Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; William T-C Tseng, MD; Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM
Marketing & Production Manager: Jennifer Rohr
Art Director: Lisa Williams
Copy Editor: Adam Elder
OFFICERS
President: Steve H. Koh, MD
President–Elect: Preeti S. Mehta, MD
Immediate Past President: Nicholas (dr. Nick) J. Yphantides, MD, MPH
Secretary: Maria T. Carriedo-Ceniceros, MD
Treasurer: Karrar H. Ali, DO, MPH
GEOGRAPHIC DIRECTORS
East County #1: Catherine A. Uchino, MD
East County #2: Rachel Van Hollebeke, MD Hillcrest #1: Kyle P. Edmonds, MD
Hillcrest #2: Stephen R. Hayden, MD (Delegation Chair)
Kearny Mesa #1: Anthony E. Magit, MD, MPH
Kearny Mesa #2: Dustin H. Wailes, MD
La Jolla #1: Toluwalasé (Lasé) A. Ajayi, MD
North County #1: Arlene J. Morales, MD (Board Representative to the Executive Committee)
North County #2: Christopher M. Bergeron, MD, FACS
North County #3: Nina Chaya, MD
South Bay #1: Paul J. Manos, DO
South Bay #2: Latisa S. Carson, MD
AT–LARGE DIRECTORS
#1: Rakesh R. Patel, MD, FAAFP, MBA (Board Representative to the Executive Committee)
#2: Kelly C. Motadel, MD, MPH
#3: Irineo (Reno) D. Tiangco, MD #4: Miranda R. Sonneborn, MD #5: Daniel D. Klaristenfeld, MD #6: Alexander K. Quick, MD #7: Karl E. Steinberg, MD, FAAFP #8: Alejandra Postlethwaite, MD
ADDITIONAL VOTING DIRECTORS
Young Physician: Emily A. Nagler, MD
Retired Physician: Mitsuo Tomita, MD
Medical Student: Christina Noravian
CMA OFFICERS AND TRUSTEES
Trustee: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM
Trustee: Sergio R. Flores, MD
Trustee: Timothy A. Murphy, MD
AMA DELEGATES AND ALTERNATE DELEGATES
District I: Mihir Y. Parikh, MD
District I Alternate: William T–C Tseng, MD, MPH
At–Large: Albert Ray, MD
At–Large: Robert E. Hertzka, MD
At–Large: Theodore M. Mazer, MD
At–Large: Kyle P. Edmonds, MD
At–Large: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM
At–Large Alternate: Sergio R. Flores, MD
CMA DELEGATES
District I: Steven L.W. Chen, MD, FACS, MBA
District I: Vikant Gulati, MD
District I: Eric L. Rafla-Yuan, MD
District I: Ran Regev, MD
District I: Quinn Lippmann, MD
District I: Kosala Samarasinghe, MD
District I: Mark W. Sornson, MD
District I: Wynnshang (Wayne) C. Sun, MD
District I: Patrick A. Tellez, MD, MHSA, MPH
District I: Randy J. Young, MD
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Opinions expressed by authors are their own and not necessarily those of SanDiegoPhysician or SDCMS. SanDiegoPhysicianreserves 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 SanDiegoPhysicianin no way constitutes approval or endorsement by SDCMS of products or services advertised. SanDiegoPhysicianand 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. SanDiegoPhysicianis 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.]
4
The Dawn of Intelligent Medicine: Leading With Innovation and Humanity By William Tseng, MD, MP, FACP
6 Physicians and the Outlook for Leading the Adoption of AI in Practice
By Patrick Tellez, MD, MPH, MSHA
10 Climate Change and AI: Sustainable Implementation and Use of AI Systems in Healthcare By Christina Noravian
14 A Call for AI Literacy in Healthcare Curricula By Dipu Patel, DMSc, MPAS, PA-C, ABAIM
21 Classifieds FEATURES
17 Physician Suicide: Something Needs to Change By Sidney Zisook, MD, Desiree Shapiro, MD, Judy E. Davidson, DNP, RN, MCCN, and Hirsh Makhija, MS DEPARTMENTS
2 Briefly Noted: * Practice of Medicine * Advocacy * Medicaid/Advocacy
19
The Art of Disagreeing (Without Losing Your Cool) — Or How to Disagree and Feel Good About It By James T. Hay, MD
CMA and AMA Urge Court to Uphold Ban on ‘Doctor’ Title for Nonphysicians
WHAT YOU NEED TO KNOW: CMA AND AMA have filed a joint brief in defense of California’s long-standing Truth in Advertising law that prohibits the use of the title “doctor” in a healthcare setting by anyone other than licensed physicians.
The California Medical Association (CMA) and the American Medical Association (AMA) have filed a joint amicus curiae brief in Palmer v. Bonta defending California’s long-standing truth-in-advertising law that prohibits the use of the title “doctor” or the prefix “Dr.” in a healthcare setting by anyone other than California-licensed allopathic (MD) or osteopathic (DO) physicians.
This case arises from a lawsuit by three nurse practitioners holding “Doctorate of Nursing” degrees who want to refer to themselves as “doctors” when treating patients. Their lawsuit seeks to invalidate California Business and Professions Code section 2054, arguing that the statute violates their First Amendment speech rights. The nurses claim they are not misleading patients because they use “doctor” and the title “Dr.” in conjunction with their nursing degrees. They admit such usage is not permitted under the law in patient-facing settings. Last month, both sides in the case filed motions for summary judgement. (A petition or motion for summary judgment is a request for the judge to decide a case without a full trial, arguing that there are no genuine disputes of material fact.)
CMA and AMA filed a joint brief, in support of the state’s motion for summary judgment, emphasizing that courts have repeatedly found a legitimate government interest in preventing misleading advertising or misrepresentation in healthcare settings. California’s 88-year-old statutory rule designed to protect Californians
who interface with the healthcare delivery system helps ensure that patients are not misled into thinking a practitioner is a licensed physician when they are not.
Physicians are educated and trained differently and more deeply and robustly than any other professional healthcare practitioner; and industry practice and the law continue to place physicians at the center of medical care.
“The rigorous requirements for physician education and training aim to not just create practitioners to handle routine issues, but leaders in modern healthcare who are able to coordinate healthcare teams and solve complex medical issues, identify critical diagnoses, and render timely treatment decisions,” the brief said.
A misrepresentation of a practitioner’s level of licensing can jeopardize patient safety as a patient may mistakenly believe that the midlevel practitioner possesses the same level of training and qualification as physicians licensed by a California medical board.
Patients have a right to clear, honest information about who is providing their care. Yet in today’s healthcare settings, it’s becoming harder for patients to distinguish between who is — and who isn’t — a physician.
The truth-in-advertising laws exist to protect patients, helping ensure they aren’t mistakenly led to believe they’re being treated by a physician when they’re not. To safeguard patient trust and promote informed decision making, it’s essential we uphold these laws and continue prioritizing transparency in healthcare.
Drs. Tseng and Gulati Represent SDCMS and CMA in Fight Against $880 Billion in Medicaid Cuts
By SDCMS Staff
DR. WILLIAM TSENG AND DR. VIK Gulati represented the San Diego County Medical Society and California Medical Association at a recent press conference rallying opposition to $880 billion in proposed cuts by Congress to Medicaid. They were joined at the San Diego County Administration building by Rep. Juan Vargas, Rep. Sara Jacobs, and Rep. Mike Levin along with San Diego business, healthcare, and community leaders.
One in four San Diegans is dependent on Medi-Cal/Medicaid, and the points were repeatedly made that these cuts would have a devastating impact on healthcare and the local economy.
San Diego Doctors Flock to Sacramento to Advocate for Patients and Fellow Physicians
By Robert Hertzka, MD
APRIL 9 WAS THE ANNUAL CMA LEGISLATIVE Day, when hundreds of physicians and medical students descended on Sacramento to persuade our state legislators to support the legislation that CMA has introduced on our behalf.
The legislation that CMA introduces comes from hundreds of ideas from CMA members that are debated and refined by CMA delegates all year long. These ideas are then prioritized and then presented to various legislators, who in turn introduce our ideas as legislation.
San Diego always sends a delegation of physicians
and medical students to Leg Day — this year led by our SDCMS President, Steve Koh, MD. The topics included support four different ways to improve prior authorization, the restoration of a physician wellness program, and opposition to a proposal that could dramatically increase medical malpractice lawsuits.
Our group met with all 11 of the state legislators that represent San Diego County (four state senators and seven assemblymembers). Our messages were well received, but several of us will stay continuously in touch with these legislators as the CMA legislative package progresses.
The Dawn of Intelligent Medicine: Leading With Innovation and Humanity
By William Tseng, MD, MP, FACP
AS WE STAND AT THE THRESH OLD of a new era in medicine, it is my privilege as your editor to offer both a glimpse into the technological advances that await us and a vision for how we, as San Diego physicians, can lead the way forward.
