July/August 2019

JULY/AUGUST 2019

Official Publication of SDCMS

James H. Schultz, MD Becomes 2019–2020 SDCMS President 2019 “Rendezvous by the Bay” Gala Installs New Officers

SPECIAL THANKS TO THE

rendezvous

BY THE BAY

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CONTENTS

VOLUME 106, NUMBER 7

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: James H. Schultz, MD President-elect: Holly B. Yang, MD Secretary: Sergio R. Flores, MD Treasurer: Toluwalase (Lase) A. Ajayi, MD Immediate Past President: David E. J. Bazzo, MD GEOGRAPHIC DIRECTORS East County #1: Heidi M. Meyer, MD (Board Representative to the Executive Committee) East County #2: Rakesh R. Patel, MD Hillcrest #1: Kyle P. Edmonds, MD Hillcrest #2: Steve Koh, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Alexander K. Quick, MD La Jolla #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 #2: Maria T. Carriedo, MD GEOGRAPHIC ALTERNATE DIRECTORS Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County #1: Franklin M. Martin, MD South Bay: Karrar H. Ali, DO AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Paul J. Manos, DO; #3: Irineo “Reno” D. Tiangco, MD; #4: Nicholas J. Yphantides, MD (Board Representative to Executive Committee); #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Karl E. Steinberg, MD; #8: Alejandra Postlethwaite, MD

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AT-LARGE ALTERNATE DIRECTORS #1: Mark W. Sornson, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Susan Kaweski, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD ADDITIONAL VOTING DIRECTORS Communications Chair: William T-C Tseng, MD Finance Committee Chair: J. Steven Poceta, MD Young Physician Director: Obiora “Obi” Chidi, MD Resident Director: Vishnu Parthasarathay, MD Retired Physician Director: David Priver, MD Medical Student Director: Grace Chen

features

8 James H. Schultz, MD, MBA, FAAFP, DiMM, FAWM, SDCMS President 2019 Gala Speech

12 David E.J. Bazzo, MD, FAAFP, CAQSM, SDCMS Immediate Past President, 2019 Gala Speech

14 Update on Cardiovascular Disease Prevention and Management: The Importance of ClinicalCommunity Linkages

BY THOMAS R. COLEMAN, MD, MS

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departments

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BY ADAMA DYONIZIAK

Love the Skin You’re in

Briefly Noted: Calendar • Drug Prescribing/Dispensing • Practice Management • Medical Licensing

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2019 Rendezvous By the Bay — An Evening to Celebrate 149 Years of Healing

A Timely Addition to the Hippocratic Oath

JULY/AUGUST 2019

ADDITIONAL NON-VOTING MEMBERS Alternate Retired Physician Director: Mitsuo Tomita, MD Alternate Resident Director: Nicole Herrick, 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

Physician Classifieds

BY HELANE FRONEK, MD, FACP, FACPh

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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CMA MEMBER HELP LINE! Endorsed by

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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DRUG PRESCRIBING/DISPENSING

When Are You Required to Prescribe Naloxone to Patients?

A NEW LAW took effect on Jan. 1, 2019, that requires opioid prescribers to also offer a prescription for an opioidoverdose reversal drug such as naloxone.

Under the new law, physicians must offer a prescription for naloxone or another drug approved by the U.S. Food and Drug Administration (FDA) for the complete or partial reversal of opioid depression when one or more of the following conditions are present: • The patient’s opioid prescription dosage is 90 or more morphine milligram equivalents per day.

• An opioid medication is prescribed concurrently with a prescription for benzodiazepine.

• The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.

Physicians must then provide patients who are prescribed naloxone with education regarding overdose

prevention and use of naloxone or other similar drug approved by the FDA. The California Medical Association (CMA) has received calls from physicians regarding the ambiguity of these new requirements. Specifically, there have been questions regarding exactly when co-prescribing is required.

Concerns have also been expressed about the applicability of this law to patients receiving hospice care or to patients in inpatient settings where immediate medical attention is readily available.

Presently, there is an active bill, AB 714 (Wood), that seeks to address these concerns. CMA continues to work with legislators and other stakeholders to clarify a physician’s obligations under the law and will update members as soon as we know more.

To learn more about prescribing controlled substances, including this new requirement, see CMA health law library document#3201, “Controlled Substances: Prescribing.”

This document, as well as the rest of CMA’s online health law library, is available free to members at cmadocs. org/health-law-library. Nonmembers can purchase documents for $2 per page.

Contact: CMA Legal Information Line, (800) 786-4262 or legalinfo@ cmadocs.org.

CALENDAR

JULY 28: Live Well San Diego 5K and Kids’ 1-Mile Fun Run, County Administration Center, Waterfront Park. 5K Starts at 7:30 a.m. and 1-Mile Fun Run at 8:30 a.m.

JULY 29: SDCMS Physician Networking/Social Mixer and Book Signing, 6–9 p.m., UCSD Faculty Club, La Jolla.

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OCT 12–16: Academy of Integrative Health & Medicine Annual Conference, Sheraton Hotel & Marina, San Diego. Learn evidencebased integrative medicine. AMA PRA Category 1 CME accredited program.

////////////////////////////////////////////////////////////////////////////////////////////////// PRACTICE MANAGEMENT

New Law Requires Sexual Harassment Training for All Employees

MEDICAL LICENSING

Coming Soon: Changes to Medical Board Licensure Application THE MEDICAL BOARD of California has made changes to its physician license application aimed at removing stigma around getting diagnosed and treated for conditions that may impair practice, if left untreated.

The new language changes the way physicians are asked to disclose impairments (physical, mental, substance abuse, etc.) that may impact their ability to practice safely.

The California Medical Association (CMA) has advocated for changes in the application language out of concern that questions were targeting specific impairments and conditions and unnecessarily stigmatizing physicians who seek treatment. In 2019, the CMA Board of Trustees adopted policy requesting that the Medical Board of California amend its licensing application to align with recommendations from the Federation of State Medical Boards, which recommended that state licensing boards evaluate whether it is necessary to include probing questions about a physician applicant’s mental health, addiction, or substance use, and

whether the information these questions are designed to elicit in the interests of patient safety may be obtained through means that are less likely to discourage treatmentseeking among physician applicants.

CMA has worked hard to remove stigmas associated with mental health issues and has led efforts to encourage physicians to think more about their own wellbeing.

Working in collaboration with Stanford University, our new Well Physician California program will promote physician wellness across California. It will be the most comprehensive state level effort in the country, led by nationally recognized leaders on physician wellness who bring academic expertise, as well as hands-on experience building successful organizational initiatives to improve physician fulfillment and wellbeing.

You can learn more about CMA’s efforts on physician wellness at https://www.cmadocs.org/ wellness.

The changes will be implemented on the paper application within a few weeks. Changes to the online application are expected to be completed by the end of the year.

A 2018 CALIFORNIA law expands existing sexual harassment and abusive conduct prevention training requirements for employers. Under the new law, employers with five or more employees must provide two hours of sexual harassment training to supervisors and one hour to all other employees within six months of their hire (or promotion to supervisor) and every two years thereafter.

The law’s five-employee threshold includes full-time employees as well as temporary and seasonal employees who “regularly” provide services in accordance with a contract, and those acting directly or indirectly as an “agent” of the employer.

Training for all existing employees must be provided by Jan. 1, 2020. New employees must receive the training within six months of their hire (or promotion to supervisor).

The training can be in person or online, and it must be interactive.

