Sep/Oct 2017 | Los Angeles Medicine by Los Angeles County Medical Association

OFFICIAL PUBLICATION OF THE LOS ANGELES COUNTY MEDICAL ASSOCIATION

E PLURIBUS UNUM

LACMA Welcomes 146 President William K. Averill, MD, at 2017 Installation of Officers th

RECAP: Saving Private Practice Consortium S E P/O C T 2 0 1 7

GEARING UP FOR THE GOLDEN YEARS: Three tips to help small business owners plan for retirement By: Patrick Nygren, San Fernando Valley Region Banking President, Community Bank, Wells Fargo & Company

Becoming financially stable so you can live comfortably in retirement is a goal that many of us spend our entire careers working towards. This is particularly true for small business owners who have spent their working years running a business with the intent to eventually retire. Fortunately, according to a recent Wells Fargo/Gallup survey, 82 percent of small business owners said they are currently saving or investing money toward their retirement, and 76 percent said they think they’ll have enough money to live comfortably in retirement. While it’s great to see that most small business owners are thinking ahead and saving for the future. Here are three tips for small business owners to consider as they plan for retirement. START WITH A SUCCESSION PLAN | Even if your plans to retire or transition your business are distant, planning for your company’s future now will help you in the long-term. It’s a great idea to create a transition plan while you’re writing or updating your business plan.

Patrick Nygren

MAX OUT YOUR SAVINGS | As you map out your retirement savings strategy, it’s helpful to take a long, hard look at your current finances to determine how much money you can afford to put aside each month. Once you have a savings goal in mind, set up an automatic monthly transfer into a savings account and/or self-employed retirement plan. There are a variety of retirement plans that can meet your needs. BUILD AN EMERGENCY FUND | In addition to your retirement savings accounts, it’s important to maintain an easily accessible emergency fund for your small business. No matter how well you plan, the unexpected can happen and having cash reserves is an important component of your overall financial picture. Start by putting cash aside when profits are comfortable, and if you can swing it, allocate a portion or all of your tax return into this account. As a small business owner, there are many important steps you can take now to get your finances in order and enjoy a comfortable retirement. The key is to get started early and stay committed to your long-term vision and goals. The article is for informational purposes only and is not tax, legal or retirement planning advice. Please contact your tax, legal or retirement planning professionals for advice if you have questions regarding any of the points discussed in this article.

01_20781

75x4.625

We help focus on your finances so you can focus on your patients

When you’re running an important healthcare business like yours, you need a bank that specializes in practice financing and offers a full range of tailored financial services, including checking, savings, Merchant Services, and more. We also offer complimentary planning resources and professional support to help your practice thrive. Let’s talk today about the financial options that work for your practice. wellsfargo.com/practicefinance

ii L O S A N G E L E S M E D I C I N E | S E P T E M B E R /O C T O B E R 2 0 1 7

EDITOR Sheri Carr | editors@physiciansnewsnetwork.com ADVERTISING SALES Dari Pebdani 858.231.1231 | dpebdani@gmail.com EDITORIAL ADVISORY BOARD David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD

VOLUME 148 ISSUE 6 | SEP/OCT 2017

HEADQUARTERS LOS ANGELES COUNTY MEDICAL ASSOCIATION 801 S. Grand Avenue, Suite 425 | Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.losangelesmedicine.org

2 4 6

William K. Averill, MD

When Medicine Saves the Doctor

LACMA BOARD OF DIRECTORS COUNCILORS-AT-LARGE Jerry Abraham, MD (1) Samuel Fink, MD (6) Jeffery Lee, MD (6) Maria Lymberis, MD (5) Nhat Tran, MD (9)

PRESIDENT’S LETTER

TRUSTEES & CHAIR DELEGATION David Aizuss, MD, CMA Trustee Marvin Kaplan, MD, Chair of the LACMA Delegation Peter Richman, MD, CMA Trustee

COUNCILORS Robert Bitonte, MD (D1) Emil Avanes, MD (D2) Stephanie Booth, MD (D3) Troy Elander, MD (D5) Kambiz Kosari, MD (D6) David Hopp, MD (D7) Omer Deen, MD (D9) Christine Phan, MD (D10) Jinha Park, MD (D14) Sidney Gold, MD (D17) Roxana Yoonessi, MD (SCPMG) Heather Silverman, MD (SSGPF) Mitch Katz, MD (LADHS) Albert Young, MD (Allied Pacific) Po-Yin Samuel Huang, MD (1, YP Councilor) Hector Flores, MD (1, EPC Chair) Laura Halpin, MD (Resident Councilor) Erik Berg, MD (Alt. Resident Councilor) Ali Tafreshi (Student, USC) Gwendolyn Lee (Alt. Student, UCLA)

10 11

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@losangelesmedicine.org or 213-226-0304. SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Los Angeles Medicine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Los Angeles Medicine, 10755 Scripps Poway Parkway, Suite 615 | San Diego, CA 92131. To inform us of a delivery problem, email editors@physiciansnewsnetwork.com. Acceptance of advertising in Los Angeles Medicine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Los Angeles Medicine, LACMA Services Inc. or the Los Angeles County Medical Association. Los Angeles Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Los Angeles Medicine is not responsible for unsolicited manuscripts.