In this vibrant season of spring, when life begins anew and possibilities blossom, we find ourselves at the dawn of a transformational era in healthcare. Artificial Intelligence (AI), just three years ago, was science fiction to many
of us. Today, it has become the proverbial elephant in the room. No longer a distant promise, it is now a fast-evolving presence in our clinics, hospitals, and research centers. What began as an academic curiosity in the mid-20th century has matured into a technological force poised to redefine diagnostics, clinical decision making, medical education, and the physician-patient relationship. From streamlining workflows to reimagining how we learn and deliver care, AI is already reshaping
the fabric of modern medicine.
The field of AI began in the 1950s, when pioneers like Alan Turing, who referred to it as “machine intelligence,” and John McCarthy, who coined the term “artificial intelligence,” laid its conceptual foundation. A pivotal moment came in 1956 at the Dartmouth AI Conference, where leading thinkers formally launched the field. Soon after, Frank Rosenblatt introduced the perceptron in 1957, a computational model inspired by the human neuron.
Over the following decades, AI evolved rapidly. In the 1970s and 1980s, expert systems such as MYCIN attempted to mimic clinical reasoning, though they were limited by computing power. The 1980s marked the emergence of machine learning, while the 2010s ushered in the era of deep learning, fueling today’s AI revolution and enabling many of the breakthroughs we now see in healthcare.
Notable milestones include Deep Blue’s 1997 victory over world chess
champion Garry Kasparov, IBM Watson’s 2011 triumph over Ken Jennings on Jeopardy! in a landmark demonstration of natural language processing, and AlphaGo’s 2016 win against Go master Lee Sedol, showcasing the power of deep reinforcement learning. Contemporary pioneers like Geoff Hinton and Yann LeCun have further advanced neural networks, driving modern innovations that impact medicine today. With the explosion of digital health data, these tools have transitioned from theory to practice across nearly every medical discipline.
Today, AI is not a singular tool but a constellation of technologies: machine learning, natural language processing, computer vision, and large language models. Together, they form the foundation of a new paradigm in healthcare, where human and artificial cognition co-evolve to enhance care.
In San Diego hospitals, we are already seeing the real-world impact of AI. Early warning systems for sepsis, powered by AI, have helped reduce hospital mortality. These successes demonstrate what’s possible when clinicians and data scientists collaborate to save lives. Radiologists now use AI-powered image analysis to detect cancers with greater precision. In pathology, algorithms assist in reviewing complex tissue samples. In emergency departments, AI helps triage patients and streamline care.
But perhaps one of the most exciting developments is the rise of ambient and generative AI. These tools promise to transform clinical documentation from a burdensome chore into a catalyst for connection. Imagine walking into an exam room and simply speaking with your patient as you always have — while an AI system quietly transcribes, summarizes, and codes your conversation in the background. No more screens stealing our gaze. Just presence, empathy, genuine connection, and meaningful interaction.
This is not merely a technological upgrade; it is an invitation to reimagine the cognitive landscape of medi-
cine. A future where physicians spend 80% of their attention on caring for patients — listening to their symptoms, thinking through differential diagnoses, crafting thoughtful treatment plans, and building therapeutic relationships — and only 20% on record keeping. A future where documentation supports care instead of interrupting it. If guided thoughtfully, this transformation won’t just improve efficiency; it will restore the humanity at the heart of medicine.
Yet despite its promise, the risks of AI are real. Bias, lack of transparency, and overdependence on automation threatens to undermine trust in healthcare. Our experience with electronic medical records serves as a cautionary tale — systems built without meaningful clinical input often fall short. We cannot afford to make the same mistake with AI.
As safety experts remind us, “Every system is perfectly designed to get the results it gets.” If we want AI systems that promote trust, compassion, and effectiveness, physicians must be involved in every step — from design to deployment.
Looking ahead, the future is equally bright for our medical students and trainees. Imagine future physicians learning from personalized AI tutors, practicing rare cases in immersive simulations, and using real-time clinical decision support tools that adapt dynamically to global knowledge. Predictive models powered by wearable sensors could enable truly proactive and preventive care, turning insights
from population health into personalized, precision medicine tailored to each individual.
But this future demands preparation. Despite growing reliance on AI, medical school and residency curricula still lack standardized training in AI, data science, and ethics. We must embed AI literacy into every layer of medical education. Just as we teach anatomy and pharmacology, we must teach future physicians to critically evaluate, ethically apply, and co-create AI tools.
AI should not replace clinical judgment but support it. It should not diminish our presence but deepen it. Our patients deserve the best of both human wisdom and machine intelligence. And our colleagues deserve training that empowers rather than leaves them behind. Let us learn from the past. Let us shape the future. Let us lead with foresight, compassion, and courage.
Here in San Diego, home to some of the nation’s most innovative health systems and biotech pioneers, we have a unique opportunity. We can be early adopters. We can be ethical stewards. We can ensure that our profession remains at the helm of this transformation.
Let San Diego be a beacon. Let us be the physicians who embrace innovation without surrendering our humanity. The era of intelligent medicine is here, and with it, the chance to renew our purpose, strengthen our relationships, and lead with both innovation and heart.
The future is bright. Let’s shape it together.
Dr. Tseng is editor of San Diego Physician and a past-president of SDCMS. He is a respected member of the Southern California Medical Group at Kaiser Permanente San Diego since 2000, and is known for his dedication to patient care, education, and community service. As a board-certified internal medicine physician and assistant area medical director at Kaiser Permanente, he upholds high standards in patient safety and healthcare quality. Recently honored with a fellowship at the American College of Physicians, Dr. Tseng is recognized for his excellence in internal medicine.
Physicians and the Outlook for Leading the Adoption of AI in Practice
By Patrick Tellez, MD, MPH, MSHA
Introduction
The AI revolution is here. There are a growing number of AI solutions being developed with the physician practice in mind. Though there is increasing evidence of how AI can improve operational efficiency and/or outcomes in practice, it remains a challenge for the average practice to adopt this new technology. So, for many, there’s a natural inclination to wait and see. However, this approach carries its own risk as well; by not leading the change, our future will be shaped by someone else.
So, this is an article about where to start. Some key tips are presented for how physicians can adopt a proactive posture to lean in and effectively lead the evolving revolution that is healthcare AI.
The Business We Are In
One thing that makes physicians good at what they do is their ability to react to events and situations that present before them. This is how we are trained. However, at the current pace of change, even the most talented in the art and science of “reacting” are finding it increasingly challenging to maintain even a modicum of control over the quality of a rapidly evolving professional experience.
However, sometimes adversity is what it takes to open the gate to innovation. We live in such a moment now. In many ways, what may look like a “crisis” is really an “opportunity.” Perhaps the emergence of “augmented intelligence” (AI) is just that opportunity. By better understanding this technology, we will be better positioned to apply it in a positive way to improve our professional experience, quality of care, and health of our patients. Here’s why.
AI Is Knowledge
AI (augmented intelligence) is a rapidly evolving technology that processes data into information, which leads to insight that advances knowledge. So, it follows that “AI” can be thought of as simply a knowledge management tool. It’s basi-
cally a computer application that’s programed with the capacity to sort through vast volumes of data and detect meaningful patterns that inform decision making. In many ways, this is precisely what physicians are trained to do. In this sense, AI can be thought of as a powerful tool for augmenting pattern recognition and knowledge management — thus, potentially enhancing a physician’s core abilities.
What is AI?
Basically, AI is just math. It’s a computer program that assigns a numerical value to every data element in a database in a way that labels the data elements and enables them to be classified into different categories of information. An inbound question is converted into a numerical sequence; the numerical sequence carries a pattern that represents a concept or sequence of concepts. The program matches the numerical sequence of the “question” (prompt) to same or related patterns in its database and, by employing calculus and statistics it predicts with very high accuracy the next most likely numerical sequence — which is then converted into a meaningful sequence of concepts which form the “AI response.” It’s the massive volume and speed of this processing sequence that makes AI so impressive.
AI models can produce insights and understanding of the data that is not otherwise “visible” by the user. Some of the most common AI applications include:
• Computer vision – image interpretation
• Natural language processing or “NLM”
» Speech recognition and conversion to text or conversion of written text to speech
» Machine learning and analytics and even some elemental “reasoning/logic”
Opportunities
Here is one prediction for which AI is not needed: Going forward, we will be expected to do more with less. Physiciansupervised, AI-enhanced workflows can potentially help lessen common administrative tasks of patient care, reduce clinician burnout, and improve physician resilience. This, in turn, contributes to improved professional recruitment and retention.
Some of the more common examples of use-cases for AI in medical practice include:
1. RN assistance with patient triage and intake
2. Detection and screening (ambulatory screening, risk stratification)
3. Diagnostic support (imaging, genetics)
4. Quality and risk gap detection
5. Treatment planning (summarizing care plans or transitions of care)
6. Visit documentation (“ambient AI”)
7. Prior authorization processing
8. AI assisted surgery6
9. Pharmacotherapy selection and medication management
MYTH
AI is like black-box magic
REALITY
A solid AI algorithm is usually calculus with a dash of statistics (and sometimes linear algebra). AI is nothing more than a set of prediction engines—what pixel to display next, what word to type next. While extremely impressive, AI has no creative thought, nor does it possess intelligence.
AI is inherently unethical
AI naturally leads to better productivity
General-purpose AI will cause major, longterm transformation
As with many other technologies, there is potential for misuse. It’s up to each company to build policies and procedures governing AI model design, training and stating how to, and how not to, leverage AI solutions.
