March 2015

official publication of SDCMS March 2015

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March

Contents

Volume 102, Number 3

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: Sherry L. Franklin, MD, James Santiago Grisolía, MD, Theodore M. Mazer, MD, Robert E. Peters, PhD, MD, David M. Priver, 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 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

features Leadership & Management

8

BY TOM GEHRING, EXECUTIVE DIRECTOR AND CEO, SDCMS

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

10

Introduction

12

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

The Art of the Big Picture

14

What Does the Boss Really Do?

16

our Strategic Plan: Keep It Simple and Y Short

18

Contextual Decision-making: What Do You Know?

20

“I Don’t Have Enough Time to Get It All Done!” Important vs. Not Important — Urgent vs. Not Urgent

22

2

28 departments 4

riefly Noted: Calendar • Commercial B Real Estate • Welcome New Members • And More …

BY HELANE FRONEK, MD, FACP, FACPh

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24

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March 2015

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

8 We Are All Physician Leaders

ffective Meetings: 15 Rules to E Conduct By

I Hate Email: Taking Control of Your Inbox

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

Physician Marketplace: Classifieds

The Ever-present Possibility of Loss

BY DANIEL J. BRESSLER, MD, FACP

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 //////////////////////////////////////////////////////////////////////// 16th Annual Sharon’s Ride.Run.Walk for Epilepsy APR 26 at De Anza Cove (sharonsride2015. kintera.org/faf/ home/default. asp?ievent=1118436) 16th Annual UC San Diego Stroke Conference: Stroke 360 MAY 2 at the Skaggs School of Pharmacy and Pharmaceutical Sciences (cme.ucsd. edu/stroke)

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.

Healthcare Facility Employee OSHA & Safety Training (seminar/webinar) APR 16: 11:30am–1:00pm Physician Networking Opportunity and Mixer (social) APR 24: 5:30pm– 8:00pm Work-Life Balance Workshop for Physicians MAY 2: 9:00am– 12:00pm — hsfronek@ aol.com Financial & Legal Life Skills Workshop for Physicians JUN 6: 8:00am– 12:00pm SDCMS White Coat Gala (event) JUN 13: 6:00pm– 11:00pm The Leader’s Toolkit (workshop) JUL 11–12: 8:00am– 4:00pm & 8:00am– 12:00pm

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March 2015

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.

35th Annual Radiology Review APR 5–11 at the Hotel del Coronado (ucsd. edusymp.com/product/ brochure/52) Ulnar Collateral Ligament Injuries: An Epidemic?

APR 15 at Scripps Green Hospital (www. scripps.org/sparkleassets/documents/ sports_medicine_ seminar_2015.pdf) Oral Pathology: Helping You Guard Your Galaxy APR 17 at the Manchester Grand Hyatt San Diego (www.sdcds.org/ continuingeducation/ course/78479) Emerging Therapeutic Trends to Optimize Diabetes Care APR 17–18 at the Holiday Inn San Diego, Bayside (www.scripps.org/ events/emergingtherapeutic-trends-tooptimize-diabetes-careapril-17-2015)

Spine Injuries in Sport JUL 15 at Scripps Green Hospital (www. scripps.org/sparkleassets/documents/ sports_medicine_ seminar_2015.pdf) Critical Care Summer Session 2015 JUL 23–25 at Paradise Point, San Diego (cme. ucsd.edu/criticalcare) Pan-Pacific Biomedical Informatics Training Camp AUG 3–13 at the UC San Diego Biomedical Research Facility II, La Jolla (cme.ucsd.edu/ bioinformatics) Advanced Therapeutic Interventions to Optimize Obesity and Diabetes Care SEP 25–26 at the San Diego Marriott La Jolla (www. scripps.org/events/ advanced-therapeuticinterventions-tooptimize-obesityand-diabetes-careseptember-25-2015) Surgical Stabilization and Rehabilitation of the Unstable Shoulder NOV 18 at Scripps Green Hospital (www. scripps.org/sparkleassets/documents/ sports_medicine_ seminar_2015.pdf)

commercial real estate

San Diego Medical Office Report: Q4 2014

By Chris Ross

It’s official: Countywide medical office vacancy has fallen below the 10% benchmark. Rental rates are now steadily rising. The market is showing consistent signs of improvement, with some properties achieving record sale prices and rental rates. Investment properties have recently traded for as much as $729 per square foot. Unique owner-user properties have reached upward of $500–$600 per square foot. And the new high-water mark for Class A medical office rent is $4.00 NNN. Comps in this range are limited to very specific properties and submarkets, the point being that acquisition and occupancy costs are breaking new barriers. The wiser investors, developers, and occupiers of healthcare real estate are strategizing and planning accordingly.

As the evolving healthcare environment becomes more competitive, providers are placing a higher value on visibility, space functionality, and aesthetics. A growing number of physician groups are forging new partnerships and strategic relationships, allowing them to gain economies of scale with payers, streamline staffing needs, and add new services and technology. Additionally, these new relationships often allow practices to consolidate into larger and more efficient space with reduced overhead per provider while improving the patient experience through a more appealing environment for care.

As a result, medical tenants continue to vacate Class B- and C buildings and move into Class A and B+ properties. So while countywide vacancy has dropped a healthy 120 basis points over the past year, the Class A and B+ MOB market has improved more substantially.

Class A vacancy has been cut in half over the past two years, dropping from 13.3% at the end of Q4 2012 down to 6.6% today.

The countywide average asking rate is now at $2.54 per square foot, up 2.7% from 12 months ago. This upward trend has only just begun since increases in rental rates tend to lag vacancy compression and reduction in concessions, two trends that have been steadily occurring over the past 24 months.

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. To receive the complete Q4 2014 report, call Mr. Ross at (858) 410-6377 or email him at chris.ross@am.jll.com.

/////////////////////////////////////////////////////////////////////////////////////////////////// SDCMS-CMA Membership

quote of the month

Welcome New and Returning SDCMS-CMA Members!

New Members David W. Cline, MD Diagnostic Radiology Coronado (619) 532-6854 Tina J. Dhillon-Ashley, MD Obstetrics and Gynecology Oceanside

David P. Gallus, MD General Surgery San Diego (619) 532-7577

Edward S. Rotunda, MD Emergency Medicine Carlsbad (760) 439-1963

Dan O. Harper, MD Family Medicine Solana Beach (858) 755-1126

Kenneth C. Vitale, MD Physical Medicine and Rehabilitation San Diego (619) 543-2539

Jared H. Heimbigner, DO Diagnostic Radiology Poway (619) 280-4213

Ariana N. Dillman, MD Emergency Medicine Carlsbad (760) 439-1963 Colin M. Dougherty, MD Emergency Medicine Carlsbad (760) 439-1963

Veronica Nicholas Mahon, DO Obstetrics and Gynecology San Diego (619) 280-4213

WELCOME RETURNING MEMBER Beth Ann Zelonis-Shou, MD Emergency Medicine Carlsbad (760) 439-1963

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5

/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// SDCMS-CMA Membership

Congratulations and Thank You to the Following Physicians Who Have Been Paid SDCMS Members for a Third of a Century and Longer!