RECAP: SAVING PRIVATE PRACTICE CONSORTIUM

2017 INSTALLATION OF OFFICERS

Beware of How You Classify Your Staff

CMA Awards Recognize LACMA Members

Los Angeles Medicine (ISSN 1533-9254) is published bimonthly (Jan/Feb, Mar/Apr, May/Jun & Jul/Aug, Sep/Oct & Nov/ Dec) by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Los Angeles Medicine, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Advertising rates and information sent upon request.

A PUBLICATION OF PHYSICIANS NEWS NETWORK 10755 Scripps Poway Parkway, Suite 615 | San Diego, CA 92131 | Tel 858.226.7647 | www.PhysiciansNewsNetwork.com

L ACMA PRE S I D E N T

W I L L I AM AV E R I L L , M D

WORKING TOGETHER

Inspiration for Leadership

“THROUGH LACMA WE AS PHYSICIANS CAN HELP TO EDUCATE OUR LEGISLATORS. PERHAPS THROUGH THAT PROCESS, WE CAN INSPIRE GREATER UNDERSTANDING AND COOPERATION, WHICH ULTIMATELY LEADS TO SOLVING THE TOUGH CHALLENGES IN HEALTHCARE AND IMPROVING CONDITIONS FOR PHYSICIANS AND PATIENTS.”

EXCITED. EAGER. HONORED. HUMBLED. These are the words I used in my speech at the Installation of Officers in talking about my new role as president. I want to add another word to the list and that word is INSPIRED. In this issue of Los Angeles Medicine, I’m pleased to see events like the Installation and the Saving Private Practice Consortium highlighted along with practice management advice from one of LACMA’s expert partners. And the story of a med student who overcame adversity in early life to make it to UCLA. In short, inspiration in action. While I am looking forward to the coming year with LACMA, this new role has given me pause to think about what draws us to the practice of medicine. The AMA released results of a physician survey that confirms what we all know: As doctors we are committed to do what we do for the right reasons – to help people, our patients. The survey showed that half of physicians believe their choice of medicine is not just a job, but a calling. Three-quarters of us are primarily motivated by the opportunity to make a difference in the lives of our patients. And we committed early — three out of four of us knew we wanted to be physicians before we were out of our teens. The idealism that started us on the journey to become physicians sustains us on our path and helps us to counter any impediments we might find along the way. While we, as physicians, are taking care of patients, we have LACMA to take care of us, especially in the legislative arena, where critical issues continue to be decided at a breakneck pace. Healthcare reform, medical liability and insurance regulations are just a few of the key issues where vital parts of our practices are debated, and decided, in Sacramento and Washington, D.C. Through LACMA we as physicians can help to educate our legislators. Perhaps through that process, we can inspire greater understanding and cooperation, which ultimately leads to solving the tough challenges in healthcare and improving conditions for physicians and patients. I’d like to thank Dr. Vito Imbasciani for his leadership over this past year. Dr. Pedram Salimpour is enormously helpful as a passionate advocate for LACMA, and I would like to thank him for his personal support and friendship. Dr. Robert Bitonte, thank you for your leadership, mentoring and friendship. And posthumously, Dr. Marshall Morgan. I am counting on the ongoing support of Dr. David Aizuss, Dr. Peter Richman and our friends in high places at the California Medical Association. I am looking forward to working with the LACMA Board and my fellow officers - Dr. C. Freeman, president-elect, Dr. Sion Roy, treasurer and Dr. Diana Shiba, secretary. I am honored to serve LACMA over this next year as we continue to grow the organization, expand benefits to members and put our inspiration into action.

2 L O S A N G E L E S M E D I C I N E | S E P T E M B E R /O C T O B E R 2 0 1 7

Being a physician can be tough. At CAP, we try to make your job a little easier.

Request a no-obligation quote for med-mal coverage and membership.