Employment Law Resources There are several online resources available to help physician practices address the new harassment training requirements.

• California Department of Fair Employment and Housing (dfeh.ca.gov) — Note that the new law requires DFEH to make online training courses available.

DFEH will make the trainings available in late 2019. In the interim, DFEH has published a sexual harassment and abusive conduct prevention toolkit, which contains a sample training.

• California Chamber of Commerce (calchamber.com) • California Employers Association (employers.org) Employers may also use eligible trainers to provide the training. The California Medical Association (CMA) also maintains a list of “physician-friendly” attorneys who specialize in employment law, including those that provide sexual harassment training. If you’d like contact information for an attorney in your area, please contact CMA’s Legal Helpline at (800) 786-4262 or via email.

SAN DIEGO PHYSICIAN.ORG

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2019 rendezvous

BY THE BAY AN EVENING TO CELEBRATE 149 YEARS OF HEALING

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THE SAN DIEGO COUNTY Medical Society hosted its annual gala at Paradise Point Resort this year, bringing together hundreds of physicians, their spouses and significant others, local elected officials including San Diego Mayor Kevin Faulconer and County Supervisor Kristin Gaspar, a number of candidates for public office, and other distinguished guests to celebrate the installation of our incoming president.

Dr. James H. Schultz was welcomed as SDCMS’ new President for 2019–2020 and Dr. David E. J. Bazzo was thanked for his service as SDCMS President for 2018–2019.

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9 1. Dr. David Bazzo with his wife, Sabrina, and daughter Eliana. 2. SDCMS Treasurer Dr. Lase Ajayi and her husband, Dr. Kyle Edmonds. 3. Dr. Obi Chidi and his wife, Masha Efros.

4. SDCMS President Elect Dr. Holly Yang with her husband, Joe Runnion.

5. Dr. Mark Sornson and Dr. Caroline Thornton with their daughter Madeline. 6. Mayor Kevin Faulconer with SDCMS CEO Paul Hegyi. 7. Dr. Sergio Flores and his wife, Tina. 8. SDCMS President Dr. James Schultz and Immediate Past President Dr. David Bazzo. 9. (L–R) Dr. Jennifer Noerenberg, Jennipher Ohmstede, Marty Ohmstede, and Dr. Jane Lyons. 10. Dr. Patrick Tellez and his wife, Carol.

11. Supervisor Kristin Gaspar with Dr. Preeti Mehta. 12. UCSD Medical Students Grace Chen, Adam Schaar, Milli Desai, Michelle Sun, and Rachel Hartsell with Dr. Robert Hertzka. 13. Dr. David Bazzo receiving his Past President medallion from Dr. Mark Sornson.

14. SDCMS President Dr. James Schultz with his wife Shelley and their daughter Danielle. 15. (L–R) Dr. Kosala Samarasinghe, Dr. Jennifer Pendleton, Mayor Kevin Faulconer, Angela Shiau, and Dr. Will Tseng. 16. (L–R) SDCMS past presidents Dr. Mihir Parikh, Dr. Albert Ray, Dr. Bob Wailes, Dr. David Bazzo, Dr. Mark Sornson, Dr. Robert Hertzka, Dr. James Hay, and Dr. Will Tseng.

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James H. Schultz, MD, MBA, FAAFP, DiMM, FAWM, SDCMS President 2019 Gala Speech

I

’ve been struggling with trying to figure out who I should thank first: God or Bob. My struggle lies in the fact that I’m not sure who is more important and carries more weight around here. I think I know the answer but am afraid to say it.

Thank you to Dr. Bazzo for your leadership over the past year and for being instrumental in working on the development of a new comprehensive statewide Physician Wellness improvement effort. Dave, you have been a great role model for me.

I would like to thank all the elected officials who are here. Your support does not go unnoticed and is much appreciated.

And a huge thank-you goes out to my wife, Shelley, and my daughter, Danielle, who are sitting here along with my son-inlaw, Ricky. Being in the immediate family of a physician is never easy and I can’t express how much I appreciate the sacrifices made by my family over the decades. None of us flies on our own power, and my family has been nothing but supportive of me for my whole career. They have been my rock.

Thank you to my colleagues at the San Diego County Medical Society for putting me in this position. (I think!) I believe I may be the first Community Health Center physician to hold this position, and hopefully I won’t be the last. I value and do not at all take lightly the trust and confidence you have put in me.

I would like to acknowledge Health

Center Partners, who are here tonight, with whom I’ve been associated and have helped counsel for the last 18 years. This is a great organization that represents the interests of almost all of the local Community Health Centers. This means they represent the interest of, along with Family Health Centers, over a million patients at 150 sites, and they represent the interests of over 300 physicians and over a thousand other clinicians. Health Center Partners’ health centers provide elite-level quality of care to those most in need. Thank you.

Thank you also to Graybill Medical Group. I joined Graybill Medical Group in 1988 as a wet- behind-the-ears new graduate family medicine specialist, their fifth doctor at their only site in Escondido. They took me right out of residency as Doogie Houser, MD. I learned how to be a doctor and how to be a leader at Graybill. I really learned about the business of medicine at Graybill. If you need a great medical group, go to Graybill.

Thank you also, and perhaps most of all, to Neighborhood Healthcare for being willing to share me for a period of time.

Although I don’t think I really asked. Sorry!

It’s been a great source of pride to me to see one of my protégés, Rakesh Patel, become my boss. Now I have to treat him nice. Rakesh is here tonight along with the smarter of the pair, his wife, Rina. Tell them nice things about me!

Neighborhood Healthcare has really allowed me to do a lot of these other things that I have gotten involved with. But I have to admit, many of these other things that I do is really to help Neighborhood Healthcare. Almost all of the “outside“ stuff that I do I have an ulterior motive — helping my patients. Sometimes helping your patients takes a longer and broader view than what happens just in the exam room. It’s the reason I am here today.

I’m humbled to be standing here in front of you. I don’t feel like I deserve to be here and represent more than 3,000 physician members in San Diego County. I hope I am worthy of the honor and responsibility bestowed upon me.

I really thought at this point I would be working in the bush in Africa or Asia somewhere. The reason I moved from Graybill to Neighborhood Healthcare was that I discovered a mission field right in my own backyard that was completely out of sight to me. I discovered my mission field was right down the street.

Did you know that one-third of Californians are on Medi-Cal? Did you know that until the Affordable Care Act, about a quarter of Californians had no insurance at all? Did you know that we still have 2 or 300,000 uninsurable people in San Diego County?

I work at a Community Health Center.

The work of community health centers keeps thousands of people out of our emergency rooms and hospitals. We don’t have people dying on the street largely because of community health centers and our local hospitals. And we don’t just provide stopgap care. I am proud to say that in San Diego County, poverty does not equal poor quality. Sorry to bore you with these numbers; if you’re a physician administrator or involved in quality you know what these mean. At Neighborhood Healthcare our hypertension control rate is 79%. Our diabetic blood pressure control rate is 81%. Our colorectal cancer screening rate is 63%, which I’m not satisfied with but it is better than 17% where we started.

Our breast and cervical cancer screening rates are both about 75 to 80%. These are not perfect but they do put us in the top

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SDCMS LEADERSHIP

quartile nationally, as far as I can tell.