NOTE: Current SDCMS-CMA Members as of March 10, 2015 SDCMS Member Physician’s Name • Years of Membership Joseph DeLuca, MD • 67 Alanson A. Mason, MD • 60 Robert M. Barone, MD • 57 Lino P. Trombetta, MD • 55 Raymond Dann, MD • 53 Ernest E. Pund Jr., MD • 52 Edward J. Sheldon, MD, FAAFP • 52 Garry E. Goldfarb, MD • 49 Robert Penner, MD • 48 Raymond M. Peterson, MD • 48 Myron Schonbrun, MD • 48 Richard N. Learn, MD • 47 Allan H. Rabin, MD, DLFAPA, DFAACAP • 47 John A. Berger, MD • 46 Allan H. Goodman, MD • 46 George W. Kaplan, MD • 46 Leonard D. Rutberg, MD • 46 Miguel A. Losada, MD • 45 William L. Nyhan, MD • 45 Robert M. Thomas Jr., MD • 45 Steven A. Balch, MD • 44 Elaine H. Cohen, MD • 44 H. Douglas Engelhorn, MD • 44 James C. Esch, MD • 44 Edwin B. Fuller, MD • 44 Sidney H. Levine, MD • 44 Richard D. Perlman, MD, MPH, FACS • 44 Fernando A. Zamudio, MD • 44 Lawrence N. Cooper, MD • 43 Franklin A. Crystal, MD • 43 Anthony J. Cuomo, MD • 43 Steven R. Drosman, MD • 43 Thomas A. Flanagan, MD, DFAPA • 43 Ronald J. Goldman, MD • 43 Leon R. Kelley, MD • 43 Victor H. Lipp, MD • 43 William G. Moseley, MD • 43 David R. Schmottlach, MD • 43 Russell S. Weeks, MD • 43 O. Douglas Wilson, MD • 43

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March 2015

Dennis F. Coughlin, MD • 42 George D. Gibson, MD • 42 Edward M. Goldstein, MD • 42 Danny L. Keiller, MD • 42 Thomas G. Neglia, MD • 42 William A. Pitt, MD • 42 Carlos J. Sanchez, MD • 42 David J. Shaw, MD • 42 Dee E. Silver, MD • 42 Lawrence P. Bogle, MD, FACR • 41 Frank E. Corona, MD • 41 Yaroslav Kushnir, MD • 41 Jerome S. Litvinoff, MD • 41 John B. Marino III, MD • 41 Joseph Shurman, MD • 41 James P. Tasto, MD • 41 John M. Casey, MD • 40 Ronald E. Feldman, MD, FACG, FACP • 40 Henry E. Golembesky, MD • 40 Richard Greenfield, MD • 40 Vincent J. Guzzetta, MD • 40 Michael I. Keller, MD • 40 Steven M. Leshaw, MD • 40 Stuart C. Marshall, MD • 40 G. Douglas Moir, MD • 40 Kenneth Ott, MD, FACS • 40 Bruce M. Prenner, MD • 40 Stephen L. Reitman, MD • 40 William F. Resh, MD • 40 Thomas R. Vecchione, MD • 40 Richard L. Buccigross, MD • 39 Douglas H. Clements, MD • 39 Nicholas R. Frost, MD • 39 Theodore G. Ganiats, MD • 39 Harry C. Henderson III, MD • 39 P. Lance Hendricks, MD • 39 Leonard M. Kornreich, MD • 39 Leland D. Lapp, MD • 39 Marc J. Lebovits, MD • 39 Marshall J. Littman, MD • 39 Peter H. B. Mccreight, MD • 39 Robert S. Scheinberg, MD • 39 Jeffrey W. Selzer, MD • 39 Paul F. Speckart, MD • 39 Michael J. Thoene, MD • 39

Patricia C. B. Vennwatson, MD • 39 Arthur B. Warshawsky, MD • 39 Eric C. Yu, MD • 39 Robert E. Brucker Jr., MD • 38 James E. Bush, MD • 38 Paul B. Dean, MD • 38 Stewart L. Frank, MD • 38 Daniel Gardner, MD • 38 Mitchel P. Goldman, MD • 38 Gary L. Isley, MD • 38 Wayne L. Iverson, MD, MBA, FACP • 38 Adrian M. Jaffer, MD • 38 Michael K. Kan, MD • 38 Richard A. Katz, MD • 38 Donald C. Lipkis, MD • 38 Jon H. Lischke, MD • 38 Merritt S. Matthews, MD • 38 Howard G. Milstein, MD • 38 Rodrigo A. Muñoz, MD • 38 Robert C. Pace, MD • 38 Edward L. Racek, MD • 38 Ruth M. Robles-Goche, MD • 38 Robert J. Santella, MD • 38 Barry M. Scher, MD • 38 Edward L. Singer, MD • 38 Seung-Yil T. Song, MD • 38 Robert M. Stein, MD • 38 Richard L. Stennes, MD • 38 John Randolph Backman, MD, FACC, FACP, FACSM • 37 Lawrence D. Eisenhauer, MD, FACOG • 37 Leon Fajerman, MD • 37 Theodore L. Folkerth, MD • 37 Athanasios J. Foster, MD • 37 Richard G. Friedman, MD • 37 James T. Hay, MD • 37 Roy A. Kaplan, MD • 37 Jerry Kolins, MD • 37 Charles R. Kossman, MD • 37 William P. Mann, MD • 37 Leslie A. Mark, MD • 37 Thomas E. Page, MD • 37 Arthur C. Perry, MD • 37 Scott A. Riedler, MD • 37 Jeffrey M. Rosenburg, MD • 37 Steven M. Steinberg, MD • 37 Robert S. Yuhas, MD • 37 William T. Chapman, MD • 36 Gregory T. Czer, MD • 36 Victor M. Dalforno, MD • 36 Blaine A. Fowler, MD • 36 Edward B. Friedman, MD • 36 Paul M. Goldfarb, MD • 36 Michael Gordon, MD • 36 James Santiago Grisolía, MD • 36 James A. Helgager, MD • 36

