September 2014

official publication of SDCMS September 2014

GET THE

FACTS ABOUT

PROP 46 See Page 10 for a Message From the President of SDCMS

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

SEPT.

Contents

Volume 101, Number 9

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: J. Steven Poceta, MD PRESIDENT-ELECT: William T-C Tseng, MD, MPH (CMA Trustee) TREASURER: Mihir Y. Parikh, MD SECRETARY: Mark W. Sornson, MD IMMEDIATE PAST PRESIDENT: Robert E. Peters, PhD, MD

features 10

Have You Joined the Fight?

Vote No on Proposition 46

BY J. STEVEN POCETA, MD, PRESIDENT, SDCMS

12

No on Prop 46: Get Engaged!

departments

GEOGRAPHIC AND GEOGRAPHIC ALTERNATE DIRECTORS EAST COUNTY: Venu Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD, Alt: Susan Kaweski, MD (CALPAC Treasurer) HILLCREST: Gregory M. Balourdas, MD, Thomas C. Lian, MD, Alt: Thomas J. Savides, MD KEARNY MESA: Sergio R. Flores, MD, John G. Lane, MD, Alt: Anthony E. Magit, MD, Alt: Eileen R. Quintela, MD LA JOLLA: Geva E. Mannor, MD, Marc M. Sedwitz, MD, Alt: Lawrence D. Goldberg, MD NORTH COUNTY: James H. Schultz, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD, Alt: Anthony H. Sacks, MD SOUTH BAY: Reno D. Tiangco, MD, Michael H. Verdolin, MD, Alt: Elizabeth Lozada-Pastorio, MD

4

AT-LARGE DIRECTORS Lawrence S. Friedman, MD, Karrar H. Ali, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Stephen R. Hayden, MD, Peter O. Raudaskoski, MD, Vimal Nanavati, MD (Board Representative), Holly B. Yang, MD

Vote No on 46 — Pullout Poster

8

16

BY VENU PRABAKER, MD

AT-LARGE ALTERNATE DIRECTORS Karl E. Steinberg, MD, Jeffrey O. Leach, MD, Toluwalase A. Ajayi, MD, Phil Kumar, MD, Wayne C. Sun, MD, Kyle P. Edmonds, MD, Carl A. Powell, DO, Marcella M. Wilson, MD

BY THE CALIFORNIA MEDICAL ASSOCIATION

14

How to Talk to Your Patients: Prop 46 — A Costly Threat to People’s Personal Privacy Californians Can’t Afford

BY THE CALIFORNIA MEDICAL ASSOCIATION

24

Vote No on 46: Have You Joined the Growing Coalition Opposed to Prop 46?

Briefly Noted: Calendar • Real Estate Tips & Trends • And More …

Discrimination: My Perspective

26

Physician Marketplace: Classifieds

28

roject Access Physician Volunteers P Are All Heroes to the SDCMS Foundation

BY BARBARA MANDEL

28 2 septem b er 2014

OTHER VOTING MEMBERS COMMUNICATIONS CHAIR: Sherry L. Franklin, MD (CMA Trustee) YOUNG PHYSICIAN DIRECTOR: Edwin S. Chen, MD RESIDENT PHYSICIAN DIRECTOR: Jane Bugea, MD RETIRED PHYSICIAN DIRECTOR: Rosemarie M. Johnson, MD MEDICAL STUDENT DIRECTOR: Spencer D. Fuller OTHER NONVOTING MEMBERS YOUNG PHYSICIAN ALTERNATE DIRECTOR: Daniel D. Klaristenfeld, MD RESIDENT PHYSICIAN ALTERNATE DIRECTOR: Diana C. Gomez, MD RETIRED PHYSICIAN ALTERNATE DIRECTOR: Mitsuo Tomita, MD SDCMS FOUNDATION PRESIDENT: Albert Ray, MD (CMA Trustee, AMA Delegate) CMA SPEAKER: Theodore M. Mazer, MD CMA PAST PRESIDENTS: James T. Hay, MD (AMA Delegate), Robert E. Hertzka, MD (Legislative Committee Chair, AMA Delegate), Ralph R. Ocampo, MD CMA TRUSTEES: Robert E. Wailes, MD, Erin L. Whitaker, MD CMA SSGPF Delegate: James W. Ochi, MD CMA SSGPF ALTERNATE DELEGATES: Dan I. Giurgiu, MD, Ritvik Mehta, MD AMA ALTERNATE DELEGATE: Lisa S. Miller, MD

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org.

All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// Free Work-Life Balance Workshop for Physicians (workshop) OCT 11: 9:00am–12:00pm

calendar SDCMS Seminars & Webinars SDCMS.org

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

Covered California: What Your Healthcare Team Needs to Know (seminar/webinar) SEP 18: 11:30am–1:00pm HIPAA Compliance Update (webinar) SEP 25: 11:30am–1:00pm SDCMS Leader’s Toolkit (workshop) SEP 27–28 Payer Denials & Appeals: Effective Management and Best Outcomes (seminar/ webinar) OCT 9: 11:30am–1:00pm

Covered California: What Your Healthcare Team Needs to Know (seminar/webinar) OCT 16: 11:30am–1:00pm Covered California: What Your Healthcare Team Needs to Know (seminar) OCT 16: 5:30pm–7:00pm Pain Management Strategies to Decrease Liability Risk (seminar/webinar) NOV 13: 11:30am–12:30pm

Cma Webinars CMAnet.org/events Informed Consent for Psychotropic Medications: What’s Required of Physicians, Hospitals, and Nursing Homes SEP 25: 12:15pm–1:15pm

Family Medicine: Frontline of Care OCT 1: 12:15pm–1:15pm Protect and Preserve Your Patient Relationships OCT 8: 12:15–1:15pm Managing Up! For Managers OCT 29: 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.

SDCMS Foundation Solana Beach Sunset 5K Run/Walk SEP 27 (sdcmsf.org/events/5k) The Heart Course: Emergency OCT 2–5 (Aria Resort and Casino in Las Vegas, www. theheartcourse.com)

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25th Annual Cardiovascular Interventions OCT 21–24 (www.sdcms. org/Portals/18/Assets/pdf/ seminars/Cardiovascular InterventionsBrochure2014. pdf) Physicians of Exceptional Excellence (Top Doctors) Gala NOV 1 (Birch Aquarium) The 2014 San Diego Day of Trauma NOV 7 (www.sdcms.org/ Portals/18/Assets/pdf/ seminars/Trauma%20 2014%20Brochure-.pdf) Essential Tools in Serving Diverse Populations NOV 18 (Scottish Rite Event Center on Camino Del Rio South, registration open in September)

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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!

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Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude.

