July 2016

official publication of SDCMS July 2016

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From San Diego Cardiologist Brian E. Jaski, MD

STAGE A

STAGE B

STAGE C

STAGE D

At high risk for HF but without structural heart disease or symptoms of HF

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Structural heart disease with prior or current symptoms

Advanced HF

Features: – Includes over 200 color figures and tables – Specific recommendations backed by clinical trial data – Practical algorithms for diagnosis and therapy Topics include: –New therapies: Entresto, ivabradine –Prevention of heart failure –Reversing decompensated heart failure – How to combine lifestyle changes, medications, and devices to improve outcomes – Indicators of advanced heart failure and appropriate treatment options – Outpatient pulmonary artery pressure-guided HF management –Heart transplant, LVAD

Brian E. Jaski, MD, FACC

Director of Clinical Research, San Diego Cardiac Center Medical Director, Advanced Heart Failure and Cardiac Transplant, Sharp Memorial Hospital, since 1985 Team Coach, Sharp Memorial Heart Transplant Recipients, 2012 San Diego Triple Crown 1/2 Marathon Finishers (third from left)

Available at cardiotextpublishing.com and Amazon in print or e-book editions.

SAN DIEGO PHYSICIAN.org

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Contents

Volume 103, Number 7

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: James Santiago Grisolía, MD • Mihir Parikh, MD • Robert E. Peters, MD, PhD • J. Steven Poceta, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: Mihir Y. Parikh, MD President-elect: Mark W. Sornson, MD Secretary: David E. J. Bazzo, MD Treasurer: James H. Schultz Jr., MD Immediate Past President: William T-C Tseng, MD, MPH (CMA Trustee)

features

16

Thank You, Dr. Tseng! SDCMS President for 2015–16

20

8

Welcome, Dr. Parikh! SDCMS President for 2016–17

GEOGRAPHIC and GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD (Alt) • Jay P. Mongiardo, MD • Venu Prabaker, MD • Kosala Samarasinghe, MD Hillcrest: Gregory M. Balourdas, MD • Kyle P. Edmonds, MD (Alt) • Thomas C. Lian, MD Kearny Mesa: Sergio R. Flores, MD (Board Rep) • 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 • 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: Maria Carriedo, MD (Alt) • Reno D. Tiangco, MD • Michael H. Verdolin, MD AT-LARGE and AT-LARGE ALTERNATE DIRECTORS Lase A. Ajayi, MD • Karrar H. Ali, DO, MPH • Steven L-W Chen, MD, MBA (Alt) • Stephen R. Hayden, MD • Vimal I. Nanavati, MD (Alt) • Alexexandra E. Page, MD • Robert E. Peters, MD, PhD (Alt) • Carl A. Powell, DO (Alt) • Peter O. Raudaskoski, MD • Albert Ray, MD (Alt) • Thomas J. Savides, MD • Karl E. Steinberg, MD (Alt) • Erin L. Whitaker, MD (Alt) • Marcella (Marci) M. Wilson, MD (Alt) • Holly B. Yang, MD (Board Rep) • Nicholas J. Yphantides, MD

22 June 4 SDCMS White Coat Gala: Photo Montage

departments

OTHER VOTING MEMBERS Communications Chair: J. Steven Poceta, MD Delegation Chair: Robert E. Peters, MD, PhD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Michael C. Hann, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: David Li

4

Briefly Noted: Calendar • Veteran Healthcare • Commercial Real Estate • History Thumbnails • And More …

8 Thank You, Jim, for Your Years of Dedicated Service to San Diego County’s Physicians

BY SAN DIEGO PHYSICIAN

12

Don’t Think You Can Be a Leader?

Think Again!

BY HELANE FRONEK, MD, FACP, FACPh

14

Know Your Source: Protect Your Patients and Your Practice From Unsafe Medications

28

BY SUSAN MARR, MSA, LHRM, CPHRM

OTHER NONVOTING MEMBERS Young Physician Alternate Director: Heidi M. Meyer, MD Resident Physician Alternate Director: Zachary T. Berman, MD Retired Physician Alternate Director: Mitsuo Tomita, MD SDCMS Foundation President: Albert Ray, MD (Delegation Vice Chair) (At-large AMA Delegate, Appointed by CMA) Delegation Chair: Robert E. Peters, MD, PhD CMA Speaker of the House: Theodore M. Mazer, MD (At-large AMA Delegate, Appointed by CMA) CMA Past Presidents: James T. Hay, MD (AMA Delegate) • Robert E. Hertzka, MD (Legislative Committee Chair, At-large AMA Delegate, Appointed by CMA) • Ralph R. Ocampo, MD CMA Trustee: Bob E. Wailes, MD AMA Alternate Delegate: Lisa S. Miller, MD

24

Practice Management Tip of the Month

Y THE CALIFORNIA MEDICAL B ASSOCIATION

26 Physician Marketplace: Classifieds 28

Just a Bit Ahead of Me in Line

BY DANIEL J. BRESSLER, MD, FACP

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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.]

J L L T R U S T

“ Over the last 30 years I have talked and interacted with a number of real estate brokers for a number of reasons. I truly felt that Chris Ross with the Healthcare Practice Group was the most knowledgeable and honest of any that I have dealt with. ” - Dr. Marty Thurston Find out more at sdmedicalrealestate.com

We build relationships.

SAN DIEGO PHYSICIAN.org

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/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// calendar SDCMS-CMA CALENDAR

For further information or to register for the following, contact Jen at (858) 300-2781 or at JOhmstede@ SDCMS.org.

Physician Networking Opportunity & Mixer (social) AUG 5: 5–8pm at 57 Degrees in Mission Hills

CMA House of Delegates (event) OCT 15–16 at the Sacramento Convention Center Remaining HOD Resolutions Schedule:

Event

Quarter 3

Quarter 4

Resolution Submission Deadline

April 21

July 8

30-day Testimony Period

May 20 – June 19

Aug. 5 – Sept. 4

Council Meetings

June 20–27

Sept. 5–12

Comment Period

June 28 – July 25

Sept. 13 – Oct. 10

Board of Trustees Meeting

July 29

Oct. 14

HEALTHCARE CONFERENCES

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.

2016 Heart Attack and Stroke Free Zone Summit JUL 27 at Paradise Point Resort & Spa 33rd Annual Primary Care Summer Conference AUG 5–7 at Loews Coronado Bay Resort

“

Fourth Annual Stroke Conference AUG 20 at the University of San Diego Joan B. Kroc Institute for Peace and Justice Keys to Physician Wellness: From Burnout to Professional Satisfaction AUG 24 at the Anaheim Marriott (Jointly Provided by the California Society of Addiction Medicine and the California Public Protection & Physician Health With CME Credits and NAMSS Accreditation) AMA House of Delegates Interim Meeting NOV 12–15 in Orlando, Florida

”

The way the inevitable came to pass was effort.

— Oliver Wendell Holmes Jr., American Jurist (1841–1935)

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VETERAN HEALTHCARE

Do You Take a Military History?

By Rosemarie Marshall Johnson, MD Fifty years ago we did not routinely ask our patients smoking and other addiction histories. Over time, obesity, nutrition and exercise, domestic violence, and the horrors inflicted on children became leading personal issues that have become routine inquires when taking a medical history.

PTSD, TBI, and their predecessor, “shell shock,” were sometimes recognized but early on were given scant credibility. Veterans with these conditions often came home to little sympathy, were often vilified, were given less than honorable discharges, and denied ranking positions in the civilian sector.

Because of continued global conflicts, we now face expanded responsibilities to care for our military as they reengage in civilian life. It is imperative that this new cohort of veterans has access to the remarkable advances in the practice of medicine, communication, technology, and research. Before we can use these tools, we must request a military history from each patient.

Without that simple inquiry, they might be denied diagnostic, preventive, and treatment modalities that we take great pride in having developed.

Being home to a large and rapidly increasing number of transitioning veterans and enlisted military in our community has resulted in growing numbers of patients who are frustrated and confused about their health situations and do not know where to get help. They get excellent care from overburdened health professionals but are drowning in stupefying and overwhelming medical troubles, victims of a lack of

knowledge and of coping methods.