We can’t do this good work alone though. The County Medical Society, through its Champions for Health Project Access program, helps with specialty care for those who have no insurance.. Here’s another did-you-know: Did you know that over 700 San Diego specialist physicians and a few hospitals and surgery centers have donated over $19 million worth of services to 6,000 patients, including 17,000 specialty appointments and over 1,500 surgeries? We believe the care Project Access provided directly interceded to save more than 20 people who would otherwise not be here today and has resulted in a 91% reduction in work days missed and an 84% reduction in ER visits by those patients in Project Access.

a 15-page form so that one of my disabled patients can access services designed for disabled people.

Coding and billing requirements are onerous and we work in an environment in which, with every single patient, we are presumed to be guilty of fraud and we have to prove with every visit that we aren’t committing fraud.

Administrators and our own leaders sometimes seek to require us to become experts in coding and clicking — all taking time away from our critical mission, and the thing that only we can do: direct patient care.

Physician suicide and burnout levels remain high. I lost one of my own colleagues just a few short years ago to suicide, another years ago, and I still don’t understand

San Diego County physicians on the whole — the folks represented in this room — are charged with keeping over 3 million people healthy. When you stop and think about it, it’s really overwhelming and a daunting responsibility. But we’re up to the task!

San Diego County physicians on the whole — the folks represented in this room — are charged with keeping over 3 million people healthy. When you stop and think about it, it’s really overwhelming and a daunting responsibility. But we’re up to the task!

It is becoming increasingly difficult to do this work, however. We have crushing regulatory requirements that aren’t getting any better. Any mid-level state or federal bureaucrat, and even local jurisdictions and 20-year-old day care workers, can require a physician signature on a piece of paper. My local transit district requires me to fill out

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it. I don’t want that to happen to any physician ever again. We have high burnout rate largely because of the meaningless tasks we have to do and the frustration with inefficient and nonsensical electronic medical record systems that are not evolving to support us. We are facing a burnout rate approaching 50%, and in some specialties, higher.

What kind of doctor do you want to see when you go to see your doctor? Do you want to see someone who is an expert coder or do you want to see someone who is an expert clinician? Do you want to see some-

one who is disillusioned with medicine and can’t wait to retire or do you want to see someone who finds joy in helping others and can’t wait to get to work? Do you want to see someone is just getting by with the bare minimum, who just goes by the latest clinical pathway, or do you want to see someone who still has a thirst to learn? Do you want to see someone who is an expert at clicking just the right boxes, or do you want to see someone who looks you in the eye and listens to you when you talk about your symptoms, your fears, your desires?

Our San Diego County Medical Society is trying to help with all of this. This year we are rolling out, in partnership with the California Medical Association, the first comprehensive physician wellness survey ever done. With these data, and with San Diego County at the vanguard, we will be able to provide useful, evidence-based resources and interventions to help our physicians thrive.

When our physicians thrive, so will our patients, our community and our healthcare systems — and this is not just trickledown economics. This is evidence-based.

Research shows that happy physicians have better clinical outcomes and higher patient satisfaction.

Part of the effort to return joy to medicine should be reducing administrative burden. We need to free our healers to heal.

For those of you in the room in legislative, regulatory, or leadership positions, please think about this every time you are contemplating adding some new rule or requirement regarding healthcare. Physician leaders: Don’t forget what it was like to be in the exam room and please get yourself into the board room and advocate for us there.

The San Diego County Medical Society and the California Medical Association have done some great things. I joined reluctantly. I always thought of the Medical Society and CMA as a country club full of old white specialists. I found this not to be the case despite the fact that you’re looking at just another old white guy standing in front of you. The face of the San Diego County Medical Society and CMA is changing. We are much more primary care

and cognitive-specialty oriented than in the past. And look what CMA and the component societies have done: among many other recent things, protected MICRA, keeping insurance rates and healthcare costs lower. Proposition 56 tobacco tax funds have improved reimbursement to thousands of physicians, mostly in primary care. We need to work on specially payments now — $22 for an office visit just doesn’t cut it.

Proposition 56 has added residency slots in emergency medicine, family medicine, and internal medicine, including locally. It has also provided loan repayment that helps new physicians to work in underserved and rural areas and in community health centers.

What’s next? We’re taking on obesity.

Obesity is killing us and literally and figura-

tively, and sucking billions of dollars out of our economy in direct medical expense and indirect lost productivity cost. Processed foods, sugary drinks, and inactivity are all major drivers of obesity and CMA is leading the way in making it a little harder to have soda be the easiest, cheapest default drink to get by supporting a new “soda tax.”

My goals for SDCMS this coming year include: • implementing the wellness program, • finding ways to make membership more meaningful and valuable to all physicians, including large group and foundation/employed physicians, • to continue to be an effective advocacy group representing all physicians regardless of practice style and type.

That would include small group and solo practices, and physicians in group practices of all sizes who find their voice diluted in a sea of administrators.

Finally, I would like to continue exploring leadership development opportunities and trainings for physicians because I believe that more physicians should be in the boardrooms and more physicians should be running our healthcare organizations — for the good of our patients. But we physicians need to learn new languages, skills, and competencies to be effective leaders.

Thank you for coming tonight. I hope you all continue to find and work in your own personal mission field. I look forward to a great year with the San Diego County Medical Society.

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SDCMS LEADERSHIP

David E.J. Bazzo, MD, FAAFP, CAQSM, SDCMS Immediate Past President 2019 Gala Speech

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ood evening colleagues, friends, and family.

Every president says this, but it is truly amazing how quickly a year passes.

Especially when everything with the Society this year has gone great! Many of my predecessors had important issues to address and fix, but I’m happy to report that SDCMS is thriving and in good hands — no, great hands with the passing of the reins over to Jim Schultz.

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Last year I spoke to you about a few themes that I wanted to focus on during my presidency. They were famiglia, teamwork, giving back, and helping others. There were some great accomplishments this year that really highlighted these themes and I believe we as a Society were quite successful.

First, the famiglia. I spoke of that fateful evening where my mentors in this society, Al Ray, Bob Hertzka, Jim Hay, Ted Mazer and Bob Wailes, met with me to start me

on the path to today. I am grateful to them, but to stop there would be shortsighted. It’s really the entire SDCMS famiglia, the physicians, the staff, our collaborators, and our patients. They all contribute in their way to making this Society great. I’m not speaking in hyperbole either — SDCMS remains one of the most successful chapters in California, if not the nation, and it’s due to the great efforts of our extended famiglia.

The concept of teamwork is encompassed here too. We have a knack for organizing, consensus building, and acting that helps good ideas become great programs. This brings me to what I consider is the crowning achievement for CMA and SDCMS this year, which is Well Physician California. Two years ago, the SDCMS Board held a meeting with the leaders of San Diego’s largest groups. Dustin Corcoran, CEO of CMA, was in attendance. We had an open-table discussion, but the room lit up and came alive when the topic of physician wellness came up.

One of my personal goals for the Society was to have us work toward improving the lives of physicians in practice. Through the literature on physician burnout, where it is reported that over half of doctors have experienced burnout in their career, and my work with the UC San Diego PACE Program, where physicians are sent due to difficulty in practice, and seeing firsthand the stress they all experience — and the fact that burnout has been shown to lead to errors in practice, it made sense as a place to focus. Errors hurt physicians and patients, and if we can help our colleagues before errors occur, everyone wins.

