April 2024

APRIL 2024

Official Publication of SDCMS

SDCMS ELECTIONS

CANDIDATE STATEMENTS 2024–2025 BOARD OF DIRECTORS

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Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; William T-C Tseng, MD; Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM Marketing & Production Manager: Jennifer Rohr Art Director: Lisa Williams Copy Editor: Adam Elder OFFICERS President: Nicholas (dr. Nick) J. Yphantides, MD, MPH President–Elect: Steve H. Koh, MD Secretary: Preeti S. Mehta, MD Treasurer: Maria T. Carriedo-Ceniceros, MD Immediate Past President: Toluwalase (Lase) A. Ajayi, MD GEOGRAPHIC DIRECTORS East County #1: Catherine A. Uchino, MD Hillcrest #1: Kyle P. Edmonds, MD Hillcrest #2: Stephen R. Hayden, MD (Delegation Chair) Kearny Mesa #1: Anthony E. Magit, MD, MPH Kearny Mesa #2: Dustin H. Wailes, MD La Jolla #1: Karrar H. Ali, DO, MPH (Board Representative to the Executive Committee) La Jolla #2: David E.J. Bazzo, MD, FAAFP La Jolla #3: Sonia L. Ramamoorthy, MD, FACS, FASCRS North County #1: Arlene J. Morales, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Nina Chaya, MD South Bay #1: Paul J. Manos, DO South Bay #2: Latisa S. Carson, MD AT–LARGE DIRECTORS #1: Rakesh R. Patel, MD, FAAFP, MBA (Board Representative to the Executive Committee) #2: Kelly C. Motadel, MD, MPH #3: Irineo (Reno) D. Tiangco, MD #4: Miranda R. Sonneborn, MD #5: Daniel Klaristenfeld, MD #6: Alexander K. Quick, MD #7: Karl E. Steinberg, MD, FAAFP #8: Alejandra Postlethwaite, MD ADDITIONAL VOTING DIRECTORS Young Physician: Emily A. Nagler, MD Resident: Alexandra O. Kursinskis, MD Retired Physician: Mitsuo Tomita, MD Medical Student: Kenya Ochoa CMA OFFICERS AND TRUSTEES Immediate Past President: Robert E. Wailes, MD Trustee: William T–C Tseng, MD, MPH Trustee: Sergio R. Flores, MD Trustee: Timothy A. Murphy, MD AMA DELEGATES AND ALTERNATE DELEGATES District I: Mihir Y. Parikh, MD District I Alternate: William T–C Tseng, MD, MPH At–Large: Albert Ray, MD At–Large: Robert E. Hertzka, MD At–Large: Theodore M. Mazer, MD At–Large: Kyle P. Edmonds, MD At–Large: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM At–Large: David E.J. Bazzo, MD, FAAFP At–Large: Sergio R. Flores, MD At–Large Alternate: Bing Pao, MD CMA DELEGATES District I: Steven L.W. Chen, MD, FACS, MBA District I: Vikant Gulati, MD District I: Quinn Lippman, MD District I: Eric L. Rafla-Yuan, MD District I: Ran Regev, MD District I: Kosala Samarasinghe, MD District I: Thomas J. Savides, MD District I: James H. Schultz, MD, MBA, FAAFP, FAWM, DiMM 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 RFS Delegate: David J. Savage, 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.]

Contents APRIL

VOLUME 111, NUMBER 4

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FEATURE

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Candidate Statements: 2024–2025 SDCMS Board of Directors

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Recognizing Black Maternal Health Week and the Ongoing Need to Achieve Health Justice in the Perinatal Space

By Wilma Wooten, MD, MPH and Thomas R. Coleman, MD, MS

DEPARTMENTS

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Briefly Noted: SDCMS • Medicare • Healthcare Information Technology

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Post-COVID Burnout and Mental Health Issues in Physicians: Is There a Vaccine for That?

By Hardeep Phull, MD

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Borrowing From the Future/Investing in the Present

By Daniel J. Bressler, MD, FACP

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The Importance of Recognizing and Treating Loneliness

By Helane Fronek, MD, FACP, FASVLM, FAMWA

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Classifieds SANDIEGOPHYSICIAN .ORG

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SDCMS

Sergio Flores Zambonis a San Diego Gulls Victory

THE SAN DIEGO COUNTY MEDICAL

Society Board of Directors enjoyed a special board-appreciation event at a recent game of the San Diego Gulls ice hockey team. Dr. Sergio Flores, former SDCMS president, had the honor of driving the Gulls’ Zamboni machine to clean and smooth the ice surface between play periods at Pechanga Arena.

The Gulls’ mascot, Gulliver, also made a special appearance to thank San Diego’s physician leaders for all their hard work and time spent advocating for medical doctors and their patients.

It was a tremendously entertaining evening for all and, most importantly, Dr. Flores’ impressive Zamboni skills clearly contributed to the Gulls’ 5–3 win over the Bakersfield Condors.

MEDICARE

CMS Fixes System Issue Causing Some Telehealth Claims to Be Underpaid IN LATE JANUARY, NORIDIAN — California’s Medicare administrative contractor — issued an alert about a Medicare system issue that has resulted in Place of Service 10 telehealth claims being priced at the facility rate regardless of the provider specialty.

The Centers for Medicare & Medicaid

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Services has fixed the issue that was causing some telehealth services to be underpaid.

According to Noridian, the system logic was updated on Feb. 27, 2024, to reflect the nonfacility rate for claims received with POS 10.

Practices do not need to take any action.

Automatic adjustments are being made back to Jan. 1, 2024.

HEALTHCARE INFORMATION TECHNOLOGY

CMA Partners With HealthTech 4 Medicaid for 2nd Annual HIT Summit

THE CALIFORNIA MEDICAL

Association (CMA) and the CMA Physician Services Organization (PSO) have partnered with national nonprofit HealthTech 4 Medicaid (HT4M) for the second annual CMA HIT Summit, “Health IT in the Safety Net.” HT4M is dedicated to supporting innovation in Medicaid, the nation’s largest insurer, with a focus on enhancing quality, equity, and access to care for vulnerable communities. Through a multifaceted approach encompassing program service delivery, ecosystem development, policy advocacy, and dynamic convenings, HT4M accelerates innovation in Medicaid by fostering collaboration among diverse stakeholders and addressing the real challenges impacting Medicaid enrollees and the networks that support them.

“In an era where technology and healthcare are increasingly intertwined, the partnership between CMA and HealthTech 4 Medicaid for the 2nd annual CMA HIT Summit represents a groundbreaking step forward in our mission to redefine healthcare delivery,” said HT4M executive director and CEO Adimika Arthur. “By harnessing the power of Health IT, we are not just anticipating the future of healthcare but actively shaping it to ensure equitable access and quality care for all, especially

the most vulnerable populations in California. This summit is more than an event; it’s a beacon of hope and innovation, uniting diverse stakeholders to tackle the complex challenges of MediCal and pave the way for a healthier, more inclusive future. Together, we are not just discussing change; we are catalyzing it.”

The CMA HIT summit, which takes place May 7–8 at the Grand Hyatt at SFO in San Francisco, will highlight the pivotal role that health IT can play in ensuring equitable access to care. The summit will bring together thought leaders from across California and the nation to explore how to make that vision a reality. The Medi-Cal program is undergoing a series of unprecedented changes. Thanks to CMA’s advocacy, the bipartisan passage of the 2023–24 state budget included historic investments in Medi-Cal that will expand access to healthcare for patients by supporting healthcare workers and Medi-Cal providers.

“CMA has been a steadfast advocate for building a robust and accessible Medi-Cal system,” said CMA Physician Services Organization CEO David Ford. “Given their extensive work using technology to better serve Medi-Cal enrollees, HealthTech 4 Medicaid is a natural partner for us in organizing this summit.”

Building off the success of last year’s sold-out summit, CMA, PSO, and HT4M expect a diverse and engaged set of attendees that will include physicians, medical groups and IPAs, health plans, health information organizations (HIOs), and others who will take the learnings from this conference to change how care is delivered in this state.

To register for the CMA HIT Summit and view a tentative agenda, visit cmadocs.org/healthit.

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CANDIDATE STATEMENTS 202 4–202 5 SD CMS B OA R D OF DIR E C T OR S

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SDCMS BOARD CANDIDATE STATEMENTS

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

Candidate for Presidentelect: Preeti S. Mehta, MD, MBBS (1) I am honored to be nominated for the position of president-elect of the San Diego County Medical Society. I have certainly learned a lot being on the Board and Executive Committee of SDCMS as I have closely watched the commitment and passion of my predecessors. Our medical society continues to be a tremendous asset to the physician community as we represent our physicians and work toward making our medical community stronger.

As a medical society supported by your membership, we have several shared goals geared toward physician wellness, growing physician relations, and giving back to the patients who look up to us and entrust us with their lives. I plan to promote and support all these causes to the best of my ability. Together, I hope to bring our physician community closer, giving us a unified voice as we represent ourselves and our patients. In my role, I plan to support our president, Dr. Koh, and the executive committee and have a successful year celebrating doctors, saving patient lives, and enhancing physician careers as we continue to grow and build meaningful relationships within the physician community. I also plan to bring more awareness to the many challenges faced by our profession as well as support and shape the young minds who hope for a career in medicine.