To make matters worse, these health nightmares seriously afflict family and others related to the military patient.

This is where Physician Advocates for Veterans (PAVE) enters the picture.

About three years ago, my friend and colleague, Harvey Shapiro, MD, brought me the idea of Physician Advocates for Veterans. Together with a respected core of retired physicians and the umbrella support of the San Diego County Medical Society Foundation (Champions for Health), we created this unique volunteer organization in which a military veteran is paired with a retired physician advocate who answers their questions and teaches them how to take charge of their own health.

This is not the practice of medicine, but rather mentoring or navigating assistance pertinent to that particular veteran’s desires and needs. We have been fortunate to have the approval of the veteran hierarchy in San Diego and of many organizations dedicated to serving veterans in a myriad of ways. We are a member of the San Diego Veterans’ Council and the Veterans’ Council of North County. We work in parallel with the VA Medical Center, where we have been given a place to interview referred veterans. Our office is in the new 211 Connections Center, 3860 Calle Fortunada [info@ pave4vets.org, (858) 753-5784].

Besides reminding our practicing colleagues to take a military history, we encourage retired physicians to join PAVE for a rewarding encounter, guiding our veterans to PAVE for a truly life enhancing experience.

/////////////////////////////////////////////////////////////////////////////////////////////////// commercial real estate

San Diego Medical Office Snapshot | Q1 2016

By Chris Ross News, Facts, and Updates Healthcare Sale Transaction of the Quarter: The 31,522-square-foot medical office project at Lomas Santa Fe Medical Center (530 Loma Santa Fe Drive in Solana Beach) sold in March for $15.5 million (approximately $492 per SF). The building was 100% at the time of sale and was sold by a private group of physicians who occupy the building to private investor George Krikorian out of Los Angeles.

Lease Transaction of the Quarter: Children’s Primary Care Medical Group leased 8,715 square feet at Physicians Medical Center (7910 Frost Street) and will be consolidating and relocating its two offices from 3030 Children’s Way, which Rady Children’s Hospital is currently renovating.

By the Numbers

Market Conditions and Trends San Diego medical office demand persisted in the first quarter of 2016. Overall, direct vacancy increased slightly from 7.8% in the fourth quarter to 8.0% in the first quarter. However, vacancy in Class A medical office space continued its downward trend, decreasing by 50 basis points from the previous quarter to 6.1%.

Higher quality medical office space is becoming increasingly hard to find. Over the past six years, Class A medical office vacancy has dropped a whopping 81.7%.

While overall rental rates for medical office were flat on a year-over-year basis, Class A and B rates recorded minor increases of 1.5% and 0.7%, respectively. Average Class A rental rates are now only $0.03 off of the previous high-water mark of $3.45 per square foot, which was reached in 2007.

8.0%

Countywide Direct Vacancy

-50,321

Q1 Net Absorption (s.f.)

0.0%

12-month Rent Growth $2.68 s.f. Average Asking

206,680 Total Under Construction (s.f.)

Health System Event of the Quarter: Tri-City Medical Center has announced that it will be replacing former CEO Tim Moran with its former CFO, Steven Dietlin.

The new CEO’s salary is not yet clear and will be under a microscope as the hospital’s union, United Healthcare Workers West, has scrutinized hospital executive salaries and is working on a ballot initiative that would limit their pay to $250,000 per year.

New MOB Construction: Developers in Tijuana, Mexico, are planning to build a 26-story medical tower with an adjacent 140-room hotel. The tower will include doctors’ offices, a medical lab, and a surgery center in anticipation of drawing U.S. residents to lower-cost medical care such as bariatric surgery, plastic surgery, ophthalmology, and dental care. The project, called City Medical Plaza, is estimated to cost $50 million and is scheduled to open in 2019.

Mr. Ross is vice president of healthcare solutions for Jones Lang LaSalle. He is a commercial real estate broker specializing exclusively in medical office and healthcare properties in San Diego County. To receive the complete Q1 2016 report, call Mr. Ross at (858) 410-6377 or email him at chris.ross@am.jll.com SAN DIEGO PHYSICIAN.org

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/////////////Briefly /////////////////Noted ///////////////////////////////////////

TrusT

History Thumbnails

Rawson J. Pickard, MD

By Ralph R. Ocampo, MD

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I first met Dr. Rawson J. Pickard on grand rounds as a first-year surgical resident in 1960 at the San Diego County General Hospital. Pickard, a bespectacled, white-haired 78-year-old wearing a starched collar and cuffs, greeted me with a whimsical smile. He was born on May 18, 1882, in Loda, Ill. Pickard’s father was a respected Chicago banker and a collateral relative of Scottish economist Adam Smith. Rawson and his wife-to-be, Bertha “Bea” Riedesel, each received degrees from the University of Wisconsin in 1903. His came with a French major and hers in chemistry.

After finishing Northwestern University Medical School in 1906, he spent five years practicing in the Panama Canal Zone during the building of the Panama Canal. He and Bea moved to San Diego in 1915, where his mother was living, and later opened an office in the Watts Building at Fifth and E. He was the first clinical pathologist in San Diego and soon joined the U.S. Army as a captain in the medical corps during World War I. His last duty post was at Yale University.

Dr. Pickard became a professor of chemistry at San Diego State College and published an article on a microtechnique for blood sugar determination [JAMA. 1930:94(15):1134]. He served as chairman of the San Diego Zoo’s Research Council from 1932 to 1955. Getting started in medicine was a challenge in the 1920s and ’30s, so, after setting up his office, he held a weekly party at 5 p.m. for physician friends. It was spirited in more ways than one, even with prohibition in effect. He and fellowpathologist Tommy Thompson learned the technique for ether and chloroform anesthesia to supplement incomes that became even more meager during the Great Depression. His talents included painting (wench with a wrench), horticulture, wild mushroom expertise, and,

most famously, hundreds of pranks and practical jokes.

Rawson J. Pickard, MD, was a frequent contributor to the Medical Society Bulletin, the predecessor to this magazine.

In the 1920s he wrote about early relations with the San Diego Bar, as well as celebrating a nearly 10% census of women in U.S. medical schools! His most accomplished prank was the creation of famed scientist, the Honorable J. Fortescue, MD, PhD, LLD, in Tijuana’s Turf Bar. Leading a group of refugee physicians from “The Great American Drought,” Dr. Pickard helped found the International Board of Health. The Board obviously could not function without a president, so Dr. Pickard nominated the Hon. J. Fortescue, an eminent English jurist who died in 1476. A constitution was written with a requirement that anyone who attended one meeting would be a member for life.

On October 21, 1926, the secretary of the new organization, H. Marie Smythe (i.e., Pickard), wrote a letter in perfect French to the League of Nations requesting a formal charter. Fortescue was ultimately listed in San Diego and U.S. Who’s Who. “J. Fortescue” contacted the manager of the Aztec Brewery in San Diego saying that the International Board of Hygiene would evaluate their beer if they would send samples for testing. He then wrote a glowing report that was published on posters and on the largest billboards in town.

Dr. Pickard founded the pathology laboratory at St. Josephs (Scripps-Mercy) Hospital and the clinical lab at the County (UC San Diego) Hospital, and an amphitheater was named after him for a time at the Hillcrest UC San Diego Hospital.

He died on May 22, 1963, at 81 years of age. Pick’s wife, Bertha “Bea” Pickard, featured in a Union-Tribune article at age 98, said about her husband, “He didn’t tell jokes; he played them.”

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PHYSICIAN SOCIALS

You’re Invited to Attend Our August 5 Physician Social!

Please join your San Diego County physician colleagues at SDCMS’s next physician social on Friday, August 5 at 57 Degrees wine bar (1735 Hancock Street, San Diego 92101). Come mingle, socialize, and network with your colleagues, and be sure to bring your spouse / significant other. RSVPs are required, so register soon!

Services: Accounts Payable Auditing Billing Services Business Growth Contracting Credentialing Electronic Medical Record Executive Assistant Financial Management Information Management Operational Management Practice Assessment Practice Management Relocation Management Technological Advances

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THE DETAILS: WHO: Physicians, Spouses, Significant Others WHAT: Physician Social With Hors d’Oeuvres and Refreshments WHEN: Friday, August 5, 5–8pm WHERE: 57 Degrees Wine Bar COST: Free to Members, Spouses, Significant Others SPONSOR: Cooperative of American Physicians

RSVP: www.SDCMS.org QUESTIONS: Contact Jen at JOhmstede@SDCMS.org or at (858) 300-2781

A full-service consulting and outsourcing company dedicated to the healthcare industry.

