April 2017

APRIL 2017 OFFICIAL PUBLICATION OF SDCMS

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APRIL

CONTENTS

VOLUME 104, NUMBER 4

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) 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 • Patrick A. Tellez, MD South Bay: Maria Carriedo, MD (Alt) • Reno D. Tiangco, MD

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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

feature

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Champions for Health Annual Report for Fiscal Year 2015–16 • Community Impact … 15 • Health Heroes … 16 • Annual Events … 17 • Community Partners … 18 • Financial Highlights … 19 • Improving Health, Changing Lives … 20 • Alzheimer’s Project Update … 22 • Improving Community Health … 24

departments 3

J oin Us for Our 2017 White Coat Gala: An Evening to Celebrate 147 Years of Healing

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Briefly Noted: Calendar • Medical Students • Physician Socials • Welcome New and Returning Members • And More …

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APRIL 2017

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

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Candidate Statements: 2017–18 SDCMS Board of Directors

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 President-elect: 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

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Discussing Advance Directives With Adult Patients as a Standard of Care

BY DANIEL J. BRESSLER, MD, FACP

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Physician Marketplace: Classifieds

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ut Your SDCMS-CMA Membership P to Work: Get Involved!

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.]

Physicians & Guests: You are cordially invited to attend the San Diego County Medical Society and Champions for Health

White Coat Gala 2017

AN EVENING CELEBRATING 147 YEARS OF HEALING!

presented by welcoming thanking celebrating

The San Diego County Medical Society & Champions for Health Mark W. Sornson, MD SDCMS President 2017–2018 Mihir Y. Parikh, MD, for His Service As Immediate Past President The Life and Work of 48-Year SDCMS-CMA Member Richard O. Butcher, MD

Saturday, June 3, 2017 Hyatt Regency La Jolla at Aventine 3777 L A J O LL A V I LL AG E D R I V E , L A J O LL A

6:00 – 7:30 PM: No-Host Cocktail Hour 7:30 – 9:00 PM: Dinner & Program 9:00 – 10:30 PM: Dessert & Dancing black tie optional

www.SDCMS.org/WhiteCoatGala SAN DIEGO PHYSICIAN.ORG

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/////////BRIEFLY /////////////////NOTED ////////////////////////////////////////////////////////////////////////

CALENDAR

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

Aligning Clinical Practice With Diabetes Prevention (webinar) APR 26: 12:15pm–1:15pm SDCMS Physician Social (event) APR 28: 5:30pm–8pm Western Health Care Leadership Academy (conference) MAY 5–7 at the Marriott Marquis San Diego Marina SDCMS White Coat Gala (event) JUN 3: 6pm–10:30pm

HEALTHCARE CONFERENCES To submit a community healthcare event for possible publication, email Editor@SDCMS. org. Events should be physician-focused and should take place in or near San Diego County.

California MGMA Annual Conference APR 27–29 at The Westin San Diego Clinical Advances in Heart Failure and Arrhythmias APR 28–30 at the Loews Coronado Bay Resort in Coronado

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APRIL 2017

MEDICAL STUDENTS

Match Day — Class of 2017 UC San Diego School of Medicine’s Class of 2017 opened their Match envelopes on Friday, March 17, promptly at 9:00 a.m. Matched students then pinned their results to a large map to show where they will reside for the next few years.

“

QUOTE OF THE MONTH

Among those whom I like or admire, I can find no common denominator, but among those whom I love, I can: all of them make me laugh.

— W. H. Auden, English Poet (1907–1973)

/////////////////////////////////////////////////////////////////////////////////////////////////// MEMBERSHIP

PHYSICIAN SOCIALS

JOIN US ON APRIL 28!

Please join your physician colleagues on Friday, April 28, for SDCMS’s next physician networking opportunity and mixer from 5:30 p.m. to 8 p.m. at Casa Machado Restaurant, 3750 John J. Montgomery Dr., San Diego 92123 — overlooking Montgomery Field Airport. Come mingle, socialize, and network with your colleagues, and be sure to bring your spouse/significant other — complimentary hors d’oeuvres and drinks will be provided.

RSVPs are required, so register soon at SDCMS.org — and do spread the word by letting your colleagues know to join us as well. If you have any questions, contact Jen at JOhmstede@ SDCMS.org or at (858) 300-2781.

WELCOME! Welcome New Members!

Patrick R. Cook, DO Vascular Surgery San Diego (619) 460-6200 Mark J. Deaver, MD Emergency Medicine San Diego (619) 260-7000 Stacy A. Fikert, MD Emergency Medicine San Diego (619) 502-5800

Craig R. Larson, DO Thoracic Surgery San Diego (858) 939-7471 Marisa M. Magana, MD Pulmonary Critical Care Medicine Encinitas (760) 230-8994 Ravichandra R. Mutyala, MD Internal Medicine Escondido (442) 281-5000

Badalin Helvink, MD Geriatric Medicine Encinitas (760) 739-3000

Johannes M. Neuendorf, DO Family Medicine La Jolla (858) 554-8638

Benjamin J. Hidy, MD Psychiatry San Diego (760) 739-3000

Quang H. Nguyen, MD Internal Medicine La Jolla (858) 554-7996

Erik T. Hogen, MD Pediatrics San Diego (858) 605-7969

William Pazdral, MD Pediatrics El Cajon

David J. Hoopes, MD Radiation Oncology San Diego (619) 543-7777 Carol Kashefi, MD Urology La Jolla (858) 554-9999 Kristi L. Koenig, MD Emergency Medicine Seal Beach (858) 694-3900 Amara J. Lai, MD Family Medicine San Diego (760) 737-6900

James Y.C. Tang, MD Family Medicine San Diego (858) 613-4000 Patrick G. Thomas, MD Emergency Medicine La Jolla (619) 502-5800 Kevin T. Toliver, MD Anesthesiology San Diego (619) 299-8500 Craig M. Uejo, MD, MPH Occupational Medicine San Diego (858) 678-6963

Jordan C. Wagner, DO Emergency Medicine San Diego (619) 502-5800

Welcome Returning Members!

Ronald E. Cann, MD Psychiatry San Diego Casey W. Buitenhuys, MD Pediatric Emergency Medicine San Marcos (760) 739-3000 Harris G. Effron, MD Cardiovascular Disease Rancho Santa Fe Paula A. Eisenhart, MD Internal Medicine San Diego (619) 245-2820 Erik O. Gilbertson, MD Dermatology La Mesa (619) 660-1828 Serge C. Kaska, MD Orthopaedic Surgery San Marcos (760) 750-1902 Gene Ma, MD, FACEP Emergency Medicine Oceanside (760) 681-5222 Kevin D. Shaw, MD Pulmonary Critical Care Medicine Encinitas (760) 230-8994 Emily E. Sladek, MD Geriatric Medicine La Jolla (858) 554-6158 Christine P. Taft, MD Pediatrics Fallbrook (760) 520-8330 Prabhakar Tripuraneni, MD Radiation Oncology San Diego (858) 554-4100 SAN DIEGO PHYSICIAN.ORG

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SDCMS ELEC TIONS

CANDIDATE STATEMENTS 2017–18 SDCMS Board of Directors

Notes: • (inc.) After Name = Incumbent • Number in Parentheses (#) After Name = Term Length in Years OFFICERS

President-elect: David E.J. Bazzo, MD, FAAFP (1): I’ve had the privilege to serve on the SDCMS board of directors since 2009. During this time, I’ve seen what advocacy through organized medicine can accomplish. This past year, advocating for Prop. 56 (Cigarette Tax), we experienced firsthand the power of the political process. Now, we must assure that intended purpose of the monies from Prop. 56 are allocated as intended. This past election cycle also brought uncertainty to the landscape of U.S. healthcare. Locally, the San Diego County Medical Society is second to none when it comes to representing the needs and interests of physicians in advocating to optimize our ability to help our patients. The politics of our state and nation have enormous impact on our capacity to keep our patients healthy and keep costs controlled. As with any process, unless you have a seat at the table, your opinion is not heard. Through the work of your county and state medical societies, your voices are heard. Your interests are represented. The members of the board do have influence and work on your behalf to ensure that physicians have a say on the future practice of medicine. I am proud of my membership and position on the board, and view it an honor to volunteer to help our organization. I ask that you continue to place your trust in me to serve our organization by supporting my candidacy. Please grant me the privilege to continue to represent you as president-elect. Thank you.

