September 2020

SEPTEMBER 2020

Official Publication of SDCMS

Celebrating 150 Years

San Diego County Medical th Society’s 150 Anniversary

Congratulations!

We are grateful for the care San Diego physicians provide every day and would like to congratulate the San Diego County Medical Society for 150 years of service to our community.

Visit kp.org/sandiego.

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September 2020

Contents SEPTEMBER

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

VOLUME 107, NUMBER 8

OFFICERS President: Holly B. Yang, MD President-Elect: Sergio R. Flores, MD Secretary: Toluwalase (Lase) A. Ajayi, MD Treasurer: Nicholas J. Yphantides, MD Immediate Past President: James H. Schultz, MD

features:

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150 Years of Medicine in San Diego County: Celebrating the SDCMS Sesquicentennial

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 H. Koh, MD (Board Representative to the Executive Committee) Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Preeti Mehta, MD La Jolla #2: David E.J. Bazzo, MD, FAAFP North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Kelly C. Motadel, MD, MPH South Bay #2: Maria T. Carriedo, MD

By Holly B. Yang, MD

6

An Anniversary We Didn’t Expect — A Challenge We Are Meeting

AT-LARGE DIRECTORS #1: Thomas J. Savides, MD #2: Paul J. Manos, DO #3: Irineo “Reno” D. Tiangco, MD #4: Miranda R. Sonneborn, MD #5: Stephen R. Hayden, MD (Delegation Chair) #6: Marcella (Marci) M. Wilson, MD #7: Karl E. Steinberg, MD #8: Alejandra Postlethwaite, MD

By Paul Hegyi, MBA

ADDITIONAL VOTING DIRECTORS Young Physician Director: Brian Rebolledo, MD Retired Physician Director: Mitsuo Tomita, MD Resident Director: Nicole Herrick, MD Medical Student Director: Lauren Tronick 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: David E.J. Bazzo, MD, FAAFP At-large AMA Alternate Delegate: Kyle P. Edmonds, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD CMA DISTRICT I DELEGATES Karrar H. Ali, DO Steven L.W. Chen, MD, FACS, MBA Susan Kaweski, MD Franklin M. Martin, MD Vimal I. Nanavati, MD, FACC, FSCAI Peter O. Raudaskoski, MD Allen Rodriguez, MD Kosala Samarasinghe, MD Mark W. Sornson, MD Wayne C. Sun, MD

Departments

2

Briefly Noted: Practice Management • Physician Workforce • COVID-19

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Arab Americans Are an Invisible Ethnic Group When It Comes to Healthcare Disparities

By Raed Al-Naser, MD, FCCP

12 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.]

California Governor’s Ban on Education: An Infectious Disease Physician’s Views

By Jeannette L. Aldous, MD

14

CDC Details COVID-19’s Massive Mental Health Impact

by Elizabeth Hlavinka

16

Safe Prescription Disposal Starts with Medical Professionals

17

Images of Health

By Adama Dyoniziak

18

Classifieds

20

A Pathway to a More Effective, Productive, ‘Difficult’ Conversation

By Helane Fronek, MD, FACP, FACPh

SanDiegoPhysician.org 1

BRIEFLY NOTED 2

September 2020

PRACTICE MANAGEMENT

Blue Shield Announces Temporary Increases to Professional Fee Schedule IN AN AUG. 5, 2020, NOTICE to providers, Blue Shield announced it would be temporarily increasing reimbursement rates for certain Evaluation and Management services to help reduce the negative impacts to practices as a result of the COVID-19 pandemic.

The increased reimbursement rates, which will reflect a flat 5% fee schedule increase, will apply to providers on the Blue Shield standard fee schedule and will be effective for dates of service from Aug. 24 to Dec. 31, 2020, for the following services: CPT Code

Description

99201 – 99205

Office visit – new patient

99211 – 99215

Office visit – existing patient

99241 – 99245

Office consultation

99381 – 99387

Initial preventive medicine visit – new patient

99391 – 99397

Periodic preventive medicine visit – established patient

99441 – 99443

Physician/qualified health professional telephone evaluation.

99421 – 99423

Online digital evaluation and management services for established patient

99446 – 99449

Interprofessional phone/internet assessment and management service

The new rates are available on the Blue Shield website (log in then select “Professional Fee Schedule” under the Claims section of the menu). You can search for the above listed temporary rates by CPT code with a date of service on or after August 24, 2020. Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Information and Enrollment Department at (800) 258-3091.

The COVID-19 pandemic has created an unprecedented threat to the viability of physician practices. The California Medical Association (CMA) has called on state lawmakers to ensure that health plans and insurance companies do their part to maintain our healthcare infrastructure, and to ensure we emerge from the COVID-19 crisis with a healthcare system that can meet patients’ needs. CMA appreciates that Blue Shield is taking independent steps to assist primary care physicians during this difficult time.

Contact: CMA Reimbursement Helpline, (888) 401-5911 or economicservices@cmadocs.org.

PHYSICIAN WORKFORCE

Department of Consumer Affairs Extends Waiver Relaxing Healthcare Workforce Rules

By California Medical Association Staff THE CALIFORNIA DEPARTMENT

of Consumer Affairs (DCA) has extended a waiver that temporarily removes the ratios for physicians supervising nurse practitioners and physician assistants. Physicians can continue to supervise the number of NPs or PAs they can competently and confidently supervise without a statutory ratio in place.

This waiver was authorized by Gov. Gavin Newsom’s executive order (N-39-20) that eased the path for many healthcare professionals to practice in an expanded capacity during the COVID-19 outbreak.

The waiver does not lift the physician supervision requirement for PAs, NPs or other allied health professionals.

You can read the full waivers and see a list of current waivers on the DCA website.

COVID-19

California Medical Association Launches New #WearAMaskCA Campaign

By California Medical Association Staff

MASKS HELP STOP THE SPREAD of COVID-19, period. This is the central message of a new video released today by #WearAMaskCA, a California Medical Association (CMA) sponsored effort to promote science-based measures to control our current health crisis.

“Californians have spent five difficult months fighting the spread of COVID-19.

The months ahead depend on what we

do now,” says CMA president Dr. Peter N. Bretan Jr. “Our ability to return to school and work depends on everyone wearing face coverings when they are out in public. The science is clear — masks help stop the transmission of COVID-19 and are needed to keep Californians safe.”

The #WearAMaskCA video, called “Choices,” captures the concerns of California parents as they help their children adapt to abnormal circumstances and tire of antagonism that prolongs and deepens our health crisis. It is a follow-up to the previously released video “Deadly.”

Just last week, California Health and Human Services Secretary Dr. Mark Ghaly was quoted as saying widespread mask wearing could cut coronavirus transmission in half across the state.

Recent public opinion polls show the vast majority of Americans support face coverings and policies to encourage them. This has not stopped a handful of often vocal individuals from advocating reckless behavior and failing to abide by public policies aimed at protecting the public.

This is part of a troubling trend seen around anti-science political rallies, on social media and in government hearings. This animosity toward science and public health did not begin with COVID-19, but it is especially lethal now.

