April 2014

official publication of SDCMS April 2014

2013

SDCMS Physician Workforce & Compensation Survey “Physicians United for a Healthy San Diego”

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APR.

Contents

Volume 101, Number 4

MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: Theodore M. Mazer, MD, James Santiago Grisolía, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Van C. Johnson, 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. Peters, PhD, MD PRESIDENT-ELECT: J. Steven Poceta, MD TREASURER: William T-C Tseng, MD, MPH (CMA Trustee) SECRETARY: Mihir Y. Parikh, MD IMMEDIATE PAST PRESIDENT: Sherry L. Franklin, MD (CMA Trustee)

feature

departments

2013 SDCMS PHYSICIAN WORKFORCE & COMPENSATION SURVEY

4 Calendar • Get in Touch In Memoriam • And More …

TOM GEHRING

24

Summary of Key Findings

31

GEOGRAPHIC AND GEOGRAPHIC ALTERNATE DIRECTORS EAST COUNTY: Venu Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD (A: Susan Kaweski, MD (CALPAC Treasurer)) HILLCREST: Gregory M. Balourdas, MD, Thomas C. Lian, MD (A: Sunny R. Richley, MD) KEARNY MESA: Jason P. Lujan, MD, John G. Lane, MD (A: Anthony E. Magit, MD, Sergio R. Flores, MD) LA JOLLA: Geva E. Mannor, MD, Wayne Sun, MD (A: Lawrence D. Goldberg, MD) NORTH COUNTY: James H. Schultz, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD (A: Anthony H. Sacks, MD) SOUTH BAY: Reno D. Tiangco, MD, Michael H. Verdolin, MD (A: Elizabeth Lozada-Pastorio, MD) AT-LARGE DIRECTORS Jeffrey O. Leach, MD (Delegation Chair), Karrar H. Ali, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD (Board Representative), Peter O. Raudaskoski, MD, Vimal Nanavati, MD (Board Representative), Holly B. Yang, MD

8

The Face of Courage

DANIEL J. BRESSLER, MD

10

A Tale of Five Practices

2014–15 SDCMS Board of Directors Candidate Statements

32

15

Specialty-specific Information

2013 SDCMS Annual Report

21

2013 SDCMS Foundation Annual Report

34

Physician Marketplace Classifieds

36

An Alphabet of Communication Styles HELANE FRONEK, MD, FACP, FACPH

AT-LARGE ALTERNATE DIRECTORS Karl E. Steinberg, MD, Phil Kumar, MD, Samuel H. Wood, MD, Elaine J. Watkins, DO, Carl A. Powell, DO OTHER VOTING MEMBERS COMMUNICATIONS CHAIR: Theodore M. Mazer, MD (CMA Vice Speaker) YOUNG PHYSICIAN DIRECTOR: Edwin S. Chen, MD RESIDENT PHYSICIAN DIRECTOR: Jane Bugea, MD RETIRED PHYSICIAN DIRECTOR: Rosemarie M. Johnson, MD MEDICAL STUDENT DIRECTOR: Jason W. Signorelli OTHER NONVOTING MEMBERS YOUNG PHYSICIAN ALTERNATE DIRECTOR: Renjit A. Sundharadas, MD RESIDENT PHYSICIAN ALTERNATE DIRECTOR: Erin Whitaker, MD RETIRED PHYSICIAN ALTERNATE DIRECTOR: Mitsuo Tomita, MD SDCMS FOUNDATION PRESIDENT: Stuart A. Cohen, MD, MPH CMA PAST PRESIDENTS: James T. Hay, MD (AMA Delegate), Robert E. Hertzka, MD (Legislative Committee Chair, AMA Delegate), Ralph R. Ocampo, MD CMA TRUSTEE: Albert Ray, MD (AMA Alternate Delegate) CMA TRUSTEE (OTHER): Catherine D. Moore, MD CMA SSGPF Delegates: James W. Ochi, MD, Marc M. Sedwitz, MD CMA SSGPF ALTERNATE DELEGATES: Dan I. Giurgiu, MD, Ritvik Prakash Mehta, MD AMA ALTERNATE DELEGATE: Lisa S. Miller, MD

8 15 2 apri l 2014

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.]

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All Physician Networking Opportunity & Mixer MAY 8: 5:00pm–8:00pm (East County location)

For further information or to register for any of the following SDCMS seminars, webinars, workshops, and courses, email Seminars@SDCMS.org.

Financial and Legal Life Skills (for Financially and Legally Clueless Docs) (workshop) MAY 31: 8:00am–12:00pm

Contract Negotiation Challenges in 2014 and Beyond (seminar/webinar) APR 24: 11:30am–1:00pm

SDCMS 2014 White Coat Gala JUN 14: 6:00pm–11:00pm (Hyatt La Jolla at Aventine)

What Providers Need to Know About the Coordinated Care Initiative in San Diego County (seminar) MAY 1: 11:00am–2:00pm

OSHA Update (seminar/webinar) JUL 10: 11:30am–1:00pm Consent and Abuse Reporting: Your Duties and Responsibilities (seminar/ webinar) JUL 17: 11:30am–1:00pm

H/R Hiring and Firing (seminar/webinar) MAY 8: 11:30am–1:00pm Project4:Layout 1

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Surviving Covered California: What Physicians Need to Know (webinar) APR 23: 12:15pm–1:15pm State 2 Meaningful Use — the 2014 Edition: What You Need to Know! (webinar) APR 30: 12:15pm–1:15pm

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.

Clinical Advances in Arrhythmias and Cardiovascular Disease MAY 2–4 (www.scripps.org/ events/clinical-advancesin-arrhythmias-andcardiovascular-diseasemay-2-2014)

Nurse Practitioners Physician Assistants

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

Fashion That Heals Fashion Show and Champagne Luncheon (Tri-City Foundation) MAY 17 (www.tricitymed.org/ ways-to-give/foundation/ events/fashion-that-heals) RCMA’s 10th Annual “Cruisin’ Thru CME” JUL 9–22 (www.rcmanet. org/Portals/17/04Events/ Flyer/2014Cruise.pdf) Summer Medical Academy JUL 14–25 (facesforthefuture. org/san-diego/san-diego. html)

LETTER TO THE EDITOR

Re: February 2014 San Diego Physician I applaud the effort performed by the American Red Cross to Prepare San Diego for a potential disaster. I would like to include two other organizations assisting physicians and other affiliated individuals to be prepared. This is the Medical Reserve Corps (MRC), which is a community-based, organized group of local medical and health workers who can serve as volunteers during a local health emergency.

Volunteers perform duties that match their backgrounds, skills, and expertise. For further information, contact the MRC coordinator at mrcvolcoord@sdcounty.ca.gov or at (619) 285-6429.

The other organization is CERT San Diego (Community Emergency Response Team). During the first few hours and days after a disaster strikes, emergency services could be overwhelmed, leaving families, neighborhoods, and businesses on their own for hours or days. This team was developed by the Fire-Rescue Department. CERT San Diego helped citizens become a part of the solution in their communities. San Diego Fire-Rescue personnel train and empower citizens in safe, effective neighborhood CERT teams. For more information, contact Carie DeMarco-Krzys, program manager, at (619) 533-4453 or at cert@sandiego.gov.

Bill Sperling, MD

4 apri l 2014

8th Annual Brain Injury Rehabilitation Conference MAY 16, 17 (www.scripps. org/events/brain-injuryrehabilitation-conferencemay-16-2014)

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/////////////////////////////////////////Physicians /////////// /////////////////////////////////////////////// recommend In Memoriam

Frederick Bruce Kimball, MD Bruce Kimball, SDCMS-CMA member since 1951, passed away on March 4 at the age of 95. Bruce had a remarkable zest for life and was always willing to try new things. In spite of his many accomplishments, he was modest to a fault, and was genuinely interested in those around him, especially children. Bruce loved his wife, Muriel, and their extended family.

He had many pursuits, including skiing, world travel, dancing, woodworking, and video making. Perhaps nothing sums up his outlook on life more than his record of skiing with his buddies at Mammoth Mountain until the age of 89. One of his friends recently recounted his experience of looking over the edge of a steep ski run, when a voice behind him said, “Are you going to stand there all day?” That was Bruce.

Bruce grew up in Grand Rapids, Michigan, and graduated from high school in 1933. He received his MD from the University of Michigan in 1942 at the tender age of 23. After an orthopedic residency in San Francisco, he established his first practice in Port Huron. He and his family moved to San Diego, where he joined the Rees-Stealy clinic in 1950. Early in his career, Bruce performed the first total hip replacement surgery in San Diego, as well as the first surgery at Rady Children’s Hospital. He was recognized by the community of doctors in San Diego when he was named chief of staff at Scripps Hospital in La Jolla. Bruce was proud to serve his country and enlisted in the Army Medical Corps in 1954 for two years because he had been exempted from service in World War II. Bruce is survived by his wife, Muriel, his son, Ralph, and a close family of stepchildren, grandchildren, and greatgrandchildren. Donations may be sent in Bruce’s memory to Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA 92123-4282.

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/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// SDCMS-CMA Membership

Welcome New and Rejoining SDCMS-CMA Members!

New Members Toluwalase A. Ajayi, MD Pediatrics San Diego (858) 699-2568 Jordan Y. Cohen, MD Emergency Medicine Rancho Santa Fe (619) 287-3270 Lejla Delic, MD, FACOG Gynecologic Oncology San Diego (858) 455-5524 Christopher M. Dewar, MD Emergency Medicine San Diego (310) 379-2134 Mary C. Gessner, DO Emergency Medicine San Diego (310) 379-2134

Ellen Grossnickle Rodarte, MD Family Medicine Del Mar (858) 499-2708 Heather L. Hofflich, DO Endocrinology, Diabetes, and Metabolism La Jolla (858) 657-8000 Theodoros F. Katsivas, MD Infectious Disease San Diego (619) 808-6492 Benjamin T. Kilian, DO Emergency Medicine El Cajon (619) 287-3270 Dawn M. Long, MD Family Medicine San Diego (858) 499-2600

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Simona C. Pop, MD Obstetrics and Gynecology Vista (760) 630-5487 Rebecca R. Smith, MD Family Medicine La Mesa (619) 499-2600 Anna L. Techentin, MD Family Medicine San Diego (858) 499-2703 Hui Xue, MD Nephrology San Diego (619) 471-9198 Rejoining Members Brooke L. Ballard, MD Orthopedic Surgery San Diego (619) 286-9480 Houman Dahi, MD Pulmonary Critical Care Medicine San Diego (619) 299-2570 Kyle P. Edmonds, MD Hospice and Palliative

Medicine San Diego (619) 471-9424 Mark D. Jacobson, MD Orthopedic Surgery San Diego (619) 286-9480

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/////////////////////////////////////////////////////////////////////////////////////////////////// Become an SDCMS Featured Member!

SDCMS features member physicians for their noteworthy accomplishments in these pages. If you would like to be considered for our next “Featured Member” spotlight, please email Editor@SDCMS.org. Thank you for your membership in SDCMS and CMA!

TrusT A Common sense ApproACh To InformATIon TeChnology

Trust us to be your Technology Business Advisor Ask Your Physician Advocate SDCMS Member Question: I am very concerned about the Cal MediConnect program, and how it will affect my Medi-Medi patients. How are patients being notified of their choices? Also, I do not contract with any of the participating plans, and I don’t plan to. How do I communicate this to my patients just in case they want to keep me as their physician?

Answer: Three separate notices will be mailed out 90, 60, and 30 days before the start of the passive enrollment period (May 1, 2014). The first notice will simply alert the beneficiary to the implementation of the dual demonstration program. The second notice will include information about plan benefits and provider networks to help them select a plan (these notices have already been sent out to dual eligible patients in San Diego County).

The third notice will be sent out 30 days ahead and provide the beneficiary with information about their specific plan.

The state has chosen to do a “choice form” in order to give patients the opportunity to either choose a Cal MediConnect plan that will put them into a managed care plan for both their Medicare and Medi-Cal, or they can choose to remain in fee-for-service Medicare, but they must still pick a managed care plan for their Medi-Cal services.

If SDCMS members are interested in obtaining a letter geared toward patients who are with the “contracting physician” or the “non-contracting physician,” or if you have any further questions about the Cal MediConnect program, please contact your SDCMS physician advocate, Marisol Gonzalez, at MGonzalez@SDCMS.org or at (858) 300-2783.

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POETRY AND MEDICINE Do Not Say Goodnight, Old Friend

The Face of Courage

by Daniel J. Bressler, MD

Do not say goodnight, old friend Although the hour is getting late Let’s linger past the midnight bend We’ve still grand questions to set straight Do not say goodnight, old friend I know the dark is beckoning But there are fences yet to mend Blown down in days past reckoning Do not say farewell, old friend We must appoint a future visit Just for now we’ll both pretend The world goes on and bears us with it Please don’t say goodbye, old friend Although this night’s been long approaching Suppose that we have years to spend In raucous boasts and soft reproaching Do not say adieu, old friend It’s just a phase you’re going through What temporal laws can we suspend?

What amnesty applies to you?

Do not say sweet dreams, old friend Immersed into that separate river Tumbling seaward to descend In secret streams of strange forever Do not say goodnight, old friend Yes you’re tired and reconciled But can’t this final cycle blend The crusty man and buoyant child?

The great Welsh poet Dylan Thomas published Do Not Go Gentle Into That

Good Night in 1951 as a tribute to his sick father and as a rousing exhortation to anyone facing mortality. The poem insists that the ending of any life, no matter how well-lived, is bound to be a frustrating process that is best and most courageously met with protest and struggle. “Rage, rage against the dying of the light” is Thomas’ instruction. Go down fighting!