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APRIL 2017

Secretary: James (Jim) H. Schultz Jr., MD, MBA, FAAFP, DiMM (1): Jim Schultz is a family physician who practices at Neighborhood Healthcare, a federally qualified community health center serving about 70,000 of the underserved and medically needy. He sees outpatients in Escondido, Pauma Valley, and Temecula, and inpatients as part of the California Emergency Physicians Hospitalist program. He has been chief medical officer of Neighborhood Healthcare since 2001, and is currently the CMO of Integrated Health Partners and of Champions for Health / Project Access San Diego.

Prior to his role at Neighborhood Healthcare, Jim was medical director and practicing physician at Graybill Medical Group in Escondido, where he began his professional career in 1988. He is also a volunteer clinical professor at UCSD in the Department of Family and Preventive Medicine and hosts the Family Medicine Residency PGY-1 outpatient gynecology rotation. His goals at SDCMS include helping fashion a strategy for meaningful membership into the future, fairly representing the interests of the physicians of North County, and bringing in the voice and perspective of those physicians whose practice is predominantly that of the underserved.

Treasurer: Holly B. Yang, MD (1): I have been a member of the San Diego County Medical Society (SDCMS) since I moved to San Diego more than 10 years ago. I have been on the board of directors since 2012, and have served as board representative to the Executive Committee for the past two years. At the California

Medical Association House of Delegates, I have served on two reference committees, and I am currently the vice chair of the Council on Membership, Governance, and Bylaws. With the current issues and uncertainty facing medicine, physicians must have a voice to protect our patients’ ability to access high-quality healthcare and our ability to provide and direct that care.

SDCMS serves us well in that role, and is a great resource to physicians of all specialties and practice types in the daily issues we deal with as doctors. Since being elected to the board of directors, I am continually impressed by what we can accomplish when we have a diverse group of physicians come together as a team. I am honored to have the opportunity to give back to my community, and engage with the things that make a difference to our patients and our profession. Thank you for all the work you do to care for the people of our county.

Thank you for your trust to represent you.

I ask for your continued trust and support for my candidacy for treasurer.

GEOGRAPHIC DIRECTORS:

East County #2: Rakesh R. Patel, MD, FAAFP, CPE (3): I am a family physician who practices at Neighborhood Healthcare, a federally qualified community health center serving about 70,000 of the underserved and medically needy. I have been practicing in El Cajon since 2002.

Currently, I am the medical director of operations for Neighborhood Healthcare since 2015. I am also a CMA delegate representing the Medium Size Group Practice Forum. My background in family medicine allows me to speak of the various challenges of primary care: access, reimbursement, administrative burdens, staffing, etc. I also currently work for a health plan as a physician reviewer, which has provided me a glimpse into the other side of medicine. I have spent considerable time learning new skills through various leadership develop-

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ment opportunities, the most significant being when I became a California HealthCare Foundation — Healthcare Leadership Fellow. I am also a voluntary clinical instructor at UC San Diego in the Department of Family and Preventive Medicine.

My overarching goals are to improve the health of our community while continuing to advocate for the under- and uninsured.

I will bring to SDCMS the perspective of a family physician who continues to take care of patients in the community while also leading change in turbulent times.

East County #3: Jane A. Lyons, MD (3): My name is Jane (Bugea) Lyons, and I am a pediatrician and a candidate for East County director.

My involvement with SDCMS began more than eight years ago, during my first year at the UC San Diego School of Medicine.

Since then, I have held the positions of both medical student and resident director, which provided me the opportunity to learn about and advocate for many issues facing San Diego patients and physicians.

I have now completed residency and I am a pediatrician with the Southern California Permanente Medical Group, specializing in hospital medicine and newborn care, as well as providing care through clinics and urgent cares. Medicine continues to have what feels like an unlimited number of hurdles and challenges; physicians are necessary at the forefront fighting for our patients, the advancement of the medical sciences, and our profession. As the East County director, I will work with SDCMS in their efforts to protect physicians and patients, as well as continue to learn more about medical politics and the ways I can contribute to San Diego’s and California’s healthcare system. Being a part of SDCMS has been an amazing experience, and I ask for your vote to continue my involvement now as the SDCMS East County director.

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SDCMS ELEC TIONS

Kearny Mesa #1: Sergio R. Flores, MD (inc.) (3): I have served on the SDCMS board of directors for the past six years as a Kearny Mesa alternate and as geographic director, and was recently placed on the Executive Committee. I would like to continue serving on the SDCMS board. I am currently serving on the CMA board of directors since 2012 as well as the CMA finance committee. I was born and raised in San Diego and graduated from SDSU in 1985. I graduated from the UCSF School of Medicine in 1989 and trained at UC Irvine in internal medicine and gastroenterology from 1989 to 1994, and was board certified in both. I am in private practice and have been a partner at San Diego Digestive Disease Consultants since 1998. I have served on the board of Sharp Community Medical Group for the past 18 years and currently serve on the executive committee as the vice president as well as chairman of the finance committee. I also served on the Sharp Healthcare board of directors for seven years and continue to serve on their finance committee. I would like to continue to offer my services to you and SDCMS. Thank you.

Kearny Mesa #2: Alexander K. Quick, MD (3): If elected, I will be serving my first term on the SDCMS Board of Directors.

That said, I hope my background will allow me to be a well informed and contributing board member.

Specifically, I was introduced to organized medicine 10 years ago when I took Bob Hertzka’s health policy class for UC San Diego medical students. The class included an opportunity to travel with Dr. Hertzka to Sacramento. The entire experience was an eye opener and, since then, I have done my best to stay involved in CMA and my county medical society. As for the rest of my background, I completed my anesthesia residency at Stanford in 2014, and I am a partner in the large medical group ASMG. I try to stay on top of practice management issues and contribute to the group where I am able. Most recently, I have been involved with an EMR implementation. At home, I have two young daughters, and my wife is a provider for a community clinic.

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APRIL 2017

I am happy to provide my full CV upon request. Thank you for considering me for the SDCMS Board of Directors. La Jolla #2: Marc M. Sedwitz, MD (inc.) (3) (no statement) North County: Christopher M. Bergeron, MD, FACS (3): I am honored to be considered for the SDCMS Board of Directors. I am a rhinologist/otolaryngologist practicing at Scripps Clinic in La Jolla and Rancho Bernardo. I am the immediate past president of the San Diego Academy of Otolaryngology and maintain voluntary faculty privileges at UCSD and the VA Medical Center in La Jolla. During my 10-plus years in the San Diego area, I have seen the impacts of increased governmental regulation on physicians and patients alike. I look forward to participating in the shaping of future healthcare policy at the local, state, and national level during my service with SDCMS, all the while keeping the interests of physicians and patients as the top priority.

GEOGRAPHIC ALTERNATE DIRECTORS

Kearny Mesa #2: Eileen R. Quintela, MD (inc.) (3) (no statement) AT-LARGE DIRECTORS

#1: Thomas J. Savides, MD (inc.)

(3) (no statement) #4: Nicholas “dr.

Nick” J. Yphantides, MD, MPH (inc.) (3): I am thankful for your support of my service as an SDCMS director.

