization” model.

• We have to stay flexible, responsive, and adaptive while not losing our unity.

• The funding model for our SDCMS Foundation is not self-sustaining. We have to evolve to a stable fiscal model for our 501.c.3 charitable arm.

• It will not be easy transitioning to the new CEO. He or she will be different from me, and that’s OK, but please help her or him learn.

What will I miss?

• Solving a problem for a San Diego doctor who has nowhere else to turn.

• Representing physicians in places where their voice had not been heard.

• Sharing a lifetime of leadership lessons with doctors who are desperate to learn how to lead.

• The power and privilege to change dumb things!

Please stay in touch. My SDCMS email, Gehring@SDCMS.org, will only work for a while after December 31, so do change my email to tom@tsgehring.net. I will keep my cell phone number: (619) 206-8282.

I will close with two thoughts.

First, you did not get into medicine to fill out forms or argue with health plans. Please, please do not let the mundane overcome the marvelous, nor let administrative drudgery eclipse the joys of your profession. Until you have been a patient, you have no idea of how extraordinary your art and science is. Don’t let medicine become just a job — remember the magic!

Second, I spent almost half of my adult life at sea — albeit submerged — but never far from the traditions of sail. In the days, not that long ago, when tall ships met on the vast empty ocean, they would lash together, share news, exchange mail, chow down together, and consume copious amounts of alcohol — after all, the water was not fit to drink! The ships would spread their sails and sadly sail their separate, lonely ways, slowly disappearing over the horizon, with only heartfelt best wishes echoing across the waves — exactly as I wish you today — Godspeed, Fair Winds, and Following Seas.

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S D C M S L eadership

Thank You for Your 14 Years of Dedication to SDCMS, Tom!

by SDCMS Staff

16

november 2015

Fourteen years! That’s how long Tom Gehring has been dedicated to the San Diego County Medical Society’s noble vision: “Physicians United for a Healthy San Diego.”

Now, on December 31, Tom will retire and we — the employees of SDCMS — want to thank our CEO for his leadership and wish him well.

When Tom accepted the CEO position, SDCMS was experiencing a decline in physician membership. Due to Tom’s commitment to the mission, his pursuit of excellence, his focus on building an excellent staff, and his mentorship and co-leadership with the physician board of directors, the San Diego County Medical Society has seen membership rise at a steady pace during Tom’s tenure. SDCMS consistently battles for first place as the largest medical society in the state of California, and is actually larger than many state medical societies across the country.

Tom Gehring’s 21 years of naval experience as an officer on fast-attack submarines has brought color and candor to the office. Besides his 90-seconds rule (in a mere 90 seconds, anyone on a sub can kill everyone), we have also been counseled to consider that on a submarine one must feel independent in the middle of the ocean, for, when trouble strikes, there is no one but yourself to find a solution. During those times, it is our “interdependence” we must rely on: the confidence our coworkers are doing their jobs in timely, professional, and excellent quality toward a successful mission. Tom’s leadership style has attempted to replicate that “independence/ interdependence” work environment, much to the benefit of SDCMS. The amazing success of Tom’s tenure at SDCMS is a tribute to his leadership, as the majority of us have been working with him for more than a decade.

Tom Gehring’s legacy is not only leaving SDCMS with an enthusiastic office team, but also with a physician leadership team set to embrace an exciting vision: enrollment of all San Diego County physicians into SDCMS as “Physicians United for a Healthy San Diego.”

Fair winds and following seas, Tom … you will be missed!

HEALTH HERO

As a Physician, You’re a Natural Educator

Join the San Diego County Medical Society Foundation’s Live Well Special San Diego thanks to John Han, PharmD, Regents Pharmacy in Physicians’ Speakers Bureau.

La Jolla for his help to assure Physicianspatients volunteer to with are able to comply physician orders.interactive Project Access provide pro bono recently partnered with Alison SATURDAY, NOVEMBER 14 presentations (30–60 Gordon Cohn, MD, and Elizabeth FLETCHER COVE, SOLANA BEACH Viriya, MD, of Gordon-Weiss-Schanzlin minutes) near where they Vision Institute; ASMG; and Outpatient Centerof of La Jolla, work or live, to Surgery groups to assure that eight patients regained youths, adults, seniors, their sight with cataract surgeries.

Volunteer to Build the Physicians: But the necessary prescriptions employees, and more.

We Knowledge, would have cost Project Access a YouPublic’s are a Health Role Model SATURDAY, NOVEMBER 14 will provide adaptable prohibitive $600 per patient! John Skills, and Positive Han was able to facilitate reduced COVE, SOLANA BEACH presentation materials.

ModelAttitudes healthy living to FLETCHER patients and staff by inviting them to cost prescriptions down to $175 About Health per patient, a 70% savings!

