August 2017

AUGUST 2017 OFFICIAL PUBLICATION OF SDCMS

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AUGUST

CONTENTS

VOLUME 104, NUMBER 8

EDITOR: James Santiago Grisolía, MD EDITORIAL BOARD: James Santiago Grisolía, MD • Mihir Parikh, MD • Robert E. Peters, MD, PhD • J. Steven Poceta, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: Mark W. Sornson, MD, PhD President-elect: David E.J. Bazzo, MD Secretary: James H. Schultz Jr., MD Treasurer: Holly B. Yang, MD Immediate Past President: Mihir Y. Parikh, MD GEOGRAPHIC & GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD(Alt); Jane A. Lyons, MD; Rakesh R. Patel, MD; Venu Prabaker, MD Hillcrest: Gregory M. Balourdas, MD; Kyle P. Edmonds, MD(Alt), Thomas C. Lian, MD Kearny Mesa: Sergio R. Flores, MD (Board Representative to Executive Committee); Anthony E. Magit, MD; Alexander K. Quick, MD; Eileen R. Quintela, MD(Alt) La Jolla: Geva E. Mannor, MD, MPH; Marc M. Sedwitz, MD, FACS; Wayne C. Sun, MD(Alt) North County: Christopher M. Bergeron, MD, FACS ; Neelima V. Chu, MD(Alt); Michael A. Lobatz, MD; Patrick A. Tellez, MD South Bay: Maria T. Carriedo, MD; Irineo “Reno” D. Tiangco, MD AT-LARGE & AT-LARGE ALTERNATE DIRECTORS Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); Karrar H. Ali, DO, MPH; Steven L-W Chen, MD, FACS, MBA(Alt); Stephen R. Hayden, MD; Preeti Mehta, MD(Alt); Vimal I. Nanavati, MD, FACC, FSCAI(Alt); Alexandra E. Page, MD; Robert E. Peters, MD; Peter O. Raudaskoski, MD(Alt); Al Ray, MD(Alt); Kosala Samarasinghe, MD(Alt); Thomas J. Savides, MD; Karl E. Steinberg, MD(Alt); Erin L. Whitaker, MD(Alt); Marcella (Marci) M. Wilson, MD; Nicholas J. Yphantides, MD ADDITIONAL VOTING DIRECTORS Communications Chair: J. Steven Poceta, MD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Michael C. Hann, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: Meghana Pagadala

6 features

14 National Immunization Awareness Month

BY CALIFORNIA MEDICAL ASSOCIATION

departments 4 Briefly Noted: Calendar • New and Returning Members • Volunteer Opportunities • And More…

6

2

8 Promote Safe Storage and Disposal of Opioids and All Medications

BY THE AMA TASK FORCE TO REDUCE OPIOID ABUSE

12 Winning The Tontine

BY DANIEL J. BRESSLER, MD, FACP

18 Physician Marketplace: Classifieds

Cyberattacks Threaten Patient Safety: Different Ways to Handle Computer Failures

20

BY ROBIN DIAMOND, MSN, JD, RN

BY HELANE FRONEK, MD, FACP, FACPh

AUGUST 2017

ADDITIONAL NONVOTING MEMBERS Alternate Young Physician Director: Heidi M. Meyer, MD Alternate Resident Physician Director: Zachary T. Berman, MD Alternate Retired Physician Director: Mitsuo Tomita, MD San Diego Physician Editor: James Santiago Grisolia, MD Champions For Health President: Al Ray, MD Delegation Chair: Steven R. Hayden, MD CMA President-elect: Theodore M. Mazer, MD (AMA At Large Delegate, Appointed by CMA) CMA Past Presidents: James T. Hay, MD (AMA Delegate); Robert E. Hertzka, MD (Legislative Committee Chair; AMA At Large Delegate, Appointed

by CMA); Ralph R. Ocampo, MD, FACS CMA Trustees: William T-C Tseng, MD; Robert E. Wailes, MD AMA Alternate Delegate: Lisa S. Miller, MD

What are You Tolerating? Personal & Professional Development

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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CALENDAR

SEPTEMBER 7, 5:30-8:00PM at

SDCMS-CMA CALENDAR For further information or to register for the following events, contact Jen at (858) 300-2781 or at JOhmstede@SDCMS.org.

SDCMS Physician Social (event) SEPT 7: 5:30pm-8pm at Rock Bottom Brewery ZERO: The End to Prostate Cancer (event) SEPT 9 Run/ Walk, De Anza Cove CMA’s “Medical Staff Self Governance and the Tulare Medical Staff Trial” (webinar) SEPT 13 Save the Date: 4th Annual Solana Beach Sunset 5K OCT 7

HEALTHCARE CONFERENCES To submit a community healthcare event for possible publication, email Editor@SDCMS. org. Events should be physician-focused and should take place in or near San Diego County.

Integrative Medicine for Mental Health Conference SEP 28-OCT 1 at the Hyatt Regency Orange County The Future of Medicine: A Conference for Physicians SEP 29 (7:30am–4pm) at Kona Kai Resort & Spa NEPO Building Health Communities Summit at Disneyland OCT 19-20 Register for Emergency Care by the Bay NOV 16

4

AUGUST 2017

MEMBERSHIP

Welcome New and Returning SDCMS-CMA Members!

OUR NEW MEMBERS Emily Cole, MD Female Pelvic Medicine and Reconstructive Surgery San Diego (858) 939-8375 Trent Douglas, MD, FACS Plastic Surgery San Diego (858) 224-2281 Katerina Gallus, MD Plastic Surgery San Diego (858) 926-8614 OUR RETURNING MEMBERS George Delgado, MD Family Medicine Escondido (619) 692-4401

ROCK BOTTOM RESTAURANT & BREWERY La Jolla Come mingle, socialize, and network with your fellow San Diego County physicians — SDCMS members and nonmembers are welcome and encouraged to attend (non-member fee $50.00).

Complimentary hors d’oeuvres and hosted wine and craft beer will be provided. Please note — this event is open EXCLUSIVELY to physicians and their guests and rsvps are required.