For eight years I have been blessed with the opportunity to be the chief medical officer (CMO) of the County of San Diego’s Health and Human Services Agency. My life and passion is to be an advocate and catalyst to improve the health and wellbeing

of our entire region. Prior to my service with the County, I served as the CMO of Neighborhood Health Care, the publicly elected board chair of Palomar Health, and the CMO of the Council of Community Clinics. I currently serve on the board of Champions for Health, and as vice chair of our regional heath information exchange (HIE), known as San Diego Health Connect. We are in a very dynamic and strategic time of collaborative partnership between SDCMS and its physician leaders with the County of San Diego through the nationally recognized Live Well San Diego vision. As a director, I eagerly look forward to strengthening our regional collective impact even further as we strive to improve the wellness of our patients and their families throughout San Diego. #6: Marcella “Marci” M. Wilson, MD (3): It has been my pleasure to serve as an alternate on the board for the past three years. The learning curve for me has been immense concerning insight into CMA proceedings and legislation, and understanding exactly how our society represents us as physicians at the state level. Having participated in this, I now want to increase this commitment to addressing physicians’ concerns by becoming an at-large director on the board of SDCMS, and I would greatly appreciate your support.

These coming years will see much change as the ACA is challenged by the new administration, and the health system is once again put in flux. You need representation for your voices at the table of CMA. I would like to be one of those voices that carries your message into our state meetings. Besides the ACA repeal, other ongoing issues will need our input, such as the ongoing opioid epidemic and ways in which our county and state handles this emerging crisis. With constant political uncertainties and government changes threatening the welfare of physicians’ autonomy over medical practices, it is critical for all area physicians to not only have a strong focus, but also a unified voice that is truly heard and to take action when needed.

As well, I no longer doubt the fact that organizing and uniting physicians is a necessity in preserving our autonomy, our leadership, and our interest concerning the real practice of medicine, not that ascribed

to nonphysicians. There is a growing need to protect physician independence and maintain the integrity of our medical professions with the respect deserved for the education, money, and years committed, that should not be so easily diluted by simply any group that feels they can take three to six months of classes and then prescribe and treat under the illusion that they are comparable to a physician, with or without our supervision.

Finally, after more than 25 years in psychiatric practice here in San Diego, I understand that it is only by organizing with our societies such as SDCMS that we can have the true power it takes to determine the future of our practices: how we care for our patients, how we prescribe their treatment, including the coding of that treatment, and ultimately how we are reimbursed. For all of us, what hard work has created, we do not want toppled by insurance companies, government changes, or anything that can take us by surprise. I am

hoping that you feel the same way. Please join me in this endeavor, and support my candidacy with SDCMS. Thank You. #8: Robert E. Peters, PhD, MD (3): I consider it an honor to serve our organization. I have had the privilege to again ask for your support as I run for at-large director of SDCMS. I have served as an SDCMS at-large director for six years, eight years as a representative on the Executive Committee, 10 times as a CMA delegate representing San Diego, and nine years on Council for Ethical Affairs for CMA, five years as chair. I have served as president of SDCMS and as past chair, Presidents Forum for CMA. Currently I have the privilege to serve as your delegation chair to CMA. I have also been active as a member of SDCMS’s GERM Commis-

sion for 12 years and SDCMS’s Editorial Board for 10 years. Our San Diego County Medical Society provides both a critical vehicle and an important opportunity for our physician community to be able to speak as a singular “voice” to the public and to the politicians in the city, county, state, and federal government. We have seen more pressures on, and changes to, the patientphysician-payer relationships in the past 20 years than were seen in the prior 50 years.

All signs indicate that the next 20 years will see even greater externally driven pressures on the physician-patient relationship than we have seen in the past 20 years. Given this reality, it will be critical that we as practicing physicians represent, with a unified voice, the medical care interests of our patients. We must represent, in consistent fashion, patient interests, and explain to patients as well as to politicians the economic and the infrastructure requirements of the healthcare “delivery system” necessary for continued optimal patient care.

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SDCMS ELEC TIONS

AT-LARGE ALTERNATE DIRECTORS

#5: Preeti S. Mehta, MD (3): I am honored to be nominated for the position of at-large alternate director for the board of directors at the San Diego County Medical Society. I have been involved in several leadership positions throughout my career as an academic and private practice hospitalist. My experience on the Physician Advisory Group at Scripps gave me an insight into the workings of a large organization that gives physicians a voice and safeguards interests of physicians. As a member of the board at SDCMS, I hope to continue supporting us, physicians, as a unified group. My past interests have included implementation of computerized physician order entry and choosing a platform for integration and easy exchange of information across hospital systems in San Diego County. My current passion is physician wellbeing, serving on the similarly named committee at Scripps. I hope to strongly promote this along with other physician interests that benefit our community as a whole. Thank you for this nomination, and I hope to serve on the board to the best of my ability. #6: Vimal I. Nanavati, MD, FACC, FSCAI (inc.)

(3): I respectfully seek your support for atlarge board director for the San Diego County Medical Society. I’m an interventional cardiologist who works in the South Bay and East County. I’ve had the privilege to serve you through the San Diego County Medical Society for the last 11 years. I started out as a geographic director for the South Bay, then was elected to the Executive Committee after several years. Though I am no longer on the Executive Committee, many current leaders have sought my advice before running for the position. I not only have encouraged them to run, I have actively campaigned for them in front of the board of directors and written press (see San Diego Physician magazine interviews). I’ve also attended the CMA House of Delegates annually without interrup-

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APRIL 2017

tion since 2006. I have been active in the House of Delegate process, introducing many resolutions. For example, one resolution dealt with patient care issues such as establishing patients’ rights to know they may be losing their longtime physician if they sign up for HMOs and other continuity of care issues (2011). Another resolution was introduced to protect hospitalist physicians from being fired without cause (2009). I continue to be very active in the protection of doctors’ rights to care for patients only, without undue influence from any other nonpatient care forces. My biggest contribution, in my estimation, is the ability to bring your concerns to the board of directors for consideration. I feel I can do more in that regard.

My other main contribution is the ability to bring physician leaders together to understand their common interests.

This is increasingly difficult in this era of physicians being part of different modes of practice. Many of us are now a part of large institutional entities and increasingly identify ourselves through them. During my 11 years at SDCMS, I’ve always tried to emphasize: No matter what your mode of practice or your specialty, as physicians, we stand for certain common goals: • Allowing patients access to best medical practice.

• Representing our patients’ interest above all other considerations.

• Assuring the profession of medicine remains a secure and rewarding way of making a living while allowing us to focus on our patients.

I’ve found many willing partners in this endeavor. Though I’m a solo practitioner, to my delight, I’ve found colleagues that serve at large entities to not only agree with my goals but actively assist me in this regard. I strongly feel collegiality and unequivocal support of each other with a unified voice is the best way to allow our profession to grow and thrive.

In this time of ever-shifting landscape of medicine, very little of what we considered fundamental to a successful practice of medicine has remained. Yet, if we examine our daily practice carefully, we will quickly realize that the fundamentals of how physicians practice have not changed. We still take care of one patient at a time. We just have less time to do it because of the sheer volume of sick patients sent to us for attention (leading to “physician burnout”).

I’m convinced the three fundamental com-

mon goals must remain intact no matter what our mode of practice may be if we are to survive as a profession. It is my goal to continue this endeavor not only at the county but also the state level and make it easier for physicians to do what they do best: provide the best medical care possible for their patients. Thank you for your support. #7: Peter O. Raudaskoski, MD (3): I have had the pleasure of serving on the SDCMS board for the last six years.

During this time I have come to appreciate that SDCMS and CMA are the best organized and strongest advocates for both physicians and patients alike.

While serving as the president of Anesthesia Service Medical Group (250 physician anesthesiologists) for six years, there were many times that SDCMS and CMA were able to assist us on many levels both in the local arena as well as at the state level.