I have been involved in several leadership positions throughout my career as an academic and private practice hospitalist. My experience on the board of Champions for Health is rewarding as we reach and work for a very vulnerable patient population. The Physician Leadership Committee at Scripps continues to give me insight into the workings of a large organization, which has shaped my personnel management and leadership skills. It has allowed me to bring my novel ideas to light and allow exchange of ideas and resources among

organizations. Being on the Respiratory Care Board of California, I continue to learn the workings of a government organization and become a more effective leader.

As the presidentelect of the SDCMS, I plan to support us physicians in advocating for our resources and continue to keep us a strong, unified group. Thank you for this nomination and I hope to continue to serve you to the best of my ability.

of practices, and regions come together for the betterment of the diverse communities and patients of San Diego County. During the past two years serving on the Executive Committee, I have gained further knowledge about the work and responsibilities of SDCMS in ensuring the voices of our patients and physicians are heard and honored.

Through my various leadership roles, I have continued to appreciate the value of collaboration and unity among our fellow colleagues. I have been the VP and chief medical officer for San Ysidro Health Center since 2012. Serving the underserved and addressing health disparities has been my passion throughout my career.

Ensuring continued access for our communities has made workforce development an additional priority and led to my work in graduate medical education. It will be an honor and a privilege to serve as your SDCMS secretary and I ask for your continued trust and support. Thank you.

Candidate for Secretary: Maria T. Carriedo-Ceniceros, MD (1) I am grateful to be considered for the post of secretary of the San Diego County Medical Society. I have had the privilege to serve on the SDCMS Board of Directors for the past eight years and have seen first-hand the valuable role advocacy plays in meeting the needs of our patients and our physicians.

While serving on the board, I have watched physicians from all specialties, modes

Candidate for Treasurer: Karrar H. Ali, DO, MPH (1) It is a privilege and honor to be a candidate for treasurer. As part of the Executive Committee for the San Diego County Medical Society, my goal is to promote our physicians to thrive.

I am an emergency room physician and have been in practice for 18 years. Educated and trained in Chicago, I moved to San Diego in 2007 and started working at Sharp Chula Vista Medical Center. I am a senior partner with Vituity, a multispecialty, national medical group that staffs the Sharp Chula Vista emergency department. In my career, I have been fortunate to have been involved with both my ED group and Sharp Healthcare. Recently I completed a two-year term with the Sharp Chula Vista Medical Executive Committee. Additionally, I am on faculty with the University of Rochester Mindfulness in Medicine program, leading sessions on mindfulness and resiliency to fellow physicians.

I have been involved with the San Diego County Medical Society Board of Directors for more than a decade. The advocacy we do at the county and state level and the education we provide throughout the county has benefitted physicians in all specialties. SDCMS and CMA

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have been instrumental in advocating for physicians for MICRA, during the pandemic, and when there were threats to Medi-Cal and access to care.

My hope is to continue to advocate for my colleagues throughout the county so that we may be able to take care of our patients and help them navigate through our healthcare system.

On a personal level, I live with my wife, Shahrzad Nooravi, a business psychologist and principal of Strategy Meets Performance who coaches and trains executives, and my nephew, a UCSD student who aspires to become a physician. Thank you for your support.

GEOGRAPHIC DIRECTORS

Candidate for East County Director #2: Rachel Buehler VanHollebeke, MD (3) I am honored to be considered for the San Diego County Medical Society East County director position. I was born and raised in San Diego and care deeply about our community. I returned home for medical school at UCSD and then completed my family medicine residency at Scripps Mercy Hospital in Chula Vista. During residency, I had the honor of serving as a resident delegate and learned so much from that process. I am now working for San Ysidro Health in Alpine, and I hope to continue my involvement in the SDCMS in the East County director position. As a former member of the U.S. women’s national soccer team and two-time Olympic gold medalist, I hope I can share my passion for healthy living and utilize the leadership skills I have developed in both my soccer and medical careers. Thank you so much for considering me for this role.

Candidate for Kearny Mesa Director #1: Anthony E. Magit, MD, MPH (inc.)(3) It is a privilege to serve as the Kearny Mesa director #1 and provide support for our entire San Diego community, and specifically our pediatric population. As a pediatric otolaryngologist in San Diego for more than 30 years, I am well acquainted

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with collaboration between our pediatric practices and the challenges of providing access to specialty pediatric services for the entire spectrum of practice types, ranging from individual practices to regional healthcare systems. My career includes local leadership positions as the associate chief medical officer for Rady Children’s Hospital and a past president for the Children’s Specialty Care Coalition, a statewide advocacy organization representing most of the pediatric specialists in California with the mission of providing access to pediatric care for all children in our state. I hope to continue as the Kearny Mesa director #1 and support the healthcare needs of our population through advocacy and education.

Candidate for La Jolla Director #1: Toluwalase (Lase) A. Ajayi, MD (3) I have had the honor of serving on the SDCMS Board of Directors for the past

10 years and on the SDCMS Executive Committee for the past seven 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 director of La Jolla.

I have served as an SDCMS at-large director prior to joining the executive committee in 2017 where I served as treasurer from 2018 to 2019 and secretary during our exciting 2019–2020, president elect from 2020–2021 and becoming our post-COVID president from 2021 to 2022.

I have been very active 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 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 patient-physician-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 one of the La Jolla directors.

Candidate for North County Director #1: Arlene J. Morales, MD (inc.) (3) I would like to continue to represent my colleagues as the North

SDCMS BOARD CANDIDATE STATEMENTS

County geographic director for the San Diego County Medical Society. I am a reproductive endocrinologist/infertility specialist and founded Fertility Specialists Medical Group in 2000.

Since my first term, I have served on the State CALPAC (our CMA fundraising arm) as well as on the SDCMS Legislative Committee, where we interview local political candidates to assess their alignment with physicians’ concerns. I have been involved with SDCMS since 2000 in several long-term capacities ranging from bioethics to physician wellness committees as well as several leadership positions throughout my career in both academics and hospital systems.

The SDCMS provides a vital forum/tool for physician voices to be heard by the public and government bodies both locally and statewide.

SDCMS also provides a space for physicians to collaborate on issues central to continued excellence in patient care as well as our own wellness. Our voices are critical in today’s changing medical landscape, where the physician-patient relationship is being influenced by many other stakeholders. It has been a privilege to serve on the SDCMS Board and I hope to continue to do so.

Candidate for North County Director #3: Nina Chaya, MD (inc.) (3) Since 2012, I have been a physician anesthesiologist, leader, and patient advocate in San Diego County. While on staff at Tri-City Medical Center, I served as chairperson of the anesthesiology department, Blood Utilization Committee chairperson, and am currently serving as vice chair of the Tri-City Hospital District (TCHD) board of directors. I am passionate about patient care and have utilized my administrative positions to advocate for patient safety and wellness.

During my tenure as a director on the TCHD BOD, I organized and implemented the in-house COVID vaccine clinic, as well as assisted in establishing community vaccine clinics that impacted countless lives. As a member of the board, I oversaw the psychiatric inpatient facility project in partnership with the county, the emergency room remodel project, and I played an integral role in exploring a partnership with another hospital system that will ensure the sustainability of TCMC for generations to come.

I am heavily involved with philanthropic work locally and abroad. I spend my spare time volunteering for a local animal rescue group called The Rescued Dog and am an active foster and fundraiser for animals in need. I also volunteer and serve on the fundraising committee with Mercy Outreach Surgical Team and have participated in multiple pediatric surgical missions to various towns in Mexico. I have been heavily involved in fundraising for TriCity Hospital, punctuated by serving as chair of the Tri-City Hospital Foundation gala in 2021 when Seal was our entertainment, and participating in the Fashion that Heals fundraisers, raising money for life-saving equipment.

I was born and raised in San Diego to Lebanese immigrants. Having undergone a spine fusion for scoliosis as a teenager, I developed an acute appreciation of medicine and caregivers at an early age and committed to medicine as my vocation of choice before entering Rancho Bernardo High School. I attended UC San Diego as a premed major.

During my time there, I volunteered in the campus student clinic, served as secretary of Alpha Epsilon Delta Medical Fraternity chapter I helped establish, and did clinical research on protein C deficiencies at The Scripps Research Institute. I went on to attend medical school at New York Medical College, where I fell in love with the practice of anesthesia. I completed my anesthesiology training in Brooklyn, N.Y. at Maimonides Medical Center and moved back to my hometown of San Diego to be closer to my family.

Candidate for South Bay Director #2: Paul J. Manos, DO (inc.) (3) It is an honor to have had the opportunity and privilege to serve on the SDCMS Board for the past six years. It has been a privilege to work with a distinct, diverse group of physicians who advocate for patient care, physician wellness, and healthcare advocacy. Each of us has the unique opportunity to impact the lives of those in need.

Having served in an underserved community for over 25 years, what we do is essential in providing care for those most in need. I am honored and grateful to serve with this distinguished group of physicians to effect change in our communities. Thank you for this opportunity.

AT-LARGE DIRECTORS

Candidate for At-large Director #2: Kelly C. Motadel, MD, MPH (inc.) (3) I have been a member of SDCMS for more than 15 years. Born and raised in San Diego County, I knew from a young age that I wanted to practice medicine in this community. I was a pediatrician and the chief medical officer of Vista Community Clinic and on staff at Tri City Medical Center for more than 15 years before becoming the chief pediatric officer for the County of San Diego, Health and Human Services Agency in 2020. Just as I enjoyed caring and advocating for the vulnerable population that VCC serves, my current role allows me to champion the health needs for children and youth, but now throughout the county.