More than half a million Californians have contracted COVID-19, and more than 10,000 Californians have lost their lives, and that number continues to increase.

For more information, go to www.wearamaskca.org.

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SanDiegoPhysician.org 3

150 Years of Medicine in San Diego County Celebrating the SDCMS Sesquicentennial

BY HOLLY B. YANG, MD

O

ne hundred and fifty years. Our sesquicentennial is something to be celebrated despite the current challenging times. As the 150th president of the San Diego County Medical Society, and the eighth woman to hold this office, I reflect on how much we have been through, the importance of our work, and the many opportunities ahead and challenges we continue to face. Now, like no other time in most of our lives, we face a crisis in SARS-CoV-2. Our medical society has weathered a pandemic before during the 1918 influenza, and I sometimes wonder what our organization and then president, Dr. J.A. Jackson, did 102 years ago. I am proud of what our staff, our board, and our members have done to respond to our present crisis in our community and our world, much of which is described in this month’s article by SDCMS CEO Paul Hegyi, and in other articles in past issues of San Diego Physician.

While I am disappointed we cannot celebrate our important milestone of 150 years together, I am deeply grateful to be of service to you, our membership, at this time. As always, we as physicians rise to the challenge and care for our community. In that, I believe there is much to celebrate.

The hard work, dedication, selflessness, and compassion that our profession and you, my colleagues, have shown and continue to show despite risk to yourselves is heroic. Yet the physicians I know prefer adequate PPE supplies to being labeled a hero. They prefer science-based public health interventions and adequate resources to care for patients rather

than a spotlight. SDCMS and its members have defended public health, called out health inequities and spoken up against racism, and adapted quickly despite sometimes heavy financial losses in order to care for patients. At times this meant temporarily closing your doors or halting nonemergent surgeries at the start of this pandemic, and other times it has meant keeping your offices and ORs open with modified hours with different protocols and procedures. I am incredibly honored to serve with you during this time of constant rapid change. Still, we have miles to go.

I have had incredible support from our staff, past presidents, Board of Directors, our membership, and our foundation, Champions for Health. While we may be remote, the work is getting done. I never would have dreamed that many of my interviews would be virtual or while wearing a mask. Yet we have been working hard at advocacy and making sure our voice is heard at the local and state level. Thank you for taking the time to advocate with us for Black lives, for our public health and the safety of our public health officer, for access to high-quality healthcare, for protection of MICRA, and for physicians as leaders of the healthcare team. I hope you feel supported and you know how much your membership as part of SDCMS means. We cannot be a strong voice for physicians without your participation, and in this time of rampant misinformation the physician voice is even more critical.

I have no idea what the rest of this year will bring, but I know that we will do it together as a medical community. In change, there is grief and discovery. If we keep the wellbeing of our patients as our North Star and look out for each other during these historic and stressful times, we will find our way no matter what comes. I cannot overstate my gratitude for each of you and your work caring for our community, and I look forward to what we will build together in our next 150 years.

Dr. Yang is president of the San Diego County Medical Society.

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September 2020

SanDiegoPhysician.org 5

ars

Celebrating 150 Ye

An Anniversary We Didn’t Expect

A Challenge We Are Meeting

BY PAUL HEGYI

A

100-year pandemic. Closing our office under a statewide stay-at-home order. Social distancing.

This is not how we planned to be celebrating our sesquicentennial. SDCMS had planned to host a wonderful evening with community leaders honoring the work of physicians over the decades, feting our newest president.

While we cannot control the challenges 2020 has placed in front of us, SDCMS has risen to new levels on behalf of our members. When confusion reigned across our community, we partnered with County Health and Human Services to bring weekly, interactive town-hall meetings attended by hundreds every week. As PPE became nearly impossible to procure, SDCMS worked with the County to ensure practices had access to emergency stockpiles (in contrast to reports from the rest of the state) and even purchased a supply of masks for practices in need.

I’ve never been accused of being particularly warm and fuzzy, but being able to deliver N95 masks to a physician whose practice didn’t qualify for the limited emergency supplies, even while their spouse is undergoing cancer treatment, melts even the coldest heart.

Our focus on physician practices didn’t stop there. We worked locally and at the state level to restart non-emergency treatment, promulgating safety guidelines and educating the public.

We dug deep to find financial resources at the federal, state, and local level.

A series of webinars were started to answer the many practical questions we were hearing from practices.

And when the state finally received an influx of still critical PPE, SDCMS and CMA partnered with the State Office of Emergency services to host massive PPE Relief events at SDCCU Stadium, distributing nearly 800 cases of equipment intended to supply an office for two months and worth a total of $3.8 million.

Most importantly, when our public health officer was attacked, SDCMS led

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September 2020

a vigorous effort defending her, making it clear that sort of treatment wouldn’t be tolerated in our community. Through media attention, direct action with the County Board of Supervisors, and a viral social media campaign leading hundreds of physicians to participate, we’ve been able to prevent similar treatment from happening.

We never planned for a 100-year pandemic, but that doesn’t mean we didn’t plan. As Eisenhower said, “Plans are nothing, planning is everything.” A number of years ago, SDCMS reorganized around three priorities: Advocacy, Partnerships and Membership. That focus, embracing that our first mission is to advocate for patients and the practice of medicine, that we are best when working in partnership with the many organizations in our community that share a common interest, and that we are most successful with a large and engaged membership, helped prepare us for these challenges.

One of the major changes we made in the past few years was the reinvigoration of our committee structure. SDCMS had fallen into a rut where the board and executive committees handled all of the activity of the society. Now we have robust committees allowing board members to have a larger voice on issues and welcoming non-board members an opportunity to be more involved. This process has helped SDCMS be nimbler to contemporary issues, such as the Wellness Committee, which has become the pilot site for a statewide wellness initiative and subsidiary of CMA. Earlier this year we began the work of establishing a Diversity, Equity, and Inclusion committee to lead our efforts in dealing with this persistent problem across our society and industry.

Pandemic. Civil discontent. Murder hornets (OK, we didn’t do anything about that). SDCMS rises to the challenge. Whatever 2021 has in store for us and the many years beyond, SDCMS will rise to the challenge.

Paul Hegyi, MBA, is CEO of the San Diego County Medical Society.

SDCMS staff and volunteers, in coordination with the California Medical Association, Altais, and the State of California, spent two days at SDCCU Stadium recently, distributing over 2 months worth of free PPE, worth $3.8 million, to almost 800 local small and mediumsized practices.

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HEALTHCARE SYSTEM INEQUALITIES

Arab Americans Are an Invisible Ethnic Group When It Comes to Healthcare Disparities

By Raed Al-Naser, MD, FCCP

R

ACE AND ETHNICITY ARE

becoming forefront conversations in our media, academic debates, and daily life discussions here in the United States.

Each of us has an identity that defines how we see ourselves and others. Arab Americans are a historically understudied minority group in the United States, and their health needs and risks have been poorly documented. As a physician and healthcare provider who belongs to this group, I see that Arab American identity is largely absent from national and academic conversations about race and ethnicity, especially when it comes to healthcare disparities. The emergence of COVID-19 as a pandemic and public health crisis has exposed this reality and made it more visible and undeniable.

