May 2018

MAY 2018 OFFICIAL PUBLICATION OF SDCMS

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CONTENTS

VOLUME 105, NUMBER 5 Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; Robert E. Peters, MD, PhD; William T-C Tseng, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: David E. J. Bazzo, MD President-elect: James H. Schultz, MD Secretary: Holly B. Yang, MD Treasurer: Sergio R. Flores, MD Immediate Past President: Mark W. Sornson, MD, PhD GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD East County #2: Rakesh R. Patel, MD East County #3: Jane A. Lyons, MD Hillcrest #1: Gregory M. Balourdas, MD Hillcrest #2: Thomas C. Lian, MD Kearny Mesa #1: Jamie M. Jordan, MD Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Laura H. Goetz, MD La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Veena A. Prabhakar, DO South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD GEOGRAPHIC ALTERNATE DIRECTORS East County: Heidi M. Meyer, MD Hillcrest: Kyle P. Edmonds, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County: Franklin M. Martin, MD South Bay: Karrar H. Ali, DO AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Paul J. Manos, DO; #3: Alexandra E. Page, MD; #4: Nicholas J. Yphantides, MD; #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); #8: Robert E. Peters, MD AT-LARGE ALTERNATE DIRECTORS #1: Karl E. Steinberg, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Susan Kaweski, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD ADDITIONAL VOTING DIRECTORS Communications Chair: William T-C Tseng, MD Finance Committee Chair: J. Steven Poceta, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Margaret Meagher

feature

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6 Champions for Health: Physicians Moved to Action Annual Report for Fiscal Year 2016–2017

departments 4

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CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MPH Sergio R. Flores, MD

24 Communication and Resolution Programs Improve Patient Safety, Mitigate Risk

AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Mihir Y. Parikh, MD At-large AMA Delegate: Albert Ray, MD At-large AMA Delegate: Theodore M. Mazer, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD

BY DAVID B. TROXEL, MD

Briefly Noted: Calendar • Legislative Action Day • Live Well San Diego Public Health Champion Award

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Physician Marketplace Classifieds

NAFLD: A Major GloCal Problem

Aiming for Mental Health

BY ROHIT LOOMBA, MD, MHSc

BY HELANE FRONEK, MD, FACP, FACPh

MAY 2018

ADDITIONAL NON-VOTING MEMBERS Alternate Resident Physician Director: Zachary T. Berman, MD Alternate Retired Physician Director: Mitsuo Tomita, MD San Diego Physician Editor: James Santiago Grisolia, MD CMA Past President: James T. Hay, MD CMA Past President: Robert E. Hertzka, MD (Legislative Committee Chair) CMA Past President: Ralph R. Ocampo, MD, FACS CMA President: Theodore M. Mazer, MD CMA Trustee: William T-C Tseng, MD CMA Trustee: Robert E. Wailes, MD CMA Trustee: Sergio R. Flores, MD

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org.

All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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/////////BRIEFLY /////////////////NOTED //////////////////////////////////////////////////////////////////////// LEGISLATIVE ACTION DAY

From left to right: UCSD medical student Jonathan Cunha; Holly Yang, MD; Mihir Parikh, MD; CMA President Theodore Mazer, MD; Senator Joel Anderson, Susan Kaweski, MD; Bing Pao, MD; Alex Quick, MD; SDCMS CEO Paul Hegyi

CALENDAR JUNE 22–24: San Diego Academy of Family Physicians 61st Annual Family Medicine Update at Paradise Point Resort. More information: www.sandiegoafp.org July 27–29: Clinical Updates in Allergy and Immunology 2018, presented by Mayo Clinic School of Continuous Professional Development. Hotel del Coronado. www.ce.mayo.edu

AUG 1–4: Metabolic & Endocrine Disease Summit(MEDS) for NPs and PAs. Physicians welcome.

More information: www. globalacademycme.com Sept 22–26: AIHM 2018 Annual Conference, the Interprofessional Health and Medicine Conference of the Year. Sheraton San Diego. www.conference.aihm.org OCT 12–14: UCSD School of Medicine 50th Anniversary Alumni Reunion. More information: medalumni@ucsd.edu

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GIVING BACK

VOLUNTEER OPPORTUNITIES Email Your Volunteer Opportunity Ads to Editor@SDCMS.org PHYSICIANS: HELP US HELP IMPROVE THE HEALTH LITERACY OF OUR SAN DIEGO COUNTY COMMUNITIES by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and help improve the health literacy of those with limited access to care. For further details on how you can get involved, please email Andrew.Gonzalez@ChampionsFH.org.

CHAMPIONS FOR HEALTH PROJECT ACCESS: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology. We are seeking these specialists throughout all regions of San Diego to support those that are uninsured and not eligible for Medi-Cal receive short term specialty care. Commitment can vary by practice. The mission of the Champions

for Health’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Will you be a health CHAMPION today? For more information, contact Andrew Gonzalez at (858) 300-2787 or at Andrew.Gonzalez@ ChampionsFH.org, or visit www.

ChampionsforHealth.org.

SHORT-TERM MEDICAL VOLUNTEERS NEEDED FOR HAITI: We are looking for physicians, mid-level providers and nurses for one-week, primary-care medical clinics in rural Haiti in June and October 2018. This is a rewarding and fun opportunity to work with the people of Haiti and provide care in a rural clinic in a medically under served area. Seattle-King County Disaster Team (a U.S.-based nonprofit) has been operating these clinics since 1998. We coordinate all in-country travel and logistics. Please contact Bob Downey at (619) 905-7157 or at labboy@earthlink.net if you are interested in applying. Visit www.skcdteam.org for further information

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www.soundoffcomputing.com POLITICAL ADVOCACY

CALIFORNIA PHYSICIANS: Time to Take Action to Stop the Dangerous AB 3087. AB 3087 would move health care in the entirely wrong direction and drive physicians out of California.

A recent survey of California physicians by CMA found: • 92 percent opposed AB 3087 (6 percent undecided, 2 percent in support).

• 58 percent believed AB 3087 would force them to leave California and practice elsewhere.

• 39 percent believed AB 3087 would force them into early retirement.

• Only 5 percent believed AB 3087 would have little to no effect on their medical practice.

• Of the 79 percent of respondents who currently serve Medi-Cal patients, 64 percent believed AB 3087 would force them to decrease the number of Medi-Cal patients they serve.

SDCMS Physicians are urged to visit actnow.io/PriceFixing to ask their legislators to stop this dangerous bill.

