March 2012

official publication of the san diego county medical society March 2012

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S A N D I E G O P HY S I CI A N .or g O c tob e r 2011

Our passion protects your practice

Octo ber 2011 SAN DIEGO P HY SIC I A N. o rg

1

this month Volume 99, Number 3

features TOMORROW’S PHYSICIANS 16 Training Physicians for the 21st Century

by David A. Brenner, MD, and Maria C. Savoia, MD

18 UC San Diego School of Medicine: A Remarkably Diverse Group of Students

by Carolyn J. Kelly, MD

22 It’s Not Your Father’s GME Training Anymore

by Stephen R. Hayden, MD

26 Innovation in Medical Education

by Daphna Finn, MSI

28 Health Frontiers in Tijuana: A Binational Approach

by Amy Eppstein, MSIV, and Jose Luis Burgos, MD

30 It’s 4 a.m. on a Sunday Morning: Thoughts From a Fourth-year Medical Student

by Julia Tomlin, MSIV

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, PhD, MD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager Jennifer Rohr Sales Director Dari Pebdani Art Director Lisa Williams Copy Editor Adam Elder

SDCMS Board of Directors Officers President Robert E. Wailes, MD (CMA Trustee) President-elect Sherry L. Franklin, MD (CMA Trustee) Treasurer Robert E. Peters, PhD, MD Secretary J. Steven Poceta, MD Immediate Past President Susan Kaweski, MD geographic and geographic alternate Directors East County William T-C Tseng, MD, Heywood “Woody” Zeidman,

MD, Kimberly M. Lovett, MD (A:Venu Prabaker, MD) Hillcrest Theodore S. Thomas, MD, Steven A. Ornish, MD, Jason P. Lujan, MD (A:Gregory M. Balourdas, MD) Kearny Mesa John G. Lane, MD (A:Marvalyn E. DeCambre, MD, Sergio R. Flores, MD) La Jolla Gregory I. Ostrow, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County James H. Schultz, MD, Douglas Fenton, MD, Niren Angle, MD (A: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Mike H. Verdolin, MD (A: Andres Smith, MD) 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, Peter O. Raudaskoski, MD, Mihir Y. Parikh, MD, Suman Sinha, MD (A: Carol L. Young, MD, Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Samuel H. Wood, MD, Elaine J. Watkins, DO, Carl A. Powell, DO, Theresa L. Currier, MD) other voting members Communications Chair Theodore M. Mazer, MD (CMA Vice Speaker) Young Physician Director Van L. Cheng, MD Resident Physician Director Steve H. Koh, MD Retired Physician Director Rosemarie M. Johnson, MD Medical Student Director Beth P. Griffiths

departments

OTHER NONVOTING MEMBERS Young Physician Alternate Director Renjit A. Sundharadas, MD Resident Physician Alternate Director Christina Pagano, MD Retired Physician Alternate Director Mitsuo Tomita, MD

4 Briefly Noted

SDCMS Seminars, Webinars, and Events • CMA Webinars • Community Healthcare Calendar • Upcoming Legislator Birthdays • And More …

8 Nurse-Family Partnership Home Visitation Program

CMA President-elect James T. Hay, MD CMA Past Presidents Robert E. Hertzka, MD (Legislative Committee Chair), Ralph R. Ocampo, MD CMA Trustee Albert Ray, MD CMA Trustee (OTHER) Catherine D. Moore, MD CMA SSGPF Delegates James W. Ochi, MD, Ritvik Prakash Mehta, MD CMA SSGPF Alternate Delegates Dan I. Giurgiu MD, Ashish K. Wadhwa, MD

8

by Wilma J. Wooten, MD, MPH, and Linda Lake, RN, MSN

12 The Valley of the Shadow

by Dan McCollum

34 Physician Marketplace

Classifieds

36 Errata

SDCMS Pictorial Membership Directory and County Physician Directory

36 2 SAN DIEGO PHYSICIAN .org march 2012

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.]

“We call First Republic and instantly talk to someone who truly helps us with our account.”

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brieflynoted calendar SDCMS Seminars, Webinars, & Events SDCMS.org/event

For further information or to register for any of the following SDCMS seminars, webinars, and events, visit SDCMS.org/event or contact Serena Sauerheber at (858) 300-2779 or Serena.

Sauerheber@SDCMS.org.

Surviving Economic Times: Avoiding Employment Lawsuits (seminar / webinar) MAR 15 • 11:30am–1:00pm Media Training (workshop) MAR 24 • 8:00am–12:00pm ICD-10 Training (seminar / webinar) MAR 29 • 11:30am–1:00pm The Business of Medicine (seminar / webinar) MAR 31 • 8:30am–11:00am Managing Challenging Patients (seminar / webinar) APR 18 • 6:30pm–7:30pm Managing Challenging Patients (seminar / webinar) APR 19 • 11:30am–12:30pm The Leader’s Toolbox (workshop) APR 20 • 8:00am–4:00pm & APR 21 • 8:00am–12:00pm Subpoenas (seminar / webinar) APR 26 • 11:30am–1:00pm Preparing to Practice (workshop) APR 28 • 8:00am–4:00pm SDCMS White Coat Gala (event) JUN 2 • 6:00pm–11:00pm

Cma Webinars

CMAnet.org/events

HIPAA Update 2012 MAR 21 • 12:15pm–1:15pm A Guide to Managing Upset and/or Difficult Patients APR 4 • 12:15pm–1:15pm Medicare Audits: How and Why APR 11 • 12:15pm–1:15pm Best Practices for Managing Your Accounts Receivable APR 18 • 12:15pm–1:15pm California’s Public Health Insurance Programs APR 23 • 12:15pm–1:00pm

Community Healthcare Calendar To submit a community healthcare event for possible publication, email KLewis@ SDCMS.org. Events should be physician-focused and should take place in or near San Diego County.

Topics and Advances in Internal Medicine MAR 12–16 • Catamaran Resort Hotel, San Diego • cme.ucsd.edu/ internalmed Prescription Opioid Misuse Academy: The Dark Side of Prescription Opioids MAR 15 • An Educational Program of the American College of Medical Toxicology • Catamaran Resort Hotel, San Diego • acmt.net Topics and Advances in Pulmonary and Critical Care Medicine MAR 17–18 • Catamaran Resort Hotel, San Diego • cme.ucsd.edu/ internalmed Emerging Markets and Global Health MAR 23 • San Diego Hilton Harbor Island Hotel • The recognition that the world’s health cannot be limited by geopolitical borders has emphasized the need for global health strategies. Yet, simultaneously, improving health in emerging markets provides both challenges and

4 SAN DIEGO PHYSICIAN.org march 2012

opportunities for policymakers and the private sector. The tenuous availability of resources and extant vulnerable patient populations and access needs are interfacing with growing economic strength and demand for healthcare products and services. As globalization becomes increasingly dominant in both issues of health and sovereign well-being, a forum to identify key issues in global health in these markets is needed to explore solutions that may serve as lessons for future developments in global public policy and health. • This is an invitation-only conference. If you are interested in attending, please contact Pam Tait, program administrator at The Institute of Health Law Studies, California Western School of Law, at (619) 515-1568 or prt@cwsl.edu to reserve a seat.

Sharon’s Ride Run Walk for Epilepsy 2012!

APR 15 • De Anza Cove, Mission Bay Park • $25 for Adults / $10 for Ages 7–17 / Free for Ages 6 and Under • 7:30am-1:00pm • sharonsride2012.kintera.org Hospital Medicine 2012 APR 1–4 • The Society of Hospital Medicine’s 15th Annual Meeting • San Diego Convention Center • See Page 27 for Details California Orthopaedic Association Annual Meeting APR 19–22 • Park Hyatt Resort in Carlsbad • www.coa.org/coaannual-meeting.html 15th Annual California Health Care Leadership Academy APR 27–29 • Disneyland Hotel, Anaheim • Models of healthcare financing and delivery will change as implementation of federal health reform kicks into high gear.

What are the best options for successful medical practice in the new environment? Hear from the experts and leaders of change, and attend a comprehensive slate of practice management seminars and workshops to position your practice for success. Details coming in January — stay tuned!

13th Annual Science and Clinical Application of Integrative Holistic Medicine NOV 2 • Hilton San Diego Resort

legislator birthdays

One way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday!

BIRTHDAY: MARCH 7 State Senator Juan Vargas (District 40) E: (via website) sd40.senate.ca.gov/contact E: senator.vargas@sen.ca.gov Sacramento Office: State Capitol, Rm. 3092, Sacramento, CA 95814 T: (916) 651-4040 • F: (916) 327-3522 Chula Vista Office: 333 H St., Ste. 2030, Chula Vista, CA 91910 T: (619) 409-7690 • Fax: (619) 409-7688

BIRTHDAY: MARCH 17 State Assemblyman Ben Hueso (District 79) E: (via website) asmdc.org/members/a79 E: assemblymember.hueso@assembly.ca.gov Sacramento Office: State Capitol, PO Box 942849 Sacramento, CA 94249-0079 T: (916) 319-2079 • F: (916) 319-2179 Chula Vista Office: 303 H St., Ste. 200, Chula Vista, CA 91910 T: (619) 409-7979 • F: (619) 409-9270

BIRTHDAY: MARCH 24 State Assemblyman Martin Garrick (District 74) E: (via website) arc.asm.ca.gov/member/74 E: assemblymember.garrick@assembly.ca.gov Sacramento Office: State Assembly, Sacramento, CA 95814 T: (916) 319-2074 • F: (916) 319-2174 Carlsbad Office: 1910 Palomar Point Way, Ste. 106, Carlsbad, CA 92008 T: (760) 929-7998 • F: (760) 929-7999

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

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

healthcare communit y.

get in touch

3 income Tax Planning 3 Wealth Management

Your SDCMS and SDCMSF Support Teams Are Here to Help!

