March 2010 by San Diego Physician

✖ SDCMS Celebrates Its 140th Anniversary in 2010 ✖ Reaching 8,500 Physicians Every Month

March 2010

official publication of the san diego county medical society

San Diego’s Physician Workforce Landscape:

Which Is It?

“Physicians United For A Healthy San Diego”

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 82 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. The San Diego County Medical Society has exclusively endorsed our medical professional liability program since 2005. To learn more about our benefits for SDCMS members, call (800) 328-8831, extension 4390, or visit us at www.thedoctors.com/sdcms.

Endorsed by

S A N D I E G O P HY S I CI A N .or g Ma r ch 2010

What comes next? V V V V

Changing demographics. Curbs in Medicare expenditures. Cost-shifting to the healthcare consumer. The rising use of NPCs.

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thismonth Volume 97, Number 3

feature Physician Workforce and Compensation 18

2009 SDCMS Physician Workforce and Compensation Survey: Executive Summary by Tom Gehring, CEO and Executive Director, San Diego County Medical Society

departments 4 Contributors This Issue’s Contributing Writers 6 SDCMS Seminars / webinars / Events 8 Community Healthcare Calendar 10 Briefly Noted SDCMS Partners With Health Butler, Physicians Get Noticed, and More … 14 FROM our san diego county legislators Budget, Healthcare, Education and the Future of California 16 From San Diego County Healthcare leaders "HMO": A Good Three-letter Word

31 CMA’S 13TH ANNUAL CALIFORNIA HEALTH CARE LEADERSHIP ACADEMY 35 SDCMS ENDORSED PARTNER SPOTLIGHT The Doctors Company 39 SDCMS ENDORSED PARTNER BENEFITS Potential Value: $10,000–$17,000 42 PHYSICIAN MARKETPLACE Classifieds 44 DISASTER MEDICINE Thoughts on Haiti

Physicians: Don’t Miss Out!

44 2

S A N D I E G O P HY S I CI A N .or g Ma r ch 2010

Renew your 2010 SDCMS-CMA membership before April 1, 2010, to be listed in San Diego Magazine’s 2010 Medical Guide, SDCMS’ 2010 Pictorial Membership Directory, and SDCMS’ first-annual All San Diego County Physician Directory. — SEE PAGE 4 FOR DETAILS

mar ch 2010 SAN DIEGO P HY SICI A N. o rg

contributors PAUL BERNSTEIN, MD

TOM GEHRING

Dr. Bernstein, SDCMS-CMA member since 2000, a head and neck surgeon, is the medical director of Kaiser Permanente, San Diego, and author of Courage to Heal, the story of one physician’s struggle to change medicine in America (award winner in the London, San Francisco, and San Diego book festivals).

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

Dr. Reicher, SDCMS-CMA member since 1987, is board-certified in diagnostic radiology and practices in North County.

ASSEMBLYMEMBER MARTY BLOCK

JOHN A. LAFATA, MD

Elected in 2008, Assemblymember Block represents the 78th District, which includes portions of the cities and communities of San Diego, Chula Vista, Lemon Grove, Bonita, and Spring Valley. He previously served as president of the San Diego Board of Education, president of the San Diego Community College District Board of Trustees, and professor, dean, and director at San Diego State University.

Dr. LaFata, SDCMS-CMA member since 1981, was part of the medical response team with Haitian Endowment Fund from January 22 to February 2, 2010

MURRAY A. REICHER, MD

Physicians: Don’t Miss Out — Deadline Approaching! Renew Your 2010 SDCMS-CMA Membership Before April 1, 2010, to Be Listed in:

San Diego Magazine’s 2010 Medical Guide: A Directory of San Diego County Physicians Mailed in May to All 330,000 San Diego Magazine Subscribers SDCMS’ 2010 Pictorial Membership Directory Mailed in May to All 2,600 SDCMS Member Physicians, With an Additional 400+ Copies Mailed to Regional Healthcare Stakeholders SDCMS’ First-annual All San Diego County Physician Directory Mailed in May to All 8,500 San Diego County Physicians

Managing Editor Kyle Lewis Editorial Board Van L. Cheng, MD, Adam F. Dorin, MD, Kimberly M. Lovett, MD, Theodore M. Mazer, MD, Robert E. Peters, MD, PhD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager Jennifer Rohr Sales Director Dari Pebdani Project Designer Lisa Williams Copy Editor Adam Elder SDCMS Board of Directors Officers President Lisa S. Miller, MD Immediate Past President Stuart A. Cohen, MD, MPH President-elect Susan Kaweski, MD Treasurer Robert E. Wailes, MD Secretary Sherry L. Franklin, MD geographic and geographic alternate Directors East County William T. Tseng, MD, Heywood “Woody” Zeidman, MD (Alternate: Venu Prabaker, MD) Hillcrest Steven A. Ornish, MD, Niren Angle, MD (Alternate: Eric C. Yu, MD) Kearny Mesa Adam F. Dorin, MD, John G. Lane, MD (Alternate: Jason P. Lujan, MD) La Jolla J. Steven Poceta, MD, Wayne Sun, MD (Alternate: Matt H. Hom, MD) North County Arthur “Tony” Blain, MD, Douglas Fenton, MD, James H. Schultz, MD (Alternate: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Michael H. Verfolin, MD (Alternate: Andres Smith, MD) At-large Directors John W. Allen, MD, David E.M. Bazzo, MD, V. Paul Kater, MD, Jeffrey O. Leach, MD, Mihir Parikh, MD, Robert E. Peters, MD, PhD, David M. Priver, MD At-large alternate Directors James E. Bush, MD, Richard O. Butcher, MD, Ben Medina, MD, Jerome A. Robinson, MD, Alan A. Schoengold, MD, Edward L. Singer, MD, Carol L. Young, MD Communications Chair Theodore M. Mazer, MD Young Physician Director Kimberly Lovett, MD Young Physician alternate Director Van Le Cheng, MD Resident Physician Director Katherine M. Whipple, MD Resident Physician Alternate Director Steve H. Koh, MD Retired Physician Director (open) Retired Physician alternate Director John A. Bishop, MD Medical Student Director Jane Bugea Medical Student alternate Director Iain J. Macewan CMA Speaker of the House James T. Hay, MD CMA Past Presidents Robert E. Hertzka, MD, Ralph R. Ocampo, MD CMA Trustees Catherine D. Moore, MD, Theodore M. Mazer, MD, Albert Ray, MD, Diana Shiba, MD, Robert E. Wailes, MD AMA Delegates James T. Hay, MD, Robert E. Hertzka, MD AMA Alternate Delegates Lisa S. Miller, MD, Albert Ray, MD

CALL SDCMS AT (858) 565-8888 TODAY!

››Send your letters to the

editor to Editor@SDCMS.org 4

S A N D I E G O P HY S I CI A N .or g Ma r ch 2010

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

mar ch 2010 SAN DIEGO P HY SICI A N. o rg

sdcmsseminars/webinars/events

Free to Member Physicians and Their Office Staff! Don’t See What You Need? Let Us Know!

For further information, visit SDCMS.org or contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

SDCMS 2010 Seminars / Webinars / Events Date APR 14

Day WED

Time

Topic

Presenter

11:30am – 1:00pm

Best Practices (“What Every Physician Needs to Know About Their Practice” — for Office Managers and Administrators)

California Medical Association

x x

APR 14

WED

6:00pm – 8:30pm

Best Practices (“What Every Physician Needs to Know About Their Practice” — for Physicians)

APR 15

THU

11:30am – 1:00pm

Recovery Audit Contractor (RAC)

Jay Lynch, Boyton & Boyton

APR 16

FRI

6:00pm – 9:00pm

Membership Social at the Rock Bottom Restaurant and Brewery

SDCMS

APR 21

WED

6:30pm – 7:30pm

Risk Management (“eHealth: Telemedicine and Telehealth”)

The Doctors Company

APR 22

THU

11:30am – 12:30pm

Risk Management (“eHealth: Telemedicine and Telehealth”)

The Doctors Company

APR 28

WED

11:30am – 1:00pm

Medi-Cal

Therese Calcagno, EDS Corp.

(TBD)

9:00am – 7:00pm

EMR / EHR Trunk Show

Maxwell IT, Multiple Exhibitors

MAY 6

THU

11:30am – 1:00pm

Ofer Shimrat, SOUNDOFF Computing Corporation

MAY 12

WED

11:30am – 12:30pm

e-Town Hall

Tom Gehring, SDCMS

MAY 20

THU

11:30am – 1:00pm

Workers’ Compensation Billing

CHMB Solutions

MAY 21

FRI

6:00pm – 9:00pm

Young Physician Spring Social (T)

SDCMS

JUN 5

SAT

6:00pm – 11:00pm

SDCMS/SDCMSF White Coat Gala (SDCMS Installation Dinner & Dance)

SDCMS and SDCMSF

JUN 18–19

FRI–SAT

8:00am – 4:00pm

Leader’s Toolbox

Tom Gehring, SDCMS

JUN 24

THU

11:30am – 1:00pm

Sexual Harassment

Alliant Insurance Services

JUL 21

WED

6:30pm – 7:30pm

The Doctors Company

JUL 22

THU

11:30am – 12:30pm

Risk Management (“The Employee’s Role in Decreasing Liability Risks in the Physician Office”) Risk Management (“The Employee’s Role in Decreasing Liability Risks in the Physician Office”)

The Doctors Company

AUG 18

WED

11:30am – 1:00pm

OSHA Updates

Tom Gehring, SDCMS

* "S" = Seminar • "W" = Webinar • "E" = Event

S* W* E*

S A N D I E G O P HY S I CI A N .or g Ma r ch 2010

x x

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For more than eight decades, Alliant Insurance Services has provided innovative and solutions-oriented programs and services for our clients. One of the nation’s leading specialty insurance brokerage firms, Alliant Insurance Services has the experience and drive to meet the needs of SDCMS members.

