April 2020

APRIL 2020

Official Publication of SDCMS

Celebrating 150 Years

Secretary Toluwalase (Lase) A. Ajayi, MD President Holly B. Yang, MD

President-elect Sergio R. Flores, MD

San Diego County Medical Society

2020-2021 INCOMING LEADERSHIP

Treasurer Nicholas J. Yphantides, MD

150th ANNIVERSARY

ReNDEZ ReNDEZVOUS VOUS Friday, JUNE 19, 2020 6:00 PM-10:00 PM THE ABBEY ON FIFTH

Please join the San Diego County Medical Society in celebrating our 150th Anniversary, welcoming Holly B. Yang, MD, MSHPEd, FACP, FAAHPM as SDCMS President for 2019 and thanking James H. Schultz, MD, MBA, FAAFP for his service as Immediate Past President.

Suggested Attire: Cocktail Elegance, Black Tie Optional For additional information and to purchase tickets visit www.SDCMS.org/2020Rendezvous

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April 2020

Contents APRIL

Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; Robert E. Peters, MD, PhD; William T-C Tseng, MD Marketing & Production Manager: Jennifer Rohr Sales Director: Dari Pebdani Art Director: Lisa Williams Copy Editor: Adam Elder

VOLUME 107, NUMBER 4

OFFICERS President: James H. Schultz, MD President-elect: Holly B. Yang, MD Secretary: Sergio R. Flores, MD Treasurer: Toluwalase (Lase) A. Ajayi, MD Immediate Past President: David E. J. Bazzo, MD

feature:

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GEOGRAPHIC DIRECTORS East County #1: Heidi M. Meyer, MD (Board Representative to the Executive Committee) East County #2: Rakesh R. Patel, MD Hillcrest #1: Kyle P. Edmonds, MD Hillcrest #2: Steve Koh, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Alexander K. Quick, MD La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS South Bay #2: Maria T. Carriedo, MD

SDCMS Board of Directors Candidate Statements, 2020–21

GEOGRAPHIC ALTERNATE DIRECTORS Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County #1: Franklin M. Martin, MD South Bay: Karrar H. Ali, DO AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Paul J. Manos, DO; #3: Irineo “Reno” D. Tiangco, MD; #4: Nicholas J. Yphantides, MD (Board Representative to Executive Committee); #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Karl E. Steinberg, MD; #8: Alejandra Postlethwaite, MD AT-LARGE ALTERNATE DIRECTORS #1: Mark W. Sornson, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Susan Kaweski, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD ADDITIONAL VOTING DIRECTORS Communications Chair: William T-C Tseng, MD Young Physician Director: Obiora “Obi” Chidi, MD Resident Director: Vishnu Parthasarathay, MD Retired Physician Director: David Priver, MD Medical Student Director: Grace Chen ADDITIONAL NON-VOTING MEMBERS Alternate Young Physician Director: Brian Rebolledo, MD Alternate Resident Director: Nicole Herrick, MD Alternate Retired Physician Director: Mitsuo Tomita, MD San Diego Physician Editor: James Santiago Grisolia, MD CMA Past President: James T. Hay, MD CMA Past President: Robert E. Hertzka, MD (Legislative Committee Chair) CMA Past President: Ralph R. Ocampo, MD, FACS CMA President: Theodore M. Mazer, MD CMA Trustee: William T-C Tseng, MD CMA Trustee: Robert E. Wailes, MD CMA Trustee: Sergio R. Flores, MD CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MPH Sergio R. Flores, MD AMA DELEGATES AND ALTERNATE DELEGATES District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Mihir Y. Parikh, MD At-large AMA Delegate: Albert Ray, MD At-large AMA Delegate: Theodore M. Mazer, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD

Departments

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Briefly Noted: COVID-19 • SDCMS Leadership • Practice Management

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The Political Journey of SDCMS

By James Santiago Grisolia, MD, and Sue Fledderjohn Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS. org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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2019 Novel Coronavirus and Patient Safety in the Medical Office

By Debbie Hill, MBA, RN

16

Beware the Vampires in Your Life!

By Helane Fronek, MD, FACP, FACPh

17

A Decade of Love

By Adama Dyoniziak

18

Physician Classifieds

20

A Doctor Walking in Pain

By Daniel J. Bressler, MD, FACP SanDiegoPhysician.org 1

PUBLIC HEALTH

A Special Message on COVID-19, SDCMS and You

By James H. Schultz, MD, MBA, FAAFP, FAWM, DiMM President, San Diego County Medical Society THIS ISSUE OF SAN DIEGO

Physician magazine was largely produced before social distancing was implemented and the “shelter at home” order was issued by the governor. The COVID-19 pandemic is a constantly changing and dynamic situation, and whatever I write now may very well be out of date by the time you read this.

So let me stress the importance of some fundamentals. The San Diego County Medical Society is working closely with the San Diego County Department of Public Health at the local level and with the California Medical Association (CMA) at the

statewide level to keep you as informed as possible and to help meet the medical challenge.

Hundreds of doctors participated in the first Clinical Town Hall webinar on COVID-19 offered by HHSA and sponsored by the Hospital Association of San Diego and Imperial Counties, Live Well San Diego, and SDCMS. As these Clinical Town Hall webinars continue, I strongly urge you to participate in them to get the latest information and have your questions answered.

Furthermore, we have a special COVID-19 Resource Page on our website at sdcms.org. We also have separate resource pages for ambulatory physicians and for clinicians in post-acute and long-term care, which offer practical and specific advice for the daily challenges faced by physicians.

In addition, the California Medical Association has a COVID-19 newsfeed at cmadocs.org. CMA has been working hard to expand telehealth as quickly as possible and is compiling telehealth guidance from California payers.

Most importantly, it’s vital that healthcare providers stay safe and that physician wellness is not forgotten during this extremely stressful period. The San Diego County Medical Society is here for you and working hard on your behalf. Stay safe.

SDCMS LEADERSHIP

SDCMS Board Holds Retreat The San Diego County Medical Society’s Board of Directors held a weekend retreat in Rancho Mirage at the end of February. Physicians planned for the next year, strategized over the looming battle this November about the expected new initiative to gut MICRA, and discussed issues such as physician wellness.

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April 2020

Top left: President-elect Dr. Holly Yang led the weekend’s discussions.

She received a standing ovation from her colleagues for the exceptional job she did. Above: The SDCMS Board of Directors retreat reminded us why we’re so grateful for our leadership. Pictured (L–R) President James H. Schultz, MD, President-elect Holly B. Yang, MD, Immediate Past President David E.J. Bazzo, MD, Secretary Sergio R. Flores, MD, Treasurer Toluwalase (Lase) A. Ajayi, MD Left: Physicians received media training and practice during the weekend as SDCMS continues to increase its presence in local media.

PRACTICE MANAGEMENT

OptumRx Policy Requiring E-Prescribing for Controlled Substances Now in Full Effect SINCE MARCH 1, THE OPTUMRX HOME DELIVERY PHARMACY — THE

pharmacy benefit provider for UnitedHealthcare (UHC) —no longer fills prescriptions received by hard copy, fax, or phone for opioids and other controlled substances. Though the policy took effect Jan. 1, OptumRx offered a two-month grace period in response to concerns raised by the California Medical Association (CMA). That grace period came to an end on Feb. 29.

After the new policy was announced, CMA reached out to UnitedHealthcare to share our concerns with the change in policy and to discuss the potential impact on our physician members and their patients. In response to CMA’s concerns, including the potential for disruption in patient care if a physician lacked the technology, hardware, or certifications required for Electronic Prescribing of Controlled Substances (EPCS), OptumRx elected to offer a two-month grace period where all prescriptions would be filled regardless of whether they were sent electronically.

Prescriptions that are submitted by hard copy, fax, or phone for controlled substances during the grace period will be filled, with OptumRx home delivery pharmacy sending a reminder to both the prescribing physician and patient advising that future controlled substance prescriptions must be submitted electronically.

If a prescription is submitted to OptumRx home delivery pharmacy for a controlled substance using a means other than e-prescribing, OptumRx will work with the provider and patient to help get the prescription filled at a local pharmacy if necessary.