JOIN YOU at San Diego County Medical Society Foundation’s Solana Beach Sunset 5K Run/WalkToluwalase November John and his wife also provide Ajayi, 14 at 3 PM! MD, educating college preparatory middle school students about “Easy Ways to Eating Right for a Healthy Body and Mind”

for Project Access Live Well Sanongoing Diegosupport Physicians’ through their Charity Support Speakers Bureau Presentations: Program; for each prescription filled »» Living Your Life

by Best Regents Pharmacy for any of a »» Easy Waysprovider’s to Eating Right for will a patients, Regents donate a small portion to help Healthy Body and Mind prescriptions for Project »» Creating asupport Healthier Workforce Access’ uninsured patients. Since »» Athletics: Playing for Life Regents both delivers and mails (Teen Sports Benefits and Issues) prescriptions, they are able to serve »» Recognizing Unhealthy the entire county. For more Relationships information, contact SDCMS Foundation, or Regents Pharmacy »» Reading Your Child’s Emotional at regentsrx.com, 858-281-5200.

Health »» Topics of Your It takesChoice! the partnership of the entire

Lead a team more patients and staff and Model ans: You areof 20aorHealth Role receive FREE your own team t-shirts with your living to patients andidentification. staff by inviting practice/team

ealthy them to U at San Diego County Medical Society Foundation’s For more information please contact Carlos Medina Beach Sunset 5K Run/Walk November 14 at 3 PM! at carlos.medina@sdcms.org or 858.565.7930 Benefiting

eam of 20 or more patients and staff and receive FREE wn team t-shirts with your practice/team identification.

Improving Health…Changing Lives

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medical community to reach our vision of improving health and 858.565.7930changing lives. Thank you to all our For moreProject information, Access San Diego physician volunteers, and surgery please contacthospitals Liz Brave: centers, and ancillary partners!

Liz.Brave@SDCMS.org With your help, we facilitated care for uninsured patients in 2014, or (858) 821 300-2789 getting folks back to health, back to work and caring for their families, This Initiative Is Made Possible Through a Partnership With the improving their quality of life!

County of San Diego’sand Health and Human Services Agency

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S D C M S L eadership

Tom, We Wish You I will miss Tom. A lot.

He was the one guy who, above anyone else, made me feel at ease at the Society. I will not forget the close attention and guidance he gave me at my first HOD. He made sure to take time to talk to the Philippine Medical Association. His energy, smarts, and drought-dry humor are gonna be long remembered. Mabuhay!

— Irineo Tiangco, MD

I wanted to let you know how much I have respected, admired, and enjoyed working with you these past years. SDCMS was fortunate to have someone like you, and you in particular, at its helm for so long. Thank you for all you have done! I enjoyed the Leader’s Toolkit program that I attended, the email/Outlook management seminar that Jan and I attended, and I appreciated the opportunities you gave me to write for San Diego Physician magazine and offer the workshops. I wish you a retirement that is filled with everything you’re hoping for, and many years of enjoyment and good health.

— Helane Fronek, MD, FACP, FACPh

I have not seen any nonphysician to be as passionate as Tom in physicians’ welfare.

He is not only a true leader, but also had uncovered talents in numerous physician leaders in San Diego. We will miss his services in the future.

— Venu Prabaker, MD

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november 2015

Farewell!

Thank you for all you have done for the San Diego medical community these past few years. San Diego physicians practicing independently or within integrated delivery systems have found common issues of importance for our patients, and we have a voice that would not be possible without the relationships you developed. UC San Diego Health physicians have especially appreciated your updates about the impact of local, state, and national politics on our practices and the healthcare of our patients, and also the interest SDCMS has taken in our medical students and trainees. Best wishes for all your future endeavors.

— Thomas J. Savides, MD, Professor of Clinical Medicine, Chief Experience Officer, UC San Diego Health

Thank you for 14 wonderful years of service to SDCMS. You really helped turn us into the best medical society in the state.

— Sergio Flores, MD

If it weren’t for you, I would never have become as active in SDCMS as I have. Your creativity and vision resulted in a partnership between us that brought over 800 house officers at UCSD membership in the Medical Society. This is unprecedented! I cannot tell you the impact this has had on young physicians preparing to transition to clinical practice. That is the essence of true leadership. It has been an honor and a privilege working with you. I hope you enjoy your well-deserved retirement and,

as Emerson said, “Do not go where the path may lead, go instead where there is no path and leave a trail.”

— Stephen R. Hayden, MD, FAAEM, Professor of Emergency Medicine, UC San Diego; Editor-in-Chief, Journal of Emergency Medicine

Thank you for leading SDCMS for the last 14 years.

Your stewardship has propelled our medical society to be recognized as a model of success for physician organizations. Personally, your guidance, advice, educational programs, and conversations have helped develop my leadership skills, giving me tools to help advocate for our patients and physicians. Your mark on our medical society is indelible. It’s always better to leave somewhere in better shape than when you came, and you have certainly done so! Again, THANK YOU! — David E.J. Bazzo, MD

Tom Gehring’s retirement brings to a close an amazing era of growth for the San Diego County Medical Society and CMA: growth in membership, growth in leadership and direction of organized medicine, growth in recognition of SDCMS as a voice of medicine, and growth in enduring relationships between SDCMS and community organizations. The legacy he leaves us is one of cooperative action and planning, and respect for all of our colleagues regardless of specialty or mode of practice. It’s a legacy he should be proud of, and one we all need to continue to build on. Tom, thank you for your unyielding dedication to all of us and to medicine, for your magic in helping us to do

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S D C M S L eadership

our magic, and for your friendship and support over the years. Wishing you wonderful new adventures, pushed ahead by fair winds and following seas.

