December 2015 by San Diego Physician

official publication of SDCMS december 2015

Your SDCMS Physician Advocate Is Here to Answer Your Practice Management Questions! Are other insurers following Medicare’s lead and allowing ICD-10 “flexibilities”?

Can we terminate a patient relationship if they refuse to get their vitals taken?

What is the CME requirement for pain management?

Can I refuse a patient’s medical record request if they have an outstanding balance with us?

I need to send a patient to a collection agency. Should I be concerned about violating HIPAA?

We submitted a TAR over a month ago. Who can we call to get a status update?

How do I register for CURES? Our patient is demanding that a copy of their medical record be made available tomorrow. Do we have to fulfill this request?

I don’t want to share my private banking information with Aetna. What can I do?

How much can I charge patients for copies of their medical records?

Do all physicians need an NPI to bill?

Can we charge patients for canceled or missed appointments?

My physicians shouldn’t be using unspecified ICD-10 codes on their Medicare claims, correct?

I don’t want my home address listed on the MBC website. Is there a workaround for this?

Should I keep my license active or change it to retired status?

Do you have a sample termination letter to share?

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December

Contents

Volume 102, Number 12

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, MD, PhD • David M. Priver, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: William T-C Tseng, MD, MPH (CMA Trustee) President-elect: Mihir Y. Parikh, MD Secretary: Mark W. Sornson, MD Treasurer: David E. J. Bazzo, MD, FAAFP Immediate Past President: J. Steven Poceta, MD

feature

departments

Your SDCMS Physician Advocate Is Here to Help!

BY MARISOL GONZALEZ

Briefly Noted: Calendar • Directory Errata • Volunteer Opportunities • Welcome New and Returning Members • Commercial Real Estate • And More …

ow What? Preparing Residents for N Their Transition to Practice Y STEPHEN R. HAYDEN, MD, FAAEM, B AND ERIN M. KING, MD

Remembering Anne Baldock and Madison Cornwell, UC San Diego Medical Students

Take the Best of 2015 to Create an Even Better 2016

GEOGRAPHIC and GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD (Alt.) • Jay P. Mongiardo, MD • Alexandra E. Page, MD • Venu Prabaker, MD Hillcrest: Gregory M. Balourdas, MD • Kyle P. Edmonds, MD (Alt.) • Thomas C. Lian, MD Kearny Mesa: Sergio R. Flores, MD • John G. Lane, MD • Anthony E. Magit, MD (Alt.) • Eileen R. Quintela, MD (Alt.) La Jolla: Geva E. Mannor, MD, MPH • Marc M. Sedwitz, MD, FACS • Wayne C. Sun, MD (Alt.) North County: Neelima V. Chu, MD (Alt.) • Michael A. Lobatz, MD • Eileen S. Natuzzi, MD • Patrick A. Tellez, MD South Bay: Elizabeth Lozada-Pastorio, MD (Alt.) • Reno D. Tiangco, MD • Michael H. Verdolin, MD AT-LARGE and AT-LARGE ALTERNATE DIRECTORS Lase A. Ajayi, MD • Karrar H. Ali DO, MPH • Steven L-W. Chen, MD, FACS, MBA (Alt.) • Stephen R. Hayden, MD • Phil Kumar, MD (Alt.) • Vimal I. Nanavati, MD, FACC, FSCAI (Alt.) • Robert E. Peters, MD, PhD (Alt.) (Delegation Chair) • Carl A. Powell, DO (Alt.) • Peter O. Raudaskoski, MD • Kosala Samarasinghe, MD • Thomas J. Savides, MD • James H. Schultz Jr., MD, MBA, FAAFP (Board Rep) • Karl E. Steinberg, MD, FAAFP (Alt.) • Erin L. Whitaker, MD (Alt.) • Marci M. Wilson, MD (Alt.) • Holly B. Yang, MD (Board Rep) OTHER VOTING MEMBERS Communications Chair: Sherry L. Franklin, MD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Michael C. Hann, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: Sandeep Prabhu OTHER NONVOTING MEMBERS Young Physician Alternate Director: Heidi M. Meyer, MD Resident Physician Alternate Director: Quinn C. Meisinger, MD Retired Physician Alternate Director: Mitsuo Tomita, MD SDCMS Foundation President: Albert Ray, MD (At-large AMA Delegate) CMA Speaker: Theodore M. Mazer, MD (At-large AMA Alternate Delegate) CMA Past Presidents: James T. Hay, MD (AMA Delegate) • Robert E. Hertzka, MD (Legislative Committee Chair, At-large AMA Delegate) • Ralph R. Ocampo, MD, FACS CMA Trustee: Bob E. Wailes, MD AMA Alternate Delegate: Lisa S. Miller, MD