/////////////////////////////////////////////////////////////////////////////////////////////////// Charles K. Jablecki, MD • 36 R. Bruce Johnson, MD • 36 Joseph F. Leonard, MD • 36 Louis J. Levy Jr., MD • 36 Dom Antonio Lopez-Velez, MD • 36 Jose E. Otero, MD • 36 Michael J. Rensink, MD • 36 Steven R. Ruderman, MD • 36 Jeffrey A. Sandler, MD • 36 Maurice P. Sherman, MD • 36 Paul L. Treger, MD • 36 Bernard J. Urlaub, MD • 36 Raymond M. Vance, MD • 36 Benito Villanueva, MD • 36 Marvin J. Zaguli, MD • 36 Robert W. Ziering, MD • 36 Nicholas A. Zubyk, MD • 36 Lance L. Altenau, MD • 35 Carroll D. Bucko, MD • 35 David C. Campbell, MD • 35 Irene L. Chennell, MD • 35 Jorge M. Delaguila, MD • 35 Thomas R. Farrell, MD • 35 Carla G. Fox, MD • 35 Robert A. Ginsberg, MD • 35 David P. Hansen, MD • 35 William P. Hitchcock, MD • 35 Marilyn C. Jones, MD, FAAP • 35 Rokay G. A. Kamyar, MD • 35 Murray J. Kornblit, MD • 35 Eva P.-S. Leonard, MD • 35 Albert L. Martinez, MD • 35 Jeffrey B. Mazin, MD • 35 Gary P. Mcfeeters, MD • 35 S. Michael Millbern, MD • 35 James S. Otoshi, MD • 35 Alexander Rodarte, MD • 35 Nathaniel G. Rose, MD • 35 Eugene W. Rumsey Jr., MD • 35 Laurence K. Tanaka, MD • 35 Donald P. Tecca, MD • 35 Gary Vandenberg Jr., MD • 35 John E. Welton, MD • 35 Michael C.-W. Wong, MD • 35 John A. Wright Jr., MD • 35 George G. Zorn III, MD • 35 Thomas C. Adamson III, MD • 34 Jorge T. Arce, MD • 34 Gonzalo R. Ballon-Landa, MD • 34 Frank D. Bender, MD • 34 Michael T. Bennett, MD • 34 Duane M. Buringrud, MD • 34 Kenneth W. Carr, MD • 34 Harold Copans, MD • 34 Dennis L. Costello, MD • 34 John H. Detwiler, MD • 34

Peter S. Friend, MD • 34 Robert L. Gagnon, MD • 34 Steven R. Garfin, MD • 34 Jeffrey I. Gorwit, MD • 34 Said M. Hashemi, MD • 34 Robert E. Hertzka, MD • 34 Paul V.B. Hyde, MD • 34 Gary M. Jacobs, MD • 34 Nancy Kollisch, MD • 34 John A. Lafata, MD, FACP • 34 David R. Ostrander, MD • 34 Richard E. Payne, MD • 34 Glenn O. Plummer, MD • 34 Gary Prodanovich, MD • 34 Joseph E. Scherger, MD • 34 Paul R. Woody, MD • 34 James M. Amberg, MD, ABFP • 33 Rosa M. D. Arias, MD • 33 William E. Bowman Jr., MD • 33 Ira R. Braverman, MD • 33 Stephen H. Carson, MD • 33 Maria E. Castillejos, MD • 33 Edward S. Cohen, MD • 33 Terrence W. Crouch, MD • 33 Violeta B. Curbelo, MD • 33 Brian Datnow, MD • 33 John W. Fox Jr., MD • 33 Roger A. Freeman, MD • 33 Frank J. Goicoechea, MD • 33 Kuljinder S. Grewal, MD • 33 Kenneth G. Gross, MD • 33 Ronald R. Harrington, MD • 33 Marc E. Kramer, MD • 33 John M. Kroener, MD • 33 Julian P. Lichter, MD • 33 Gregory B. Mahan, MD • 33 Thomas D. Martinez, MD • 33 Bernard A. Michlin, MD • 33 William J. Mittendorff, MD • 33 Paul Neustein, MD • 33 Laura A. O’Donnell, MD • 33 Stanley W. Perkins, MD • 33 Michael G. Plopper, MD • 33 Layne J. Rasmussen, MD • 33 Stephen N. Rogers, MD • 33 Richard F. Santore, MD • 33 Jerome L. Sinsky, MD • 33 David P. Slack, MD • 33 M. Hertzel Soumekh, MD • 33 Randal J. Vecchione, MD • 33 Michael J. Welch, MD • 33 Barry G. Zamost, MD • 33

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P e r s o n a l & P r o f e s s i o n a l D e v e lo p m e n t

We Are All Physician Leaders

by Helane Fronek, MD, FACP, FACPh Years ago, I mistakenly believed that providing excellent medical care to patients was my only role. My employees were unengaged, communication faltered, and morale plummeted as I failed to involve my team and appropriately address certain issues. I didn’t realize that we physicians are leaders. We may not have thought we were signing up for that when we applied to medical school, but the truth is that we are often expected to lead — in our practices, families, and communities.

Unfortunately, medical education doesn’t teach those skills. Our training rewards individual medical competence and an almost selfless devotion to our work — not much grist for leadership there. In their classic work, The Leadership Challenge, Kouzes and Posner define five competencies of effective leadership:

8

March 2015

1. Challenging the Process in Order to Grow and Innovate 2. Inspiring a Shared Vision 3. Enabling Others to Act 4. Modeling the Way Through Behavior That Reflects Shared Values 5. Encouraging the Heart by Regularly Recognizing Individual and Team Accomplishments How can we use these suggestions to become better leaders?

We begin by reflecting on what is important to us. What values do we want our practice to embody? Do we want to be known for compassionate care? Cuttingedge medicine? Integration of complementary medical philosophies and techniques?

Why is that important? Do we believe in the self-healing power of the human body, being the first to offer new and innovative

treatments in our community, providing tested, reliable approaches to our patients’ conditions? We then present our intentions to staff and colleagues and ask for their ideas, suggestions, beliefs. Together, we create a clear vision that all can commit to.

What needs to change in order to make this a reality? A great leader will critically challenge the status quo in service of improvement or readiness for future challenges. How can we do things better, more efficiently, and promote greater engagement? Although physicians have historically operated as “lone wolves,” medicine is increasingly a team sport. By determining the skills and interests of our teammates, we can encourage them to use the abilities they possess and to grow by developing new competencies, all in service of our shared vision. As wise leaders, we seek honest feedback on our own behavior. Is it congruent with our stated values? Does it reflect both confidence as well as openness to change and to the opinions of others?

We seek help to hone new skills. Finally, we acknowledge the contributions of our team — both individuals and the group as a whole. We inspire more of the behaviors we reward. Recognizing effort and good work builds team spirit and commitment to shared goals.

Each step requires reflection, intention, and action. If we are to become the leaders to effectively guide our practices and organizations through the evolving future of healthcare, we need to approach leadership as we did our medical competencies, accept its increasing importance in our careers and our lives, and take action to acquire these valuable competencies. After all, don’t we want physicians leading the future of healthcare?

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.

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Physician

Leadership

t p i n h e s m r e e g d a a n e L ma

10

March 2015

18 Table of Contents

12

Contextual Decision-making

20

Introduction

By Tom Gehring

Leadership, except for the singularly blessed, is a learned art. Very few physicians have the time or the opportunity to learn leadership during their medical training. A decade ago, when SDCMS realized that we could help train tomorrow’s leaders, we created the Leaders Toolkit, a day and a half intense but fun Socratic seminar on how to lead — and how to manage! As of this past March 14–15, we have exposed 247 healthcare leaders to the principles and basic concepts of leadership.

The following articles highlight some of the key skills that every leader must master, no matter how small or large the organization. These seven articles are not meant to be inclusive or particularly detailed; they are meant to give you an overview, and a taste of what you could learn during the Leaders Toolkit. The next two seminars are July 11–12 and September 19–20; please email me if you are interested — the most typically heard comment at the wrap-up is, “I wish I had taken this course earlier.” If you need any references or any other ideas on how to improve your leadership skills, do not hesitate to contact me at (619) 206-8282 or at Gehring@SDCMS.org.

Lead on!

