JULY 2017 OFFICIAL PUBLICATION OF SDCMS
PASSING the BATON ANNUAL GALA INSTALLS 2017 BOARD OF DIRECTORS
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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 Healthâ€™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
In Partnership With
THE DOCTORS INSURANCE AGENCY Bob DeSimone
5575 Ruffin Rd., Ste 250, San Diego, CA 92123 www.SB5K.org 858.300.2777
VOLUME 104, NUMBER 7
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
18 Outgoing President Dr. Mihir Parikh’s 2017 Gala Speech
20 Incoming President Dr. Mark W. Sorenson’s 2017 Gala Speech
10 On Demand Webinars Provide Physicians Tools For Dementia
Dr. Bob Hertzka Receives 2017 Atlas Award
Another Vaccine-Preventable Disease Returns: Hepatitis A
White Coat Gala in Photos
BY ERIC MCDONALD, MD, MPH
4 Briefly Noted: Calendar • New and Returning Members • Volunteer Opportunities • And More…
The Art and Science of Prognosis BY DANIEL J. BRESSLER, MD, FACP
The Lifecycle of Legislation: From Idea Into Law
26 Physician Marketplace: Classifieds
Future of Medicine Conference for Physicians Set for September 29 JULY 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
BY ROBIN DIAMOND, MSN, JD, RN
MACRA Is a Marathon, Not a Sprint
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
2017 Leadership Awards: Call for Nominations
Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]
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/////////BRIEFLY /////////////////NOTED ////////////////////////////////////// / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Physician Networking Opportunity & Mixer SEPTEMBER 7, 5:30-8:00PM at
ROCK BOTTOM RESTAURANT & BREWERY La Jolla
For further information or to register for the following events, contact Jen at (858) 300-2781 or at JOhmstede@SDCMS.org. Register for CMA’s “Buzz on Zika Should We Still Be Concerned?” (webinar) AUG 23 SDCMS Physician Social (event) SEPT 7: 5:30pm-8pm at Rock Bottom Brewery 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. 34th Annual Primary Care Summer Conference AUG 4–6 at the Hilton San Diego Resort & Spa 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 Register for Emergency Care by the Bay NOV 16
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). SCHOLARSHIP WINNER ANNOUNCED
Dr. Sabrina Owens Named 2017 Champions For Health Resident Scholar Sabrina Owens, MD, is the 2017 winner of the Champions for Health Resident Scholarship. Dr. Owens will begin her family medicine residency at Scripps Chula Vista, and participated in the PRIME-HEq program during her years at UC San Diego School of Medicine. Each year, Champions for Health provides scholarships for medical students and residents, in part thanks to the John Houkom, MD Memorial Scholarship Fund, an endowed fund at Champions for Health.
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
QUOTE OF THE MONTH
I never did anything worth doing by accident, nor did any of my inventions come indirectly through accident, except the phonograph. No, when I have fully decided that a result is worth getting, I go about it, and make trial after trial, until it comes. — Thomas Edison
/////////////////////////////////////////////////////////////////////////////////////////////////// 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.
Welcome New and Returning SDCMS-CMA Members! OUR NEW MEMBERS Brent Brown, DO Internal Medicine San Diego (619) 528-5000 Jerald Cook, MD Occupational Medicine San Diego (619) 532-8225 Kathryn Gold, MD Medical Oncology La Jolla (858) 822-5182 Javier Jardon, MD Ophthalmology El Centro (760) 352-7755
Michael Lajin, MD Gastroenterology La Mesa (619) 460-4055
Jason Moss, MD Ophthalmology El Centro (760) 352-7755
Mikael Langner, MD Internal Medicine San Diego (484) 432-2177
Jason Toranto, MD Plastic Surgery San Diego (619) 810-1243
Jamie Lavender, MD Internal Medicine San Diego (858) 499-2703
OUR RETURNING MEMBERS
Tommy Le, DO Family Medicine Carlsbad (800) 290-5000
Seth Camhi ,MD Family Medicine San Diego (858) 263-0422
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TDC RISK TIP
MACRA IS A MARATHON, NOT A SPRINT How to Get Started Now by Robin Diamond, MSN, JD, RN With contributions from Kim Hathaway, Healthcare Quality & Risk Consultant, The Doctors Company
IN SEPTEMBER 2016 — just three months from the release of the final rule of the Centers for Medicare & Medicaid Services (CMS) Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) — half of the physicians surveyed had not heard of MACRA, which establishes a new way to pay doctors for Medicare patients. In January 2017, the beginning of the first performance reporting period, only 19 percent of physicians reported that they were very or somewhat familiar with MACRA. Physicians and practice managers may feel as if they’re being left at the starting line, but although the first quarter of 2017 is already over, there is still time to get in the MACRA race.
On your mark …
Assemble a team. A team is vital to tackle MACRA data collection, data analysis, and submission. Team members should come from various roles in the practice. For example, a team might include the practice manager, a physician, a clinical staff member, and an administrative staff member. The team should brainstorm strategies to incorporate metrics into existing workflow and optimize the workflow to include data collection. The team can also then educate the rest of the organization about MACRA and its role in the process.
Get set …
Decide whether to report as a group or individual. An individual is defined as a single National Provider Identifier (NPI) tied to a single Tax Identification Number (TIN). A group is defined as a set of clinicians (identified by their NPIs) sharing a common TIN, regardless of their specialty or practice site. This is also important for the method of submission, because only clinicians reporting as individuals may use a claims submission method, and the CMS Web Interface is only available to groups of 25 or more clinicians. Know the criteria, advantages, and disadvantages of reporting in each category—the Quality Payment Program (QPP) website (qpp.cms.gov/mips/individualor-group-participation) is a helpful resource.
Pick your pace. In this transitional year of the QPP and alternative payment models, CMS solicited feedback from stakeholders about the burden of reporting under MACRA and responded by making this a learning year. Practices have
four options to choose from and can participate as much, or as little, as they choose. It is pointsdriven: The more participation, the more points earned. The goal is to exceed 70% in the composite score to be considered for a bonus. The composite score is composed of Quality + Advancing Care Information + Improvement Activities. Understand your participation options. For example, most clinicians will report under the Merit-Based Incentive Payment System (MIPS) versus an Alternative Payment Model (APM). There will be a small group of physicians in an APM who will only partially qualify and thus need to report under MIPS. It’s important to understand this and report correctly to avoid a negative adjustment.