I’ve always felt the poem — for all the power of its famous imagery — offers rash advice for those actually dealing with death and for their circle of family, friends, and medical caregivers. Too often raging against the dying of the light gets transformed by our technological capacities into a campaign of inappropriately intensive care and false hope that is cruel rather than courageous.

That said, the sentiment of wishing and hoping that we and those we love could remain just a little longer on this side of the Narrow Divide is natural and perhaps universal. Do Not Say Goodnight, Old Friend is a deliberately gentle request to “stay while the staying is good” knowing that finally fate will call our number. The face of courage may sometimes wear the grimace of rage, but this poem suggests that a deep authentic courage in our confrontation with mortality is more likely to reflect grit and wistfulness. Perhaps one of our roles as physicians is to find and speak to that face of courage in our patients.

Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and a longtime contributing writer to San Diego Physician.

8 apri l 2014

Do not wave me off, old friend Let’s take another walk together And with the world’s sad news contend Amidst this unpredicted weather Do not say you’re done, old friend Stay at least until tomorrow Attach another day-on-end From Time’s account divert or borrow Don’t throw in the towel, old friend The world will shrink without you in it How little still I comprehend Come teach me yet another minute Do not concede defeat, dear friend Maintain a proud and stern resistance Only finally to attend Not to your loss but fate’s insistence

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SDCMS elections

practice. More importantly, we will, together, overcome political uncertainties and systemic assaults on the practice of medicine to increase the desire for future generations to pursue medicine as a career. Thank you.

Candidate Statements

2014–15 SDCMS Board of Directors Notes: Asterisk (*) After Name = Incumbent Number in Parentheses (#) After Name = Term Length in Years OFFICERS President: J. Steven Poceta, MD (1): I plan to be president of the San Diego County Medical Society for the upcoming year. I have been a member of SDCMS since I came to San Diego in 1987.

I have served on the board of directors and, for the past five years, on SDCMS’s Executive Committee. I am dedicated to the pursuit of medicine, and I believe in a pluralistic approach to the practice. All physicians have a role to play in the optimal delivery of healthcare to our fellow community members. The respect that we receive from our patients is great, and it not only serves to enrich our lives, but also to indicate our value to the community. No specific healthcare delivery system is better than another, considering the changes that have occurred since our profession was founded. That is, the practice of medicine has survived since long before the U.S. depression of the 1930s, the creation of Medicare, the HMO, and the current trend toward consolidation. All doctors are needed — from those in academics to those in solo practice — and I support them all. The backbone of the system remains the same: doctors who study, train, and work hard to take care of people who are sick and to understand the causes of disease.

We need a system that fosters the most capable young people to go into our profession, rewards them appropriately, and provides career and personal satisfaction. I believe that we can meet these goals under the changing system.

10 apri l 2014

President-elect: William T-C Tseng, MD, MPH (1): I appreciate this opportunity to share with you my concerns and visions for SDCMS in 2014 and what I hope to achieve with our medical society as presidentelect. As president-elect, I am committed to addressing physicians’ concerns affected by challenges facing our local and national healthcare policy. Ask a colleague what makes him/her unhappy about practicing medicine regardless of specialty, and the overwhelming answer would be “increasing regulatory burden.” Increasing over-regulation, and intensified administrative loads demand for us to speak out. Without a doubt, synchronizing our voices and uniting our priorities are necessary to preserving our authority, our autonomy, and our interest in the practice of medicine. As your candidate, I intend to focus my priorities on preventing further waning of our professional sovereignty. Through community, professional, and political involvement, I hope to assist SDCMS in becoming an even more influential organization. More so now than ever before, we need to deliberate on increasing regulatory complexities, partake in discussions shaping social and political mandates, and curtail external constraints that continue to “deprofessionalize” a physician’s influence over the medical decision-making process. We need to be a part of all conversations that negotiate favorable terms of reimbursement, and integrate health promotion as our agenda locally. Through SDCMS, we can take the helm in determining the future of our practices — how we care for patients, how we code (prescribe treatment), and how we are reimbursed. I believe that through SDCMS we can join our services in the best interest of all physicians, regardless of their modes of

Treasurer: Mihir Y. Parikh, MD (1): I ask for your support as I run for treasurer of SDCMS. It is an honor and privilege to have served for five years as the young physician director and for the past three years as a member of the Executive Committee.

We have elected and assembled an amazing team of directors and staff who are strongly committed to protecting the interests of our patients and our medical practices in this uncertain time of inevitable healthcare change.

There are numerous challenges to our autonomy of practicing medicine from upcoming ballot measures, pending federal and state legislation, and the challenges of implementing already passed laws. One person cannot guard all of these fronts alone. Our best line of defense is through organized medicine. We need all physicians in every mode of practice to become members of SDCMS and join the leadership in place. With a united voice we can sway public opinion, provide quality patient care, and maintain the integrity of the medical profession. As treasurer I pledge to work with the other directors to advocate for the doctors and patients of San Diego County, educate fellow colleagues about pending legislative changes, expand our physician membership, and, of course, keep a watchful eye on the SDCMS budget. Thank you for supporting my candidacy for SDCMS treasurer.

Secretary: Mark W. Sornson, MD (1): It is a privilege to ask for your support as I run for secretary of SDCMS. I have served as at-large director for the past four years, two years as a representative on the Executive Committee, and six times as a CMA delegate or alternate delegate representing San Diego.

Previously, I chaired the CMA Young Physicians Section and authored a successful resolution. Through these experiences I have seen firsthand that when a medical society speaks with a unified voice and builds relationships, we can make a difference. Our challenges this upcoming year are especially notable, and major advocacy efforts will be needed. When physicians come together, they are listened to. As secretary, I will continue to be a voice for reasoned discussion, representing all physicians. I’ve greatly enjoyed my service on behalf of SDCMS and CMA, and I am honored to ask for your vote to continue.

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Kearny Mesa #1: Sergio R. Flores, MD (3): I have served on the SDCMS board for the past three years as a Kearny Mesa alternate director and would like to continue serving on the SDCMS board as a Kearny Mesa geographic director. I was recently elected to the CMA board of directors in 2012 after serving as the chairman of the Large Group Forum for seven years. I was born and raised in San Diego and graduated from SDSU in 1985. I graduated from UCSF School of Medicine in 1989 and trained at UC Irvine in internal medicine and gastroenterology from 1989 to 1994, and was board certified in both. I am in private practice, and have been a partner at San Diego Digestive Disease Consultants since 1998. I have served on the board of Sharp Community Medical Group for the past 15 years and currently serve on the executive committee as the vice president as well as chairman of the finance committee.

I also served on the Sharp Healthcare board of directors for seven years and continue to serve on the finance committee. I would like to continue to offer my services to you and SDCMS. Thank you.

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East County #3: Jay P. Mongiardo, MD (Inc.) (3): We live in an exciting time. As a practicing family medicine physician in San Diego’s East County for the past 15 years, it’s been my privilege to care for patients amid an esteemed group of colleagues. However, as we all know, change is upon us, and — now more than ever — organized medicine is vital to the future of our vocation, and our united voice is critical as we shape the practice of medicine today and in the future. As your East County representative, I will be dedicated to representing your voice no matter what your mode of practice. I will work to preserve physicians’ professional autonomy as well as an environment that continues to value the most basic tenet of our profession: the doctorpatient relationship. We are a diverse group of individuals but all dedicated to giving our patients the best care possible. I believe that, above all, we cannot lose that sacred trust, the bond between doctor and patient. We’ve all dedicated our lives to the service and care of others, and, as your representative, I will do all I can to help ensure that patient care remains at the center of all we do. I would be honored to serve as your representative as we face these exciting challenges together.

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2004 - 2014

“think SDCMS FIRST!” Start by contacting SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

SAN DI EGO PHYSICIAN.org 11

SDCMS elections Kearny Mesa #2: John G. Lane, MD (Inc.) (3) La Jolla #2: Marc M. Sedwitz, MD (3): Healthcare in San Diego has historically always been in flux and the first to be challenged in response to the uncertainty that comes with it. Over the past decade, the outstanding leadership and commitment from within our San Diego medical community and SDCMS staff has made our medical society both dynamic and progressive. The current assault that has attempted to reduce the influence of our profession by national policies, consumerism, insurers, and malpractice reform leave many of our colleagues frustrated, distracted, and burned out. Only through our medical organizations can we address the shortcomings of the current medical environment. The first challenge ahead of us is understanding organized medicine’s role and responsibility in navigating the transformation of our healthcare system that has presently been produced by the Affordable Care Act and universal coverage. The second challenge is the evolution of physician reimbursement issues that come with population-based management (managing risk, independent national board oversight, value-based modifiers, pay for performance, bundling). The final challenge is to create value for our physicians and support their independence and self-determination in the current era. It will be my pleasure to participate and serve our medical society in any way possible.

GEOGRAPHIC ALTERNATE DIRECTORS Hillcrest #1: Thomas J. Savides, MD (3) La Jolla #1: Lawrence E. Goldberg, MD (Inc.) (3) AT-LARGE DIRECTORS #1: Lawrence S. Friedman, MD (3): It is an honor to be considered for the SDCMS board. I have practiced medicine in San Diego for nearly 20 years and have seen many changes over that time, some for the good and some for the not so good. In my current role as interim dean for clinical affairs at UCSD, I represent the clinical faculty of the county’s academic medical center. Our integration and collaboration with San Diego County physicians is vitally important to our vision for the coming years.

We believe that we bring an important voice to San Diego County medicine and in turn want to be considered an essential resource to physicians and patients working and residing 12 apri l 2014

in San Diego. It will be an honor to have a seat on the board. #5: Stephen R. Hayden, MD (2): For most of my career as faculty in emergency medicine at UC San Diego, I have been involved in national academic affairs. With the healthcare landscape changing so quickly, I believe it is more important than ever for academic physicians and community physicians to partner and face current challenges in medicine together. I believe my experience will allow me to contribute to SDCMS’ advocacy efforts. I graduated from the accelerated six-year biomedical program at Rensselaer Polytechnic Institute and Albany Medical College. I did a general surgery internship at the San Diego Naval Hospital in 1986, followed by a tour as senior flight surgeon for the Naval Strike and Air Warfare Center NAS Fallon, Nevada. I then completed an emergency medicine residency at the University Medical Center at Stony Brook, New York, where I served as chief resident. I joined the faculty at UC San Diego in 1993, and am board certified in emergency medicine and undersea and hyperbaric medicine. My current position is the associate dean for graduate medical education and DIO after serving for many years as the program director of the UC San Diego Emergency Medicine Residency. I am past president of the national Council of Emergency Medicine Residency Directors. In 2006 I was selected as the editor-in-chief of The Journal of Emergency Medicine. In 2005 I was the recipient of the American Academy of Emergency Medicine’s (AAEM) Residency Director of the Year Award and was recognized in 2005–2007 as one of America’s Top Physicians. In addition, I was fortunate to receive the 1999 American College of Emergency Physicians (ACEP) National Faculty Teaching Award. I am a primary author/editor for a major textbook in emergency medicine, The Five-Minute Emergency Medicine Consult, as well as numerous textbook chapters and peer-reviewed publications, and more than a hundred invited national and international speaking engagements. I am married with three children and have a third-degree black belt in tae kwon do. I would consider it a privilege to serve the San Diego County Medical Society and its members. #6: Peter O. Raudaskoski, MD (Inc.) (3) #8: Holly B. Yang, MD (3): I have been a member of the San Diego County Medical Society (SDCMS) since I moved to San Diego eight years ago. Since 2012, I have been happy to represent San Diego physicians as an at-large alternate director and now a director on the board. I am a two-time

participant at the California Medical Association House of Delegates, most recently serving on the reference committee that deals with government health programs and health system reform. Being a part of this work has only strengthened my belief that this is a critical time for our patients and our profession. With the current issues facing medicine, physicians must have a voice to protect our patients’ ability to access high-quality healthcare and our ability to provide and direct that care. SDCMS serves us well in that role, and its members have influence at the local, state, and federal levels. SDCMS is also a great resource to physicians of all specialties and practice types in the daily issues we deal with as doctors.

Since being elected to the board of directors, I have been deeply impressed by what we can accomplish when we have a diverse group of physicians come together as a team. I am honored to have the opportunity to contribute back to my community and engage with the things that make a difference to our patients and our profession. I ask for your support to continue to serve.

AT-LARGE ALTERNATE DIRECTORS #2: Jeffrey O. Leach, MD (2): As a practicing internist in North County for the past 25 years, I have seen major changes in the practice of medicine. The one constant has been the need for organized medicine to represent and advocate for the practicing physician. I have been fortunate to be on the SDCMS Executive Committee for the past 10 years and the chairman of the San Diego delegation at CMA’s House of Delegates for the past four years. I would be honored to continue to represent the physicians of San Diego. #5: Wayne C. Sun, MD (3): I have been honored to serve as one of the La Jolla representatives to the San Diego County Medical Society (SDCMS) for the past three terms. During the last six years on the board, I have come to realize how important it is that we all speak with one voice to work toward what is best for San Diego physicians and their patients.

Although my immediate concerns as a general internist in private practice may be different from a specialist in academic medicine or a physician in a large-group practice, the changes that are coming to healthcare in the next few years will affect all of us. Therefore, it is essential that we approach these challenges with a united front so that we can all survive and flourish. I believe my role on the board would be to continue to educate physicians in the importance of being a part of organized medicine, and to help make SDCMS an organization that all physicians would like to join.

