Nov/Dec 2019 | Los Angeles Medicine Magazine by Los Angeles County Medical Association

OFFICIAL PUBLICATION OF THE LOS ANGELES COUNTY MEDICAL ASSOCIATION

YEAR IN REVIEW

M E M B E R S | PA R T N E R S | C O M M U N I T Y

What We Accomplished Together PLUS: HIGHLIGHTS OF THE 2019 LOS ANGELES HEALTHCARE AWARDS

N O V/ D E C 2 0 1 9

TIPS DOCTORS AND THE REST OF US CAN USE TO REACH RETIREMENT GOALS Gavin Shea, SVP, National Director, Healthcare

In my 18 years of helping health care professionals with financing options, I’ve learned that many doctors struggle to build a nest egg – just like many average Americans. One reason for this could be a higher debt load due to student loans. The average debt for medical school graduates in the U. S. in 2017 was $192,000, up from $173,000 in 2011, and according to the American Dental Education Association, the average student loan debt for a 2017 dental school graduate was $287,3331. Additionally, many physicians don’t start earning or saving until their 30s, meaning fewer years of compounded savings than other professionals who may enter the workforce sooner. The good news is that achieving retirement goals is doable through planning, discipline, and working with the right people. Here are some tips to consider with your financial advisor when preparing for your next chapter of life. INVEST IN A RETIREMENT PLAN | In the Wells Fargo retirement

study, 36 percent of interviewees said they didn’t have a retirement savings plan. Meanwhile, people with 401 (K) plans, on average, started saving for retirement earlier and saved more consistently than those without them. Plans like Simplified Employee Pension IRAs (SEP IRAs) and small business 401(k)s enable you to accumulate wealth on top of the assets from your business and may offer tax benefits*. Other tools like non-qualified retirement plans can help you retain employees during a transition, as well as build retirement.

CREATE A REALISTIC RETIREMENT BUDGET | Your planning should include a budget for your retirement lifestyle. Health care expenses can be higher in retirement than while in the workforce. A 2018 analysis by the Kaiser Family Foundation estimates that out-ofpocket health care costs for Medicare beneficiaries are likely to take up half of their average Social Security income by 2030. Moreover, 50 percent of retirees in a Wells Fargo study said their expenditures on healthcare are higher than anticipated. Life expectancy should also factor in, as many advisors recommend that people who retire at age 65 should plan to live 30 years in retirement. Work with a financial advisor to ensure your retirement plan helps you achieve your goals for the future. CONSULT WITH A TAX ADVISOR | Talking to a tax professional can

help you effectively manage your investments from a tax perspective. A tax expert can help you maximize retirement income by protecting your retirement funds and investments from capital gains taxes. Using tax law to your benefit is a great way to help you reach your retirement goals. Remember, the longer you wait to start saving, the more you’ll need to save. Your future retirement options depend on you making the right choices now.

Running a small business takes big insights There are a lot of moving parts to running a successful small business — optimizing cash flow, increasing efficiency, and growing revenue. You’ll find the strategies and solutions you need to run your business better at wellsfargoworks.com. Let’s get started. Visit your local branch or find a time that works for you at wellsfargo.com/appointments.

Gavin Shea is Senior Vice President, National Director, Healthcare for Wells Fargo Practice Finance, the only practice and commercial real estate lender recommended for members of the American Dental Association. *Wells Fargo Practice Finance does not provide tax or legal advice. Please see your tax advisor to determine how this information may apply to your own situation. This information and any information provided by employees and representatives of Wells Fargo Bank, N.A. and its affiliates is intended to constitute investment education under U.S. Department of Labor guidance and does not constitute “investment advice” under the Employee Retirement Income Security Act of 1974. Neither Wells Fargo nor any of its affiliates, including employees, and representatives, may provide “investment advice” to any participant or beneficiary regarding the investment of assets in your employer-sponsored retirement plan. Please contact an investment, financial, tax, or legal advisor regarding your specific situation. The information shown is not intended to provide any suggestion that you engage in or refrain from taking a particular course of action.

