November/December 2025

N OV E M B E R / D E C E M B E R 2 0 2 5 Official Publication of SDCMS

Fatty Liver Disease Is San Diego Ready for What’s Coming?

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Contents NOV. / DEC.

Editor: William T–C Tseng, MD, MPH 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

VOLUME 112, NUMBER 10

OFFICERS President: Preeti S. Mehta, MD President–Elect: Maria T. Carriedo-Ceniceros, MD Immediate Past President: Steve H. Koh, MD Secretary: Karrar H. Ali, DO, MPH Treasurer: Rakesh R. Patel, MD, FAAFP, MBA GEOGRAPHIC DIRECTORS East County #2: Rachel B. Van Hollebeke, MD Hillcrest #1: Vikant Gulati, 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: Toluwalase (Lase) A. Ajayi, MD La Jolla #2: Audra R. Meadows, MD La Jolla #3: Emily A. Nagler, MD North County #1: Arlene J. Morales, MD (Board Representative to the Executive Committee) North County #2: Phil E. Yphantides, MD North County #3: Nina Chaya, MD South Bay #1: Paul J. Manos, DO South Bay #2: Latisa S. Carson, MD AT–LARGE DIRECTORS #1: Steven L.W. Chen, MD, FACS, MBA (Board Representative to the Executive Committee) #2: Kelly C. Motadel, MD, MPH #3: Kyle P. Edmonds, 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: Quinne C. Sember, MD Retired Physician: Mitsuo Tomita, MD Medical Student: Christina Noravian CMA OFFICERS AND TRUSTEES Trustee: Sergio R. Flores, MD Trustee: Timothy A. Murphy, MD Trustee: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM AMA DELEGATES AND ALTERNATE DELEGATES District I: Mihir Y. Parikh, MD District I Alternate: William T–C Tseng, MD, MPH At–Large: Kyle P. Edmonds, MD At–Large: Sergio R. Flores, MD At–Large: Robert E. Hertzka, MD At–Large: Theodore M. Mazer, MD At–Large: Albert Ray, MD At–Large: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM CMA DELEGATES District I: Christopher M. Bergeron, MD, FACS District I: Corrie D. Broudy, MD District I: Mojgan Hosseini, MD District I: Quinn K. Lippmann, MD District I: Yolanda Marzan, MD District I: Bijal V. Patel, MD District I: Eric L. Rafla-Yuan, MD District I: Ran Regev, MD District I: Kristen N. Rice, 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 District I: Nicholas (dr. Nick) J. Yphantides, MD, MPH RFS Delegate: Shawn A. Ali, 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.]

FEATURE

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Metabolic Dysfunction Associated Steatotic Liver Disease Affects 30% of Adult Global Population. Is San Diego Ready for This?

By Rohit Loomba, MD, MHSc

DEPARTMENTS

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Briefly Noted: Advocacy • Affordable Care Act • Environmental Health

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Healthcare Legislative Update from Washington, DC and Sacramento

By Paul Hegyi, MBA

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CMA Committed to Fighting for Healthcare: Report from CMA’s Annual Meeting

By Quinn Lippmann, MD, MPH

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‘The Pumpkin Spice of Fall Social Mixers’

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Reclaiming Our Voice: The Time Is Now

By Vik Gulati, MD, FACEP

Turning Reaction into Resolve: A Student Report from the CMA House of Delegates

By Christina Noravian and Samuel Fuentes

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Childhood Holiday Memories

By Adama Dyoniziak

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Classifieds

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Left: Assemblymember Darshana Patel, Senate candidate Dr. Sion Roy, and Dr. Robert E. Hertzka

AFFORDABLE CARE ACT

Dr. Tseng Joins Sen. Schiff and Rep. Levin to Support Healthcare Subsidies

ADVOCACY

Dr. Hertzka Hosts Important Fundraiser for Physician and State Senate Candidate Sion Roy EARLIER THIS YEAR FORMER CMA BOARD member and practicing cardiologist Sion Roy, MD announced he is running to replace Ben Allen in the California State Senate.

This is an extraordinarily important — and deeply challenging — time for healthcare and patient advocacy. We have seen the impact that physicians such as Drs. Richard Pan and Akilah Weber Pierson have had in the legislature. Dr. Roy will be the additional voice we need as two of the three physicians currently in the legislature will be leaving.

Dr. Robert E. Hertzka, chair of the SDCMS Political Action Committee, and his wife, Roxana Foxx, hosted an important fundraiser at their beautiful home in Rancho Santa Fe for Dr. Roy. Dr. Roy has long been an advocate for physicians and their patients, and having his voice in the State Senate is among CMA’s top priorities.

You can learn more about Dr. Roy and donate directly to this critical campaign at DrSionRoyforSenate.com.

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NOVEMBER / DECEMBER 2025

THE SAN DIEGO COUNTY MEDICAL Society and California Medical Association were represented by a former SDCMS President Dr. William T-C Tseng as he joined U.S. Senator Adam Schiff, Congressman Mike Levin and colleagues at TrueCare in Oceanside at a press conference to stand up for patient access to healthcare. They urged Congress to extend healthcare subsidies for the Affordable Care Act (ACA) set to expire.

“Physicians live by the oath “primum non nocere” … first do no harm,” Dr. Tseng declared.

That oath doesn’t stop at the clinic door. It must also guide Congress as it decides whether to extend the Affordable Care Act’s enhanced premium tax credits.”

This is a vital issue for patient access and Dr. Tseng was quoted in the local news media as saying, “If Congress fails to act, the harm will be real: children without care, families without doctors, communities without hospitals. It will be every physician’s nightmare — standing at a bedside knowing the harm was preventable if only someone had acted sooner.”

Above: Dr. Tseng with U.S. Senator Adam Schiff and U.S. Representative Mike Levin

TRUST Dr. Nguyen with Assemblymember Tasha Boerner

ENVIRONMENTAL HEALTH

Dr. Vi Nguyen Receives Environmental Justice Award for Her Work on Tijuana Sewage Crisis CONGRATULATIONS TO VI Nguyen, MD, the recipient of the 2025 Environmental Justice Award from California State Assemblymember Tasha Boerner. Her work has brought attention to the Tijuana sewage crisis as a health crisis, lifting up the families who cannot simply “go elsewhere.”