Over the last few years I have become

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increasingly engaged in fighting for access to quality care for all patients and fair treatment of those who care for them. I have been able to focus my energies on the pediatric population in my county role, serving as a clinical liaison for the numerous programs that county has that serve children and youth. I also currently sit on the Medi-Cal Children’s Health Advisory Panel for the state and am actively involved in the American Academy of Pediatrics’ local chapter.

I view myself as an activist in striving for healthcare for all and I would be honored to serve as an at-large director on the SDCMS Board of Directors. Only in combining efforts with other like–minded physicians can we make the changes needed to care for our patients the way we know best.

Candidate for At-large Director #7: Karl E. Steinberg, MD, FAAFP (inc.) (3) I’m a family physician, geriatrician, palliative care physician and bioethicist, and I have been a nursing home and hospice medical director in coastal North County continuously since 1995. My passions are providing compassionate care to the frail elder population and others with serious or chronic illnesses, and helping to educate patients and healthcare providers about palliative care.

In addition to patient care, I am president of the National POLST Collaborative, a past chair of the Compassionate Care Coalition of California (the people who brought POLST to California), and past president (2021–22) of AMDA, the Society for Post-Acute and Long-Term Care Medicine, a national organization with AMA delegates (of which I am one) representing nursing home physicians and medical directors. I’m a past president of their state chapter, CALTCM (the California Association of Long Term Care Medicine); I also currently serve on the government relations committee of CAHF (the California Association of Health Facilities). I am also vice president of National POLST. I provide long-term care consulting and medico legal services, I’m chief medical officer for two nursing home service organizations, and I’m medical director of two North County skilled nursing facilities (Vista View Post Acute

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and Carlsbad by the Sea Care Center). I’ve been medical director of Hospice by the Sea in Solana Beach since 1995. I do home visits for complex case management patients for Scripps and have been an employed physician with Scripps Coastal and its corporate predecessors since 1990.

I do a fair amount of speaking around town and at statewide and national meetings, mostly on topics of geriatrics, dementia, advance care planning, palliative care, bioethics, and medicolegal affairs.

At CMA, I was recently appointed to chair the Council on Ethical, Legal and Judicial Affairs (CELJA), of which I was previously a member. At SDCMS, I’ve been on the Bioethics Commission for over 10 years, on the Communications Committee for several years, have served on the BOD for quite a few years, been a delegate for the CMA HOD since 2014, and have been chair of the San Diego Coalition for Compassionate Care. I’ve also contributed to a number of projects through Champions for Health, including the Alzheimer’s

workgroup that created the AlzDxRx app, and have represented SDCMS on the Prescription Drug Task Force and some county COVID workgroups.

I believe we have a long way to go in getting incentives aligned to optimize care (for example, taking care of ill nursing home residents in the nursing home instead of shipping them to the hospital), increasing awareness of palliative care and advance care planning, and helping our patients get the care they want (and not get the care they don’t want). I’ve testified before several California Assembly and Senate committees about pending legislation on behalf of organizations I represent.

By participating in organized medicine and the political process, I hope I can help move things along — with the assistance of many other committed individuals within SDCMS and other involved organizations. Thanks for your support in allowing me to continue my service on this board.

YPS DIRECTOR

Candidate for YPS Director: Emily A. Nagler, MD (inc.) (1) I have been honored to serve as the Young Physician Section director position for SDCMS since 2022. As I have grown in my role professionally, I have recognized how important connections between physicians are, especially those new in their careers. Being early in one’s career is a time of excitement and growth but also uncertainty, doubt, and an ongoing struggle to maintain a work-life balance. To have physicians in a similar situation, offering guidance and friendship in this time, is critical to ameliorate the feelings of imposter syndrome and self-doubt. Having mentors in SDCMS has inspired me to provide support to others early in their career and provide advice based on my own failures and successes. I recommend joining SDCMS to all of my colleagues early in their career as this organization has not only been a major support network, but also provides a way for us to see our impact beyond the clinic. I would be privileged to be your YPS director and continue to promote SDCMS during such a critical time in our careers.

SDCMS BOARD CANDIDATE STATEMENTS

AMA DISTRICT I DELEGATE

Candidate for AMA District I Delegate: Mihir Y. Parikh, MD (inc.) (3) I am reaching out to respectfully request your continued support and vote as I run for a three-year term as AMA delegate for San Diego.

Since joining the SDCMS board in 2007, I have served in various capacities, from Young Physician Delegate to president of the San Diego County Medical Society. My involvement has extended to numerous advocacy efforts, fundraisers, and membership drives at both local and state levels. Through these experiences, I have had the privilege of collaborating with a diverse group of physician leaders across San Diego, California, and now nationally, on initiatives ranging from electoral campaigns to public education on healthcare policy.

This journey has reinforced my belief in the value of representing San Diego physicians and the California delegation at the AMA. It is a role I find not only beneficial but also deeply rewarding and fulfilling professionally. Having completed a three-year term as an AMA alternate delegate, I currently serve as the vice chair for the PAC WEST “hospitality committee,” a role that has enabled me to support regional physicians aspiring to leadership positions within the AMA and connect with many other AMA members across the country. This endeavor creates the presence needed to make an impact as a San Diego AMA delegate.

Balancing local engagement with national involvement requires time commitment. Yet my enthusiasm, keen interest, and passion for this work remain undiminished. I value our longstanding relationship and would be honored to receive your continued support. Thank you.

Board of Directors of the San Diego County Medical Society for the past several years.

While on the Board, I’ve seen the importance of all physicians speaking with one voice to work toward what is best for San Diego physicians and their patients. Even though the percentage of physicians in independent practices has been decreasing over the years, our voices are still viewed as important by the CMA and the SDCMS, and together with other physicians in large group or academic settings, we can accomplish more when we speak with a united voice about the changes in healthcare that affect all of us.

If chosen to serve on the Board again, my role will be educating private practice physicians about the importance of being part of organized medicine, as well as helping to make SDCMS an organization that all physicians want to join.

CMA DISTRICT I DELEGATES

Candidate for CMA District I Delegate: Wynnshang (Wayne) C. Sun, MD (inc.) (3) I am a general internist in private practice on the campus of Scripps La Jolla and have served on the

Candidate for CMA District I Delegate: Patrick A. Tellez, MD, MHSA, MPH (inc.) (3)

I am privileged to be considered as a candidate for the Board of SDCMS in 2024. I recently retired in September 2023. I maintain active licensure and membership in the San Diego County Medical Society and am currently serving as one of three co-chairs of the SD Retired Physicians Society.

I have been a member of the SDCMS Board since 2014. In the distant past, I have served on CMA’s Council on Legislation and Scientific Advisory Council on Allergy & Immunology. I have been active in the AMA for 35 years. Since 1995, I have served mainly in medical group practice leadership within the FQHC community medicine setting and, just prior to retiring, spent the most recent four years as CMO of Community Health Group.

Over the years, it’s been a privilege to actively support, through the SDCMS and CMA, successful policies and measures that have supported medical practice in California. Issues such as stabilizing medical malpractice, addressing economic pressures of reimbursement, shaping healthcare reform, addressing implications of a single payer healthcare system of financing, designing the pandemic response and preparedness, addressing the broader adoption of telehealth and the corporatization of medicine are all just a few examples of issues that have presented themselves to us. It has been through SDCMS and CMA that we have been able to help shape the medical practice experience in ways that improve the resilience and vitality of medical practice in California.

Looking forward, there are important issues that deserve our attention; these include the influence of climate change on health, the management of technology in medical practice, protections of privacy and security in remote monitoring, the management of misinformation as we enter the era of artificial/augmented intelligence, and the opportunities to ensure that our patients are able to become more engaged in their care through informed decision making.

As a member of SDCMS, it would be my privilege to serve our community and assure that we physicians may continue to proactively serve as architects of systems changes that sustainably meet the needs of our patients and measurably advance health equity.

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Recognizing Black Maternal Health Week and the Ongoing Need to Achieve Health Justice in the Perinatal Space

BY WILMA WOOTEN, MD, MPH AND THOMAS R. COLEMAN, MD, MS 10

APRIL 2024

Introduction Black Maternal Health Week was created by the Black Mamas Matter Alliance and is celebrated each year from April 11 to 17. This occurs in conjunction with the International Day for Maternal Health and Rights, the first day of that week, which celebrates every person’s right to respectful, quality, safe, and comprehensive maternal healthcare.

Additionally, the month of April is recognized in the United States as National Minority Health Month, a month-long initiative to advance health equity across the country on behalf of all racial and ethnic minorities.

These events are very pertinent as maternal mortality is decreasing throughout the world, with the United States a notable exception, as it has the highest such mortality rate in the developed world. Over the last decade, California’s rate of maternal death has significantly decreased, yet women of color are still dying at a disproportionate and unacceptable rate, with the rate for Black women remaining three to four times higher than for White women.

The purpose of this article is to highlight the legislative and organizational efforts implemented in recent years to address infant or maternal mortality rates in California.

This publication provides a “call to action” for providers to support these strategies and take an active role to improve Black maternal health. Despite these efforts, more work is still needed.

