February 2008

San Diego County’s Physician Workforce – Today and Tomorrow Report on SDCMS’ 2007 Physician Workforce and Compensation Survey

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Contents

VOL. 95 | NO. 2

REPORT OF SDCMS’ 2007 PHYSICIAN WORKFORCE AND COMPENSATION SURVEY PAGE 26

[ F E A T U R E ]

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[ O N L I N E ]

REPORT OF SDCMS’ 2007 PHYSICIAN WORKFORCE AND COMPENSATION SURVEY

By TOM GEHRING

“MALPRACTICE CLAIMS: COPING WITH THE STRESS”

By THE DOCTORS COMPANY

VISIT SANDIEGOPHYSICIAN.ORG FOR THIS ARTICLE AND MORE.

[ D E P A R T M E N T S ]

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EDITOR’S COLUMN: A Symphony of Care SEMINARS: SDCMS’ 2008 Seminars and Events

COMMUNITY HEALTHCARE CALENDAR BRIEFLY NOTED: Medical Myth, Ask Your Advocate, and More…

RISK MANAGEMENT: Lost in Translation INTERVIEW: Chris Van Gorder

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AMA: Report From the 2007 Interim Meeting HEALTHCARE TECHNOLOGY: UCSD’s Online Clinical Library II THE PULSE: SDCMS Foundation Newsletter PHYSICIAN MARKETPLACE: Classifieds PRODUCTIVITY: What Does the Boss Really Do?

Contributors CRAIG HAYNES Mr. Haynes is head of UCSD’s Medical Center Library.

MARISOL GONZALEZ Ms. Gonzalez is your SDCMS physician advocate. She can be reached at (858) 300-2783 or at MGonzalez@SDCMS.org with any questions you may have about your practice or your membership.

TOM GEHRING Mr. Gehring is the executive director and CEO of the San Diego County Medical Society.

JAMES T. HAY, MD Dr. Hay is a full-time family physician in Encinitas. He was president of SDCMS in 2001, is currently speaker of the California Medical Association House of Delegates, and an AMA delegate.

KETTY LA CRUZ Ms. La Cruz is assistant editor of San Diego Physician.

JOSEPH E. SCHERGER, MD, MPH Dr. Scherger is clinical professor of family medicine at UCSD. He is also medical director of AmeriChoice, which administers San Diego County Medical Services. Dr. Scherger, along with editing San Diego Physician, is chair of the SDCMS Communications Committee.

CHRIS VAN GORDER Mr. Van Gorder is president and CEO of Scripps Health.

EAST COUNTY DIRECTOR HILLCREST DIRECTOR KEARNY MESA DIRECTOR EDITOR MANAGING EDITOR ASSISTANT EDITOR

Joseph Scherger, MD, MPH Kyle Lewis Ketty La Cruz

EDITORIAL BOARD

Adam Dorin, MD Robert Peters, MD David Priver, MD Roderick Rapier, MD Joseph Scherger, MD Sandra Wilcox, MD

LA JOLLA DIRECTOR NORTH COUNTY DIRECTOR

SOUTH BAY DIRECTOR AT-LARGE DIRECTOR

YOUNG PHYSICIAN DIRECTOR RESIDENT PHYSICIAN DIRECTOR RETIRED PHYSICIAN DIRECTOR MEDICAL STUDENT DIRECTOR

Published by

PRESIDENT PUBLISHER DIR., BUSINESS DEVELOP. & MARKETING MARKETING & PRODUCTION MNGRS.

William Tseng, MD Woody Zeidman, MD Roneet Lev, MD Tom McAfee, MD Adam Dorin, MD Sherry Franklin, MD Steve Poceta, MD Wynnshang Sun, MD Robert Wailes, MD Douglas Fenton, MD Tony Blain, MD Vimal Nanavati, MD Anna Seydel, MD Jeffrey Leach, MD Robert Peters, MD David Priver, MD Wayne Iverson, MD Paul Kater, MD John Allen, MD Kevin Malone, MD Mihir Parikh, MD Kimberly Lovett, MD Glenn Kellogg, MD Lindsey Frost

Jim Fitzpatrick Maureen Sullivan Heather Back Jennifer Rohr

SDCMS EXECUTIVE COMMITTEE PRESIDENT PRESIDENT-ELECT PAST PRESIDENT SECRETARY TREASURER COMM. CHAIR DELEGATION CHAIR BOARD REP. BOARD REP. LEGISLATIVE CHAIR EXECUTIVE DIRECTOR

Albert Ray, MD Stuart Cohen, MD, MPH Theodore Mazer, MD Susan Kaweski, MD Lisa Miller, MD Joseph Scherger, MD, MPH Jeffrey Leach, MD Robert Wailes, MD Sherry Franklin, MD Robert Hertzka, MD Tom Gehring

SDCMS CMA TRUSTEES

Theodore Mazer, MD Albert Ray, MD Robert Wailes, MD

OTHER CMA TRUSTEES

Catherine Moore, MD Diana Shiba, MD

AMA DELEGATES

ALTERNATE DELEGATE

ACCOUNT EXECUTIVE PROJECT DESIGNER SENIOR DESIGNER COPY EDITOR

James Hay, MD Robert Hertzka, MD Albert Ray, MD

Dari Pebdani Jane Hughes Jessica Hedberg Adam Elder

1450 Front Street • San Diego, CA 92101 • 619-230-9292 • Fax: 619-230-0493 • 800-600-CITY (2489) • www.sandiegomagazine.com 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 cpinfo@sandiegomag.com . 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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Editor’s Column

By Joseph E. Scherger, MD, MPH

A Symphony of Care I

[ What Physicians Should Strive For ]

had the honor and pleasure of doing an oral history on one of the founders of the specialty of family medicine: Roy Gerard, MD. Dr. Gerard is a veteran of World War II, being the only survivor in his Army unit after a German mortar attack.

He survived because the dead body of an-

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other soldier fell on him. After the war, he returned to his native Michigan a changed man from what he describes as the “family idiot” to a serious student.

The GI bill helped him through college and medical school at the University of Michigan.

Dr. Gerard returned to his native area

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and did a rotating internship and a year of general internal medicine in Saginaw, Michigan. During his training, a local GP asked him to cover his practice for a week.

He said that he was not sure what to do with the patients. The GP said no worry, just ask Alice (the office assistant), she’ll tell you what to do with the patients. This was a simpler time for medicine.

Dr. Gerard started his own general practice in Saginaw in the early 1960s, doing many house calls, deliveries, and surgeries.

In the late 1960s, as the new specialty of family medicine was forming, he saw the vision of a better-trained generalist and founded the family medicine residency program in Saginaw.

By the mid-1970s, Michigan State University was ready for a department of family medicine, and Dr. Gerard became the founding chair, a position he held for 17 years. Now in his early 80s, he remains clinically active every day and is one of the most popular teachers of medical students in the problem-based learning curriculum.

When I asked Dr. Gerard for his vision of how healthcare should be, he described a symphony of care. A person’s healthcare should be “conducted” by a personal physician and harmonized among all specialists and caregivers. Excellent care for sick patients should be a masterpiece performance with today’s modern medical miracles.

Regrettably, today’s care is often not a symphony, unless you want to compare it to the period before a performance when all the musicians are warming up. This cacophony of sounds is irritating to listen to as each specialist acts alone with his or her instrument. Similar irritations come to patients and families in the hospital or during the course of outpatient care when each specialist acts alone, not communicating or seeing the records of others.

Dr. Gerard has not given up on his vision of a symphony of care despite mounting frustrations of cacophonous care among a patient population with changing insurance plans and providers. New information technologies are developing that provide the opportunity to coordinate har-

PRACTICE ANNOUNCEMENT

ADULT & PEDIATRIC SLEEP DISORDERS monious care among numerous physicians working off the same portable and accessible medical record.

While primary care physicians conduct the care for most patients, other specialists often need to be in that role. Every patient at all times needs a physician who is in charge. Hospitalists do this during inpatient stays. Patients with cancer have their

patients. The tools for doing this better are rapidly becoming available through health information technology. A physician’s will is required. We all have the talent. Our patients deserve no less. Best of all, we physicians can work in an environment of harmony – not as listeners, but as creators of beautiful music. I can see Dr. Gerard smile.

Bradley J. Schnierow, MD Scripps Memorial Hospital Campus HM Poole Medical Office Building 9834 Genesee Avenue, Suite 412 La Jolla, California 92037 TEL (858) 623-3266 FAX (858) 630-2426 www.SanDiegoSleep.com

A person’s healthcare should be “conducted” by a personal physician and harmonized among all specialists and caregivers.

Education and Training care conducted by oncologists. Patients with severe collagen vascular diseases have their care conducted by rheumatologists.

Neurologists conduct the care for many patients. The list goes on.

A symphony of care is a metaphor all physicians should strive for in the care of

A B O U T T H E A U T H O R : Dr. Scherger is clinical professor of family medicine at UCSD. He is also medical director of AmeriChoice, which administers San Diego County Medical Services. Dr. Scherger, along with editing San Diego Physician, is chair of the SDCMS Communications Committee.

• M.D. (1994) University of Kansas.

• Psychiatry Residency (1994–1998) University of New Mexico.

• Sleep Disorders Fellowship (1998–2000) University California, San Diego, School of Medicine.

Board Certifications • Diplomate, American Board of Psychiatry and Neurology (2000).

• Diplomate, American Board of Sleep Medicine (2002).

Academic Appointment • Assistant Clinical Professor. University of California, San Diego, School of Medicine.

PROJECT ACCESS SAN DIEGO (PASD)

Clinical Affiliations

Connecting Uninsured and Underinsured San Diegans With Volunteer Physicians

• Staff Physician. Scripps Memorial Hospital, La Jolla, California.

• Staff Physician. Pomerado Hospital, Poway, California.

• Member Physician. Ximed Medical Group.

PHYSICIANS WANTED: • Primary care physicians to provide a “medical home” for one or more people.

• Specialty care physicians to provide one or more specialty consult(s) and procedure(s).

Professional Memberships • San Diego County Medical Society.

• California Medical Association.

• Fellow, American Academy of Sleep Medicine.

Selected Awards • Lilly Fellowship Award (1997) Society of Biological Psychiatry.

• Glenn Foundation Endocrinology and Aging Award (1998) Endocrine Society.

• President’s Award (2005) San Diego Psychiatric Society.

For more information about PASD or to let us know how you would like to help, contact Aron Fleck, SDCMSF executive director, at (858) 300-2780 or at AFleck@SDCMS.org.

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Seminars 2008 San Diego County Medical Society Seminars and Events

GETTING PAID SEMINAR — OFFICE MANAGERS FORUM

Practice: What You Need to Know Before You Begin Your Practice” April 19, 8:30 a.m. 3:30 p.m.

SDCMS NEW MEMBER SOCIAL

Feb. 29, 6:00 p.m. 9:00 p.m.

For further information about any of these seminars or events, watch your emails and faxes, visit SDCMS’ website at www.SDCMS.org, call SDCMS at (858) 565-8888, or email us at SDCMS@SDCMS.org.

Details may change as seminars approach — contact SDCMS to confirm. Thank you for your membership!

PRACTICE MANAGEMENT SEMINAR “Financial Con-

RESIDENT AND NEW PHYSICIAN SEMINAR “Preparing to

Feb. 21, 11:30 a.m. - 1:00 p.m.

Along with its many social events held throughout the year, the SAN DIEGO COUNTY MEDICAL SOCIETY (SDCMS) strives to build a robust schedule of free seminars for our physician members and their staffs (attendance rates for nonmember physicians and their staffs vary by seminar).

JUNE

A P R I L (cont.)

F E B R U A RY

RISK MANAGEMENT SEMINAR

April 23, 11:30 a.m. - 1:00 p.m., 6:30 p.m. - 8:30 p.m., April 24, 11:30 a.m. - 1:00 p.m.

MARCH CERTIFIED MEDICAL CODER PREPARATORY COURSE

trol for Physicians: Preventing Money Leaks,” June 18, 6:30 p.m. - 8:30 p.m.

PRACTICE MANAGEMENT SEMINAR – OFFICE MANAGERS FORUM “Treating Pa-

tients Right: Tack, Courtesy, and Etiquette in the Medical Office,” June 19, 11:30 a.m. 1:00 p.m.

M AY

March 7, 14, 28, April 4, 11, 8:00 a.m. - 4:00 p.m.

EMR ROAD SHOW “To EMR

COLLECTIONS SEMINAR — OFFICE MANAGERS FORUM

or Not to EMR?” May 8 and 9 LEGAL SEMINAR “Contract Law” May 21, 6:30 p.m.– 8:30 p.m.

March 20, 11:30 a.m. - 1:00 p.m.

YOUNG PHYSICIANS SOCIAL

Mar. 28, 6:00 p.m. – 9:00 p.m.

LEGAL SEMINAR — OFFICE MANAGERS FORUM

AUGUST SDCMS NEW MEMBER SOCIAL

Aug. 29, 6:00 p.m. 9:00 p.m.

SEPTEMBER

“HR Laws” May 22, 11:30 a.m. – 1:00 p.m.

APRIL

YOUNG PHYSICIANS SOCIAL

Sep. 6, 3:00 p.m. - 8:00

CONTRACT NEGOTIATIONS SEMINAR April 16, 6:30 p.m. -

8:30 p.m.

CONTRACT NEGOTIATIONS SEMINAR – OFFICE MANAGERS FORUM April 17, 11:30 a.m. - 1:00

CMA CEO JOE DUNN DISCUSSIONS WITH PHYSICIANS May 27 and 28,

all day, both days at several different San Diego County hospitals

p.m.

OFFICE MANAGERS NETWORKING OPPORTUNITY Arrive 30 minutes before the beginning of our Office Managers Forums to network with other office managers!

p.m.

SDCMS

Get In Touch ADDRESS: 5575 Ruffin Rd., Ste. 250, San Diego, CA 92123 TELEPHONE: Dareen Nasser, office manager, at (858) 565-8888 or at DNasser@SDCMS.org FAX: (858) 569-1334 CEO/EXECUTIVE DIRECTOR: Tom Gehring at (858) 565-8597 or at Gehring@SDCMS.org COO/CFO: James Beaubeaux at (858) 300-2788 or at Beaubeaux@SDCMS.org DIRECTOR OF MEMBERSHIP AND MEMBER SERVICES: Janet Lockett at (858) 300-2778 or at JLockett@SDCMS.org PHYSICIAN ADVOCATE: Marisol Gonzalez at (858) 300-2783 or at MGonzalez@SDCMS.org

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OFFICE MANAGER ADVOCATE: Lauren Woods at (858) 300-2782 or at LWoods@SDCMS.org DIRECTOR OF EVENTS AND LEADERSHIP SUPPORT: Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org SDCMS FOUNDATION EVP: Aron Fleck at (858) 300-2780 or at AFleck@SDCMS.org DIRECTOR OF COMMUNICATIONS AND MARKETING: Kyle Lewis at (858) 300-2784 or at KLewis@SDCMS.org ASSISTANT EDITOR AND WEBMISTRESS: Ketty La Cruz at (858) 565-7930 or at KLaCruz@SDCMS.org LETTERS TO THE EDITOR: Editor@SDCMS.org GENERAL SUGGESTIONS: SuggestionBox@SDCMS.org

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Calendar

NEW ADVANCES IN SOLID ORGAN TRANSPLANTATION WHAT: The 2008 program will consist of plenary speeches from nationally known experts in the field, panel discussions, and opportunities for poster and case presentation segments. The conference is designed for healthcare professionals specializing in the fields of nephrology, gastroenterology, and hepatology.

WHEN: February 9, 2008 WHERE: The Dana on Mission Bay COST: $210 INFORMATION: Visit www.scripps.org/conferenceservices.

CLINICAL HEMATOLOGY AND ONCOLOGY 2008 CONFERENCE WHAT: The primary objective of this course is to bring together clinicians and leading experts in diverse areas of hematology and oncology, affording them an environment in which to discuss new clinical developments and significant advances.

WHEN: February 16-19, 2008 WHERE: Omni San Diego Hotel INFORMATION: Visit www.scripps.org/conferenceservices.