For physicians who are unable to submit e-prescriptions due to a hardship or for patients that are unable to obtain or pickup their prescription from a local pharmacy, OptumRx has implemented several exemptions to the e-prescribing requirement.

Providers requesting an exemption should email EPCSquestions@optum.com with the following information: • A brief description of the obstacle for e-prescribing • Your name, address, and phone number • Your National Provider Identifier (NPI) number For more information on the OptumRx policy, visit professionals.optumrx.com/ epcs. There you will also find a short video that provides more details regarding the transition to e-prescriptions.

Physicians who have questions about the new OptumRx policy should contact UHC at (877) 842-3210 or visit UHCprovider.com.

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SDCMS ELEC TIONS

CANDIDATE STATEMENTS

2020–21 SDCMS Board of Directors Note: • (inc.) After Name = Incumbent • Number in Parentheses (#) After Name = Term Length in Years

OFFICERS Candidate for Presidentelect: Sergio R. Flores, MD (1) I have served on the SDCMS Board of Directors as both a Kearny Mesa alternate as well as geographic director.

I am currently serving on the Executive Committee as Secretary. I would like to continue serving on the SDCMS Board as your President-elect. I have been on the CMA Board of Directors since 2012 and am the current Chairman of the CMA Finance Committee.

I also serve on the Board of IMQ as Treasurer and Chairman of the Finance Committee. I was born and raised in San Diego and graduated from SDSU in 1985. I graduated from the UCSF School of Medicine in 1989 and trained at UC Irvine in internal medicine and gastroenterology from 1989 to 1994, and was board certified in both. I am in private practice and have been a partner at San Diego Digestive Disease Consultants since 1998. I have served on the Board 4

March 2020

of Sharp Community Medical Group for the past 20 years and currently serve on the Executive Committee as the Vice President as well as the Chairman of the Finance Committee.

I served on the Sharp Healthcare Board of Directors from 2005 to 2012 and continue to serve on the Sharp Finance Committee. I would like to continue to offer my services to you and SDCMS. Thank you.

Candidate for Secretary: Toluwalase (Lase) A. Ajayi, MD (1) I have had the honor of serving on the SDCMS board of directors for the past six years and on the SDCMS

Executive Committee for the past three years.

I consider it an honor to serve our medical community and I have the privilege to again ask for your support as I run for Secretary of SDCMS. I have served as an SDCMS at-large director for the past four years, and joined the executive committee in 2017 where I served as Treasurer in 2018–2019.

I have been very active in bringing the voice of the community physician and the

patients we serve to the California Medical Association. Through my active involvement with SDCMS, I have represented San Diego physicians at the CMA, on the Council of Legislation, the Ethnic Minority section, the Young Physician section and recently as the chair of the Council on Medical Services. I take these responsibilities seriously and work passionately in these roles because I believe that our San Diego County Medical Society provides a vital opportunity for our physician community to be able to speak as a singular “voice” to the public and to the politicians in the city, county, state, and federal government. We have seen our California Medical Board, the CDC and CMS react to the opioid epidemic in ways that may not truly benefit the patients that we are trying to help and place restrictions on the practicing physicians.

We have seen and continue to see the cost of medical education increase, leading to an increased debt burden on young physicians.

EHR interoperability and scope of practice continue to place a burden the patientphysician-payer

relationships. Given this reality, it will be critical that we as practicing physicians represent, with a unified voice, the medical care interests of our patients. I have worked to help our medical society speak with that united voice and continue to work on the ground to help ease these tensions and much more. I would truly appreciate your support as I seek election to the SDCMS board of directors as its secretary.

Candidate for Treasurer: Nicholas “Dr. Nick” J. Yphantides, MD, MPH (1) I am thankful for your support of my service as your Treasurer. For over 10 years I have been blessed with the opportunity to be the first chief medical officer (CMO) of the County of San Diego. My life and passion is to be an advocate and catalyst to improve the health and wellbeing of our entire region with a focus on those who need it the most.

Prior to my service

with the County, I served as the CMO of Neighborhood Health Care, the publicly elected board chair of Palomar Health, and the CMO of the Council of Community Clinics. I currently serve on multiple local and national boards and we are in a very dynamic and strategic time of collaborative partnership between SDCMS and its physician leaders with the County of San Diego through the nationally recognized Live Well San Diego vision. As a director, I eagerly look forward to strengthening our regional collective impact even further, as we strive to improve the wellness of our patients and their families throughout San Diego.

GEOGRAPHIC DIRECTORS

qualified community health center serving about 70,000 of the underserved and medically needy. I am also a CMA delegate representing the Medium Size Group Practice Forum. My background in family medicine allows me to speak of the various challenges of primary care: access, reimbursement, administrative burdens, staffing, etc.

I also understand the many challenges of running a healthcare organization. My overarching goals are to improve the health of our community, while continuing to advocate for the underand uninsured.

Candidate for Kearny Mesa Director #2: Alexander K. Quick, MD (inc.) (3)

Candidate for East County Director #2: Rakesh R. Patel, MD, FAAFP, CPE (inc.) (3)

I am a family physician and the CEO of Neighborhood Healthcare, a federally

In 2007, I was introduced to the San Diego County Medical Society and the CMA as a medical student in Dr. Hertzka’s UCSD health policy class. I learned then how important it is to have these wellrun organizations here to advocate on behalf

of patients and their doctors. Today, I serve on the SDCMS Board of Directors and on the CMA Council on Legislation, and it would be an honor to continue to support these organizations in this capacity.

Candidate for La Jolla Director #1: Preeti S. Mehta, MD (3) I am honored to be nominated for the new position of La Jolla Geographic Director at the San Diego County Medical Society. I am a hospitalist at Ximed Hospitalists Inc. and have been practicing in La Jolla for the past 12 years. I have been involved in several leadership positions throughout my career as an academic and private practice hospitalist. I have been on the Physician Advisory Group at the Scripps Foundation and am the immediate past president of the San Diego Association of Physicians of Indian Origin. I am currently the Internal Medicine section chief and serve on the Physician Wellness Committee at Scripps Memorial Hospital, La Jolla. As an At-large Alternate Director at SDCMS for the past three years, I have served on the membership committee and more recently was added to the Physician Wellness Committee. I continue to be very keenly interested in physician wellbeing and putting tools into place to recognize and prevent physician burnout. Helping physicians find a work-life balance is at the heart of my interest and I hope to continue to work toward that during my time on the SDCMS board. I truly believe that SDCMS is a great platform to bring awareness to physician wellness and will be a resource to seasoned and newer physicians going forward.

I plan to continue to encourage physicians to be unified and engage with SDCMS to make a difference in the life of us physicians. I hope to represent the physicians of La Jolla and bring us closer as a community of doctors. Thank you for this nomination and I hope to serve on the board to be best of my ability.

Candidate for La Jolla Director #2: David E.J. Bazzo, MD, FAAFP (3) It has been my honor to serve you and the San Diego SanDiegoPhysician.org 5

CANDIDATE STATEMENTS

County Medical Society. Having held many officer positions, including President, I have witnessed firsthand the great work that our Society does. I want to continue my involvement and am asking you to support my candidacy as Director. The San Diego County Medical Society is second to none when it comes to representing the needs and interests of physicians in advocating to optimize our ability to help our patients. The politics of our state and nation have enormous impact on our capacity to keep our patients healthy. And, as with any process, unless you have a seat at the table, your opinion is not heard. Through the work of your county and state medical societies, your voices are heard and your interests are represented. The members of the board do have influence and work on your behalf to ensure that physicians have a say on the future practice of medicine. I am proud of my membership and position on the board, and view it an honor to volunteer to help our organization. I ask that you continue to place your trust in me to serve our organization by supporting my election.

Thank you.

I would be honored to take my efforts further in serving as the North County Geographic Director for the SDCMS Board of Directors. Only in combining efforts with other like-minded physicians can we make the changes needed to preserve our workforce and care for our patients the way we know best.

AT-LARGE DIRECTORS Candidate for At-large Director #1: Thomas J. Savides, MD (inc.) (3)

Candidate for North County Director #3: Kelly C. Motadel, MD, MPH (1) I have been a member of the SDCMS for over 10 years.