Select measures and submission methods. Choose measures that best fit your practice. Understand that not all of the measures are equal in value. Under the quality category, one measure could earn as many as 10 points. Take time to review your options. The measures may be reported in several ways, including through the electronic health record (EHR), a qualified registry, CMS Web Interface, and administrative claims data. Submission methods are particularly important because they will increase points, which affect the composite score and may assist in maximizing payment or earning a bonus. The EHR is one of the easiest ways to capture and report data. Consult your EHR vendor about functionality and creating a workflow for collecting data and
reporting. EHR vendors are the primary source for ensuring the documentation of best practices data is accurately captured in the software and producing correct credits for the work provided. Regardless of how reporting is done, now is the time to work out the process and learn how easy or difficult it is to upload and track progress prior to final submission. At least 90 consecutive days of data is required to be considered for a positive upward or neutral adjustment.
Review and improve. Evaluate past performance in the Physician Quality Reporting System (PQRS), which now becomes the Quality Measures and will have the greatest weight (60% of the composite score). Review past performance in the Meaningful Use (MU) measures. MU now becomes Advancing Care Information (ACI) and will require greater participation than in the past. Prior to 2017, measures had low thresholds and were easy to attain. As of 2017, it’s necessary to include as many patients as possible. Practices will also have base measures to report, including conducting or reviewing a security risk analysis; e-prescribing; and providing patients with access to view, download, and transmit their health information. A new performance category for 2017 is the Improvement Activities (IA). Most groups will attest to completing four activities. Small groups with less than 15 physicians will attest to two activities. These activities focus on patient safety, care coordination, and engagement.
Start now. Reporting a single measure will avoid a negative adjustment in 2019. Don’t stop there — take advantage of this transition year. Don’t aim for the bare minimum. Instead, use this time to learn as much as possible and close as many gaps before the year’s end. This time is designed for practices to implement workflows and processes to be successful for 2018 and beyond. Use this time to partner with your EHR vendor. Don’t wait until the third or fourth quarter to find out data is not calculating. Schedule weekly calls with your EHR account manager. Ask for a user guide, provide it to your team, and review it often to close gaps in documentation. If you are already reporting PQRS and MU, you’re halfway there. If you’re not reporting yet, there is still time to start before Oct. 2, 2017 — and the earlier the better. The positive or neutral adjustments are less challenging to meet in 2017, and what is done this year will reflect in the 2019 public reporting and pay-for-performance. Delaying participation may make next year more challenging. For more information, go to the Medical Advantage Group website at www.medicaladvantagegroup.com, or contact The Doctors Company Patient Safety Department at patientsafety@ thedoctors.com. Robin Diamond, MSN, JD, RN, is senior vice president of Patient Safety and Risk Management at The Doctors Company.
SAN DIEGO PHYSICIAN.ORG
T E C H N O LO G Y
FUTURE OF MEDICINE CONFERENCE FOR PHYSICIANS SET FOR SEPT. 29 Physicians will learn the latest and future advances in medicine by attending the Future of Medicine Conference for Physicians on Friday, Sept. 29 at the Kona Kai Resort, hosted by Champions for Health and the San Diego County Medical Society. 8
Ruth Haskins, MD, president of the California Medical Association, will be the welcoming keynote speaker. State Senator Ricardo Lara, co-author of SB562, The Healthy California Act, is slated as the luncheon speaker. William Mobley, MD, chair of the Department of Neurosciences at UC San Diego, will discuss medical research advances toward a cure for Alzheimer’s disease. Currently through the funding efforts of the countywide Alzheimer’s Project, five research projects have advanced toward discovery. Champions for Health has been involved in the Alzheimer’s Project Clinical Roundtable, on which Dr. Mobley serves, over the past three years. James Mault, MD, FACS, senior vice president and chief medical officer at Qualcomm Life, will present on new technology for digital health and
the internet of medical things. Digital health assists physicians to improve patient outcomes in a variety of innovative ways. Ali Bagheri, MD, Girard Orthopaedic Surgeons, will discuss new technology in spine surgery, and David Fabi, MD, San Diego Orthopaedic Associates Medical Group, will present on advances in robotic surgery for joint replacement. Donald Durden, MD, PhD, vice chair for research, UC San Diego Dept. of Pediatrics, also serves as associate director for pediatric oncology at Moores UCSD Cancer Center. He will address progress to date and discovery of cancer immunotherapy. The full-day conference is accredited for up to 6 AMA PRA Category 1 Credits for Continuing Medical Education through the joint providership of the University of California, Irvine and Paradise Valley Hospital/
State Sen. Ricardo Lara
Ali Bagheri, MD Girard Orthopaedic Surgeons
James Mault, MD Senior VP And Chief Medical Officer, Qualcomm Life
Donald Durden, MD, PhD Vice -Chair for Research, UC San Diego Dept. of Pediatrics
William Mobley, MD Chair, Dept. of Neurosciences, UC San Diego
David Fabi, MD San Diego Orthopaedic Associates Medical Group
Ruth Haskins, MD President, California Medical Association
Champions for Health. The University of California, Irvine School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. The cost for the full-day conference, including breakfast, luncheon, and CME credits is $150 for SDCMS/CMA members and $250 for non-members. To register, visit ChampionsforHealth.org/futureconference or call (858) 300-2779.
C H A M P I O N S F O R H E A LT H
ON DEMAND WEBINARS PROVIDE PHYSICIANS TOOLS FOR DEMENTIA PRIMARY CARE PHYSICIANS will be primarily responsible for the screening, evaluation and diagnosis, and treatment of behavioral issues for the increasing number of patients with cognitive issues. With San Diego, along with the rest of the country, seeing an increase in the number of adults over age 65 and living into their 80s and 90s, primary care physicians will need tools to assist with this increasing healthcare issue. The Alzheimer’s Project
Clinical Roundtable, led by neurologist Michael Lobatz, MD, and County of San Diego Chief Medical Officer Nick Yphantides, MD (both SDCMS/CMA members), has developed five hours of Continuing Medical Education on-demand webinars to improve clinical practice. The Doctors Company, a physician malpractice insurance provider, has worked tirelessly with Champions for Health, which has been facilitating the Clinical
Roundtable, to develop the webinars. The Doctors Company is accredited to jointly provide for CME credit The Alzheimer’s Project, a four-course series with Champions for Health. The goal for the series seeks to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. The series was developed with support from San Diego State University San Diego/Imperial Geriatric Education Center, and the Centers for Disease Control and Prevention. There is no charge for participating in the webinars, or for CME credit. To access the webinars, go to ChampionsforHealth. org/alzheimers and click the link near the top of the page. Also included on the page is a download link to the 60-page guidelines created through the two-plus years of effort of the Clinical Roundtable, a group of neurologists, psychiatrists, geriatricians, geriatric psychologists, and primary care providers. Included are direct links to numerous screening and evaluation instruments, along with the algorithms for how to effectively and time-efficiently conduct screening and evaluation, and assess behavioral and psychological symptoms. If your group or practice is interested in an in-service presentation by one of the Clinical Roundtable faculty, contact Barbara.Mandel@ChampionsFH.org or call (858) 300-2780.