BY HELANE FRONEK, MD, FACP, FACPH

ight Principles of an Effective Patient E Safety Team BY SUSAN SHEPARD, MSN, RN

26 Physician Marketplace: Classifieds 28

28 2

december 2015

Happy Holidays From Your SDCMS and SDCMS Foundation Support Teams!

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.]

Rents are rising. See how some of our clients are taking back control. Fourth Avenue Medical Plaza

Kaiser Mission Bay 1 Building 2

Venture 41 Sorrento 5 2Office Park 3

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Take a look at how we help our clients by visiting www.sdmedicalrealestate.com

Paul Braun 71 +1 858 410 6388 paul.braun@am.jll.com 76

Chris Ross +172 858 410736377 7471 chris.ross@am.jll.com 76 77 78

Sales ▪ Leases ▪ Renewals ▪ Investments

Kelly Moriarty 736359 74 7572858 410 71 75 72 +1 kelly.moriarty@am.jll.com 77 78 76 77

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/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// directory ERRATA

Please update the following physician listings in your copy of SDCMS’s 2016 San Diego County All Physician Directory, aka, The Little Purple Book. Delete Listing for the Following Physician: • Mia Hosaka, DO

calendar SDCMS-Cma Webinar and Event

For further information or to register for the following SDCMSCMA webinar and/or social, contact Jen at (858) 300-2781 or at JOhmstede@SDCMS.org. Meaningful Use: 2015 and 2016 Modified Rules (webinar) DEC 16: 12–1pm All Physician Networking Opportunity & Mixer (social) FEB 4: 5–8pm at the Handlery Hotel San Diego in Mission Valley

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.

Practical Endocrinology for Primary Care (SDAFP) JAN 9 at UC San Diego San Diego Pulmonary, Critical Care, and Sleep Medicine Case Conference & Clinical Updates JAN 11 at VA San Diego, Room 3004 Advances in Medical and Surgical Management of Thyroid Cancer JAN 15–16 at the Phoenix Marriott Tempe at the Buttes

Advanced Nephrology: Nephrology for the Consultant JAN 28–30 at the Omni San Diego 13th Annual Natural Supplements: An Evidence-based Update JAN 29–31 at Paradise Point Resort & Spa, San Diego

Update Listings for the Following Physicians: • Correct Work Address for Einat R. Duhamel, MD »» 310 Santa Fe Dr., #204 »» Encinitas, CA 92024 • Corrections for Leo J. Murphy, MD »» Address Suite = 102 »» Telephone = (619) 800-7942 »» Fax = (619) 800-7385 • Correct photo for Steven George Pratt, MD

PRISM Meeting: Pediatric Research in Sports Medicine JAN 29–30 at the Hilton San Diego

Melanoma 2016: 26th Annual Cutaneous Malignancy Update JAN 23–24 at the Hyatt Regency Mission Bay, San Diego

UC San Diego Essentials and Advances in Apheresis Therapies MAR 3–5 at the Marriott Mission Valley, San Diego

35th Annual Advanced Nephrology: Nephrology for the Consultant JAN 27–30 at the Omni San Diego

Butters-Kaplan West Coast Neuropsychology Conference APR 7–10 at the Hyatt Regency La Jolla

• Corrections for Erin J. Vance, MD »» Address = 4405 Vandever Ave., San Diego 92130 »» Telephone = (800) 290-5000 • Corrections for Cameron W. Wilson, MD »» Address = 8851 Center Drive, Suite 208, La Mesa 91942 »» Telephone = (619) 828-1000 »» Fax = (619) 828-1001

Superficial Anatomy and Cutaneous Surgery JUL 9–17 at the San Diego Marriott Del Mar

quote of the month

“

I think, at a child’s birth, if a mother could ask a fairy godmother to endow it with the most useful gift, that Eleanor Roosevelt, American Politician, gift would be curiosity. — Diplomat, and Activist (1884–1962)

december 2015

/////////////////////////////////////////////////////////////////////////////////////////////////// giving back