You give your all to helping others live full, healthy lives. You go the extra mile to seek out answers and cures, knowing that sometimes even your best efforts aren’t enough. You’re a physician, and that’s how you do your job. At CAP, we salute your dedication and support you in every way we can — with protection to reduce the worry of professional liability lawsuits, but also with a host of value-added services to help manage your practice so you can focus on the highest quality professional care. Ask for a no-obligation quote and more information on CAP membership.

For Your Protection. For Your Success.

800.356.5672 CAPphysicians.com/quote

When Medicine Saves the Doctor BY DEBORAH STAMBLER

I sat down to talk with third-year medical student David Lyons at a busy courtyard café on the UCLA campus. David started by telling me about the Adverse Childhood Experience (ACE) Study and how the test is used to look at cycles of early abuse and trauma and predict possible health outcomes. He’s decided on adolescent medicine for his specialty. This makes sense based on the story of his childhood that he shared with me. David’s score on ACE was 8 out of 10, but this misses essential factors in what has propelled him far from his rocky, painful childhood. David’s father had a military career and later earned his master’s degree in special education. His mother worked as a bartender on the military base. Beyond these basic facts, David shared how job layoffs and a gambling addiction contributed to constant financial pressure, insecure housing situations and an unsafe home life. For David, corporal punishment, sexual abuse and drug abuse were part of an intensely dysfunctional childhood. So how did he beat the odds and make it to one of the top medical schools in the country? He credits a school counselor with being the first one to really call him out and make him think about what he wanted. She pulled him into her office and made him watch a video with inspirational messages flashing across the screen while the song “Arms of an Angel” played in the background. It might have been a little cheesy, but it worked. David ended up attending adult school and regular school while working in order to graduate high school on time. But before he got to college, David had to confront his own drug use. In the end, he went into the Navy and became a corpsman (medic). “I loved the idea of being a doctor,” he said, “but didn’t think it was something that someone with my background could ever achieve. “Our job as corpsmen was to check patients in, triage them, and then we did the history and physical. Then we were charged with providing follow-up care.” David paused for a moment and then said, “Removing toenails. I became the guy who removed toenails. I wanted to be that guy. I remember the first procedure I saw and I thought I was going to pass out. I had a cold shock up through my head and I had to leave. So I was determined not to show that sort of weakness. I asked to stand in for toenail removals, and eventually I was the guy who did them.” David explained that he was treating 18- and 19-year-old kids straight out of boot camp who were afraid to show any weakness. But they also trained hard in boots that weren’t always a great fit. The result: many opportunities for David to overcome his weakness. He remembers clearly the first time he fell in love with what he was doing. “I was living in the barracks,” he said, “and one of the submariners caught me in the elevator and said, ‘Hey,

what’s up, doc? You saw me in the sick hall last week.’ I just felt really good. It was the kind of respect I’d never experienced before. It was rewarding that I was able to help someone.” By age 21, David was dealing with his childhood demons and searching for stability in his life. He was dealing with depression, insomnia and panic attacks. David completed his tour of duty after being deployed to Fallujah and ended up studying pre-med at San Diego State. Part of David’s story involves how difficult it was for him to come out as gay. He points to the health disparities in the LGBT community. Many LGBT men and women avoid seeing a doctor due to prejudice they’ve experienced. Consequently, they have a high rate of ER visits. Self-medication is common due to depression and anxiety. Most people don’t know that there are high rates of cancer, cardiovascular disease and lung disease in the LGBT community. In many cases, this is a result of using drugs at a young age. Among homeless teens, 40% identify as LGBT. It’s clear talking with David that social leadership and combating injustice are closely woven into his desire to work with adolescents. David talked about how challenging it is to get adolescents who have experienced trauma to see a social worker, a doctor or a therapist who can offer support and guidance. How do you get teens who have been abused to trust authority figures and ask for help? David said he thought school-based health clinics could see some success. “Since pre-med, the drive just gets stronger and stronger to make sure abuse and trauma don’t happen to other people,” he said. “Every adversity that I go through is more of a reason why I need to make sure that others don’t. I learned that there was a specialty called adolescent medicine my first year in med school. I realized this is something I really want to do.” Like so many of our physician members engaged in social justice work, David recognizes that caring for the community is just as important as caring for the individual. That’s an important philosophy here at LACMA, too. Student members like David inspire us to work harder, keep refining benefits for members and support the community in confronting challenging issues.

“Every adversity that I go through is more of a reason why I need to make sure that others don’t.”

4 L O S A N G E L E S M E D I C I N E | S E P T E M B E R /O C T O B E R 2 0 1 7

While you’re busy treating patients...

We’ve got your back! With Group Long-Term Disability protection from New York Life Insurance Company.