— Thomas Jefferson (1743–1826)

”

LoS angeLeS PaLo aLTo SacramenTo

SAN DI EGO PHYSICIAN.org 5 CAP_1402.indd 1

2/5/13 11:13 AM

/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// Commercial Real Estate Tips & Trends

SAN DIEGO MEDICAL OFFICE OVERVIEW: Q2 2014

By Chris Ross

Market Conditions and Trends There is no doubt by now that the national and local healthcare real estate market is recovering at a steady pace. In San Diego, a number of projects that struggled through the downturn have stabilized, with a few at or close to 100% occupancy. As leading medical practices and physician groups slowly regain at least some confidence about what their future holds, Class A medical office space is reaching extremely low vacancy. Over the last six to nine months, we have seen a resultant “trickle-down” effect, increasing activity among buildings that fall into the next tier of quality and/or location.

The countywide average asking rate is now at $2.53 per square foot full service, up slightly from last quarter and year-overyear. The $2.53 number is still somewhat misleading, since weighted average asking rents are tied to available space (not total inventory), and the rise in Class C vacancy and drop in Class A vacancy is offsetting the current gradual lift in market rents.

The average vacancy rate in the county is up slightly from last quarter, but by the time 2014 comes to a close it would be no surprise if vacancy breaks into the single digits. A healthy number of lease transactions took place late in the second quarter (and the early stages of Q3), and we will not see their impact on the vacancy numbers until these tenants move in later in the year.

Class A rents are climbing at a steadier pace and average around $2.50 NNN in San Diego County. Class A vacancy is now less than 6%, down from its peak of nearly 40% in mid-2009 — a number that was temporarily inflated from the construction boom.

There still exists a premium for oncampus or adjacent-to-campus buildings, but more and more providers are opening up to the idea of moving to “near-campus” buildings or mixed office/medical projects to reduce occupancy costs.

Forecast The only medical buildings currently under construction in the county are Scripps’ 80,000-square-foot medical building on its La Jolla campus, which is 100% pre-leased, and American Assets’ 13,000-square-foot medical building at 6 septem b er 2014

Torrey Reserve in Carmel Valley. Meanwhile, our population is aging, increasing the demand for healthcare, and health systems continue to push more services out of hospital campuses and into outpatient medical office buildings. Couple all of this with demand from discretionary-incomebased practices that are steadily increasing as the economy strengthens, and vacancy has nowhere to go but down.

Vacancy will continue to shift out of Class A and B MOBs — especially those with flexible floor plates — into Class B and C buildings as providers continue to improve their environment for care and seek out quality space and property.

In terms of investment sales activity, the first half of 2014 has been steady — albeit at a slightly lower amount of sales volume as the record-breaking 2013 — but there continues to be high demand for medical buildings of varying types and locations locally, regionally, and nationally.

Surveying San Diego Submarkets Escondido / San Marcos Leasing activity remains tapered in this submarket, although there are signs that vacancy could tighten over the next six to 12 months. Nordahl Medical Centre, approximately three-quarter miles north of the new hospital, is now able to sell individual Class A medical condos. Owner-user opportunities are something all tenants should consider as a solution for long-term cost containment. The jury is still out as to how much movement this submarket is still expected to see, but we wouldn’t be surprised if more relocations and new practice openings are announced in the near future.

Oceanside / Vista: The Tri-City area is still making its gradual recovery, one small transaction at a time.

Net absorption was essentially flat in 2013, but this year has seen better activity. A few projects have reduced pricing enough to generate interest from providers looking for low-cost alternatives with relatively good value — somewhat of a trend that is taking place, particularly among private practices and in certain areas.

North County Coastal Vacancy in coastal North County is extremely tight, by far the lowest in the county at 5.1%, down from its 8.0% peak in 2008. This is leading to a steady increase in asking rents.

Limited vacancy continues to taper transaction volume since relocation alternatives are scarce. Net absorption was the highest of any submarket in San Diego in 2013, although it is slightly negative in 2014 — a trend that will not last.

I-15 corridor As expected, 4S Health Center in 4S Ranch, Pinnacle Medical Plaza in Scripps Ranch, and Pomerado Outpatient Pavilion on the Pomerado Hospital campus (the three most recently completed buildings in the area) have all reached stable occupancy. The health of these Class A buildings should lead to an increase in leasing activity and more stable rents among the submarket’s Class B MOBs. La Jolla / UTC / Sorrento Over the past two years, the greater UTC medical office submarket has undergone one of the more dramatic recoveries (physically and statistically) ever seen in San Diego.

The MOBs on the two hospital campuses are essentially full, as are La Jolla Medical & Surgical Center, University Pacific Centre, and Pacific Medical Plaza. Chancellor Park and Genesee Plaza both made significant upgrades to their common areas, and each have less than 10,000 square feet of available medical space. La Jolla Village Professional Center continues to have limited vacancy as well. Regents Medical Center is pushing forward with its renovation plans (some of which have been completed) and contains most of UTC’s vacancy. With now limited competition, this well-located project will see increased activity going forward. As a whole, UTC leasing concessions are steadily tightening, and, it goes without saying: Rents are rising.

Kearny Mesa / Mission Valley With two hospitals and hundreds of thousands of medical office square footage in one compact and centrally located healthcare community, Kearny Mesa remains one of the more dynamic areas to practice

///////////////////////////////////////////////////////////////////////////////////////////////////

TrusT

Inventory by Submarket Other

Escondido/ San Marcos

6%

East County

14%

8%

Kearny Mesa/ Mission Valley

I-15 Corridor

8%

13%

Oceanside/Vista

South County

8%

12%

Uptown/Hillcrest

9%

North County Coastal

10%

La Jolla/ UTC/Sorrento

12%

medicine. What is holding back the overall health of this submarket is the competitive leasing environment. Tenants in the market simply have a variety of options to choose from. That said, these buildings are evenly spread across the spectrum of cost and quality, which typically leads to a prospective tenant focusing in on just one or two properties. As a result, rents are generally stable but vacancy remains near the county average.

past 12 months but are still just below the county average. No new medical buildings have been built since the early ’90s, and only 306 Walnut Ave. is under renovation. However, with the amount of commercial and residential development (mostly redevelopment) taking place between downtown and “Pill Hill,” leasing and sales activity seems to be picking up, and we would not be surprised to see a trend of rising occupancy and rents come the end of the year.

East County East County medical office is quietly plugging along at sub-10% vacancy, flat net absorption, and essentially no change in lease rates. A few properties have changed hands recently, but no major renovations have been announced. Most physicians and medical groups have little reason to relocate, and the submarket sees very little activity from new providers entering the area.

South County South County’s vacancy is geographically spread out, which keeps market conditions fairly stable. Eastlake’s economy is bouncing back, and the area’s large population is growing again. It will be interesting to monitor the ACA’s effects on payer mix in South County, which may ultimately have an impact on its medical real estate market.

Uptown / Hillcrest The Hillcrest submarket remains flat, with near-zero net absorption in 2013 and YTD 2014. Vacancy is just above the county average. Rental rates increased slightly over the

Mr. Ross is vice president of healthcare solutions for Jones Lang LaSalle. He is a commercial real estate broker specializing exclusively in medical office and healthcare properties in San Diego County. He can be reached at (858) 410-6377 or at chris.ross@am.jll.com.