Not necessarily — AI is not a singular entity with autonomous capabilities. It is a collection of technologies and algorithms created and guided by humans. AI is most impactful when humans understand how to effectively leverage it within their workflows and applications.
General-purpose AI tools—such as ChatGPT—will not be the major drivers of digital transformation, job losses and social upheaval in the near future. Instead, we will feel the biggest impact on our lives from smaller, special-purpose, open-source AI applications.
AI will take a long time to become a ‘mainstream’ technology in healthcare
The time window during which Chat-GPT logged 100 million users was just 2 months4
10. Supplies distribution, inventory and vendor management
11. Conversational patient concierge services (e.g., helping to access community-based services addressing social determinants of health)
12. Case management surveillance
13. Patient outreach, education, engagement
14. Remote monitoring (e.g., chronic disease management, transitions in care, prenatal and post-partum care)
15. Call center operations supporting patient/member services
16. Screening and selection of participants in clinical research
Practice Readiness Considerations
The first step in planning is to be aware of known risks and challenges and the effective ways to manage them in the course of implementing an AI solution:
• First, many medical practices are already operating at a high level of efficiency and may not have budgets to cover the “switching costs” of adopting new technology; however, such investment pays for itself over the long run.
• Second, diligent planning effectively manages the risk of practice workflow disruption.
• Third, plan for how the practice will preserve the quality and safety of patient care during the change process; and,
• Fourth, engage your staff in the design and implementation process; this will go a long way toward building a team approach which enhances professional camaraderie and staff retention.
AI Project Management
A. Strategy: Find the greatest need
1. Take inventory of where the greatest administrative or operational needs exist. It’s much easier to vet potential vendors when you know exactly what you’re looking for.
For example:
• Scheduling
• Front desk functions: Agent can perform registration desk functions can be done either from home or by kiosk/iPad at the office
• MA functions: Agent can do initial interview
• Chief complaint, HPI, current medications, insert summary into the EHR
• Conduct health screenings, e.g., PRAPARE, ACE, PHQ, AUDIT, DAST, other Behavior/Health screens
• A conversational AI office practice “digital assistant” can perform patient outreach functions and even call up and present relevant video health education vignettes perhaps even in a language most preferred by the patient.
• Larger practices may discover potential efficiencies in call center operations
2. Partnering: Consider partnering with other practices to develop a joint plan for group purchasing and AI adoption in a specific area of operations.
A collaborative organizational approach may offer the following advantages:
a. Positions physicians to better supervise and curate the training of the AI model
b. Organizes project management and improves efficiency of project
c. Improves standards of AI development and implementation policy
d. Assures quality of patient experience within a given practice community
e. Better positioned to improve health equity
3. Scan the market: Take inventory of commercial “off the shelf” products that offer solutions
4. Structure the selection criteria, due diligence and vetting processes
5. Physician oversight: Active physician engagement helps to assure patient safety and/or patient experience.
B. Implementation planning
1. Document the “current workflow” vs. the desired result Quantify the “success measures”; e.g., staff or professional time saved and/or costs avoided through newly implemented workflows.
For example:
• How would you imagine applying a conversational agent?
• Consider: Physician or RN should personally introduce the agent to patient. Initially, engage patients as participants helping to shape the experience (offer incentives)
• Above functions can be done by phone, or Zoom with an AI avatar
• How would you approach an ROI determination?
• Consider: Document (patient-Agentic conversational time) x (staff hourly rate) = overhead savings to practice
• Document “Patient experience”
• Document clinical outcomes
2. Implementation plan should address:
a. Assuring protection of PHI Mitigations:
- Remove protected health information from patient data (PIH)
- Offer patients the ability to opt-out of participating
b. Assure transparency in data collection Mitigations:
- Create guidelines on how/ when to collect patient data
- Explain to patients how data is collected and used
c. Guarding intellectual property Mitigations:
- Educate the workforce about risks of sharing sensitive data
- Consider internal, or closed versions of generative AI models
d. Navigating potential liability
- Monitor state and federal guidance and/or legislation and regulations
- Identify and list potential risks and potential effective mitigation measures
- Adopt internal practice guidelines, policies and procedures for specific AI use-cases
- Monitor adherence, measure outcomes and report quality assurance and accountability
- Consider prioritizing AI administrative use cases vs. AI use cases that may impact medical decision making
- Automation of iterative workflows
- Target lower administrative burdens in practice
3. AI model training/technology caveats
When vetting potential AI business partners, seek understanding of their model and how it was trained; this will help to assess the performance characteristics of the model:
a. Algorithmic bias
Data sets lacking representation for minority groups will make AI less accurate for those populations thereby inadvertently building in bias of different types:
- Sample bias
- Exclusion bias
- Confirmation bias
- Measurement bias
- Racial bias
- Reinforcement bias
b. Overfitting
When too many factors influence a result, algorithms learn unimportant associations; multiple variables can inform AI inaccuracies
c. Incomplete or inaccurate training data
Factual errors or inconsistencies in training data can lead to incorrect outputs
d. Hallucinations
Sometimes, when generative AI outputs are not grounded in training data, AI generated responses may be produced that are fabricated and not factual or reliable. There are emerging techniques in AI development that employ a combination of clinically supervised training of the AI model along with additional AI programming that is designed to explain the basis for an AI response (an attribute known as “interpretability”) which are proving to be effective at significantly reducing the incidence of hallucinations. Consider using workflows that have a human in the loop. A hybrid (human+ AI) workflow design can augment the productivity and/or efficiency of a trained staff or professional and makes for a pragmatic approach to initial AI adoption in practice.
You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
Parting Thoughts
– BUCKMINSTER FULLER
1. The quadruple aim: Generally, any change that carries a reasonable chance of improving cost, minimizing physician burn-out, measurably improving population health and/or improving the patient experience, is a change that is on the right track.
2. Seek engagement with your health system leaders. The fundamental ethics that guide medical practices are also applicable to health systems; however, they don’t get adopted into the health system by themselves. Physicians are uniquely positioned to ensure health system fidelity to foundational medical ethics:
• “First, do no harm”
• Beneficence: minimize pain, optimize health
• Autonomy: assure the patient has access to the information and understanding to make informed decisions
• Justice: Ensure that patients have access to an acceptable standard of care
3. AI is an emerging and powerful tool for knowledge management and decision support. Knowledge management is also a core talent of physicians. Physicians who embrace and leverage AI should expect to meaningfully mitigate burn-out and improve both quality of care and patient experience.
4. As physicians, we own the relationship with our patients. Patients are currently exposed to an ocean of content on the internet including much misinformation and disinformation, some of which can play into the emotional aspects of their decision trees and influence their behavior. Practices can leverage AI to better engage their patients in their own self-care which carries potential for enhancing both health outcomes and patient experience.
5. We do live in seriously challenging times. Maintaining a positive attitude and a proactive approach to adopting AI technology will improve the chances of being able to shape one’s own future – which is always much more enjoyable than trying to survive by being reactive. For those in the contemplation stage, just know that it’s never too late to start. In fact, having read this, you have already begun what is likely to become a rewarding journey. While it may be prudent to crawl before you walk and walk before you run, just remember, the ultimate goal is to run! The time is now to shape the future and be the change!
References
1. Advisory Board; “AI and Generative AI 101: Examining the Role of AI in Healthcare” https://www.advisory.com/dailybriefing/2023/08/02/ai-roundup
3. “18 Tech Experts Discuss AI Myths That Should Be Debunked”; Forbes Technology Council Expert Panel; Council Post, Aug. 21, 2023 https://www.forbes.com/councils/ forbestechcouncil/2023/08/21/18-tech-experts-discuss-aimyths-that-should-be-debunked/
4. Source: CB Insights; Rao, P, “How long it took for popular apps to reach 100 million users,” Visual Capitalist; https:// www.visualcapitalist.com/threads-100-million-users/
5. Medical education, professional development and credentialing”; American Medical Association, Augmented Intelligence in Healthcare, 19-388436, Aug. 19, 2019
6. “Future of Artificial Intelligence in Surgery: A Narrative Review” Cureus. 2024 Jan 4, 16(1): e51631. doi: 10.7759/ cureus.51631 https://pmc.ncbi.nlm.nih.gov/articles/ PMC10839429/
Dr. Tellez is an SDCMS board member. He formerly served as CMO of TrueCare and Community Health Group, and currently serves as co-chair of Healthy San Diego Consumer Provider Advisory Board, and adviser to the SDSU School of Public Health.
Climate Change and AI: Sustainable Implementation and Use of AI Systems in Healthcare
By Christina Noravian
ADVANCEMENTS IN AI HAVE revolutionized the landscape of tools available to those in the medical field, from students and professors to physicians and providers. As medical students, we can now generate practice questions and answer complex questions with a simple ChatGPT search. In courses like our Equity in Systems Science class at UC San Diego School of Medicine, we are encouraged to use AI to familiarize ourselves with the tools that will inevitably be incorporated into our future medical practice. Evidently, AI has made its way into the healthcare space, and its utility grows with each new advancement. But are we, as medical students and future physicians, adequately taught the consequences of AI on individual, community, and global health?