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INFEC TIOUS DISE ASE
ANOTHER VACCINEPREVENTABLE DISEASE RETURNS: HEPATITIS A by Eric McDonald, MD, MPH
Introduction In recent years, several vaccine-preventable diseases have resurged in California. There have been two waves of whooping cough (pertussis), in 2010 and 2014; several outbreaks of measles â€“ one due to exposure in Europe (2008) and one that started at Disneyland (2014); and clusters of mumps and chickenpox cases on college and elementary school campuses (2016). And now, an outbreak of hepatitis A is occurring in San Diego County that has the second largest number of cases in the United States since the introduction of the vaccine. Background San Diego Outbreak As of July 25, 2017, the San Diego County Health and Human Services Agency (HHSA) has identified 275 cases in an outbreak that began in late November 2016 and has claimed seven lives. Seven in ten of those who became ill with hepatitis A have been hospitalized. The groups primarily affected by the disease are persons who are homeless and/or report drug use, and one in four had existing liver disease, (e.g., chronic hepatitis B or C, cirrhosis). The overall case count is larger than that of all other hepatitis A outbreaks in California combined over the past 20 years. According to the California Department of Public Health, there were seven hepatitis A outbreaks in the state from 1998 to 2015, totaling 224 cases and one death. This outbreak differs from most of the prior outbreaks because it is a result of personto-person transmission, and has not been linked to a contaminated product or to a specific food or water source. History of Hepatitis A Before the vaccine was introduced in 1995,
the western states, including California, had higher incidence rates of hepatitis A than other parts of the country. Routine childhood vaccination in the state in 1999, followed by routine vaccination across the country in 2003, led to steep declines in hepatitis A. In the past ten years, most cases nationally, and in San Diego, were related to international travel or to consumption of specific contaminated food products. Signs & Symptoms Symptoms of hepatitis A may begin anywhere from two to seven weeks after exposure to the virus. The illness is characterized by fever, fatigue, nausea, loss of appetite, diarrhea, and abdominal pain, followed by the classic triad of jaundice, dark urine, and pale stools. In children under six years of age, the majority of infections are asymptomatic, and if illness does occur, there is typically no jaundice. Among older children and adults, infection usually causes symptoms, with over 70% having jaundice. Hepatitis A symptoms usually last less than two months, although 10% to 15% of symptomatic persons have prolonged illness for up to six months. Hospitalization is required in at least 20% of cases, but older adults and those with underlying medical conditions have rates of hospitalization over 40%. Complications of hepatitis A include relapsing disease (10%), cholestatic hepatitis (5%), fulminant hepatitis leading to liver failure (0.1%), and autoimmune hepatitis (rare). Treatment of hepatitis is supportive. Prevention Strategies Hand Hygiene Good hygiene and vaccination are the best prevention strategies against hepatitis A. Hepatitis A is a non-enveloped virus, like
norovirus, and it may be similarly difficult to inactivate in the environment. Alcohol-based hand rubs and typically-used surface disinfectants may not be effective. Therefore, washing hands with soap and running water for at least 20 seconds is critical to controlling the spread of hepatitis A. Contact precautions, in addition to standard precautions, should be used in the care of diapered or incontinent hepatitis A patients. Environmental cleaning in areas housing possible hepatitis A patients should be performed with bleach products or other products effective against norovirus. Vaccination The hepatitis A vaccines are more than 99% effective in preventing the disease. A concerning aspect of the outbreak is the fact that the most of those who have been ill have had a known indication for vaccination against hepatitis A. Vaccination is routinely recommended for children, travelers to countries with higher rates of hepatitis A, men who have sex with men, illicit drug users, individuals with chronic liver diseases, and household or sexual contacts of patients with hepatitis A. Homeless people are also at increased risk for hepatitis A and should be vaccinated. Recommendations Preventive Vaccination HHSA recommends that homeless persons, illicit drug users and others at high risk in San Diego County get vaccinated immediately if they are not already immune. In addition, unvaccinated workers and volunteers who interact with these populations should also be vaccinated. This would include persons working in public safety, sanitation, homeless shelters, and homeless and behavioral service provider
agencies. Three healthcare workers have contracted hepatitis A during this outbreak, and although standard precautions can be expected to protect providers who may be exposed to hepatitis A, those who care for at-risk groups are strongly encouraged to get vaccinated. Post Exposure Vaccination Vaccination is so effective that it can be used for prevention after someone has been exposed to hepatitis A. Susceptible people exposed to hepatitis A should receive a dose of single-antigen hepatitis A vaccine, intramuscular (IM) immune globulin (IG) (0.1 mL/kg), or both, as soon as possible within two weeks of last exposure. Note that this recommended IG dose is five times greater than the package insert and some published dosage schemes: it was increased in July 2017 by the manufacturer due to the decreasing amount of antibod-
ies in plasma donors. Updated information about post-exposure prophylaxis may be found in detail at the updated CDPH Quicksheet on Hepatitis A. Travel Vaccination Anyone planning an international trip should check whether hepatitis A vaccination is recommended prior to departure. Fifteen hepatitis A cases unrelated to the current outbreak have been reported this year among San Diegans who traveled overseas. High-risk areas for the disease include parts of Africa and Asia, and moderate-risk areas include Central and South America, Eastern Europe, and parts of Asia. There are currently hepatitis A outbreaks associated with men who have sex with men in Western Europe, notably France, Portugal, and Spain. A good resource is the CDC Travelers’ Health website which has information about hepatitis
A and any other health issues that can be prepared for prior to departure. Resources HHSA has established a website to keep local providers up-to-date on the hepatitis A outbreak that can be found at www.sdepi. org by clicking on “hepatitis A” under “diseases and conditions.” Case counts are posted weekly, and health advisories and other resources for the public and for providers are regularly updated. For questions about hepatitis A, providers may contact the County Epidemiology Program at 619-692-8499 or email EpiDiv.HHSA@ sdcounty.ca.gov. Eric McDonald, MD, MPH is the Medical Director for the Epidemiology and Immunization Services Branch of the County of San Diego Public Health Services Agency.
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POE TRY AN D M EDICIN E
Numbers You can count the numbers on your hands Even right now, even while reading this Each little sausage with a personality assigned so long ago But not forgotten. We call them digits, numbers. You can count the number of planets in our solar system Color coded in a children’s book on space It’s either eight or nine (depending on Pluto’s status) Almost the same as the number of fingers if you add the sun. We can count, too, the days in a week In a month and even in a year. Turns out there’s 365.2422 a number awkward enough to prove (As if we need such proof this late in history) That nature’s perfection is not the same As what humans imagine perfection to be.