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SAN DI EGO PHYSICIAN.org 7

FIRST-PERSON PERSPECTIVE

Discrimination

Here in the medical community, I am proud to say that while cases of discrimination do occasionally exist, they are usually outweighed by the idea that people should be valued for their knowledge and experience rather than their skin color.

My Perspective

“I say to you quite frankly that the time for racial discrimination is over.”

— Jimmy Carter

by Venu Prabaker, MD

“In the long run, there is not much discrimination against superior talent.”

— Carter G. Woodson Having been born in India, a country with a long tradition of having a strong caste system, I am no stranger to discrimination. The Indian government has tried to change this negative aspect of their culture in recent years, and Gandhi drew worldwide attention to the problem by speaking out against oppressing the constantly downtrodden “Untouchables.”

But judging people by their social class, color, or profession continues to be a persistent issue in India. Unfortunately, this mentality expands past the borders of a single country.

The reasons I came to America are intriguing and involved, but, for the sake of brevity, I’ll skip them for now. Though I had completed training as a doctor in India, the American medical system demanded that I restart my residency upon coming to this 8 septem b er 2014

country. Consequently, I lived in poverty for eight months, often on just one meal a day. My first place of employment was in Paintsville, Kentucky, a very small town.

So small, in fact, that a classmate and I were the only people in the entire town who weren’t Caucasian. He was faring better than I financially, so one night he offered to take me to dinner. We sat and talked at a table in the restaurant for over an hour before noticing that other patrons had come and gone, but the two of us hadn’t even been acknowledged by the staff.

I finally flagged down a waiter, a gruff looking man with a voice to match, and asked that we be served, but was bluntly told that the restaurant “don’t serve niggers!” I was taken aback, not only by the blatant show of racism, but by the fact that my friend and I aren’t black, but Indian!

It’s amazing, and almost comedic, that someone could be so blinded by color that he thought everyone with darker skin than himself was of African descent.

My encounters with discrimination and racism aren’t limited to social experiences, but carry over into my professional career.

The incident that still raises the most outrage within me happened during my first year of residency in Washington, DC. At the time, I was under training in pediatrics (though I changed my specialization to internal medicine later). Quite the opposite of Paintsville, about 85% of the residents and patients at the hospital where I worked were African-American, followed by other minority groups, leaving Caucasians very much outnumbered. And while no one was refused treatment, the parents of Caucasian children were clearly looked down on by the staff. They were treated like dirt, as if they were less human than the rest of us simply because people of color were in the majority.

I actually confronted my colleagues about this reverse discrimination. After all, these were children that we were supposed to be caring for, no matter their race. I was furious about the way they and their families were being treated. But the rest of the residents retaliated for what I stated.

“How I wish we lived in a time when laws were not necessary to safeguard us from discrimination.” — Barbra Streisand

Still, intolerance didn’t prevent me from having a successful practice, or hold me back from positions I have held throughout my career, such as assistant director of an internal medicine residency training program in Ohio or director of internal medicine in a family practice residency program in San Diego. Here in the medical community, I am proud to say that while cases of discrimination do occasionally exist, they are usually outweighed by the idea that people should be valued for their knowledge and experience rather than their skin color.

But we must be constantly vigilant of our own thoughts and oppress feelings of discrimination before they surface, so that we don’t become oppressors ourselves.

“If you believe that discrimination exists, it will.” — Anthony J. D’Angelo In conclusion, I deem that we are all privileged to live in this great nation where a person with skills, talent, perseverance, and hard work can reach the moon if he or she determines to do so. “We cannot judge the book by the cover.”

Dr. Prabaker, SDCMS-CMA member since 1999, is board-certified in internal medicine.

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“Discrimination has a lot of layers that make it tough for minorities to get a leg up.” — Bill Gates

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I have come to the conclusion that discrimination may just be human nature, but it is human nature that can be conquered.

Perhaps our judgments are brought about by personal experiences we have had throughout our own lives. I credit my point of view to my father, who strongly believed that no matter a person’s background, he can achieve success through effort and education. But at times even I catch myself guessing a person’s profession, capability, or personality based only on appearance. There have been times that after attending a lecture, for example, I have looked back at the speaker and realized that I had gone into the session with a preconception about how much I would actually learn from the person. Whether male or female, black, white, or otherwise, even I make judgments about how knowledgeable they are and how much I will learn from the lecture before the speaker even opens his or her mouth. And with this realization comes an incredible sense of guilt. But I suppose in feeling this I can understand, to a point, why some of my newer patients would wonder to themselves whether I speak English before actually hearing me talk.

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SAN DI EGO PHYSICIAN.org 9

MICRA

From SDCMS Presiden

Have You Join Vote No on Pr O

ver the past several months, you may have read information about the Medical Injury Compensation Reform Act (MICRA) lawsuit initiative, Proposition 46, in the pages of this magazine, on SDCMS’ website, in information from the California Medical Association (CMA), and likely from the hundreds of coalition partners that have all pledged to oppose the measure this November. On Nov. 4, 2014, voters will be asked to cast their ballots. In the final months, weeks, and days leading up to Election Day, it will be our task as physicians to educate our patients, neighbors, friends, and families about the real intentions behind Prop. 46.

An Overview of Prop. 46 The measure is complex and contains three separate and distinct pieces that trial lawyer proponents have thrown together in an effort to mask their real intent: quadrupling non-economic damages in MICRA, pulling money directly out of the healthcare delivery system and putting it into their own pockets. The pieces voters will be asked to weigh in on are as follows: 1. A quadrupling of the non-economic damages limit on medical malpractice awards in California, which will cost consumers and taxpayers hundreds of millions of dollars every year in higher healthcare costs, and cause many doctors and other medical care professionals to quit their practices or move to places with lower medical malpractice insurance premiums — reducing access to care in California.

10 septem b er 2014

2. An unfunded mandate that will require physicians, pharmacists, and veterinarians to check a government-run database before prescribing schedule II or III drugs. This piece in particular threatens patient privacy by requiring a massive expansion of the use of a personal prescription drug database.

3. Both a random and mandatory requirement to perform alcohol and drug testing on doctors, which was only added to this initiative to distract from the main purpose.

Let’s not be fooled: Prop. 46 uses alcohol and drug testing of doctors to disguise the real intent: to increase the limit on the amount of medical malpractice lawsuit awards.

Raising Healthcare Costs I’ve been speaking about Prop. 46 for months now, and explaining to people how it was carelessly thrown together without concern for taxpayers’ pocketbooks, healthcare, or privacy, but one question that comes up repeatedly is, “How will this increase health costs?”

We know that trial lawyers out to profit from medical lawsuits sloppily drafted Prop. 46, and it will result in higher healthcare costs for everyone. We’ll see money come directly out of the healthcare delivery system and straight into the pockets of the lawyers that stand to gain most.

These higher costs will be passed to every purchaser and provider of healthcare: state and local governments, employers, employees, consumers, and taxpayers.

That’s why such a broad coalition of group stands in solid opposition to Prop. 46.