As mentioned, the idea for Well Physician California started in San Diego, but thanks to the efforts of CMA, including a $25 million commitment, a CEO, Kathleen Creason, was hired, and a contract with Tate Shanafelt and Mickey Trockel from Stanford’s Wellness institute was signed on Dec. 31, 2018. As the pilot site, we are currently in the midst of the survey to gauge the overall wellness of San Diego Counties’ physicians. In fact, if you haven’t already done so, I encourage all of you to complete the survey and encourage your colleagues to do the same. The survey is for all San Diego physicians but when the program’s

support offerings become available, it will be for members only. So, please also encourage your colleagues who are not members to consider this additional support service in signing up!

With regard to giving back and helping others, I have to mention SDCMS’s foundation, our incredible Champions for Health. Champions is on good financial footing and continues to offer amazing medical care to those in need. The millions of dollars of in-kind services are a tribute to the spirit of helping our patients who may not have had access were it not for Champions. Thank you to the Champions’ volunteer physicians and staff, led by Adama Dyoniziak.

Additionally, giving back to our physicians was a priority. Our state and local

leadership worked to secure $40 million from Prop 56 money, which has been awarded and distributed to extend graduate medical education in our state, $100 million in loan repayment for those practicing in underserved areas, and approximately $2 billion in increased reimbursement for Medi-Cal services. This would not have been possible with supporting organized medicine. Thank you!

And speaking of thank you, I can’t let the evening go by without recognizing the people who really do all of the work: our amazing staff. Led by Paul Hegyi, Jen Ohmstede, Brandon Ethridge, Hanna Basler, and Sue Fledderjohn are incredible. This small staff of hardworking folks are committed and MAKE IT ALL HAPPEN. Thank you, thank you, thank you!

OUR MARKETING TOOLS MARCH 2018 OF SDCMS

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Medical Coalitions Join Forces to Educate Politicians

ALL TOGETHER NOW TO SAVE LIVES Be There San Diego Addresses Cardiovascular Disease Disparities

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Finally, my family. Their sacrifices for all the time away make it possible to do what I can to help. My daughter Eliana, successfully completing her freshman year in environmental sustainability at Colorado State, my daughter Mara, who is graduating from Drexel University Magna Cum Laude, and already has a great job working fulltime as she finished her requirements last quarter, and my wonderful wife, Sabrina, who embraces the spirit of volunteerism in her own work and life, really has been the force that has made all of this possible.

Thank you and I love you.

It has been my honor and privilege to serve as your president, and I look forward to my continued work on physician wellness with SDCMS and CMA in the years to come. Thank you!

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SAN DIEGO PHYSICIAN.ORG

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Update on Cardiovascular Disease Prevention and Management The Importance of Clinical-Community Linkages By Thomas R. Coleman, MD, MS

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Introduction and Background Considerable progress has been made in cardiovascular disease (CVD) prevention and management over the past two decades. The age-adjusted mortality rate for all cardiovascular diseases in the United States has decreased from 352.4 deaths per 100,000 in 1999 to 220.4 deaths per 100,000 in 2016. This decrease has been seen across all racial and ethnic groups, and in both women and men. However, there is still considerable progress to be made, as the latest data from the American Heart Association show.1 CVD is the leading global cause of death.

Listed as the underlying cause of death, it accounted for 840,678 deaths in the U.S. in 2016: approximately 1 of every 3 deaths.

It is estimated that as many as 1 in 2 people in the U.S. have CVD, with the proportion even higher in African Americans (57.1% in non-Hispanic Black females and 60.1% in non-Hispanic Black males). On average, nationally in 2016, someone had a heart attack every 40 seconds and someone else

tial. This reinforces that much remains to be done to lessen the burden of CVD in our area, especially given that people tend to develop multiple chronic conditions as they age.

had a stroke every 40 seconds as well.

In San Diego County, progress has occurred so that CVD is no longer the number one cause of death. Since 2006, cancer has surpassed CVD. However, coronary heart disease and stroke are the second and fifth leading causes of death in our county, respectively. According to 2016 data, someone in San Diego County died of coronary heart disease approximately every three hours and someone else died of stroke approximately every six and a half hours. Age-adjusted Black/African American rates for both coronary heart disease and stroke mortality are lower than those for Whites (105.1 per 100,000 vs.

135.8 and 35.0 vs. 59.5, respectively). Also, the gender gap remains between men and women for coronary heart disease (111.5 per 100,000 vs 58.1, respectively).

These statistics are sobering and do not encompass the broader burden of CVD with respect to hospitalizations, emergency department visits, disability, or economic costs — all of which are substan-

Million Hearts 2022 A significant part of the challenge of intervention is that almost half of Americans (47%) have one of the primary risk factors for heart disease, including high blood pressure, high cholesterol, and smoking. But it is also estimated that as many as 80% of heart attacks and strokes may be prevented. Because CVD events are common, costly, and largely preventable, the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) launched the Million Hearts initiative in 2012, with a 5-year aim to prevent 1 million acute CVD events by spotlighting risk factor improvement. Two recent Vital Signs reports published in the Morbidity and Mortality Report (MMWR)2,3 and a “Viewpoint” article in the Journal of the American Medical Association 4 documented the progress, to date. The good news is that it is estimated that as many as 500,000 acute CVD events may have been prevented by 2016, although the improvement in risk factors was not as great as desired. Because of that, Million Hearts 2022 began in 2017 with a strengthened framework, with three core components: Keeping People Healthy, Optimizing Care, and Improving Outcomes for Priority Populations.

The Keeping People Healthy component emphasizes reduced sodium intake, decreased tobacco use, and increased physical activity. This definitely has a clinical component, concentrating on behavioral interventions, but is inherently also the province of public health. For example, the County of San Diego implements a Sodium Reduction Initiative that works to decrease sodium in food procured by organizations; the Tobacco Control Resource Program has particular objectives on tobacco retailer licensing and smoke-free outdoor dining policy development and implementation; and the CalFresh Healthy Living Program, formerly known as the Nutrition Education and Obesity Prevention Program, has a discrete focus on active transportation and the built environment. Although these three programs have elements that are applicable to the clinical arena, the primary

concentration is on population-based interventions to facilitate policy, systems, and environmental changes within the community.

The Optimizing Care component emphasizes improved “ABCS” (i.e., aspirin use when appropriate; blood pressure control; cholesterol management; and smoking cessation), increased use of cardiac rehabilitation, and engagement of patients in heart-healthy behaviors.

The Improving Outcomes for Priority Populations component has emphasis on Blacks/African Americans with hypertension (as this group is disproportionately impacted by this condition), 35- to 64-year-olds (as there is increasing evidence that CVD rates are actually getting worse in this subgroup), people who have had a heart attack or stroke (for whom enhanced preventive efforts are paramount), and people with mental health and/or substance use disorders (for whom life expectancy is dramatically decreased, substantially because of the impact of CVD related to tobacco use).

Enhancing Integrative Efforts Between Public Health and Healthcare Optimal CVD prevention efforts — as exemplified by Million Hearts 2022 — center on individual as well as population-based interventions. This is in alignment with extensive research across multiple chronic conditions that shows lifestyle change is the best defense, alone or used in concert with prescribed medications, for reducing the CVD epidemic. Eliminating three risk factors — poor diet, physical inactivity, and exposure to tobacco products — can prevent, delay, or alleviate CVD. These actions also have ancillary positive effects related to diabetes prevention and management, as well as the decrease in development of some cancers. The American College of Cardiology and American Heart Association jointly recommend that every U.S. adult be encouraged to engage in healthy lifestyle habits to prevent hypertension.