3 employee Benefit Plans

SDCMS Contact Information

3 Profitability Reviews

5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org CEO • EXECUTIVE DIRECTOR Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO • CFO James Beaubeaux at (858) 300-2788 or James.Beaubeaux@SDCMS.org DATABASE ADMINISTRATOR Janet Lockett at (858) 300-2778 or Janet.Lockett@SDCMS.org DIRECTOR OF MEMBERSHIP SUPPORT • PHYSICIAN ADVOCATE Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org DIRECTOR OF ENGAGEMENT Jennipher Ohmstede at (858) 300-2781 or JOhmstede@SDCMS.org DIRECTOR OF COMMUNICATIONS AND MARKETING • MANAGING EDITOR Kyle Lewis at (858) 300-2784 or KLewis@SDCMS.org MEMBERSHIP ADMINISTRATIVE ASSISTANT Serena Sauerheber at (858) 300-2779 or Serena.

Sauerheber@SDCMS.org OFFICE MANAGER • DIRECTOR OF FIRST IMPRESSIONS Betty Matthews at (858) 565-8888 or Betty.Matthews@SDCMS.org LETTERS TO THE EDITOR Editor@SDCMS.org GENERAL SUGGESTIONS SuggestionBox@SDCMS.org

3 outsourced Professional services (CFo, Controller) 3 organizational and Compensation structure 3 succession Planning 3 Practice Valuations 3 internal Control Review and Risk Assessment

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SDCMSF Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 300-2777 F (858) 560-0179 (general) W SDCMSF.org EXECUTIVE DIRECTOR Barbara Mandel at (858) 300-2780 or Barbara.Mandel@SDCMS.org project access PROGRAM DIRECTOR Tanya Rovira at (858) 565-8161 or Tanya.Rovira@SDCMS.org RESOURCE DEVELOPMENT DIRECTOR Lauren Banfe at (858) 565-7930 or Lauren.Banfe@SDCMS.org Patient Care Manager Rebecca Valenzuela at (858) 300-2785 or Rebecca.Valenzuela@SDCMS.org Patient Care Manager Elizabeth Terrazas at (858) 565-8156 or Elizabeth.Terrazas@SDCMS.org IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org

S A N DIEGO

W W W.AKTCPA.COM ron mitchell, cpa director of health services

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Give Us 5 Minutes and We’ll Give You a Benefits Check-up!

Call SDCMS at (858) 565-8888 to schedule a time Today!

march 2012 SAN DIEGO PHYSICIAN.org 5

brieflynoted featured member

Become an SDCMS

Featured Member!

SDCMS would like to feature some of our member physicians you co heruld app e ne e for their noteworthy xt! ar accomplishments in these pages and on SDCMS.org! If you would like to be considered for our next “Featured Member” spotlight, please email Editor@SDCMS.org. Thank you, and thank you for your membership in SDCMS and CMA!

Stay on top of the issues critical to managing your practice …

Sign up to receive SDCMS’ e-newsletter “News You Can Use” by emailing Gehring@ SDCMS.org.

6 SAN DIEGO PHYSICIAN.org march 2012

Contributed by SDCMS-endorsed The Doctors Company

To Scribe or Not to Scribe?

Medical scribes can be an important productivity booster, allowing the busy physician to see more patients.

According to The Joint Commission, a scribe is an unlicensed person who enters information into the electronic medical record (EMR) or chart at the direction of a physician or licensed independent practitioner. A scribe cannot act independently. Scribes can document physician dictation and activities, assist the physician in navigating the EMR, and locate information, such as test results and lab results, in the record.

They can support workflow and documentation for medical record coding.

Properly trained, scribes can assist with the office implementation of an EMR, capture pertinent patient information in real time, and decrease the need for other members of the team to learn new computing skills. In addition, a scribe can increase the physician’s ability to focus on patients and may catch potential lapses in medication reviews.

Before using scribes, however, it is important to be aware of possible documentation issues:

• Scribes should not interfere with a physician’s adequate review of documentation. The physician should always review the record and attest to its correctness and completeness.

• At the end of each day or shift, the physician should review the scribed documentation to ensure all events were recorded accurately.

• The scribe should note the date and time of all entries.

• Safeguards must be in place in the EMR to ensure that the signatures for entry and attestation are clear.

The signature of the scribe must be clearly identifiable and distinguishable from the physician’s signature.

Hiring a scribe from a management company can simplify training and liability issues. If you hire a scribe directly, look for candidates with some medical education and background and a good understanding of medical practices. Develop a job description that clearly defines the qualifications and responsibilities of the scribe. Also, keep in mind that most insurance will not pay for scribes, so they are an out-of-pocket expense for practices.

John O. Johnson, MD

Imaging Healthcare Specialists: The Low Radiation Dose Leader How do we measure radiation risk?

• The unit of measurement used to estimate radiation exposure is the millisievert (mSv) • Annual unavoidable background radiation is 3 mSv • Experts estimate an incremental 0.1% increased cancer risk for each 10 mSv of exposure • Chest x-ray: 0.1 mSv = 10 days of background • CT of the abdomen: 10 mSv = 3 years of background

Imaging Healthcare Specialists is the leader in low radiation dose initiatives to ensure our patients’ safety, health, and well-being. We are committed to limiting the use of radiation for our patients through the practice of ALARA (As Low As Reasonably Achievable). Under the leadership of radiologist, Dr. John O. Johnson, Imaging Healthcare Specialists has optimized its CT imaging protocols to ensure we are using the least amount of radiation necessary to acquire a diagnostic quality examination for each patient.

• An estimated 70 million CT scans are performed annually in the United States

• Approximately 1 in 5 adults will receive a CT scan each year

• Low dose CT protocols can reduce radiation exposure in the average patient by as much as 75%

For more information on Imaging Healthcare Specialists’ low dose initiatives, visit imaginghealthcare.com

T E M E C U L A VA L L E Y

OCEANSIDE

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march 2012 SAN DIEGO PHYSICIAN.org 7

From Your County Public Health Officer

Nurse-Family Partnership Home Visitation Program

By Wilma J. Wooten MD, MPH, and Linda Lake, RN, MSN

Note: To read this article with references, please visit www.SDCMS.org.

San Diego Birth Demographics In 2009, there were 44,960 live births in San Diego County. Of these, 43.7% were Hispanic, 32.7% were Caucasian, 10% were Asian, 4.8% were African American, and the remaining 8.8% was Native American, mixed race, or non-identified race/ethnicity. Of the above total live births, 1,669 (3.7%) women received late or no prenatal care, and 3,548 (7.9%) girls ages 15–19 delivered.

There were 4,420 (9.8%) preterm births in San Diego, below the state rate of 10.7%.

The Healthy People 2020 target for preterm births is 11.4%. There were 2,991 (6.7%) low-birth-weight infants and 486 (1.1%) very-low-birth-weight infants, lower than the Healthy People 2020 targets of 7.8% and 1.4%, respectively.

Lastly, the infant mortality rate in San Diego County is 4.9, with a state average of 5.1 per 1,000 live births. However, the local 8 SAN DIEGO PHYSICIAN.org march 2012

infant mortality for African Americans is 9.9, which is above the Healthy People 2020 target of 6.0.

Despite the fact that the prevalence and rates for the above community indicators in San Diego are lower than the Healthy People 2020 targets and state rates, there were still 4,420 preterm births, 2,991 low-birth-weight infants, and 486 verylow-birth-weight infants born in San Diego County in 2009. While San Diego is defined as a “moderate risk” county, pockets of high-risk and high-need populations are still evident.

The Role of the County Public Health Nurse County of San Diego Health and Human Services Agency (HHSA) public health nurses (PHNs) work with pregnant, postpartum, and parenting women and their infants and children. PHNs are registered nurses who have special education and experience working with population-focused health issues, individuals and families in the

home, and groups having common health interests. PHNs work under the direction of the San Diego County public health officer and closely coordinate with community healthcare providers to ensure patients receive necessary social and medical services.

Up to 30% of those initially referred for PHN services do not have a healthcare provider, so PHNs assist women and children in establishing and maintaining medical homes. Lack of insurance is a significant barrier to accessing care. According to 2009 California Health Interview Survey data, approximately 37,000 (4.5%) children ages 0–17, and 344,000 (17.7%) non-elderly adults ages 18–64, were uninsured in San Diego County.

Maternal Child Health (MCH) PHNs help women obtain prenatal care to prevent maternal complications, preterm births, and low-birth-weight infants. Over the past seven years, progress has been demonstrated in the number of MCH clients who obtained prenatal care visits; however, there is room for improvement. More than 10,000 babies (less than 37 weeks of gestation) died from preterm-related causes in 2005.

Infants born even a few weeks early, or “late preterm” (34–36 weeks of gestation), had three times the mortality rates compared to full-term infants. If pregnant women follow through with the recommended number of prenatal visits, infants are less likely to be born preterm. The number of recommended prenatal care visits takes into account both the timing of prenatal care initiation and the estimated delivery date. In fiscal year (FY) 05/06, the percent of clients seen by a San Diego County PHN over the course of their pregnancy who received the recommended number of prenatal visits was 90.7% (400 out of 441).