EDITOR Sheri Carr | editor@physiciansnewsnetwork.com ADVERTISING SALES Dari Pebdani 858.231.1231 | dpebdani@gmail.com

VOLUME 150 ISSUE 6 | NOV/DEC 2019

EDITORIAL ADVISORY BOARD David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD HEADQUARTERS LOS ANGELES COUNTY MEDICAL ASSOCIATION 1055 West 7th Street, Suite 2290 | Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.losangelesmedicine.org LACMA OFFICERS PRESIDENT | Sion Roy, MD PRESIDENT-ELECT | Diana Shiba, MD TREASURER | Jeffery Lee, MD SECRETARY | Omer Deen, MD IMMEDIATE PAST-PRESIDENT | C. Freeman, MD, MBA, FAPA LACMA BOARD OF DIRECTORS COUNCILORS-AT-LARGE TRUSTEES & CHAIR DELEGATION Jerry Abraham, MD (1) Jack Chou, MD, CMA Trustee Samuel Fink, MD (6) Po-Yin Samuel Huang, MD, Chair of the LACMA Delegation Sunny Jha, MD (1) Sion Roy, MD, CMA Trustee Karen Sibert, MD (5) Valencia Walker, MD (5) COUNCILORS Robert Bitonte, MD, JD (D1) Emil Avanes, MD (D2) Stephanie Booth, MD (D3) Troy Elander, MD (D5) Marc Mendes, MD (D6) David Hopp, MD (D7) Steven Sawelson, MD (D9) Christine Phan, MD (D10) William Hale, MD (D14) Nancy Ellerbroek, MD (D17) Lisa Firestone, MD (SCPMG) Roxana Yoonessi, MD, JD (SCPMG) Heather Silverman, MD (SSGPF) Muntu Davis, MD (LA County) Po-Yin Samuel Huang, MD (1, YP Councilor) Hector Flores, MD (1, EPC Chair) Anna Yap, MD (Resident Councilor) Cecilia Leggett, MD (Alt. Resident Councilor) Ali Tafreshi (Student Councilor, USC) Stacy Songco (Alt. Medical Student Councilor, UCLA)

LACMA’s Board of Directors consists of a group of 31 dedicated physicians 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, VP of Operations and Strategic Initiatives, at lisa@lacmanet.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.

PRESIDENT’S LETTER

Sion Roy, MD

Gustavo Friederichsen

2019 LOS ANGELES HEALTHCARE AWARDS

A MESSAGE FROM LACMA CEO

8 YEAR IN REVIEW

Advancing Equity and Optimizing Care for All Women of Reproductive Age with One Key Question

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 1055 West 7th Street, Suite 2290 Los Angeles, CA 90017-2548. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Copyright ©2017 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, 1055 West 7th Street, Suite 2290, Los Angeles, CA 90017. Advertising rates and information sent upon request. Statement of Ownership, Management, and Circulation: Publication Title: Los Angeles Medicine. Publication Number: 1533-9254. Filing Date: 10/01/19. Issue Frequency: Bimonthly. Number of Issues Published Annually: 6. Annual Subscription Price: $39. Complete Mailing address of Known Office of Publication: 1055 West 7th Street, #2290 Los Angeles, CA 90017-2548. Complete Mailing Address of Headquarters or General Business Office of Publisher: 1055 West 7th Street, #2290 Los Angeles, CA 90017-2548. Publisher/Editor: Sheri Carr, 10755 Scripps Poway Pkwy., #615, San Diego, CA 92131-3924; Owner: LACMA Services, Inc. 1055 West 7th Street, #2290 Los Angeles, CA 90017-2548. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or more of Total Amount of Bonds, Mortgages, or Other Securities: None. Tax Status: Has Not Changed During Preceding 12 Months. Publication Title: Los Angeles Medicine. Issue Date for Circulation Data Below: Sep/Oct 2019. Extent and Nature of Circulation - 15a. Total Number of Copies: 3827 (avg)/3836 (actual); 15b1. 3494 (avg)/3594 (actual); 15b2. 0 (avg)/0(actual); 15b3. 0 (avg)/0(actual); 15b4. 0 (avg)/0(actual); 15c. 3494 (avg)/3594 (actual); 15d1. 0 (avg)/0(actual); 15d2. 0 (avg)/0(actual); 15d3. 0 (avg)/0 (actual); 15b4. 333 (avg)/339(actual); 15e. 333 (avg)/339(actual); 15f. 3827 (avg)/3933 (actual). 15g. 0(avg)/0 (actual). 15h.3827 (avg)/3933 (actual). 15i. 91 (avg)/91 (actual). 16a: Requested and Paid Electronic Copies: 7272 (avg)/7741 (actual); 16b. Total Requested and Paid Print Copes + Requested/Paid Elctronic Copies: 10,766 (avg)/11,335(actual); Percent Paid and/or Requested Cirulation (both print and electronic copies); 97 (avg)/97(actual). Publication of Ownership: If the publication is a general publication, publication of this statement is required. Will be printed in the Nov/Dec 2019 issue of the Publication. Signature and Title of Editor, Publisher, Business Manager or Owner. , Publisher. 10/1/19.