Also, those with hypertension are encouraged to adopt a healthier lifestyle, either alone or along with medical treatment, to reduce their blood pressure. Behavioral approaches are important to help patients make changes in their diet, physical activity, nicotine use, alcohol intake, and weight to reduce their CVD risk.5 Most patients only see their doctor SAN DIEGO PHYSICIAN.ORG

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once every few months or less frequently, especially if they have risk factors that have not progressed to disease. If health education messages are not reinforced between clinic visits, it is very difficult to change the underlying risk factors that lead to chronic diseases, including CVD, and poor health.

This is where community-clinical (or clinical-community) linkages can be supportive and even additive. CDC has defined community-clinical linkages as “connections between community and clinical sectors to improve population health. …

When clinical and community sectors work synergistically, they can improve care and support patients better than either of these sectors could do alone.”6 There is scientific evidence that such an approach leads to improved clinical health outcomes for coronary heart disease, as well as control of blood pressure, cholesterol, prediabetes, diabetes, and asthma. Such an approach helps to “ensure that people with or at high risk of chronic diseases have access to the resources they need to prevent, delay, or manage chronic conditions once they occur.”6 Previous, Current, and Planned Efforts The Community Preventive Services Task Force, staffed by the CDC, develops evidence-based community preventive services, which are stored in a repository (The Community Guide) for utilization. Two of these recommendations related to clinical-community linkages — Interventions Engaging Community Health Workers and Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control—are very pertinent to our prior work at the County of San Diego. During a previous four-year cooperative agreement with the CDC, which ended September 2018 (the Healthy Works: Prevention Initiative, HWPI), the County of San Diego partnered with Be There San Diego, a local coalition dedicated to make San Diego County “a heart-attack- and stroke-free zone,” through multiple activities. One of these activities was development of multiple clinical practice recommendations, two of which directly emanated from Community Guide recommendations (Approach for Integrating Community Health Workers on the Care Team and Organizational Approach to Self-Measured Blood Pressure Monitoring) and another (Linking with Community Pharmacists to Improve Hypertension Management) that focused on Medication Therapy Management

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within the community. Through HWPI, there was also a concerted goal to develop and spread CDC-recognized Diabetes Prevention Programs (DPPs) throughout the community. Lastly, there was an activity to work with 2-1-1 San Diego and others to pilot development of a bidirectional referral process for lifestyle change programs, such as DPP. In September 2018, the County of San Diego was awarded two additional cooperative agreements based on CVD prevention and management: Healthy Works: Heart Disease and Stroke Prevention, and Racial and Ethnic Approaches to Community Health (REACH). The County is again partnering with Be There San Diego to continue to strengthen implementation of the seven clinical practice recommendations from HWPI, with considerable concentration on community health worker and community pharmacist involvement. In addition, there will be an emphasis on high blood cholesterol, as well as the continued prioritization of unidentified/untreated hypertension. Now that DPP is a covered benefit by Medi-Cal, Medicare, and several commercial insurers, we intend to continue the spread of these programs. Additionally, it is anticipated to work with 2-1-1 San Diego and other community partners more broadly. This approach will yield a more robust, bidirectional referral system for multiple lifestyle change programs in the areas of diabetes prevention, diabetes self-management education, hypertension, high blood cholesterol, and smoking cessation.

Conclusion Cardiovascular disease is common, increasingly costly, and debilitating — but largely preventable. Although progress has been made, much remains to be done, as inequities remain and certain subgroups may be at risk for having progress reversed.

Public health, clinical, and community sectors must work together to create a seamless system through clinical-community linkages to enhance the availability and utilization of lifestyle change programs that optimally prevent and manage risk factors and diagnosed disease. A continued focus on prevention, population health, high-quality care, and prioritized interventions to groups at highest risk will facilitate success. Given the previous efforts to date and the remarkable collaborative spirit within San Diego County, those of us in public health welcome the

opportunity to continue to partner with healthcare systems and our community to decrease the burden of cardiovascular disease. Such chronic disease prevention and management efforts through collective impact will help to achieve the Live Well San Diego vision for a region that is healthy, safe, and thriving.

Dr. Coleman is medical director, Maternal, Child, and Family Health Services, for the County of San Diego.

References Benjamin, E.J., Muntner, P., Alonso, A., Bittencourt, M.S., Callaway, C.W., Carson, A. P., . . . Virani, S. S. (2019). Heart disease and stroke statistics - 2019 update: A report from the American Heart Association.

Circulation, 139, e56-e528. doi: 10.1161/ CIR.0000000000000659

1

Ritchey, M. D., Wall, H. K., Owens, P. L., & Wright, Janet S. (2018). Vital signs: Statelevel variation in nonfatal and fatal cardiovascular events targeted for prevention by million hearts 2022. MMWR Morbidity and Mortality Weekly Report, 67, 974-982. doi: 10.15585/mmwr.mm6735a3

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3 Wall, H. K., Ritchey, M.D., Gillespie, C., Omura, J.D., Jamal, A., & George, M.G. (2018). Vital signs: Prevalence of key cardiovascular disease risk factors for million hearts 2022 — United States, 2011-2016.

MMWR Morbidity and Mortality Weekly Report, 67, 983–991. doi: 10.15585/mmwr. mm6735a4

Wright, J. S., Wall, H. K., & Ritchey, M. D. (2018). Million hearts 2022: Small steps are needed for cardiovascular disease prevention. JAMA, 320(18), 1857-1858. Doi: 10.1001/ jama.2018.13326 4

Janke, E. A., Richardson, C., & Schneider, K. L. (2019). Beyond pharmacotherapy: Lifestyle counseling guidance needed for hypertension. Annals of Internal Medicine, 170(3), 195-196. Doi: 10.7326/M18-236 5

Centers for Disease Control and Prevention.

(2016). Community-clinical linkages for the prevention and control of chronic diseases: A practitioner’s guide. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

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The author would like to thank Alison Sipler, MPH, CHES; Lindsay Riedel, MA; Christy Lopez, MPH, CPH; and Tanya Lozano, MD, MPH, for assistance with preparation of this article.

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

Love the Skin You’re in

By Adama Dyoniziak “YOU HAVE A TYPE of skin cancer.”

When Sofia H. heard this she got scared and sad, and cried. “Lord, why? Why is this so? My husband and son got scared too because we did not expect it. They said to not be sad, they are going to give you surgery,” Sofia says. “Even my husband said that he would take me to the doctor. He works during the day and had to ask permission with his employer. We honored the appointment by arriving early, so grateful for the help that they were giving us.”

Sofia H. is a Project Access patient who was referred to Dr. Anne Truitt, a dermatologist and Mohs Micrographic surgeon with Skin Surgery Medical Group.

“I’m very grateful to the doctor (Truitt),” Sofia says. “She treated me well and would encourage me. She cared for me a lot, and I for her. She would support me, hug me.

God gave her that talent … I am so grateful for her.”

Since childhood, Dr. Truitt has wanted to help others and do something that interests her. She wanted to combine medicine with flying, so she joined the Air Force Academy. Unfortunately, she got airsick looking at a plane, so after completing active duty she attended medical school and specialized in dermatology. “Do what you love” has been Dr. Truitt’s motto, and she really enjoys dermatology and its surgical aspects. Her joy of traveling and seeing the world was incorporated with part of medical school in Paris, being on assignment in Korea, and a fellowship at St John’s School of Dermatology in London.

When asked what she liked most about Project Access, Dr. Truitt says, “Some of the sweetest people I ever met. [The patients are] so grateful that someone is taking their time to talk with them and treat them. [Project Access is a] very good service: patients are in need.”