Contact us today for your free consult!

858.256.0351 www.abs-sol.com

“think SDCMS FIRST!” Start by contacting SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

SAN DIEGO PHYSICIAN.org

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S D C M S S TA F F

Thank You, Jim

for Your Years of Dedicated Service to San Diego County’s Physicians

by San Diego Physician

Note: Jim Beaubeaux was interviewed for San Diego Physician on June 14, 2016.

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W

e could talk about his Jimbos, the slot cars he painted in the late ’60s and sold at local raceways, or the magic show he began at 16 and how he was widely known as San Diego’s foremost magician throughout the ’70s. We could talk about the small bookstore in Lemon Grove he acquired in ’78 and sold to a national business in ’95. We could talk about his 15 years as CFO with Lamb’s Players Theatre, whose budget he took from $500,000 to $4.5 million and whose staff he took from 10 to more than 50 … ¶ Or we could talk about his 12 years of dedicated service to the physicians and patients of San Diego County as, in addition to being CFO and COO of the San Diego County Medical Society, a member or board member or volunteer or chair or co-chair or founder or treasurer or CFO of the …

• SDCMS GERM Commission • SDCMS Emergency Medicine Oversight Commission • Community Health Improvement Partners (CHIP) board of directors/ Executive Partners Committee/ Steering Committee • San Diego Childhood Obesity Initiative Healthcare Domain • San Diego Community Health Needs Assessment Committee • Mental Health America San Diego • 211 Steering/Coalition/Health Navigator Committee • United Way San Diego Health Vision Committee • San Diegans for Healthcare Coverage • Alliance Healthcare Foundation • Health Services Advisory Board • Healthy San Diego Advisory board • Coordinated Care Initiative/Cal MediConnect Committee • County of San Diego’s Alzheimer’s Project • Health Advisory Committee on Threats • Health Resources and Services Administration Steering Committee • San Diego County Safety Net Funding Committee • Long-Term Care Integration Project • etc. etc. etc.

Or … we could mention his winning the “Outstanding Community Partner Recognition” for “exceptional contribution and commitment to CHIP and its mission,” his being selected as a finalist in the Lead San Diego Herb Klein Memorial Award for Exemplary Leadership, or the San Diego Business Journal’s awarding him “CFO of the Year” finalist in 2014, etc. etc. etc.

But let’s not.

Let’s talk instead about what he’s going to do next.

San Diego Physician: What’s the count down to today?

Jim: I come to the office only 10 more times … 10 more times.

San Diego Physician: You’ve been working for just shy of 50 years, and now you only have 10 days left. What’s going through your mind?

Jim: I’ve re-created myself four different times with four different careers, but this time is very different. It’ll be a challenge to discover who I am if I’m not a particular person in a particular position. It’s

exciting, but there’s also a lot of fear: Who will I be if I’m not the CFO, COO of the Medical Society?

San Diego Physician: What are you excited about?

Jim: The idea of owning nothing. My wife, Carmen, and I have sold our home and rental property. We’re debt free. We have nothing in storage anywhere; everything we own is in a truck and a 30-foot Airstream trailer. There’s an excitement in having that level of freedom, to be able to just go anywhere, anytime, with nothing to tie us down to one place.

San Diego Physician: When are you leaving?

Jim: July 15 is an all-day meeting for Alliance Healthcare Foundation; I’m on their program committee, and we’re going to give away a million dollar innovative grant that afternoon. I’m sticking around for that meeting, and then we’ll leave the morning of the 16th and just head north. We’ll visit friends, campsites, national forests, and parks.

San Diego Physician: How far can you or will you drive in one day?

Follow Jim and Carmen at LivingInBeauty.net.

SAN DIEGO PHYSICIAN.org

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S D C M S S TA F F

job. Why sell their property? Why live in a little trailer and travel with no particular agenda? She’s been talking about the excitement and adventure along with the problems, fear, and stress. The plan is to continue with the blog and share — at least weekly — what we’re doing, what we’re learning, what we’re seeing …

San Diego Physician: Since you’re not going to drive for longer than a day at a stretch, you’ll probably end up in northern California after you first take off?

Jim: The plan — and this is as far as we like to plan — is to drive no more than a day, and then to stay a week or two wherever we end up, enjoying the things the area has to offer. Then we’ll drive another day or so and do the same thing.

San Diego Physician: Is this a philosophy or just a plan?

Jim: There are different words out there to describe the concept, like purging … simplifying … pruning … clearing. A lot of this has been tantalizing America because of the popularity of the TV show Tiny House Nation. If you downsize your space, your needs will follow. We will be living in a 240-square-foot Airstream trailer that’s eight feet wide and 30 feet long.

Yes, it is a philosophy. We’ve been landlords for 20-some years, owned property for 41. We bought our first home when I was 20 and my wife was 18. The burden of all that just finally caught up with us, and we decided to simplify. We’ve been working on this plan for two years by slowly donating, gifting, or selling all of our possessions.

San Diego Physician: You’re going to keep a blog, yes?

Jim: My wife, Carmen, is a writer and voice actor. She wanted to create a journal to explain our philosophy and our transition to a spare, mobile lifestyle, so she created a blog called Living In Beauty.

She named the trailer Beauty, and the truck is called The Beast, so the blog is LivingInBeauty.net. She’s written over a dozen posts so far about why someone who didn’t need to retire would leave their

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Jim: That first day, we’ll swing by and see some friends in Corona and have dinner with them. Then we’ll keep going north.

We have some other friends in Sacramento, might swing by there. The next stop is to visit friends in Oregon, then more friends in Washington. Along the way we’ll see the national parks, unusual places, and stay in campsites.

San Diego Physician: Canada?

Jim: Oh yeah. We renewed our passports and we have friends in Calgary and Vancouver. Won’t go to Alaska probably till the summer of ’18 because the roads are so hard on your trailer that you need to go in groups. When you have problems — and you will have problems — the group environment helps out with repairs and stuff.

San Diego Physician: There’s no plan to finish?

Jim: No plan to finish; this is indefinite.

We originally talked about one year, then we said two years, then we said “this is indefinite” for as long as our interest and health hold out.

San Diego Physician: OK, I lied. Let’s talk briefly about your years at SDCMS. What are you proudest of having achieved at the Medical Society?

Jim: Tom Gehring, who retired as CEO at the end of last year, wanted to increase the awareness of the Medical Society among San Diego’s healthcare stakeholders. Tom and I both went out into the healthcare communities and represented physicians with one message and one message only: that physicians are not the problem, they are the solution to the healthcare challenges we face. The physician’s voice needs to be heard — that was the message we have given over the past decade.

Whether I was on Mental Health America’s board helping to create access

for mental health patients; or co-chairing the Childhood Obesity Healthcare Domain improving children’s health; or working with San Diegans for Healthcare Coverage to reach the uninsured; or with Alliance Healthcare Foundation financing innovative and mission-driven healthcare initiatives that serve the poor and disenfranchised; or chairing the Health Services Advisory Board helping the Board of Supervisors select priorities for healthcare in San Diego County, these hundreds of meetings were just a small part of what I did at SDCMS for the past 12 years. It would be way too much to discuss all of the different boards and committees I had the privilege to serve on, but one highlight was leading and chairing United Way of San Diego Health Vision Council to award $2 million for healthcare innovation to San Diego.

Probably the greatest thing I have accomplished in my 12 years at the Medical Society is raising the visibility and voice of San Diego County physicians, demonstrating that physicians are willing to participate and get down and dirty into lots of different stakeholders’ worlds to increase the health of San Diegans.

San Diego Physician: Are you ever going to come back to San Diego?

Jim: Because of my personal healthcare, my insurance is tied to San Diego County.

We’re not on Medicare yet (we’re too young), so we have to come back to San Diego if we need doctors. I’ve been here since 1954, so it’s kind of like home.

