June 2018

JUNE 2018 OFFICIAL PUBLICATION OF SDCMS

DAVID BAZZO, MD BECOMES 2018-2019 SDCMS PRESIDENT

2018 White Coat Gala Installs New Officers

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JUNE

CONTENTS

VOLUME 105, NUMBER 6

Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; Robert E. Peters, MD, PhD; William T-C Tseng, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: David E. J. Bazzo, MD President-elect: James H. Schultz, MD Secretary: Holly B. Yang, MD Treasurer: Sergio R. Flores, MD Immediate Past President: Mark W. Sornson, MD, PhD GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD East County #2: Rakesh R. Patel, MD East County #3: Jane A. Lyons, MD Hillcrest #1: Gregory M. Balourdas, MD Hillcrest #2: Thomas C. Lian, MD Kearny Mesa #1: Jamie M. Jordan, MD Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Laura H. Goetz, MD La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Veena A. Prabhakar, DO South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD

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AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Paul J. Manos, DO; #3: Alexandra E. Page, MD; #4: Nicholas J. Yphantides, MD (Board Representative to Executive Committee); #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); #8: Robert E. Peters, MD

features

AT-LARGE ALTERNATE DIRECTORS #1: Karl E. Steinberg, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Susan Kaweski, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD

6 2018 White Coat Gala

ADDITIONAL VOTING DIRECTORS Communications Chair: William T-C Tseng, MD Finance Committee Chair: J. Steven Poceta, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Margaret Meagher

8 Dr. David Bazzo, 2018-2019 SDCMS President Gala Speech

BY DAVID BAZZO, MD

10 Dr. Mark Sornson, 2017–2018 SDCMS Gala Speech

BY MARK SORNSON, MD

16 CMA Defeats Dangerous RateSetting Proposal

BY CALIFORNIA MEDICAL ASSOCIATION

departments

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Physician Learning Must Evolve to Keep Healthcare Workforce Prepared

Briefly Noted: Calendar • NEPO Conference • On-Demand Webinars • Political Advocacy

12 Volunteering With Global Health Teams in Rural Haiti

BY ALEXANDRA MYERS, DO

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BY ERIC BARNA, MD

22 Are You Ready to Check CURES?

BY KATHERINE BOROSKI, CALIFORNIA

ADDITIONAL NON-VOTING MEMBERS Alternate Resident Physician Director: Zachary T. Berman, MD Alternate Retired Physician Director: Mitsuo Tomita, MD San Diego Physician Editor: James Santiago Grisolia, MD CMA Past President: James T. Hay, MD CMA Past President: Robert E. Hertzka, MD (Legislative Committee Chair) CMA Past President: Ralph R. Ocampo, MD, FACS CMA President: Theodore M. Mazer, MD CMA Trustee: William T-C Tseng, MD CMA Trustee: Robert E. Wailes, MD CMA Trustee: Sergio R. Flores, MD CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MPH Sergio R. Flores, MD AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Mihir Y. Parikh, MD At-large AMA Delegate: Albert Ray, MD At-large AMA Delegate: Theodore M. Mazer, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD

MEDICAL ASSOCIATION

26 Physician Marketplace Classifieds

Saturday Surgery Day Launches New Health for Area Residents

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BY CHAMPIONS FOR HEALTH STAFF

BY HELANE FRONEK, MD, FACP, FACPh

JUNE 2018

GEOGRAPHIC ALTERNATE DIRECTORS East County: Heidi M. Meyer, MD Hillcrest: Kyle P. Edmonds, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County: Franklin M. Martin, MD South Bay: Karrar H. Ali, DO

Reaping the Benefits of an Anniversary

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

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

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

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/////////BRIEFLY /////////////////NOTED //////////////////////////////////////////////////////////////////////// CONFERENCE

CALENDAR July 27–29: Clinical Updates in Allergy and Immunology 2018, presented by Mayo Clinic School of Continuous Professional Development. Hotel del Coronado. www.ce.mayo.edu AUG 1–4: Metabolic & Endocrine Disease Summit (MEDS) for NPs and PAs. Physicians welcome.

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

NEPO Building Healthy Communities Summit, Sept. 13–15 in Pasadena Registration is now open for the 2018 Network of Ethnic Physician Organizations (NEPO) Summit. This year’s theme, Building the Best You: Celebrating the Joy of Medicine, will address issues of physician burnout and provide solutions to create a culture of wellness and physician wellbeing.

The 2018 NEPO Summit is a unique and exciting educational event for physicians, medical students, public health professionals and community leaders. The NEPO Summit will provide you with opportunities to learn about key health policy issues, building diversity in the workforce and increasing cultural competency in clinical care.

To register visit www.phcdocs.org.

ERRATUM

In the May 2018 issue of San Diego Physician, ASMG or Anesthesia Services Medical Group, Inc., was not recognized as a valued healthcare partner in the Champions For Health Annual Report “Thank you to Our Community Partners” on page 19. The excellent physicians of ASMG are integral to Project Access patients’ health and the success of the program overall. Champions for Health apologizes for this oversight.

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NEW ON-DEMAND WEBINARS

Legislative Advocacy Day 2018: This webinar reviews, in detail, CMA’s list of legislative issues and bills to be lobbied, effective advocacy tips, and other relevant program information.

MACRA and the Quality Payment Program: Dr. Wolfe reviews the details of the Quality Payment Program including a brief overview of the MIPS and APM pathways, details regarding Data Submission for the 2017 performance year, an overview of participation requirements for the 2018 performance year, and details on obtaining technical assistance.

Sugary Drinks – Using Grassroots Advocacy to reduce consumption: This webinar that will discuss how communities are working to pass and implement prevention interventions aimed at reducing sugary beverage consumption and how clinicians can lend their voice during the phases of these local campaigns.

All webinars can be found at: http://www.cmanet.org/resources.

ADVOCACY

Health Net to rescind modifier 25 and emergency services payment policies In March, Health Net notified physicians of planned changes to its modifier 25 and emergency services payment policies for Medicare and Medi-Cal lines of business. The California Medical Association (CMA) was opposed to these policies and has been working in coordination with many national and state specialty organizations to push back on the proposed changes.

Health Net has announced to CMA that it will not proceed with implementation of its modifier -25 and emergency services payment policies in California. Health Net will be sending out an official notice to physicians about the change. Additionally, Health Net has expressed a commitment to work with CMA and others to implement an educational program focused on providing data and feedback to physicians, as well as information on proper coding practices for emergency department services.

The policies at issue would have cut reimbursement of an evaluation and management service with modifier 25 by 50 percent when billed with a minor surgical procedure or a preventive visit (CC.PP.052 and CC.PP.057). Additionally, Health Net planned to implement a Non-Emergent Emergency Room policy (CC.PP.053), which would have reduced reimbursement for Level 4 (99284) and Level 5 (99285) emergency services to a Level 3 (99283) reimbursement rate if Health Net deemed the diagnosis was non-emergent.