Questions: Contact Jen Ohmstede at (858) 300-2781 or via email at JOhmstede@SDCMS.org

THANK YOU TO OUR SPONSORS COOPERATIVE OF AMERICAN PHYSICIANS AND AWM GLOBAL ADVISORS

G

“

QUOTE OF THE MONTH

Did you ever see an unhappy horse? Did you ever see a bird that had the blues? One reason why birds and horses are not unhappy is because they are not trying to impress other birds and horses. — Dale Carnegie

/////////////////////////////////////////////////////////////////////////////////////////////////// GIVING BACK

VOLUNTEER OPPORTUNITIES Email Your Volunteer Opportunity Ads to Editor@SDCMS.org Physicians: Help Us Help Improve The Health Literacy Of Our San Diego County Communities by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and help improve the health literacy of those with limited access to care. For further details on how you can get involved, please email Andrew.Gonzalez@ChampionsFH.org.

Champions for Health Project Access: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology,

orthopedics, pulmonology, rheumatology, and urology. We are seeking these specialists throughout all regions of San Diego to support those that are uninsured and not eligible for Medi-Cal receive short term specialty care. Commitment can vary by practice. The mission of the Champions for Health’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism.

Will you be a health CHAMPION today?

For more information, contact Andrew Gonzalez at (858) 300-2787 or at Andrew.

Gonzalez@ChampionsFH.org, or visit www.ChampionsforHealth.org.

Humanitarian Teams Need Medical Volunteers for Haiti: We are looking for physicians and mid-level providers for one-week, primary-care medical clinics in rural Haiti in February, June, and October 2017. This is a rewarding opportunity to work with the people of Haiti and provide care in a very austere environment in a medically underserved area. Seattle-King County Disaster Team (a U.S.-based nonprofit) has been operating these clinics since 1998. We coordinate all in-country travel and logistics. Please contact Bob Downey at (619) 905-7157 or at labboy@earthlink. net if you are interested in applying.

Visit www.skcdteam.org for further information.

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

CYBERATTACKS THREATEN PATIENT SAFETY Different Ways to Handle Computer Failures

by Robin Diamond, MSN, JD, RN 6

AUGUST 2017

THE RECENT WANNACRY ransomware attack that crippled the United Kingdom’s National Health Service (NHS) showed how more than money and IT security are at risk — patient safety is also compromised by a cyberattack.

Hospitals and doctors’ offices in parts of England had to turn away patients and cancel appointments because their IT systems were infected with ransomware. Electronic health records (EHRs) were not accessible, and entire communities were advised to seek medical care only in emergencies. The same scenario could play out here in the United States.

Ransomware is not the only risk to patient safety. As the use of computerized

medical devices continues to grow, hackers may target these devices. And because healthcare is the most frequently attacked form of business, more cyber threats to patient safety are certain to arise. Our nation’s healthcare providers must approach cybersecurity as an organizational risk management and quality-of-care issue.

And they must do it now.

After WannaCry, I asked myself: Would physicians and hospital staff know how to respond to protect patient safety if all computer access suddenly vanished? With 79,000 member physicians nationwide, The Doctors Company has access to experts in specialties that might be most affected by a cyber attack: obstetrics, emergency medicine, anesthesiology, and surgery. So I reached out to some of these experts to share their concerns as well as their plans to protect patients. Their insights are a wakeup call to be prepared.

Some physicians have considered the potential danger and prepared a response, which is often a return to paper records when EHR systems go down. But that might not always be easy, or even possible. Paper copies of patient medical records may not always be available, a situation that could jeopardize patient care when clinicians must act without sufficient knowledge of allergies, medications, and past treatment.

This is why Dr. Marcus Tower, director of gynecology at Hillcrest Hospital (part of the Cleveland Clinic Health System), always keeps a paper backup of patient records that can be accessed quickly in the event of a computer failure. While he says losing access to computer records would be devastating to patient safety, access to paper backups would enable him to continue seeing patients even if his system was offline. Without a computer system, Dr. Tower would keep notes with time stamps.

Diligence with time stamping is particularly important in obstetrics, where so much hinges on exactly when decisions were made and care was provided.

Anesthesiologist Dr. Randolph Steadman, at UCLA, said in case of computer failure, ordering labs, imaging, and other diagnostic tests would be done by paper form and transmitted within the hospital by fax and/or conveyed by phone with paper forms to follow. But that would only be a workaround. Patient care overall would be affected, with registration slowed, he notes. Many clinicians and staff would be challenged to adapt to non-digital processes, as happened in the March 2016

cyberattack on the MedStar Health system, which has 10 hospitals and more than 250 outpatient clinics. When hackers seized control of their computer data, senior staff had to assist their younger counterparts with learning how to use paper messages and recordkeeping.

The ER could be hit hard by a cyberattack, but the physicians and staff there might be best prepared to respond, says Dr. Roneet Lev, chief of emergency medicine at Scripps Mercy Hospital and president of the Independent Emergency Physicians Consortium.

“Emergency departments have all experienced downtime with computer systems,” Dr. Lev says. “At our facility, we call this ‘Code White.’ When we hear ‘Code White’ on the speaker system, we know to get out the white board and the markers, and that things will be slower. It’s annoying and no one likes it, but we’d manage by keeping track of patients the old-fashioned way.”

Even so, a “Code White” still leaves clinicians without a way to refer to any medical records that are stored electronically. Not knowing a patient’s allergies or medical conditions is not optimal, she says, suggesting that all patients should always carry a list of their medications, allergies, and pertinent medical history on paper or on their smartphone.

Workarounds can only accomplish so much, Dr. Lev notes. A cyberattack could affect all computer-related hospital activities such as labs, X-rays, patient tracking, operating room scheduling, access to previous medical records, and treatment recommendations.

“While the emergency department would function using ‘Code White’ procedures, this is not sustainable for long-term operation of a hospital,” she says.

What these experts all seem to agree on is that in the face of an attack, the best way to protect patients is to return to practices that worked before computers.

As Dr. Ralph Gambardella, orthopedic surgeon and president of the Kerlan-Jobe Orthopaedic Clinic (affiliated with CedarsSinai) in Los Angeles, so aptly states: “Rather than relying on computers, I still believe that talking to — and communicating directly with — my patients is the best way to impact patient safety.”