In FY 09/10, the percent of clients seen by a San Diego County PHN who received the recommended number of prenatal visits was 97.51% (391 out of 401). The overall case numbers in FY 09/10 are slightly lower than FY 05/06 due to a change in staff work assignments.

What is Nurse-Family Partnership?

NFP is one of several home visitation models for first-time mothers. PHNs in the NFP program work to ensure pregnant women receive the recommended number of prenatal visits in order to decrease the prevalence of preterm births. Specifi-

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From Your County Public Health Officer cally, NFP is a voluntary, evidence-based program that provides nurse, home visitation services to low-income, first-time mothers. Nurses begin home visits early in the mother’s pregnancy and continue visitation until the child’s second birthday.

Nurses provide support, as well as education and counseling, for health, behavioral, and self-sufficiency issues. First-time mothers can expect to receive referrals to healthcare, childcare, job training, and other support services. The program’s goals are to improve pregnancy outcomes by helping women have a healthy pregnancy; to improve child health and development by helping parents become engaged in caring for their children; and to improve the economic self–sufficiency of families by helping parents develop a vision for their future, plan future pregnancies, continue their education, and find employment.

visits for accidents and poisonings; • 59% reduction in arrests at age 15; • 67% reduction in behavioral and intellectual problems at age 6; and • 72% fewer convictions of mothers at age 15.

In 1998, a study by the RAND Corp. found that savings accrue in areas such as healthcare delivery, child protection, education, criminal justice, mental health, and public assistance. A 2004 study conducted by the Washington State Institute of Public Policy estimated a $17,180 lifetime cost savings for every mother and child.

In 2005, the RAND Corp. found a $5.70 savings for every dollar invested on highrisk families. Pacific Institute for Research and Evaluation (PIRE) found total government cost savings averaged $10,104 within five years of the birth of a first child whose mother received any NFP services. The PIRE evaluation, completed in June 2010, was able to delineate between savings to California state and local governments PHYSICIAN CALL TO ACTION: As physicians, of $5,113 and savings to the you play an important role in the lives of your federal government of $4,991.

patients. Please refer women to NFP who are low-income and first-time pregnant patients, are in no more than the 28th week of gestation, and could benefit from PHN services. For more information about how to make a referral, please contact Linda Lake at (619) 542-4137 or at linda.lake@sdcounty.ca.gov.

What Is the Proven Impact?

NFP transforms the lives of vulnerable mothers and the lives of their children. The program has demonstrated effectiveness based on 30 years of research evidence from randomized, controlled trials. A research study by David Olds, PhD, in Elmira, N.Y, began in 1977. Since that time, three other randomized, controlled trials, in different locations with diverse populations, have proven that the program works. Data from a 15-year follow-up study of the Elmira trial showed lasting positive impacts for families more than 12 years after the nurse visits ended. The following outcomes have been seen among participants in at least one of the program trials: • 48% reduction in child abuse and neglect; • 56% reduction in emergency room 10 SAN DIEGO PHYSICIAN.org march 2012

Nurse-Family Partnership in San Diego The HHSA East Region has implemented NFP for 11 years and the HHSA South Region for four years. In October 2010, NFP was expanded to every HHSA region in the county. In 2011, the County of San Diego HHSA converted 25 PHN positions to NFPs and will convert an additional 15 positions for a total of 51 program staff by June 2012.

Each PHN carries a caseload of 25 clients.

Every year in San Diego County, approximately 5,800 children are born to first-time mothers from low-income households (<200% federal poverty level or FPL). San Diego County PHNs will be able to serve 1,275 first-time, low-income mothers and their children when fully expanded. This expansion will address 22% of the NFP target population.

NFP aligns with the “Building Better Health” component of the County of San Diego’s Live Well, San Diego! initiative. This is a 10-year strategic plan with a focus on quality, efficiency, and outcomes. NFP aligns with two of the strategies of this framework: “Building a Better System” and

“Supporting Healthy Choices.” NFP aligns with “Building a Better System” because the program improves the system of care. The program has guidelines, which are tools that guide PHNs in the delivery of program content to clients. PHNs use strength-based approaches when working with families and individualize the guidelines to meet clients’ needs. The strong relationships that are built between the PHNs and clients over a two-and-a-half-year period are key in helping clients learn how to manage, and advocate for, their own health and the health of their children. NFP aligns with “Supporting Healthy Choices” because clients are given information that empowers them to practice sound, health-related behaviors. The program supports healthy choices by teaching clients to obtain good prenatal care from their healthcare provider; engage in active living and healthy eating; and reduce the use of cigarettes, alcohol, and illegal drugs.

Physicians are encouraged to refer lowincome, high-risk pregnant women to the NFP program. Alternatively, women who are ineligible are referred to the MCH PHN home visitation program. Referral criteria for this program include low-income, highrisk pregnant women who do not qualify for NFP; pregnant women with previous premature deliveries; those women with gestational diabetes, hypertension, and substance-use issues; postpartum women who were identified as substance users during pregnancy, first-time moms, or having postpartum depression; and infants with high-risk medical conditions or discharged from Neonatal ICUs. Women who are ineligible for the MCH program will be referred to other home visiting agencies. Examples include Project Concern International California Border Healthy Start Project, serving pregnant and postpartum women and infants; Project Early Head Start, serving infants and children with developmental and educational needs; Families Together Program, serving pregnant women and children under 3 years of age; Community Services for Families, serving parents with at least one child in the home; and the countywide San Diego Adolescent Pregnancy and Parenting (SANDAPP) program, serving pregnant teens. Given the local need, the First 5 Commission of San Diego has established a priority to identify funding options to support a targeted at-

risk home visitation pilot.

Dr. Wooten, SDCMS-CMA member since 2006, is the public health officer and director of the Division of Public Health Services in the County of San Diego Health and Human Services Agency (HHSA). Ms. Lake is the chief public health nurse for the County of San Diego, HHSA, Division of Public Health Services.

San Diego County Health Statistics During FY 2010–11, the county received 2,419 NFP referrals. The NFP PHNs made 5,813 home visits, working with 584 families and 873 individuals.

Client Demographics at Intake: »» Median Age: 20 years »» 79% Unmarried »» 68% Medicaid Recipients »» 78% English Speaking »» 19% Spanish Speaking »» 03% Other Language »» 53% Completed High School »» 02% Completed GED Positive Outcomes for NFP Clients FY 2010–11: »» 29% reduction in maternal smoking during pregnancy between intake and 36 weeks »» 96% of mothers initiated breastfeeding »» 93% of babies were born at a healthy weight — at or above 2500g (5.5lbs) »» 96% of children were up-to-date with immunizations at 24 months of age »» 14% increase in workforce participation among clients 18 years and older between intake and at closure (child 24 months of age) To request additional health statistics describing health behaviors, diseases and injuries for specific populations, health trends and comparisons to national targets, please call the County’s Community Health Statistics Unit at (619) 285-6479. To access the latest data and data links, including the Regional Community Profiles document, go to www. sdhealthstatistics.com.

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From the Patient’s Perspective Note: Mr. McCollum’s article is the latest in the “From the Patient’s Perspective” series in San Diego Physician. Readers are encouraged to submit their feedback to Editor@SDCMS.org.

After Keith’s funeral, we gathered at my grandmother’s house. None of us felt like playing. I guess we knew it wouldn’t be right. Sadness was everywhere. We were scared. How does a 6-year-old die? The six months they had given him to live had gone by so quickly, not like they do when you’re waiting for Christmas.

My grandmother gathered us to talk.

She didn’t want us to be scared, but she sure scared us. She told us our family was prone to cancer. Cancer hung over us like a shadow.

Forty years and 15 deaths later, it was my turn to walk into the valley of the shadow.

Who should give the patient the diagnosis? Should it be the specialist or the primary care physician? Should it be the one who knows the patient or the one who has been engaged to help?

The Valley of the Shadow

By Dan McCollum

12 SAN DIEGO PHYSICIAN.org march 2012

Prostate cancer had made its presence known in another family member. I was number six. My primary care physician had been regularly testing my condition because of my family history. He knew not only my immediate family but also my extended family. My 14-year association with this clinic and my five-year association with this particular doctor had given us time to develop a relationship and time for him to learn my complete history. His guidance through this process had been done with a great deal of concern and compassion.

Once my tests indicated that it was time for me to be referred to a urologist, I was placed in the care of a handpicked physician. My care continued at the highest quality and in a suitable manner. The main thing missing was the relationship I valued with my physician. I understand that my urologist was chosen to move my testing and probable treatment to a higher level.

He, of course, could not be expected to

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have the level of relationship I had with my primary care physician. However, on our third face-to-face meeting, he shared I had cancer. Here was by all practical purposes a stranger giving me the most crushing news I had ever had in my life. His job is not easy.

It makes me question: Who should discuss this part of the process with the patient? Again, I realize the specialist cannot be all things to all people. Time is money. You cannot accomplish all that needs to be done in seven to 12 minutes.

Who would pay for this? Should this service be supplied by the clinic, or should this be a separate discipline requiring a separate appointment? Would this be too much information for the average patient? I know for my father it would have been. My father’s generation took the doctor’s word as gospel. You did not question their decisions or their recommendations. However, times have changed. The patients of today are better informed and much more interested in being informed and being active in their treatment decisions.

I think it’s time for a coordinated effort between the primary care physician, the specialist, the surgeon, and a qualified individual to take the time to share, explain, comfort and guide, schedule, and follow up. Who is this person: RN, nurse practitioner, patient advocate, patient navigator, or someone with special training in counseling and knowledge of available support groups and services? For us prostate cancer patients, it would be nice if this individual was a man. We do not like to talk about our weaknesses and concerns, and especially not to a woman we do not know.