mar ch 2010 SAN DIEGO P HY SICI A N. o rg

communityhealthcarecalendar

To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. All events should be physician-focused and should take place in San Diego County. 20th Annual Nelson Butters’ West Coast Neuropsychology Conference Mar. 25–28 • Hilton San Diego Resort and Spa • cme.ucsd.edu/neuro

Collaborating for Healthy Communication: Conference on Language Access to Health Care Apr. 9 • Cuyamaca College • sdrefugeeforum.org/conference

6th Annual San Diego Health Policy Conference — Pharmaceutical Crime: Investigating and Prosecuting Drug Diversion and Counterfeiting Mar. 26 • Sponsored by the Institute of Health Law Studies and the California Western School of Law • San Diego Hilton Harbor Island Hotel • Email Pam Tait at prt@cwsl.edu

13th Annual California Healthcare Leadership Academy — “The Era of Health Reform: Harnessing the Currents of Change” Apr. 9–11 • San Diego Marriott Hotel and Marina • cmanet.org/leadership

23rd Annual Review of Vascular and Interventional Radiology Apr. 3 • Hotel del Coronado • cme.ucsd.edu 30th Annual Residents’ Radiology Review Course Apr. 4–9 • Hotel del Coronado • cme.ucsd.edu

S A N D I E G O P HY S I CI A N .or g Ma r ch 2010

Plant-based Diets in Clinical Practice Apr. 10 • Sheraton Universal Hotel, Universal City, Calif. • pcrm.org/VitalSigns, (202) 527-7310 Sharon’s Ride.Run.Walk for Epilepsy Apr. 25 • DeAnza Park Inside Mission Bay Park • All Money Raised Goes Directly to the Epilepsy Foundation of San Diego County • epilepsysandiego.org 11th Annual UC San Diego Stroke Conference May 15 • cme.ucsd.edu/stroke

U.S. Public Health Service Scientific and Training Symposium May 24–27 • Sheraton Hotel and Marina • phscofevents.org Alzheimer’s Disease: Update on Research, Treatment, and Care May 27–28 • Omni San Diego Hotel • cme.ucsd.edu/alzheimers UCSD Conference on Limb Salvage and Functional Reconstruction: Orthopedic, Vascular, and Wound Care Team Approval Jun. 25–27 • Westin San Diego • cme.ucsd.edu Hugh Greenway’s 27th Annual Superficial Anatomy and Cutaneous Surgery Jul. 12–16 • San Diego Marriott Del Mar • cme.ucsd.edu American Society for Bioethics and Humanities 12th Annual Meeting Oct. 21–24 • Hilton San Diego Bayfront Hotel • asbh.org

Take a

at your marketing plan.

Reach 8,500 doctors by advertising in San Diego Physician magazine. San Diego Physician is the only publication in San Diego County that is distributed to all 8,500 physicians in the region every month. Contact Dari Pebdani today to help you increase your business’ proﬁts.

Phone: 858.231.1231 or Email: DPebdani@SDCMS.org

mar ch 2010 SAN DIEGO P HY SICI A N. o rg

brieflynoted SDCMS Partners With Health Butler To Offer Free Wellness Opportunity for Member Physicians

By Murray A. Reicher, MD, SDCMS-CMA Member since 1987 and former SDCMS board member

Health Butler is an online preventive health information organization founded by longtime San Diego County physicians Drs. Murray (SDCMS-CMA member since 1987) and Danielle Reicher, along with their medical student son, Joshua Reicher. Health Butler’s mission is to gather research-backed preventive health information and organize it to motivate and educate individuals to actively participate in their own preventive care. A web-based wellness decision support engine is provided at HealthButler.com (Figure 1) that presents and tracks information in three general health categories: screenings, immunizations, and healthy habits. Health Butler fundamentally believes that the best healthcare can be affordable for all only if we also develop a culture of health literacy and personal responsibility. Health Butler offers healthy living email reminders (Figure 2), personal health information tracking, and a variety of health tools to users registered with the site. These tools help both physicians and employers increase the fitness and prevention compliance of their employees and patients. Health Butler

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

Figure 1: HealthButler.com. can provide physicians/employers with aggregate data about their associated enrollees, but does not collect personally identifiable information and will not spam or intentionally distribute any user-provided email address to any third parties.

Health Butler’s recommendations are based on referenced and credentialed material published by the U.S. National Institutes of Health (NIH), the U.S. Department of Health and Human Services

Figure 2: Example of part of a Health Butler-generated report card for an enrollee.

A web-based wellness decision support engine is provided at HealthButler.com that presents and tracks information in three general health categories: screenings, immunizations, and healthy habits. (USDHHS), and the Centers for Disease Control and Prevention (CDC), as well as multiple, recognized U.S. professional societies. Health Butler aims to work collaboratively with healthcare providers. The information we provide is intended only to inform individuals of reasonable guidelines in order to encourage discussion of recommended measures with a doctor. There is no advertising at the Health Butler website; instead users generally pay a subscription fee of $14.95 per year.

SDCMS and Health Butler Collaborate to Offer a New and Exciting Free Member Benefit! Health Butler is launching a pilot program for up to 50 physicians wherein members can now enroll themselves, their employees, patients, and families with Health Butler for free. Participating physicians will receive a sponsor I.D. number that they can provide to their sponsored employees and patients to gain access to the free benefits. What are the benefits of this program for participants?

1. F or you, your family, and employees: You will receive a free subscription to Health Butler, including e-reminders of your recommended measures and a place to track your compliance history. 2. P rovided you have more than 15 sponsored enrollees, sponsor physicians will receive aggregate data that can tell you about the preventive health issues of your affiliated individuals. That means you will see compiled information to help you assess the wellness issues facing your population of patients and employees. Your sponsored enrollees will be more motivated to see you at appropriate intervals and stay healthy. SDCMS member physicians who are interested in receiving this free benefit should email Dr. Reicher at admin@healthbutler.com to learn more.

Physicians Get Noticed! Wish Your Legislators a Happy Birthday!

Physicians: Let your legislators know that you’re paying attention and that you vote by wishing them a happy birthday! Birthday: MARCH 21

Senator Denise Moreno Ducheny E: senator.ducheny@sen.ca.gov Capitol Office: California State Capitol, Room 5035 Sacramento, CA 95814 T: (916) 651-4040 F: (916) 327-3522 District Office: 637 3rd Avenue, Suite A-1 Chula Vista, CA 91910 T: (619) 409-7690 F: (619) 409-7688

Birthday: MARCH 24

Assemblyman Martin Garrick E: assemblymember.garrick@assembly.ca.gov Capitol Office: California State Capitol Sacramento, CA 95814 T: (916) 319-2074 F: (916) 319-2174 District Office: 1910 Palomar Point Way, Suite 106 Carlsbad, CA 92008 T: (760) 929-7998 F: (760) 929-7999

Birthday: April 13

Congresswoman Susan Davis E: www.house.gov/susandavis Capitol Office: U.S. House of Representatives 1526 Longworth House Office Building Washington, DC 20515 T: (202) 225-2040 F: (202) 225-2948 District Office: 4305 University Avenue, Suite 515 San Diego, CA 92105 T: (619) 280-5353 F: (619) 280-5311

mar ch 2010 SAN DIEGO P HY SICIA N. o rg

brieflynoted In case you were wondering whether California’s Medical Injury Compensation Reform Act — better known as MICRA — still needs CMA’s protection …

98000reasons.org & PeopleOverProfits.org website snapshot Websites sponsored by the American Association for Justice (Formerly the Association of Trial Lawyers of America)

From 98000reasons.org: Tell Congress to put patients first. There are 98,000 reasons why you should. According to the Institute of Medicine, 98,000 people die every year from preventable medical errors — and this number doesn’t include those seriously injured. This is the sixth leading cause of death in America, equivalent to two 737s crashing every day. Trial attorneys see firsthand the effects medical errors have on patients and their families. The best way to have fewer medical malpractice cases is to reduce the number of medical errors. If less people need to seek legal recourse, that means patients are getting safer. Patients that are safer also means lower costs to the healthcare system. Everyone can support this. Learn more about medical negligence and the role of the civil justice system in the current healthcare debate: • Real Stories (links to eight patient stories) • Take Action! (links to PeopleOverProfits.org)

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

From PeopleOverProfits.org: People Over Profits, sponsored by the American Association for Justice, is committed to fighting back against the well-organized and well-funded assault on the civil justice system, and protecting American civil rights and trial by jury. When someone you love has been seriously injured or killed by a careless medical error or a defective product or drug, shouldn’t you have the right to hold the wrongdoers accountable?

Protect MICRA — Get Involved! One way to get more involved with our efforts to protect MICRA is through political action. CALPAC, the California Medical Association Political Action Committee, supports candidates and legislators who understand and embrace the House of Medicine’s agenda and are supportive of our efforts to protect MICRA. To contribute to CALPAC, please call (916) 444-5532 or, for more information about MICRA, please contact Nicole Madani at (916) 551-2571.