San Diego Physician: Is there anything in parting you’d like to say to the physicians?

Jim: I’ve always wanted to serve my community, and, of all of my careers, my work at SDCMS fulfills the dream of being able to witness the social impact of my efforts.

My hometown is a healthier place than it was 12 years ago, and our work at SDCMS is part of that legacy.

San Diego Physician: Other than just going to LivingInBeauty.net, can people subscribe in some way?

Jim: Yes. You can hit the Follow button to receive new posts as followers, or just stop in and visit whenever you want. Who knows where we’ll be a year from now?

The Grand Tetons? Maine? Prince Edward Island? Mazatlan? Not knowing your own next move, that’s our idea of a beautiful life.

PRESENTED BY:

THE DOCTORS INSURANCE AGENCY Bob DeSimone

P e r s o na l & P r o f e ss i o na l D e v e lo p m e nt

Don’t Think You Can Be a Leader?

Think Again!

by Helane Fronek, MD, FACP, FACPh

Healthcare is undergoing tremendous change, and our work is increasingly being monitored and dictated by nonphysicians. It’s one of the factors contributing to the rise in physician burnout. As our industry changes, physician voices are crucial. Physicians are the strongest advocates for our patients. Only we can create a culture that supports and fulfills physicians. Many of us are reticent to step up into leadership roles, believing we don’t have the necessary skills or knowledge and not wanting to take time away from other pursuits. It’s time to challenge our assumptions and broaden our vision of leadership so that more of our voices are heard.

We live in an extroverted culture, so many prominent leaders are loud, dynamic, and engaging. If we don’t see ourselves this way, we might believe we aren’t cut out for leadership. The truth is that extroverts can tend to dominate discussions. Recently, I sat in a board meeting where the extroverted president and vice president carried on a prolonged dialogue. The organization spent thousands of dollars bringing in its directors; none were encouraged to contribute.

Introverts tend to ask more questions and allow more room for others to be heard. This expands the pool of ideas and possibilities, frequently resulting in even better outcomes.

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If you are passionate about the future of medicine, we need you to step forward and add your voice to the discussion.

As a new leader, we might fear that we don’t know enough. It’s important to remember that leadership requires a different skill set than actually doing the work. If we approach leadership believing we know everything, we’re less likely to ask questions or challenge the status quo. If we realize that others may know things

we don’t know, we bring a “beginner’s mind” that encourages discussion and creativity. We’re more likely to take advantage of what each person brings to the effort and create a richer and more representative product.

Many of us feel as if we’re struggling to maintain a sense of balance in our lives. We wonder how we can add yet another

meeting or responsibility to our already overfilled plates. And we fear that if we prioritize our family or other activities in our leadership role, we’ll be seen as less committed. In fact, we all need balance in our lives.

When we create boundaries, we tell our team that we appreciate their need to have a life as well. We create a culture that is healthier and sustainable. We show others that they can participate and make a difference too, while still having a fulfilling life outside of work.

We all have assumptions about what it means to be a leader, and whether we have what it takes to be one. If you are passionate about the future of medicine, we need you to step forward and add your voice to the discussion. It’s the only way we can create a culture that protects our patients and honors our need to practice medicine in a way that is fulfilling and sustainable.

Dr. Fronek, SDCMSCMA 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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R i s k Manag e m e nt

Know Your Source Protect Your Patients and Your Practice From Unsafe Medications by Susan Marr, MSA, LHRM, CPHRM

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May 2016 july 2016

The United States has one of the safest drug and medication supply systems in the world, in part due to careful regulation in the face of globalization and increasing threats to the supply chain. However, according to the FDA, there is a growing network of rogue wholesale drug distributors selling potentially unsafe drugs in the U.S. market. To combat this threat, the FDA has launched the Know Your Source campaign (www.fda.gov/Drugs/ResourcesForYou/ HealthProfessionals/ucm389121.htm) to ensure physicians are aware of the problem and to help them play their part in protecting the integrity of the U.S. drug supply chain. In addition, the FDA is participating in a collaborative initiative targeting drug safety on a global level.

While any specialty could be at risk, most of the counterfeit drugs in the United States targeted to physicians are expensive medicines, and the targeted specialties are often oncology, dermatology, plastic surgery, and dentistry.

Dangerous Drugs in the Supply System How real is the threat? There have already been cases where adulterated, diverted, stolen, unapproved, or counterfeit drugs made their way into the American drug supply system. Counterfeit Avastin made it into the United States in 2012. Altuzan, a non-FDAapproved drug equivalent to Avastin but only approved to be sold in Turkey, arrived in the country in a counterfeit form in 2013.

In 2012 and 2015, counterfeit Botox was found in the United States. The FDA has indicated that anti-depressants, hormone replacement therapies, sleep aids, cholesterol medications, and seizure medications are reaching the United States as well.

What does this mean for patients? They may receive a medication containing harmful ingredients, or they may receive medications containing no active ingredients at all. Issues include the purity of the medication, whether harmful ingredients have been added, or whether it contains active ingredients. In addition, many drugs must be stored and transported within specific temperature guidelines in order to maintain effectiveness — and rogue distributors do not follow these precautions.

In certain parts of the world, counterfeit or substandard antimalarial drugs constitute one-third of the supply. The result is a malaria patient population that may not be receiving lifesaving treatment. Additionally, the counterfeit drug creates a situation in which the parasites become resistant to the real medications. Fortunately, the FDA has found a solution to this problem and is sharing that solution globally (www.fda. gov/ForConsumers/ConsumerUpdates/ ucm349110.htm).

Guide Patients to Safe Websites Rogue distributors have expanded their efforts to advertise FDA-approved prescription drugs on unofficial websites with familiar-sounding names. The clear intent is to fool patients into thinking they are dealing with trusted entities. In addition to health risks, patients who order from these websites are at risk of credit card fraud and

identify theft.

Commonly ordered medications on these sites are: • Avandaryl (a non-FDA-approved Glimepiride) • Non-FDA-approved Generic Celebrex • Levitra Super Force, a non-FDAapproved medication to treat erectile dysfunction The FDA has cooperated with Interpol to place a warning on such sites, but physicians are encouraged to educate their patients about the risks of these websites.

Direct patients to the FDA’s resource for safe pharmacies: BeSafeRx: Know Your Online Pharmacy (www.fda.gov/Drugs/ ResourcesForYou/Consumers/BuyingUsingMedicineSafely/BuyingMedicinesOvertheInternet/BeSafeRxKnowYourOnlinePharmacy/default.htm).

What Doctors Should Do Which doctors are the main targets? While any specialty could be at risk, most of the counterfeit drugs in the United States targeted to physicians are expensive medicines, and the targeted specialties are often oncology, dermatology, plastic surgery, and dentistry.

Regardless of your specialty, these tips can help ensure that your practice is ordering safe medications: • In situations where there is a medication in short supply, the FDA may authorize limited importation of such medications from approved international suppliers.

When that occurs, information will be available on the FDA drug shortages website (www.accessdata.fda.gov/ scripts/drugshortages/).

• Beware of email blasts and faxes that advertise the option of buying expensive medications at a discount. Remember the adage, “If it sounds too good to be true, it probably is.”

• Emphasize to staff — especially those in charge of ordering medications for patients — that it is illegal and ill-advised to buy medications and drugs from outside the United States. The FDA is often aware of practices that order drugs

from outside the United States and may initiate contact with the practice in order to educate employees. The FDA’s involvement may also trigger contact from a state’s board of medicine.

• “Know Your Source” means know that a supplier of drugs and medications is legitimate. Practices can verify this through the FDA (www.fda.gov/Drugs/ DrugSafety/DrugIntegrityandSupplyChainSecurity/ucm281446.htm).

Select a state and click on the link to the agency that can verify that the supplier is legitimate. Once you’ve verified a supplier, rechecking once a year is sufficient — as long as there are no changes in the name, address, and other information from the supplier.

• Keep the “pedigree sheets” that are shipped with the product. Under federal law, they should contain: »» proprietary and established name of the drug »» dosage »» container size »» number of containers »» lot or control numbers »» business name and address of all parties to each prior transaction involving the drug, starting with the manufacturer »» the date of each prior transaction • Keep a log of drugs and medicines ordered, the supplier information, and when the legitimacy of the supplier was checked.