THE ART AND SCIENCE OF PROGNOSIS by Daniel J. Bressler, MD, FACP
“DOC, WILL THIS affect my life expectancy?” Asked of me by a 93-yearold retired rocket designer recently admitted with CHF exacerbation after reading the hospital booklet given to him about that diagnosis. “Medicine is a science of uncertainty and an art of probability.” William Osler, MD It’s tough to make predictions, especially about the future. Yogi Berra. Nicholas Christakis, MD, a professor of medicine and sociology at Yale, in his 1999 book, Death Foretold: Prognosis and Prophecy in Medical Care, proposes that medical
practice has three prongs: diagnosis, prognosis, and treatment. Of these, doctors do the worst (and put in the least amount of time and training) in prognosis. He outlines the reasons and includes among them a fear that a negative or poor prognosis will become a self-fulfilling prophecy, with the doctor’s words acting like a curse and leading to an unnecessarily shortened life. As a consequence, doctors either avoid prognosis altogether or gloss over it with excessive optimism. As an internist who graduated medical school in the ’80s, I came of age with a few classic
And speaking now, just for a moment, about Human imperfection, what about the number of our days? I mean your days and my days. For most of us, it is more than a handful of fingers or planets But then again, not so many as the stars on a June night But the number is something, some “X.” “Solve for X,” said Mr. Arredondo in high school algebra Solve for X, says the radiation oncologist and the cardiac surgeon Solve for X, say the Four Horsemen on their cybernetic steeds. It is a final exam, of sorts. It’s one we all must take. This, too, is a school and we all eventually graduate Our final answers given, one way or another, Walking off the stage down the steps into an unknown world. So I count my fingers, add my toes Multiply by the number of planets And include, to a false precision of 4 decimal places The solar year. That gives me a number, some number. And then, for extra credit, I go to ask the Principal If I might take a look in the back of the book You know, the book of counting, of planets, of solar systems And oncology and cardiology Let me read ahead to find the number To get the correction factor that makes it all add up. And the Principal invites me to the front of the class. On the desk is the book of life, the book of books The entire history of the universe bursting from every page. It’s a living record that overflows up until the present moment; After that, nothing but blank pages. Ah, yes, the Principal smiles. You want the number. But I don’t have the number. The book does not have the number. Solve for X.
predictive tools that used simple tally methods to determine likely outcomes. These included the CHAD score (its latest iteration is called the CHA2DS2-VASc) for the calculation of stroke risk in atrial fibrillation, the APACHE score (its latest update is APACHE IV) for risk of death in ICU patients, and the Pugh Child score (now called the ChildTurcotte-Pugh) for predictions about outcomes in cirrhosis of the liver. Since the publication of Death Foretold, there has been an explosion in the number of prognostic tools that use the best available data to predict various kinds of outcomes. There are now aggregators of those tools available online and in smartphone apps. Ones that I use in my practice include QXMD (qxmd.com) which
covers the waterfront, the Memorial Sloan Kettering (mskcc. org/nomograms) for cancers, and ePrognosis (eprognosis. ucsf.edu) for geriatrics. These sites and apps integrate the hundreds of various predictive tools from the full spectrum of medical specialties. These tools can give practicing physicians some additional confidence in the statistics of their predictions but do not remove the onus their predictions have on influencing patients’ quality of life and even lifespan. In this regard, context is everything. The first context is that of statistics themselves. They apply to groups but not individuals. Every normal distribution curve has tails with outliers. Of course there are tails on both sides. For every patient with glioblastoma multiforme who
lives five years, there is one who is dead in a month. The capacity to convey the upside and downside of statistical facts is a skill that a compassionate physician must master. There is also the concept of current lifestyle practices affecting outcomes. Someone with alcohol abuse disorder who stops drinking certainly has a better expected outcome than one who doesn’t, regardless of the other factors on the nomogram. And finally, there is the issue of technologic innovation. Before Gleevec (imatinib), chronic myelogenous leukemia had a five-year mortality rate of 50%; it has now dropped to 5%. I sometimes tell my patients with an aggressive cancer that one of our goals is to keep you alive with the current technology so that you can live to benefit
from the better ones still in the pipeline. As for that 93-year-old whose quote begins this essay? If I had looked him up 10 years ago, these tools would have predicted that he would be dead for five years by now. So much for our conversation last night about rocket engine design, carbon-dating the earth’s crust, and World War II adventures. This poem, Numbers, is dedicated to 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.
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THE LIFECYCLE OF LEGISLATION From idea into law
THE CALIFORNIA MEDICAL Association (CMA) is the largest, most influential medical organization in California, and an aggressive advocate for doctors and patients. CMA relies on the involvement of its members to communicate the physician vision of medical care to the public, to lawmakers and to the regulators who determine how medicine is practiced. An idea is born: Ideas for new health policy are born in a number of places. One of them is in the hearts and minds of the physicians of California. CMA members can directly influence the association’s health care advocacy agenda by submitting a resolution for consideration to the CMA House of Delegates.
CMA policy is established: Resolutions are assigned to councils and subcommittees for study and development, then opened up for discussion by your physician colleagues before recommendations are developed for action by the CMA Board of Trustees. Many of CMA’s sponsored bills have their genesis in an idea submitted by our physician members. While not all CMA policies result in direct legislative action, they are used to guide CMA’s positions on the hundreds of health care bills that are introduced into the State Legislature each year. Bills are introduced: The California Legislature operates on a two-year session. Each year, primarily in January and February, bills are introduced by lawmakers for
“Change is happening, and change will always happen. CMA remains focused on the future and will act boldly to shape the world of health care to support physicians and patients.” consideration. The governor may also call a special session of the Legislature to deal with specific subjects. CMA takes a position: Each year, with physician input, CMA monitors more than 500 bills and takes a public position on around 200 bills. Those positions include watch, support, oppose, support if amended and oppose unless amended. CMA also may choose to sponsor or co-sponsor legislation that is of critical importance to the physicians of California. Bills move through the process: If a bill is to become law, it must be passed out of one or more committees, approved by a simple majority of both houses, and signed by the governor. Laws ordinarily take effect on January 1 of the following year. Briefly, a bill progresses through the following steps: 1. A bill is introduced. 2. The bill is heard in one or more committees in its house of origin (either Senate or Assembly), including public testimony. 3. If the bill passes out of committee(s), it goes to the house floor for a vote. If it passes out of the house, it is sent to the other house for consideration following the same process described above. 4. If approved by both houses, the bill goes to the governor for signing. 5. The governor has three choices: sign the bill into law, allow it to become law without his or her signature, or veto it. A governor’s veto can be overridden by a two-thirds vote in both houses.
Connecting with your elected official through social media CMA monitors and protects physician interests: CMA’s powerful government relations team works tirelessly with legislators to educate them on how legislation could enhance or threaten patients’ health or physicians’ ability to practice medicine. Their activities include reading and tracking bills and amendments, shaping bill language, meeting with legislators, testifying in committee, conducting research, and preparing policy papers and position letters. Every year, CMA not only supports and shapes the development of valuable health care policy, but the association also stops a number of harmful legislative proposals. For more information on CMA’s legislative advocacy, and how you can get involved, visit www.cmanet.org.
