April 2011 by San Diego Physician

April 2011

o ff i c i a l pu b l i c a t i o n o f

the san diego county medical society

Malpractice Insurance up to Brown

Reaching

Doctors Treat Only Emergency Cases8,500 Doctors Physicians Every Month

Storm Capitol in Insurance Protest Anesthesiologists Find Themselves up Front Governor Resists Demand for Malpractice Session Medical Strike Passions Run High Malpractice Crisis Prompts Call for Special Session Insurance Companies Balk — Pact to End Malpractice Dispute Collapses MDs Start Boycott; Emergencies Only

micra

Protesting Physicians Should End Walkout Statewide Strike? Legislature Given Ultimatum by CMA

Go Back to Work AMA, State Unit Clash Over Doctor Walkout

Brown Signs Bill on Malpractice but Crisis Remains Doctors Win Vote, Barbs • Too Many Risks in California — Doctor Warns of ‘Impending Disaster’ Headlines: May–November 1975 Sacramento Union and Sacramento Bee in Medical Care Malpractice Bill - Band-Aid or C ure UC’s Malpractice

Rate Soars 745% Physicians Do Without Malpractice Insurance Malpractice

Insurance up to Brown

Doctors Treat Only Emergency Cases Doctors Storm Capitol

in Insurance Protest Anesthesiologists Find Themselves up Front Governor Resists Demand

for Malpractice Session Medical Strike Passions Run High Malpractice Crisis

Prompts Call for Special Session Insurance Companies Balk — Pact to End Malpractice Dispute Collapses MDs

Start Boycott; Emergencies Only Protesting

Physicians Should End Walkout Statewide Strike? Legislature Given Ultimatum by CMA Go Back to Work AMA, State Unit Clash Over Doctor “ P h y s i c i a n s U n i t e d F o r A H e a l t h y S a n D i e g o ”

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April 2011 SAN DIEGO P H YS I CI A N. o rg

thismonth Volume 98, Number 4

features

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

Micra Under Attack

20 California’s Medical Injury Compensation Reform Act (MICRA): A Brief History 21 MICRA Reforms Don’t Reduce Access to Courts

SDCMS Board of Directors Officers President Susan Kaweski, MD Past President Lisa S. Miller, MD President-elect Robert E. Wailes, MD Treasurer Sherry L. Franklin, MD Secretary Robert E. Peters, MD, PhD

24 Texas Medical Liability Reforms: Stunningly Successful 26 Increasing MICRA Cap to $500,000 Would Cost Californians $7.9 Billion 26 MICRA Has Stabilized California’s Medical Liability Premium Costs: Rates Soar in States Without Major Reform

geographic and geographic alternate Directors East County William T. Tseng, MD, Heywood “Woody”

28 New York Medical Liability

ctions Experience Especially Painful sdcmsele

ents m e t a t S e Candidat 28 Reasons to Support MICRA

28 Is Your Voice Being Heard? S DIRECTOR BOARD OF S M 29 64,041 Ways SDCMS-CMA C D S 2 2011–1 Are Working for You

4 SDCMS Seminars, Webinars, and Events Mark Your Calendars! 4 Community Healthcare Calendar 6 Briefly Noted SDCMS Medical Office Manager Bulletin Board, and More …

12 2011–12 SDCMS Board of Directors Candidate Statements 18 Medicare EHR Incentive Program Overview

ex-officio, nonvoting board members

t, top Left to righ

34 Physician Marketplace Classifieds

CMA Past Presidents Robert E. Hertzka, MD

n, MD, Robert , COMMITTEE CHAIR) Sherry Frankli , Steven Poceta(LEGISLATIVE , MD Peters, PhD , Niren ly Lovett, MD MD, Kimber odore Thomas, CMA district I Trustees The , Angle, MD , John Lane, MD an, Luj MD, Jason , Wayne y Ostrow, MD MD, Gregor Hom, MD, Gregory tt Sun, MD, Ma CMA Trustee (other) MD Balourdas,

, Ralph R. Ocampo, MD Albert Ray, MD, Robert E. Wailes, MD,

Sherry L. Franklin, MD

Catherine D. Moore, MD

CMA SOLO AND SMALL-GROUP PRACTICE FORUM DELEGATES

SDCM 18 S

CIA GO PH YSI SA N DIE

IL 201 1 N.O RG APR

2 0 1 ANNU 0 AL R EPORT

to bottom:

Michael T. Couris, MD, James W. Ochi, MD

18 SDCMS’ 2010 Annual Report

When Is It Time to Retire?

At-large and At-large alternate Directors Jeffrey O. Leach, MD, Bing S. Pao, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD, Mihir Y. Parikh, MD ( Carol L. Young, MD, Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Alan A. Schoengold, MD) other board members Theodore M. Mazer, MD Van L. Cheng, MD Kimberly M. Lovett, MD Katherine M. Whipple, MD Steve H. Koh, MD Rosemarie M. Johnson, MD Mitsuo Tomita, MD Adi J. Price James T. Hay, MD Theodore M. Mazer, MD

by Rob Yeates

36 A Dinosaur’s Story

rs Length in Yea

bers of d nonmem mbers an of coming both me open lines cute maintain witnesshfully exe SDCMS to ted. We are fait tec to , pro pe ers are n, I ho ting for the patients, pay physicians municatio ce, advoca time where clamorsion, s of my offi : fes are a historic tie ect ns du pro -el ing al cia the ent ysi medic g for Presid nt, and ph e. We sts of our increasin Candidate governme best intere (1) effective car se times of ient nklin, MD re efficient, during the , especially ce, govA: Sherry Fra ple. The Pat ing for mo especially l societies pe of practi Athis very sim professiona table where sco re Act (PP physician, Let’s make need our d unpredic difficulty breeds of ordable Ca an all Aff n, in d ing tio ns can ent cia l regula r perspe ere with Protection ived. Physi those repres ernmenta , speak ou may interf Os have arr tr interests as to what ent issues ysician ts. Respec CA) and AC to serve ou ctity of ph are unclear reimbursem our patien ian tect the san of practice ure. To be to care for ient-physic all modes tive, and pro for the fut our ability and the pat of , MD e rep an nges mean lism ty sur na Luj un cha too sio se on Co the profes fully, Jas ment isn’t as an East ern ve ine diser gov I dic Me c the ip. me ty d un graphi honest, relationsh Organize Diego Co Mesa #2 Geo sians either. sit at the e on the San for Kearny with enthu what it me Communications Chair se entities, resentativ Candidate * (3) directors to shape the voices n Lane, MD y board of ties work must work cal Societ r combined that all par Director: Joh make sure ing ieve that ou care, bel eth of d Young Physician Director c ry som an phi ive o table, and asm fession int ess and del dila #1 Geogra sts pro acc Jol me r of ere ve La ou ce int pro for ke to im can ma serves the Candidate g the practi , MD (1) Alternate Young Physician Director protectin d foremost exam sitting at gory Ostrow while still ector: Gre director of that first an forward to occupy the k o Dir the loo wh is I , . ers ole old trow, MD n. Scripps cine as a wh theResident of the stakeh alf. d physicia Gregory Os Physician Director ology for on your beh patient an ophthalm rnal Interthat table room daily: pediatric for the jou d an editor A father of #3 Resident Physician Director : Clinic an gy Clinics. Alternate rth County Treasurer olo No for alm (1) for ate hth MD to Stacy Candid Candidate en Angle, national Op husband , MD (1) a Nir d or: PhD an , ls ect ers c Dir ful gir Retired Physician Director of the Robert Pet are Geographi two beauti acutely aw phic today’s MD, he is gra in w, ns : Geo tro cia ary Os #1 ysi st w Retired Physician Director for Secret Alternate for Hillcre faced by ph . Dr. Ostro Candidate Candidate challenges mas, MD (1) al climate eta, MD (1) odore Tho ing medic the board Steven Poc Director: The ever-chang sition on Medical c Di-Student Director lize his po graphic Geographi then the San hopes to uti Mesa #1 Geo ng t County #3 rny stre Eas p Kea for tect for to hel ll as pro Candidate , MD (3) Candidate CMA PRESIDENT-ELECT of directors MD* (3) nity as we berly Lovett on Lujan, d physithe nominatal commu Director: Kim Director: Jas of a unifie ego medic ctices from vilege to be the power hts and pra nor and pri district eer has it rig ho sa car n CMA VICE SPEAKER OF THE HOUSE an Me cia I believe in my is It e in physi Kearny At no tim h clarity, resent the ouragcian voice. ed and rep to speak wit or. By enc important phic direct purpose been more as its geogra d sense of ifie d un a an d ts an ien certainty, erests of pat that the int to be sure risk Note: Aste

departments

e = Term After Nam ntheses (X) nt / # in Pare e = Incumbe (*) After Nam

Zeidman, MD (A:Venu Prabaker, MD) Hillcrest Niren Angle, MD, Steven A. Ornish, MD Kearny Mesa John G. Lane, MD, Jason P. Lujan, MD La Jolla J. Steven Poceta, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County James H. Schultz, MD, Doug Fenton, MD (A: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Mike H. Verdolin, MD (A: Andres Smith, MD)

SA N D I E G O P HY S I CIAN . or g A pril 2011

As you rea d about with a mi our 2010 xture of accomp lishmen pride an you are ts, we ho d hope — fighting pe that pride th to protec and hope you do so at as an t what is that our SDCMSimporta collective CMA me nt to yo mber str u and to en tinue to gth, vigila your patie protect nce, and the noble nts, dedicati professio on wi ll conn of medic ine.

ALTERNATE CMA SOLO AND SMALL-GROUP PRACTICE FORUM DELEGATE Dan I. Giurgiu, MD AMA Delegates James T. Hay, MD, Robert E. Hertzka, MD Alternate AMA Delegates Lisa S. Miller, MD, Albert Ray, MD

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.]

April 2011 SAN DIEGO P H YS I CI A N. o rg

calendar

sdcms Seminars / Webinars / Events Free to member physicians and their staff. For further information, contact Sonia Gonzales at (858) 300-2782 or at Sonia.Gonzales@SDCMS.org, or visit SDCMS.org. Look to our January issue of San Diego Physician for a complete listing of SDCMS’ seminars, webinars, and events in 2011!

Disciplinary Actions, Employee Terminations (seminar/webinar) April 14, Thursday 11:30am–1:00pm Resident and Young Physician Social (event) April 15, Friday 6:30pm–9:30pm Disclosure: Doing the Right Thing in the Right Way (two seminars/webinars) April 27, Wednesday 6:00pm–7:30pm April 28, Thursday 1:30am–1:00pm Best Practices in Revenue Cycle Management (seminar/webinar) May 5, Thursday 11:30am–1:00pm Preparing to Practice (workshop) May 7, Saturday 8:00am–4:00pm

Medi-Cal Updates (seminar/webinar) May 12, Thursday 11:30am–1:00pm IT Update and Overview (seminar/webinar) May 19, Thursday 11:30am–1:00pm The Leader’s Toolbox (workshop) May 20–21, Friday–Saturday 8:00am–4:00pm Coding Specifics: ICD-10 (seminar/webinar) May 26, Thursday 11:30am–1:00pm SDCMS Installation Dinner and Dance / 2011 White Coat Gala (event) June 4, Saturday, from 6pm to 11pm at the Hilton Torrey Pines Resort in La Jolla. $75 per person. Black tie optional. Tables can be purchased at a discount. Call Jennipher at (858) 300-2781 or email her at JOhmstede@SDCMS.org.