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TABLE OF CONTENTS Our Mission … 7 Community Wellness … 8 Project Access … 10 Physician Support … 12 Our Volunteers … 14 Community Impact … 16 Champions for Health Events … 17 Financial Highlights … 18 Thank You to Our Community Partners … 19

Champions for Health Physicians Moved to Action ANNUAL REPORT FOR FISCAL YEAR 2016–2017 6

MAY 2018

The mission of Champions for Health is to improve community health and wellness, access to care for all, and support for physicians through engaged volunteerism.

Physicians are moved to action through: Community Health & Wellness by addressing preventable and chronic diseases through immunizations, screenings, diabetes prevention education, and Live Well San Diego Speaker’s Bureau speaking engagements.

Access to care for all as volunteer physicians for Project Access San Diego.

Supporting physicians with scholarships and in the legislative process as medical students, through the use of technology as practitioners, and by staying updated in their field as retired professionals.

SAN DIEGO PHYSICIAN.ORG

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Community Wellness

Immunizations The 2017 flu season and the Hepatitis A epidemic resulted in high rates of emergency room visits, hospitalizations and deaths. The Hispanic Nurses Association, the Black Nurses association, and volunteer nursing students from several nursing schools were mobilized to provide these free immunizations. Eighty percent of the participants were uninsured and low income residents of San Diego County, saving them $20-$65 for this free service.

IMMUNIZATIONS

Flu: 2,063 Hepatitis A: 900 Tdap: 50 PCV13: 50 Sites: 143 Volunteers: 162

“Part of the issue is the lack of education when it comes to vaccines. I'm glad we get to take time to provide these clinics and educate our neighbors on the importance of these types of preventive measures.”

–TERESA MISENHELTER, RN Mayor Faulconer at the 12th Annual Project Homeless Connect event where Champions for Health provided free flu shots.

BLOOD PRESSURE SCREENINGS:

Love Your Heart Screenings: 5,452 (Out of 9,362 taken in San Diego) Additional Blood Pressure Screenings: 2,745 Sites: 160 Volunteers: 138

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Blood pressure screenings Love Your Heart Day Champions for Health is committed to helping San Diegans prevent heart disease by providing free blood pressure screenings all year, but especially during “Love Your Heart Day.” This community effort, aptly falling on Valentine’s Day, is part the County of San Diego’s Live Well San Diego initiative. Participants receive strategies for heart health and a listing of community resources.

Speakers Bureau physicians volunteer to provide education to the community on various topics, such as keeping myopia away. Pictured: Dr Rob Joyce, Optometrist.

Sites 132 Speakers Bureau The “Live Well Speakers Bureau” are physician volunteers providing presentations to community residents on healthy living topics with the goal being to produce positive health outcomes and outlooks for San Diego families.

San Diegans Served 4,240 Volunteer Speakers

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“ I love watching the eyes of the audience open as they begin to fully understand a health topic that has been confusing them.”

–ROMINA ESPINOSA, MEDICAL INTERPRETER VOLUNTEER

Jump Start for Health Jump Start For Health is a collaborative partnership between the Skinny Gene Project and Champions For Health to bring evidence-based diabetes prevention programs to underserved areas in San Diego County. This eight-week course offers pre-diabetic families weekly group meetings, nutrition counseling and personalized coaching on healthy living. The Jump Start for Health model allows us to launch programs in new communities, gradually transitioning to a sustained community partner-led program, over the course of three years.

Jump Start for Health, a diabetes prevention program, celebrates the graduation of its participants and their weight loss.

SAN DIEGO PHYSICIAN.ORG

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Project Access

P

roject Access San Diego, our flagship program, provides specialty healthcare for lowincome, uninsured individuals who are referred by partner community clinics.

Champions for Health staff navigate and coordinate care for men and women and transforming their lives from pain and dire medical diagnoses to health, renewed family involvement, and productive work and community life. The network of physicians, hospitals, surgery centers, and healthcare service partners donate a full range of pro bono specialty healthcare services to qualifying San Diego residents.

The life-changing, pro bono work of three local physicians was honored by Champions for Health at its 2018 Health Heroes awards ceremony. This annual reception celebrates these physician volunteers and the patients who are forever grateful for their care and compassion.

Dr. Jo Marie Janco Dr. Jo Marie Janco exemplifies being a Health Hero for vulnerable patients in need. She is a gynecologist and oncologist who joined Project Access in 2015, and has donated her services during 24 appointments and 19 surgeries.

Dr Janco puts her patients at ease with her calm demeanor. She ensures that her explanation of the diagnosis, procedure and outcome is clear, thorough and easy to understand. Our patients always feel confident that they are in good hands with Dr Janco.

Dr. Lawrence Cooper

Dr. Jo Marie Janco

Dr. Lawrence Cooper Dr. Lawrence Cooper, an ophthalmologist, has dedicated his life to volunteering for those in need in San Diego and abroad, and exemplifies the Health Hero spirit. He joined PASD in 2011 and has donated his services during 53 appointments and numerous surgeries. When asked about his experience with PASD, Dr. Cooper said, “It’s the best time of my year, seeing these patients. [Champions for Health] makes it easy for people like me to give back, because [it] streamlines the process. You don’t have to travel abroad to help people and our compatriots right here.”

Dr. Nikolas London Our final Health Hero has been described as a heart on legs with a flying cape behind him: Dr. Nikolas London, an ophthalmologist specializing in retinopathy, has volunteered since 2013 has donated 94 appointments and numerous surgeries. Dr. London believes no San Diegan should suffer preventable blindness. Any day you walk into Dr. London’s waiting room, he is greeting a PASD family.

Adama Dyoniziak, Dr. Nikolas London, and Board President Dr. Al Ray, Board chairman

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MAY 2018

Mayra Ramirez with Dr. Janco

Mayra Ramirez Mayra Ramirez spoke of the extreme pain and inability to work or care for her son, Daniel, that she experienced prior to receiving care from Dr. Janco. Ramirez expressed her love for her angel — Dr. Janco — and how the doctor’s treatment and care saved her. Daniel also expressed gratitude on the care that his mom was provided. “I got my mom back and we can be involved in each other’s lives again,” he says. Daniel also thanked the doctors among the guests for supporting families such as theirs in transforming their lives for the better.

Rosalia Ruiz

Rosalia Ruiz Rosalia Ruiz, expressed tears of joy at being able to see her grandchildren’s smiles at Christmas, something she’d once thought she’d never experience again. Rosalia is so grateful to Dr Lawrence Cooper for her life changing surgery.

She couldn’t believe that there were such generous and compassionate people in the world.