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

The Art of the Big Picture “I Don’t Have Enough Time to Get It All Done!”

14 What Does the Boss Really Do?

22 Effective Meetings

16 Your Strategic Plan

24 I Hate Email

SAN DIEGO PHYSICIAN.org

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Physician

Leadership

The Art of the Big Picture

By Tom Gehring

The boss has to have the big picture! As well, the boss has to have a grasp of (some) critical details. Managing these sometimes-conflicting perspectives — seeing the forest for the trees, as well as the microscopic detail on the trees — is a critical leadership skill.

By design, the CEO is the only person who has access to everything in the organization.

In addition, the leader has the senior-level contacts outside the organization to sense the context, the environment. From these many sources and many pieces of information, you must create a (big) picture of what’s happening to you and your organization.

An important caution is in order: Just because you can have all the information does not mean you should. You have to be selective or else you’ll drown in (not helpful) data. You should have written instructions on what data or information you expect to get at what frequency — and that should be very carefully thought through.

A sophisticated leader must differentiate between data and actionable intelligence.

Having a lot of numbers is nice, but being able to draw conclusions from those numbers is the goal.

In today’s numbers-obsessed world, it’s important to remember that qualitative or subjective analysis can be just as important as numerical data. In fact, the more complex the system, the more it requires non-numerical data to truly understand.

The overworked metaphor, “connecting the dots,” is just another way of saying that you interpolate between many sources/ many data points to build a picture, a

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The surest way for a leader to fail is when data or information about things not going right does not make it to her.

model, of what is happening now, as well as what happened in the past.

But it is not enough to simply interpolate the data, looking at the past and creating a coherent picture of the present.

It is just as important to extrapolate, to project into the future. Yogi Berra famously said that it’s tough to make predictions, particularly about the future; however, that’s part of your job description as the leader.

The scenario-planning process is particularly helpful for prognostication because, while very few people have the ability to absolutely determine what’s going to happen in the future, many are able to create multiple, realistic possible scenarios. The essence of scenario planning is understanding what the possible future realities are, and identifying the signposts that tell you which reality/scenario is coming to fruition.

Understanding when the current reality is dramatically changing is another way of saying that you are looking for inflection points. Many companies, many industries, many civilizations change very quickly,

and the leader’s role is to anticipate change by spotting the early signs of an inflection point.

While many of us are trained to look for data or information, one of the most sophisticated skills of a leader — which often comes with experience — is looking for the absence of data or information. Said differently, what should’ve just happened that didn’t? A sophisticated leader will be able to tell just as much from what just didn’t happen as what just did — the absence of normal.

Finally, it is so important that the leader get the bad news, the data that indicates that something bad is happening. The surest way for a leader to fail is when data or information about things not going right does not make it to her. When something goes wrong, the CEO must clearly and fundamentally understand the “why” of what just happened, what I call “turning over every rock.” But in order to do that introspection, she has to know about it in the first place.

For me, developing the big picture and using it to inform decisions is one of the most critical skills in leadership.

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

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What Does the Boss Really Do?

By Tom Gehring

As SDCMS’ CEO, I have to constantly ask myself what my job consists of; what, in general, my board expects me to do. Not the penny-ante stuff, but the really, really important stuff. This is a question that should run (frequently) through the mind of every leader, from the CEO of GE to the physician leader of a solo practice.

I would argue that the leader has six nonnegotiable responsibilities: • Sense the big picture.

• Articulate the vision.

• Make sure people have the tools to achieve the vision.

• Set the boundaries.

• Make the really big decisions.

• Accept responsibility.

Let’s look at each of these in a little bit of detail.

The only person who has access to all the information in the organization is you! You have to build, from many sources and many pieces of information, a (big) picture of what’s happening to you and your organization. That involves interpolation, extrapolation, sensing inflection points, looking

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for the absence of data as information, and, finally, being able to tell the forest from the trees. One of the most important traits of an effective leader is the ability and willingness to, when something goes wrong, clearly and fundamentally understand the “why” of what just happened — what I call “turning over every rock.”

If you don’t know where you’re going, any path will get you there. You, as the boss, have to be able to say strategically, and often tactically, “This is where we’re going,” and, “Oh, by the way, this is how we’ll know when we’ve gotten there.” You have to articulate, in simple (read: short) terms, what you want the group to achieve.

For example, SDCMS staff has set a goal of 180 net new physician members in this fiscal year. A goal that’s easy to understand, easy to measure every action against, easy to state, hard to accomplish, but it’s a target we’re all collectively working toward.

Make sure your team has the tools to get there. And we’re not talking pens and paper.

We’re talking hardware, software, warmware (the right people necessary to accomplish the tasks), the resources (money), and the environment that supports your team.

If we’re going to bring in 180 net new SDCMS physician members, we have to have a recruiting budget — asking SDCMS staff to accomplish this goal without a recruiting and retention budget is straight out of Dilbert.

Set the boundaries, but set them smart.

Make the boundaries clear but not restrictive. Make sure your team knows that they must challenge/push the boundaries, but never, ever exceed your boundaries without your permission. While some of these boundaries are ethics- and morals-based (we will not lie, cheat, or steal), many are very simple. And, if one of your team violates a boundary that you as the boss did not

Auditing

Practice Management

Contracting

Relocation Management

Credentialing

Technological Advances

Billing Service

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

Business Growth Executive Assistant Financial Management EHR Meaningful Use Support Operational Management Practice Assessment

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We can help - absolutely! lutions So Celebrating

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articulate, you can only blame yourself.

For example, anyone on the SDCMS staff may commit up to $500 in resources without asking me first.

You have to be able to make the really big decisions. Hiring, firing, committing major resources, stopping a project, the list could go on and on.

Many bosses recognize that a big decision has to be made, but then they make two cardinal errors: They either can’t make the decision, or they make the decision in an erroneous manner (more on how to make decisions in the next installment).

Let’s say you just caught your most valuable employee red-handed in a major lack-of-integrity problem. Do you have the gumption to fire him? Only you can do so (and firing him may not be the answer until you fully investigate the issue), and if you make the wrong move, everyone will know.

Accept responsibility. Be in charge in time of crisis (and avoid the urge to be in charge of everything — that’s called micromanagement). Physicians get this on a clinical level, i.e., you know to be in charge when the patient is crashing. Your non-clinical responsibilities are no different. You cannot delegate decision-making when the world is crashing down around you. Be in charge!

During the 2007 wildfires, County Supervisor Ron Roberts and Mayor Jerry Sanders were on television three, sometimes four times a day. Everyone in San Diego County knew who was making the decisions, and we wanted that!

So remember: Sense the big picture, articulate the vision, provide the tools, set the boundaries, make the decisions, and accept responsibility.

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Physician

Leadership

Your Strategic Plan Keep It Simple and Short

outcomes



Vision

metrics

Where you want to be



By Tom Gehring

SWOT

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Strengths

Opportunities

Weaknesses

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guiding principles

Environment

Mission What you do

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priorities

I am a big believer in KISS: Keep It Simple and Short.