The lack of racial or ethnic identifiers makes collecting data on Arab Americans exceedingly difficult for medical researchers as well as for public health personnel. Persons who classify themselves as Arab American are required to identify themselves as White, and, in some cases, including the Census, are

8

September 2020

switched from Other to White based on their affiliation to the Middle East and North Africa.

Arab Americans are those American individuals of either Arab ethnic, cultural, linguistic, familial, or heritage ties to the countries that comprise the Arab world. Arab Americans trace ancestry to any of the various waves of immigrants of these countries. It is estimated that there are approximately 3.7 million Arab Americans in the United States.

California has the largest number of Arab Americans, while Michigan has the highest proportion of Arab Americans in the population.

While there is no paucity about stigmatizing representation and unfavorable visibility of Arabs and Arab Americans in the mainstream media, there is not much documentation about their health and wellbeing in the official records.

Most of the healthcare research about Arab Americans comes from studies of certain geographic enclaves in the United States with large representative populations. Studying the Arab American community in Dearborn, Michigan,

and to a lesser degree New York City and California provides most of the U.S. medical literature. Meaningful information must be extrapolated and unpacked from general data of White Americans to draw findings and conclusions.

Arabs are disproportionately represented among recent immigrants to the United States due to successive wars and instability in the Middle East. This subset of immigrants has its own misfortunes when it comes to healthcare disparities, poverty, and level of education.

Most of these immigrants came from war-torn Iraq and Syria. More research on Arab American health is needed to identify risks and needs of this marginalized population given the current volatile social and political climate in the United States. Earlier immigration waves of Arab Americans came from relatively more stable and wealthy countries and this group tends to have higher levels of education and socioeconomic security.

First-, second- and third-generation U.S. born Arab Americans have assimilated in a way that might not reflect on the whole group in terms of health-related issues. The diversity in country of origin, geographic location, time of immigration to the United States, and acculturation make the task of studying Arab American health extremely enormous.

Among the specific health problems that Arab Americans are experiencing is a general surge of bias-motivated violence and hate crimes in the past few years. Arab Americans reported high levels of depression and anxiety symptoms. Refugees appear to have poorer mental health outcomes than either immigrants or U.S.-born Arab Americans.

Arab Americans had higher prevalence of lack of health insurance, living below the federal poverty level, and lower home ownership than non-Hispanic Whites despite high levels of education and lower unemployment. Research finds that Arab Americans have high rates of smoking in all age groups and low rates of smoking cessation. Recent studies have shown an increasing prevalence of polysubstance abuse among Arab Americans, particularly men associated with higher levels of U.S. acculturation.

Some of the widespread health issues found for women are a high prevalence of

PLACE YOUR AD HERE FEBRUARY 2020

Official Publication of SDCMS

Celebrating 150 Years

MARCH 2020

Official Publication of SDCMS

NOVEMBER/DECEMBER 2019 Official Publication of SDCMS

Celebrating 150 Years

Artificial Intelligence and Medicine THE DEBATE

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San Diego Academy of Family Physicians Symposium, Family Medicine Update: 2020

The SDAFP 2020 Family Medicine Update

IS GOING VIRTUAL

Please plan to join us for our 63rd Annual AND first ever virtual symposium! The program will take place October 2nd-4th,

Register Today: www.sandiegoafp.org

2020 and has been approved by AAFP for 19.5 CME Credits. Although the format has changed we are very excited to still offer you a fabulous line-up of speakers to provide the most up-to-date research and patient treatment information for your busy Family Medicine practice.

The program will feature the latest evidence-based CME on pertinent issues for today’s primary care provider.

Questions? Please contact Sabrina Bazzo: sbazzo@sandiegoafp.org

HEALTHCARE SYSTEM INEQUALITIES

intimate partner violence in Arab American communities. Arab American women tend to have lower rates of mammography and are diagnosed at a later stage of breast cancer. Barriers to breast cancer screening for Arab American women included immigration-related barriers, fear, lack of knowledge, and access issues.

While there is extremely little known about the impact of COVID-19 on the Arab American population in the media and recent medical publications, as a physician practicing in San Diego’s East County among many other Arab American colleagues, we are witnessing an alarming rise in the number of COVID-19 cases in our county — particularly from the Arab and Middle Eastern communities in the city of El Cajon and neighboring towns. According to the latest San Diego county numbers of COVID-19 cases, El cajon stands as the third city in absolute numbers and close fourth in terms of cases per 100,000 population in the whole county. El Cajon has the highest number

of coronavirus deaths when factoring in population, with 70 recorded as of July 17. When factoring in population size, the East County city had 7 deaths per 10,000 residents. Though there are no accurate statistics about the number of Arabs and other Middle Easterners, they are estimated to be at least 50,000 out of 103,000.

As the COVID-19 pandemic continues to escalate, the direct and indirect impacts are tremendously costly to every single aspect of our daily lives.

This pandemic has exposed racial disparities the likes of which we have never experienced before. Arab Americans are the most frequently forgotten ethnic minority when it comes to healthcare across the U.S. and more so during this pandemic. African Americans, Hispanics, Asians, Alaskan/Native Americans, and Native Hawaiians/Pacific Islanders are well documented ethnic minorities in the census and rightfully so. Unpacking the White category to identify Arab Americans in a comparative analysis

will identify how Arab American health and social relations are distinct from whites, Hispanics, blacks, and others.

Arab Americans’ place in society has been always negatively impacted by developments in the Middle East that led to increased discrimination and exclusion, and this should not be the case here when it comes to people’s health.

Here I am as a community member and proud San Diegan Arab American representing the National Arab American Medical Association in San Diego pleading for San Diego County to add a new Race and Ethnicity identifier that recognizes Arab Americans. I am hopeful that this will be the first baby step in a long march for Arab Americans across the whole country.

Dr. Al-Naser is San Diego Chapter president of the National Arab American Medical Association and a pulmonary and critical care physician practicing in San Diego’s East County.

Congratulations to

San Diego County Medical Society on their 150th Anniversary!

We are proud to prepare the next generation of our healthcare leaders via our: • New San Ysidro Health Internal Medicine Residency Program, est. 2020 • Partnership with The Scripps Family Medicine Residency Program – graduating 136 residents since 1999.

• Collaboration with A.T. Still University School of Osteopathic Medicine as we welcome first year students.

Maria Carriedo-Ceniceros, M.D. Vice President & Chief Medical Officer

2003 Graduate of the Scripps Family Medicine Residency Program

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September 2020

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COVID-19

California Governor’s Ban on Education: An Infectious Disease Physician’s Views

By Jeannette L. Aldous, MD

G

AVIN NEWSOM’S RECENT

decision to close school for California children rejects the science we know about COVID-19, ignores the advice of medical experts, and disproportionately harms our most vulnerable populations.