ADVANCES IN THE PRACTICE OF PEDIATRICS: SAN DIEGO 2008 WHAT: This event combines lectures, workshops, the popular “Pediatric Clinical Vignettes,” and question and answer sessions to allow the opportunity to interact with the faculty in solving problems encountered in practice.

WHEN: February 22-24, 2008 WHERE: Hilton La Jolla Torrey Pines CME: 16.0 AMA PRA Category 1 Credits INFORMATION: Call (888) 892-9249 or email cme@chsd.org.

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11TH ANNUAL WINTER MEDICAL UPDATE 2008 WHAT: Attendants will learn to identify and

evaluate current trends and practical insights into primary care medicine, review treatment options and prevention interventions in commonly encountered medical conditions, and review and discuss the latest recommendations and guidelines for a variety of clinical problems.

WHEN: February 23 - March 1, 2008 WHERE: Loews Coronado Bay Resort CME: Maximum of 20 AMA PRA Category 1 Credits INFORMATION: Visit www.metrodoctors.com/ event_detail.cfm?id=203.

FOURTH ANNUAL BIOMARKERS IN HEART DISEASE: WHAT EVERY HEALTH CARE PRACTITIONER NEEDS TO KNOW WHAT: This annual event is designed to provide the most up-to-date standards in clinical application of biomarkers.

WHEN: March 1-2, 2008 WHERE: San Diego COST: $50-$125 CME: Up to 11.25 credits CONTACT: Kate Greathouse at (619) 543-6031 or at kgreathouse@ucsd.edu.

FRESH START’S 2008 SURGERY WEEKENDS WHAT: Surgery Weekends happen seven

times per year when more than 100 volunteers join together to provide free reconstructive surgery and related medical services to disadvantaged children with physical deformities caused by birth defects, accidents, abuse, or disease.

WHEN: March 1-2; April 12-13; June 7-8; July 26-27; Sept. 13-14; Nov. 1-2, 2008 WHERE: The Center for Surgery of Encinitas INFORMATION: Visit www.freshstart.org.

ISRAELI EMERGENCY MEDICINE CONFERENCE WHAT: The trip will include visiting all the

historic sites and tours of hospitals and disaster preparedness centers.

WHEN: March 3-12, 2008

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CONTACT: Roneet Lev, MD, tour leader, at roneet@cox.net.

TOPICS AND ADVANCES IN INTERNAL MEDICINE WHAT: This program will feature pre-

sentations of the latest information in virtually every area of medicine.

The entire course is focused on a presentation of the evidence for or against diagnostic or therapeutic recommendations with an emphasis on evidenced-based decision-making in internal medicine.

WHEN: March 6-12, 2008 WHERE: Hilton San Diego Resort CONTACT: Cheryl Featherstone at (888) 229-6263 or at ocme@ucsd.edu.

13TH ANNUAL PRIMARY CARE IN PARADISE WHAT: This four-day course will stress

preventive health issues and updates in general internal medicine and office family practice.

WHEN: March 17-20, 2008 WHERE: Hapuna Beach Prince Hotel, Hawaii INFORMATION: Visit www.scripps.org/conferenceservices.

57TH ANNUAL YOSEMITE POSTGRADUATE INSTITUTE FOR PRIMARY CARE PHYSICIANS WHAT: Continuing medical education course. Topics include dermatology, orthopedics, emergency preparedness, cardiology, sleeping disorders, COPD, ophthalmology, and diabetes.

WHEN: March 28-30, 2008 WHERE: Yosemite Lodge, Yosemite National Park COST: $325 physicians; $275 allied health professionals (RN, NP, PA); $100 medical students, interns, or residents CME: Up to 16 hours, Category 1 and Prescribe Credit INFORMATION: Call (559) 224-4224, ext. 118 or email csrau@fmms.org.

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Briefly Noted Nurse Practioner Supervision Requirements B y C A L I F O R N I A M E D I C A L A S S O C I AT I O N

here have been a number of questions about the law with respect to physician supervision of nurse practitioners. There are no statutory limits on how many nurse practitioners a physician may supervise, except that with respect to the furnishing and ordering of drugs a physician may supervise no more than four nurse practitioners at one time. For Medi-Cal it should be noted that the number of nonphysician medical practitioners who may be supervised by a single primary care physician must be limited to the full-time equivalent of one of the following: four nurse practitioners three nurse midwives four physician assistants four of the above individuals in any combination

T

The law requires nurse practitioners, when furnishing or ordering drugs or devices, to function pursuant to standardized procedures or protocols that are developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or his or her designee. The standardized procedure or protocol covering the furnishing of drugs or devices must also specify: which nurse practitioner may furnish or order drugs or devices; which drugs or devices may be furnished or ordered, and under what circumstances; the extent of physician and surgeon supervision; the method of periodic review of the nurse practitioner’s competence, including peer review; and review of the provisions of the standardized procedure.

(Business & Professions Code §2836.1.)

In addition, for Schedule II controlled substance protocols, the provision for furnishing such substances must address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is furnished. Nurse practitioners who are authorized to furnish Schedule II controlled substances must complete a continuing education course including Schedule II controlled substances based on the standards developed by the Board of Registered Nursing (Business & Professions Code §2836.1(g)(2)).

While the furnishing or ordering of drugs or devices by a nurse practitioner must occur under physician supervision, the statute does not require the physical presence of the physician, but does require: collaboration on the development of the standardized procedure, approval of the standardized procedure, and availability by telephone contact at the time of the patient examination.

Contact the California Medical Association or the San Diego County Medical Society for further information.

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Briefly Noted MEDICAL MYTHS

Reading in Dim Light Will Damage Your Eyes

By KETTY LA CRUZ | ASSISTANT EDITOR REALITY: Centuries before the invention

of electricity and the light bulb, people did most of their night reading by firelight. Does this mean our ancestors were unknowingly ruining their eyesight?

“Not necessarily,” according to Dr. Nicola Kim, assistant professor of ophthalmology at the Jones Eye Institute at the University of Arkansas for Medical Sciences. Dr. Kim asserts, “reading in dim or bright light will not change the health or function of your eyes. It may feel more difficult to focus if the

lighting is suboptimal, but this has no permanent effect on the structure of your eyes.” In other words, your eyes won’t wear out, nor will they become injured if you choose to read by candlelight.

The only negative consequence from reading in dim light is eye dryness. Dr. Kim explains that “any challenging visual activity will generally decrease a person’s blink rate and lead to discomfort from drying.” Fortunately, this discomfort can be easily remedied by applying lubricating eye drops.

As ophthalmologists well know, our eyes are designed to be resilient against most

RESOURCES: www.medem.com www.intelihealth.com www.uams.edu

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stresses. It is imperative that we take care not to do anything that may damage them prematurely. Looking directly into the sun or laser light, for example, can cause severe, irrevocable injury to your eyes, as does being exposed to certain toxic fumes. Small particles, like pieces of wood or glass, may also have damaging effects and should be avoided.

Although good lighting makes reading easier and can prevent eye fatigue and dryness, reading in dim light will not have any permanent, negative effects on your eyes.

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Letter to the Editor “What If There Were No SDCMS or CMA?”

To run display advertising in San Diego Physician, please contact Dari Pebdani for information and rates.

619-744-0528 or darip@sandiegomag.com

Dear Sir: I applaud Dr. Scherger’s excellent exposition of the benefits of membership in SDCMS and CMA [see November 2007 San Diego Physician]. He omitted one significant financial reason that no physician can argue they can’t afford to belong. “What if there were no SDCMS or CMA?” There would still be a 2 percent tax on physicians’ gross receipts as part of the governor’s healthcare reform package. That savings alone covers the dues for almost all physicians.

James T. Hay, MD Past President, SDCMS, 2001 Speaker, House of Delegates, CMA

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Ask Your Advocate

By Marisol Gonzalez

Expert Witness Fees

Q

UESTION: Do you have any information on what physicians can charge when they receive a subpoena or are giving testimony during a deposition?

ANSWER: CMA’s ON-CALL document #0910, “Expert Witness Issues,” discusses what physicians can charge when testifying as an expert or statutory witness.

EXPERT WITNESS FEES: TREATING PHYSICIAN

A non-party treating physician who is to be asked during a deposition to express opinion testimony or factual testimony regarding the past or present

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diagnosis or prognosis made by the physician, or who is asked the reasons for a particular treatment decision, must be paid as an expert witness. The physician’s reasonable and customary hourly or daily fee must be paid (A) for any time spent by the physician from the time specified in the deposition subpoena; or (B) from the time of the arrival of the physician should that be later than the time set forth in the deposition subpoena; and (C) until the time the physician is dismissed from the deposition, whether or not the physician is actually examined by any party attending the deposition (1).

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STATUTORY WITNESS FEES: NO EXPERT TESTIMONY

If the deposition or other examination of a treating physician involves only reading words and symbols in the medical records and requires no opinion, prognosis/diagnosis, or treatment justification testimony, only statutory witness fees must be paid: $35 per day plus $0.20 per mile round trip (2). This includes situations where words and symbols are not legible to the deposed practitioner and he or she approximates their meaning. Only the party requesting the deposition is responsible for payment of the physician’s statutory witness fee.

ceipt of an itemized statement from the expert (5).

PAYMENT OF EXPERT WITNESS FEES: TIMING

If the physician is a formally designated expert in a case, or is a treating physician and will be asked opinion questions at the deposition or other proceeding, payment for the expert’s anticipated time at the proceeding must either accompany the notice or subpoena, or be paid at the commencement of the proceeding (3). If the party giving the notice for the proceeding fails to tender the expert fee in this manner, the expert is not required to give testimony unless there is a stipulation to the contrary (4). If the examination of the expert takes longer than anticipated, the party giving notice of the proceeding must pay the balance of the expert’s fee within five days of re-

R ESO UR CES: (1) Code of Civil Procedure §2034.430(b) (2) Code of Civil Procedure §2020(f); Government Code §68093 (3) Code of Civil Procedure §2034.450; Government Code §68092.5(a) (4) Code of Civil Procedure §2034.460; Government Code §68092.5(b) (5) Code of Civil Procedure §2034.450(c); Government Code §68092.5(a)

QUESTION: I understand that United Healthcare has released an announcement requiring all participating, freestanding imaging facilities and physician offices performing echocardiography procedures be accredited by March 1, 2008, as a condition for reimbursement.

ANSWER: As long as these facilities have submitted their application to the American College of Radiology (ACR) or the Intersocietal Accreditation Commission (IAC) by March 1, 2008, they will be in compliance with the accreditation program. On the average it takes six to nine months to become accredited.

A B O U T T H E A U T H O R : Ms. Gonza-

lez is your SDCMS physician advocate. She can be reached at (858) 300-2783 or at MGonzalez@SDCMS.org with any questions you may have about your practice or your membership.

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Briefly Noted 2007-08 SDCMS Pictorial Membership Directory Please Correct the Following in Your Directory Copy e at SDCMS try our best to print a pictorial membership directory free of errors — with several rounds of proofing by several different people — but, unfortunately, there were several errors in our 2007-08 edition that we did not catch. If you haven’t done so already, please make the following corrections to your copy of our directory. Our sincerest apologies to those physicians whose listings were printed incorrectly. Thank you to all our physician members for your support of your colleagues, your patients, and your Medical Society!

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LOUBABA A. ADLOUNI, MD

HOUSE 1/2 PAGE VERTICAL AD

Dr. Adlouni’s office address is incorrect. It should be 15725 Pomerado Rd., Ste. 203, Poway, CA 92064.

KRISTI ANN DOVE, MD

Dr. Dove should be listed as board certified in both neurology and pain medicine.

MAHJABEEN M. KAMYAR, MD

Dr. Kamyar should be listed as specializing in pediatrics instead of pediatric allergy.

HYUN SIL KIM, MD

The photograph included with Dr. Kim’s listing is not in fact Dr. Kim. Dr. Kim does not have a photograph for our 2007-08 pictorial membership directory.

NISHA LAKHANI, MD

Dr. Lakhani does not specialize in anatomic pathology and clinical pathology.

And Dr. Lakhani’s correct address is 525 Third Ave., Chula Vista, CA 90190.

ROBERT A. SHUMWAY, MD

Though Dr. Shumway is board certified in otolaryngology, he should have been listed as specializing in — along with being board certified in facial plastic and reconstructive surgery — cosmetic surgery.

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Risk Management

Lost in Translation The Cost of Poor Communication he use of written educational materials, such as brochures and instruction sheets, is a fundamental and important part of any medical practice. Without them, effective communication with patients is jeopardized.

Developing written materials can be an expensive and time-consuming process, but it can become even more costly if patients find the materials confusing or hard to understand, leading them to misinterpret the information or not use it at all.

The National Assessment of Adult Literacy, a large survey conducted in 2003 by the National Center for Education Statistics, estimated that 14 percent of U.S. adults have a “below basic” level of “prose literacy,” defined as the ability to use “printed and written information to

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function in society, to achieve one’s goals, and to develop one’s knowledge and potential.”

The Joint Commission and the National Committee for Quality Assurance have both adopted guidelines specifying the need for patient education information and consent documents to be written in such a way that patients can understand them. Some legal experts indicate that providers and hospitals can be held liable for adverse outcomes suffered by patients who do not understand important health information needed for diagnosis and treatment.

All healthcare providers can best serve their patient populations by providing patients with easy-to-understand information, but it needs to be recognized that translating, like interpreting, is a

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By THE SCPIE COMPANIES

highly complex skill. Simple, temporary documents, such as flyers, can be successfully translated by a skilled volunteer; more substantive medical or legal documents should be translated by a professional.

While a centralized clearinghouse of translated health materials does not yet exist, national healthcare associations, pharmaceutical companies, and immigrant and refugee community-based organizations are often good sources of translated health-related patient materials.

Useful resources for translated materials can be found at the Resource Center of the Cross Cultural Care Program (www.xculture.org) or at the Health and Literacy Compendium (www.worlded.org).

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Interview Chris Van Gorder, FACHE President and CEO of Scripps Health

By SAN DIEGO PHYSICIAN

new technology. Our population continues to grow both larger and older, which creates greater demand for healthcare services.

And while many growth initiatives are taking shape across the Scripps system, the state of California requires us to focus much of our capital on complying with the seismic laws (SB 1953) just to keep our hospitals open past 2013 and 2030. Unlike some other local healthcare providers, Scripps receives no taxpayer subsidies. We rely on operating margin, philanthropy, and debt (borrowing) to fund our expansion and retrofitting work, which means we face pressure to perform strong financially so we can access the capital markets.

And California’s insurance industry has consolidated. There are fewer insurance companies now, which builds economic and contracting leverage that challenges hospitals and doctors.

SDP: WHAT DO YOU SEE AS THE BIGGEST CHALLENGES FACING SAN DIEGO COUNTY’S PHYSICIANS?

S

DP: WHAT DO YOU SEE AS THE BIGGEST CHALLENGES FACING THE SCRIPPS HEALTH SYSTEM TODAY AND INTO THE COMING FEW YEARS?

VAN GORDER: Like everybody in healthcare, we face challenges on a number of fronts. One significant issue for Scripps is the physician shortage. We’re already seeing shortfalls in some areas – ED calls and trauma calls are particularly affected – and we expect the situation to worsen over time. This is due largely to an aging physician community, the high cost of living in San Diego, low reimbursements for providers, and the small number of medical schools training future physicians in the United States.

In addition to having too few doctors, the nursing shortage is also going to continue. And often missed in the discussion are the pharmacists, imaging techs, therapists, and other allied healthcare workers we rely on. These shortages create supply-and-demand issues, compelling us to use more expensive travel and registry options, as well as more overtime for our own employees.

Another challenge is access to capital to expand our facilities and invest in

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VAN GORDER: Physicians are facing some of the same challenges affecting Scripps Health, namely, low reimbursement rates from state and federal government payers, as well as from the commercial sector. This places a financial strain on physicians, which is compounded by the steep costs associated with their own office staff and space. The independent physicians in particular are at a disadvantage when negotiating contracts with the consolidated insurance companies.

As our physician population gets older, we find they typically become less interested in taking ED and trauma center call. This dynamic places additional demand on the region’s already strained physician population.