Get in

touch

Your SDCMS and SDCMSF Support Teams Are Here to Help! SDCMS Contact Information 5575 Ruffin Road, Suite 250 San Diego, CA 92123 T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org CEO/Executive Director Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO/CFO James Beaubeaux at (858) 300-2788 or Beaubeaux@SDCMS.org Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or at JLockett@SDCMS.org Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org director of medical office manager support and Office Manager Advocate Sonia Gonzales at (858) 300-2782 or SGonzales@ SDCMS.org Director of Engagement Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org Director of Communications and Marketing Kyle Lewis at (858) 300-2784 or at KLewis@SDCMS.org Specialty Society Advocate Karen Dotson at (858) 300-2787 or at KDotson@SDCMS.org BUSINESS MANAGER Nathalia Aryani at (858) 300-2791 or NAryani@SDCMS.org administrative assistant Betty Matthews at (858) 565-8888 or at BMatthews@SDCMS.org Letters to the Editor Editor@SDCMS.org General Suggestions SuggestionBox@SDCMS.org

SDCMSF Contact Information 5575 Ruffin Road, Suite 250 San Diego, CA 92123 T (858) 565-8888 F (858) 560-0179 W SDCMSF.org Executive Director Kitty Bailey at (858) 300-2780 or KBailey@SDCMS.org Associate Director Tana Lorah at (858) 300-2779 or at TLorah@SDCMS.org Patient Care Manager Barbara Rodriguez at (858) 300-2785 or at BRodriguez@SDCMS.org PROJECT ACCESS PROGRAM DIRECTOR Brenda Salcedo at (858) 565-8161 or at BSalcedo@SDCMS.org SURGERY DAY PROGRAM MANAGER Alisha Mann at (858) 565-8156 or at AMann@SDCMS.org Healthcare Access Manager Lauren Radano at (858) 565-7930 or at LRadano@SDCMS.org

Personal: • Income Tax Planning • Wealth Management • Financial Planning

Local: • Employee Benefit Plans • Profitability Reviews • Outsourced professional services (CFO, Controller)

Ron Mitchell, CPA Director of Health Services rmitchell@aktcpa.com 760-431-8440

Global: • Organizational Structure • Succession Planning • Internal Control Review and Risk Assessment 5946 Priestly Drive, Ste. 200 Carlsbad, CA 92008

CPA’s and Consultants

SDCMS Tweets! Follow SDCMS on Twitter.com to keep abreast of H1N1 updates, the latest healthcare reform developments, SDCMS seminars, and more!

mar ch 2010 SAN DIEGO P HY SICIA N. o rg

fromoursandiegocountylegislators By Assemblymember Marty Block

One in an occasional series of articles from San Diego County's legislators.*

Budget / Healthcare / Education And the Future of California

*Opinions expressed herein are not necessarily endorsed by SDCMS or CMA

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

We all know how easy it is to tune out when news reporters talk about California’s budget problems. It’s probably even easier to tune out when that talk comes from politicians. But as unglamorous as the budget may be, its impact on all Californians can’t be understated. Cuts in education aren’t just something on paper. They have real, tangible effects on students today and on the state’s health and economy in the future. How many aspiring physicians will be budget cut out of higher education? Will we have fewer nurses, physician assistants, technicians, and physical therapists to address the coming healthcare tidal wave because

they were unable to find an open space in a college freshman class? The implications for our healthcare future are clear. There may be, however, legislative tools that will help us avoid what is truly becoming an imminent crisis. For nearly 50 years, California’s higher education system has been the envy of the world. The University of California (UC) campuses have produced groundbreaking research in everything from agriculture to biotechnology. The California State University (CSU) system has produced millions of professionals that teach in our schools and are leaders in our communities. And yet, as

impressive as these systems have been and continue to be, perhaps the most overlooked and underappreciated system of higher education is California’s community colleges. With 110 campuses and an enrollment of more than 2.9 million students, the California Community Colleges award associate degrees, prepare students for transfer, and run the critical career technical-educations programs that our state relies so heavily upon. Yet, with enrollment that dwarfs both UC and CSU several times over, why are we not doing more to use our community colleges to address job shortages in California’s most vital areas? Throughout the state, UC and CSU campuses are turning away record numbers of applicants as classroom space becomes more and more of a premium. In fact, some campuses (San Diego State University in particular) are turning away local students in favor of bringing in additional revenue. It’s clear something needs to be done, and the time to do it is now. This year, I intend to introduce

legislation that will allow a small number of California Community Colleges to begin offering bachelor’s degrees in high-need professions. While there is some opposition to this idea, most of that opposition comes from entrenched bureaucrats who seem more concerned about maintaining the status quo than attempting to divert a very calamitous future. And make no mistake: The situation in California is dire. According to the Public Policy Institute of California, our state needs to produce 1 million more bachelor’s degrees than we do currently to remain economically competitive in the coming decades. The legislature can help us attain this necessary endeavor by following the path of 17 other states and allowing our community colleges to offer bachelor’s degrees. That’s right, this idea isn’t a new one, but it can be a successful one. States such as Florida, Washington, and most recently Hawaii are among those already offering bachelor’s degrees in limited

fields at their community colleges. Most often these programs are in nursing, allied health professions, and information technology — areas that desperately need qualified people to meet a growing demand. California needs to prepare for the future, and the best way to do that is by addressing problem issues today. If we work together we can demonstrate that 40,000 students being turned away from a CSU campus doesn’t mean we have to forfeit 40,000 potential nurses, physician assistants, technicians, and physical therapists. Yes, the budget problems are overwhelming, but we have a golden opportunity to help students, provide for a more secure future, and guarantee that we will continue to lead the nation and the world in innovation and leadership by addressing some of those budget issues now. And I am committed to making certain that we give every opportunity to those students who want to learn, want to lead, and ultimately want to keep California the most productive state in the nation.

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fromsandiegocountyhealthleaders By Paul Bernstein, MD, Medical Director, Kaiser Permanente, San Diego

One in an occasional series of articles from San Diego County's healthcare leaders.*

“HMO”

A “Good” Three-letter Word

*Opinions expressed herein are not necessarily endorsed by SDCMS or CMA

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

You’re on the exam table, wearing a flimsy gown, and worrying what the doctor may find. The paper crunches under you, and a sudden chill needles your neck. You’re not sure if it’s the room temperature or your nerves. In his calm, trusting manner, the doctor reassures you that you passed your physical and everything is fine, but then, instead of rushing off to his next patient, he shares your test results with you on a computer in the exam room, even brings up an image of your last MRI, before counseling you on blood-pressure control and the use of aspirin and cholesterol-lowering drugs to reduce your risk of heart attack. He explains that

people your age who follow his advice have a 30 percent decrease in death rate from heart disease. This patient and doctor were part of Kaiser Permanente, the nation’s largest nonprofit health maintenance organization. Prepaid medical care — now known as managed care or simply as an HMO — has been around for 70 years. Born out of the challenge of the Great Depression and World War II when patients had the choice of either paying expensive doctors’ fees or going to a charity hospital, Dr. Sidney Garfield, a young surgeon, and industrialist Henry Kaiser created Kaiser Permanente, the first and now the largest nonprofit HMO.

HMOs are prepaid a single premium and are motivated to keep you healthy. They do everything they can to encourage you to come in for mammograms, diabetes testing, colonoscopies, vaccinations, weight-loss programs, no-smoking classes — the list goes on. The better they take care of you, the less sickness you have, the lower the costs are to them. Kaiser Permanente currently leads the nation in colonoscopy screening and mammograms in women over 65, and will soon lead in blood-pressure screening. Learnings from Kaiser Permanente highlight the effect of lifestyle and clinical risk on medical costs that can be attributed to the following 15 key risk factors: excessive alcohol consumption; high blood pressure; high BMI; high total cholesterol; low HDL cholesterol; excessive work absences; low job satisfaction; low life satisfaction; fair or

of our organization. As well, we developed a vision of wellness through our THRIVE advertising campaign that was visible to our members and potential members. Our strategy was based on delivering affordable and demonstrable, high-quality healthcare that was both easy to access and provided with a personal touch. We both demonstrated and were recognized that we could be the prevention leader. Most physicians want nothing other than to keep you healthy. But no matter how dedicated we are to the Hippocratic Oath, no matter how much we want to be Good Samaritans, in the end, to keep our practices going, doctors have to bill. In the current state, healthcare costs continue to skyrocket, traditional health management approaches are insufficient, rising costs create the need to do “more with less,” and demands on em-

It’s no surprise that a Consumer Reports study of 20,000 people showed that patient satisfaction rates were much higher in nonprofit HMOs. poor perception of health; low level of physical activity; lack of consistency wearing seat belt; smoking; high stress; use of drugs for relaxation; and existing medical problem. Exercise is also medicine. If we had a pill that conferred all the proven health benefits of exercise, physicians would prescribe it to every patient, and our healthcare system would find a way to make sure every patient had access to this wonder drug. Not all HMOs are created equally. There are two models of HMO care: for-profit and nonprofit. A nonprofit HMO health plan, like Kaiser Permanente, reinvests all revenues back into quality patient care. Its incentive is to keep you healthy and prevent illnesses such as heart disease and cancer because healthier people require less costly care. Efforts to contain costs are done solely to provide quality healthcare at a price you can afford. It’s no surprise that a Consumer Reports study of 20,000 people showed that patient satisfaction rates were much higher in nonprofit HMOs. Our experience at Kaiser Permanente has taught us several lessons. We have our electronic medical record, which provides a powerful tool for outpatient and inpatient care. We also possess a prevention culture ingrained in our genetic code based in the roots

ployees increase. As a result, employee health and productivity is a growing concern for employers. All of my decisions on care are based on what’s best for the patient. The patient and I are on the same team. That’s why I’ve looked forward to going to work every day for the last 25 years. Okay, you can put your clothes back on now. H … M … O … let the three letters come off your tongue more upbeat. As my son would say: “Dad, it’s a no-brainer.” We should pay doctors for keeping us healthy. To put it simply, American medicine needs to change from a “sick plan” to a “health plan.” At Kaiser Permanente, we believe that the conversation about health needs to change from health as the absence of disease to health as vitality and energy, from only caring for the sick to enabling healthy people to stay healthy, from the cost of healthcare to the total value of health, from individual participation to population engagement, and from behavior change to a culture of health. As the numbers of the uninsured (45 million Americans, one in five Californians) spiral out of control, competing nonprofit HMO models may be the best solution to our nation’s health crisis. Trust me, I’m a doctor.