According to California’s independent, nonpartisan Legislative Analyst’s Office (LAO), Prop. 46 could increase costs for state and local governments by “several hundred million dollars annually.”

The LAO goes on to warn that “even a small percentage change in healthcare costs could have a significant effect on government healthcare spending.”

But, how exactly?

State and local governments are hit with higher costs in two ways: 1. They provide healthcare benefits for current and retired government employees; 2. They also provide healthcare services for low-income residents through Medi-Cal and other locally run healthcare programs like community clinics and public hospitals.

Higher healthcare costs for state and local governments would reduce funding available for vital local services like police, fire, social services, parks, and libraries, to name a few. If Prop. 46 passes, everyone will carry the burden of these increased costs.

While the LAO estimates costs to state and local governments, they aren’t the only ones who will pay for more lawsuits and higher payouts.

According to a study by California’s former Legislative Analyst, Prop. 46 will increase healthcare costs across all sectors by $9.9 billion annually, which translates to around $1,000 per year in higher health costs for a family of four.

nt Dr. Steve Poceta:

ned the Fight? roposition 46 For many families across the state, that is a tough choice between groceries and healthcare — and one that we can’t afford to let happen.

Threatening Privacy Proposition 46 includes a provision that could significantly jeopardize the privacy of patients’ personal prescription medical information. The initiative forces doctors and pharmacists to use a massive statewide database, called CURES, which is filled with patients’ personal prescription drug information. Though the database already exists, it is underfunded, understaffed, and technologically incapable of handling the massively increased demands this ballot measure will place on it. In fact, in evaluating Prop. 46 the LAO noted, “Currently, CURES does not have sufficient capacity to handle the higher level of use that is expected to occur when providers are required to register beginning in 2016.”

Many of us as physicians want the CURES database to work to help keep patients safe. Unfortunately, the provision in this ballot measure isn’t that simple.

Prop. 46 will force the CURES database to respond to tens of millions of inquiries each year — something the database simply cannot do in its current form or functionality. A nonfunctioning database system will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing needed medications to patients.

Another concerning piece of this provi-

sion is that the massive ramp-up of this database will significantly put at risk patients’ private medical information. Prop.

46 doesn’t contain any provisions or funding to upgrade the database with increased security standards to protect personal prescription information from government intrusion, hacking, theft, or improper access by nonmedical professionals.

The CURES database contains a record of every dispensed prescription of a Schedule II, III, or IV substance and contains highly sensitive, personal, and potentially stigmatizing details about a person’s health. It includes prescription information, including medicines used to treat anxiety, insomnia, obesity, narcolepsy, drug detoxification, pain, epilepsy, conditions related to cancer and AIDS, asthma, chronic infection, and other sensitive medical conditions.

What’s more, the law gives the Department of Justice unfettered discretion to disclose confidential patient prescription information to any state, local, or federal public agencies for disciplinary, civil, or criminal purposes.

There are literally hundreds of entities and thousands of individuals who work for those agencies that meet this definition, providing access to highly personal and sensitive patient health information for nonmedical reasons.

What Now? We’ve got a lot of work to do between now and Election Day. The proponents of Prop.

46 continue to mislead the public about the real intentions behind the measure: quadru-

pling the cap on non-economic damages in MICRA, which will result in higher healthcare costs for everyone.

For the future of medicine in California — and the nation — and for the safety of our patients, I ask you to get engaged in these final weeks and months. You can: • Donate to the campaign. It’s as simple as visiting NoOn46.com and clicking on “contribute.” Every dollar counts as we need to produce material to ensure voters understand the risks associated with Prop. 46.

• Order campaign material. We’ve got buttons, office posters, informational brochures, lab coat cards, and more, all available at NoOn46.com. Simply click “Take Action” and “Get Campaign Material,” and it will be sent directly to you.

• Sign up to be a part of the campaign. As physicians, we see dozens of patients daily. Take the time to let them know about the dangers and real intent behind Prop. 46.

With the changing times in the healthcare delivery system, I know it can be tough to make the time for something else. The future of our profession depends on us here, and I urge you to commit to being involved through Nov. 4 and beyond.

For all of your efforts until now and moving forward, thank you.

Sincerely, J. Steven Poceta, MD, President, SDCMS

SAN DI EGO PHYSICIAN.org 11

No on Prop 46

Get Engaged!

By now, many of you are familiar with the MICRA lawsuit initiative that will appear on the November 4, 2014, ballot. Proposition 46 is being opposed by a coalition of doctors, community health clinics, Planned Parenthood Affiliates of California, local governments, working men and women, business groups, taxpayer groups, hospitals and educators, all of whom know that the measure will lead to more lawsuits and higher health care costs. What’s more, it will threaten personal privacy and jeopardize people’s access to their trusted doctors or clinics.

This information is intended to be useful for coalition members who are on the ground working to defeat Prop.

46. To that end, please also visit www.NoOn46.com for updated campaign information and to find out what you can do to join the efforts as an individual or organization.

WHAT YOU CAN DO SIGN UP FORMALLY (AS AN ORGANIZATION, PRACTICE OR INDIVIDUAL) IN OPPOSITION TO THE CAMPAIGN Visit the campaign website at www.NoOn46.com to add your name to the growing list of groups and organizations opposing Prop. 46.

REQUEST A CMA STAFF MEMBER TO SPEAK TO YOUR GROUP, HOSPITAL OR SPECIALTY SOCIETY Let your local county medical society or CMA know and we can ensure you’re hearing from the right people about the most recent campaign updates.

ORDER CAMPAIGN COLLATERAL Download the Order Form to receive office posters, Englishand Spanish-language patient brochures, campaign buttons, message cards and more. You can also order directly online by visiting NoOn46.com SPREAD THE MESSAGE ON SOCIAL MEDIA If you’re active on social media, start by following the California Medical Association and No on Prop 46. Retweet and repost the information that is being put out to help spread the word about how dangerous and costly Prop.

46 will be for everyone. For questions about how to start a Twitter or Facebook account or how to engage with CMA, please contact Brooke Byrd at bbyrd@cmanet.org.

PARTICIPATE IN MESSAGE/MEDIA TRAINING The campaign is looking for physicians interested in taking on a more public role speaking to community groups about why this ballot measure should be defeated. Contact Molly Weedn at mweedn@cmanet.org for more information.

Twitter

SPEAK TO YOUR COLLEAGUES, PATIENTS AND COMMUNITY Use the resources at NoOn46.com to talk to your colleagues, patients, friends and family. Don’t forget to speak to community members as well – groups such as Rotary, Kiwanis, Soroptimist and more provide great venues for presentations.

Facebook

12 septem b er 2014

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6 4 n O Paid for by No on 46 - Patients, Providers and Healthcare Insurers to Contain Health Costs, with major funding from the Cooperative of American Physicians IE Committee and The Doctors Company

How to Talk to Your Patients Prop 46 - A costly threat to people’s personal privacy Californians can’t afford.