SDP: WHAT DO YOU SEE AS THE BIGGEST CHALLENGES FACING SAN DIEGO COUNTY’S HEALTHCARE SYSTEM?

One of the key areas is behavioral health, which is going to loom as a huge weakness in this county. There are very few acute care providers that deliver inpatient behavioral health. It’s virtually impossible to make ends meet financially, given the reimbursements we receive, which VAN GORDER:

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in this case come primarily through the state and county. And while we have an excellent working relationship with the county, reimbursement here is lower than most places across the state, and our state is lower than most places across the country.

Another key issue revolves around the costs and approval processes for hospital construction projects. Our building costs in California are virtually twice as much as they are in other states, largely due to our requirement to upgrade for seismic reasons and our very high administrative costs created by many layers of government bureaucracy. The cost of building a replacement bed in this state is now more than $2 million per bed when you look at the square footage cost. That’s enormously expensive. And the steep costs are coupled with some really long processes to get approval to build. It can literally take years to get all the approvals to actually start construction – these longer lead times drive up costs. On top of that, there’s a lack of coordination between local and state government agencies that can be frustrating.

Additionally, our emergency departments in San Diego and across the nation are in a state of crisis. Scripps’ chief medical officer, Dr. Brent Eastman, was one of the authors of the recent Institute of Medicine report, “The Future of Emergency Care,” which found serious overcrowding of EDs, long wait times, and a shortage of critical specialists. This situation could be exponentially troubling in the event of a large-scale disaster. Fortunately, California has mechanisms in place to deal with disaster situations, with three mobile field hospitals that can be deployed anywhere in the state within 72 hours. Scripps also has extra capacity with surge tents at each of our hospital campuses.

SDP: WHAT HEALTHCARE REFORM PROPOSALS OR CONCEPTS DO YOU FAVOR? VAN GORDER: Scripps favors a public-private solution to reforming our healthcare system. I think history has shown that when you have government taking responsibility for healthcare insurance

and/or delivery, you’re going to end up with some form of rationing, either through time delays or actual rationing of care. I don’t think people are going to be very happy with that. And you can’t say that there’s a pure private solution, because government already assumes a huge burden with Medicare and Medicaid, and that’s not likely to change. So the only solution comes down to a more efficient public-private relationship, similar to what Gov. Schwarzenegger and others have proposed. A single, one-size-fits-all solution won’t work in this country.

One concept that will be fundamental to whatever healthcare system we have in the future will be the regionalization of resources, given our limited resources and the shortage of physicians, nurses, and key technical staff. If there is one thing to stand out from the IOM report, it is that we’re not going to have enough doctors, enough resources, and enough of the expensive, high-tech equipment, so we are simply going to have to face regionalization for people to have access to care. San Diego County’s trauma system has proven that regionalization of services can save lives.

SDP: WHAT WOULD YOU WANT EVERY PHYSICIAN IN SAN DIEGO COUNTY TO KNOW IF YOU HAD FIVE MINUTES ALONE WITH THEM? VAN GORDER: The notion that physicians and hospital administrators are adversaries needs to be left in the past. I think physicians and administrators are far more aligned as partners than they are as adversaries, and with all of the challenges now facing us, we certainly need to be more collaborative moving forward.

Scripps created the Physician Leadership Cabinet (PLC) eight years ago as a monthly forum where our elected physician leaders and hospital administrators sit down together and fill in the information gap that had previously existed between us. The goal is to share information and address controversial issues as a team, before they can become problems. By getting together in the same room and talking openly, we gain a common understanding of the challenges that we all face.

The PLC includes the chiefs of staff and chiefs of staff-elect from each of our five hospital campuses, the chief executives from each of our hospitals, and a chief nurse executive who represents the entire system.

Members of Scripps’ corporate executive team (in areas such as finance, IT, HR, and others) attend as guests and present as subject matter experts.

Dr. Eastman and I chair the PLC, but the meeting agendas are driven by physicians, and their issues receive top priority for discussion. And even though the PLC is an advisory cabinet, it does wield tremendous power and influence. In fact, 100 percent of physicians’ recommendations have been accepted since the PLC was formed in 2000.

I think physicians and administrators are far more aligned as partners than they are as adversaries, and with all of the challenges now facing us, we certainly need to be more collaborative moving forward.

It’s no coincidence that since the PLC was created, Scripps has achieved a remarkable turnaround as an organization, going from annual losses of $21 million in 2000 to an operating margin of $129 million in 2006. By sharing clinical and financial information across the table in a spirit of collaboration, Scripps physicians and administrators now have a broader understanding of key issues – and, as a result, can make better-informed decisions. Not surprisingly, Scripps has returned to strong financial footing, able to borrow and build for the future. Mutual support is the key; neither physicians nor the administrators can do it alone.

SDP: WHAT IS SCRIPPS HEALTH DOING TO HELP ADDRESS THE CHALLENGES IT FACES?

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VAN GORDER: We’re trying to create solutions to our own challenges where we can, and two key areas for Scripps are education and research. Scripps invested $12 million last year toward graduate medical education (GME) programs at Scripps Mercy Hospital’s San Diego and Chula Vista campuses and Scripps Clinic/Scripps Green Hospital. These programs train local doctors, most of whom stay in the San Diego community and help address our physician shortage. We’re also strong supporters of local nursing programs, having invested a combined $1 million in financial support toward nurse training in San Diego the past two fiscal years.

Scripps is also committed to excellence in clinical research, which is the source of advances in patient care. We add more than 100 new clinical trials each year, and we’re now expanding our infrastructure for clinical research so physicians across the Scripps system who are interested in participating in clinical trials will have the necessary support to do so. Scripps is also home to three newly created research programs led by renowned physician-scientist Eric J. Topol, MD: Scripps Genomic Medicine, Scripps Translational Science Institute, and Scripps Advanced Clinical Trials. We also recently recruited Brian F. Issell, MD, an accomplished oncologist and clinical research leader from the University of Hawaii, to lead Scripps’ systemwide research initiatives.

One of the things I recently proposed to the San Diego Regional Economic Development Corporation is that a public-private partnership be developed to create a regional clinical research organization (CRO), so patients can remain within their own healthcare system and remain with their own physician, and yet have access to the latest clinical trials and studies. Some patients don’t get access to the latest clinical trials because individual physicians can’t afford the infrastructure under which they can get patients into these programs. Physicians may also be concerned that if they refer their patients into these programs, they may not get them back. By creating a community CRO in partnership with other local healthcare providers, San Diego could be a hotbed for the latest trials, without the competitive nature of patients being referred out of their own healthcare system.

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AMA

Report From the AMA House of Delegates 2007 Interim Meeting

By JAMES T. HAY, MD

ouldn’t it be great if there were someone fighting for you to always be able to bill for all the services you render, to be able to collectively bargain with your peers against the megalithic health insurers, and to be able to develop private contracts with the seniors you treat? There is – it’s called the American Medical Association (AMA), Our AMA. This is a report of the activities and the policies developed, including those above, at the interim meeting held in Honolulu, November 9-13, 2007.

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FINANCING HEALTHCARE

In addition to resolutions that asked our AMA 1) to introduce national legislation to allow “balance billing” of Medicare patients and to preempt states from prohibiting balance billing of all other patients; 2) to redouble efforts for antitrust relief; and 3) to eliminate Medicare’s limiting charge, AMA’s Council on Medical Services released valuable reports on Medicare reform (e.g., study combining parts A and B), using tax credits and tax deductions to finance care, covering the uninsured, and on high-risk coverage. Each is filled

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with information we need as we work to improve the system we all work within. For more detail, see AMA’s National Health Care Policy Agenda.

It is clear physicians across the country are angry and restless and ready to “take back the profession” from those they feel have usurped its control. One of the more hotly debated issues of this meeting was a resolution about the “physician consortium for performance improvement” and whether the consortium should grant voting memberships to nonphysicians. The resolution was “referred for decision” to AMA’s board with a loud and clear message that quality must be defined by physicians and that physicians must be defined exclusively as MDs and DOs (CMS currently defines “physician” to include chiropractors, optometrists, and podiatrists).

GOVERNMENT PROGRAMS

The reauthorization of SCHIP has been a priority for both AMA and CMA in the quite recent past. This AMA House of Delegates defeated a resolution that would have changed AMA’s policy by advocating for a limit on SCHIP to those under 200 percent of the federal poverty level, to children only, and to have federal law preempt state laws that might offer more benefits

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or expand the pool of eligible participants.

Also considered were resolutions to “recognize that providing access to quality and affordable healthcare for all U.S. citizens is a fundamental society obligation,” and to “distribute our policy positions in opposition to a singlepayer system to all declared candidates for the presidency.” There is a fundamental division in our profession about what government’s role should be in the financing of healthcare. Nothing could be more obvious than in the diametrically opposite ideas embodied in these two resolutions. The first was referred for study, and the second was softened to state that we should tell the candidates what AMA’s solutions are for healthcare reform rather than say what we oppose. Incidentally, it was proposed, and the resolution referred for action (which means the board can go ahead as it sees fit), that the two major party candidates be invited to address AMA at its June 2008 meeting.

It will be quite interesting to see if that can be done logistically, and, if so, what the candidates say to a room full of a thousand doctors. Stay tuned.

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OTHER ISSUES

Bright on my (admittedly biased) radar screen was a resolution that was adopted without debate to “explore the barriers to primary care medicine as a career choice and … (its) impact.” Interestingly, this blends well with the report of CMA’s Primary Care Committee, just adopted by CMA’s board two weeks earlier and provides an opportunity to forward that report to AMA as it deliberates on this issue that is so important to such a significant portion of our membership.

Also adopted was a resolution asking that “AMA urge states to adopt legislation that provides liability relief for volunteer physicians,” a critical issue locally as our own SDCMS Foundation rolls out its volunteer recruitment efforts as part of Project Access San Diego (PASD).

The House adopted a lengthy set of “principles for strengthening the physician-hospital relationship,” proposed by the Organized Medical Staff Section (OMSS) of AMA. They are available to those interested on AMA’s website.

“

Those who choose not to be at the table end up on the menu.

”

California’s resolution to “work to reinstate the economic hardship deferment qualification” for student loans was also adopted. The discussion made it clear to many of us who didn’t know that these deferments had ceased.

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THE PEOPLE

None of this happens without the hard work of your delegates and alternate delegates. Bob Hertzka, San Diego’s senior on this delegation, threw his hat in the ring to be elected next June to AMA’s Council on Medical Services. Al Ray led as chair of California alternates in being sure there were never empty California seats at the table. Lisa Miller continued her networking and contributing to the discussion as our newest San Diegan at AMA. Diana Shiba, our San Diego resident delegate, made a significant impact in testimony at reference committees and at the House. And a San Diegan, Kristen Bell, from Encinitas, was honored with AMA’s “Beaumont Award in Medicine,” a recognition for a young physician who has already made substantial contributions to the profession.

Feel free to contact me (jthay@ncfmg.com) or any of those named above if you have questions or comments. And check out the AMA website (www.ama-assn.org) for more details of the issues or CMA’s website (www.cmanet.org – membersonly section) to find a more detailed summary of the resolutions and reports considered at this meeting.

Our AMA is all about people, you and me, the physicians of this country. It is the voice for medicine nationally. As the saying goes, those who choose not to be at the table end up on the menu. We hope you are already a member and therefore at the table. Together we are stronger.

A B O U T T H E A U T H O R : Dr. Hay is a full-time family

physician in Encinitas. He was president of SDCMS in 2001, is currently speaker of the California Medical Association House of Delegates, and an AMA delegate.

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Healthcare Technology

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icensing point-of-care databases such as MDConsult or UpToDate can be expensive. Annual fees for these and other well-regarded database licenses or even a small core of clinical journals can easily cost thousands of dollars per year for a physician in private practice. For larger user groups, e.g., healthcare systems, hospitals, and universities, tens of thousands of dollars in annual licensing fees is very common. In addition to the escalating fees for these electronic resources, there is also the administration and maintenance of the licenses, which is also costly in terms of both the staff time spent negotiating the license and in maintaining the subscription(s) to the legal satisfaction of the publisher. Fortunately, for San Diego area clinicians, there is an alternative.

user’s email box. As a back-up precaution, the user may want to supply an alternate email address/account when registering for such sites.

Presently, however, there are only three sites requiring registration at the OCL II: Merck Medicus, WebMD’s eMedicine, and the United Health Foundation (UHF), which requires a registration/request in order to obtain a free copy of the British Medical Journal’s (BMJ Group) Clinical Evidence, a leading international database of systematic reviews with an evidencebased focus on therapies.

The Online Clinical Library II (OCL II — http://gort.ucsd.edu/clinlib/public) UCSD’s Online Clinical Library II is a public portal providing one-stop access to some excellent and free knowledgebased information resources currently available on the Internet. The OCL II was created by the staff at the UCSD Medical Center Library in Hillcrest to meet the needs of a growing number of unaffiliated users who regularly visit the university’s Online Clinical Library I but who are unable to access the subscriber resources there due to publisher and licensing restrictions. As a public-use portal, clinicians in San Diego County have access to the OCL II from anywhere in the world. Some sites at the OCL II require registration, and, for those sites, the user is advised to be sure to opt out of the mailings and promotional offers; otherwise, certain unwanted advertising (i.e., email) will most surely arrive in the

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reference (e.g., Merck Manual of Dx and Rx); and evidence-based practice resources (e.g., TRIP-Turning Research Into Practice).

Merck’s site is one of the most comprehensive of the free medical portals currently available for professionals. More than 40 medical texts covering 20 specialties are provided through the Merck Medicus version of Elsevier’s MDConsult. Harrison’s Online, the venerable textbook of internal medicine, along with Dxplain, a diagnostic database, are just two of the leading patient care resources provided. In addition, Merck Medicus supplies full text and abstracts to more than 150 peer-reviewed journals in all specialties.

A database of images and slides and a version of Medline (PubMed) are also integrated into this portal. The Cochrane Library, the gold standard for systematic reviews, provides access to both abstracts and the full-text reviews.

Caveat: Because of Merck’s depth of content, many resources are restricted to licensed healthcare workers within the United States. Therefore, a user’s medical license will be required at registration to gain access to certain areas of the site, e.g., MDConsult, Dxplain, and Harrison’s Online, et al.

OCL II RESOURCES

A visit to the OCL II will reveal a very clean layout of free resources organized under familiar categories: databases (e.g., eMedicine, Relemed, PubMed, et al); electronic texts and journals (e.g., FreeBooks4doctors, Merck Medicus, and the Directory of Open Access Journals); drug information (e.g.,DailyMed, ePocrates, The Natural Standard); patient education (e.g., Medline Plus and WebMD); medical

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WHY FREE?

For certain free sites, the incentive to the publisher is obviously advertising and branding. This is most likely the case with Merck Medicus. For other free sites, e.g., Free Medical Journals or the Directory of Open Access Journals, free access is the result of a growing scientific research and political movement called open access. Open access is not a

business model, but rather an availability or “access” model. There are a variety of open access business models. Generally speaking, though, open access journals do not charge readers or their institutions subscription fees. In the United States, open access is supported by members of Congress through legislation known as the Federal Research Public Access Act (FRPAA). The National Institutes of Health (NIH) supports open access by strongly encouraging researchers who receive federal funding to make the final version of their articles publicly available through the national repository, PubMed Central (a National Library of Medicine entity), immediately after the final date of the journal’s publication.

The Directory of Open Access Journals (DOAJ) at the OCL II provides access to about 3,000 free, peer-reviewed or editorial quality controlled, full-text journals.

In addition to the resources that are available at the OCL II, users may also learn about other services like the article delivery service Loansome Doc, a feebased service provided by the National Library of Medicine (NLM). In the event that the article needed is not available through a free service, NLM will supply the document to the user for a small fee.

Decidedly, fee is no contest for free.

However, there may be certain pointof-care resources the user may want, no matter what the price. In these instances, a discount is not unwelcome.

Many professional medical associations provide free access or discounts to publications or point-of-care resources as a benefit to their members. For example, the American College of Physicians (ACP) provides to its members a free subscription to ACP Journal Club along with access to the top-rated, evidence-based, ACP PIER (Physician Information and Education Resource). The American Academy of Family Physicians provides discounts on Dynamed, FirstConsult, MDConsult, and other point-of-care resources for its members. Continuing medical education

has never been more accessible or economical.