Born and raised in San Diego County, I knew from a young age that I wanted to practice medicine in this community. I have been a pediatrician and the Chief Medical Officer of Vista Community Clinic and on staff at Tri City Medical Center for over 15 years. I enjoy caring for the vulnerable population that VCC serves and advocating for my patients and our clinicians. Over the last few years, I have become increasingly engaged in fighting for access to quality care for all patients and for clinician wellness to care for those patients. Beyond my clinical and administrative duties at VCC, I was a founding member of Time’s Up Healthcare, a national organization founded to fight for a safe, fair, and dignified workplace for women of all kinds. I also serve on the District Advisory Council for Health & Human Services for my state assemblymember and as a preceptor for medical students at UC San Diego and at Arizona College of Osteopathic Medicine. I view myself as an activist in striving for healthcare for all and 6

April 2020

I have been privileged to be a member of the SDCMS Board of Directors since 2014. I graduated from UCSD School of Medicine in 1987 and have been a UCSD faculty member in the Division of Gastroenterology since 1993. I am a clinical gastroenterologist and specialize in interventional gastrointestinal endoscopy related to the diagnosis and endoscopic treatment of mucosal and pancreaticobiliary

GI neoplasia. My leadership roles at UC San Diego include serving as the UC San Diego Health Chief Experience Officer, the Associate Chief Medical Officer for Faculty Affairs, and the GI Clinical Services Chief. Physician wellbeing and burnout are areas of recent focus for me. I direct efforts at UC San Diego to address these issues for faculty physicians, am a member of the SDCMS Wellness Committee, and I cochair a University of California system-wide collaborative to address physician wellbeing and professionalism. It is my honor to serve the members of the San Diego County Medical Society, and thank you for your continued support.

Candidate for At-large Director #4: Miranda R. Sonneborn, MD (3)

I am a family medicine physician with Sharp Rees-Stealy Medical Group. My passion is championing provider wellbeing as a critical component

of providing excellent patient care. I am honored to be considered as a new member for the SDCMS Board, where I hope to continue this work.

I am proud to have served on the SDCMS Committee for Provider Well-Being since this committee’s inception.

Within the Sharp ReesStealy Medical Group I serve on the Providers’ Well-Being Committee (as one of the founding members) as well as a member of our CME Committee. I have recently been honored with the San Diego Downtown News Readers’ Choice Award for best physician for 2019 (as well as earning the distinction of second place in 2018).

Candidate for At-large Director #6: Marcella “Marci” M. Wilson, MD (inc.) (3)

I have always been driven by purpose, passion, and goals, as most of us are in our field. It has been my pleasure to serve on the SDCMS board of directors over the past six years, first as an

alternate, and more recently as an at-large director.

As with many, my concern for my patients’ welfare and for the state of healthcare continues to push this drive. I find that by maintaining a level of activity where I have a voice for these concerns is both satisfying and necessary. It is thus an honor to serve the broader medical community in this manner.

As we all come from varying backgrounds and specialties, my voice is one of many that advocates for the mentally ill and all the issues that this encompasses. As I have been in both private practice and community practice, I am able to understand the difference in needs, and where those needs meet and coalesce.

I have previously noted that the learning curve was steep when I initially joined this impressive society.

Like all matters, the learning continues, and I am committed to continuing to be a voice for our patients and for physicians in the many matters that come before us, or the matters that we desire to work with and change. These are many and varied, such

as the opioid crisis, which still has not really slowed down, or the continued poor access to healthcare.

I continue to see the value in organizational medicine as being your voice, my voice, and my patients’ voices to helping solve the multitude of issues we all face as a community.

I am dedicated to continuing to work toward powerful solutions that aid us all.

I want to thank you all for your trust in my previous representation, and ask that you continue to support me in my candidacy for At-Large Director #6.

Candidate for At-large Director #8: Alejandra Postlethwaite, MD (inc.) (3)

Dear colleagues, I appreciate the opportunity to continue my service as director at large for the San Diego County Medical Society Board of Directors. I am Alejandra Postlethwaite, MD, DFAACAP, a board

certified community child and adolescent psychiatrist and clinical team leader at Neighborhood Health Care, medical staff at Rady Children’s Hospital, San Diego, and Assistant Clinical Professor at UCSD’s Department of Psychiatry, where I teach first-year medical students their Practice of Medicine course.

I am the current President for San Diego’s Academy of Child and Adolescent Psychiatry, and President-elect for California’s Academy of Child and Adolescent Psychiatry.

I am also an Assembly delegate for the American Academy of Child and Adolescent Psychiatry, and an active member of AACAP’s Diversity and Culture Committee.

Prior to joining Neighborhood Healthcare, I was the Behavioral Health Services Director at La Maestra Community Health Centers, and Associate Training Director for UCSD’s Community Psychiatry Fellowship Program.

I was born and raised in Mexico, went to medical school at the Universidad Autonoma of Guadalajara, did my general psychiatry residency at Harvard Medical School South

Shore Program and UCSD, and my child psychiatry fellowship at UCLA. I am married and have three active boys.

I consider it an honor to serve our medical community and advocate for the best healthcare for our patients.

AT-LARGE ALTERNATE DIRECTORS Candidate for At-large Alternate Director #6: Vimal I. Nanavati, MD, FACC, FSCAI (inc.) (3): No Statement Candidate for At-large Alternate Director #7: Peter O. Raudaskoski, MD (inc.) (3) I have had the pleasure of serving on the SDCMS Board for the last nine years.

During this time I have come to appreciate that SDCMS and CMA are the best organized and strongest advocates in organized medicine that support both physician concerns and ultimately patient access to quality care.

I went to medical school at the USC School of Medicine in Los Angeles and did my residency at the UCLA School of Medicine, where I also served as the Chief Resident. Soon after training my family and I moved to San Diego, where I joined Anesthesia Service Medical Group (ASMG).

I have served as the President of ASMG (over 260 physician anesthesiologists in San Diego) and currently serve as the Chief Medical Officer. While serving in these roles, there have been many times when the SDCMS and CMA were able to assist our group on many levels both in the local arena as well as at the state level. While our state and national societies do excellent work in our given specialties, SDCMS supports all physicians despite their specialty or group size. It is for these reasons I would like to continue to serve as an alternate director on the SDCMS Board. As more changes in our healthcare system are sure to be coming our way, I would appreciate the opportunity to continue providing input that supports our ability to do what we do best: provide excellent medical care to our patients.

Thank you for your support.

SanDiegoPhysician.org 7

CANDIDATE STATEMENTS

Candidate for At-large Alternate Director #8: Kosala Samarasinghe, MD (inc.) (3)

I am asking for your support as I run for reelection for an At-Large Alternate Director Position at SDCMS. It has been my privilege to serve as an At-Large Alternate Director for the past three years.

Previously I served as your East County Geographic Director for three years. I have had the honor of serving on the SDCMS Board of Directors to help improve healthcare access to patients while advocating for physician rights. I am an internist and have been in the San Diego Medical community for almost 17 years. I started my career in Southern California working with Neighborhood HealthCare, a federally qualified clinic caring for the lives of the underserved population in northeastern San Diego. My career later led me to a private practice in East County with Alvarado 8

April 2020

Medical Group. As my professional career in East County began to grow, I too found great rewards by being part of organized medicine.

I quickly became involved at Alvarado Hospital and rose up the leadership ladder to become the Chief of Medicine at Alvarado Hospital. Because the work that was being done at SDCMS by local doctors was very inspiring to me, I involved myself and eventually became a board member.

My involvement on the SDCMS board has enabled me to represent patients and physicians in San Diego as well as the rest of California.

There has been a drastic paradigm shift in healthcare reform during the past decade and next few years will continue to be challenging.

We continue to struggle with our work-life balance as the expanding EMR capabilities challenge our patient care time.

It is imperative that physician voices be heard not only to protect our profession, but also to protect the rights of our patients. My interest in medicine has also allowed me to help shape the minds of young physicians. I

have been privileged with the honor of proctoring first- and second-year medical students from UCSD for the last seven years. This has been a very rewarding experience. I wish to continue contributing not only to the young physicians in our community but also to the experienced physicians as well.