SA N D I E G O P HY S I CIAN . or g A pril 2011

community Healthcare Calendar Medi-Cal County Presentations for Seniors and Persons With Disabilities April 27 • 10:00am–11:00am Embassy Suites, 601 Pacific Highway, San Diego 92101 Geriatric Frailty (Presented by Sharp HealthCare) May 3 • 8:00am-9:00am Spectrum Auditorium, 8695 Spectrum Center Blvd., San Diego 92123 • 1-800-827-4277

CMA Webinars & Events Implementing a Compliance Program (webinars) April 20, Wednesday 12:15pm–1:15pm, 6:00pm–7:00pm Dealing With Sensitive Personnel Issues (webinars) May 4, Wednesday, 12:15pm–1:15pm, 6:00pm–7:00pm

12th Annual UC San Diego Stroke Conference May 14 • cme.ucsd.edu/stroke

To submit a physician-focused, San Diego County healthcare event for possible publication, email KLewis@ SDCMS.org.

Finding Answers to Your Legal Questions in Five Minutes or Less May 18, Wednesday 12:15pm–1:15pm The Next Step: Successfully Negotiating Health Reform (event) 14th Annual California Health Care Leadership Academy June 3–5, Friday–Sunday • Renaissance Esmeralda Resort and Spa, Indian Wells 92210 • (800) 795-2262

Visit CMAnet.org/ calendar

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brieflynoted

SDCMS Medical Office Manager

CUS: SPECIAL yFO Actions,

Disciplinar Employee Terminations

loyee is the Q: When do I know if terminatingonantoemp take? most appropriate course of acti

and practical — should A: A number of issues — legaling an employee. Might

be considered prior to terminat loyee? Is there additional training rehabilitate the emp er suited for the another position within the practice bett retaining the ant warr s employee? Etc. If consideration uss and disc employee, it becomes very important to their job perfordocument with them those aspects of why modification mance that need improvement and/or beneficial. ually mut of their job description might be be aware of On the other hand, employers should also odative of an the danger of becoming unduly accomm ests there is little employee whose job performance sugg delaying the tere.g., , tion chance of meaningful rehabilita bly give rise to eiva mination of such an employee can conc loyment. For more implied expectations of continuing emp CMA ON-CALL information on employment issues, see sician Practice document #0217, “Overview of Select Phy Employment Issues.”

By Sonia Gonzales,

Your Off ice Manager Advocate 6

SA N D I E G O P HY S I CIAN . or g A pril 2011

Congratulations to Anne Hedges!

Diego, Anne, from Children’s ENT of San contest the is i, Och es Jam Dr. the office of was one e Ann ch. Tou iPod our of ner win who of the first five office managers ration side con for n submitted a questio etin Bull r age Man e Offic ical for the Med th. mon last rd Boa

Why Attend SDCMS Seminars/Webinars? KNOWLEDGE: Increase your knowledge base and become more informed. COMPLIANCE: Learn about the latest laws and regulations for your office. LUNCH: Enjoy a delicious, catered meal :-) ANSWERS: Talk to experts and get the help you need to solve those tough questions. NETWORK: Get to know your peers and put faces to the names of the people you talk to every day.

Help Us Help You Wit Human Resources! h

Please take a few moments to answer the following que stions: • Do you have an accurate termination process? YES/NO • Do you have proper implem entation of discipline in you r office? YES/NO • Do you have written disciplin ary policies? YES/NO • Do you know how to provide meaningful evaluations? YES /NO • Do you effectively docum ent employee issues? YES /NO If you answered “NO” to any of these questions, or if you simply want to be more informed about human resources, SDCMS will be hosting a “Disciplinary Actions, Emplo yee Terminations” seminar /webinar on April 14 from 11:30 a.m. to 1 p.m . For more information, con tac t me at (858) 300-2782 or at Sonia.G onzales@SDCMS.org.

Save the Dates

The Best even ts and semina medical office rs managers! for ✓ APRIL 14: Discipl inary Actions, Employee Term inations ✓ APRIL 27, 28: Disc losure: Doing th e Right Thing in the Righ t Way ✓ MAY 5: Best Practic es in Revenue Cycle Managem ent ✓ MAY 12: Medi-Cal Up ✓ MAY 19: Informat dates ion Technology Up date and Overview

BENEFITS CORNER

ce Calendar” from 11 Webinars At-a-Glan • Do you have the “20 of the upcomomic Services? A few CMA’s Center for Econ liance Program mp Implementing a Co ing webinars include: me at Sonia. like one, please email and ICD-10. If you would u. to have one sent to yo Gonzales@SDCMS.org ld have been claim denial that shou • Have you received a u can’t seem gh coding question yo paid? Do you have a tou led the Free cal fit ne has a member be to figure out? SDCMS to SDCMS at your coding question Coding Hotline. Email Coding@SDCMS.org.

Contact Sonia at (85 8) 30 or at Sonia.Gonzales@ 0-2782 SDCMS.org

April 2011 SAN DIEGO P H YS I CI A N. o rg

brieflynoted

Protect Your Patients Against Pertussis New Tdap Requirement for 7th–12th Graders By the County of San Diego Immunization Program

SA N D I E G O P HY S I CIAN . or g A pril 2011

Under a new law, all California middle and high school students entering or advancing into 7th through 12th grades will need proof of a Tdap booster shot before starting the 2011–12 school year. Act now to ensure your adolescent patients are protected against the ongoing threat of pertussis and ready for school entry next fall by taking the following steps: 1. View this free one-hour CME webcast: “Shots for School: Clinicians’ Role in California’s New Tdap Requirement for 7th– 12th Graders” (available at www.uctv.tv/ capertussis). 2. Send reminder and recall phone calls and notices now to your patients who have not yet received a Tdap booster, including those who have received a dose of Td but not Tdap. 3. Order enough Tdap vaccine to immunize your patients affected by the new law. Before ordering, ensure you have adequate storage in your vaccine refrigerator for your orders — in many clinics, multiple orders will be indicated. 4. Immunize with Tdap now at every opportunity, including sports physicals and visits for mild illness or injury, and give other recommended immunizations: meningococcal conjugate, HPV, influenza, and any catch-up doses of varicella, MMR, and hepatitis B. 5. Provide clear and accurate documentation about Tdap immunization for your patients and their schools. Vaccines have similar names and abbreviations, e.g., Tdap, Td, DTaP, DT, etc., which can be confusing to the school staff who will be keeping records for the new law. If you use the California Immunization Registry, consider printing out a copy of the “Blue Card” after Tdap has been given for the student to take to school. 6. Have parents check with their child’s school about how they should provide the Tdap documentation. 7. Post downloadable electronic banners (eziz.org/new_rule_banner.html) on your practice’s website and in electronic newsletters to help notify your patients. For additional information on the new Tdap school requirement, visit www.ShotsForSchool.org. Information on pertussis and additional immunization information is also available on the County of San Diego Immunization Program’s website at www.sdiz.org.

Get in

touch

you take care of the san diego communit y ’s health. we take care of san diego’s

healthcare communit y.

Your SDCMS and SDCMSF Support Teams Are Here to Help! SDCMS Contact Information

3 income Tax Planning

5575 Ruffin Road, Suite 250, San Diego, CA 92123

3 Wealth Management

T (858) 565-8888 F (858) 569-1334

3 employee Benefit Plans

E SDCMS@SDCMS.org • Editor@SDCMS.org • President@SDCMS.org • Membership@SDCMS.org • Accounting@SDCMS.org • SuggestionBox@SDCMS.org • Webmaster@SDCMS.org

3 Profitability Reviews 3 outsourced Professional services (CFo, Controller)

W SDCMS.org • SanDiegoPhysician.org CEO/Executive Director Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org

3 organizational and Compensation structure

COO/CFO James Beaubeaux at (858) 300-2788 or James.Beaubeaux@SDCMS.org Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or Janet.Lockett@SDCMS.org

3 succession Planning

Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org

3 Practice Valuations 3 internal Control Review and Risk Assessment

director of medical office manager support and Office Manager Advocate Sonia Gonzales at (858) 300-2782 or Sonia.Gonzales@SDCMS.org Director of Engagement Jennipher Ohmstede at (858) 300-2781 or JOhmstede@SDCMS.org Director of Communications and Marketing Kyle Lewis at (858) 300-2784 or KLewis@SDCMS.org BUSINESS MANAGER Nathalia Aryani at (858) 300-2789 or Nathalia.Aryani@SDCMS.org administrative assistant Betty Matthews at (858) 565-8888 or Betty.Matthews@SDCMS.org

akt A KT LLP, CPAs and Business Consu LTAnTs CARL SBAD

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760-431-8440

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SDCMSF Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123

ron mitchell, cpa director of health services

T (858) 565-8888 F (858) 560-0179 W SDCMSF.org project access PROGRAM DIRECTOR Brenda Salcedo at (858) 565-8161 or Brenda.Salcedo@SDCMS.org Healthcare Access Manager Lauren Radano at (858) 565-7930 or Lauren.Radano@SDCMS.org

S ItS 140 Celebrate ✖ SDCMS

0✖ ary In 201 annIverS reaching 8,500

ation official public octobe

h every Mont Physicians

of the san

diego county

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Infe Disease m Dominos Fro Stopping the

Falling

Patient Care Manager Rebecca Valenzuela at (858) 300-2785 or at Rebecca.Valenzuela@SDCMS.org

advertising in San Diego Physician.

Patient Care Manager Elizabeth Terrazes at (858) 565-8156 or at Elizabeth.Terrazes@SDCMS.org IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org

off % 25 SDCMS member physicians receive

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April 2011 SAN DIEGO P H YS I CI A N. o rg

brieflynoted

Rosemarie Marshall Johnson, MD Receives 10News Leadership Award

Rosemarie Marshall Johnson, MD, retired SDCMS-CMA member and past president of SDCMS, has been selected as the recipient of the 10News Leadership Award for her volunteer efforts for Project Access San Diego and the SDCMS Foundation. To date, Dr. Johnson has recruited more than 500 specialists to volunteer for Project Access and provide critically needed specialty care for the medically underserved in the community. The 10News team presented Dr. Johnson with her award at Neighborhood Healthcare in Escondido, a community clinic that refers patients into Project Access. The news segment can be viewed at www.10news.com/leadershipaward/index. html. Congratulations, Dr. Johnson!

Leadership Award Dr. Johnson (left) receives the 10News of LEAD San Diego CEO and from Vicky Carlson, president

Know the Label

FDA-approved Electronic Drug Label Updates and Free CME Physicians can now stay up to date with the most frequently updated FDA prescribing information through a new online partnership with the FDA, the PDR, and The Doctors Company. Clinically relevant changes to existing prescription labels affect more than 25 percent of drugs yearly. Those changes are important to protecting your practice and to patient safety. Nationally, nearly 30 percent of medical malpractice suits involve pharmaceuticals, and the FDA-approved labeling is often the standard to which physicians are held in these suits. The new PDR Network updates physicians on all of the changes electronically, and allows them, immediately after review, to earn CME credits at no charge. The service is delivered to healthcare providers via the PDR Network website, liability carriers such as The Doctors Company (provider of the CME credits), and via electronic health records systems. To register, visit http://www.pdr.net/cme/cme.aspx.

Let Your Legislators Know You’re Paying Attention, and That You Vote! One way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday! NOTE: Due to mail handling procedures for government office buildings, postal mail to Washington, DC, offices may be delayed by several weeks or even months. Please fax or email if possible.