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Social media is an excellent platform to communicate with your elected officials, especially Twitter. The key is to “tag” the elected official(s) you’re addressing using their official Twitter account. Keep in mind that many elected officials may have both a campaign Twitter account and an “official” Twitter account – the latter is preferred. With Twitter, you have only 140 characters to convey your message, plus an image or link. Try writing out your full message first, then review with a critical eye and pare down accordingly. Always keep it professional, even if you’re tweeting your opposition to a legislator’s bill. Most legislation can be viewed as either solving a problem – or creating one, depending on which side you stand. When tweeting in support of something, or to encourage a vote for something, make sure you’re stating WHY (ie, the problem) and what you want the legislator to DO about it (ie, the solution). Keep in mind that a legislator may not be familiar with all the bill numbers in a session, especially if they’re not the ones introducing that legislation. Any reference to legislation should be #hashtagged, with a very short description of the bill after. For example: As a practicing physician, I know how critical vaccinations are to prevent the spread of disease. @DrPanMD, vote YES on #SB277 #vaccinebill
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The following is outgoing president Dr. Mihir Parikh’s speech given at SDCMS’s June 3 White Coat Gala.
Thank you, Dr. Parikh! SDCMS President for 2016–17
ood evening doctors, elected officials, medical society partners and distinguished guests. What a year of covfefe this has been! I am absolutely honored to have served as your president this past year. I joined the medical association as a fledgling solopractice physician in 2002. As a newbie ophthalmologist, I would see things that irked me and ask questions like, “Why?” and, “What are the other docs doing about this?” I soon learned that the answer was usually “just because someone thought that was a good idea” and then doctors don’t complain, they just adapt. It was around that time I met Tom Gehring, our society’s former CEO (and he is here tonight with his personal psychiatrist and lovely wife, Catherine) and in his true military parlance, he signed me up to fight the fight. I was surrounded by many amazing physician leaders and mentors — such as Bob Hertzka, Jim Hay, Ted Mazer, Bob Wailes — former presidents of this county society, two of which are past CMA presidents, one who is now the incoming CMA president, and, over a 15-year journey of experiences, I stand before you today. This past year has been quite rewarding for us at the Medical Society, and there is certainly plenty of work left to do. The Medical Society’s core mission is to advocate for the wellbeing of our doctors so we can help make San Diego the healthiest and finest city in America. We had a great year for advocacy, meeting our elected officials in Sacramento and Washington, DC, engaging medical students in the legislative process, and participating in numerous San Diego County events. We appreciate everyone involved for their time spent and dedication to get the MD voice heard. I am so impressed how our elected officials will almost always meet with the visiting doctor teams. It really shows how interested the legislators are in our thoughts on healthcare delivery — so we need our San Diego County doctors to be equally engaged. The entire county is now finally talking about healthcare —this is the time we all need to stand side by side and in a unified voice and advocate for patients’ rights and doctors’
autonomy. We need every doctor to be a member, join our committees and commissions to widen the diversity, and participate in our now monthly social networking events throughout the county — we want you on the table, we need you on the table. This is the best time to join. We are now at almost 3,000 paid members, and we should be aiming for 4,000. We already have more members than the entire state of West Virginia. But when almost 18% of the GDP is spent on healthcare — the highest percentage in the world by a long shot; when one in three Californians are on Medi-Cal but yet most doctors don’t accept it because the reimbursement rate is not sustainable to run a practice; because doctors and our partners took on the tobacco industry in November with Prop 56 and we saw a smashing win at the ballot, just to see our governor now illegally redirect the funds away from Medi-Cal to the general fund but yet onboard more people into the system, these are all areas that need to see change and we must be there to fight the fight. These policies both affect patients’ access to care and physicians’ ability to deliver the care. Besides advocacy, another core mission is to make our County Medical Society appeal to all physicians in all modes of practice. We have multiple projects and initiatives that work toward that goal. One strategy to executing on that level has been to broaden our partnership with other darling organizations in the county. We have been working with the Leavitt Group, who is also a sponsor here tonight. We have been working together for the past two years trying to find an affordable business solution so our doctors who run their own medical practices can afford health insurance for themselves and their staffs. As some of you business owners know, in the past four years the individual and smallbusiness owners’ health insurance market has seen a high price surge to purchasing health coverage. It is a tremendous challenge to retain quality staff, and we are starting to discover some potential solutions. Thank you Leavitt Group for helping us fight the fight. We are also partnering with 2-1-1, the San Diego Food Bank, the San Diego Hunger Coalition group and the San Diego Chapter of the American Academy of
Left: Dr. Mihir Parikh at the podium. Right: (L-R): Nathan Parikh, Mangala Gurushanthaiah, Gunjiganur Gurushanthaiah, Keerti Gurushanthaiah, Mihir Parikh, Yogesh Parikh, Kavita Parikh and Nishan Parikh
Pediatrics to roll out a solution to identify and treat food-insecure children in San Diego County. It is hard to believe that the San Diego Food Bank serves 400,000 meals a month to food-insecure residents living in this county and we still have so many kids who do not eat from lunch on Friday until Monday when they go back to school. Social determinants such as food insecurity, homelessness, inability to find transportation, or pay your electric bills will certainly negatively impact healthcare outcomes. We are very excited about these new relationships, and it is dramatically expanding the footprint of SDCMS and broadening our appeal to all doctors. I can certainly go on. We can talk about how the federal government is now suing United Health Care for $1 billion for improper billing of its Medicare Advantage patients. We can talk about the $155 million fine that e-ClinicalWorks was just assessed for faulty software security of patient data despite doctors’ multiple complaints. We can talk about medical student loans being at all-time highs. And yet our government continues to inadequately fund residency programs, making it harder for medical students to match in California residencies. Or not expanding loan forgiveness programs that encourage young MDs to work in communities that have severe physician shortages. These policies do not make sense, and we need to educate decision makers to make smarter choices. I want to end by thanking a few people personally for a job well done. First of all, our chief architect, Paul Hegyi, who is doing an extraordinary job in his first full year installed as the CEO of the Medical Society.