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mar ch 2010 SAN DIEGO P HY SICIA N. o rg

Physician Workforce

2009 SDCMS Physician Workforce and Compensation Survey E x e c u t i v e

Summ a r y

By Tom Gehring, CEO and Executive Director, San Diego County Medical Society 18

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

n 2002, the San Diego County Medical Society (SDCMS) conducted San Diego County’s first Physician Workforce and Compensation Survey — a paper survey mailed to all physicians in the county for whom we had an address. The 2002 results provided us and local healthcare policymakers with the first insights into physician attitudes toward their work and their workplaces. Our 2002 survey quantified San Diego County’s physician compensation environment as well. In 2005 we conducted our second Physician Workforce and Compensation Survey, which, unlike the 2002 survey, was an electronic survey sent to all physicians in the county for whom SDCMS had a valid email address. In 2007 we conducted our third survey, which contained all of the questions included in our 2005 survey plus two questions on physician on-call behavior and several questions on County Medical Services reimbursements. In October, November, and December of 2009, we conducted our fourth survey, using the identical questions as the 2007 survey and an online surveying tool. With 580 physicians responding — a significant increase over the previous two — we are able to claim a confidence level of 95% with a margin of error of +/– 4%. The preponderance of respondents were SDCMS members; however, the distribution of respondents was consistent with San Diego County’s 6,500-plus physician community across modes of practice, geography, gender, and primary/specialty care.

mar ch 2010 SAN DIEGO P HY SICIA N. o rg

Physician Workforce Key Findings: Physician History With and Plans for Medicare

Definitions: •Solo Physicians: One or two physicians practicing together. •Small-group Physicians: Three or four physicians practicing together. •Small, Medium-group Physicians: Five to 25 physicians practicing together. •Large, Medium-group Physicians: Twenty-six to 150 physicians practicing together. •Large-group Physicians: More than 150 physicians practicing together. •Solo or Small-group Physicians Cohort: One to four physicians practicing together. •Medium- or Large-group Physicians Cohort: Five or more physicians practicing together. •Academic Medicine Physicians Cohort: Physicians practicing at UCSD.

Table 1: Distribution of Responses to a 21% Cut in Medicare, by Mode of Practice 100% 90% 80%

32% 54%

70%

58%

60%

86%

50% 40% 30%

68% 46%

20%

42%

10% 0%

14% UCSD

Large Group Change Medicare practice if 21% cut

S AN DI E G O P HY S I CI A N . or g Ma r ch 2010

Medium Group

Solo and Small Group

Take Medicare As Is if 21% cut

When pediatricians are factored out of the data, given that Medicare for children is a rarity, every statistical grouping except solo physicians takes Medicare at or near 100%. However, only 82% of non-pediatric solo physicians take Medicare, consistent with 2007 when 81% of all solo physicians took Medicare. Of the solo physicians who took Medicare three years ago, 9% do not take Medicare today. This indicates that while existing solo physicians are dropping Medicare, enough new solo physicians are accepting Medicare that there is no net year-over-year change for Medicare acceptance among non-pediatric solo physicians. If Medicare rates are left unchanged, a political likelihood, only solo and small-group physicians will change their behavior significantly, with roughly one-third saying they will not continue to take Medicare as is. These solo and small-group physicians will, in the main, significantly reduce Medicare patient hours. Physicians practicing in large, medium-group practices also indicate that they will reduce Medicare patient hours. If Medicare rates are reduced by 21%, — politically unlikely but certainly a worst-case scenario — the behavior of physicians changes dramatically across the board. A huge decrease in solo and small-group physicians taking Medicare in light of such a large cut is to be expected. What is astonishing is the rate at which medium- and even large-group physicians would change their behavior in the event of a 21% change in Medicare (see Table 1).

Key Findings: Physician History With and Plans for Medi-Cal Physicians were asked whether they took Medi-Cal three years ago; whether they take Medi-Cal now; and what they would do in the face of no change to Medi-Cal’s low reimbursement rates. On average, 59% of physicians took Medi-Cal in 2009. Physicians reported that in 2007 63% took Medi-Cal, and in 2005 70% took Medi-Cal. Table 2 provides a detailed breakdown of Medi-Cal acceptance rates by mode of practice. Table 3 displays the specific change(s) methodology in the absence of a Medi-Cal rate increase for physicians who currently take Medi-Cal. Without a Medi-Cal rate increase, things look grim for overall Medi-Cal acceptance. When the data is analyzed for the responses of specialist versus primary care physicians, two interesting trends emerge: • Solo and small-group primary care physicians will change their Medi-Cal acceptance rates (in the absence of a rate increase) at a much higher rate (57%) than will solo and small-group specialists (34%). • Medium-group primary care physicians will not change their Medi-Cal acceptance rates (less than 10% will change), but medium-group specialists will change their Medi-Cal acceptance rates in the absence of a rate increase (41%). Since the behavior in Table 3 excludes physicians who do not take Medi-Cal, the net impact is even more severe. Table 4 represents the net acceptance, by mode of practice, in the face of failing to increase Medi-Cal rates, by multiplying the changed behavior of Table 3 with the current percentage of physicians who take Medi-Cal, analyzed by mode of practice.

Table 2: Distribution of Medi-Cal Acceptance, by Mode of Practice 100% 90%

100% 88%

80%

60%

62%

50%

40% 30%

36%

Small Group

Solo

10% 0%

Community Clinic

UCSD

Large Group

Large, Medium Small, Medium Group Group

Table 3: Distribution of Medi-Cal Actions in the Face of No Rate Increase, by Mode of Practice

100% 90% 80% 70% 60%

67%

68% 84%

56%

78%

80%

50% 40%

22%

30%

12%

20% 10%

11% 3% 1%

UCSD

11%

12%

4% 4%

Large Group

Large, Medium Group

Continue to Take Medi-Cal

— San Diego County Physician

36%

20%

“Exponentially increasing demands of extraneous factors divert my time and attention from active patient interaction and care. The toll of the frustration and anxiety on my peers — and myself — causes me concern for the health and wellbeing of my medical community.”

85%

70%

27%

11%

0% 7%

Small Group

Solo

4% Small, Medium Group

Significantly Reduce Medi-Cal

No New Medi-Cal

14%

Eliminate Medi-Cal

Table 4: Projected Net Acceptance of Medi-Cal in the Face of No Rate Increase, by Mode of Practice

100% 90% 80% 70%

74%

60%

58%

50%

48%

40%

30%

24%

20%

10% 0%

UCSD

Large Group

Large, Medium Group

Small, Medium Group

Small Group

Solo

mar ch 2010 SAN DIEGO P HY SICIA N. o rg

Physician Workforce Key Findings: Physician History With and Plans for County Medical Services (CMS) Table 5: Distribution of CMS Acceptance, by Mode of Practice 100% 90% 80%

77%

70% 60%

65% 55%

50% 40%

36%

30%

29%

20%

28% 21%

10% 0%

Community Clinic

UCSD

Large Group

Large, Medium Small, Medium Group Group

Small Group

Physicians were asked whether they took County Medical Services (CMS) three years ago; whether they take CMS now; and what they would do in the face of no change to CMS’ very low reimbursement rates. On average, 41% of physicians took CMS in 2009, as opposed to 47% in 2007. Projecting forward, absent a change in CMS reimbursement, the future looks bleak for CMS patients who need to see a physician. By multiplying the changed behavior of Table 6 with the current percentage of physicians who take CMS, analyzed by mode of practice, Table 7 represents the net acceptance, by mode of practice, if CMS rates are not increased.

Solo

Table 6: Distribution of CMS Actions in the Face of No Rate Increase, by Mode of Practice 100% 90% 80% 70% 60%

67% 80%

84%

77%

75%

92%

50% 40% 30%

20%

20% 10% 0%

12% 1% 3%

UCSD

4% 4% 0%

Large Group Continue to Take CMS

13% Large, Medium Group

7% Small, Medium Group

Reduce CMS

S AN D I E G O P HY S I CI A N . or g M a rc h 2010

No New CMS

23% 0%

Small Group Eliminate CMS

18% 4% 4% Solo

“Having moved here from Florida, I am glad we don’t have the tort problems as other states do.” — San Diego County Physician

â&#x20AC;&#x153;Government and insurance payors know that doctors (and other professionals) love San Diego and are unlikely to leave; therefore, they have no incentive to be more generous. Until there is radical unavailability of care, little will change.â&#x20AC;?

Table 7: Projected Net Acceptance of CMS in the Face of No Rate Increase, by Mode of Practice

100% 90% 80%

â&#x20AC;&#x201D; San Diego County Physician

70% 60%

65%

50% 40%

36%

30%

26%

20%

29% 21%

10% 0%

UCSD

Large Group

Large, Medium Group

Small, Medium Group

Small Group

16% Solo

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Physician Workforce Key Findings: Specialties That Are in Crisis

“Yes, medicine is more challenging with increased demands placed by more complicated/sick patients. The tax burden is crushing. I’m not sure how we’ll survive with healthcare reform. I’m concerned that our medical organizations are more interested in being politically correct than being honest about the deep-set concerns regarding medicine. Most of our problems would improve if we didn’t have to constantly and vigilantly practice defensive medicine. Federal tort reform is underemphasized in the upcoming bills. Finally, Medicare reimbursement feels like a deal with the devil. The rules change, always to the detriment of the physician, and you’re often left with pennies on the dollar for the care of very complicated patients, always with the threat of government penalties and fraud over your head.” — San Diego County Physician

S AN D I E G O P HY S I CI A N . or g M a rc h 2010

The study highlighted the following specialties (listed alphabetically) that are in crisis, defined as a combination of the following three criteria: longer-than-average wait times for new patients, a perception that the specialty was in shortage, and a perception of difficulty recruiting within the specialty: • dermatology (in difficulty in 2005) • gastroenterology • neurology (in crisis in 2005 and in 2007) • psychiatry (in difficulty in 2005 and in 2007) • rheumatology (in difficulty in 2005) • urology (in crisis 2005)

Key Findings: Specialties That Are in Difficulty The study highlighted the following specialties (listed alphabetically) that are in difficulty, defined as a combination of two of the following three criteria: longerthan-average wait times for new patients, a perception that the specialty was in shortage, or a perception of difficulty recruiting within the specialty: • endocrinology • family medicine (in difficulty in 2007) • general surgery (in difficulty in 2005) • hematology/oncology (in difficulty in 2007) • internal medicine (in difficulty in 2007) • nephrology (in difficulty in 2007) • neurosurgery (in crisis in 2005) • obstetrics and gynecology (in difficulty in 2005) • orthopedic surgery (in crisis in 2005) • otolaryngology (in crisis in 2005 and in difficulty in 2007) • pediatrics

Key Findings: Physician Shortages Overall, 38% of physician respondents felt there was a physician shortage, down from 45% in 2007 and 2005. There is a significant difference in the response of UCSD physicians and non-UCSD physicians. Few UCSD physicians believe there is a physician shortage (23%), while an average of 43% of physicians in the two other cohorts (solo and small-group physicians, and medium- and large-group physicians) believe there is a physician shortage, with no significant variation between the two cohorts on this question.