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

LACMA PRESIDENT

S I O N R O Y, M D

Making Progress It’s been a great fall for LACMA, as our organization continues to move forward in a very positive direction this year. We’ve made significant progress on membership growth and retention and are in a position to meet our year-end goals. Our organization is close to 100% membership retention for this year, which is a fantastic achievement, and we strive to continue to be the leading “Our organization was a membership organization that advocates for the physicians patients of Los Angeles County. leader in advocating for andThe Docs4LA initiative continues to build positive gun violence prevention momentum. Our organization was a leader in advocating for violence prevention legislation in the state, including legislation in the state, gun the package of bills just signed into law by Governor including the package of Newsom. Recently, we collaborated with the Los Angeles County Bar Association to advocate for technology that bills just signed into law automatically disables firearms within 1,000 feet of schools, by Governor Newsom.” places of worship, and state government buildings. Additionally, we are working with partners like Skid Row Housing Trust and Community Corps in Santa Monica to help find solutions to the barriers to healthcare for those in supportive and low-income housing in the county. Finally, along with the Department of Public Health, we continue to lead on the issue of vaping as we look to educate Angelenos on the dangers of use and seek to find legislative solutions to reduce vaping consumption. This past month, we were proud to honor LA City Councilmember Mitch O’Farrell for his leadership on gun violence and homelessness, and we had a fantastic awards luncheon celebrating Women in Medicine. Happy holidays to all LACMA members!

2 LOS ANG ELES MEDI CINE | N OVEMB ER/DECEMB ER 2019

ITâ&#x20AC;&#x2122;S ABOUT TRUST Your priority is protecting your patients. Our priority is protecting you. For more than 40 years, the Cooperative of American Physicians, Inc. (CAP) has provided our physician members with superior medical malpractice coverage. Our mission is to help independent California physicians deliver the best care possible, while realizing personal and professional success.

Sarah E. Scher, JD Chief Executive Officer

CAP members also receive proactive risk management services, in-house legal and claims support, practice management resources, and so much more. Find out what makes CAP different.

CAPphysicians.com 800-252-7706

Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.

LACMA CEO

G U S TAV O F R I E D E R I C H S E N

2019: A Preamble to the Year That Will Be As we close out 2019, I want to start this column by acknowledging those who helped make this year pretty special. Before I begin, I’d like to take a page from the Academy Awards in that our results have been verified by CMA’s finance and accounting teams. That said, I don’t foresee a scandal caused by PricewaterhouseCoopers (PwC) for mixing up the envelopes that contained the names of the Best Picture winners back in 2017. Let’s start with why we exist: to support physicians and the practice of medicine. Did we accomplish that? To help solo and small practices, we added several new partners to the LACMA portfolio, like LibertyID, an identity theft restoration company; we signed a two-year agreement with Westpac Wealth Partners; introduced BGR Consulting (rebate experts), Avery Healthcare (practice appraisal experts), Home Helpers (home support services), VIP Remote Health (patient engagement), and Carr Healthcare (commercial real estate services for doctors); we extended our groundbreaking partnerships with PatientPop (practice growth experts), Mercer (insurance), Wells Fargo (banking), CAP (malpractice protection), McKenna Auto Group (which, in addition to BMW, now includes Audi, Porsche, Mini); and we are in negotiations with Medici.md (which recently purchased DocbookMD). We also launched a retail discount portal where members can get deals on trips, hotels, events and amusement parks, and a practice purchasing site to get discounts on vaccines, medical supplies, credit card services, medical liability, office supplies, and more. For medical groups, hospitals, and health systems, we offer strategic solutions such as leveraging our technology partners, supply chain/utility cost reduction partners, secure messaging partners, and the vast resources that come with a healthy partnership with CMA. So, what is the bottom line? We will finish the year (at the time of writing) with a healthy financial bottom line and a historically high 93.8% member retention rate, which speaks to the engagement of our members, and with almost 6,500 total members, which demonstrates the breadth and depth of our impact in the Los Angeles area. We signed MLK Jr. Community Hospital to a 5-year agreement, we added 200 new UCLA members, added a cardiology group to a 3-year deal, and are poised to sign a national organization to an unprecedented 3-year agreement as well (adding over 100 new members). We launched Docs4LA, our new civic engagement initiative, to address homelessness, gun violence, vaping, and the effects climate change has on health. We have also ramped up our legislative program by engaging Pear Strategies and are the only county medical association with a digital newsletter that reaches our delegation. We are addressing physician burnout through our unique partnership with the Four Seasons Resort and the California Health & Longevity Institute. Our members can participate in 3 ½ day retreats designed for them so they can rest and recharge, and LACMA subsidizes the cost. We should all celebrate these milestones and be optimistic about 2020 thanks to a sustainable model supported by the work of our board, executive committee, district finance oversight committee, our small but mighty staff and members like you. We should all share a sense of pride on the heels of the CMA House of Delegates Annual Session that witnessed LACMA member Dr. Jack Chou win his race for CMA vice speaker (congrats, Dr. Chou!). Also, former LACMA President Dr. Vito Imbasciani was elected as a delegate to the California Delegation to the AMA, representing LACMA, and former LACMA President Dr. David Aizuss transitioned from CMA president to immediate past president. I owe a debt of gratitude to those who’ve been unwavering in their support of the cause, who put organization before themselves and who understand the power of working together so that LACMA can continue a trajectory now that it’s overcome malaise. To say the future looks bright is a testament to our members who believe in the value of membership. After all, they invest in it while we fight for it. Welcome, 2020!