VOLUNTEER OPPORTUNITIES Email Your Physician Volunteer Opportunities to Editor@SDCMS.org SDCMS Foundation Project Access: Volunteer specialty physicians are needed for the following specialties: gynecology, pulmonology, urology, general surgery, ENT or head and neck, ophthalmology, GI, rheumatology, and endocrinology. We are seeking these specialists throughout all regions of San Diego. Commitment can vary by practice. The mission of the SDCMS Foundation’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Help us help the most vulnerable population seek care. For more information, please call Barbara Mandel at (858) 300-2780 or email Barbara.Mandel@SDCMS.org, or visit our website at www.SDCMSF.org. Interested in Becoming a Preceptor for Osteopathic Medical Students? Midwestern/AZCOM osteopathic medical school in Phoenix has thirdand fourth-year medical students in San Diego looking for clinical rotations, particularly in pediatrics, psychiatry, general surgery, and OB/GYN. Requirements: Either MD or DO; physicians interested must commit to minimum one four-week rotation per year/or more as desired (2–3 preferable) and to FT hands-on training for each student as is reasonable for the duration of the rotation. Compensation and CME provided. If interested, please contact Dr. Kevin Considine at kconsidine@sbcglobal.net for more information. Humanitarian Teams Need Medical Volunteers for Haiti: We are looking for physicians and midlevel providers for one-week primary care medical clinics in rural Haiti in February and June 2016. This is a rewarding opportunity to work with the people of Haiti and provide care in a very austere environment in a medically underserved area. Seattle-King County Disaster Team — a U.S.-based nonprofit — has been operating these clinics since 1998. We coordinate all in-country travel and logistics. Please contact Bob Downey at (619) 905-7157 or at labboy@ earthlink.net if you are interested in applying. Visit www.skcdteam.org for further information. Physician Volunteer Opportunity: Established in 2011, Flying Samaritans of SDSU provides free healthcare to the underserved community of Ejido Matamoros, Mexico (15 minutes away from the border), through monthly medical and dental clinics (every second Saturday of the month), seeing 60-80 patients/medical clinic and 10/dental clinic. Click here for details, or email FlyingSamaritansSDSU@ gmail.com.

SDCMS-CMA Membership

Welcome New and Returning SDCMS-CMA Members! New Members Richard M. Barboza, MD Anesthesiology San Diego (858) 565-9666 Audra L. Budde, DO Family Medicine San Diego (619) 499-2600 David J. Burnikel, MD Orthopaedic Surgery San Diego (619) 286-9480 Christina M. Chirico, MD Obstetrics and Gynecology Encinitas (858) 277-9378 David J. Clayton, MD Internal Medicine La Jolla (858) 452-7040 Andrea A. D’Auria, DO Pathology Escondido (858) 514-1610 Xupeng Ge, MD Anesthesiology San Diego (858) 565-9666 Moltu J. Guy, MD Anesthesiology San Diego (858) 565-9666 Jeffrey J. Hollingsworth, DO Psychiatry Del Ma (858) 259-0599 Andrew Y-T Hsing, MD Pulmonary Disease San Diego (760) 230-8994 Jason T. Ipson, MD Anesthesiology San Diego (858) 565-9666 Stacy B. Krueth, MD Anesthesiology San Diego (858) 565-9666 Tina K. Ku, MD Ophthalmology San Diego (760) 631-3500 Todd M. LaRocque, MD Obstetrics and Gynecology Escondido (760) 745-1363