For those reasons, I would be privileged to be able to serve on the board for another term. #7: Carl A. Powell, DO (Inc.) (3): I have been interested in executive medicine and the legislative process for some time. I have been working on the American College of Physician Executives board certification.

I served on the legislative committee of the San Diego chapter of CMA during the last election cycle. I feel we are going into a very critical time for the future of physicians in this country. I believe the American Medical Association on a national level and the California Medical Association on the state level is the leading organization that has to stand up for physicians. The board of directors of the San Diego chapter of the California Medical Association is one step I can take to protect physicians in the state from policies that will result in the destruction of the practice of medicine. Doctors have not done a good job of representing themselves to politicians. I want to do my part to properly represent physicians in Sacramento and in San Diego County. I want to be part of the solution rather than part of the problem. #8: Marcella M. Wilson, MD (3): My name is Marcella Wilson. I am honored to be a candidate for the SDCMS board of directors. As your candidate, I am committed to addressing physicians’ concerns affected by challenges facing our local and national healthcare policy and issues. I have already been working with these topics with my specialty association, the SDPS, and now hope to do so with the broader Medical Society. With constant political uncertainties and government changes threatening the welfare of physicians’ autonomy over medical practices, it is critical for all area physicians to not only have a strong focus, but also a unified voice that is truly heard, and then acted upon. I no longer doubt the fact that organizing and uniting physicians is a necessity in preserving our autonomy, our leadership, and our interest concerning the real practice of medicine, not that ascribed to non-physicians. There is a growing need to protect physician independence and maintain the integrity of our medical professions with the respect deserved for the education, money, and years committed, that should not be so easily diluted by just any group who can take a blood pressure measurement being given the right to dole out prescriptions without they themselves going to medical school. Issues such as the “deprofessionalization” of a physician’s influence over the medical decision-making process, using appropriate codes, and being justly reimbursed for those codes has been the new

*

Election Opens April 9 and Closes May 6, 2014

war that the insurance companies have used to undercut physician autonomy and cause undue red tape, adding hours of senseless audits to justify their nonpayments. As more insurance companies take advantage of the new healthcare climate, it will be most important that our medical societies have a cohesive base to collect information from physicians, and then have the ability to unite quickly to thwart their takeovers. After 25 years in practice here in San Diego, I understand that it is only by organizing with our societies such as SDCMS that we can have the true power it takes to determine the future of our practices — how we care for our patients, how we prescribe their treatment, including the coding of that treatment, and, ultimately, how we are reimbursed.

I do not want to stand idly by and watch everything topple after working so hard for so many years. I am hoping that you feel the same way.

Please join me in this endeavor and support my candidacy with SDCMS. Thank you.

YOUNG PHYSICIAN DIRECTOR Edwin S. Chen, MD (Inc.) (1): Healthy and happy physicians take better care of healthy and happy patients. In the dramatically changing healthcare landscape, SDCMS provides a meeting place and a launching platform from which we can advocate for ourselves and our patients. New physicians often find themselves immersed in a healthcare world they never imagined. I have had the honor and privilege of serving as the young physician director for the past year, and it has been a wonderful experience. As a young physician who recently started a solo practice, I look forward to collaborating with all of you in sharing our knowledge and experience so that we can better advocate for the medical community and the patients we serve.

YOUNG PHYSICIAN ALTERNATE DIRECTOR Daniel D. Klaristenfeld, MD (1): I am honored to be a candidate for the young physician alternate representative to the SDCMS board. As a colon and rectal surgeon just a few years out of fellowship, I felt a need to become part of the conversation taking place in this country about the future of medicine. If doctors do not join together to shape our own future, it will be shaped for us by lawyers and politicians. Specifically, I hope to be a strong voice for the needs of the young physicians in our community. I want to share our perspectives and harsh realities as we continue to learn and become comfortable with our craft, find jobs and negotiate contracts, establish and build practices, balance professional and personal life, struggle with the burden of medical school debt, and find our own voices in the contentious debate over the administration of healthcare in this country. I am excited to be part of the SDCMS board and for the opportunity to forge a stronger, more stable future for myself and my fellow physicians.

RESIDENT PHYSICIAN DIRECTOR Jane Bugea, MD (Inc.) (1) RESIDENT PHYSICIAN ALTERNATE DIRECTOR Diana C. Gomez, MD (1): I have been involved in organized medicine since early in my medical education.

While in medical school at the University of Florida, I served for two years as alternate delegate from UF to the Florida Medical Association. At a more local level, I was an active member of the Alachua County Medical Society and served on the leadership board as a student representative. I was also an active member of the AMA Medical Student Section and served on the Parliamentary Procedure Committee for two years. This involvement at local, state, and national levels gave me a strong foundation and understanding into the steps needed to effect change and influence policy. I hope, as a representative of SDCMS, to work as liaison with medical students and residents. I am particularly interested in incorporating education on policy matters and health economics into standard medical education. By doing so, more young physicians will be informed of and involved in the decisions that affect their practice and patients, and ultimately be better equipped to practice in today’s healthcare climate. I am excited by the opportunity to have an impact on the practice of medicine by serving with this organization. Thank you for your support.

SAN DI EGO PHYSICIAN.org 13

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After almost a decade of

struggle, San Diego County’s GPCI inequity has finally been resolved …

2013 SDcms Annual Report “Physicians United for a Healthy San Diego”

2013 Defending MICRA Eliminating GPCI Once and for All! After almost a decade of struggle, the Geographic Practice Cost Index (GPCI) inequity for San Diego County has finally been resolved!

On April 1, President Obama signed legislation that permanently eliminates this geographic inequity for select California urban counties (like San Diego) while holding rural counties harmless. This is a HUGE HUGE HUGE win for San Diego, which has been getting less than what we actuarially should from Medicare, to the tune of roughly $30 million per year, and 2–3 times that amount for insurance reimbursements denominated in Medicare rates. The GPCI inequity has cost San Diego physicians roughly $100 million per year for more than a decade, or roughly $14,000 per physician per year. While in a perfect world the GPCI elimination would have been immediate, in a political compromise the permanent elimination of the GPCI inequity will be phased in over six years, starting in 2017, but the issue has at last been put to rest, allowing us to focus on other issues. For every individual or organizational member of SDCMSCMA, thanks for your support over the long haul. We literally could not have pulled this off without you.

And for every physician who is not a member, you need to join — today!

A huge huge huge win for San Diego

For four decades, SDCMS and CMA successfully spent your dues dollars and CALPAC contributions to ensure MICRA’s safety in the California Legislature and to defend it in both state and federal courts. In 2013, CMA stopped several attempts by the trial lawyers to eviscerate MICRA in the Legislature — a major CMA victory. The trial lawyers have qualified a November 2014 ballot measure to raise the MICRA non-economic damages cap to $1.2 million, with a permanent and annual cost-of-living adjustment, and to drug-test doctors — among other onerous provisions. In order to win at the ballot box in November, we will need every member to contribute above and beyond his or her dues, and we will need nonmembers to contribute by joining SDCMSCMA — we are all in this together!

Thank you to the following medical staffs and medical groups for their donations to defend MICRA! Alvarado: $10,000 Grossmont: $33,000 Palomar: $33,000 Paradise Valley: $10,000 Pomerado: $33,000 Rady Children’s: $33,000 San Diego Imaging: $12,000 San Diego Pathologists Medical Group: $10,000 Scripps Clinic: $10,000 Scripps Encinitas: $10,000 Scripps Memorial: $33,000 Scripps Mercy (San Diego and Chula Vista): $33,000 Sharp Chula Vista: $10,000 Sharp Coronado: $20,000 Sharp Memorial: $33,000 Tri-City: $5,000 The California Hospital Association matches hospital medical staff contributions 2:1! In other words, medical staffs have raised $918,000, plus the $22,000 from San Diego Imaging and San Diego Pathologists Medical Group, or almost $1 million for San Diego!

To defeat this ballot measure, we will need non-members to join SDCMS-CMA! Protecting Patients CMA stopped nurse practitioners from independently practicing medicine without supervision (SB 491).

CMA stopped optometrists from performing surgical procedures (SB 492).

CMA ensured pharmacists collaborate with physicians (SB 493).

CMA ensured physical therapists continue to work within the legal boundaries of medical corporations (AB 1000).

CMA stopped cancer patients from being inappropriately treated with methods not scientifically proven (SB 117).

CMA kept school district governing boards out of the physicianpatient relationship (SB 312).

CMA stopped legislators from determining standards of care (SB 430).

CMA ensured medical assistants do not perform unsupervised tests or exams (SB 352).

CMA stopped the MBC from limiting a physician’s prescribing authority (SB 670).

CMA supported legislation signed by the governor to expand Medi-Cal coverage to low-income adults (SBX1 1).

Mitigating Cal MediConnect’s Negative Impact

CMA advocacy eliminated the 10% Medi-Cal clawback … a huge win for physicians and patients.

Fighting to Repeal and Replace SGR SDCMS and CMA have been fighting in the courts and in Congress for years to repeal and replace the sustainable growth rate (SGR) formula. Though Congress did kick the can down the road yet again with another 12-month patch, we will continue this fight until we prevail.

CMA Fought Hard to Eliminate the 10% Medi-Cal Cut and Mitigate Its Effects After holding off the cut in the courts for almost five years, CMA is now working to reverse it through the legislative budget process.

CMA advocacy eliminated the retrospective 10% Medi-Cal clawback from the 2014–15 budget, a huge win for California’s physicians and patients.

CMA sponsored two bills to prospectively eliminate the 10% cut to Medi-Cal (SB 640 and AB 900).

CMA filed a request for an en banc review by the Ninth Circuit Court of Appeals to stop California from implementing the cut.

CMA joined an unprecedented coalition of physicians, dentists, healthcare workers, and hospitals to march on Sacramento on June 4.

CMA updated its Medi-Cal Survival Toolkit with a summary of the changes, important dates, options for physicians, and links to important resources.

SDCMS and CMA helped members with the Cal MediConnect (dual eligibles) transition enrollment process, i.e., how to opt out, what the physician rates and payment rules are, how the delivery system works, network adequacy, next steps, and more through seminars, webinars, and one-on-one assistance.

Addressing the Prescription Drug Overdose Epidemic CMA secured ongoing funding for and upgrades to the Controlled Substance Utilization Review and Evaluation System (CURES) database (SB 809).

SDCMS signed up more than 100 physicians on April 12, 2013, to gain access to the CURES database — the largest number of single-day sign-ups in California up to that time.

SDCMS worked with the San Diego and Imperial County Prescription Drug Abuse Medical Task force to publish www.

SanDiegoSafePrescribing.org on the SDCMS website.

SDCMS’s Emergency Medicine Oversight Commission (EMOC) continues to work to reduce prescription pain drug abuse in the ER.

Protecting Hospital Medical Staffs CMA helped kill AB 975, which would have made it extremely difficult for hospitals to be classified as nonprofit — a big issue for hospital chiefs of staff.

CMA updated its annotated model medical staff bylaws for 2013.

CMA stopped a slippery slope of “what specialty physician would be required to be on-call next in every general acute care hospital with an emergency department?

Pediatricians? Ophthalmologists?” etc. (AB 591).

Cultivating Strong Legislator Relations SDCMS physician leaders, medical students, and staff traveled to Sacramento and Washington, DC, on several occasions in 2013 to build and maintain strong personal relationships with all of our state and federal legislators.

Addressing Physician Workforce Issues CMA successfully secured an annual $15 million appropriation to fully fund the University of California, Riverside School of Medicine (SB 21).

CMA sponsored legislation signed by the governor to encourage physicians to locate their practices in underserved regions of the state (AB 565 and AB 1288).

CMA supported statue amended to include physician assistants as primary care providers while maintaining that they must operate under the supervision of a physician (SB 494).

SDCMS conducted its sixth biennial San Diego County Physician Workforce and Compensation Survey in 2013, a critically important gauge of physician workforce trends in San Diego County that we can take to our legislators.

Navigating Healthcare Reform SDCMS and CMA made available the following Covered California resources for members only: one-on-one access to practice management experts patient FAQs, clinician FAQs, staff FAQs participation status tool & assistance with incorrect information understanding the grace period surviving the first/second/third months ON-CALL documents

2013

Bringing the Next Generation Into Organized Medicine

SDCMS and CMA Physician Leaders Dr. Ted M. Mazer was elected speaker of CMA’s House of Delegates in 2013.

Dr. Susan Kaweski was elected CALPAC treasurer.

Grossmont Healthcare feted six SDCMS Foundation volunteers, including Dr. Susan Kaweski.

Dr. Sherry L. Franklin served as president of SDCMS during the first half of 2013, and Dr. Robert E. Peters during the second half.

Dr. Robert Peters, SDCMS president, leads the UC San Diego commencement ceremony procession.

Dr. Mark Sornson, SDCMS board member, leads the UC San Diego White Coat Ceremony.

SDCMS signed up the entire first-year class of UC San Diego medical students in 2013!

SDCMS continued signing up resident physicians at a brisk rate in 2013, adding all UC San Diego resident physicians to our membership roster.

SDCMS held its annual “Preparing to Launch Your Medical Practice” workshop in February with almost 80 residents attending.

SDCMS sent UC San Diego medical students up to Sacramento twice in 2013 to meet with our San Diego County legislators.