Tips to Love the Skin You’re In

1 Sofia adds, “[Dr. Truitt] told me that if I felt that something was affecting me to come by her office, but since [my surgery] I have felt good.”

“To whom much is given, much is required” was a refrain Dr. Truitt heard often as she was growing up. Dr. Truitt encourages other physicians and surgeons to volunteer for Project Access San Diego.

“We have a unique gift and training,” she says. “We can use that gift and give back to the community to those who are not as fortunate.”

If you who would like to volunteer with Champions for Health to provide pro bono specialty care for Project Access San Diego, please contact Adama Dyoniziak at (858) 300-2780 or adama.dyoniziak@championsfh.org.

Ms. Dyoniziak is executive director of Champions for Health.

Use sun protection • Sunscreen SPF 30+ with 5% zinc oxide • Full-coverage swimwear, glasses, hat • Avoid peak sun hours 10 a.m.–2 p.m.

2

Be self-aware: Do a skin review using the ABCDE guide for any skin lesions.

• Asymmetry • Border • Color • Diameter • Evolving over time

3

See your doctor if a skin bump or lesion changes over time.

SAN DIEGO PHYSICIAN.ORG

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CLASSIFIEDS PHYSICIAN OPPORTUNITIES ANESTHESIOLOGIST WANTED: Experienced, skilled, and personable board-certified anesthesiologist wanted for part time/per-diem work in private office-based ambulatory surgery facility. Cash rate negotiable. jesselyn@davidandrossi.com for more information. (Posted 6/7/2019).

PSYCHIATRIST WANTED: UPAC Counseling and Treatment Center is seeking a consultant psychiatrist (4-6 hours/week) who can provide treatment for adults and older adults with serious mental illness and promote psychosocial rehabilitation principles of wellness and recovery through providing psychiatric evaluations, diagnose, and treatment. Mail, fax, or email your resume to: UPAC HR DEPARTMENT 1031 25th Street San Diego, CA 92102 Fax: 619-232-4113 Email: upacjobs@upacsd.com PEDIATRICIANS WANTED: Grossmont Pediatrics mission of providing family-focused individualized care of the child - a private pediatrics practice with over 4500 Commercial HMO, PPO, Tricare and MediCal patients. Clinical cases include ADHD, asthma, adolescent mental, behavioral health and minor procedures. See an average of 2.8 patients/hour, very light call & newborn rounding at one hospital 1 in 3.

Using Epic EHR access real-time to Rady Children’s, UCSD, Scripps, Sharp for outside care to your patients.

Working 28 or 32 hours per week [M-F only] you will earn between $150,000 and $180,000 annually in compensation; accrue 2-3 weeks PTO plus holidays, and a future share in practice growth. Grossmont Pediatrics pays for professional expenses related to your employment; and after 90 days, Health and Dental, 401K, etc. Contact venk@gpeds.sdcoxmail.com or 619-504-5830 with resume in .doc, .pdf or .txt.

UCSD, DEPARTMENT OF PEDIATRICS AND RADY CHILDREN’S HOSPITAL, CLINICAL POSITIONS AVAILABLE: The University of California, San Diego (UCSD) Department of Pediatrics (http://wwwpediatrics.ucsd.edu), and Rady’s Children’s Hospital of San Diego (http://www.rchsd.org ) is seeking clinicians to provide patient care at the Urgent Care Clinics of the Division of Emergency Medicine and Urgent Care.

Clinicians should be board certified or board eligible in general pediatrics and have some experience in urgent care. The Urgent care has 5 centers located throughout San Diego County. We have full time and part time clinical positions available and see about 60,000 pts/ year. We have a great team of nurses, patient access reps and physicians and are looking for those who can work independently with excellent personal and clinical skills. UC benefits are acknowledged to be among the finest in higher education. As UC Staff, you’ll enjoy comprehensive health and welfare plans protecting you and your family, an attractive pension, and optional retirement savings opportunities. Interested persons should contact Katherine M. Konzen, MD, MPH at 858966-8036.

IMPERIAL RADIOLOGY - RADIOLOGIST NEEDED: Our facility is an outpatient Diagnostic facility located in Imperial, CA and we are in search of a Part-Time/FullTime Radiologist. All candidates must have an active California Medical License. Pay to be determined.

Please contact us at info@carlsbadimaging.com if this job is of interest to you.

FAMILY MEDICINE PHYSICIANS NEEDED: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners. We currently have FM openings in our Ramona and Valley Center locations (solo practices) 3-4 days/week and a full-time FM or IM opening in Vista . Current CA and DEA licenses required. Must be BC/BE. Conduct medical diagnosis and treatment of patients in an outpatient setting. Bilingual in English/Spanish helpful. We offer a competitive compensation and benefit package including malpractice coverage and shareholder opportunity. Check out a full list of our benefits under Careers at www.graybill.org. Send CVs to ssnodgrass@ graybill.org, apply online, or fax (760) 738-7101.

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JULY/AUGUST 2019

CARDIOLOGIST POSITION AVAILABLE: Seeking a cardiologist to work part-time in an outpatient cardiology practice in North San Diego County.

Practice opportunities from Mon.-Friday. Hours are from 8 to 5 p.m. There is no night calls, or holidays work days. The contracted cardiologist would decide from the days available which days to work.

Please fax resume to 760.510.1811 or via e-mail at evelynochoa2013@yahoo.com.

FAMILY PRACTICE MD/DO: Family Practice MD/DO wanted for urgent care and family practice office in Carlsbad, CA. Flexible weekday and weekend shifts available for family practice physician at busy, wellestablished office. FAX or email CV to (760) 603-7719 or gcwakeman@sbcglobal.net.

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

SharpCare is a primary care, foundation model (employed physicians) practice focused on local community referrals, the Patient Centered Medical Home model, and ease of access for patients.

Competitive compensation and benefits package with quality incentives. Bilingual preferred but not required. Board certified or eligible requirement. For more info visit www.sharp.com/sharpcare/ or email interest and CV to glenn.chong@sharp.com.

PHYSICIAN NEEDED: Family Practice MD. San Ysidro Health is looking for an MD for our Family Practice center. The Family Practice MD manages and provides acute, chronic, preventive, curative and rehabilitative medical care to patients and determines appropriate regimen in specialized areas such as family practice, prenatal OB/GYN, pediatrics and internal medicine.

Bilingual preferred but not required. Medical school graduate, CPR, CA MD and DEA License, board certified or eligible in primary care specialty. For more info on San Ysidro Health, visit: http://www. syhealth.org/ If interested, please email CV to Meagan.underwood@syhealth.org.

DERMATOLOGIST NEEDED: Premier dermatology practice in beautiful San Diego seeking a full-time/ part-time BC or BE eligible Dermatologist to join our team. Existing practice taking over another busy practice and looking for a lead physician. This is a significant opportunity for a motivated physician to take over a thriving patient base. Work with two 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, cosmetic and surgical dermatology (including MOHs) in a medical office with state of the art tools and instruments. Please call Practice Administrator at (858) 761-7362 or email jmaas12@ hotmail.com for more information.

OUTPATIENT PRIMARY CARE OPPORTUNITY: San Diego Internal Medicine Associates (SDIMA) is looking for a strong MD candidate to join our 6 physicians and 6 physician assistants in providing excellent care in a private practice setting. SDIMA is a well-established office with board certified internists and med/peds physicians. No hospital call. Please send your CV, or any questions you may have to Jared.Kowerski@ SDIMA.com.