• Be sensitive to any complaints by patients that might indicate there is a problem with the integrity of a product.

The FDA also has extensive information on its website about protecting the U.S. drug supply chain (www.fda.gov/Drugs/DrugSafety/DrugIntegrityandSupplyChainSecurity/).

Ms. Marr is senior patient safety risk manager for SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors. com/patientsafety.

SAN DIEGO PHYSICIAN.org

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SDCMS LEADERSHIP

Left: Senator Marty Block and Assemblymember Lorena Gonzalez recognizing Dr. Will Tseng.

Below: Dr. Tseng and his wife, Angela Shiau.

Thank you, Dr. Tseng!

SDCMS President for 2015–16 The following is immediate past president Dr. Will Tseng’s speech given at SDCMS’s June 4 White Coat Gala.

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hank you all for celebrating with us tonight and for supporting our San Diego County Medical Society!

To my colleagues and partners at Southern California Permanente Medical Group: Dr Bernstein, my medical director, thank you for your strong membership support and for making our Champions for Health programs, such as Project Access and Super Surgery Saturdays, so successful year after year; Dr. Al Ray and Dr. Stony Anderson, thank you for your leadership at SCPMG and in the community — you were an inspiration even before I needed bifocals.

What an amazing year it’s been for me as president of our Medical Society! Everyone looks happy to be here, celebrating … undoubtedly for my farewell?!

Truth be told, a few board members did approach me about a second term as president. But, frankly, I miss having normal conversations with people. Instead of a friendly “Hello” or “How’s the family?” I get interrogated: “What are you doing with our membership money?” I get demands: “When is the next party?!” Otherwise, I am seen as the debt collector: “I’ll pay my dues soon! I promise!”

After tonight, I am looking forward to

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singing a different tune, from “Hello, is it me you’re looking for?” to “Hello, from the other side.” Regardless, I am happy to be stepping down on a high note. If you will, allow me to highlight some of our achievements during this past year.

First of all, not to toot my own horn, but did you all know that, as your president, I made a positive impact on our economy by lowering California’s unemployment rate?!

Yes, many are thankful, and I take credit for being the president to hire our new CEO, Mr. Paul Hegyi. Welcome Paul! Thank you for joining us, Paul. With your fancy MBA from USC, we can expect bigger budgets every year, right? Including galas?

As you all know, it takes strategic planning and extensive, coordinated efforts to usher in a new CEO. Thank you, Dr. Steve Poceta, for your vision and perseverance. I will miss your calls in the morning, afternoon, and the evening ... NOT!!!! Steve, we can both let go now ... I am serious about that ICD 10 code with your name on it.

Dr. Bob Wailes, Dustin Corcoran, Dr. Ted Mazer, Dr. Bob Hertzka, and Roxana, thank you for all your 3 a.m. consults — whether personal, political, or legal — throughout this year. I am grateful to be able to lean on the shoulders of our Medical Society’s institutional giants to be able to accomplish some of the things I had promised to do: 1. Preserve the quality and integrity of

our profession; 2. Promote education and outreach; 3. Protect and strengthen our Medical Society.

I am happy to report that we have made progress in all the above areas, and the state of our Medical Society remains strong.

In the area of preserving the quality and integrity of our profession: Routinely, we visit Sacramento to touch base with our legislators and to closely monitor scopeof-practice issues concerning healthcare quality. Under Dr. Hertzka’s guidance, we involve eager and inquisitive medical students in the advocacy process to ensure that values of our profession will be preserved for generations to come.

Tonight, I am humbled by the senators and assemblymembers who have honored me with a service plaque. Thank you, Senators Marty Block, Joel Anderson, and Ben Hueso. Thank you Assemblymembers Toni Atkins, Lorena Gonzalez, Brian Maienschein, and Shirley Weber. Thank you for your leadership on funding Medi-Cal, on AB 2121 to reduce drunk driving, and on supporting the cigarette tax. You exemplify our Champions for Health in San Diego.

In the area of health promotion, education, and outreach: We have been working with our foundation, Champions for Health, to reach out to local churches and schools and business communities to educate the public on health topics and healthy living. We participated with the County in Live Well San Diego’s Love Your Heart Day where over 31,000 blood pressure screenings were performed at 152 sites by more than 90 organizations. We are also working closely with the County on the Alzheimer’s Project where world-class researchers, healthcare innovators, and community leaders fight the growing epidemic of Alzheimer’s disease.

Lastly, in the area of strengthening our Medical Society: I leave you with a highpowered new CEO, with a new direction and new goals. I leave you with a savvier and more astute eye doctor with perfect vision!

What more can I say? Does everyone know that Dr. Parikh is a doctor for the Chargers?

Yes! We can count on him to always have his eyes on the ball! I am thrilled to highlight that the state of the Medical Society is stronger than ever; and, as promised, I am delivering the Medical Society in good hands.

Mihir, here are my coveted keys to the corner office, but don’t say I didn’t warn you. It’s still too dark in the corner office at 7 a.m. for meetings.

Finally, thank you for the privilege to serve as your SDCMS president. Now tweet someone else at six in the morning!

WILL OUT (keys dropped)!

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SDCMS LEADERSHIP

Welcome, Dr. Parikh!

SDCMS President for 2016–17 The following is incoming president Dr. Mihir Parikh’s speech given at SDCMS’s June 4 White Coat Gala.

T

hank you.

Exciting times. It is time for us, as doctors, as the San Diego County Medical Society, as the California Medical Association, to make some noise! As I am learning from watching our presidential candidates, sometimes you need to organize a revolution to make an impact.

So clearly there are big changes, maybe even huge changes, coming our way starting with the California primaries this Tuesday, June 7, and then eventually electing a new president of the United States in five months on Tuesday, November 8. However, I’ll assume everyone in this crowd has already mailed in their ballot. But, on a local level, I don’t anticipate the changing of our presidency at the San Diego County Medical Society between Dr. Will Tseng and me to be quite as dramatic. Just to compare us a little bit: Will is clearly Asian; I was Caucasian or “White American” when I applied for medical school in 1990, but, after the change in U.S. Census rules 10 years later, I am now Asian also. I am the first Asian-IndianAmerican president in the Medical Society’s 146-year history. We have our South Asian Physicians of Indian origin (SAPI) group here. My wife and I are both lifetime members as well, since 2000. Dr. Tseng wears trendy eyeglasses — I don’t. Actually, I make a living getting rid of them for people. Will, we need to line up better on that; we should talk later.

To borrow a phrase from our former SDCMS and CMA president, Dr. Jim Hay, “Behind every solid president, there is a powerful speaker of the house.” Angela, Will’s beautiful, smiling, intelligent wife, on behalf of the SDCMS board of directors, we thank you for teaching Will how to use the gavel so well in his presidency year. We all know the strong role that you play in Will’s success, and we thank you for all of your support. My speaker of the house — my amazing wife and my best friend, my 5 a.m. gym partner — we have been married now for 21 years, and she still gets carded when we go out. Thank you for your speech earlier tonight and for being not just a regular Top

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july 2016

Doc but Top Mom to our two wonderful, superstar kids, Nathan and Karina. My wife’s parents are also present; 21 years might seem like a long time, but her parents are celebrating their 50th wedding anniversary next week. And to my parents, who I am eternally grateful to for all of the sacrifices they made so that I could live such a blessed life, they celebrate their 50th wedding anniversary next year on Christmas Day. So, where was I? Will is the president of the Professional Staff of Southern California Permanente Medical Group. Kaiser and Southern California Permanente Medical Group represent a rising healthcare giant here in San Diego and California and throughout the United States. I am one of the chief surgeons of a very solid company called NVISION. We have 29 offices and surgery centers, primarily in California but also in nearby states, and we most recently opened an office in Toronto, Canada. The president of NVISION, Mr. James Peraya, executive director John Brunsell, and clinical director Steve Peterson are here tonight.