I am an infectious disease physician responsible for implementing infection control measures to allow my health center to operate safely during the pandemic (using the COVID-19 “universal precautions” of masks, physical distancing, hand/environmental hygiene, symptom screening, and staying home when sick).

When I speak with my medical colleagues about school closure, we marvel at how it seems like rational thinking has gone out the window on this topic. People talk about protecting children, yet they

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September 2020

embrace a policy that produces documented harm to children in exchange for benefits that are theoretical or minimal at best. COVID-19 is mild in children, multiple studies have shown they are not the super-spreaders we assumed they were, and modeling data tells us that school closure does not have a significant impact on the trajectory of the pandemic.

Plus, we now know the prevention measures that protect staff in workplaces, including schools, and we have experience implementing them.

Meanwhile, keeping kids home is causing great harm to children and society, with a particularly deep impact on racial and ethnic minority groups (take a look at the baseline low engagement of children in online education, add the significant disparity for black and brown children,

and you find that we have essentially decided not to educate these kids at all). In addition to lack of education and widening racial disparities, the dismal list of harms to children from school closure includes social isolation, loneliness and depression, hunger, lack of exercise, domestic violence and abuse, increased exposure to inappropriate internet content, and goes on. For parents and society, school closure results in loss of income, career delay (especially for women), stress and mental health issues, and worsening of the socioeconomic inequality that is already tearing our country apart.

In addition to these known harms, school closure may have other undesirable ripple effects that can paradoxically increase COVID-19 cases. Instead of spending their days in a structured

school environment with masks on and physical distancing enforced, our kids and teens will just be hanging out together elsewhere, spreading the virus (as is happening now). Families will arrange ad-hoc childcare groupings without appropriate guidance and mask precautions. Many working families will call upon grandparents to provide childcare, potentially increasing exposures and cases among the very population that needs the most protection (COVID-19 is much more serious for older adults).

If this were all unavoidable, we could write it off as sad reality. But we must not do so because a ban on school is completely unnecessary. Since March, the “universal precautions” have been effectively employed in our health centers and other essential businesses to allow necessary work to continue while controlling transmission of the virus.

And what is more “essential” than school?

We know the harm school closure is causing to children and to society.

We have the data and the tools to safely educate our children. Many experts and professional societies such as the American Academy of Pediatrics have already put out clear school-specific guidelines.

All we have to do now is follow them.

The experts have spoken and our leaders should listen. They should provide schools with the funding, support, and rational guidance they need to implement the recommended evidence-based strategies to reopen schools.

Dr. Aldous is a San Diego infectious disease physician and serves as the clinical director of infectious disease for San Ysidro Health. This article represents her opinion as a specialist in the field and does not necessarily reflect the view of San Ysidro Health. This column previously appeared in The San Diego Union-Tribune Opinion section.

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SanDiegoPhysician.org 13

PSYCHIATRY

CDC Details COVID-19’s Massive Mental Health Impact By Elizabeth Hlavinka

N

EARLY 11% OF AMERICAN

adults seriously considered suicide this June, according to CDC data.

Among 5,470 people surveyed in the last week of June, 30.9% reported symptoms of an anxiety or a depressive disorder, 25.3% reported a traumatic or stressor-related disorder (TSRD), and 13.3% said they were using substances to cope with the pandemic’s stressors, said Rashon Lane, MA, of the Centers for Disease Control’s COVID-19 Response Team.

And 10.7% reported seriously considering suicide in the prior month, more than double the rate reported in a 2018 CDC survey, the researchers wrote in the agency’s Morbidity and Mortality Weekly Report. Specifically, the risk for suicidal ideation was elevated among respondents between ages 18 and 25 (25.5%), Hispanic respondents (18.6%), Black respondents

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September 2020

(15.1%), unpaid adult caregivers (30.7%), and essential workers (21.7%).

The “markedly” high rates of mental and behavioral health conditions show the “broad impact of the pandemic and the need to prevent and treat these conditions,” the authors wrote, adding that interventions to reduce these numbers should target financial strain, racial discrimination, social connectedness, and community support for patients considering suicide. Medical professionals cautioned that social isolation associated with social distancing, along with soaring unemployment rates, could further accelerate the national suicide crisis.

However, suicidal ideation should not be seen as an inevitability from this data, commented Jessica Gold, MD, MS, of the department of psychiatry at Washington University in St. Louis.

Instead, it should be seen as “a call for help,” and motivate the government, employers, families, and individuals to focus on the mental health needs of the population, Gold says.

“This study says we need help, especially in certain populations, and mental health needs to be a focus of all of our conversations,” she told MedPage Today in an email.

The web-based survey used the Patient Health Questionnaire to assess depression and anxiety symptoms and the Impact of Event Scale to assess pandemic-related TSRD. Substance use and suicidal ideation were self-reported.

Altogether, 40.9% reported having at least one mental or behavioral health condition. That proportion was higher among the following groups:

• Young adults ages 18–24 (74.9%) and 25–44 (51.9%) • Hispanic respondents (52.1%) • Individuals who did not receive a high school diploma (66.2%) • Essential workers (54%) • Unpaid adult caregivers (66.6%) • Individuals with baseline mental health conditions (68.8%-88%) Compared with CDC data from the second quarter of 2019, adults in this survey reported three times the rate of anxiety symptoms (25.5% vs 8.1%) and four times the rate of depression symptoms (24.3% vs 6.5%), the researchers stated. Overall, young people ages 18–24 had a far greater risk of considering suicide in the past 30 days than adults ages 45–64 (6.66, 95% CI 5.115–8.61) and adults ages 65 and up (12.51, 95% CI 7.88–19.86).

Hispanic and Black individuals were also at an elevated risk for anxiety or depressive symptoms, substance use, and suicidal ideation in the past 30 days compared with white respondents.

In an analysis of 1,497 respondents who also completed surveys in April and May, unpaid adult caregivers were more likely to start using substances to cope in June than they were in May (adjusted odds ratio 3.33, 95% CI1.75–6.31, P<0.001), and more likely to report new suicidal ideation in June (aOR 3.03,95% CI 1.20–7.63, P=0.019).

The survey relied on self-reported answers for some classifications and was web-based, both of which are limitations, Lane and co-authors noted.

Elizabeth Hlavinka covers clinical news, features, and investigative pieces for MedPage Today, where this article originally appeared. She also produces episodes for the Anamnesis podcast.