By now, many of you are familiar with the MICRA lawsuit initiative that will appear on the November 4, 2014, ballot. Proposition 46 is being opposed a coalition of doctors, community health clinics, Planned Parenthood Affiliates of California, local governments, working men and women, business groups, taxpayer groups, hospitals and educators, all of whom know that the measure will lead to more lawsuits and higher health care costs. What’s more, it will threaten personal privacy and jeopardize people’s access to their trusted doctors or clinics.

This information is intended to be useful for coalition members who are on the ground working to defeat Prop.

46. To that end, please also visit www.NoOn46.com for updated campaign information and to find out what you can do to join the efforts as an individual or organization.

TALKING TO YOUR PATIENTS Communicating the No on 46 message to your patients will be critical to defeating the trial lawyers’ attacks on the medical profession. As a trusted medical expert, you are in a unique position to share how Prop 46 would truly affect all health care users and taxpayers. Please use the Frequently Asked Questions (FAQ) below to guide your conversation with patients.

WHAT WILL PROP. 46 DO? Prop 46 does three things: • Quadruples the limit on medical malpractice awards in California, which will cost consumers and taxpayers hundreds of millions of dollars every year in higher health care costs, and cause many doctors and other medical care professionals to quit their practice or move to places with lower medical malpractice insurance premiums – reducing access to care.

• Threatens your privacy by requiring a massive expansion of a personal prescription drug database.

• Requires alcohol and drug testing of doctors, which was only added to this initiative to distract from the main purpose.

Proposition 46 uses alcohol and drug testing of doctors to disguise the real intent – to increase a limit on the amount of medical malpractice lawsuit awards.

16 septem b er 2014

WHO OPPOSES PROP. 46?

Thousands of organizations and individuals representing doctors, nurses, community clinics, local governments, labor unions, business groups, education groups, taxpayer groups, hospitals, community groups and many others oppose Prop. 46 because it will lead to more lawsuits, higher health care costs, threaten people’s access to their trusted doctor or clinic, and jeopardize people’s personal prescription drug information.

WHO SUPPORTS PROP. 46?

One hundred percent of the reported contributions to pay for signature gathering to place this on the ballot in November 2014 came from trial lawyers and their allies.

HOW WILL PROP. 46 INCREASE HEALTH CARE COSTS? There is no question that more lawsuits against health care providers will increase costs, and someone has to pay. And that someone is consumers and taxpayers.

California’s former Legislative Analyst found Prop. 46 would increase health costs for consumers and the state by about $9.9 billion annually.

This translates to more than $1,000/year in higher health care costs for a family of four.

California’s current independent, non-partisan Legislative Analyst Office (LAO) said impacts to state and local

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Fee is $250and for Sharp non-Sharp-affi liated topics related to medical and Free for all physicians, physician assistants, conference featuring leaders in the field of employees.

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GH213A Š2014 SHC

And who controls the database? The government – in an age when government already has too many tools for violating your privacy.

governments (i.e. – taxpayers) would be “several hundred million dollars annually.”

In its evaluation, the LAO warned “even a small percentage change in health care costs could have a significant effect on government health care spending.”

WHAT IS WRONG WITH THE PROVISION MANDATING USE OF THE CURES DATABASE? This database sounds simple, but it’s not. While the CURES database is already in existence, Prop. 46 would require an immediate ramp up (the day after the election, on November 5, 2014), and will force the CURES database to respond to tens of millions of inquiries each year – something the database simply cannot do in its current form or functionality.

HOW DOES THIS AFFECT TAXPAYERS? State and local governments pay for current and retired government employee health benefits and they provide health care “safety net” services directly through Medi-Cal, state and county hospitals and community clinics, and other local programs.

If lawsuits increase and health care costs go up, state and local governments pay these out of the budgets they receive from taxpayers. Increased health costs to state and local governments could force cuts to other vital services like education, public safety and social safety net programs. Or, state and local governments may decide to make up that additional cost by raising revenues, and that will come from taxpayers.

In fact, in evaluating Prop. 46 the LAO noted, “Currently CURES does not have sufficient capacity to handle the higher

The physician community and all health care providers are always looking for ways to improve patient safety.

WHAT ABOUT ACCESS TO HEALTH CARE? HOW WILL THAT BE AFFECTED BY PROP. 46?

If California’s medical liability cap goes up, people could lose the ability to see their trusted doctors.

Many community clinics operate on slim margins.

Any significant increase in their costs will force them to reduce or eliminate services for patients. Many doctors will be forced to leave California to practice in states where medical liability insurance is more affordable.

But don’t be fooled by Prop 46.

Respected community clinics, including Planned Parenthood, warn that specialists like OB-GYNs will have no choice but to reduce or eliminate vital services, especially for women and families in underserved areas.

WHY ARE COMMUNITY CLINICS SO STRONGLY OPPOSED TO PROP. 46?

Community clinics, like Planned Parenthood Affiliates of California, Community Clinic Association of Los Angeles County, and the California Association of Rural Health Clinics and hundreds of others say Prop. 46 will raise costs that will cause specialists, like OBGYNs, to reduce or eliminate services to their patients. Many clinics struggle financially, particularly community clinics that serve low-income, uninsured and rural patients. Anything that increases costs could jeopardize access to care for those patients most in need.

HOW WILL PROP. 46 THREATEN PEOPLE’S PERSONAL PRIVACY? Prop. 46 forces doctors and pharmacists to use a massive statewide database filled with Californians’ personal medical prescription information. A mandate government will find impossible to implement, and a database with no increased security standards to protect personal prescription information from hacking and theft – none.

18 septem b er 2014

level of use that is expected to occur when providers are required to register beginning in 2016.”

This poses two problems: • Jeopardizes patient access to their prescriptions. Prop.

46 will force the CURES database to respond to tens of millions of inquiries each year– something the database simply cannot do in its current form or functionality. A non-functioning database system will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing needed medications to patients.

• Significantly puts at risk patients’ private medical information. Prop. 46 contains no provisions and no funding to upgrade the database with increased security standards to protect personal prescription information from government misuse, hacking, theft or improper access by non-medical professionals.

SHOULDN’T DOCTORS BE DRUG TESTED? The physician community and all health care providers are always looking for ways to improve patient safety. But don’t be fooled by Prop 46.

The drug testing provision was included for political, not policy reasons. The lawyers who wrote and funded getting Prop. 46 on the ballot have never gone to the state legislature to propose drug testing of doctors. In fact, the consultant for Prop 46, Jamie Court, cynically told the LA Times on December 10, 2013, that drug testing of doctors was “the

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Visit cme.ucsd.edu/genome to register for this event.

Physicians attending this program will be able to:

For further assistance contact UC San Diego Continuing Medical Education at (619) 543-7602.

• Review the history of genomic science as well as current trends in research.

• Examine the ethics and economics of Genomic Science.

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SAN DI EGO PHYSICIAN.org 19

ultimate sweetener,” designed to deceive voters from the real reason behind the initiative, to make lawsuits easier and more lucrative for the lawyers who wrote and funded Prop 46.

The $250,000 cap reduces incentives to file meritless lawsuits, while at the same time ensures that legitimate claims can move forward.