S A N D I E GO P HY SIC IAN . or g A pril 2011

BIRTHDAY: APRIL 13 U.S. Representative Susan Davis (District 53) E: (via website) house.gov/susandavis Washington, DC, Office: T: (202) 225-2040 F: (202) 225-2948 San Diego Office: 2700 Adams Ave., Ste. 102 San Diego, CA 92116 T: (619) 280-5353 F: (619) 280-5311

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A Higher Level of Service. Sound Business Practices. Relationships Built on Values. April 2011 SAN DIEGO P HYS I CI A N. o rg

sdcmselections

Candidate Statements 2011–12 SDCMS Board of Directors Note: Asterisk (*) After Name = Incumbent / # in Parentheses (X) After Name = Term Length in Years

Candidate for President-elect: Sherry Franklin, MD (1) Let’s make this very simple. The Patient Protection and Affordable Care Act (PPACA) and ACOs have arrived. Physicians in all modes of practice are unclear as to what these changes mean for the future. To be honest, the government isn’t too sure of what it means either. Organized medicine must work to shape these entities, sit at the table, and make sure that all parties work to improve access and delivery of care, while still protecting the practice of medicine as a whole. I look forward to sitting at that table on your behalf. Candidate for Treasurer: Robert Peters, PhD, MD (1) Candidate for Secretary: Steven Poceta, MD (1) Candidate for East County #3 Geographic Director: Kimberly Lovett, MD (3) I believe in the power of a unified physician voice. At no time in my career has it been more important to speak with clarity, certainty, and a unified sense of purpose to be sure that the interests of patients and

physicians are protected. We are witnessing a historic time where patients, payers, government, and physicians are clamoring for more efficient, effective care. We need our professional societies, especially those representing all breeds of physician, to serve our interests, speak our perspective, and protect the sanctity of physician professionalism and the patient-physician relationship. I serve as an East County representative on the San Diego County Medical Society board of directors with enthusiasm and believe that our combined voices can make our profession into something that first and foremost serves the interests of the stakeholders who occupy the exam room daily: patient and physician. Candidate for North County #3 Geographic Director: Niren Angle, MD (1) Candidate for Hillcrest #1 Geographic Director: Theodore Thomas, MD (1) Candidate for Kearny Mesa #1 Geographic Director: Jason Lujan, MD* (3) It is an honor and privilege to be nominated and represent the Kearny Mesa district as its geographic director. By encourag-

ing both members and nonmembers of SDCMS to maintain open lines of communication, I hope to faithfully execute the duties of my office, advocating for the best interests of our medical profession, especially during these times of increasing difficulty where scope of practice, governmental regulation, and unpredictable reimbursement issues may interfere with our ability to care for our patients. Respectfully, Jason Lujan, MD Candidate for Kearny Mesa #2 Geographic Director: John Lane, MD* (3) Candidate for La Jolla #1 Geographic Director: Gregory Ostrow, MD (1) Gregory Ostrow, MD, is the director of pediatric ophthalmology for the Scripps Clinic and an editor for the journal International Ophthalmology Clinics. A father of two beautiful girls and a husband to Stacy Ostrow, MD, he is acutely aware of the challenges faced by physicians in today’s ever-changing medical climate. Dr. Ostrow hopes to utilize his position on the board of directors to help strengthen the San Diego medical community as well as protect physician rights and practices from the

Left to right, top to bottom:

Sherry Franklin, MD, Robert Peters, PhD, MD, Steven Poceta, MD, Kimberly Lovett, MD, Niren Angle, MD, Theodore Thomas, MD, Jason Lujan, MD, John Lane, MD, Gregory Ostrow, MD, Wayne Sun, MD, Matt Hom, MD, Gregory Balourdas, MD

S A N D I E GO P HY SIC IAN . or g A pril 2011

Congr at ul ations to the 2011

Candidate for La Jolla #2 Geographic Director: Wayne Sun, MD* (3) I am interested in serving as one of your La Jolla representatives to the San Diego County Medical Society (SDCMS) for another term because of what I hope to bring to the physicians I represent. Having not been involved in organized medicine prior to SDCMS, I have since come to realize how important it is that we all speak with one voice to work toward what is best for San Diego physicians and their patients. My goal is to work on educating physicians about the importance of participating in organized medicine because of what it can do for all of us. It is too easy for all of us to be involved in just the daily care of our patients and the health of our individual practices because we are all very busy. However, we need a strong group that represents all of us in order to advocate for what is best for physicians and their patients in the long run. Only when we all get involved can we guarantee the preservation of our love for practicing medicine, a viable livelihood for all physicians, and the health and wellbeing of our patients. Candidate for La Jolla Geographic Alternate Director: Matt Hom, MD* (3) Candidate for Hillcrest Geographic Alternate Director: Gregory Balourdas, MD (1) Greetings Medical Society colleagues: As an orthopedic hand specialist located in the Mission Hills-Hillcrest area for 22 years and a member of the Medical Society for as long, I feel that it’s about time I give something back. It is difficult to find the time to attend to the important-but-not-urgent issues that face us. With your consideration, I hope to actively participate as the Hillcrest alternate director while keeping my practice’s “routine” plates spinning. I look forward to providing representation for my colleagues and to adding my voice and perspective to the debate of the many impending changes affecting our practice of medicine. I will endeavor to represent our interests and priorities as an advocate for our patients and for our profession. Thank you in advance for this opportunity.

Combined HealtH agenCies

HealtH Heroes The 17th annual Health Hero Awards honored individuals and companies selected by each of the members of Combined Health Agencies. The heroes have give freely of their time, talent and resources to improve the health and well-being of our community.

Sponsored in part by:

Dr. John Daly • Alzheimer’s Association San Diego/Imperial Chapter San Ysidro Health Center • American Diabetes Association Dr. Tarek Hassanein • American Liver Foundation San Diego Gas & Electric and Mike Niggli • American Lung Association Dr. Nasrin Mani • American Melanoma Foundation Brian Reeder • Amyotropic Lateral Sclerosis Association Dr. Robert Sheets • Arthritis Foundation Dr. Siri Martin Andrews • Autism Society of San Diego Sunroad Enterprises • The Burn Institute Dr. Michael Docherty • Crohn’s & Colitis Foundation of America Dr. Henry Wojtczak • Cystic Fibrosis Foundation Qualcomm, Inc. • Epilepsy Foundation Dr. Steven Cohen • Fresh Start Surgical Gifts Terrance Gregg and DexCom • Juvenile Diabetes Research Foundation The Bravo Foundation • Hemophilia Association of San Diego County Olive Garden Italian Restaurant • The Leukemia & Lymphoma Society Celgene • Lupus Foundation of Southern California Veterans Village of San Diego • Mental Health America of San Diego County Northgate Markets • Muscular Dystrophy Association NBC San Diego • National Multiple Sclerosis Society Dr. Michael Lobatz • Parkinson’s Association of San Diego Girard Securities, Inc. • San Diego Hospice Hematology Team at Rady Children’s Hospital • Sickle Cell Disease Association Evans Hotels • Stepping Stone of San Diego

More information at combinedhealth.org

brateS ✖ SDCMS Cele

✖ th verSary In 2010 ItS 140 annI Month Physicians Every Reaching 8,500

✖ SDCMS Cel ebrateS ItS 140th annIve rSary In 201 0✖

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April 2011 SAN DIEGO P HYS I CI A N. o rg

sdcmselections Candidate for Kearny Mesa #1 Geographic Alternate Director: Marvalyn DeCambre, MD, MPH (2) Marvalyn DeCambre MD, MPH, FAAP, is an assistant clinical professor in the Department of Pediatrics and Surgery under the division of Pediatric Urology at the University of California, San Diego, and a practicing pediatric urologist at Rady Children’s Hospital for the past five years. A native Caribbean transplant from the East Coast, her specialty began with medical school at the University of Rochester, residency in surgery and urology at the University of Connecticut, pediatric urology fellowship training in Seattle at the University of Washington and Seattle Children’s Hospital, where she also completed a master’s degree in public health genetics. She has received numerous awards and honors along the way, including an NIH Supplement Award for basic science research in pediatrics and the National Medical Association; she received an American Medical Association’s Foundation Leadership Award and Most Valuable Player from Amherst’s women’s rugby team. She is more of a Pilates and yoga aficionado now. She is well versed in medical Spanish, having learned Spanish as an algebra teacher and kickball coach in Venezuela prior to medical school. Locally, she participates on the bioethics committee for Sharp Rees-Steely and Rady Children’s Hospital; is a reviewer for Tissue Engineering, Community Genetics and the Journal of Pediatric Dermatology (skin manifestations of GU disorder/disease section) — and is currently teaching and training residents, nurses, nurse practitioners, and ancillary staff the workup and management of urologic disorders/diseases. She has represented SDCMS as an alternate voting delegate at the California Medical Associa-

tion (CMA) in 2010. Currently, she is an active member of SDCMS, participating in programs designed by SDCMS for training and supporting skills beneficial for lobbying state and federal representatives on behalf of SDCMS’ best interests. She finds leadership most satisfying when it represents the interests of others in her constituency. She gladly accepts the candidacy for the SDCMS board of directors representing Kearny Mesa. Candidate for Kearny Mesa #2 Geographic Alternate Director: Sergio Flores, MD (3) I would like to be considered for a position on the SDCMS board or directors. As a brief bio, I was born and raised in San Diego and graduated form San Diego State University in 1985. I graduated from UCSF School of Medicine in 1989 and trained at UC Irvine Medical Center in internal medicine and gastroenterology from 1989 to 1994 and was board certified in both. I am in private practice and a partner at San Diego Digestive Disease Consultants since 1998. I have served on the board of Sharp Community Medical Group for the past 12 years and currently serve on the executive committee as the secretary/treasurer as well as the chairman of the finance committee. I have also been on the Sharp Healthcare board of directors for the past four years and serve on the finance committee. For the past four years, I have been the chairman of the Large Group Forum at the CMA House of Delegates and served as a member of the House Rules Committee this past year. I would like to offer my services to SDCMS and look forward to serving on the board. Thank You, Sergio Flores, MD Candidate for At-large Director #1: Jeffrey Leach, MD* (3)

Left to right, top to bottom:

Marvalyn DeCambre, MD, Sergio Flores, MD, Jeffrey Leach, MD, Peter Raudaskoski, MD, Mihir Parikh, MD, Suman Sinha, MD, Samuel Wood, MD, Elaine Watkins, MD