Initiation of the County of San Diego’s Perinatal Equity Initiative, AB 1810 In addition to the maternal mortality disparity noted above, Black infants in San Diego County are nearly three times more likely to die than White infants. Although progress has been made over time, the African-American infant mortality rate has continued to be the only such rate stratified by race/ethnicity that exceeds the Healthy People 2030 goal of 5.0 deaths per 1,000 live births. The persistent gap that exists between mortality rates for African-American infants compared to infants of other races and the steady increase of preterm births drove the passage of AB 1810, by the California Legislature, establishing the Perinatal Equity Initiative (PEI). The County of San Diego received PEI planning funds in late 2018 to conduct an environmental scan to gain a deeper understanding of its African-American community and infant mortality rate.

To gather primary data, the County held three qualitative data gathering sessions in the spring of 2019. Designed to be inclusive of a wide range of community stakeholders (e.g., African-American pregnant women, mothers, fathers, health and social service providers, academia, and community advocates), the meetings were organized and facilitated to gain awareness of the structures and systems that create and perpetuate health disparities that impact African-Americans, with a specific focus on infant and maternal indicators.

These sessions reinforced the legacy of African-Americans

being treated poorly by the healthcare system and the subsequent distrust of medical providers. Many respondents noted biases and racism during provider-patient interactions.

African-American mothers often felt disrespected and judged by clinic and medical providers; during one meeting, eight of 10 such participants felt their providers did not care about them. On multiple occasions, respondents noted the importance of services being delivered by culturally competent providers and creating traumainformed environments in hospitals and medical settings.

In 2019, the California Department of Public Health began to administer the PEI program through agreements with local health jurisdictions that were currently implementing a Black Infant Health (BIH) program. The County received PEI funds to support its long-standing Black Infant Health program for African-American pregnant and postpartum women and the San Diego County Perinatal Equity Initiative (SDCPEI) was launched. A community advisory board (CAB) was formally established and tasked with informing and providing feedback on the County’s birth equity

efforts. The CAB guidance led to the development of a substantial media campaign — branded as “Black Legacy Now” — and two initiatives: one focused on fatherhood and the other focused on implicit bias training.

California Dignity in Pregnancy and Childbirth Act (SB 464) The very comprehensive legislation of SB 464, implemented in January 2020, codified findings relating to implicit bias and racial disparities in maternal mortality rates.

“The bill would require a hospital that provides perinatal care, and an alternative birth center or a primary clinic that provides services as an alternative birth center, to implement an evidence-based implicit bias program, as specified, for all healthcare providers involved in perinatal care of patients within those facilities.” In addition, the bill required the healthcare provider to complete initial basic training through the program and a refresher course every two years thereafter, or on a more frequent basis if deemed necessary by the facility.

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To help perinatal care providers comply with the new legislation, the SDCPEI contracted with a national nonprofit change organization, Health Resources in Action (HRiA), to implement the required implicit bias training.

Unique to San Diego County, HRiA created an SB 464-compliant training for the entire perinatal healthcare workforce, stressing the importance of training everyone from front desk staff to each healthcare provider that interacts with patients.

This two-part training series, which occurred from January 2021 to December 2022, attempted to empower clinicians and their teams to provide high-quality and equitable care essential for the health and wellbeing of all birthing people within their healthcare systems. Part I of the training, “Breaking through Implicit Bias in Maternal Healthcare,” was an asynchronous 45-minute virtual training, which participants could take on their own time. The Part II training, “Strategies to Reduce Implicit Bias,” was a 90-minute synchronous (in-person) training facilitated by HRiA staff. It was designed to engage participants to explore their implicit biases through an instructor-led training.

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The following outcomes were achieved for this training: • Established a physician subcommittee to inform the training curriculum • Ensured that 114 healthcare providers and medical staff completed an asynchronous training • Ensured that 144 healthcare providers and medical staff completed a facilitated training • Identified that 100% of those completing the facilitated training indicated they had made changes to their practice as a result of the training.

There were several lessons learned from this focus on implicit bias training, even though the response was not what was originally envisioned.

Lessons learned included the following: there was no defined enforcement entity and this made recruitment more difficult; healthcare providers and medical staff were receiving implicit bias training, either from their own agency or other organizations; and implementation during the pandemic was challenging, given competing priorities within the healthcare milieu.

California Department of Justice ‘Report on Healthcare Facilities and the California Dignity in Pregnancy and Childbirth Act’ In October 2023, the California Department of Justice (DOJ) issued a report1 that summarized an effort to collect compliance data from 258 California facilities between Jan. 1, 2020, when SB 464 went into effect, and July 8, 2022. This effort was focused on hospitals because more than 98% of births in the United States occur there. Key findings included that only 42 of the 242 responding facilities had completed training all staff members. For the other reporting facilities, 185 had trained some staff members, with an average of 77.5% of appropriate providers. Just over 80% of reporting facilities used an asynchronous training (i.e., a one- to two-hour training that is not live instruction, but provided by video), developed by Diversity Science called “Dignity in Pregnancy and Childbirth.”

The report noted two main conclusions. First, SB 464 did not include any explicit enforcement mechanism and did not assign oversight of its requirements to any particular agency. This reinforced the SDCPEI findings, as there were no repercussions for lack of training completion. Second, there seemed to be substantial confusion regarding the scope of SB 464, as the Act’s language was not specific in defining what positions are mandated to be trained. Although the SDCPEI program took the approach to try to train all staff, within a particular clinical team, this strategy was not attempted uniformly throughout the state.

Ongoing Efforts Across Multiple Domains The two primary professional organizations involved with the care for birthing people recognize the importance of these efforts. The American College of Obstetricians and Gynecologists has explicitly noted that it is committed to eliminate disparities in women’s health and to confront implicit and explicit bias and racism. This means recognizing and examining one’s own prejudice and bias and addressing the way in which healthcare systems perpetuate inequality. As well, the American Academy of Family Physicians recommends educating physicians about implicit bias and strategies to address it as a tool to support culturally appropriate patient-centered care, reduce health disparities, and achieve health equity. Implicit bias education and mitigation strategy education should be part of broader institutional and structural policy changes and interventions to achieve greater health equity.

The California Maternal Quality Care Collaborative (CMQCC) is a multi-stakeholder organization committed to ending preventable morbidity, mortality, and racial disparities in California maternity care. CMQCC uses research, quality improvement toolkits, statewide outreach collaboratives, and its innovative Maternity Data Center to improve outcomes for mothers and infants. The organization was established in 2006 at Stanford University School of Medicine in conjunction with state government in response to

rising maternal mortality and morbidity rates. The efforts of CMQCC, along with its collaborative efforts with hospitals, patients, communities, and other partners, have certainly contributed to the decline in maternal mortality in the time of its existence.

However, as noted at the beginning of this article, substantial improvement has not been seen for Black birthing people. Because of that, CMQCC convened a five-hospital pilot collaborative and created a Birth Equity Implementation Guide Task Force, which included San Diego County physician participation. In August 2023, CMQCC launched the “Hospital Action Guide for Respectful and Equity-Centered Obstetric Care,” which was developed with two purposes. First, it will help California hospital users, including those in San Diego County, understand the drivers of inequities in maternal care and deepen the understanding of how and why racism, discrimination, and implicit bias are root causes of maternal inequities. Second, the task force created a guide that provides hospital maternity teams with a sample of action-oriented, equity-centered tools and resources that go beyond implicit bias training and, if followed, may translate into real change in culture and patient care. It is notable that CMQCC was notified near the end of 2023 that it was awarded a five-year,

$10 million grant by the Health Resources and Services Administration (HRSA) to address health inequities facing pregnant women. This funding will allow CMQCC to convene: (1) a steering committee in collaboration with multiple stakeholders, including patients with lived experience, and (2) a subsequent task force with a goal to reduce severe birth complications, maternal deaths, and racial and ethnic inequities.

With respect to implicit bias training, through funding from the California Health Care Foundation, Diversity Science continues to provide its SB 464-specific training at

no cost to physicians and physician trainees, nurses, and allied health and other healthcare professions.

The SDCPEI is working to facilitate such training with San Diego County perinatal providers.

The Department of Health Care Services (DHCS), through its 2022 Comprehensive Quality Strategy, has stipulated a “Bold Goal” to close the maternity care disparity for Black and Native American persons by 50% by 2025. Through its MediCal Transformation efforts and ongoing Birthing Care Pathway process, with multiple workgroups convened, DHCS should continue to

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unfold changing programmatic efforts during this calendar year.

Nationally, the American Medical Association has hired a chief equity officer who leads the Center for Health Equity and has instituted a Truth, Reconciliation, Healing, and Transformation Taskforce. In our state, the California Medical Association has health equity efforts through Physicians for a Healthy California and its Diversity and Inclusion Technical Advisory Committee.

There is also an increasing recognition that medicine is not immune to the effects of structural racism, as many professional organizations are now assessing clinical practice algorithms for removal of race-based equations. The reality is that race is a social construct and not a biological one. Notably, The New England Journal of Medicine announced in its December 7, 2023 issue that it has commissioned an independent group of historians to produce a series of articles covering various aspects of the biases and injustice that the Journal has helped to perpetuate in its more than 200 years.

Finally, a recently introduced, updated version of the “California Dignity in Pregnancy and Childbirth Act,” co-sponsored by Assemblymember Dr. Akilah Weber and members of the California Legislative Black Caucus, has been introduced. This bill would codify more explicit conditions to rectify some of the uncertainty related to implicit bias training in

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the original bill, as noted in the DOJ’s report discussed above.