Rosalia very often when speaking with staff, family and friends tells of her love and gratitude for her angel Dr Cooper.

Hermelinda Torres at the Health Heroes awards

Hermelinda Torres Hermelinda Torres tearfully told of how she was frightened about her loss of sight. She would not be able to care for her daughter, not be able to see to create the floral and balloon arrangements that she was known for. She prayed to God to send her an angel, and that angel was Dr London. He transformed her life from darkness and despair to light and happiness. The flowers she gave to Dr Nikolas London as he received his award she had arranged herself, a testament to her determination and his compassion.

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Physician Support Dr Robert Hertzka with medical students on legislative advocacy day visit law makers in Sacramento with the California state bear.

S

upport for doctors is our way of forging connections with the full range of physicians — from medical students through practitioners to retired professionals. First-year medical students from UC San Diego School of Medicine are awarded scholarships with the future intent of serving the medically underserved in San Diego County.

Legislative trips to Sacramento provide a firsthand view of how the governmental process works. Practitioners get technical advice and linkages through econsultSD, CALHIPSO, and the Alzheimer’s Project app. The Retired Physician Society meets quarterly to stay up to date on the latest happenings and opportunities in the healthcare field and beyond.

Dr. Sabrina Owens

Medical Student/ Resident Scholarship Winner Sabrina Owens was named Champions for Health’s 2017 resident scholarship recipient. Sabrina is a San Diego native who completed her B.S. in biology and B.A. in ethnic studies at UC San Diego.

Having found a love of serving the San

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Diego community, she attended medical school as part of the UC San Diego PRIME Health Equity Program, a five-year, dualdegree program for students interested in serving the underserved. She completed her master’s in public health at UCLA in community health sciences. After residency she plans to continue her work in the community, with a part-time focus on adolescent health, healthy relationships, and STI prevention with underserved populations.

Practitioners Alzheimer’s Project One way practicing physicians are supported

by Champions for Health is by connecting them to the newest developments in technology in the field of medicine. AlzDxRx is a mobile application for Alzheimer’s diseases for use in screening, evaluation, and behavioral management. The app, available in both iOS and Android, provides practitioners a means of connecting face to face with individuals with cognitive decline, walking them through the best-practices algorithms and instruments.

MedApps, the online reviewer of all medical applications, named AlzDxRx as one of the Top 10 medical applications for 2017.

Legislative Advocacy Trip We build professional connections between experienced physicians and medical students to foster valuable educational experiences, insight, and inspiration.

Understanding the legislative processes that govern the practice of medicine at the state and federal levels prepares the physicians of tomorrow. Champions for Health and the San Diego County Medical Society introduce these physicians to legislators and the legislative process so that one day they can advocate for physicians as well.

Retired Physicians Speakers Luncheon

Retired Physicians Society The Retired Physicians Society provides retired and non-practicing physicians a network to stay connected with the medical community, remain current with modern health issues and give back to the community through volunteer opportunities.

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Volunteers

462

PROJECT ACCESS PHYSICIANS

Time, Talent, and Treasure – that is what our volunteers bring to Champions for Health. Volunteers donate their time and expertise, passion and commitment to helping San Diegans get healthy and remain healthy. Volunteers help shape initiatives, generously contribute through donations, are compassionate with patients and contribute to the mission of Champions for Health. WE are so grateful and thankful for our engaged volunteers every day.

300

NURSES AND NURSING STUDENTS

263

LIVE WELL SPEAKERS BUREAU PRESENTERS

105

Volunteer medical interpreters assist Project Access patients during medical appointments, procedures, and surgeries.

MEDICAL INTERPRETERS

80 ANCILLARY PARTNERS

18 INTERNS

Left: Shelby, Jessica, and Lacoya: public health interns working the strategic plan. Right: Our volunteer, Nurse Valdez, provides blood pressure screening and information at a Love Your Heart event.

“He is the best physician who is the

most ingenious inspirer of hope.

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MAY 2018

–SAMUEL TAYLOR COLERIDGE

Volunteer nurses at a blood pressure screening event

Volunteer Voices “When I first came on with Champions for Health, the big health event they had me focus on was the Love Your Heart blood pressure screening, put on by Live Well San Diego. My volunteer coordinator gave me a lot of responsibility for the event and I was enthusiastic to take on the challenge. The level of support and encouragement from Champions was astounding, and I loved the adrenaline and excitement of being on the ground, reaching out to venue coordinators, volunteers, and community members. I appreciated every moment I got to meet and work with fellow stakeholders of the San Diego community, and feel closely connected in that way.”

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

— DANIEL BURDSALL SAN DIEGO PHYSICIAN.ORG

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Community Impact: Snapshot of FY 16–17

PATIENTS RELIED ON PASD AS A SAFETY NET

Specialty Appointments

138 Interpretation and

Transportation Services

OVERARCHING IMPACT SINCE 2008

$15,962,107 in Specialty Medical Care Donated 16

MAY 2018

Tdap vaccinations

97%

522 130

fifty

Reduction in Workdays Missed

FLU VACCINATIONS

HEPATITIS A VACCINATIONS

Reduction in Emergency Department Visits

FIFTY PNEUMONIA VACCINATIONS

2,073 2,063 91%

900

990

Procedures and Surgeries

37 LIVES SAVED!

Champions for Health Events Left: Nick Yphantides, Nick Macchione, Kristin Gaspar, Barbara Mandel, Keerti Gurushanthaiah, and Jim Hay at the Solana Beach Sunset 5K. Below: Participants at the Solana Beach Sunset 5K.

4th Annual Solana Beach  Sunset 5K Run/Walk

More than 700 walkers convened on October 7, 2017 at the Solana Beach Sunset 5K Run/Walk. This family-friendly event with Honorary Chair Kristin Gaspar, District 3 county supervisor, raised more than $40,000 for Champions for Health’s diabetes prevention program, Jump Start for Health.

2018 Aces for Health Golf & Tennis Tournament

Champions for Health hosted its sixth annual Aces for Health Golf & Tennis Tournament on March 26.

Golf foursomes and tennis doubles consisted of old friends from years past and new friends brought along for a fun time. Competition was fierce among golf foursomes with first, second, and third place winners being just 1–3 strokes apart. Tennis doubles were played round-robin and rackets swung with great power, with the most dynamic play being the women of the exhibition match, Gabi DeSimone and Mylene Petitpas. The Health Heroes Awards concluded this fun tournament, with golfers, tennis players, and guests celebrating the engaged volunteerism of the Health Heroes, with the highlight being the patient stories of their dear doctors.