Please allow me to continue to serve on the SDCMS Board of Directors to represent physician and patient interests. Thank you.

YPS DIRECTOR Candidate for YPS Director: Brian J. Rebolledo, MD (1)

It has been an honor to serve as the YPS Director. In joining SDCMS, a highlight was attending last year’s House of Delegates in Anaheim. Participating with a group of engaged physicians who feel deeply about the direction of healthcare was empowering.

Overall this experience has served to enrich my practice and scope

of medicine. I continue to serve as an Orthopaedic Surgeon/Sports Medicine at Scripps Clinic in Torrey Pines. My participation as YPS Director and SDCMS Board Member has been a rewarding experience, and one that has helped enlighten me on what it takes to positively impact healthcare delivery.

RESIDENT DIRECTOR Candidate for Resident Director: Nicole L. Herrick, MD (1) It is a privilege to ask for your support to continue as the Resident Director for the San Diego County Medical Society Board of Directors. I am currently a second-year combined Internal Medicine and Pediatrics resident at UC San Diego, planning to pursue a career in adult congenital cardiology. I became involved in health policy and organized medicine as a first-year medical student at UCSD in Dr. Hertzka’s Politics in Medicine course and later worked closely with the CMA and Assemblymember Gonzalez to draft, and subsequently pass, the Responsible Beverage Service (RBS) Training Act of 2017 (AB 1221-Gonzalez). It was a privilege to serve as the CMA District 1 Resident delegate in the 2018–2019 session and now as the resident director on the San Diego County Medical Society Board of Directors.

I came to San Diego in 2008 as an undergraduate and hope to stay in our wonderful city through fellowship and beyond. During my time in Sacramento I experienced firsthand the strong influence organized medicine can have on health policy and am excited to continue to be a part of the positive change we are all working toward. I would be honored to continue serving our community as the resident representation on the SDCMS board of directors.

No photo available

RESIDENT ALTERNATE DIRECTOR Candidate for Resident Alternate Director: Allen R. Rodriquez, MD (1) No Statement

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Celebrating 150 Years

THE POLITICAL JOURNEY OF SDCMS

Left: Dr. Robert Hertzka (r) with then-Assemblyman Nathan Fletcher (l) and medical students discussing public policy on the Floor of the California State Assembly. Below: Dr. Jonas Salk (left) gives Dr. Gladden Elliott (center), a onetime SDCMS president, CMA president and pioneering physician political leader, a tour of the Salk Institute.

History and Lessons for Today

BY JAMES SANTIAGO GRISOLÍA , MD

“POLITICIANS CREATE THE RULES FOR HOW WE PRACTICE,”

says Dr. Jim Hay, former CMA and SDCMS president. Or as sci-fi author Robert Heinlein wrote, “Pay attention to politics. It’s barely less important than your own heartbeat.” The cholera crisis of Northern California forced creation of the California Medical Association in 1856. A few years later, SDCMS founders curbed smallpox through wide vaccination, including extensively within Native American settlements. From the beginning, San Diego and CMA physicians educated political leaders about key issues and served in public health positions. SDCMS continues to play a leading role in state and national politics, as coronavirus and hepatitis A now compete with healthcare economics for impact on our lives.

SDCMS presidents have served as CMA presidents many times. In recent years, they include Dr. Ralph Ocampo (1994), Dr. Bob Hertzka (2004), Dr. Hay (2011), and Dr. Ted Mazer (2017), each bringing their own expertise and policy priorities to state- and national-level advocacy. Including other officer positions, San Diego consistently helps shape the health dialogue at state and national levels. Currently, Dr. Bob Wailes chairs the CMA Board of Trustees while Dr. Susan Kaweski chairs CALPAC and Dr. Vimal Nanavati serves as its treasurer.

Nowadays, few recall the terror of the swimming hole. For

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April 2020

parents, an undertow of dread always lurked beneath the lazy, sweet surface of summer days. Throughout the early 20th century, polio could strike without warning, leaving your beautiful child paralyzed in an iron lung. All this changed when Jonas Salk released his polio vaccine in 1955.

Dr. James MacLaggan, a soft-voiced, Stanford-educated pediatrician, immediately knew the Salk vaccine was a game-changer for his young patients. In 1955, he was already fielding questions on the vaccine from the Medical Society offices, as reported in The San Diego Union. With no prior political background, the fight against polio evidently transformed Dr. MacLaggan, who quickly became SDCMS president by 1957, collaborating with the county Health Department and other stakeholders to provide one of the first comprehensive vaccination programs in the nation, including individual doctors’ offices, volunteer physicians reaching organized community groups, and county health vaccination centers to administer free vaccine to children and adults, creating true herd immunity.

Dr. MacLaggan rose to president of CMA in 1966, focusing on public health and on preserving the private practice of medicine. His son Peter MacLaggan recalls spending all family

vacations at meetings of the AMA or AMPAC, the AMA political action committee, where Dr. MacLaggan helped formulate national policy, interview candidates, and raise campaign donations. He served on the taskforce to implement the Medicare Act in 1965, and chaired the taskforce to enact the Federal Heart Disease, Cancer and Stroke Amendments of 1965. Peter recalls going with his father to the Republican convention in 1972, where Dr. MacLaggan served as a delegate.

Dr. MacLaggan helped CMA develop CALPAC and served as its chair. He actively championed strong professional relations between physicians and political leaders. CMA recognized his work by founding the James C. MacLaggan Award to recognize politically active physicians. Correspondingly, the San Diego Rotary Club developed a James MacLaggan Award to recognize physicians dedicated to the betterment of children.

Dr. Hertzka, chair of our Legislation Committee, cites Dr. Gladden Elliott as another inspiration for his own career.

Trained at Washington University, Elliott came to San Diego and co-founded Xray Medical Group in La Mesa. He served as SDCMS president in 1968 and CMA president in 1986. Also active in the American College of Radiology, Dr. Elliott testified on relevant bills for CMA in Sacramento and for ACR in Washington, DC. But Dr. Hertzka treasures Dr. Elliott’s personal commitment to poli-

tics and politicians. “He walked precincts for Pete Wilson when he ran for State Assembly in 1996,” Dr. Hertzka says. “How many doctors do that? Wilson always remembered Gladden fondly and had great respect for him.”

During Dr. Elliott’s presidency, CMA began to grapple with managed care and the growing importance of large groups in medicine. Dr. Elliott was in the forefront of reaching out to all modes of practice on the common ground of patient benefit and professional autonomy. He also signed the argument against the anti-AIDS Proposition 64, sponsored by the notorious Lyndon LaRouche, together with both Senator Alan Cranston and his Republican opponent Ed Zschau.

Dr. Hertzka also says the AIDS crisis opened his own eyes to healthcare politics while working in San Francisco. After med school at UCSD, he did anesthesiology residency and clinical work at UCSF. On his return to San Diego in 1987, he paid a courtesy call on Dr. Eric Wahrenbrock, anesthesiologist and then dean of students at UCSD. Teasingly, Dr. Hertzka told Dr. Wahrenbrock that UCSD had not prepared him for the importance of medical politics. “Can you start a course in six weeks?” was Dr. Wahrenbrock’s unblinking reply. The rest is history.

Since 1988, the Dr. Hertzka course on health policy and poli-

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THE POLITICAL JOURNEY OF SDCMS

tics has been a favorite of medical students, interrupted only by the four years of his CMA officer duties. Integrating CMA legislative and media staff with local politicians and other experts, Dr. Hertzka provides a hands-on understanding of building consensus, how to pass a bill, and effective media relations.

His graduates tell of many valuable lessons that helped them become leaders within their medical groups and to work for positive change in health policy.

Ironically, Dr. Hertzka’s hands-on methods are popular with medical students but anathema to the academics. “The health policy professors at UCSD tried to destroy the class for five years,” he says with a twinkle. “But the student ratings saved me time and time again.”

UCSD students’ hunger for experience led Dr. Hertzka to arrange unpaid summer internships in legislators’ offices during the key last two weeks of August. Since 2015, some 49 students have interned in multiple legislators’ offices.