Action Steps: All Healthcare Providers Can Play an Important Role in Black Maternal Health As healthcare professionals who may interact with pregnant people, care teams have the responsibility to provide all patients with: • Respect, dignity, and nondiscrimination throughout their care • Education and information about their pregnancy and childbirth, and shared decision making throughout their care • The ability to ask questions and provide informed consent for anything related to their wellbeing and that of their child • Quality, respectful, trauma-informed care that honors patient’s choices, preferences, preferred language, culture, religion, or traditions • Personal support before, during, and after their pregnancy and childbirth The realization of the health disparities noted within this article is not new, as the landmark report from the Institute of Medicine — Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care — was published more than two decades ago.2 Given the multiple factors that contribute to health disparities, including social determinants of health that

prevent many from having fair opportunities for economic, physical, and emotional health; variations in the quality of healthcare; underlying chronic conditions that disproportionately impact people of color; and implicit bias and structural racism, we must continue efforts synergistically.

As the National Academy of Medicine prepares to finalize its “Unequal Treatment Revisited” report for distribution this summer, healthcare and public health systems must recommit to moving toward true perinatal health justice. Every pregnant person in our community deserves no less, and you are welcomed to join the San Diego County Perinatal Equity Initiative efforts to achieve this outcome together.

References: 1. California Department of Justice, “Report on Healthcare Facilities and the California Dignity in Pregnancy and Childbirth Act”, October 2023.

2. Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press. https://doi. org/10.17226/12875.

Dr. Wooten is the San Diego County Public Health Officer. She has worked for the County for 23 years, serving as Public Health Officer for over 17 years. Dr. Coleman has more than 25 years of diverse experience as a public health officer, physician, executive, and epidemiologist. His current role is medical director of the Maternal, Child, and Family Health Services Branch in the Public Health Services Department for the County of San Diego. Dr. Coleman has particular interests in the integration of public health and clinical medicine; evidence-based clinical and community preventive services, especially related to underserved populations; and the significant issues of health equity and low health literacy.

PHYSICIAN WELLNESS

Post-COVID Burnout and Mental Health Issues in Physicians: Is There a Vaccine for That?

By Hardeep Phull, MD Empathy and Resilience Are in Our DNA Physicians possess some of the highest levels of empathy, humanity, and emotional intelligence across numerous professions and industries. We see some of the sickest patients in emotionally draining circumstances during perhaps some of the most vulnerable moments of an individual’s life. We develop meaningful relationships with these patients as the person behind the illness emerges, allowing us to empower this soul in the hopes of reclaiming their lives that are inevitably changed forever. When we deal with death and dying, we also handle this difficult event with a spirit of healing, compassion, and dignity toward patients and their families. Though we are not superhuman or immune from the physical and emotional exhaustion of compassion fatigue, we tend to strive daily with a sense of joy, resilient purpose, and duty to never lose our empathy or allow ourselves to become cynical or depersonalized.

How Do We Become ‘Burned Out’ and How Does It Lead to Mental Health Issues?

To understand the problem, we must define fundamentally the crucial terms, which often become blurred. The word “burnout” has become the most common vernacular to describe employee disgruntlement in nearly any industry.

The issue with this term is in its implied form of gaslighting in which an individual lacks the necessary resilience to perform the work, and therefore the problem insidiously shifts to reside somehow within the deficient individual.

By contrast, moral injury in healthcare practitioners is defined as a fundamental disconnect between the needs of healthcare systems and one’s own passion, moral beliefs, and motivation to serve patients, which is unable to be met due to existing demands or restrictions that perpetuate beyond one’s control, yet with an implied culpability 1.

This is compounded significantly by administrative burdens. For example, it can take hours of time to interpret and synthesize complex laboratory, imaging, and clinical information, followed by face-to-face education and discussion of the findings with patients. However, as soon as we walk away from that genuine human-to-human connection, we are left staring at a computer screen to synthesize the complex information, differential diagnoses, treatment plan, and shared decision making involved with the patient. The arbitrarily long note must be completed quickly in between visits (or saved until the late afterhours) while multitasking the needs of a

busy clinical practice, and yet it must be specific and technical enough to read like a legal report while incorporating dozens of EHR clicks to incorporate arbitrary but necessary features to enable medical billing. This does not even start to encompass the critical analysis required to write time-sensitive orders for important studies, diagnostics, or the actual treatment regimen itself. It also does not account for the countless uncompensated hours spent in prior authorization paperwork and peer-to-peer visits to prove to an arbitrary party that we are following evidence-based guidelines along with the art of medicine as advocates for our patients.

Regardless of the above, and despite perpetually running behind for the next patient visit, to repeat the same process all over again, physicians still typically keep their heads up with a sense of joy, resilient purpose, and duty. Indeed, we have grown accustomed to, and even (sadly) accepted, the administrative chores that we perilously allow to put a small dent into our sense of purpose.

However, other factors beyond our immediate control can also erode into our journeys, pushing us closer to the edge of becoming cynical, depersonalized, or worse, threatening our hard-earned moniker of empathy. Since we are not superhuman nor immune from the physical and emotional exhaustion of compassion fatigue, physical factors such as the lack of structured breaks, decreased physical activity or time spent outdoors away from computer screens, worsening

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PHYSICIAN WELLNESS sleep habits, and developing health conditions or illnesses can also take a toll in the spiral of becoming cynical and depersonalized. Without even accounting for social, gender, or personal/family factors, the above process along with a progressive loss of autonomy to practice medicine can lead to a sense of detachment and disconnection from meaningful, rewarding duties, giving way to detrimental feelings of personal failure, imposter syndrome, and depression 2.

In a culture of repetitive, fundamental moral injury, combined with stoicism and “toxic” resiliency, the same positive traits that originally gave a physician purpose and compassion can begin to create unrealistic expectations. Like an infectious disease, these spiraling mental health symptoms can be harmful and even contagious as they infiltrate entire clinics or institutions, trickling down to the entire care team from pharmacists, nurses, and medical aides to the caregivers and patients themselves.

The COVID-19 Pandemic Was a Wake-up Call That a ‘Trial

by Fire’ Was No Longer Sustainable Even before the pandemic, the rates of “burnout” were approaching 50% in physicians and healthcare professionals such as physician assistants, nurse practitioners, and pharmacists 3. However, the COVID pandemic raised even more mental health issues to the surface, partially because it added fuel to the already burning fire with additional burdens and stressors.

Beyond the sudden disruption in care, the added fears, expectations, and dangers of working as a first-responder created literal “life or death” decisions daily 4. Moreover, we also started to spend less face-to-face time with patients and colleagues, leading to concerns about job satisfaction, job security, and ongoing professional development. This caused many practitioners to leave clinical practice, which exacerbated shortages in the workforce, especially with the influx of postpandemic patients who delayed care, wellness exams, or critical screenings, resulting in more advanced cases and sicker patients overall with fewer (yet more “burned out”) physicians and a diminished, exhausted workforce to take care of them 4.

In fact, in 2022, U.S. Surgeon General Dr. Vivek Murthy recognized the post-COVID crisis among healthcare workers, declaring it an “urgent need” and writing in The New England Journal of Medicine that healthcare workers “continue showing up to battle the pandemic and its sequelae” despite contending with severe symptoms of “insomnia, depression, anxiety, post-traumatic stress disorder” that they were not prepared to face or handle 5. Unfortunately, even for the astute clinician or observer, a developing mental health disorder in this milieu was dangerously easy to deny or ignore. Along with the lack of time and availability of easily accessible mental health professionals, there continued to be a perceived stigma around mental health problems in society and in medicine, especially with the latter due to an intuitive instinct of physicians to protect their ability to remain employed. Subtle clues pointing toward early depres-

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sion were easily blurred by temporary “burnout” and denial, sadly leading to increased cases of physician suicide 2.

How Can We Reconnect the Pieces of Authentic Purpose, Genuine Wellness, and Emotional Renewal?

The first step in solving any problem is to acknowledge that it exists. We must be provided a system that breaks the status quo, promising safety and immunity with an open, non-punitive platform to speak candidly about mental health symptoms and disorders. Indeed, as Dr. Murthy stated in 2022, “Burnout manifests in individuals, but it’s fundamentally rooted in systems.” 5 Therefore, resilience training and wellness initiatives need to be authentic and practical, rather than “contrived wellness” checkboxes. This includes addressing the entire scope of a person beyond their practitioner duties or responsibilities, including practical needs such as physical activity and fitness, childcare and family obligations, sleep habits, coping skills, and stress management strategies among others. There need to be fewer barriers to getting help, including breaks (beyond a fleeting lunch period mostly spent catching up on EHR tasks or attending conferences) during the daytime for appointments and wellness sessions. Moreover, colleagues from the entire spectrum of the clinical team should be taught and allowed to recognize symptoms in each other in the spirit of advocacy, empathy, and interpersonal relatedness. 6 Lastly, efforts should be made to harness technology to work for us, rather than the other way around; EHRs, burdensome tasks and paperwork, and patient visits could be simplified perhaps by harnessing the power of AI and telemedicine (perhaps one of the positive sequelae of the COVID-19 pandemic) 6.

“Burnout is not only about long hours. It’s about the fundamental disconnect between health workers and the mission to serve that motivates them.” 5 Due to this statement by Dr. Murthy, there have been numerous task forces assigned a central mission to reconnect physicians to the meaningful, rewarding duties that enable and empower them to practice the joy of medicine, promoting healthy work cultures at institutions nationwide in which mental health is not stigmatized, but rather recognized openly, with appropriate resources provided in a non-punitive fashion 6 . However, in order to truly battle detachment, we need to promote attachment on a local level beyond just what national task forces are attempting to accomplish. In essence, we must recognize our mission of reconnecting each other to meaningful, rewarding duties that enable and empower the entire care team to practice the joy of medicine.