Key Findings: Specialty Shortages Following is a list of specialties in descending order (more to less) where more than 20 physicians felt there were shortages. Among those specialties listed, some had longerthan-average wait times for new patient appointments, an informal indicator that a perceived shortage by physicians is translating into a real problem for patients. • family medicine (repeat from 2005 and 2007) • internal medicine (repeat from 2005 and 2007) • neurology (repeat from 2005 and 2007) (longer-thanaverage wait times) • psychiatry (repeat from 2005 and 2007) (longer-thanaverage wait times) • general surgery (repeat from 2005 and 2007) • dermatology (repeat from 2005 and 2007) (longer-thanaverage wait times)

• pain medicine (repeat from 2007) • gastroenterology (repeat from 2007) (longer-thanaverage wait times) • obstetrics and gynecology (repeat from 2005 and 2007) • neurosurgery (repeat from 2005 and 2007) • rheumatology (repeat from 2007) (longer-than-average wait times) • endocrinology (repeat from 2007) • orthopedic surgery (repeat from 2005 and 2007) • pediatrics (repeat from 2007) • otolaryngology (repeat from 2005 and 2007) • urology (longer-than-average wait times) • allergy and immunology • emergency medicine • hematology/oncology

“I have been in practice seven years and have seen a decline in morale amongst the physicians in private practice.” — San Diego County Physician

mar ch 2010 SAN DIEGO P HY SICIA N. o rg

Physician Workforce Key Findings: Physician Recruiting Of those who were involved in recruiting, while there does not seem to be as strong a sense of physician shortage, there is still a strong sense of concern about recruiting physicians. Of those who were involved in recruiting, 39% reported some difficulty in recruiting (down slightly from 41% in 2007 and 45% in 2005). Twenty-nine percent reported significant difficulties in recruiting (down slightly from 33% in 2007 and 34% in 2005). A significant difference emerged when analyzing recruiting difficulty by practice size. While there was no significant change

“The children and their parents are the highlight of my day. The third-party payers have raped medicine for their profit and have over the years encroached on the practice of medicine so that I have to do battle with them just to try to practice good medicine. They are a blight on scientific and evidence-based medicine.” — San Diego County Physician

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

in recruiting for medium- and large-group practices, an astonishing 84% of solo and small-group physicians reported difficulty recruiting (either some difficulty or significant difficulty), essentially unchanged from 2007; the percentage of solo and small-group physicians experiencing significant difficulties in recruiting, however, jumped from 44% to 59%. Academic physician recruiting difficulties appear to have eased, with no difficulties in recruiting up from 21% in 2007 to 44% in 2009. Significant in-specialty recruiting difficulty was indicated for the following specialties (sorted alphabetically): • gastroenterology • general surgery (repeat from 2005 and 2007) • infectious diseases (upgraded from “some difficulty” in 2007) • nephrology (repeat from 2007) • obstetrics and gynecology (upgraded from “some difficulty” in 2007) • orthopedic surgery (repeat from 2005 and 2007) • plastic surgery

• psychiatry (repeat from 2005 and 2007) • radiology (repeat from 2005 and 2007) • rheumatology • thoracic surgery • urology Some difficulty in in-specialty recruiting was identified for the following specialties (listed alphabetically): • cardiology • colorectal surgery • dermatology • endocrinology • family medicine (downgraded from “significant difficulty” in 2005 and 2007) • hematology/oncology (downgraded from “significant difficulty” in 2007 and “some difficulty” in 2005) • internal medicine (downgraded from “significant difficulty” in 2005 and 2007) • neurology (downgraded from “significant difficulty” in 2005 and 2007)

“More paperwork. More regulation. Less time with patients. More time with charts. Overall, more frustration, less satisfaction.” — San Diego County Physician

• neurosurgery • otolaryngology (downgraded from “significant difficulty” in 2005 and 2007) • pediatrics (repeat from 2007) • pulmonology (downgrade from “significant difficulty” in 2007 and “some difficulty” in 2005) • radiation oncology • transplant surgery • vascular surgery (repeat from 2007)

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Physician Workforce Key Findings: Physician Retention

“I am seeing 30 patients on average per day, and yet my income has not increased. This year our revenue increased 15 percent, but our COSTS increased 17 percent, over last year. It feels as if I am that little hamster on the wheel, never making progress.” — San Diego County Physician

“Overall, the low reimbursement makes it difficult to attract new, toprated physicians to a practice, unless: 1) They have a spouse in the area and are forced to work here; 2) They have relatives/family in the area that they want to be close to; 3) They love the beach/weather and are willing to work for lower wages; 4) They need to live here for health reasons.” — San Diego County Physician

On the subject of physician retention, the 2009 survey projects 81% of San Diego County physicians will maintain their practice “as is” for the next three years, essentially unchanged from 2007 and 2005. Physicians were asked what they intended to do with their practice in one to three years. The results, all essentially unchanged from 2005 and 2007, are as follows: • Leave (retire, change jobs, or move) practice of medicine in one year: 3%, essentially unchanged from 2007 and 2005. • Leave (retire, change jobs, or move) practice of medicine in three years: 9% up slightly from 6% in 2007 and 2005. • Reduce hours in the practice of medicine in one year: 1%, down slightly from 2007 and 2005. • Reduce hours in the practice of medicine in three years: 6%, essentially unchanged from 2007 and 2005. When analyzed by mode of practice, there is a clear difference: Solo physicians are likely to get out of the practice of medicine at a much larger rate than any of the other cohorts.

Key Findings: Total Physician Hours Worked The average number of total hours worked by San Diego County physicians, including clinical and non-clinical hours, was 60.1 hours per week, unchanged from 2007. The difference in total hours worked between solo/small-group physicians on the one hand and medium/large-group physicians on the other has narrowed: from 61.9 hours for solo/small-group physicians and 54.4 hours for medium/ large-group physicians in 2007, to 59.7 hours and 56.8 hours respectively in 2009. There was a slight reduction in academic total work hours.

Key Findings: Hours per Week Seeing Patients A full-time, San Diego County physician spends an average of 40.4 hours per week seeing patients, essentially unchanged from 39 hours per week in 2007. As in 2007, there was negligible (less than one hour per week) variation when the data was analyzed by specialist versus primary care physician; however, in 2009 the difference in patient hours between male and female physicians has essentially disappeared.

S AN D I E GO P HY S I CI A N . or g M a rc h 2010

Key Findings: Time Spent With Patients Physicians were asked whether they felt that the time spent with patients was adequate. Sixty-four percent responded that time with patients was adequate, while 36% said time was inadequate. Physician satisfaction with the time spent with patients was up slightly from 2007, when the ratio was 60% satisfied with patient time versus 39%; however, when the data was analyzed by practice size, a very significant difference emerged: • Solo and small-group physicians, by a wide margin — 70% satisfied to 30% dissatisfied, up from 62% to 38% in 2007— felt that time spent with patients was adequate. • Medium- and large-group physicians, on the other hand, were split 57% to 43% that time spent with patient care was adequate, essentially unchanged from 2007. • Sixty-six percent of physicians practicing in an academic setting were satisfied with time spent with patients, unchanged from 2007. There were similar, although not as significant, diver-

gences of opinions when time spent with patients was analyzed by gender. There were no significant gender differences for solo/small-group physicians, but there were gender divergences in the academic and medium/largegroup cohorts, with female physicians significantly less satisfied with time spent with patients. In the academic setting, male physicians were 71% satisfied with the time spent with patients, while female physicians were 55% satisfied. In the medium- and large-group settings, the male-to-female satisfaction-with-time-spent-with-patients ratio was 63% to 43%. Specialists are overwhelmingly satisfied with time spent with patients, at 69%, up from 64% in 2007. At 55%, primary care physician satisfaction with time spent on patient care was unchanged from 2007. One significant anomaly is that primary care physicians in medium and large groups were significantly less satisfied with the time spent with patients (49% positive) than were their peers in academic (66%) and solo and small-group settings (57%).