According to Dr. Hertzka, when he returned to San Diego the Legislative Committee was the exclusive province of very senior physicians. “However, incoming President Dr. Richard Butcher put me on the Committee in 1988, even though I was 25 years younger than the rest of the members.” In 1990, a division within

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SDCMS resulted in Dr. Hertzka’s rise to chair as a compromise candidate.

1990 proved to be a watershed, as census-based redistricting coincided with term limits to create dozens of open positions, and suddenly Dr. Hertzka found that Leg Comm Chair “was nearly a full-time job.” He and the Committee set about finding and supporting the politicians, who, in his words, “believe that physicians are part of the solution, not part of the problem.”

SDCMS carries an unparalleled record in interviewing and supporting physician-friendly candidates, then maintaining personal relationships with elected officials and their health staffers. Honed over 30 years, Dr. Hertzka’s personal touch guides and reinforces the work that CMA and CALPAC perform, reducing harmful legislation and bringing professional expertise to the health issues of state, local, and federal government.

His great friend Dr. Hay points out that Dr. Hertzka, after chairing the AMA Council on Health Policy, is widely respected for his expertise in Washington, DC. “In fact, he was the only physician appointed to serve on the health policy team for the Jeb Bush presidential campaign,” Dr. Hay says.

Paul Hegyi, CEO of SDCMS, began as staff for elected officials in Sacramento, then became a CMA lobbyist before running

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membership and other departments for CMA. “What CMA lobbyists do would not be successful without doctors,” Hegyi says. “You provide the professional experience that informs elected officials and their staffs. These are lawyers, real estate people, teachers who got into politics, yet they are making decisions on healthcare and need your expertise to make the right decisions for patients.”

Hegyi cites doctors’ contributions to CALPAC as essential to give CMA the muscle it needs to reinforce education with financial support. “Every year at House of Delegates, SDCMS gets cited for giving the most to CALPAC. These dollars are critical to make CMA a serious player in Sacramento.”

Defending MICRA illustrates the critical partnership between CMA, SDCMS and other component medical societies. MICRA (the Medical Injury Compensation Reform Act) was enacted in 1975 as malpractice awards and insurance premiums spiraled out of control. This essential legislation averted a crisis and has protected patients and physicians ever since. Trial attorneys attacked MICRA in the courts, requiring aggressive defense by CMA attorneys. Next, trial attorneys proposed bills in Sacramento to weaken MICRA, requiring serious and sustained education in district offices, as well as by CMA physicians and lobbyists in Sacramento. Since 1975, each candidate for elected office in San

Diego knows that support for MICRA is a litmus test for CMA/ CALPAC support. Most dramatically, in 1999, Antonio Villaraigosa, then speaker of the Assembly and among the most powerful leaders in Sacramento, tried to weaken MICRA with AB 1380 but was soundly defeated by CMA education and advocacy.

With both legislative chambers solidly pro-MICRA, the trial attorneys turned to ballot propositions as their only option to weaken MICRA. In 2014, trial attorneys and their allies aggressively pushed for Prop 46, but CMA’s coalition raised $60 million to defeat the measure by 67% to 33%.

Even now, out-of-state trial attorneys are gathering signatures for another attack on MICRA, this one more radical and destructive than Prop 46. SDCMS and CMA will need YOUR membership and donations to CALPAC to educate voters on how MICRA sustains healthcare access for Californians. All physicians benefit from CMA advocacy, but more membership increases our strength while better representing all specialties and types of medical practice.

Dr. Grisolía is the editor of San Diego Physician and a 40-year member of SDCMS. Sue Fledderjohn provided historical research for this article. Her contributions are gratefully acknowledged.

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RISK MANAGEMENT

2019 Novel Coronavirus and Patient Safety in the Medical Office

By Debbie Hill, MBA, RN

The CDC has been responsive in its role to gather data and advise clinicians on COVID-19; however, it is up to physicians and all healthcare facilities to take necessary steps to provide effective screening for the public, followed by recommended protocols.

THE 2019 NOVEL CORONAVIRUS (COVID-19) CONTINUES to spread across multiple continents, infecting hundreds of thousands and causing tens of thousands of deaths. On Feb. 25, the Centers for Disease Control and Prevention (CDC) in Atlanta urged the public to begin making preparations for the possibility of a U.S. pandemic with “the expectation that this could be bad.” Given that outbreaks are beginning to occur at a community level, medical offices will undoubtedly experience an influx of patients seeking assistance. The question is: Are medical offices doing enough to prepare?

Most medical offices have, for the most part, learned from experience and are paying closer attention to widespread outbreaks of disease. One lesson learned from Ebola, measles, and other recent outbreaks — when many healthcare organizations were unprepared — is that all medical offices should have an infection control and emergency preparedness plan in place.

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Preparedness Matters A well-constructed infection control preparedness plan for COVID-19 is essential for facilities where patients receive care, such as physician offices, dental offices, long-term care facilities, and ambulatory care centers.

Leading into the Ebola crisis, nearly 80 percent of hospitals in the U.S. acknowledged that they were unprepared to deal with patients who might present with Ebola symptoms. That led to avoidable early mistakes when clinicians encountered cases they had not anticipated seeing.

Unlike Ebola, patients with a COVID-19 infection may look a lot like patients with fairly routine cold and flu symptoms, or they may be infectious without any presenting symptoms at all. But by following best practices, facilities where patients receive care can make great strides

in identifying and treating the coronavirus early.

Careful screening with a bias for suspicion that a patient might have the coronavirus will serve healthcare providers well in this situation.

The following are some recommendations in the event a patient with suspected COVID-19 seeks care: • Follow the CDC’s patient assessment protocol for early disease detection. If a patient calls to schedule an appointment for an acute respiratory illness (e.g., fever, cough, and difficulty breathing), he or she should be screened using the Criteria to Guide Evaluation of Persons Under Investigation (PUI) for COVID-19.

We recommend that you check this CDC website daily for any updates in screening criteria.

• It is strongly recommended that practices do not turn patients away simply because a patient presents with acute respiratory symptoms.

All patients should be triaged and managed according to CDC recommendations. Refusing assessment/care may lead to concerns of patient abandonment.

• Practices should consider developing front-door and office signage that informs patients who are exhibiting any of the PUI evaluation criteria (e.g., presenting symptoms, recent contacts, and/or travel history) to notify facility personnel. Include this information on the practice website, also.

• In some communities

•

•

•

•

with the potential for community spread, the CDC recommends exploring alternatives to face-to-face triage during visits if screening can take place over the phone or via telemedicine. Staff should be trained in triage protocol to determine which patients can be managed safely at home vs. those who need to be seen either at the office or at a properly designated community facility. See the CDC’s Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States.

If presenting symptoms, travel history, or patient contacts are suspicious, immediately isolate patients coming into the office (segregate them from other patients in the facility) in a designated exam room with dedicated patient care equipment. A back entrance may be utilized, if available.

Since most medical offices don’t have negative pressure airflow, a spare bathroom with negative exhaust fans may be an option in the medical office setting instead of a regular exam room. The CDC provides guidelines for environmental infection control in healthcare facilities. Be aware that it is unknown how long the virus remains airborne once a room is vacated, and there are currently no CDC instructions on length of time before the room may be used again.

Once suspected patients are inside the facility, instruct them to put on a face mask, utilize tissues, practice good hand hygiene, and dispose properly of any contaminated protective equipment/tissues in a designated waste receptacle. Educational resources, including posters for use in the medical office, are available from the World Health Organization (WHO). Again, reference the CDC’s Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States for patient management guidance.

Follow standard, contact, and airborne precautions including gloves, gowns, protective eyewear, and NIOSH-certified N95 respirators that have been properly fit-tested. This applies to all healthcare staff interacting with patients.

Limit staff exposure to suspected patients, with the exam room door kept closed.

• When there is a reasonable presumption that a patient may have been exposed to COVID-19, contact the local or state health department to determine if the patient needs to be tested.

• Maintain records of staff-patient contact, i.e., who was assigned to work with the patient, either in a log or in the medical record.

• Once the patient exits the room, conduct surface disinfection while staff continues to wear personal protective equipment (PPE).

• Provide up-to-date, factual information on the virus to the patient and close contacts, including how to follow infection-control practices at home, such as in-home isolation, hand hygiene, cough etiquette, waste disposal, and the use of face masks.