Saving ER Funding CMA co-sponsored SB 191, legislation signed into law that will extend ER (Maddy) funding to 2017, allowing counties, hospitals, and physicians to continue providing emergency services to their communities.

Physician Professional Development SDCMS Held the Following Workshops: 1. How to Be a Better Lobbyist 2. Financial and Legal Life Skills for Financially and Legally Clueless Docs 3. Media Training 4. Preparing to Launch Your Medical Practice 5. Taming Microsoft Outlook 6. The Leader’s Toolkit (offered four times in 2013)

SDCMS-CMA Seminars, Webinars, and Courses

SDCMS and CMA conducted more than 70 seminars, webinars, and courses in 2013 — with nearly 600 physicians and office staff attending SDCMS’s seminars alone! A broad range of topics were covered, including auditing documentation, and coding, Cal MediConnect, contracting, Covered California, EHR implementation and conversion, ICD-10, meaningful use, and more!

18 apri l 2014

Office Manager of the Year Congratulations to the winner of SDCMS’s fifth annual “Outstanding Medical Office Manager” contest, Pat Russell. Ms. Russel was nominated by the SDCMS-CMA members of Internal Medicine Associates: Paul F. Speckart, MD, Raymond G. Pigeon, MD, Deanna K. Price, MD, Brian J. Lenzkes, MD, and Theresa R. Bohun, MD.

Your SDCMS Physician Advocate at Work In 2013, your physician advocate solved more than 450 member problems, among them …

A health plan was denying a member physician’s services.

After the physician got nowhere with the appeals process, CMA stepped in, got the denials overturned, and $16,000 plus interest was released.

A member physician not contracted with any health plans was concerned when she received an EOB from a silent PPO at a 50% discount. After reaching out to SDCMS, the physician was able to send a letter to the silent PPO to get her name cleared from their system.

After a member’s prescription pads were stolen, we were able to provide the physician with the information needed to get this quickly reported to the proper authorities.

A practice administrator had concerns about an agreement a commercial plan wanted them to sign. CMA’s legal team recommended a language modification to the plan, which agreed to make the change. As a result, physicians nationwide will benefit from the revised language.

Contact Marisol at (858) 300-2783 or MGonzalez@ SDCMS.org

Tangible Member Benefits More than 985 SDCMS physicians saved nearly $346,183 with The Doctors Company, SDCMS’s endorsed professional liability carrier, which offers a 5% members-only discount on professional liability insurance.

SDCMS members enjoy discounted disability insurance, a free annual physician mailing list, car insurance discounts, free classified ads, a free California Emergency Driving Emblem, and significant savings on medical malpractice insurance, accounting services, security prescription pads, billing solutions, IT support, computer hardware, contract negotiations services, practice management consulting, and legal services.

CMA Guide: Getting Started with the Physician Quality Measure System (to avoid a 1.5% PQRS fee schedule penalty in 2015) SDCMS helped its members promote their conferences, seminars, symposia, fundraising events, new practices, new medical staff and more in 2013.

Member physician office managers and practice administrators continued to use SDCMS’s private e-forum in 2013 to get answers to their practice management questions, share best practices, stay abreast of upcoming deadlines, and much more!

EHR Implementation Assistance at No Cost Free Help for Primary Care Practices to Complete Meaningful Use Attestation SDCMS completed its second Medical Office Salary Survey in 2013.

SDCMS Events The SDCMS/SDCMS Foundation 2013 White Coat Gala was held on June 8: Dr. Robert Peters was installed as SDCMS president for 2013–14.

Outgoing president Dr. Sherry Franklin was honored for her service.

Almost 200 people attended, including Sen. Mark Wyland, Sen. Marty Block, Assemblymember Rocky Chavez, Assemblymember Brian Jones, Assemblymember Shirley Weber, and Former Assemblymember Martin Garrick.

The 2012 Presidential Award winners were Dr. Roneet Lev, longtime SDCMS member chair of the Emergency Medicine Oversight Commission, and Tom Gehring, SDCMS CEO. The 2013 Top Docs — “Physicians of Exceptional Excellence” — blacktie gala was held on Nov. 9 with more than 500 attendees. The Top Doctors selection process was refined in 2013 to further balance the selection opportunity for all modes of practice.

2013 April coverage of SDCMS’s CURES sign-up event (KPBS, KUSI, CW, Daily Transcript), and San Francisco Chronicle interview on dual eligibles.

May interviews for Voice of San Diego on long ambulance response times and on the ACA. June U-T San Diego op-ed titled “Physicians Should Take the Lead on Patient Care.”

July KGTV interview on falling Medicare/Medi-Cal reimbursements, U-T San Diego interview on physician workforce and access to care, and California Healthline interview on MediCal cuts.

September KPBS interview on Medi-Cal patients’ going to the EDs, KPBS interview on vaccinations, 10News interview on health exchanges, and Fox and KUSI interviews on Covered California.

October Los Angeles Times interview on Covered California.

Communications to, for, and From Physicians A sampling of media turning to SDCMS for comment in 2013: January U-T San Diego op-ed titled “Medi-Cal Rate Cuts Hurt Health Care, Access,” and KPBS interview on Medi-Cal cuts.

February KPBS interview on NPs and PAs practicing independently, and Fox scope of practice interview.

December California Healthline interview on Covered California and narrow plans.

We sent out 25 issues of our commercial-free e-newsletter, “News You Can Use,” to a growing circulation of more than 5,000 physicians, staff, and healthcare stakeholders.

We published 12 issues of San Diego Physician on varied topics, including “Remembering David Knetzer, SDCMS CEO From 1979 to 2001,” “The Death of Fee-for-Service,” “Prescription Drug Abuse,” “Infectious Disease,” and more!

SDCMS delivered a treasure trove of daily healthcare news updates to its followers via its @SDCMS Twitter feed.

San Diego Magazine again listed SDCMS (and only SDCMS) physicians in its annual “Health Annex” and online in its Find a Doctor tool.

2013: 2,813

2012: 2,683

2011: 2,670

2010: 2,652

2009: 2,578

2008: 2,562

2007: 2,419

2006: 2,390

2005: 2,195

2004: 2,163

2003: 2,056

2002: 2,029

SDCMS Membership Continues to Increase!

SDCMS members at the end of 2013: 541 Medical Students 2,813 Physicians 1,236 Resident Physicians 4,590 Total Members SDCMS gained enough new resident physician members in 2012 to allow us to take eight new resident physician delegates to CMA’s 2013 House of Delegates.

CMA grew by almost 5% in 2013, its membership increasing to 39,462!

SDCMS Financials

8%

Physician Engagement

10%

15%

Governance

Rent: 11% Credit Card/Bank Charges: 2% Insurance: 1% Miscellaneous Expenses: 3% Telephone: 1% Staff Time G&A: 8%

Physician Database

26%

22%

12% Expenses

Benefits

Specialty Societies

Foundation

3%

3%

Foundation

4%

Advocacy

Income

Credit Card Commission

56%

19%

Infrastructure

Communications

1%

5%

Investments

16%

Advertising and Sales

Dues

2013 ANNUAL REPORT

Improving Health…

Changing Lives SiNcE 2008

PROJECT ACCESS

BOARD OF DIRECTORS 2012-2013 Executive Committee Stuart Cohen, M.D., Board President Will Tseng, M.D., Vice President Al Ray, M.D., Treasurer & Secretary Carol L. Young, M.D., Immediate Past President Tom Gehring, CEO Board of Directors Ellen Beck, M.D. Family Medicine, UC San Diego Stuart Cohen, M.D. Pediatrician, Children’s Primary Medical Group Robert DeSimone Doctors Insurance Company Tom Gehring CEO, San Diego County Medical Society James Hay, M.D. Family Medicine, PASD Leadership Committee Chair Oscar Medina Founding Partner, Strategic P.E.T. Solutions International Ron Mitchell, CPA AKT CPAs and Business Consultants Al Ray, M.D. Family Medicine, Southern California Permanente Medical Group

Our Mission:

Improving community health, access to care for all, and wellness for patients and physicians through engaged volunteerism.

Will Tseng, M.D. Internal Medicine, Southern California Permanente Medical Group Jeffrey Willmann Opprime’ Investments, Inc. Carol L. Young, M.D. Internal Medicine/ Rheumatology, Arthritis Medical Clinic Mary Robberson, Esq. Partner, Higgs Fletcher & Mack, LLP Ex Officio Rosemarie Marshall Johnson, M.D. Medical Liaison James Schultz, M.D. Medical Director Barbara Mandel, MBA, Executive Director

RESTORING VISION, RENEWING LIFE: Glen Cook, M.D. For most of us, driving to work, reading the paper, watching your child’s soccer game, are all second nature. But if your vision had diminished for years due to cataracts to the point you were considered legally blind, cataract surgery to restore your vision would allow you to regain the life you had: independence, employment, and connection with the world around you.

Financial Highlights During fiscal year 2013 we assisted 451 low-income and uninsured adults access healthcare services through Project Access San Diego.

Ophthalmologist Glenn Cook, MD, anesthesiologist Babak Abedi, MD, and their team at Surgery Center of Del Mar gave a new meaning of Thanksgiving to eight low-income individuals on the Saturday in late November. Maria Maldonado arrived totally blind, and her unusually thick cataracts caused after diabetic coma were a challenge to the team. Upon awakening Maria, Dr. Cook asked what color she saw. Initially, the answer was “black.” But just minutes later, Maria exclaimed that she could see Dr. Cook’s hand. When he asked how many fingers he was holding up, Maria correctly answered “two.” The entire surgical team burst into cheers and high-fives! They had accomplished something they did not see every day; restoring vision to a sightless person who had become so isolated and dependent due to her blindness. Maria can now leave her apartment by herself, grocery shop and cook for her family, and enjoy the antics and activities of those around her. Thanks to Dr. Cook and team for changing the lives of Maria and others like her.

Total Revenue 2013: $749,447 Total Assets as of 9/30/13: $396,190 Contributed Medical Services: $1,675,114

Project Access exists due to the dedication of our volunteer physicians, such as those helping Maria. We are here for patients like Maria so that we can improve health and change lives in our community.

LIFE SAVED DUE TO COLORECTAL CANCER EARLY DETECTION Total 2013 Expenses: $997,992

Program Services: 85% Fundraising & Event Expense: 12% Management & Administration: 3%

This information extracted from Audited Financial Statements year ended September 30, 2013. SDCMSF received an unmodified opinion on these audited financial statements from Leaf & Cole, LLP; this is the highest designation from an independent audit.

Through our partnership with Kaiser Permanente, SDCMSF has provided 211 colorectal cancer diagnostic colonoscopies and sigmoidoscopies to uninsured community clinic patients with positive screening tests or symptoms since 2008. Yuk Ja Chan is one of those whose positive FIT test brought her to Project Access San Diego, and to a Kaiser Permanente Saturday Surgery Day on October 19, 2013.

Yuk Ja was born in Hong Kong, emigrated with her family to Panama at age five, and was finally reunited with her brother in Escondido 2000 as a widow with young children. She now cares for her brother’s children, whose mother died of cancer. Her colonoscopy, performed by Payan Afshar, MD, revealed colon cancer and needed surgery. Marco Tomassi, MD (seen with Chan), performed a colon resection to remove the cancer, saving her life! Yuk Ja is now cancer-free, and grateful for the life-changing care she received. And true to our efforts to improve access, she became eligible for health insurance in January 2014 due to the expanded benefits of the Affordable Care Act.

San Diego County Medical Society Foundation | 5575 Ruffin Rd., Suite 250 San Diego, CA 92123 | 858.300.2777 | www.sdcmsf.org | foundation@sdcms.org

1 in 5

Mobile Mammograpy Creates Community Access Our partnership with We Support U, a grassroots group focused on breast and cervical cancer prevention, allowed us to expand our prevention efforts in 2013. Funded by Susan G. Komen for the Cure, we provided 84 free clinical breast exams and mammograms in one day at Chargers Stadium, and 824 during October through December. Many of the women served had never had a breast exam or mammogram previously.

Adults Will Remain Uninsured After Full Implementation of the Affordable Care Act Project Access Serves Those Most Vulnerable

2013 HEALTH HEROES 2013 marked the inaugural Health Heroes awards for SDCMSF. We acknowledged the remarkable contributions of: Wendy Buchi, MD Imaging Healthcare Specialists SurgeryOne/ASMG Champion Award Unsung Heroes Award Spirit Award Rosemarie Marshall Johnson, MD Kaiser Permanente Legacy Award Above & Beyond Award

2013 Project Access San Diego Highlights Number of uninsured 2,357 patients receiving specialty care 2008 2009 2010 2011 2012 2013 services Number of 1,324 patients receiving preventative 2008 2009 2010 2011 2012 2013 services

Members of the SurgeryOne/ASMG team received Wendy Buchi, MD received Champion Award at the award at the 2013 White Coat Gala fall Heroes de la Salud event.

PHYSICIAN WELLNESS PRIORITY FOR SDCMSF

2013 ACES FOR HEALTH The 451 patients who received specialty medical services through Project Access in FY 2013 say thank you to the golfers and sponsors who contributed to the success of our first annual Aces for Health Golf Tournament at Del Mar Country Club in February 2013. Based on its great success, the 2nd annual tournament on March 13, 2014, followed suit!