You’re busy practicing medicine. Why not have the Los Angeles County Medical Association/CMA and Mercer help to protect your financial security? As a physician, you probably know better than anyone else how quickly a disability can happen and leave you unable to provide for yourself and your family. Whether it is cancer, a stroke, a car accident or a fall off a ladder, any of these things can affect your ability to perform your medical specialty. LACMA/CMA sponsors a Group Long-Term Disability program underwritten by New York Life Insurance Company with features that include: • A policy that isn’t tied to a practice, giving you more flexibility with potential career changes • Benefit payments that are 100% TAX-FREE — when you pay premiums yourself • High monthly benefits up to $10,000

LEARN MORE ABOUT THIS VALUABLE PLAN TODAY! ——————————————————

Call Mercer for free information, including features, costs, eligibility, renewability, limitations and exclusions at: 800.842.3761 ——————————————————

• Protection in your medical specialty for the ﬁrst 10 years of disability With this critical protection, you’ll have one less thing to worry about while you’re busy helping your patients.

SPONSORED BY:

UNDERWRITTEN BY:

ADMINISTERED BY:

OR SCAN TO! LEARN MORE!

New York Life Insurance Company New York, NY 10010 on Policy Form GMR

F17-78307

Program Administered by Mercer Health & Benefits Insurance Services LLC • CA Insurance License #0G39709 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com

R ECA P

Saving Private Practice Consortium

More than 100 physicians and office managers filled the Golden State Ballroom at the DoubleTree Hotel in downtown Los Angeles on Saturday, July 15, to attend the Saving Private Practice Consortium. LACMA CEO Gustavo Friederichsen welcomed the attendees. Attendees spent the day moving between breakout and individual sessions to gather information and advice on issues doctors in private practice are facing. Reimbursement was a hot topic as were billing and coding. The breakout session “Optimizing Reimbursements While Enhancing Patient Care” was filled to standing room only. The brainstorming session “Digital Marketing” at the end of the day was also extremely popular. Experts were on hand all day to talk with physicians about specific pain points, answer questions and strategize around common issues, from technology to finance to practice THE #1 TAKEAWAY FROM management and more. Physicians THIS EVENT IS THAT had the chance to tell their stories, work on resolving key issues and DOCTORS MUST JOIN connect with other doctors. One TOGETHER, BECAUSE young cardiologist found himself deep in discussion about dealing TOGETHER WE ARE with the occasionally dysfunctional STRONGER AND TO- politics that can come when working with a team and how important GETHER, WE CAN SAVE good management is in providing PRIVATE PRACTICE.” optimal care. The philosophy of unity was felt - JANUS NORMAN, SENIOR VICE PRESIDENT, CENTERS FOR GOVERNMENT RELATIONS throughout the day as LACMA partAND POLITICAL OPERATIONS ners and experts met and shared stories around the struggles doc-

“

6 L O S A N G E L E S M E D I C I N E | S E P T E M B E R /O C T O B E R 2 0 1 7

“

I TRULY HAVE TO COMMEND LACMA FOR PUTTING TOGETHER A CONFERENCE THAT FOCUSES ON PRIVATE PRACTICE. AN OUTSTANDING CONFERENCE THAT MORE THAN MET MY NEEDS AND EXPECTATIONS. I HAVE ALREADY MET WITH SEVERAL VENDORS FROM THE CONFERENCE TO CONSULT ON METHODS TO IMPROVE MY OFFICE STRUCTURE AND OVERALL WORKFLOW.”

- WILLIAM D. KING, MD, JD, AAHIVS INTERNAL MEDICINE/HIV SPECIALIST W KING HEALTH CARE GROUP

P R IVAT E P R ACT ICE

CONSORTIUM RECAP

“ 4

tors deal with on a daily basis. They shared ideas on ways to work collaboratively to provide physicians with key services. Now the real work begins. It is important that physicians and medical staff receive the service, support and guidance that so many experienced at the Consortium. Through LACMA, physicians have an entire team of industry experts available to help them personally and professionally. The Consortium was simply one day for you to get to know our partners and understand the power of membership. Remember, as a member of LACMA, physicians are also members of CMA, and have access to not only a trusted portfolio of preferred partners, but a host of additional benefits, like access to legal resources, jury duty assistance, education programs (inperson and digital), office manager trainings, networking events, leadership opportunities, and much more. Additionally, members can take comfort knowing that there is a powerful professional staff protecting private practice from legal, legislative and regulatory intrusions. PHOTOS: 1. The team of experts working one on one with physicians and office managers. 2. Susan Pailet, EdD, presents “Understanding Staffing Solutions to Better Recruit and Retain Employees.” 3. Keynote speaker Janus Norman talking about advocacy issues and private practice. 4. LACMA CEO Gustavo Friederichsen thanks Dr. Emil Avanes for being the inspiration for the Consortium.