In the medical school curriculum at UCSD, we discuss AI as a tool to mitigate physician burnout by alleviating the time spent on patient-facing electronic messaging. A recent study by UCSD found that although AI-generated replies did not reduce the time physicians spent responding to messages, they did relieve the cognitive burden of starting an empathetic draft (Tai-Seale et al., 2024). In fact, most patients found that the AI-generated replies were more empathetic than those written by physicians alone. Our takeaways from these discussions demonstrate that the systemic implementation of AI can be a collaborative tool to help patients feel seen and allow physicians more time in patient care. Surely, AI is also a disruptive tool forcing a cognitive and technological shift in healthcare delivery (Bajwa et al., 2021). Like any systemic change, the power of AI must be wielded for the right purpose to create frameworks that enhance accessibility and quality of care. Building safe, effective, and reliable AI systems requires physician input at the helm.
The ultimate impact of AI depends heavily on how society chooses to use it. Many have posed worries that under the wrong applications or circum-
stances of deployment, AI-driven technologies may become drivers of global resource consumption and emissions (Kaack et al., 2022). Training a generative AI model like Open AI’s GPT-4 requires extensive processing units, cooling systems, and computational power with billions of parameters (McQuate, 2023; Zewe, 2024). The sum of this energy expenditure is roughly equivalent to the yearly electronic consumption of over 1,000 U.S. households (McQuate, 2023). These staggering electricity demands lead to increased carbon dioxide emissions and pressures on the electric grid (Zewe, 2024). Computing-related consumption impacts both carbon emissions and our energy, water, and materials use, and this depletion of natural resources will ultimately damage human health and global ecosystems (Bashir et al., 2024). As models become larger and more sophisticated — and as each big technology company tries to develop its own — there becomes a huge, potentially unsustainable training load of AI data centers on the environment (McQuate, 2023). Responsible development of AI thus requires a focus on technological advancement that supports social and environmental sustainability alongside economic opportunity (Bashir et al., 2024; Zewe, 2024).
Healthcare’s need for large datasets, complex algorithms, and frequent model updates further exacerbates the energy consumption of AI (Ueda et al., 2024). Considering healthcare’s increasing reliance on AI systems, we must consider the indirect environmental effects of this consumption and develop adequate mitigation strategies (Karliner et al., 2020). By this same token, however, AI can be applied to solve the environmental problems currently caused by the healthcare industry itself. Healthcare’s global climate footprint is equivalent to 4.4% of net emissions, with the top three contributors being the United States, China, and the European Union (Karliner et al., 2020). Of this footprint, 71% of emissions stem
from the healthcare supply chain (Karliner et al., 2020). Overall, the healthcare industry has a critical role to play in addressing climate change. There are many existing strategies for AI to minimize healthcare’s environmental impact. One such strategy is the adoption of green computing practices in healthcare facilities and data centers. Green computing involves power management techniques like dynamic voltage and frequency scaling, which reduce energy consumption during periods of low utilization (Karliner et al., 2020). An example of successful energy reduction in radiology includes CT system shutdowns during overnight non-operational times, which saved approximately 14,000 kWh of energy over one year (Brown et al., 2022). AI scheduling algorithms can also optimize healthcare workflows and resource utilization. This optimization ranges from minimized patient wait times to enhanced equipment usage and reduced energy consumption during imaging (Curtis et al., 2018). AI techniques can also minimize the environmental impact of radiological procedures by offering image noise reduction and higher-speed imaging (Chaika et al., 2023). Rather than replacing physicians, AI can offer tools to enhance decision-making through a streamlined and environmentally friendly approach (Karliner et al., 2020). Moreover, we can further decrease healthcare’s carbon footprint by integrating renewable energy sources, like solar and wind power, into the energy mix of AI data centers (Karliner et al., 2020). Key to this strategy is a lifecycle assessment of AI systems’ environmental impact. This involves a comprehensive evaluation of AI’s environmental footprint, from the extraction of raw materials and manufacturing process to the energy used during operation and eventual disposal (Karliner et al., 2020). Embracing this holistic approach promotes a more sustainable and
environmentally conscious healthcare industry that addresses the environmental impacts of AI at each stage. Ultimately, the environmental impact of healthcare and AI has direct effects on the communities and patient populations that we serve. Communities of color and low-income populations are among the first to feel the health effects of climate change. “America is segregated, and so is pollution,” according to one article (Beard et al., 2024). Recent studies show that zip code is one of the strongest predictors of lifespan and health outcomes in the United States (Orminski, 2021). Environmental health research demonstrates that race is a key factor in deciding where toxic facilities are located. Due to environmental racism, racial and ethnic minorities and low-income groups often live in neighborhoods that are disproportionately burdened with health-harming policies, practices, and infrastructure (Beard et al., 2024; Salas, 2021). These include proximity to hazardous waste, environmental pollution, and inadequate protection against natural disasters (Beard et al., 2024). With a society that breeds discrimination and inequity, our system also generates unjust, yet predictable, patterns of disease.
In medical school, we continuously learn about the value of culturallyconcordant care for marginalized folks. We are taught about the systemic, historical barriers to care that exist in our nation. But do we adequately consider the ways that uncontrolled, environmentally extractive AI use inadvertently contributes to the health crisis we are trying to solve? Managing this feedback loop within an evolving framework of social and systemic determinants of health will indeed be a problem my peers and I must address.
By mindfully embracing and integrating AI technologies into healthcare delivery, we can work toward a healthcare system that not only improves patient outcomes, but actively contributes to the preservation of our planet (Karliner et al., 2020). AI has use in many
aspects of healthcare, including diagnostics, treatment planning, resource management, and energy optimization. Interdisciplinary collaboration among physicians, policymakers, industry stakeholders, and academics is key to developing regulatory frameworks for AI that consider safe, sustainable, and effective use in healthcare (Karliner et al., 2020). Frameworks should include guidelines for energy-efficient AI models that incorporate green computing practices, e-waste management, and use of renewable energy sources (Karliner et al., 2020). Whether or not AI use can reduce, rather than increase, resource consumption will depend on smart policies, regulations, and incentives (Kaack et al., 2022). Now more than ever, we hold the power — and the responsibility — to shape AI’s trajectory in healthcare, steering it toward a future that heals both people and the planet.
Interdisciplinary collaboration among physicians, policymakers, industry stakeholders, and academics is key to developing regulatory frameworks for AI that consider safe, sustainable, and effective use in healthcare.” “
Christina Noravian is an MD candidate in the class of 2028 at UC San Diego School of Medicine. She is also the medical student representative on the San Diego County Medical Society’s board of directors.
Evidence-Based Treatments for Mood Disorders and Addiction at Sharp Mesa Vista
For individuals facing drug or alcohol dependency along with a mental health condition such as depression, anxiety or post-traumatic stress disorder (PTSD), recovery can be especially challenging. Navigating these unique issues is one aim of the Dual Recovery Intensive Outpatient Program (IOP) at Sharp Mesa Vista Hospital.
The eight-week program includes group therapy sessions led by licensed clinicians in a safe, supportive environment. Patients receive FDA-approved medications to help ease withdrawal symptoms and manage cravings. This medication-assisted therapy (MAT) is provided under the close supervision of a doctor and team of specialists.
Shelby Espiritu, LMFT, the lead clinician of Dual IOP at Sharp Mesa Vista, explains that stopping substance use isn’t enough to promote healing and lasting change. Patients also need help developing healthy coping skills. “Many people with addiction turn to using substances due to struggling with a life stressor,” she says. “Substance use is a dysfunctional coping skill that helps patients initially and then becomes problematic in their life.”
Dual IOP includes education sessions in which licensed therapists use various therapy modalities, including cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), acceptance and commitment therapy (ACT) and motivational interviewing (MI). These forms of therapy help patients develop skills to heal from loss, be assertive and resolve conflict. They also cultivate confidence and help challenge the shame that often accompanies addiction.
“The goal is to equip our patients with healthy thought processes and skills for growth and self-empowerment,” says Espiritu. “We aim to help our patients know how to properly address problems that may arise in their life.”
Group therapy is particularly beneficial for encouraging recovery from substance use and mental health issues. Participants in Dual IOP can relate to each other — which
lessens their feelings of isolation and shame — while holding one another accountable.
The program also provides opportunities for loved ones to join patients in therapy. “We realize that addiction affects not only the individual using substances, but also the entire family unit,” says Espiritu.
The availability of various clinicians, including therapists, psychologists, psychiatrists, mental health nurse practitioners and social workers, distinguishes Sharp Mesa Vista in San Diego. “We are able to collaborate with each other every day within a close-knit team to devise helpful treatment methods for each of our patients,” says Espiritu.
Sharp Mesa Vista and its sister facility, Sharp McDonald Center, provide a range of addiction treatment programs to meet patients’ individual needs. These include detoxification, residential treatment (RTC), partial hospitalization (PHP) and intensive outpatient programs (IOP).
“We believe that patients should have the space to heal in one central facility. So, we help our patients move from detox to residential, partial hospitalization, and finally to intensive outpatient once they are ready. This promotes a higher chance of effective treatment results,” says Espiritu.