My journey through the valley could have been easier. A friend or family member could have told me what I was facing.

I could have been guided to counseling or support groups. I could have been better prepared for the side-effects both physically and emotionally. However, the circumstances ignited a desire to educate myself and then share what I learned with others to make their journey through the valley of the shadow easier. Hopefully, by writing this article, it will inspire the medical community to address this important situation to help patients navigate better, and with more support, when they share the devastating news, “You have cancer.”

I think it’s time for a coordinated effort between the primary care physician, the specialist, the surgeon, and a qualified individual to take the time to share, explain, comfort and guide, schedule, and follow up.

The responsibility of having to do this has to be hard. I know from my years in funeral service that having to inform a family of the death of a loved one is very difficult. It is something that I never wanted to do, and I’m sure my urologist felt the same way. To say it comes with the job does not diminish the effect it has on the patient or the doctor.

This experience makes me ask some questions. Who should give the patient the diagnosis? Should it be the specialist or the primary care physician? Should it be the one who knows the patient or the one who has been engaged to help? Since the primary care physician started the testing and elevated it to the specialist, should he/ she be the one to give you the final report?

In the days of electronic patient records, the information could be readily available to all concerned. Who is best qualified to dispense this information?

Once my diagnosis was explained and my options discussed, I was sent to a separate office for scheduling the operation. I was told this office could provide information about my condition and my treatments. I was given two pieces of paper. One was a two-sided brochure giving a phone number for the American Cancer Society, and one was on post-operative care. Nothing to help me learn more about what was going on with me. Nothing was given to fully discuss my treatment options. At no time was any counseling or support group of any kind offered.

Mr. McCollum (dan.mccollum@vanderbilt. edu), employee of Vanderbilt University Medical Center, is an eight-year prostate cancer survivor.

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[T o m o r row ’s P h y s ic i a n s]

Training Physicians for st the 21 Century

UC San Diego’s Integrated Science Curriculum and Medical Education– Telemedicine Building

By David A. Brenner, MD, and Maria C. Savoia, MD

16 SAN DIEGO PHYSICIAN.org march 2012

T

he fast pace of medical discovery today requires physicians who are highly proficient and highly motivated to constantly learn new skills and stay abreast of medical advances.

They must deliver superb care and have the curiosity and drive to ask questions and seek answers on behalf of their patients.

With a progressive new medical curriculum in place, as well as a new state-of-the-art Medical Education– Telemedicine Building that incorporates the latest design standards and technologies, UC San Diego School of Medicine is reaffirming its role as an institution focused on the medical and surgical training needs of the future.

The foundation for this innovative learning environment is the integrated science curriculum, three years in development and introduced to the entering medical school class in the fall of 2010. Holistic and learneroriented, the new curriculum focuses from the start on clinical medicine and patient interactions. Traditionally, students have primarily spent the first two years of medical school in classroom lectures, and then applied this knowledge to the care of patients in the clinical setting in their second two years.

The new UC San Diego curriculum is less didactic and more interactive.

Much more instruction occurs in small groups in which students apply the knowledge they are gaining.

Basic sciences are introduced as the foundation for clinical medicine, and basic science concepts are taught in the clinical context in which they eventually will be used. There is much less distinction between the preclinical and clinical curricula, an approach to medical education that is far more integrated than in the past. This framework calls for more and different faculty participation in instruction, with the emphasis on teachers facilitating student learning rather than just spouting facts that need to be memorized.

Scientific concepts are threaded throughout courses that focus on

organ systems, health, and disease.

This gives students a solid grounding in the direct relevance of science as a foundation for clinical practice, and in the important role of genetics and molecular biology in the delivery of highly personalized care. Students begin learning medical and surgical skills well in advance of their first patient encounter, while utilizing advanced simulation technologies.

To reinforce the focus of the new curriculum, from the first day students are assigned to one of six learning communities — an affiliation they will maintain throughout medical school. Each community includes members from each year’s class, giving newcomers built-in peer mentors and colleagues who can provide support and guidance as they face the challenge of medical school, and ultimately in the development of their professional identity. In

will be a resource to teach physicians and students how to provide care to patients across long distances.

The building is also home to the Center for the Future of Surgery, the largest state-of-the art facility in the nation dedicated to catalyzing novel surgical technologies, techniques, and teaching methods. Here we are developing revolutionary surgical techniques and tools that will change the way surgery is performed in the next decade. From minimally to maximally invasive techniques, surgeons can access the newest operating platforms, while working alongside engineers and scientists to refine everything from laparoscopic cameras to robotics.

The UC San Diego School of Medicine’s new home and curriculum is designed to foster interdisciplinary training, continuing the model of integrated classes of pharmacy and

The foundation for this innovative learning environment is the integrated science curriculum, three years in development and introduced to the entering medical school class in the fall of 2010. addition, each learning community will partner with a community-based health program to give students valuable public health and service learning experience from the beginning of their education.

The Medical Education–Telemedicine Building provides the physical home where students will learn to become skilled, compassionate, and innovative physicians. The facility’s Clinical Skills and Simulation Center has 18 clinic exam rooms, simulated hospital rooms, an operating room, and a simulated emergency care/ intensive care unit. The medical and surgical teaching laboratories provide a high-tech setting where students, residents, and practitioners can practice procedures on tiny blood vessels and nerves, and learn surgical, robotic, and laparoscopic techniques.

The Telemedicine Training Center

medical students, along with opportunities for additional team training with other healthcare professionals.

The new Medical Education–Telemedicine Building is designed to bring together students, residents, physicians, and health professionals at all levels to learn to provide outstanding patient care in an environment of safety and collaboration.

At UC San Diego, we aren’t content simply to be among the best medical schools; we want to provide a model for how a medical school should function in the 21st century.

Dr. Brenner, SDCMS-CMA member since 2007, is vice chancellor of UC San Diego Health Sciences and dean of the UCSD School of Medicine. Dr. Savoia, SDCMS-CMA member since 1998, is dean of medicine education at the UCSD School of Medicine.

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18 SAN DIEGO PHYSICIAN.org march 2012

UC San Diego School of Medicine A Remarkably Diverse Group of Students

By Carolyn J. Kelly, MD

E

ach year the UC San Diego School of Medicine admissions office receives about 6,000 applications from students interested in pursuing their medical education at our school.

Only 2% of this applicant group will ultimately matriculate as first-year medical students at UC San Diego, making for what seems like insurmountable odds. Indeed, the most common comment from physicians who interview our applicants is, “I would never get into medical school if I applied today!” The admissions committee is faced with a challenging task. They select applicants for interview and acceptance based on a holistic review of each application, reviewing each applicant’s academic preparation, their involvement in research and service activities, and their letters of recommendation.

These attributes are additionally viewed in the context of an applicant’s socioeconomic background, as well as particular challenges an applicant may have overcome in their pursuit of higher education.

What emerges each year as an entering class is a remarkably diverse group of students who will learn from one another (as well as from their faculty) during their medical education. The entering class is

diverse in many respects. About half of our school is made up of female students. In most years, there is no single majority racial or ethnic subgroup. Instead, there are multiple minority groups of students who describe their racial background as Caucasian, Asian (including Chinese, Japanese, Taiwanese, Korean, Vietnamese, Laotian, Cambodian, Thai, and Burmese), Asian Indian, Pakistani, Filipino, and African American. Approximately 10 to 15% of students self-identify as Hispanic.

In each incoming class, approximately 25% of students were born outside the United States; an equal number are children of immigrant parents.

Such is the remarkably diverse applicant pool of highly accomplished students in the state of California.

We also regularly have a number of entering “nontraditional” students, those who are “career changers” — former lawyers, physical therapists, scientists, and military personnel for example — or some who have simply taken more time to arrive at their destination.

The majority of entering students enroll in a four-year program leading to the MD degree. Approximately 8 or 10 incoming students enroll in the Medical Scientist Training Program, which leads to both the MD and PhD

degree after an average of eight years.

An equal number of students (8 to 10) enter our Program in Medical Education–Health Equity (PRIME–HEq).

These students pursue a yearlong master’s program of their choice (public health, clinical research, education, etc.) in order to acquire additional training and skills for their future career pathway. An additional 10 to 15 students annually choose to extend their time in medical school by participating in yearlong mentored research projects in San Diego or other sites around the country, or in other master’s degree programs.

Many of these research endeavors are funded through the NIH, the Howard Hughes Medical Institute, the Sarnoff Foundation, or the Doris Duke Charitable Trust.

Upon entering the UC San Diego School of Medicine, students are assigned to one of six Academic Communities, each led by a different faculty member. This community structure is part of the school’s integrated scientific curriculum, which was rolled out in the fall of 2010. The Academic Community structure provides each student with a smaller student community vertically integrated over the four years of medical school. This structure serves to facilitate peer advising. Academic

march 2012 SAN DIEGO PHYSICIAN.org 19

[T o m o r row ’s P h y s ic i a n s] Communities are also tasked with developing service learning opportunities and providing mentoring for students. UC San Diego School of Medicine has had a proud tradition of student involvement in community service, best exemplified in the Student-Run Free Clinic Project. The Academic Community-based activities will build on this tradition.