• Remind patients and their families to access information about the virus through reputable sources such as the CDC, not social media.

• Check with your local public health authorities for locations designated to triage suspected patients so exposure is limited in general medical offices. Emergency preparedness plans most likely will be activated so that parties are coordinating efforts to deliver effective public health intervention.

Suspected cases must be reported to applicable local and state health departments. The CDC provides instruction on their website for reporting requirements by medical offices to state and local health departments, who, in turn, report PUI to the CDC for further evaluation and testing. Also, any unprotected occupational exposure by staff members should be assessed and monitored.

Consider Legal Risks When the Ebola virus was new to the U.S., there was one wellreported case where a patient who came to the hospital with Ebola was sent home without treatment. Such situations not only put the patients and others at risk, but also put healthcare providers and hospitals at risk for litigation.

We recommend that when in doubt, healthcare providers should adopt a clinical suspicion of COVID-19 to protect the patient and others. The dynamics surrounding the virus will continue to change in the days and weeks ahead. What must not change is that physicians and care teams should remain vigilant and careful. They should be exceptionally proactive in asking the right questions, documenting interactions, following rigorous protocol, and keeping abreast of emerging insights and data as they become available from the CDC. Debbie Hill is senior patient safety risk manager at The Doctors Company.

SanDiegoPhysician.org 15

PERSONAL & PROFESSIONAL DEVELOPMENT

Beware the Vampires in Your Life!

By Helane Fronek, MD, FACP, FACPh A MEDICAL STUDENT RECENTLY ASKED HOW ONE creates a successful practice. As I described the phases of my life and career, it struck me how much the “seasons” of our lives affect our priorities and what we spend time on. Medical training, creating a strong primary relationship, building a practice, raising children, or accepting professional or civic roles each define a “season” that both enriches and limits what we include in our lives. It’s wise to consider our lives as a continuum — we might not be able to do everything all at once, but over time we can manage to fit most of our interests into the various “seasons” we experience.

The seasons of the year also create a certain definition. Along with new sprouts and blossoms of spring, we often feel a sense of optimism and possibility. We make plans and consider new ventures. Yet this excitement often fizzles, leaving us with confusion, regret, and the fear that we aren’t able to make our dreams come true. I hear from many accomplished physicians, frustrated by their seeming inability to create the life they dreamed they would have. What prevents us from being successful with so many 16

April 2020

plans throughout our lives?

The threat of failing an exam or being exposed as less knowledgeable, the fear of harming a patient if we lack information or skills, or peer pressure may have provided motivation in the past. If a lack of motivation is derailing your plans, creating some form of accountability in your current life may offer the same, helpful stimulus.

Anthropologist Dr. Clarissa Pinkola Estes suggests another possible culprit: vampires.

But not exactly the type of vampires you’re thinking of!

Vampires appear in cultures, myths, and literature worldwide. Charming and charismatic by day, they steal their victims’ life blood by night. Pinkola Estes explains that vampires exist in all of our lives — as people, activities, or even ideas that initially seemed interesting or intriguing, leading us to imagine a wonderful future or fulfilling accomplishments.

However, over time, we find

ourselves feeling depleted by them. As our life blood is drained by the challenges of dealing with certain people or spending time on activities and issues that don’t inspire us, we become exhausted and disillusioned. The goal is to identify those vampires in our lives, separate from them, and redirect our energies to what we’re truly passionate about.

Some vampires are unavoidable, although it may be possible to find ways of containing them or not investing as much energy into them.

Even for those you can remove from your life, this exercise is not easy — you may need to let go of longstanding relationships or roles you once felt pride or satisfaction in, acknowledge you have changed, or admit you were wrong about your prior assessments. Still, I invite you to look carefully at your life and identify the vampires that are draining your life blood and keeping you from living the joyful, fulfilling life that this season of spring beckons us to.

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

CHAMPIONS FOR HEALTH

A Decade of Love

By Adama Dyoniziak “AT FIRST I DIDN’T KNOW WHY I WAS

feeling bad,” remembers Alicia LG. “Then I was told I would need surgery and medication for life; I was very sad. After the thyroid surgery, my situation was different. The treatment helped me a lot.”

Alicia is one of many uninsured patients who receive free specialty care treatment, procedures, and surgeries through Project Access, a program of Champions for Health.

Alicia was diagnosed in August 2009 with thyroid cancer. She had to simultaneously deal with other life issues as well: Her father died, she was raising three children, and her husband was ill and on dialysis. She had delayed care for herself throughout her life while taking care of her husband until his death, which left her a young widow.

For Rebecca Valenzuela, Project Access manager, this was one of her first patients and it was a complicated case. Valenzuela worked diligently with Alicia and her many specialists, helping to shape Valenzuela’s case management strategy. Alicia spoke warmly of the program. “Project Access is something wonderful — they give their time and treat you well,” she says.

“They don’t charge anything, and have a lot of patience with you. Rebecca would call me and always be on top of things.”

Ten years later, Alicia was referred to Project Access again for severe right shoulder pain, and Valenzuela was by her side again. “When my shoulder first started to hurt, I was unable to work or do chores around the house,” Alicia says. “I did not know that my bones had degenerated and I would need surgery. It was sad because I knew I would not be the same again.” She had a massive full rotator cuff tear that required a reverse total shoulder arthroplasty.

Dr. Luke Bremner from Core Orthopaedic provided the pro bono surgery.

“Volunteer work is always gratifying, “Dr. Bremner says. “It is the reason we go into medicine — to help people.” When

Dr. Bremner was in high school, his best friend had Ewing’s sarcoma. He accompanied him to his surgeries and chemotherapy visits. He wanted to do more in the situation. “No one in my family was in medicine, but I went to medical school to be a pediatric oncologist,” he says. “During my third-year rotations, it became clear that I had a surgical mindset, so I became an orthopedic surgeon.” Dr. Bremner had a calling to help others and put his skills to the best use. Alicia continues, “Dr. Bremner was a very kind person, he treated me very well. I’m lucky to have been treated so wonderfully. I thank him for everything he did for me.”

“Our patients show us what resilience really looks like,” says Valenzuela. “When I see patients at church or at the store, they are a completely different person than when they first were referred to Project Access. It is a pleasure and very rewarding to help patients who live in my community.”

Early on in her career, Valenzuela wasn’t sure of her calling. During the past 10 years, each patient at Project Access has given her a learning opportunity and the chance to help them reach their potential. She remembers a

moment when her grandma was on her deathbed. “I was doing little things to keep her comfortable,” Valenzuela says.

“My aunt asked me if I was a nurse. And I responded ‘Not yet.’ I had been praying, asking for guidance of what should I be doing. And this brought clarity to me.”

Valenzuela will be starting the Nurse Practitioner program at Azusa Pacific University in May 2020. The decade of love between patient, care manager, and many volunteer physicians creates a full circle of gratitude, transforming more than one life in the process.

For more information on how you can use your physician power to protect and heal our most vulnerable San Diegans, please contact Adama Dyoniziak at adama.dyoniziak@championsfh.org or call (858) 300-2780. During this time of crisis, your support of the patients of Project Access is more important than ever. Join our pledge drive with a one-time gift or a recurring monthly donation, both of which are tax deductible. Please go to www.championsforhealth.org and click on the donate button.

Ms. Dyoniziak is executive director of Champions for Health.

Above: Alicia and Dr. Luke Bremner Right: Alicia and Rebecca Valenzuela

SanDiegoPhysician.org 17

CLASSIFIEDS PHYSICIAN OPPORTUNITIES PHYSICIAN CONSULTANT FULL-TIME: San Diego-Imperial Counties Developmental Services, Inc. (San Diego Regional Center). Great opportunity to work in a multidisciplinary setting in a private nonprofit agency that serves persons with developmental disabilities. Must be licensed to practice medicine in California issued by the State Board of Medical Examiners. Experience in pediatrics, internal medicine, family practice and/or neurology. Training or experience in the field of developmental disabilities is desirable, but not required. Please visit our website at www.sdrc.org for more information and to submit an application.