“We should all celebrate these milestones and be optimistic about 2020 thanks to a sustainable model supported by the work of our board, executive committee, district finance oversight committee, our small but mighty staff and members like you.”

4 LOS ANG ELES MEDI CINE | N OVEMB ER/DECEMB ER 2019

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

6514_CA_LosAngeles_Medicine_PD_MayJun2018.indd 1

4/17/18 3:44 PM

LOS ANGELES HEALTHCARE AWA R D S PHYSICIAN LEADERSHIP AWARD

Dr. Edgar Chavez, CEO Universal Community Health Center

On November 8, the Los Angeles County medical community gathered at the Four Seasons Beverly Hills for the 8th Annual LA Healthcare Awards, benefitting the Patient Care Foundation of the L.A. County Medical Association. Dr. Sion Roy warmly welcomed colleagues, friends, new LACMA members and guests. “Many of the world’s finest physicians – as well as the world’s most caring and compassionate – fill this room or are one of the more than 6,600 physicians in LA County who comprise our full membership. “This is the eighth time we have gathered to recognize those individuals, as well as those organizations, who do so much to improve the caliber of medical care and improve patient lives in all areas of our community,” Dr. Roy continued. “Advocacy is where LACMA excels. LACMA is a vital and necessary voice in the areas of public policy, government and community relations. Healthcare is perhaps today’s most discussed topic, and never before has our voice as physician leaders been more needed in every debate.” Dr. Roy introduced LACMA’s Patient Care Foundation president, Dr. Troy Elander, who began with a quote and a riddle: “The great Roman orator and philosopher Cicero noted over 2,000 years ago, ‘In nothing do men more nearly approach the gods than in giving health to men.’ ” More recently, that sentiment was expressed in the riddle, What’s the difference between God and a doctor? The answer? God doesn’t think he’s a doctor.” After the laughter subsided, Dr. Elander continued: “Over the past eight years, I’ve been struck by a very gratifying observation: It feels so good to recognize that we live in a city filled with so many people doing positive, amazing, helpful things. Whether it’s an individual or an institution, a politician, a clinician, a young innovator or an established entrepreneur, the people we’ve honored have found wonderful, innovative and successful ways to improve the health of their communities and Southern California as a whole. These are, at best, stressful times. It is wonderful to have one night that is about nothing but pride in great accomplishment. It makes me so glad to be in medicine. You leave feeling positive and happy. What could be better for your health? If you’re not a member, I hope you’ll join LACMA – both for the good we encourage, and how good it makes you feel.” LACMA CEO Gustavo Friederichsen then took the stage, highlighting the growing community of LACMA members. “I always like the analogy of ‘connecting the dots.’ We’re doing that in ways that are having such positive impact on the community.” “For eight years we’ve come together, and with every year our membership grows. We’re close to 7,000 members, and what’s even more impressive than the number is the stature and the scope of our membership.” After announcing agreements with LA Department of Public Health, UCLA and a historic partnership with AltaMed Health Services, Gustavo continued: “I’d like to share some of the good news from this year thanks to many of you in this room. After all, it takes more than a village to change the course of history; it takes teamwork and tenacity: In 2019 we saw a rise in membership again. We saw membership retention at an all-time high of almost — are you

SAVE THE DATE INNOVATION AWARD FOR HEALTH CARE FACILITIES

Venice Family Clinic

INNOVATION AWARD FOR PUBLIC EDUCATION

Dr. Tony Kuo Director, Chronic Disease and Injury Prevention LA County Department of Public Health SHINE THE LIGHT MEDIA AWARD