PRACTICE FOR SALE MEDICAL SPA AVAILABLE TO LICENSED PHYSICIAN: Southern California | Owner Benefit: $410,000 | This practice performs cosmetic procedures such as dermal fillers, Botox, and cosmetic laser treatments. The business has strong cashflow and is poised for continued growth. Minimal physician in-clinic time required and patients pay at time of service. Owner is retiring. A strong operations team will remain post acquisition. To see more (video interview with seller, assessment report, financials, etc.) visit: https://goexio.com/med-spa and select “Private Access” to sign an electronic NDA. Diligence materials available to qualified buyers only. Prefer a personal touch? Contact Bill Littlefield: (541) 4292950. bill.littlefield@goexio.com.

FOR SALE, BUSY FAMILY PRACTICE - POTENTIAL URGENT CARE: Established family practice for 27 years located in Chula Vista near H Street at 805 in upscale mall setting. Ideal location with free and easily accessible parking. Spacious 2600ft office space with CLIA Certified Lab and X-Ray. Practice accepts and experienced in billing: Medicare, Tricare, Immigration Exams, DOT Certification, Workers Comp.

Contact: S.J. Anderson 858-736-5818 or email marva. winchi.garcia@gmail.com INTERNAL MEDICINE PRACTICE OPPORTUNITY: Internal Medicine practice in North San Diego County, Tri-City community, established for over forty years, available for full or part-time physician. This practice has an established EMR system, exceptional office staff and shares overhead with five other Internists.

Inpatient activity available at your option. Please email: jalafata@aol.com, or call North County Internal Medicine at 760-726-2180.

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 non-invasive 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.

PRACTICE AVAILABLE IN EL CAJON: Mature board certified Family physicians grossing $1 million per year are selling this practice in El Cajon, California.

This is a busy practice, on the Allscripts EHR in a busy neighborhood and contracted with local IPAs. I will lease the 1500 sqft office condo to you as well. Send an inquiry to Dennis O Dominguez dd489583@gmail. com or send text to 619 2464548 and I will call you.

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

NEW OFFICE SPACE IN VISTA

500-4000 sq. ft. office units available for lease in brand new high-quality building, in second story with elevator above a thriving primary care clinic and urgent care attracting 100 patients per day of foot traffic. Street-facing and located in Vista along the growing redevelopment zone.

Please contact Richard Alvarez at Prime Investors Corp. ralvarez2@verizon.net or 760-224-9283.

EL CAJON MEDICAL OR DENTAL BUILDING FOR SALE OR LEASE: 3,700 square foot medical or

dental building with 11 exam rooms available for sale or lease! Sink in all exam rooms, nurses station, break room, abundance of storage, etc. Building has been very well cared for and $200,000+ has gone into it since 2006. Prime location only three blocks from I-8 freeway exit right off of Broadway. Property also features oversized lot with 20+ parking spaces.

Asking Sale: $1,199,000. Asking Lease: $7,500/month + NNN. Terms are negotiable. Please contact: Dillon.

Myers@TonyFrancoRealty.com | (619) 738-2318

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

MEDICAL OFFICE LEASE: We currently have a small medical office ready to lease. The office is located in Imperial county and is approximately 910 sqft. Please email us at info@carlsbadimaging.com with any with further questions or needed details.

MEDICAL OFFICE SPACE FOR LEASE: Medical office space available for lease, located at 15721 Pomerado Road, Poway, 92064 in the Gateway Medical Center. This large facility has a large shared waiting room, front desk reception area, two exam rooms, nursing station, private office, 3 shared in office restrooms & staff lounge. The suite is shared with an internal medicine group, neurology group, podiatry group, laboratory, endocrinology, & acupuncture. Walking distance to Pomerado Hospital. Ample parking & private tenant gym with showers. Imaging, Lab Corp & Quest are located in an adjacent building. Great opportunity in this affluent community. Call Angie (858) 485-6644.

OFFICE SPACE AVAILABLE FOR LEASE: 5004000 sq. ft. office units available in brand new high-quality building, in second story with elevator above a thriving primary care clinic and urgent care attracting 100 patients per day of foot traffic.

Street-facing and located in Vista along the growing redevelopment zone. Please contact Richard Alvarez at Prime Investors Corp. ralvarez2@verizon.net or 760-224-9283 SUBLEASE OFFICE SPACE: 9834 Genesee (Poole Bldg) La Jolla Scripps Memorial campus. Sublease full or part of the office with 5 plus rooms, bathroom/ shower. Excellent referral situation. Between I-5 and I-805. Call 858-344-9024 or 858-320-0525.

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE FOR 2-3 DAYS PER WEEK in the 4520 Executive Drive Bldg. Excellent location between I-5 and I-805 . Beautiful renovated office space with 2 exam rooms and large physicians office for consultations. Ideal for Vein and vascular, primary care, pain management, physical therapy, rheumatology, infectious disease, dermatology, orthopedics. Interested parties, please email missyphilip@gmail.com ENCINITAS OFFICE SPACE TO SHARE/SUBLEASE: Longstanding (38 years) allergist in Encinitas has a 3000 square foot office space available to share/ sublease. Six exam rooms and a permanent private office/consultation room. Office is available Tuesday morning and all day Wednesdays and Fridays. Office located on El Camino Real in Encinitas. Please contact wwpleskow@sbcglobal.net or call 760-436-3988.

MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in a small boutique office space located close to Moonlight Beach in Encinitas. First floor with 570 square feet and peek ocean views. Available February

1st. Physician/Dentist parking spot comes with lease and lease would be until December 31, 2020. Sinks in 2 exam rooms, office space for physician/dentist and laboratory storage area in addition to lobby/reception area. Asking: $2,000/month. Terms are negotiable.

This will rent fast so hurry! Please contact: dana@ sdrheumatology.com | (858) 603-2068 SHARED OFFICE SPACE: Office Space, beautifully decorated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist. Please call 619-606-3046.

OFFICE SPACE/REAL ESTATE AVAILABLE: Scripps Encinitas Campus Office, 320 Santa Fe Drive, Suite LL4 It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery.

It is located just off Interstate 5 at Santa Fe Drive, and a half-mile from Swami’s Beach. Contact Kristi or Myra 760-753-8413. View Space on Website:www. eisenhauerobgyn.com. Looking for compatible practice types.

OFFICE SPACE AVAILABLE: 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.

OFFICE SPACE FOR RENT: Multiple exam rooms in newer, remodeled office near Alvarado Hospital and SDSU. Convenient freeway access and ample parking.

Price based on usage. Contact Jo Turner (619) 7334068 or jo@siosd.com.

MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in an office space with other medical offices located in downtown Chula Vista close to Scripps Chula Vista hospital. First floor with ~1000 square feet. Available January 1st. 2 physician/dentist parking spots comes with lease and lease would be until June 4, 2020 or longer should you negotiate with the building manager. Sinks in 3 exam rooms, office space for physician/dentist, bathroom, and laboratory area or additional exam room in addition to lobby/reception area. There is a long term subleasor on Fridays, so rent could be lower if you are willing to keep the subleasor, but asking: $2,000/month. Terms are negotiable. Please contact: dana@sdrheumatology. com | (858) 603-2068 OFFICE SPACE / REAL ESTATE WANTED MEDICAL OFFICE SPACE SUBLET DESIRED NEAR SCRIPPS MEMORIAL LA JOLLA: Specialist physician leaving group practice, reestablishing solo practice seeks office space Ximed building, Poole building, or nearby. Less than full-time.