— Ted Mazer, MD

Thanks, Tom, for all of your hard work, dedication to and support of the physicians, patients, and the profession of medicine in San Diego. We are fortunate to have had your years of service; you’ve done great work. All the best in your retirement. Enjoy!

— Jay Mongiardo, MD, MBA

Tom has been a terrific leader for the Medical Society. Tom’s enthusiasm for teaching and commitment to sharing knowledge outside of organized medicine is a special gift that is appreciated by anyone who had the good fortune to spend a weekend in one of Tom’s workshops. I trust that he will continue to be a resource for the San Diego medical community.

— Anthony Magit, MD, Director, UCSD Human Research Protections Program

Tom Gehring has played a pivotal role in the physician community here in San Diego.

During his more than 14 years of service, he has never lost sight of the mission of the San Diego County Medical Society and the importance of uniting all physicians in a common purpose. He has done so with equal parts humor, temerity, and boundless enthusiasm. Not bad for a Navy guy! He will be missed. Best of luck in retirement.

— Tom Sounhein, CEO, XiMED Medical Group

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november 2015

Congratulations, Tom, and many thanks for all of your help these past 14 years. You have been a great partner and ally, a source for great counsel and wonderful collaboration. As you sail into the next phase of your life, may the wind always be at your back and the seas be smooth!

— Maria C. Savoia, MD, FACP, Dean for Medical Education, Professor of Medicine, UC San Diego School of Medicine

Tom has been a relentless voice for San Diego physicians during a time when strong leadership has been vital. He has always been available to address mutual interests and concerns, and has led the way toward seeking solutions. Tom developed his leadership skills commanding nuclear submarines. I think that experience helped to create the strong, resilient nature and inherent values that we all have appreciated in working with him.

— Chris D. VanGorder, FACHE, President & CEO, Scripps Health

Tom, Scripps Coastal Medical Group thanks you for your tireless advocacy for physicians, as well as the health and well-being of our San Diego community.

— Kevin S. Hirsch, MD, FACP, President, Scripps Coastal Medical Group

A successful team is a group of many hands but of one mind.

We were glad to work with Tom and his efforts to make SDCMS representative of all the physician groups in San Diego to improve the overall health of our community. Best wishes in retirement.

— Paul E. Bernstein, MD, Medical Director, San Diego, Kaiser Permanente

Tom is one of the hardest working, most positive, efficient, effective leaders I have ever worked with. He has a great grasp of the politics and reality of medicine at the county, state, and federal levels, and I always value hearing his analysis of the issues of the day. Tom has been a good friend, and I’ll miss working with him at the Medical Society. I’m optimistic I’ll see him around at Rotary and other San Diego venues.

— Steve Green, MD, Chief Medical Officer, Sharp Rees-Stealy Medical Group

It has been great working with you over the years, and I appreciate your passion and leadership for making healthcare the best it can be. I wish you the very best of everything good in this next chapter, and hope that our paths continue to intersect.

— Mike W. Murphy, President and CEO, Sharp HealthCare

As the executive director of the Imperial County Medical Society, I have come to know Tom Gehring personally and professionally. As a small, rural medical society, ICMS doesn’t have many of the resources that can be found in large medical societies. Tom’s policy was to share everything available to SDCMS members with members of ICMS. That willingness to share was not conditioned on some payment but rather came from his desire to provide the highest level of support to Southern California physicians. Tom carried that same attitude to the Medical Executives Conference, comprised of all California medical executives.

Time and again, Tom shared everything from future trends, to successful ideas, to software. His directive to us was always, “plagiarize shamelessly,” and he meant it.

Anything that would serve to improve the medical community was shared with all.

On a personal level, Tom has been equally devoted to his family. I can’t count the times that we worked out schedules that would

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allow Tom time to be with his wife and son.

On every occasion that we have been away from San Diego, Tom would call his wife and son to let them know he was OK, to ask after them, and to tell them when he would return.

In addition to all of the above, Tom also took leadership roles with the Red Cross, Rotary, and Regional Chamber of Commerce. Few people can juggle as many balls as Tom has.

Even fewer are able to do it as successfully as Tom. He will be missed.

— Thomas W. Henderson, MA, Executive Director, Imperial County Medical Society

Tom, thank you for your extraordinary leadership over the past 14 years. I’ve greatly appreciated your candor, honesty, and ability to advance the healthcare priorities for San Diego. Your advocacy for San Diego physicians has been superb and valued. Partnering with you on enumerable issues has been fruitful. You leave an indelible mark on San Diego and will be greatly missed. I wish you well.

— Dan Gross, EVP, Sharp HealthCare

Tom has taken SDCMS to new heights with his knowledge, experience, and passion. We have all learned much from his wise counsel and guidance. He has made San Diego a much healthier place both for patients and physicians.

— Albert Ray, MD, Past President, SDCMS; President, SDCMS Foundation

In my 10 years in organized medicine, I have never met anyone like Tom. As soon as he was aware of me as a fellow, he began reaching out and making personal connections. Never before could I just pick up the phone and be in contact with such a leader.