While our state and national specialty societies do excellent work in our given specialties, SDCMS supports all physicians regardless of their specialty. It is for these reasons I would like to continue to serve as an alternate director on the SDCMS board.

As changes in our healthcare system are sure to come our way, I would appreciate the opportunity to continue giving input that supports both physicians and patients. Thank you for your support. #8: Kosala Samarasinghe, MD (3): I am asking for your support as I run for an at-large alternate director position at SDCMS. It has been my privilege to serve as your East County geographic director for the last three years. I have had the honor of serving on the SDCMS Board of Directors to help improve healthcare access to patients while advocating for physician rights. I am an internist and have been in the San Diego medical community for 12 years. I started my career in Southern California working with Neighborhood Healthcare, a federally qualified clinic caring for the lives of the underserved population in north-

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If you’re a medical professional who wants to buy a home, I’d like to help.

The Bank of America® Doctor Loan is designed to meet your unique needs, and may make it easier to qualify for a mortgage.1 For instance, we may not count student loans when we calculate your total debts.2 Other benefits include: • You can put as little as 5% down on mortgages up to $1 million and 10% down on mortgages up to $1.5 million (some limitations apply) • Start your new position up to 60 days after closing3 • Choose from a fixed- or adjustable-rate loan

May 2 at 12 p.m.

eastern San Diego. My career later led me to a private practice in East County with Alvarado Medical Group. As my professional career in East County began to grow, I too found great rewards by being part of organized medicine. I quickly became involved at Alvarado Hospital and rose up the leadership ladder to become the chief of medicine. Because the work that was being done at SDCMS by local doctors was very inspiring to me, I involved myself and eventually became a board member.

My involvement on the SDCMS board has enabled me to represent patients and physicians in San Diego as well as the rest of California. There has been a drastic paradigm shift in healthcare reform during the last eight years, and the next four years will continue to be challenging. It is imperative that physician voices be heard not only to protect our profession, but also to protect the rights of our patients. My interest in medicine has also allowed me to help shape the minds of young physicians.

I have been privileged with the honor of proctoring first- and second-year medical students from UCSD for the last four years.

This has been a very rewarding experience.

I wish to continue contributing not only to the young physicians in our community but also to the experienced physicians as well. Please allow me to continue to serve on the SDCMS Board of Directors to represent physician and patient interests. Thank you.

The Doctor Loan could be a good choice for medical residents and licensed, practicing doctors, dentists or other eligible medical professionals. You can count on me to guide you through the process and help you find a home loan option that fits your needs.

Contact me to learn more.

Gina McLeod Financial Center Lending Officer NMLS #332599 Direct: 858-344-4254 Fax: 877-328-9216 gina.mcleod@bankofamerica.com mortgage.bankofamerica.com/ginamcleod

An applicant must have, or open prior to closing, a checking or savings account with Bank of America. Applicants with an existing account with Merrill Edge®, Merrill Lynch® or U. S. Trust prior to application also satisfy this requirement. Medical professional (MD, DDS, DMD, OD, DPM, DO, residents, and students whose employment begins within 60 days of closing) must be actively practicing in their field of expertise. Those employed in research or as professors are not eligible. For qualified borrowers with excellent credit. PITIA (Principal, Interest, Taxes, Insurance, Assessments) reserves of 4-6 months are required, depending on loan amount. Other restrictions apply.

2 Additional documentation is required.

3 If applicant’s employment does not commence until after closing, sufficient reserves to handle all debt obligations between closing and employment start date + 30 days must be verified.

Credit and collateral are subject to approval. Terms and conditions apply. This is not a commitment to lend. Programs, rates, terms and conditions are subject to change without notice. Bank of America, N.A., Member FDIC. Equal Housing Lender. ©2016 Bank of America Corporation. ARM5MFD3 HL-112-AD 05-2016 1

CMA MEMBER HELP LINE! Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262

SAN DIEGO PHYSICIAN.ORG

11

POE TRY AN D M EDICIN E

DISCUSSING ADVANCE DIRECTIVES WITH ADULT PATIENTS AS A STANDARD OF CARE

by Daniel J. Bressler, MD, FACP

Oh build your ship of death, oh build it! for you will need it.

For the voyage of oblivion awaits you.

— DH Lawrence, “The Ship of Death” (1933) THE BENEFITS OF completing an advance directive are compelling and evidencebased. They include a greater satisfaction with care [1, 6], a reduction in both hospitalizations and ICU admissions at the end of life [4-6], increased use of hospice services [4], and a decrease in the emotional and moral distress in family members and the medical team [1, 2, 3].

Almost every day in my primary care practice I have a dialog about death and dy-

12

APRIL 2017

ing using the advance directive as the pretext and context. On turning 50, my patients will be scheduled to discuss advance directives along with colonoscopies, prostate exams, and regular mammograms. Other prompts to an AD conversation include a recent significant change in their own health or that of a family member.

My interest in bioethics may trace back to an experience I had as a preteen walking on the sands of Huntington Beach with my then middle-aged father. A line from a popular mid-’60s rock song (“We’ve Gotta Get Out of This Place” by The Animals) was playing on repeat in my head: “See my daddy in bed he’s dying/see his hair is turning gray.” At

the time, my 41-year-old father’s hair was, in fact, graying at the temples. The song, the beach, and the grayness awoke in me the nascent idea of the inevitability of aging, dying, and death, and the need to somehow prepare for them.

I’ve told the story of my meandering dialogues with death in the accompanying poem using the phrase “free and clear.” It’s a slang term from real estate indicating that a property is completely paid off. It caught my ear a few years ago as having other potential connotations. I’m using it in this poem to mean a condition of having come to grips with mortality. The rhythm or scan of the poem is a little tricky, so I have bolded the emphasized syllables in case you want to read it out loud.

Dr. Bressler, internist and 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.

Free and Clear I remember being twelve and walking with my father on the beach A figure from the foamy waves came riding like a spectral Paul Revere The crashing waters offered up the ruthless sermon it had come to preach Death is coming. Death is coming. Time to make your own life free and clear.

TrusT

I wandered texts and churches, and behind the baffled doorways of my mind Meeting self-proclaimed messiahs who were clever and some even quite sincere They wanted my allowance and a promise to leave worldly ways behind But they lacked robust instructions on the way to make my own life free and clear In loin clothes and with prayer beads, a monk with humming mantras on his lips Told me he could meditate until his flesh dissolved to mystic sphere He judged my worldly ways with his thin arms akimbo planted on his hips With all his talk of freedom he was trapped outside the way to free and clear I knew a man of towering wealth, the world would step and fetch at his command He regaled me with the stories of his travels and the coups of his career To help him feel immortal he kept stem cells and a doctor close at hand But all his money couldn’t book him passage to the land of free and clear I met a man of simple ways, his face would deeply wrinkle when he smiled He stripped his shirt to show me scars that marked his body here and here and here These are just mementos of missteps to which my life is reconciled My goal is not to be unscathed but stay upon the path to free and clear The way up to the mountaintop is littered with the holy and profane On days of wind and cold you will be tempted to come back another year Travelers spouting gibberish are either quite enlightened or insane To tell the two apart is an essential task en route to free and clear There are many stops and detours on the incidental road unique to you Know that on your journey trusted friends will shrug you off and foes will jeer If it’s daunting and familiar that’s a hint that it may actually be true Your deepest intuition is your compass on the road to free and clear No matter what your core beliefs, the sun goes down each evening as a death And whatever prayers or chants you call each morning it is bound to reappear To grasp this cyclic resurrection hidden in the tide of every breath Is, I say, your marching order pointing on the map to free and clear References: 1. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010; 340:c1345.

2. Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. Am J Crit Care 2005; 14:523.

3. Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300:1665.