SDCMS Foundation hosts tri-annual regional workshops for the California Public Protection and Physician Health, Inc. (CPPPH), a non-profit developed by the CMA, CHA, California Psychiatry Association and California Society of Addiction Medicine. Bringing together the members of the Physician Well Being Committees from area hospital medical staffs and medical groups, participants share experiences and resources, mentor newer members, and learn about developments in the area of physician wellness. CPPPH also develops guidelines for Well Being functions and educates and connects physicians across the state who treat doctors with medical, substance abuse, or mental health issues that potentially put patients at risk.

SDCMSF Board member James T. Hay, MD, chairs CPPPH, and facilitated this important partnership. For more information visit www.

CPPPH.org.

Number of specialty care appointments Number of donated surgeries & GI procedures

7,139 2008 2009 2010 2011 2012 2013

754 2008 2009 2010 2011 2012 2013

MEDICAL STUDENT SUPPORT SDCMSF continues to support UC San Diego School of Medicine students through scholarships for both students and residents, and legislative advocacy training. In Spring 2013, Steven Rojas, MD, was awarded the resident scholarship for his impressive commitment to caring for the medically underserved and mentorship of minority undergraduates. Steven says of his residency in Family Medicine, “I think primary care is the most relevant with the direction medicine is heading; prevention is critical for keeping folks out of the hospital, so everyone wins.” First-years John Waggoner and Lindsey Youngquist were awarded scholarships to provide support during their four-year med school studies.

P R O J E SAN C TDI EGO PHYSICIAN.org ACCESS 23

SDCMS Physician Workforce & Compensation Survey

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By Tom Gehring, CEO, SDCMS

Table of Contents I. Summary of Key Findings A. Background and History B. Physician Respondent Demographics C. San Diego County Physician Workforce Demographics D. Physicians and Medicare E. Physicians and Medi-Cal F. Physicians and Covered California G. Physician (Dis)Satisfaction With the Practice of Medicine H. Perceived Physician Shortages I. Specialty-specific Perceived Physician Shortages J. General Physician Recruiting K. Specialty-specific Physician Recruiting

24 apri l 2014

L. Physician Retention M. Physician Work Hours N. Hours Spent With Patients O. Physician Satisfaction With Time Spent With Patients P. New Patient Time to Obtain an Appointment Q. Physician Compensation R. Physician Compensation Trends S. Physician Compensation by Specialty II. A Tale of Five Practices III. Specialty-specific Information

I. Summary of Key Findings A. Background and History In 2002, the San Diego County Medical Society (SDCMS) conducted San Diego County’s first Physician Workforce and Compensation Survey. The results provided SDCMS and local healthcare policymakers with their first insights into physicians’ attitudes toward their work, as well as San Diego County’s physician compensation environment. Subsequent SDCMS surveys conducted in 2005, 2007, 2009, 2011, and now again in 2013, using almost exactly the same questions for consistency, continue to yield valuable data and insights for our San Diego County physician community and local and state legislators.

B. Physician Respondent Demographics The response rate to the 2013 survey was impressive. We received 886 valid responses (from among a population of 7,200, giving us a 99% confidence level), up from 757 in 2011, and 580 in 2009. The preponderance of respondents were SDCMS members; however, the distribution of respondents was consistent with the physician community in San Diego County across modes of practice, age, geography, gender, and primary care vs. specialty care.

C. San Diego County Physician Workforce Demographics The data for 2013 is consistent with the continuing evolution of the modes of practice for the physician workforce: There were fewer solo physicians (21%), more physicians practicing in medium-size groups (22%), and more physicians practicing in large groups (29%). An excellent approximation for the workforce distribution in San Diego County is roughly as follows: ♦♦ 25% solo and small-group physicians (1–4 doctors) ♦♦ 25% medium-group physicians (5–150 doctors) ♦♦ 10% academic physicians (UC San Diego) ♦♦ 30% large-group physicians (>150 doctors) ♦♦ 10% other, i.e., community clinics, government-employed (excluding Navy), and miscellaneous Note: These percentages specifically do not include the sizable physician population at the Naval Regional Medical Centers at Balboa and Pendleton.

San Diego’s doctors are, on average, slightly younger than the national average (just under 52 years of age), 69% male and 31% female (not unexpectedly, the proportion of female physicians has steadily increased over the years of this survey), and 30% primary care vs.

70% specialty care.

D. Physicians and Medicare Physicians were asked about their history and plans for Medicare.

When pediatricians are factored out of the data, given that Medicare for children is a rarity, every statistical grouping except solo physicians (a category defined as either one or two doctors practicing together) takes Medicare at or near 100% — consistent with past surveys. For non-pediatric solo physicians, 88% take Medicare, almost identical to 2011. Of solo physicians who took Medicare three years ago, 98% take Medicare today, i.e., Medicare is extremely “sticky.”

If Medicare rates are unchanged, a political probability despite the onerous rhetoric about the 25% cut mandated by the outdated and

inaccurate Sustainable Growth Rate (SGR) formula, about a quarter of San Diego County’s non-pediatric solo and small-group physicians (defined as four or fewer doctors practicing together) who currently take Medicare will change their Medicare practice. An important distinction must be made between “drop out of Medicare” and “change their Medicare practice.” Few, if any, doctors “drop out of Medicare”; however, a not insignificant number “change their Medicare practice” by reducing the number of Medicare patient-hours or by not taking on new Medicare patients. Surprisingly, the “change their Medicare practice” phenomenon is starting to show up in medium-size groups.

Table 1: Distribution of Medicare Actions With Rates Unchanged, by Mode of Practice 100

10%

9%

19%

24%

80 Down from 89% in 2011

60

90%

91% 81%

40

No change from 2011

20

0

76%

UCSD

Large Group

Change Medicare Practice if Rates Unchanged

Medium Group

Solo & Small

Take Medicare As-Is if Rates Unchanged

E. Physicians and Medi-Cal Physicians were asked about their history and plans for Medi-Cal. On average, 55% of physicians took Medi-Cal in 2013, vs. 62% in 2011, 59% in 2009, 63% in 2007, and 70% in 2005. The decade-long downward trend in Medi-Cal acceptance is very clear. Medi-Cal is losing physicians in medium groups, small groups, and solo practices at an alarming rate: For doctors who took Medi-Cal three years ago, one in 10 medium-group doctors, one in three small-group doctors, and one in five solo physicians have stopped taking Medi-Cal. Of those solo physicians who took Medi-Cal three years ago, 21% have stopped taking Medi-Cal. The drop rate for primary care solo physicians was 29%, and for solo specialists was 17%. The average loss-rate for all other Medi-Cal providers averaged 6%. Table 2 gives a detailed breakdown of Medi-Cal acceptance rates. Noteworthy is the acrossthe-board decrease in Medi-Cal acceptance among every group except the community clinics and UC San Diego, who are required to accept Medi-Cal.

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Finally, the data is very clear about the net impact on access to San Diego’s physicians in the face of a 10% cut. Today, only 30% of solo and small-group doctors — the majority of whom are specialists — take Medi-Cal. If, in the face of a 10% cut, 50% of solo and small-group doctors will restrict access to Medi-Cal patients, and 25% will eliminate Medi-Cal altogether, that means that in the face of the programmed 10% cut, only 9% of solo and small-group doctors will grant unrestricted Medi-Cal access. Table 4 presents the same analysis for other Medi-Cal providers; unrestricted access to MediCal will suffer significantly unless the state obviates the 10% cut in prospective Medi-Cal rates.

Table 2: Distribution of Medi-Cal Acceptance,

by Mode of Practice 100

100% 90%

80

60%

60

53% Table 4: Net Medi-Cal Acceptance With a 10% Rate Reduction, by Mode of Practice

40

80

31%

30%

70

20

60

0

Community Clinic

UCSD

Large group

Medium group

2011 Medi-Cal Acceptance

Small group

50

Solo

40

2013 Medi-Cal Acceptance

73%

30

What would happen in light of a 10% Medi-Cal reduction? The behavior of solo and small-group doctors is dramatic and predictable. Roughly a quarter of them would keep their Medi-Cal practice unchanged. One quarter would eliminate Medi-Cal completely, and half would restrict Medi-Cal access. The behavior of the medium groups and large groups is likewise dramatic, considering that they have not demonstrated an inclination to change Medi-Cal behavior.

Over 45% of medium-group doctors would restrict or eliminate Medi-Cal in the face of a 10% reduction in rates, while 25% of largegroup doctors would restrict or eliminate Medi-Cal. Table 3: Distribution of Medi-Cal Actions in the Face of a 10% Rate Reduction, by Mode of Practice

28% 54%

80

10

9% 0

UCSD

Large Group

Medium Group

Solo & Small

F. Physicians and Covered California San Diego’s doctors were asked about Covered California. Table 5 below presents their opinions about whether they will or will not (or don’t know yet) take Covered California patients. Acceptance of Covered California clearly decreases as practice size decreases.

100

80

81%

74%

Down from 89% in 2011

40

28% 17%

5%

12% 2% 4%

4% 5%

13%

UCSD

Large Group

Medium Group

19%

34%34% 62% 62% 62%

60 60

23% Solo & Small

No new Medi-Cal

Significantly reduce Medi-Cal

Eliminate Medi-Cal

Behavior for 10% Cut in Medi-Cal Rates

40

20

0

49%

70% 70% 70% 44% 44%44%

40 40 No change 20 20

11% 0 0 0%

34%

49% 49% 49%

89% 89% from 2011

Continue to take Medi-Cal

26 apri l 2014

28% 28%

80 80

89%

20

28%

100 100

30% 60

0

32%

Table 5: Physician Acceptance Projections for Covered California, by Mode of Practice

100

60

39%

20

37% 37% 37%

11% 11% 0% 0% Community

2%

Community Community

42% 42% 42% 27% 27% 27%

22%

22%22%

9% 3% 2% 3% 9% 9% 2% UCSD 3%Large Group Medium Group UCSD UCSD

Large Large Group Group Medium Medium Group Group

Clinic Community Clinic UCSD Large Group Medium Group Clinic Clinic Will accept Covered California patients Will Will accept accept Covered Covered California California patients patients Will accept Covered California patients Not sure/don’t know enough enough to decide decide Not sure/don’t know Not sure/don’t know enough to to decide Not sure/don’t know enough to decide Will NOT NOT accept California Health patients patients Will accept California Health Will NOT accept California Health patients

Will NOT accept California Health patients Covered California Accepetance Projections Covered Covered California California Accepetance Accepetance Projections Projections

Covered California Accepetance Projections

Solo & Small Solo Solo & & Small Small

Solo & Small

G. Physician (Dis)Satisfaction With the Practice of Medicine The dissatisfaction of physicians with the practice of medicine in San Diego County is strong, but 2013 data does not reflect significant changes since 2011 or prior years.

Table 6: Change in Physician (Dis)Satisfaction With the Practice of Medicine, by Mode of Practice 100 Down from 89% in 2011

80

56%

52%

52%

46% 58%

60

66%

66%

average

40

31%

36%

35%

34% 31%

15%

20

13% 0

Community Clinic

12%

13%

Government

UCSD

Less satisfied

20% Large Group

No change

11% Medium Group

19% Small Group

No change from 2011

24% average

10% Solo

More satisfied

Physician Satisfaction by Mode of Practice

Overall, 56% of physicians are less satisfied with the practice of medicine than they were five years ago, as compared with 59% in 2011, 54% in 2009, 50% in 2007, and 53% in 2005. Doctors reported that, overall, 14% are more satisfied and 30% see no change in their satisfaction with the practice of medicine. There is strong variation along several axes of data analysis: ♦♦ Female physician dissatisfaction in the first 10 years of practice is less than for their male counterparts, but in mid-career (11–30 years in practice) female doctors are significantly more dissatisfied. Dissatisfaction among male physicians has stayed in the mid-50% range since 2007. ♦♦ The dissatisfaction among solo and small-group physicians continues to be extraordinarily high. Doctors practicing in large groups are the least dissatisfied, followed closely by UC San Diego and government physicians. ♦♦ Differences in dissatisfaction between specialists and primary care physicians (PCPs) emerged in this survey: PCPs are significantly less dissatisfied (48%) than specialists (59%). ♦♦ The dissatisfaction of physicians with medicine over time in practice has flattened out. In prior surveys, we saw a distinct upward slope in dissatisfaction, i.e., the more time in practice, the unhappier. Now, the curve is much flatter, with little change in satisfaction over time.

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H. Perceived Physician Shortages Physicians were asked whether they felt there was a physician shortage, and, if so, in what areas. Overall, 40% — essentially unchanged since 2009 — felt there was a physician shortage. Of note, community clinic physicians overwhelmingly (66%) feel there is a physician shortage. UC San Diego physicians’ feelings about shortages have re-

SAN DI EGO PHYSICIAN.org 27 CAP_1402.indd 1

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SDCMS Physician Workforce & Compensation Survey

39%

32%

2013

J. General Physician Recruiting Paradoxically, while there is not a strong a sense of physician shortage, there is still a significant concern about recruiting physicians.

Down from 89% The recruiting picture appears to have gotten better since 2011. Of in 2011 those who were involved in recruiting: ♦♦ 33% — down from 39% in 2011 and years prior — reported some difficulty in recruiting ♦♦ 24% — down slightly from 2011 — reported significant difficulties recruiting An astonishing 79% of solo and small-group physicians reported difficulty recruiting No (either some or significant difficulty), essenchange tially unchangedfrom from 2011, 2009, and 2007. When examined more 2011 closely, solo physicians (1 or 2 physicians) are having a more difficult time than small groups (3 or 4 doctors). While large groups and government are having absolutely no problem recruiting, medium-size groups (5 to 150 doctors) and community clinics are having a surprising time recruiting, almost as significant as solo physicians and small groups!