Last month, at CMA’s urging, Health Net agreed to delay implementation of the new policies until July 1, 2018, to allow time to review provider concerns with the new policies and to continue discussions with CMA and other stakeholders.

CMA appreciates the collaborative dialogue with Health Net and its willingness to work with CMA and physicians to identify alternative strategies to address proper coding and cost concerns. We believe that Health Net’s decision reflects a growing recognition of the need for a different type of engagement between health plans and the physician community to improve health care quality, access and affordability.

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SAN DIEGO PHYSICIAN.ORG

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2018 White Coat Gala

An Evening Celebrating 148 Years of Healing 1

OUR ANNUAL GALA, presented by the San Diego County Medical Society and Champions for Health, brought together hundreds of physicians, their spouses and significant others, local, state, and national legislators, and other distinguished guests to celebrate the installation of our incoming president.

At the White Coat Gala, we welcomed David E. Bazzo, MD, as SDCMS president for 2018-2019 and thanked Mark W. Sornson, MD for his service as SDCMS president for 2017-2018.

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9 1. Santee Councilmember Brian Jones with his wife, Lisa, and Dr. Keerti Gurushanthaiah and Dr. Mihir Parikh. 2. Dr. Al Ray and his wife, Cheryl. 3. SDCMS Immediate Past President Dr. Mark Sornson with his wife, Dr. Caroline Thornton, and their daughter, Madeline. 4. Dr. Jim Schultz, winner of the 50/50 raffle.

Dr. Schultz donated his winnings to Champions for Health. 5. San Diego County Supervisor Chair Kristin Gaspar, Chandra Sharma, Jill Monroe and Cristi Knight. 6. SDCMS CEO Paul Hegyi assisting with the 50/50 raffle. 7. Dr. Kelly Keefe and Dr. Michael Keefe. 8. San Diego County Health and Human Services Director Nick Macchione and his wife, Lisa. 9. Guests mingling and enjoying the evening’s festivities. 10. San Diego City Councilmember Chris Cate and his wife, Maria. 11. Dr. Mark Sornson and Assemblymember Shirley Weber. 12. SDCMS President Dr. David Bazzo with family and friends.

13. County Supervisor Kristin Gaspar during her keynote speech. 14. Dr. Mark Sornson receiving his Past President medallion from Dr. Mihir Parikh. 15. SDCMS Presidents Dr. James Hay, Dr. Mark Sornson, Dr. Susan Kaweski, Dr. Mihir Parikh, Dr. Al Ray, Dr. Bob Hertzka, Dr. Rosemarie Johnson, Dr. Steve Poceta, and Dr. Will Tseng. 16. Daniel Trujillo, Maggie Meagher, Dr. Bob Hertzka, Athena Hsu, and Jonathan Cunha.

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SDCMS LEADERSHIP

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David Bazzo, MD SDCMS President

2018-2019 Gala Speech

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Welcome! It’s an honor to be standing here before you, especially in a year that coincides with UCSD’s 50-year anniversary. This is the first time a UCSD faculty member will be President of the Medical Society. Thanks to Mark Sornson and all the presidents that have come before me. They have laid the foundation that we stand upon. Thanks also to Bob Hertzka — he was far too generous with his introduction.

As with all of us, many people have influenced and set me straight through my life. They are mentors, coworkers, friends, and family. We are molded by our experiences, and, with any luck, embrace the best that we carry forward. I truly believe and embody this premise — but I’ll return to this theme with my thank-you’s at the end of my remarks. I promise, no more than 30 minutes from now! Just kidding!

I’d like to talk about a few themes tonight: famiglia, teamwork, giving back, and helping others. However, before we get to that, let’s start with the first rule — to always stay humble. Thanks, Bill Norcross, for teaching me that.

Many years ago the dean of Bill’s medical school, as a preventive measure against egotism and hubris, told this to his students: “When you have arrived at a place of supreme confidence and believe that you have learned everything about medicine, and that you are the best doctor in the world, cup your hands before you and imagine you hold solids, liquids and gases in that cup. Can you separate the fingers on the bottom to allow only the gases to escape? Of course, you cannot. But the anal sphincter can.” Remember this and you’ll be in good shape.

I got my start in the medical society as a member 20 years ago and have served on the Board for 10 years now. In 2008, Al Ray, Bob Hertzka, Jim Hay, Ted Mazer, and Bob Wailes had a meeting with me at a clandestine little diner near the Med Society. That was the “Famiglia”— the godfathers met with me that night, put their collective arms on my shoulder, and the journey began.

Their counsel, planning, and strategizing showed me the love they had for the Society and they wanted to confirm entrustability.

Again, an honor.

Despite medicine taking me all over the world from New Zealand to Canada, American Samoa to Europe, the important work is taking place here at home, here in San Diego and California.

Teamwork: I believe that Medicine is the noblest profession — we learn our patient’s deepest secrets, can help with life, and help with a noble exit. We are given a special place in society. But, I do have to point out that the average human being works eight hours per day, sleeps for eight hours per day, and does everything else (family, friends, hobbies, personal hygiene, etc.) for the remaining eight hours. Not only that, the average human being has Saturday and Sunday off.

You and I are not average people. Society’s expectations from us are not average. Taking care of people is great, but it’s not as easy as that. Since being on the SDCMS Executive Committee, I have learned that you can help one patient in the room, but you can help thousands with advocacy. We need our team around us to be most effective, and it’s all members of the team. This is an election year, and we need to have representation. We need to help our doctors stay in the room. We need our team to represent this November.

We also need to address burnout. Last year, we met with some of the leaders of large groups in San Diego. It started out as a dinner discussing various issues, but when the issue of physician wellness came up, the room lit up! We found common ground.

Through work with the UC San Diego PACE program, we’ve seen many doctors in distress, and our long-term goal became to look upstream. To highlight “upstream,” I share with you the parable of the children floating in a river. Three doctors happen upon this. The first jumps in and saves a child about to go over the waterfall. The second doctor saves a child in the rapids. The third asks, “Why are the children in the river in the first place?”

There are three things to consider when looking at helping doctors: 1. Connections: personal, frequent, and genuine relationships are essential.

2. Individuals, and also institutions, have a role in supporting providers to build and maintain resiliency in our professional lives.

3. Well-run systems, continually refined, are an investment worth making in order to improve a physician’s experience and performance.

As it turns out, research suggests several elements are predictive of physician resiliency and an increased ability to maintain constructive progress in the face of challenging times.

One factor is mindfulness — the develop-

(L-R): Dr. Michael Moreno, Dr. David Bazzo, and Dr. Lee Ralph

ment of skills in self-awareness not only to notice the times when our stress is rising so that we can invest in ourselves to respond more optimally to the challenge at hand, but also to identify and improve upon the maladaptive processes in our systems that erode our sense of purpose and sap our stamina.

Second is a connectedness that allows us to get advice on the management of a complex patient, to process together the experiences we have in doing the work of medicine, and a connectedness that gives a deep sense of support and love from the people in the world around us, so that we are cared for.