S A N D I E GO P HY SIC IAN . or g A pril 2011

Candidate for At-large Director #6: Peter Raudaskoski, MD (3) Candidate for At-large Director #7: Mihir Parikh, MD* (2) It is a privilege to be a candidate for the position of “at-large director” for SDCMS for a second term. I thoroughly enjoyed learning and participating in the political process over the past five years. During this time I have come to truly understand the importance and necessity of having an active medical society that bridges multiple specialties and multiple types of physicians. The consensus voice that emerges from the Medical Society becomes our position when discussing issues such as access to healthcare, scope of practice, and quality of patient care. I am very interested in continuing to participate in the process of representing physicians at SDCMS meetings, helping to formulate organized medicine’s position, and then communicating this information back to the physicians and of course to the public. If elected, I will do this to the best of my ability. Candidate for At-large Director #8: Suman Sinha, MD, MS (3) San Diego is a unique community that has grown from a sleepy beach town of the 1960s to the booming metropolis of today. Few places in the world allow one to surf the waves of the vast Pacific Ocean, ski the slopes of the San Bernardino Mountains, hike the desert of Borrego, and cross the southern border into Mexico all within the same weekend. The people of this beautiful city are equally diverse, including those of many cultural backgrounds, interests, and religions. The strength of this community is found in its great diversity. As the globe becomes smaller through social networks, San Diego provides a model for the modern, well-integrated world community to follow. Similarly, the medical community of San Diego serves as a model to other developing systems. In the 1950s, San Diego developed a tradition of scientific advancement in the biomedical sciences. Many great researchers and developments emerged from the creative wellsprings of the Scripps Clinic on Coast Boulevard and the Salk Institute on North Torrey Pines Road. Roger Revelle carried on a similar

tradition as the University of California, San Diego became a center for leadership in discovery in the biomedical sciences. Since then, these centers and many others in San Diego have continued to lead the world in research and development. The clinical arena has been nothing less. Several excellent hospital systems have developed to serve the needs of this growing and diverse community. Scripps Clinic has several centers that cover North County, the coastal cities, and South Bay. Sharp Healthcare has many centers that cover the metro area, Coronado, East County, and South Bay. The University, Kaiser Health, Pomerado Hospital, and other groups have their large population bases covered as well. With the support of our great city, these incredible systems have grown and adapted to the needs of this growing and ever-changing community. The glaring reality is that healthcare reform is upon us. And now we must accept it and embrace it. Our challenge in the coming years will be to provide

the highest level of care to a growing and aging population in a more cost-effective and efficient manner. Mission impossible? Absolutely not. Quite the contrary. Healthcare reform at the most basic level will involve change in the “culture” of medicine. It is incumbent on the leaders of this healthcare community to redefine value in medicine adapted to the needs of our changing world. I hope to be involved in introducing fundamentals of change that will enhance the value of healthcare services provided to the people of this community in a more efficient manner. Among my many areas of interest and platforms for change are preventive medicine through education of our youth, efficiency in intensive care, and holistic health at physical, mental, and spiritual levels. It is time to use our experience and diversity to implement the changes that will allow us to thrive in the years to come. It is a privilege to practice medicine in America’s Finest City. Our health as individuals is intricately tied to the health

of our community and to the health of our entire society at a national and global level. Together, let us renew our interest in healthcare so as to provide better care for each of us and for the members of our community in the generations to come. Through hard work and collaboration, I believe the future will bring good health, peace, happiness, and prosperity to us all. Candidate for At-large Alternate Director #5: Samuel Wood, MD (3) Candidate for At-large Alternate Director #6: Elaine Watkins, MD, MSPH (2) I am a board-certified internist (ABIM), and I also hold a master’s degree in public health and nutrition. I went to medical school at the Philadelphia College of Osteopathic Medicine and did my internship at Presbyterian Hospital of the University of Pennsylvania. I completed my residency at Lankenau Hospital, an affiliate of Thomas Jefferson University. My master’s degree was obtained at

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April 2011 SAN DIEGO P HYS I CI A N. o rg

sdcmselections Columbia University. I was an American Medical Association Nutrition Scholar at the University of Pennsylvania during my training. My work experience encompasses a multitude of areas in medicine. This experience is one of the major criteria that makes me an asset to the board of directors. I have worked on both the East and West coasts as a provider. A large part of my experience has been in community clinics, but I have also worked for the Navy and have been in private practice. I have functioned as provider, medical director, laboratory director, consultant, private practice owner, and researcher. I have also served in the public health service for many years. I have experience with PPO and HMO insurance. I was recently part of Sharp Community Medical Group, and I am a member of Scripps Mercy Physician Partners. As a researcher I deal with many healthcare issues in the subjects that we recruit. Many of these people have little or no medical care and have a multitude of health issues because of this fact. I would be proud to be on the board, and I believe my experience and personality would be an asset. I am an excellent problem solver and believe there is more than one way to get a job done. I am passionate about healthcare issues and would bring that enthusiasm to my tenure on the board of directors. Elaine Watkins, DO, MSPH Candidate for At-large Alternate Director #7: Carl Powell, DO (3) Dr. Powell graduated from the United States Naval Academy, served in the Navy for 31 years, initially in the air, ship, and special forces communities. He graduated from the College of Osteopathic Medicine of the Pacific in 1986, completed a general surgery internship at Portsmouth Regional Medical Center in Virginia, spent a year as a general medical officer with the Marine

Corps in Okinawa, Japan, and completed a general surgery residency at the University of California, Davis-East Bay. Dr. Powell served his last seven years in the Navy at Camp Pendleton Naval Hospital as a general surgeon taking care of military personnel both at the hospital and in the field. Dr. Powell presently has offices in El Centro, La Mesa, Cardiff, and Oceanside. He maintains hospital privileges at Grossmont Hospital, Alvarado Hospital, and Tri-City Medical Center. Dr. Powell had the opportunity to attend the California Medical Association 2010 House of Delegates where it was impressed upon him the importance of physicians organizing as a strong political force in order to protect ourselves from outside interests and other special-interest groups. Dr. Powell looks forward to contributing to physician advocacy and protection as a member of the board of directors of the San Diego chapter of the California Medical Association. He feels CMA is the main pro-physician organization that has the ear of the politicians in Sacramento. He feels he can make a difference as a board director lobbying for physician rights and protections in the upcoming year. Candidate for At-large Alternate Director #8: Theresa Currier, MD (3) Dear Colleagues, I am Theresa Currier, DO, and I would like you to know what an honor it is to be a candidate to serve on the board of the San Diego County Medical Society (SDCMS). I am a native of California, and I received my bachelor of science degree in electrical engineering at SDSU in 1992. (My maiden name is Siefken.) I graduated from Western University of Health Sciences in 1999 and served three years as a resident in family medicine at Arrowhead Regional Medical Center in

Left to right: Carl Powell, DO, Theresa Currier, MD, Van Cheng, MD, Renjit Sundharadas,

MD, Steve Koh, MD

S A N D I E GO P HY SIC IAN . or g A pril 2011

San Bernardino County. During 2001–02, I served as house staff president for 75 residents. Also during that year I had the privilege to serve on the board of directors for the San Bernardino County Medical Society as house staff officer, alongside a great man, the late Ron Bangasser. I began working for the department of family medicine at Sharp Rees-Stealy Medical Group in 2002, with my office location in Otay Ranch, Chula Vista. I see a wide variety of patients, including Spanishspeaking patients. I am bilingual, with Spanish being my second language. I am board-certified in family medicine with both the AOBFP and the ABFM. I would like to serve on the board of directors for SDCMS. I have a great appreciation of those who have stood up for physicians and surgeons in the past. MICRA is a great example. It has helped both the doctor and the patient in California, and other states are longing to have the same protection under the law. I would like to work with others to help protect MICRA. The future of medicine is facing many other challenges, and I would like to serve you as we all face those challenges. Candidate for Young Physician Director: Van Cheng, MD* (1) Dr. Van Cheng graduated from Harvard University with highest honors and training in surgery at UCSF. She was then named the first phlebology fellow in the United States, through the UCSD/Scripps fellowship. Dr. Cheng has written a definitive book on foam sclerotherapy that was published in July 2008 (Royal Society Med press). She specializes in treating all vein problems without surgery. Her experienced techniques have proven to be first-rate, even for spider veins, unsightly hand and temple veins, varicose veins, and the most advanced forms of venous insufficiency. Dr. Van Cheng received San Diego’s 2008 Women Who Mean Business award. In addition, she was awarded the 2009 40 Under 40 award. Dr. Cheng was also honored with the San Diego Business Journal’s 2009 Health Care Champions Awards. Candidate for Young Physician Alternate Director: Renjit Sundharadas, MD (1)

Candidate for Resident Physician Director: Steve Koh, MD (1) It has been my privilege to have been involved with the San Diego County Medical Society (SDCMS). As resident alternate director on the SDCMS board of directors, I have had a unique experience in learning from our county’s great medical professional leaders and have been privy to the important discussions on issues facing our profession in California. Involvement in SDCMS has been my educational experience on medical policy issues and has greatly added to my residency training. I am honored to be considered for resident physician director. It is my hope that I can serve to bridge the relationship between SDCMS and the residency programs in San Diego. I would like for residents and fellows to be aware of the needs in our county and state. We must not train in isolation from the happenings in our state as it pertains to patient care, and I believe that SDCMS is the ideal source for such information.

SDCMS' 2,681 Members by Group Size: 32%

Solo & Small Group (1 to 4 physicians)

35%

Medium Group

(5 to 149 physicians)

Administrative/ Government

29%

Large Group

(150 to 1000 physicians)

Unknown

Are You Getting Your Reimbursement Issues Resolved?

Does Your Office Manager Have an Ally She Can Turn To?

Have a question? Don’t know where to begin? Contact your full-time, 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.

Let your office manager and staff know that they have a full-time office manager advocate at SDCMS ready to help them with any questions they may have, free of charge. Contact Sonia Gonzales at (858) 300-2782 or at Sonia.Gonzales@SDCMS.org.

April 2011 SAN DIEGO P HYS I CI A N. o rg

healthinformationtechnology

Medicare EHR Incentive Program Overview By Rob Yeates

Under the provisions of the American Recovery and Reinvestment Act of 2009 (ARRA, or the “Stimulus Act”), providers are eligible for financial incentives for demonstrating “meaningful use” of an electronic health record (EHR) system. You can qualify for incentives either through the Medicare program or through the Medicaid (MediCal) program. Eligible Medicare providers will be eligible for as much as $44,000 in incentives paid out over five years beginning in 2011. Medicare providers can begin demonstrating meaningful use as early as 2011. Starting in 2015, providers who have not demonstrated meaningful use will receive Medicare payment reductions. Eligible Providers: You are eligible to receive incentive payments under the Medicare program if you are a physician (MD/ DO), dentist, podiatrist, optometrist, or chiropractor. Maximum Incentive Payments: The maximum incentive that you can receive under the Medicare program is $44,000, paid out over a five-year period. You will only receive the maximum incentive if you achieve meaningful use in calendar year 2011 or 2012. In 2013 and 2014, you can still receive incentives but for lower amounts. The following chart lays out the maximum amount that you will receive based on the first year of meaningful use:

2011

2012

2013

2014

2011

$18,000

-----

2012

$12,000

$18,000

-----

2013

$8,000

$12,000

$15,000

-----

2014

$4,000

$8,000

$12,000

2015

$2,000

$4,000

$8,000

2016

$2,000

$4,000

Total:

$44,000

$39,000

$24,000

Calculation of Incentive: In any given year, the maximum incentive that you can receive is 75 percent of your Medicare Part B (fee-for-service) charges from the previous year. Therefore, in order for you to receive the maximum incentive in 2011, you must

S A N D I E GO P HY SIC IAN . or g A pril 2011

have at least $24,000 in Medicare Part B charges from the previous year. Exclusion of Medicare Advantage: For the purposes of calculating your incentive, you cannot include any charges paid by a Medicare Advantage (Medicare Part C) plan. There is a separate incentive program specifically established for Medicare Advantage Organizations (MAOs). In order to qualify as an MAO, however, the providers in your organization must provide 80 percent of their Medicare Advantage services to patients covered by the organization. The rules of the MAO incentive program will prohibit all but a few very large integrated systems from qualifying. Reductions in Payment: Beginning in 2015, providers who do not demonstrate meaningful use will see reductions in payment. These reductions increase from 1 percent of total Medicare charges in 2015 to 2 percent in 2016 and 3 percent in 2017 and every year thereafter. Bonus for Providers in Shortage Areas: Providers who practice in a federally designated Health Professions Shortage Area (HPSA) are eligible for 10 percent bonus payments, meaning that their maximum incentive is $48,400. In order to qualify for this bonus, you must provide more than 50 percent of your patient encounters at a location that is in a HPSA. Demonstrating Meaningful Use: Meaningful use is the set of criteria — known as “Objectives and Measures” — that you will have to demonstrate in order to qualify for provider incentives. In 2011, you will demonstrate meaningful use through the use of an attestation. Beginning in 2012, CMS expects to have an internet website through which you will report on your objectives. To learn more, visit www.calhipso.org or contact Rob Yeates at the SDCMS Foundation at (858) 300-2791 or Rob.Yeates@SDCMS.org.