SAVING PRIVATE PRACTICE CONSORTIUM WAS THE CULMINATION OF MANY YEARS OF BRAINSTORMING BY LACMA LEADERSHIP TO ENGINEER AN EVENT FOR BOLSTERING OUR SOLO AND SMALL GROUP PRACTICES. IT WAS INCREDIBLY ATTENDED, WITH MANY PHYSICIANS SIGNING UP TO WORK WITH PARTNER VENDORS ON THE SPOT. IN TURN, MANY PHYSICIANS SIGNED UP TO BE LACMA MEMBERS AT THE EVENT GIVEN THE NEW DIMENSION OF PARTNERSHIP AND SUPPORT.”

- EMIL AVANES, MD, INTERNAL MEDICINE, GLENDALE, CA

MEDICAL BOARD HOSPITAL STAFF F R A U D / A B U S E MEDI-CAL/M E D I C A R E

MEDICAL PRACTICE PURCHASES, SALES AND MERGERS

Assisting physicians with legal issues for over three decades. Fenton Law Group, LLP 1990 South Bundy Drive Suite 777 Los Angeles, CA 90025 310.444.5244

The brand physicians trust

www.fentonlawgroup.com

S E P T E M B E R /O C T O B E R 2 0 1 7 | L O S A N G E L E S M E D I C I N E . O R G 7

One From Many LACMA CELEBRATES THE 146TH INSTALLATION OF OFFICERS

Dr. William K. Averill, left, with LACMA CEO Gustavo Friederichsen and Dr. Vito Imbasciani

DR. AVERILL ASKED EVERYONE PRESENT TO PULL A COIN OUT OF

After being officially installed as the 146th president of LACMA on June 29, Dr. William K. Averill addressed the more than 200 physicians, family members and supporters in the audience at the The Portofino Hotel and Marina in Redondo Beach. He recognized the leadership of Dr. Vito Imbasciani, the outgoing president, and other key board members and referenced LACMA CEO Gustavo Friederichsen’s vision for moving LACMA forward. “Shortly after our CEO, Gustavo Friederichsen, came aboard,” Dr. Averill said, “LACMA’s leadership asked him to convene a strategic planning session. He jumped right in, and the proceedings were given a nautical theme. Our strategic plan is entitled ‘Charting the Course.’ The actions resulting from the plan as we move forward are entitled ‘Holding the Course.’” Dr. Averill then dedicated his speech to “navigating the winds of change.” In detailing those changes facing physicians at the legislative and judicial levels, he said, “To best achieve our goals with LACMA, we must stand united.” The other officers for 2017-18 were also sworn in and are as follows: President-Elect — Dr. C. Freeman; Treasurer — Dr. Sion Roy; and Secretary — Diana Shiba. Dr. Averill was warm in his praise for each of the incoming officers. Dr. Imbasciani praised Dr. Averill for his leadership skills and offered his full support as immediate past president to Dr. Averill and all the officers. “For LACMA, the new year starts tonight,” Dr. Imbasciani said, “where we celebrate not only the installation of our newest president, but a 146-year-long unbroken line of Los Angeles County physicians who have worked hard to heighten public awareness, safeguard public health, safeguard the profession, educate themselves and advocate for sane public policy. . . . Since 1871, LACMA has been at the forefront in addressing every medical issue that has touched our city, our county and our state, and will continue to do so without interruption.” At LACMA, we’re looking forward to a year of strong leadership and a clear vision of unity. Thank you to all who serve the organization and the healthcare community with such dedication.

THEIR PURSE OR POCKET AND FIND THE LATIN PHRASE E PLURIBUS UNUM, WHICH MEANS “ONE FROM MANY.” TOWARD THE END OF HIS SPEECH HE SAID, “WE AT LACMA RECOGNIZE THAT OUR STRENGTH

The Childhood Obesity Challenge Winners, Sara Arastoo, Roya Moheimani and Mohammad Karimzada (not pictured) from the David Geffen School of Medicine at UCLA, were announced by Dr. Jerry Abraham and Dr. Samuel Huang from the Young Physicians Committee.