Ms. Diamond is senior vice president for patient safety and risk management for SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

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7

PREVENTION

PROMOTE SAFE STORAGE AND DISPOSAL OF OPIOIDS AND ALL MEDICATIONS

by The AMA Task Force to Reduce Opioid Abuse 8

AUGUST 2017

The American Medical Association Task Force to Reduce Opioid Abuse strongly supports the education and awareness of physicians, patients, policymakers, and other key stakeholders regarding the risks of prescription opioids and other medications if they are not taken as prescribed — as well as steps needed to ensure safe storage and disposal of expired, unwanted or unused medications. The Task Force urges all physicians and other health care professionals to take three steps that can help: First, physicians and other health care professionals need to talk to their patients and educate them about safe use of prescription opioids — more than 70 percent of people using opioid analgesics for nonmedical reasons get them from family or friends.1 Opioid analgesics should only be taken as directed since misuse or diversion of these products can be illegal, extremely harmful and even deadly.

Second, remind patients that medications should be stored out of reach of children, and in a safe place — preferably locked — to prevent other family members and visitors2 from taking them.

The CDC recommends that prescribers “discuss risks to household members and other individuals if opioids are intentionally or unintentionally shared with others for whom they are not prescribed, including the possibility that others might experience overdose at the same or at lower dosage than prescribed for the patient.”

Third, talk to your patients about the most appropriate way to dispose of expired, unwanted and unused medications. The preferred option is that unwanted or unused pills, liquids or other medications should be disposed of in a local “take back” or mail back program or medication drop box at a police station, DEA-authorized collection site or pharmacy, if the pharmacy has a secure drop-box program.

Additional take back and disposal options and resources are below.

AMA Task Force to Reduce Opioid Abuse Organizations American Academy of Addiction Psychiatry American Academy of Family Physicians American Academy of Hospice and Palliative Medicine American Academy of Orthopaedic Surgeons American Academy of Pain Medicine

Learn more at ama-assn.org/opioids-disposal Take back and disposal resources for physicians and patients • Search for a drug disposal location near you

American Academy of Pediatrics American Academy of Physical Medicine and Rehabilitation American Association of Neurological Surgeons and Congress of Neurological Surgeons

https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1

American College of Emergency Physicians

• Find an authorized local collector

American College of Occupational and Environmental Medicine

Contact the DEA Office of Diversion Control’s Registration Call Center at (800) 882-9539

• View the FDA guide “How to Dispose of Unused Medicines” https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm

American College of Physicians American Congress of Obstetricians and Gynecologists American Dental Association American Medical Association

• View the FDA “Disposal of Unused Medicines: What You Should Know” resource

American Osteopathic Association

https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ BuyingUsingMedicineSafely/ EnsuringSafeUseofMedicine/ SafeDisposalofMedicines/ucm186187.htm

American Society of Addiction Medicine

• View the California State Board of Pharmacy’s quick reference resource

Arkansas Medical Society

http://pharmacy.ca.gov/publications/dont_flush_meds.pdf

American Psychiatric Association

American Society of Anesthesiologists California Medical Association Massachusetts Medical Society

Sources: 1. ONDCP findings from the Substance Abuse and Mental Health Service Administration’s NSDUH averaged for 2009 and 2010 show that 55 percent of persons who used pain relievers non-medically obtained the pain relievers from a friend or relative for free, another 11 percent bought them from a friend or relative, and 5 percent got them from a friend or relative without asking. https://nsduhweb.rti.org/ respweb/homepage.cfm 2. The Safe Homes Coalition’s Keep Kids Safe Program is an example of a program that provides plastic bags to real estate professionals such as Realtors® so their clients can secure prescription medications while their home is being shown to potential buyers. http://makeitasafehome.org

1

Talk to your patients!

More than 70 percent of people misusing opioid analgesics are getting them from family and friends — sharing opioids is illegal and may be deadly.

2

Remind your patients!

Store medicines out of reach from children and never share prescription(s) with anyone.

Medical Society of the State of New York New Mexico Medical Society Ohio State Medical Association Oregon Medical Association Utah Medical Association

3

Urge your patients to safely dispose of expired, unwanted and unused medications!

Recommend patients use pharmacy and law enforcement “take back” resources whenever possible.

SAN DIEGO PHYSICIAN.ORG

9

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11

POE TRY AN D M EDICIN E

Winning the Tontine For MB All of them are gone now except for you.

The CCNY Sigma Alpha Mu Pledge Class of 1940 Sons and grandsons of immigrants The rough and tumble cream of the city schools Their accents scrubbed of Yiddish + Lithuanian They spoke Brooklyn and Bronx and baseball and jazz.

Arnie, the smartest of this smart clique Who tested with an IQ of 170 Who took off his thick glasses to swim in the afternoons He was destined to be first in the class.

When the war broke out your sophomore year He was the first to enlist, the first to complete Officer Training And the first to fall, killed leading his even younger recruits Kids from Flatbush and Hell’s Kitchen and Yonkers Up a hill in the slaughterhouse the historians Later sanitized as The Battle of the Bulge.

WINNING THE TONTINE

by Daniel J. Bressler, MD, FACP

Based on my long interest in the experience of people facing the last chapter of their life, I’ve concluded that most of them, when given the chance, tend to reflect on events that stand out to them as most vivid, even if many of those events are incidental to the broad strokes of their life history. I’ve heard a crusty old retired railroad engineer tearing up remembering the first time he saw the new toy railroad set he got for his 10th Christmas.

12

AUGUST 2017

Your best friend Howie had convinced you the summer before To take a train to Connecticut and work as farm hands For 15 cents an hour plus room and board plus stories This wasn’t a fortune but was a fair wage in a country Still out of work and waiting for war.

So you pulled weeds and potatoes for the laconic Mr. Ledbetter and slept on his haybeds warm from curing You picked fruit on the estate of Mr. Pratt, a Morgan Partner Who, hearing you were college boys, would engage you in banter And let you speak your classroom French to his precocious daughters Two summers later, Howie, too, met with the Nazi killing machine His good manners and enthusiasm unable to save him.

Walter got a Japanese bullet through his wrist And other injuries that never kept him long from battle.

After the war, a VA doctor recommended that he take up piano as therapy His lucky wound, he called it, because he married his quiet piano teacher Who planned on escaping poverty through her fingers And seduced him with her Schubert and Beethoven soulfulness In one of the listening rooms below the Steinway store in Midtown.

Walter, like you, moved to California and lived to see old age Your friendship persistent and sweet but muted By the losses you had shared but could never discuss.

You survived your Navy service in the Pacific Your landing craft always too small a target for the kamikazes You missed a few days in sickbay with a jellyfish sting And a few weeks in the Philippines with dysentery The hospital, all its windows broken by the Marines and sailors Rioting in protest after hearing about a tanned and coiffed Douglas MacArthur Starring in a made-for-Hollywood newsreel shot on the beachhead Outside the hospital where yes, he had returned as promised While they had stayed, slogging through the mud and mosquitos Losing their limbs and eyes and comrades.