Chris Erskine L.A. Times

FRIDAY, NOVEMBER 8TH, 2019 FOUR SEASONS BEVERLY HILLS INNOVATION AWARD IN TECHNOLOGY

Cedars-Sinai Accelerator INNOVATION AWARD FOR COMMUNITY SERVICE

5:30 PM COCKTAIL RECEPTION 6:30 PM DINNER AND AWARDS

Dr. Efrain Talamantes Mi Mentor DOCS 4 LA AWARD

Los Angeles Rams and Skid Row Housing Trust HEALTHCARE CHAMPION OF THE YEAR

Assemblymember Mike A. Gipson 64th District

LACMA PATIENT CARE FOUNDATION 2019 SCHOLARSHIP AWARD WINNERS

Charity Abuyo Aileen Arevalo Yadira Bribiesca Betty Njenga Vanessa Nunez Jamila Rahmaan-Colder Charnise Taylor Edward Valle

FOR SPONSORSHIP OPPORTUNITIES AND TICKETS CALL 213-683-9900 6 LOS ANG ELES MEDI CINE | N OVEMB ER/DECEMB ER 2019

LEFT: LACMA’s Patient Care Foundation president, Dr. Troy Elander (left), with the night’s awardees, left to right: Dr. Tony Kuo (LA County Department of Public Health), Dr. Efrain Talamantes (Mi Mentor), Jack Lahey and Monique Davis (Skid Row Housing Trust), Dr. Edgar Chavez (Universal Community Health Center), Andrew Whitworth (Los Angeles Rams), Chris Erskine (LA Times), Dr. Despina Kayichian (Venice Family Clinic), Christopher Wilson (Office of Assemblymember Mike Gipson), Anne Wellington (Cedars-Sinai Accelerator) and LACMA President Dr. Sion Roy. BOTTOM RIGHT: Dr. Troy Elander (left) with scholarship winners Vanessa Nunez, Yadira Bribiesca, Aileen Arevalo, Charity Abuyo, Betty Njenga and Dr. Sion Roy.

ready for this? — almost 95%. We continue to engage physicians every day and help solve their problems, one physician, one practice, one group at a time. Every new alliance helps us truly help the practice of medicine for all patients in Southern California. “LACMA’s vision will continue to find the best ways to positively impact every member of our community – no matter where he or she lives. Care cannot be tied to a ZIP code,” he concluded. Following the introduction of the 2019 awardees and videos highlighting their inspiring work and impact on the Los Angeles community and beyond, Dr. Elander recognized this year’s scholarship winners. “Scholarship is possibly the most vital aspect of the Foundation’s mission. Every year we are blown away by the dedication and caliber of the young medical students who look to us for financial assistance. In truth, in all the years I’ve been doing this, I’ve never seen as strong a group of contenders as our 2019 applicants,” he said. “Of the 16 who applied, the review process was nothing less than one amazing person after another.” On behalf of LACMA, congratulations to all of the 2019 Los Angeles Healthcare Awardees and scholarhip winners.

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

N OVEMB ER/DECEMB ER 2019 | L AD O C S .ORG 7

YEAR IN REVIEW

M E M B E R S | PA R T N E R S | C O M M U N I T Y

What We Accomplished Together 2019 has been a remarkable year for LACMA, and as the year draws to a close, we reflect on the highlights and initiatives that have shaped this momentous year. LACMA has continued to grow in membership, and we are just shy of 7,000 members strong with a record-breaking 93.8% retention rate. This is, we believe, a reflection of the fact that LACMA members want to contribute in a meaningful way to organized medicine; they see the value in community, collaboration, and, most importantly, advocacy. Advocacy is where LACMA excels. LACMA is a vital and necessary voice in the areas of public policy, government, and community relations. Healthcare is possibly todayâ&#x20AC;&#x2122;s most discussed topic, and never before has our voice been more needed in every debate. We know better than anyone that what matters is our ability to give our patients one hundred percent of our time and effort and not waste endless hours navigating seemingly infinite levels of bureaucracy. Our advocacy thrives on the hard work and dedication of our physician leaders, staff, members, and partners.

8 LOS ANG ELES MEDI CINE | N OVEMB ER/DECEMB ER 2019

APRIL fery Lee, Dr. Jerry Abraham, Dr. Jack Chou, Dr. Bill Averill, Dr. Sam Huang, in addition to several members and a record number of In April, we had major success at Legislative Advocacy Day in Sacramento. LACMA leaders Dr. C Freeman, Dr. Sion Roy, Dr. Jef-

students, were in attendance as major topics were discussed including Assembly Bill 764 (Bonta) Prohibiting Manufacturer Discounts and Coupons of Soda and Senate Bill 276 (Pan), the Child Safety and Disease Prevention Act.