The third element is a sense of permission, a sense that we physicians, too, require and deserve healing — it’s not just for our patients. And further, imagine organizational cultures where wellbeing is a celebrated foundational value as suggested by the Quadruple Aim. How do we benefit from developing these skills as a part of medical practice? As a part of institutional culture? The answer: We are better doctors … more empathic, more emotionally available to our patients. We commit fewer errors and provide a higher quality of care. We are less likely to be impaired, less likely to leave practice early or reduce our hours at a time when the primary care workforce is strained and under-resourced.

Simply put, physicians who care for themselves do a better job caring for others.

And so this is my ask of you: What can you do individually to cultivate mindfulness, connectivity, and the permission to take action in the work you do? Take a mindfulness class, begin practicing meditation, and take a breath to clear your mind before you open the door for each patient.

In addition: As leaders, what can we ask of our organizations that will transform culture? Support a Balint group for your colleagues or provide personal- and professional-development sessions for pro-

viders; facilitate meetings that build trust and safety; provide sessions on mindfulness as CME course offerings, open an employee gym, deploy effective wellness programs, right-size expectations to time allotted, build EHRs with a lens for reducing the isolation they bring.

I ask you to take action. Connect with the amazing SDCMS and CMA tribe here in this room and back at your practice. Plan how you will lead outside this room to promote the resiliency that we all seek to be the best physicians possible: for our patients, for our loved ones, and for ourselves.

We’ve already committed two meetings to this end: From CMA, Dustin Corcoran, CMA CEO, Alicia Sanchez, CMA senior vice president, Tait Shannefelt, Stanford chief wellness officer, and his colleague Mickey Trockel to help us. And our local committee includes Lase Ajay, Robert Bonakdar, Lisa Miller, Jim Hay, Arlene Morales, Miranda Sonneborn, Danny Valentine, and Tom Savides. Stay tuned as this is only the beginning of something great.

Thank you to my mentors, colleagues (doctors and staff), friends and family (here and not). Many are here tonight including Bill Norcross, Tyson and Lydia Ikeda and all my staff. Also all of the staff at PACE, and colleagues at UCSD where I’ve spent my career. The SDCMS board of directors, the staff at SDCMS: Paul Hegyi, special thanks to Jen Ohmstede, Brandon Ethridge, Hanna Basler, Sue Fledderjohn, also a shout-out to Tom Gehring. Family and friends: Jim, Sara, Derry, Cole, Nick, Brandon, Rob, Eli, and Mara. And, family in my heart: my fatherin-law, Mom and Dad. Bob, are we done?

Oh yeah, I can’t forget my rock: my wife, Sabrina. She shares with me a strong sense toward volunteerism to help make our surroundings — and us — better. I love you and couldn’t have anyone better in my life.

SAN DIEGO PHYSICIAN.ORG

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SDCMS LEADERSHIP

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Mark Sornson, MD SDCMS Immediate Past President

2017–2018 Gala Speech

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ood evening! It has been an incredible experience to serve as your president this past year.

Advocacy for doctors and on behalf of our patients is our core mission, and to have taken part in our efforts this last year and help where I could has been an experience I will forever treasure.

One thing that particularly stands out is the advocacy legacy of Anne and Madison, UCSD medical students who three years ago tragically lost their lives in a head-on collision with a drunk driver. Their medical student friends, with the support of the medical society and CMA, fought for the passage of a bill that mandates additional training of bartenders to prevent DUIs. AB1221 was successfully passed and signed

by Governor Brown. This bill will save lives.

We fought to recover more than a billion dollars of Proposition 56 funds that were placed in the general fund instead of increasing MediCal reimbursements. This will help doctors care for our underserved.

When hepatitis A threatened San Diego, we in the medical society along with local physicians, community clinics, healthcare systems, and county health responded. We were successful because of our teamwork.

Paul Hegyi, our CEO, and I have had more than 20 outreach meetings this year to build bridges. The next time our community health is threatened, we’ll be even more nimble. Along with this effort, we’ve aided a transition for Champions for Health.

Executive Director Adama Dyonisiak is filled with passion for her mission. Make sure you say hi to her, purchase one of the 50:50s, and show your support!

Our advocacy efforts continue today with AB 3087. This terrible bill is before the legislature right now. It would set arbitrary price fixing for physicians and hospitals, restrict access, and compromise quality of care. Dave and I, with Bob Hertzka, Paul Hegyi, the Executive Committee, SDCMS colleagues, and medical students went to Sacramento two weeks ago to educate our legislators on what a devastating effect it would have. We could not fight this without the support our SDCMS members give.

So, at this moment I would like our SDCMS members in the audience to stand … Thank you, I recognize you and am humbled and proud to be part of the organization that

you make great.

I could not have led SDCMS this last year without the strong support of my family … my parents and in-laws are here tonight. I’d like to especially recognize my wonderful wife, Caroline, and daughter, Madeline, who have been so patient with the time demands. I’d like to thank Paul Hegyi, SDCMS CEO, who has been the finest partner we could ask for to advocate for physicians. The staff at SDCMS — you’ve all been incredible! Also, during this year our own Ted Mazer has been President of CMA, a great role model! Bob Hertzka, who has taught us all so much.

And Dave Bazzo, incoming president, from UCSD at the time of the UCSD School of Medicine’s Golden anniversary.

He is already doing amazing things to improve wellness and prevent burnout among physicians, coordinating in San

Diego and across the state. His presidency is going to be one to watch and remember!

I’d also like to thank my Sharp ReesStealy leadership, especially our Chief Medical Officer, Steven Green, and President Alan Bier, who have been so supportive of my time in the medical society.

And, I’d like to bring particular attention to Mike Murphy, the CEO of Sharp Healthcare. Some in the audience may have heard that he has announced his upcoming retirement. I could go on in depth about his incredible personal accomplishments since becoming CEO of Sharp Healthcare in 1996. He has such a reputation within and outside of Sharp that when we see him around Sharp, we can’t help but internally hear a cue for celestial music. But whenever we try to offer any personal praise, he redirects us. As in my invitation email to this event, when I

said how much he will be missed at Sharp and he replied, “You are very welcome. For anything I do, I am honored and humbled to work with all the amazing people at Sharp, thanks for all you do!” Throughout his years at Sharp he has tirelessly promoted the Sharp Experience, focusing on Seven Pillars of Excellence: Quality, Safety, Service, People, Finance, Growth, and Community. These stand for what we physicians as a service industry need to highlight in everything we do. But, in addition to motivational Pillars to support the highest quality care, you need someone to champion them and spread these ideals both within and outside of Sharp.

You need an Atlas to help the Pillars support everything that they stand for. So it is also my great honor and privilege to announce Mike Murphy as the recipient of the SDCMS Atlas award for 2018!