4. Teno JM, Gruneir A, Schwartz Z, et al. Association between advance directives and quality of end-of-life care: a national study. J Am Geriatr Soc 2007; 55:189.

5. Silvester W, Blackhall LJ, Stickland E. Final Evaluation Report of the Community Implementation of the Respecting Patient Choices Program. http://www.health. gov.au/internet/nhhrc/publishing.nsf/Content/018-wilsiletal/$FILE/018%20 William%20Silvester%20et%20al%20Submission%20B.pdf 6. Molloy DW, Guyatt GH, Russo R, et al. Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial. JAMA 2000; 283:1437.

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13

TABLE OF CONTENTS Community Impact … 15 Health Heroes … 16 Annual Events … 17 Community Partners … 18 Financial Highlights … 19 Improving Health, Changing Lives … 20 Alzheimer’s Project Update … 22 Improving Community Health … 24

Champions for Health Advancing Health Equity in San Diego ANNUAL REPORT FOR FISCAL YEAR 2015–16 14

APRIL 2017

899

PATIENTS RELIED ON PASD AS A SAFETY NET

Specialty Appointments

Procedures and Surgeries

239

2,202 1,100 91% MORE THAN

Reduction in Workdays Missed

97%

1,030 BREAST CANCER SCREENINGS

Reduction in Emergency Department Visits

FLU VACCINATIONS

407 151

Interpretation and

Transportation Services

AND SINCE 2008 …

$13,024,130 in Specialty Medical Care Donated

33

COMMUNITY IMPACT: CHAMPIONS FOR HEALTH ANNUAL REPORT

DURING OUR 2015–16 FISCAL YEAR ALONE …

LIVES SAVED! SAN DIEGO PHYSICIAN.ORG

15

2017 HEALTH HEROES

The life-changing, pro bono work of 10 local physicians was honored by Champions for Health at our 2017 Health Heroes awards ceremony. This annual reception celebrates physician volunteers and the specialty care they donate to heal uninsured San Diegans through Project Access San Diego, the flagship program of Champions for Health.

L–R: Dr. Heather Gunnarson, Dr. Kim Bui, Bob DeSimone, Dr. Keerti Gurushanthaiah, Dr. Valerie Gafori, and Dr. Laura Robertson

Dr. Kevin Yoo (center) With Bob DeSimone and Barbara Mandel

Above and Beyond Award: Dr. Kevin Yoo, San Diego Neurosurgery Kevin Yoo, MD, exemplifies what it means to go above and beyond for vulnerable patients in need. Since 2010, Dr. Yoo has dedicated his highly specialized skill as a neurosurgeon to transform the lives and health of Project Access patients. His pro bono work has included complex medical cases — such as a spinal tumor and traumatic head injuries — that he has addressed through spinal surgeries and cranioplasty procedures.

Hilda Mancilla had been experiencing back and neck pain for years. Sometimes it became so extreme that she suffered from numbness in her upper extremities.

Imaging revealed that Hilda had a spinal tumor that, if left untreated, would eventually lead to paralysis.

Dr. Yoo reviewed Hilda’s case and generously agreed to volunteer his expertise to remove the tumor. The highly specialized procedure went well, and Hilda has regained full mobility and vitality.

Without the generosity and partnership of Dr. Yoo, Project Access patients like Hilda would have nowhere else to turn for the extensive neurosurgery they need to regain their health, return to work, and continue taking care of their families. Champions for Health is delighted to recognize Dr. Kevin Yoo and his tremendous contributions to Project Access with the 2017 Health Heroes Above and Beyond Award. 

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Champion Award: IGO Medical Group More than 80 uninsured female patients, previously suffering from chronic gynecologic issues, are healthy today because of IGO Medical Group. Since 2010, eight physicians within this practice have generously donated their time and expertise to provide specialty care to Project Access patients. These chronic conditions were often so severe that patients would end up in local emergency departments needing blood transfusions.

But today these women have returned to work and are able to continue taking care of their families because of IGO Medical Group.

Champions for Health is proud to honor IGO Medical Group with the 2017 Health Heroes Champion Award. We are deeply grateful to the practice and its physician volunteers — Dr. Wendy Buchi, Dr. Kim Bui, Dr. Valerie Gafori, Dr. Heather Gunnarson, Dr. Keerti Gurushanthaiah, Dr. Amita Jain, Dr. Laura Robertson, and Dr. Sarah Wilkinson — for their inspiring dedication, compassion, and support. 

L–R: Dr. Carol Young, Dr. Rosemarie Johnson, and Barbara Mandel

Lifetime Achievement Award: Dr. Rosemarie Marshall Johnson Rosemarie Marshall Johnson, MD, has demonstrated exemplary leadership improving community health in San Diego. In addition to serving on the Champions for Health leadership team and board of directors for several years, Dr. Johnson has also played a pivotal role in the inception and growth of Project Access San Diego since 2008.

ANNUAL EVENTS

Beyond that tremendous contribution to community health, Dr. Johnson also served as the second-ever female president of the San Diego County Medical Society. Statewide, she served for years as a delegate from District I to the CMA House of Delegates and was elected its speaker. She encouraged leadership by inviting female delegates at the CMA House to gather socially and founded The Roberta Fenlon Society, named after the first female president of CMA. She was elected president of the California Society of Anesthesiologists for 1995–96. Nationally, she was a presidential appointee to the Border Commission.

Dr. Johnson is by definition a lifetime champion for health, and we are delighted to present her with the first-ever Champions for Health Lifetime Achievement Award. 

2016 Solana Beach Sunset 5K Run/Walk: More than 700 walkers convened on Oct. 1, 2016, to raise funds and awareness for diabetes prevention at the Solana Beach Sunset 5K. This family-friendly event is Champions for Health’s thirdannual fundraiser and brought in more than $70,000 for its diabetes prevention program, Jump Start for Health. Through this program, pre-diabetic families in San Diego receive personalized coaching, healthy living tips, and nutritional counseling to reduce their risk of developing diabetes. 

2017 Aces for Health Golf & Tennis Tournament: Champions for Health hosted its fifth-annual Aces for Health Golf & Tennis Tournament on March 27, 2017, at Lomas Santa Fe Country Club in Solana Beach. Physicians, other healthcare professionals, and community members participated in the daytime event and evening reception, which raised more than $73,000 for Project Access San Diego.

This flagship program of Champions for Health provides pro bono specialty care to low-income, uninsured San Diegans. 

SAN DIEGO PHYSICIAN.ORG

17

COMMUNITY PARTNERS

2016 Solana Beach Sunset 5K Sponsors The Doctors Company The Doctors Insurance Agency / Bob DeSimone Northgate Market Tri-City Medical Center KUSI The County of San Diego’s Live Well San Diego Skinny Gene Project KPBS California Coast Credit Union The Brighter Side First 5 Commission Solana Beach Executive Plaza T&M Mechanic Architectural Interior Resource Farm Fresh to You Movin Shoes Coastal Roots WANU Water LÄRABAR Smart & Final Colonial Life Juice Wave City of Solana Beach Jimbo’s…Naturally!