NVISION’s founding surgeon was not able to make it; however, Dr. Tooma and I and two other NVISION surgeons, along with my wife, as a GYN doc, and families are all traveling to Fiji later this month on a

mission for cataract surgeries. NVISION is a medical company held by surgeons, operated by surgeons serving our patients. It’s a different model than Will’s, but this is what makes it such an exciting time. We can have different healthcare models working side by side in the same community, and everyone can prosper. This is the United States of America, and regardless of our ethnic descent or what we call ourselves — solo, medium-, large-group doc or academic doc — we can all participate in the mixed market that makes up U.S. healthcare, and I am very happy to be here today.

But what makes me excited?

Technology and medicine are rapidly converging, and that synergy could and should be allowing physicians and patients to truly enjoy the “golden age of healthcare.”

In my ophthalmology world, for example, we have been doing LASIK since the 1990s.

My first LASIK case was in 1997. I had my own procedure in the Flintstone era … about 1999. It was good then — I see just fine — but it is really primed now. Add in the lens implant technology we use after cataract removal, and we can make patients pretty much glasses-independent for life. I am involved in a few FDA clinical trials for approval of medical and surgical assist products — the future has never been brighter for technology and medicine.

If we turn our attention to the regenera-

Above: Dr. Parikh at the podium. Top Right (L–R): Nathan Parikh, Karishma Parikh, Karina Parikh, Nirav Parikh, Kavita Parikh, Yogesh Parikh, Bharti Parikh, Keerti Gurushanthaiah, Mihir Parikh, Mangala Gurushanthaiah, Gunjiganur Gurushanthaiah, and Nishan Parikh.

Bottom Right (L–R): Nathan Parikh, Yogesh Parikh, Bharti Parikh, and Karina Parikh

tive power of stem cells, it gets even more incredible. For example, jaw-dropping work by Dr. Zhang’s team here at the Shiley Eye Institute at UC San Diego Health and colleagues in China was published in the March 2016 issue of Nature. Basically, they were able to remove a cataract, and, instead of replacing it with a lens implant, they kept the person’s own lens epithelial stem cells in the eye, and those cells regenerated a new, natural, fully functional lens. This was successfully replicated in 12 pediatric patients. This is an absolute game-changer, and it will be fun to watch as they scale up their surgeries and start applying to other populations of patients.

This technology-medicine overlap applies to all fields of medicine. We are seeing new products in cardiology, cancer treatments, and designer drugs based on a person’s genetic code. For doctors and patients alike, there is so much promise in healthcare. It is really exciting!

But as technology becomes more mainstream, so does the sheer volume and availability of electronic information. All of my patients now get at least two opinions: mine and Dr. Google’s — and not necessarily in that order.

Dr. Eric Topol, an internationally renowned cardiologist and director of the Scripps Translational Science Institute here in La Jolla, recently authored a book titled The Patient Will See You Now. Topol discusses the merging of science, technology, and society through the eyes of the consumer, and the big changes it will mean for healthcare. Empowering patients and increasing physician access is upon us now.

Gone are the days of merely giving out your emails and cell phones. Thanks to companies like Doctible — of which I am in the advisory board, and whose co-founder, Ajit Viswanathan, is here tonight — patients can go online, see what our internet reputation is, book an appointment at the exact time they want to be seen, and they expect to be seen on time, or Yelp and the rest of San Diego will soon hear all about it. But in the name of improved efficiency, are patients getting better healthcare? Telemedicine is an emerging frontier in medicine, and, as physicians, we need to have a strong voice on how to deliver healthcare in this space.

Individually, we do not have that voice, but as an organized group we can and we must!

If we cannot control when a patient comes into our office, then we doctors are now just pawns in the healthcare system.

There is also an obvious second reality. We as a society need to put healthcare

spending on a diet. As of December 2015, healthcare spending represented 17.5% of the U.S. GDP, which averages out to almost $10,000 per person. 17.5% represents the highest percentage spending for GDP in the world. About 45% of California’s population has private, employer–sponsored health coverage, and about 40% of California has public or government insurance (i.e., Medicare or Medi-Cal). As you have been reading in the headlines, private insurance premiums will be rapidly rising next year with the anticipated announcement coming in July, and the public insurances, if we stay on the same course, are projected to be insolvent — Medicare in 2030, and Medi-Cal is a budget crusher.

Even though physician services make up only 20% or less of the total healthcare cost, it’s the payment to the doctors that everyone wants to reduce. Restrict the technologies we can use, limit the medications we can prescribe, create barriers on who can have surgery, allow less experienced and less trained healthcare extenders to play doctor. Instead of the KISS (Keep It Simple Stupid) principle, we get the SLAPICD10, Meaningless Use for EMR, MACRA, MIPS, Alternative Payment Methods, Audits, Utilization Reviews, it’s endless. One doctor here tonight told me their hospital has pajama parties where the doctors go home, change into their pajamas, and work on their EMR charts because they couldn’t finish them during normal business hours.

How is this leveraging technology and improving healthcare?

Using Dr. Bob Hertzka’s words, “Are doctors part of the problem or part of the solution?” As an organized body, we must change the perception and become part of the solution. The Medical Society needs to make a forceful impact on this issue specifically, and, as the incoming president, that is what I hope to do this year.

Our SDCMS — led by Dr. Ted Mazer and many others over a very exhaustive 14-year process — was able to get every San Diego County doctor a pay raise starting January 1, 2017. Have you heard of the GPCI fix? The Geographic Practice Cost Index had San Diego County listed as a rural county and its physicians paid as rural physicians. Maybe in the 1960s when it was first designed, that was true. In 1996, when they reevaluated the indexes, they left San Diego as a rural county, which is obviously unfair since we are one of the 10 largest cities in the United States, and we have an NFL football team too. Rural designation means lower cost to practice

medicine. Thus doctors need less money for expenses, and so are paid less compared to doctors, for example, in Orange County, doing the same tasks. The GPCI fix for us goes into effect at the start of 2017 — that is a big win for organized medicine. Thank you, Ted, and all of the people involved in making such a significant impact — every San Diego County doctor and every one of their patients will be a benefactor of that battle.

Now, as doctors, we all need to get behind the ballot measure this November to increase the tax on tobacco and electronic cigarettes by $2. Increasing the tax will decrease consumption and deter our youngest patients from becoming addicted to nicotine and smoking. Our own Dustin Corcoran at CMA is taking a lead role in this fight, and the house of medicine is taking the tobacco industry head on, and it’s about time! You want a solution to the problems that tobacco causes? How about stop smoking and discourage the young from ever starting? Plus, the money from the taxation goes toward increasing MediCal reimbursements, which we desperately need! That is making an impact!

As Jim Floros discussed, we need to partner with others in the community who are also helping patients. Food insecurity is as much a healthcare concern as it is part of the poverty cycle. Doctors as healthcare leaders should be involved in identifying food-insecure patients and then working with a coalition network so these hungry patients can gain access to food. When we work with our partners, side by side, all of our organizations will grow and become stronger. As Steve Kerr, San Diego resident and coach of the NBA champion Golden State Warriors, tells his team, “Strength in numbers.” Our partners will understand how important it is to have MDs on the team when we join the team. And then when non-MDs advocate for us, the physicians, then we truly made an impact.

We need to make healthcare great again!

Although, thankfully, this is not a fouryear term, I am determined to make an impact in one year, and I need all of your help. Strength in numbers to get our message out: Let Doctors Be Doctors!

Thank you everyone for coming out tonight. Thank you, Dr. Bob Hertzka, for doing a wonderful job emceeing the event, and the SDCMS staff for organizing another fantastic White Coat Gala! I look forward to spending a little time with all of you at the after-dinner event.

Thank you.

SAN DIEGO PHYSICIAN.org

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June 4 SDCMS

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White Coat Gala Photo Montage 1

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1. Medical students David Li and Abhishek Kumar. 2. SDCMS Presidential Atlas Award winner Dr. Stony Anderson. 3. Dr. Karrar Ali and his wife, Sherry Nooravi, PsyD. 4. Dustin Corcoran, speaking during the evening’s program. 5. L–R: Dr. Bob Hertzka, Dr. Ted Mazer, Dr. Mihir Parikh, Congressman Scott Peters, Dr. Bob Wailes, and Dr. Jim Hay. 6. Dr. Mark Sornson and his wife, Dr. Caroline Thornton.