Need procedure room. Possible interest in using your existing billing, staff, equipment, or could be completely separate. If interested, please contact me at ljmedoffice@yahoo.com.

NON-PHYSICIAN OPPORTUNITIES PSYCHIATRIC NURSE PRACTITIONER WANTED: UPAC Counseling and Treatment Center and Community Wellness Center is seeking a Full Time Psychiatric Nurse Practitioner (40 hours/week) who can provide treatment for adults and older adults with serious mental illness and promote psychosocial rehabilitation principles of wellness and recovery through providing psychiatric evaluations, diagnoses, and treatment. Mail, fax, or email your resume to: UPAC HR DEPARTMENT 1031 25th Street San Diego, CA 92102 Fax: 619-232-4113 Email: upacjobs@upacsd.com

DIRECTOR OF NURSING POSITION: The Director of Nursing is responsible for assuring the quality of the clinical practice of RNs, LVNs, and related healthcare staff to maximize access for patients and facilitate the delivery of prompt, quality health care. This includes developing, revising and maintaining up-to-date nursing protocols and procedures; developing and administering training programs for non-provider medical staff; maintaining a clinical risk program for loss prevention and claims control; and assisting medical staff and health center staff in understanding and complying with regulatory requirements including Department of Health and Human Services (DHHS) standards. Requirements are a Bachelor of Science in Nursing (BSN) Degree from an accredited institution. Five (5) years of general nursing experience, with at least two years of managing health center services, hospital programs or other major health care projects. Managed care and quality assurance experience.

PHYSICIAN ASSISTANT POSITION AVAILABLE: Full time Physician Assistant position for a busy Internal Medicine outpatient practice in La Mesa.

Efficient, hardworking, team player with compassion towards patient care is expected. Clinical competency, knowledge about Quality measures as well as HCC codes are preferred. Communication skills, Caring, connecting with the patients and ability to adequately document are expected. Supervising physician is a faculty in multiple universities and has great experience with teaching. The office is run in a pleasant and friendly atmosphere. Candidate must have current California license and DEA certificate.

Compensation is competitive and commensurate on experience. Interested candidates can E-mail CV to vprabaker@gmail.com CLINICAL RESEARCH ASSISTANT WANTED: Experience in supporting or managing clinical research studies is a plus (we are not targeting laboratory-based research professionals). The position is part-time (24 hrs a week) and flexible.

Tuesday and Wednesday mornings preferable.

Applicants must speak Spanish to help with our Spanish-speaking population. Individuals need also be organized and detailed. A high degree of computer literacy is required. A Bachelor’s degree in life sciences (or equivalent, e.g. RN) is preferred but candidates with ‘qualification through experience’ will be considered. Please email your resume and desired pay to careers@rheumSD.com (posted 4/9/2019) SEEKING PHYSICIAN ASSISTANT/NURSE PRACTIONERS: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners. The PA or NP will provide direct, in office patient care; this will include examination and treatment of patients and completion of all necessary paperwork. We currently have a FM part-time opening in our Ramona & Valley Center offices and a full-time Urology opening in Escondido. Prior Urology experience highly preferred.

Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Comfortable working independently. Bilingual in English/Spanish helpful.

Send CVs to ssnodgrass@graybill.org or apply online at www.graybill.org, or fax (760)738-7101.

SEEKING PART-TIME FM AND UROLOGY PHYSICIAN ASSISTANT/NURSE PRACTIONER: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners.

The PA or NP will provide direct, in office patient care; this will include examination and treatment of patients and completion of all necessary paperwork.

We currently have a FM part-time opening in our Ramona office and a part-time Urology opening in Escondido. The Urology position is 2 days per week; preferably Mondays & Thursdays 8 am - 5 pm. Prior Urology experience highly preferred. Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Comfortable working independently.

Bilingual in English/Spanish helpful. Send CVs to ssnodgrass@graybill.org or apply online at www. graybill.org, or fax (760) 738-7101.

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

A Timely Addition to the Hippocratic Oath As Important as Primum Non Nocere By Helane Fronek, MD, FACP, FACPh

AT A RECENT PHYSICIAN leadership conference, many physicians expressed frustration with the epidemic of burnout in our profession. While the focus has been on what physicians can do to enhance their resilience, Dr. Nassir Azimi expressed a common sentiment: If we see physicians jumping off a cliff, why do we keep buying more ambulances, rather than building a fence?

Increasingly, our profession is acknowledging the impossible burden the EHR, insurance companies, and multiple regulations place on physicians; the inadequate time we are given to interact meaningfully and build relationships with our patients; and the erosion of our autonomy and sense of value. We cannot wait for these matters to be addressed. A recent article in Time put the cost of physician burnout in the US at $4.6 billion per year. Perhaps this will motivate our government, organiza-

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tions, and institutions to pay attention and implement changes.

Our job, as individual physicians, is to step up and participate in leadership roles so we can push the right initiatives forward and keep this issue front and center until meaningful changes are made. California Medical Association’s Well Physician California initiative is an important step in this endeavor.

In the meantime, what support in the form of ambulances is available? Having coached many physicians through and out of burnout, I know the answer is different for each person. Examining our entire life to see what areas can be improved is a good first step. Each aspect of our life affects the others: If we are ignoring health problems, our primary relationship isn’t as nurturing as we would like, or we feel a void from not connecting with nature or our spiritual self, improving these situations may en-

hance our sense of wellbeing.

Creating realistic expectations of ourselves, such as limiting what we cover in each patient visit by focusing on what is most important and being honest about our time constraints, may help us feel more successful. Saying no to requests that are not congruent with our goals or values, and prioritizing time for family, friends, and pursuits that truly bring us joy will ensure that our time is spent wisely and in ways that feed our sense of purpose and fulfillment.

For our colleagues, we can provide crucial interactions. By reaching out when they are struggling, listening with compassion and without judgment, we demonstrate that they matter and are not alone. Intentionally acknowledging what we appreciate about them can balance the negative inputs that otherwise feel defeating.

We have a responsibility to monitor and maintain our own wellness. In fact, the Hippocratic oath, the ultimate ethical contract in medicine, should include such an agreement. Given that burnout results in increased medical errors, reduction in working hours, and physician suicide, being an ethical doctor requires that we prioritize our wellness. Let’s stand together in personally declaring and supporting our colleagues in taking this important vow. We, our profession, and our patients deserve nothing less.

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

t hank you

TO OUR ADVERTISERS WHO HAVE SUPPORTED SAN DIEGO PHYSICIAN MAGAZINE THIS YEAR.

INSURANCE

The Doctors Company (800) 852-8872 www.thedoctors.com/SDCMS

BANKING

First Republic Bank (855) 886-4824 www.firstrepublic.com

EMPLOYMENT

Tracy Zweig & Associates (800) 919-9141 www.tracyzweig.com

Vista Community Clinic (760) 631-5000 www.vistacommunityclinic.org

Cooperative of American Physicians, Inc. (800) 356-5672 www.CAPPhysicians.com

MEDICAL BILLING

Medical Billing Strategies (619) 260-0999 askmbs.com

MORTGAGE BANKING

Bank of America 858.692.9698 billy.cafcules@bankofamerica.com mortgage.bankofamerica.com/ billycafcules

TECHNOLOGY

Soundoff Computing (858) 569-0300 www.soundoffcomputing.com

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Please contact these vendors for your business needs.

Additional information can be found at the Practice Management Resources page at www.SDCMS.org.

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