Our 850+ Primary Care Providers Celebrate the 150th Anniversary of the San Diego Medical Society

Find out why 1 in 5 San Diegans gets their care at a Community Health Center Health Center Partners of Southern California, a family of companies, includes a 16-membership organization of federally qualified health centers, collectively serving 850,000+ patients each year, for 3.6 million patient visits each year, at 160 practice sites across San Diego, Riverside, Imperial counties, with the seventh largest provider group in the region. www.hcpsocal.org

Get the mortgage benefits you deserve with the Bank of America® Doctor Loan1 Low down payments. As little as 5% down on a mortgage up to $1 million and 10% down on a mortgage up to $1.5 million.2 Delayed job start. New jobs can start up to 90 days after closing.3 Flexible options. Student loan debt may be excluded from the total debt calculation.4

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An applicant must have, or open prior to closing, a checking or savings account with Bank of America. Applicants with an existing account with Merrill Edge®, Merrill Lynch® or U. S. Trust prior to application also satisfy this requirement. Eligible medical professionals include: (1) medical doctors who are actively practicing, (MD, DDS, DMD, OD, DPM, DO), (2) medical fellows and residents who are currently employed, in residency/fellowship, or (3) applicants who are medical students or doctors and are about to begin their new employment/residency or fellowship within 90 days of closing. Must be actively practicing in their field of expertise. Those employed in research or as professors are not eligible. For qualified borrowers with excellent credit. PITIA (Principal, Interest, Taxes, Insurance, Assessments) reserves of 4 – 6 months are required, depending on loan amount.

2 Minimum down payment requirements vary by property type and location; ask for details.

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Credit and collateral are subject to approval. Terms and conditions apply. This is not a commitment to lend. Programs, rates, terms and conditions are subject to change without notice. Bank of America, N.A., Member FDIC. Equal Housing Lender. ©2019 Bank of America Corporation. AR7QN56V HL-230-AD 03-2019 1

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Safe Prescription Disposal Starts with Medical Professionals

In the 2019 PDATF Report Card there were 246 unintentional prescription-related deaths in San Diego County. Now more than ever, safe disposal takes on considerable significance as prescription pharmaceuticals stored in the home become a temptation for abuse under the stressful conditions associated with the COVID-19 pandemic.

When asked, “What do you typically do with your unwanted/unused prescription medications?” Thirty-one percent of respondents said they “store them at home.” Twelve percent said they “throw them in the trash.” Ten percent said they “flush them down the toilet.” That’s HE RESULTS OF THE SAN DIEGO more than half making the wrong decision County Prescription Drug Abuse about prescribed medication disposal.

Task Force 2020 Medication Disposal As illustrated by the 17% that did get inSurvey are in and 83% of people surstruction, nearly all of it came from medical veyed stated that no healthcare provider had professionals. In addition, when asked, “Who ever taken the initiative to speak to them dielse has ever guided safe disposal?” 31% said rectly about how to safely dispose of unwanted/ they learned from media coverage of events unused medicines. like the Drug Enforcement Administration’s That is one of the critical outcomes of the Take Back Day events. However, 28% said they survey that gauges safe disposal practices and learned from flyers and other collateral mateawareness within San Diego County. rials they saw posted.

There were 1,245 surveys completed by San Those materials can be placed in every type Diegans. The following is how the remaining of medical office, waiting rooms, examina17% say they received safe disposal advice. tion rooms, pharmacy counters, and many

other strategic locations. Those resources are available to you at no cost at https://www.

44% said it came from sandiegorxabusetaskforce.org/communityresources and available in six languages. their pharmacist These findings indicate how important the 42% from their physician role of the healthcare professional can be in educating the public to dispose of their medi15% from a nurse cines safely.

For more information and more resources 5% from their psychiatrist on safe pharmaceutical disposal, you can also go to DEA Take Back Day. 3% from a veterinarian To learn more about the PDATF, visit the San Diego Drug Abuse Task Force website.

2% from their dentist Drug treatment is also available through 13% from other Live Well San Diego, the County vision for healthy, safe, and thriving residents and commedical sources munities. To speak with a trained counselor, 6% didn’t recall call the Access and Crisis Line at (888) 7247240 or dial 211.

T

DISPOSAL TIPS

Scratch out all identifying information on the prescription drug bottle to make it unreadable. This will help to protect your identify and the privacy of your personal health information. Unused or expired prescription medications are a public safety issue, leading to potential accidental poisoning, misuse, and overdose. Proper disposal of unused drugs saves lives and protects the environment.

16

September 2020

SAFE MEDICATION DISPOSAL

DO dispose of unused or expired medications the safe way by bringing them to an approved collection site.

DO follow disposal directions you receive with your medicines.

DON’T throw away unused or expired medications. Those that are thrown in the trash can be misused by others or sold.

DON’T flush your prescription medications. Flushed medications end up in our waterways and sewage systems.

CHAMPIONS FOR HEALTH

Images of Health

By Adama Dyoniziak

“MY VEINS ARE TRICKY TO FIND AND

access. They had become weak due to all the [cancer] medications and testing I received,” said Irma S. Cancer had changed Irma’s life forever. “I’m very satisfied and grateful for Project Access because I am alive.”

Champions for Health supports the most vulnerable in our community through Project Access San Diego and partners such as Imaging Healthcare Specialists (IHS). IHS has generously provided Project Access patients a full range of pro bono radiology services for more than 10 years. Dr. Mark Schechter, an IHS interventional radiologist with more than 30 years of experience, performed a port placement procedure that Irma’s oncologist requested. This minimally invasive procedure, a proven alternative to surgery, allows the use of imaging to precisely guide therapy from inside the body.

Irma was a very active, hard working mother who worked in childcare and housekeeping. Her life changed when she was diagnosed with ovarian cancer, suffering from severe abdominal pain from an extremely large mass. After her emergency surgery, Project Access helped Irma receive chemotherapy and imaging services from IHS. “God bless all those who have been in my path to getting better. God bless the hands of all those who have helped me so that they can continue to help others like me,” Irma gratefully states. Although unable to work and dependent on her son as she slowly recovers, Irma states, “I feel better right now as I am able to have a conversation. Some months ago I was unable to speak since the cancer spread to my lungs and stomach. I continue to feel fatigued and weak, but remain with a positive attitude as I see improvement.”

Left: Dr. Mark S. Schechter. Above: Irma S., Project Access cancer survivor.

Another way that IHS is helping our community is by delivering non-invasive treatments for peripheral artery disease (PAD) that, left untreated, can lead to amputations. One study showed that there was a 65% greater PAD-related amputation rate in individuals of lower socioeconomic status.1 IHS’s Dr. Sharjeel Sabir believes that greater awareness and screening for PAD in these populations, along with the minimally invasive treatment options provided by IHS, can reverse this trend and help more patients avoid an amputation.

“When detected early enough, less invasive treatments like angioplasty, atherectomy and catheter-directed thrombolysis may be performed on an outpatient basis,” says Dr. Sabir. “More severe cases will require vascular surgery, but when limb-salvaging procedures are performed

in the outpatient setting, the risks to the patient are lower, the overall cost is lower, and the outcomes are excellent.”

For more information on how you can share your time and talent with our most vulnerable San Diegans through Project Access, please contact Adama Dyoniziak at adama.dyoniziak@championsfh.org or call (858) 300-2780.

Adama Dyoniziak is executive director of Champions for Health.