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About the Author: Mr. Yeates is the IT project manager for the SDCMS Foundation. April 2011 SAN DIEGO P HYS I CI A N. o rg

MICRA UNDER ATTACK

California’s Medical Injury Compensation Reform Act (MICRA) A Brief History By the California Medical Association and the San Diego County Medical Society

Today in California, trial lawyers are waging an aggressive campaign to weaken or overturn California’s landmark Medical Injury Compensation Reform Act (MICRA). This issue of San Diego Physician provides a brief history of MICRA and the medical liability crisis that led to its enactment, looks at the situation in other states without MICRA-like reforms, and shows how for 36 years MICRA has kept malpractice insurance rates affordable for California physicians and has protected access to care. Background on MICRA Under MICRA, injured patients are fairly compensated, medical liability rates are kept in check, and physicians and clinics can remain in practice treating patients. MICRA has no limits on the economic damages that can be recovered by injured patients (medical costs and lost wages). Injured patients also can sue for unlimited punitive damages and recover up to $250,000 in non-economic damages (pain and suffering). In addition, MICRA includes a sliding pay scale, which ensures that more money goes to patients, not lawyers. The $250,000 cap on non-economic damages is an effective way of limiting meritless lawsuits and keeping healthcare costs lower, but has been targeted by the trial lawyers because it restricts the amount of money they can collect in damage awards. Increasing MICRA’s cap on speculative non-economic damages will have a dramatic, costly, and negative impact on the cost of healthcare in California, including medical liability rates. What Are MICRA’s Key Provisions? MICRA allows patients with justifiable medical malpractice claims to receive the following forms of compensation: • Unlimited economic damages for past and future

S A N D I E GO P HY SIC IAN . or g A pril 2011

medical costs. • Unlimited damages for lost wages, lifetime earning potential, or any other economic losses. • Unlimited punitive damages. • Up to $250,000 for non-economic damages, often referred to as “pain and suffering.” Unlike economic damages, non-economic damages are inherently subjective and often difficult to verify and measure. MICRA’s $250,000 ceiling on non-economic damages has proved effective in reducing and stabilizing medical liability insurance costs, which in turn has limited the rate of growth in healthcare costs and increased access to healthcare for all Californians. What Led to MICRA’s Enactment? In the mid-1970s, California physicians were embroiled in a malpractice insurance crisis. Driven by frivolous lawsuits and excessive jury awards, medical liability insurers levied massive insurance premium increases and canceled insurance policies for many physicians across the state. “In 1974 we were served notice they were going to increase our premiums 250 percent,” said Brad P. Cohn, MD, who was president of the San Francisco Medical Society at the height of the malpractice crisis. “The profession became highly exercised about what was going on1.” The situation worsened in early 1975 when malpractice carriers announced that premiums for some physicians would increase by as much as 400 percent, effective May 1. Many medical physicians had four choices, none of them acceptable: raise fees and make medical care unaffordable for many patients, drop their professional liability insurance coverage, leave the state, or quit practicing medicine. Newspaper headlines reflected the extent of the problem:

• “Insurance Rates Peril Medical Care” from the San Jose Mercury News, 02/23/75 — Premiums have reached the point that some physicians are leaving California or retiring from active practice and some other physicians in high-risk categories are unable to obtain liability insurance. • “Doctors Face Insurance Crisis — May Affect 8,000 in Southland” from the Los Angeles Times, 02/22/75 — Eight thousand physicians in seven Southern California counties face loss of their malpractice insurance coverage …. The seven counties are Los Angeles, Orange, San Bernardino, Ventura, Santa Barbara, Kern, and San Luis Obispo. The 8,000 doctors make up the bulk of medical practitioners in those counties. • “New Bay Area Crisis in Medical Care: Doctors Might Halt Practice” from the San Francisco Chronicle, 01/31/75 — A major healthcare crisis loomed yesterday with the cancellation of malpractice insurance, effective May 1, for most of the doctors in eight Northern California counties. “As May arrives, it is accompanied, for some 4,000 Northern California physicians, by staggering increases in medical insurance costs …,” announced a May 1, 1975, San Francisco Chronicle editorial. As their premiums more than tripled, anesthesiologists and surgeons in the Bay Area and other parts of Northern California began a walkout, refusing to handle any patients except those in imminent danger of death. Some hospitals agreed to pay premiums for anesthesiologists, and some physicians agreed to work emergency cases without pay. Throughout the winter and spring of 1975, the crisis continued to escalate as the May 1 rate increase approached. The Legislature worked on stop-gap bills that would allow formation of joint underwriting associations among the state’s private insurance com-

MICRA Reforms Don’t Reduce Access to Courts A favorite argument of trial lawyers is that medical liability reforms such as those in California and Texas reduce access to the courts for medical patients with injury claims. A November 2008 study led by former California Legislative Analyst William Hamm refutes that assertion: “There is no evidence that MICRA’s cap on non-economic damages awards has materially reduced access to the courts for those individuals with meritorious claims of medical liability,” the study concludes. In fact, “tort claims for personal injury, other than those involving medical liability, have declined more rapidly than those subject to the MICRA cap,” says the study, by LECG, LLC, of Emeryville, CA9.

In 1975 a CMA-led group of more than 800 physicians, nurses, lab technicians, and hospital personnel marched on the Capitol, demanding relief from soaring professional liability insurance rates.

April 2011 SAN DIEGO P HYS I CI A N. o rg

MICRA UNDER ATTACK panies to offer malpractice coverage, but no major legislation addressing the medical liability issue had cleared the Legislature by May 1. There was general alarm throughout California’s medical profession. Seeking a stronger focus on the issue, CMA channeled physician outrage into a massive grassroots campaign that mobilized thousands of physicians, patients, and other medical professionals to call and

MICRA’s $250,000 ceiling on non-economic damages has proved effective in reducing and stabilizing medical liability insurance costs, which in turn has limited the rate of growth in healthcare costs and increased access to healthcare for all Californians. write their legislators to demand that the state act to cut the cost of malpractice insurance. On May 13, 1975, CMA led more than 800 physi-

cians, nurses, lab technicians, and hospital personnel in a Capitol rally calling on Gov. Edmund G. “Jerry” Brown Jr. to convene a special session of the Legislature to deal with the crisis. Three days later, on May 16, Brown yielded, issuing a proclamation for a special session that began on May 19. Negotiations and legislative hearings that involved CMA and other healthcare providers, the insurance industry, and trial lawyers continued until Sept. 11 when the Legislature passed AB 1XX, a collection of statutes that is now known as the Medical Injury Compensation Reform Act (MICRA). Governor Brown signed the CMA-supported bill on Sept. 23, 1975, and MICRA today remains the model for national medical liability tort reform. MICRA’s Constitutionality Upheld Passage of MICRA was only the first step. Lawsuits challenging the constitutionality of MICRA weaved their way through the judicial system until 1985, when the California Supreme Court upheld its constitutionality with the following comments: • [I]n enacting MICRA, the Legislature was acting in a situation in which it had found that the

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rising cost of medical malpractice insurance was posing serious problems for the healthcare system in California, threatening to curtail the availability of medical care in some parts of the state and creating the very real possibility that many doctors would practice without insurance, leaving patients who might be injured by such doctors with the prospect of uncollectible judgments. In attempting to reduce the cost of medical malpractice insurance in MICRA, the Legislature enacted a variety of provisions affecting doctors, insurance companies, and malpractice plaintiffs. • [The limitation on recoverable non-economic damages] is, of course, one of the provisions that made changes in existing tort rules in an attempt to reduce the cost of medical malpractice litigation, and thereby restrain the increase in medical malpractice insurance premiums. It appears obvious that this section — by placing a ceiling of $250,000 on the recovery of noneconomic damages — is rationally related to the objective of reducing the costs of malpractice defendants and their insurers.2

The California Supreme Court decision was appealed to the U.S. Supreme Court, which, on Oct. 15, 1985, declined to review the case, “for want of a substantial federal question.” Thus, 10 years after passage, the question of MICRA’s constitutionality finally was settled law. About the Authors: The California Medical Association (CMA) represents 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. The San Diego County Medical Society (SDCMS), chartered by the California Medical Association (CMA), is a nonprofit organization founded in 1870. SDCMS’ mission is to act independently — as well as jointly with CMA — to promote the science and art of medicine, the quality care and well-being of patients, the protection of the public health, the betterment of the medical profession, and the adjudication of ethical relations of its members, as well as the provision of education to its members in scientific, social, legal, ethical, and medio-economic aspects of medical practice. SDCMS’ vision is “Physicians United for a Healthy San Diego.”

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MICRA UNDER ATTACK

Texas Medical Liability Reforms S t u n n i n g ly S u c c e s s f u l



At the start of the 21st century, Texas was experiencing a medical liability insurance crisis much like California faced 28 years earlier. But after enacting reforms similar to California’s MICRA, insurance rates plummeted, large numbers of new physicians were licensed, and health access in the Lone Star State increased dramatically. “Before Texas’ reform, physicians were concerned, scared, frustrated, and forced to practice defensive medicine,” says Louis J. Goodman, PhD, executive vice president and CEO of the Texas Medical Association (TMA). “Some retired early; others left the state because of the fear of a lawsuit and increasing liability premiums. Since reform, new physicians have told TMA they moved here because of Texas’ reforms.” In 2001, Texas licensed only 2,088 new physicians, the fewest in a decade6. It ranked 49th of 50 states in physician-per-citizen ratio. By 2003, more than 150 of Texas’ 254 counties didn’t have a single obstetrician, and 120 counties had no pediatrician7. The reforms came in the fall of 2003 when the Texas Legislature approved, and the governor signed, a bill that resembled California’s MICRA law. The legislation’s centerpiece was a $250,000 cap on non-economic (pain and suffering) damages for all physicians. To avoid waiting for relief until the reform act passed constitutional muster, as happened in California, Texas lawmakers placed a state constitutional amendment on the ballot that conformed the constitution to the new law. Texas voters approved it, and within a short time premiums began to drop, leading to improved access to and quality of care. All Major Liability Carriers Cut Rates TMA reports that all major medical liability carriers in Texas have cut their rates, most by double digits, since passage of the reforms in 2003. Ninety percent of Texas physicians have seen their rates slashed 30 percent or more, and roughly half of the

In 2001, Texas licensed only 2,088 new physicians, the fewest in a decade. It ranked 49th of 50 states in physician-per-citizen ratio. By 2003, more than 150 of Texas’ 254 counties didn’t have a single obstetrician, and 120 counties had no pediatrician. state’s doctors are now paying lower liability premiums than they were in 2001. As a result, physicians have been moving to Tex-

S A N D I E GO P HY SIC IAN . or g A pril 2011

as in large numbers, and access to medical care has increased dramatically. “Texas has had a 62 percent higher growth rate in newly licensed physicians in the past three years (2008–10) compared with the three years preceding medical liability reform (2001–03),” says Goodman. “This growth means more than 2 million patient visits per year. Good doctors are coming to Texas in record numbers. Since 2003, Texas has averaged 3,021 newly licensed physicians per year. “Patients in Texas’ rural and underserved areas also are enjoying benefits of reform,” Goodman says. “Twenty-two rural Texas counties have added at least one obstetrician, including 10 counties that previously had none. The number of obstetricians practicing in rural Texas has grown by 27 percent. Overall, Texas added 218 obstetricians between 2003 and 2009. “Ask a typical Texas patient who lived somewhere with no medical specialists whether his or her health quality has improved,” Goodman says. “Not having to travel great distances to see a pediatric specialist, neurologist, obstetrician, general surgeon, or geriatrician has most certainly improved

the quality of life and care for those patients.” Lower Premiums Result in Improved Efficiency, More Charity Care Lower medical malpractice premiums have other benefits, Goodman notes. “Lower premiums have allowed physicians to invest in tools like electronic medical records to improve care and efficiency. Finally, lower premiums allow physicians to provide charity care to patients — care they otherwise would not have been able to afford to provide.” Another benefit of the Texas reforms is greater access to the courts by patients who have meritorious claims. “Our expertise is medicine, not law, but we believe that without frivolous and non-meritorious lawsuits clogging the courts, patients who may have legitimate legal issues have greater access,” Goodman asserts. “We want patients to be healthy and safe, and to have proper avenues to turn to if an unintended outcome occurs. And TMA has always supported a strong medical board to ensure patient safety — so much so that we even voted to increase physician fees to the Texas Medical Board.”