The SDCMS staff: Jennipher, Brandon, Eric, and Sue for making Paul and me look good when you know the real truth. The SDCMS Executive Committee — please stand — believe me when I tell you the upcoming lineup of presidents will make you forget about me so quickly it is scary. These doctors are off-the-charts good, and it has been a pleasure to work with all of them. And then finally, my entire family — who heard my grumbles as I was reading emails early in the morning and late at night, and the telephone calls and the conference calls and the weeknight meetings and the out-of-town trips. Thank you to my wife’s parents and my dad — we have all never been so political as in this past year. My wonderful wife and graduating son, who made their own personal sacrifices so I can have the time to meet my obligations. I am very much looking forward to passing the gavel over to Dr. Mark Sornson and so without further ado, Mark, I wish you and your family the best of luck. I know as chief of dermatology at Sharp Rees-Stealy, you are one busy doctor within a vibrant healthcare system. I suggest an earlymorning workout with the wife, some strong coffee, a phone with a large data plan, and a firm bed with a soft pillow so you can recharge and repeat. I know your wife and daughter will be at your side and will remind you to take a few deep breaths and take a few ski trips. It is so much fun, with such great people, just enjoy the ride. Thank you everyone for your attention. I can’t be like President Obama and buy an $8 million house after my presidency, and I don’t think there will be an $18 million book deal either, but I can drop the mike ... SAN DIEGO PHYSICIAN.ORG
Welcome, Dr. Sornson! SDCMS President for 2017–18 The following is incoming president Dr. Mark W. Sornson’s speech given at SDCMS’s June 3 White Coat Gala.
hank you, thank you all for celebrating this evening with us. Thank you, Bob Hertzka, for all you do for us. And thank you, Mihir, for your amazing example as president, your guidance and your friendship.
I’d like to give special thanks to my wife, Caroline; my daughter, Madeline; my in-laws, including my father-in-law, an orthopedic surgeon; my dad, a 24-year SDCMS member; and my mom, who always told me as a kid that I would be president someday. I’d like to start with a quote from Jimmy Johnson of Miami and Dallas fame. I first read this painted neatly on the wall of our
employee entrance at Sharp Rees-Stealy Sorrento Mesa. The difference between ordinary and “extra-ordinary” is that little extra. The difference between ordinary and extraordinary is that little extra. I think of that quote when I think of Richard Butcher. As we’ve just heard so eloquently, he always gave that little extra for his patients. But for him, giving extra permeated his life. I remember one evening as I was going to an event much like this one, I came across him fully dressed in his tuxedo going the other way. I joked, “Hey, you’re going the wrong way,” and he said, “No, no … we gave up our tickets to a couple of the medical students.” If all of us wake up in the morning asking how can we be like Richard Butcher, we will all be better physicians. A few days ago, I spoke to a familymedicine doctor who is here tonight. She said, “Man, it felt so great to be a doctor last week.” A 54-year-old woman whose husband had just been diagnosed with ALS came to see her. The patient and her husband had been expecting to retire, travel and enjoy their golden years together. Instead, they were selling their home to move and accommodate his decline. Her doctor said, “This was the proverbial bus that came from nowhere to hit someone.” She cried with her patient, sharing her tears, hopes, and understanding of the arbitrary cruelty of the husband’s disease, spending 45 minutes for a 20-minute visit. They dried their tears and the doctor went on. The patient checked out, stopping to tell the nurse, “Thank god I have this doctor who will help me through what is next.” I spoke to another physician, who told me about a 34-year-old breastfeeding mom who she saw in October for a plugged milk duct. She felt it, it seemed superficial, but something alerted her, something that just didn’t seem right. So she ordered studies, breast cancer was found, and a life was likely saved. It has been said, “Who saves a life saves the world entire,” and that is also our special calling. I spoke with this wonderful physician and asked “How did you
Left: Dr. Mark Sornson speaking during the program. Right: SDCMS 2017-2018 president Dr. Mark Sornson with his wife, Dr. Caroline Thornton, their daughter, Madeline Sornson and his parents, Zola and Dr. Rodney Sornson
know? What made you say ‘wait a minute’ when it seemed so routine?” She said that if you go and see her for a sore throat, for anything, she’s thinking cancer first, then the routine diagnoses. That she gets joy every day from making sure her patients are up to date on all their screenings. And, that if you come to her with a subtle sign of early cancer, she said “Dammit, I’m not going to miss it!” Advocating for physicians who do things like that is easy. We’re not apologetic about SDCMS being an advocacy organization. That’s an “extra” that SDCMS and CMA give to us. We fight for your ability to care for your patients, and for your patients’ welfare. And when we speak to legislators who have experienced that extra care that you can provide, it breaks through. Those incredible legislators are here tonight, all friends of medicine, as a testament to your care. I’m not going to pretend there aren’t challenges. And most of them are acronyms. On those days when I spend more time with my EHR deciphering my ICD10s and trying to incorporate my MIPSs than I do talking with my patients, then something is fundamentally wrong. When I have to adapt my practice to the ACA and the AHCA, EHBs, and PQRSs, I think of the WT … effrontery of it all… but I don’t give up! I think of our 10-year battle against GPCI — the geographic price cost index — which has just been changed in San Diego due to the San Diego County Medical Society spearheading advocacy efforts. Finally we have Medicare reimbursements that do not assume San Diego is a rural cow town. I think of our successful Proposition 56 that will keep thousands of kids from starting smoking, and I think of SB 277, physician-led by Dr. Richard Pan in the Assembly, which has greatly increased vaccination rates. I spoke to another physician at her office and asked, “What has made you feel great about being a doctor?” She looked thoughtful, smiled and said, “I keep a file.” She opened a drawer and pulled out an
incredibly overstuffed hanging file folder of patient thank-yous, and said that she had so many stories it was hard to choose. Whenever she has a really tough day, she pulls out a few mementos from the file and recharges her batteries. I’ll close with a story from my father, about Calvin, his best friend growing up. Despite a vigorous rural life, Calvin had his first heart attack at 50 and it was a bad one. It was the one where the nurses came in the next day and said, “Is Calvin still with us?” He had a cardiologist who got him through it and cared for him for years. Calvin liked to fish and asked his cardiologist over the years many times if he didn’t want to go fishing some weekend, but the cardiologist always said, “No, I just don’t have time, Calvin.” Finally, the cardiologist retired. Calvin called him again, said, “Let’s go fishing,” and the cardiologist said yes. So Calvin hooked up his boat, took it to the lake, put it in the water, then drove to pick up the cardiologist and brought him to the lake. As Calvin was helping him into the boat, the boat moved away from the dock, and the cardiologist stepped right into the
lake. Fortunately it wasn’t too deep, he just went in about to his waist. Calvin says the cardiologist was the biggest thing he ever fished from a pond… After getting him out, Calvin said, “Maybe we should call it a day,” but, dripping and cold, the cardiologist said, “No, we’ve been looking forward to this for years. We’re going to fish!” As it turned out, the fish were biting that day, and within an hour they had caught their limit. They went to the cardiologist’s place to clean the fish and divided them. As Calvin was about to leave, the cardiologist said, “This was one of the best days of my whole life,” and they gave each other a big hug. And, as Calvin tells it, tears were rolling down both their cheeks. All of these stories tonight have been doctor-patient stories, not doctor-government-patient stories. So keep giving extra. Keep that bulging file to store what you have done for your patients, and accept their gratitude. And take the time to actually open that file once in a while and remind yourself how special what we do really is. And, you deserve to have fun tonight … let’s party! SAN DIEGO PHYSICIAN.ORG
Left: Dr. Bob Hertzka accepting the SDCMS Atlas Award. Below: (L-R): Dr. Mark Sornson, Dr. Mihir Parikh, Roxana Foxx, Dr. Bob Hertzka, and SDCMS CEO Paul Hegyi
Dr. Bob Hertzka
2017 “Atlas Award” Recipient This year’s Atlas Award was presented to Dr. Bob Hertzka by SDCMS outgoing President Dr. Mihir Parikh
hank you once again. It is my privilege to recognize someone in this audience for the 2017 Atlas award. The “Atlas Award” was started in 2005 to recognize an SDCMS member who has shown outstanding community service and dedication to the San Diego County Medical Society and the medical community at large. This person routinely exceeds the call of duty in dedication to the needs of patients as well as the needs of the entire medical community.