If you or a colleague have a patient who may benefit from Dual IOP or other services offered at Sharp Mesa Vista, you can refer them by calling 858-836-8434 or visiting sharp.com/mesavistareferral.
A Call for AI Literacy in Healthcare Curricula
By Dipu Patel, DMSc, MPAS, PA-C, ABAIM
THE YEAR I STARTED PA SCHOOL, stem cells were first isolated, which made it possible to test for new treatments. By the time I graduated, two years later, the mapping of the human genome draft was complete. The year after I graduated, the first telesurgery was performed (it was a cholecystectomy). The pace at which technology has enabled medicine to progress has been nothing short of amazing. And with artificial intelligence (AI) in the past three years, that pace has been exponential, and is leading to seismic shifts in healthcare organizational and strategic planning. What was once a concept that only tech companies grappled with is now a reality for providers and patients alike. The reshaping the future landscape of healthcare has begun and we have to learn to harness it.
A 2024 AMA survey1 reported that 66% of physicians use AI in their current practice, and another survey conducted by Forrester2 noted that 46% of U.S. healthcare organizations are in the initial production implementation of generative AI. This makes the need for clinical and clinician engagement crucial. AI is enhancing clinical decision-making and streamlining administrative workflows, and just these two changes will impact how we deliver care in the near future. As a PA, educator, and an advocate for interprofessional education and leadership, I see how critical it is for us to understand and leverage AI to provide high quality, safe, patient-centered care. Implementing and learning AI will not be easy in our complex healthcare landscape. It presents both opportuni-
ties to reinvent and redesign clinical workflows but also challenges around data, privacy, and security. Another gap is that of AI literacy among healthcare providers. As an educator, it comes naturally to me to help bridge this gap. AI education must be integrated into healthcare training across all professions. We cannot afford to wait; the need is here, not in the future.
In this article, I hope to make a case for why AI education and literacy should be part of medical curricula.
Before diving into what role AI can play in healthcare teams, it’s important to understand AI’s current capabilities and limitations.
There are several categories of healthcare AI tools and applications; each vary in terms of maturity and clinical validation and applicability. Diagnostic imaging tools such as those used in radiology, pathology, or dermatology are actually pretty accurate for specific uses. For example, a number of studies have demonstrated that deep learning algorithms are com-
parable to a board-certified dermatologist in identifying skin cancers from photographs. Another example is the detection of diabetic retinopathy from retinal images. Another category, clinical decision support systems, utilize predictive analytics that provide data-driven insights that allow clinicians to make decisions on treatment options, potential adverse effects, and complications. Another robust area of application is administrative tasks. AI tools have aided in reducing the burden of documentation through automated note generation, billing and coding assistance, and general workflow optimization.
Few AI applications should be used without the supervision of a human. In fact, at the core of almost all AI applications is the human-in-the-loop component, which allows for verification of the information, data, and ultimate decision. While current systems
perform well with pattern recognition tasks, they struggle with contextual understanding, causal reasoning, and novel situations. The main reason for this is because AI algorithms are dependent on the quality and diversity of the training data. As noted by Kim et al. (2025)3, “Foundation models that are capable of processing and generating multi-modal data have transformed AI’s role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety.”
While there has been interest and some implementation at large hospital organizations with regard to AI, most are still struggling with AI governance structures and validations processes. As a community, we have not reached consensus on frameworks of governance and ethics, although many have been suggested and are in the research
phase. This also brings up the issue of equity. Smaller community hospitals and other constrained systems lack the resources and expertise to implement AI. Although AI has the promise of democratizing access, we as a community have to push for collaborative and nontraditional approaches to addressing disparities that may worsen some existing issues in our current system.
History has proven that medical education can evolve as scientific and technological advancements occur. From the Flexner Report of 1910, which standardized medical training to the implementation of competency-based education, medical curricula have evolved to meet the needs of students and patients. AI is the next major shift.
Healthcare education professions must incorporate AI literacy into their curricula in order to ensure that future healthcare providers are workforce ready. At the very minimum, curricula
$280,000 - $300,000+
should include an understanding of AI’s capabilities and limitations, a recognition of when and where to utilize AI, and where it excels compared to humans and where human oversight is essential. Furthermore, as AI increasingly becomes embedded into workflows, an understanding of predictive modeling and how it is used in various specialties and other areas is necessary so that they know when and what to question, and when to accept a recommendation. These curricular changes are going to require the healthcare professions to look at interprofessional collaboration differently and more broadly. We are going to have to expand our clinical care teams beyond the health professionals to include data scientists, computer engineers, and health information technologists in order to provide the highest quality of care through the use of AI.
Interprofessional collaboration is crucial to the future of practice and it offers numerous advantages, the least of which is risk mitigation. By involving multiple professions and viewpoints, clinical teams can identify issues that may not have been apparent from a single professional viewpoint. Interprofessional practice is not a new concept in medical curricula; we now have to expand our view beyond the traditional and truly aim and educate for cross-industry collaboration.
The fear that AI will replace healthcare providers is misplaced. AI should augment practice, not replace it. Although AI has many benefits, it should not replace human judgement. One of the best ways to mitigate the fears of being replaced is by educating current and future clinicians on how to responsibly utilize AI in their practice. Not all areas of practice need AI, nor should we aim to find an AI solution for every area of practice. The current state of AI has many flaws, especially in clinical applications. As noted by Kim et al. (2025), “Just as human clinicians can be susceptible to cognitive biases in
clinical decision making, LLMs exhibit their own form of systematic errors through what we refer to as medical hallucinations. These errors can mislead providers, delay proper interventions, or redirect care pathways.” This further iterates the point that humans need to be involved in decision making but also need to be educated on how AI models work in specific situations.
As we continue to research, learn, and implement AI into our practice, we should aim to be involved at all levels of development of AI tools, models, and algorithms. This requires an AIliterate workforce and collaborative leadership across disciplines. We — physicians, PAs, nurses, IT specialists, policymakers — must work together to advocate for ethical use of AI. We must champion AI literacy at our institutions but also begin efforts to teach within the pipeline of future healthcare professionals. To close the AI literacy gap, we must engage upstream and downstream leadership. As noted by Kim et al. (2025), “A growing body of literature emphasizes the importance of AI education in healthcare. Clinicians must understand where AI adds value, where it falls short, and how to interpret AI-generated insights responsibly to mitigate risks.”
AI literacy in medical curricula is no longer optional, it is imperative and essential. Just as we adapted to electronic health records and more recently, telemedicine, we must prepare to learn how to augment our practice with AI. The beautiful aspect of this new wave of technological adaption is that we are recognizing its importance to our practice early in the
“
“The fear that AI will replace healthcare providers is misplaced. AI should augment practice, not replace it. Although AI has many benefits, it should not replace human judgement.”
adoption curve, and that allows us to be involved in the planning, education, and implementation of it. This is an opportunity we should embrace as a healthcare community. AI is here to stay. It is very quickly becoming vital in our care delivery, and it is changing our practice. The future of medicine is interprofessional, AI-augmented, and patient-centered — and we need an AI literate workforce ready to meet the demands of this future.
Dipu Patel is a nationally recognized physician associate, educator, and healthcare innovator specializing in digital health, artificial intelligence, and clinical education. She serves as vice chair for innovation at the University of Pittsburgh and president of the Physician Assistant Education Association. Dipu is the editor of Digital Health: Telemedicine and Beyond (Elsevier, 2024) and author of multiple influential works on AI in medicine, clinical thinking, and healthcare education.