Kenneth K. Lau, MD Anesthesiology San Diego (650) 723-4000

Emily L. Wang, MD Anesthesiology San Diego (858) 565-9666

Tracy S-T Leong, MD Dermatology San Diego (858) 453-7224

Garth S. Watkins, MD Psychiatry Vista (619) 528-5000

Steven T. Liu, MD Internal Medicine Encinitas (760) 633-2345

Jared S. Wei Wong, MD Colon and Rectal Surgery San Diego (858) 939-8350

Andrew W. M. Maeda, MD Anesthesiology San Diego (858) 565-9666

Yifan Yang, MD General Surgery Chula Vista (619) 425-0797

Christopher S. Mingrone, MD Anesthesiology San Diego (858) 565-9666

RETURNING Members

Brian D. Modena, MD Allergy and Immunology San Diego (858) 764-9010 Vinod V. Narla, MD Anesthesiology San Diego (858) 565-9666 Mohammed D. Neyaz, DO Nephrology Escondido (760) 745-1551 Thienkim V. Ngo, MD Anesthesiology San Diego (858) 565-9666 Matthew C. Nuckols, MD Anesthesiology San Diego (858) 565-9666 Dana A. C. Reddy, MD Rheumatology Chula Vista (619) 427-1721 Alexander A. Roher, MD Anesthesiology San Diego (858) 565-9666 Hanna H. Serdarevic, MD Anesthesiology San Diego (858) 565-9666 Azadeh Shirazi, MD Adolescent Medicine (Internal Medicine) San Diego (858) 521-2300 Robert M. Smith, MD Pulmonary Disease San Diego (858) 642-9349

Timothy D. Bilash, MD Obstetrics and Gynecology La Jolla (858) 997-0212 James J. Choi, MD Anesthesiology San Dieg (619) 543-5897 Chrysten E. Cunningham, DO Gynecology La Jolla (858) 945-7906 James H. Harrell, MD Pulmonary Disease Encinitas (760) 230-8994 Paul J. Manos, DO Emergency Medicine San Diego (619) 470-4141 Padma Nanduri, MD, FACS Ophthalmology San Dieg (858) 450-1010 Ahmad N. Saad, MD Plastic Surgery San Diego (858) 453-7224 Erica A. Smith, MD Anesthesiology San Diego (619) 543-5897 Cristiana G. Vasile, MD Ophthalmology Rancho Santa Fe (800) 765-2737 Denise A. Whitfield, MD Emergency Medicine San Diego (202) 814-1963

SAN DIEGO PHYSICIAN.org

/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// commercial real estate

San Diego Medical Office Snapshot | Q3 2015 By Chris Ross

By the Numbers

8.2%

Countywide Direct Vacancy

161,132 YTD Net Absorption (SF) // 135,006 SF (Q3 2015)

4.2%

12-month Rent Growth // $2.70 SF Average Asking

Market Conditions and Trends: The impact of tightening medical office vacancy throughout the county is becoming more significant by the quarter. Year-over-year rent growth reached 4.2% in Q3 — a relatively steep figure. Providers in most areas of the county with leases expiring in 2016 and 2017 are experiencing some sticker shock and are being forced to be extra mindful and strategic about how to contain occupancy costs. Vacancies become particularly limited at sizes over 3,500 sq. ft., and oftentimes it comes down to a stroke of luck as to whether the tenant is stuck competing for the target property or space. Brokers representing healthcare tenants are now frequently challenged with not only identifying hard-

december 2015

to-find properties but educating their clients on a market that has evolved significantly since the tenant’s last lease or renewal was signed. Several of our clients have been forced to renew for a year or two to buy time until a better opportunity surfaces. Meanwhile, property owners and sellers are becoming more bullish on pushing rents and prices, but they also must be diligent in thoroughly evaluating the state of the market and the competitive landscape for each vacancy and each prospective tenant or buyer. There will always remain the age-old question of how long it will take to find the next tenant or buyer if the current prospect walks away. These days, landlords and sellers are generally more willing to roll the dice. Our final bit of advice to

providers out there: If you find the right property — whether a lease or a purchase — do the best you can, but do not lose the opportunity over a few percent (of overall costs). For a host of reasons we will not go into here, barring a major global event or a greater-than-expected spike in interest rates, we do not foresee a dip in medical office prices or rental rates anytime in the next three or four years, and good opportunities are only becoming more scarce. 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 Q3 2015 report, call Mr. Ross at (858) 410-6377 or email him at chris.ross@am.jll.com.