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Physician Workforce

Key Findings: Wait Times for New-patient Appointments

“The real breakdown in our county is the inability to obtain specialty care for unfunded and underfunded patients.” — San Diego County Physician

“My patients are wonderful people. My staff is wonderful. That is the only reason why I stay in this business. I have no time for a personal life. I do not own my own home. I do not take care of my own health. I barely have anything to show in savings for my retirement.” — San Diego County Physician

S AN D I E G O P HY S I CI A N . or g M a rc h 2010

Physicians were asked for the wait times for a new patient to obtain an appointment. The average time for a new patient to obtain an appointment was 2.1 weeks, or 11 business days, essentially unchanged from 2007 and 2005. When compared to 2007 data, there is no significant change in the overall, average wait time distribution for new appointments: • 38% in 1 week, essentially unchanged from 2007. • 30% in 2 weeks, essentially unchanged from 2007. • 15% in 3 weeks, up slightly from 11% in 2007. • 17% in 4 weeks, down slightly from 20% in 2007. The data was analyzed to determine any variance by physician gender, physician experience, or whether the physician was a specialist versus a primary care physician. Across the mode of practice spectrum, it takes longer to see a female physician than a male physician: 2.4 weeks or 14 days versus 2.0 weeks or 10 days. This is a new trend. There was, new for 2009, significant variation between the years-in-practice cohorts: Counterintuitively, in the first 10 years of practice, it takes significantly longer to get an appointment.

13th ANNUAL CALIFORNIA HEALTH CARE The Era of Health Reform: Harnessing the Currents of Change April 9-11, 2010 • • • •

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Hospital-Physician Alignment and New Models of Practice Health System Reform: Then and Now Leadership in a New Health Care Era and more...

New for 2010: Academy Curricular Tracks • Health Information Technology • Practice Management • Leadership Development

TO REGISTER - call 800.795.2262 or visit our website at caleadershipacademy.com Continuing medical education: The California Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The California Medical Association designates this educational activity for a maximum of 18.25 AMA PRA Category 1 Credits ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education. mar ch 2010 SAN DIEGO P HY SICIA N. o rg

Physician Workforce Key Findings: Physician Dissatisfaction With the Practice The dissatisfaction of physicians with the practice of medicine in San Diego County is strong, but the overall numbers reflect no significant changes. Overall, 54% are less satisfied with the practice of medicine than they were five years ago, as compared with 50% in 2007 and 53% in 2005. Physicians reported that 14% are more satisfied and 32% see no change in their satisfaction with the practice of medicine. On a positive note, physicians practicing in the academic setting at UCSD are the most satisfied cohort, by far, of San Diego County’s physicians. There is strong variation along several axes of data analysis: • The difference in dissatisfaction between male and female physicians has disappeared since 2005. In a worrying trend, female physician dissatisfaction has increased significantly, from 39% in 2005 to 57% in 2009. • The dissatisfaction among solo and small-group physicians continues to grow, now at 67% dissatisfied, up from 60% in 2007.

S AN D I E G O P HY S I CI A N . or g M ar ch 2010

• Dissatisfaction among medium- and large-group physicians is also growing: In 2009, a majority are more dissatisfied than five years ago (60% for medium-group physicians and 51% for large-group physicians), up significantly from prior years. • The differences in dissatisfaction between specialists and primary care physicians has disappeared in that the primary care dissatisfaction has now increase from 39% in 2007 to 53% in 2009, a dramatic increase. 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 differential between dissatisfied and satisfied physicians goes from 15% for physicians in their first five years of practice to 47% in their second five years of practice and then to 42% in their third five years of practice.

Key Findings: Physician Compensation Physician compensation improved vis-à-vis 2007. Physicians were asked whether their compensation went up, stayed the same, or went down relative to their compensation three years ago. • Compensation increased in the last three years: 43%. • Compensation decreased in the last three years: 29%. • Compensation remained the same in the last three years: 28%. While the differential continues, both primary care physicians and specialists have increased their compensation vis-à-vis 2007. Solo and small-group physician compensation is going down. When analyzed for years in practice, the trends are not surprising: Younger physicians see their compensation increasing, while older physicians do not; however, there is an anomalous behavior in the six to 10 year cohort: They are not getting the increases in pay they expect.

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9/22/08

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“I’ve been very pleased with my mix of managed care to give me predictable income and Medicare patients.” — San Diego County Physician

“I do not take insurance and am not contracted with any PPOs. With that said, my patients are the happiest with the unrushed, purposeful way I practice. I believe it can be done for all, regardless of financial status. Take government and insurance out of the exam room! That is why I am happy practicing the art of medicine.” — San Diego County Physician

Page 1

Tracy Zweig Associates A

REGISTRY

PLACEMENT

FIRM

Physicians

Nurse Practitioners Physician Assistants

Locum Tenens Permanent Placement V oic e: 800- 9 1 9 - 9 1 4 1 or 8 0 5 - 6 4 1 - 9 1 4 1 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

tz w eig@ t r a cy zw e i g. com w w w. tra cy zw e i g. com

mar ch 2010 SAN DIEGO P HY SICIA N. o rg

Physician Workforce Key Findings: Specialty-specific Compensation Information The five lowest-paid specialties are (listed alphabetically) family medicine, internal medicine, pediatrics, psychiatry, and rheumatology. The five highest-paid specialties are radiation oncology, urology, vascular surgery, general surgery, and ophthalmology.

“We must disengage from insurance and Medicare/ Medi-Cal in order to force the system into a healthier financial structure.”

Key Findings: Average On-call Days per Month Physicians were asked about average on-call days per month. For those physicians seeing patients, on average, … (see Table 8).

— San Diego County Physician

Table 8: On-call Behavior

S AN D I E G O P HY S I CI A N . or g M a rc h 2010

Percentage Taking Uncompensated Call

Average Days of Uncompensated Call for Those Taking It

Percentage Taking Compensated Call

Average Days of Compensated Call for Those Taking It

Academic Physicians

62%

4.3 Days

28%

4.9 Days

Medium- and Largegroup Physicians

41%

4.4 Days

22%

5.3 Days

Solo and Smallgroup Physicians

34%

6.2 Days

27%

5.4 Days

S D C M S E ndo r sed P a r t ne r S po t l igh t

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there were 46 breaches encompassing nearly 80 million records. San Diego Physician: What steps can doctors take to avoid breaches? Mr. Francis: Most of the recommendations are pretty simple: Medical offices should have computer systems in place with log-out and password protection. They should ensure their computer systems and servers are backed up and secure. Physicians should limit online communications to existing patients as traditional email is not secure. In addition, doctors’ offices should prepare a data recovery and/or disaster plan so that they can comply with the Federal Trade Commission’s Red Flags Rule, which requires that holders of financial records develop and maintain a recovery and notification plan in the event of exposure. To access this rule, physicians should visit ftc.gov/bcp/ edu/pubs/business/alerts/alt050.shtm. San Diego Physician: What is the average cost to rectify a typical breach? Mr. Francis: While there’s no such thing as a typical breach, examples include the loss of a laptop computer with patient informa-

tion, and the loss of medical records. As part of its medical liability coverage, The Doctors Company now provides CyberGuard, which is complimentary privacy and cyber-liability protection that includes the cost of notifying patients — for physicians, the most frequently incurred cost associated with information breaches. CyberGuard also covers the cost of purchasing credit monitoring for affected persons in cases of exposure of personal financial information. The Red Flags Rule instituted by the Federal Trade Commission — as well as other local regulations aimed at preventing breaches of patient records and financial information — are sure to add to the price tag of these incidents. San Diego Physician: How will CyberGuard coverage help physicians who suffer a breach that results in financial repercussions? Mr. Francis: Most of the costs associated with breaches are notifying patients, and CyberGuard includes this in its coverage. The Doctors Company has added this coverage for solo and small-group physicians to protect their business. For more information, physicians should visit thedoctors. com/cyberguard.

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Physician Workforce Key Findings: A Tale of Three Practices Table 9: Diﬀerences Among Solo and Small-group Physicians, Medium- and Large-group Physicians, and Academic Medicine Physicians Solo and Small-group Physicians

Medium- and Large-group Physicians

Academic Medicine Physicians

Very Dissatisfied

Majority Are Now Dissatisfied

Satisfied

Physician Satisfaction With Time Spent With Patients

Very Satisfied

Satisfied

Total Physician Work Hours

Long: 59.7 Hours/Week

Long: 56.8 Hours/Week

Longest: 67.8 Hours/Week

Highest: 42.5 Hours/Week

40.5 Hours/Week

Lowest: 35.9 Hours/Week

Lowest

Highest

Middle

Very Concerned

Concerned

Not Concerned

73%

86%

82%

Take Medicare

1–2 Physicians: 82% 3–4 Physicians: Near 100%

Near 100%

Take Medi-Cal

36%

5–25 Physicians: 62% 26–150 Physicians: 85% > 150 Physicians: 50%

88%

1–2 Physicians: 21% 3–4 Physicians: Near 28%

5–25 Physicians: 36% 26–150 Physicians: 55% > 150 Physicians: 29%

77%

Dissatisfaction With the Practice of Medicine

Patient Care Hours Compensation Concerned About Recruiting New Physicians Remain in the Practice of Medicine

Take CMS

“I get headhunter requests on a weekly basis that guarantee nearly twice my current salary in other regions.” — San Diego County Physician

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

An underlying theme of our 2005 Physician Workforce and Compensation Survey was the widening gulf between solo and small-group practices on the one hand — defined as fewer than five physicians in a practice — and mediumand large-group practices on the other — defined as five or more physicians in a practice. With the significant number of academic physicians responding to our 2007 survey, there appeared to be three distinct cohorts in modes of practices. Across a number of factors, there are significant differences between these practice types. Table 9 summarizes these differences.

Key Findings: Differences Between Male and Female Physicians In previous reports, we noted significant differences between male and female physicians. In the 2009 survey, in almost every area examined, the differences have narrowed. While not yet there, San Diego County’s physician community is rapidly approaching, at least statistically, gender neutrality.

POLITICAL REALITY:

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AT THE

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MENU SDCMS Is at the Table!

By choosing to join the San Diego County Medical Society (SDCMS), over 3,000 practicing physicians, resident physicians, and medical students in San Diego County have given voice to our patients and to our communities in the healthcare reform discussions and in every single healthcare issue being debated locally, in Sacramento, and in Washington, DC.