Physician Suicide: Something Needs to Change
By Sidney Zisook, MD, Desiree Shapiro, MD,
Judy E. Davidson, DNP, RN, MCCN, and Hirsh Makhija, MS
FOR YEARS, THE PREVAILING wisdom was that physicians were more likely to die by suicide than nonphysicians in the general population. The most widely cited study to back that assertion was a 2004 meta-analysis that was limited by its reliance on older — pre-2000 — data, mostly non-U.S. populations, and few female decedents1 In our updated 2025 cohort research study, we sought to overcome these limitations, gathering data exclusively from the U.S. and using the most recent available data, spanning the period between January 2017 to December 20212 As expected, we found more male than female physicians were identified as dying by suicide during that period (354 vs. 94; ratio ~ 4:1). Female physicians were also found to have higher rates of suicide than female nonphysicians, while male physicians had a lower suicide risk than male nonphysicians. These findings do not give us any sense of relief about the risk for male physicians, as each of these 354 male physician suicides was a potentially preventable tragedy. However, it does raise serious concerns about the heightened risk female physicians experience. Our study does not tell us why female physicians are at such high risk compared to other females. We know from the literature that females, in general, attempt suicide more and have higher rates of depression than males — both of which are risks for suicide. But we do not know if these risks are
even more true of female physicians than nonphysician females. We do know that during COVID-19, work-life conflicts were accentuated for all physicians, but were particularly onerous for female physicians who were much more likely to manage childcare and schooling responsibilities3,4,5. We also know that physicians, especially female physicians, have extraordinarily high burnout rates and that gender as well as sexual discrimination or harassment are not uncommon6. Finally, female physicians are well informed regarding fatal suicide methods and have direct access to lethal drugs; hence female physicians may die at a higher rate per attempt than women in the general population. Furthermore, we have found similar findings regarding female nurses in the U.S7. As both physicians and nurses have the same sex-specific suicide patterns and higher odds of job problems, there is likely some intersection between the healthcare space and the many stressors related to being a woman in the U.S. workforce that is
driving the suicide risk higher. Findings underscore the urgent need for US healthcare systems to prioritize the mental health of all physicians with a special focus on suicide prevention for female physicians. The first, most important step, is to recognize and acknowledge the problem. Benign neglect hidden under a conspiracy of silence is no longer acceptable. Next, ensuring the implementation of suicide prevention strategies proven to reduce suicide risk in the general population is vital. These include ensuring access to timely, evidence-based care; lethal means restrictions; safety planning for those at risk; and postvention for suicide and suicide-loss survivors. Third, since suicide is a complex act with multiple contributors, a multipronged approach from all levels of the healthcare system is best practice. These include8:
• Implementing licensing and regulatory policies that are mental health promoting, rather than stigma inducing (e.g., not requiring disclosures of mental health diagnosis or
treatment for licensure, promoting accessible and supportive physician reentry programs, integrating professional wellbeing into quality improvement)
• Institutional and program reform (e.g., ensuring flexible hours, maximizing efficiency, eliminating mindless documentation and training requirements, promoting adequate sleep, reinforcing safety, instituting physician peer support, establishing wellness leadership)
• Enlightened leadership (e.g., leading by example, compassion, listening and hearing)
• Individual reflection and responsibility (e.g., cultivating daily habits of self-care, maintaining self-compassion, cultivating hobbies and worklife balance, supporting others)
At UC San Diego, we are proud of our Healer Education Assessment and Referral (HEAR) Program, which provides students, trainees, faculty, and staff free, anonymous, and confidential emotional health screenings linked to engagement and referral, group processing sessions after critical or traumatic events, individual “check-ins” and support, confidential counseling/ therapy separate from the electronic healthcare records system, and referrals to mental healthcare9. All components of the well-received program can be readily transported to other health institutions10
If you or anyone in your life may benefit from mental health support, please reach out to resources such as the 988 suicide and crisis lifeline. This resource is available 24/7 with chat, text, or phone options. Caring counselors are always available to talk through any challenges, struggles, or concerns. The Physicians’ Support Line (1-888409-0141) offers free and confidential peer support to American physicians and medical students by creating a safe space to discuss immediate life stressors with volunteer psychiatrist colleagues who are uniquely trained in mental wellness and have similar shared experiences of the profession.
References
1. Schernhammer ES, Colditz GA (2004) Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 161: 2295–2302. pmid:15569903
2. Makhija H, Davidson JE, Lee KC, Barnes A, Choflet A, Zisook S. National incidence of physician suicide and associated features. JAMA Psychiatry. Published online February 26, 2025. doi:10.1001/ jamapsychiatry.2024.4816
3. Smith, J., Abouzaid, L., Masuhara, J., Noormohamed, S., Remo, N., & Straatman, L. (2022). “I may be essential, but someone has to look after my kids”: women physicians and COVID-19. Canadian Journal of Public Health, 113(1), 107-116.
4. Frank, E., Zhao, Z., Fang, Y., Rotenstein, L. S., Sen, S., & Guille, C. (2021). Experiences of work-family conflict and mental health symptoms by gender among physician parents during the COVID-19 pandemic. JAMA network open, 4(11), e2134315-e2134315.
5. Brubaker, L. (2020). Women physicians and the COVID-19 pandemic. Jama, 324(9), 835-836
6. Guille C, Sen S. Burnout, depression, and diminished well-being among physicians. N Engl J Med 2024;391(16):1519-1527. doi:10.1056/ NEJMra2302878
7. Davidson, J. E., Makhija, H., Lee, K. C., Barnes, A., Richardson, M. G., Choflet, A., ... & Zisook, S. (2024). National Incidence of Nurse Suicide and Associated Features. JONA: The Journal of Nursing Administration, 10-1097
8. Moutier, C. Y., Myers, M. F., Feist, J. B., Feist, J. C., & Zisook, S. (2021). Preventing clinician suicide: a call to action during the COVID-19 pandemic and beyond. Academic medicine, 96(5), 624-628.
9. Zisook, S., Doran, N., Moutier, C., Shapiro, D., Downs, N., Sanchez, C., Accardi, R., & Davidson, J. (2024). Supporting Healthcare Workers Well-Being and Suicide Prevention: The HEAR Program May 2009–April 2023. Journal of Medical Regulation, 110(3), 18-32.
10. Mortali, M., & Moutier, C. (2018). Facilitating help-seeking behavior among medical trainees and physicians using the interactive screening program. Journal of Medical Regulation, 104(2), 27-36.
Sidney Zisook, MD is a distinguished professor of psychiatry at UC San Diego, director of the Physician Peer Support Program, and founding director of the UC San Diego Healer Education, Assessment and Referral (HEAR) Program dedicated to supporting clinician resilience and wellbeing while decreasing stigma and preventing healthcare worker burnout and suicide. Desiree Shapiro, MD is a clinical professor of psychiatry at UC San Diego and is honored to support the wellbeing of healthcare trainees and professionals. She serves as the director of the Healer Education, Assessment, and Referral (HEAR) Program, and is involved in medical education and training. Judy E. Davidson, DNP, RN, MCCM is the nurse scientist for the UC San Diego division of nursing and assistant director for the Healer, Assessment and Referral (HEAR) suicide prevention program. Her research focuses on workplace wellness, mental health of healthcare professionals, suicide, and suicide prevention among healthcare professionals. Hirsh Makhija, MS is a postgraduate researcher at the UC San Diego School of Medicine department of psychiatry.
The Art of Disagreeing (Without Losing Your Cool) — Or How to Disagree and Feel Good About It
By James T. Hay, MD
HAVE YOU EVER FELT UNHEARD or isolated because of your political views? Do you worry that our divisions are making it harder to work, connect, or even have a conversation with those who see the world differently? If so, you’re not alone. Political polarization isn’t just an abstract problem: It affects our relationships, communities, and sense of belonging. But there’s a way forward — one that doesn’t require us to agree on everything, but to listen, understand, and engage with respect.
There is a movement involving many organizations across the country to bring us back to civil discourse and to cross this partisan divide. Being partisan isn’t a bad thing: Our democ-
racy depends on vigorous discussion of competing ideas. But when it involves rancor, i.e., the affective or emotionally negative argument which implies that the other side is evil, it is destructive to our civil society and interferes with effective governance. If it is affecting your work or family environment, it is probably hurting you there personally. I’ll tell you about one nationwide nonpartisan organization, Braver Angels, and how its ideas can help us all with our relationships with coworkers, friends, and family. A good example was demonstrated by Judy Woodruff on the PBS Newshour recently when she interviewed Francis Collins (former head of the NIH) sitting next to a very conserva-
tive and articulate owner of a trucking company. The interview demonstrated that even people with extremely different views, like theirs on the government’s handling of the COVID crisis, could argue civilly, find common ground, and even end up friends.
Here’s how, and what we all can do in our daily lives. The first step is opening ourselves up to curiosity. Too often, we assume we already know what “the other side” thinks — and we’re usually wrong. Multiple studies on this perception gap show that people tend to misjudge their political opponents, believing that their views are more extreme than they really are. A survey done at a recent San Diego event by our
own Alliance leadership showed just how far off perceptions by conservatives were about progressives’ views, and equally how wrong progressives’ opinions about conservative attendees’ views were. When we take the time to ask genuine questions and then listen, we often find more nuance, common ground, or at the very least a better understanding of where others are coming from. Braver Angels teaches a simple tool, a pneumonic for navigating difficult discussions (and it has even helped me at home, too). LAPP:
L: Listen actively to make sure you understood what someone is saying.
A: Acknowledge. Repeat back at least a little of what you heard to show that your friend was heard and you understood their point of view.
P: Pivot by using positive words like “and”, not “but” e.g., to what you’d like to say.
P: Perspective. Give your view not as a rebuttal “you” message, but with an “I” message stating what you believe.
Braver Angels has a lot more to offer, too. If you’re a leader in your organization and find partisan divisions affecting the culture, there are workshops that trained leaders can conduct for you to help improve communication. If you personally have issues with friends
or family and are unable to discuss hot topics without pain, there are many inperson or online opportunities to learn how to navigate those discussions more effectively, all enumerated on the Braver Angels website.
Braver Angels is a nationwide organization with hundreds of chapters (called Alliances), including one here in San Diego that meets on the second Saturday morning of each month to have frank and open bipartisan discussions often on difficult subjects. The goal is not to convince others of our own opinion, but to listen and learn about theirs. Braver Angels has thousands of volunteers all over the country leading workshops in schools, churches, and businesses, always to help people see that those who think differently are not the enemy, not the “other.” The very basis of our society is dependent on that civil engagement and will die without it. Braver Angels is not a political organization attempt-
ing to find compromise on issues and then advocate for them, but rather to help members gain a better understanding of the nuances of those issues. Braver Angels does not take political or policy positions itself, but does foster attempts by its members to work together (always with a requirement for 50-50 conservative and progressive leadership and participation in the work groups) to find common ground that they as individuals can then advocate for. One example of that was developed by such a group after hundreds of focus groups and townhalls across the country, resulting in 23 unanimously adopted recommendations, out of many more considered, to create a white paper, “Trustworthy Elections.” There is a similar effort ongoing nationwide to see what can be agreed to on the contentious subject of immigration.