7. Dr. Marci Wilson (left) and her partner, Dr. Donna Mills. 8. Dr. Keerti Gurushanthaian, speaking on behalf of Champions for Health during the program. 9. Dr. Sergio Flores and his wife, Tina.

10. Standing (L–R): Dr. Alexe Page, Rogert Fogerson, Barbara Mandel, Michael Goldman, Genevieve and Scott Leggett. Seated (L–R): Shelley Schultz, Dr. Jim Schultz, Tricia Hay, and Dr. Jim Hay. 11. Paul Hegyi, winner of the 50/50 Raffle; Paul donated his winnings to Champions for Health. 12. SDCMS Presidents (L–R): Dr. Bob Hertzka, Dr. Bob Peters, Dr. Ted Mazer, Dr. Bob Wailes, Dr. Sherry Franklin, Dr. Will Tseng, Dr. Steve Poceta, Dr. Jim Hay, Dr. Al Ray, Dr. Susan Kaweski, and Dr. Ralph Ocampo.

13. James Floros, CEO of the San Diego Food Bank, speaking during the program. 14. L–R: Dustin Corcoran, Speaker Emeritus Toni Atkins, Dr. Jim Hay and his wife, Tricia. 15. 50/50 Raffle 16. Dr. Tom Lian and his wife, Terrie Litwin.

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CALIFORNIA MEDICAL ASSOCIATION

PRACTICE MANAGEMENT:

TIP OF THE MONTH

JuLy

Don’t forget: All California physicians with DEA certificates must submit their CURES registration applications by July 1, 2016.

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Through its robust webinar series, CMA gives you the opportunity to watch live presentations on important topics from the comfort WEBINARS • SEMINARS • PODCASTS • AND MORE of your home or office. Webinars are free to members and their staff and provide timely information to help you run a successful medical DID YOU KNOW? practice.

Check out the current webinar schedule at www.cmanet.org/webinars.

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Meet Your Advocate: Mitzi Young

Mitzi is a physician advocate in CMA’s Center for Economic Services. She has spent more than 20 years in health care settings, including county organized health programs, surgery centers and specialty health care practices, and brings a variety of skills suited to help CMA members tackle their practice management questions.

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Mitzi Young, Physician Advocate, CMA Center for Economic Services TO OPT OUT OF FUTURE NOTICES, EMAIL MEMBERSERVICE@CMANET.ORG OR FAX (916) 551-2036. BE SURE TO INCLUDE THE FAX NUMBER YOU WANT REMOVED.

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classifieds PHYSICIAN POSITIONS AVAILABLE LOOKING FOR PULMONOLOGIST OR INTERNIST: Established practice of pulmonary / sleep and worker’s comp looking for associate (pulmonologist or internist) to join and inherit practice in beautiful office in La jolla. Call (858) 581-0400 and speak to Dr. Vevaina for details — or email jrvevaina@yahoo.com. [509] CLINICAL RESEARCH PHYSICIAN WANTED: Profil Institute for Clinical Research, Inc., is an early phase clinical research organization and innovator of research methodologies for diabetes and obesity. We are seeking a physician who will provide medical leadership, oversight, and management of human clinical trials while ensuring the integrity of the studies and the safety and wellbeing of human subjects. Must have current unrestricted license to practice medicine in the State of California. Experience in clinical trials and/or drug development preferred. For more information and to apply, please visit our website at www.profilinstitute.com/careers/career-opportunities. [507] SDSU IS LOOKING TO FILL ONE FULL-TIME OR UP TO TWO PART-TIME PSYCHIATRIST POSITIONS FOR OUR STUDENT HEALTH SERVICES: A practice here provides the opportunity to make a difference in the lives of young scholars.

Collaborate with primary care providers, psychologists, and disability specialists. Engage in opportunities to participate in a variety of research activities. SDSU is an equal opportunity employer and does not discriminate against persons on the basis of race, religion, national origin, sexual orientation, gender, gender identity and expression, marital status, age, disability, pregnancy, medical condition, or covered veteran status. Apply on SDSU website at hr.sdsu.edu/employment/staffjobs.htm. [504] HIRING PHYSICIANS, NPs, AND PAs: Clinicas de Salud del Pueblo, Inc., is hiring Californialicensed physicians, nurse practitioners, and physician assistants. We are a successful and longstanding nonprofit organization that offers a full range of benefits, including excellent and competitive compensation. Our current need is to serve patients that live in the following communities: Blythe, Brawley, Calexico, Indio, and Mecca.

It would be wonderful to hear from you. Please email us at work@cdsdp.org or call us at (760) 344-9951, ext. 120 or 121. [502] SEEKING FAMILY MEDICINE PHYSICIANS: Graybill Medical Group, an independent physician group of 80 + physicians, is seeking full-time BC/ BE family medicine physicians for its offices in Escondido, San Marcos, and Ramona. We offer a competitive compensation package and shareholder opportunity. Please send CV to Jackie Craw, Director Human Resources, via fax at (760) 738-7101 or via email at humanresources@graybill.org. [499] SEEKING CARDIOLOGISTS: Graybill Medical Group is seeking full-time interventional cardiologists and non-invasive cardiologists for its Escondido office. We have a significant patient base and offer competitive compensation packages.

Please send CV to Jackie Craw, Director Human Resources, via fax at (760) 738-7101 or via email at humanresources@graybill.org. [498] FULL- AND PART-TIME FAMILY MEDICINE PHYSICIAN POSITIONS: North County Health

Services (NCHS) • Job Title: Family Medicine Physician • Location: Multiple Locations • Job Status: Full Time and Part Time. We have several open family medicine physician positions. Must have active California state license (MD/DO), CPR, board certified or board eligible. Full benefits package, malpractice liability insurance included, CME allowance, and license reimbursement. NCHS is proud to be an equal opportunity workplace and is an affirmative action employer. Contact Araceli Mercado, www.nchs-health.org, araceli.mercado@nchs-health.org, (760) 736-6780. [497] PRIVATE PRACTICE IM/FP OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO GOUNTY: Unique opportunity to enjoy outpatient medicine in a premier private practice setting. Practice is part of a well-established internal medicine group with 30-plus-year history of outstanding care in the community. Exceptional office staff, flexible scheduling options, small-group environment, and very high quality patient care set this far apart from many other situations. Office is easily accessible from all parts of San Diego County.

Interested in board-certified IM or FP applicants with EHR experience. Please email CV to portofino3@aol.com or call (619) 248-2324. [462] PER DIEM PHYSICIANS NEEDED: The County of San Diego Health and Human Services Agency is seeking physicians to work in sexually transmitted diseases (STD) clinics located in Old Town / Point Loma, City Heights, Chula Vista, and Oceanside.

Applicants (MD or DO) must hold a current California medical license. Board certification in internal medicine, family medicine, or preventive medicine is desired but not required. Applicants must be comfortable discussing sexual health and working with diverse patient populations, and willing to work a minimum of three days per week. If interested, please email CV to winston.tilghman@ sdcounty.ca.gov or call (619) 692 8394. [496] PRIMARY CARE POSITION: San Diego area.

Outpatient only. No calls. No hospital and no weekends. Email sandiegoprimarycare@yahoo. com. [495] FULL OR PART-TIME BC/BE DERMATOLOGIST TO JOIN OUR TEAM: Two employment opportunities with a premier dermatology practice. One position to cover our Oceanside / Escondido / Murrieta locations, and a second separate position to cover our Murrieta / Temecula locations.

Full or part-time BC/BE dermatologist to join our team. This is a busy, eight physician, three physician assistants, and seven office practice. Dermatology Specialists is well established in the local communities with a wide referral base and good patient mix. Candidate will have the flexibility of practicing general, surgical, and cosmetic dermatology. This is an excellent opportunity for a physician who is team oriented, motivated, enthusiastic, and caring to join a well-established, busy, and stable practice. We offer a generous base salary plus production incentive and benefits. This is a practice opportunity without the hassle of managing and partnership obligations. If you are interested in finding out more information concerning employment opportunities with Dermatology Specialists, Inc., please forward your CV to Jane Lisk, administrator, via fax at (760) 828-9140, via email at dsioceanside@aol.com, or call (760) 8289129. [494] SHARED PARTNERSHIP PRACTICE: Seeking internal medicine physician to join a shared-expense private practice partnership in Vista, California. Wonderful opportunity to join a well-established internal medicine group that has a history of over 30 years of outstanding care in the com-

munity. Established EMR system and exceptional office staff. CA license, board-certified IM physicians should send CV to dene@ncim.sdcoxmail. com or call Dene at (760) 726-2180. [492] PART-TIME URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a part-time physician. Flexible hours, strong staff, and good compensation (based on experience).