Above left: Kosala Samarasinghe and his fivesome with Bob Wailes and sponsors from The Dizzy Doctor. Left: Project Access patients, family and staff at the Health Hero awards reception.

SAN DIEGO PHYSICIAN.ORG

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Financial Highlights 17%

Individual contributions

FISCAL YEAR 2016–17 REVENUES

$330,901

58%

13%

Contract income

Revenue sources including pro bono contributions

PASD Pro Bono $1,150,520

$267,207

10% Grants

$78,750

8%

Event income $151,416.46

4%

40%

Grants

Individual contributions

$78,750

$330,901

18% Event income $151,416

32%

Contract income $267,207

FISCAL YEAR 2016–17 EXPENSES

6.5%

Administrative

7.6%

Fundraising

85.8% Program

Distribution of total resources

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MAY 2018

FY 16–17 Revenue sources without pro bono contributions

Thank You to Our Community Partners 2017 Future of Medicine Sponsors Advantage Health Systems Arrowhead Evaluation Services Aspen Medical Products Avalon Hospice & Palliative Care Bank of America Emerald Triune Generation Healthcare Kindred Hospice San Diego Nuvasive Omni Pain & Functional Solutions Paradise Valley Hospital SDSU Smith & Nephew SoCal Medical Revenue Management Spine & Sport Therapy Specialists Titan Spine UC San Diego Health Vital Health Care System Vitas Healthcare

2017 Solana Beach Sunset 5K Run/ Walk Sponsor List Architectural Interior Resource California Coast Credit Union Cooking 4 Life First 5 Commission Fit Athletics Club Fitwall KUSI Live Well San Diego Aging and Independent Services Movin’ Shoes Northgate Gonzalez Markets Preferred Employers Group The Doctor’s Company The Doctor’s Insurance Agency/Bob DeSimone United Healthcare 2018 Aces for Health Sponsor Barney & Barney/Marsh Charity Golf International Cooperative of American Physicians

Dizzy Doctor Ensign Services Marsh & McLennan Agency Neil, Dymot, Frank, McFall, & Trexler APLC Promenade Dentists The DeSimone Family Therapy Specialists VDP Direct Wealth Advisors Inc. Thank You to Our Many Healthcare Partners Alcon Alvarado Hospital American Medical System American Red Cross of SD/IC Anesthesia Consultants of California Medical Group Applied Medical Arizona AFO Black Nurses Association BioTissue Breg, Inc. Borrego Health Boston Scientific Carlsbad Surgery Center cCare California Cancer Associates Coast Surgery Center Community Health Imaging Community Health Systems Inc. County of SD Health & Human Services Agency CSU San Marcos Student Healthcare Project Escondido Surgery Center Euclid Endoscopy Center Eye Tech Service LLC Genzyme Corp Grace Medical ENT Specialist Hanger Prosthetics & Orthotics Harmony Home Medical Imaging Health Care Specialists IOP Ophthalmics Kaiser Permanente La Jolla Endoscopy Center La Maestra Community Clinic

Longevity Physical Therapy Miracle Life Sciences Neighborhood Health Care Nextmed Inc. North Coast Pathology Medical Group North Coast Surgery Center North County Health Services Outpatient Surgery Center of La Jolla Pacific Surgery Center Palomar College School of Nursing Palomar Health Paradise Valley Hospital Parkway Endoscopy Center Physicians Surgery Center at Alvarado Point Loma Nazarene University Health Promotion Center Poway Surgery Center Premier Lithotripsy Prime Anesthesia Services Rancho Bernardo Surgery Center San Diego County Speech Pathology Services Inc. San Diego Family Care San Diego National Association of Hispanic Nurses San Diego Outpatient Ambulatory Surgical Center San Diego Pathologists Medical Group San Diego Spine and Support San Ysidro Health Center Scripps Health Scripps Mercy Surgery Pavilion Sleep Data Smith & Nephew SpineZone St. Leo’s Medical Program St. Vincent de Paul Health Clinic Stryker Surgical Center of San Diego The Endoscopy Center Tri City Medical Center UC San Diego Health System UC San Diego Student Run Free Clinic Project Vista Community Clinic Volunteers in Medicine

Champions for Health Is Proud to Be a Live Well San Diego Partner SAN DIEGO PHYSICIAN.ORG

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NAFLD

NAFLD: A Major GloCal Problem

by Rohit Loomba, MD, MHSc

NONALCOHOLIC FATTY liver disease (NAFLD) is now estimated to afflict approximately 1 billion individuals worldwide1 and approximately 50,000 individuals in San Diego. Therefore, it is both a global and local problem. It is defined as presence of hepatic steatosis on either a liver biopsy or an imaging study documenting at 5% of hepatocytes infiltrated with hepatic steatosis in individuals with either little or no alcohol use and no other causes for fat deposition in the liver2.

It can be broadly classified into two subcategories: nonalcoholic fatty liver (NAFL), which is characterized by liver fat but limited inflammation and no ballooning or fibrosis, and is considered to be non-progressive form of NAFLD; and nonalcoholic steatohepatitis (NASH), which is typically characterized by liver fat, lobular inflammation, and ballooning with or without peri-sinusoidal fibrosis3.

NASH can lead to cirrhosis, hepatocellular carcinoma (HCC), and liver-related

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morbidity and mortality4. NASH is now the second leading indication for liver transplant. It is particularly relevant to the population in San Diego County, as NAFLD has a specific ethnic predisposition. It is more commonly seen in individuals with Hispanic, Southeast Asian, Far East Asian, and American Indian ethnicity than Caucasians. African Americans are thought to be protected2. The increased risk in Hispanics is thought to be related to patatin-like phospholipase-3 (PNPLA3) genotype. NAFLD is thought to be a hepatic manifestation of metabolic syndrome including obesity, hypertriglyceridemia, hypertension, hyperuricemia, and impaired glucose tolerance or diabetes5. The prevalence of NAFLD and advanced fibrosis in patients with type 2 diabetes is thought be approximately 65–75% and 10%, respectively6. Despite these high rates of NAFLD and advanced fibrosis among patients with type 2 diabetes,

there is limited guidance by major societies regarding how to screen, identify, and manage these patients who are at increased risk of death from cirrhosis and HCC. NAFLD Research Center, at UC San Diego’s Altman Clinical and Translational Research Institute, is a major hub of new innovation and practice-changing science in this area. Over the past decade, radiologist Claude Sirlin and I joined forces to develop an advanced magnetic resonance imaging assessment for liver fat quantification as well as liver fibrosis quantification, and led a series of major clinical investigations. Many of these methods are now being used to assess treatment response in NASH trials, and these advanced, noninvasive methods have helped quantify liver fat and fibrosis without the need for invasive liver biopsy, and have further streamlined epidemiologic studies.