I feel as though I can always count on him to keep me in mind for the right opportunity and to provide the right advice at the right moment. His responsiveness, directness,

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and proactive nature have been refreshing and will be deeply missed.

— Kyle P. Edmonds, MD, Assistant Clinical Professor, Doris A. Howell Palliative Care Service, UC San Diego Health Sciences

Tom’s strong leadership and guidance during his years at SDCMS have been an inspiration. He has consistently gone above and beyond the call of duty, providing education, support, cheerleading, and true mentorship to virtually a whole generation of San Diego docs, while building an outstanding, functional team in the office. He has frequently worked weekends and evenings, and truly has lived, breathed, and embodied SDCMS — embodying what a great CEO does. Tom, it’s been a pleasure working with you, and you will be sorely missed.

— Karl Steinberg, MD, Chair, Coalition for Compassionate Care of California

I had the pleasure to participate in the selection of Tom for the position he has so well occupied. I was also the first SDCMS president to enjoy his presence, his advice, his ideas, and his vigor. Through the years, I saw him grow as our friend, advocate, persistent supporter, and ever-ready companion. I just hope he continues to keep medicine and its goals close to his heart.

— Rodrego A. Muñoz, MD

I have known Tom for only a couple years out of his long tenure at SDCMS. He has, no doubt, been a powerful and guiding influence for the Society and has made it what it is today. I wish Tom the best in his future endeavors and all success.

— Phil Kumar, MD

I haven’t known Tom that long; that said, I’ve been most impressed with his willingness to reach out to the community health sector physicians. These are physicians who, as a chief medical officer of a community health center, I look up to (even though I’m one myself), and it’s been great to feel welcomed into the Society. I hope, through example, I am able to engage others in community health with the important mission of the San Diego County Medical Society. Many thanks to Tom and all the best looking forward!

— Patrick Tellez, MD, Chief Medical Officer, North County Health Services

I am proud to say I was SDCMS president and chair of the search committee when we hired Tom in 2001. I will forever remember the amazing (volunteer) effort he made as the facilitator of the CMA’s Reengineering Task Force and, many years later, as the facilitator of CMA’s “Strike Force” that began the effort that has now revolutionized CMA governance. Tom figured out how to finance the start-up of the SDCMS Foundation, and I will always be proud of that too.

In between he just grew our SDCMS more than anyone else could have, membership, visibility, as well as respect in the community and within the physician community.

Most importantly, I am proud that he is my friend. Fair winds and calm seas, Tom; we’ll miss you.

— James T. Hay, MD, SDCMS President 2001, SDCMS Foundation President 2001–06, CMA President 2012

The practice of medicine was turned into a commodity by managed care. Many medical organizations became irrelevant because of this and ceased to exist. Even our highly respected SDCMS dropped to nearly half its size. Tom Gehring came first as business consultant and then was retained as executive director. By the force of his intellect and drive, Tom turned us

around and made our medical society representative of all San Diego physicians.

Thanks, Tom. Have a great time in your retirement.

— Ralph R. Ocampo, MD, Past President, SDCMS

I had the pleasure of working with Tom Gehring from the time his tenure at SDCMS started in 2001 until just this past year when I went into formal retirement from the practice of medicine. The first thing I learned about him was that he had spent many years aboard a submarine, where the only complaint ever reported about him was that he liked to sleep with the windows open! They say that one of the first skills that a submariner develops is to work effectively with potentially difficult people in close-quarter situations. On that particular score, Tom managed magnificently to come to terms with relating to me!

But seriously, folks, Tom has an extraordinary ability to make everyone with whom he interacts feel that their contribution to organized medicine is unique and valuable.

We surely did not share a great number of political postures, but I felt he always dealt with those differences with great understanding and respect. I will forever carry the memories of Tom and me getting up early at CMA meetings in Sacramento to jog around the Capitol building in the dark, when sensible people were still asleep, although I have always harbored a suspicion that his silence during those runs was because he was dreaming up some lampoon about me that he would share at the Delegation dinners! I am honored to have this opportunity to express my profound gratitude for having worked with Tom and to welcome him into the world of retirement.

— David Priver, MD, President, SDCMS, 1997; Chair, CMA District One Delegation, 2001–07

On behalf of the Hospital Association of San Diego and Imperial Counties (HASD&IC), our members, and our board of directors, thank you for your commitment to the San Diego County Medical Society

(SDCMS) as a collaborative entity within our provider community and engaging with hospitals and health systems on important issues of shared interest. Individually, you have been a tireless advocate on behalf of your members — in particular, on the issues of the Sustainable Growth Rate (SGR) and the Geographic Practice Cost Index (GPCI), and we join you in celebration this year of the SGR fix — a long awaited victory! Thank you most of all for being a great neighbor and instilling a culture of mutual respect and support that goes beyond the sharing of conference rooms. The value to our daily work experience is immeasurable. So it is with appreciation from all the staff at HASD&IC that I wish you the best in your retirement with “cheers” to the adventures to come.

— Dimitrios Alexiou, FACHE, President/CEO, Hospital Association of San Diego & Imperial Counties

Tom Gehring was an integral part of one of the most legislatively active districts in California. He actively tried to grow the Medical Society.