Disclaimer: Neither the author nor the University of California, San Diego, have a direct financial interest in discussing any of the publishers or products presented in this article.

ABOUT THE AUTHOR: Mr. Haynes is head of UCSD’s Medical Center Library. He can be reached at chaynes@ucsd.edu.

Rosenberg, Shpall & Associates, APLC If your medical license or privileges are on the line…

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PHYSICIAN WORKFORCE

Solo and smallgroup physicians report that they have reduced Medi-Cal by 13 percent each, and, surprisingly, large-group physicians report that they have reduced Medi-Cal by more than 25 percent.

2007 San Diego County Physician Workforce and Compensation Survery

By Tom Gehring, SDCMS CEO and Executive Director n 2002, the San Diego County Medical Society (SDCMS) conducted San Diego County’s first Physician Workforce and Compensation Survey, the results of which provided SDCMS and local healthcare policymakers with their first insights into physicians’ attitudes toward their work and workplace – with our 2002 survey quantifying as well San Diego County’s physician compensation environment. In 2005, we conducted our second Physician Workforce and Compensation Survey, and in 2007 our third. Our 2007 survey, the highlights of which are detailed in this report, contained all of the questions included in our 2005 survey, and added two questions about physician on-call behavior and several questions about reimbursements from County Medical Services.

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I. KEY FINDINGS A) Physicians were asked about their history and plans for Medicare.

1. Physicians were asked whether they took Medicare three

2.

3.

years ago. a) For every grouping except solo physicians, physicians reported no change from three years ago. b) However, solo physicians reported a 10 percent drop – from 91 percent to 81 percent – in taking Medicare.

In the face of a 10 percent cut in Medicare, a significant number of physicians would change their behavior with respect to Medicare: a) Roughly two-thirds of community clinic and academic physicians would continue to see Medicare “as is,” but one-third would change their Medicare practice by reducing or eliminating Medicare. b) Roughly 40 percent of large- and medium-group physicians would continue to see Medicare “as is,” but roughly 60 percent would change their Medicare practice by reducing or eliminating Medicare. c) Only about one-quarter of small-group and solo physicians would continue to see Medicare “as is.”

Recognizing that not every physician accepted Medicare before a postulated 10 percent cut, the net Medicare acceptance rate, without any change in practice pattern, is presented in blue below.

3.

TABLE 2: MEDI-CAL ACCEPTANCE RATES WITH AND WITHOUT A 5% PHYSICIAN REIMBURSEMENT CUT

90%

81%

67%

5% Cut - Continue to Take Medi-Cal “As Is”

65%

64% 59%

60% 53%

50% 50%

40%

36%

30% 20%

20% 10% 0% Community Academic Clinics Medicine

19%

30%

80% 70%

0% Cut - Continue to Take Medi-Cal “As Is”

72%

4.

35%

77%

70%

100% 21%

86%86%

80%

TABLE 1: NET MEDICARE ACCEPTANCE RATES WITH AND WITHOUT A 10% PHYSICIAN REIMBURSEMENT CUT

90%

prisingly, large groups report that they have reduced MediCal by more than 25 percent.

Table 2 graphically represents the percentage of physicians currently taking Medi-Cal who would continue to take Medi-Cal “as is.” All others would either eliminate MediCal, significantly reduce the number of patients they see with Medi-Cal, or take no new Medi-Cal patients.

Large Group

Medium Group

Small Group

Solo

Recognizing that not every physician accepted Medi-Cal before a postulated 5 percent cut, the net acceptance rate, without any change in practice pattern, for Medi-Cal is presented in blue below:

TABLE 3: NET MEDI-CAL ACCEPTANCE RATES AFTER A 5% PHYSICIAN REIMBURSEMENT CUT

69%

60%

100% 7%

50% 40%

79% 65%

80%

44%

70% 33%

Take Medicare “As Is” after 10% Cut Do Not Take Medicare “As Is” after 10% Cut

31%

19%

81%

70%

30% 20%

17%

90%

60%

10%

50%

0%

40%

62% 86% 93%

Community Academic Clinics Medicine

Large Group

Medium Group

Small Group

83%

81%

Solo 30% 56%

B)

Physicians were asked about their history and plans for Medi-Cal. 1. On average, 63 percent of physicians took Medi-Cal in 2007. Physicians reported that three years ago 70 percent took Medi-Cal. 2. Physicians reported that for solo and small-group physicians, they have reduced Medi-Cal by 13 percent each, and, sur-

20%

38%

Take Medi-Cal After 5% Cut Do Not Take Medi-Cal After 5% Cut

10% 14% 0%

F E B R U A R Y

Community Academic Clinics Medicine 2 0 0 8

|

S A N

Large Group D I E G O

Medium Group

Small Group

Solo

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27

PHYSICIAN WORKFORCE

C)

Physicians were asked about their history and plans for County Medical Services (CMS).

1. On average, 47 percent of physicians took CMS in 2007.

2. Physicians reported that three years ago, 48 percent took CMS. Community clinic physicians reported they reduced CMS by 14 percent. All other modes had no significant change in CMS acceptance.

3. Projecting forward, absent a change in CMS reimbursement, the future looks bleak for CMS patients who need to see a physician:

TABLE 4: COUNTY MEDICAL SERVICES ACCEPTANCE RATES WITH NO CHANGE IN CMS REIMBURSEMENT

100% 11% 90%

17%

14%

83%

86%

29% 80%

42%

70%

63%

60% 50% 89%

40% 71% 30%

58%

20%

37%

Take CMS If Unchanged Do Not Take CMS If Unchanged

10%

Large Group

Medium Group

Small Group

Solo

D) The

specialties that are in crisis in San Diego County – defined as having longer-than-average wait times for new patients, a perception that this specialty was in shortage, and a perception of difficulty recruiting within the specialty – are internal medicine, neurology (also in crisis in 2005), orthopedic surgery (also in crisis in 2005), and psychiatry (also in difficulty in 2005).

E)

The specialties that are in difficulty in San Diego County – defined as one meeting two of the three criteria defining a specialty “in crisis” (see “D” above) – are family medicine, ob-gyn (also in difficulty in 2005), hematology/oncology, nephrology, otolaryngology, (also in crisis in 2005), and pulmonology (also in difficulty 2005).

F)

Forty-five percent (unchanged from 2005) of physician respondents felt there was a physician shortage; however, when the significant influx of academic respondents in the 2007 survey is factored out (resulting in an “apples to apples” comparison to 2005 data), there is an increase from 45 percent to 50 percent of physicians who believe there is a shortage. When examined by practice size, 43 percent (up from 35 percent in 2005) of solo and small-group physicians felt there was a physician shortage, while 54 percent (up from 48 percent in 2005) of physicians practicing in a medium or large setting felt there was a physician shortage.

Academic physicians do not believe there is a physician shortage.

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than 20 physicians felt there were shortages. Of those listed, some specialties had longer-than-average wait times for a new patient appointment – an informal indicator that a perceived shortage by physicians is translating into a real problem for patients.

1. Internal Medicine (repeat from 2005) (excessive wait time in 2007) 2. Family Medicine (repeat from 2005) 3. Gastroenterology 4. Neurology (repeat from 2005) (excessive wait time in 2007) 5. Dermatology (repeat from 2005) 6. Endocrinology 7. Pain Medicine 8. Psychiatry (repeat from 2005) (excessive wait time in 2007) 9. General Surgery (repeat from 2005) 10. Neurosurgery (repeat from 2005) 11. Rheumatology 12. Orthopedic Surgery (repeat from 2005) (excessive wait time in 2007) 13. Obstetrics and Gynecology (repeat from 2005) (excessive wait time in 2007) 14. Otolaryngology (repeat from 2005) (excessive wait time in 2007) 15. Pediatrics 16. Anesthesiology (repeat from 2005) H) Of those who were recruiting or involved in recruiting, 41 per-

0% Community Academic Clinics Medicine

G) The following is a list (in priority order) of specialties where more

F E B R U A R Y

cent (down slightly from 45 percent in 2005) reported some difficulty in recruiting, while 33 percent (essentially unchanged from 34 percent in 2005) reported significant difficulties recruiting.

1. A significant difference emerged when analyzing recruiting difficulty by practice size. An astonishing 86 percent of solo and small-group physicians reported difficulty recruiting (either some difficulty or significant difficulty). No less surprising and disconcerting is that academic physicians are similarly challenged: 74 percent reported difficulty recruiting (either some difficulty or significant difficulty). That same statistic for physicians practicing in medium and large groups was “only” 64 percent. Everyone is having a problem recruiting physicians to San Diego County.

2. Significant in-specialty recruiting difficulty was indicated for the following specialties (sorted alphabetically): • Family Medicine (repeat from 2005) • General Surgery (repeat from 2002 and 2005) • Hematology/Oncology (upgrade from some recruiting difficulty in 2005) • Internal Medicine (repeat from 2005) • Nephrology • Neurology (repeat from 2002 and 2005) • Orthopedic Surgery (repeat from 2005) • Otolaryngology (repeat from 2005) • Psychiatry (repeat from 2002 and 2005) • Pulmonology (upgrade from some recruiting difficulty in 2005) • Radiology (repeat from 2002 and 2005) 2 0 0 8

3.

I)

In 2005, significant problems were reported in recruiting primary care physicians in internal medicine and family medicine. In 2007, this trend dramatically accelerated: The quantitative numbers on physicians reporting difficulty in recruiting to internal medicine and family medicine are very high.

On the subject of physician retention, the 2007 survey projects that 82 percent of San Diego County physicians will maintain their practice “as is” for the next three years.

1. This is essentially unchanged from 2005. When analyzed by district, North County Inland and South Bay physician “retention” was lower than the average.

2. Not surprisingly, of those physicians likely to change their practice mode, there was a clear dropoff for physicians in practice for more than 30 years, of whom only 59 percent said they would be in practice in three years.

3. Very surprisingly, there is a sharp dip in physician retention at the six- to 10-year point.

J) The

average number of total hours worked

by San Diego County physicians, including clinical and non-clinical hours, was 60.1 hours per week, up from 57 hours in 2005. The most significant component of this increase was from academic physicians. When compared to 2002 data, the physician workweek is getting longer. The 2002 average was 53 hours, in 2005 the workweek was 57 hours, and in 2007 it was 60.1. Over the past five years, working hours have increased by seven hours.

1. There was a clear difference in total hours worked when analyzed by group size. Solo and small-group physicians work longer hours – on average 61.9, up from 60 hours per week in 2005 – than doctors practicing in the medium- and large-group settings: 54.4 hours per week (unchanged from 2005).

2. The total hours worked by female physicians was significantly less: 53.6 (same as in 2005) hours per week versus

3.

K)

62.1 hours (up from 58 hours per week in 2005) worked by their male counterparts. Of note, there was no significant difference in the number of patient-care hours for female versus male physicians.

Specialists averaged 62.8 total hours per week (up from 58 hours per week). Primary care physicians averaged 54.7 total hours per week (up from 53 hours per week), with no significant difference in patient-care hours between specialists and primary care doctors.

A San Diego County physicians spend, on average, 39 hours per week seeing patients.

1. There was a significant difference in patient hours between full-time male (40.4 hours seeing patients) and full-time female physicians (35.7 hours seeing patients).

2. There was also significant variation between the hours spent with patients for the various modes of practice: a) Solo and small-group physicians: 42.6 hours per week seeing patients. b) Medium- and largegroup physicians: 39 hours per week seeing patients. c) Physicians practicing in academic medicine: 34.3 hours per week seeing patients.

3. When compared to 2005 data, the number of hours spent directly in patient care in 2007 dropped. However, in 2005 there were almost no academic physicians. If the academic physicians are factored out of the 2007 data, then there is negligible difference between the 2005 and 2007 data for patient hours per week.

F E B R U A R Y

1.

2.

L) Sixty percent of physicians responded that time spent with patients was adequate, while 39 percent said that time spent was inadequate. This is unchanged from 2005.

Solo and small-group physicians, by a 62 percent to 38 percent ratio, felt (overwhelmingly) that time spent with patients was adequate. Of note, this satisfaction with time spent for solo and small-group physicians is down significantly from 2005 data.

Medium- and large-group physicians, on the other hand,

2 0 0 8

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PHYSICIAN WORKFORCE

3.

4.

5.

M)

N)

30

were almost evenly split (55 percent to 45 percent) that time spent with patient care was adequate. This is unchanged from 2005.

Of note, physicians practicing in an academic setting were the most satisfied with time spent with patients of any of the modes of practice at 66 percent.

In 2007, 57 percent of male physicians were satisfied with the time spent with patients, while 66 percent of female physicians were satisfied with the time spent with patients.

Of note, this a reversal from 2005 data, where the ratio was males at 61 percent satisfied versus females at 52 percent satisfied.

Specialists are 64 percent satisfied with time spent with patients, while primary care physicians were at 54 percent.

This is essentially identical to 2005 values.

Overall wait times for new patient appointments have not changed since 2005. The average time for a new patient to obtain an appointment in 2005 and 2007 was 2.2 weeks, or 11 business days. In a reversal from 2005, the time to obtain an appointment for solo physicians went from the shortest in 2005 to next to longest.

1. In 2007, small- and medium-group wait times for new appointments went from among the longest to the two shortest wait times.

2. In 2007, there were longer-than-average wait times for nephrology, neurology, allergy and immunology, ophthamology, hematology/oncology, psychiatry, orthopedic surgery, and pulmonology.

3. Neurology, ophthalmology, and pulmonology also had longer-than-average wait times from 2005.

4. When compared to 2005 data, the wait times for internal medicine increased significantly, while wait times for family medicine dropped.

The dissatisfaction of physicians with the practice of medicine in San Diego County is strong. Overall, 50 percent (down slightly from 53 percent in 2005) are less satisfied with the practice of medicine than they were five years ago. Physicians reported that 19 percent – up from 13 percent two years ago – are more satisfied, and 31 percent (almost unchanged) see no change in their satisfaction with the practice of medicine. Unlike 2005, there is strong variation along several axes of data analysis.

1. Male physicians are significantly more dissatisfied (54 percent vs. 39 percent) than female physicians.

2. Solo and small-group physicians are hugely more dissatisfied (60 percent dissatisfied vs. 10 percent more satisfied) than medium- and large-group physicians or academic physicians (where the dissatisfied still outweigh the satisfied but by a much lower ratio: about 42 percent dissatisfied vs. 22 percent satisfied).

3. A similar differential exists when analyzed by specialty versus primary care. The specialists are much more dissatisfied (57 percent dissatisfied vs. 14 percent more satisfied) than primary care physicians (39 percent dissatisfied vs. 28 percent more S A N

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4.

satisfied).

There is a huge dissatisfaction-satisfaction differential when examined by years in practice. Physicians who have been in practice six to 10 years are unhappy, and those practicing between 11 and 15 years are even unhappier. The dissatisfiedsatisfied differential (the difference between those who are more satisfied and those less satisfied) goes from 26 percent for physicians in their first five years of practice to 38 percent in their second five years of practice to 47 percent in their third five years of practice.

O)

Physician compensation has improved vis-à-vis 2005.

1. Physicians were asked whether their compensation went up, stayed the same, or went down relative to their compensation three years ago. The general compensation trend is positive. Forty-three percent felt that compensation increased since 2005; 28 percent felt that compensation remained the same; and 29 percent felt that compensation decreased.

2. In a geographic anomaly, solos and small-group physicians in Hillcrest and South Bay are paid less than their geographic peers.

3. Female physicians make less than their male counterparts, though the female physician compensation trend is more positive than the male physician compensation trend.

4. Relative to three years ago, the compensation trend of specialists has not been as positive as primary care physicians, though primary care physicians are reimbursed less than specialists.

5. When analyzed for years in practice, the trends are not surprising: Younger physicians see their compensation increasing, while older physicians do not. However, the 6–10 year cohort is not getting the increases in pay they expect.

P)

Specialty-specific compensation information (more detailed information is presented in the complete report).

1. The lowest paid specialties are family medicine, nephrology, neurology, pain medicine, pediatrics, internal medicine, and psychiatry.