Now only you are left.

You have won the tontine, this chalice of memories Paying out a steady royalty of recollection and regret For decade after decade And for a little time yet to come.

“To win the tontine” means to be the last survivor of a group that had formed for a specific purpose.

A frail arthritic widower once sat on my consultation room couch and relived out loud the details of an unconsummated love affair she had with a young man she met while traveling in Europe in the 1950s.

Many of the women acutely remember the seemingly trivial anecdotes of early motherhood. Many of the men remember their experiences of war as if it were yesterday.

More than 16 million Americans were part of the armed services during World War II. Of those, slightly less than 600,000 remain, according the Department of Veterans’ Affairs. The very youngest of those who served is now in his or her late 80s. Most are in their 90s — as is my father, Marty, who provided the source material for this poem. In geriatrics, we call people in this age group (85–94) the “old old.”

By way of clarification, the phrase “to win the tontine” means to be the last

survivor of a group that had formed for a specific purpose. Its origin is from the 17th century, when a banker from Naples named Lorenzo Tonti set up an investment fund based on subscribers who would put money into a “pot” with the interest paid out only to the survivors. As you might imagine, such a setup has given rise to a number of interesting and amusing books, movies, and plays. It has also, indirectly, has given rise to this poem written for my father and his group of college buddies, now all gone but for him.

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

Tracy Zweig Associates INC.

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AUGUST IS NATIONAL

IMMUNIZATION AWARENESS MONTH Talk to Your Patients About the Importance of Vaccination

by California Medical Association

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AUGUST 2017

AUGUST MARKS NATIONAL IMMUNIZATION Awareness Month (NIAM), a national effort to promote vaccinations and protect children and adults from serious, and sometimes deadly, preventable diseases. According to the Centers for Disease Control and Prevention (CDC), immunization is one of the top 10 public health accomplishments of the 20th century.

Among children born between 1994 and 2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations and 732,000 deaths over the course of their lifetimes.

As part of this important effort, the California Medical Association (CMA) and its county medical societies are encouraging physicians to talk to their patients about the importance of vaccinations — for people of all ages.

“Immunizations represent one of the greatest public health accomplishments of the 20th century,” says Dr. Ruth Haskins, CMA president. “As an OB-GYN, I see the life-preserving benefits of vaccines every single day in my patients and their babies. The science is crystal clear on this issue — vaccines are safe and effective at preventing potentially deadly diseases.”

To help get the word out about the importance of vaccination at every age, the National Public Health Information Coalition, in collaboration with the CDC’s National Center for Immunization and Respiratory Diseases, has developed toolkits to help you communicate with your patients about vaccines. Each week of #NIAM17 focuses on a different stage of the lifespan:

• Babies and young children (July 31–Aug. 6) • Pregnant women (Aug. 7–13) • Adults (Aug. 14–20) • Preteens and teens (Aug. 21–27)

The NIAM toolkit contains key messages, vaccine information, sample articles, social media messages, FAQs, and web links and resources. You can also get eye-catching NIAM logos and banners to highlight your NIAM participation on your social media profiles. Download the toolkit at www.nphic.org/niam.

NIAM also provides a back-to-school toolkit for to help you remind parents to get their children vaccinated before the school year starts. As you know, last year marked the implementation of California’s landmark legislation (SB 277) that eliminated personal belief exemptions from school vaccinations. CMA sponsored this critical legislation, which will help protect the most vulnerable Californians — including babies too young to be immunized and people who are immunocompromised — from the risks associated with contracting these diseases. It will also protect the community at large from increased outbreaks of vaccinepreventable disease.

SAN DIEGO PHYSICIAN.ORG

15

CALIFORNIA CALIFORNIAMEDICAL MEDICALASSOCIATION ASSOCIATION

AB AB72 72

WHAT WHATPHYSICIANS PHYSICIANS NEED NEEDTO TOKNOW KNOW

AB AB72 72HAS HASTAKEN TAKENEFFECT EFFECT On July On July 1, 2017, 1, 2017, a new a new law law (AB(AB 72) 72) tooktook effect effect andand has has changed changed the the billing billing practices practices of non-contracted of non-contracted physicians physicians providing providing non-nonemergent emergent carecare at in-network at in-network facilities facilities including including hospitals, hospitals, ambulatory ambulatory surgery surgery centers centers andand laboratories. laboratories.

TheThe law,law, signed signed in 2016, in 2016, waswas designed designed to reduce to reduce unexpected unexpected medical medical billsbills when when patients patients go to goan to an in-network in-network facility facility but but receive receive carecare from from an out-of-network an out-of-network doctor. doctor.

CMA CMA is aware is aware of the of the potential potential adverse adverse impacts impacts of the of the newnew law law on our on our physician physician members members andand has has dedicated dedicated significant significant resources resources in order in order to achieve to achieve the the bestbest possible possible outcomes outcomes for physicians for physicians in light in light of the of the newnew billing billing restrictions. restrictions.

AB AB 7272 RESOURCES RESOURCES • Webinar • Webinar (9/27/17): (9/27/17): HowHow to Challenge to Challenge the Interim the Interim Payment Payment for Out-Of-Network for Out-Of-Network Services Services at In-Network at In-Network Facilities Facilities • CMA • CMA FAQ:FAQ: “A Physician’s “A Physician’s Guide Guide to AB to72: ABQuestions 72: Questions and and Answers” Answers”

• Sample • Sample letter letter to appeal to appeal to the to payor the payor for additional for additional reimbursement reimbursement • Billing • Billing Requirements Requirements Under Under California’s California’s NewNew LawLaw on on Billing Billing and and Payment Payment for Out-of-Network for Out-of-Network Services Services at at In-Network In-Network Facilities Facilities

• Webinar • Instructions • Instructions and and Sample Sample Form Form for Obtaining for Obtaining Patient Patient • Webinar (recorded (recorded on 5/17/17) on 5/17/17) : Assembly : Assembly Bill 72: BillWhat 72: What Consent Consent Under Under California’s California’s NewNew LawLaw on Billing on Billing and and Physicians Physicians Need Need to Know to Know About About the New the New LawLaw on on Payment Payment for Out-of-Network for Out-of-Network Services Services at In-Network at In-Network Payment Payment and and Billing Billing for Out-Of-Network for Out-Of-Network Services Services Facilities Facilities • CMA • CMA On-Call On-Call Document Document #7508: #7508: “Non-Contracting “Non-Contracting Physicians” Physicians”

JOIN JOIN NOW! NOW!