April 2011 SAN DIEGO P HYS I CI A N. o rg

MICRA UNDER ATTACK

Increasing MICRA Cap to $500,000 Would Cost Californians $7.9 Billion California trial lawyers are currently pushing a proposal to raise the cap on non-economic damages to as much as $1 million, which would be devastating to both physicians and healthcare consumers. An increase to even $500,000 in California’s cap on non-economic damages would raise California healthcare costs by $7.9 billion per year, according to a 2008 study by LECG, LLC, whose managing director is William G. Hamm, PhD. Hamm is the former director of the nonpartisan and highly respected Legislative Analyst’s Office, which provides fiscal and policy advice for the California Legislature. The increase would be passed through to Californians using the state’s healthcare system, further limiting access, the study found. The study concluded that a cap on non-economic damages reduces medical liability insurance costs because it dampens the incentive to litigate weak claims and lowers the average size of liability awards. “By reducing the cost of medical services, a cap makes healthcare more affordable and increases the public’s access to physicians and hospitals,” the study says.

MICRA Has Stabilized California’s Medical Liability Premium Costs Rates Soar in States Without Major Reform After 1985 court actions affirmed the constitutionality of California’s MICRA, medical liability premiums stabilized at significantly lower rates for California physicians than for physicians in states without strong MICRA reforms. Today, MICRA is still working to restrain premium rates in California, while states without liability reform are paying dramatically higher premiums. “After more than three decades, it’s clear that MICRA has benefitted patients, their doctors, and the entire healthcare system,” says CMA President James Hinsdale, MD. “A look at other states without MICRA-like protections demonstrates why rolling back MICRA or weakening this law would be a disaster for patients and our profession.” For example, New York places no cap on noneconomic (“pain and suffering”) damages, and Florida’s $500,000 cap is twice as high as California’s. Obstetricians and gynecologists in Los Angeles County paid an average annual medical liability premium of $49,804 in 2010, compared with $196,111 paid by OB/GYNs practicing on

S A N D I E GO P HY SIC IAN . or g A pril 2011

Long Island (Nassau and Suffolk counties), New York. OB/GYNs in Dade County, Florida, paid an annual average of $200,3773. This information is bolstered by the Medical Liability Monitor’s Annual Rate Survey, 2010. The Liability Monitor reported that as of July 1, 2010, OB/GYNs in New York and Florida ranked first and second, respectively, in average annual medical malpractice premiums paid, while OB/ GYNs in 10 Central and Northern California counties paid among the nation’s lowest rates. The Liability Monitor survey found that Long Island OB/GYNs paid an annual average liability premium of $204,864, while OB/GYNs in the 10 California counties paid an annual average of only $13,4004! In Florida, where the liability cap for non-economic damages is double California’s cap, OB/ GYNs in Miami and Dade counties paid an annual average of $201,808, the survey reported. A comparison of average annual premiums paid by internists in the same Florida, New York, and California counties yielded similar disparities: $48,245 in Florida, $35,028 in New York, and only $3,200 in California5.

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New York Medical Liability Experience: Especially Painful In New York, medical malpractice insurance costs soared 55–80 percent between 2003 and 2008. Physicians avoided even greater rate increases only because the Legislature and the governor cooperated in the 2008–09 and 2009–10 policy years to enact legislation that prohibited any rate increase or surcharge on physician liability premiums. The rate freeze placed only “a temporary lid on a boiling pot that will trigger even more staggering increases in medical liability costs” unless elected officials act to address the problems, according to the Medical Society of the State of New York (MSSNY). “Medical liability costs are a huge component of Medicaid expenditures and healthcare costs in general …,” said MSSNY President Leah McCormack, MD, writing to the Albany Times Union on Feb. 16, 2011. “The enactment of meaningful medical liability reform is absolutely essential to achieve immediate and substantial cost savings to healthcare in New York State. Any argument to the contrary is without merit.” Skyrocketing liability insurance premiums are forcing hard-pressed OB/GYNs to abandon practices across New York state. A 2009 survey by the Center for Health Workforce Studies at Albany State University of New York found that 19 of New York’s 62 counties had no practicing OB/GYNs. The 19 rural counties, scattered throughout the state, had a combined population of nearly 875,000 in 2009, according to the U.S. Census Bureau.

MICRA UNDER ATTACK

Reasons to Support MICRA 1. Changes to MICRA Will Increase the Overall Cost of Healthcare in California: While eliminating or increasing the MICRA cap on non-economic damages will impact physician medical liability rates, it will also lead to higher costs and reduced access for patients. A recent study found that doubling MICRA’s cap could cost consumers and taxpayers in California $7.9 billion a year in higher healthcare costs. 2. MICRA Creates a Stable Insurance Market so That Physicians Are Willing and Able to Practice Medicine in California: Adopted in 1975, MICRA is the best reason why California has not experienced the regular medical liability crises suffered by physicians in other states. It is a seven-part law where all parties involved with medical liability contributed to a compromise solution that best serves the interests of patients. As a result of MICRA, California has a system that is affordable, gives patients their full economic

and medical losses, promotes patient safety and improved patient care, supports teaching hospitals and positions, and permits innovative and experimental medicine. 3. Changes to MICRA Would Increase State Taxpayer Costs: Tax dollars also are used at the state level to fund healthcare services for others. Changes to MICRA will result in increased costs to the state general fund of hundreds of millions of dollars annually by increasing healthcare costs. The following state programs provide healthcare benefits or services and are among those that will be impacted: CalPERS, Medi-Cal, Healthy Families, Department of Mental Health, Department of Corrections, and Department of Developmental Services. Higher costs for these state programs can be made up in only two ways: increased taxes or cuts to other programs and services, such as further cuts to Medi-Cal reimbursements, cuts to education, public safety, transportation, or any of the other services provided by the state.

For additional information, go to www.MICRA.org.

Is Your

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If you are not an SDCMS-CMA member, we invite you to join today by calling (858) 565-8888. We will advocate on your behalf at the state and federal levels, and you will receive regular updates and news on regulations and legislation that would impact your ability to serve your patients. Join today to ensure your voice is heard!

64,041 Ways SDCMS-CMA Are Working for You! Specialty

San Diego County

Dade County, FL

Long Island, NY

Wayne County, MI

FL-NY-MI Average

MICRA Savings

Allergy

$3,931

$24,183

$10,826

$16,909

$17,306

$13,375

Anesthesiology

$10,472

$48,367

$37,657

$41,697

$42,574

$32,102

Cardiology (invasive)

$13,408

$95,007

$40,738

$66,711

$67,485

$54,077 $124,318

Cardiovascular Surgery

$32,123

$172,739

$121,665

$174,918

$156,441

Dermatology (lipo/cosmetic)

$21,897

$54,413

$36,779

$23,797

$38,330

$16,433

Emergency Medicine

$19,993

$95,007

$58,971

$87,121

$80,366

$60,373

Family Practice (nonsurgical)

$7,447

$44,912

$26,817

$33,893

$35,207

$27,760

General Surgery (excluding bariatric)

$35,273

$200,377

$121,665

$143,445

$155,162

$119,889

Internal Medicine (noninvasive)

$9,730

$50,094

$36,779

$34,350

$40,408

$30,678

Neurosurgery

$55,364

$248,744

$321,713

$201,512

$257,323

$201,959 $136,346

OB/GYN

$41,128

$200,377

$196,111

$135,935

$177,474

Ophthalmology (LASIK/cosmetic)

$10,963

$50,094

$36,437

$37,955

$41,495

$30,532

Orthopedic Surgery (with spinal)

$29,037

$146,828

$146,084

$144,667

$145,860

$1 6,823

Otolaryngology (cosmetic)

$19,468

$60,459

$108,110

$81,556

$83,375

$63,907

Pathology

$8,759

$44,912

$24,769

$19,524

$29,735

$20,976

Pediatrics (nonsurgical)

$9,179

$31,093

$26,817

$28,928

$28,946

$19,767

Plastic Surgery

$23,641

$95,007

$108,110

$91,565

$98,227

$74,586 $43,335

Proctology

$19,041

$69,096

$64,281

$53,751

$62,376

Psychiatry (nonshock)

$4,712

$24,183

$10,826

$17,853

$17,621

$12,909

Radiology (noninvasive)

$13,880

$95,007

$61,100

$45,293

$67,133

$53,253

Thoracic Surgery

$32,123

$172,739

$100,500

$154,089

$142,443

$110,320

Urology

$14,947

$60,459

$64,281

$55,655

$60,132

$45,185

Average — All Specialties

$19,842

$94,732

$80,047

$76,869

$83,883

$64,041 $64,041

MICRA is California’s hard-fought law to provide for injured patients and stable medical liability rates. But this year California’s trial lawyers have launched an attack to undermine MICRA and its protections, and we need your help — membership has never been so valuable! 2011 SDCMS MICRA Premium Savings Chart Note: Comparison reflects mature annual premium costs for $1 million maximum per case/$3 million maximum for all cases in a given year. Sources: The Doctors Company Mutual Insurance Co. (Los Angeles County, CA); First Professionals Insurance Company (Dade County); American Physicians Assurance Corporation (Wayne County, MI); Medical Liability Mutual Insurance Company (Long Island, NY).

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MICRA UNDER ATTACK

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Footnotes: 1. Helping Physicians Help Patients for 150 Years, California Medical Association, p. 47 2. Lawrence Fein, v. Permanente Medical Group, S.F. No. 24336, Supreme Court of California, 38 Cal. 3d 137; 695 P.2d 665; 211 Cal. Rptr. 368; 1985 3. Sources: The Doctors Company Mutual Insurance Co. (Los Angeles County, CA); First Professionals Insurance Company (Dade County); American Physicians Assurance Corporation (Wayne County, MI); Medical Liability Mutual Insurance Company (Long Island, NY). 4. OB/GYNs in Fresno, Madera, Mariposa, Merced, Monterey, San Benito, San Mateo, Santa Clara, Santa Cruz and Stanislaus counties. 5. Ibid 6. Texas Medical Association document, “Texas Medical Liability Reforms Produce Healthy Benefits,” undated. 7. Statement from former Texas state Rep. Joseph Nixon, writing for the Texas Public Policy Center in the Tyler Morning Telegraph, 5/27/08, as quoted in MICRA and Access to Healthcare report of November 2008 by LECG, LLP. 8. MICRA and Access to Health Care, a November 2008 study by LECG, LLC, p.2 9. MICRA and Access to Health Care, a November 2008 study by LECG, LLC, p. 15

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Community Clinics Need YOUR Help! Specialists Are Needed to Provide Quality Care for the Medically Underserved in San Diego

COMMUNITY CLINICS in San Diego provide the vast majority of primary care for MEDICALLY UNDERSERVED patients.

ity clinic There are 18 commun er 110 ov h wit organizations unty. Co go Die n Sa in SITES

Clinic patients often have little or NO ACCESS TO SPECIALTY CARE. Community clinics serve over 650,000 PATIENTS every year.