ARE THE DRUG TESTING PROVISIONS IN PROP. 46 THE SAME AS WHAT THE FAA AND DEPARTMENT OF TRANSPORTATION REQUIRE OF PILOTS AND AIRLINE PERSONNEL? No. In fact, Prop. 46 cherry picks portions of the FAA procedure for pilots, but excludes other important provisions that ensure due process and fairness. For instance: Prop. 46 imposes a “presumption of negligence” immediately upon a positive test or if a physician is unable to take the test within the mandated 12 hour timeframe. This is not part of the FAA/Department of Transportation regulatory framework.

WHAT ABOUT CHILDREN, SENIORS, AND LOW-INCOME CALIFORNIANS AND THE $250,000 MICRA CAP? Those who will be most hurt by Prop. 46 and the higher health care costs are the very people who are most vulnerable and least able to absorb higher costs: children, seniors, families and low-income Californians.

More lawsuits, like those that will result from Prop. 46, will increase costs for those who can least afford them. And it will reduce patient access to care.

Increasing lawsuits is not the answer and will do absolutely nothing to improve health care quality.

Anyone (disgruntled patient, co-worker, family member) could make a claim that a physician is impaired. In fact, Prop. 46 grants immunity to anyone who reports any information that “appears” to show that a physician “may” be impaired.

The FAA and Department of Transportation’s drug testing policies are designed to identify and respond to impairment that directly places passengers at risk. In contrast, Prop. 46 focuses on identifying and imposing sanctions for physician substance use during an arbitrary time period, regardless of whether there is any evidence that it places patient safety at risk.

ARE PATIENTS ONLY ENTITLED TO $250,000 IN THE EVENT OF A MEDICAL LIABILITY CASE? No. MICRA was set up to ensure patients received fair compensation if they were injured. Under MICRA, patients receive: • UNLIMITED economic damages for any and all past and future medical costs.

• UNLIMITED economic damages for lost wages and lifetime earning potential.

• UNLIMITED punitive damages - punishment awarded for malicious or willful misconduct.

• Up to $250,000 for speculative “non-economic” damages, often called pain and suffering.

20 septem b er 2014

The bottom line is that Prop. 46 will make it harder for all of California’s patients, including children, seniors, and low-income families to receive quality care.

That’s why groups like the American Academy of Pediatrics – California, California Children’s Hospital Association, Children’s Specialty Care Coalition and senior advocates like those at Curry Senior Center oppose this measure.

WON’T PROP. 46 HELP IMPROVE QUALITY BY HOLDING DOCTORS MORE ACCOUNTABLE? Even one medical error is too many and that’s why the entire health care community is always looking for ways to improve patient safety. But don’t be fooled by this measure.

The bottom line is that Prop.

46 will make it harder for all of California’s patients, including

children, seniors, and low-income families to receive quality care.

Increasing lawsuits is not the answer and will do absolutely nothing to improve health care quality. Worse, the resulting higher health care costs will put health care services even more out of reach for people who already suffer from lack of access. Community clinics, rural practitioners and safety net providers are the most vulnerable to cost increases and could be forced to cut back services.

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Vote no

46

Increased costs. Losing your doctor. Threatening your privacy.

A broad coalition of doctors, community health clinics, hospitals, local governments, public safety, business and labor opposes Proposition 46, which would make it easier and more profitable for lawyers to sue doctors and hospitals.

Have you joined the growing coalition opposed to Prop 46?

L earn M ore A t

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classifieds PHYSICIAN POSITIONS available SEEKING F/T PHYSICIAN/MED DIRECTOR: Oversee medical tx. Services for San Diego clinics. CRC Health Group operates 80 substance abuse clinics in U.S., serving over 40,000 patients with addiction to opioid drugs. Will work closely with clinic directors and clinic staff, in accordance with state and federal regulations, to provide exceptional quality care. Qualifications: 1) current MD or DO license in CA and active DEA registration without restrictions; 2) psychiatrist, addictionologist, and/or ASAM cert preferred; 3) experience treating opiate-addicted patients; 4) experience with medication-assisted treatment; 5) excellent verbal and written communication skills; 6) ability to communicate effectively with staff, patients, patientfamilies, and the public. CRC Health Group offers competitive benefits package to all F/T employees.

Send CV with salary history to rkennedy@crchealth. com or fax to (760) 744-1382. Visit our website at www.crchealth.com. EOE. [279]

censed to practice medicine in the state of California.

Opportunity for clinical research / clinical trial duties in an outpatient office setting. Professional liability insurance required. Contract salary of $200,000, or commensurate with experience. Please send CV/resume to pbhatiaxj@gmail.com. [274] LOOKING FOR EXPERIENCED GENERAL PRACTICE / EMERGENCY MEDICINE PHYSICIAN: Fulltime or part-time position available for experienced general practice / emergency medicine physician in a busy urgent care center. Must be available to work days, evenings, weekends, and holidays. Please send your CV along with references to lohara@san.rr.com or fax to (858) 274-9614. Pacific Beach Urgent Care established since 1982. Open weekdays 8–8 / weekends & holidays 8–4. [271] PSYCHIATRISTS NEEDED: Full-time or part-time positions available for a well managed program at San Diego County correctional facilities. Telepsychiatry position also available. Flexible hours with very competitive pay. Send CV to steve@cpmedgroup.com or call (619) 885-3907. [272]

PRIMARY CARE PHYSICIAN (PART TIME) (URGENT CARE — PACIFIC BEACH): We are seeking a part-time primary care physician for a well-established, busy primary care family practice / urgent care medical practice 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 send your CV in confidence for consideration to pbyrnes@andersonmedicalcenter.com. Compensation: excellent pay rate. [278]

PRIVATE PRACTICE, PART-TIME IM/FP OPPORTUNITY: Unusual and exceptionally attractive private practice, primary care opportunity in beautiful North San Diego County. Well-established, collegial, single-specialty internal medicine group with >30 years in the community, exceptional office staff, and very high quality patient care set this far apart from many other situations. Option for 1–2 days/week with flexible scheduling; very attractive opportunity as an add-on to other part-time work. Interested in boardcertified IM or FP applicants with EHR experience.

Please email CV to portofino3@aol.com or call (619) 248-2324. [263]

CARDIOLOGIST NEEDED: To cover busy outpatient practice for periodic vacations and time off scheduled from November 2014 through April 2015.