While his energy was too much for some, if you stopped to talk to him on his very brief moments of repose, he is actually quite personable. He truly loves working with doctors. He takes delight in seeing them develop into advocacy experts.

Tom has become a fixture in San Diego medical advocacy. He will be missed. Thank you, Tom, for all you did.

— Vimal I. Nanavati, MD

Tom Gehring has taught me much about leadership, organization, dedication, and passion. He has always gone out of his way to answer any questions or concerns that I may have had. I’ve attended his courses on leadership and organization and found them outstanding. I cannot conceive of SDCMS without him. I will miss him terribly, but he leaves an amazing legacy.

— Geva Mannor, MD, MPH, Scripps Clinic Medical Group

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Tom Gehring has been wonderfully generous in giving his time and talent to the San Diego physician community. His knowledge and encouragement have been instrumental in helping me understand the true value of each physician’s role in organized medicine, especially in advocating for our patients. I’m grateful for his leadership and mentorship, and his many contributions over the years to SDCMS and the SDCMS Foundation!

— Holly Yang, MD, MSHPEd, HMDC, FACP, FAAHPM, Scripps Co-Director, UCSD/Scripps Health Hospice and Palliative Medicine Fellowship Program

At first, Tom struck me as the wrong person for our medical society — too military, too forceful for an association of doctors.

How wrong I was! Tom has had a pivotal role in shaping SDCMS into one of the premier medical societies in the nation. We often congratulate ourselves that we have superb

physician leaders in San Diego, but the truth is that talented and dedicated docs exist all over the state and the nation. The driving force and the cohesion that permitted our leaders to achieve their best were entirely Tom’s. I like Tom for the same reason I like surgeons: he’s direct and focused, and you always know where you stand. Tom believes in collecting all the data, then crafting a strong vision of where to take an organization. His strength of vision can rub you the wrong way, but I have always found him to respond to fresh points of view — and especially to new data. He has a fine analytical mind that absorbs political, economic, cultural, and demographic trends and finds the connections. On his off-time, he absorbs geopolitical trends with gusto and cheerfully resends key international data to a broad panel of doctors … basically for fun. Tom’s acronyms are well known but should not be mistaken for oversimplification. His famous multicolored, complex graphs and vector maps trace a subtle intelligence wrestling with a complex world. He combines Germanic love of detail with French grace of intellect. The resulting acronyms serve as mnemonics to permit the rest of us to hold on to his key conclusions.

Tom’s military and consulting background brought real discipline to SDCMS, morphing us from an old boys’ club to a younger, more

Where are your patients coming from?

Each month, every practicing physician in San Diego County receives a copy of San Diego Physician magazine. What better way to ensure that other physicians know about your medical practice than through a referral advertisement in this highly regarded publication? Advertising packages are available at very attractive price points, and for a limited time SDCMS member physicians receive 50% off by mentioning this ad.

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november 2015

“…patients…get nearly 70% of specialist referrals from their primary care doctors.” “…most experts say referral marketing will only become more entrenched as health care cuts continue.”

diverse body of engaged leaders committed to finding common ground across modes of practice and specialties. His impatience with mediocrity challenged all of us beyond ourselves, to become better together than we’d ever been separately. After Tom, our challenge will be to do more together, to include more stakeholders, both physician and nonphysician, and to better help our members succeed in the coming revolution in healthcare delivery. We’ll need to keep inventing new strategies and tactics, but we will remain indebted to Tom for his extraordinary leadership in a critical time.

— James Santiago Grisolía, MD I want to thank Tom Gehring for his many years of service as the CEO of the San Diego County Medical Society. His focus, energy, and thoughtfulness have clearly created a more stable medical society that has improved its services to physicians and patients alike. I wish him all the best as he moves on to new challenges.

— Peter Raudaskoski, MD, Vice President, ASMG Board of Directors; Past President, ASMG

Physician referral marketing is on the rise — just read some of the statistics:

“According to one national survey, four in 10 medical office managers flagged referrals from other physicians as the most effective way to attract new patients.”

Contact Dari Pebdani today to get your campaign started.

DPebdani@SDCMS.org or 858-231-1231

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classifieds PHYSICIAN POSITIONS WANTED SHORT-TERM LOCUMS AVAILABLE! D. (Doyle) Eugene Johnson, family physician with a wealth of experience, looking for short-term locums, preferably in North County. Have been a full-time practicing certified family physician for 50+ years and would like to continue seeing patients on a part-time basis. Had one of the largest solo family practices in San Diego for 25+ years. Excellent references! Continually certified in family practice, ACLS, BLS, regularly use computerized records.

Please email d.eugenejohnsonMD@gmail.com with particulars. [301] PHYSICIAN POSITIONS AVAILABLE LOOKING FOR A GENERAL FAMILY MEDICINE PHYSICIAN AND A PSYCHIATRIST: Indian Health Council (IHC) is looking for a general family medicine physician to provide quality patient care to all ages of patients — full-time position, excellent benefits package and work environment. In addition, IHC is looking for a psychiatrist two days per week, excellent benefits package and work environment.