The first two years of medical school at UC San Diego consist of blocks of study based on organ systems. These blocks integrate information from multiple scientific disciplines as they pertain to particular organ systems. Each organ system is examined twice, with the first-year course largely focusing on normal anatomy and physiology and the second-year course focusing on the pathophysiology and treatment of human disease. Integrated with the human health and disease course of organ system blocks is the clinical foundations course. This multicom-

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ponent course strives to imbue our students with the knowledge, skills, and attitudes essential to deliver compassionate, effective, high-quality, patient-centered healthcare. We are indebted to a large group of primary care providers in San Diego County who share their time and expertise with our students by supervising them in longitudinal ambulatory care apprenticeships.

The third and fourth years of medical school are spent in required and elective clinical clerkships. By the end of the third year, students have typically decided on a residency pathway and plan their fourth year of study accordingly. UC San Diego School of Medicine students pursue residency training along all accredited pathways. In recent years, approximately 40% of graduates have entered internal medicine, pediatric, and family medicine residencies, with the remaining students pursuing training in other specialties. The school strives Page 1

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to expose students to multiple career pathways during their first three years of medical school, through an integrated Career in Medicine program. Community-based physicians and our own local alumni are very helpful in this regard, as they provide multiple perspectives on the current practice of medicine.

Our students benefit from their school’s location in a county where practicing physicians willingly share their time and expertise to help educate the next generation of physicians. It is no surprise that every year about 25% of our graduates choose to pursue their residency training in San Diego County, and many others hope to return to the county to practice medicine after completing their residency training.

Dr. Kelly, SDCMS-CMA member since 2007, is associate dean for admissions and student affairs at the UC San Diego School of Medicine.

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[T o m o r row ’s P h y s ic i a n s]

It’s Not Your Father’s GME Training Anymore

By Stephen R. Hayden, MD

22 SAN DIEGO PHYSICIAN.org march 2012

I

f it’s been 10 years since you finished your training, you may not recognize many of the residency or fellowship training programs today. I’m sure most of you have at least heard of the Accreditation Council for Graduate Medical Education’s (ACGME) duty hour restrictions that first took effect in 2003. Well, in July 2011, ACGME launched the newest iteration of the duty hour standards that went well beyond the first set. In addition to simply restricting hours further, they decided it was necessary to turn the supervision pyramid upside down.

What do I mean by this? For many years, in the traditional immersion training model, interns and junior residents spent long hours in the clinical setting learning their craft at the bedside, in the clinics, in the operating rooms, and in the emergency department. As a young physician achieved progressive responsibility, the latter years in training were spent perfecting technique and engaging in more reading, research, supervision, administration, and teaching.

In the new paradigm, the youngest physicians are now considered the most vulnerable and need to be protected from the often-arduous schedules expected of them. Therefore, the newest set of duty standards prohibits interns from working more than 16 consecutive hours. Postgraduate (PG) level 2 and above residents are permitted to work 24 consecutive hours, but must transition care of their patients and leave the hospital within four hours after this period ends. Senior residents are permitted to remain in the hospital longer than 24 hours to participate in the care of a single patient if they transition all other care to another provider, and report each of these instances to the program director.

Most residents I have talked to recently feel that this has resulted in a shift of the workload and immersive learning opportunities to later years in training. It also may mean that interns and junior residents are more disconnected from senior residents

or fellows because their schedules are very different. As you might imagine, this is a significant change for most training programs, and has required a great deal of thought and alteration in the manner in which hospital coverage and supervision is provided.

Interns can no longer work 24-hourin-house-call; thus, to maintain the integrity of patient care teams, many programs have evolved to shift work and changed coverage entirely to day team and night team assignments.

It is unclear at present how this shift work model will affect continuity of care or individual doctor-patient relationships.

“Indirect supervision” has two levels: indirect supervision with direct supervision immediately available, and indirect supervision with direct supervision available. The former requires that the supervising physician be in the building; the latter requires that the supervising physician be available by phone, text, and able to respond to the hospital if necessary. The lowest level of supervision is defined as “oversight,” in which the supervising physician can review patient care the following day or some other specified time frame. Each specialty can define who a “supervising physician” is.

UC San Diego has to evolve in order

In the new paradigm, the youngest physicians are now considered the most vulnerable and need to be protected from the often-arduous schedules expected of them.

There are other recent changes as well. GME training programs have always been required to provide education on sleep deprivation and fatigue, but a few new terms have been introduced into the glossary. We no longer talk about being sleep-deprived, rather that we utilize “alertness management strategies.” These include the judicious use of caffeine, brief physical activity, taking short breaks to relieve mental stress, and even taking “strategic naps.” This is requiring institutions to rethink the traditional assignment of call rooms based on specialty to a model where unassigned call rooms can be used hotel-style (ideally for sleeping!).

Furthermore, ACGME has defined new supervision requirements and provided definitions for appropriate levels of supervision. For example, “direct supervision” means the supervising physician is at the bedside or in the operating room with the resident.

to respond to these new training requirements. We have been in a period of significant growth for several years now. At present, UC San Diego sponsors 68 training programs with several others in the pipeline. There are nearly 700 residents and fellows in training programs accredited by ACGME, and approximately 130 fellows in training programs accredited by ABMS or other similar organizations. Altogether, this represents more than a 25% increase in the past 5–10 years.

To monitor and track all the required elements for these programs requires sophisticated residency management software and a small army of staff, program coordinators, and program directors. Gone are the days when a program director apprenticed a resident or fellow and simply attested that they achieved the necessary knowledge, attitude, and skills to practice independently. ACGME requires continuous and detailed monitoring

march 2012 SAN DIEGO PHYSICIAN.org 23

[T o m o r row ’s P h y s ic i a n s] of resident and fellow competency in six major areas, and regular evaluations of everything that can be evaluated and from every perspective — in some cases including direct patient or family feedback.

So what’s in the future? Many physicians in the community, as well as some medical educators, are concerned that due to decreased patient contact time resulting from some of the changes described above, residents may graduate with limited experience in certain areas, especially procedurally based specialties. ACGME is attempting to counter this concern in several ways.

Competency-based education will evolve toward defining a series of key “milestones” and “landmarks” that will confirm a resident or fellow’s progression through training. Milestones are developmental benchmarks a resident must achieve before moving on to the next skill level. Milestones are often specialty specific and defined nationally.

Traditionally, progression to the next

level was defined by time-in-service; if an intern successfully completed his or her PG 1 year, then most of the time he or she was automatically passed on to the PG 2 level. Now, interns and residents will need to demonstrate the ability to perform various skills (milestones) before they are deemed competent to progress to the next level. Landmarks are entrustable professional activities in which a resident must demonstrate competency before being delegated that activity or role. An example might be performing intubation without direct supervision, becoming a code team leader of the rapid response team, senior resident for a medicine ward team, etc.

Milestones and landmarks will be used to document a resident’s progression toward becoming competent to practice without direct supervision. Programs will be judged on how they train their residents to achieve these milestones and landmarks in a timely and efficient manner.

From the perspective of GME at UC

San Diego, we live in interesting times.

UC San Diego certainly cannot stand on its laurels or past reputation, and a lot of work will go into keeping up with all the evolving requirements. In the end there is no amount of faculty compensation that makes up for all the blood, sweat, and tears that go into training residents and fellows.

However, all it takes is one appreciative patient, neighbor, or someone else I know in the community to tell me of the wonderful experience they had with their doctor and know that physician is one of my graduates. The student surpasses the teacher; an inevitable cycle that makes the hard work rewarding.

Dr. Hayden, SDCMS-CMA member since 2011, is professor of clinical emergency medicine and associate dean for Graduate Medical Education and DIO at UC San Diego Medical Center. Dr. Hayden is also editor-in-chief of The Journal of Emergency Medicine.

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Innovation in Medical Education The Basic Sciences in a Whole New Light

By Daphna Finn, MSI

26 SAN DIEGO PHYSICIAN.org march 2012

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patient presents to the emergency department.

Ten minutes later you have completed a thorough history and physical, and are reviewing her laboratory values. Is this magnitude of efficiency actually possible?

Maybe not in real life, but it approximates the initial pace of a problembased learning exercise, a teaching approach that is quickly becoming de rigueur in preclinical medical education across the country. In problembased scenarios, students learn about the diagnosis and medical management of a disease in the context of a realistic and often multifaceted case.

Working in groups and guided by a preceptor, they extract clinically relevant details from serially provided texts, much as a physician learns more about his patient through step-bystep interviewing, examination, and adjunct studies. As the students are still learners, they identify aspects of the case that they do not know or understand, and parcel them out for each individual to research and report back on, ultimately combining their knowledge to resolve the case as much as is possible.

While rote memorization is a hefty and inescapable part of medicine — and lectures still comprise the majority of teaching hours — problembased learning infuses psychosocial context and clinical decision-making into the memorized details, grounding them in a functional and engaging framework. In addition to this method, patient contact starting in the first weeks of school, an integrated organ system curriculum (cardiovascular, pulmonary, musculoskeletal, etc.), and pass-fail grading comprise the major current trends in preclinical medical education.

These ideas may hardly seem controversial, but the fact that they supplant established lectures and educational techniques does not always make them instantly popular when

proposed. A belief in the time-tested prudence of old ways was part of the reason that my medical school, UC San Diego, was a relatively late entrant onto the scene of curricular revision, establishing its integrated scientific curriculum in 2010 after not having made significant changes to its teaching methods since the school’s inception in 1968.

It is true that when something is added to a fixed-length course of study, something else must be

— other structures and vessels. And learning the developmental basis for each organ system discretely jumbles their true embryological chronology.

Clearly the human body itself is the ultimate integrator, yet no matter what path is taken, some things must be learned before others are fully understood.