JUNE county-employed physician to hold the title of president in LACMA’s history. Over 200 people attended the event, and we heard

In June, Harbor-UCLA Medical Center cardiologist Dr. Sion Roy was sworn in as LACMA president, making him the youngest and first

remarks from California State Senator Henry Stern, Los Angeles City Councilmember Paul Koretz, Dr. Patrice A. Harris, and Dr. David Aizuss. We also launched Docs4LA to serve as the impetus for LACMA to be a leader and policy partner on issues that we have not always traditionally weighed in on but are some of the most significant issues affecting the people of Los Angeles county. These issues include housing, homelessness, transportation, the environment, and gun violence. LACMA leadership has had several productive meetings with legislators, organizations, and advocates to identify ways that LACMA can assist our public servants to develop policies that help our housing and transportation crises, find solutions to environmental issues, and help address gun violence.

SEPTEMBER improved functionality and easier access to essential information. We hosted our Young Physician Mixer at the Luxe

September was a busy month for LACMA. We launched our new website featuring a streamlined, modern design with

Hotel in Downtown Los Angeles. We also hosted the Celebration of Women in Medicine luncheon, where we honored: Anna Yap, MD – Rising Star of Physician Leadership Award Christina Ghaly, MD – Extraordinary and Inspirational Achievement Award Elaine Batchlor, MD, MPH – Rose Talbot Bullard Award – Woman Physician Champion and Trailblazer

OCTOBER broad policy on current major issues. This year’s major issues were: cannabis, augmented intelligence, and homelessness. In October, the annual CMA House of Delegates convened in Anaheim with delegates from all over the state to establish

LACMA was allotted 35 delegate and 35 alternate delegate spots to represent its constituents. Dr. David Aizuss transitioned to immediate past CMA president, and Dr. Vito Imbasciani was elected as a delegate to the California Delegation to the AMA, representing LACMA. Lastly, family medicine physician and a fellow of the American Academy of Family Physicians, Dr. Jack Chou won his race for CMA vice speaker.

NOVEMBER cians, organizations, policymakers, and advocates at the Los Angeles Healthcare Awards. Our honorees have led initiaAs you read on the previous pages, just this month, we honored some of Los Angeles County’s most dedicated physi-

tives to improve healthcare in Los Angeles County through increased patient access to care and treatment; advanced public health education; emboldened physician engagement in underserved communities; promoted the furtherance of professional development for current and future physicians; and their contributions have shaped the future of healthcare. Also, in November, LACMA members and Hiroshima Prefectural Medical Association attended a luncheon at the General Consul of Japan’s residence. Since the 1970s, LACMA has teamed up with the Hiroshima Prefectural Medical Association to sponsor doctors from Hiroshima to examine and provide medical care to Hiroshima survivors.

DISTRICT EVENTS athenahealth sponsored the District 9 dinner in Torrance, where guests learned how to thrive independently, 2019 also brought about an opportunity to reconnect district members through district events. In May,

engage patients and maximize self-pay collections. District 10 and 14 hosted a dinner in July in Whittier, where they learned about Single Payer Health Systems. In August, District 1 partnered up with the Young Physicians Committee for a summertime mixer. In October, District 5 held a dinner in Santa Monica, where ACap Accounting Advisors presented on tax credits for private practices. In November, District 6 and District 17 held a dinner in Tarzana, where Home Helpers presented on home aftercare services and Medicare updates. Finally, District 7 gathered in Beverly Hills to learn about patient alert systems from VIP Remote Health.

As we reflect, we think about who we are and who we want to be, and we continue to build new, industry-leading relationships with organizations that fundamentally help physicians and their patients. Our commitment to LACMA members is unwavering, and now more than ever, together we must strive towards one common goal - to help healthcare providers fulfill their mission and strategic goals while supporting the physicians that provide quality care in our richly diverse and uniquely complex county. On behalf of LACMA’s physician leaders and staff, we thank our members for their continued membership. We are gearing up for 2020 programming, and rest assured we have a productive year ahead. Finally, we once again express our most sincere appreciation to our members, partners, and supporters. We wish you and your families a wonderful holiday season and a bright start to 2020. N OVEMB ER/DECEMB ER 2019 | L AD O C S .ORG 9

Advancing Equity and Optimizing Care for All Women of Reproductive Age with One Key Question® Susie Baldwin MD, MPH, Medical Director, Office of Women’s Health, Sarah Guerry, MD, Chief, Medical Education and Communication, Rita Singhal, MD, MPH, Chief Medical Advisor, Health Promotion Bureau, Deborah Allen, ScD, Deputy Director, Health Promotion Bureau, County of Los Angeles Department of Public Health