Both incumbents must hold a current California license and be board-eligible. IHC is a Native American healthcare facility located in North San Diego County, providing a full spectrum of onsite and outreach services and programs. For consideration, please visit our website at indianhealth.com or email resume to hr@indianhealth.com. [432] KAISER PERMANENTE SAN DIEGO LOOKING FOR PEDIATRIC PER DIEM MDs: As many hours per week as you want! Shifts are available during the day, evenings, and/or weekends. We have 13 different locations across the county, and three main ones for evenings and weekends: San Marcos, Vandever, Otay Mesa. Competitive hourly rates!

Please contact (619) 641-4324 if interested. [430] ED PHYSICIAN WANTED: Full/part-time opportunity for BC/BE emergency physician, 20-bed ED, GlideScope, ultrasound, mid-levels. Independent group with partnership tract. Send CV to ppiememergencyphysicians@yahoo.com. Call (619) 417-6581. [428] PHYSICIAN POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, 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. 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) 906-4591 or email ajameson@ fhcsd.org. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org.

[046a] FAMILY PRACTICE PHYSICIAN FOR A BUSY FEDERALLY QUALIFIED HEALTH CENTER: Mountain Health is a mission-driven organization that serves both rural and urban residents of San Diego County. We have been in business for 40 years and offer a competitive salary, medical benefits, vacation, paid holidays, sick time, CME reimbursement, and license reimbursement. Board-certified and bilingual English/Spanish preferred. Send CV to tfindahl@mtnhealth.org or (619) 478-9164.

You may contact HR directly at (619) 478-5254, ext 30. Visit www.mtnhealth.org. [416]

INTERESTED IN BECOMING A PRECEPTOR FOR OSTEOPATHIC MEDICAL STUDENTS? Midwestern / AZCOM osteopathic medical school in Phoenix has third- and fourth-year medical students in San Diego looking for clinical rotations, particularly in pediatrics, psychiatry, general surgery, and OB/ GYN. Requirements: Either MD or DO; physicians interested must commit to minimum one four-week rotation per year / or more as desired (2–3 preferable) and to FT hands-on training for each student as is reasonable for the duration of the rotation.

Compensation and CME provided. If interested, please contact Dr. Kevin Considine at kconsidine@ sbcglobal.net for more information. [408] SPANISH-SPEAKING FAMILY PRACTICE OR INTERNAL MEDICINE: Spanish-speaking family medicine or internal medicine physician for Borrero Medical Group located in south San Diego next to Chula Vista. The practice is growing and needs to hire a new physician. Borrero Medical Group is a well-established practice, 22 years in the community, exceptional office staff. Every member of our team plays an important role in improving the health of our patients. We offer an excellent comprehensive benefits package that includes malpractice coverage, health insurance, competitive and attractive salaries and bonus. If interested, please submit inquiry and CV to rosa10borrero@att.net. [384] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fastgrowing 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 (619) 992-5330 or email CV to drhunt@thehousecalldocs.com. Visit www.thehousecalldocs.com. [037] PHYSICIANS NEEDED: Internal medicine and family medicine physician positions currently open.

Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County with openings for full-time, part-time, and per-diem positions. Current CA and DEA licenses required. Malpractice coverage provided. Bilingual English/Spanish preferred.

Forward resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at www. vistacommunityclinic.org. EEO Employer / Vet / Disabled / AA [912] OFFICE SPACE AVAILABLE OFFICE ASSOCIATE TO SHARE SPACE WITH FULL-TIME PCP: Ideal for part-time PCP or fulltime subspecialist who needs presence near hospital. 2700ft2 beautifully appointed setup with four exam rooms, a cardiac testing room, two consultation rooms, and balcony in classy and well-maintained, multi-use building. One block from Scripps Mercy Hospital in Hillcrest. Highly trained and service-oriented back- and front-office staff with time to spare. EHR fully set up and smoothly functioning. Friendly office dog. Costs negotiable. Most important factor for the associate is personal and professional compatibility. Interested? Send letter of inquiry with contact information to associate@ personalprimarycare.com. [429] CENTRALLY LOCATED UTC/LA JOLLA MEDICAL OFFICE SPACE and Medicare/AAAASF-accredited surgery center available for sublease starting January 2016. Facility has three examination rooms, physician office space, full operating room, and recovery area.

This is an excellent opportunity and location for a busy dermatologic, surgical, ENT, or internal medicine practice. Please contact drmofid@drmofid.com for further information. [425]

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.

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LAST CLASS “A” MEDICAL OFFICE AVAILABLE, VISTA Upgrade to Class “A” medical office in TriCity’s leading outpatient health center.

1,250 RSF office for lease. 3 large exam rooms, MD office, nurse station, ADA restroom, and ample waiting. Will be completely rebuilt.

Reserved physician parking & ample surface patient parking.

One block from TriCity Medical Center. More than 40 physicians and strong primary care referral base. Contact Greg Petree at (858) 792-0696 x112 or visit www.vistamedicalplaza.com/ suite-265

MEDICAL OFFICE FOR SUBLEASE / SHARE: Scripps Encinitas Campus, 332 Santa Fe Dr. — great location on the hospital campus directly off the I-5.