COMES FROM OUR DIVERSITY.” Former LACMA President Dr. Peter Richman did the honors of awarding the Lifetime Achievement Award to Thomas Horowitz, DO, for his decades of service to LACMA, Los Angeles County Political Action Committee (LACPAC) and the healthcare community. Dr. Horowitz is a board-certified family practitioner in Los Angeles and is active on the medical staff at Hollywood Presbyterian Medical Center, St. Vincent Medical Center and Good Samaritan Medical Center. He has been a member of LACMA since 1986 and has served as chair of the LACMA Political Action Committee since 2000. He is the past president of the Los Angeles County Osteopathic Medical Association and chair of OsteoPac. PHOTO: Dr. Horowitz (center), with State Treasurer John Chiang (left) and Assemblymember Al Muratsuchi, 66th District.

NORCAL

G R O U P

O F

CO M PANIES

MEDICAL PROFESSIONAL LIABILITY INSURANCE

PHYSICIANS DESERVE Offering top-tier educational resources essential to reducing risk, providing versatile coverage solutions to safeguard your practice and serving as a staunch advocate on behalf of the medical community.

Talk to an agent/broker about NORCAL Mutual today. NORCALMUTUAL.COM | 844.4NORCAL

nm5001

S E P T E M B E R /O C T O B E R 2 0 1 7 | L O S A N G E L E S M E D I C I N E . O R G 9

BEFORE THE IRS COMES KNOCKING Beware of How You Classify Your Staff ALEXIS D. JAMES AND RENEE N. NOY OF WORKWISE LAW, PC

As a busy doctor, does your practice survive and grow with help from physician assistants, nurse practitioners, mental health counselors or other health professionals? You treat them as independent contractors because they work part time, provide services to a few different offices or they simply ask to be given a 1099. You figure, they make decent money and no one is being cheated. You’re pleased that you don’t have to deal with the headache and costs associated with deducting employment taxes, providing workers’ compensation insurance, benefits and compliance with other employment laws.

DOES THE FOLLOWING SCENARIO APPLY TO YOU?

In most cases, doctors, nurses, physical BUT YOU ACTUALLY therapists, psychologists, nurse practitioMAY BE AT RISK! ners, physician assistants, mental health counselors, massage therapists and other health professionals should be treated as employees. Labeling someone as an independent contractor, business partner or consultant is not sufficient to pass the Fair Labor Standards Act (FLSA) and Internal Revenue Services’ tests for proper classification. Even if your office has a written agreement with the contractor, an employment relationship can still be determined to exist. You cannot contract away your legal responsibility to properly classify staff. The FLSA uses a complex Economic Realities Test to determine whether someone is an employee or an independent contractor. The IRS has articulated a 20-Factor Test that they use to determine employment classification. Unfortunately, there is no magic number with these factors that indicates employee or independent contractor status. Hence, the confusion that employers experience. (For more information on the factors, visit https://www.irs.gov.) A key question to ask yourselves is whether the worker has his or her own business and is economically independent of your practice. If the worker generates most of their income from providing services to your practice and the type of service is largely related to your specialty, there is a strong likelihood that an employment relationship exists. California fines include $250 for each paycheck for which there is not a pay stub itemizing proper tax deductions. The statute of limitations can go back three years, and the employer bears the burden of keeping accurate time records. At two paychecks a month, that would be an $18,000 penalty. In addition, if the employer is not carrying workers’ compensation insurance on a worker that should be classified as an employee, the California Division of Labor Standards Enforcement can fine a business an extra $1,000. Additionally, the worker can seek back wages for overtime and meal breaks, which include a host of other penalties and attorney’s fees. Bottom Line: There are no hard and fast rules to classifying independent contractors and employees, but the fines are significant. Though the IRS will work with employers who innocently misclassify to reduce the penalties assessed, their incentive is to recoup missed tax revenue. If in doubt, have an employment attorney evaluate the factors of your employment relationship and recommend the most legallysound classification. Better to be safe than sorry.

A FEW OF THE GENERAL FACTORS THAT THE FLSA CONSIDERS: 1) The extent to which the work

performed is an integral part of the employer’s business (if the work is tangential to the business, then the worker is more likely a contractor) Whether the worker’s manage-

2) rial skills affect his or her op-

portunity for profit and loss (contractors who manage their own businesses are more likely to result in a profit) The relative investments in fa-

3) cilities and equipment by the

worker and the employer (the more investment the greater the likelihood that the worker is in business for himself or herself ) The length or permanency of

4) the worker’s relationship with

the employer (indefinite, on-going relationships signal an employment relationship; project-based assignments would reflect contractor status) The nature and degree of

5) control by the employer over

the worker (the more control the employer has over the worker, the greater the chance the worker is an employee)

WHAT FINES AND PENALTIES COULD YOU FACE?