The Los Angeles County Department of Public Health (LAC DPH) is promoting the screening tool for pregnancy desire, One Key Question®, to advance equitable women’s health. Use of One Key Question can maximize patient safety, optimize health and well-being prior to pregnancy, and help ensure that all women who desire contraception are provided access. One Key Question has been incorporated into the LAC DPH multi-pronged initiative to reduce African American Infant and Maternal Mortality (AAIMM) by 2023.1 This abridged article summarizes One Key Question and includes the rationale for including it in the LAC DPH AAIMM initiative. For detailed information on clinical implementation strategies plus clinic and patient resources related to each One Key Question response, view the full article: www.rx.ph.lacounty.gov/RxOKQ0718. In LA County, chronic diseases that negatively impact pregnancy, such as diabetes and hypertension, are increasing in women of reproductive age.2 In addition, many younger women with chronic diseases are prescribed medications that are teratogenic and contraindicated in pregnancy. Teratogens often cause harm to development early in embryonic development, before people realize they are pregnant. To maximize patient safety and improve care for women of reproductive age, LAC DPH recommends that physicians routinely screen for pregnancy desire in well-woman and primary care visits for all women of childbearing potential.

Assessing Pregnancy Desire with One Key Question One Key Question integrates routine, proactive screening for pregnancy desire into the primary health care visit by asking all women of reproductive age who can get pregnant: “Would you like to become pregnant in the next year?”3 This question was developed by the Oregon Foundation for Reproductive Health to more accurately identify the preventive reproductive health services needed by women of childbearing age.3 The accompanying figure shows the action steps that physicians and their teams can take based upon women’s answers. While some action steps can be deferred to a subsequent appointment or referral to a specialist, there are key steps that should be addressed at the point of screening; those are marked with an asterisk. Patient Assessment at Clinic Visit - One Key Question® Would you like to become pregnant in the next year?

1. Assess and Initiate Preconception Care

Yes

• Review medications.* • Recommend daily folic acid.* • Screen and counsel on tobacco and substance use.* • Counsel patients with untreated/poorly controlled medical conditions. • Screen for conditions that can affect pregnancy. • Screen for intimate partner violence. • Review immunization history. • Provide or refer for contraceptive counseling and care if health/meds are not yet optimized for pregnancy. • Refer for a preconception visit and recommend early prenatal care.

2. Determine if Patient is at Risk for Unintended Pregnancy - If Indicated, Discuss Contraception No

Unsure/ Okay Either Way

• Inquire about contraceptive method use and satisfaction.* • Offer or refer for full spectrum of contraceptive options including LARC (for patients not using contraception or not satisfied with method).* • Offer emergency contraception as indicated.

3. Plan for Pregnancy but Attend to Family Planning Needs as Indicated. • Offer a combination of responses from #1 & #2 about contraception and preconception care, depending on individual patient needs and circumstances.* • Discuss ambivalence and relevant issues or refer to a provider who can explore and support the patient’s reproductive decision-making. *Recommended actions during this visit.

10 LOS ANG ELES MEDI CINE | N OVEMB ER/DECEMB ER 2019

One Key Question: Addressing Patient Responses4,5 Would you like to become pregnant in the next year? 1. YES | Assess and initiate preconception care.

For women who would like to get pregnant within a year, One Key Question alerts the physician to consider the impact of patients’ medical conditions and medications on pregnancy, and to work with patients to adjust treatment accordingly. It also provides physicians an entrée to educate women on the importance of health-related behaviors in the preconception period, including tobacco cessation and folic acid supplementation. At a minimum, for a woman who desires pregnancy, a busy physician should consider alternatives to teratogenic medication and refer her for more comprehensive preconception counseling. 2. NO | Determine if patient is at risk for unintended pregnancy. If indicated, discuss contraception.

For women who do not desire pregnancy within a year (and are at risk for conception), the physician should assure that the patient is adequately protected against unintended pregnancy. At a minimum, it should be determined if the patient is currently using contraception, is satisfied with her choice, and is using it consistently and correctly. Ideally, for women at risk

of contraceptive failure or unprotected Recent research suggests a physiologic intercourse, an advance prescription of pathway that links social experience to emergency contraception should be these poor birth outcomes via exposure to Are you treating hypertension, hyperlipidemia, or diabetes in reproductive-aged offered at that visit. Use of emergency chronic stress, the common experience of women? What are you prescribing? contraception (including oral medication black women in the U.S. across generations or copper intrauterine contraception) and lines of class, education, and maternal ACE inhibitors, angiotensin receptor within 72-120 hours of unprotected vagibehaviors.10-12 While multifactorial solutions blockers, and statins should not be prescribed during pregnancy. are required, physicians play a key role in nal intercourse can prevent pregnancy the response. Ensuring that all women can by inhibiting ovulation (oral hormonal Be sure to consider womenâ&#x20AC;&#x2122;s desire for pregavoid unwanted pregnancy and that their medication) or impairing sperm (copper nancy when prescribing any medication. health is optimized prior to pregnancy can intrauterine device). help reduce risk factors for maternal and Patients who are at risk for unintended infant morbidity and mortality. pregnancy who are not using contraThe implementation of preventive ception or who are not satisfied with reproductive health care in primary care their current method should receive full settings is essential, and One Key Question provides a straightforward contraceptive counseling and care. If this cannot occur during the tool for engaging women in a critical conversation about optimizing current visit, an appointment or referral should be provided. Ensure health and well-being prior to pregnancy and preventing unintendthat the patient receives contraceptive services as soon as possible ed pregnancies. and that any barriers to this care are minimized. For references, please see www.publichealth.lacounty.gov/owh/OKQ/OKQReferences.pdf.