These These materials materials are are exclusively exclusively designed designed for for members members of CMA of CMA andand component component medical medical societies. societies.

CallCall the the CMA CMA Member Member Resources Resources lineline during during normal normal business business hours hours to join to join andand have have immediate immediate access access to this to this toolkit: toolkit: (800) (800) 786-4262.

786-4262.

AskAsk about about ourour newnew monthly monthly payment payment planplan for for membership. membership.

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Access Access to CMA’s to CMA’s reimbursement reimbursement experts experts is aisFREE, a FREE, members-only members-only benefit. benefit.

Need Need help? help?

CallCall (800) (800) 786-4262 786-4262 or email or email economicservices@cmanet.org. economicservices@cmanet.org.

AUGUST 2017

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FEBRUARY 2017 OF SDCMS

OFFICIAL PUBLICATION

Each month, every physician in San Diego County receives a copy of San Diego Physician magazine (over 10,000 in July).

What better way to ensure other physicians know about your medical practice than through a referral ad? Advertising packages are available at very attractive price points, and, for a limited time, member physicians receive 45% off of rates.

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CLASSIFIEDS PHYSICIAN POSITIONS AVAILABLE PART TIME OR FULL-TIME SUB-INVESTIGATOR: Work under the supervision of the Medical Director/Principal Investigator performing a variety of scientific clinical research activities to include the direct assessment of study participants and execution of protocol specific procedures.

Required Education and Experience: M.D., Board Certification (or Board eligible) in Internal medicine, Family practice or Emergency Medicine, Prior clinical research experience preferred. Skills/Competencies: Excellent professional communication, punctual and responsible, friendly and outgoing demeanor, must demonstrate a passion for direct patient interaction. Demonstrate clinical competence, positive leadership and ability to work collaboratively with a multi-disciplinary team. Send resume to: eliku@artemisresearch.com 7/28 FAMILY MEDICINE POSITION AVAILABLE: The Sycuan Medical Dental Center is a tribal health center, located on the Sycuan Indian Reservation in El Cajon, CA. This is a full-time position to provide outpatient care, no OB. Current CA and DEA licenses required. Student loan repayment possible.

Must be BC/BE. Competitive compensation, full benefits. If interested, please e-mail CV to Amy Laughner (ALaughner@ sycuan.com) or apply online at www.sycuan.com. 7/21 ASSISTANT, ASSOCIATE OR FULL PROFESSOR (HS CLIN, CLIN X, ADJUNCT, IN RESIDENCE - PEDIATRICT GASTROENTEROLOGIST WANTED: THE UCSD Department of Pediatrics is committed to academic excellence and diversity within the faculty, staff, and student body and is recruiting for fulltime gastroenterologists for our inpatient care at RCHSD, and at our outpatient clinics located throughout San Diego County.

Candidates must have an MD, be board-certified or boardeligible in pediatric gastroenterology, with general clinical GI experience and be licensed/licensable to practice medicine in the state of California. Applications must be submitted through the UC San Diego’s Academic Personnel RECRUIT system at: http://apptrkr.com/1036106. The University of California is an EOE/AA Employer.

DERMATOLOGIST NEEDED: Premier dermatology practice in La Jolla seeking a full-time/part-time BC- or BE-eligible dermatologist. Existing practice taking over another busy practice and looking to add dermatologist. 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 environment. We care about our patients and treat our staff like family. Opportunity to do medical, cosmetic, and surgical dermatology. Please call practice administrator at (858) 761-7362 or email jmaas12@ hotmail.com for more information. [612] PRIVATE PRACTICE INTERNAL MEDICINE OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO COUNTY: Unique opportunity to practice outpatient internal medicine in a private practice setting. Practice is part of a well-established internal medicine group with a 30+ year history of outstanding care in the community, seeking physician who enjoys providing thoughtful, personalized patient care. Exceptional office staff, flexible scheduling options, small group environment, autonomy, and very high quality patient care are among the many benefits of this opportunity. Office is easily accessible from all parts of San Diego County, as well as Orange County.

Seeking BC/BE applicants. Please send CV to portofino3@aol. com or call (619) 248-2324. [611] FULL-TIME PRIMARY CARE PEDIATRIC POSITION AVAILABLE in beautiful San Diego, California, to provide coverage for newborn care in Maternal Child Health Unit and community outpatient pediatric clinic. Job duty includes supervision and teaching of residents and medical students.

Average 20–25 patients daily. No evening or weekend calls or attendance of deliveries. Centrally located in San Diego with easy access to gorgeous beaches, parks, hiking trails, San Diego Zoo, and fine dining. Opening available now. Must be certified for PALS and NRP. BC or BE. Must have a valid California medical license. An additional part-time position is also available. Please submit inquiry and CV to Garcia.LeanneSarah@scrippshealth.org. [610]

FAMILY PRACTICE MD / DO WANTED for urgent care and family practice office in Carlsbad. Flexible morning, 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. [609]

County, Riverside County, and Orange County. We have openings for full-time and part-time physicians. Current CA and DEA licenses required. Malpractice coverage provided.

Full benefits packet. Email resume to hr@vistacommuntyclinic. org or fax to (760) 414 3702. Visit our website at www. vistacommuntyclinic.org. EEO Employer/Vet/Disabled/AA [566]

LOOKING FOR A FAMILY PRACTITIONER: Well-established solo family practitioner located in suburban San Diego wishing to transition into retirement and looking for a fellow family practitioner to assume fully operational practice. This practice is part of a 15-member incorporated family practice medical group with lab, X-ray, and MRI facilities. All interested candidates will be considered. Please email CV with contact information to Editor@SDCMS.org. [607]

PRIMARY CARE JOB OPPORTUNITY: Home Physicians is a fast-growing group of house-call doctors. Great pay ($200– $250+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 992-5330 or email CV to drhunt@thehousecalldocs.com. Visit www.thehousecalldocs.com. [037]

SEEKING PART-TIME PHYSICIAN: Anderson Medical Center is a busy primary care, sports, and occupational medicine practice housed in a state-of-the-art urgent care facility in Pacific Beach. We’re seeking a part-time physician. Experience in a busy practice, emergency department, or urgent care; with musculoskeletal medicine, X-ray, and sutures/wound care required; and ability to provide compassionate care in a fastpaced environment necessary. We seek someone who values: integrity and quality medical care; with impeccable bedside manner, emotional / professional maturity, ability to work well with patients / team members, easily manages multiple priorities / patients; detail-oriented and team-focused. We’re open 8:00am–8:00pm, Monday–Friday, 8:00am–4:00pm weekends. Providers share day, night, and weekend coverage.