223,990 Total Under Construction (SF)

San Diego County Medical Office Class A Vacancy

8.1%

San Diego County Medical Office Class B Vacancy

# of San Diego County MOBs Currently Under Construction

HEALTH HERO /////////////////////////////////As ////////////a //////////////// / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Join the San Diego County

Physician, You’re a Natural Educator

Medical Society Foundation’s Live Well Special San Diego thanks to John Han, PharmD, Regents Pharmacy in Physicians’ Speakers Bureau. La Jolla for his help to assure Physicianspatients volunteer to with are able to comply physician orders.interactive Project Access provide pro bono recently partnered with Alison SATURDAY, NOVEMBER 14 presentations (30–60 Gordon Cohn, MD, and Elizabeth FLETCHER COVE, SOLANA BEACH Viriya, MD, of Gordon-Weiss-Schanzlin minutes) near where they Vision Institute; ASMG; and Outpatient Centerof of La Jolla, work or live, to Surgery groups to assure that eight patients regained youths, adults, seniors, their sight with cataract surgeries. Volunteer to Build the Physicians: But the necessary prescriptions employees, and more. We Knowledge, would have cost Project Access a YouPublic’s are a Health Role Model SATURDAY, NOVEMBER 14 will provide adaptable prohibitive $600 per patient! John Skills, and Positive Han was able to facilitate reduced COVE, SOLANA BEACH presentation materials. ModelAttitudes healthy living to FLETCHER patients and staff by inviting them to cost prescriptions down to $175 About Health per patient, a 70% savings! JOIN YOU at San Diego County Medical Society Foundation’s Solana Beach Sunset 5K Run/WalkToluwalase November John and his wife also provide Ajayi, 14 at 3 PM! MD, educating college preparatory middle school students about “Easy Ways to Eating Right for a Healthy Body and Mind”

for Project Access Live Well Sanongoing Diegosupport Physicians’ through their Charity Support Speakers Bureau Presentations: Program; for each prescription filled »» Living Your Life by Best Regents Pharmacy for any of a »» Easy Waysprovider’s to Eating Right for will a patients, Regents donate a small portion to help Healthy Body and Mind prescriptions for Project »» Creating asupport Healthier Workforce Access’ uninsured patients. Since »» Athletics: Playing for Life Regents both delivers and mails (Teen Sports Benefits and Issues) prescriptions, they are able to serve »» Recognizing Unhealthy the entire county. For more Relationships information, contact SDCMS Foundation, or Regents Pharmacy »» Reading Your Child’s Emotional at regentsrx.com, 858-281-5200. Health »» Topics of Your It takesChoice! the partnership of the entire

Lead a team more patients and staff and Model ans: You areof 20aorHealth Role receive FREE your own team t-shirts with your living to patients andidentification. staff by inviting practice/team

ealthy them to U at San Diego County Medical Society Foundation’s For more information please contact Carlos Medina Beach Sunset 5K Run/Walk November 14 at 3 PM! at carlos.medina@sdcms.org or 858.565.7930 Benefiting

eam of 20 or more patients and staff and receive FREE wn team t-shirts with your practice/team identification. Improving Health…Changing Lives

on please contact Carlos Medina at carlos.medina@sdcms.org or Jeffrey Howell, MD, educating San Diego’s Retired Senior Volunteer Patrol, Northern Division, about “Living Your Best Life” Presented By In Partnership With

Benefiting

Improving Health…Changing Lives

medical community to reach our vision of improving health and 858.565.7930changing lives. Thank you to all our For more information, Project Access San Diego physician volunteers, hospitals and surgery please contact Andrew Gonzalez: centers, and ancillary partners! Andrew.Gonzalez@SDCMS.org With your help, we facilitated care for or (858) 300-2787 821 uninsured patients in 2014, getting folks back to health, back to work and caring for their families, This Initiative Is Made Possible Through a Partnership With the improving their quality of life! County of San Diego’sand Health and Human Services Agency

SAN DIEGO COUNTY MEDICAL SOCIETY FOUNDATION

PRESENTED BY: Rd., Ste 250, San Diego, CA 92123 www.sdcmsf.org 858.300.2777 5575 Ruffin SAN DIEGO PHYSICIAN.org 7