Left: Dr. Sornson accepting the “Live Well San Diego Partner” award on behalf of SDCMS. Above: Dr. Sornson presenting the SDCMS Presidential “Atlas Award” to Mike Murphy.

SAN DIEGO PHYSICIAN.ORG

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P H Y S I C I A N VO LU N T E E R S

Volunteering with Global Health Teams In Rural Haiti

By Alexandra Myers, DO

THE PRACTICE OF MEDICINE offers numerous opportunities and challenges. One of the great opportunities is to connect with people from other cultures and countries.

In the past several years we’ve both had the honor to work in Leon, Haiti with Global Health Teams (GHT, formerly known as the Seattle-King County Disaster Team). GHT began going to Haiti 20 years ago initially to help their members develop skills in responding to a domestic disaster, but the experience in Haiti transformed their directive. The group decided to continue going

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back to Leon to set down roots in a clinic and serve the Haitian people with large clinics each February, June and October. Over the years, GHT has expanded its reach to two other locations in southwestern Haiti: Abricots and Castillon. Clinics are also offered in those locations in April and October.

Located in the mountains of southwestern Haiti, Leon is a beautiful place with unfortunate circumstances. It is no more than a dirt road in the middle of the forest, about an hour’s drive from the nearest city, Jérémie.

Most of the inhabitants of the Leon region

are subsistence farmers. Their livelihoods are subject to the whims of nature. Natural disasters like the earthquake in 2010 and Hurricane Matthew in 2016 devastated the region. Access to basic services is limited, and medical care is sparse.

Thankfully, through a public/private partnership, GHT has been able to provide consistent medical care to the region for 20 years. A clinic building was developed and is funded through GHT as well as a Catholic parish in Maryland. The government provides funding for a nurse and sometimes a physician in the clinic year-round. For all of the various clinic locations, GHT organizes nine separate week-long trips with 6-9 providers. The providers include MDs, DOs, PAs, NPs, RNs, clinical laboratory scientists, paramedics, and EMTs. A mix of provider specialties including emergency, family and internal medicine are welcome and contribute to the effectiveness of the teams. There is a role for everyone on the team from intake to evaluation and management of patients.

People interested in volunteering on trips to Leon often have many questions - where do we stay? What can we do for the patients in such an austere environment? How do ensure our safety on the trip?

Thankfully, GHT is more than prepared on each trip. Each medical team meets in Miami and travels together through Port Au Prince to Leon. The teams have a designated leader and team physician. Orientation on safety, security, clinical practice and cultural information is provided both prior to the tip as well as before starting work in country.

In Leon, the team stays in a part of the local parish rectory that has running water, clean drinking water, and delicious home cooked meals. Medicines, extensive laboratory testing, and diagnostic ultrasound are available for use with the patients. About 1000 patients are seen each week – providers working with a local interpreter see about 40 patients a day on average. Each patient is given quality personalized care, much like what we strive to give here in the U.S. The team leader organizes travel between each site, and safety is a top priority for each trip.

If there is instability in the region from either a natural disaster or political turmoil the team leader may alter travel plans.

With that said, the importance of what GHT does goes beyond the details of the trip.

Each mission allows providers to connect to why they decided to practice medicine.

No one pursues a career in medicine to work on an EMR. People desire to help others and connect to humanity, and that is exactly what happens in Haiti.

Dr. Myers works at San Diego Sports Medicine & Family Health Center where she also completed her Sports Medicine Fellowship. She also completed an undergraduate teaching fellowship in osteopathic manipulative medicine at Western University, where she learned to incorporate osteopathy into the care of all of her patients. Dr. Myers completed her undergraduate studies in Biology and Spanish at Cornell College and is bilingual. She works with Global Health Teams annually in Haiti, and travels to Mexico regularly with Liga International and Flying Samaritans. More information is available at doctormyersdo.com.

We encourage you to consider volunteering with GHT in Haiti.

It is a life changing experience that is inspirational, eyeopening, and transformative.

Please don’t hesitate to contact either of us or our local board member Bob Downey regarding opportunities in Haiti.

Alexandra Myers, DO alexandramyers10@gmail.com Bart Smoot, MD charless@fhcsd.org Bob Downey bob@globalhealthteam.org

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CMA MEMBER HELP LINE! Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262

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C H A M P I O N S F O R H E A LT H

Saturday Surgery Day Launches New Health for Area Residents THE ROAD TO GOOD HEALTH and resuming a normal life began for seven San Diegans on April 21, 2018. The surgeries they received by volunteer physicians and staff through Project Access San Diego have now helped them begin that journey.

Project Access San Diego, the flagship program provided by the Champions for Health, has touched nearly 6,000 people through care offered by San Diego-area

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volunteer specialty healthcare physicians.

This program of engaged volunteerism includes more than 600 physician volunteers who donate their time to improve health and wellness in the San Diego region.

Area residents are able to access care via referrals from their community clinics to Project Access staff to determine eligibility for the program. Specialists who volunteer provide care in their office and in surgery

facilities.

The Carlsbad Surgery Center was the site of April’s care, where professionals from the center voluntarily staffed two surgical suites for the day. Surgeon Adam Fierer, MD, and Dhruvil Gandhi MD, a colorectal surgeon, performed surgeries and colonoscopies.

Champions for Health Executive Director Adama Dyoniziak says about the atmosphere in the center: “I can’t describe it any other way than to say how much joy there is here today. The patients and their families, the staff, all of the volunteers are just joyful.

The patients are regaining their health, their families are regaining their loved ones, and the staff and physicians are truly doing what they intended when they became healthcare providers — to help others.”

The patients expressed their joy in their stories. To many, having a hernia repair is minor and, when completed in a timely manner, quickly gets them back to functioning normally. But one of the patients has been dealing with a hernia for 10 years.

With this repair, he will get back to active life with his soccer- and tennis-playing daughter, and have fewer limitations at work. He thanked his doctor and everyone who has cared for him, saying, “I have

never met angels until now.” Other patients expressed relief in knowing they do not have cancer, gaining back energy to be with their children and grandchildren, and being able to pursue goals such as opening a business.

The physicians, Drs. Fierer and Gandhi, joined Project Access to help others close to home. Both volunteered as soon as they heard about the program through fellow physicians who were also volunteers. “I always wanted to go on a mission trip to help others, but it is really difficult for me because of my practice here,” Dr. Gandhi said between his cases. “Helping through Project Access is something that I can do, and really helps people in my own community.”

Staff of the Carlsbad Surgery Center, and even staff who previously worked there, volunteer to help without hesitation, says Jennifer, the center’s manager: “At the Center, we feel this is a time for giving back. We are a small family here, so helping

Since it began, Project Access has transformed the lives of nearly 6,000 local people from pain and dire medical diagnoses to health, renewed family involvement, and productive work and community life.

with this reinforces our ideal of family and giving back to the community.”

The Center has been a surgery site since 2011, providing space, staff, equipment, and supplies for each case. High school and college student volunteers, who are children and friends of the staff, have been volunteering for the day as well. Sheila, a Center RN who has helped since the start, also brings her daughter, now a sevenyear veteran who’s heading into a nursing career herself.