Ranch & Coast Magazine Foster and Adoptive Services 2017 Aces for Health Golf & Tennis Tournament Sponsors The Doctors Company The Doctors Insurance Agency / Bob DeSimone Carroll, Kelly, Trotter, Franzen, McKenna & Peabody UCSD Health System Sharp Health Care Aldrich Genesis Healthcare Partners Pettigrew Surgical Associates Imaging Healthcare Specialists Neil, Dymott, Frank, McFall & Trexler Sutter Health Wealth Advisors, Inc. MV Advisors Barney & Barney

Cooperative of American Physicians, Inc. The Brighter Side Thank You to Our Many Healthcare Partners Alcon Allosource Alvarado Hospital American Medical Systems American Red Cross of SD/IC Amplatzer Anesthesia Consultants of California Medical Group Anesthesia Service Medical Group Applied Medical Arizona AFO Arthrex Black Nurses Association BioTissue Breg, Inc. Boston Scientific Cardinal Health Radiopharmacy Carlsbad Surgery Center cCare California Cancer Associates Coast Surgery Center Coloplast Community Health Imaging County of SD Health & Human Services Agency The Endoscopy Center Escondido Surgery Center Euclid Endoscopy Center Exagen Eye Tech Services LLC Genzyme Corp Grace Medical ENT Specialist Gyrus ACMI Hanger Prosthetics and Orthotics Harmony Home Medical Health Tronics Imaging Healthcare Specialists Innovative Ophthalmic Products Inc. IOP Opthalmics Kaiser Permanente Kolberg Ocular Prosthetics La Jolla Endoscopy Center Longevity Physical Therapy Miraca Life Sciences

Champions for Health Is Proud to Be a Live Well San Diego Partner 18

APRIL 2017

MJ Medical, Inc. Mitek Sports Medicine Nextmed, Inc. North Coast Pathology Medical Group North Coast Surgery Center Omni Motion Opthalmic Biologics Company Outpatient Surgery Center of La Jolla Otay Lakes Surgery Center Ottobock Pacific Surgery Center Palomar College School of Nursing Palomar Health Paradise Valley Hospital Parkway Endoscopy Center PhenoPath Laboratories Physician’s Surgery Center at Alvarado Poway Surgery Center Practice Plus Solutions Premier Lithotripsy Prime Anesthesia Services Rancho Bernardo Surgery Center ResMed SD County Speech Pathology Services Inc. San Diego National Association of Hispanic Nurses San Diego Outpatient Ambulatory Surgical Center San Diego Pathologists Medical Group San Diego Spine and Sport Scripps Health Scripps Mercy Surgery Pavillion SIGVARIS, Inc. Sleep Data Smith and Nephew SpineZone Sportstek Medical Stryker Surgical Center of San Diego Tri-City Medical Center UC San Diego Health System UC San Diego Radiation Oncology Center South Bay Wright Medical Vital Wear

FINANCIAL HIGHLIGHTS 12%

Individual Contributions

FISCAL YEAR 2015–16 REVENUES

$248,802

10%

Contract Income $200,417

58%

6%

Event Income $117,337

14%

PASD Pro Bono $1,197,038

Grants

$301,418

Revenue Sources Including Pro Bono Contributions

29%

35%

Individual Contributions

Grants

$248,802

$301,418

23%

Contract Income $200,417

13%

FISCAL YEAR 2015–16 EXPENSES

Event Income $117,337

4%

Administrative

6%

Fundraising

FY 16 Revenue Sources Without Pro Bono Contributions

90% Program

Distribution of Total Resources

SAN DIEGO PHYSICIAN.ORG

19

IMPROVING HEALTH, CHANGING LIVES

Joseph Chammas, MD, a cardiothoracic surgeon, and Palomar Health generously donated the highly complex surgery to save Ana’s life. Thanks to the expertise and compassion of both physicians, Ana’s heart defect was healed, and she was able to enjoy this past holiday season healthy, at home, knowing she will be able to continue raising her young family. 

Andrew Gonzalez, Chelsea Walczak, Daniel Burdstall, Gerardo Lopez, Rebecca Valenzuela, Barbara Mandel, Lorena Garcia Dr. Julie Berry With Reino and His Wife

Julie Berry, MD, Helps Patient Regain Senses Through Donated Surgery — For 12 years, Reino battled a sinus condition that obstructed his nasal passage and negatively impacted most facets of his life.

His condition was so severe that he was unable to taste, smell, or breathe normally. Uninsured and in desperate need of specialized medical care, Reino was referred to Project Access physician volunteer Julie Berry, MD, who performed the complex sinus surgery Reino needed at Tri-City Medical Center. Thanks to Dr. Berry’s pro bono services, today Reino is healthy and finally able to relish the simple pleasures of breathing easily, tasting food, and enjoying scents.  Open Heart Surgery Patient Ana Delia Hernandez With Her Husband and Daughter

Roger Acheatel, MD, and Joseph Chammas, MD, Lifesaving Medical Care for Heart Defect Patient — When Ana, 32, began experiencing severe heart palpitations, she didn’t have the time or resources to seek medical attention. Uninsured and busy raising two young children, Ana pushed concern for her symptoms to the back of her mind. But when her heart palpitations persisted and Ana ended up in the emergency room on four separate occasions, she was referred to Project Access physician volunteer Roger Acheatel, MD, at Arch Health Partners Cardiology. Dr. Acheatel performed pro bono diagnostics that revealed Ana had a severe heart defect that would require openheart surgery.

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APRIL 2017

Roderick Rapier, MD, and Marco Tomassi, MD, at Kaiser Permanente Identify and Extricate Cancer for Working Father of Four — Gerardo, an employee for a local construction company, works six days a week to support his four children. His ability to work became deterred by debilitating and persisting abdominal pain. Uninsured and unable to pay out-of-pocket costs for these diagnostics, Gerardo was in the difficult position of forgoing the diagnostics and medical care he desperately needed.

Kaiser Permanente physician Roderick Rapier, MD, performed a diagnostic colonoscopy through a Project Access Saturday Surgery Day, and diagnosed colorectal cancer. Marco Tomassi, MD, then performed the successful surgery that saved Gerardo’s life. Gerardo is now cancer free and recently celebrated with the Champions for Health team at the Undy Run, an event for colorectal cancer survivors. 

Josefa Alonso With Dr. Hernan Goldsztein

Thanks to Hernan Goldsztein, MD, Josefa Can Finally Hear Her Children’s Laughter — For years, Josefa had experienced difficulty hearing clearly.

When her daughter’s pediatrician administered a simple test that Josefa failed, she was shocked to realize how severe her hearing impairment was.

Uninsured and with her health in jeopardy, Josefa was referred to Champions for Health. We turned to physician volunteer Hernan Goldsztein, MD, at Pacific ENT, who generously performed pro bono diagnostics and a cochlear implant for Josefa.

The highly specialized procedure went very well, and, thanks to Dr. Goldsztein, Josefa is able to finally hear her children laugh again. 

SAN DIEGO PHYSICIAN.ORG

21

CLINICIANS ADDRESSING THE TSUNAMI OF ALZHEIMER’S DISEASE

By James S. Grisolía, MD and Barbara Mandel Alzheimer’s disease and related dementias have no known cause, no cure, and no established prevention protocol. Yet it is the third leading cause of death in San Diego County, claiming more than 64,000 individuals and 145,400 family caregivers. With the growing number of seniors, this tsunami will affect more than 94,000 San Diegans by 2030.

At the March 20 County of San Diego Board of Supervisors meeting, County officials learned of the progress made just in the past year on improving clinical practice, cure, and care for individuals with dementia. The Clinical Roundtable, co-chaired by Michael Lobatz, MD, director of rehabilitation for Scripps Health, and Nick Yphantides, MD, MPH, chief medical officer for the County of San Diego, brought together neurologists, psychiatrists, geriatricians, geriatric psychologists, and other healthcare professionals to develop standards to more effectively manage this disease. Included were representatives from Scripps, Sharp, Kaiser-Permanente, UC San Diego, Alzheimers San Diego, and a host of agencies.

The small number of specialists will be inadequate to treat all those afflicted. Clearly, the bulk of diagnosis and treatment of Alzheimer’s disease must be handled by primary care providers.

The Alzheimer’s Project, encompassing Cure, Care, and Community Education along with Clinical Practices, began in 2014 as a countywide initiative under the leadership of County Supervisor Dianne Jacob (2nd District), a partnership unique in U.S. healthcare. The Cure Roundtable focuses on research to bring drugs to clinical trial sooner; so far eight research projects have already yielded two worthy of more extensive development and potential NIH grant funding. The Care Roundtable provides education and support to caregivers, residential and day care providers, public safety personnel, and community-based organizations.