P RACTICE M ANAGE M ENT

Now What? Preparing Residents for Their Transition to Practice

by Stephen R. Hayden, MD, FAAEM, and Erin M. King, MD

Reprinted with permission from The Journal of Emergency Medicine. Introduction Each year, a graduating class of senior emergency medicine (EM) residents enters the workplace, marking an important milestone in the development of practicing physicians. This transition from senior resident to attending physician is an exciting time, but bears with it daunting challenges for even the most seasoned resident. Financial decisions, personnel management, clinical autonomy, and patient care are just a few of the challenges with which new graduates are faced. Although residency training programs strive to prepare residents for these challenges, there remains a gap between

december 2015

the theory of medicine and the practice of healthcare. This gap represents the ‘‘transition to practice.’’ Program directors serve as important guides during the development of resident physicians. As mentors, program directors help shepherd residents through the challenges of residency training and help prepare these residents for their transition to practice. Not only have program directors made this transition themselves, but they have witnessed hundreds of residents make the same journey. The collective experience of program directors serves as an invaluable resource and helps new graduates navigate this challenging period. We tapped into the collective wisdom and asked the members of the Council of Residency Directors (CORD) in EM to reﬂect

upon their experience with the transition to practice, both personal experience and the experience of their programs’ graduates. We asked, ‘‘What advice do you give to your resident graduates as they are leaving your program?’’ In addition, we asked, ‘‘What pitfalls should young physicians avoid as they make the transition to practice?’’ The response from the members of CORD was overwhelming, and we are grateful that they are willing to freely share their experience and guidance. We have been asked on several occasions to compile and publish the advice — we chose this forum to disseminate the information. Comments fell into several general categories, and we combined and paraphrased comments to create a resource that we hope will help graduating residents navigate their transition to practice successfully, and provide a reference for program directors of all specialties to provide advice to their graduates. Responses were categorized as follows: (1) outside activities/personal; (2) finances; (3) isolation after graduation; (4) compassion; (5) burnout; (6) interpersonal interactions; (7) clinical practice skills; (8) academic endeavors; (9) professional development; and (10) passing board certification examinations. Program directors from >48 EM residencies responded to our questions. Program director experience among respondents ranged from 3 to >20 years in the position. Responding programs represented all major geographic areas of the nation and all EM program formats. Summarized Advice by Category Personal Activities Outside of Work The pitfall is not taking care of yourself — physically, mentally, or spiritually. • Graduates should rediscover their passion outside medicine so that they can rely on it to remove stress and add dimension to their lives. For some it may be ballet, but many others do sports, music, church groups, community organizations, art, etc. The nice thing is that they get a circle of nonmedical friends to add perspective to their lives. For most people, other interests were suppressed during clinical training. • Make time for yourself (separate from time for your family). Get back into that exercise routine that fell by the wayside during residency. • Find a balance between work and play; do not forget to take care of yourself. • Do not take a job that you end up loathing for whatever reason and then not having the courage to leave and find another one.

Finances The pitfall is getting in over your head. • Start saving up during residency for the first year out. There are many expenses no one tells you about. Moving, security deposits, first and last month’s rent, board examination fees, cost of licensure. It adds up to several thousand dollars, and you should be prepared for it. • Do not spend more than you earn. Spending quickly rises to match income. Do not live beyond your means now that you are getting a real paycheck. Do not buy a house too soon; buy a modest one initially. Owning a home can get you in over your head faster that you can imagine. Do not buy a $60,000 BMW right away! • Do not underfund your savings plan, and do not overpay for a car. Too many recently graduated residents buy a big-ticket item as soon as they become attendings but do not put money into savings. You need to max out 401k/403b and similar plans from day one. • Pay off some debt, live like a resident financially for a while, which allows for saving money so you can travel, change jobs if needed, etc. • Start saving for retirement as early as possible, and start college funds for your kids the minute they are born. • Continue short-term disability plans from residency, if possible, because they are often fairly inexpensive, and some companies offer a guaranteed issue disability policy to residency graduates; take advantage of it! • Many residents do not understand their contracts or sign ones that may get them into trouble (i.e., agreeing to restrictive covenants). Do not feel like you will not get the job if you do not agree to all the provisions; in the end almost everything is negotiable. Look to your specialty societies if you have questions. Isolation After Graduation (You Are Not Alone) The pitfall is being afraid to ask questions or ask for help. • You can always call ‘‘home.’’ If you are out moonlighting or on your own and just want to bounce something off one of your colleagues from where you trained, you can always call. Someone from your department is on 24/7. Stay in communication with the mother ship! • Never lose your humility or be too afraid/too proud to ask for help. Just because you have graduated does not mean you know/can do it all. Medicine is the most humbling of professions; if you