Sublease Office Space: 2,745ft2 available January 1, 2016. Available Immediately to Share: MD and nurse station, 2–3 exam rooms, ADA restroom, ample waiting. High-speed wireless, and conference room onsite. Large parking garage for patient convenience. Please call (760) 943 -6700, ext. 676, for further information. [421] OFFICE BUILDING FOR SALE: Approximately 11,000ft2 building for sale. Established tenants producing income in 2,190ft2 and 3,010ft2 suites.

Remaining suite approximately 5,800ft2 with large waiting room, six exam rooms, minor procedure room, PT area, digital X-ray suite, ample storage, and administrative offices. Free parking. Located near Sharp Memorial and Rady Children’s Hospital.

Email lvista55@yahoo.com. [420] FOR LEASE — SORRENTO MEDICAL PLAZA: 9200 Scranton Road, San Diego, CA 92121. New construction. This one-story Class ‘A’ medical office building is designed and constructed to meet the demands of contemporary medical and dental practices. An open layout achieves a balance of light and offers flexibility for designing a fully customized office. Great location with easy access for patients and excellent parking. Sorrento Medical Plaza is a strategic location that provides immediate access to visibility to Interstate 805 with easy connection to Interstate 5 and the 56 & 52 freeways and close proximity to San Diego’s leading hospitals. Accessibility extends to the expanding patient base of UTC / La Jolla, Carmel Valley, Central San Diego, and Coastal North County. Please call Paul Braun at (858) 410-6388 or email him at paul.braun@am.jll. com. [419] ESCONDIDO OFFICE AVAILABLE FOR SUBLEASE: Four exam rooms with reception and waiting area, located near downtown. Available full and half days. Please email staff@palmedinc.com for info. [417] LAST CLASS ‘A’ MEDICAL OFFICE AVAILABLE, VISTA: Upgrade to Class ‘A’ medical office in TriCity’s leading outpatient health center. 1,250 RSF office for lease. Three large exam rooms, MD office, nurse station, ADA restroom, and ample waiting.

Will be completely rebuilt. Reserved physician parking and ample surface patient parking. One block from Tri-City Medical Center. More than 40 physicians and strong primary care referral base. Contact Greg Petree at (858) 792-0696, ext. 112, or visit www.vistamedicalplaza.com/suite-265. [415] OLD DEL MAR MEDICAL OFFICE SPACE FOR LEASE: 317 14th St., Del Mar, CA. 1,400 square feet / $3 square foot gross rent — located in the heart of Del Mar in an established medical complex. 3–5 year terms with TI allowances available. Email inquiries to richcardow@yahoo.com or call (970) 390-7026. [406]

LA JOLLA (NEAR UTC) MEDICAL OFFICE FOR SUBLEASE OR SHARE: Scripps Memorial medical office building. Great location, steps to main hospital entrance. 9834 Genesee Ave. between I-5 and I-805. Up to four exam rooms and private or shared consult office available. Please call (858) 622-9076 and ask for Jennifer. [394] VISTA MEDICAL OFFICE SPACE FOR LEASE: Offered at $1.40/ft2. 1.1 miles from Tri-City Hospital. Ideal place for solo practitioner. Ground floor, 1,424ft2, has break room, which is leaded for radiology if needed, two bathrooms, two exam rooms, spacious waiting room, ample room for support staff, physicians private office, excellent parking with seven spaces per 1,000ft2. Also available in same building, office space to share with pediatrician. Ideal for solo practitioner, either family practice or pediatrics. Space portioned off with separate wing and includes three exam rooms, two offices, shared reception area and lobby with access to two bathrooms. Area under city renovation, and lots of new business starts surround. Contact Jill at (760) 630-4715. [393] HILLCREST OFFICE SPACE: Office space available in beautiful, updated Hillcrest medical office that also houses a fully accredited ambulatory surgery center. Great opportunity for a plastic surgeon, facial plastic surgeon, oculoplastic surgeon or dermatological surgeon. Office is conveniently located minutes from freeway access and downtown San Diego. Please contact via email at info@ drhilinski.com. [355] NEW MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE IN KEARNY MESA: Brand new office suite located at 3750 Convoy Street with nine exam rooms and digital X-ray, hi-speed wireless, free parking for patients and staff, conference room in building. Several minutes from Sharp Memorial Hospital and Children’s Hospital. Convenient freeway access to 163 and 805. Multiple half-day clinics available days, evenings, and weekends. Please contact Lisa Vaughn at (858) 278-8300, ext. 210, for more information. [343] LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group. Excellent referral base in the office and on the hospital campus.

Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127] SCRIPPS XIMED MEDICAL CENTER BLDG, LA JOLLA — OFFICE SPACE TO SUBLEASE AVAILABLE: Vascular & General Surgeons have space available. One room consult office available, with one or two exam rooms, to a physician or team.

Located on the campus of Scripps Memorial Hospital, The Scripps Ximed Medical Center is the office space location of choice for anyone seeking a presence in the La Jolla/UTC area. Reception and staff may be available. Complete ultrasound lab on site for scans or studies. Full-day or half-day timeslots.

For more information, call Irene at (619) 840-2400.