Ask your colleagues: “Are You a Member of SDCMS?” San Diego County Medical Society (SDCMS) | 5575 Ruﬃn Road, Suite 250 San Diego | 858.565.8888 | SDCMS.org mar ch 2010 SAN DIEGO P HY SICIA N. o rg

Physician Workforce Table 10: Overview of Specialties in Crisis (Red) and in Diﬃculty (Yellow) for Specialties With Five or More Responses Greater Than Average Wait Times for New Patients

Physicians Perceive This As a Shortage

Diﬃculty Recruiting

Yes

Some

Yes

Some

Family Medicine

(primary care) (in diﬃculty in 2007)

Internal Medicine

(primary care) (in diﬃculty in 2007)

Yes

Some

OB/GYN

Yes

Signiﬁcant

Allergy and Immunology

Yes

Pediatrics

(primary care)

(primary care) (in diﬃculty in 2005)

Anesthesiology Cardiology Dermatology

(in diﬃculty in 2005)

Some Yes

Yes

General Surgery (in diﬃculty in 2005)

Some

Yes

Signiﬁcant

Yes

Signiﬁcant

Yes

Some

Hand Surgery Hematology/Oncology (in diﬃculty in 2007)

Nephrology

(in diﬃculty in 2007)

Yes

Ophthalmology

Yes

(in diﬃculty in 2005)

Signiﬁcant

Yes

Neurology

(in crisis in 2005 and 2007)

Although highly subjective, the study identified specialties in crisis — highlighted in red in tables 10 and 11 and defined as having longer-than-average wait times for new patients, a perception that the specialty was in shortage, and a perception of difficulty recruiting within the specialty. In addition, those specialties in difficulty — defined as meeting two of the three criteria above — were highlighted in yellow.

Yes

Emergency Medicine Gastroenterology

Yes

Key Findings: Specialty-specific Information

Yes

Some

Greater Than Average Wait Times for New Patients

Endocrinology

Physicians Perceive This As a Shortage

Diﬃculty Recruiting

Yes

Some

Geriatric Medicine Hepatology Signiﬁcant

Infectious Disease

Orthopedic Surgery

Yes

Signiﬁcant

Otolaryngology

(in crisis in 2005 and in diﬃculty in 2007)

Yes

Some

Pain Medicine

Yes

(in crisis in 2007)

Table 11: Overview of Specialties in Crisis (Red) and in Diﬃculty (Yellow) for Specialties With Four or Fewer Responses

Neurosurgery

Yes

(in crisis in 2005)

Occupational Medicine Sports Medicine

Pathology Physical Medicine and Rehabilitation Signiﬁcant

Plastic Surgery Psychiatry

(in diﬃculty in 2005 and 2007)

Yes

Pulmonology

Some

(in diﬃculty in 2005)

Radiology

Signiﬁcant

(in diﬃculty in 2005)

Some

Radiation Oncology Rheumatology (in diﬃculty in 2005)

Yes

Thoracic Surgery Urology

(in crisis in 2005)

Signiﬁcant Signiﬁcant

Yes

Vascular Surgery

Signiﬁcant

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

Yes

Signiﬁcant Some

“We need to work together as a whole to improve our lot rather than competing against each other or splitting into smaller contracting entities, which weaken us.” — San Diego County Physician

Some

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SDCMS

Endorsed Partner Benefits

Total Potential Value to SDCMS Members:

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mar ch 2010 SANâ&#x20AC;&#x2C6; DIEGOâ&#x20AC;&#x2C6; P HY SICIA N. o rg

Project Access

San Diego

Volunteerism Made Easy The heart of the program is to link low-income, uninsured adults in San Diego County with specialist volunteers who agree to see a limited number of patients per year in their office for free. • Physician Volunteer Flexibility: Physicians set their own volunteer commitment (ideal is one patient per month). Project Access patients are seen in the private office setting so you do not have to travel far to provide care for the medically underserved. • Enrolling Patients Based on Need: Patients are referred to us exclusively from the community clinics in the area and do not qualify for any type of public health insurance program. Specialty care is a significant challenge for the clinics, and many patients endure wait times of up to six months to see a volunteer specialist at their clinic. • Making Appropriate Referrals: Project Access publishes referral guidelines for community clinic

use. Our Chief Medical Officer also reviews each case individually so that specialists see only the most appropriate referrals. • Providing Enabling Services: We provide services such as transportation and translation so that you don’t have to wonder if a patient is going to miss an appointment or if there will be a language barrier. • Providing Case Management Services: We work with each patient one-on-one to coordinate followthrough on all medical needs. • Providing All Needed Services: Through our partnerships, we ensure that a full scope of services is available to all of our patients, from hospital and ancillary services to a defined pharmacy benefit.

Join over 75 specialists as a Project Access volunteer! Project Access is actively recruiting physicians, hospitals, and ancillary service providers to participate in our program. Together we can ensure that our vulnerable populations have access to needed healthcare services. Your commitment to Project Access is needed for our success! Please visit our website at SDCMSF.org to learn more and to sign up.

Sign up NOW at SDCMSF.org We need your volunteer commitment to help even one patient. Our Medical Community Liaison, Rosemarie Marshall Johnson, MD, can answer your questions. Dr. Johnson can be paged at 619.290.5351. You may also contact Lauren Radano, Healthcare Access Manager, at 858.565.7930. 40

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

Thoughts on Haiti continued from page 44

their families, who are responsible for feeding them, cleaning them, emptying the buckets under their beds, and chasing the flies from them. When you walk by, they look at you with hope and expectancy for any sense of relief. Your training tells you what to do, but your efforts are impeded by locked supplies, and resistant nursing staff and hospital administration. Although there are many foreigners trying to deliver aide to this population, their efforts are met with incomprehensible delays and hurdles from those in charge, who do not seem to mind the suffering around them. Oh, the massive relief effort has provided food and masses of medical supplies; however, these supplies are not available to the medical teams and relief efforts — instead, these desperately needed supplies are warehoused and locked away, by customs or hospital officials. To access them, you need to run from one authority to another, wasting precious time and energy at the expense of suffering and death. The UN and the U.S. military try to assist, but remember they are there to help in a sovereign country and have very limited authority to act. Many religious organizations have made significant strides

in their attempts to serve the people and move them into the 21st century, but their efforts are not enough by themselves, and require country leadership. It has been hard to have experienced this without developing a mixture of love, sadness, frustration, and anger. Haiti is a “country” without any semblance of structure. Perhaps this devastating earthquake is a moment — not to start rebuilding, but to build a country from scratch, with a new economy, educational efforts, public health, and perhaps a whole new social culture. This will require a totally unselfish political and engineering leadership, which hopefully can arise from the ashes that now cover this country.

mar ch 2010 SAN DIEGO P HY SICIA N. o rg

classifieds housing needed CANADIAN SURGEON SEEKING HOUSING: Canadian surgeon moving to San Diego for a one-, possibly two-year fellowship with wife and single child. Seeking housing, preferably furnished. Any and all assistance is greatly appreciated. Please contact at nearest convenience: denniskim@rogers.com. [791] OFFICE SPACE SCRIPPS ENCINITAS CONSULTATION ROOM/ EXAM ROOMS: Available consultation room with two examination rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Receptionist help provided if needed. Contact Stephanie at (760) 753-8413. [703] CARMEL VALLEY OFFICE SPACE FOR SHARED LEASE OR SUBLEASING: 2,900 square feet located in the Scripps Medical Offices on El Camino Real and High Bluff. Busy women's health office ideal for physician seeking exposure to new patients. Convenient practice ready space ideal for a solo physician. Possibility for shared staff and/or overhead. Contact Mrs. Kim at cvwh858@ gmail.com or at (858) 259-9821. [790]

NEW MEDICAL BUILDING ALONG I-15: Pinnacle Medical Plaza is a new 80,000 SF building recently completed off Scripps Poway Parkway. The location is perfect for serving patients along the I-15 from Mira Mesa to Rancho Bernardo and reaches west with easy access to Highway 56. Suites are available from 1,000—11,000 SF and will be improved to meet exact requirements. FREE RENT INCENTIVES and a generous improvement allowance is provided. For information, contact Ed Muna at 619-702-5655, ed@lankfordsd.com www.pinnaclemedicalplaza.com

BEAUTIFUL OFFICE IN SCRIPPS LA JOLLA XIMED BUILDING TO SHARE/SUBLET: Scripps La Jolla Ximed office to sublet/share. Upscale décor; currently equipped for ophth. Could work well for derm, cosmetic, bariatric, neuro, IM, etc., or even consultant. Days/fees negotiable/ reasonable, ~1700ft2, could share staff/phones, etc. (858) 449-9867 or fwlmd@cox.net. [787] SORRENTO VALLEY/MIRA MESA OFFICE SPACE TO SHARE: Space includes physician’s office, three exam rooms, and space for receptionist. This office is available Monday, Wednesday,

and Friday afternoons. Reduce your overhead by sharing space. Call us at (858) 458-0940 or fax your letter of interest to (858) 458-3688. [785] OFFICE SPACE TO SHARE: Currently occupied by orthopaedic surgeon situated in La Mesa, five minutes away from Alvarado Hospital and 10 minutes from Grossmont Hospital. Looking to share with part-time or full-time physician. Fully furnished, fully equipped, with X-ray equipment and three exam rooms. Please call (619) 6680900 or email either rcham1000@aol.com or carmen@drcham.com. [784] 1,200FT2–1,600FT2 OF OFFICE SPACE IN EAST SAN DIEGO/LA MESA AVAILABLE FOR LEASE: Ideal as a satellite clinic or administrative office, on University Ave. near 70th St. Very visible tower signage provides outstanding visibility and exposure to cars and pedestrians on University Ave. Adjacent to a pediatrics office, and with easy access from Highways 8, 94, 125, and 15, Alvarado and Grossmont College, La Mesa, El Cajon, Spring Valley, Lemon Grove, points south and north. Plenty of parking and directly across from the Joan Kroc Recreation Center (over 3,000 families visit each week). Fixed rent for three years $1.95/ft2 per month, includes lighted tower signage, and NO additional charges for common areas or services. Please contact Venk at (619) 504-5830 or by email at venk@gpeds. sdcoxmail.com. [777] MEDICAL OFFICE SPACE: Multi-specialty medical office with large office available with view of San Diego harbor/downtown. Share three fully equipped exam rooms, reception, lobby, and common areas. Lab on site, underground parking available. Phone (619) 233-4044 or email hivdocs@yahoo.com. [775] LA JOLLA MEDICAL OFFICE AVAILABLE FOR PART-TIME SUBLEASE: Beautiful ScrippsXimed office offers two consultation offices and one exam room. Receptionist help provided if needed. Contact Cindi at (858) 452-6226. [774] NORTH COUNTY THERAPIST OFFICE SPACE AVAILABLE IN THE TRI-CITY AREA: 2–3 days a week. Spacious, ocean view, fully furnished office suite. Contact Laura at (760) 967-5898. [772] SPACE AVAILABLE FOR SINGLE DOCTOR PRACTICE: Office located in the Alvarado Hospital area, near San Diego State College. Space includes a physician office and two exam rooms. Please call (619) 229-5055 or email cnc_case@ cox.net. [765] LA JOLLA OFFICE SPACE AVAILABLE AT