Since it began, Project Access has transformed the lives of nearly 6,000 local people from pain and dire medical diagnoses to health, renewed family involvement, and productive work and community life. Project Access’ work was recognized in April 2018 by the County of San Diego Health and Human Services Agency when it received a Live Well San Diego 17th Annual Public Health Champion Director’s award.

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L E G I S L AT I V E S U C C E S S

CMA Defeats Dangerous RateSetting Proposal AB 3087 Would Have Decimated California’s Healthcare Delivery System

IN LATE MAY, the California Medical Association (CMA) killed a reckless legislative proposal that would have put a new government bureaucracy in charge of healthcare.

Assembly Bill 3087 (Kalra) would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all healthcare services in all clinics, hospitals and physician practices in California. By unilaterally setting the price for all medical services, the bill would have essentially eliminated the commercial healthcare market in California.

Due in large part to staunch opposition led

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by CMA, the bill died in the Assembly Appropriations Committee.

“No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every healthcare service,” says CMA President Theodore M. Mazer, M.D. “Had this bill passed, it would have reversed the historic gains for health coverage and access made in California since the passage of the Affordable Care Act.” Since passage of the ACA, the state’s uninsured rate has dropped to an all-time low of 7.1 percent.

A Groundswell of Physician Opposition Key to the bill’s demise was a groundswell of physician opposition. Through CMA’s Grassroots Action Center, thousands of physician members contacted their legislators because AB 3087 would have: • Decimated California’s healthcare delivery system • Disrupted care and limited choice for millions of California patients • Caused 175,000 healthcare workers to lose their jobs • Forced hospitals to close and pushed healthcare providers into early retirement • Caused a “brain drain” of talented medical students and residents fleeing California for more ideal working conditions The Wrong Answer to a Real Problem This poorly conceived legislation would have done nothing to solve the fundamental problems of the healthcare payment system.

“Simply setting physician rates without addressing the rising cost of providing care will do nothing to address healthcare spend-

ing,” says San Francisco pediatrician Shannon Udovic-Constant, M.D., vice chair of the CMA Board of Trustees. “AB 3087 would have driven a lot of physicians out of our state, and it doesn’t address the underlying reasons around rising healthcare costs in our state.”

This dangerous rate-setting proposal would have also moved California away from value-based care and universal access backward to an antiquated fee-for-service model that discourages contracting and stifles innovation. Instead of addressing the underlying issues, this bill would have forced hospitals to close, pushed healthcare providers into early retirement and caused a “brain drain” of talented medical students and residents fleeing California for more ideal working conditions.

Medicare Should Not Be a Benchmark for Costs AB 3087 would have required the commission to cap prices for commercial payments for all services to Medicare rates, which is a fundamentally flawed approach that does not address coverage and benefits or the costs to provide care. Medicare was created to reimburse medical services for an age-specific population based on federal budgetary and regulatory constraints.

Medicare rates do not keep up with inflation or the cost of running a practice. Adjusted for inflation in practice costs, Medicare physician pay has declined 19 percent from 2001 to 2017, or by 1.3 percent per year on average. Medicare rates are not intended to represent the fair market value of healthcare services. Rather, they fluctuate based on variables unrelated to the services provided, such as the federal budget.

AB 3087 Did Not Address Medi-Cal Rates Medi-Cal is the largest Medicaid program in the nation, with 13.5 million people — about one-third of the state’s population — enrolled in the program. And yet, California still pays among the lowest reimbursement

rates of all 50 states, creating a serious access issue for patients.

California’s Medi-Cal rates don’t come close to covering the cost of providing care — meaning that physicians lose money for every Medi-Cal patient they serve. Due to low Medi-Cal rates, physicians must make up revenue through their commercial contracts to keep their doors open. Because the AB 3087 proposal did nothing to address California’s substandard Medi-Cal rates, hospitals and healthcare providers would have continued to be underpaid by these governmental programs, putting them in an untenable situation.

AB 3087 Would Have Driven California’s Physicians Out AB 3087 also ignored the recommendations from the University of California, San Francisco’s report — commissioned by the Assembly — to achieve universal access to healthcare, which includes implementing a comprehensive strategy to overcome the physician workforce shortage in the state by removing barriers that prevent physicians and other clinicians from specializing in primary care and practicing in underserved areas.

Currently, six of nine California regions are facing a primary care provider shortage, and 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. The state needs 8,243 additional primary care physicians by 2030 — a 32 percent increase.

“AB 3087 would have caused an exodus of practicing physicians, which would exacerbate our physician shortage and make California unattractive to new physician recruits,” says Dr. Mazer. “When I look at the economics of my own practice, it’s enough to tell me that I could not survive that environment and continue to see Medi-Cal patients.

And probably at this stage of my career, it would drive me out of practice earlier than I might otherwise.”

The bill also operated on the false premise that the cost of professional services — in

other words, what physicians and hospitals charge for their services — is what’s behind the increase in healthcare spending in California.

Data shows, however, that the price of prescription drugs and increases in healthcare utilization are what’s driving healthcare spending growth. Professional services had relatively low impact on spending growth.

In fact, nationally, California had lower than average annual growth in per capita spending on physician and clinical services over the past 20 years. The primary driver of spending on doctor visits is increased utilization, not price.

“Physicians want real solutions to these problems too,” says Valencia Walker, M.D., chair of the CMA Council on Legislation.

“We remain focused on real solutions that would protect the access and coverage gains made under the ACA, further value-based care, ensure patients can access healthcare in a timely and affordable manner, and tackle California’s healthcare workforce shortage.”

California Physicians: Thank You for Your Support “I want to thank each of you for your support and dedication to CMA,” says Dr. Mazer. “We could not have dealt this bill such a resounding defeat without the united voices of our physician members. Together, we stand stronger.”

CMA applauds the Assembly for recognizing that this deeply flawed legislation would result in enormous costs to the state and restricted access to care for millions. CMA remains fully committed to working with stakeholders on a practical solution that addresses the affordability and accessibility of healthcare in California.

Join the Fight to Protect Medicine Your voice is key to our success. All you need is the desire to make an impact, and CMA will give you the rest. Join CMA’s Physician Advocate Program today! Learn more at www.cmanet.org.

SAN DIEGO PHYSICIAN.ORG

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

Physician Learning Must Evolve to Keep Healthcare Workforce Prepared

By Eric Barna, MD

IN MEDICAL SCHOOL, students are trained on skills that will make them better future physicians, team members, and caregivers.

It’s a curious thing — once we make headway into our medical careers and our days are filled with patient visits and paperwork, we rarely have the opportunity to assess our skillsets in the same way, despite the fact that new technologies and approaches to treatment have emerged since many of us attended medical school.