Several seminal studies are now underway at the NAFLD Research Center at UC San Diego with an aim to impact future clinical practice. These studies include developing evidence regarding screening of diabetics who are 50 years or older and screening first-degree relatives of patients with NAFLD cirrhosis. Furthermore, several novel blood, stool, microbiome, and proteome-based noninvasive biomarker assessment studies are under investigation to replace liver biopsy to assess NAFLD severity and find new therapies to reverse scarring due to NASH. For example, Dr. Caussy, a French endocrinologist from Lyon University who is a visiting scholar at the NAFLD Research Center, is assessing how to screen type 2 diabetics for the presence of advanced fibrosis, and Dr. Ajmera, a hepatologist who was recently recruited from University of California at San Francisco to join the investigative team at the NAFLD Research Center, is trying to develop novel plasma-based biomarkers of NASH and fibrosis. Both are working alongside a large multidisciplinary team of investigators encompassing systems biology, microbiome, cell signaling, macrophage biology, fibrosis, lipidome, advanced imaging, radiology, pathology, endocrine, epidemiology, genetics, and hepatology.

June 12 is being celebrated as the International NASH Day to increase awareness regarding NAFLD and its risk of silent progression to cirrhosis. We invite the broader San Diego community to help us spread

Our Doctor Loan could help eligible medical professionals buy a home¹ the word among primary care providers, internists, family practitioners, and diabetologists as well as among patients who are at risk of progressive forms of NAFLD. We are particularly excited that this increased awareness will help us identify those who are at risk for NAFLD-related cirrhosis, and we certainly hope to make San Diego NAFLD-cirrhosis-free by 2035 by intensive screening programs and enhancing new drug development by collaboration and innovation. Let us all work together to help screen for advanced fibrosis due to NAFLD and serve our community better.

• Low down payments. As little as 5% down on a mortgage up to $1 million and 10% down on a mortgage up to $1.5 million.² • Flexible options. Student loan debt may be excluded from the total debt calculation.³

Call me to learn more.

Dr. Loomba is a professor of medicine and director of hepatology at UC San Diego’s NAFLD Research Center.

References: 1. Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol 2013;10:686-690.

2. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, Harrison SA, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases.

Hepatology 2018;67:328-357.

3. Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies.

Clin Gastroenterol Hepatol 2015;13:643-654 e641-649; quiz e639-640.

4. Dulai PS, Singh S, Patel J, Soni M, Prokop LJ, Younossi Z, Sebastiani G, et al.

Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis.

Hepatology 2017;65:1557-1565.

5. Tapper EB, Loomba R. Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD. Nat Rev Gastroenterol Hepatol 2018.

6. Doycheva I, Cui J, Nguyen P, Costa EA, Hooker J, Hofflich H, Bettencourt R, et al. Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE. Aliment Pharmacol Ther 2016;43:83-95.

Billy Cafcules

Ed Woolery

Lending Associate NMLS ID: 1485046 858.692.9698 Mobile billy.cafcules@bankofamerica.com mortgage.bankofamerica.com/billycafcules

Retail Sales Manager NMLS ID: 632979 858.922.3325 Mobile ed.woolery@bankofamerica.com mortgage.bankofamerica.com/edwoolery

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 Minimum down payment requirements vary by property type and location; ask for details.

3 Additional documentation is required.

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. ©2017 Bank of America Corporation. ARWQWBD3 HL-112-AD 04-2017 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

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R I S K M A N AG E M E N T

events leading to claims are made available to physicians, this often reduces their future occurrence, i.e., it reduces the risk of specific missed diagnoses, thus improving patient safety and reducing physician liability risks.

Transparency and Disclosure: With Individual Patients CRPs teach hospitals, medical practices, and physicians how to respond to an adverse event. For example, medical professionals learn how best to respond when explaining why a wrong diagnosis was made or explaining why a pharmacy released the wrong medication. And CRPs stress the importance of offering to help, such as by reassuring the patient that healthcare costs resulting from the error may be ameliorated by fee reduction or waiver.

At The Doctors Company, we encourage our physician members to participate in structured disclosure programs, and we provide resources to educate and assist them.

Communication and Resolution Programs Improve Patient Safety, Mitigate Risk

By David B. Troxel, MD

THE MEDICAL PROFESSION is part of the cultural shift happening throughout our society toward greater transparency — and this is benefiting physicians as well as patients.

I like to think that our profession has been a leader in this area with the movement to disclose medical errors, which began about 12 years ago. Because of this movement, many hospital systems are using Communication

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and Resolution Programs (CRPs) to guide patients, families, physicians, and staff members when adverse events occur.

We know now that when a medical error occurs, disclosure and transparency often reduce the patient’s anger, and anger often leads to a medical liability claim. And greater transparency may mitigate risk on a larger scale as well: When analyses of adverse

Transparency and Disclosure: Across the Profession One of my main jobs as medical director of The Doctors Company is to review closed claims, both by specialty and by type of diagnostic error. Since we are the largest physician-owned medical malpractice insurance company in the United States, we have the largest claims database. By reviewing our closed claims data, we can achieve valuable insights, such as which diseases are most frequently misdiagnosed. By sharing our findings, we alert physicians to the most frequent causes of claims in their specialty, thus increasing patient safety and lowering physicians’ liability risks.

I can offer two examples of how studying our data, and distributing the results of our studies, have yielded positive outcomes for patients and physicians.

Difficult Diagnosis 1: Spinal Epidural Abscess. When we completed a study several years ago of closed claims in hospital medicine, the most common claim allegations were diagnosis related. Of these, we were surprised to see that there were a significant number of claims for missing a diagnosis of spinal epidural abscess.

Spinal epidural abscess is so uncommon that many physicians have never seen one.

So we shared our study with the Society of Hospital Medicine, and it agreed to publish our study in its medical journal and pres-

ent the findings at its national meetings.

Meanwhile, I wrote an article on our findings in The Doctor’s Advocate, our quarterly publication. We’ve seen a gradual decline in the incidence of claims related to spinal epidural abscess as a result of sharing this data with physicians.