Although this is the only curriculum my peers and I have experienced, halfway through our first year we are amazed with the enormous amount

While rote memorization is a hefty and inescapable part of medicine — and lectures still comprise the majority of teaching hours — problem-based learning infuses psychosocial context and clinical decision-making into the memorized details, grounding them in a functional and engaging framework. removed. First-year students no longer have to learn such details as the names of the bronchopulmonary segments (unless they choose to become a pulmonologist), sit through the derivation of pharmacokinetics equations (as long as they know how to use them), or be schooled on the current mouse models of human disease.

Yet some may argue that spending an average of 10 hours per month in clinic is of limited utility until one understands basic physiology and the particulars of the physical exam. And while the organ system blocks seek to integrate their relevant embryology, anatomy, and biochemistry, it is not always to the neat exclusion of other clinical material. For example, while dissecting the muscles of mastication in the gastrointestinal block, one must take a regional approach because there is a necessity to abut — and thus end up destroying or learning about

we have learned, and are generally pleased with the varied, highly integrative teaching methods employed.

A fellow student recently joked that the only thing missing from our experience was having a chance to ridicule the “gunners” he expected to find in our midst. It’s true, practically none of the 125 students in our class engages in the type of supercilious hypercompetitiveness many of us dreaded experiencing upon our entry into medical school. Unless UC San Diego has perfected interviewing strategies to weed out such personalities, perhaps the collaborative learning environment we are imbedded in succeeds in fostering medicine as a team sport.

The competency-based, pass-fail grading probably doesn’t hurt either.

Ms. Finn, SDCMS-CMA member since 2011, is a first-year medical student at the UC San Diego School of Medicine.

march 2012 SAN DIEGO PHYSICIAN.org 27

[T o m o r row ’s P h y s ic i a n s]

Health Frontiers in Tijuana A Binational Partnership

By Amy Eppstein, MSIV, and Jose Luis Burgos, MD

28 SAN DIEGO PHYSICIAN.org march 2012

I

t is Saturday morning like any other, and there is already a line forming in the courtyard of a small concrete building in Tijuana’s Zona Norte, which is less than a mile from the U.S. border.

The neighborhood is known for high levels of drug use and for its proximity to Tijuana’s red light district, where prostitution is tolerated. Among health providers and researchers, it is also a hotbed for HIV, TB, and sexually transmitted infections. Oblivious to this, children are kicking a ball around, while elderly people are sitting in chairs. Both groups are waiting for the same thing: a doctor’s visit at Health Frontiers in Tijuana (HFiT).

HFiT is a new, binational clinic founded upon a partnership among the UC San Diego School of Medicine, the Universidad Autonoma de Baja California (UABC), and Prevencasa AC, a nonprofit organization

knowledge, no other program quite like it exists,” says Steffanie Strathdee, PhD, professor and associate dean of global health sciences at UC San Diego, who helped found the clinic together with Amy Eppstein, Dr. Jose Luis Burgos, and partners from UABC and Prevencasa AC. It started when UC San Diego medical students formed a student organization in 2008. Their goal was to start a free clinic in Tijuana to provide a context in which they and their classmates could learn about the dynamics and challenges of border health. Understanding the importance of cultural humility in global health, collaboration became a key component, and the idea eventually grew into a preclinical elective at the two medical schools in San Diego and Tijuana.

According to students from both sides of the border, time spent in the clinic has been valuable.

It all started when UC San Diego medical students formed a student organization in 2008.

Their goal was to start a free clinic in Tijuana in order to provide a context in which they and their classmates could learn about the dynamics and challenges of border health.

in Tijuana. HFiT opened in May 2011 and now provides free medical services to a variety of locals, including individuals such as sex workers, deportees, and substance abusers, who are often denied healthcare.

“HFiT is an outstanding example of binational collaboration, where students from both Mexico and the United States train alongside one another, providing free healthcare to Tijuana’s underserved. To my

“With Health Frontiers in Tijuana, I learned that medical students driven by conscience to alleviate our border crisis could find true allies, both among Mexican health professionals delivering care to underserved populations and among UC San Diego faculty members participating in sustainable partnerships with these professionals,” says Matthew Cappiello (SDCMS-CMA member since 2010), a second-year UC San Diego

medical student.

Laura Saldivar, a third-year UABC medical student, adds, “This has been a great opportunity to really know the HIV-affected population and to become more sensitive to their issues.”

Since launching in May 2011, HFiT has been open every Saturday. The staff, comprising Mexican and American physicians and medical students, has seen more than 250 patients.

One Mexican attending physician explained that, although some patients have Seguro Popular, the Mexican government-sponsored insurance, many still prefer HFiT. This preference is especially strong among U.S. citizens who live in Mexico and Mexicans who have been deported from the United States, who want doctors that are sensitive to their issues and knowledgeable about resources on both sides of the border.

While HFiT is new to the healthcare scene and remains a small entity, there are already signs that it will continue to grow. New partnerships have already formed, and services have expanded. On a given weekend, patients have an opportunity to visit not only with physicians but also with mental health professionals, social workers, and nurses.

For Eppstein, these signs are encouraging.

“In a short time, HFiT has become a great model for global health that can benefit other regions in the world,” says Dr. Jose Luis Burgos.

For more information about volunteering with the clinic or donations, please contact Dr. Jose Luis Burgos at (858) 822-2055 or at jlburgos@ucsd. edu. Prevencasa AC is a registered 501(c)(3) nonprofit organization.

Ms. Eppstein, SDCMS-CMA member since 2011, is a fourth-year medical student at the UC San Diego School of Medicine. Dr. Burgos is a project scientist at UC San Diego and practices medicine in Mexico.

march 2012 SAN DIEGO PHYSICIAN.org 29

[T o m o r row ’s P h y s ic i a n s]

It’s 4 a.m. on a Sunday morning …

Thoughts From a Fourth-year Medical Student

By Julia Tomlin, MSIV

30 SAN DIEGO PHYSICIAN.org march 2012

I

t’s 4 a.m. on Sunday morning, and my fitful night of anxious sleep is rudely interrupted by the blaring and infamous iPhone alarm … you know, the one that when played on full volume sends you into a panicked fear of the imminent end of the world. As I peer through the darkness, I wonder if perhaps I would have preferred that fate to my own. Somewhere, my more sane friends will remain in the comfort of their warm beds for several more hours, until they awaken to enjoy the phenomenon I’ve heard referred to as “a lazy Sunday.” Perhaps others are just beginning to retire after a night out on the town. As for me, I am expected in the hospital in less than an hour. Walking the dark and silent streets to UCSD Hillcrest, I can’t help but wonder: What was I thinking?

hear the faint whimper of my idealism cowering beneath every indignant stomp of my heavy Dansko clogs.

It is a well-known and hopefully universally accepted fact that medical school is difficult. But for all the warnings and reservations, there are some nuances of the word “difficult” that you simply can’t predict or even appreciate until you’re knee-deep and tens of thousands of dollars in debt.

No one tells you that no matter how many hours you study, words you highlight, or flashcards you make, you still won’t ace every test — or any test for that matter. No one tells you that there will be times when your apartment looks like it fell victim to a hurricane, and all that’s left in your fridge is a bottle of ketchup and some questionable-looking leftovers from that one time you actually cooked dinner last month. No one tells you

No one tells you that no matter how many hours you study, words you highlight, or flashcards you make, you still won’t ace every test — or any test for that matter.

Well, when I first entered medical school, I was thinking that I wanted to make a difference. I was thinking that this kind of education would give me the tools to help those unable to help themselves. I was thinking that I had committed myself to an exciting and fulfilling career that would never leave me wondering if I should have chosen to do something else. Now, nearly three years later, I could almost

how your friendships, family, and personal relationships will be tried.

And no one tells you there will be countless days when you’ll just feel like giving up.

But I haven’t. My classmates haven’t. And now that we’re nearly on the other side of it all, those days have become fewer and farther in between. Sure, I may sometimes daydream about one day doing this

or that, or joke with classmates about where we might be now had we chosen an easier life, but, in truth, these thoughts are all fleeting. In fact, in a process with so many ups and downs and unexpected turns, the only constant for me has been my desire to be a physician. And as ardently as medical school may have tried to beat it out of me, I feel that desire stronger now more than ever. It doesn’t always make sense, especially in light of all the unpleasant things I’ve just shared about the journey to becoming a physician. But there is something inexplicably unique about learning and practicing medicine. It is at once humbling and empowering. It presents challenges and experiences unparalleled in other fields. And it is truly the only profession that I can confidently say I will be happy and privileged to call a career.

So many undergraduates considering medical school ask me if I would make the same decision to apply with full knowledge of “what it’s really like.” I do briefly think back to those times of defeat or frustration, the dark mornings and even darker nights.

What resonates infinitely more intensely, however, are the bonds forged during those long hours, the people whose lives I could play a part in making better, the incredible transformation of intellect and character that has taken place in myself and my classmates that has not only prepared us but made us eager for a lifetime of service. Then, I smile and reply, “It’s difficult, but it’s worth it.”

Ms. Tomlin, SDCMS-CMA member since 2008, is a fourth-year medical student at the UC San Diego School of Medicine.

march 2012 SAN DIEGO PHYSICIAN.org 31

Looking for a way to give back to the community?

The San Diego County Medical Society Foundation’s (SDCMSF) mission is to address the unmet San Diego healthcare needs of all patients and physicians through innovation, education, and service. SDCMSF is proud to partner with volunteer specialty physicians and nearly 100 community clinics in the county who provide primary care services for the medically uninsured and underserved. These clinics have little to no access to specialty care for their patients and need your help!