As a hospitalist at Mount Sinai Hospital in New York City, I’m part of a team that cares for moderately to severely ill patients at a major academic institution. I’m also a physician adviser, and I have the pleasure of teaching some of the youngest and brightest medical students, interns, and residents at various stages of their careers. I consider this the best part of my work, so I’m sure it comes as no surprise that I’m a firm believer in the importance of continuous learning.

That’s why I was so excited when I had the chance to participate in three standardized patient (SP) encounters training designed for me and my 22 hospitalist colleagues to improve our communication skills, funded by a grant from The Doctors Company Foundation. A standardized patient encounter is essentially a live simulation in a clinical setting with trained actors.

To start the simulation, a physician is given a short prompt about the patient scenario.

They may also be provided with some basic

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information such as a diagnosis or a relevant imaging study prior to entering the room.

Once the testing center provides a signal, physicians are allowed to enter the room. An introduction of our role on the medical team is provided and a discussion ensues. The actors provide relevant history, incorporate true emotional response to questioning and display any behavioral or physical prompts that a real patient would. This allows physicians to react in real time to the needs of the patient. The use of standardized patients can also be adapted to desired testing scenarios, whether in the realm of communication, clinical reasoning, or establishing a differential diagnosis.

Like many hospitals, we have a program in place aimed at assessing how we educate students and younger physicians. But Mount Sinai is the first hospital in New York that has established a program designed specifically to assess and address some of the unique communication challenges we face as hospitalists to improve patient care.

As hospitalists, we’ve never met patients or families before beginning conversations at critical points of care. It takes sensitivity and particular thoughtfulness to create rapport and share substantial information with a patient — without having a prior relationship.

Through the training, my colleagues and I each encountered three different SPs in key scenarios: one at daily rounds, one upset over a missed diagnosis, and one at discharge,

when the potential for errors and miscommunication is greatest. We were video recorded during the encounters for our personal review, and received direct feedback afterward from the patient.

We discovered that we as physicians have become great at taking care of patients, but we don’t have enough opportunities to investigate which elements of our day-to-day communication need adjustment—or what good behaviors need reinforcing.

It was extremely helpful for us to be able to watch the videos and ask ourselves, “Do I use medical jargon that’s hard for the patient to understand? Do I say things that aren’t warm and welcoming to the patient?” Then, by adding in patient feedback, we learned how we performed across these core domains, such as treating patients with courtesy and respect, listening skills, and explaining complex topics in an understandable way.

Strengthening these individual communication skills is paramount to improving patient comprehension, which in turn can improve patient follow-though on discharge instructions and reduce risk of readmission.

And as educators, our takeaways from the training can empower others in the healthcare system at large to better communicate with their patients.

Mount Sinai is proud to spearhead this innovative training effort in New York. In fact, since the initial date of the training, the three modules have expanded into a program

run by The Morchand Center for Clinical Competence at the Icahn School of Medicine at Mount Sinai. So far, the Morchand Center has adapted the SP methodology for hospitalists to train 1,845 additional residents in various specialties across New York City.

Nationwide, the entire medical community stands to benefit from continuous physician learning and partnerships that facilitate it, like The Doctors Company, which makes trainings like this possible. At a time of tremendous change for healthcare, having a well-trained physician workforce is more important than ever before. Our patients deserve to be cared for by physicians whose knowledge evolves alongside the transformation of care delivery.

Physician learning must keep pace with our industry’s transformation. By setting the bar higher for what patients should expect on a patient communication level, we increase patient safety, raise levels of patient satisfaction and drive quality care — no matter what the future of healthcare delivery looks like.

Contributed by The Doctors Company (thedoctors.com) Dr. Barna is associate residency program director of Inpatient Medicine, Division of Hospital Medicine/Samuel Bronfman Department of Medicine at Icahn School of Medicine at Mount Sinai Hospital.

CMA MEMBER HELP LINE! Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262

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C U R E S U P DAT E

CMA Publishes Safe Prescribing Resources for Physicians

Are You Ready to Check CURES? Starting Oct. 2, all physicians must consult database before prescribing controlled substances. BY KATHERINE BOROSKI

E

ffective Oct. 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) — prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish, or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload.

On April 2, 2018 — two years after the law was enacted — DOJ finally certified that CURES was ready for statewide

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use. The certification began a six-month transition period, with the duty-to-consult taking full effect on Oct. 2, 2018.

What Physicians Need to Know Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering, or furnishing of a controlled substance to the patient.

The California Medical Association (CMA) has published a membersonly resource page to provide physicians with the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction, and overdose.

The page includes two CMA white papers on opioid prescribing, links to CMA’s health law library resources on the topic, the Medical Board of California’s “Guidelines on Prescribing Controlled Substances for Pain,” a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state’s prescription drug monitoring database.

Members can find the page at cmanet.org/ safe-prescribing.

The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed a five-day supply.

Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are: • Admitted to a facility for use while on the premises; • In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply; • As part of a surgical procedure in a clinic, outpatient setting, health facility, or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or • Receiving hospice care.

In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational, or the database cannot be accessed because of technological limitations that are beyond the control of the physician.

“CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed a fiveday supply.”

CMA Fights for CURES Protections CMA worked closely with the bill’s author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 482, Lara). Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that healthcare providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that healthcare providers sharing

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the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.

Save the Date: CURES Webinar With DOJ on 8/22 CMA will be cohosting a live CURES webinar with DOJ on Aug. 22, 2018. The webinar will be free to all interested parties.

Registration will open soon at cmanet.org/events.

For More Information For more information, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA’s online resource library at www. cmanet.org/cma-on-call.

Nonmembers can purchase documents for $2 per page.

Additional Resources: • CURES website: oag. ca.gov/cures • CURES FAQ: oag.ca.gov/ cures/faqs • Medical Board CURES webpage: mbc.ca.gov/cures • CMA CURES webpage: cmanet.org/cures • CMA Safe Prescribing webpage: cmanet.org/safeprescribing CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement. Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov.

Ms. Boroski is senior director of communications for the California Medical Association.

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New Report Shows California’s Progress Addressing Opioid Crisis

“The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California’s Controlled Substance Utilization Review and Evaluation System (CURES) database, number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid use disorder, and naloxone access.”

The American Medical Association (AMA) recently issued a new report documenting how California’s physician leadership is advancing the fight against the opioid crisis. The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California’s Controlled Substance Utilization Review and Evaluation System (CURES) database, number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid use disorder, and naloxone access. California also saw two consecutive years of decreases in prescription-related opioid deaths and surpassed the national average for prescription decreases between 2014 and 2017.

“This report demonstrates that California physicians have made significant strides against the opioid crisis by expanding access to effective treatments for substance use disorders,” says California Medical Association (CMA) President Theodore M. Mazer, M.D. “CMA will continue to lead the nation in implementing effective solutions to reduce opioid abuse and ensure that patients have timely access to medically necessary treatment.”

For more details on the report, visit end-opioidepidemic.org.