XIMED MEDICAL BUILDING: Brand new, renovated office space available, preferably to a primary care MD to share. This is a rare opportunity to have a presence at the prestigious XiMed Medical Building right next to Scripps Memorial Hospital and to reduce your overhead by sharing space. Currently, the office is being used by a single physician part of the time. Flexible to any arrangement proposed. Call (858) 837-1540 or email melkurtulus@hotmail.com. [664] LA MESA OFFICE SPACE TO SHARE: Over 6,000ft2 OB/GYN office of three doctors, with space available immediately. Ideal for a medical practice or clinical studies and is located on Grossmont Hospital campus. Contact La Mesa OB/GYN at (619) 463-7775 or fax letter of interest to (619) 463-4181. [648] PHYSICIAN POSITIONS AVAILABLE FT SAN MARCOS IM, FP • PT ENCINITAS OB/GYN: North County Health Services is a Joint Commission-accredited, FQHC, celebrating nearly 40 years of service and serving more than 60,000 patients in multiple locations in North San Diego County. We have opportunities for BC/BE physicians. Spanish communication skills helpful. Compensation includes attractive base, incentive, and great benefit programs, malpractice, reimbursement for CME/licensure. This is an opportunity to make a difference in the lives of patients who are under or uninsured without having the expense of overhead or management concerns, and provides work-life balanced hours. NHSC loan repay may also be available. Contact cynthia.bekdache@nchs-health.org or fax to (760) 736-8740. [794] PHYSICIANS NEEDED: Full-time, part-time, and per-diem opportunities available for family medicine, pediatric, and OB/GYN physicians. Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English-Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 4143702. Visit our website at VistaCommunityClinic. org. EOE/M/F/D/V [792] SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT 3.5 DAYS PER WEEK POSITION (TO START: Private practice in La Mesa seeks pediatrician 3.5 days per week (to start) on a PARTNERSHIP track. Practice pediatrics in a modern office setting with a reputation for outstanding patient satisfaction for 14 years. Dedicated triage-pharmacy-referrals and education nurse takes routine calls off your hands, leaving

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

you to focus on direct, quality patient care. Nine office staff provide experienced, attentive support. Clinic care is three patients per hour, 1-in-3 call is minimal, rounding at Sharp Grossmont on newborns, no high-risk delivery attendance (ALS nurse team present), all make for a very tolerable practice profile. Benefits include paid tail coverage included professional liability insurance, paid holidays/vacation/sick time off, paid practice expenses, professional dues, health and dental insurance, uniforms, CME, disability and life insurance. Please contact Venk at (619) 504-5830 or by email at venk@gpeds.sdcoxmail.com for a July–September placement. [778] PHYSICIAN: Profil Institute for Clinical Research Inc. (PICR) is an independent research institute conducting clinical phase I–II trials, primarily in diabetes and carbohydrate metabolism, under contract to the biopharmaceutical industry [http://www.profil-research.com]. We are seeking a physician who will ensure integrity of study data and provide medical leadership and supervision for human clinical trials within PICR. Will screen, review of I/E criteria, and determine suitability of study volunteers for enrolment. Provide supervision of clinical procedures for all ongoing clinical studies at Profil and provide medical expertise to all clinical staff. Works with the associate medical director and medical director in training of physicians and other clinical staff as needed. Requirements: medical doctor, current, unrestricted license to practice medicine in Cali-

fornia and current advanced cardiac life support (ACLS) certification. Understanding of the drug development process and of basic physiology of glucose homeostasis, diabetes, and obesity. Ability to manage medical care of diabetics, obese subjects, and other common medical problems, including medical emergencies. Thorough understanding of good clinical practices and FD, a regulations governing conduct of clinical trials. Previous clinical research experience desirable. If interested, please send CV/resume to hrpicr@ profil-research.com. [779] THE COUNTY OF SAN DIEGO HAS AN EXCITING OPPORTUNITY FOR DEPUTY PUBLIC HEALTH OFFICR: The full posting can be found at sdcounty.ca.gov/hr. For questions, contact Carmen A. Padilla-Baluis, human resources analyst, at (619) 531-5144 or carmen.padillabaluis@sdcounty.ca.gov. [773] FAMILY PRACTICE DOCTORS NEEDED: Full time and part time. Days, nights, weekends available. Fax CV to La Costa Urgent Care at (760) 603-7719. [750] PRACTICE FOR SALe Del Mar-area General Practice: Prime location, huge potential for practice expansion in fast growing Carmel Valley community. Established in 1990; terms available. Inquiries call (858) 755-0510. [185]

Increase Your Referral Business

NONPHYSICIAN POSITIONS AVAILABLE NURSE PRACTIONERS NEEDED: Full-time, part-time, and per-diem opportunities available for family medicine, pediatric, and OB/GYN physicians. Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English-Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at VistaCommunityClinic.org. EOE/M/F/D/V [793] PHYSICIAN ASSISTANT: Multi-site rheumatology practice is seeking a physician assistant to provide support and treatment of patients with rheumatoid arthritis as well as other diseases affecting the body’s connective tissues. Background in internal medicine is a must and rheumatology experience is helpful but not required. This position will require travel between our San Diego offices and our office in Imperial Valley. Qualified candidates may email CV to hr.providerjobs@ gmail.com. [788] FULL-TIME FRONT DESK / BILLING POSITION (EAST COUNTY): Full time front desk/billing position available for a small, two-physician specialty office. Billing experience required. Please send resume to Debbie0774@gmail.com. Call (619) 2291005 for further information. [780]

San Diego Physician is the only publication that is distributed to all 8,500 practicing physicians in San Diego County. Advertising is a cost-effective and profitable way to increase your referral business.

Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

mar ch 2010 SAN DIEGO P HY SICIA N. o rg

disastermedicine By John A. LaFata, MD

Thoughts on Haiti Jan. 22–Feb. 2, 2010

Having just returned from a medical relief effort, I cannot get my mind off of Haiti. The experience continues to haunt me, brings tears to my eyes, and overwhelms me with emotion. At the same time I feel anger for the unnecessary suffering and misery that this country has dealt its people. The common man in Haiti has a life expectancy of 50 years and an average daily wage — when he can find a job — of $2. Although he has nothing, he still manages to walk with pride and exude friendliness and kindness. (This is true in the countryside and smaller cities, as I was not in a large urban area.) The children are beautiful, friendly, and innocent. The women work hard trying to scratch out a subsistence living. The people are clean, although they are ridden with malnutrition and congenital and acquired health issues. It is not money for which they occasionally hold out their hands, but for food. And when you hand them a sandwich, a small snack, or a bag of trail mix, the smile of gratitude makes you wish you had more in your backpack to give.

The economy seems to be one based on bartering. Charcoal, the primary cooking fuel and the manufacture of which may have contributed to the devastating deforestation of the county, is traded for rice. Sugarcane is traded for beans, and a chicken or pig or goat for something else, and on, and on. The ubiquitous burning of charcoal leaves a haze of irritating smoke over the populated areas, which is largely responsible for the chronic complaints of cough, asthma, and burning eyes. Anger? Yes, for it is hard for an American to comprehend a country without any sense of organization or infrastructure. Chaos and inefficiency rule. There is no running water, unless you count the river, which is full of people bathing, doing their laundry, digging sand, dumping garbage, etc. Even the hospital has no water! Can you imagine a hospital without the basics of water? There is no electricity, unless you have a solar panel, or diesel and a generator. Even with these, the power is turned off at around 5 p.m., which includes public facilities such as the airport and hospital. Voluntary surgeons are ready to work through the night to save lives and limbs, but are told to leave at 5 p.m., and the power is shut down. There is no organization, and the country smacks you with total chaos. Nothing runs as expected or according to any sense of planning. There seems to be no interest in public welfare or the suffering that is universal, rather than occasional. I presume there are some people who have better living conditions than average, but these “well-to-do” do not seem to have any interest in helping the masses of needy around them. Indeed, in my shallow experience, they seemed to be clearly more interested in themselves than their countryman. Imagine a hospital filled with people suffering with fractured limbs as well as mindboggling medical issues, covered with flies and lying in darkened, warm, humid rooms without ventilation. They are tended primarily by continued on page 41

S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

150 BEST ONE OF MEDICAL ECONOMICS

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S AN D I E G O P HY S I CI A N . or g Ma r ch 2010

PRSRT STD U.S. POSTAGE PAID DENVER, CO PERMIT NO. 5377