If you are a specialist physician who is interested in working or volunteering in a community clinic, please contact Lauren Radano, program manager for the Specialty Care Access Initiative*, at Lauren.Radano@SDCMS.org or at (858) 565-7930.

* The Specialty Care Access Initiative (SCAI) is a program of the Council of Community Clinics and the San Diego County Medical Society Foundation. SCAI is made possible with funding from Kaiser Permanente.

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classifieds office space / real estate SUBLET ~ 2 EXAM ROOMS AND PHYSICIAN OFFICE: Beautiful new spacious medical office suite located at 501 Washington St., San Diego 92130, contiguous to Vibra Hospital and across from Scripps Mercy Medical Campus in a Class A office building. Shared waiting room, break room, receptionist areaincluded. Currently office suite is occupied by seasoned primary and specialty physicians. Ample parking, freeway access to interstates 5/163/8, ancillaryservices are in close proximity for patient convenience. Please contact Ms. Betterton or Dr. Carla Fox at (619) 299-2570. [914]

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

OFFICE SPACE TO SHARE FOR RENT OR LEASE: Adjacent to Tri-City Medical Center and North Coast Surgery Center. Provide large consultation room, two exam rooms, fax, copier, wireless. FREE parking. Conditions are negotiable. Full or part time. Easy access to 78 or I-5. If interested, please email jean@tricitycts.com or call (760) 726-2500. [911] 3998 VISTA WAY IN OCEANSIDE: Two medical office spaces approximately 2,000ft2 available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground floor access. Lease price: $2.20 +NNN. Tenant improvement allowance. For further information, please contact Lucia Shamshoian at (760) 931-1134 or at shamshoian@coveycommercial.com. [834] OFFICE SPACE IN HILLCREST: Office space available in Hillcrest at the Mercy Medical Building. Located directly across from Scripps Mercy Hospital. Excellent staff, stateof-the-art office and equipment. Please send letter of interest to KLewis@sdcms.org. [810] OFFICE SPACE FOR RENT IN POWAY: Medical office space for lease, 1,215ft2. Office has furnished waiting area, front and back stations for four staff members, two exam rooms, a break room, and a doctor’s office. This office is fully furnished. Equipment and furniture are negotiable and can be removed if not necessary. Located in a great medical/dental complex in Poway, close to Pomerado Hospital, on the border with Rancho Bernardo. Second floor. Elevator/stair access. Large free patient parking area. Ideal for medical, complementary/alternative medicine, physical therapy, chiropractic, acupuncture, massage/ body work, etc. Patients/clients from Poway, Rancho Bernardo, Carmel Mountain, 4-S Ranch, Scripps Ranch, Escondido, Ramona, and surrounding areas. Affordable rent. Please contact Olga at (858) 485-8022. [903] OFFICE SPACE TO SHARE IN LA MESA: Currently occupied by orthopaedic surgeon. Great location close to Grossmont and Alvarado Hospital. Looking to share with part-time or full-time physician. Fully furnished, fully

equipped with X-ray machine, three exam rooms, and staff. Please contact Carmen at (619) 668-0900 or email at carmen@drcham.com or at rcham1000@aol.com. [902] SHARE OFFICE SPACE IN LA MESA — AVAILABLE IMMEDIATELY: 1,400 square feet available to an additional doctor on Grossmont Hospital Campus. Separate receptionist area, physician’s own private office, three exam rooms, and administrative area. Ideal for a practice compatible with OB/GYN. Call (619) 463-7775 or fax letter of interest to La Mesa OB/GYN at (619) 463-4181. [648] MEDICAL OFFICE SPACE FOR RENT IN ENCINITAS: Convenient location five minutes from Scripps Encinitas Hospital. Close to 5 freeway. The 800ft2 space includes two spacious exam rooms, private consultation/doctor’s office, private bathroom, lunchroom, and a spacious waiting room shared with one other doctor. Very affordable rent. Office located at the corner of Encinitas Blvd. and Manchester Ave. Call (760) 519-0102 or email ktagdiri@ gmail.com for more information. [855] MEDICAL OFFICE SPACE AVAILABLE IN PROMINENT RETAIL CENTERS: Increase your business exposure by relocating to a prominent retail shopping center. Shopping centers improve business marketability, as well as provide convenience for patients/clients. Through managing a portfolio of over 100 shopping centers across San Diego County, we can advise you of space opportunities suitable for your business. For current opportunities, please contact Chris Carter, Flocke & Avoyer Commercial Real Estate, at (858) 875-4663. [898]

private restroom, spacious penthouse exercise gym, storage closet with private lock in each office, soundproofing, common waiting room, and abundant parking. Contact Christine Saroian, MD, at (619) 682-6912. [862] 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] OFFICE SPACE TO SHARE: Currently occupied by orthopedic surgeon. Great location close to Scripps/Mercy and UCSD Hospital. Looking to share with part-time or full time physician. Fully furnished, fully equipped with fluoro machine and 4 exam rooms and staff. (NEGOTIABLE) Please contact Rowena at (619) 299-3950. [804] PHYSICIAN POSITIONS AVAILABLE PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private nonprofit outpatient clinic serving the communities of North San Diego County, has opening for part-time, per diem positions. 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 www.vistacommunityclinic.org. EOE/MF/D/V [912]

OPPORTUNITY TO PURCHASE YOUR OWN SURGERY COMPLEX IN CORONADO: 2,100 square feet, street presence, three (3) exam, mini and larger surgery, scrub and recovery rooms (with private exit), business office, large reception area, nurse’s stations, two (2) private offices, and in-house restroom. Further information, please call: Apua Garbutt, Real Living Napolitano Real Estate, at (619) 818-8126. [899]

SEEKING EXPERIENCED HOSPITALISTS: XiMED Hospitalists, Inc., La Jolla, CA — Prestigious 400-physician multispecialty group seeks experienced hospitalists to be part of an established hospitalists program at Scripps Memorial Hospital, La Jolla. Board-certified internal medicine physicians with superior clinical skills and willing to work in a team environment. Excellent communication skills a must. Outstanding salary, bonus, and benefits. Please send CV to Yvonne Montelius/XiMED Hospitalists at ymontelius@ ximedinc.com or fax to (858) 587-1642. [910]

BUILD TO SUIT: Up to 1,900ft2 office space on University Avenue in vibrant La Mesa/East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable. Contact venk@cox.net or (619) 504-5830. [835]

PHYSICIAN: Multiple positions available at our family practice clinics in Escondido and Temecula. Seeking pediatricians, family practice, and internal medicine physicians. All positions provide comprehensive medical services for members of family, regardless of age or sex, on continuing basis. Candidates must have current California medical license, DEA and CPR certification. Please send CVs to Dr. Jim Schultz via email at jims@nhcare.org or fax to (760) 796-4021 “Attn: Physician.” [907]

MEDICAL OFFICE SPACE TO SHARE: Three furnished exam rooms, one physician office, and one accessory room. Spacious reception area to share. Close to Alvarado Hospital. First floor with easy access. Large free patient parking area. Very reasonable rent. Please call Dr. Fred Shahan at (858) 945-1162. [886]

PEDIATRICIAN OR PEDIATRIC NURSE PRACTITIONER: Part-time position (four days per week) provides comprehensive medical services for pediatric patients. Candidates must have a current California medical or NP license, DEA and CPR certifications. Please send CVs to Dr. Jim Schultz via email at jims@nhcare.org or fax to (760) 796-4021 “Attn: Pediatrician — Peds.” [909]

HILLCREST OFFICE SPACE AVAILABLE: Office space available at the corner of 8th Avenue and Washington St in Hillcrest. Approximately 3,000ft2. Surgical center building. Ample parking and freeway access. Proximity to Scripps Mercy Hospital. Contact Laura Hurshman at (619) 299-5000 or at laura@sdhandcenter.com. [874] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@sdcms.org for more information. [867] OFFICE SPACE IN UTC: Full-time office in 8th floor suite with established psychologists, marriage and family therapist, and psychiatrist in Class A office building. Features include private entrance, staff room with kitchen facilities, active professional collegiality and informal consultation,

FULL-TIME PHYSICIAN: Full-time physician for St. Paul’s PACE program for all-inclusive care for the elderly. Monday–Friday, 8:00am–5:00pm. Geriatric experience preferred. Visit our website at www.stpaulspace.org to learn about our innovative program. Contact Shirley O’Brien at (619) 239-6900, ext. 3003. Send resumes to hrdirector@ stpaulseniors.org. [905] FULL-TIME FAMILY MEDICINE PHYSICIAN: The San Diego American Indian Health Center is seeking a BC/BE full-time family medicine physician for an ambulatory care clinic. Clinic hours are Monday through Friday, 8:00am to 5:00pm. Light telephone call. No hospital duties. No weekends. Malpractice covered. Benefits. Disclaimer: Preference is given to qualified American Indian applicants in accordance with the Indian Preference Act of 1934 (Title 25, USC Section 472). Please email CV to Natalie Dominguez at natalie.dominguez@sdaihc.com. [904]

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 A N D I E GO P HY SIC IAN . or g A pril 2011

INTERNAL MEDICINE PHYSICIAN: SHARP ReesStealy Medical Group, a 400+ physician multi-specialty group in San Diego, is seeking a part-time (job-share) BC/BE internal medicine physician to join our staff in La Mesa. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 2001 Fourth Ave., San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@sharp.com. [901] LOOKING FOR A PART-TIME PHYSICIAN: Bilingual Spanish a plus — to permanently join our group practice of three physicians and six providers in the San Diego/ Chula Vista area. Family medicine or internal medicine preferred. The opportunity can become full time as well as eligible for partnership in this well-established (30 year) group. The office is exceptionally well run, efficient, and friendly, and is completely on EHR. Respond by email with CV to sharpgate@yahoo.com or contact our office manager Connie Espinoza for additional information at conniee4@gmail.com. [900] LOOKING FOR EXPERIENCED FAMILY PRACTICE OR INTERNAL MEDICINE PHYSICIAN: Interested in working in a community clinic setting. Our corporation recently converted to electronic medical records and would need to have some computer experience. Salary and benefits are dependent on qualifications and years of experience. The site is in the Linda Vista area close to Fashion Valley Mall and USD. We have great hours with no hospital call. Physician should be available to work 32–36 hours a week. If interested, email CV to awalton@Lvhcc.com. [897] SEEKING BOARD-CERTIFIED / BOARD-ELIGIBLE FAMILY PHYSICIAN: To work in solo family practice office in Chula Vista. Excellent work environment and staff support in a well-established, patient-centered practice. Open to flexible hours. Must have excellent communication skills, bilingual in Spanish preferred. Must have a compassionate and caring attitude. Please email CV and interest to ann@padillamd.com or fax to (619) 422-1324. [896] P/T FAMILY PRACTICE PHYSICIAN NEEDED FOR A BUSY, FEDERALLY QUALIFIED HEALTH CENTER IN ESCONDIDO: MHCS is a mission-driven organization that serves both rural and urban residents of San Diego County. We have been in business for 35 years and offer a competitive salary. Board certified and bilingual English/Spanish preferred. Send CV to hr@mtnhealth.org or (619) 478-9164. You may contact HR directly at (619) 4785254, ext. 30. www.mtnhealth.org. [894] CHIEF MEDICAL OFFICER TO SERVE FOUR FEDERALLY QUALIFIED HEALTH CENTERS: MHCS is a mission-driven organization that serves both rural and urban residents of San Diego County. We have been in business for 35 years and offer a competitive salary, medical benefits, vacation, paid holidays, sick time, CME reimbursement, and license reimbursement. Board certified family practice and bilingual English/Spanish preferred. This position will require 60 percent clinical and 40 percent administrative. Contact Tabitha at (619) 478-5254 or at hr@ mtnhealth.org. [893] PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private, nonprofit, outpatient clinic serving the communities in North San Diego County, has openings for part-time and per-diem positions. 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. [887] FAMILY PRACTICE PHYSICIAN: Three positions available. Full-time family practice or internal medicine/pediatrics in Temecula (physician: Temecula). Full-time family practice or internal medicine in Escondido at clinic as well as at a skilling nursing facility (physician: Grand). Full-time family practice in Escondido (physician: Elm). All positions provide comprehensive medical services for members of family, regardless of age or sex, on continuing basis. Candidates must have current California medical license, DEA and CPR certifications. Please send CVs to Dr. Jim Schultz