2. The highest paid specialties are neurosurgery, cardiology, orthopedic surgery, otolaryngology, pathology, radiology, thoracic surgery, and gastroenterology.

Q)

Physicians were asked about average on-call days per month.

1. Solo and small-group physicians: 2.3 days of call without stipend and 1.4 days of call with stipend 2. Medium- and large-group physicians: 2.7 days of call without stipend and 0.8 days of call with stipend 3. Academic physicians: 4.0 days of call without stipend and 1.3 days of call with stipend.

II. A TALE OF THREE PRACTICES An underlying theme of the 2005 Physician Workforce and Compensation Survey was the widening gulf between the solo and smallgroup practices – defined as fewer than five physicians in a practice

2 0 0 8

– and the medium- and large-group practices. With the significant number of academic physicians responding to the 2007 survey, there appear to be three distinct cohorts in modes of practice. Across a number of factors, there are significant differences between these practice types. Table 5 below summarizes the differences:

An astonishing 86 percent of solo and small-group physicians reported difficulty recruiting (either some difficulty or significant difficulty).

TABLE 5: TABLE DIFFERENCES BETWEEN SOLO AND SMALL-GROUP PRACTICES AND MEDIUM- AND LARGE-GROUP PRACTICES

SOLO OR SMALL GROUP PHYSICIANS

MEDIUM- OR LARGE-GROUP PHYSICIANS

ACADEMIC MEDICINE PHYSICIANS

Very Dissatisfied

Somewhat Dissatisfied

Somewhat Dissatisfied

Satisfied

Less Satisfied

Very Satisfied

Longer

Shorter

Much Longer

Longer Than Average

Average

Shorter Than Average

Lesser

Greater

Greater

CONCERNED ABOUT RECRUITING NEW PHYSICIANS:

Very Concerned

Less Concerned

Concerned

CONCERN ABOUT A PHYSICIAN SHORTAGE:

Less Concerned

Concerned

Not Concerned

DISSATISFACTION WITH THE PRACTICE OF MEDICINE: SATISFACTION WITH TIME SPENT WITH PATIENTS: TOTAL WORK HOURS: PATIENT CARE HOURS: COMPENSATION

III. DIFFERENCES BETWEEN MALE AND FEMALE PHYSICIANS While there are many similarities, there are some differences between male and female physicians. Table 6 below summarizes the differences: TABLE 6: DIFFERENCES BETWEEN MALE AND MALE PHYSICIANS

TOTAL WORK HOURS: PATIENT CARE HOURS: SATISFACTION WITH TIME SPENT WITH PATIENTS: DISSATISFACTION WITH THE PRACTICE OF MEDICINE: COMPENSATION AND COMPENSATION TREND:

MALE PHYSICIANS

FEMALE PHYSICIANS

Longer

Shorter

Slightly Longer

Slightly Shorter

Slightly Less

Slightly More

More Dissatisfied

Less Dissatisfied

Paid More, but Improvement Rate Lower

Paid Less, but Improvement Rate Greater

IV. PHYSICIAN DIFFERENTIAL BEHAVIOR ALONG THE AGE CONTINUUM While there are many similarities, there are some clear differences along the age continuum.

A. With respect to physician retention: 1. There is a surprisingly sharp dip in physician retention at the six- to 10-year point.

F E B R U A R Y

2 0 0 8

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PHYSICIAN WORKFORCE

Not surprisingly, of those physicians likely to change their practice mode, there was a clear drop-off for physicians in practice for more than 30 years, of whom only 59 percent said they would be in practice in three years.

There is a huge dissatisfaction-satisfaction differential when examined by years in practice. The physicians who have been in practice for six to 10 years are unhappy, and those 2.

B.

C.

practicing between 11 and 15 years are even unhappier. The dissatisfied-satisfied differential (the difference between those who are more satisfied and those less satisfied) goes from 26 percent for physicians in their first five years of practice to 38 percent in their second five years of practice to 47 percent in their third five years of practice.

When analyzed for years in practice, the trends are not surprising: Younger physicians see their compensation in-

TABLE 7: OVERVIEW OF SPECIALTIES IN CRISIS AND IN DIFFICULTY

Red = In Crisis • Blue = In Difficulty (See definitions of “in crisis” and “in difficulty” on page 28, letters “D” and “E.”) PRIMARY CARE

Family Medicine

Yes

Internal Medicine

Yes

Pediatrics

Yes

OB/GYN (in difficulty 2005)

Yes

FEWER THAN FIVE RESPONSES

GREATER THAN AVERAGE WAIT TIMES FOR NEW PATIENTS

PHYSICIANS PERCEIVE THIS AS A SHORTAGE

DIFFICULTY RECRUITING

Yes

Significant

Yes

Significant

Yes

Some

Yes

Yes

Some

Yes

Some

Yes

Allergy and Immunology

Yes

Anesthesiology

Some

Some

Cardiology

Yes

Dermatology (in difficulty 2005)

Some

Emergency Medicine Endocrinology

Yes

Yes

Gastroenterology

Yes

Yes

Geriatric Medicine

Yes

Yes

Hand Surgery

Yes

Significant

General Surgery (in difficulty 2005)

Yes

Hematology/Oncology

Some

Significant

Yes

Hepatology Nephrology

Yes

Neurology (in crisis 2005)

Yes

Significant Yes

Significant

Yes

Neurosurgery (in crisis 2005)

Yes

Occupational Medicine Ophthalmology (in difficulty 2005)

Yes

Orthopedic Surgery (in crisis 2005)

Yes

Otolaryngology (in crisis 2005)

Yes

Pain Medicine

Some Yes

Significant

Yes

Significant

Yes

Pathology Physical Medicine and Rehabilitation

Yes

Plastic Surgery

Yes

Psychiatry (in difficulty 2005)

Yes

Yes

Significant

Pulmonology (in difficulty 2005)

Yes

Some

Significant

Some

Significant

Radiology (in difficulty 2005) Radiation Oncology

Yes

Rheumatology (in difficulty 2005)

Yes

Sports Medicine

Yes

Thoracic Surgery

Yes

Yes

Some

Urology (in crisis 2005)

Yes

Vascular Surgery

32

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F E B R U A R Y

Some 2 0 0 8

creasing, while older physicians do not. However, the six- to 10-year cohort is not getting the increases in pay they expect.

The dissatisfaction of physicians with the practice of medicine in San Diego County is strong.

V. SPECIALTY SPECIFIC INFORMATION Although highly subjective, the study identified specialties in crisis – defined as longer-than-average wait times for new patients, a perception that this specialty was in shortage, and a perception of difficulty recruiting within the specialty – highlighted in red in Table 7.

The specialties that are in crisis in San Diego County are internal medicine, neurology (also in crisis in 2005), orthopedic surgery (also in crisis in 2005), and psychiatry (also in difficulty in 2005).

In addition, those specialties that were in difficulty – defined as meeting two of the three criteria above – were highlighted in blue in Table 7. The specialties that are in difficulty in San Diego County are family medicine, ob-gyn (also in difficulty in 2005), hematology/oncology, nephrology, otolaryngology (also in crisis in 2005), and pulmonology (also in difficulty 2005).

E.

VI. DEMOGRAPHICS OF THE PHYSICIAN RESPONDERS 359 active physicians responded. Eight residents, students, retired physicians, and physicians not seeing patients were removed from the total response of 367 data pool. The 2005 survey had approximately 100 more respondents.

B. 70 percent of the respondents were SDCMS members. This was consistent with the 2005 survey. SDCMS members represent about 30 percent of San Diego County’s approximately 6,500 to 7,000 active, practicing physicians.

C. Respondents were 70 percent male and 30 percent female.

This compares favorably with a 75/25 ratio of male-tofemale physicians in San Diego County. Proportionally more female physicians responded than in the last two surveys.

D. Respondents were evenly distributed throughout the physician lifecycle: 32 percent in their first 10 years of practice; 31 percent were in their second decade of practice; and 37 percent were in practice for more than 20 years. This was consistent with the 2005 survey.

A.

F.

Of the responding physicians, 41 percent were in primary care – defined as practicing in the specialties of family medicine, ob-gyn, pediatrics, and internal medicine. 59 percent were categorized as practicing outside of primary care, i.e., as specialists. This compares favorably with a primary care physician/specialist ratio of 39 percent/61 percent for all physicians in San Diego County, and was consistent with the 2005 survey. Of note, female physicians make up 42 percent of the primary care physicians but only 22 percent of specialists.

The mode of practice breakdown was as follows: 1. Solo (1-2 physicians): 24 percent 2. Small Group (3-4 physicians): 7 percent 3. Medium Group (5-25 physicians): 19 percent 4. Large Group (more than 25 physicians): 22 percent 5. Academic Medicine: 26 percent 6. Community Clinic: 2 percent

When compared to the 2005 survey, proportionally fewer Permanente Medical Group physicians participated, and significantly more UCSD physicians (referred to as physicians practicing in academic medicine) responded.

TABLE 9: DISTRIBUTION OF SURVEY RESPONDENTS BY SIZE OF PRACTICE

TABLE 8: DISTRIBUTION OF SURVEY RESPONDENTS BY YEARS IN PRACTICE

50%

48%

25%

2005

22%

2007

40%

20% 16%

17%

17%

16%

30%

15%

24%24%

12%

22%

26%

19%

20%

10%

14% 10% 7% 7%

5%

6%

1% 2%

0%

0% 0-5 Years

6-10 Years

11-15 Years

16-20 Years

21-30 Years

30+ Years F E B R U A R Y

Solo (1-2)

2 0 0 8

Small Group (3-4) |

S A N

Medium Group (5-150) D I E G O

Large Group (>150)

Academic Community Medicine Clinic

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PHYSICIAN WORKFORCE

There is a huge dissatisfaction-satisfaction differential when examined by years in practice.

The physicians who have been in practice for six to 10 years are unhappy, and those practicing between 11 and 15 years are even unhappier.

G.

H.

85 percent were full-time, and 15 percent were half-time.

This represents a doubling of the percentage of physicians working part-time who responded to the survey, and may be indicative of more physicians working at half-time or less.

Of note, there was no significant difference between the percentage of males and females working part-time (defined as 20 hours of patient care or fewer) since the last survey.

Because of the excellent response from UCSD, there was a completely expected geographic distribution peak for academic physicians in Hillcrest and in La Jolla. However, solo, small group, medium group, and large group physicians were evenly distributed. Compared to the last survey, there were fewer Permanente physicians. There were no underrepresented geographic areas.

TABLE 10: DISTRIBUTION OF SURVEY RESPONDENTS BY MODE OF PRACTICE AND

BY AREA OF COUNTY

50% 45% Solo/Small

44

Medium/Large Academic Medicine

40% 35% 30% 27

25% 23

23 20

20%

18

17 15

15% 10%

15

15

15

10

9

13

11

6

5%

3 1

2

0% E - East County

34

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F E B R U A R Y

2 0 0 8

HHillcrest

J - La Jolla

K - Kearny N - North N - North S - South County Mesa County County Coastal Inland

I. SPECIALTY DISTRIBUTION 1. THE FOLLOWING SPECIALTIES HAD MORE THAN 20 RESPONDENTS (# OF RESPONDENTS):

• • • •

PHYSICIANS CAPITAL ASSURANCE SERVICES

“The Physician’s Advocate”

Family Medicine (51) Internal Medicine (40) Pediatrics (36) Obstetrics and Gynecology (22)

2. THE FOLLOWING SPECIALTIES HAD BETWEEN 5 AND 20 RESPONDENTS (# OF RESPONDENTS):

• • • • • • • • • • • • • • • • • • • •

Emergency Medicine (19) Orthopedic Surgery (18) Psychiatry (13) Ophthalmology (13) Radiology (12) General Surgery (12) Otolaryngology (9) Pulmonology (8) Hematology/Oncology (8) Neurology (8) Anesthesiology (7) Nephrology (7) Cardiology (6) Pathology (6) Urology (5) Urgent Care (5) Allergy and Immunology (5) Neurosurgery (5) Infectious Diseases (5) Dermatology (5)

3. THE FOLLOWING SPECIALTIES HAD FEWER THAN 5 RESPONDENTS (# OF RESPONDENTS):

• • • • • • • • • • • • •

Vascular Surgery (4) Gastroenterology (4) Radiation Oncology (4) Plastic Surgery (4) Pain Medicine (3) Occupational Medicine (3) Thoracic Surgery (3) Endocrinology (2) Physical Medicine (2) Geriatric Medicine (2) Hepatology (1) Sports Medicine (1) Rheumatology (1)

Note: Specific specialty pay information is available to SDCMS members and those who filled out the survey. Contact Tom Gehring at Gehring@SDCMS.org to obtain a complete copy of our 2007 San Diego County Physician Workforce and Compensation Survey.

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F E B R U A R Y

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San Diego County Medical Society Calculate the Value of Your Membership!

THE TANGIBLES Mark Those TANGIBLE SDCMS-CMA Member Benefits You Take Advantage of and Write in Your Savings: Discounted Professional Liability Insurance (The Doctors Company) . . . . . . . . . . . . . . . $ ________ Discounted Practice Management Consulting (Practice Performance Group) . . . . . . . . $ ________ Discounted Contract Analysis and Negotiations (Coastal Healthcare Consulting Group) . . $ ________

Discounted Collections Services (TSC Accounts Receivable Solutions) . . . . . . . . . . . . . $ ________ Discounts on Ladd Young Attorneys at Law Corporate Legal Services . . . . . . . . . . . . . $ ________ Discounted Billing Services (CHMB Solutions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________

Free Annual San Diego County Physician Mailing List (SDCMS) . . . . . . . . . . . . . . . . . . . $ ________ Discounted Automobile Insurance (AAA and Mercury Insurance Group) . . . . . . . . . . . . $ ________ Discounted Tamper-resistant Prescription Pads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________ Free Coding Hotline (CHMB Solutions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________ Free Classified Advertising (San Diego Physician Magazine) . . . . . . . . . . . . . . . . . . . . . . $ ________

Discounted Display Advertising (San Diego Physician Magazine) . . . . . . . . . . . . . . . . . . $ ________

Free Attendance at All SDCMS Seminars for Members and Their Staffs . . . . . . . . . . . . $ ________ Free California Emergency Driving Emblem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________ Free Legal Advice (CMA ON-CALL Documents) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________

Discounted Clinical Reference Guide (Epocrates) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________ Free Reimbursement Advocacy (SDCMS-CMA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________ Free Annual San Diego County Physician Pictorial Membership Directory (SDCMS) . . . $ ________

The 2% Tax Not Lost on Gross Receipts That Was Called for by the Governor . . . . . . . $ ________

Your RICO Settlement Checks (HealthNet / WellPoint / Humana) . . . . . . . . . . . . . . . . . . $ ________ The 5% Not Lost From Averted Medicare Physician Reimbursement Cuts . . . . . . . . . . $ ________

AVERAGE MEMBER SAVINGS

$750 $500 $150 $250 $500 $396 $500 $250 $125 $50 $100 $220 $400 $50 $50 $25 $60 $100 $5,000 $568 $TBD

Calculate Your Total Savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________

$4,476 Subtract Your Annual SDCMS-CMA Dues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________

$925 SDCMS-CMA Membership Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________

$3,551

SDCMS-CMA PHYSICIAN MEMBERSHIP APPLICATION FAX TO SDCMS AT (858) 569-1334 OR MAIL TO SDCMS AT 5575 RUFFIN RD., STE. 250, SAN DIEGO, CA 92123 First / Middle / Last Name: ____________________________________________________________________________________ PLEASE PRINT YOUR NAME AS IT APPEARS ON YOUR MEDICAL LICENSE

Degree: MD K DO K • Medical School: __________________________________________________ Year Graduated: ___________ Specialty: _________________________________________________________________________________________________ ABMS Board Certification: Yes K No K • If Yes, Year of Certification: ________________ Year of Re-certification: ________________ Self-designated Practice Specialty: _____________________________________________________________________________ Practice Name: ____________________________________________________________________________________________ Office Address: ____________________________________________________________________________________________ Office City / State / ZIP: ______________________________________________________________________________________ Office Telephone / Fax: _______________________________________________________________________________________ Local Home Address: _______________________________________________________________________________________ Home City / State / ZIP: ______________________________________________________________________________________ Home Telephone / Fax: _______________________________________________________________________________________ Which address would you like us to use for correspondence and publications from SDCMS? Office K Home K Email: ___________________________________________________________________________________________________ Should SDCMS publish your email address in our annual pictorial membership directory? Yes K No K Place and Date of Internship / Specialty: _________________________________________________________________________ Place and Date of Residency / Specialty: _________________________________________________________________________ Place and Date of Postgraduate-Fellowship / Specialty: ______________________________________________________________ California Medical License Number: _____________________________________________________________________________ Sex: Male K Female K Place and Date of Birth: ______________________________________________________________________________________ Language(s) Spoken (other than English): ________________________________________________________________________ Applicant’s Signature*: ______________________________________________________________________________________ Application Date: ___________________________________________________________________________________________ *BY SIGNING ABOVE, I ATTEST THAT THE FOREGOING IS TRUE AND COMPLETE, AND I ENDORSE THE PRINCIPLES OF MEDICAL ETHICS OF SDCMS, CMA, AND AMA.