Opportunities for Physicians 1

Volunteer for Project Access San Diego:

If you are a specialist in private practice in San Diego, please consider joining more than 180 specialists in the county by seeing a limited number of uninsured adult community clinic patients in your office for free. Project Access coordinates all aspects of care so your volunteerism is hassle-free for you and your office staff.

2

Volunteer for eConsultSD:

eConsultSD allows primary care physicians from the community clinics in San Diego to articulate a clinical question to a specialist and receive a timely response in a HIPAA-compliant, web-based portal. eConsultSD is an easy way for busy specialist physicians to give back to the community who are not able to provide direct patient care.

3

Obtain a Volunteer or Paid Position at a Local Community Clinic: SDCMSF is happy to connect specialist physicians with a community clinic that needs your services on site. This opportunity involves traveling to a clinic within San Diego County as your schedule permits.

4

Make a Contribution:

SDCMSF needs your support to care for the medically underserved in our community. Please consider making a contribution of any size to support the Foundation’s efforts.

Contributions can be made online at SDCMSF.org or sent to the San Diego County Medical Society Foundation at 5575 Ruffin Road, Suite 250, San Diego, CA 92123.

Thank you for your support!

Thank you for your dedication to the medically underserved. If you are interested in any of the opportunities above, please contact Lauren Banfe, resource development director, at (858) 565-7930 or at Lauren.Banfe@SDCMS.org.

The San Diego County Medical Society Foundation is a 501(c)3 organization (Tax ID # 95-2568714).

Please visit SDCMSF.org for more information. Telephone: (858) 300-2777 or Fax: (858) 569-1334

SDCMSF was formed as a separate 501(c)3 in 2004 by the San Diego County Medical Society.

32 S AN D I E G O P HY S I CI A N. or g A u2012 gust 2011 32 SAN DIEGO PHYSICIAN.org march

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classifieds PRACTICE ANNOUNCEMENTS JENNIFER EASTLACK, MD, JOINS DEL MAR MED: Dr. Jennifer Eastlack, a board-certified dermatologist specializing in medical, surgical, and cosmetic disorders of the skin, hair, and nails, has joined a new practice. She is now seeing pediatric and adult patients with partners Dina Massry, MD, and Jeffrey Eaton, MD, at Del Mar MED in Carmel Valley. Her address is 12395 El Camino Real, #200, San Diego, CA 92130. (858) 481-3376. [020] PHYSICIAN POSITIONS AVAILABLE MEDICAL DIRECTOR — Sunny San Diego: County Psychiatric Hospital needs a full-time medical director.

This is a key leadership role in our very physician-friendly, dynamic behavioral health system. Facility includes an inpatient unit and a very busy psychiatric emergency unit.

County has partnered with UCSD to develop a community psychiatry fellowship, and teaching opportunities will be available, though the facility does not do research. Medical director does limited direct clinical care. Required: Proven administrative, leadership, and supervisory skills, and a “big-picture” orientation to help us evolve our entire system. Salary competitive and excellent County employee benefit package. San Diego combines the lifestyle of a resort community and the amenities of a big city. Hospital centrally located, minutes from many recreational opportunities and great residential communities.

Wonderful year-round weather, of course! CV and letter of interest can be submitted online at www.sdcounty. ca.gov/hr. For questions, please contact Gloria Brown, human resources analyst, at (858) 505-6525 or at gloria.brown@sdcounty.ca.gov, or Darah Frondarina, human resources specialist, at (858) 505-6534 or at darah. frondarina@sdcounty.ca.gov. Questions and interest can also be directed to Marshall Lewis, MD, Behavioral Health Clinical Director, Health & Human Services Agency, at marshall.lewis@sdcounty.ca.gov. [021] MEDICAL CONSULTANT — COUNTY OF SAN DIEGO: BC/BE internist/family practice physician sought for fulltime employment with the County of San Diego, Edgemoor in long-term care at the 192-bed Santee facility.

Compensation includes salary, bonuses for certifications, and on-call reimbursement, as well as medical, dental, vision, and retirement benefits. Seeking physician with superior interpersonal and clinical skills, attention to detail, comfortable working in teams to serve patients ages 18 and up with mental and physical disabilities. CV can be submitted online at www.sdcounty.ca.gov/hr. [015] CHIEF MEDICAL OFFICER: San Ysidro Health Center, a Federally Qualified Health Center with nine medical clinics serving southern San Diego, is recruiting for a chief medical officer. Reports to the president/CEO. Partners with the board of directors, senior leadership, and all healthcare providers to ensure the highest quality of healthcare for patients. Provides clinical supervision of provider staff.

Provides some direct patient care (80% administrative / 20% direct patient care). Qualifications: MD valid / current / unrestricted California medical license and BC; minimum 10 years professional experience in primary care setting; 10 years administrative and patient care management.

Send resume to jobs@syhc.org. [012] ASSOCIATE MEDICAL DIRECTOR: San Ysidro Health Center, a federally qualified health center with nine medical clinics serving southern San Diego, is recruiting for an associate medical director. Will report to the chief medical officer with a dotted line relationship to the CEO. Works collaboratively to ensure SYHC continues to provide high quality, cost-effective healthcare. Leads efforts to increase healthcare access and enhance the patient experience. Provides some direct patient care (80% administrative, 20% direct patient care). Qualifications: Doctorate degree in Medicine (MD or DO) from accredited school of medicine; valid, current, unrestricted California medical license; BC in primary care specialty; minimum five years clinical/administrative practice in primary care setting; minimum five years as an associate medical director or clinical lead physician. Send resume to jobs@ syhc.org. [005]

GERIATRICIAN: Full-time position available at Neighborhood Healthcare in North San Diego County. This position provides comprehensive medical services for geriatric patients 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: Geriatrician” must be included in the subject of your email or fax for your application to be considered. [010]

to share. Please contact Jaleh Brunst at (858) 756-2340 or at jalehbrunst@mac.com. [019]

CONTRACT PHYSICIAN: Profil Institute for Clinical Research is in need of three contract physicians for primarily weekend shifts. Requirements: One year of clinical experience in adult medicine and/or equivalent experience.

License to practice medicine in California. Responsibilities: Perform medical histories, physical exams, and protocol-based assessments for qualification of subjects for studies. Admit, discharge, and monitor subjects including reviewing labs results, EKGs, and telemetry. Assess and manage adverse events and medical emergencies. Participate in safety and dosing assessments. Interested parties please email resumes to hrpicr@profilinstitute. com. If you have further questions, please contact Robyn Nielsen, recruitment manager, at (619) 419-2048. [007]

POWAY OFFICE SPACE AVAILABLE IN GATEWAY MEDICAL BUILDING, NEXT TO POMERADO HOSPITAL: Close to the 15 and 56. Large (18 ft. x 10.5 ft.) consult room with large windows, lots of natural light. Ample free parking. Rooms are soundproofed. Separate exit. Secure waiting room with large, comfortable seating. Kitchen with refrigerator, microwave, coffee maker, and toaster.

Bathroom in suite. Utilities, high-speed internet included.

Suite has new carpet, paint, and waiting room furniture upholstery. Days, evenings, and weekends available.

Please email lisa@thinnertimes.com with inquiries. [013]

INTERNAL MEDICINE, PRIVATE PRACTICE PART TIME: LIFE/WORK BALANCE! Unusual and exceptionally attractive private practice IM opportunity in beautiful North San Diego County. Stable, long-term, part-time position available with flexible scheduling. Collegial, single-specialty group, exceptional office staff, and above all very high-quality patient care set this far apart from many other situations. Outpatient only, paperless office, easy access from anywhere in the county. Multiple scheduling options available, making this very attractive for any physician wanting part-time only work or wanting to combine with other job opportunities. Outstanding way to experience private practice. Email CV to portofino3@ aol.com or call (619) 248-2324. [993] 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] PRACTICE WANTED WE BUY URGENT CARE OR READY MED-CLINIC: We are interested in purchasing a preexisting urgent care or ready med-clinic anywhere in San Diego County. Please contact Lyda at (619) 417-9766. [008] OFFICE SPACE / REAL ESTATE 1450 sq. ft. Office Space for Lease in La Mesa, New Building, Near Grossmont Hospital: Beautiful building recently completed at 5980 Severin Dr. in La Mesa. Off highways 8 and 125. Space includes handicap bathroom, new HVAC, upgraded electrical panel, tall ceilings, plenty of parking, very functional design and layout. Price is $1.50 per sq. ft., a very good rate for new construction. Call Nathan at (619) 787-3422 or email at hythams@att.net for further information or a private showing. [022] SPACE AVAILABLE FOR SUBLEASE IN A 1,850 SQFT FAMILY PRACTICE OFFICE IN ENCINITAS: Two furnished exam rooms. One doctor’s office furnished with computer — EMR available. One lab/procedure room

2,142 SQ-FT OFFICE AVAILABLE FOR SHARING/ SUBLEASE: Currently occupied by cardiothoracic and vascular surgeons. Share partially furnished reception and waiting area. Three exam rooms furnished. One doctor office available. Terms negotiable. Please call Sonia at (619) 287-6003. [018]

LOOKING FOR SPACE TO SUBLET: Please contact if you have office space available to sublet. Would specifically be interested in Poway, Escondido, Vista, North County, San Marcos, Sorrento Valley, Del Mar, etc. Prefer situation where we can use existing office staff. Contact sundhmail@yahoo.com. [011] LUXURIOUS / BEAUTIFULLY DECORATED DOCTOR’S OFFICE NEXT TO SHARP HOSPITAL FOR SUBLEASE OR FULL LEASE: The office is conveniently located just at the opening of Highway 163 and Genesee Avenue. Lease price if very reasonable and appropriate for ENT, plastic surgeons, OB/GYN, psychologists, research laboratories, etc. Please contact Mia at (858) 2798111 or at (619) 823-8111. Thank you. [836] NEW — EXTREMELY LOW RENTAL RATE INCENTIVE — EASTLAKE/RANCHO DEL REY: Two office/ medical spaces for lease. From 1,004 to 1,381 SF available.