Difficult Diagnosis 2: Malignant Melanoma. Some time ago, after reviewing a large number of pathology claims, I was struck by the fact that the most common reason pathologists got sued was for missing a diagnosis of malignant melanoma. Like spinal epidural abscess, melanoma is well recognized as a difficult diagnosis because there are many variants of melanoma, some of which look benign. Unless you’re seeing a large number of melanomas, you may not

recognize the subtleties that lead to the correct diagnosis.

I shared this data with pathology specialty societies and published it in pathology journals. Additionally, I spoke on the subject at the societies’ national meetings, and they invited pathology experts to speak at their meetings on melanoma misdiagnosis.

About seven years ago, I looked to see if the dissemination of this information and the specialty societies’ educational programs had reduced the incidence of claims against pathologists involving melanoma. I was pleasantly surprised to see that the frequency of such claims had dropped dramatically.

Sharing closed claims data is one of the most important things we do at The Doctors Company. This information is available to

anyone on our website, and we encourage all physicians to review these studies.

Transparency and Disclosure: Optimism About Our Future Within the medical profession, we’ve achieved positive momentum in terms of education for physicians to learn areas of practice where they need to be more attentive, and also for physicians to learn what to do if an adverse event occurs.

Contributed by The Doctors Company.

For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

Dr. Troxel is medical director at The Doctors Company.

*The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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Send resume to: hr@vistacommunityclinic.org or fax to 760-414-3702

Vista Community Clinic is a private, nonprofit outpatient community serving people who experience social, cultural or economic barriers to health care in a comprehensive, high quality setting.

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25

CLASSIFIEDS CLINICAL TRIALS WE ARE LOOKING FOR VOLUNTEERS TO PARTICIPATE IN CLINICAL TRIALS: Currently enrolling volunteers who suffer from rheumatoid arthritis, lupus, psoriasis, and psoriatic arthritis.

Qualified volunteers may receive: no-cost investigational study medication, no-cost study-related care from a study doctor. There is compensation available for time and travel.

All study-related care will be at no cost, and volunteers can continue seeing their primary care doctor during the study. Health insurance and doctor referrals are not required to participate. Please email Joy at joy@rheumSD. com for more information. [607] PHYSICIAN OPPORTUNITIES DERMATOLOGIST NEEDED: Premier dermatology practice in beautiful San Diego seeking a full-time/part-time BC or BE eligible Dermatologist to join our team. Existing practice taking over another busy practice and looking for a lead physician. This is a significant opportunity for a motivated physician to take over a thriving patient base. Work with two energetic dermatologists and a highly trained staff in a positive work environment. We care about our patients and treat our staff like family. Opportunity to do medical, cosmetic and surgical dermatology (including MOHs) in a medical office with state of the art tools and instruments. Please call Practice Administrator at 858-761-7362 or email jmaas12@ hotmail.com for more information.

FULL-TIME PHYSICIAN EMPLOYEE Private primary care office in San Diego currently seeking a full-time physician employee to work in an outpatient setting. Candidates that enjoy a collaborative, patient-centered atmosphere are encouraged to apply. Requirements include: Active CA medical license in good standing, Board Certification in Family Medicine or Internal Medicine, excellent verbal and written communication skills; computer experience including email and EHR. Must be able to work within a care giving team with focus on patient satisfaction. Experience with Centricity CPS EHR is a plus, bilingual English/Spanish, Vietnamese or Tagalog is a plus. A background check will be required. This is a full-time, benefits eligible position with potential for partnership. For consideration, send your CV and a cover letter via email to alexr@geneseemedical.com. Subject line must say “Physician Opportunity”. Other inquiries will not be opened. Phone calls, walk-ins and/or faxes will not be accepted. (posted 4/10/2018) PHYSICIAN POSITION AVAILABLE: We are looking for a passionate physician who believes in putting their patients first and values the patient-physician relationship to help engage them in their health risks, goals, objectives and work collaboratively with the patient to engage them in maintaining or improving their health Position Details: Work Schedule: Monday - Friday 9:00am-5:00pm (Flexible), Strong Support Staff, Electronic Health Records, 1 Year Salary Guarantee Benefits: Free Medical/Dental/ Vision, CME Stipend, Malpractice Insurance, Disability, Annual Leave Requirements: MD with Directly Related Experience in Family Medicine, DEA Certificate, Eligible to Work in the United States, CA Medical Licensure, Exceptional

Communication and Interpersonal Skills (POSTED 3/28/2018) Contact: Careview Medical Group, Inc, 292 Euclid Ave, Suite 210 619-262-7523 press#1 PHYSICIAN POSITION AVAILABLE: San Diego area; Out-patient only, Primary Care position; No calls; No hospital and no weekends; Email: sandiegoprimarycare@yahoo.com (Posted 3/28/2018) PHYSICIAN POSITIONS AVAILABLE: A fulltime position is immediately available for a Primary Care/Long Term Care physician at the Veterans Home of California - Chula Vista.

Employment is through the State of California within the California Department of Veterans Affairs (Calvet). Training in primary care (Internal Medicine or Family Practice) is required and additional experience and/or training in Long Term Care Medicine or Geriatric Medicine is preferable. Salary range is $17,113.00$19,969.00/month. Benefits package includes, but is not limited to, vacation, CME, medical, dental, vision and pension. For more information or to apply please use the following URL at http://bit.ly/2BPKDFK (Posted 2/21/2018) MEDICAL CONSULTANT: The County of San Diego, Health and Human Services Agency’s Behavioral Health Division is looking for Board Certified Family Practice or Internal Medicine physicians to provide care for residents at Edgemoor Distinct Part Skilled Nursing Facility (DP/SNF), an award winning, 192-bed rehabilitation and care facility located in the San Diego suburb of Santee. The individual chosen for this vacancy will provide medical care for a younger Medi-Cal population, most of which have brain injuries and significant disabilities, as well as complex physical, social and psychological problems. Visit our website: www.sdcounty. ca.gov/hr for more information on how to apply.

FAMILY PRACTICE MD / DO needed for urgent care and family practice office in Carlsbad.

Flexible afternoon, evening and weekend shifts available for family practice physician.

Exceptional office staff and flexible scheduling options at this busy, well-established private practice. Please fax or email CV to (760) 6037719 or gcwakeman@sbcglobal.net.

PER DIEM PHYSICIAN NEEDED: The County of San Diego Health and Human Services Agency is seeking a physician to work with California Children’s Services (CCS). Applicants (MD or DO) must hold a current California medical license. Board certification in Pediatrics, Child Neurology, Orthopedic Surgery, Physical Medicine and Rehabilitation, Family Medicine or Preventive Medicine is desired, but not required.