Well, that is a very tall bar, and the previous recipients have all been big-league contributors, but there is one person who has not yet been recognized but to me he is such an obvious choice. I actually thought it was a typo when I saw he wasn’t on the list. I only have two minutes to present this award, so I can only briefly list some of his stellar contributions: • Former president of SDCMS • Past and the youngest president CMA has ever had • Former Chairman of the Council on Medical Service at the AMA • Former AMA Political Action Committee chair
OK, this is all FORMER stuff. What does he do with all of his free time now? I am building to that. He works with ASMG, specializing in obstetrics anesthesiology — he is still one of their top doctors in terms of hours worked, RVUs billed, nights of no sleep. He is of course a Top Doc as well. He teaches a 40-hour “Introduction to the Politics of Medicine” class at UCSD every Fall Quarter since 1988 (29 years and counting, folks). He also teaches a second course for the past seven years that is on “the advanced studies on the politics of medicine.” The Politics of Medicine class has been voted the most popular classroom elective by the medical students every year since 1995. He has raised more than $100,000 so medical students can travel to Sacramento and other places and better understand the legislative process. He has taken so many medical students over the years on this trip, he himself probably does not know the number. It must be in the hundreds. For the past four years he has been arranging two-week legislative internships in Sacramento for motivated first-year medical students transitioning to second year. Last summer, 11 medical students participated in this program (that is almost 10 percent of the entire first-year class). This in turn has inspired medical students to propose legislative changes to CA law,
Attention employees of
advocate for policy change in the House of Medicine, publish editorials, motivate other medical students to become more engaged — and his medical students absolutely make a difference. Very impactful. He also chairs the legislative committee for SDCMS, which entails meeting and interviewing candidates for political office, and he involves many of us in this room in that process so we have all gained tremendous knowledge on how that process works. Paul and I just traveled with him to Washington, DC, two weeks ago, where in three days we sat down and met with 10 elected congressmen, two U.S. senators, and interviewed two other U.S. senators who will be running in the primaries in 2018. The sitting U.S. senator for Louisiana (Sen. Bill Cassidy) recognized him as we were waiting for a taxicab in front of our hotel. He called him out by his first name. All of these legislators at the federal, state, and local levels have him on their cell phone to call and ask about healthcare policy or other health bills at a moment’s notice. I am not even sure how you can quantify how powerful that is. He actually might be the one of the most influential doctors in the U.S. who is not the president of AMA or another similar organization. I think by not being president, he gathers more trust and thus, a stronger relationship. But there is more. While we were in DC, after I went to bed, he would stay up another four hours working on the campaign speech for president-elect of the AMA, Dr. Barbara McAneny. He is actually her campaign manager with the AMA election next week. And so in his free time away from his busy clinical practice, away from the medical school, away from the capitol buildings, he runs political campaigns. I think we will be renaming this year’s award the Tony Atlas award for his Herculean resume. On Valentine’s Day this year he was advocating in Sacramento while I was spending time with his lovely wife — I will leave the story there. Please welcome me in congratulating the one and only, no one more deserving than our emcee tonight, my friend and mentor, a person that has touched the lives of probably every person in this room in a meaningful way, Dr. Bob Hertzka.
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**Monthly charges exclude taxes & Sprint Surcharges [incl. USF charge of up to 17.1% (varies quarterly), up to $2.50 Admin. & 40¢ Reg. /line/ mo. & fees by area (approx. 5–25%)]. Surcharges are not taxes. See sprint.com/taxesandfees. Activ. Fee: Up to $30/line. Credit approval req. $100 Visa Prepaid Card SDP Offer: Offer ends 10/12/17. Sel. discount programs with qualifying corp. id. While supplies last. Limit 3 per new acct. New acct. must remain active & in good standing for 31 days to receive Prepaid Card. Allow 8–10 wks. for delivery. Excl. CL, select discount programs, add-a-line, tablet activ. upgrades, replacements, and ports made between Sprint entities or providers associated with Sprint (i.e., Virgin Mobile USA, Boost Mobile, and Assurance). May not be combinable with other offers. See store or sprint.com for details. Prepaid Card: is issued by MetaBank®, Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card and funds expires after 6 months. Card terms and conditions apply, see www.SprintPrepaidCard.com. Sprint Unlimited Freedom Plan: Offer is for a limited time only. Req. eBill & new acct. activ. Incl. unlimited domestic Long Distance calling, texting & data & 10GB of high-speed Mobile Hotspot, VPN & P2P. Third-party content/ downloads are add’l. charge. Sel. int’l. svc. incl. see sprint.com/globalroaming. Plan not avail. for tablets/MBB devices. AutoPay: To receive $5/ mo. discount you must remain enrolled in AutoPay. Quality of Service (QoS): Customers who use more than 23GB of data during a billing cycle will be deprioritized during times & places where the Sprint network is constrained. See sprint.com/networkmanagement for details. Usage Limitations: To improve data experience for the majority of users, throughput may be limited, varied or reduced on the network. Sprint may terminate service if off-network roaming usage in a month exceeds: (1) 800 min. or a majority of min.; or (2) 100MB or a majority of KB. Prohibited use rules apply — see sprint.com/termsandconditions. SDP Offers: Sel. SDP only. Offers avail. for eligible company/agency employees or org. members (ongoing verification). Subject to change according to the company’s/agency’s/org’s agreement with Sprint. Offers are avail. upon request. Other Terms: Offers/coverage not avail. everywhere or for all phones/networks. Restrictions apply. See store or sprint.com for details. © 2017 Sprint. All rights reserved. Sprint & logo are trademarks of Sprint. Other marks are the property of their respective owners. N175731
CMA MEMBER HELP LINE! Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262
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White Coat Gala Photo Montage 1
6 9 7 8
date for next year’s gala! May 5, 2018 at Paradise Point Resort.