CHILD HEALTH OFFICER (MEDICAL DIRECTOR): The County of San Diego Health & Human Services Agency (HHSA), Medical Care Services (MCS), is seeking online applications and résumés from qualified individuals for Child Health Officer/Medical Director. This unclassified management position plays a key leadership role in our medical care system by supporting the planning, directing, and coordinating of all forensic and clinical functions specific to Medical Care Services. In accordance with Federal, state, and local policies and regulations, the Child Health Officer will have significant responsibility for monitoring and/or evaluating medical assessments of child abuse and/or neglect, pediatric care, and an array of services. Regular - Full time $240,000.00 $250,000.00 Annually. Please visit the County of San Diego website for more information and to apply online.

PEDIATRIC POSITION AVAILABLE: Grossmont Pediatrics, a private pediatrics practice with Commercial HMO, PPO, Tricare, Medi-Cal patients, provides family-focused individualized care in East San Diego. Clinical cases include ADHD, asthma, adolescent behavioral health. Average 2.5 clinic patients per hour, 1-in-3 light call & newborns at one hospital. With Epic HER, access real-time care at Rady’s and area hospitals. Working 24 or 28 hours weekly, you will earn $130,000-150,000 annual compensation, up to 3 weeks PTO plus holidays, and future share in practice. Direct professional expenses are paid, Health, Dental, 401K, etc. Contact venk@gpeds.sdcoxmail.com or (619) 504-5830 with resume in .doc, .pdf or .txt.

GENERAL FAMILY MEDICINE PHYSICIAN: to provide quality patient care to all ages of patient in a full-time traditional practice. The Physician will conduct medical diagnosis and treatment of patients using medical office procedures consistent with training including surgical assist, flexible sigmoidoscopy, and basic dermatology. The incumbent must hold a current California license and be board eligible.

Bilingual Spanish/English preferred. Founded as a small family practice in Escondido 1932 by Dr. Martin B. Graybill, today we’re the region’s largest Independent Multi-specialty Medical Group. Our location is 277 Rancheros Dr., Suite 100, San Marcos, CA 92069. We are an equal opportunity employer and value diversity.

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April 2020

Please contact Natalie Shields at 760-2916637/nshields@graybill.org. You may view our open positions at: https://jobs.graybill.org/ BOARD CERTIFIED OR BOARD-ELIGIBLE PHYSICIAN DERMATOLOGIST: Needed for busy, well-established East County San Diego (La Mesa) private Practice. We currently have an immediate part-time opening for a CA licensed Dermatologist to work 2-3 days per week with the potential for full-time covering for existing physicians, whenever needed. We are a full-service Dermatology office providing general, cosmetic and surgical services, including Mohs surgery and are seeking a candidate with a desire to provide general dermatology care to our patients, but willing to learn laser and cosmetics as well. If interested, please forward CV with salary expectation to patricia@grossmontdermatology.com.

PHYSICIAN CONSULTANT FULL-TIME: San Diego-Imperial Counties Developmental Services, Inc. (San Diego Regional Center).

Great opportunity to work in a multidisciplinary setting in a private non-profit agency that serves persons with developmental disabilities.

Must be licensed to practice medicine in California and certified by specialty board such as Neurology, Neurodevelopmental Disabilities, Developmental Behavioral Pediatrics, Pediatrics or Internal Medicine. Experience in the field of developmental disabilities and administrative or supervisory experience required. Please visit our website at www. sdrc.org for more information and to submit an application.

DEPUTY PUBLIC HEALTH OFFICER: The County of San Diego is seeking a dynamic leader with a passion for building healthy communities. This is a unique opportunity for a California licensed or license eligible physician to work for County of San Diego Public Health Services, nationally accredited by the Public Health Accreditation Board. Regular - Full Time: $220,000–$230,000 annually. For more information and to apply: https://www. governmentjobs.com/careers/sdcounty/ jobs/2359704/deputy-public-health-officer19092204u?keywords=Deputy%20Public%20 health%20&pagetype=jobOpportunitiesJobs TEMPORARY EXPERT PROFESSIONAL (TEP) MEDICAL DOCTORS (MD’s) NEEDED: The County of San Diego Health and Human Services Agency is seeking numerous MD positions to work in a variety of areas including Tuberculosis Control, Maternal and Child Health, Epidemiology and Immunizations, HIV, STD & Hepatitis, and California Children’s Services. Applicants (MD or DO) must hold a current California medical license. Applicants must be proficient in either Opioid Abuse Prevention and Treatment Strategies, Communicable Diseases and/or Healthcare Systems, and willing to minimally work three days a week. Hourly rate is $103/hour. If interested, please e-mail CV to Anuj.Bhatia@ sdcounty.ca.gov or call (619) 542-4008.

PRACTICE OPPORTUNITY: Internal Medicine and Family Practice. SharpCare Medical Group, a Sharp HealthCare-affiliated practice, is looking for physicians for our San Diego

County practice sites. SharpCare is a primary care, foundation model (employed physicians) practice focused on local community referrals, the Patient Centered Medical Home model, and ease of access for patients. Competitive compensation and benefits package with quality incentives. Bilingual preferred but not required. Board certified or eligible requirement. For more info visit www.sharp. com/sharpcare/ or email interest and CV to glenn.chong@sharp.com.

PRACTICE FOR SALE PRACTICE FOR SALE IN ENCINITAS: A GYN-only practice for sale in Encinitas with a majority of the patients in North County.

Insurance accepted are PPO, cash and some Medicare patients. Could be turnkey or just charts. Practicing is closing December 31st, 2019. Please call Mollie for more information at (760) 943-1011.

CLINICAL RESEARCH SITE/MULTI-SITE SPECIALTY PHYSICIAN PRACTICE COMBO FOR SALE: Great opportunity for a Group Practice. Clinical Research offers a way for physicians to continue to practice medicine the way they like and provide an additional source of income that is compatible with their goal of providing great care and options for their patients. Patients will have the opportunity to participate in the research of new treatments.

Current site has staff and facilities for research, physician suites, and X-Ray. Use as a primary location or as a satellite office with research site. Current physicians and staff willing to train and work alongside physicians new to research. Contact E-Mail: CL9636750@ gmail.com PRACTICES WANTED PRIMARY OR URGENT CARE PRACTICE WANTED: Looking for independent primary or urgent care practices interested in joining or selling to a larger group. We could explore a purchase, partnership, and/or other business relationship with you. We have a track record in creating attractive lifestyle options for our medical providers and will do our best to tailor a situation that addresses your need. Please call (858) 832-2007.

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

OFFICE SPACE / REAL ESTATE AVAILABLE MEDICAL OFFICE SPACE FOR SUBLEASE: Brand new medical office space available for sublease in La Jolla near UCSD. 8950 Villa La Jolla at The Campus, easy access from I-5.

Perfect for specialist, includes one exam room and one procedure room. Brand new flooring, paint, furniture etc. Please send your email to eferrermd@gmail.com if interested.

MEDICAL OFFICE LEASE: We currently have a small medical office ready to lease.

The office is located in Imperial County and is approximately 910 square feet. Please email

LA JOLLA OFFICE FOR SUBLEASE OR TO SHARE Scripps Memorial Medical office building at 9834 Genesee Ave. Amazing location by the main entrance to the hospital between I-5 and I-805. Multidisciplinary group available to any specialty. Excellent referral base in the office and on the hospital campus.

Great need for a psychiatrist.

We have multiple research projects.

If you have an interest or would like more information, please call 858-344-9024 or 858-320-0525.

us at info@carlsbadimaging.com with any with further questions or needed details.

NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista, CA 92083. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, décor, 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: Digital X-ray suite, 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.

Contact Harish Hosalkar at hhorthomd@gmail. com or call/text (858) 243-6883.

MEDICAL OFFICE AVAILABLE FOR RENT: Furnished or unfurnished medical office for rent in central San Diego. Can rent partial or full, 5 exam rooms of various sizes, attached restroom. Easy freeway access and bus stop very close. Perfect for specialist looking for secondary locations. Call (858) 430-6656 or text (619) 417-1500.