Applicants must have previous experience in providing medical care for children with disabilities and willing to work a minimum 60 hours per month. If interested, please e-mail your CV to Dr. Marie Green, CCS Medical Director, at Marie.Green@sdcounty.ca.gov or call (619) 528-4010.

physician. Borrero Medical Group is a wellestablished practice, 22 years in the community, exceptional office staff. Every member of our team plays an important role in improving the health of our patients. We offer an excellent comprehensive benefits package that includes Malpractice Coverage, Health Insurance, Competitive & Attractive Salaries, and Bonus.

If interested, please submit inquiry and CV to rosa10borrero@att.net.

PART TIME PHYSICIAN: Progressive Medical Specialists is an outpatient medication assisted treatment program located in San Diego, CA. We are currently in need of a part-time Physician to work 1 - 3 days per week. The Program Physician is responsible for providing the day-to-day medical care and treatment for all program patients. The Program Physician performs all duties in compliance with the California Code of Regulations for Narcotic Treatment Programs.

Training is provided. Please send your CV to tboylan@pms911.com or call 619-286-4600. 12/5 OB/GYN PRACTICE FOR SALE IN SAN DIEGO: ASKING $480,000,00. FY 2017 Gross $1,445,688,00. Established practice for 38 years. Suburban district. Easy freeway access.

Dedicated and experienced staff able to stay on board through sale. Situated within a modern, high-end building. The region’s fast-growing population assures for an expanding client base. Features 3200 sq. ft. of working space; 6 fully equipped patient rooms (5 exam & 1 surgery rooms with surgical lighting and fully adjustable treatment tables). Furnished waiting room and reception area; doctor’s private office, sterilization area, staff lounge and storage. ADA compliant. Contact: dixon@cwmc4women.com PRACTICES WANTED

PRIMARY OR URGENT CARE PRACTICE WANTED Looking for independent primary or urgent care practices interested in joining or selling to a larger group.

We could explore a purchase, partnership, and/or other business relationship with you. We have a track record in creating attractive lifestyle options for our medical providers and will do our best to tailor a situation that addresses your needs.

Please call 858.832.2007

PRIMARY CARE PRACTICE WANTED: I am looking for a retiring physician in an established Family Medicine or Internal Medicine practice who wants to transfer the patient base. Please call 858-257-7050 PRACTICES FOR SALE

FAMILY PRACTICE OR INTERNAL MEDICINE: Spanish-speaking family medicine or internal medicine physician (Board Certified) for Borrero Medical Group located in South San Diego next to Chula Vista. The practice is growing and needs to hire a new

HIGHLY PROFITABLE MEDSPA NOW AVAILABLE TO LICENSED PHYSICIAN. Southern California. Asking Price: $1,050,000.

Cash Flow: $410,419. This profitable and expandable company performs non-invasive cosmetic procedures, including dermal fillers,

TO SUBMIT A CLASSIFIED AD, email Editor@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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MAY 2018

Botox, and laser treatments. Experienced staff plans to stay, and protects current physician/ owner at 30 hours/week max. If you’re ready to see online financials, a studio-quality video of their story, an industry-leading assessment, and more – visit: https://goexio.com/med-spa-landing-sd for a summary. Interested? Click on “Private Access” to sign an instant nondisclosure and unlock the entire story. Full financials available on request. Prefer a personal touch? Contact Doug Miller: 208-7623451. doug.miller@goexio.com.

OFFICE SPACE / REAL ESTATE AVAILABLE

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp Memorial and Rady Children’s hospitals.

Suites ranging from 1,300-5,000 SF. For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org SHARED OFFICE SPACE AVAILABLE: Established orthopedic group seeks additional orthopedic surgeon for partnership or overhead sharing opportunity. Our office is centrally located in Kearny Mesa near Highway 163 and Balboa, easy access to freeways, affiliations with Sharp, Scripps. Extensive referral base, EMR/”paperlight” office, experienced MA/surgery scheduler/ referral coordinator. Please call Lisa Vaughn, practice administrator, at (858) 278-8300 or email lmvomg@yahoo.com. (posted 5/7/2018) 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 1-5 and 1-805. Multidisciplinary group and available to any specialty. Note we are in great need of a psychiatrist. Excellent referral base in the office and on the hospital campus.

Please call (858) 455-7535 or (858) 320-0525 and ask for Sofia or call Dr. Shurman, (858) 3449024. (Posted 4/4/2018) SCRIPPS ENCINITAS CAMPUS OFFICE 320 SANTA FE DRIVE, SUITE LL4 It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center.

Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and ½ mile from Swami’s Beach. Contact Kristi or Myra 760-753-8413. View Space on Website: www. eisenhauerobgyn.com. Looking for compatible practice types. (Posted 4/4/2018) MEDICAL OR DENTAL BUSINESS SPACE AVAILABLE: For lease a medical or dental related practice or business in a small boutique office space located in the center of “Hillcrest/ Bankers Hill” Just renovated! The second story of this beautiful two story building is available for lease. A private gated entrance leads to a 1,139 square foot upstairs with 4 to 5 consultation rooms, waiting room with adjoining private deck and full bathroom. Additional security gate

and mailbox. Separate address. Wood floors, refinished windows, natural light, quiet street, walkable to restaurants. On-site parking with up to 8 parking spaces available! Asking: $3,000/ month. Terms are negotiable. This will rent fast so hurry! Click For Photos. Please contact: hillcrestofficerental@gmail.com 858.775.5075 OFFICE SPACE FOR RENT: La Jolla -- lease - medical or dental related practice or business in a small boutique office space located in the center of beautiful La Jolla California. Perfect opportunity for psychiatrist, psychologist, counselor, dentist, physician, surgeon, any dental or medical related occupation welcome.

Located in medical dental building. Come join these great practices. 612 Sq feet, classy second floor suite with elevator. Perfect for entrepreneur.

Partially equipped for dental practice, surgical practice. Terrific opportunity. $4.90 Per sq/ft per month triple net lease contact Kevin Gott : dynamold@aol.Com (posted 3/22/18) OFFICE SPACE/REAL ESTATE AVAILABLE: Furnished office space with licensed surgical center available for full or part time rent.

Location 8705 Complex Drive in Kearny Mesa.

Call 858-715-1822. (Posted 2/27/2018) SOUTH BAY OFFICE SPACE AVAILABLE: Monthly sublease, 3 exam rooms, medical office, 5 days per week. Reasonable rates. Directly across from Scripps Mercy Hospital, Chula Vista.