TO DETERMINE YOUR SDCMS-CMA DUES, PLEASE CALL SDCMS AT (858) 565-8888 Payment Options (choose one): K K

Payment in Full by Check (make payable to “SDCMS” • mail to SDCMS at 5575 Ruffin Rd., Ste. 250, San Diego, CA 92123) Payment in Full by Credit Card [fax this form to SDCMS at (858) 569-1334] Amount to Charge: __________________________________________________________________________________ Visa / MasterCard #: _________________________________________________________________________________ Expiration Date: ___________________________________________________________ Billing ZIP Code: ___________ Cardholder’s Signature: ______________________________________________________________________________

Questions? Contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

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building a healthier San Diego by addressing unmet healthcare needs for all patients and physicians through education, innovation and service

The

Pulse

No 36

INITIATIVE HIGHLIGHT

Access to Care SDCMS Foundation Initiatives Access to Care Consumer Health Education Medical Student Support Engaging Retired Physicians in Volunteering in the Community Improving Technology he Physician’s Rx Care Card is for any patient paying out of pocket for prescriptions.

In the third quarter of 2007, 68 patients saved more than $8,167* on their prescriptions using the card. Patients, on average, each saved just over $118 on their prescriptions. 61 percent were generic, 33 percent brand-single source, and 6 percent were brand-generics available. On average, the savings per prescription was $16.47.

To obtain a full report, order more cards, or learn more about the program, contact SDCMSF at (858) 565-8888, ext. 106, or email Aron Fleck at AFleck@SDCMS.org.

Thank you to Deb Stumpf at Pharma Futures Inc. for providing this information.

T

Pharmacy

# Rx

Ave. % Savings-all

Ave. % Savings-brand

Ave. % Savings-generic

CVS

145

23%

21%

26%

Costco**

81

3%

5%

3%

Rite Aid

66

47%

19%

62%

Ralph’s (Kroger)

63

47%

21%

59%

Longs Drugs

53

40%

29%

50%

U&C Total

$32,667.78

Sav-On (Albertson’s)

33

27%

23%

33%

Card Total

$24,200.53

Target

15

8%

3%

11%

Savings

$8,167.25

Garfield Beach Pharm. 8

4%

15%

0%

Kmart

5

42%

15%

61%

Ave. Savings/Rx

$16.47

Burns Drugs

4

62%

N/A

62%

Ave. Savings/Patient $118.37

Park Blvd. Pharm.

2

73%

N/A

73%

Wal-Mart

5

23%

10%

26%

Safeway

3

16%

20%

14%

Vons

9

21%

24%

19%

Walgreen Drug

3

27%

N/A

27%

Med-Rx Drug

1

16%

16%

N/A

All

496

30%

14 %

33%

Please Note: * % and $ savings are off of usual and customary prices. ** Costco sets its usual and customary price lower than most other pharmacies and will therefore not show a high % or $ savings The higher utilization of Costco has resulted in a lower overall % and $ savings; however, patients continue obtaining competitive prices on their Rxs.

38

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Ave. Rx Cost

$48.79

Ave. Quantity

42

Ave. Days

22

To find participating pharmacies, use the Pharmacy locator at www.PhysiciansRxCare.com or call the Pharmacy Help Desk at (866) 652-4325.

Supporting Your Foundation November 2007 I want to thank you for becoming a Foundation Friend and supporting the SDCMS Foundation through your 2007 and 2008 SDCMS dues statement contribution in November 2007.

Every dollar is a dollar closer to our goal of eliminating gaps in healthcare in San Diego County.

– Carol L. Young, MD, President, SDCMSF Board of Directors INDIVIDUAL DONORS: CENTURY CLUB ($100-$999) David Javid Najafi, MD (3) INDIVIDUAL DONORS: FOUNDATION FRIENDS (UP TO $100) Stanley Genshyo Ambo, MD Corinne J. Ancona-Young, DO (3) Schubert J. Atiga, MD (2) Timothy S. Bailey, MD (4) Sam Baradarian, MD Teresita T. Barbadillo, MD (2) Douglas G. Bolitho, MD (3) Sherry L. Braheny, MD (3) Richard Parks Burruss, MD (2) John B. Campbell, MD (3) Jorge Luis Castro, MD Joseph Hanna Chammas, MD Bradley H. Chesler, MD Frederick W. Close, MD (2) Stuart Davidson, MD (3) Chrystal E. De Freitas, MD David D. Dowling, MD Daniel Einhorn, MD (3)

Michael Gilbert Essex, MD (4) Karl L. Evelyn, MD (2) Sandy T. Feldman, MD (2) Bessie B. Floyd, MD Richard G. Friedman, MD Frank J. Goicoechea, MD Michael Goldhamer, MD (3) Paul M. Goodman, MD (4) Michael Gordon, MD (3) Janette Joyce Gray, MD (2) Joshua Kenneth Greenstein, MD (3) Pascal John Imperato, MD (3) Mark Y. Johnson, MD (4) Noah Compton Johnson, MD (2) Joan H. Kaestner, MD (2) Paul R. Keith, MD (4) Michael A. Kosmo, MD (2) Judith J. La Barbera, MD (2) Joel M. Lamon, MD (2) John J. Lilley, MD (3) Margaret A. Magone, MD Kevin A. Malone, MD (3) Hamid Mani, MD (3) Majid Mani, MD (3)

Note: The number in parentheses indicates years of consecutive donations.

Nasrin Mani, MD (3) Sami N. Maywood, MD (3) Rahele Mazarei, DO (3) Theodore Marc Mazer, MD (3) James Rafael McClurg, MD (2) Jane Ursula Mertens, MD David B. Meyer, MD (2) Daniel P. Molden, MD (3) Jose M. Montenegro, MD (3) Thomas J. Murphy, MD (2) Veronica Lynn Naudin, MD Paul Neustein, MD (3) Lyra W. Ng, MD Troy Huvilla Niguidula, MD Walter L. Olsen, MD (2) Cheryl L. Olson, MD (3) Mihir Y. Parikh, MD (3) Tammy Van-Truc Pham, MD (2) Laurie Jo Pierce, MD (3) William A. Pitt, MD (3) Robert B. Pollack, MD (3) Venu Prabaker, MD (3) Steven G. Pratt, MD (2) David M. Priver, MD (3)

Michael L. Puckett, MD (2) Edward L. Racek, MD (2) George N. Riffle II, MD (2) Luis M. Rivera, MD (3) Kenneth A. Romero, MD (4) David M. Roseman, MD (3) Jeffrey M. Rosenburg, MD (3) Kenneth J. Roth, MD David C. Ryan, MD (3) Anna Sanchez Seydel, MD Mark H. Shapiro, MD (3) Mark J. Sherman, MD (3) Harold J. Simon, MD Robert Singer, MD (3) Joel M. Snyder, MD (3) Carla Stayboldt, MD Robert M. Stein, MD (3) Merton C. Suzuki, MD (3) Jane C. Tanaka, MD (3) Bruce E. Van Dam, MD (3) Shen Ye Wang, MD (3) Vernon M. White, MD (3) Scott L. Worman, MD (3) Paul J. Zlotnik, MD (3)

thank you

Brad Anderson, Architectural Photography Inc. (www.architecturalphotographyinc.com) Michelle Bell, Anna’s Office Works! (www.annasofficeworks.com) Arthur Blain, MD Edgar Canada, MD

Dana’s Housekeeping (www.danashousekeeping.com) Alexandra DiMarco, Feng Shui Design San Diego (www.fengshuidesignsandiego.com) Alexandra DiMarco, Distributor, Shaklee (www.shaklee.net/dimarcoassociates) Thomas Fallon, Fallon Fine Art (www.fallon-fine-art.com) Jeff and Linda Figler, Figler Foundation (www.figlerfoundation.com) Aron Fleck Hornblower Cruises and Events (www.hornblower.com) Anne Joseph, M.Y. Therapy

La Casa del Zorro Resort (www.lacasadelzorro.com) Lamb’s Players Theatre (www.lambsplayers.org) Stan Lawrence, Stan Lawrence Portrait Art (www.stanlawrence.com) Emily Miller, L.Ac., Anywhere Acupuncture (www.anywhereacupuncture.com) Ralph Ocampo, MD, and his wife, Bonnie Old Globe Theatre (www.oldglobe.org) Pearl P. Pereira, P3 Designs (www.p3designs.com) San Diego Chargers (www.chargers.com)

Cheryl Ray Diana A. Rittinger, CPCC, BeT, Conscious Brilliance (www.consciousbrilliance.com) Cynthia Viveros, Body Beautiful Car Wash (www.bodybeautiful.com) Ann von Gal, Olmstead von Gal Associates (www.ovga.net) January West, D.C., Synergy Chiropractic (www.synergylifestudio.com) Gerald Wilson, Wilson Creek Winery (www.wilsoncreekwinery.com) Carol Young, MD

SDCMS FOUNDATION ADVISORY COUNCIL James Lewis Bowers, PhD, Consultant for Philanthropy Steven A. Escoboza, President/CEO, Hospital Association of San Diego and Imperial Counties Ronne Froman, RADM, USN Retired, Chief Operating Officer, City of San Diego Richard S. Ledford, President, Ledford Enterprises Michael I. Neil, BGN, USMC Retired, President, Neil, Dymott, Perkins, Brown and Frank

SDCMS FOUNDATION BOARD OF DIRECTORS Carol Young, MD, President, Rheumatology, Escondido David Priver, MD, Vice President, Obstetrics and Gynecology, San Diego Ralph Ocampo, MD, Secretary/ Treasurer, General Surgery, Retired James Hay, MD, Immediate Past President, Family Medicine, Encinitas Sarah Aghassi, Esq., Director, Office of Strategy and Intergovernmental Affairs, County of San Diego

Gabriel Arce, CEO, Retired, Community Health Group Ellen Beck, MD, Family Medicine, San Diego John Berger, MD, Family Medicine, San Diego Edgar D. Canada, MD, Anesthesiology, San Diego Judy Forrester, Consultant, Forrester Enterprises Tom Gehring, CEO, San Diego County Medical Society Theodore M. Mazer, MD, Otolaryngology and Head and

Neck Surgery, San Diego Albert Ray, MD, Family Medicine, San Diego

The San Diego County Medical Society Foundation would like to thank the following businesses and individuals for their donations to our 2007 annual silent auction to support access to affordable healthcare:

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SDCMS FOUNDATION STAFF Aron R. Fleck, MBA, Executive Director Stephen H. Carson, MD, Chief Medical Officer, Pediatrics, San Diego Claudia Gastelum, Care Coordinator, PASD

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San Diego County Medical Society Take Advantage of These SDCMS-CMA Benefits!

INSURANCE PRODUCTS AND SERVICES: SDCMS has partnered with Alliant Insurance Services, Inc., to provide SDCMS members with discounts on a comprehensive portfolio of insurance products and services. Contact Franco Ganino (619) 699-1313 or at fganino@alliantinsurance.com.

PRACTICE MANAGEMENT CONSULTING: Practice Performance Group has signed an agreement to offer SDCMS members practice management consulting discounts (equal to 10% or $500, whichever is larger), free half-day seminars at SDCMS (watch your faxes and emails), and a free one-year subscription to their newsletter. Call (800) 452-1768 or visit www.PPGConsulting.com.

CONTRACT ANALYSIS: Coastal Healthcare Consulting Group has signed an agreement to offer SDCMS members a free contracting analysis, a discount on hourly rates, and a package price on services for contract negotiations, including health plan contracts! Call Kim Fenton at Coastal Healthcare Consulting Group at (714) 544-5488 or visit www.healthcareconsultant.org.

COLLECTIONS SERVICES: Receive a 10% discount on monthly charges with TSC Accounts Receivable Solutions.

Call Catherine Sherman at (888) 687-4240, ext. 14.

CORPORATE LEGAL SERVICES: Receive a free consultation and discounts on corporate legal services. Call Ladd Young Attorneys at Law at (619) 564-6696.

free directory each year and a 50% discount on any addi- www.cmanet.org. tional directories purchased. Contact SDCMS. CMA REIMBURSEMENT HOTLINE: (888) 401-5911 — Free CODING HOTLINE: Access a coding hotline free of charge (provided by CHMB Solutions. Email your coding CMA LEGAL INFORMATION HOTLINE: (415) 882-5144 — question(s) to SDCMS at Coding@SDCMS.org.

Free SAN DIEGO PHYSICIAN MAGAZINE: Receive a CMA LEGISLATIVE HOTLINE: (866) 462-2819 — Free free subscription to the voice of San Diego County’s physicians. Place free classified ads and discounted display ads. CMA PHYSICIAN CONFIDENTIAL LINE: A free, 24-hour Contact SDCMS. phone service for physicians, dentists, medical students, residents, and their families and colleagues who may have SAN DIEGO MAGAZINE: Receive a gift subscrip- an alcohol or other chemical dependence or mental/betion (active physician members) or a discounted subscrip- havioral problem. Completely confidential. Using it will not tion (resident physician members). To sign up, contact result in any form of disciplinary action or referral to any SDCMS. To update your subscription address, contact San disciplinary body. Call (213) 383-2691.

Diego Magazine at (888) 350-0963 or at sdgm@kable.com.

LOCAL, STATE, AND FEDERAL PHYSICIAN ADVOCACY: SDCMS EMAIL NEWSLETTER, “NEWS YOU CAN USE”: SDCMS-CMA continue to be vigilant in our protection of Receive, free of charge, the latest in medical, local, state, MICRA, in fighting against nonphysician scope of practice and federal news critical to your practice … free of adver- expansions (all scope bills in 2006–07 were killed!), in worktising. Contact SDCMS. ing closely with our political representatives and other healthcare stakeholders to fix our broken healthcare fi SDCMS SEMINARS: SDCMS member physicians and their nancing system, and in doing everything we need to do to office staff attend free of charge all SDCMS seminars (in- protect physicians’ interests wherever they are challenged. cluding Office Managers Forums), covering legal issues, Contact SDCMS. HIPAA, risk management issues, how to begin your practice, contract negotiations, getting paid, billing, and much more. FULL-TIME SDCMS PHYSICIAN ADVOCATE: Have a quesContact SDCMS. tion? Don’t know where to begin? Contact your full-time,

BILLING SOLUTIONS: Receive a 50% discount on HIPAA COMPLIANCE: Receive a discount on a complete, startup fees and a $33 per physician per month services do-it-yourself HIPAA privacy and security compliance toolkit credit. Contact Ron Anderson (CHMB Solutions) at (760) 520- (CD ROM). Call David Ginsberg at PrivaPlan at (877) 218-7707.

1340 or at randerson@chmbsolutions.com.

CALIFORNIA EMERGENCY DRIVING EMBLEM: Receive PROFESSIONAL LIABILITY INSURANCE: Most SDCMS your first California physician emergency driving emblem members who use The Doctors Company for their profes- free of charge, and any additional emblems at the dissional liability insurance receive a 5% discount on their counted price of $10 each. Contact SDCMS. professional liability insurance. Contact SDCMS. EPOCRATES CLINICAL REFERENCE GUIDES: Receive a SAN DIEGO COUNTY PHYSICIAN MAILING LISTS: Receive 30% discount off of a one-year subscription and a 35% one free physician mailing list annually and a discount on discount off of a two-year subscription to Epocrates’ clinall additional mailing lists requested in the same year. Con- ical reference guides. Students and residents receive a 50% discount. Contact Epocrates at (800) 230-2150 or visit tact SDCMS. www.cmanet.org.