If it took a devastating COVID-19 pandemic to bring these issues to a critical breaking point, then just as the COVID-19 vaccine provided some hope, we too must be willing to inoculate the system with drastic and meaningful reform that results in “herd immunity” for ourselves and for all of our valuable colleagues including nurses, pharmacists, advance practice providers, technologists, therapists, social workers, support staff, and administrators. Ultimately, we owe it not

only to the care team but also to the most important clients in the healthcare business: our patients whose empowered experience and life-deciding outcomes with a vulnerable medical condition depend on the downstream effects of our behaviors and actions. Indeed, if we can nurture emotional renewal and promise a sense of authentic wellbeing to all physicians, we can infiltrate the entire system in pandemic proportions.

5. Murthy VH. Confronting Health Worker Burnout and Well-Being. N Engl J Med. 2022; 387(7): 577-579.

6. Hartzband P, Groopman J. Physician Burnout, Interrupted. N Engl J Med. 2020; 382(26): 2485-2487.

References: 1. Rosenbaum L. Beyond Moral Injury — Can We Reclaim Agency, Belief, and Joy in Medicine? N Engl J Med. Published online January 24, 2024.

2. Sen S. Is It Burnout or Depression? Expanding Efforts to Improve Physician Well-Being. N Engl J Med. 2022; 387(18): 1629-1630.

3. Shanafelt TD, West CP, Dyrbye LN, et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clin Proc. 2022; 97(12): 2248-2258.

4. Lim KHJ, Murali K, Kamposioras K, et al. The concerns of oncology professionals during the COVID-19 pandemic: results from the ESMO Resilience Task Force survey II. ESMO Open. 2021; 6(4): 100199.

Dr. Phull is the director of oncology at Palomar Health, the alumni specialty director at the Cleveland Clinic Lerner College of Medicine, and a clinical instructor at UC San Diego. He views his ongoing journey in medicine as a series of experiences that have enabled him to appreciate different values, cultures, and viewpoints. He remains committed to his initial calling to be a compassionate and caring clinician, advocating for deeply rooted principles of empathy, humility, dignity, and empowerment toward his patients and colleagues.

PLACE YOUR AD HERE Contact Jennifer Rohr 858.437.3476 Jennifer.Rohr@SDCMS.org

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Artificial Intelligence and Medicine THE DEBATE

PREVENTION DIABETES Reversing the Risks

DEMENTIA Reducing the Burden How to Engaging Patients GUN SAFETY

BUILD TRUST

BREAST CANCER Preventing Deaths

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THE PRACTICE OF MEDICINE

Borrowing From the Future/Investing in the Present

By Daniel J. Bressler, MD, FACP I AM WRITING THIS IN JANUARY 2024, IN THE month named for the Roman God Janus — who represented time, beginnings, endings, and passages. Apropos of that etymology, I’m reflecting on how we “inherit” our current health status from the entirety of our past: our genetics, our place in history, and our personal experiences. This is both trivial and deep. The errors, triumphs, and accidents of the past have led us precisely to this here and this now. What we do with this inherited present depends partly on how we take on the future.

In the 2002 sci-fi film Minority Report, Tom Cruise plays chief John Anderton, who works in the section of “precrime” in the police department, using clairvoyant humanoid mutants and artificial intelligence to see into the near future and intervene to prevent a crime’s completion. In our modern science of medical “precrime analysis,” we use data from a patient’s physical exam, blood chemistry, hematology, genetics, imaging, and tissue sampling along with our knowledge of pathophysiology to assess the likelihoods of future diseases and then intervene to prevent them. Better the polypectomy than the future adenocarcinoma. Better the statin than the future MI. Better the CPAP than the future stroke. Better the laser photocoagulation than the future retinopathic blindness.

That said, we must admit that whenever we claim to be “preventing future disease” we are playing a little fast and loose with the facts. We can’t prevent most diseases in an absolute sense any more than we can prevent an engine from eventually wearing out by changing the oil every 3,000 miles. What we can do is reduce the risk of certain conditions happening during a finite amount of time. I tell patients every day: If you get a heart attack when you’re 100 years old, we have succeeded in “preventing heart disease”; if it’s when you’re 70, we have failed. The same might be said about cancer, stroke, or dementia.

There is an ongoing debate in health economics that is sometimes referred to as the “red herring hypothesis.” It asks whether the increase in healthcare spending that occurs as a person ages is due to age per se or is rather due to that person’s temporal proximity to death. The potential red herring (or misleading fact) is that healthcare expenditures go up with age, but when data on time of death is factored in, it is that factor that best explains the increased expenditure.

The debate has not been resolved but is worth considering as we care for an increasingly aged population. To the extent

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that we can enhance healthspan, there is a chance that per capita healthcare expenditures needn’t rise dramatically.

With the most rosy interpretation of these data, one could claim that borrowing from the future in this way is actually a zero interest loan.

We can’t know the future but we can make informed estimates and skilled interventions about it. By delaying the MI, the stroke, the cancer, or the dementia, we have in a sense borrowed from our patients’ futures and invested in their presents. By delaying the inevitable, we might expand their opportunities for joy, love, and service. To me, this is a noble (if still ultimately tragic) framing of our profession’s calling.

Borrowed Time We live our lives on borrowed time A law of nature, not a crime Mending defects while we can Still subject to the master plan We live our lives on borrowed time Descending once we pass our prime The dream of our decline’s reversal Is still a scammy fake commercial We live our lives on borrowed time A truth both tragic and sublime Built-up structures breaking down We royals must concede our crown We live our lives on borrowed time A call to prayer, a church bell chime The future’s distant guiding fire A flickering flame, a funeral pyre

Dr. Bressler has practiced outpatient internal medicine in San Diego since 1984. He maintains privileges at Scripps Mercy Hospital, where he served as chairman of the Biomedical Ethics Committee, and at Mission Hills Post Acute Care where he served as medical director. Dr. Bressler has been a member of CMA for 35 years.

PERSONAL AND PROFESSIONAL DEVELOPMENT

The Importance of Recognizing and Treating Loneliness

By Helane Fronek, MD, FACP, FASVLM, FAMWA

AFTER LIVING WITH GOOD FRIENDS WHO provided a deep sense of belonging, starting residency in a new city was jarring. Facing a never-completed workload and with no time to develop relationships, I felt extremely lonely. Unfortunately, loneliness is pervasive. And it seems it’s not just an unpleasant feeling. Surgeon General Vivek Murthy’s 2023 advisory (SurgeonGeneral.gov/Connection) details that the epidemic of loneliness and social isolation increases “the risk for premature death … as much as smoking … 15 cigarettes a day.” “Insufficient social connection increases our risk of heart disease and stroke by 30% … our risk of anxiety, depression, and dementia” and “susceptibility to viruses and respiratory illness.” I applaud Dr. Murthy’s focus on this issue and the efforts of medical groups to address this by scheduling more social gatherings.

Yet there is more to relieving loneliness than simply bringing people together. Extensive research by Brene Brown, PhD, demonstrates that connection and belonging

require a willingness to share our concerns and perceived shortcomings with another person. We may feel apprehensive about this in our judgmental medical culture, where we fear threats to our reputation and job security if we disclose too much. This makes it crucial for physicians to develop a circle of trusted colleagues with whom it is safe to share honestly, rather than hiding behind a façade of perfection, when we are worried or doubting ourselves. This trustworthy circle can foster a needed sense of belonging and acceptance, and should be considered as important for a sustained and healthy career as medical training.

Social media, teeming with stories and images of seemingly perfect lives, further compromises our willingness to share honestly. While a weekend course may add to our knowledge base, it doesn’t replace experiential training programs that incorporate supervision and feedback. Similarly, social media allows us to connect, but developing deep connection or friendship requires a commitment to spend time with a person and the courage to be vulnerable and authentic.

Unfortunately, many of us formed beliefs about ourselves and relationships in environments lacking honesty, trust, or compassion; thus, our ability to form deep relationships may be diminished by fears or conditioning. After recognizing the origin of these limiting beliefs, people often expand their capacity for connection and trust. Given the toxicity of loneliness, therapy or other modalities to help overcome these obstacles are worth the effort.

Aristotle wisely outlined three types of friends: those who are helpful to us, bring pleasure to our lives, or share our values. A friendship can be based on any of these qualities, which also offer guidance for finding meaningful relationships. Asking for or offering help are powerful ways to create bonds with others, as are seeking connection through activities we enjoy or those that reflect one of our passions.

While simple recipes to relieve loneliness are unrealistic, ignoring its health risks seems foolhardy. With genuine respect and concern for my colleagues who have dedicated their lives to improving the health of others, I ask that you seriously consider what you can do to develop meaningful connections in your lives and take those steps to reduce your own risk of falling prey to this epidemic.

Dr. Fronek is an assistant professor of clinical medicine at UC San Diego School of Medicine and a Certified Physician Development Coach, CPCC, PCC.

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CLASSIFIEDS PRACTICE ANNOUNCEMENTS PSYCHIATRIST AVAILABLE! Accepting new patients for medication management, crisis visits, ADHD, cognitive testing, and psychotherapy. Out of network physician servicing La Jolla and San Diego. Visit hylermed.com or call 619-707-1554.