Your strategic plan starts with the environment. Absent a clear understanding of the world you inhabit, everything is wishful thinking. Using SWOT analysis to clearly articulate your strengths and weaknesses, and the opportunities and threats inherent in the world you cannot control, will go a long way toward clearly understanding the environment that you are unlikely to change.

You must understand your mission — what you do, who you do it for, and how you do it — so that you have a baseline from which to start. Often the mission is part of

either statutory or bylaws language, which you may not be likely to change.

Your vision must be a compelling statement about where you want to be at some point in the future — months, years, or decades.

Guiding principles are the rules you want to live by as you are getting to your vision.

Strategies are vectors, tasks, actions, methods — in fact, anything that gets you from here to there — that takes you from what you are doing today, your mission, to where you want to be tomorrow, your vision.

Priorities are the sequence of strategies.

Metrics are how you measure the accomplishment of strategies.

Finally, outcomes measure the achievement of the vision.

A little bit of common sense and some hard work and you’re ready to start your strategic plan.

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

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SAN DIEGO PHYSICIAN.org

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Physician

Leadership

Contextual Decision-making What Do You Know?

By Tom Gehring

Many think about decisionmaking by assuming that all decisions are made in essentially the same manner. In this article I’ll discuss why decisions need to be made in context.

Let me start with an example: A patient comes into the ER with severe trauma. While the outcome may not be preordained, the protocols are clear — the decision-making is (nearly) straight line, i.e., cause and effect, because in this case we are dealing with (mostly) “known knowns,” and there is usually one “right” answer.

This in no way diminishes the skill necessary to do the right thing; becoming an effective trauma surgeon takes decades. However, the process of making decisions in this case is referred to by David Snowden and Mary Boone in their Harvard Business Review article as “The Simple Context — The Domain of Best Practice” (“A Leader’s Framework for Decision Making” by David J. Snowden and Mary E. Boone, Harvard Business Review, November 2007). Since I don’t want to focus on medical decision-making, let’s try another example: executing a budget. The facts are (usually) clear, and the actions to

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The single most important message for the reader is to understand which context you are in and then apply the appropriate decisionmaking style.

be taken if off budget are (usually) clear. We adhere to best practices. What should the leader do in this context? Avoid micromanaging, make sure people don’t become complacent by ensuring every anomaly is investigated, and make sure processes are adhered to.

What happens if there are multiple right answers?

This is the realm of “known unknowns.” Rather than make a simple cause-effect decision, we need to investigate multiple options and choose between them. There is often incomplete and even conflicting information. Experts are often helpful in providing the information necessary to make decisions. What must the lead-

er do? Investigate all the options, ensure that all the experts are heard from, make sure the “wild and crazy” ideas of the nonexperts are considered, avoid analysis paralysis, and, in the end, as all leaders must do, make the decision. The best medical example would be a patient who comes in with multiple, undifferentiated symptoms. In this case, the treating physician must marshal all of the relevant experts to come up with a diagnosis, often in the face of incomplete information and multiple strong opinions. Snowden and Boone refer to this as the “complicated context — the domain of experts.”

What happens if there is no right answer?

If the decision-making context is filled with unpredictability, incomprehensible change,

KNOWN KNOWNS:

SIMPLE CONTEXT

KNOWN UNKNOWNS:

COMPLICATED CONTEXT

UNKNOWN UNKNOWNS:

COMPLEX CONTEXT

UNKNOWABLES:

CHAOS

and often a complete lack of understanding (except in retrospect) of what is going on?

Then we are in the domain of “unknown unknowns” — the most challenging decision-making environment for a leader, and the context in which we increasingly find ourselves. Consider two problems: repairing a Prius and building a power line through a desert preserve.

A Prius is a complicated machine and takes an expert to fix, but there are technical manuals, there are a finite number of parts, and, in the end, the Prius is the sum of its parts. The ecology of the desert preserve, on the other hand, is never the same: There is constant change, there are many stakeholders, and there is conflicting science, i.e., the whole is more than the sum of the parts. Snowden and Boone refer to this as the “complex context — the domain of emergence.” For leaders used to the dictum “don’t just stand there, make a decision,” the complex context is nerve-racking because it calls for the leader not to make snap decisions, not to try to impose order (or a tried-and-true model) on a situation that is oh-so-unclear, to foster creativity and experimentation, and to be patient.

Finally, we have a “chaotic context —

the domain of rapid response.” Quoting Snowden and Boone, “In a chaotic context, searching for the right answer would be pointless. The relationships between cause and effect are impossible to determine because they shift constantly and no manageable patterns exist, only turbulence. This is the realm of the unknowables. The events of September 11, 2001, fall into this category.

The leader’s task is obvious — and the exact opposite of the complex context: communicate and direct in a “top-down” manner (there is no time for input or committee meetings) to establish order. Paradoxically, the leader must look and listen for signs that stability is emerging and then revert to the leadership styles of the complex context.

Having reviewed the four basic contexts of decision-making — simple, complicated, complex, and chaotic — the single most important message for the reader is to understand which context you are in and then apply the appropriate decision-making style. Applying the right style for the given context is just using the right tool for the task!

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

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Physician

Leadership

“I Don’t Have Enough Time to Get It All Done!”

Important vs. Not Important — Urgent vs.

Not Urgent

By Tom Gehring

If there is one cry heard throughout the working world, it has to be “I don’t have enough time to get it all done!”

Well, people are right: There is never enough time to get it all done. But let me challenge the assumption that all needs to get done!

Stephen Covey, in his numerous books, explains that any task can be parsed along two axes: important vs. not important, and urgent vs. not urgent.

We spend a huge percentage of our time in category 3: items that are urgent but not important! The best examples are phone calls and emails. Most, if not all, phone calls and emails are urgent (usually by someone else’s definition) but, fundamentally, not important!

Category 4 tasks, which are not urgent and not important, are usually obvious and require little talent (but much willpower because they are often fun) to push to the bottom of the pile or straight into the trash.

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Similarly, category 1 tasks — important and urgent — are easy to spot; I refer to these as firefighting tasks.

The real genius in Stephen Covey’s analysis of our tasks, and how we allocate time to them, is in recognizing that, unless trained or naturally brilliant, people spend little if any time on category 2 tasks: not urgent but important. Category 2 is where actions with strategic and/or long-term impact are accomplished. These tasks require significant thinking and unconstrained time. Unless you force yourself to make time for these tasks, they will never get done because there will always be something more “urgent” to consume your limited time.

Self-awareness is critical to effectively managing your limited time. I am most effective early in the morning before the phones start to ring and everyone starts responding to last night’s emails. When I need to do category 2 work, I do it early in

The real genius in Stephen Covey’s analysis of our tasks, and how we allocate time to them, is in recognizing that, unless trained or naturally brilliant, people spend little if any time on category 2 tasks: not urgent but important.

TrusT URGENT

NOT URGENT

IMPORTANT

1

2

NOT IMPORTANT

3

4

the morning. My wife is the exact opposite: She does her best work late at night. The key is to know when you are most effective and to allocate that time for the important and not urgent tasks.

Is this really a crisis? Being in charge (or thinking you’re in charge) affords one the option of saying, “No, that’s not a crisis. I can do that later.” Turn off the phone, turn off the computer, and shut the door. In a world were multitasking is the norm, try single-tasking by eliminating the distractions. Again, being in charge affords one the luxury of saying, “Do not interrupt.”