Dr. Nguyen helped launch the Heat and Human Health Summit so frontline clinicians can recognize heat-related illnesses sooner and keep

high-risk patients safe.

As self-proclaimed Dr. Plastic Picker, Dr. Nguyen has served as a community advocate for the difference all of us can make by simply picking up the trash we see. She reminds us that environmental damage prevention begins on our own streets and shorelines.

Health starts where we live, learn, and play, and Dr. Nguyen fights for that health every day.

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ADVOCACY

SDCMS Leadership Attends HASD&IC Annual Meeting

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SDCMS leadership showed up in force for the Annual Meeting of the Hospital Association of San Diego & Imperial Counties (HASD&IC).

(From left to right) Dr. Patrick Tellez, SDCMS President Dr. Preeti Mehta, SDCMS CEO Paul Hegyi, Dr. Robert E. Hertzka, and Dr. Steve Sang-Hyun Koh

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SDCMS

‘The Pumpkin Spice of Fall Social Mixers!’

SDCMS Gathering at UCSD Spices Up Fall for San Diego’s Physicians

THE SAN DIEGO COUNTY MEDICAL SOCIETY’S Fall Social and Physician Mixer saw a large number of local doctors gather at the UC San Diego Ida and Cecil Green Faculty Club.

One attendee called the event “the Pumpkin Spice of Fall Social Mixers.” Physicians and their guests enjoyed appetizers, wine, and craft beer while meeting their colleagues on a beautiful evening on campus. Be on the lookout for the next Physician Social and Mixer in early spring.

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NOVEMBER / DECEMBER 2025

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ADVOCACY

Reclaiming Our Voice:

THE TIME IS NOW

By Vik Gulati, MD, FACEP

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NOVEMBER / DECEMBER 2025

MY GRANDFATHER, P. N. GULATI, PASSED AWAY AT the age of 97, three years ago. If you had asked him how he made it to such an impressive age — despite two myocardial infarctions, hypertension, high cholesterol, glaucoma, and pre-diabetes — he would have credited the United States healthcare system.

As an immigrant, he was in awe of American medicine.

He believed it was home to the world’s brightest physicians, graduates of the finest medical schools, supported by cuttingedge research, strong ethical standards, and a regulatory system largely free from corruption or greed — qualities not always guaranteed in his country of birth.

But I often wonder: If he were here today, would he still feel that way?

It sometimes feels as though the pillars that once defined the U.S. healthcare system, the very ones my grandfather admired, are being systematically dismantled. Access to medical education increasingly feels like a privilege reserved for the wealthy. Research grants are under attack, threatening the innovation that defines our universities. Vaccine skepti-

cism has replaced trust in science. Medication regulations grow more confusing by the day. And the financial pressures on both systems and providers are nearing a breaking point.

I worry that soon, we may no longer be so different

from the system my grandfather once left behind.

Many of my colleagues have already relocated to Australia, New Zealand, and Europe. I can’t say I blame them. They see the writing on the wall and fear for their children’s futures. Perhaps some reading this have considered the same. When it feels like a relentless assault on healthcare, escape can seem like the only option.

Meanwhile, those of us who remain often feel like we’re plugging leaks in a dam with our fingers as the water keeps rising.

Too many of us are waiting for solutions from political leaders, or for those responsible to suddenly recognize their errors. But I suspect neither is likely. Still, I’m encouraged that many Americans are beginning to recognize that chaos isn’t reform and that destruction doesn’t always bring progress. Some damage will take years to repair — but history tells us that physicians will again lead the rebuilding. Reform begins when we reclaim our collective voice.

As a Millennial physician who came of age alongside Facebook’s rise, I’ve learned that our voice doesn’t come from tweets, posts, or

likes. And I think the generation behind us is realizing that too. True change requires unity. It requires belonging to something larger than ourselves: a professional society, an organized body, a collective purpose.

While many medical and specialty societies have seen declining membership in recent years, perhaps this is the moment to reverse that trend. Because only through solidarity can we achieve the change we all seek.

Of course, the organizations of tomorrow will not look like those of the past. For younger generations, the conversation cannot revolve solely around reimbursement — it must also center on relevance, mentorship, and meaning.

It’s time for established leadership to open the door and help new voices rise.

Even amid today’s chaos, there’s still much we can accomplish locally. With physician and hospital reimbursements under threat, now is the time to advocate for state-level reforms. We should demand that peer-to-peer reviews occur only between licensed California physicians of the same specialty — and that AI, if used, may approve but never deny a claim. We should work with hospital partners to ensure that copay collections for emergency visits and hospitalizations fall on insurers, not providers or systems — after all, we aren’t employees of the insurance companies.

And as one of the world’s largest economies and home to the biggest technology companies, California has the means to create a dedicated funding stream to support its medical schools. Doing so would protect access and affordability for future generations of physicians — and ultimately, for the patients we serve.

But none of this happens without participation. That’s why I encourage every physician to get involved: attend an SDCMS board meeting, come to a mixer, share your ideas, and volunteer with Champions for Health. Now more than ever, our community needs us — not just as doctors, but as advocates and leaders.

Because at the end of the day, bureaucracy doesn’t heal — people do. My grandfather believed America’s healthcare system worked because it trusted its doctors to do what was right. And I haven’t lost that faith either.

Dr. Gulati is a board-certified emergency medicine physician with more than 13 years of clinical experience across a diverse range of practice environments. His passion for advocacy began during residency, leading him to complete a Health Policy and Advocacy Fellowship with the California Chapter of the American College of Emergency Physicians (CAL/ACEP). He later served on the CAL/ACEP board of directors and as president of the organization. Dr. Gulati now serves on the board of directors of the San Diego County Medical Society, where he continues to champion the voice of his physician colleagues and advocate for the future of patient-centered care. Outside of medicine, he enjoys skiing with his two sons, traveling with his wife, and finding opportunities to learn something new every day.