The Clinical Roundtable, facilitated by SDCMS’s own Champions for Health, has achieved substantial progress toward goals as well. The Physician Guidelines for Screening, Evaluation, and Disease Management were published in December 2016, and are available on the ChampionsforHealth.org/Alzheimers website, along with a multitude of resources for physicians and our staffs. Fourteen on-demand webinars, each taking just 15–20 minutes to review, are in the process of receiving CME accreditation. Grand rounds presentations at the various health systems are being

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APRIL 2017

scheduled over the next 12 months.

A survey of primary care providers illuminated the need for resources for patients and caregivers; we physicians simply do not know what community resources are available. The Clinical Roundtable developed a quick listing for physician practices, along with other materials to share with caregivers. These resources are also available on the ChampionsforHealth.org/ Alzheimers website.

Over the next year, the Clinical Roundtable will launch a mobile app that will include algorithms for screening, evaluation, and disease management. The app will allow physicians easy access to screening and treatment algorithms while staying eyeball to eyeball with our cognitively challenged patients. The Roundtable also plans a full-day conference geared toward

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primary care providers to share in-depth knowledge, supporting and empowering practitioners to better care for this growing segment of our practices.

We encourage physicians to review and utilize these resources, and give us feedback on your experience. We consider the guidelines a living document that will be reviewed and updated regularly as we make progress in treatment. San Diego is uniquely positioned to integrate caring and competent providers with an immensely powerful research community. Together, we can make progress toward a cure. Only together, as a physician community, can we successfully surf this coming tsunami. 

CMA MEMBER HELP LINE! Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262

SAN DIEGO PHYSICIAN.ORG

23

IMPROVING COMMUNITY HEALTH

L–R: Barbara Mandel, CEO, Jenna Diggs, Elise Britt, Jeffrey Willmann, Board Member

Medical Student Scholarship Winners — Jenna Diggs, MD, and Elise Britt, MD, were named Champions for Health’s 2016 resident scholarship recipients.

Scholarships provide financial support for incoming medical students during their four years of study, and to new residents. Awards are granted annually on merit and the candidate’s alignment with Champions for Health’s mission. 

2016 Flu Season: Immunization Clinics — The 2016 flu season took its toll with record numbers of deaths in San Diego. Champions for Health played a key role in preventing an even higher rate by providing more than 1,100 free vaccinations at community locations in San Diego. “We are pleased to support community health in this important way, through our free vaccination clinics.” says Barbara Mandel, CEO at Champions for Health. 

Love Your Heart Day — Champions for Health is committed to helping San Diegans prevent heart disease by facilitating free blood pressure screenings each year during the “Love Your Heart Day” event. This community effort, aptly falling on Valentine’s Day, is part the County of San Diego’s Live Well San Diego initiative.

“Love Your Heart Day activates San Diegans to know their blood pressure so they can take charge of their own heart health. Many people are unaware that high blood pressure increases the risk for heart disease and stroke,” says Al Ray, MD, Board President, Champions for Health.

Of the more than 10,000 blood pressures tracked county-wide, Champions for Health contributed 2,785 screenings. There were 27 physician practices that participated in this effort by reporting their in-office screenings, and Champions for Health utilized 32 volunteers at various community locations on Feb. 14.

In addition to the free screening, participants received information that includes strategies for heart health and a listing of community resources should they need a medical provider. 

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APRIL 2017

Live Well Speakers Bureau — A big component of improving community health begins in the community. Champions for Health is proud to facilitate the Live Well Speakers Bureau, in which physician volunteers from across San Diego County provide presentations to community residents on a variety of healthy living topics. The goal of these informational sessions is education and empowerment to produce positive health outcomes and outlooks for San Diego families. Presentations are given by physician volunteers at schools, libraries, churches, and other community meetings. 

Jump Start for Health — 2016 marked the launch of Champions for Health’s first cohort of the National Diabetes Prevention Program, Jump Start for Health, carried out in partnership with YMCA and the Skinny Gene Project. This one-year course offers pre-diabetic families weekly group meetings, nutrition counseling, and personalized coaching on healthy living.  Project4:Layout 1

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Tracy Zweig Associates A

REGISTRY

&

PLACEMENT

FIRM

Physicians

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Seeking Family Medicine, Pediatrics and Obstetrics and Gynecology Physicians in San Diego, Riverside and Orange Counties Position: Full-time and part-time. Full benefits package and malpractice coverage is provided by clinic.

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CLASSIFIEDS PHYSICIAN POSITIONS AVAILABLE SEEKING LICENSED MD/DO FOR CONSULTATIVE WORK: Medical Marijuana Evaluation Center, San Diego. Work remotely from home or in our San Diego office. Must hold a valid medical license in the State of California. We are looking for compassionate doctors who believe in the benefits of medical marijuana to join our team. Our doctors will be assessing patients to determine if they meet the California guidelines for the use of medical marijuana. Full-time / part-time. To work from home you must have a telephone and modern computer with Internet connection and webcam. Please email CV and contact info to knewidea@gmail.com. [601] SEEKING PART-TIME CARDIOLOGIST: Seeking a cardiologist to work part-time in an outpatient cardiology practice in North San Diego County. Practice opportunities from Monday through Saturday. Hours are from 8am to 5pm. There is no night call or holiday workdays. The contracted cardiologists would decide from the days available which days to work. Please fax resume to (760) 510-1811 or email to evelynochoa2013@yahoo.com. [596] SHARPCARE MEDICAL FOUNDATION CHIEF MEDICAL OFFICER: Full-time CMO for new primary care Foundation model.

Adult primary care physician, 80% clinical / 20% administrative with practice in La Mesa area: Current unrestricted license to practice medicine in the State of California; board certified in primary care or related sub-specialty area; minimum five years of medical administration experience; excellent communication skills; demonstrated clinical practice leadership experience; knowledge of managed healthcare systems, medical quality assurance, quality improvement and risk management; demonstrated leadership, management, organizational, and interpersonal skills; ability to work collaboratively internally and externally; demonstrated ability to assess business needs, design and implement programs, and evaluate results; demonstrated commitment to group practice and healthcare system values. Job type: Full-time. Contact Glenn Chong at glenn.chong@sharp.com or call (858) 499-4557. [594] SEEKING FAMILY MEDICINE AND INTERNAL MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group is seeking full-time or half time (job share) BC/BE family medicine and internal medicine physicians to join our staff. We offer a first-year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 2334730. Email: lori.miller@sharp.com. [590] SEEKING EMERGENCY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group is seeking full-time BC/BE emergency medicine physicians to join our urgent care department. We offer a first-year competitive compensation and an excellent benefits package.

Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619)

233-4730. Email: lori.miller@sharp.com. [591] FAMILY MEDICINE / INTERNAL MEDICINE PHYSICIANS NEEDED: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and midlevel practitioners.