via email at JimS@nhcare.org or fax to (760) 796-4021, Attn: Physician — Date. Please indicate which position (Temecula, Grand, or Elm) is desired. [884] SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT FOUR-DAYS-PER-WEEK POSITION: Private practice in La Mesa seeks pediatrician four days per week on partnership track. Modern office setting with a reputation for outstanding patient satisfaction and retention for over 15 years. A dedicated triage and education nurse takes routine patient calls off your hands, and team of eight staff provides attentive support allowing you to focus on direct, quality patient care. Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, rounding on newborns, and occasional admission, NO delivery standby or rushing out in the night. Benefits include tailcovered liability insurance, paid holidays/vacation/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disability and life insurance. Please contact Venk at (619) 504-5830 or at venk@gpeds. sdcoxmail.com. Salary $ 102–108,000 annually (equal to $130–135,000 full-time). [778] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of house-call doctors. Great pay ($140–$200+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 279-1212 or email CV to hpmg11@yahoo.com. [801] INTERNAL MEDICINE, PART-TIME POSITION, PRIVATE PRACTICE, WONDERFUL JOB OPPORTUNITY!: Outstanding opportunity to work part time or more in a mature, premiere private practice setting in North San Diego County, outpatient only. This unique position blends the rewards of private practice and traditional continuity of care with scheduling flexibility. Perfect for any physician who wants to transition from the demands of a fulltime position, or who wants to maximize job satisfaction in an extremely high quality work environment while still working part time. Contact (619) 248-2324 for more information. [861]

SEEKING NURSE PRACTITIONER / PHYSICIAN ASSISTANT: To work in solo family practice in Chula Vista. Excellent work environment and support in a well-established, patient-centered practice with flexible hours. Must have excellent communication skills, bilingual in Spanish preferred. Must be experienced with a compassionate, caring attitude and able to practice independently with appropriate backup. Please email CV and interest to ann@ padillamd.com or fax to (619) 422-1055. [895] FULL-TIME OFFICE MANAGER / MEDICAL BILLER: Busy Hillcrest OB/GYN practice. Pay and 401k eligibility based on experience. Medical manager transitioning to EHR. Must be outgoing, proactive, flexible, and willing to work with small staff. Fax resume to (619) 298-4250. [891] EXPERIENCED MEDICAL INSURANCE BILLER/COLLECTOR needed for busy orthopedic and occupational therapy office: Must have excellent AR collections skills and proven abilities. Workers’ compensation experience a must and excellent understanding of their reimbursement as well as other third-party payers. Must have the ability to work accounts and denials, including re-determinations, appeals, and collections procedures. Candidates should be able to work independently, organized, pays attention to details, and motivated. Minimum of two years experience, high school diploma or general education degree. Thirty-two a week. Excellent benefits. Salary based on experience. Please fax resume to (619) 718-4122. [890] PSYCHOTHERAPIST: Full-time position (40 hours per week) open at our behavioral health clinic in Escondido. The staff psychotherapist does individual, family, and/or group psychotherapy with children and/or adolescents and/or adults. Also designs, markets, conducts, and evaluates health promotion programs for smoking cessation, weight management, stress management, and other types of health promotion groups. Candidates must have PhD in psychology or counseling or a master’s degree in social work. Two years of experience is preferred. Please send applications/resumes to Matt Holden, PhD, via email at MattH@nhcare.org or fax to (760) 796-4021, Attn: Psychiatry — Date. [888]

PRACTICE FOR SALE INTERNAL MEDICINE PRACTICE FOR SALE: Beautiful beach weather. Established 27 years with excellent reputation. Two exam rooms. Free-standing building. Main street corner location. Great visibility. Office shared with another physician. Patient parking. 2010 gross $483K. Asking $290K. 100% financing available. Please Contact ProMed at (888) 277-6633 or at info@promed-financial. com, or visit www.promed-financial.com. [906] 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] NONPHYSICIAN POSITIONS AVAILABLE NURSE PRACTITIONER / PHYSICIAN’S ASSISTANT: Provides medical oversight and supervision for human clinical trials within PICR (under the supervision of a physician) while ensuring the integrity of the studies and the safety and wellbeing of human subjects. Performs duties in accordance with company’s values, policies, and procedures. For further information, visit www.profilinstitute. com. Qualified candidates please forward resumes to hrpicr@profil-research.com. [913] FAMILY NURSE PRACTITIONER OR PHYSICIAN ASSISTANT: Two positions available. Full-time position (40 hours per week) and part-time position (24 hours per week) open at our clinic in Temecula. The FNP or PA provides healthcare services to patients under direction and responsibility of physician. Candidates must have a current California PA or FNP license, DEA and CPR certifications. Please send CVs to Dr. Jim Schultz via email at jims@nhcare.org or fax to (760) 796-4021 “Attn: FNP/ PA — Date.” Please indicate which position (FT or PT) is desired. [908]

FAMILY NURSE PRACTITIONER OR PHYSICIAN ASSISTANT: Two positions available. Full-time position (40 hours per week) and part-time position (24 hours per week) open at our clinic in Temecula. The FNP or PA provides healthcare services to patients under direction and responsibility of physician. Candidates must have a current California PA or FNP license, DEA and CPR certifications. Please send CVs to Dr. Jim Schultz via email at JimS@nhcare.org or fax to (760) 796-4021, Attn: FNP/ PA — Date. Please indicate which position (FT or PT) is desired. [885] BILLING PERSON NEEDED: We are looking for a billing person to fill the position that we currently have open. Here are the requirements: full-time; Monday – Friday 8:00 – 4:30 with a half hour lunch; UTC area with free parking; busy orthopedic office, solo practice; full medical and dental benefits; must have minimum of five current years of workers’ compensation experience. Send resume with salary requirements to slevine@northcountyomg. com. [883] PART-TIME NURSE PRACTITIONER OR PHYSICIAN ASSISTANT: Busy family practice with strong geriatric population located in downtown is seeking full- or parttime nurse practitioner or physician assistant. Experience in EMR preferred. Must be fluent in Spanish and English. Please fax resume to (858) 270-7633. [881]

Place your advertisement here Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

April 2011 SAN DIEGO P HYS I CI A N. o rg

adinosaur’sstory By F. Bruce Kimball, MD

When Is It Time to Retire? When I started practice in Michigan, I found office space available because a doctor’s brother had died. Dr. McCall was an 82-yearold family practitioner who still made home deliveries. This was the era when adult patients were never called by first names, when nurses proudly wore their caps and, yes, stood when the doctor arrived to make rounds. Dr. McCall was the epitome of a physician: tall, well-dressed, well-liked. One day he asked if I planned to go to a doctor’s funeral. I replied that I hadn’t, as I had never met the deceased. Dr. McCall replied, “He was a doctor!” I went to the funeral. One day he came in to my office asking

S A N D I E GO P HY SIC IAN . or g A pril 2011

a question about cardiology. I told him I didn’t have an answer because it was outside my field of expertise. He replied that his brother didn’t know the answers either but always gave one. On another day he came to me saying he had a man in great pain, and did I have any morphine? Sometime earlier I had had a patient die. The family insisted I take all her meds. One unlabeled packet was said to contain morphine. I fished it out of my bag. Dr. McCall touched a tablet to his tongue and said, “That’s morphine,” dropped it into a syringe, and injected it into his patient. One day in San Diego, while visiting with an elderly patient, a doctor’s widow,

we talked about retirement, especially when skills are slipping. I told her of a pact between my partner and me in which one would tell the other when it was time to put the scalpel aside. She nodded understandingly and then said, “But will you listen?” About the Author: Dr. Kimball, who first joined SDCMS-CMA in 1957 and was editor of San Diego Physician — then known as The Bulletin of the San Diego County Medical Society — in 1960 and 1961, is now a retired member and a retired orthopedic surgeon. San Diego Physician is happy to publish a series of articles by Dr. Kimball under the rubric “A Dinosaur’s Story.”

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Richard Richard E.Richard Anderson, E. Anderson, E. Anderson, MD, MD, FACPMD, FACPFACP Chairman Chairman Chairman and CEO, and CEO, and TheCEO, Doctors The Doctors TheCompany Doctors Company Company Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company

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YouYou deserve You deserve deserve more more than more than a little than a little gratitude a little gratitude gratitude for afor career afor career aspent career spent practicing spent practicing practicing goodgood medicine. good medicine. medicine. That’s That’s why That’s why Thewhy The Doctors The Doctors Doctors You deserve more than littlePlan. gratitude for one-of-a-kind a career spent practicing medicine. That’s whywith Company Company Company created created created the Tribute the Tribute thea Plan. Tribute This Plan. This one-of-a-kind This one-of-a-kind benefit benefit provides benefit provides provides ourgood our long-term our long-term long-term members members members with aThe with aDoctors a Company created thereward Tribute Plan. This one-of-a-kind provides our long-term members a significant significant significant financial financial financial reward when reward when they when they leave they leave medicine. leave medicine. medicine. Howbenefit How significant? How significant? significant? Think Think “new Think “new car.” “new car.” Orcar.” maybe Or maybe Orwith maybe significant financial reward when they leave How significant? Think “new Orexclusively maybe “vacation “vacation “vacation home.” home.” home.” NowNow that’s Now that’s a fitting that’s a fitting atribute. fitting tribute. tribute. Themedicine. The SanThe San Diego San Diego County Diego County County Medical Medical Medical Society Society Society has car.” has exclusively has exclusively endorsed endorsed endorsed home.” Now that’s aprogram fitting tribute. The San Diego County Medical Society hasSDCMS exclusively endorsed our “vacation our medical our medical medical professional professional professional liability liability liability program program sincesince 2005. since 2005. To2005. learn To learn To more learn more about more about our about our program our program program for for SDCMS for SDCMS members, members, members, our medical liability program since 2005. Tovisit learn more about our program for SDCMS members, including including including the Tribute theprofessional Tribute the Tribute Plan,Plan, call Plan, call us atcall us(800) atus(800) at852-8872, (800) 852-8872, 852-8872, or visit or www.thedoctors.com/tribute. or visit www.thedoctors.com/tribute. www.thedoctors.com/tribute. including the Tribute Plan, call us at (800) 852-8872, or visit www.thedoctors.com/tribute. Endorsed Endorsed byEndorsed by by Endorsed by

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