SDCMS MEMBERSHIP CERTIFICATE: Receive a free CMA ON-CALL DOCUMENTS: You can access, free of SDCMS membership certificate. Contact SDCMS. charge, thousands of pages of medical-legal, regulatory, and AUTO INSURANCE: Along with your spouse, receive dis- reimbursement information, through CMA’s online library. counts of 4.5% to 14% on all lines of coverage from the Au- Contact CMA at (415) 882-5144, at legalinfo@cmanet.org, tomobile Club of Southern California. Contact SDCMS. or visit www.cmanet.org.

TAMPER-RESISTANT PRESCRIPTION PADS: Receive dis- CMA’S WEEKLY NEWSLETTER, “ALERT”: Delivered dicounts on tamper-resistant prescription forms. Contact rectly to you, free of charge, via email or fax. Contact SDCMS. Katherine Gallia at CMA at (916) 551-2074 or at kgallia@cmanet.org.

INVESTMENTS: Invest with Dunham & Associates and discount your SDCMS dues by $150. Call Jeff Dunham (Dun- CONTRACT ANALYSIS: Receive free access to CMA’s ham & Associates) at (619) 308-9700.

Model Managed Care Contract and objective written analyses of major health plan contracts. As well, receive from SDCMS PICTORIAL MEMBERSHIP DIRECTORY: Appear in CMA-contracted attorneys a 15% discount on other conSDCMS’ annual pictorial membership directory. Receive a tract analysis services. Call CMA at (415) 882-3361 or visit

SDCMS physician advocate, Marisol Gonzalez, free of charge, to get the answers to all your questions, at (858) 300-2783 or at MGonzalez@SDCMS.org.

FULL-TIME SDCMS OFFICE MANAGER ADVOCATE: Let your office manager and staff know that they have a fulltime office manager advocate on staff at SDCMS ready to help them with any questions they may have, free of charge. Contact Lauren Woods at (858) 300-2782 or at LWoods@SDCMS.org.

SDCMS NEWS ALERTS: Stay informed of the news that affects your bottom line and your patients’ health with faxed and emailed alerts sent by SDCMS to you, free of charge … and free of advertising! Contact SDCMS. SDCMS AND CMA WEBSITES: Access, free of charge, the “Member Physicians” section of SDCMS’ website and the members-only section of CMA’s website to find valuable resources, such as a list of San Diego County physician NPIs, updated weekly. Contact SDCMS. ENGAGEMENT IN HEALTHCARE ISSUES: Be a part of the solution! Become involved in any of a broad spectrum of opportunities both SDCMS and CMA afford their member physicians, including joining an SDCMS or CMA committee or becoming a physician leader. Contact SDCMS.

CONTACT SDCMS TODAY (858) 565-8888 • SDCMS@SDCMS.org

OFFICE SPACE

LEASING, RENEWALS AND SALES: Call the Healthcare Real Estate Specialists at Colliers International for a complete inventory of all available medical office space for lease or for sale in San Diego County. Use our knowledge and expertise to help you negotiate a new lease, renewal, or purchase agreement to assure you obtain the best possible terms. There is no charge for our consulting services. Contact Chris Ross at 858.677.5329; e-mail chris.ross@colliers.com.

OFFICE BUILDING FOR SALE: Kearny Mesa medical suites for sale or lease. Address: 8910-12 Clairemont Mesa Blvd. (off Highway 163). Ground and/or second floor: 12,312ft2. X-ray and physical therapy on ground floor. Price: $4,300,000 or $1.80 NNN. 6.5/1,000 parking. Call Shauna at CB Richard Ellis at (858) 546-2606. [540] EASTLAKE: Prime location, in new medical office building: 1,000ft2 office (shell condition). Tenant build-out credited in reduced rent. Basic office infrastructure already provided. Ideal for neurologist, psychiatrist, podiatrist, etc. One mile from new SR-125 exit. Call (619) 216-0400 or email drsable@eastlakeeye.com. [538] OFFICE SPACE FOR SUBLEASE: Office available parttime for Scripps doctor in desirable Scripps/ Ximed building in La Jolla. Share elegant office; available all day Mondays and Friday afternoons.

Includes consultation office, two exam rooms, front desk, common waiting area, staff bathroom, and kitchen. Use of operating suite or use on other days negotiable. Contact Cindi at (858) 452-6226. [535] BEAUTIFUL NEW MEDICAL OFFICE CONDOS: Own your medical office space for effectively less than the cost to rent. Build wealth and save money.

1,200ft2 suites to 14,000ft2 suites available in the new North County Regional Medical Center next to the intersection of Rancho Santa Fe Road and San Elijo Road Carlsbad/San Marcos border.

Expected occupancy is summer of 2008. Call American Real Estate Development at (858) 550-0670 for more information. [534] ACROSS FROM SHARP AND CHILDREN’S HOSPITAL: Beautifully furnished 2,000ft2 office; fully equipped; five exam rooms. Share with part-time physician. Please call (619) 823-8111 or (858) 279-8111. [385] OFFICE SPACE TO SHARE: Share fully furnished, sixexam-room/two-office suite with internist.

Ample free parking, great location. Contact Elaine Watkins at (858) 945-3813 or at ewatkins@gmail.com. [527]

Classifieds MEDICAL SPACE FOR LEASE: 2,350-11,761ft2 completed shell building on Highway 86 in Imperial County for $2.05ft2/month. Please contact Dr. Maghsoudy at (760) 730- 3536 or afsaneh_maghsoudy@hotmail.com. [525] PREMIUM HILLCREST OFFICE SPACE: 800ft2 office space available immediately. Includes 200ft2 waiting room/balcony; great location next to Mercy hospital. Competitive pricing: opportunity to share office staff and resources. hillcresteyecare@yahoo.com. [524] OFFICE SPACE TO SHARE (SOUTH COUNTY): Chula Vista-area family practice office to sublease at 340 4th Ave., Ste. 10, just north of Scripps Mercy Chula Vista Hospital. Office includes three exam rooms and one treatment room, and is 1,700ft2.

Supporting staff available. Contact Dr. Jenkin or Dr. Tetteh at (619) 804-7252. [521] SUBLEASE BEAUTIFUL, NEW MEDICAL OFFICE IN SAN MARCOS: Premium Class A medical office space in San Diego County’s fastest growing city! All or part of an approximately 1,850ft2 newly constructed suite in San Marcos’ City Hall building.

Spacious reception area, large procedure room with hardwood floors, four exam rooms, two restrooms, doctor’s office with large window, and reserved parking. Easy access to I-78.

Ample patient parking. Contact Kristina at (760) 942-9028 or email Kristinasm@yahoo.com for more information. [520] MEDICAL SPA AVAILABLE TO SHARE: Brand new, upscale medical spa in Eastlake available to sublet a portion of the facility to a specialist. Ideal for plastic surgeon or aesthetic physician performing minimally invasive procedures. Also open to acupuncturist or wellness/anti-aging physician, which complements the spa and noninvasive aesthetic services currently being offered. Call (619) 228-4483 for more information. [519] MEDICAL OFFICE AVAILABLE TO SHARE: Primary care office available to share. Storefront building with great visibility and recently updated interior. Current physician has been in practice for 10 years and wants to cut down on hours. Lots of opportunities for a starting physician or a specialist. Office staff available to share if needed. Call (619) 575-4442 or fax letter of interest to (619) 575-1297. [518] OFFICE SPACE AVAILABLE: Office space in a desirable location directly across the street from Scripps Mercy Hospital. The office is currently occupied by a well-established internal medicine practice. Inquiries: call Connie at (619) 718-9440 or email to sdmg@covad.net. [515] MEDICAL OFFICE AND OFFICE EQUIPMENT FOR SALE: Waiting room, operating room, and surgical equipment. Inventory list on request. Contact Keith Wahl, MD, at (858) 558-8879 or kwahl@san.rr.com. [506] OFFICE SPACE FOR LEASE (ESCONDIDO): Premier furnished medical office space for lease in Escondido. Excellent location near Palomar Medical Center. Please call (760) 743-1033. [501] AVAILABLE OFFICE SPACE: For an updated list

of available offices, please visit www.sandiegohealthcareproperties.com. [495] SUBLEASE AVAILABLE IN DEL MAR: Beautifully remodeled, state-of-the-art office space in affluent Del Mar off 5 freeway. Share rent. 2,100ft2 in professional building. Utilities included. Great opportunity in very desirable area. (858) 342-3104. [426] MEDICAL OFFICE SPACE FOR LEASE (ENCINITAS): Share suite with three established physicians. On second floor with ocean view and convenient location. Features include: ample free parking, private entrance, roomy front desk area, private bathroom, and a spacious waiting room. In a multispecialty medical building located minutes from Scripps Encinitas. Perfect for outpatient consultation. Affordable lease rate in desirable area. Contact Wendy Khentigan, MD, or Deeann Wong, MD, at (760) 753-7341 or WendyKMD@AOL.com. [487] MEDICAL OFFICE SPACE: Two medical suites (approximately 2,500ft2 and 1,300ft2) available for lease. Building located about one mile from TriCity Hospital; easy access from Freeway 78. For further details, please contact Aruna Garg, MD, at (760) 724-8562, Wendy Shumate, MD, at (760) 940-2268, or call (760) 630-4715. [478] MEDICAL OFFICE SPACE AVAILABLE: Medical office space located in convenient Hillcrest location available. The space is approximately 4,500ft2 with several advantages for a group of one to four surgical specialists. There is ample parking, full outpatient surgical center on first floor of the building, and a therapy area on the second floor.

Ample medical records storage space and phone and computer wiring already installed. For more information, please contact (619) 299-0007. [462] OFFICE SPACE TO SUBLET: Internal medicine practice in Escondido has office space available for one part-time physician/ healthcare professional. Excellent location near Palomar Medical Center. Please contact office manager at (760) 432-6644 or EIM2006@sbcglobal.net. [459] SPACE FOR LEASE (CORONADO): Brand new building in Coronado. Last space available: 1,105ft2, $2.75+NNN. Call (619) 742-5555 or email cpatricia@glenncookmd.com. [435] MEDICAL OFFICE SPACE FOR LEASE: La Jolla medical office in convenient location for solo spine sugeon, psychiatrist, or pain management specialist. Contact Jo Turner at (858) 587-0773, at (619) 7334068, or by email at jturner@spondylos.com. [416] UTC: Full-time windowed office and part-time inside office in eighth-floor suite with established psychologists and psychiatrist in Class A office building available. Features include private entrance, staff room/kitchen facilities, professional collegiality and informal consultation, private restroom, spacious penthouse, exercise gym, storage closet with private lock in each office, soundproofing, common waiting room, and abundant parking.

Available now! Contact Christine Saroian, MD, at (619) 682-6912, or Jody Saltzman, PhD, Tom Wegman, PhD, or Manny Tobias, PhD, at (858) 4555252. [404]

TO SUBMIT A CLASSIFIED AD, email Ketty La Cruz at SDCMS at KLaCruz@SDCMS.org. SDCMS members place classified ads free of charge (excepting services-offered ads); all others pay $100 for the first 75 words and $0.50 per word thereafter. Ads will also appear on SDCMS’ website at www.SDCMS.org.

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Classifieds NORTH COUNTY OFFICE SPACE TO SHARE (POWAY): In-house, accredited surgery office available, 3,000ft2, includes exam room, dexa scanner, and physical therapy. Ideal for a wide range of healthcare practitioners. Call John at (619) 5498870 for more details. [398] LARGE SUITE (CHULA VISTA): Beautiful suite, 4,550ft2, adjacent to Scripps Hospital, includes large reception and front office, audiology lab, private office space as well as three large area rooms, many built-in storage cabinets, and staff lounge. Previous tenant was Children’s Hospital.

Contact Sammye at (619) 342-7207, ext. 8, or at baymedical@smiser.net. [389] CHULA VISTA: Several suites available now at Bay Medical Plaza. We are conveniently located near Scripps Hospital, major freeways, and many restaurants and retailers. There’s an onsite pharmacy, a good parking ratio, and building is secure. This is a great opportunity to expand or relocate your medical practice in Chula Vista.

For more information, contact Sammye at (619) 342-7207, ext. 8, or at baymedical@smiser.net.

[387] BEAUTIFUL, NEWLY RENOVATED OFFICE SPACE TO SHARE: Located in Hillcrest/Uptown San Diego. Physician with large suite seeking physician/healthcare professional or other business professional to share offices and/or exam rooms and receptionist. Parking spaces available for rent (off street, covered). Call (858) 354-9833 for further information. [346] PART-TIME OFFICE SPACE: Available for sublease in 502 S. Euclid medical building, across from Paradise Valley Hospital emergency room, in National City. Nice office with four exam rooms ideal for sub specialist. Supporting staff available. Contact Iman Mikhail, MD, at (619) 4702300. [328] PHYSICIAN POSITIONS AVAILABLE P MEDICAL DIRECTOR – PART TIME: Interested in clinical research? Accelovance, Inc., conducts clinical research for pharmaceutical and biotech companies with its primary focus on vaccine and general health conditions. Accelovance is seeking a medical physician as part-time medical director for our research clinic located at 5920 Friars Road in San Diego. The medical director will interface with patients, conducting physical exams and providing general research program oversight. Prior clinical research experience a plus.

Submit cover letter and CV to: Accelovance, Inc., 2275 Research Blvd., Ste. 700, Rockville, MD 20850; email: careers@accelovance.com; fax: (240) 238-4901.

Dr. Prabaker at (619) 698-0606 or email vprabaker@yahoo.com. [536] PSYCHIATRIST NEEDED: San Diego Family Services is hiring newly licensed or licensed psychiatrists for its Kearny Mesa location. We are looking for a skilled provider to accommodate all SDFS clients. Great supportive team atmosphere and flexible part-time hours. Plenty of growth opportunities. Please send resume to hr@sdfamilyservices.com, or for more information please visit our website at www.sdfamilyservices.com. [532] URGENT CARE (EAST COUNTY): Busy practice established in 1982 seeks a full-time or part-time physician. Fax CV to (619) 442-2245. [479] NAVAL HOSPITAL CIVILIAN POSITION: Naval Hospital Camp Pendleton has an immediate opening for one full-time civilian faculty for its 12-12-12 family practice residency program. This opportunity includes precepting residents, inpatient/ outpatient care (including ICU and maternity care), and educational responsibilities. Must be residency trained and board certified. Previous teaching experience preferred. A competitive compensation package is available as a GS-15 with bonuses. If you are interested, check our website www.cpen.med.navy.mil. Send your CV to or contact Jim La Joie, business manager, Department of Family Medicine, Naval Hospital Camp Pendleton, CA 92055, by email at jim.lajoie@med.navy.mil, by fax (760)-725-1101, or call (760) 725-1398. [530] FAMILY MEDICINE OPPORTUNITY: Seeking a BC physician in family medicine, full-time position, call responsibilities include telephone triage, minimal inpatient care, no OB, competitive salary and excellent benefits package. Please submit CV to: Vivian Hudson, Physician Resource Manager, Sharp Mission Park Medical Group, 2201 Mission Ave., Oceanside, CA 92054, call (760) 901-5259, fax (760) 901-5242, or email Vivian.hudson@sharp.com. [529] FAMILY PRACTICE POSITION: Join a growing family practice office in the Carmel Valley area of San Diego. The practice is professional, caring, delivers outstanding primary care, and is PPO and fee-for-service ONLY with NO HMO care! Generous starting salary with production bonus, malpractice, pension plan, health benefits, and vacation. Easy call every three to four weeks, with no OB, and hospital care is optional but not required. Send resume to DelMarFamilyPractice@earthlink.net, or fax to (858) 793-2650. Call Dr. Schlitt at (858) 793-2727. [526]

OB/GYN NEEDED: Full-time OB/GYN is needed in a busy private practice. Every four- to fivenight call. Beautiful San Diego lifestyle. State-ofthe-art office practice and excellent hospital with level III nursery. Please fax CV to (858) 277-9370 attn: Katy Scheneberg, office manager; call (858) 277-9378; or email westcoastobgyn@yahoo.com for more information. [541]

BC/BE NEUROLOGIST, PULMONOLOGIST, OCCUPATIONAL THERAPIST: Harmony Multi Specialty Group has the following, immediately available positions: Part time BC/BE neurologist, pulmonologist, and occupational therapist. Flexible hours, excellent pay with possible profit sharing.