Contact Anderson Medical Center at (858) 224-7977. CVs may be emailed to jhardyman@andersonmedicalcenter.com. [606]

KEARNY MESA MEDICAL OFFICE - FOR LEASE

SEEKING PART-TIME CARDIOLOGIST: Seeking a cardiologist to work part-time in an outpatient cardiology practice in North San Diego County. Practice opportunities from Monday through Saturday. Hours are from 8am to 5pm.

There is no night call or holiday workdays. The contracted cardiologist would decide from the days available which days to work. Please fax resume to (760) 510-1811 or email to evelynochoa2013@yahoo.com. [596] SEEKING FAMILY MEDICINE AND INTERNAL MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group is seeking full-time or half time (job share) BC/BE family medicine and internal medicine physicians to join our staff. We offer a firstyear competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 2334730. Email: lori.miller@sharp.com. [590] SEEKING EMERGENCY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group is seeking full-time BC/ BE emergency medicine physicians to join our urgent care department. We offer a first-year competitive compensation and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@sharp.com. [591] FAMILY MEDICINE / INTERNAL MEDICINE PHYSICIANS NEEDED: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and midlevel practitioners. We currently have full-time openings in our San Marcos, Ramona (solo practice), and Temecula locations. Current CA and DEA licenses required. Must be BC/BE. 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. [592] GENERAL, FAMILY, OR INTERNAL MEDICINE PHYSICIAN NEEDED IMMEDIATELY: This opening is an independent contractor position. We are a house-call practice located in beautiful North San Diego County. We will also provide paid training on our EMR. 8–5, Monday–Friday, 10–12 patients per day, and on-call pager one week every three weeks, telephone call only. No rounds or hospital duties. If interested, please email your CV to julie@sandiegomobiledoctor.com. We are very anxious to fill this position, and we look forward to hearing from YOU! No agencies please. [584] FAMILY MEDICINE / PEDIATRIC PHYSICIANS NEEDED: Family medicine and pediatric physician positions currently available. Vista Community Clinic is a private nonprofit outpatient clinic serving the communities of North San Diego

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.

18

AUGUST 2017

7910 Frost Street. Class A medical office building adjacent to Sharp & Rady Children’s. Ready-to-occupy suites ranging from 1,300-5,000 SF with mix of exam rooms and offices. Will consider short-term & long-term leases.

For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org

CLASS “A” MEDICAL OFFICES, VISTA

Grow your business and upgrade to a new Class “A” medical office in TriCity’s leading outpatient health center.

Collegial environment with more than 40 physicians in 15+ specialities.

Strong primary care referral base. Fully renovated offices with today’s modern finishes. Close hospital proximity.

Multiple sizes available ranging from 1,200-6,800 SF. For more information, including floor plans, please call Greg Petree at (858) 792-0696 x112 or visit www.vistamedicalplaza.com/leasing OFFICE SPACE / REAL ESTATE AVAILABLE KEARNY MESA MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE: 1500 sq.ft Frost Street office with 2 exam rooms, 2 offices, front office area, bathroom, kitchenette and lobby. Easy access to Sharp Memorial Hospital and Rady Children’s Hospital and the 163 and 805 freeways. Up to 4 month lease with possible extension. Please call (858)4671899. 8/3 POWAY OFFICE SPACE AVAILABLE - PARTIME: Spacious 5 exam room office including large treatment room. Located across the street from Palomar Medical Centery Poway (aka Pomerado Hospital). Well suited for surgical or medical specialty. Contact bmorales@genhp.com. 7/21 SOLANA BEACH OFFICE 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.

CARLSBAD OFFICE TO SHARE: New Medical office in Carlsbad close to Carlsbad outlet mall; with 4 exam rooms, a large nurse station, and break room. All days available. Please call Katia at : 760-352-4103. 6/28 CARLSBAD OFFICE SPACE AVAILABLE: 3144 El Camino Real, Carlsbad, CA 92008. Beautiful new office space located in Class A building in Carlsbad, California. Brand new state of the art decor and furnishings located in beautiful new building. Located conveniently near the 5 and 78 freeways, Tri City Medical Center, and Carlsbad Shopping Center. Multiple exam rooms, procedure room, in suite bathroom, and office available. Free parking available. Contact Gehaan D’Souza MD @ Email: Gehaan@gmail.com or call Cell: 7145956589.

CARLSBAD WOMEN’S MEDICAL CENTER SUB-LEASE/ SHARE SPACE AVAILABLE: Modern with freeway exposure and easy access: 6125 Paseo Del Norte, Suite 140, Carlsbad, 92011. Seeking complementing women’s medical services: Perinatology, Weight Loss / Dietitian, Plastic or Cosmetic Surgery, Dermatology and or Pediatrics. Contact Katia Moukarzel at Feminacareo@gmail.com or, Tel (760)352-4103 MEDICAL OFFICE IN SOUTH BAY AVAILABLE TO SUBLEASE: Located next to Paradise Valley Hospital, this large, recently renovated office consists of six exam rooms and one procedure room. The office is currently utilized by orthopedic surgeons, and a med-legal specialist, 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 at jeff@sdmiortho.com or at (858) 245-9109. [613] OPPORTUNITY TO OWN A MEDICAL OFFICE BUILDING IN BEAUTIFUL ESCONDIDO: Why rent when you can own and have other medical professionals (building tenants) help pay your mortgage?! For about the price of a nice southern California home, you can own a seven-tenant office building.

For more information, call or text Ralph Hemphill (CA BRE licensee 01238305) at (760) 613-9791. [608] NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista 92083. Large office space is located in an upscale medical office. Finishings, décor, and atmosphere are upscale and inviting, a great place to build your business and clientele following. Few blocks from Tri-City Medical Center. X-ray suite is included. Included with multiple exam rooms, procedure / dressing room, is access to a kitchenette / break room, two bathrooms, and spacious reception areas all located on the property. Wifi is included as well. Ample free parking. Contact Harish Hosalkar, MD, at hhorthomd@gmail. com or on cell at (858) 243-6883. [605] SOUTH COUNTY MEDICAL SPACE AVAILABLE: 2323 E. 8th St., Wellness Center Suite 103, National City 91950. Large office space available for lease/rent. Finishings, décor, and atmosphere are upscale and inviting, a great place to build your business and clientele following. X-ray suite is included.