The principles of Braver Angels have made a difference for me personally, with my friends and with my family. It has already demonstrated help in many workplaces, too. I encourage you to check out the website www. braverangels.org. I also encourage you to attend our monthly Alliance meetings and see how civil discourse works and how it might help you at work, at home, and at the holiday dinner table with family. Maybe most importantly, try hard with those who see the world, our government, and our policies with a different view than you do, and see them as fellow Americans, fellow San Diegans, and not the evil “other.” You can get on our mailing list by emailing either of our co-chairs Brady Young, byoung@braverangels.org, or Kelly Simmons, bsimmons@braverangels. org. And feel free to contact me anytime at jhay@braverangels.org as well.
Dr. Hay is a retired family physician living in Del Mar. He was president of SDCMS in 2001 and president of the California Medical Association in 2012. He is involved with several nonprofits, currently serves as the chair of the board of the San Diego Wellness Collaborative and is an ambassador for Braver Angels.
PRACTICE ANNOUNCEMENTS
VIRTUAL SPEECH THERAPY AVAILABLE: Accepting new pediatrics and adult patients. We accept FSA/HSA, Private pay, Medicare, Medi-Cal, and several commercial insurance plans pending credentialing. Visit virtualspeechtherapyllc.org or call 888-855-1309.
PSYCHIATRIST AVAILABLE: Accepting new patients for medication management, crisis visits, ADHD, cognitive testing, and psychotherapy. Out of network physician servicing La Jolla & San Diego. Visit hylermed. com or call 619-707-1554.
VOLUNTEER OPPORTUNITIES
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 SAN DIEGO: Volunteer physicians are needed in the following specialties: endocrinology, rheumatology, vascular surgery, ENT or head and neck, general surgery, GI, and gynecology. These specialists are needed in all regions of San Diego County to provide short term pro bono specialty care to adults ages 26-49 who are uninsured and not eligible for Medi-Cal. Volunteering is customized to fit your regular schedule in your office. Champions for Health is the foundation of the San Diego County Medical Society. Join hundreds of colleagues in this endeavor: Contact Evelyn.penaloza@championsfh.org or at 858-300-2779.
PHYSICIAN OPPORTUNITIES
FAMILY MEDICINE/INTERNAL MEDICINE PHYSICIAN | PHMG
Ramona: Palomar Health Medical Group is seeking a Family Medicine or Internal Medicine Physician (MD/DO) to join our multi-specialty practice at our Ramona clinic location. Experienced physicians and new graduates are encouraged to apply. Clinic schedule is Mon – Fri, outpatient only, no weekends or holidays. We offer competitive salary of $300k/year or more depending on experience. In addition, we offer productivity and other bonuses, PTO, CME reimbursement, health, dental, vision insurance, participation in 401K with partial employer match, short and long-term disability, and life insurance. Student loan repayment assistance is also available. Join Palomar Health Medical Group, where we’re reimagining healthcare with compassion, excellence, and integrity. Please email CV to clayton.trosclair@palomarhealth.org or phil.yphantides@phmg.org.
CLINICAL DIRECTOR | BEHAVIORAL HEALTH SCIENCES | COUNTY OF SAN DIEGO: The County of San Diego is seeking a dynamic physician with a passion for building healthy communities. This is an exceptional opportunity for a California licensed, Board–certified, Physician to help transform the local behavioral health continuum of care and lead important work within the Health and Human Services Agency’s Behavioral Health Services department. Visit our website to view a detailed brochure outlining the duties and responsibilities of the position and to file your application. Anticipated Hiring Range: $310,000 to $320,000 annually. In addition to the base salary, the incumbent may receive a 10% premium for Board Certification or a 15% premium for Board Certification and Sub–specialty. [2877-0225]
VENOUS DISEASE SPECIALIST | NORTH COUNTY: La Jolla Vein & Vascular, the premier vein care provider in San Diego, is seeking a highly skilled and experienced Venous Disease Specialist to join our team at our newest location in Vista, CA, nestled in the stunning coastal region of North County San Diego. This full–time position offers competitive salary and benefits, including profit-sharing and a 401(k). Our state-of-the-art facility operates Monday through Friday, with no weekend or night shifts, promoting an excellent work-life balance. Ideal candidates may also consider a locum or locum-to-hire arrangement. Join us in making a difference in our patients’ lives while enjoying your dream location! Email CV to jobs@ljvascular.com. [2875-1030]
PART–TIME PRIMARY CARE PHYSICIAN: Primary Care Clinic in San Diego searching for part-time physician for 1 to 2 days a week, no afterhours calls. Please send CV to medclinic1@yahoo.com. [2872-0909]
OB/GYN POSITION AVAILABE | EL CENTRO: A successful Private OBGYN practice in El Centro, CA seeking a board eligible/ certified OB/GYN. Competitive salary and benefits package is available with a tract of partnership. J-1 Visa applicants are welcome. Send CV to feminacareo@gmail. com or call Katia M. at 760-352-4103 for more information. [2865-0809]
COUNTY OF SAN DIEGO PROBATION DEPT. MEDICAL DIRECTOR: The County of San Diego is seeking dynamic physician leaders with a passion for building healthy communities. This is an exceptional opportunity for a California licensed, Board-certified, physician to help transform our continuum of care and lead essential medical initiatives within the County’s Probation Department. Anticipated Hiring Range: Depends on Qualifications Full Salary Range: $181,417.60 - $297,960.00 annually. As part of the Probation Administrative team, the Medical Director is responsible for the clinical oversight and leadership of daily operations amongst Probation facilities’ correctional healthcare programs and services. As the Medical Director, you will have significant responsibilities for formulating and implementing medical policies, protocols, and procedures for the Probation Department. Medical Director.
PART–TIME CARDIOLOGIST POSITION AVAILABLE: Cardiology office in San Marcos seeking part–time cardiologist. Please send resume to Dr. Keith Brady at uabresearchdoc@yahoo.com. [2873-0713]
INTERNAL MEDICINE PHYSICIAN: Federally Qualified Health Center located in San Diego County has an opening for an Internal Medicine Physician. This position reports to the chief medical officer and provides the full scope of primary care services, including diagnosis, treatment, and
coordination of care to its patients. The candidate should be board eligible and working toward certification in Internal Medicine. Competitive base salary, CME education, Four weeks paid vacation, year one, 401K plan, No evenings and weekends, Monday through Friday 8:00am to 5:00pm. For more information or to apply, please contact Dr. Keith Brady at: uabresearchdoc@yahoo.com. [2874-0713]
FAMILY MEDICINE/INTERNAL MEDICINE PHYSICIAN: San Diego Family Care is seeking a Family Medicine/Internal Medicine Physician (MD/DO) at its Linda Vista location to provide outpatient care for acute and chronic conditions to a diverse adult population. San Diego Family Care is a federally qualified, culturally competent and affordable health center in San Diego, CA. Job duties include providing complete, high quality primary care and participating in supporting quality assurance programs. Benefits include flexible schedules, no call requirements, a robust benefits package, and competitive salary. If interested, please email CV to sdfcinfo@sdfamilycare.org or call us at (858) 810-8700.
PHYSICIAN POSITIONS WANTED
PART–TIME CARDIOLOGIST AVAILABLE: Dr. Durgadas Narla, MD, FACC is a noninvasive cardiologist looking to work 1-2 days/week or cover an office during vacation coverage in the metro San Diego area. He retired from private practice in Michigan in 2016 and has worked in a San Marcos cardiologist office for the last 5 years, through March 2023. Board certified in cardiology and internal medicine. Active CA license with DEA, ACLS, and BCLS certification. If interested, please call (586) 206-0988 or email dasnarla@gmail.com.
OFFICE SPACE / REAL ESTATE AVAILABLE
MEDICAL OFFICE FOR SUBLEASE OR SHARE: A newly remodeled and fully built-out medical clinic in Torrey Hills. The office is approximately 2,700 sq ft with 5 fully equipped exam rooms, 1 lab, 1 office, spacious and welcoming waiting room, spacious reception area, large breakroom, and ADA-accessible restroom. All the furniture and equipment are new and modern design. Ample parking. Perfect for primary care or any specialty clinic. Please get in touch with Charlie at (714) 271-0476 or cmescher1@ gmail.com. Available immediately. [2871-0906]
LA JOLLA/XIMED OFFICE TO SUBLEASE: Modern upscale office on the campus of Scripps Hospital — part or full time. Can accommodate any specialty. Multiple days per week and full use of the office is available. If interested please email kochariann@yahoo.com or call (818) 319-5139. [2866-0904]
SUBLEASE AVAILABLE: Sublease available in modern, upscale Medical Office Building equidistant from Scripps and Sharp CV. Ample free parking. Class A+ office space/medical use with high-end updates. A unique opportunity for Specialist to expand reach into the South Bay area without breaking the bank. Specialists can be accommodated in this first floor high-end turnkey office consisting of 1670 sq ft. Located in South Bay near Interstate 805. Half day or full day/week available. South Bay is the fastest growing area of San Diego. Successful sublease candidates will qualify to participate in ongoing exclusive quarterly networking events in the area. Call Alicia, 619-585-0476.