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LIVER HEALTH

Metabolic Dysfunction Associated Steatotic Liver Disease Affects 30% of Adult Global Population. Is San Diego Ready for This?

By Rohit Loomba, MD, MHSc METABOLIC DYSFUNCTION ASSOCIATED STEATOTIC liver disease (MASLD — previously known as nonalcoholic fatty liver disease) is one of the most common causes of chronic liver disease globally afflicting 1.7 billion individuals worldwide. In the United States, approximately 100 million Americans have MASLD. It is commonly associated with obesity and type 2 diabetes, and considered the hepatic manifestation of metabolic syndrome. Due to a parallel rise in obesity and type 2 diabetes globally, there has been a tremendous increase in the prevalence of MASLD over the last two decades. MASLD can be largely classified into two broad categories including metabolic dysfunction associated steatotic liver (MASL), the

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non-progressive sub-type of MASLD, and metabolic dysfunction associated steatohepatitis (MASH), the progressive sub-type of MASLD, which may lead to progressive liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC).

Among patients with MASLD, cardiovascular disease is the leading cause

of mortality followed by cancer-related mortality and then liver-related mortality.

The risk of liver mortality has been linked to liver fibrosis, and it particularly increases in those with stage 2 fibrosis or higher. Therefore, patients who have MASH with stage 2 fibrosis or higher are considered candidates for pharmacologic therapies so we can focus on reducing their liver-related morbidity and mortality. All patients with MASLD regardless of stage of fibrosis benefit from cardiovascular risk optimization and lifestyle interventions such as low carbohydrate diet, reducing the intake of sugar and sugar-containing beverages, weight loss in those with overweight and obesity,

increasing exercise, and reducing alcohol consumption (or ideally abstain from it) and abstain from smoking. Regular intake of coffee is considered to be protective in reducing liver-related morbidity and mortality in patients with MASLD. San Diego County and Imperial County are considered a hotbed for MASLD related cirrhosis and HCC, and therefore this disease entity is of immense clinical and public health significance for us in San Diego. Based upon the data from the Dallas Heart Study as well as a series of studies conducted at UCSD, it has been recognized that MASLD rates are significantly higher among Hispanics compared to non-Hispanics.

The rates of MASH, cirrhosis and HCC are significantly higher among Hispanics. Furthermore, a genetic underpinning to explain this increased risk among Hispanics has been discovered and is thought to be related to a single nucleotide polymorphism in the PNPLA3 gene. The PNPLA3 risk allele is much more common among those with Hispanic ethnicity and it explains the increased risk of cirrhosis and HCC among those with Hispanic ethnicity. One in every three San Diegans is of Hispanic ethnicity, hence prevalence of MASLD in San Diego is strikingly higher than other parts of the country.

Therefore, it is important for all healthcare providers in San Diego to be aware of this disease entity and the risks associated with MASLD in our community.

This was an impetus for me to move to San Diego and establish a clinical and research program in MASLD at University of California at San Diego (UCSD) approximately 18 years ago. One of the first things we did in San Diego was to create an awareness among healthcare providers across multiple institutions that led to the creation of San Diego Integrated NAFLD Consortium (SINC), which included physicians from

Key TakeHome Points Regarding MASLD 1 MASLD is the most common chronic liver disease in San Diego.

2 Anyone with obesity or type 2 diabetes or family history of cirrhosis should be screened for MASLDrelated fibrosis.

3 Screening for MASLD can be done in any healthcare system using FIB-4 (includes age, serum ALT, AST and platelet count). If FIB-4 > 1.3 then refer to hepatology.

4 Liver stiffness assessment by fibroscan and magnetic resonance elastography is readily available and accessible in San Diego.

5 Resmetirom and Semaglutide are both FDA-approved for the treatment of MASHrelated moderate to advanced fibrosis without cirrhosis.

The MASLD research team

UCSD, Sharp Healthcare, Scripps, Kaiser, and Balboa Naval Medical Center. We started working together on finding noninvasive biomarkers for risk stratification as well as predicting treatment response in patients with MASH. We also put together a series of basic, translation, and clinical studies across various laboratories at UCSD, which led to the establishment of the MASLD Research Center at UCSD approximately a decade ago.

UCSD MASLD Research Center fostered collaborative team science where a multi-disciplinary team of researchers started conducting cutting-edge research in all aspects of MASLD including noninvasive biomarkers, genetics, epidemiology, clinical trial design, imaging end-points, and integrated OMICs using microbiome, metabolome and lipidome. This integrated approach led to several innovative applications such as establishment of magnetic resonance imaging proton density fat fraction (MRI-PDFF) as a noninvasive biomarker of treatment response in clinical trials in MASH, which has now been adopted in more than 100 clinical trials conducted worldwide. Our collaborative work has led to several advances in clinical practice and replaced the need for liver biopsy with the use of advanced MRIbased methods as well as ultrasound-based methods for clinical risk stratification of liver fibrosis, which

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LIVER HEALTH

Resources for You and Your Patients has now become standard of care in routine clinical practice. UCSD MASLD Research Center has become an epicenter in the development of noninvasive biomarkers of risk stratification and treatment response in MASH. Our mission has been to work locally and impact globally. Furthermore, we have established a series of collaborations across multiple institutions in San Diego including UCSD, Rady Children’s Hospital, Salk Institute, La Jolla Institute of Allergy and Immunology, Sanford Burnham Prebys Institute, The Scripps Research Institute, and the Sanford Consortium for Regenerative Medicine.

Based upon U.S. News & World Report, UCSD Gastroenterology and Hepatology is ranked No. 1 in research across all global universities.

This is a testament to the collaborative-team science approach, and the credit is shared with both local and global collaborators working in concert to bring better therapies for our patients suffering from MASH. Over the last two years, two therapies including resmetirom (a thyroid hormone beta receptor agonist) and semaglutide (a glucagon like peptide-1 [GLP-1] analogue) have been approved by the Food and Drug Administration for the management of patients with MASH-related

moderate to advanced fibrosis without cirrhosis. We are leading several large Phase 3 treatment trial programs globally.