Lots of free parking space. Included with multiple exam rooms, procedure / dressing room, is access to a kitchenette / break room, two bathrooms and spacious reception areas all located on the property. Wifi is included as well. Contact Harish Hosalkar, MD, at hhorthomd@gmail.com or on cell at (858) 243-6883. [604] OPEN TO ALL MEDICAL PROFESSIONALS: Lease an office from San Diego Psychological Center in Poway or work as a licensed contractor. First floor, bathroom, receptionist area, waiting room, playroom, kitchen, handicap access, separate entrance / exit. By Pomerado Hospital. Contact Sam at (760) 607-6463. [603] MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE / SHARE IN UTC / LA JOLLA AREA: Established orthopedic surgeon seeks tenant to share office space. 4675ft2 in Chancellor Park, near Scripps Memorial Hospital. Completely rebuilt in 2009. Six exam rooms, digital X-ray onsite. Beautiful finishings, spacious waiting room, conference room, break room. Ample space for support staff and a private office for physician. Available immediately, full or part time. Ideal for primary or satellite office. Excellent freeway access (1-5 and 805), first-floor suite located off lobby near main building entrance. For further information, please contact Georgana Bradley at (858) 457-0050 or at gbradley@jpbamc.com. [602] MEDICAL OFFICE BUILDING FOR SALE OR LEASE: 1729 Palm Avenue is an approximately 2,433ft2, freestanding, professional medical office building conveniently located in San Diego. The property offers excellent exposure and visibility along Palm Avenue with approximately 38,000 ADT (Costar) and is minutes away from Imperial Beach and the Pacific Ocean. Sale Price: $519,000. Lease Rate: $1.35/ sf + Utilities. Please contact Chris Baumgart with Cushman & Wakefield for more information at (760) 431-3847 or at chris. baumgart@cushwake.com. [600] EAST COUNTY SINGLE-STORY HOME FOR SALE: East county single-story home on cul-de-sac, 4,800+ square feet, Hidden Mesa Estates, custom built 1990, on 0.8 acres, 5 bedrooms, 3.5 baths, 2 family rooms, plus den, pool, spa, deck with cabana, original owner. To contact agent, email ranchhouse21@gmail.com. [597] KEARNY MESA MEDICAL OFFICE FOR LEASE: 7910 Frost Street. Class A medical office building adjacent to Sharp & Rady Children’s. Ready-to-occupy suites ranging

from 1,300–5,000 SF with mix of exam rooms and offices.

Will consider short-term & long-term leases. For details, floor plans, and photos, contact David DeRoche at (858) 966-8061 or at dderoche@rchsd.org. [589] MISSION VALLEY AMBULATORY SURGICAL CENTER FOR LEASE: Centrally located in Mission Valley, AAAHCaccredited with two fully equipped operating rooms, recovery department, nicely appointed patient waiting area, and doctor’s lounge. Highly qualified surgical staff is provided. The center is leasable by the day, week, or month. Please contact Matthew Rifat for further information at (619) 708-3675. [588] HILLCREST OFFICE TO SHARE: Fourth floor suite at 4033 Third Avenue, a short walk to Mercy Hospital. Two exam rooms, private office, and break room. All days available.

Please call Jack Yang at (619) 548 0450. [585] EL CAJON OFFICE SPACE FOR RENT: Centrally located in East County in El Cajon. Rent by the hour, day, week, or month.

Reasonable rates. Free parking. Quiet office building. Free WiFi. Kitchen available. Central workroom. Wheelchair accessible.

Perfect for therapists, consultants, etc. Call Marlene at (619) 401-1430 or email saben615@sbcglobal.net. [582] 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 I-5 and I-805.

Multidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127] POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage therapist. Low rates. Email inquiries to kathysutton41@yahoo.com. [173] BUILD TO SUIT: 950SF office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with six gated parking spaces, two entryways, restrooms, lighted tower sign space. Build-out allowance to $5,000 for 4–5 year lease, rent $1,800 per month net ($400 NNN).

Contact venk@cox.net or (619) 504-5830. [835] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BOULEVARD: Two exam rooms and one minor OR room with potential to share other exam rooms in building.

Medicare certified ambulatory surgery center next door.

Minutes from Sharp Grossmont Hospital. Very reasonable rent.

Please email Editor@SDCMS.org for more information. [867] MEDICAL EQUIPMENT / FURNITURE FOR SALE USED OFFICE FURNITURE FOR SALE: Exam tables, stools, chairs, x-ray view boxes, executive desk, waiting room chairs, tables, filing shelves and cabinets. Please call (858)467-1899. 8/3 USED MEDICAL EQUIPMENT FOR SALE: (2 )centrifuges , excellent condition. Price new was $400.00 each . Offering at $ 200.00 each. Sonosite portable ultrasound machine (2006) , good condition, with 2 soni printers and a stand . Price new was over $20,000.00. Offering at 1000.00. Summit Doppler Vista ABI system w stand for performing Ankle Brachial index. (2012) Price new was $5400.00 . Barely used.

Offering at $2000.00. Call 619-606-3046.

WAITING ROOM KIOSK WITH TABLETOP STAND: (eClinicalWorks Compatible) Decrease wait times, increase collections, and improve financial performance. 17-inch touchscreen with swipe magnetic credit card reader. Copays and accounts receivable payable upon check-in. Software included. Original cost new $5,199. Sell for only $1,299. Email docpaul7@sdmedgroup.com. [587]

NONPHYSICIAN POSITIONS AVAILABLE Part Time or Full-Time Sub-Investigator: Work under the supervision of the Medical Director/Principal Investigator performing a variety of scientific clinical research activities to include the direct assessment of study participants and execution of protocol specific procedures. Required Education and Experience: M.D., Board Certification (or Board eligible) in Internal medicine, Family practice or Emergency Medicine, Prior clinical research experience preferred. Skills/ Competencies: Excellent professional communication, punctual and responsible, friendly and outgoing demeanor, must demonstrate a passion for direct patient interaction.