Email: albertochaviramd@yahoo.com. Phone: (760) 510-1808. Address: 334 Via Vera Cruz, Suite 257, San Marcos, CA 92078. [277]

PHYSICIAN WANTED — LA MESA / EL CAJON: Busy internal medicine practice with strong focus in geriatric patients is currently hiring a physician. Efficient, team player with compassion towards patient care is expected. Ability to use computerized EHR is important; Speech recognition Program is available for efficient documentation. Weekly / biweekly education program, including specialists’ topic discussion as well as patient case presentation are provided. Hard work, dedication, compassion, and communication skills are required. Job satisfaction will be guarantied. Opportunity to enhance the income by rounding at Grossmont Hospital and skilled nursing facilities is provided . Internal medicine work experience is desired; compensation is competitive and partnership opportunity is offered. You can apply with your CV to vprabaker@yahoo.com. [261]

LOOKING FOR A PART-TIME PHYSICIAN: Wellestablished (and growing) family practice office centrally located in the Mission Valley area is looking for a part-time physician to join their practice. Must have current licensure, be board certified, and have experience in family medicine. The ideal candidate would be available to work three days a week, including some Saturdays and 1–2 evenings per week. Salary to be determined based on hours and productivity. Please send current CV to danielle.uhl@mfpmg.com. [276] PHYSICIANS WANTED FOR OUR GROWING ORGANIZATION: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net.

Since 1970, our mission has been to provide caring, affordable, high-quality healthcare and supportive services to everyone, with a special commitment to uninsured, low-income, and medically underserved persons. Every member of our team plays an important role in improving the health of our patients and community. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more!

For more information, please call Anna Jameson at (619) 906-4591 or email ajameson@fhcsd.org. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org [046]

SEEKING P/T PEDIATRICIAN to join fun, well established pediatric practice. Opportunity to grow and long-term commitment for the right candidate. Office has EMR and stable staff. No nighttime call and occasional weekend clinic. Great family location. For more information, send CV to cvp315@sbcglobal.net. [259]

PSYCHIATRY PHYSICIAN OPPORTUNITIES: South Bay practice seeking a B/C, B/E psychiatrist li-

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JOIN HOUSE CALL DOCS INC., a dynamic group of pioneering healthcare practitioners striving for excellence while developing sound socioeconomic models of healthcare delivery. Our mobile / primary care / specialty practice complements our panoramic outpatient practices in primary care, pain management, oncology, cardiology, gastroenterology, infectious diseases, and psychiatry. Pay is among the best in the country, with part-time income in the 150K range (exclusive of incentives/bonuses). A good fit is essential. Interview questions should be directed to Dr. Wolfram Forster, Senior Partner, House Call Docs Inc., at 1855 B Street, Suite 200 B, San Diego, CA 92101; phone (619) 7937988; or email house.call.physician@gmail.com. [260]

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.

26 septem b er 2014

for full-time or buy-in. If interested, please respond to sd_I_doc@yahoo.com. All replies confidential. [257] BE IN CHARGE OF YOUR OWN DESTINY! If you are a general internist interested in becoming your own boss, this may be the opportunity for you. Patients from the practice of a retiring general internist on the campus of Scripps La Jolla need a new physician.

You would be sharing an office and overhead with another general internist who is well established on the campus and can help you make all the connections to accelerate and grow your practice. Part-time practice is even possible. Interested? Please email XimedMD@ gmail.com. [254] PART-TIME INTERNIST NEEDED: Work in an outpatient office on the campus of Scripps La Jolla. Must be board certified and have had experience treating in the primary care setting. Available immediately, with flexible hours and days. For more information, please send a CV or request for more information to XimedMD@gmail.com. [255] DERMATOLOGIST NEEDED: Board-certified or board-eligible dermatologist is needed for busy, wellestablished East County San Diego (La Mesa) private practice. We currently have an immediate opening for a CA-licensed dermatologist to work 2–3 days per week with the potential for full-time covering for existing physicians, whenever needed. We are a full-service dermatology office providing general, cosmetic, and surgical services, including Mohs surgery, and are seeking a candidate with a desire to provide general dermatology care to our patients, but willing to learn laser and cosmetics as well. If interested, please forward CV to swagner@virtualdermatology.com. [253] 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) 569-2590. Visit www.DoctorsExpressSanDiego.com for more information. [229a] 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) plus good pay. Please send CV to jeff@eastcountyurgentcare.com or fax to (619) 442-2245. [161] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing 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) 992-5330 or email CV to drhunt@thehousecalldocs.com. Visit www.thehousecalldocs.com. [037] 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 DERMATOLOGY SOLO PRACTICE FOR SALE: Mature physician is retiring December 2014 after practicing 36 years in coastal San Diego County on the campus of Scripps Memorial Hospital, Encinitas, California 92024. Professional services provided have been medical dermatology and minor dermatologic surgery. Doctor has limited his patient base to original Medicare and fee for service. New owner could add managed care and cosmetic services if desired.

Office space is leased from Scripps Real Estate. Turnkey sale could be arranged. Reply to email class259@ hotmail.com or cell phone (760) 666-0571. [275] SOLO OPHTHALMOLOGIST PRACTICE FOR SALE IN NORTH COUNTY: Physician retiring. Earn-out possible. If interested, please respond to sd_I_doc@ yahoo.com. All replies confidential. [258] 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] PRACTICE FOR SALE: Comprehensive Sleep Medicine Practice with Integrated American Academy of Sleep Medicine-accredited Sleep Testing Center. 2013 revenue $550,000. Well-known for expertise in the diagnosis and treatment of sleep disordered breathing and offering the full range of treatment options (PAP therapy, dental appliances, surgery). Both facility-based and home sleep testing performed with active referrals. Attractively furnished with up to date equipment and furnishings. Third-party appraisal available. Selling due to health issue, and offered for quick sale at a very attractive price. Small practice subset in minimally invasive nasal and sinus treatment may also be included in any transaction. Please contact adowslt@gmail.com. [250] OFFICE SPACE WANTED BANKERS HILL PRIMARY CARE / HEALTHCARE PROFESSIONAL & RESEARCH OFFICE SPACE TO SUBLEASE: 50-year established primary care practice and clinical research office, with currently two internists, have space to sublease to another primary care or primary care / subspecialist, or other independent healthcare professional, to help curb overhead and, if primary care, help with acute overflow patients’ needs. Also can provide opportunity to get into clinical research. Contact Jeff at crf@att.net. [265] 3998 VISTA WAY, IN OCEANSIDE: Four medical office spaces approximately 1,300–2,800SF available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground-floor access. Lease price: $1.75+NNN. Tenant improvement allowance to customize the suites is available. For further information, please contact Lucia Shamshoian at (760) 931-1134, ext. 13, or at shamshoian@coveycommercial.com. [234] 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] OFFICE SPACE AVAILABLE MEDICAL OFFICE IN LA MESA — LOW PRICE! Fully functional medical office, ready for move in. In perfect condition. Fully furnished or empty, depending

on your needs. Large reception area, one office, two exam rooms, restroom. Lots of storage space. Internet, phones — installed. Free patient parking. Close to public transportation and freeways. 969 square feet. $1,500/month. Contact ucsurgeon@gmail.com. [266] DEL MAR / CARMEL VALLEY MEDICAL OFFICE FOR SUB-LEASE: Available October 2014 (4765 Carmel Mountain Rd., San Diego, CA 92130). 1,000SF. Two treatment / consultation rooms / office reception / photography room / break room. Unlimited patient free parking. Call (858) 481-4888 or email mobyrne61@gmail.com. [252] SCRIPPS XIMED MEDICAL CENTER BLDG, LA JOLLA — OFFICE SPACE TO SUBLEASE AVAILABLE: Vascular & General Surgeons have space available. One room consult office available, with one or two exam rooms, to a physician or team. Located on the campus of Scripps Memorial Hospital, The Scripps Ximed Medical Center is the office space location of choice for anyone seeking a presence in the La Jolla/UTC area. Reception and staff may be available.