1. Ferguson HJ, Nightingale P, Pathak R, Jayatunga AP. The Influence of Socio-Economic Deprivation on Rates of Major Lower Limb Amputation Secondary to Peripheral Arterial Disease. European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery. 2010;40:76–80

SanDiegoPhysician.org 17

CLASSIFIEDS CLINICAL TRIAL VOLUNTEERS NEEDED PARTICIPATION IN CLINICAL RESEARCH TRIALS: Physicians in the following specialties are needed for participation as Principal or Sub-Investigator in Pharmaceutical sponsored Clinical research trials involving COVID-19 vaccine, RSV vaccine, Flu vaccine, Migraine, Multiple sclerosis, Parkinson’s disease, Asthma, COPD, NASH, Diabetes studies. Prior Clinical Research Experience is preferred but not essential. Our team of Clinical Research Professionals will conduct the clinical trials under your supervision. Financial incentives and scientific publication opportunity. Will not take time away from your practice or increase liability. Primary care; Internal medicine; Pulmonology; Dermatology; Neurology; Gastroenterology. Please contact jsaleh@paradigmresearch.com or anguyen@paradigm-research.com or Afalconer@paradigm-research.com PHYSICIAN OPPORTUNITIES NEIGHBORHOOD HEALTHCARE MD, FAMILY PRACTICE AND INTERNISTS/HOSPITALISTS: Physicians wanted, beautiful Riverside County and San Diego County- High Quality Family Practice for a privatenonprofit outpatient clinic serving the communities of Riverside County and San Diego County. Work Full time schedule and receive paid family medical benefits.

Malpractice coverage provided. Be part of a dynamic team voted ‘San Diego Top Docs’ by their peers. Please click the link below to be directed to our website to learn more about our organization and view our careers page. www.

Nhcare.org PHYSICIAN WANTED: Samahan Health Centers is seeking a physician for their federally qualified community health centers that emerged over forty years ago. The agency serves low-income families and individuals in the County of San Diego in two (2) strategic areas with a high density population of Filipinos/Asian and other low-income, uninsured individuals — National City (Southern San Diego County) and Mira Mesa (North Central San Diego). The physician will report to the Medical Director and provide the full scope of primary care services, including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance to patients. For more information and to apply, please contact Clara Rubio at 844-200-2426, Ext 1046 or at crubio@samahanhealth.org.

INTERVENTIONAL PHYSIATRY/PHYSICAL MEDICINE SPECIALIST POSITION AVAILABLE: Practice opportunity for part time interventional physiatry/physical medicine specialist with well-established orthopedic practice. Position includes providing direct patient evaluation/ care of spine and musculoskeletal cases, coordinating PMR services with all referring providers. Must have excellent interpersonal and communication skills. Office located near Alvarado Hospital. Onsite digital x-ray and EMR. Interested parties, please email lisas@sdsm.net.

CARDIOLOGIST WANTED: San Marcos cardiology office looking for a part-time cardiologist. If interested, send CV to evelynochoa2013@yahoo.com or via fax to (760) 510-1811.

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

(Posted 12/4/19)

DEPUTY PUBLIC HEALTH OFFICER - COUNTY OF SAN DIEGO: The County of San Diego is seeking a dynamic leader with a passion for building healthy communities.

This is a unique opportunity for a California licensed or license eligible physician to work for County of San Diego Public Health Services, nationally accredited by the Public Health Accreditation Board. Salary: $220,000-$230,000 annually and candidates may receive an additional 10% premium for Board Certification and 15% premium for Board Certification and Sub-specialty. For more information click here.

PUBLIC HEALTH MEDICAL OFFICER - COUNTY OF SAN DIEGO: Under the direction of the Deputy Public Health Officer or designee, this position will be responsible for providing medical oversight of health programs and service delivery, and for performing administrative and operational duties that include the guidance and approval of policy and procedure, developing strategy, and overseeing quality assurance and quality improvement efforts for County of San Diego health services programs.

Salary: $190,000-$200,000 annually and candidates may receive an additional 10% premium for Board Certification and 15% premium for Board Certification and Subspecialty. For more information click here.

PHYSICIAN CONSULTANT FULL-TIME: San DiegoImperial Counties Developmental Services, Inc. (San Diego Regional Center). Great opportunity to work in a multidisciplinary setting in a private non-profit agency that serves persons with developmental disabilities. Must be licensed to practice medicine in California and certified by specialty board such as Neurology, Neurodevelopmental Disabilities, Developmental Behavioral Pediatrics, Pediatrics or Internal Medicine. Experience in the field of developmental disabilities and administrative or supervisory experience required. Please visit our website at www.sdrc.org for more information and to submit an application. (Posted 10/7/2019)

FULL-TIME CARDIOLOGIST POSITION AVAILABLE: Seeking full time cardiologist in North County San Diego in busy established general cardiology practice. EP or Interventional also welcome if willing to hold general cardiology outpatient clinic also at least 50% of time while building practice. Please email resume to jhelmuth1220@ gmail.com. Immediate opening.

DEPUTY PUBLIC HEALTH OFFICER: The County of San Diego is seeking a dynamic leader with a passion for building healthy communities. This is a unique opportunity for a California licensed or license eligible physician to work for County of San Diego Public Health Services, nationally accredited by the Public Health Accreditation Board. Regular - Full Time: $220,000 - $230,000 Annually. For more information and to apply: https://www.governmentjobs.com/ careers/sdcounty/jobs/2359704/deputy-public-health-

September 2020

TEMPORARY EXPERT PROFESSIONAL (TEP) MEDICAL DOCTORS (MD’s) NEEDED: The County of San Diego Health and Human Services Agency is seeking numerous MD positions to work in a variety of areas including Tuberculosis Control, Maternal and Child Health, Epidemiology and Immunizations, HIV, STD & Hepatitis, and California Children’s Services. Applicants (MD or DO) must hold a current California medical license. Applicants must be proficient in either Opioid Abuse Prevention and Treatment Strategies, Communicable Diseases and/or Healthcare Systems, and willing to minimally work three days a week.

Hourly rate is $103/hour. If interested, please e-mail CV to Anuj.Bhatia@sdcounty.ca.gov or call (619) 542-4008.

PRACTICE OPPORTUNITY: Internal Medicine and Family Practice. SharpCare Medical Group, a Sharp HealthCareaffiliated 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 POSITIONS WANTED

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

The incumbent must hold a current California license and be board eligible. Bilingual Spanish/English preferred.

Founded as a small family practice in Escondido 1932 by Dr. Martin B. Graybill, today we’re the region’s largest Independent Multi-specialty Medical Group. Our location is 277 Rancheros Dr., Suite 100, San Marcos, CA 92069.

We are an equal opportunity employer and value diversity.

Please contact Natalie Shields at 760-291-6637/nshields@ graybill.org. You may view our open positions at: https:// jobs.graybill.org/ BOARD CERTIFIED OR BOARD-ELIGIBLE PHYSICIAN DERMATOLOGIST: Needed for busy, well-established East County San Diego (La Mesa) private Practice. We currently have an immediate part-time opening for a CA licensed Dermatologist to work 2-3 days per week with the potential for full-time covering for existing physicians, whenever needed. We are a full-service Dermatology office providing general, cosmetic and surgical services, including Mohs surgery and are seeking a candidate with a desire to provide general dermatology care to our patients, but willing to learn laser and cosmetics as well. If interested, please forward CV with salary expectation to patricia@ grossmontdermatology.com

18

officer-19092204u?keywords=Deputy%20Public%20 health%20&pagetype=jobOpportunitiesJobs

PAIN MANGEMENT POSITION WANTED: Pain Management Physician Position Wanted: Fellowship-trained at MD Anderson Cancer Center, pain management with anesthesia background physician looking for a private practice, hospital, or academic position. Skilled in basic and advanced procedures, chronic pain and cancer pain management. Have CA, DEA, and Fluoro licenses. Please call/text (619) 977-6300 or email Ngoc.B.Truong@dmu.edu.