We currently have full-time openings in our San Marcos, Ramona (solo practice), and Temecula locations. Current CA and DEA licenses required. Must be BC/BE. We offer a competitive compensation and benefit package, including malpractice coverage and shareholder opportunity. Check out a full list of our benefits under Careers at www.graybill.org. Send CVs to ssnodgrass@graybill.org, apply online, or fax (760) 738-7101. [592] GENERAL, FAMILY, OR INTERNAL MEDICINE PHYSICIAN NEEDED IMMEDIATELY: This opening is an independent contractor position. We are a house-call practice located in beautiful North San Diego County. We will also provide paid training on our EMR. 8–5, Monday–Friday, 10–12 patients per day, and on-call pager one week every three weeks, telephone call only. No rounds or hospital duties. If interested, please email your CV to julie@sandiegomobiledoctor.com. We are very anxious to fill this position, and we look forward to hearing from YOU! No agencies please. [584] PART-TIME ORTHOPAEDIC PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks an orthopaedic physician to see patients in our office one afternoon per week. If interested, please call Jeff Dill at (619) 456-2453 or send CV to jeff@eastcountyurgentcare.com. [581] PRIVATE PRACTICE INTERNAL MEDICINE OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO COUNTY: Unique opportunity to practice outpatient internal medicine in a private practice setting. Practice is part of a well-established internal medicine group with a 30+ year history of outstanding care in the community, seeking physician who enjoys providing thoughtful, personalized patient care. Exceptional office staff, flexible scheduling options, small group environment, autonomy, and very high quality patient care are among the many benefits of this opportunity. Office is easily accessible from all parts of San Diego County, as well as Orange County. Seeking BC/BE applicants. Please send CV to portofino3@aol.com or call (619) 2482324. [577] FAMILY MEDICINE / PEDIATRIC 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. Email resume to hr@vistacommuntyclinic.org or fax to (760) 414 3702. Visit our website at www.vistacommuntyclinic.org. EEO Employer/Vet/Disabled/AA [566]

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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OPPORTUNITY FOR INTERVENTIONAL PHYSIATRY / PHYSICAL MEDICINE SPECIALIST: Practice opportunity for parttime or full-time interventional physiatry / physical medicine specialist with wellestablished orthopaedic practice. Office located near Alvarado Hospital. Onsite digital X-ray and EMR. Interested parties, please email lisas@sdsm.net. [554] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of house-call doctors. Great pay ($200–$250+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] OFFICE SPACE AVAILABLE / REAL ESTATE

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp & Rady Children’s. Ready-to-occupy suites ranging from 1,300-5,000 SF with mix of exam rooms and offices. Will consider short-term & long-term leases.

For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE / SHARE IN UTC / LA JOLLA AREA: Established orthopedic surgeon seeks tenant to share office space. 4675ft2 in Chancellor Park, near Scripps Memorial Hospital.

Completely rebuilt in 2009. Six exam rooms, digital X-ray onsite. Beautiful finishings, spacious waiting room, conference room, break room.

Ample space for support staff and a private office for physician. Available immediately, full or part time. Ideal for primary or satellite office.

Excellent freeway access (1-5 and 805), firstfloor suite located off lobby near main building entrance. For further information, please contact Georgana Bradley at (858) 457-0050 or at gbradley@jpbamc.com. [602] MEDICAL OFFICE BUILDING FOR SALE OR LEASE: 1729 Palm Avenue is an approximately 2,433ft2, freestanding, professional medical office building conveniently located in San Diego. The property offers excellent exposure and visibility along Palm Avenue with approximately 38,000 ADT (Costar) and is minutes away from Imperial Beach and the Pacific Ocean. Sale Price: $519,000. Lease Rate: $1.35/sf + Utilities. Please contact Chris Baumgart with Cushman & Wakefield for more information at (760) 431-3847 or at chris.baumgart@cushwake.com. [600] EAST COUNTY SINGLE-STORY HOME FOR SALE: East county single-story home on cul-desac, 4,800+ square feet, Hidden Mesa Estates, custom built 1990, on 0.8 acres, 5 bedrooms, 3.5 baths, 2 family rooms, plus den, pool, spa, deck with cabana, original owner. To contact agent, email ranchhouse21@gmail.com. [597] HILLCREST OFFICE TO SHARE: Fourth floor suite at 4033 Third Avenue, a short walk to Mercy Hospital. Two exam rooms, private office,

and break room. All days available. Please call Jack Yang at (619) 548 0450. [585] EL CAJON OFFICE SPACE FOR RENT: Centrally located in East County in El Cajon. Rent by the hour, day, week, or month. Reasonable rates. Free parking. Quiet office building. Free Wi-Fi. Kitchen available. Central workroom.

Wheelchair accessible. Perfect for therapists, consultants, etc. Call Marlene at (619) 401-1430 or email saben615@sbcglobal.net. [582]

MISSION VALLEY AMBULATORY SURGICAL CENTER FOR LEASE Centrally located in Mission Valley, AAAHC Accredited with two fully equipped operating rooms, recovery department, nicely appointed patient waiting area and doctor’s lounge.

Highly qualified surgical staff is provided. The center is leasable by the day, week or month.

Please contact Matthew Rifat for further information at 619-708-3675.

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 $5,000 for 4–5 year lease, rent $1,800 per month net ($400 NNN). 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

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE FOR 2–3 DAYS PER WEEK: In the 4520 Executive Drive bldg. Excellent location between I-5 and I-805. Beautiful, renovated office space with two exam rooms and large physicians office for consultations. Ideal for primary care, pain management, physical therapy, rheumatology, infectious disease, dermatology, orthopedics. Interested parties, please email missyphilip@gmail.com. [573] 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]

PSYCHIATRIC NURSE PRACTITIONER: Status: FT. Rate: $50.00–$52.00/hour. The Neighborhood House Association is seeking a psychiatric NP responsible for providing comprehensive psychiatric services to severally mentally ill adults (with mental health, substance abuse, and co-occurring conditions), nursing care, including health screening, diagnosis, assessment/ treatment, and client management. Qualifications: Two years full-time RN experience in a psychiatric or other mental health facility; A valid adult family practice nurse practitioner certification / license or certified psychiatric nurse practitioner in the State of California required; CPR certification and TB test required upon hire; A valid California driver’s license. To apply, email résumé to recruiting@neighborhoodhouse.org.

[599]

PLACE YOUR AD HERE Contact Dari Pebdani at 858-231-1231 or DPebdani@SDCMS.org

FAMILY MEDICINE NURSE PRACTITIONER: Needed at the Sycuan Medical Dental Center, a tribal health center on the Sycuan Reservation in El Cajon. Full-time position includes part-time patient care / part-time administrative duties.

Mon.–Fri., 8am–4pm. Apply online at www.sycuan.com. [595] SEEKING PER DIEM PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and midlevel practitioners.

We are currently looking for a per diem PA or NP to provide direct patient care in an urgent care / extended family practice setting in Escondido; to work three weekend shifts per month (8am–4pm) with a possibility of additional shifts as needed. Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Two years’ prior experience in an urgent care or ER required. Bilingual in English/Spanish helpful. Send CV to ssnodgrass@graybill.org, apply at www.graybill.org, or fax to (760) 738-7101. [593] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for busy pediatrics office with three doctors in Chula Vista. Part time, flexible days/hours. Fluent in English and Spanish. Call (619) 454-0457 or email condorsoul@aol.com. [576] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 9925330 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] MEDICAL EQUIPMENT WAITING ROOM KIOSK WITH TABLETOP STAND: (eClinicalWorks Compatible) Decrease wait times, increase collections, and improve financial performance. 17-inch touchscreen with swipe magnetic credit card reader. Copays and accounts receivable payable upon check-in.

Software included. Original cost new $5,199.

Sell for only $1,299. Email KLewis@SDCMS.org.

[587] FREE MEDICAL EXAM TABLE: Good condition. Free for the taking. Email KLewis@SDCMS.org. [586] SERVICES OFFERED PHYSICIAN OFFICES IN NEED OF ASSISTANCE FOR MEANINGFUL USE ATTESTATION of their electronic health records can avail themselves of technical assistance from Champions for Health, the sister organization to SDCMS. Practices attesting on the Medi-Cal Incentive Program with at least 30% of patients billed to Medi-Cal can receive free assistance thanks to a federal funding source. Medicare practices can receive the same great service at a very reasonable rate, and SDCMS-CMA members receive a discount. For more information, email Barbara.Mandel@ChampionsFH.org or call (858) 300-2780. [559]

SAN DIEGO PHYSICIAN.ORG

27

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