Complete ultrasound lab on site for scans or studies.

Full-day or half-day timeslots. For more information, call Irene at (619) 840-2400. [154] NORTH COAST HEALTH CENTER, 477 EL CAMINO REAL, ENCINITAS, OFFICE SPACE TO SUBLEASE: Well-designed office space available, 2,100SF, at the 477-D Bldg. Occupied by Vascular & General Surgeons. Excellent and central location at this large medical center. Nice third-floor window views, all new exam tables, equipment, furniture, and hardwood floors. Full Ultrasound lab with tech on site, doubles as procedure room. Will sublease partial suite, one or two exam rooms, half or full day.

Will consider subleasing the entire suite, totally furnished, if there is a larger group interest. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. [153] 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] 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, 1,467SF 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 SEEKING F/T OR P/T NP OR PA: To help patients with their quest for recovery in our San Diego Clinics. CRC Health Group operates 80 substance abuse clinics in U.S., serving over 40,000 patients with addiction to opioid drugs. Will work closely with clinic directors and clinic staff, under supervision of medical director, in accordance with state and federal regulations, to provide exceptional quality care. Qualifications: 1) current NP or PA license in CA and active DEA registration without restrictions; 2) experience treating opiate-addicted patients; 3) experience with medication-assisted treatment; 4) excellent verbal and written communication skills; 5) ability to communicate effectively with staff, patients, patient-families, and the public. CRC Health Group offers competitive benefits package to all F/T employees. Send resume with salary history to rkennedy@crchealth.com or fax to (760) 744-1382. Visit our website at www. crchealth.com. EOE. [280] NURSE PRACTITIONERS WANTED FOR OUR GROWING ORGANIZATION: See ad #046 under “PHYSICIAN POSITIONS AVAILABLE.” PSYCHIATRIC NURSE PRACTITIONER NEEDED: For part-time or full-time work at San Diego County correctional facilities. Flexible hours and very competitive pay. Send CV to steve@cpmedgroup.com or call (619) 885-3907. [273] POSITION OPEN FOR A CALIFORNIA LICENSED PSYCHIATRIC PA/NP IN IMPERIAL COUNTY: The ideal candidate is a self-driven individual interested in relocating to Imperial County, who is able to communicate in Spanish, computer skilled, and likes the challenge of working in an underserved community. Experience is not required; we will train you. Relocation expenses are covered. Base salary plus productivity bonus. Our community qualifies for loan repayment program. Part-time positions also available. For more information, contact Cruz Lopez-Castleberry at (760) 355-0161 or at orclc@sunvalleyb.com. [251] 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) 569-2590.

Visit www.DoctorsExpressSanDiego.com for more information. [229b] 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 MEDICAL CHART RACKS FOR SALE: We have five seven-foot-tall chart racks, each one three feet wide with seven shelves. They are sturdy and tan or putty-colored. Price negotiable. Call Linda at (760) 724-8749. [267] ENT AND FACIAL PLASTIC EQUIPMENT FOR SALE: We have ENT general office and exam room as well as OR equipment available. Also many excellent plastic surgery instruments for sale. ENT chairs, powered exam table, ear microscope, Kay strobe and Endodigi video unit, autoclave, ultrasonic cleaner, portable suctions, etc. Photos available. Call if interested: (858) 458-1287. [264]

SAN DI EGO PHYSICIAN.org 27

SDCMS FOUNDATION

“It just takes a bit of your time and makes all the difference to the patients. Volunteering is something we all should be doing.”

From left, Barbara Mandel; Bret Langenberg, MD, 2014 Project Access San Diego, Unsung Hero Award; Albert Ray, MD; Alberto Bessudo, MD, 2014 Project Access San Diego, Above & Beyond Award

Project Access Physician Volunteers Are All Heroes to the SDCMS Foundation

by Barbara Mandel, Executive Director, SDCMS Foundation

More than 640 physicians volunteer to help improve the health and change the lives of hundreds of uninsured, very low-income adults in our community each year through the SDCMS Foundation’s Project Access San Diego. Since the program’s inception in late 2008, more than 2,600 patients have found the healthcare needed to get back to work and care for their families. Physicians, hospitals and surgery centers, and other ancillary healthcare partners have provided more than $8.3 million in pro bono care to those most vulnerable.

Two of these dedicated volunteers received 2014 Project Access Health Hero awards at SDCMS’s White Coat Gala held in June.

Dr. Bret Langenberg, a general surgeon on the medical staff at Scripps Mercy Hospital, has been volunteering for Project Access since 2010. He provides care for many Proj28 septem b er 2014

ect Access patients, like Maria, in desperate need of colorectal surgeries due to debilitating conditions. Maria speaks for many patients when she told Dr. Langenberg, “You have given me my life back, and I am once again healthy. I hope you will continue to help others like me.”

“Treating Project Access patients has been very rewarding to me,” says Dr. Langenberg. “These patients are so appreciative after having been stuck in a ‘spin cycle’ without hope of getting the healthcare they need. There are many patients who need that help, assistance, and treatment, and realize that someone does care.”

Dr. Alberto Bessudo is an oncologist with cCare Cancer Associates, and has helped patients diagnosed with cancer through Project Access. Patients like Joel, who was diagnosed with stage 4 colorectal cancer, would not be alive today without the care

and access to chemotherapy treatment Dr. Bessudo provides.

Joel, a father of two young children, expressed his gratitude to Dr. Bessudo and the other healthcare providers who have seen him through multiple surgeries and treatments. “Thank you for what you are doing, and not only for me but for my wife and my children,” says Joel. “Thanks to Dr. Bessudo and all the doctors I have been seeing, I am here with them.” Joel is now cancer-free and back to work as a painter in North County.

“Volunteering for people who need our help is really a pleasure,” says Dr. Bessudo.

“It just takes a bit of your time and makes all the difference to the patients. Volunteering is something we all should be doing.”

Patients are referred to Project Access through their primary care provider, typically one of the 85 community health center sites throughout the county. Services range from a simple office visit to complex surgical procedures that may have impeded the patient’s health for five or more years. Because many uninsured patients seek care for painful health issues at hospital emergency departments, Project Access saves precious resources throughout the community. A research study by UC San Diego health economist Todd Gilmer, PhD, has shown the program has reduced patients’ emergency department visits by 88%, reduced in-hospital days by 90%, and reduced the number of workdays missed due to illness or injury by more than 75%.

The SDCMS Foundation is launching its diabetes prevention program, Jump Start for Health, this fall. For more information on Project Access or any of the SDCMS Foundation wellness and prevention programs, contact Barbara Mandel, executive director, at Barbara.Mandel@SDCMS.org.

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