3. OKAY EITHER WAY OR UNSURE | Plan for pregnancy but attend to family planning needs as indicated.

An ambivalent response to One Key Question is not uncommon.6 Studies demonstrate that 23-36% of young women are conflicted about their desire to have a baby.7-9 While these responses are the most challenging for a physician to address, they provide a critical opportunity to explore patientsâ&#x20AC;&#x2122; reproductive decision making and help them take action to avoid an unintended pregnancy or to plan for a healthy one. In the context of primary and chronic disease care, physicians can explore with women the steps they need to take to optimize their health for pregnancy, should one occur, or refer them for preconception counseling. Physicians can also immediately offer contraception or provide a referral to family planning if there are medical, social, or other issues that would make deferral of pregnancy a safer choice. In sum, for women who are ambivalent about pregnancy, One Key Question opens a discussion that allows for the delivery of preventive reproductive health care.

Physicians are encouraged to read the AAIMM action plan available at: www.publichealth.lacounty.gov/ CenterForHealthEquity/PDF/AAIM-ActionPlan.pdf

Addressing Health Equity with One Key Question Black women and their families bear a disproportionate burden of infant deaths across the United States. In LAC, the death rate for infants born to black mothers is 3 times higher than for those born to white mothers. Black mothers also die from maternal indications at 4 times the rate of white mothers. These alarming, persistent disparities result not from black womenâ&#x20AC;&#x2122;s individual behaviors or choices, but from complex interactions between social, medical, and structural factors that impact their lives, including experiences of racism. N OVEMB ER/DECEMB ER 2019 | L AD O C S .ORG 11

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

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

CONSULTING & SERVICES

Arthur S. Shorr & Associates, Inc.

Consultants to Healthcare Providers

Practice Appraisal & Sales Partnership Buy-In / Buy Out Supporting Southern California Physicians Since 1983 Call for a Courtesy Consultation

818-693-7055

avishorr@gmail.com

LOCUM TENENS AVAILABLE

TRACY ZWEIG ASSOCIATES, INC. • Physicians • Nurse Practitioners • Physician Assistants

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

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

SEEKING MEDICAL ONCOLOGIST/HEMATOLOGIST FOR A UNIQUE OPPORTUNITY IN PRIVATE PRACTICE. MULTIPLE PRIME LOCATIONS (WEST HOLLYWOOD / ENCINO). SALARY NEGOTIABLE. PLEASE SEND CV’s, RESPONSES OR QUESTIONS TO: SYNERGYMEDMGMT@AOL.COM OPPORTUNITY WANTED

RADIOLOGIST

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

COMING IN 2020 JANUARY/FEBRUARY

Vision: 2020 | A Look Ahead MARCH/APRIL

LACMA Symposium: Focus on Physicians MAY/JUNE

The Member Benefits Issue JULY/AUGUST

The Changing of the Guard SEPTEMBER/OCTOBER

Los Angeles Healthcare Awards Profiles NOVEMBER/DECEMBER

Annual Report

Reach Thousands of California Physicians

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

PhysiciansNewsNetwork.com 12 LOS ANG ELES MEDI CINE | N OVEMB ER/DECEMB ER 2019

Your Membership Offers Additional Savings on Already Low Rates! Preferred Employers Insurance workers’ compensation rates are trending down in California and there is the potential for savings to physicians. Los Angeles County Medical Association/CMA members are eligible to save an additional 5%* because of their membership! LACMA and CMA partner with Mercer Health & Benefits Insurance Services LLC and Preferred Employers Insurance to provide best-in-class Workers’ Compensation insurance that includes safety and risk management advice along with outstanding customer service and an easy to navigate website in the event of a claim. This program is already serving the needs of hundreds of California physicians. Have you considered the Safety, Service, Stability, and Savings, offered by Preferred?

Save today! It’s easy to get a quote. Visit CountyCMAMemberInsurance.com, call 800-842-3761 or email CMACounty.Insurance.service@mercer.com to request a premium indication form.