PRACTICE FOR SALE PRACTICE FOR SALE IN ENCINITAS: A GYN-only practice for sale in Encinitas with a majority of the patients in North County. Insurance accepted are PPO, cash and some Medicare patients. Could be turnkey or just charts.

Practicing is closing December 31, 2019. Please call Mollie for more information at 760-943-1011.

CLINICAL RESEARCH SITE/MULTI-SITE SPECIALTY PHYSICIAN PRACTICE COMBO FOR SALE: Great opportunity for a Group Practice. Clinical Research offers a way for physicians to continue to practice medicine the way they like and provide an additional source of income that is compatible with their goal of providing great care and options for their patients. Patients will have the opportunity to participate in the research of new treatments. Current site has staff and facilities for research, physician suites, and X-Ray. Use as a primary location or as a satellite office with research site. Current physicians and staff willing to train and work alongside physicians new to research. Contact E-Mail: CL9636750@ gmail.com (Posted 9/13/2019) 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 KEARNY MESA OFFICE FOR SUBLEASE: Kearny Mesa area sublease in our orthopedic office which

includes: onsite x-ray available, storage space, space for 1-2 employees and free parking. Can discuss internet, phones, fax line, access to printer/copier, and more. Please contact Kaye Spotz at kspotz@synergysmg.com for more information.

SUBLEASE IN SHARP HOSPITAL: Sublease of a shared office space on the Sharp Hospital campus a small office on the third floor that is now shared with one other physician. Includes: two exam rooms, an office for the doctor, space for three employees, and a small amount of storage space. Please contact kspotz@synergysmg.com for more information.

REDUCED PRICE - EL CAJON MEDICAL OFFICE BUILDING FOR SALE OR LEASE: 3,700 square foot standalone medical building with 11 exam rooms & huge private parking lot 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: $950,000. Asking Lease: $5,500/month + NNN. Terms are negotiable. Seller financing is available. Please contact: Dillon.Myers@TonyFrancoRealty.com | (619) 738-2318 MEDICAL SUITE AVAILABLE: Modern and luxurious medical suite located in the Scripps Ximed Building, on the campus of Scripps Memorial Hospital available for sublease/space sharing. The lobby is spacious, and there is a large doctor’s office, staff room and 4 exam rooms.

Terms are flexible, available to share part-time, half days or full days 4 exam rooms. Rent depends on usage. For more information, call 858-550-0330 extension 106.

ESCONDIDO MEDICAL OFFICE TO SHARE: Medical office space available at 1955 Citracado Parkway, Escondido. Close to Palomar Medical Center-West, Two to three furnished exam rooms, 2 bathrooms, comfortable waiting room, lab space, work area, conference room, kitchen. Radiology and Lab in the medical building. Ample free parking Contact Jean (858) 673-9991.

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.

NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista, CA 92083. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, décor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele. Just a few blocks from Tri-City Medical Center and across from the urgent care.

Includes: Digital X-ray suite, multiple exam rooms, access to a kitchenette/break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is NOT included. Contact Harish Hosalkar at hhorthomd@gmail. com or call/text (858) 243-6883.

MEDICAL OFFICE AVAILABLE FOR RENT: Furnished or unfurnished medical office for rent in central San Diego.

Can rent partial or full, 5 exam rooms of various sizes, attached restroom. Easy freeway access and bus stop very close. Perfect for specialist looking for secondary locations. Call 858-430-6656 or text 619-417-1500.

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

LA JOLLA OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial Medical office building at 9834 Genesee Ave. Amazing location by the main entrance to the hospital between 1-5 and 1-805. Multidisciplinary group available to any specialty. Excellent referral base in the office and on the hospital campus. Great need for a psychiatrist. We have multiple research projects. If you have an interest or would like more information, please call 858-344-9024 or 858-320-0525.

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

OFFICE SPACE/REAL ESTATE AVAILABLE: Scripps Encinitas Campus Office, 320 Santa Fe Drive, Suite LL4.

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

Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics.

Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery.

It is located just off Interstate 5 at Santa Fe Drive, and half a mile from Swami’s Beach. Contact Kristi or Myra 760-7538413. View Space on Website:www.eisenhauerobgyn.com.

Looking for compatible practice types.

OFFICE SPACE FOR RENT: Multiple exam rooms in newer, remodeled office near Alvarado Hospital and SDSU. Convenient freeway access and ample parking. Price based on useage. Contact Jo Turner (619) 733-4068 or jo@siosd.com.

OFFICE SPACE / REAL ESTATE WANTED MEDICAL OFFICE SUBLET DESIRED: Solo endocrinologist looking for updated bright office space in Encinitas or Carlsbad to share with another solo practitioner. Primary care, ENT, ob/gyn would be compatible fields. I would ideally have one consultation room and one small exam room but I am flexible. If the consultation room was large enough I could have an exam table in the same room and forgo the separate exam room. I have two staff members that will need a small space to answer phones and complete tasks.

Please contact 858-633-6959.

MEDICAL OFFICE SPACE SUBLET DESIRED NEAR SCRIPPS MEMORIAL LA JOLLA: Specialist physician leaving group practice, reestablishing solo practice seeks office space Ximed building, Poole building, or nearby.

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

MEDICAL EQUIPMENT / FURNITURE FOR SALE MEDICAL EQUIPMENT/FURNITURE FOR SALE: San Diego Multi-specialty Surgical Center going out of business. A wide variety of medical and surgical equipment and supplies are available at bargain prices.

For a listing of equipment and supplies available or further information, please contact us at infosandiego1@gmail. com with your request.

OBGYN RETIRING WITH OFFICE EQUIPMENT FOR DONATION: Retiring from practice and have the following office equipment for donation: speculums, biopsy equipment, lights, exam tables with electric outlets, etc.

Please contact kristi.eisenhauermd@yahoo.com, 760753-8413 MEDICAL EQUIPMENT FOR SALE: 2 Electric tables one midmark, 3 Ultrasounds including high resolution Samsung UG-HE60 with endovag and linear probes, STORTZ hysteroscopy equipment, 2 NOVASURE GENERATORS ,ENDOSEE OFFICE HYSTEROSCOPY EQUIPMENT : NEW MODEL, OLDER MODEL, Cynosure laser equipment:MONALISATOUCH (menopausal atrophy), TEMPSURE Vitalia RF (300 watts!) for incontinence, ENVI for face, Cynosure SculpSure with neck attachment for body contouring by warm sculpting. Please contact kristi. eisenhauermd@yahoo.com, 760-753-8413 FOR SALE: Nuclear medicine equipment including Ge Millennium MG system, hot lab, and sources Cs-137.