Due to advances in noninvasive testing (NIT) for detection of patients with MASH with stage 2 or 3 fibrosis, we no longer require a liver biopsy assessment for initiation of treatment with either resmetirom or semaglutide in routine clinical practice. Key take-home points regarding MASH are listed in the table below.

Although newer treatment modalities are becoming available for MASHrelated fibrosis, prevention is key. One of the key issues to understand the genetic susceptibility is to see the gene environment interaction associated with MASLD. PNPLA3 genotype disease risk for MASLD is attenuated by weight gain and excessive alcohol consumption. Hence maintaining a normal body weight and avoiding alcohol consumption and regular exercise can minimize the risk of liver disease occurrence and progression in those at risk of MASLD. We should also focus on screening for advanced fibrosis among those with obesity and/or type 2 diabetes and/or those with family history of cirrhosis.

Dr. Loomba is a professor of medicine, director of MASLD Research Center, and chief of the Division of Gastroenterology and Hepatology at the University of California at San Diego.

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The Liver Coalition of San Diego is a member of the Global Liver Institute’s Liver Action Network.

This alignment connects local efforts to national and global programs — such as Global Fatty Liver Day, a premier international education campaign convened annually by the Global Liver Institute on the second Thursday of June. The campaign raises visibility and urgency around the impact of fatty liver disease and its more advanced forms on our communities.

An informed community is essential to reducing the prevalence of fatty liver disease, which can progress dangerously if left undetected. This campaign brings together physicians, advocates, and other experts to share the latest insights on preventing, diagnosing, and managing fatty liver disease in ways that are relevant to their local communities. There are nine educational topics on fatty liver disease available in 18 different languages.

You and your patients can print these resources as needed at globalfattyliverday.com.

In collaboration with the Liver Coalition, the Global Liver Institute supported a medical education forum titled “Beyond the Biopsy: Breaking Barriers in Diagnosis” in October. The presentation, focused on MASLD/MASH in Hispanic populations and advancing early detection, was delivered by Julio Gutierrez, MD, and was filmed for future availability through the campaign. Dr. Gutierrez serves as the current chair of the Liver Coalition’s Medical Advisory Council and is a transplant hepatologist at the Scripps Organ and Cell Transplant Program at Scripps Green Hospital.

A continuing medical education resources locally is the Scripps annual “New Treatments in Chronic Liver Disease” conference. Dr. Gutierrez and Dr. Paul Pockros are co-directors of the conference, which will be held March 14–15, 2026, in Oceanside.

Information about this and other liver-connected events can be found on our calendar page at www.livercoalition.org.

Julio Gutierrez, MD (center) with leadership from the Liver Coalition and the Global Liver Institute at the “Beyond the Biopsy” presentation.

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ADVOCACY

Healthcare Legislative Update from Washington, DC and Sacramento

By Paul Hegyi, MBA

THE RECENT FEDERAL GOVERNMENT SHUTDOWN (this was the fourth since 2013) is indicative of a lot of the uncertainty we face in health policy and related legislative actions, particularly from the federal government.

H.R. 1, the One Big Beautiful Bill, was covered extensively in September’s San Diego Physician so I will not go into all of the details, but two major health-funding issues are set to expire this year and, to date, remain unresolved.

The first issue, which has been a major sticking point in negotiations to fund the government, are tax credits for Affordable Care Act plans (through Covered California). These credits, enacted in 2021 as part of the pandemic relief package, have led to double the number of people who select these plans, over 24 million nationally. Roughly 92% of enrollees receive subsidies.

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These tax credits expire at the end of 2025 and without them annual premiums for subsidized enrollees will skyrocket by an average of 114% without the subsidies.

As many as one million ACA enrollees are expected to lose coverage.

As of Oct. 1, Medicare’s pandemic-era telehealth waivers expired, meaning that — with the exception of mental health and substance use disorder treatment and

physicians participating in certain Medicare Shared Savings Program ACOs — only patients in rural areas remain eligible for Medicare telehealth services under federal law. (For Medicare, “rural” means a Health Professional Shortage Area or a non-Metropolitan Statistical Area.) This means most traditional Medicare and Medicare Advantage patients outside of rural areas are no longer authorized to receive telehealth visits from their homes, and payment for audio-only visits is no longer permitted. The Acute Hospital Care at Home program has also ended. (These changes apply only to Medicare; Medi-Cal telehealth payments are not affected by the shutdown.)

Hopefully by the time you are reading this the government is back in business and those issues have been positively resolved.

Some Important Success in California In California, CMA’s legislative efforts have been broad based, including response where possible to federal actions while seeking to improve the practice of medicine here at home.

One of our most exciting victories was when Governor Gavin Newsom signed Senate Bill 306, a CMAsponsored bill that delivers critical reforms to the prior authorization process. The new law, authored by Senator Josh Becker, eliminates duplicative approval requirements and introduces new transparency measures

that will help ensure patients receive care without unnecessary red tape. CMA has long sought to improve the prior authorization process and count this as a great victory, saving physicians some of the expense dealing with this needless bureaucracy while improving the patient experience.

“This law is a decisive step toward ending wasteful prior authorization practices that too often delay or deny patients the care they need,” said CMA President Shannon UdovicConstant, MD. “By cutting out redundant requirements and increasing accountability, SB 306 puts patients’ health above paperwork. We thank Governor Newsom for his leadership in signing this reform into law and ensuring that California moves closer to a healthcare system where medical decisions are driven by clinical expertise rather than bureaucracy.”

Specifically, SB 306 removes redundant prior authorizations requirements for routine care and mandates new transparency measures through the following provisions: • The California Department of Managed Health Care may waive prior authorization for services or prescriptions that insurers approve at least 90% of the time.

• Health plans will be required to report prior authorization data, improving accountability and shedding light on approval trends.

In a show of broad support, SB 306 received 76 AYE votes and one NO vote in the Assembly and passed unanimously in the Senate.

Reacting to dramatic actions by the federal administration, California championed Assembly Bill 144, landmark legislation to safeguard access to vaccines in California. The law comes amid concerns that the Centers for Disease Control and Prevention (CDC) may adopt vaccine recommendations that undermine the health and safety of communities across the country.