Demonstrate clinical competence, positive leadership and ability to work collaboratively with a multi-disciplinary team.

Send resume to: eliku@artemis-research.com 7/28

RECEPTIONIST POSITION AVAILABLE: Solo private practice Menopause Management office in Hillcrest. Backoffice experience is not required. Free parking is available on-site. Please fax CV and last two years work experience only to (619) 794-2942. 7/24 SEEKING RHEUMATOLOGY NURSE PRACTITIONER: Private Practice in Chula Vista seeking full or part time NP. Bilingual in English/Spanish helpful. Must have current CA NP license. No weekend or night shifts. Please apply even if you do not have experience in Rheumatology as we are happy to train you. Send CV to dana@sdrheumatology.com.

PSYCHIATRIC NURSE PRACTITIONER: University of San Diego has a full-time (11-month term ) employment opportunity for a psychiatric nurse practitioner in the wellness area. In this position, the incumbent will provide psychiatric care in collaboration with the consulting psychiatrist to students at the University of San Diego. Qualifications: graduate of approved training program for graduate nursing program; current active California licensure as NP with specialty training as a psychiatric NP; possession of a current valid CPR certificate is required; current knowledge of drug and treatment protocols common to ambulatory care; prior experience in university student health is highly desirable.

Wellness area at USD: The University of San Diego places great importance on providing students with the support services necessary to help them maximize their educational experience and to challenge them to develop knowledge, values, and skills to enrich their lives. The Counseling Center, the Center for Health and Wellness Promotion, Disability Services, and the Student Health Center seek to support student academic success and personal development by providing a comprehensive and integrated range of wellness services. Interested candidates may apply and submit a cover letter and resume to http://www.sandiego.edu/jobs/ (Job: IRC23760) [616] FAMILY MEDICINE NURSE PRACTITIONER: Needed at the Sycuan Medical Dental Center, a tribal health center on the Sycuan Reservation in El Cajon. Full-time position includes part-time patient care / part-time administrative duties. Mon.– Fri., 8am–4pm. Apply online at www.sycuan.com. [595] SEEKING PER DIEM PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and midlevel practitioners. We are currently looking for a per diem PA or NP to provide direct patient care in an urgent care / extended family practice setting in Escondido; to work three weekend shifts per month (8am–4pm) with a possibility of additional shifts as needed.

Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Two years’ prior experience in an urgent care or ER required. Bilingual in English/Spanish helpful. Send CV to ssnodgrass@graybill.org, apply at www.graybill.org, or fax to (760) 738-7101. [593] COORDINATOR, EMERGENCY MEDICAL SERVICES: This is a professional level class found in the Health and Human Services Agency Public Health Services Emergency Medical Services Branch and reports to the Chief, Emergency Medical Services. Under general direction, incumbents are responsible for one of four programs: Pre-hospital Programs, Trauma and Specialty Care Systems, Disaster Medical and Health Emergency Preparedness, or Emergency Medical Services (EMS) Communications Systems. Click here for further details and to apply. [555] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary.

Call (619) 992-5330 or email drhunt@thehousecalldocs.com.

Visit www.thehousecalldocs.com. [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [038]

PRODUCTS / SERVICES OFFERED 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]

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

We don’t notice that we’re becoming increasingly disconnected from who we are and what brings us joy until we develop symptoms of burnout, irritability, or depression.

WHAT ARE YOU TOLERATING?

by Helane Fronek, MD, FACP, FACPh

MOST PHYSICIANS are hard-working, driven people. We wouldn’t have gotten where we are without that drive, ignoring fun opportunities so we could gain knowledge and skills to care for our patients. During training, other options often weren’t possible. I recall having brunch at The Prado on my first “day off” as an intern. I marveled that this was likely just another free Sunday afternoon for the other people on the patio, whereas my next day off wouldn’t occur for several months.

Unfortunately, many of us continue this pattern of overwork even after training is over, when we have more control over our schedule. By this point, it’s become a habit, a way of life that has begun to feel normal. We don’t notice that we’re becoming increasingly disconnected from

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AUGUST 2017

who we are and what brings us joy until we develop symptoms of burnout, irritability, or depression.

Similarly, people in failed relationships often look back and recall behavior of their partner that foreshadowed what was to come. Refusals to help when asked, unwillingness to spend time together, and hurtful, dismissive comments were ignored or overlooked. “She’s tired, stressed, preoccupied,” were excuses given to explain the behavior. Life is complicated, and we often tolerate unpleasant or unhealthy behaviors or situations for fear of imagined repercussions, hoping that the behavior will change.

Unfortunately, this is magical thinking.

When we tolerate undesirable behavior, from others or ourselves, what we usually get is more of the same, or worse.

What are you tolerating?

Are you tolerating intimidating or unfair treatment by others in your office? Are you tolerating a poor diet or lack of exercise, believing you don’t have time to do better?

Are you tolerating being left out of plans made by your partner or friends, even though you feel ignored and hurt? Or perhaps, rude responses from your children?

While your current level of distress or disappointment may not have reached its boiling point, take a moment and imagine that this situation has continued for another 10 years. How will you feel then?

What will you have given up? How much better would your life be if you had corrected this situation now?

Stepping up to a conversation in which you honestly share what you’re noticing and the impact it’s having affords the other person an opportunity to change. And if the behavior continues, you can make a conscious choice between continuing to tolerate it or changing the situation. Either way, you take greater control of your life.

You give yourself the opportunity to have the life that you truly want to be living, and not one that you are simply tolerating. How great would that be?

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.

SATURDAY, OCTOBER 7, 3 PM FLETCHER COVE, SOLANA BEACH

SATURDAY, OCTOBER 1 FLETCHER COVE, SOLANA BEACH

Physicians: You are a Health Role Model Model healthy living to patients and staff by inviting them to JOIN YOU at Champions for Health’s Solana Beach Sunset 5K Run/Walk on October 7!

Lead a team of 20 or more patients and staff and receive FREE team t-shirts with your practice/team identification.

Visit www.SB5K.org to sign up.

For more information email Kylene.Cummings@ChampionsFH.org.

Benefiting the Diabetes Prevention Program at

PRESENTED BY:

In Partnership With

THE DOCTORS INSURANCE AGENCY Bob DeSimone

5575 Ruffin Rd., Ste 250, San Diego, CA 92123 www.SB5K.org 858.300.2777

SAN DIEGO PHYSICIAN.ORG

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