Table 7: Physician (Dis)Satisfaction With the Practice, by Gender and Time in Practice 70

60

50

40

0-5 Years

6-10 Years

11-15 Years

Male Dissatisfaction

16-20 Years

21-30 Years

30+ Years

Female Dissatisfaction

verted to the mean — for the last several surveys they felt there was not a shortage, and now they do! Solo doctors and medium-group doctors felt, above the average, that there was a physician shortage.

I. Specialty-specific Perceived Physician Shortages Every respondent was asked which specialties were experiencing shortages. The results were tabulated to identify in what specialties there was a consensus of shortage. The following is a list (in priority listing) of specialties where more than 5% of respondents (44 physicians) felt there were shortages. Of those listed, some specialties had longer-than-average wait times for a new patient appointment, which is an informal indicator that a perceived shortage by physicians is translating into a real problem for patients. ♦♦ family medicine (repeat from 2011, 2009, 2007, 2005) ♦♦ internal medicine (repeat from 2011, 2009, 2007, 2005) ♦♦ psychiatry (repeat from 2011, 2009, 2007, 2005) (longer-thanaverage wait times) ♦♦ neurology (repeat from 2011, 2009, 2007, 2005) (longer-thanaverage wait times) ♦♦ pain medicine (repeat from 2011, 2009, 2007) (longer-than-average wait times) (moved up the shortage ranking) ♦♦ general surgery (repeat from 2011, 2009, 2007, 2005) ♦♦ rheumatology (repeat from 2011, 2009, 2007) ♦♦ endocrinology (repeat from 2011, 2009, 2007) (longer-thanaverage wait times) ♦♦ pediatrics (repeat from 2011, 2009, 2007) ♦♦ dermatology (repeat from 2011, 2009, 2007, 2005) (longer-thanaverage wait times) (moved up the shortage ranking) ♦♦ neurosurgery (repeat from 2011, 2009, 2007, 2005) ♦♦ gastroenterology (repeat from 2011, 2009, 2007) (longer-thanaverage wait times) ♦♦ urology (new to the shortage ranking for 2013) (longer-thanaverage wait times) ♦♦ hospice and palliative medicine (new to the shortage ranking for 2013) ♦♦ obstetrics and gynecology (new to the shortage ranking for 2013) (longer-than-average wait times) ♦♦ hospitalist (new to the shortage ranking for 2013)

28 apri l 2014

K. Specialty-specific Physician Recruiting Specialty-specific data was then analyzed to identify those specialties with significant recruiting problems. While the degree of difficulty in recruiting is somewhat subjective, analysis of the data indicates that significant difficulty — defined as in-specialty recruiting with significant difficulty reported by at least 33% of doctors involved in recruiting — was indicated for the following specialties (sorted alphabetically): ♦♦ general surgery (repeat from 2002, 2005, 2007, 2011) ♦♦ internal medicine (“significant difficulty” in 2005, 2007, 2011; “some difficulty” in 2009) ♦♦ orthopedic surgery (repeat from 2005, 2007, 2009, 2011) ♦♦ pain medicine (repeat from 2011) ♦♦ psychiatry (repeat from 2002, 2005, 2007, 2009, 2011) ♦♦ thoracic surgery (repeat from 2009) ♦♦ urology (repeat from 2009, 2011) The following specialties also reported significant difficulty, but with fewer than five respondents who were involved in recruiting: ♦♦ endocrinology (“significant difficulty” in 2011; “some difficulty” in 2009) ♦♦ neonatology (new for 2013) ♦♦ surgical oncology (new for 2013) Some difficulty in recruiting — characterized as at least 50% of doctors involved in recruiting having some or significant in recruiting — was identified for the following specialties (sorted alphabetically): ♦♦ family medicine (“some difficulty” in 2009, 2011; “significant difficulty” in 2005, 2007) ♦♦ hospice and palliative medicine (new for 2013) ♦♦ infectious disease (“significant difficulty” in 2009; “some difficulty” in 2007) ♦♦ neurology (“significant difficulty” in 2002, 2005, 2007, 2011; “some difficulty” in 2009) ♦♦ obstetrics and gynecology (“significant difficulty in 2009, 2011; “some difficulty” in 2007) ♦♦ otolaryngology (“some difficulty” in 2009; “significant difficulty” in 2005, 2007, 2011) ♦♦ pediatrics (repeat from 2007, 2009, 2011) ♦♦ pulmonology / critical care (“some difficulty” in 2005, 2009, 2011; “significant difficulty” in 2007) ♦♦ radiation oncology (new for 2013) ♦♦ radiology (“some difficulty” in 2011; “significant difficulty” in 2002, 2005, 2007, 2009)

L. Physician Retention The 2013 survey projects 79% of San Diego County physicians will maintain their practice “as is” for the next three years, down slightly from 82% in 2011 and prior years. Physicians were asked what they intend to do with their practice in one to three years. The results, all essentially unchanged from 2011, 2009, 2007, and 2005, are as follows: ♦♦ Leave (retire, change jobs, or move) the practice of medicine in one year: 4%, essentially unchanged from 2011, 2009, 2007, and 2005. ♦♦ Leave (retire, change jobs, or move) the practice of medicine in three years: 9% essentially unchanged from 2011, 2009, 2007, and 2005. ♦♦ Reduce hours in the practice of medicine in one year: 2%, essentially unchanged from 2011, 2009, 2007, and 2005. ♦♦ Reduce hours in the practice of medicine in three years: 5%, essentially unchanged from 2011 and 2009.

When analyzed by mode of practice, there is a clear difference: Solo/small-group doctors (70% retention in 2013 vs. 75% retention in 2011) and, new for 2013, medium-group physicians (in a significant 11% drop from 88% retention to 77% retention) are more likely to get out of the practice of medicine than the average of their peers. Retention for large-group doctors is 8% higher than the average.

There was not a significant geographic variation in retention.

Not surprisingly, of those physicians likely to change their practice mode, there was a clear drop-off for physicians in practice for more than 30 years, of whom only 54% said they would be in practice in three years, the lowest retention percentage since 2007. There is very clearly a “cliff” of retirements coming as doctors who worked through the recession are now thinking of retiring — compounding the normal retirement rate. Also very shocking was the large percentage of doctors in their first 10 years who were thinking about leaving medicine.

M. Physician Work Hours The average number of total hours worked by full-time, active San Diego County physicians, including clinical and non-clinical hours, was 57 hours per week, unchanged from the past three surveys.

N. Hours Spent With Patients A full-time San Diego County physician spends, on average, about 40 hours per week seeing patients, essentially unchanged from the past three surveys. Unlike in prior years (2011, 2009, and 2007) there was significant variation in total hours worked by specialists (59.4 hours per week) vs. primary care doctors (54.4 hours per week).

O. Physician Satisfaction With Time Spent With Patients Physicians were asked whether they felt that the time spent with patients was adequate. 60% responded that time with patients was adequate, while 40% said time was inadequate. This is consistent with prior surveys. Solo physicians (72%), small group (65%), and UC San Diego (67%) doctors overwhelmingly felt that time spent with patients was adequate. Community clinic doctors were overwhelmingly unhappy (71% not satisfied) with the time spent on patient care, consistent with 2011 data. Within the medium- and large-group cohort, large-group physicians were happiest with the time spent on patient care (62% satisfied vs. 52% satisfied for medium-group doctors). At 65%, specialists are overwhelmingly satisfied with time spent with patients, consistent with 2011.

Primary care physician satisfaction with time spent with patients was unchanged since 2007 at about 53%. One significant anomaly is that primary care physicians in large and medium groups and UC San Diego were less satisfied with the time spent with patients (around 48% positive) than their solo and small-group peers (72% positive).

While there was no significant gender differences for solo/small-

Table 8: Physician Work Hours Broken out,

by Mode of Practice 70

Do from in

60 50 40 30 20 10 0

Patient hrs/wk

Admin hrs/wk

Solo & Small

Teaching hrs/wk

Research hrs/wk

Large & Medium

Other hrs/wk

Total hrs/wk

UCSD

group physicians, in a change since 2009, female physicians in large and medium groups are more satisfied with time spent with their patients than their male counterparts, while at UC San Diego, community clinics, and government, the reverse was true.

P. New Patient Time to Obtain an Appointment The average time for a new patient to obtain an appointment, for doctors who were taking new patients, was 2.1 weeks, or 10.5 business days, essentially unchanged from prior years. When compared to 2007 data, there is no significant change in the overall average wait time distribution for new appointments: ♦♦ 38% in 1 week, essentially unchanged since 2007 ♦♦ 31% in 2 weeks, essentially unchanged from 2007 ♦♦ 14% in 3 weeks, essentially unchanged from 2007 ♦♦ 17% in 4 weeks, essentially unchanged from 2007 Of note, community clinics had the longest wait times, while solo, small groups, and medium groups had the shortest wait times. Large groups (46%), medium groups (43%), and solo physicians (39%) were able to get patients seen within a week — at a better rate than smallgroup (28%) and UC San Diego (30%) physicians.

A difference in wait times for female vs. male physicians continues to narrow: It takes, on average, one business day longer to see a female doctor than a male doctor.

There is variation between the years-in-practice cohorts. Not surprisingly, it takes about two business days longer to get an appointment with a mid-career physician than an early-or late-career doctor.

Table 9: Wait Times for New Patient Appointments,

by Years in Practice 0-5 Years 6-10 Years 11-15 Years 16-20 Years 21-30 Years 31+ Years 9.7 10.6 11.6 11.3 10.5 9.4

There is significant variation between modes of practice. Table 10 shows 2013, 2011, 2009, and 2007 wait times, in days, for the modes of practice. Small-group waits are increasing significantly, mediumgroup wait times are increasing, while large-group wait times are decreasing.

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Table 10: Wait Times for New Patient Appointments,

by Mode of Practice 12

10

8

6

4

2

0

Solo

Small Group

Medium Group

Large Group

UCSD

2007 Wait Times for New Appointments 2009 Wait Times for New Appointments 2011 Wait Times for New Appointments 2013 Wait Times for New Appointments

As would be expected, the data indicated significant variation between specific specialties. Data for those specialties receiving fewer than five physician responses was removed from the chart, and only specialties above the average of 10.5 days were included.

Table 11: Above-average Wait Times for New Patient Appointments, by Specialty

20

15

10

5

0

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30 apri l 2014

Several specialties have had longer-than-average wait times for the past four surveys (2007, 2009, 2011, and 2013): neurology, psychiatry, ophthalmology, and nephrology. Two specialties have had longerthan-average wait times for the past three surveys (2009, 2011, and 2013): urology and gastroenterology. Several specialties have had longer-than-average wait times for the past two surveys (2011 and 2013): hematology/oncology, cardiology, obstetrics and gynecology, vascular surgery, endocrinology, and pain medicine. There were four new specialties for 2013 with longer-than-average wait times: pulmonology, otolaryngology, orthopedic surgery, and dermatology.

Allergy and immunology, and internal medicine had below-average wait times, and were dropped off the list.

When primary care physicians — family medicine, obstetrics and gynecology, internal medicine, and pediatrics — were analyzed, there was also significant variation: ♦♦ Pediatrics: 8.6 days (consistent with prior years) ♦♦ Internal Medicine: 10.4 days (continuing a steadily improving trend since it was 12.2 in 2007, 11.5 in 2009, and 10.7 in 2013) ♦♦ Family Medicine: 9.8 days (improved over 10.5 in 2011) ♦♦ Obstetrics and Gynecology: 12.2 days (with significant variation over the past four surveys, but still longer than the average of 10.4 days) Q. Self-reported Physician Compensation Physicians reported their net compensation from the practice of medicine (before taxes) within paybands as follows: ♦♦ Payband 1: < $50,000 ♦♦ Payband 2: $50,000–$100,000 ♦♦ Payband 3: $100,000–$150,000 ♦♦ Payband 4: $150,000–$200,000 ♦♦ Payband 5: $200,000–$250,000 ♦♦ Payband 6: $250,000–$300,000 ♦♦ Payband 7: $300,000–$350,000 ♦♦ Payband 8: > $350,000 To calculate the approximate average, self-reported compensation, interpolate between the midpoints of the payband. For example, the 2011 average compensation payband was 5.3. Since payband 5 is $200,000–$250,000 and payband widths are $50,000, this represents an approximate pay of $215,000. Over the past five surveys, consistently using the methodology above, the average pay of full-time, active physicians has consistently increased. See Table 12 below.

Table 12: Average Pay of Full-time, Active Physicians Over the Past Five Surveys

Year

Payband

Approximate Pay

2005

4.2

$160,000

2007

4.6

$180,000

2009

5.2

$210,000

2011

5.3

$215,000

2013

5.7

$235,000

The difference between primary care physicians ($192,000) and specialists ($256,000) continues. Using the methodology above, the payband of primary care physicians increased from 4.32 in 2011 to 4.85 in 2013 (equivalent to increasing average pay from $166,000 in

2011 to $192,000 today), while the payband of specialists increased from 5.71 to 6.12 (equivalent to an increase from $235,500 in 2011 to $256,000 today).

The approximate, self-reported pay for full-time physicians in the six cohorts is as follows: ♦♦ community clinic physicians: $135,900 ♦♦ UC San Diego physicians: $220,900 ♦♦ large-group doctors: $275,700 ♦♦ medium-group doctors: $223,900 ♦♦ small-group physicians: $236,100 ♦♦ solo physicians: $213,700 The gender gap in pay is still real and significant. The average pay, across all modes and specialties, is $252,000 for men and $187,200 for women; however, the number of hours worked must also be factored into the picture. On average, female doctors work 52.2 hours per week, vs. 60.2 hours per week for male physicians, so, when adjusted for total hours, the gap is not quite as large.