Rod Std 2. Cs-137. DCRS 3. Cs-137. Spot 4. Co-57. Flood sheet. Please contact us at 760-730-3536 if interested in purchasing, pricing or have any questions. Thank you.

NON-PHYSICIAN POSITIONS AVAILABLE PART-TIME BILLER POSITION AVAILABLE: Pain Management office looking for a part-time medical biller, will work directly with a variety of payors, healthcare

providers and patients through the revenue cycle process to ensure claims are processed and paid in a timely manner, review EOB’s, verifying patient coverage, and assist with patient billing inquiries. Please email your resume to cestrada@steinermd.com DIRECTOR OF NURSING - PUBLIC HEALTH SERVICES - COUNTY OF SAN DIEGO: The Director of Nursing in Public Health Services (PHS) will lead the clinical nursing enterprise of PHS, serving on the Executive Team of the PHS Department. This position will directly oversee clinical nurse management and all nursing personnel for six programmatic branches within PHS, as well as directly oversee all Public Health Nurse Managers or Leads in each branch. This position will work with Public Health Nurses in other Health and Human Services Agency (HHSA) departments such Aging and Independence Services, Child Welfare Services, and Regional Operations. Additionally, this position will have a dotted reporting line to HHSA’s Chief Nursing Officer and receive direction from the Chief Nursing Officer to HHSAwide nursing practices. Salary: $124,092.80-$150,822.80 annually. For more information click here.

PART-TIME BILLER POSITION AVAILABLE: Pain Management office looking for a part-time medical biller, will work directly with a variety of payors, healthcare providers and patients through the revenue cycle process to ensure claims are processed and paid in a timely manner, review EOB’s, verifying patient coverage, and assist with patient billing inquiries. Please email your resume to cestrada@steinermd.com EXECUTIVE DIRECTOR, STUDENT HEALTH AND COUNSELING SERVICES: California State University San Marcos (CSUSM) has announced a national search for a visionary and collaborative leader to serve as Executive Director of Student Health and Counseling Services.

Selected candidate will be appointed into an Administrator III OR Administrator IV. Appointment will be determined by education and experience. Selected candidate with an M.D. will be appointed as Administrator IV, and selected candidate without an M.D. will be appointed as Administrator III. For position specifications, benefits summary and to apply, please visit our website at https:// apptrkr.com/1852486 FINANCE DIRECTOR: San Diego Sports Medicine and Family Health Center is hiring a full-time Financial Director to manage financial operations. Primary responsibilities include monitoring of income, expenses and cash flow, reconciling bank statements, supervision of accounts payable, oversee billing department, oversee accounts receivables, payments and adjustments, prepare contracts, analyze data, prepare financial reports, prepare budgets, advise on economic risks and provide input on decision making. MBA/Master’s and 5+ years relevant work experience preferred. Excellent references and background check required. Salary commensurate with skills and experience. To apply, please send resume to Jo Baxter, Director of Operations jobaxter@sdsm.com NON-PHYSICIAN POSITIONS WANTED MEDICAL OFFICE MANAGER/CONTRACTS/BILLING PERSON: MD specialist leaving group practice, looking to reestablish solo private practice. Need assistance reactivating payer contracts, including Medicare. If you have that skill, contact ljmedoffice@yahoo.com. I’m looking for a project bid. Be prepared to discuss prior experience, your hourly charge, estimated hours involved.

May lead to additional work.

PRODUCTS / SERVICES OFFERED DATA MANAGEMENT, ANALYTICS AND REPORTING: Rudolphia Consulting has many years of experience working with clinicians in the Healthcare industry to develop and implement processes required to meet the demanding quality standards in one of the most complex and regulated industries. Services include: Data management using advanced software tools, Use of advanced analytical tools to measure quality and processrelated outcomes and establish benchmarks, and the production of automated reporting. (619) 913-7568 | info@ rudolphia.consulting | www.rudolphia.consulting

SanDiegoPhysician.org 19

PERSONAL AND PROFESSIONAL DEVELOPMENT

A Pathway to a More Effective, Productive, ‘Difficult’ Conversation

By Helane Fronek, MD, FACP, FACPh

A

FTER WRITING LAST MONTH ABOUT THE NEED

for physicians to step forward and hold challenging conversations to promote sensible public health recommendations, the difficulty of doing that was made clear during an interaction with an acquaintance who holds very different views. These conversations require a commitment from both parties to engage, listen, and open our minds to each other’s point of view. How, you might wonder, do we accomplish this in our increasingly divided nation, where each side hears only one perspective and the “reality” we believe in is so dramatically different from theirs?

Patterson et al, in their seminal book, Crucial Conversations: Tools For Talking When Stakes Are High, suggest that we enter into such a conversation only after considering several important questions: • What do we want for us as a result of the conversation?

• What do we want for the other person?

• What do we want for our relationship?

Another question worth considering, especially when we hold

20

September 2020

a diametrically opposing opinion, is why a reasonable, rational person might believe what they do.

After doing these preconversation reflections, we know our true intentions, we understand that there might be good reasons for the other person to hold a differing view, and we are ready to engage. Stating the intentions revealed in our reflections at the beginning of the conversation is a powerful way to open the space and sets the stage for us to achieve our goals.

When entering into a conversation that may be challenging, or in any conflict situation, I’m always reminded of the excellent advice of Stephen Covey in 7 Habits of Highly Effective People: Ask first to understand, then to be understood. If we begin by explaining that, while we recognize we hold different opinions, it’s important to us to understand the other person’s view, we demonstrate the curiosity and respect that invites them to share honestly with us. Inevitably, we learn something we didn’t

understand before. This may reshape our opinion or provide more insight into our differences. Regardless, understanding the other person is a prerequisite to resolving any conflict. Next, it’s essential to repeat what we heard — so we are sure we understood correctly and they can be confident they have been heard.

If we still disagree, we can then ask if we may share our different perspective on this.

If the conversation becomes too heated, or if it veers off the original topic, we can repeat our intentions and bring both the topic and tone back to what will be most productive.

Throughout the conversation, we stay alert to areas of common ground or shared goals, highlighting and using them to both reduce distress and conflict and find solutions that all can agree on.

While this structure may seem cumbersome, the stakes of remaining divided vs. achieving mutual respect and finding common ground make it a small price to pay for more effective communication. Having used it myself and hearing the results of many clients’ utilization of these ideas, I can assure you it provides a path toward more satisfying and productive conversations and relationships.

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.

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

Since 2008, Project Access has facilitated care for 6,500+ uninsured patients by providing 14,000 free consultations and 1,563 free surgeries â&#x20AC;&#x201D; all thanks to the dedication, time and talent of our volunteer specialty healthcare physicians and healthcare professionals.

For every $1 spent on program expenses, we provide $10 in contributed healthcare services â&#x20AC;&#x201D; a return on investment of 1000%!

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

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

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