[154] NORTH COAST HEALTH CENTER, 477 EL CAMINO REAL, ENCINITAS, OFFICE SPACE TO SUBLEASE: Well-designed office space available, 2,100SF, at the 477-D Bldg. Occupied by Vascular & General Surgeons. Excellent and central location at this large medical center. Nice third-floor window views, all new exam tables, equipment, furniture, and hardwood floors. Full Ultrasound lab with tech on site, doubles as procedure room. Will sublease partial suite, one or two exam rooms, half or full day. Will consider subleasing the entire suite, totally furnished, if there is a larger group interest. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. [153] POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day

a week or more. Ideal for physician, chiropractor, massage therapist. Low rates. Email inquiries to kathysutton41@yahoo.com. [173] BUILD TO SUIT: 950SF 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 six gated parking spaces, two entryways, restrooms, lighted tower sign space. Build-out allowance to $10,000 for 4–5 year lease, rent $1,800 per month gross (no extras). Contact venk@cox.net or (619) 504-5830. [835] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: Two exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@ SDCMS.org for more information. [867] NONPHYSICIAN POSITIONS AVAILABLE ADMINISTRATIVE ASSISTANT NEEDED: Must be detailed-oriented. Know about credentialing.

Microsoft Excel, Word. Organizational skills a must.

Salary depends upon experience. Send resume to takur01@yahoo.com. [431] NURSE PRACTITIONER OR PHYSICIAN ASSISTANT: Looking for full-time nurse practitioner or physician assistant to see patients in various nursing homes. It can be salaried position (1099) or percentage of production depending on experience.

Average $100–$120 per hour. Flexible hours, choose your own days and time. Lots of upward potential for the right candidate. Please email guharoysd@ gmail.com or call (858) 430-6656. [424] FNP AND PA POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, 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. 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) 906-4591 or email ajameson@ fhcsd.org. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org.

[046b] EXPERT MA FOR SPORTS/ARTHRITIS REGENERATIVE MEDICINE PRACTICE: Seeking experienced MA (3 years +) to bridge our front and back offices. We are a female-led, sevenyear-old solo practice in Encinitas. Duties include processing patient paperwork, taking vitals and histories, entering data into EHR system, drawing blood, drawing up medications, processing orders, and ensuring a friendly, caring patient experience of excellence. BA/BS preferred; MA certification required. Attention to detail, sterile technique, and a sense of humor a must! Great compensation package, including pro growth stipend. Send your resume, salary history/requirements, and letter of interest (text pasted into the body of the email) to admin@feelboundless.com. [418]

CLINICAL TRIAL VOLUNTEERS NEEDED BIPOLAR DISORDER CLINICAL TRIAL VOLUNTEERS NEEDED: UCSD is conducting a longitudinal study on how inflammatory biomarkers and mood fluctuations among those diagnosed with bipolar disorder may be predicting factors to decline in their cognitive functioning over time. We are recruiting people between ages 35–60 who are diagnosed with Bipolar I Disorder. They must consent to three blood draws a year, clinical assessments, neurocognitive batteries, and use of smartphone.

There is monetary compensation for their participation. No medication is involved in this study. If you have any referrals or would like more information, please contact the study recruiter, Nana Kori, at nkori@ucsd.edu or at (858) 534-9439. [405]

At this time of giving thanks, SDCMS would like to thank our 2,895 practicing physician, 1,356 resident physician, 363 medical student, and 735 retired physician members for supporting the health and wellbeing of San Diego County’s 3.3 million residents.

Happy Thanksgiving, Everyone!

NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours.

Competitive compensation. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [038]

SAN DIEGO PHYSICIAN.org

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At this year’s CMA House of Delegates on Oct. 16–18, more than 500 physicians gathered from across California to set healthcare policy. Pictured are doctors, students, and staff from San Diego and Imperial counties.

For information on how you can get involved, contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

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San Diego & Imperial County Attendees: 1) Dustin Wailes, MD 2) Eileen Quintela, MD 3) Greg Balourdas, MD 4) Karrar Ali, DO 5) Michael Hann, MD 6) Marcella Wilson, MD 7) Jim Schultz, MD 8) Neelima Chu, MD 9) Holly Yang, MD 10) Steve Hayden, MD 11) Lase Ajayi, MD 12) Jim Hay, MD 13) Steve Poceta, MD 14) Kyle Edmonds, MD 15) Karl Steinberg, MD 16) Bob Wailes, MD 17) Sherry Franklin, MD 18) Robert Peters, MD 19) Al Ray, MD 20) David Bazzo, MD 21) Tom Gehring 22) Mark Sornson, MD 23) Mihir Parikh, MD 24) Steven Chen, MD 25) Kosala Samarasinghe, MD 26) Heidi Meyer, MD 27) Venu Prabaker, MD 28) Vimal Nanavati, MD 29) Wayne Sun, MD 30) Susan Kaweski, MD 31) Edwin Chen, MD 32) Will Tseng, MD 33) Ted Mazer, MD 34) Majid Mani, MD 35) Jen Ohmstede 36) Tom Savides, MD 37) Bob Hertzka, MD 38) Phil Kumar, MD 39) Michael Kramer 40) Beth Griffiths 41) Cecilia Bonaduce 42) David Li 43) Joseph Scherger, MD 44) Elizabeth Doyle 45) Nick Yphantides, MD 46) Tom Henderson 47) Michael Butera, MD

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