When active, full-time physician compensation is examined over the quarters of the doctor’s professional lifecycle, an interesting trend emerges. The first three quarters (0–10 years in practice, 11–20 years in practice, 21–30 years in practice) are all roughly equivalent, but there is a dramatic falloff for 31+ years in practice.

Said differently, there are no longevity raises for doctors in the first 30 years of practice, and there is a clear falloff in the final quarter of practice.

There are several interesting observations about the compensation data, when analyzed geographically (the following data has removed government and community clinics from the mix, as they are highly localized and pay fixed or near fixed rates): ♦♦ East County and Kearny Mesa compensation is higher than the average. ♦♦ North County and South Bay have the lowest reimbursement because there are no “large groups” to raise the average, and those areas of San Diego County tend to have a higher proportion of low-reimbursement patients. ♦♦ Hillcrest is dominated by UC San Diego, which prior data has indicated has lower reimbursement than solo/small and medium/ large groups.

R. Physician Compensation Trends Physicians were asked whether their compensation went up, stayed the same, or went down relative to their compensation three years ago.

The perception of the compensation trend is flat: Two-thirds of respondents did not get a pay increase.

The female physicians’ opinion of the compensation trend is more positive than their male counterparts’. Significantly more females than males perceive increasing compensation.

When the physicians’ opinions about compensation trends are reviewed by mode of practice, several interesting trends appear: ♦♦ Government and community clinic physicians believe that their pay is improving. ♦♦ Solo, small-group, and medium-group physicians think that their pay is decreasing. ♦♦ Large-group and UC San Diego doctors are sensing that their pay is improving.

The perception of compensation by primary care physicians has increased, while, relative to three years ago, the perceived compensation trend of specialists has been negative.

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

Table 13: Average Pay of Full-time, Active Physicians,

by Mode of Practice

40 35 30 25 20 15 10 5 0

Less than $50,000- $100,000$50,000 $100,000 $150,000

Solo & Small

$150,000- $200,000- $250,000- $300,000- Greater than $200,000 $250,000 $300,000 $350,000 $350,000

Medium

Large

Academic

reer doctors see their compensation as flat, and end-of-career physicians see their pay as decreasing.

S. Physician Compensation by Specialty The five lowest-paid specialties with five or more respondents are: ♦♦ Family Medicine ♦♦ Internal Medicine ♦♦ Hospice and Palliative Medicine ♦♦ Endocrinology ♦♦ Pediatrics The five highest-paid specialties with five or more respondents are: ♦♦ Radiation Oncology ♦♦ Vascular Surgery ♦♦ Radiology ♦♦ Urology ♦♦ Orthopedic Surgery

II. A Tale of Five Practices An underlying theme since our 2005 Physician Workforce and Compensation Survey has been the systemic differences among modes of practice. For the past three surveys, we looked at data differentiating solo and small-group practices (defined as fewer than five physicians in a practice), medium- and large-group practices, and academic physicians. It appeared as though these were three very distinct cohorts of doctors.

This year we divided medium- and large-group physicians into two discreet cohorts, as significant differences emerged between these practice types. In addition, we added community clinic physicians as there were enough responses to justify them having their own category.

SAN DI EGO PHYSICIAN.org 31

SDCMS Physician Workforce & Compensation Survey

2013

III. Specialty-specific Information Although highly subjective, the study identified specialties in crisis — defined as longer-than-average wait times for new patients, a perception that this specialty was in shortage, and a perception of difficulty recruiting within the specialty — highlighted in red. The specialties that are in crisis in San Diego County are: ♦ Neurology (five years in crisis: 2005, 2007, 2009, 2011, 2013) ♦ Obstetrics and Gynecology (three years in difficulty: 2005, 2009, 2011; one year in crisis: 2013) ♦ Pain Medicine (two years in crisis: 2011, 2013) ♦ Psychiatry (five years in crisis: 2005, 2007, 2009, 2011, 2013) ♦ Urology (four years in crisis: 2005, 2009, 2011, 2013) Four specialties that deal (in part or in whole) with older patients are in crisis for multiple surveys: neurology, psychiatry, urology, and gastroenterology. In addition, those specialties that were in difficul-

ty — defined as meeting two of the three criteria above — were highlighted in yellow: ♦ Dermatology (new in 2013) ♦ Endocrinology (one year in difficulty: 2013; one year in crisis: 2011) ♦ Family Medicine (four years in difficulty: 2007, 2009, 2011, 2013) ♦ Gastroenterology (one year in difficulty: 2013; two years in crisis: 2009, 2011) ♦ General Surgery (four years in difficulty: 2005, 2009, 2011, 2013) ♦ Hematology/Oncology (new in 2013) ♦ Hospice and Palliative Medicine (new in 2013) ♦ Internal Medicine (four years in difficulty: 2007, 2009, 2011, 2013) ♦ Orthopedic Surgery (new in 2013) ♦ Otolaryngology (new in 2013) ♦ Pediatrics (three years in difficulty: 2009, 2011, 2013) ♦ Pulmonology (new in 2013) Of note, all four primary care specialties are in difficulty or crisis.

Table 14: Differences Between Solo / Small-group Practices, Medium-group Practices, Large-group Practices, Academic Practices, and Community Clinics

Solo or Small-group Physicians

Medium-group Physicians

Large-group Physicians

Academic Medicine Physicians

Community Clinic

Dissatisfaction With the Practice of Medicine

Very Dissatisfied

Plurality Are Dissatisfied

Most Satisfied

Plurality Dissatisfied

Plurality Dissatisfied

Physician Satisfaction With Time Spent With Patients

Very Satisfied

Evenly Split

Very Satisfied

Very Satisfied

Very Dissatisfied

Total Physician Work Hours

Long — About 60 Hours/Week

Long — About 58 Hours/Week

Long — About 57 Hours/Week

Longest — About 64 Hours/ Week

Shortest — About 53 Hours/Week

Wait Times for New Patient Appointments

Increasing

Increasing

Decreasing

Steady

No Trend

Patient Care Hours

42 Hours/Week

41 Hours/Week

41 Hours/Week

32 Hours/Week

36 Hours/Week

Compensation

Middle

Middle

Highest

Middle

Lowest

Compensation Trend

Down (Lowest)

Down

Up

Up

Up (Highest)

Concerned About Recruiting New Physicians

Very Concerned

Concerned

Not Concerned

Somewhat Concerned

Very Concerned

Remain in the Practice of Medicine

About 70%

Almost 77%

Almost 90%

Near 80%

Almost 90%

Take Medicare

88%

Near 100%

Near 100%

Near 100%

Near 100%

Take Medi-Cal

31%

60%

53%

90%

100%

Will Take Covered California

34%

49%

70%

62%

89%

32 apri l 2014

Table 15: Overview of Specialties in Crisis (Red) and in Difficulty (Yellow)

Primary Care

<5 Responses

> Average Wait Times

Perceive This As a Shortage

Difficulty Recruiting

Family Medicine (in difficulty: 2007, 2009)

Yes

Yes

Some

Internal Medicine (in difficulty: 2007, 2009)

Yes

Yes

Significant

Pediatrics (in difficulty: 2009)

Yes

Yes

Some

OB/GYN (in difficulty: 2005, 2009)

Yes

Yes

Some

Yes

Allergy and Immunology Anesthesiology Cardiology

Yes

Dermatology (in difficulty: 2005; in crisis: 2009)

Yes

Yes

Endocrinology

Yes

Yes

Gastroenterology (in crisis: 2009)

Yes

Yes

Emergency Medicine

General Surgery (in difficulty: 2005, 2009)

Yes

Hematology/Oncology (in difficulty: 2007)

Yes

Hospice and Palliative Care Infectious Disease

Significant Some

Yes

Some Some

Yes

Nephrology (in difficulty: 2007, 2009)

Yes

Neurology (in crisis: 2005, 2007, 2009)

Yes

Neurosurgery (in crisis: 2005; in difficulty: 2009)

Yes

Some

Yes

Ophthalmology (in difficulty: 2005)

Yes

Orthopedic Surgery (in crisis: 2005)

Yes

Significant

Otolaryngology (in crisis: 2005; in difficulty: 2007)

Yes

Some

Pain Medicine

Yes

Yes

Significant

Psychiatry (in difficulty: 2005, 2007; in crisis: 2009)

Yes

Yes

Significant

Pulmonology (in difficulty: 2005)

Yes

Pathology Physical Medicine and Rehabilitation Plastic Surgery

Some Some

Radiology (in difficulty: 2005) Radiation Oncology

Yes

Rheumatology (in difficulty: 2005)

Yes

Thoracic Surgery

Yes

Vascular Surgery

Yes

Urology (in crisis: 2005, 2009)

Some Yes Significant Yes Yes

Yes

Significant

SANâ&#x20AC;&#x2C6; DI EGOâ&#x20AC;&#x2C6;PHYSICIAN.org 33

classifieds PRACTICE ANNOUNCEMENTS DR. TANIA RIVERA, RHEUMATOLOGIST, RECENTLY RELOCATED TO SAN DIEGO: Dr. Rivera has opened two practices in La Jolla and Bankers Hill. She also provides consultation services at Scripps Memorial La Jolla and Scripps Mercy Hospital. Dr. Rivera has been practicing medicine for about 12 years. She performed rheumatology fellowship at New York University Medical Center, and thereafter practiced rheumatology in Princeton, New Jersey. While she treats the full range of rheumatologic diseases, her special interests include lupus nephritis, lupus and pregnancy, fibromyalgia, osteoporosis, and osteoarthritis.

Dr. Rivera provides intra-articular injections and biologic treatments in the office, including denosumab. Telephone (858)-336-2810 or visit http:// www.rheumsd.com.

PHYSICIAN POSITIONS AVAILABLE BOARD-CERTIFIED PHYSICIANS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS NEEDED FOR URGENT CARE. Part-time positions available but a full-time opportunity may be offered to the right candidate. Must possess a current California medical license and ACLS certification. Please email or fax CV to (619) 5692590. Visit www.DoctorsExpressSanDiego.com for more information. [229a] SEEKING PART-TIME POSSIBLE FULL-TIME PHYSICIAN: Join an exciting group with tremendous growth potential in a collegial atmosphere!

Artemis Medical Group is currently seeking a part-time possible full-time family practice / internal medicine physician to join our new medical group in Hillcrest. The right candidate will be at the forefront of launching this clinic. Candidate must be able to work independently, must have strong leadership skills and excellent communication skills. Able to provide supervision to mid-level providers. Knowledge of EMR/EHR and Bilingual (English/Spanish) helpful. We offer a full benefit package. Competitive salary. Board certified a plus. Please email CV to artemismedicalgroup@gmail.com. [228] PART-TIME URGENT CARE PHYSICIAN OR PA: Private urgent care, occupational medicine, and family practice located in San Diego County seeking a physician or PA with at least two years urgent care experience. Conveniently located off I-15. Please email CV to kevin@mdtodayurgentcare.com or fax to (858) 622-1417. [227a] PHYSICIAN — RETIRED WITH LICENSE? Health and wellness center in San Diego area looking for California-licensed MD. General practitioner preferred. Work five days a week, excellent compensation. Please email your curriculum vitae/ résumé in confidence to Randy at wrandywood@ gmail.com. [225] PART-TIME PRIMARY CARE PHYSICIAN (URGENT CARE, PACIFIC BEACH): We are seeking a part-time primary care physician for a well-established busy primary care family practice / urgent care located in Pacific Beach. The candidate must be able to provide compassionate care in a fast-paced environment. Knowledge of musculoskeletal medicine and X-Ray is required. Must be able to suture and have experience with wound care. We have a state-of-the art medical facility.

Please email your CV in confidence for consider-

ation to pbyrnes@andersonmedicalcenter.com.

Compensation: Depends on Experience [224]

plus good pay. Please send CV to jeff@eastcountyurgentcare.com or fax to (619) 442-2245. [161]

SEEKING PER-DIEM PHYSICIAN: San Diego North County group looking for per-diem physician for busy urgent care. Family medicine physician preferred. Need coverage evening and weekends. Malpractice is covered. Please email CV to judy@cassidymg.com or fax to (760) 6302558, Attn.: Judy. [222]

PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fastgrowing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 9925330 or email CV to drhunt@thehousecalldocs. com. Visit www.thehousecalldocs.com. [037]

SEEKING IM PCP: Growing multispecialty North County practice seeks internal medicine PCP. Please send CV and request for information to anon625@cox.net. [220] PHYSICIANS: Well-established, busy pain management practice in San Diego Mission Valley is seeking a staff physician, preferably experienced in pain management and/or family practice. Convenient location in a new and modern office setting. We offer a competitive salary, flexible work schedules, and a benefits package that provides malpractice coverage, CME allowance, as well as excellent professional growth potential. Please email your curriculum vitae/résumé in confidence to painclinicsandiego@gmail.com. [216] PEDIATRICIAN: To take over existing practice for Arch Health Partners, an award-winning medical foundation affiliated with the Palomar Health System in North San Diego County. M–F, 8:00am – 5:00pm. Send CV to catherine.jones@ archhealth.org or fax to (858) 618.5820. [213] URGENT CARE PHYSICIAN — PER DIEM: Arch Health Partners is an award-winning medical foundation affiliated with the Palomar Health System in North San Diego County. Hours: 9:00am to 9:00pm. Send CV to catherine.jones@ archhealth.org or fax to (858) 618.5820. [212] PART-TIME OPHTHALMOLOGY POSITION AVAILABLE: Scripps La Jolla campus. Half day per week to start. General ophthalmology but should be proficient in anterior segment surgery.