1. Gina Fleming and Dr. Anthony Magit. 2. San Diego County Health & Human Services Director Nick Macchione and his wife, Lisa. 3. CMA Past President Dr. James Hay and his wife, Tricia. 4. Guests mingling and enjoying the evening’s festivities. 5. (L-R): Dr. Albert Ray, Cheryl Ray, Jeremy Lyons, and Dr. Jane Lyons. 6. San Diego Health Connect CEO Dan Chavez and his wife, Lisa Lewis. 7. Former State Senator Dede Alpert and Michael Alpert. 8. (LR): Dr. David Seif, Jason Baumer, Dr. Angela Smith, Dr. Alex Quick, and Dr. Shiyin Zhu. 9. SDCMS President-Elect Dr. David Bazzo and his wife, Sabrina. 10. Mrs. Vickie Butcher, wife of SDCMS Lifetime Achievement Award recipient Dr. Richard Butcher and her daughters, Crystal Butcher and April Noble. 11. Dr. Rodney Hood accepting the SDCMS Lifetime Achievement Award on behalf of Dr. Richard Butcher. 12. SDCMS Presidents (L-R): Dr. Mihir Parikh, Dr. Steve Poceta, Dr. James Hay, Dr. Susan Kaweski, Dr. Albert Ray, Dr. Leonard Kornreich, Dr. Will Tseng, and Dr. Bob Hertzka. 13. Dr. Parikh receiving his Past President medallion from Dr. Will Tseng. 14. San Diego City Councilmember Chris Cate and his wife, Maria. 15. SDCMS Past President Dr. Will Tseng and his wife, Angela Shiau, with SDCMS President Dr. Mark Sornson and his family. 16. Dr. Bijal Patel speaking during the program.
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CLASSIFIEDS CLINICAL TRIALS WE ARE LOOKING FOR VOLUNTEERS TO PARTICIPATE IN CLINICAL TRIALS: Currently enrolling volunteers who suffer from rheumatoid arthritis, lupus, psoriasis, and psoriatic arthritis. Qualified volunteers may receive: no-cost investigational study medication, no-cost study-related care from a study doctor. There is compensation available for time and travel. All study-related care will be at no cost, and volunteers can continue seeing their primary care doctor during the study. Health insurance and doctor referrals are not required to participate. Please email Joy at joy@rheumSD.com for more information. 
PHYSICIAN POSITIONS AVAILABLE 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 board-eligible 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.  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.  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.  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 email@example.com.  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.  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 firstname.lastname@example.org.  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 email@example.com.  SHARPCARE MEDICAL FOUNDATION CHIEF MEDICAL OFFICER: Full-time CMO for new primary care Foundation model. Adult primary care physician, 80% clinical / 20% administrative with practice in La Mesa area: Current unrestricted license to practice medicine in the State of California; board certified in primary care or related subspecialty area; minimum five years of medical administration experience; excellent communication skills; demonstrated clinical practice leadership experience; knowledge of managed healthcare systems, medical quality assurance, quality improvement and risk management; demonstrated leadership, management, organizational, and interpersonal skills; ability to work collaboratively internally and externally; demonstrated ability to assess business needs, design and implement programs, and evaluate results; demonstrated commitment to group practice and healthcare system values. Job type: Full-time. Contact Glenn Chong at glenn.chong@ sharp.com or call (858) 499-4557.  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: firstname.lastname@example.org.  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: email@example.com. 
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.
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.  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 firstname.lastname@example.org. We are very anxious to fill this position, and we look forward to hearing from YOU! No agencies please.  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 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  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 email@example.com. Visit www.thehousecalldocs.com. top
OFFICE SPACE / REAL ESTATE AVAILABLE
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 (858) 966-8061 | firstname.lastname@example.org POWAY OFFICE SPACE AVAILABLE - PART-TIME: 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 email@example.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 firstname.lastname@example.org or at (858) 2459109.  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.  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.  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 email@example.com or on cell at (858) 243-6883.  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.  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 firstname.lastname@example.org.  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. email@example.com.  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 firstname.lastname@example.org.  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 email@example.com.  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.  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.  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 firstname.lastname@example.org.  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.  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 email@example.com.  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 firstname.lastname@example.org or (619) 504-5830.  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. 
MEDICAL EQUIPMENT / FURNITURE FOR SALE 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 email@example.com. 
NONPHYSICIAN POSITIONS AVAILABLE
do not have experience in Rheumatology as we are happy to train you. Send CV to firstname.lastname@example.org. 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)  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.  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 email@example.com, apply at www.graybill.org, or fax to (760) 738-7101.  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.  NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email firstname.lastname@example.org. Visit www.thehousecalldocs.com.  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 email@example.com. Visit www. thehousecalldocs.com. 
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. 
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
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C M A F O U N DAT I O N
2017 LEADERSHIP AWARDS: CALL FOR NOMINATIONS The California Medical Association (CMA) Foundation and its Network of Ethnic Physician Organizations (NEPO) are seeking nominations for the Foundation’s 2017 Leadership Awards, which celebrate the efforts of extraordinary individuals and organizations who make a difference in the health of Californians.
All nominations are due by
August 18, 2017 The four awards include: The Ethnic Physician Leadership Award This award recognizes an individual physician for his or her contributions toward the health of various ethnic communities, who has shown great success in eliminating health disparities, addressing access to care, and improving cultural competency and patient advocacy. The purpose of the award is to honor an outstanding physician; inspire other physicians; and to promote leadership, caring and compassion in medicine.
Outstanding Ethnic Physician Organization Award The Frank E. Staggers, Sr., M.D., Outstanding Ethnic Physician Organization Award honors an ethnic physician organization that has taken significant action in improving the health of its community. Applicants will be evaluated based on their contribution to improving the health of their community, success at engaging physicians to be community advocates and efforts to reduce health disparities.
Access to Health Care and Disparities Award The Adarsh S. Mahal, M.D., Access to Health Care and Disparities Award honors an individual or organization that has demonstrated extraordinary interest in and efforts to improve access to health care or reduce health care disparities in California. Leadership Achievement Award The Robert D. Sparks, M.D., Leadership Achievement Award recognizes an individual or organization that has demonstrated extraordinary interest in and efforts to improve community health, consistent with the mission of the CMA Foundation—to champion improved individual and community health through a partnership of leaders in medicine, related health professions and the community.
The Ethnic Physician Leadership Award and the Ethnic Physician Leadership Award will be presented at the annual NEPO Building Healthy Communities Summit, held October 19-20, 2017 in Anaheim. The Leadership Achievement Award and the Access to Health Care and Disparities Award will be presented at the CMA Foundation’s President’s Reception and Awards Gala on October 21, 2017 in Anaheim Nomination information and packets for each award are available at the CMA Foundation website. Contact: Anita Charles, (916) 779-6623 or firstname.lastname@example.org.
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Passing the Baton SDCMS Installs New Board of Directors