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

Requirements: MD with Directly Related Experience in Family Medicine, DEA Certificate, Eligible to Work in the United States, CA Medical Licensure, Exceptional Communication and Interpersonal Skills (POSTED 3/28/2018) Contact: Careview Medical Group, Inc, 292 Euclid Ave, Suite 210 619-262-7523 press#1

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

Borrero Medical Group is a well-established practice, 22 years in the community, exceptional office staff.

Every member of our team plays an important role in improving the health of our patients. We offer an excellent comprehensive benefits package that includes Malpractice Coverage, Health Insurance, Competitive & Attractive Salaries, and Bonus. If interested, please submit inquiry and CV to rosa10borrero@att.net.

PART TIME PHYSICIAN: Progressive Medical Specialists is an outpatient medication assisted treatment program located in San Diego, CA. We are currently in need of a part-time Physician to work 1 - 3 days per week. The Program Physician is responsible for providing the day-to-day medical care and treatment for all program patients. The Program Physician performs all duties in compliance with the California Code of Regulations for Narcotic Treatment Programs. Training is provided. Please send your CV to tboylan@pms911.com or call 619-286-4600. 12/5 PRACTICE FOR SALE

PHYSICIAN POSITION AVAILABLE: San Diego area; Out-patient only, Primary Care position; No calls; No hospital and no weekends; Email: sandiegoprimarycare@yahoo.com (Posted 3/28/2018)

HIGHLY PROFITABLE MEDSPA NOW AVAILABLE TO LICENSED PHYSICIAN: Southern California | Asking Price: $1,050,000 | Cash Flow: $410,419 | This profitable and expandable company performs noninvasive cosmetic procedures, including dermal fillers, Botox, and laser treatments. Experienced staff plans to stay, and protects current physician/owner at 30 hours/ week max. If you’re ready to see online financials, a studio-quality video of their story, an industry-leading assessment, and more – visit: https://goexio.com/ med-spa-landing-sd for a summary. Interested? Click on “Private Access” to sign an instant nondisclosure and unlock the entire story. Full financials available on request. Prefer a personal touch? Contact Doug Miller: 208-762-3451. doug.miller@goexio.com.

PHYSICIAN POSITIONS AVAILABLE: A fulltime position is immediately available for a Primary Care/ Long Term Care physician at the Veterans Home of California - Chula Vista. Employment is through the State of California within the California Department of Veterans Affairs (Calvet). Training in primary care (Internal Medicine or Family Practice) is required and additional experience and/or training in Long Term Care Medicine or Geriatric Medicine is preferable.

Salary range is $17,113.00-$19,969.00/month. Benefits package includes, but is not limited to, vacation, CME, medical, dental, vision and pension. For more information or to apply please use the following URL at http://bit.ly/2BPKDFK (Posted 2/21/2018)

OB/GYN PRACTICE FOR SALE IN SAN DIEGO: ASKING $480,000,00. FY 2017 Gross $1,445,688,00.

Established practice for 38 years. Suburban district.

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

FAMILY PRACTICE MD / DO needed for urgent care and family practice office in Carlsbad. Flexible afternoon, evening and weekend shifts available for family practice physician. Exceptional office staff and flexible scheduling options at this busy, well-established private practice. Please fax or email CV to (760) 603 7719 or gcwakeman@sbcglobal.net.

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

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

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

We could explore a purchase, partnership, and/or other business relationship with you. We have a track record in creating attractive lifestyle options for our medical providers and will do our best to tailor a situation that addresses your need. Please call 858-832-2007.

PRIMARY CARE PRACTICE WANTED: I am looking for a retiring physician in an established Family Medicine or Internal Medicine practice who wants to transfer the patient base. Please call 858-257-7050 OFFICE SPACE / REAL ESTATE AVAILABLE OFFICE SPACE AVAILABLE IN MISSION VALLEY: Unique space for lease in Mission Valley. 1300 sq. ft office space in medical/surgical office building, single story, ample free parking. Is currently in use

TO SUBMIT A CLASSIFIED AD, email Editor@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

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

Suites ranging from 1,300-5,000 SF. For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org as physical therapy suite with reception area, small waiting room, private treatment room, separate office, bathroom in suite and hook ups for washer/ dryer. Easy access to all freeways. Available approximately August 1, 2018. Please contact Joan McComb,Executive Director, CA Orthopaedic Institute.

619-291-8930 or cell 619-840-0624.

NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista, CA 92083. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, décor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele. Just a few blocks from Tri-City Medical Center and across from the urgent care. Includes: Digital X-ray suite, multiple exam rooms, access to a kitchenette/ break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is NOT included.

Contact Harish Hosalkar at hhorthomd@gmail.com or call/text (858) 243-6883 (Posted 6/11/2018) SHARED OFFICE SPACE AVAILABLE: Established orthopedic group seeks additional orthopedic surgeon for partnership or overhead sharing opportunity.

Our office is centrally located in Kearny Mesa near Highway 163 and Balboa, easy access to freeways, affiliations with Sharp, Scripps. Extensive referral base, EMR/”paper-light” office, experienced MA/ surgery scheduler/referral coordinator. Please call Lisa Vaughn, practice administrator, at (858) 278-8300 or email lmvomg@yahoo.com. (posted 5/7/2018) LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave-great location by the front of the main entrance of the hospital between 1-5 and 1-805.

Multidisciplinary group and available to any specialty.

Note we are in great need of a psychiatrist. Excellent referral base in the office and on the hospital campus.

Please call (858) 455-7535 or (858) 320-0525 and ask for Sofia or call Dr. Shurman, (858) 344-9024. (Posted 4/4/2018) SCRIPPS ENCINITAS CAMPUS OFFICE 320 SANTA FE DRIVE, SUITE LL4 It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and ½ mile from Swami’s Beach. Contact Kristi or Myra 760-753-8413. View Space on Website: www. eisenhauerobgyn.com. Looking for compatible practice types. (Posted 4/4/2018) MEDICAL OR DENTAL BUSINESS SPACE AVAILABLE: For lease a medical or dental related practice or business in a small boutique office space located in the center of “Hillcrest/Bankers Hill” Just renovated! The second story of this beautiful two story building is available for lease. A private gated entrance leads to a 1,139 square foot upstairs with 4 to 5 consultation rooms, waiting room with adjoining private deck and full bathroom. Additional security gate and mailbox. Separate address. Wood floors,

refinished windows, natural light, quiet street, walkable to restaurants. On-site parking with up to 8 parking spaces available! Asking: $3,000/month. Terms are negotiable. This will rent fast so hurry! Click For Photos. Please contact: hillcrestofficerental@gmail. com 858.775.5075 OFFICE SPACE FOR RENT: La Jolla -- lease medical or dental related practice or business in a small boutique office space located in the center of beautiful La Jolla, California. Perfect opportunity for psychiatrist, psychologist, counselor, dentist, physician, surgeon, any dental or medical related occupation welcome. Located in medical dental building. Come join these great practices. 612 Sq feet, classy second floor suite with elevator. Perfect for entrepreneur. Partially equipped for dental practice, surgical practice. Terrific opportunity. $4.90 Per sq/ ft per month triple net lease contact Kevin Gott : dynamold@aol.com (Posted 3/22/18) OFFICE SPACE/REAL ESTATE AVAILABLE: Furnished office space with licensed surgical center available for full or part time rent. Location 8705 Complex Drive in Kearny Mesa. Call 858-715-1822.