Currently, insurance coverage for vaccines depends on federal recommendations rooted in scientific consensus.

Recent federal actions cast doubt on these recommendations, threaten decades of progress against preventable diseases, fuel public mistrust, and force physicians to spend critical time countering misinformation in the exam room.

AB 144 will protect Californians by: • Establishing California’s baseline for vaccine coverage as the immunization schedule recommended the Advisory Committee on Immunization Practices as of Jan. 1, 2025.

• Authorizing the California Department of Public Health to modify or supplement these baseline recommendations, considering guidance from leading medical organizations such as the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians.

• Providing liability protections for people providing immunizations in accordance with CDPH recommendations through Jan. 1, 2030.

The signing of AB 144 coincided with the release of the first coordinated vaccine guidance from the West Coast Health Alliance — a coalition formed by California, Oregon, Washington, and Hawaii to keep public health decisions rooted in science and shielded from political interference.

The Alliance states are pushing back against federal efforts undermining scientific standards and share a commitment to ensuring that health recommendations are guided by safety, efficacy, transparency, access, and trust. To develop its recommendations, public health officers (all of whom are physicians) and subject matter experts from each of the states reviewed guidelines from leading national medical organizations, including the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians.

While there are likely to be many benefits to using artificial intelligence in healthcare, it’s important to ensure that new technologies are deployed in ways that protect patient safety, preserve trust, and support the physician-patient relationship. In that interest, CMA sponsored Assembly Bill 489 by Assemblymember Mia Bonta, which prohibits artificial intelligence systems from being misrepresented as licensed medical professionals, and provides California’s state health professions boards, such as the Medical Board of California and the Board of Registered Nursing, with clear authority to enforce title protections for healthcare workers.

“Patient trust is the cornerstone of medicine, and AB 489 helps preserve that trust in an era of rapidly advancing technology,” said Dr. Udovic-Constant. “By ensuring patients know when they are interacting with artificial intelligence systems rather than a licensed clinician, this bill safeguards transparency, accountability, and the integrity of medical care. CMA thanks Assemblymember Bonta for championing this vital protection.”

Finally, the Governor signed another piece of CMA sponsored legislation, Senate Bill 351 by Senator Christopher Cabaldon, addressing the growing influence of private equity and hedge funds in healthcare delivery.

“I am grateful for the Governor’s signature to ensure that patients are receiving medical care prescribed by their doctors, not from private equity investors,” said Senator Cabaldon. “Private equity investment in healthcare practices has quintupled over the past decade. That kind of growth demands modern enforcement tools — not to restrict investment, but to make sure it doesn’t hurt patient outcomes or drive up the cost of care.”

Paul Hegyi is CEO of the San Diego County Medical Society.

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CMA HOUSE OF DELEGATES

CMA Committed to Fighting for Healthcare: Report from CMA’s Annual Meeting

By Quinn Lippmann, MD, MPH Editor’s Note. The author wishes to give special thanks to Holly Yang, MD, HMDC, FACP, FAAHPM and Paul Hegyi, MBA, for their assistance with this article.

IN OCTOBER, MORE THAN 1,000 PHYSICIANS FROM across California gathered in Los Angeles for the California Medical Association’s annual House of Delegates.

This year, much of the time was spent with major changes to how CMA handles policy development process, a reform of changes adopted 10 years ago. These proposals seek to improve member engagement in policy development, including expanding the voice of the House on issues of prioritization.

These proposed changes are grounded in principles of good governance and respond directly to member feedback while keeping governance expenses flat. Our own Dr. Holly Yang chaired the Governance Reform Technical Advisory Committee (GTAC) and put countless hours into meeting with CMA members to thoughtfully craft the proposal. District 1 unanimously supported the GTAC proposal, and we are

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thrilled to see Dr. Yang and all of GTAC’s hard work move the HOD forward.

We had a moving talk from CMA CEO, Dustin Cocoran. He captured what a lot of us are feeling when he said, “We don’t get to have coffee before the outrage of the day breaks in the news.” HR 1 (aka the “Big, Beautiful Bill”) strips out core healthcare tenets to fund tax cuts and will affect California.

Some of these effects are still unclear, including the uniformity provision which may impact Medi-Cal and the implementation of Prop 35.

Speaking of Prop 35, the initial budget attempted to take money away from healthcare codified in this proposition.

After the threat of legal action from CMA, the budget was amended to respect the will of the voters who approved this proposition last year. Prop 35 monies are starting to be distributed for EM physicians, GME funding, family planning and abortion services, and emergency transportation.

Incoming AMA Chair-elect, Dr. Toluwalase Ajayi, also a District 1 physician, gave an amazing presentation. We were reminded of the importance of our voice as physicians in this difficult time. Many of us were disappointed in AMA’s tepid response to the assault on healthcare, research and scholarship. With new leadership we will be seeing a different and more assertive stance from AMA. Dr. Anna Yap of Sacramento was elected vice speaker of the house. She reminded us that organized medicine is our “vaccine against burnout.”

The author (left), Quinn Lippmann, MD, MPH with Robert E. Hertzka, MD and Timothy A. Murphy, MD at the CMA’s House of Delegates meeting

Regarding policy development, this year the HOD focused primarily on “Responding to Federal Funding Cuts and Other Attacks on Health Care, Public Health and Medicine.” Some examples of policies considered include: • CMA reaffirms its strong commitment to access to reproductive healthcare and abortion for all patients and the need for Medicaid to cover these services. Further, CMA strongly opposes federal action to defund Planned Parenthood that reduces access to care and may lead to worse healthcare outcomes for patients.

• CMA supports protections for physicians who provide evidence-based, gender-affirming care in California and opposes criminal, civil, or licensure actions against them.

• CMA opposes burdensome administrative and financial policies in Medicaid that make it more difficult for physician practices to operate and provide timely care to patients.

• CMA opposes federal and state policies that lead to increased uncompensated care for hospitals, clinics, and physicians’ offices.

• CMA opposes premiums, copayments, and other cost-sharing methods for Medicaid and the Children’s Health Insurance Program.

During the meeting we also received updates on CMA’s activities during the year, most significantly some of the legislative challenges we had at the State.