MEDICAL OFFICE SPACE FOR SUBLEASE: Medical office space available for sublease in La Jolla-9834 Genesee Avenue, Suite 400 (Poole Building). Steps away from Scripps Memorial Hospital La Jolla. Please contact Seth D. Bulow, M.D. at (858) 622-9076 if you are interested.

LA JOLLA OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial Medical office building at 9834 Genesee Ave. Amazing location by the main entrance to the hospital between 1-5 and 1-805. Multidisciplinary group available to any specialty. Excellent referral base in the office and on the hospital campus.

Great need for a psychiatrist. We have multiple research projects. If you have an interest or would like more information, please call (858) 344-9024 or (858) 320-0525.

SHARED OFFICE SPACE: Office Space, beautifully decorated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist. Please call (619) 606-3046.

OFFICE SPACE/REAL ESTATE AVAILABLE: Scripps Encinitas Campus Office, 320 Santa Fe

Drive, Suite LL4. It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery.

Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc. and also Scripps ambulatory surgery center.

Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and half a mile from Swami’s Beach. Contact Kristi or Myra (760) 753-8413. View Space on Website:www.eisenhauerobgyn.com. Looking for compatible practice types.

OFFICE SPACE FOR RENT: Multiple exam rooms in newer, remodeled office near Alvarado Hospital and SDSU. Convenient freeway access and ample parking. Price based on usage. Contact Jo Turner (619) 7334068 or jo@siosd.com.

OFFICE SPACE / REAL ESTATE WANTED MEDICAL OFFICE SUBLET DESIRED: Solo endocrinologist looking for updated bright office space in Encinitas or Carlsbad to share with another solo practitioner. Primary care, ENT, ob/gyn would be compatible fields. I would ideally have one consultation room and one small exam room but I am flexible.

If the consultation room was large enough I could have an exam table in the same room and forgo the separate exam room. I have two staff members that will need a small space to answer phones and complete tasks. Please contact (858) 633-6959.

MEDICAL OFFICE SPACE SUBLET DESIRED NEAR SCRIPPS MEMORIAL LA JOLLA: Specialist physician leaving group practice, reestablishing solo practice seeks office space Ximed building, Poole building, or nearby. Less than full-time. Need procedure room. Possible interest in using your existing billing, staff, equipment, or could be completely separate. If interested, please contact me at ljmedoffice@yahoo.com.

NON-PHYSICIAN POSITIONS AVAILABLE EXECUTIVE DIRECTOR, STUDENT HEALTH AND COUNSELING SERVICES: California State University San Marcos (CSUSM) has announced a national search for a visionary and collaborative leader to serve as Executive Director of Student Health and Counseling Services. Selected candidate will be appointed into an Administrator III OR Administrator IV. Appointment will be determined by education and experience. Selected candidate with an M.D. will be appointed as Administrator IV, and selected candidate without an M.D. will be appointed as Administrator III. For position specifications, benefits summary and to apply, please visit our website at https://apptrkr. com/1852486.

FINANCE DIRECTOR San Diego Sports Medicine and Family Health Center is hiring a full-time Financial Director to manage financial operations. Primary responsibilities include monitoring of income, expenses and cash flow, reconciling bank statements, supervision of accounts payable,

oversee billing department, oversee accounts receivables, payments and adjustments, prepare contracts, analyze data, prepare financial reports, prepare budgets, advise on economic risks and provide input on decision making. MBA/Master’s and 5+ years relevant work experience preferred.

Excellent references and background check required. Salary commensurate with skills and experience. To apply, please send resume to Jo Baxter, Director of Operations jobaxter@ sdsm.com.

NON-PHYSICIAN POSITIONS WANTED MEDICAL OFFICE MANAGER/CONTRACTS/ BILLING PERSON: MD specialist leaving group practice, looking to reestablish solo private practice. Need assistance reactivating payer contracts, including Medicare. If you have that skill, contact ljmedoffice@yahoo. com. I’m looking for a project bid. Be prepared to discuss prior experience, your hourly charge, estimated hours involved. May lead to additional work.

PRODUCTS / SERVICES OFFERED DATA MANAGEMENT, ANALYTICS AND REPORTING: Rudolphia Consulting has many years of experience working with clinicians in the Healthcare industry to develop and implement processes required to meet the demanding quality standards in one of the most complex and regulated industries.

Services include: Data management using advanced software tools, Use of advanced analytical tools to measure quality and process-related outcomes and establish benchmarks, and the production of automated reporting. (619) 913-7568 | info@rudolphia. consulting | www.rudolphia.consulting

PLACE YOUR AD HERE

Contact Dari Pebdani at 858-231-1231 or DPebdani@SDCMS.org

SanDiegoPhysician.org 19

POETRY AND MEDICINE

A Doctor Walking in Pain

By Daniel J. Bressler, MD, FACP DIFFERENTIAL DIAGNOSIS is a foundation of medical practice.

Because human experience and ailments are so various and overlapping, the skill to hone down a large list of possibilities to a smaller list is one key to being both efficient and effective as a doctor.

Forty years ago, as a medical student, I developed mild melena.

I read in the textbooks from the library about the possible terrible diseases that could be responsible, including various cancers, inflammatory bowel diseases, and hematologic abnormalities.

Some have called this tendency to assign catastrophic explanations for symptoms “Medical Student Syndrome,” and I certainly had it.

My head was full of these dire possibilities during my evaluation by the kindly primary care doctor at student health. After a careful history, physical and simple laboratory tests, he explained that the blood from my upper GI tract almost certainly came from a gastritis caused by the highdose aspirin being taken for calf pain related to my training for the Boston Marathon. A week off aspirin and on Tagamet and the melena resolved never to return.

Today, on the other side of that 20

April 2020

clinical desk, patients bring me their assortment of symptoms and physical changes. The algorithms of assessment that I have assembled in my head and that I keep handy on my computer and phone guide the questions I ask, the tests I order, and the therapy I prescribe.

At the same time, as a 64-year-old man, my own symptoms serve as prompts both to my habits of analysis and to my fears about my own body’s inevitable decline.

As for the hip pain mentioned in this poem, it vanished as mysteriously as it arose, likely an overuse tendonitis. Although no longer suffering from Medical Student Syndrome, I am still a human being filled with the anxiety that comes with the awareness of my frailty. When I am at my best, I bring that awareness to my clinical encounters such that I address both the intellectual challenge of differential diagnosis and the emotional challenge of the human predicament.

Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and a longtime contributing writer to San Diego Physician.

A Doctor Walking in Pain

My hip hurt like hell every day last week But still I walked to my scheduled tasks.

With every painful step I took I imagined worse case scenarios A differential diagnosis of catastrophes It was a bony metastasis from an aggressive Prostate cancer that had slipped through my Biennial PSA screenings. I saw myself Chemotherapy bald and brave-faced Trying to mouth the words that This cancer is a gift.

It was a roughened ball in a desiccated socket And I become the third patient of the day For the young enthusiastic orthopedist Who cheerfully tells me he’s making it new My hip but not my life, I remind him.

It was an infection that started as a blister From those old sandals I had worn walking To Vons while talking to my mother On the phone. A multidrug resistant Staphylococcus, spreading from toe to hip.

My mother never forgives herself.

I don’t know the future, mine or yours. No one does. No AI or God can fathom it. But today, just today, I can walk and will.

Imagining the worst and hoping for the best As I always do, as we all must do. And then To keep on walking for as long as we can Where we need to go.

2020 pledge drive Champions for Health is dedicated to providing access to critically needed healthcare for uninsured, low-income residents of San Diego County who would otherwise face insurmountable barriers to care. We recruit, mobilize, and support hundreds of volunteer physicians and other professionals to provide free specialty healthcare.

Since 2008, Project Access has facilitated care for 6,500+ uninsured patients by providing 14,000 free consultations and 1,563 free surgeries — all thanks to the dedication, time and talent of our volunteer specialty healthcare physicians and healthcare professionals.

For every $1 spent on program expenses, we provide $2.23 in contributed healthcare services — a return on investment of 223%!

During this time of crisis, your support of the patients of Project Access is more important than ever. Join our pledge drive with a one-time gift or a recurring monthly donation, both of which are tax deductible.

Please go to www.championsforhealth.org and click on the donate button!

SanDiegoPhysician.org 21

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