PHYSICIAN OPPORTUNITIES COUNTY OF SAN DIEGO PROBATION DEPT. MEDICAL DIRECTOR: The Probation Medical Director plays a pivotal role in the medical management team, spearheading the Justice-Involved California Advancing and Innovating Medi-Cal (CalAIM) program. This initiative targets individuals with a history of incarceration, who face elevated risks of harm. California’s groundbreaking approval on January 26, 2023, allows Medicaid services to be extended to aid in their transition back into society.

The Medical Director’s responsibilities encompass CalAIM’s implementation, oversight of clinical programs, and seamless integration of services for justice-involved youth. This leadership role involves collaboration with various stakeholders, ensuring quality healthcare, behavioral support, and a successful return to the community. https://www.governmentjobs.com/careers/ sdcounty/jobs/4193564/medical-director-probation23034008u?keywords=medical%20director&pagetype=j obOpportunitiesJobs 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.

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, 8:00 am to 5:00 p.m. For more information or to apply, please contact Dr. Keith Brady at: uabresearchdoc@ yahoo.com.

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 participation 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.

MEDICAL CONSULTANT (MD/DO): The County of San Diego is currently accepting applications from qualified candidates for Medical Consultant-Public Health Services.

Vacancies are in the Public Health Services, Epidemiology and Immunization Services Branch (EISB) and Tuberculosis (TB) Control and Refugee Health Branch.

Salary: $183,747.20–$204,900.80 annually. An additional 10% for Board Certified Specialty and 15% for relevant sub-specialty. For job posting information visit https:// www.governmentjobs.com/careers/sdcounty?keywords =23416202PHS. MEDICAL DIRECTOR, FULL-TIME: FATHER JOE’S VILLAGES: Join us in ending homelessness! We are a dynamic team that runs an FQHC. The Medical Director oversees clinical aspects of the primary care, psychiatry, dental and behavioral health. This position will be a mix of clinic and admin time and will have direct reports (Dental Director, Director of Behavioral Health, and frontline primary care/psychiatry providers). Reports to the Chief Medical Officer, who is responsible for all aspects of the clinic. The Medical Director is a counterpart to the Clinic Director (who oversees admin staff, MA/RN team, billing, PSRs, etc.). See FJV Jobs to apply.

SEEKING MEDICAL DIRECTOR: subcontracted position: 4-8 hours per month. Responsibilities: 1. Support case conferences, refractory SUD, co‐occurring conditions, specialty populations. 2. Conduct clinical trainings on issues relevant to staff (e.g., documentation, ASAM Criteria, DSM‐5, MAT, WM, co‐occurring conditions) 3.

Provide oversight and clinical supervision. 4. Refer co‐occurring conditions. 5. Lead Quality Improvement functions (e.g., Quality Improvement Projects, clinical team meetings, etc.). 6. Attend annually 5 hours of continuing medical education on addiction medicine. Required by contract

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APRIL 2024

with San Diego County BHS, position is for a Physician licensed by CA Medical Board or CA Osteopathic Medical Board. Contact Name: Jennifer Ratoff: e-mail: jratoff@ secondchanceprogram.org, phone: 619-839-0950 PSYCHIATRIST SPECIALIST: The County of San Diego is currently accepting applications from qualified candidates. Annual Salary: $258,294.40. Note: An additional 10% is paid for Board Certification, or 15% for Board Certification that includes a subspecialty. Why choose the County? 1. Fully paid malpractice insurance; 2. 13 paid holidays; 3. 13 sick days per year; 4. Vacation: 10 days (1-4 years of service); 15 days (5-14 years of service; 20 days (15+ years); 5. Defined benefit retirement program; 6. Cafeteria-style health plan with flexible spending; 7. Wellness incentives. Psychiatrist-Specialists perform professional psychiatric work involving the examination, diagnosis, and treatment of specialty forensics, children/adolescents and or geriatric patients. This is the specialty journey level class in the series that requires a fellowship or experience in child and adolescent psychiatry or forensic psychiatry.

For more information visit our website at sandiegocounty. gov/hr or select this link to go directly to the Psychiatrist Specialist application.

PRIMARY CARE PHYSICIAN: Imperial Valley Family Care Medical Group is looking for Board Certified/Board Eligible Primary Care Physician for their clinics in Brawley & El Centro CA. Salaried/full time position. Please fax CV/ salary requirements to Human Resources (760) 355-7731.

For details about this and other jobs please go to www. ivfcmg.com ASSISTANT, ASSOCIATE OR FULL PROFESSOR (HS CLIN, CLIN X, ADJUNCT, IN-RESIDENCE) MED-GASTROENTEROLOGY: Faculty Position in Gastroenterology. The Department of Medicine at University of California, San Diego, Department of Medicine (http:// med.ucsd.edu/) is committed to academic excellence and diversity within the faculty, staff, and student body and is actively recruiting faculty with an interest in academia in the Division of Gastroenterology. Clinical and teaching responsibilities will include general gastroenterology.

The appropriate series and appointment at the Assistant, Associate or Full Professor level will be based on the candidate’s qualifications and experience. Salary is commensurate with qualifications and based on the University of California pay scales. In-Residence appointments may require candidates to be self-funded. For more information: https://apol-recruit.ucsd.edu/JPF03179 For help contact: klsantos@health.ucsd.edu DERMATOLOGIST NEEDED: Premier dermatology practice in La Jolla seeking a part-time BC or BE dermatologist to join our team. Busy practice with significant opportunity for a motivated, entrepreneurial physician. Work with three energetic dermatologists and a highly trained staff in a positive work environment. We care about our patients and treat our staff like family. Opportunity to do medical/surgical and cosmetic dermatology in an updated medical office with state-of-the art tools and instruments.

Incentive plan will be a percentage based on production. If you are interested in finding out more information, please forward your C.V. to jmaas12@hotmail.com INTERNAL MEDICINE PHYSICIAN: Healthcare Medical Group of La Mesa located at 7339 El Cajon Blvd is looking for a caring, compassionate, and competent physician for providing primary care services. We require well-organized and detail-oriented with excellent written and oral communication skills, and excellent interpersonal skills to provide high-quality care to our patients. We provide a competitive salary, paid time off, health insurance, 401K benefits, etc. We provide plenty of opportunities to refine your clinical competency. Our CEO Dr. Venu Prabaker, who has 30 years of teaching experience as a faculty at multiple universities including Stanford, UCSD, USC, Midwestern, Western, Samuel Merritt, Mayo, etc., will be providing teaching rounds once a week. You will also get plenty of opportunities to attend other clinical lectures at many of the 4- to 5-star restaurants in San Diego. We also have a weekly one-hour meeting for all the staff for team building and to create a “family atmosphere” to improve productivity and thereby create a win-win situation for all.

Visit us at caremd.us.

RADY CHILDREN’S HOSPITAL PEDIATRICIAN POSITIONS: Rady Children’s Hospital of San Diego seeking board-certified/eligible pediatricians or family practice physicians to join the Division of Emergency Medicine in the Department of Urgent Care (UC). Candidate will work at any of our six UC sites in San Diego and Riverside Counties. The position can be any amount of FTE (fulltime equivalent) equal to or above 0.51 FTE. Must have an MD/DO or equivalent and must be board certified/eligible, have a California medical license or equivalent, PALS certification, and have a current DEA license. Contact Dr. Langley glangley@rchsd.org and Dr. Mishra smishra@ rchsd.org.

PER DIEM OBGYN LABORIST POSITION AVAILABLE: IGO Medical Group is seeking a per diem laborist to cover Labor and Delivery and emergency calls at Scripps Memorial Hospital in La Jolla. 70 deliveries/month. 24-hour shifts preferred but negotiable. Please send inquiries by email to IGO@IGOMED.com.

MEDICAL CONSULTANT, SAN DIEGO COUNTY: The County of San Diego, Health and Human Services Agency’s Public Health Services is looking for a Board Certified Family Practice or Internal Medicine physician for the Epidemiology and Communicable Disease Division. Under general direction, incumbents perform a variety of duties necessary for the identification, diagnosis, and control of communicable diseases within the population. This position works closely with the medical and laboratory community, institutional settings, or hospital control practitioners. Learn more here: https://www.governmentjobs. com/careers/sdcounty?keywords=21416207 KAISER PERMANENTE SAN DIEGO PER DIEM PHYSIATRIST: Southern California Permanente Medical Group is an organization with strong values, which provides our physicians with the resources and support systems to ensure they can focus on practicing medicine, connecting with one another, and providing the best possible care to their patients. For consideration or to apply, visit https://scpmgphysiciancareers.com/specialty/ physical-medicine-rehabilitation. For questions or additional information, please contact Michelle Johnson at 866-503-1860 or Michelle.S1.Johnson@kp.org. We are an AAP/EEO employer.

PRIMARY CARE PHYSICIAN POSITION: San Diego Family Care is seeking a Primary Care Physician (MD/DO) at its Linda Vista location to provide direct 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 participation 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.

FAMILY MEDICINE OR INTERNAL MEDICINE PHYSICIAN: TrueCare is more than just a place to work; it feels like home. Sound like a fit? We’d love to hear from you!

Visit our website at www.truecare.org. Under the direction of the Chief Medical Officer and the Lead Physician, ensure the provision of effective quality medical service to the patients of the Health center. The physician is responsible for assuring clinical procedures are continually and systematically followed, patient flow is enhanced, and customer service is extended to all patients at all times.