OFFICE SPACE FOR SUBLEASE | SOUTHEAST SAN DIEGO: 3 patient exam rooms, nurse’s station, large reception area and waiting room. Large parking lot with valet on-site, and nearby bus stop. 286 Euclid Ave - Suite 205, San Diego, CA 92104. Please contact Dr. Kofi D. Sefa-Boakye’s office manager: Agnes Loonie at (619) 435-0041 or ams66000@aol.com. [2869-0801]
MEDICAL OFFICE FOR SALE OR SUBLEASE: A newly remodeled and fully built-out primary care clinic in a highly visible Medical Mall on Mira Mesa Blvd. at corner of Camino Ruiz. The office is approximately 1000 sq ft with 2 fully equipped exam rooms, 1 office, 1 nurse station, spacious and welcoming waiting room, spacious reception area, and ADA accessible restroom. All the furniture and equipment are new and modern design. Ample parking. Perfect for primary care or any specialty clinic. Please contact Nox at 619-776-5295 or noxwins@hotmail.com. Available immediately.
RENOVATED MEDICAL OFFICE AVAILABLE | EL CAJON: Recently renovated, turn-key medical office in freestanding single-story unit available in El Cajon. Seven exam rooms, spacious waiting area with floor-to-ceiling windows, staff break room, doctor’s private office, multiple admin areas, manager’s office all in lovely, drought-resistant garden setting. Ample free patient parking with close access to freeways and Sharp Grossmont and Alvarado Hospitals. Safe and secure with round-the-clock monitored property, patrol, and cameras. Available March 1st. Call 24/7 oncall property manager Michelle at the Avocado Professional Center (619) 916-8393 or email help@avocadoprofessionalcenter.com.
OPERATING ROOM FOR RENT: State of the Art AAAASF Certified Operating Rooms for Rent at Outpatient Surgery of Sorrento. 5445 Oberlin Drive, San Diego 92121. Ideally located and newly built 5 star facility located with easy freeway access in the heart of San Diego in Sorrento Mesa. Facility includes two operating rooms and two recovery bays, waiting area, State of the Art UPC02 Laser, Endoscopic Equipment with easy parking. Ideal for cosmetic surgery. Competitive Rates. Call Cyndy for more information 858.658.0595 or email Cyndy@roydavidmd.com.
PRIME LOCATION | MEDICAL BUILDING LEASE OR OWN OPPORTUNITY IN LA MESA: Extraordinary opportunity to lease or lease-to-own a highly visible, freeway-oriented medical building in La Mesa, on Interstate 8 at the 70th Street on-ramp. Immaculate 2-story, 7.5k square foot property with elevator and ample free on-site parking (45 spaces). Already built out and equipped with MRI/CAT machine. Easy access to both Alvarado and Sharp Grossmont Hospitals, SDSU, restaurants, and walking distance to 70th St Trolley Station. Perfect for owner-user or investor. Please contact Tracy Giordano [Coldwell Banker West, DRE# 02052571] for more information at (619) 987-5498.
KEARNY MESA OFFICE TO SUBLEASE/SHARE: 5643 Copley Dr., Suite 300, San Diego, CA 92111. Perfectly centrally situated within San
Diego County. Equidistant to flagship hospitals of Sharp and Scripps healthcare systems. Ample free parking. Newly constructed Class A+ medical office space/medical use building. 12 exam rooms per half day available for use at fair market value rates. Basic communal medical supplies available for use (including splint/cast materials). Injectable medications and durable medical equipment (DME) and all staff to be supplied by individual physicians’ practices. 1 large exam room doubles as a minor procedure room. Ample waiting room area. In office x-ray with additional waiting area outside of the x-ray room. Orthopedic surgery centric office space. Includes access to a kitchenette/indoor break room, exterior break room and private physician workspace. Open to other MSK physician specialties and subspecialties. Building occupancy includes specialty physicians, physical therapy/occupational therapy (2nd floor), urgent care, and 5 OR ambulatory surgery center (1st floor). For inquiries contact kdowning79@ gmail.com and scurry@ortho1.com for more information. Available for immediate occupancy.
LA JOLLA/UTC OFFICE TO SUBLEASE OR SHARE: Modern upscale office near Scripps Memorial, UCSD hospital, and the UTC mall. One large exam/procedure room and one regular-sized exam room. Large physician office for consults as well. Ample waiting room area. Can accommodate any specialty or Internal Medicine. Multiple days per week and full use of the office is available. If interested please email drphilipw@gmail.com.
ENCINITAS MEDICAL SPACE AVAILABLE: Newly updated office space located in a medical office building. Two large exam rooms are available M-F and suitable for all types of practice, including subspecialties needing equipment space. Building consists of primary and specialist physicians, great for networking and referrals. Includes access to the break room, bathroom and reception. Large parking lot with free parking for patients. Possibility to share receptionist or bring your own. Please contact coastdocgroup@gmail.com for more information.
NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista CA 92082. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, decor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele. Just a few blocks from Tri-City Medical Center and across from the urgent care. Includes: multiple exam rooms, access to a kitchenette/break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is not included. For inquiries contact hosalkarofficeassist@gmail.com or call/text (858)740-1928.
MEDICAL EQUIPMENT / FURNITURE FOR SALE
FRIDGE & FREEZER EQUIPMENT AVAILABLE | MINT CONDITION: Pristine medical cold storage refrigeration equipment available for purchase by Champions for Health, SDCMS’ philanthropic 501(c)3. Used to store vaccines. Includes 2 (two) commercial–grade Accucold ARG49ML 49 cu ft upright pharmacy refrigerators each with two glass doors, automatic defrost, digital thermostat and stainless steel cabinets (83.75” H x 55.25” W x 31.0” D), plus 1 (one) pharmaceutical–grade TempArmour BFFV15 compact freezer built to ensure stable temperatures and virtually eliminate supply losses (26.5” H x 25.0” W x 31.0” D). All units were acquired new, in use between 2-4 years and in very gently used condition. Units meet all CDC guidelines for vaccine storage. Asking price for each fridge is $4,000 OBO and $2,500 OBO for the freezer. Purchase individually or as a set. Contact Adama at (858) 300–2780 or adama.dyoniziak@ championsfh.org.
NONPHYSICIAN POSITIONS AVAILABLE
NURSE PRACTITIONER | PHYSICIAN ASSISTANT: Open position for Nurse Practitioner/Physician Assistant for an outpatient adult medicine clinic in Chula Vista. Low volume of patients. No call or weekends. Please send resumes to medclinic1@yahoo.com. [2876-1121]
POSTDOCTORAL SCHOLARS: The Office of Research Affairs, at the University of California, San Diego, in support of the campus, multidisciplinary Organized Research Units (ORUs) https://research.ucsd.edu/ ORU/index.html is conducting an open search for Postdoctoral Scholars in various academic disciplines. View this position online: https://apol-recruit. ucsd.edu/JPF03803. The postdoctoral experience emphasizes scholarship and continued research training. UC’s postdoctoral scholars bring expertise and creativity that enrich the research environment for all members of the UC community, including graduate and undergraduate students. Postdocs are often expected to complete research objectives, publishing results, and may support and/or contribute expertise to writing grant applications https://apol-recruit.ucsd.edu/JPF03803/apply. [2864-0808]
RESEARCH SCIENTISTS (NON-TENURED, ASSISTANT, ASSOCIATE OR FULL LEVEL): The University of California, San Diego campus multidisciplinary Organized Research Units (ORUs) https://research.ucsd. edu/ORU/index.html is conducting an open search for Research Scientists (non–tenured, assistant, associate or full level). Research Scientists are extramurally funded, academic researchers who develop and lead independent research and creative programs similar to Ladder Rank Professors. They are expected to serve as Principal Investigators on extramural grants, generate high caliber publications and research products, engage in university and public service, continuously demonstrate independent, high quality, significant research activity and scholarly reputation. Appointments and duration vary depending on the length of the research project and availability of funding. Apply now at https://apol-recruit.ucsd.edu/ JPF04188/apply. [2867-0904]
PROJECT SCIENTISTS: Project Scientists (non-tenured, Assistant, Associate or Full level): The University of California, San Diego, Office of Research and Innovation https://research.ucsd.edu/, in support of the Campus multidisciplinary Organized Research Units (ORUs) https:// research.ucsd.edu/ORU/index.html is conducting an open search. Project Scientists are academic researchers who are expected to make significant and creative contributions to a research team, are not required to carry out independent research but will publish and carry out research or creative programs with supervision. Appointments and duration vary depending on the length of the research project and availability of funding: https:// apol-recruit.ucsd.edu/JPF04189/apply. [2868-0904]