The following were all signed by the Governor except SB 29 (defeated earlier).

• SB 306 requires annual reporting of prior authorization data from health plans and gives DMHC the authority to remove prior authorization statewide on a code-by-code basis. Signed by the Governor.

• AB 489 prohibits AI systems or similar technologies, such as internet-based chatbots, from misleading patients into thinking they are interacting with licensed health professionals.

• SB 29 would have extended pandemic-era legal exceptions that make it easier to sue for pain and suffering damages — including in medical malpractice cases — undoing the careful balance struck in AB 35’s historic reforms to the Medical Injury Compensation Reform Act (MICRA). Unless amended to exclude medical malpractice claims, this bill would have significantly increased litigation, settlement, and damages costs across California’s healthcare system — costs that would have been passed on to physician practices, health plans and the state itself. CMA helped defeat this legislation.

• SB 351 addresses the growing influence of private equity and hedge funds in healthcare delivery, codified Medical Board of California guidance restricting nonphysicians from making business decisions that infringe upon the clinical determinations of physicians. This bill addresses the growing influence of private equity and hedge funds in healthcare. The bill also gives the California attorney general authority to bring its own enforcement actions, which is a critical new policy. Currently, violations of the corporate practice of medicine either have to be enforced through costly private litigation or through regulatory actions taken by the medical board.

Private lawsuits, even if they are successful, typically do not provide financial remuneration, and the medical board has not devoted any resources to enforcing this law. Giving the attorney general this power means the state can take enforcement action without having to rely solely on civil lawsuits filed by physicians.

Finally, we recognized leaders in medicine who were lost this year. Among them was Dr. David Bazzo, a recent pastpresident of both the San Diego County Medical Society and California Academy of Family Physicians. At 63, we lost him much too early.

Dr. Lippmann is a urogynecologist and reproductive pelvic surgeon at Kaiser Permanente in San Diego and SDCMS board member. She is on the board of Global Surgical Expedition and has done medical work in Malawi, Rwanda, and Botswana. She leads the global health curriculum for the UCSD/KP urogynecology fellowship program.

SANDIEGOPHYSICIAN.ORG

15

CMA HOUSE OF DELEGATES

Turning Reaction into Resolve: A Student Report from the CMA House of Delegates

By Christina Noravian and Samuel Fuentes from across California, with the intention of witnessing the efforts being made to address our concerns. Though initially skeptical, we quickly learned that our concerns were not just shared, but central to the HOD’s agenda, particularly under the overarching theme of “Responding to Federal Funding Cuts and Other Attacks on Health Care.” It was here that we truly saw the ability of our medical student voice to translate into tangible policy.

“A HEALTHCARE SYSTEM BUILT TO HEAL HAS turned against its healers.” This sentiment, echoed by many at the California Medical Association’s 2025 House of Delegates Meeting, perfectly encapsulated the unease that we, as medical students, brought with us to Los Angeles. As students living in unprecedented times, our education often feels split between two worlds: one of memorizing pathways and practicing clinical skills, and another of increasing concern and mobilization toward large-scale societal issues. From public healthcare funding cuts, targeted deportation operations, and loosened vaccine recommendations, each day brings news of policies that will fundamentally shape our careers. Coupled with these societal

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issues are policies that affect us promptly and personally.

Federal loan limitations, restrictions on public loan forgiveness programs, and attacks on diversity initiatives in medicine all threaten the fabric of medical education as we know it.

We traveled to the House of Delegates (HOD), joining more than 1,000 physicians

Standing for Health Equity and Immigration We sat captivated as the HOD deliberated on health equity and immigration.

Much to our surprise, our input as medical student stakeholders proved crucial in shaping the meeting’s policymaking discourse. It was powerful to realize that our generation is uniquely equipped to advocate for issues that affect our state’s most disadvantaged populations. We have, after all, come of age amidst the profound societal shifts of COVID-19, Black Lives Matter, MeToo, and a tumultuous political landscape. It didn’t take long for us to realize that organized medicine provides an essential outlet for this energy and fervor

toward systemic change.

As future physicians, our strength lies in our collective humanity and ability to redeem the values of medical trust and equity that are now under threat. As Dr. René Bravo put it, our work in organized medicine “lets us meet people at their most vulnerable with skill, understanding, and compassion.”

The Medical Student Section contributed to pivotal discussions on protecting vulnerable patient populations. Our amendments aimed to: 1. Protect hospital sidewalks, parking lots, and associated property to ensure undocumented or underinsured patients do not hesitate to seek healthcare due to fear of immigration enforcement (Recommendation 15).

2. Oppose the detention of individuals without proper legal authority and require Immigration and Customs Enforcement (ICE) officers to show their faces, aligning with efforts to prevent individuals from hiding identities for criminal intent (Recommendation 17).

These amendments culminated in a crucial moment of unity with Recommendation 22, where San Diego’s Dr. Maria Carriedo-Censiseros and Dr. Will Tseng passionately led the charge. The final amendment adopted by the HOD declared: “CMA opposes any requirements for physicians and healthcare systems to ask for immi-

gration status or to report undocumented individuals.”

As Dr. Tseng powerfully articulated, “ethics and trust are at the core of medicine; our role is to heal and not to police.” He continued, noting that “disease doesn’t ask for papers, and when we do, the whole community disappears, leaving everyone less safe.” This commitment to caring for all, regardless of status, resonated deeply, reminding us that human needs triumph over economic profits or political gain.

A Lesson in Power: From Frustration to Action As medical students, it’s easy to feel overwhelmed by the systemic problems in healthcare. We hear about administrative burdens, the corporate influence of private equity, and legal threats as if they are simply unchangeable facts of the profession we are about to enter.

This is where the HOD was most eye-opening. It wasn’t just a lesson in policy; it was a lesson in power.

We saw what Dr. Shannon Udovic-Constant called the “art of leading while in motion,” a meticulous process of turning our profession’s frustration into meaningful policy. Dr. Toluwalasé Ajayi’s rousing speech drove this home. Her call for physician unity, for making “our presence impossible to ignore,” wasn’t just rhetoric. It was a strategy, and we saw the tangible results.