Guaranteed minimum plus negotiable production. Contact ljeyedoc92037@gmail.com. [206] SEEKING A PART-TIME BC/BE INTERNAL MEDICINE PHYSICIAN: SHARP Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking a part-time BC/BE internal medicine physician to join our staff at our Genesee location. We offer a first-year competitive-compensation guarantee and an excellent benefits package. Please email CV to lori.miller@ sharp.com. [204] SEEKING A PART-TIME BC/BE INTERNAL MEDICINE / PEDIATRICS OR FAMILY MEDICINE PHYSICIAN: SHARP Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking a part-time BC/BE internal medicine / pediatrics or family medicine physician to join our staff at our Carmel Valley location. We offer a first-year competitive-compensation guarantee and an excellent benefits package. Please email CV to lori.miller@sharp.com. [205] FULL-TIME OR PART-TIME URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a full-time and/or part-time physician. Good hours (mostly 9:00am–5:30pm weekday shifts with some weekends from 9:00am–4:00pm and closed on major holidays)

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 apri l 2014

PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private nonprofit outpatient clinic serving the communities of North San Diego County, has opening for part-time, per-diem positions. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English/Spanish preferred.

Forward resume to hr@vistacommunityclinic. org or fax to (760) 414-3702. Visit our website at www.vistacommunityclinic.org. EEO Employer/ Vet/Disabled/AA [912] 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 tail-covered 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] PRACTICEs FOR SALE LA JOLLA FAMILY MEDICINE PRACTICE FOR SALE: Excellent potential to optimize you own personal lifestyle. Highly valued locale and excellent reputation for caring service. Multi-specialty certified physician looking for the perfect candidate to assume care for a special group of patients. Requires board certification with interest in family, sports, and preventive medicine. Services community with low-overhead, micro-practice model via scheduled and same-day appointments.

Patients have demonstrated long-term commitment to physician. Easy call coverage given no hospital practice required. Healthy insurance mix.

Personalized business consulting optional. Reply: info@caresmart.com. [207] LOW-STRESS, GYNECOLOGY-ONLY PRIVATE PRACTICE FOR SALE: Turnkey operation. One employee and low overhead, month-to-month lease. Minimal HMO. Perfect part-time work or add obstetrics. Various arrangements available. Email drjenma@pacbell.net. [203] OFFICE SPACE WANTED Hand Surgeon looking for part-time office location: Looking for space to share in La Jolla to Del Mar areas. Limited space and time needs. One-half to one day per week. We have flexibility to accommodate your schedule and staffing. Please contact me at greg@thehanddoctor.com. [231]

LOOKING FOR SUBLEASE: Subspecialist looking for space to sublease in the following locations: Encinitas / Carlsbad or Carmel Valley / Sorrento Valley / La Jolla / UTC. Would be able to move in May or later. Please contact sandiegodoctor23@yahoo.com with space location, availability, and type of arrangement (full or partial sublease, rooms / days available, etc.). [230] OFFICE SPACE AVAILABLE LA JOLLA OFFICE SPACE: Share reception, waiting area, and exam/consultation rooms with neurosurgeon and orthopedic surgeon in new office. Five exam rooms. On-site X-rays with radiograph tech available. Office is close to Scripps Memorial Hospital. In Golden Triangle between 805 and 5 freeways.

Terms negotiable. Please contact Kathy Koppinger at (858) 678-0455. [223] BANKERS HILL PRIMARY CARE AND RESEARCH OFFICE SPACE TO SUBLEASE: 50-year established primary care practice and clinical research office with currently two internists has space to sublease to another primary care MD (internal medicine or subspecialties / family practice) to help curb overhead and see acute overflow patients. Also can provide opportunity to get involved with clinical research. Flexible terms / space. Free parking, close to hospital, easy access to freeways. Contact Cindy at allmedgrp@hotmail.com. [146] POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage therapist. Low rates. Email inquiries to kathysutton41@yahoo.com. [173] WOMEN’S HEALTH / WELLNESS OFFICE HAS SPACE AVAILABLE FOR SUBLEASE: Exam room, office, and/or shared staff optional. Fully furnished exam rooms available and ready for use. Location features onsite billing, reception, medical assistants, potential use of in-office procedure room, and a rooftop lounge. If you are interested, please reply with the heading “Space for Sublease” outlining the details of space and/or staff use desired, with your contact information, and we will contact you to set up a showing. Reply to Mrs. Kim at cvwh858@gmail.com. [217] MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE IN LA JOLLA: 9834 Genesee Avenue, Suite 400 (Poole Building). Steps away from Scripps Memorial Hospital, La Jolla. Please contact Seth D. Bulow, MD, at (858) 622-9076 if you are interested. [215] OPPORTUNITY IN EAST COUNTY (LA MESA): Jackson Drive at Fletcher Parkway. Beautiful physical and hand therapy clinic (2800 sq. ft.) has furnished office space available to lease. Space currently available is 700–850 sq. ft. on the first floor. Includes utilities, general office and kitchen supplies/expense, and cleaning service. The office is close to Sharp Grossmont Hospital, trolley and bus lines. ADA compliant space and plenty of parking.

Contact Jeanette Barrack at jeanette@rehabst.com or at (619) 251-2417. [201] OFFICE SPACE AND PRACTICE OPPORTUNITY BANKERS HILL / HILLCREST: Surgical office space available to share in newly renovated private medical office building. Beautifully updated building inside and out. Located in Bankers Hill / Hillcrest area just minutes to Scripps Mercy Hospital. Fully accredited ambulatory surgery center onsite that is also available for use. Ideal practice setting for part-time or full-time plastic surgeon, facial plastic surgeon, or ENT surgeon. Shared office staff may be possible. Email KLewis@SDCMS.org for additional information. [200]

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] POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467 sq-ft 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] 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 / WANTED BOARD-CERTIFIED PHYSICIANS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right candidate. Must possess a current California medical license and ACLS certification. Please email or fax CV to (619) 5692590. Visit www.DoctorsExpressSanDiego.com for more information. [229b] PART-TIME URGENT CARE PHYSICIAN OR PA: Private urgent care, occupational medicine, and family practice located in San Diego County seeking a physician or PA with at least two years urgent care experience. Conveniently located off I-15. Please email CV to kevin@mdtodayurgentcare.com or fax to (858) 622-1417. [227b] PHYSICIAN ASSISTANT OPENING: Well-established orthopaedic practice in San Diego County has an opening for an experienced, licensed orthopaedic physician assistant. Responsibilities include patient evaluation, diagnosis and treatment, in-office injections. This is a clinic-based position. We are considering both part-time and full-time candidates. Interested parties, email your CV with a cover letter including part-/fulltime preference and salary range / requirements to lisas@sdsm.net (Word or PDF format only please). Thank you for your interest. [226] SEEKING PHYSICIAN ASSISTANT: Physician assistant needed on per-diem basis for busy urgent care in the San Diego North County area.

Hours are evening and/or weekends. Please email CV to judy@cassidymg.com or fax to (760) 630-2558. [221] SEEKING PA / NP AND RN: Medical spa in the Del Mar / Solana Beach area is seeking PA / NP and

RN. Should have experience with laser hair removal, IPL, CO2 laser, Botox and fillers, and sales. Positive attitude, ability to multitask, perform patient treatment, sales, consultations, effective communicator, work in a team environment, focused on client care, knowledge of lasers and laser theory, quick learner, self motivated. PA/NP will perform consultations and good faith examinations. Minimum requirements: PA, NP, RN California license.

This is a part-time position, 1–2 days a week. Please email résumé / cover letter to synergyamasb@ gmail.com or fax to (858) 259-0864. [219] PART-TIME OB-GYN NURSE PRACTITIONER: Busy established OB-GYN office in La Jolla seeking a part-time OB-GYN nurse practitioner. Please email resume to ljpp36@sbcglobal.net. [214] SEEKING NURSE PRACTITIONER: Independent pediatrics private practices in Poway and La Mesa seeking nurse practitioner (preferably pediatrics experienced) for maternity coverage in April and July for 10–12 weeks or more. Poway is for 2–3 days per week; La Mesa is for 1–2 days per week. Appointment may be extended depending upon each situation, i.e., if original provider returning to full-time, part-time care or not at all. Please contact Venk Adigopula at (619) 504-5830 with queries about the two positions or email resume and interest letter to venk@gpeds.sdcoxmail.com (La Mesa) or venk@ vvpeds.com (Poway). [211] NURSE PRACTITIONERS AND PHYSICIAN’S ASSISTANTS: Established, busy pain management practice in San Diego Mission Valley is looking for a nurse practitioner and physician’s assistant, preferably experienced in pain management or family practice. Knowledge of controlled substance prescriptions and regulations is required. Interpretation of diagnostic tests and the ability to apply skills involved in interdisciplinary pain management is necessary. We offer a competitive salary and benefits package that provides malpractice coverage, CME allowance, as well as excellent professional growth potential. Please email your curriculum vitae/résumé to painclinicsandiego@gmail.com. [210] MEDICAL ASSISTANT WANTED FOR SPORTS/ REGENERATIVE MEDICINE PRACTICE (ENCINITAS): BA or BS preferred. Please reply with resume and letter of interest to ssbunyak@hotmail.com. [199] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www.thehousecalldocs.com. [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www.thehousecalldocs.com. [038] MEDICAL EQUIPMENT WANTED PHYSICIAN SEEING ANTIQUE / VINTAGE DOCTOR’S OFFICE SCALE: Would like the traditional standing upright variety with the balance beam on top for adult patients. The scale needs to be in functional order, in at least good condition, without missing parts, and without significant rust, but nonrestored is fine. Would prefer a white cast iron scale with chrome or nickel beam and weights, not an electronic scale. Any vintage OK, but would prefer from the 1920s to the 1950s.

Email mjohnson1947@sbcglobal.net, preferably with picture(s). 25 years local MD. [218]

SAN DI EGO PHYSICIAN.org 35

Personal & Professional Development

by Helane Fronek, MD, FACP, FACPh I’m fortunate to work with enthusiastic, caring, and competent people. One of our technologists performs detailed ultrasounds while maintaining an engaging conversation with each patient. Always upbeat, she finds something that each patient likes to talk about. That is, until last week. Her patient was in a dour mood. The technologist tried every positive comment she could think of but got only curt, negative replies.

They were clearly not connecting.

We are more effective communicators when we can adapt to each patient’s personality and needs. One easy and effective tool to help us do that is the DISC assessment, which divides people into categories D, I, S, and C based on their basic communication style. We simply need to ask two questions: • Is the person extroverted or introverted?

D and I are extroverted S and C are introverted • Is the person people- or task-oriented?

I and S are people-oriented D and C are task oriented

The foundation of DISC tells us this: The “D” individual is usually ambitious, forceful, decisive, direct, and challenging. D’s care about results and efficiency, so get to the point quickly. Comments like “your opinion 36 apri l 2014

counts,” “you’ll be involved in all the important decisions,” and “getting the results you want,” will resonate with the “D.” The enthusiastic, talkative I’s crave relationship and connection. I’s appreciate small talk. When things are “exciting,” “new,” or “unique,” the “I” is most interested.

The “S” wants harmony and security and is usually systematic, reliable, steady, and modest. Demonstrating consensus and giving them praise helps the “S” feel comfortable and secure. Emphasizing how the concept is down to earth, predictable, and safe will help the “S” come on board.

“C’s” thrive on data — their comfort increases as the details are covered. Letting the “C” know that the idea and its reliability have been tested and proven through research, how risks are minimized, and that you are not suggesting a radical change will allow the “C” to feel safe and move forward.

How does this relate to the practice of medicine? As physicians, we interact and need to establish rapport with many types of people, both patients and staff. Understanding each person’s dominant communication style can help us be most effective.

Our patient, who had sought several other opinions, extensively researched her condition, and was not very communicative, was

Task-oriented

It’s as Easy as D-I-S-C

Extroverted

D

I

C

S

People-oriented

An Alphabet of Communication Styles

Introverted clearly a “C,” task-oriented, introverted, and interested in information. Sharing data from studies and my experience, describing how we minimize risks, and emphasizing that the procedure was tested and reliable helped her become comfortable enough to proceed with the treatment she had been reluctant to undergo for years. Our ultrasound technologist, a charming “I,” has been a wonderful ambassador for our practice, attending health fairs to explain the advances in the treatment of venous disease, and loving every minute of it. By using this simplified DISC, we can connect with each patient and use the natural capabilities of our staff in a more skillful way. It’s easy as A-B-C! Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.wordpress.com.

Special mortgage financing for physicians Our special home financing program is designed specifically to meet your needs as a busy physician for the purchase of your primary residence. s 'JOBODJOH BWBJMBCMF XJUI MPX EPXO QBZNFOU VQ UP SFลขJOBODFT XJUI IJHI MPBO UP WBMVFT BMTP BWBJMBCMF s 1SJWBUF NPSUHBHF JOTVSBODF JT OPU SFRVJSFE s 4JOHMF GBNJMZ IPNFT BSF FMJHJCMF 'PS EFUBJMT DPOUBDU

Daniel Schroeder

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For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner.

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