In a later article, I talk about the four Ds — Do, Delegate, Delay, or Delete — as they apply to emails. When something comes across your desk, do it, delegate it (and, if necessary, use a tasking or tracking mechanism), delete it (the trash is a wonderful management tool), or delay the task based on assignment to category 3 or 4.

PRIORITIZE RUTHLESSLY: There are many systems to prioritize: A, B, C; 1, 2, 3; or red, yellow, green. The pitfall in prioritizing is having the preponderance of your tasks as A’s or 1’s or reds. Dilbert’s boss (the cartoon character) is a caricature of the boss whose priorities are all A’s.

KEEP A LIST: It’s so obvious that people often fail to do so. Whether that list is virtual, physical, on paper, or on 3x5 cards doesn’t matter. The key is to have an understanding of the totality of your tasking.

THE DE FACTO STANDARD FOR TIME MANAGEMENT is Microsoft Outlook. The most underutilized feature in Outlook is task management. While the system is rudimentary, it does afford one the ability to drag an email directly to the task module. In addition, you have the ability to prioritize and categorize tasks within Outlook.

TOUCH EACH TASK ONLY ONCE: If you allow work to pile up in your physical or virtual inbox because you make multiple, small attempts to complete the task, you will have an overflowing work list. If possible — and it may not be — complete each task when you start it.

PERIODICALLY, RUTHLESSLY GO THROUGH YOUR ENTIRE INBOX, and make sure your trash can is close at hand!

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

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Physician

Leadership

You owe it to the participants to manage the meeting so it ends on time. I announce the schedule and the end time of the meeting right up front, and ask everyone’s help in making it so.

3.

Effective Meetings 15 Rules to Conduct By

By Tom Gehring

The only phrase heard more frequently than “I hate these meetings” is “Why are we having this *&^%$#@ meeting?” I want to shed some light on how you can chair effective meetings. ¶ I have written this from the perspective of the person convening the meeting — the assumption is that you are in charge of the meeting. If you aren’t, as physicians, you are usually in a position to influence, so even if you are only a participant, I would argue the below rules are applicable. ¶ Here are 15 rules about meetings that I have found to be extremely useful.

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1.

Clearly identify the purpose of the meeting well in advance.

At the start of every meeting, I ask participants, “What is the purpose of this meeting?” and, just as important, “What are the expected deliverables?”

2.

Start and end on time.

My standard question at 11 o’clock, is, “What time is the 11 o’clock meeting starting?” As the leader, be in a position to observe the clock, without being obvious.

Designate the scribe. In almost every situation, a scribe should record decisions reached and actions assigned, versus a verbatim transcript. The scribe should not be one of the principals, as taking notes detracts from their participation.

4.

Have an agenda.

Seems obvious, yet the number of meetings without an agenda is amazing.

5.

Stick to the agenda. Seems even more obvious, yet absent a firm hand, your meeting can easily wander off into uncharted territory.

6.

If the right people can’t make it, reschedule the meeting. Be very careful of accepting substitutes who are not fluent in the issue.

7.

If you (and more importantly, if the participants) are not prepared, reschedule the meeting.

8.

Listen. If the purpose of the meeting is to make a decision, and you’re in charge, then stop talking until everyone, particularly the junior participants, has opined.

9.

If you don’t have all the information you need to make the decision, then adjourn until you do.

10.

Do not tolerate inappropriate or rude behavior.

If someone personalizes an issue, if someone prattles on, or if someone’s behavior is inappropriate, then the meeting participants expect you to stop it. If you don’t, this aberrant behavior will be perceived as the norm, and will multiply.

11.

Make the decision. After all the opinions have been heard, and after a

consensus has been reached, decide. If it is clear that there has been no consensus, then you have to make the decision to adjourn until more data is obtained or decide without a consensus. Don’t “kick the can down the road” unless you are missing key data.

12.

Assign action items and, more importantly, deadlines.

13.

Summarize the results of the meeting and schedule the next meeting (if appropriate).

Failure to state, publicly and succinctly, the outcome of the meeting can result in people leaving with incorrect (sometimes deliberately so) assumptions.

14.

Get the minutes out, quickly.

15.

Have a shared norm for use of handheld devices, including phones and computers, during the meeting.

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

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Physician

Leadership

I Hate Email

Taking Control of Your Inbox

By Tom Gehring

I hate email! No, I love email.

No, I hate email! Sound familiar? Love it or hate it, physicians today no longer have the option of ignoring email.

On an average day, I receive between 100 and 150 non-spam emails. How to deal with the onslaught? First, read the email tech manual. The book Send: The Essential Guide to Email for Office and Home by David Shipley and Will Schwalbe is probably the best description of how to effectively use email and avoid its many pitfalls. I have given it to every member of my team and every physician in SDCMS leadership — that’s how good it is.

Email is divided into two broad categories: reading and sending. Here’s my routine for an email reading session: • First, I go through every email in my queue and read every subject line, ruthlessly deleting — without opening or reading the text — every email that looks like junk or appears irrelevant, based only on the sender, the subject line, or both. If it’s junk, don’t forget to teach Outlook to ignore all future emails from that sender.

• Then, I triage every incoming email into

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one of four categories: requests for action, information for me, requests for information from me, or scheduling. If it does not fit into one of those categories, it’s most likely junk, and I will delete it.

• Now I go back to the top and open each email (most recently received first) and ruthlessly apply the 4Ds: Do, Delegate, Delay, or, my favorite, Delete.

• If, when I open the email, it turns out to be junk, that’s easy: I delete it.

• If it’s information for me, I read it, assimilate it, then either delete it or move it to a folder (see below on folders). I’m ruthless — I don’t leave it in my inbox.

• If it’s a request for action (sometimes embedded in information emails), I then do it, delegate it, or delay it. Once I do it, I delete it from my inbox. If I delegate it, then I move it to a folder for the individual for whom I’ve delegated it. If I delay it, then I either assign it as a task or as an event, at which point I move it to a folder labeled “Pending.”

• If it’s a request for information, see item above.

• If it’s scheduling, then I respond and

move it directly to my calendar — I do not leave it in my inbox. Outlook is very powerful about dragging and dropping from email to calendar.

I have a simple metric for my inbox: If it’s empty, that’s fabulous. If it has between three and five extremely high priority current items, that’s OK. If it has more than 10 items, then I need to go back to the triage cycle.

I’m a big fan of this simple rule: Touch every email exactly once. Hard to do in practice — and there will be exceptions — but, in general, if you follow the rule, you’ll stop wasting time.

Develop a useful hierarchy of folders, including in each several broad categories: actions you’ve delegated to others, actions you’ve delegated to yourself (pending items), event-driven folders (e.g., CMA’s next House of Delegates), and broad categories of information.

Here are some suggestions for sending emails: • Prior to sending an email, ask yourself before anything else, “Is this email really necessary?” Then ask the same question again.