Please send your resume either by fax at (619) 393-0830 or email at harmonymedicalgroup@yahoo.com.

No phone calls. [523]

PRIMARY CARE PHYSICIAN WANTED: Caring and compassionate part-time/full-time physician for a traditional internal medicine office in La Mesa/El Cajon. Basic computer skills are necessary. One or two weekend calls per month is expected. Call

VOLUNTEER FP/IM PHYSICIANS NEEDED: Camp Pendleton Family Practice Residency is looking for a few enthusiastic volunteer family practice or internal medicine physicians interested in teaching to help preceptor residents and medical

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students in our outpatient family practice clinic.

Please contact CAPT John Holman at (760) 7251398 if you are interested. [511] PHYSICIAN NEEDED: Board-certified/boardeligible, full-time family practice physician needed for a busy North Inland County physician-owned and -directed group. One hundred percent outpatient based, guaranteed first-year salary, excellent benefits package. Email CV to: jshaw@pennelm.com or fax to (760) 745-0451 attn: Judy. [510] POSITION AVAILABLE: Per diem openings for urgent care center at Cassidy Medical Group located in Vista. Hours are 5:00 p.m. - 9:00 p.m., M-F, 9:00 a.m. - 5:00 p.m., Sat., and 10:00 a.m. 4:00 p.m., Sun. Competitive salary. Malpractice insurance provided. Please send CV to judy@cassidymg.com or fax to (760) 477-7881.

For additional information on our group please visit www.cassidymg.com. [508] FAMILY PRACTITIONER: Cassidy Medical Group in Vista is searching for a family practitioner for their department. The group is comprised of 16 primary care physicians including family practice, internal medicine, pediatrics, and obstetrics/ gynecology. Outpatient hours only as the group uses hospitalists for all inpatient care. Competitive salary and benefits. For more information on the group, visit www.cassidymg.com. If interested, please send CV to judy@cassidymg.com or fax to (760) 477-7881. [507] NORTH COUNTY MEDICAL GROUP: Graybill Medical Group, a 35-physician medical group with offices in Escondido, San Marcos, and Fallbrook, is actively recruiting physicians in family medicine, internal medicine, and several specialties including ENT and OB, as well as other surgical specialties. The practice openings involve both office practice and inpatient hospital care. Hospitalist-only positions are also available. Our group is well established with an integrated EMR. Physicians interested in discussing positions available should contact Floyd Farley, CEO, at ffarley@graybill.org or via fax at (760) 737-7324. [498] POSITION AVAILABLE: Four-partner internal medicine practice in Chula Vista seeking BS/BE internist to replace one or possibly two retiring partners. Quality group, well-recognized for excellence throughout the South Bay and San Diego. Partnership status or initial employee relationship is available. Call (619) 421-4000 or (619) 787-6948. [483] PRIMARY CARE JOB OPPORTUNITY: Home Physicians is a fast growing group of doctors who make house calls. Great pay ($60-$100+/hour), flexible hours, choose your own days (full or part-time).

No weekends, no call, transportation and personal assistant provided. Contact Chris Hunt, MD, at (858) 279-1212. [458] TRADITIONAL INTERNAL MEDICINE OPPORTUNITY: Seeking full-time, CA-licensed, BC/BE internist to join our three-clinician private practice group in Escondido. Inpatient/outpatient care. Competitive salary, malpractice, benefits, and partnership potential. Please send CV to EIM2006@sbcglobal.net. [456] FAMILY PRACTICE (CHULA VISTA): Seeking a family practice physician to cover solo physician

Classifieds practice one week every two months. Contact Ann at (619) 422-1324 or at doctorwp@pacbell.net. [451] FAMILY PRACTICE DOCTORS NEEDED: Full time and part time; days, nights, and weekends available. Fax CV to La Costa Urgent Care at (760) 603-7719. [449] NONPHYSICIAN POSITIONS AVAILABLE N MEDICAL ASSISTANT/BACK OFFICE: Busy OB-GYN practice needs experienced MA. Competitive wage and benefits. Spanish a plus but not required. Fax resume to (619) 298-4250. [547] MEDICAL RECEPTIONIST: New practice opening in Solana Beach looking for an experienced, bright, and well-organized person with knowledge in insurance billing (or at least willing to learn). We offer excellent salary and room for career advancement. Please fax your resume to (858) 653-0105, attn: Van Cheng, MD, or email us at vacheng@ucsd.edu. [537] PT ECHO TECH NEEDED: Flexible hours, ideal for parent with child responsibilities. Minimum two years experience, required RDMS, and experience in stress echo. Contact Marybeth at (760) 940-1982. [528] NURSE PRACTITIONER NEEDED: Part-time/full-time nurse practitioner wanted for internal medicine practice located adjacent to Scripps Mercy Hospital in a well-established office. Furnishing number and previous experience is required. Fax resume to Connie at (619) 718-9440 or email to sdmg@covad.net. [514] PRACTICE MANAGER: Retiring practice manager seeks individual with five years of full-charge experience managing a medical office of 15-25 employees. Competencies: financial oversight, HR management, monitoring general practice systems, and reporting within a computerized medical environment. Well-respected, growth-oriented clinical and surgical practice.

Good benefits package. Fax resume with salary experience to (858) 552-2182. [512] MEDICAL OFFICE MANAGER: Busy, six-physician internal medicine group looking for experienced office manager. We are located in the College area, adjacent to Alvarado Hospital. Communication and organizational skills are essential, and experience with accounts payable, accounts receivable, electronic billing, collections, and payroll are needed. A working knowledge of medical manager, QuickBooks, and general computer experience is preferred. Excellent compensation package. Fax resume to (619) 287-0833. [509] PHYSICIAN ASSISTANT WANTED: To assist busy cardiologist in Chula Vista. Must be fluent in Spanish and English; experienced; dedicated; and honest individual; full time or part time. Office hours are from 9:00 a.m. to 6:00 p.m., Monday thru Friday.

Please fax resume to (619) 656-5250. [504] NURSE PRACTITIONER: Fast growing interventional pain practitioner seeking a part-time nurse practitioner. This position will provide medical care under the supervision of a board-certified physician providing assistance and support to the physician in patient care. Experience preferred; competitive compensation available. Fax resume to Jenny at (619) 398-2988 or by email at jenny@integratedpain.com. [503]

MEDICAL RECEPTIONIST WITH MANAGEMENT SKILLS: Position available, full or part time, in a family practice office located in Scripps Ranch. Fax resume to (858) 271-5327, attn: Dr. Wasserman. [494] NURSE PRACTITIONER: Four-physician internal medicine practice in Chula Vista seeks parttime/full-time nurse practitioner. Work with a quality group; reasonable hours. Previous experience is preferable; salary negotiable depending on experience. Call (619) 421-4470 or (619) 4214000. [488] PHYSICIAN ASSISTANT: Fast-growing interventional pain practice looking for a full-time physician assistant. This position will provide medical care under the supervision of a board-certified physician, providing assistance and support to the physician in assessing, planning, and providing patient care. Experience desired, but we will train the right person. Competitive compensation and benefits package are available. Fax resume and cover letter to Jenny Reyes, office manager, at (619) 398-2987 or by email at jenny@integratedpain.com. [482] NURSE PRACTITIONER WANTED: Part-time/full-time nurse practitioner wanted for internal medicine practice in Escondido. Previous experience is desirable. Call (760) 432-6644. [455] PHYSICIAN POSITIONS WANTED P INFECTIOUS DISEASE LOCUM TENENS: Board-certified ID physician available for weekends, vacations, sick leave. Please call (619) 869-1296.

PEDIATRIC LOCUM TENENS: Board-certified pediatrician is available to do pediatric locum tenens work. Call (619) 425-3951. [421] PRACTICES FOR SALE P

DEL MAR-AREA GENERAL PRACTICE: Prime location, huge potential for practice expansion in fastgrowing Carmel Valley community. Established in 1990; terms available. Inquiries call (858) 755-0510. [185] MED ICAL EQUIPMENT M MEDICAL EQUIPMENT FOR SALE: From Advanced Dermatology and Cosmetic Surgery. 1) Surgical chair/table. Ritter electric procedure table with controls on the table and also as foot pedals; in excellent condition. Has elevation, tilt, back, and foot controls. Patient can be put in supine and Trendelenberg positions. Price normally $2000, will sell for $900. 2) Flat exam table. Back can be raised and there is a foot rest. Table has drawers and an electric outlet. $200. Call Mike at (760) 436-8700 or at (619) 261-8063.

ULTRASOUND, STRESS, ECG: HP 2000 ultrasoundcardiac, vascular, abdominal, small parts, five transducers: $6,000. Quinton 4000 monitor with Q55 treadmill, recording paper, electrodes, crash cart, defibrillator: $2,500. HP ECG Pagewriter XLE, lots of recording paper and electrodes: $700. Call (619) 460-0083 or (619) 518-9542. [513] MEDICAL OFFICE AND OFFICE EQUIPMENT FOR SALE:

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SERVICES OFFERED S PRACTICE FINANCING FOR PHYSICIANS: Up to 100 percent financing available for physicians! Includes purchase of a practice, equipment, partner buyout, working capital, and real estate. Call Dan Fencyk at CBN Financial: (619) 231-1590 or dfencyk@communitybanknv.com. [522] BILLING, CONSULTING, OUTSOURCING: We are committed to maximizing your bottom line! Our billing service uses state-of-the-art technology to ensure charge capture, code validation, electronic submission and remittance, payment postings, patient statements, structured follow-up and appeals, electronic document storage and meaningful reporting. Supplemental services include online appointment scheduling, automated call reminders, scan systems, and other technological advances. Consulting services include accounts payable, auditing, business development, electronic medical record selection and implementation, credentialing, contracting (payor, physician, and staff), executive assistant, financial management, information systems, operational management, practice assessment, practice management, relocation management, and other technological advances. Contact us today for your free consult!

Contact Kena Galvan (619) 326-0700 or kena.galvan@abs-sol.com. [452] RMC VINYL REPAIR PLUS: Medical equipment upholsterer. Expert in repair and replacement of medical fixture upholstery including exam room equipment and waiting room furniture. Free estimates and mobile service! Call (619) 443-4060.

[400] REAL ESTATE R

SUCCESSFUL MEDICAL SKIN CARE CLINIC FOR SALE: Small investment for 51 percent ownership.

Looking for new medical director. Contact Leonard Schulkind at (619) 807-5485. [539]

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Waiting room, operating room, and surgical equipment. Inventory list on request. Contact Keith Wahl, MD, at (858) 558-8879 or kwahl@san.rr.com. [506]

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HOUSE FOR RENT: Fish/Hike/Bike Mammoth! Large rustic family home; four bedrooms plus loft (2K, 3Q, 4S beds), three baths, gourmet kitchen, three fireplaces, decks, and mountain-view. Visit www.mammothevents.com for activities from Motocross, July 4th festivities, and Mammoth Festival of Wine, Music, and Food to Life and Wellness conference: $400/night plus cleaning fee, fourth night free. Ask for ski season rates.

(858) 793-7938; email for photos mgharris@michaelgharris.net. [485] MISCELLANEOUS M REIMBURSEMENT TROUBLES: Problems with payments from United Healthcare? Call (619) 4429896, ask for Jeff. We are a doctor’s office, not a fee-seeking service. [533] 2005 SEA RAY SUNDANCER 30-FOOT LOADED POWERBOAT: Excellent condition; 2K in recent/routine maintenance, new front eisenglass, 3.5 years remaining on full-warranty ($6,000 value), only a paltry 100 hours for two pristine 220-hp engines, GPS, generator, TV/DVD/stereo/air/heat and much more. Exact boat with less features costs $150K; $98,000 (firm) to first buyer. (858) 2540202. [454] 2003 BMW M3 (RED, MANUAL, CONVERTIBLE): Very good condition, low miles, and new tires: $33,750. (858) 254-0202. [453]

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Productivity

What Does the Boss Really Do?

BY TOM GEHRING

A

s SDCMS’ CEO, I have to constantly ask myself what my job consists of, what, in general, my board expects me to do. Not the penny stuff, but the really, really important stuff. This is a question that should run (frequently) through the mind of every leader, from the CEO of GE to the physician leader of a solo practice.

I would argue that the leader has five specific responsibilities: • Articulate the vision.

• Make sure people have the tools to achieve the vision.

• Set the boundaries.

• Make the really big decisions.

• Be in charge in time of disaster.

Let’s look at each of these in a little bit of detail.

If you don’t know where you’re going, any path will get you there. You, as the boss, have to be able to say strategically, and often tactically, “This is where we’re going,” and, “Oh, by the way, this is how we’ll know when we’ve gotten there.”

You have to articulate, in simple (read short) terms, what you want the group to achieve.

For example, SDCMS staff has set a goal of 180 net new physician members in this fiscal year. A goal that’s easy to understand, easy to measure every action against, easy to state, hard to accomplish, but it’s a target we’re all collectively working toward.

Make sure your team has the tools to get there. And we’re not talking pens and paper. We’re talking hardware, software,

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warmware (the right people necessary to accomplish the tasks), the resources (read money), and the environment that supports your team.

If we’re going to bring in 180 net new SDCMS physician members, we have to have a recruiting budget — asking SDCMS staff to accomplish this goal without a recruiting and retention budget is straight out of Dilbert.

• • • • •

Vision Tools Boundaries Big Decisions Being in Charge

Set the boundaries, but set them smart.

Make the boundaries clear, but not restrictive. Make sure your team knows that they must challenge/push the boundaries, but never, ever exceed your boundaries without your permission.

While some of these boundaries are ethics- and morals-based (we will not lie, cheat, or steal), many are very simple.

And, if one of your team violates a boundary that you as the boss did not articulate, you can only blame yourself. For example, anyone on the SDCMS staff may commit up to $500 in resources without asking me first.

You have to be able to make the really big decisions. Hiring, firing, committing major resources, stopping a project —

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the list could go on and on. Many bosses recognize that a big decision has to be made, but then they make two cardinal errors: They either can’t make the decision, or they make the decision in an erroneous manner (more on how to make decisions in the next installment).

Let’s say you just caught your most valuable employee red handed behaving unethically. Do you have the gumption to fire them? Only you can do so (and firing them may not be the answer until you fully investigate the issue). If you make the wrong move, everyone will know.

Be in charge in time of crisis (and avoid the urge to be in charge of everything — that’s called micromanagement). Physicians get this on a clinical level, i.e., you know to be in charge when the patient is crashing. Your non-clinical responsibilities are no different. You cannot delegate decision-making when the world is crashing down around you. Be in charge! For example, during the 2007 wildfires, Supervisor Roberts and Mayor Sanders were on television three, sometimes four, times a day. Everyone in San Diego County knew who was making the decisions, and we wanted that!

So, remember: Articulate the vision, provide the tools, set the boundaries, make the decisions, and manage the crises.

ABOUT THE AUTHOR: Mr. Gehring is the executive director and CEO of the San Diego County Medical Society.

We fight frivolous claims. We smash shady litigants. We over-prepare, and our lawyers do, too. We defend your good name. We face every claim like it’s the heavyweight championship. We don’t give up.

We are not just your insurer. We are your legal defense army. We are The Doctors Company.

Robert D. Francis Chief Operating Officer, The Doctors Company

The Doctors Company built its reputation on the aggressive defense of our member-physicians’ good names and livelihoods. And we do it well: Over 80 percent of all malpractice cases against our members are won without a settlement or trial, and we win 87 percent of the cases that do go to court. So what do you get for your money? More than a fighting chance, for starters. To learn more about our professional liability program for SDCMS members, call (858) 452-2986.

Endorsed by

© 2008. The Doctors Company. All rights reserved.

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