For the first time, we weren’t just hearing complaints about prior

authorization; we were hearing about a major legislative win to reform it. We weren’t just discussing our fears of corporate medicine; we were seeing a new law enacted that gives the state real power to protect our future clinical autonomy.

We watched our future profession successfully defend itself from legal attacks that would have destabilized the practice of medicine for all of us. For us, this was the missing link. We saw firsthand that advocacy is an essential mechanism that will protect our practices and our ability to care for patients.

Our Charge As a Voice of Progress As the meeting concluded, we recognized leaders in medicine who passed away this year, including Dr. David Bazzo, a past-president of both the San Diego County Medical Society and the California Academy of Family Physicians. This solemn moment underscored the legacy of dedication we are stepping into.

Medical students, we firmly believe, are often the voice of progress. We reflected on historic student initiatives, such as federal seatbelt laws or the prohibition of smoking on planes, and initially thought, “there’s no way that could be us. We’re just voting on resolutions physicians have put forward.”

Yet, our experience at the HOD proved otherwise. Our ability to introduce and pass resolutions and amendments that enact tangible change, particularly on immigration and care for the underserved, shows that our generation is uniquely equipped to advocate for these shifts. We were raised in a crucible of pivotal social and political movements. Organized medicine, we now understand, is a vehicle to channel social justice efforts and enact systemic change. As Dr. Bravo urged, “it is up to the governed to tell the government what is just and acceptable.” We are more committed than ever to protecting access to care in the safety net and working toward a day when it is no longer needed.

Christina Noravian is a medical student 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. Samuel Fuentes is a medical student at UC San Diego School of Medicine. He is also the Medical School Delegate for the CMA and AMA.

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CHAMPIONS FOR HEALTH

Special collected ornaments on the tree

Childhood Holiday Memories

By Adama Dyoniziak

FROM NOV. 1 THROUGH JAN. 15, there are 29 holidays observed by 70 of the world’s major religions. There are so many traditions enjoyed by all ages during this time. We were reminiscing at Champions for Health (CFH) about our childhood memories — and it all centered around spending time with extended family, belonging to a shared tradition, and enjoying each moment.

We all agreed that family is everything. It is a safe place, your anchor. It is love, warmth, and unity. Family is our past, our present, and our future. It is our connection to the world. It is how we see ourselves and how we see others.

Family is a set of memories that hug you when your parents have passed away.

Family is continuing traditions with your siblings and creating traditions with your spouse and children. Family is what makes life special.

Like family, we agreed that health is everything. Health is the best version of yourself. Health means being able to

Dressing up for the Posada

The smell of food cooking

Watching for Santa Claus

Making tamales

Taking turns opening presents 18

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Decorating gingerbread houses

do anything and everything you want without limitations or hesitation. When health is missing, it feels like a heavy fog over one’s life, activities and mood.

Without health, you have worry, isolation, pain, uncertainty. Each person’s journey to health is unique and it is not taken alone. The unwavering support By of Adama Dyoniziak our families gives a person hope even in the most difficult circumstances. Mr. Rodgers once said, “When gusty winds blow and shake our lives, if we know that people care about us, we may bend with the wind, but we won’t break.”

When CFH staff were asked what one thing they would change in a patient’s life, the answers revolved around patients receiving the care that they need and the care that they deserve. It also meant working together to transform the patient’s perspective to one of hope for the future because they have access to resources and know how to use them.

“Sisu” is a Finnish word which is defined as a special strength and persistent determination and resolve to continue and overcome in the moment of adversity … an almost magical quality. It is a combination of stamina, perseverance, courage, and determination held in reserve for hard times. Sisu would be the gift we would imbue within all our patients.

Elf on the shelf

Playing with siblings and cousins

Baking bread and cakes Cutting out paper snowflakes

Wearing matching PJs

Listening to music

Singing carols SANDIEGOPHYSICIAN.ORG

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XXXXXXXXX FOR HEALTH CHAMPIONS

Our ultimate wish for the holidays is world peace, a safe place for everyone with no worries. We wish for the entire world to take a minute and focus on people first. When people care for others in even the smallest of ways, they connect with each other and with their community. Connection to people makes living brighter, lighter, and sweeter. It provides a glimmer of hope in an otherwise busy world.

Big change begins with one person, one act of kindness, one spark of hope. The skills of our volunteers help improve the health of our patients.

Let us leverage our volunteers’ talents with the contributions of our donors to unlock the full potential of Champions for Health. Your tax-deductible monthly contribution online can be automatic and ensures that patients have access to specialty care. Double your impact by asking if your employer has a matching gift program. The end of the year is an excellent time to transfer gifts of stocks, securities, or donor-advised funds to Champions for Health. www.championsforhealth.org/donate However you celebrate the holidays, we are wishing you and your loved ones health, hope, and peace.

Decorating with lights

House full of family

No bedtime Bonfire until late at night 20

NOVEMBER / DECEMBER 2025

Cookies, walnuts and candy on the coffee table

Waiting for the first star on Christmas Eve

Adama Dyoniziak is executive director of Champions for Health.

CLASSIFIEDS PRACTICE ANNOUNCEMENTS CRANIO/MAXILLOFACIAL AND HEAD & NECK SURGERY: Accepting new adolescent and adult patients seeking evaluation and management of head and neck masses, multidisciplinary assessment of oral/facial cancers and reconstruction, nasal airway assessment and functional rhinoplasty, corrective jaw surgery including jaw advancement for obstructive sleep apnea, cleft and craniofacial reconstruction, maxillofacial fracture management and secondary facial and jaw reconstruction. We work with Medicare, Tricare, most PPO insurance plans, and some HMO plans. Referrals may be called in to (619) 452-7332, or emailed to jaw@scrippshealth.org. [2887-0808] 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.

PHYSICIAN OPPORTUNITIES PULMONOLOGY PHYSICIAN | PHMG NORTH COUNTY: Palomar Health Medical Group is seeking a board-certified Pulmonology/Critical Care Physician to join our multi-specialty, not-for-profit practice in North San Diego County. The ideal candidate will offer expert pulmonary care in a comprehensive outpatient and inpatient setting, supported by advanced facilities at Palomar Medical Center Escondido and Poway. Responsibilities include diagnosing and treating a wide range of bonus. Comprehensive benefits package is available.