SDCMS Members:

Attend Our Saturday, Aug. 22 Taming Outlook Seminar This three-and-a-half-hour SDCMS members-only seminar is a must for those busy physicians looking to make Microsoft Outlook their servant and not their master. This will be a very, very practical and user-focused seminar. Physicians will come away with a greater understanding of Microsoft Outlook and its versatility as a desktop information manager. As well, you will have a new appreciation for a system that enables you to be more efficient, productive, and in control. Details: • Title: Microsoft Outlook Seminar • Date/Time: Saturday, Aug. 22, 2015, 8:30 a.m.–12 p.m.

• Presenter: Tom Gehring, CEO and Executive Director, SDCMS • RSVP: Email Gehring@SDCMS.org

• Keep it simple and short.

• Keep emails totally — and I mean absolutely totally — free of negative emotions.

If you’re using adjectives or adverbs that are pejorative, that’s a great indicator that you should not be sending the email.

• Check your tone: Is this what you would say, and how you would say it, if you were face-to-face with the recipient?

• Remember that emails, once sent, are immortal. No matter how clever you are, somewhere there is a record of your communication — and that has gotten many, many people in trouble!

• Check your recipient list: Got everyone?

Got too many?

• With one exception, never blind carbon copy (BCC). It’s a recipe for disaster.

• The exception to not BCCing is if you want to ensure privacy for the email addresses for a large group of recipients.

• If there’s action requested, say so in the subject line, e.g., “Action Requested.”

• Make sure the subject line is clear and compelling. Be entertaining — it’s the hook to get someone to open your missive.

• Use dates, not “tomorrow” or “today” or “yesterday.”

• Spell check.

• Syntax check.

• Read the email from beginning to end at least twice before sending.

• Make sure the attachments, if there are any, are attached.

• Before you hit the Send key, ask yourself what would happen if this email were published verbatim in the U-T San Diego.

If there is any doubt in your mind, then listen to the voice in the back of your head and reconsider the email.

A short note on smartphones and the habit we’ve gotten into of sending emails from them. Many busy professionals now have a smartphone that allows them to download their emails continuously while they are away from their desks. I use my smartphone to keep me informed and to ruthlessly delete anything that is junk so that when I get back to my computer, I am able to rapidly take action as above.

Feel free to contact me at any time at Gehring@SDCMS.org or on my cell at (619) 206-8282.

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

IPMA, the Collaborative for REMS Education (CO*RE), and cordially invite you to improve your pain management and earn CME credit through a live educational activity.

ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care April 11, 2015 8:00 a.m. – 1:00 p.m.

The Centre at Vintana Wine & Dine — 1205 Auto Park Way, Escondido, CA 92025

Faculty:

Bill McCarberg, MD

WHo SHoULD attEnD / CoUrSE oBJECtIVES

CE InformatIon

The intended audience includes physicians, nurse practitioners and physician assistants practicing in family medicine, geriatrics, internal medicine, addiction medicine, pain management, neurology, and rheumatology as well as any health care professional who treats patients with chronic pain.

Interstate Postgraduate Medical Association (IPMA) designates this educational activity for a maximum 2 AMA Category 1 Credits.

More information and course objectives available online at: www.elizabethhospice.org/REMS

Continental Breakfast and Lunch provided by Vintana Wine & Dine.

Admission to this activity is free; registration is required.

RSVP REQUIRED: REMSEducation@ehospice.org (760) 737-2050, ext. 2519

SAN DIEGO PHYSICIAN.org

25

classifieds PHYSICIAN POSITION WANTED LOOKING FOR PART-TIME FAMILY PRACTICE: D. (Doyle) Eugene Johnson, family physician with a wealth of experience, looking for part-time position, preferably in North County.

Have been a full-time practicing certified family physician for 50+ years and would like to continue seeing patients part-time. Had one of the largest solo family practices in San Diego for 25+ years. Excellent references! Continually certified in family practice, ACLS, BLS, regularly use computerized records. Will consider locum tenens. Please email d.eugenejohnsonMD@ gmail.com with particulars. [301] PHYSICIAN POSITIONS AVAILABLE PHYSICIAN POSITIONS AVAILABLE AS WE CONTINUE TO GROW: 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. 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.

[046a] SEEKING A FOOT/ANKLE SPECIALIST OR HAND SURGEON: Well-established, highly respected, four-physician group, private practice in San Diego seeking a foot/ankle specialist or hand surgeon. Our group is expanding to meet high volume of cases and planned expansion. Potential opportunity for any established subspecialist looking for a permanent practice location. We have a broad-based primary care referral base, mature EHR, digital X-ray, ultrasound, and DME program. Interested parties, please email your CV in confidence to lisas@sdsm.net. [326] PART- OR FULL-TIME PRIMARY CARE PHYSICIAN WANTED: Busy pain management practice in Mission Valley seeking a primary care physician to work with our growing practice. Please fax CV to (858) 756-9012. [322] SEEKING PART-TIME PRIMARY CARE / URGENT CARE PHYSICIAN: For a busy, well-established primary care family practice / urgent care medical practice in Pacific Beach. This position could lead to an associate physician position of the practice for the right person. 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 [317]

URGENT CARE PHYSICIAN — Per Diem BC/BE: Arch Health Partners is an awardwinning medical foundation affiliated with the Palomar Health System in North San Diego County. Hours: 9:00am–9:00pm. Send CV to catherine.jones@archhealth.org or fax to (858) 618-5820. [312] GENERAL, FAMILY, OR INTERNAL MEDICINE PHYSICIAN NEEDED IMMEDIATELY: This opening is an independent contractor position. We are a house call practice located in beautiful North San Diego County. We will also provide paid training on our EMR. 8–5, Monday–Friday, 10–12 patients per day, and on-call pager 1 week every 3 weeks, telephone call only. No rounds or hospital duties. If interested please submit your CV to julie@sandiegomobiledoctor.com. We are very anxious to fill this position, and we look forward to hearing from YOU! No agencies please. [311] FULL-TIME PRIMARY CARE POSITION IN SAN DIEGO: Outpatient only office, no calls, no weekends. Please send CV to sandiegoprimarycare@yahoo.com. [308] SEEKING URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a part-time physician. Good pay and working conditions along with the potential to become a full-time position. Please send CV to jeff@ eastcountyurgentcare.com. [306] 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] 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: Internal medicine and family medicine physician positions currently open. Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County with openings for full-time, part-time, and perdiem positions. Current CA and DEA licenses required. 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

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

March 2015

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] OFFICE SPACE AVAILABLE MEDICAL SPACE FOR RENT / LEASE: Approximately 2,000ft2. Available for lease, in best location of Imperial County. Negotiable.

Please contact Dr. Maghsoudy at (760) 7303536. [328] SUBLEASE PART-TIME SPACE ON SCRIPPS LA JOLLA CAMPUS: A beautiful office space is available a few times a week for someone looking for a part-time satellite office or someone who only has clinic a few times a week. We are located in HM Poole building on the campus of Scripps Memorial La Jolla, two-minute walk from the hospital. Office reception, two exam rooms, and a conference room/break room are available. Our staff use is negotiable. Rates will depend on the needs and usage. Please contact Olga at olgald@sdneurosurgery.com for more information. [325] SUBLEASE AVAILABLE IN DEL MAR: Beautifully remodeled, state-of-the-art office space in affluent Del Mar off 5-freeway. Share rent.