(Posted 2/27/2018) SOUTH BAY OFFICE SPACE AVAILABLE: Monthly sublease, 3 exam rooms, medical office, 5 days per week. Reasonable rates. Directly across from Scripps Mercy Hospital, Chula Vista. If interested, please call, 619-422-2000. (Posted 2/21/2018) OFFICE SPACE AVAILABLE: Rent by the hour, day, week, month. Reasonable rates. Free parking. Quiet office building. Free Wi-Fi. Perfect for Consultants, Therapists, CPA’s/Bookkeepers, Web Designers, Real Estate, Insurance, Meetings, Etc. Located in central east county. Referral Potential. Please call Marlene at: 619401-1430 or e-mail: saben615@sbcglobal.net (Posted date 2/21/2018) MEDICAL OFFICE IN SOUTH BAY AVAILABLE TO SUBLEASE: Located next to Paradise Valley Hospital, this large, recently renovated office consists of 6 exam rooms and 1 procedure room. The office is currently utilized by Orthopedic Surgeons and a Cardiologist, but can accommodate any practice. Facility provides easy access the PVH Operating Room, Physical Therapist, Imaging Center, Laboratory, and Wound Care Center and has easy freeway access. Opportunity for Orthopedic ER Call at Paradise Valley Hospital and patient referrals. For more information, please contact Jeff Craven: jeff@sdmiortho.com or 858-245-9109 (Posted 2/21/2018) SHARED OFFICE SPACE AVAILABLE: Office space, beautifully decorated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist.

Please call 619-606-3046 (POSTED 2/14/2018) OFFICE SPACE AVAILABLE –LA JOLLA UTC AREA: Looking for like-minded professionals interested in a small furnished office space a couple of days a week/ part-time basis. Modern design. For details and pricing, Contact Newshaw at 866-277-3659 and visit our website www.kaizenbraincenter.com for information about our practice.

MEDICAL OFFICE SPACE, SUBLEASE HM POOLE BUILDING SCRIPPS LA JOLLA CAMPUS: Very attractive, comfortable suite with two offices, two exam rooms and two person receptionist area, and beautiful waiting room. Excellent location on the campus of Scripps Memorial Hospital La Jolla. Large windows with open, peaceful garden views, available for full time rental with the option to rent time at the adjacent surgical suite.

Rent also includes small kitchenette with sink, electricity, and janitorial service. Call- 858-344-7342

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

PRODUCTS / SERVICES OFFERED

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

Services include: Data management using advanced software tools, Use of advanced analytical tools to measure quality and process-related outcomes and establish benchmarks, and the production of automated reporting.

(619) 913-7568 | info@rudolphia. consulting | www.rudolphia.consulting A VALUABLE EDUCATIONAL RESOURCE: Extensive Medical Articles File for sale. Charts, illustrations, articles. Emphasis on Emergency Medicine and Internal Medicine. Collected since 1973. Fills a large filing cabinet. (Cabinet not included.) Would make a useful gift for a medical student or resident. Best offer takes.

Will accept offers for 30 days after the publication of this newsletter. View in person at a North County location by appointment. 858-451-6517.

PHYSICIAN OFFICES IN NEED OF ASSISTANCE FOR MEANINGFUL USE ATTESTATION of their electronic health records can avail themselves of technical assistance from Champions for Health, the sister organization to SDCMS. Practices attesting on the Medi-Cal Incentive Program with at least 30% of patients billed to Medi-Cal can receive free assistance thanks to a federal funding source. Medicare practices can receive the same great service at a very reasonable rate, and SDCMS-CMA members receive a discount.

For more information, email Barbara.Mandel@ ChampionsFH.org or call (858) 300-2780. [559]

OFFICE SPACE/ REAL ESTATE AVAILABLE IN SOUTH BAY: Available for monthly sublease, 3 exam room, medical office, 5 days per week. Reasonable rates. Directly across from Scripps Mercy Hospital, Chula Vista. If interested, please call 619-422-2000.

SAN DIEGO PHYSICIAN.ORG

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

Reaping the Benefits of an Anniversary

By Helane Fronek, MD, FACP, FACPh

HAPPY ANNIVERSARY, UC San Diego!

I’m grateful for its impressive growth and myriad contributions to our community and the world. UCSD drew me to San Diego for Internal Medicine training, and later provided an opportunity to help train the next generation of physicians when I returned to teach there in a role I have loved.

UCSD has bookended my clinical career.

Yet, there is much more to the story, and its anniversary — as all anniversaries — offers me, and all of us, the chance to reap deeper benefits than simply celebrating our presence or the passage of time.

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JUNE 2018

Like all rituals, anniversaries allow our psyches to recognize that something significant has happened and provide an opportunity to consider what we want for the future.

By asking ourselves what impact the person, relationship, or institution has had on our lives, we shift from simply celebrating endurance to appreciating our interrelationship and acknowledging how we’ve grown, what we’ve learned, who we’re becoming. Anniversaries are common rituals because we yearn to know and feel the meaning of our life.

And we don’t have to wait another year to experience these benefits. We can use rituals throughout each day to enhance the quality of every aspect of our lives. We already engage in many simple rituals, such as hugging or kissing loved ones when we leave for work in the morning. Bringing mindfulness to these often-mindless interactions can restore our awareness of how important these people are to us. A sense of gratitude for their presence in our lives sends us out the door with a more loving perspective through which to view the other experiences of our day. As we knock on each exam room door, we can recognize that we are about to make a difference in the life of another human being. This awareness may help to restore and nourish the precious relationship between doctor and patient that we all cherish. And if we become upset during our day, the ritual of taking a deep breath before reacting can help to relax and clear our mind and open our heart to the true issue at stake, allowing us to respond more appropriately, kindly, and effectively to the situation. What other rituals can you bring mindfulness to, so you will experience more of the richness of your life?

As we celebrate UCSD’s anniversary, let’s recognize that every anniversary can provide a structure for us to optimize our lives. Whether an employee has just completed one year with you, it’s been five years since you accepted a leadership role, or you’re reaching a milestone birthday, take a moment to be grateful for the growth and learning that have occurred. Then, imagine even bigger goals to work toward.

What would you love to celebrate when the next anniversary comes along? In this way, we can use anniversaries and other rituals throughout our lives to become the best versions of ourselves, creating the lives we most want to live.

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

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

If you are contemplating opening a private practice, request your free copy of CAP’s newest and most comprehensive practice management publication, The Physician’s Action Guide to Starting Your Own Practice.

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