1 0 L O S A N G E L E S M E D I C I N E | S E P T E M B E R /O C T O B E R 2 0 1 7

ABOUT THE AUTHORS: Alexis D. James (right) and Renee N. Noy of WorkWise Law, PC, are experienced employment attorneys and preferred partners of the Los Angeles County Medical Association. They work with small to medium-size businesses, providing advice, counsel and training on California state and federal employment and labor laws. 818-835-5863.

CMA SERVICE AWARDS RECOGNIZE LACMA MEMBERS veloped from feedback: Prevention; Professional Fulfillment It’s time to reward some hard work and inspiring physiand Continuing Medical Education; Practice Management; cians. A few months ago, we nominated Mitchell Katz, MD, at Department of Health Services for the Dev A. GnanaDev Collegiality and Community Service; Healthy Eating, Healthy Activity and Healthy Weight. Membership Award and Dawn Clark, MD, and Edward SCPMG physician leaders have led the way in develEllison, MD, at Southern California Permanente Medical oping and implementing Group (SCPMG) for the the program pillars. They Gary S. Nye, MD Award have created a program for Physician Health that continues to evolve and Wellbeing. We are to meet the needs of its happy to report winphysicians. ners in both categories. Congratulations to Dr. For the Membership Dawn Clark and Dr. Edward Award, the first point Ellison for being recogwe should mention is nized with the Gary S. Nye, that Dr. Katz helped MITCHELL KATZ, MD DAWN CLARK, MD EDWARD ELLISON, MD MD Award for Physician bring hundreds of new Dev A. GnanaDev Gary S. Nye, MD Award Gary S. Nye, MD Award Membership Award for Physician Health and for Physician Health and Health and Wellbeing. But members to LACMA Wellbeing Wellbeing truthfully, it’s the whole and CMA in 2016. As team of physicians, staff, our connection with Dr. nurses and even the patients who win when physician Katz and the Department of Health Services has grown, wellness is emphasized within the culture of healthcare. we’ve had a variety of opportunities to work with Dr. Katz The awards will be presented at the President’s Recepand his team. We interviewed Dr. Katz for the January istion and Awards Gala on Oct. 21 in Anaheim as part of the sue of Los Angeles Medicine on the subject of the future 146th Session of the California Medical Association. of healthcare. His unique view into public health is especially relevant in Los Angeles. Public health issues facing the county include a growing homeless population, the threat from Zika, chronic illnesses such as diabetes and heart disease, and access to quality care. The physicians PRACTICE at DHS bring a special awareness to these issues that WHAT YOU benefits all members. BELIEVE LACMA has enjoyed the opportunity to have DHS physicians participate in activities, including the Thought Every member of our multi-specialty practice, while diverse Leadership Roundtable earlier this year. Seira Kurian, MD, in background and focus, shares a common passion for medicine and a dedication to our mission. Together, we’re brought her perspective on public health concerns to the leading the way to a better future for health care. If you’d discussion on healthcare challenges. Dr. Katz has also like to join a team that actively demonstrates a commitment made it possible for LACMA to actively engage with his to delivering high-quality, affordable, culturally responsive care, consider joining our team today. team as they relaunched their Rx for Prevention publication and increased the presence of the LA Health Alert Family Medicine Physician Opportunities in Southern California Network. Again, this allows LACMA physicians to benefit (Antelope Valley, Baldwin Park, Camarillo, Downey, East Los from the perspective and experience of Dr. Katz and the Angeles, Indio, Kern County, Santa Ana and South Los Angeles) LA County Department of Health Services. Additionally, many of our SCPMG physicians devote their Congratulations to Dr. Katz for being recognized with time and effort into caring for the community through volunteer work at Free Clinics that aid those who cannot the Dev A. GnanaDev Membership Award. afford health care. The second CMA Award to LACMA members went to For consideration or to apply for one of these one of our groups. Drs. Dawn Clark and Edward Ellison at Bilingual (Spanish/English) Family Medicine Physician SCPMG led the team that was awarded the Gary S. Nye, opportunities, please visit our website at http://scpmgphysiciancareers.com. MD Award for Physician Health and Wellbeing. SCPMG has For questions or additional information about developed a strong program addressing physician wellness. Family Medicine opportunities, please contact The exemplary program at SCPMG has shifted its Bettina Virtusio at (800) 541-7946 or culture of wellness with an innovative, all-encompassing Bettina.X.Virtusio@kp.org. We are an AAP/EEO employer. approach to enhance wellness for its 8,500 physician The Answer partners and associates. to Health Care Southern California Permanente Medical Group in America. The specifics of the program focuses on five pillars de-