2,100ft2 in professional building. No nnn/utility costs. Great opportunity in very desirable area. Existing cosmetic surgeon tenant relocating and space is available now. Call (858) 3423104. [320] NORTH COUNTY / LA COSTA-CARLSBAD OFFICE SPACE FOR SUBLEASE: Beautiful, new 2,300ft2 office space available for sublease. Minor procedure room, 5 exam rooms.

Lasers available. Located in Bressi Ranch off of El Camino Real. Perfect for dermatology, OB/ GYN, wellness / weight loss. Perfect location for North County expansion. Please call Melissa at (760) 707-5090. [318] BANKER’S HILL OFFICE SPACE: Office space available in beautiful, updated Banker’s Hill medical office that also houses a fully accredited ambulatory surgery center. Great opportunity for a plastic surgeon, facial plastic surgeon, oculoplastic surgeon or dermatological surgeon. Office is conveniently located minutes from freeway access and downtown San Diego. Please contact via email at info@drhilinski.com. [313] 1,701FT2 OFFICE SPACE AVAILABLE: Approved for medical or business use. Fully built out. First floor with extensive window line. Two entrances. Excellent highway access. Short- or long-term lease available. Easy patient/client parking. 5330 Carroll Canyon Road, Suite 140, San Diego, CA 92121. Contact mobyrne61@ gmail.com or (619) 218-8980. [310] ALISO VIEJO — 5 JOURNEY: Multi Tenant Medical Building with highly successful medi-

cal and dental practices. 2 ground floor medical spaces approx. 2,135 and 2,225 rsf available for lease. $2.90 PSF NNN. Beautifully designed.

Tenant Improvement Allowance to customize suite is available. For further information please contact Lucia Shamshoian @ 769-931-1134x13 or Shamshoian@coveycommercial.com. [298] LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805.

Multidisciplinary group. Excellent referral base in the office and on the hospital campus.

Please call (858) 455-7535 or (858) 3200525 and ask for the secretary, Sandy. [127] 3998 VISTA WAY, IN OCEANSIDE: Medical office space approx. 2,488 rsf 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] 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] DEL MAR / CARMEL VALLEY MEDICAL OFFICE TO SHARE: Available immediately. Class A medical building. 1,000SF. Two treatment / consultation rooms / office reception / photography room / break room. Full or shared occupancy. Unlimited free parking. Call (858) 4814888 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 in-

formation, 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] 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 1,900SF 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: Two 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 FNP AND PA POSITIONS AVAILABLE AS WE CONTINUE TO GROW: 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. 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. [046b] SEEKING MEDICAL ASSISTANT: We are a private practice situated in Encinitas looking to hire a medical assistant. The medical assistant should be flexible and able to float from the front office (administrative area and reception) to the back office area (examination and treatment areas). Some primary duties involve scheduling, registering and rooming patients, taking vital signs and blood tests, keeping the entire office and storage spaces organized, safe, and clean. Requirements include at least three years of work experience in this field with a high school diploma and medical assisting program certificate.

Excellent computer knowledge as well as fluent written and verbal communication. Please email ktagdiri@gmail.com. [327]

PART- OR FULL-TIME NURSE PRACTITIONER WANTED: Busy pain management practice in Mission Valley seeking a nurse practitioner to work with our growing practice.

Please fax CV to (858) 756-9012. [323] PART- OR FULL-TIME PHYSICIAN ASSISTANT WANTED: Busy pain management practice in mission valley seeking a physician assistant to work with our growing practice.

Please fax CV to (858) 756-9012. [324] SEEKING PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Seeking PA with experience in dermatology or wellness / weight loss to join busy cosmetic surgery practice in North County. Beautiful office and support staff. Full complement of cosmetic lasers.

Please call Melissa at (760) 707-5090. [319] SEEKING PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Part-time, with possibility of full-time, mid-level provider position available in a primary care office in downtown San Diego. This is a wonderful opportunity to learn all aspects of primary care. Prior experience with family medicine, sports medicine, occupational medicine, and/or urgent care is preferred, but new graduates can apply. Must be a certified PA or NP and possess a current California medical license. A DEA license is helpful, but not necessary. Must be comfortable using an EHR system, but will provide training on our specific system. Wages based on experience.

Please email CV to office.mcmc@gmail.com or fax to (619) 232-6012. [315] 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 housecall 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) 9925330 or email drhunt@thehousecalldocs.com.

Visit www.thehousecalldocs.com. [038]

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

SAN DIEGO PHYSICIAN.org

27

poetry and medicine

When I see a bedraggled and unwashed man on the street corner asking for spare change, I wonder how far he has fallen.

The Everpresent Possibility of Loss

by Daniel J. Bressler, MD, FACP

Introduction No one is immune to tragedy.

There is always the possibility of a loss that can pierce through our strongest defenses and pluck us from the bunker of our triumphs. I have known friends, colleagues, and patients whose successful lives collapsed after a devastating event: an illness, a lawsuit, a divorce.

When I see a bedraggled and unwashed man on the street corner asking for spare change, I wonder how far he has fallen.

Did he once have a home and a family? Did he have friends, a fine career, and a promising future?

This poem is for him and for all of us fellow, vulnerable human beings.

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

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March 2015

I Am Blind and It Is Spring You see me hunched beside the crowd A sullen and pathetic thing But I once strutted puffed and proud I am blind and it is spring My profile known throughout the city A glamoured beauty wore my ring Now all I win are scorn and pity I am blind and it is spring Confidence my charmed companion Trading toasts with queen and king So easily does luck abandon I am blind and it is spring Sturdy fame mine for the taking Turned as flimsy as a string I learned too late the ground was shaking I am blind and it is spring Success and failure’s fickle arc A heedless and uncaring swing Has dropped me shivering in the dark I am blind and it is spring My days a train of bright parade Acrobats would dance and sing Looking back: a masquerade I am blind and it is spring From noble wine to bitter brew Despair at what the days might bring Though this is me it might be you I am blind and it is spring

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Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand the realities of running a medical practice these days, and are committed to supporting you with a range of programs and services that no other professional liability company offers. These include a 24-hour early intervention program, HR support, EHR consultation, a HIPAA hotline, and a robust group purchasing program, to name a few.

Are You ICD-10 Ready? Get Your “ICD-10 Action Guide” FREE! On October 15, 2015, all medical practices must comply with new, expanded ICD-10 codes. CAP’s ICD-10 Action Guide for Medical Practices has the answers you need to successfully make the transition.

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800-356-5672 CAPphysicians.com/icd10now

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San Diego County Medical Society 5575 Ruffin Road, Suite 250 San Diego, Ca 92123

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PAID DENVER, CO PERMIT NO. 5377

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As the nation’s largest physician-owned medical malpractice insurer, with 75,000 members, we constantly monitor emerging trends and quickly respond with innovative solutions. And our long-standing relationships with the state’s leading attorneys and expert witnesses provide unsurpassed protection to our 20,000 California members. When these members face claims, they get unmatched litigation training tailored to California’s legal environment, so they enter the courtroom ready to fight—and win.

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