If interested, please call, 619-422-2000. (Posted 2/21/2018) OFFICE SPACE AVAILABLE: Rent by the hour, day, week, month. Reasonable rates. Free parking. Quiet office building. Free Wi-Fi. Perfect for Consultants, Therapists, CPA’s/Bookkeepers, Web Designers, Real Estate, Insurance, Meetings, Etc. Located in central east county.

Referral Potential. Please call Marlene at: 619401-1430 or e-mail: saben615@sbcglobal.net (Posted date 2/21/2018)

with two offices, two exam rooms and two person receptionist area, and beautiful waiting room.

Excellent location on the campus of Scripps Memorial Hospital La Jolla. Large windows with open, peaceful garden views, available for full time rental with the option to rent time at the adjacent surgical suite. Rent also includes small kitchenette with sink, electricity, and janitorial service. Call- 858-344-7342 OFFICE SPACE/ REAL ESTATE AVAILABLE IN SOUTH BAY: Available for monthly sublease, 3 exam room, medical office, 5 days per week.

Reasonable rates. Directly across from Scripps Mercy Hospital, Chula Vista. If interested, please call 619-422-2000.

NONPHYSICIAN POSITIONS AVAILABLE PHYSICIAN ASSISTANT NEEDED: Physician Assistant needed to work in a Cardiologist office. PA must have an excellent attitude to learn Cardiology principles. Must be able to work well with others. Good bedside manner a must.

This is an excellent opportunity to work with an experienced Cardiologist with more than 20 years’ experience. If interested, fax CV to: 619810-2947. (Posted 4/5/2018) MA OR LVN POSITION AVAILABLE: This patient centered medical practice requires a skilled and professional individual with exceptional empathy, integrity, maturity and passion for patient care. You must have 5+ years of experience in the field as either an MA or LVN and be comfortable with front and back office work, be able to perform blood draws and injections, understand how to verify insurance, obtain prior authorizations, collect copays and balances. You are driven, diligent, organized, efficient, a clear communicator, honest and constantly wanting to improve. Please submit a detailed resume and 3 references from your last three positions to 92024medical@gmail.com.

PRODUCTS / SERVICES OFFERED

MEDICAL OFFICE IN SOUTH BAY AVAILABLE TO SUBLEASE: Located next to Paradise Valley Hospital, this large, recently renovated office consists of 6 exam rooms and 1 procedure room. The office is currently utilized by Orthopedic Surgeons and a Cardiologist, but can accommodate any practice. Facility provides easy access the PVH Operating Room, Physical Therapist, Imaging Center, Laboratory, and Wound Care Center and has easy freeway access. Opportunity for Orthopedic ER Call at Paradise Valley Hospital and patient referrals.

For more information, please contact Jeff Craven: jeff@sdmiortho.com or 858-245-9109 (Posted 2/21/2018) SHARED OFFICE SPACE AVAILABLE: Office space, beautifully decorated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist. Please call 619-606-3046 (POSTED 2/14/2018) OFFICE SPACE AVAILABLE –LA JOLLA UTC AREA: Looking for like-minded professionals interested in a small furnished office space a couple of days a week/part-time basis. Modern design. For details and pricing, Contact Newshaw at 866-277-3659 and visit our website www.kaizenbraincenter.com for information about our practice.

MEDICAL OFFICE SPACE, SUBLEASE HM POOLE BUILDING SCRIPPS LA JOLLA CAMPUS: Very attractive, comfortable suite

A VALUABLE EDUCATIONAL RESOURCE Extensive Medical Articles File for sale.

Charts, illustrations, articles. Emphasis on Emergency Medicine and Internal Medicine. Collected since 1973. Fills a large filing cabinet. (Cabinet not included.) Would make a useful gift for a medical student or resident. Best offer takes. Will accept offers for 30 days after the publication of this newsletter.

View in person at a North County location by appointment. 858-451-6517 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

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P E R S O N A L & P R O F E S S I O N A L D E V E LO P M E N T

Aiming for Mental Health

By Helane Fronek, MD, FACP, FACPh

THROUGH OUR TRAINING, we learn about the mental illnesses we might see in our patients. While physicians wear the white coats and stand on the “healthy” side of the exam table, thousands suffer with mental illness. Its most tragic consequence, suicide, occurs in hundreds of us each year; many others experience milder forms of depression and anxiety. While we may not have a diagnosable illness, I don’t think we can all claim to be mentally healthy - health is not simply the absence of disease. The epidemic of physician burnout proves our lack of mental health, and we often suffer from

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perfectionism, self-doubt, worry and stress.

It’s time to consider how to best enhance our own mental health.

We might even wonder what mental health looks and feels like. While our culture reveres the attainment of happiness, mental health does not require that we vanquish feelings of sadness or worry. The presence of uncomfortable feelings is not an indication of a personal problem or flaw. In fact, our emotions are our most reliable indicator of what’s true for us. Awareness of our emotions allows us to deal with them consciously (rather than having them leak

out at inopportune times) and nurtures a closer connection with ourselves. In working with burned out physicians, I’ve found that the biggest shift to greater mental health occurs when they reconnect with themselves – their values and priorities, natural ways of being in the world, and their true feelings. As they re-establish a closer relationship with themselves, they gain greater confidence and agency in their lives.

Recent electronic and regulatory demands have accentuated the less meaningful parts of our work and diminished our free time.

Accordingly, most of us have lives lacking the healthy balance that includes activities that are more lighthearted, engage our right brain, or allow us to connect with nurturing people or our other talents and interests. Adding even one activity you find interesting, nurturing, or joyful can create a major shift in your sense of wellbeing. If this activity involves endorphin-raising exercise, or mindfulness with its many benefits, the effect is even more pronounced.

And let’s look at the expectations we set for ourselves. Given the changes in medicine, it’s unreasonable to continue to expect to do everything we did when we had longer patient visits and less clerical work. Striving to accomplish only the most important outcomes for each patient interaction allowed one client to shift her expectations to more realistic ones and she began to feel like a success, rather than a failure. This single change improved her mental health dramatically.

Honing the balance in our lives, connecting with ourselves through feeling our emotions, and setting realistic expectations will strengthen our mental health. While physicians are often reticent to prioritize themselves, perhaps knowing that this effort will benefit our patients, colleagues and families will motivate for us to make these important changes. As the wise Rabbi Hillel reminded us, “If I am not for myself, who will be for me?” and, “If not now, when?”

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

As a leading California provider of medical malpractice coverage, the Cooperative of American Physicians (CAP) is committed to helping independent physicians run safe and successful medical practices.

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