S E P T E M B E R /O C T O B E R 2 0 1 7 | L O S A N G E L E S M E D I C I N E . O R G 1 1

C L ASSIFIED S /J O B B OA R D

TO PLACE A DISPLAY OR CLASSIFIED AD VISIT PHYSICIANSNEWSNETWORK.COM OR CONTACT DARI PEBDANI AT DPEBDANI@GMAIL.COM OR 858-231-1231

PMmarketplace Surgeons Needed for Expanding Nationwide Surgical Practice • Full or part-time positions • Competitive Pay • Add revenue to your current practice

• Flexible schedule, complete autonomy • No Call

PLEASE CONTACT US FOR MORE INFORMATION: Phone: 1-877-878-3289 Fax: 1-877-817-3227 or email CV to: Jobs@AdvantageWoundCare.org

www.AdvantageWoundCare.org To place an ad visit PhysiciansNewsNetwork.com LOCUM TENENS AVAILABLE

CONSULTING & SERVICES

OPENINGS—PHYSICIANS

FAMILY MEDICINE, OB/GYN AND PEDIATRICS IN ORANGE COUNTY AND RIVERSIDE COUNTY

Vista Community Clinic is a private, nonprofit outpatient community clinic serving people who experience social, cultural or economic barriers to health care in a comprehensive, high quality setting. Position: Full-time, Part-time and Per Diem Family Medicine, OB/GYN, and Pediatrics Physicians. Responsibilities: Provides outpatient care to clinic patients and ensures quality assurance. Malpractice coverage is provided by Clinic.

• Physicians • Nurse Practitioners • Physician Assistants

Practice Appraisal & Sales Partnership Buy-In / Buy Out

LOCUM TENENS PERMANENT PLACEMENT

Supporting Southern California Physicians Since 1983

Requirements: California license, DEA license, CPR certification and board certified in family medicine. Bilingual English/Spanish preferred.

800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com

Consultants to Healthcare Providers

Call for a Courtesy Consultation

818-693-7055

avishorr@gmail.com

• Physicians • Nurse Practitioners • Physician Assistants

LOCUM TENENS PERMANENT PLACEMENT

Arthur S. Shorr & Associates, Inc.

TRACY ZWEIG ASSOCIATES, INC.

Contact Us: Visit our website at www.vistacommunityclinic. org Forward resume to hr@ vistacommunityclinic.org or fax resume to 760-414-3702. EEO/AA/M/F/Vet/ Disabled

800-919-9141 • 805-641-9141 FAX: 805-641-9143 email: tzweig@tracyzweig.com www.tracyzweig.com

PRACTICE FOR SALE

HIGH END VEIN CLINIC & MED SPA IN AN AFFLUENT AREA A highly profitable business with a growth potential in Orange County; Asking Price at $290,000; Cash Flow at $177,000; FF&E + build out at $310,000. See ad in BizBuySell.com. Contact Matt Manavi at mmanavi@ tworld.com or 714-923-1222

OPPORTUNITY WANTED

RADIOLOGIST

Board certified. Have own malpractice insurance. Available for part-time position or film reading. Call 310-477-4257.

PLACE YOUR AD TODAY ONLINE. IN PRINT. ONE PRICE.

PhysiciansNewsNetwork.com 1 2 L O S A N G E L E S M E D I C I N E | S E P T E M B E R /O C T O B E R 2 0 1 7

Say goodbye to complicated, expensive EHR packages Office Ally offers the first ever, easy to use and affordable EHR solution that fully integrates with our FREE Practice Management System, Practice Mate™, and our FREE Patient Health Registry, Patient Ally™. EHR 24/7 allows providers to spend more time with patients and less time on paperwork. We believe an EHR system should empower physicians to be more effective, allowing for a more streamlined office workflow. Best of all, since its web-based you can access patient records anytime, anywhere!

• Fast implementation • Free set-up and unlimited training • Customizable design for all specialties • Capture pay-for-performance monies

(Per month / Per provider)

• Order and receive lab results online • Eligibility verification (Additional fees may apply) • Free ePrescribing • Real time clinical messages from health plans • Real time results reporting • Auto store common phrases • Customizable SOAP note guidelines • Patient follow up alerts • Secure message center ...and much more! Learn more at: www.OfficeAlly.com/certification

S E P T E M B E R /O C T O B E R 2 0 1 7 | L O S A N G E L E S M E D I C I N E . O R G 1 3

Tirelessly defending the practice of

GOOD MEDICINE. We’re taking the mal out of malpractice insurance. By constantly looking ahead, we help our members anticipate issues before they can become problems. And should frivolous claims ever threaten their good name, we fight to win—both in and out of the courtroom. It’s a strategy made for your success that delivers malpractice insurance without the mal. See how at thedoctors.com