Send CV to sdpcc@yahoo.com. [2892-0919] UCSD DEPARTMENT OF FAMILY MEDICINE | FACULTY POSITIONS AVAILABLE: UCSD Department of Family Medicine seeks motivated faculty to join our team in clinical, teaching, and scholarly roles. Faculty participate in comprehensive patient care, resident and fellow education, and research or quality improvement initiatives. We welcome candidates with diverse experiences and a passion for family medicine, community engagement, and academic medicine. Opportunities are available at various academic ranks, with salary commensurate with experience, rank, and step. Join a collaborative, supportive environment committed to excellence in primary care and education. Apply here: https://apol-recruit.ucsd.edu/JPF04341. [2889-0822] OB/GYN PHYSICIAN | PHMG ESCONDIDO: Palomar Health Medical Group is seeking a full-time, board-certified/eligible Obstetrics and Gynecology Physician to deliver comprehensive reproductive care, including labor and delivery management, gynecologic surgeries, and OB call rotations. The ideal candidate will possess strong surgical skills, California licensure, and a commitment to maternal health. We offer competitive compensation, performance-based incentives, and a collaborative team environment. Please email CV to clayton. trosclair@palomarhealth.org or phil.yphantides@phmg.org. [2882-0626] FAMILY MEDICINE/INTERNAL MEDICINE PHYSICIAN | PHMG RANCHO PENASQUITOS: Palomar Health Medical Group is seeking a Family Medicine or Internal Medicine Physician (MD/DO) to join our multi-specialty practice at our Rancho Penasquitos 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. [2881-0626] FAMILY PRACTICE | INTERNAL MEDICINE PHYSICIAN: La Jolla Village Family Medical Group is seeking a PT/FT primary care physician to join our well-established private practice. We’ve been caring for our La Jolla/UTC area neighbors for 35+ years providing comprehensive, longitudinal care to patients of all ages. Call responsibilities are minor; hours consistent with a healthy work/life balance. Our office is new, clean, modern, and well-appointed. Our clinical team is collegial, passionate, and close-knit, with a supportive, cohesive support staff. A true private practice where physicians practice artfully and build enduring relationships with patients and colleagues. Seeking a Boardcertified, California-licensed MD/DO physician, passionate about medicine and looking to establish roots in a practice dedicated to the art of good medicine.

Competitive salary and excellent benefits including medical, dental, vision, and retirement. Send a cover letter and CV to jcataluna@lajollafamilymedical. com. [2880-0520] 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 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.

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.

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]

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.

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 AVAILABILITY OF UTC MEDICAL OFFICE: Office in UTC area. 2–3 exam rooms, ample waiting room, 2 private offices. Ground floor location. Just one block from 805 exit. Close to Genesee Ave, all major shopping and restaurants in UTC. Parking available. Ground floor office, handicapped accessible. Six month–one year lease available with possibility to renew. Call (619) 585-0476.

Ask for Alisha. [2890-0825] GORGEOUS BOUTIQUE OFFICE SPACE IN PRIME LOCATION FOR PER DIEM RENTAL: A newly remodeled and meticulously decorated medical office in University Heights, close to UCSD and Scripps Mercy, available for share including one large furnished patient exam room plus ample shared space (front office, patient wait room, kitchen). Looking for specialty physician preferably and able to do per diem or monthly agreement. The office is shared with 1 other provider and is located on Park Blvd near Adams Ave. Available immediately and turnkey ready. Please contact info@prosperaima.com or (619) 206-4232 for more information. [2883-0804] OFFICE SPACE FOR LEASE | AESTHETIC SETTING: Take your practice to the next level with this beautifully appointed office space available in a modern, fully equipped clinical environment. Whether you’re already in aesthetics or starting an aesthetic practice, we offer flexible, high–end rental options.

Rentals include use of PicoSure Pro Laser and Potenza Microneedling with Radiofrequency, two private treatment rooms and staff breakroom in a professional, clean and serene setting. Available Mondays, Tuesdays, Thursdays & Fridays at $1,000/day between the hours of 8:30am–5:00pm. Ideal for dermatologists/plastic surgeons, cosmetic physicians, nurse injectors or other licensed professionals in the aesthetic field. Must see to appreciate the quality and atmosphere. Contact us today at Vivian@sandiegomobiledoctor.com to schedule an in–person tour of this great opportunity. [2886-0804] OFFICE SPACE FOR LEASE | MEDICAL SETTING: Take your practice to the next level with this beautifully appointed office space available in a modern, fully equipped clinical environment. Whether you’re in primary care or specialty medicine, we offer flexible, high–end rental options. Rentals include use of two medical exam rooms and waiting (lobby) area in a clean, professional setting.

Available Mondays, Tuesdays, Thursdays & Fridays at $350/half day or $600/ day between the hours of 8:30am–5:00pm. Ideal for primary care physicians and specialists seeking flexible space. Must see to appreciate the quality and atmosphere. Contact us today at Vivian@sandiegomobiledoctor.com to schedule an in–person tour of this great opportunity. [2885-0804] 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.

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 on-call 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

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. [2879-0502] NON–PHYSICIAN 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]

SANDIEGOPHYSICIAN.ORG

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$5.95 | www.SanDiegoPhysician.org

PRSRT STD U.S. POSTAGE

San Diego County Medical Society 8690 Aero Drive, Suite 115-220 San Diego, CA 92123

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DENVER, CO PERMIT NO. 5377

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Date!

SAVE THE

for the Champions for Health’s fundraiser and the installation of the 156th SDCMS President at our

Wellness Gala United in

Soaring Toward A Healthier San Diego

Saturday June 27, 2026

5:00 - 10:00 pm San Diego Air & Space Museum

UnitedinWellnes.givesmart.com For sponsorship information, please contact Gabriela Stichler at 858-300-2789 or email gabriela.stichler@ChampionsFH.org