Please send CV to jeff@eastcountyurgentcare. com. [474] SEEKING A FOOT/ANKLE SPECIALIST: Well-established, highly respected, four-physician group, private practice in San Diego seeking a foot/ankle specialist. Our group is expanding to meet high volume of cases and planned expansion. Potential opportunity for any established subspecialist looking for a permanent practice location. We have a broad-based primary care referral base, mature EHR, digital X-ray, ultrasound, and DME program. Interested parties, please email your CV in confidence to lisas@sdsm.net. [461] SEEKING EMERGENCY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multispecialty group in San Diego, is seeking full-time BC/BE emergency medicine physicians to join our urgent care staff. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101.

Fax (619) 233-4730. Email lori.miller@sharp.com.

[459] SEEKING FAMILY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multi-specialty group in San Diego, is seeking full-time BC/BE family medicine physicians for the South Bay. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email lori. miller@sharp.com. [458] SEEKING INTERNAL MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multi-specialty group in San Diego, is seeking full-time BC/BE internal medicine physicians for the South Bay. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email lori. miller@sharp.com. [457] 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) 9925330 or email CV to drhunt@thehousecalldocs. com. Visit www.thehousecalldocs.com. [037] PHYSICIANS NEEDED: Family medicine and pediatric physician positions currently available.

Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County, Riverside County, and Orange County. We have openings for full-time and part-time physicians. Current CA and DEA licenses required. Malpractice coverage provided.

Full benefits packet. Forward resume to hr@vistacommuntyclinic.org or fax to (760) 414 3702. Visit our website at www.vistacommuntyclinic.org. EEO Employer / Vet / Disabled /AA [912] OFFICE SPACE AVAILABLE

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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PREMIUM MEDICAL/SURGICAL OFFICE IN ENCINITAS: 1,600ft2 of professional status in North Coast Health Center for lease or sublease. Private office includes $400,000 build-out with custom

wood counter and cabinetry, marble floors / countertops, travertine, Venetian plaster, retail product display shelving and lighting, mirrored walls, sunlit reception area, etc. Furniture and fixtures optional. Perfect for concierge practice. Spacious waiting room, two private offices, two large exam rooms, lunchroom, two custom-designed restrooms, ample storage. Busy location on El Camino Real, minutes from I-5 freeway, five minutes to Scripps Memorial Hospital, Encinitas. 130 physicians onsite with pharmacy, labs, imaging, and surgery center. Call (760) 753-6464 or email jennifer@feelbeautiful.com. [503] OFFICE SPACE FOR RENT WITH WELL-ESTABLISHED ORTHOPAEDIC PRACTICE: Located near Alvarado Hospital. Onsite digital X-ray. Ideal for specialties such as pain management, rheumatology, foot/ankle, spine. Interested parties, please email lisas@sdsm.net. [493] 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] 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 SEEKING NURSE PRACTITIONER: 2–3 days per week in busy IM practice in Kearny Mesa. Must have experience and be able to work independently. Please fax resume to Monica at (858) 2770690. [508] PHYSICIAN ASSISTANT / NURSE PRACTITIONER (BANKERS HILL): An opportunity for a physician assistant / nurse practitioner in pain management under the direction of the physician supervisor. Apply and modify the principles, methods, and techniques of medicine to provide comprehensive pain management, medical services, and procedures. Diagnose and treat a variety of injuries, chronic and acute pain symptoms.

Provide leadership, direction, and coordination of all clinical activities involving professional medical judgment. Work closely with staff to ensure comprehensive quality patient care. This is a fulltime position; Monday–Friday, with competitive salary, sign-on bonus, retention bonus, and more.

Please submit CV with cover letter to claudia. steinermd@gmail.com. [506]

service and interpersonal skills, including outstanding verbal and written communication.

Knowledge and understanding of EMR systems and MS Office skills are preferred. Experience with insurance companies, including IPAs, HMO, PPO, and work comp, and familiarity with billing and coding are ideal, but not required. Familiarity with back-office duties or medical assistant certification is an additional benefit. If interested, please forward your resume to office.mcmc@gmail.com.

[505] HIRING PHYSICIANS, NPs, AND PAs: Clinicas de Salud del Pueblo, Inc., is hiring Californialicensed physicians, nurse practitioners, and physician assistants. We are a successful and longstanding nonprofit organization that offers a full range of benefits, including excellent and competitive compensation. Our current need is to serve patients that live in the following communities: Blythe, Brawley, Calexico, Indio, and Mecca.

It would be wonderful to hear from you. Please email us at work@cdsdp.org or call us at (760) 344-9951, ext. 120 or 121. [502] 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]

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Your best friend is competent counsel Call the Law Offices of Richard B. Rodriguez 33 years of experience Reasonable Rates (619) 427-7622 Email:lawrichrod@aol.com MEDICAL EQUIPMENT / FURNITURE FOR SALE CLEARWAVE OFFICE WAITING ROOM CHECKIN KIOSK WITH TABLETOP STAND: (eClinicalWorks Compatible) Decrease wait times, increase collections, and improve financial performance.

Liberty Tabletop Kiosk with 17-inch, built-in, all-inone touchscreen computer with privacy filter. Intel Celeron Dual Core, E1500, 202 GHz processor, 2GB RAM, 160GB hard-drive, ID Tech swipe magnetic credit card reader mounted on right side of the screen. Copays and accounts receivable payable upon check-in. Windows 7 OS, LogMeIn Pro2, IE 9, and McAfee. eClinicalWorks kiosk software included. Original cost new $5,199. Sell for only $1,499. Email KLewis@SDCMS.org. [443]

Place your ad here Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

MEDICAL OFFICE STAFF: We are a private family practice located in downtown San Diego looking to hire a front office staff member. This position requires excellent organization skills, customer

SAN DIEGO PHYSICIAN.org

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P o e t r y and M e d i c i n e

Just a Bit Ahead of Me in Line

by Daniel J. Bressler, MD, FACP

Just a Bit Ahead of Me in Line On an afternoon this past February, I was hurrying back from a committee meeting at Scripps Mercy Hospital to see patients. I had on my best professional persona: neatly combed hair, white coat, and a look on my face that told the world that I was on my way to some place important.

In the little lobby of my office building, I had a chance meeting with two elderly women who were holding hands as they waited for the elevator. When the arriving elevator chimed for us, I sprang into it and then, noticing the two women were struggling to follow me, held the door and made some small talk with them as they shuffled in. They found it necessary to apologize to me for the inconvenience of having to wait for them.

For some reason on that day, I felt inspired rather than frus-

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trated with that brief delay.

Somehow the words that came out of my mouth, in response to their apology, were “Don’t worry.

You’re just a bit ahead of me in line.” They laughed. I laughed.

We somehow connected as a little tribe of interconnected human beings for the 45-second ride up to the sixth floor. After they got out and thanked me for our little rendezvous, I caught a lump in my throat and told myself I’d have to remember my meeting with the sisters and maybe weave the encounter into a poem. I did. Here it is.

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.

Two ancient sisters standing in the foyer next to me Their tank and walker told of their decline Yet I saw their warm regard for one another and for me They’re just a bit ahead of me in line They apologized to make me hold the elevator door I laughed to share the space that wasn’t mine They trundled in as fast they could, quite slowly to be sure They’re just a bit ahead of me in line So tenderly they helped each other on and off this shelf Familiar friends past decades numbered nine They clutched each other tightly as they held to life itself They’re just a bit ahead of me in line One sister reached to touch me and looked me in the eye Her bones were gnarled, her skin was soft and fine When they left a floor ahead of me I felt that I could cry They’re just a bit ahead of me in line Such a simple meeting, such a simple gift The sisters teaching love without design And I the lucky student in that office building lift They’re just a bit ahead of me in line.

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