PUBLIC HEALTH LABORATORY DIRECTOR: The County of San Diego is seeking a dynamic leader with a passion for building healthy communities. This is a unique opportunity for a qualified individual to work for a Level 3 Public Health Laboratory. The Public Health Services department, part of the County’s Health and Human Services Agency, is a local health department nationally accredited by the Public Health Accreditation Board and first of the urban health departments to be accredited.

Public Health Laboratory Director-21226701UPH NEIGHBORHOOD HEALTHCARE MD, FAMILY PRACTICE AND INTERNISTS/HOSPITALISTS: Physicians wanted, beautiful Riverside County and San Diego County- High Quality Family Practice for a private-nonprofit outpatient clinic serving the communities of Riverside County and San Diego County. Work full time schedule and receive paid family medical benefits. Malpractice coverage provided. Be part of a dynamic team voted ‘San Diego Top Docs’ by their peers. Please click the link to be directed to our website to learn more about our organization and view our careers page at www.Nhcare.org.

PHYSICIAN WANTED: Samahan Health Centers is seeking a physician for their federally qualified community health centers that emerged over forty years ago. The agency serves low-income families and individuals in the County of San Diego in two (2) strategic areas with a high density population of Filipinos/Asian and other lowincome, uninsured individuals — National City (Southern San Diego County) and Mira Mesa (North Central San Diego). The physician will report to the Medical Director and provide the full scope of primary care services, including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance to patients.

For more information and to apply, please contact Clara Rubio at (844) 200-2426 EXT 1046 or at crubio@samahanhealth.org.

CLASSIFIEDS PHYSICIAN POSITIONS WANTED PART-TIME CARDIOLOGIST AVAILABLE AFTER 7/4/23: 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 PRACTICE FOR SALE GASTROENTEROLOGY GI PRACTICE FOR SALE: Looking to expand or move? Established 25+ years Gastroenterology GI office practice for sale in beautiful San Diego County, California. 500 active strong patient relationships and referral streams. Consistent total gross income of $600,000 for the past couple years; even through the pandemic. Located in a professional medical building with professional contract staff. All records and billing managed by a professional service who can assist with insurance integration. Office, staff & equipment are move-in ready. Seller will assist Buyer to ensure a smooth transition. Being On-Call optional. Contact Ferdinand @ (858) 752-1492 or ferdinand@zybex.com OTOLARYNGOLOGY HEAD & NECK SURGERY SOLO PRACTICE FOR SALE: Otolaryngology Head & Neck Surgery solo practice located in the Ximed building on the Scripps Memorial Hospital La Jolla campus is for sale. The office is approximately 3,000 SF with 1 or 2 Physician Offices. It has 4 fully equipped exam rooms, an audio room, one procedure room, one conference room, one office manager room as well as in-house billing section, staff room and a bathroom. There is ample parking for staff and patients with close access to radiology and laboratory facilities. For further information please contact Christine Van Such at 858-354-1895 or email: mahdavim3@gmail.com OFFICE SPACE / REAL ESTATE AVAILABLE 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.

EL CAJON RENOVATED MEDICAL OFFICE AVAILABLE: 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, droughtresistant 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 Diego 92121. Ideally located and newly built 5 star facility located with easy freeway access in the heart of San Diego in Sorrento Mesa. Facility includes two operating rooms and two recovery bays, waiting area, State of the Art UPC02 Laser, Endoscopic Equipment with easy parking. Ideal for cosmetic surgery. Competitive Rates. Call Cyndy for more information 858.658.0595 or email Cyndy@roydavidmd.com PRIME LOCATION – MEDICAL BUILDING LEASE OR OWN OPPORTUNITY IN LA MESA: Extraordinary opportunity to lease or lease-to-own a highly visible, freeway-oriented medical building in La Mesa, on Interstate 8 at the 70th Street on-ramp. Immaculate 2-story, 7.5k square foot property with elevator and ample free onsite 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 owneruser or investor. Please contact Tracy Giordano [Coldwell Banker West, DRE# 02052571] for more information, (619) 987-5498.

POWAY MEDICAL OFFICE SPACE FOR LEASE 2/1/2024: Fully built out, turnkey 1257 sq ft ADA-compliant suite for lease. Great location in Pomerado Medical/ Dental Building, next to Palomar Med Center Poway

campus. Building restricted to medical/allied health/dental practices, currently houses ~26 suites. Ideal for small health practice as primary or satellite location. Lease includes front lobby, reception area, restrooms, large treatment area, private treatment/exam rooms. Located on second floor, elevator/stair access. Bright, natural lighting; unobstructed views of foothills. On-site parking; nearby bus service. Flexible lease terms available from 3-5 years at fair market rate. Contact Debbie Summers at debjsummers3@gmail.com (858) 382-8127.

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 mgamboa@ortho1.com for more information. Available for occupancy projected as February 2024.

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.

PHYSICIAN OFFICE SPACE FOR LEASE. 1500 Sq ft.

3 exam room. Large private office. Large reception area and patient prep room. New upgraded flooring. Private entrance. Located in Rancho Bernardo in prime central location. Easy access to interstate 15. Palomar /Pomerado within 10 min. Security card access during off hours. $2,500/month. Contact: (619) 585-0476. Ask for Peg. HILLCREST OFFICE TO SUBLEASE OR SHARE: Gorgeous office located across from Scripps Mercy hospital.

Office is approximately 2000 sq. ft. with procedure/effusion room. Office is fully staffed and looking to add a new provider. We currently have Rheumatology/Pulmonary/ Allergy specialists but can accommodate any specialty or Internal Medicine. Multiple days per week and full use of office is available. If interested please reach out to Melissa Coronado at Melissa@sdpulmonary.com or call (619) 819-7224.

SUBLEASE AVAILABLE: Sublease available in Del Mar off 5 freeway. Share rent. 2100 sq ft office in professional building. Utilities included. Great opportunity in a very desirable area. 858-342-3104.

CHULA VISTA MEDICAL OFFICE: Ready with 8 patient rooms, 2,000sf, excellent parking ratios, Lease $4,000/ mo. No need to spend a penny. Call Dr. Vin, 619-405-6307 vsnnk@yahoo.com

OFFICE SPACE AVAILABLE IN BANKERS HILL: Approximately 500sq feet suite available to lease, includes private bathroom. Located at beautiful Bankers Hill. For more details, please call Claudia at 619-501-4758.

OFFICE SPACE IN EL CENTRO, CA TO SHARE: Office in El Centro in excellent location, close to El Centro Regional Medical Centre Hospital is seeking Doctors of any specialty to share the office space. The office is fully furnished. It consists of 8 exam rooms, nurse station, Dr. office, conference room, kitchenette and beautiful reception. If you are interested or need more information please contact Katia at 760-427-3328 or email at Feminacareo@ gmail.com OFFICE SPACE / REAL ESTATE WANTED MEDICAL OFFICE SPACE WANTED IN HILLCREST/ BANKERS HILL AREA. Mercy Physicians Medical Group (MPMG) specialist is looking for office space near Scripps Mercy Hospital. Open to lease or share office space, full time needed. Please respond to rjvallonedpm@sbcglobal. net or 858-945-0903.

MEDICAL EQUIPMENT / FURNITURE FOR SALE UROLOGY OFFICE CLOSING 6/2023—EQUIPMENT AVAILABLE: Six fully furnished exam rooms including tables (2 bench, 3 power chair/table, 1 knee stirrup), rolling stools, lights, step stools, patient chairs. Waiting room chairs, tables, magazine rack. Specialty items—Shimadzu ultrasound, SciCan sterilizer, Dyonics camera with Sharp monitor, Medtronic Duet urodynamics with T-DOC catheters, Bard prostate biopsy gun with needles, Cooper Surgical urodynamics, Elmed ESU cautery, AO 4 lens microscope. RICOH MP-3054 printer with low print count.

For more information contact: r.pua@cox.net.

NON-PHYSICIAN POSITIONS AVAILABLE 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 are conducting an open search. Research Scientists are extramurally funded, academic researchers who develop and lead independent creative research 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. https://apol-recruit.ucsd.edu/ JPF03713/apply PROJECT SCIENTISTS: Project Scientists (non-tenured, Assistant, Associate or Full level): The University of California, San Diego, Office of Research Affairs 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://apolrecruit.ucsd.edu/JPF03262/apply OFFICE MANAGER: 1. Hiring, Training, Managing staff on procedures/policies. Monitors continuing compliance and office statistics. Oversee stocking/maintenance of supplies, retail. Equipment/ facilities management. Daily bookkeeping, collections. 2. Ensure smooth/efficient patient flow with increasing production/collections. 3.

Create a friendly environment where patients expectations are exceeded, where staff can work together as a team. 4.

Ensure staff working at maximum productivity/efficiency.

Salary: 60-70K depending on experience/qualifications.

Benefits: healthcare reimbursement, PTO, retirement, employee discount, bonuses, commission. Contact: info@ manageyourage.com ASSISTANT PUBLIC HEALTH LAB DIRECTOR: The County of San Diego is currently accepting applications for Assistant Public Health Lab Director. The future incumbent for Assistant Public Health Lab Director will assist in managing public health laboratory personnel who perform laboratory activities for the purpose of identifying, controlling, and preventing disease in the community, as well as assist with the development and implementation of policy and procedures relating to the control and prevention of disease and other health threats. Please visit the County of San Diego website for more information and to apply online.

SANDIEGOPHYSICIAN .ORG

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