(Adjacent to shared X-ray room.) This building’s rental rate is marketed at $1.70/SF + NNN; however, landlord now offering first-year incentive of $0.50/SF + NNN for qualified tenants and five-year term. $2.00/SF tenant improvement allowance available. Well parked and well kept garden courtyard professional building with lush landscaping. Desirable location near major thoroughfares and walkable retail amenities. Please contact listing agents Joshua Smith / Steve Dok, Grubb & Ellis, at (858) 875-3600. [006] POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467 sqft furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease/satellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at mzarei@cox.net. [873] TWO MONTHS FREE RENT: 1,215 SQ FT MEDICAL OFFICE NEXT TO POMERADO HOSPITAL: Office has furnished waiting area, front and back stations for four staff members, two exam rooms, a break room, private bathroom, and doctors’ office. Office is updated and ready for move in. 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 from Poway, Rancho Bernardo, Carmel Mountain, 4-S Ranch, Scripps Ranch, Escondido, Ramona, and surrounding areas. Negotiable rent. Please contact Olga at (858) 485-8022. [980] SAN DIEGO NORTH COUNTY OFFICE SPACE TO SHARE: Share reception, waiting area, and exam/consultation rooms in Class A medical building. Office is close to TCMC and all ancillary services. Flexible, P/T availability.

Great opportunity for a North County satellite office. For

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.

34 SAN DIEGO PHYSICIAN.org march 2012

more information, contact Anne at abilleter@ncim.net or at (760) 726-2180. [003] 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 four exam rooms, and staff. (NEGOTIABLE) Please contact Rowena at (619) 299-3950. [804] FULL-AND PART-TIME OFFICE SPACE IN UTC with 8th floor view in suite with established psychologists and psychiatrists in Class A office building. Features include private entrance, staff room with kitchen facilities, active professional collegiality and informal consultation, private restroom, spacious penthouse exercise gym, storage closet with private lock in each office, soundproofing, common waiting room, and abundant parking. Contact Christine Saroian, MD, at (619) 682-6912. [862]

disorders. We are currently looking to recruit for the following positions: Registered Polysomnography Technician (RPSGT); Medical Office Assistant/Front Desk. We are looking for individuals who are technology savvy as we have a paperless office. We believe in providing state-of-the-art medical care and exceeding patient expectations. We are seeking applicants with previous experience, proven clinical skills, and friendly personality.

Both part-time and full-time options are available with health benefits for full-time employees. If interested in joining our team, please contact us at akaneinstitute@ gmail.com or at (858) 412-7362. [004] MEDICAL EQUIPMENT

ALMOST NEW X-RAY PROCESSOR: The Hope Micro-Max processor is value-priced to ideally serve the moderate film developing needs of the private practice market, including medical clinics and diagnostic and chiropractic care centers, as well as mobile diagnostic applications. The back-to-basics features of the Hope Micro-Max processor are designed to deliver high output for its compact size. 110V, 60Hz, 14amp. Includes stand, hoses, and refill tanks. Works great and 1/3 the price of a new processor. Processing Capacity: 135 seconds equals 68 (10” x 12”) films/hour; 45 (14” x 17”) films/hour; 113 seconds equals 89 (10” x 12”) films/hour; 57 (14” x 17”) films/hour; 90 seconds equals 110 (10” x 12”) films/hour; 70 (14” x 17”) films/hour. Contact kathy.koppinger@ bonebuilders.com or (858) 354-5549. [016]

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] 3998 VISTA WAY, IN OCEANSIDE: Two medical office spaces approximately 2,000 sq. ft. available for lease.

Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground floor access. Lease price: $1.75 +NNN. Tenant improvement allowance. For further information, please contact Lucia Shamshoian at (760) 931-1134 or at shamshoian@ coveycommercial.com. [965] 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] 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] 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] NONPHYSICIAN POSITIONS AVAILABLE FAMILY NURSE PRACTITIONER: Full-time position (40 hours per week) available in North San Diego County. The FNP provides healthcare services to patients under direction and responsibility of physician. Candidates must have a current FNP license, DEA and CPR certifications.

Candidates must also specialize in geriatrics. Please send CVs to Dr. Jim Schultz via email at JimS@nhcare. org or fax to (760) 796-4021 — “Attn: FNP-North” must be included in the subject line of your fax or email for your application to be considered. [009] PA/NP NEEDED IN VERY ACTIVE NEUROSURGERY PRACTICE: Candidate needs to be highly interested and motivated, as well as caring and flexible. Will be asked to conduct patient clinics, hospital rounds, and assist in surgeries. Motivated, as well as caring candidates, please send email with CV and references to armonia01@ me.com. [977]

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REGISTERED POLYSOMNOGRAPHY TECHNICIAN; MEDICAL OFFICE ASSISTANT/FRONT DESK: AKANE Institute of Allergy, Asthma, and Sleep Medicine is a medical practice with our main office and sleep lab located in Scripps Ranch on Scripps Poway Pkwy off I-15.

We provide specialty care for allergy, asthma, and sleep march 2012 SAN DIEGO PHYSICIAN.org 35

SDCMS-CMA MEMBERSHIP

Errata

Please make the following corrections to your copy of SDCMS’ 2012 San Diego County Physician Directory, which was mailed with the December 2011 issue of San Diego Physician magazine: Please Delete Listings for the Following Physicians: • Asher Dean B MD • Gilles Alissa J MD Please Update Listing Information for the Following Physicians: • AFRA ROBERT MD <Note: Please update Dr. Afra’s fax to be: F: 7609422418> • Chodos Marc D MD T: 6194623131 F: 6194621731 A: 5565 Grossmont Center Dr, Bldg 3, Ste 256, LM 91941 N1: 1811094873 (ors) • HOLLAND WILLIAM CARL MD {ors} T: 7609420565 F: 7609422418 W: aosm.net A: 317 N El Camino Real, Ste 405, EN 92024 N1: 1063488252 N2: 1053483610 [sm] • HOROWITZ STEVEN E DO <Note: Please update Dr. Horowitz’s contact information to the following:> T: 6194425400 F: 6194425535 A: 161 E Main St, Ste 102, EC 92020 36 SAN DIEGO PHYSICIAN.org march 2012

• KORN BOBBY S MD <Note: Please abbreviate Dr. Korn’s middle name to “S.”> • LANE JOHN G MD {ors/osm} T: 8582921433 F: 8582921979 A: 7910 Frost St, Ste 200, SD 92123 N1: 1669583191 • RICKARDS ENASS NADER MD {ors} T: 8584556460 F: 8584557197 A: 4130 La Jolla Village Dr, Ste 306, LJ 92037 N1: 1609850080 [hs/ot/sm] • SEROCKI JOHN H MD {ors} T: 8588241703 F: 8584556473 W: ljso.org A: 9834 Genesee Ave, Ste 228, LJ 92037 <Note: The “955 Lane Ave.” address listed is Dr. Serocki’s secondary address.> N1: 1679574743 [hs/ar/sm] • WEISS DANIELLE EVELYN MD {im/edm} T: 7607533636 F: 7604652332 W: centerforhormonalhealth.com A: 477 N El Camino Real, Ste D-200, EN 92024 N1: 1275731515 [mpd/ os/ost/t]

Please make the following corrections to your copy of SDCMS’ 2012 Pictorial Membership Directory: Robert Afra, MD Please update Dr. Afra’s fax number to the following: F: (760) 942-2418 William Carl Holland, MD Please update Dr. Holland’s contact information to the following: 317 N. El Camino Real, Ste. 405 Encinitas, CA 92024 T: (760) 942-0565 F: (760) 942-2418 W: aosm.net Steven E. Horowitz, DO Please update Dr. Horowitz’s contact information to the following: 161 E. Main St., Ste. 102 El Cajon, CA 92020 T: (619) 442-5400 F: (619) 442-5535

Bobby S. Korn, MD Please abbreviate Dr. Korn’s middle name to “S.” John G. Lane, MD Please update Dr. Lane’s primary practice address to the following: 7910 Frost St., Ste. 200 San Diego, CA 92123 Michael Moon, MD Our sincere apologies for mistakenly not including Dr. Moon’s photo:

Enass Nader Rickards, MD Please update Dr. Rickards’ contact information to the following: Girard Orthopaedic Surgeons 4130 La Jolla Village Dr., Ste. 306 La Jolla, CA 92037 T: (858) 455-6460 F: (858) 455-7197 Amber Paratore Sanchez, MD Please update Dr. Sanchez’s medical school to: University of Texas Medical School at Houston (2003).

John H. Serocki, MD Please update Dr. Serocki’s contact information to the following: 9834 Genesee Ave., Ste. 228 La Jolla, CA 92037 T: (858) 824-1703 F: (858) 455-6473 W: ljso.org Our sincere apologies for the errors!

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