do not know the answer, ask! • If you are not sure about a patient case, ask your colleague. It is not a sign of weakness. Your colleague has one thing that a new graduate does not: experience. • The first five years out of residency represents a steep learning curve; you will see stuff you have not seen before, you may do procedures you have never done before. Better to admit you are not sure than to make something up and potentially cause patient harm. Remember: There are no stupid questions! Compassionate Care The pitfall is forgetting why you got into medicine in the first place. • Take the time to make a true connection with a minimum of one of your patients per day or shift. Take the extra time and make the extra effort to create a connection and find out something about them as a person. It helps you keep your humanism and remember why you got into this business: to help people. • Never lose your compassion; if you see yourself moving toward indifference, do something about it; compassion is the most important quality associated with a long and happy career. The obvious corollary: Never forget that your patient is an actual person and not a scientific problem. • In the first few years of practice, most graduates end up making an important, but unconscious, choice between compassion and indifference toward their patients. Young physicians who seem jaded and annoyed by their patients (or ‘‘hits’’) frequently become bitter as the years go by. Others who really take the time to listen and care for their patients seem to become more satisfied as they go on. • Regard every patient as an opportunity to care rather than a burden or an obstacle to getting home — this is the best guarantee for long-term success and avoiding burnout. • Be nice to as many people as possible. Kindness is contagious! Burnout The pitfall is succumbing to the pressures of clinical practice and burning out. • There is a certain curve in young physicians: nervous/uncertain at first, then they gain confidence and, after a few years, become a bit overconfident, until something bad happens; particularly for high performers, there is a tendency to burn out in years three to five postgraduation (e.g., a loss of compassion/ empathy, dehumanizing patients, be-

coming judgmental or short tempered, being hard on their colleagues, etc.). Note dearly it can be readily reversed, but if allowed to progress it can become a crippling issue. Being aware of this tendency may help avoid it. • Watch the amount of overtime you take on. As a new graduate, you are seeing real money for the first time. Overtime is alluring because you think you need a lot of money to pay off debts you have accumulated. However, if you do too much overtime, you get burned out and cranky, and you do not enjoy your new job. • Remember what you enjoyed as a resident and maintain it after graduation. Interpersonal Interactions (Treat Others Well) The pitfall is, now that you are a real doctor, thinking you are above your coworkers. • Listen to your nurses and staff. They will save your butt more than you know! Scorn the nurses … look for a new job! • Be a team player (you are the new guy, and that means watching and listening more than talking). One of Steven Covey’s seven habits is seek first to understand; then be understood. • Telling all the ‘‘old’’ guys how to do it just shows your own arrogance! • Get to know other medical staff and review a list of your consultants with the current staff to find out who is really helpful, who has a personality disorder, and who you can call in a pinch even if they’re technically not on call, etc. You need to feel you are part of the larger physician team of the hospital. • Bring food for everyone in your department/office for at least the first month. • Ask the nurses/techs what you can do to help out, and clean up after yourself without being asked — the return is far greater than the effort! • Treat other physicians and staff as if they were members of your own family, especially when one of them becomes ill. • Be the ‘‘yes’’ person. If you can do it, and there is no reason to say no, then say ‘‘yes.’’ Be the dependable person others can count on. What goes around comes around. • Your character is revealed by the manner in which you treat those least important to you … be courteous and respectful to all the staff you work with. • Smile: It’s contagious. Clinical Practice Skills The pitfall is not doing what you know is right. • Do not make a ‘‘fence decision’’ that you SAN DIEGO PHYSICIAN.org

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will lose sleep over. If you are secondguessing yourself while the patient is still in the clinical space, you will wake up in a sweat at three in the morning questioning why you did what you did (or did not!). There are few absolutes in medicine. Practice varies from hospital to hospital, region to region, and by provider, so learn the local standards. Be cognizant of this and be flexible. Do not sacrifice your training and principles, but decide which battles to fight. Do not forget to use your history and physical examination skills to diagnose patients, not just the computed tomography scanner! Be prepared for change: Clinical practice will change, and you must keep up with current medical knowledge. Develop a regular reading plan. Do not become complacent in patient care; at graduation, you are proficient, but it will take many thousands of patients and many years to become a master. Keep working at it; like the aviation community says — complacency kills! Document scrupulously and honestly. Always do the right thing despite managed care, cost-effectiveness, the electronic medical record, and other administrative pressures. You are a professional: Maintain professional standards at all times and in all situations. Whether you like it or not, everyone looks up to you. Beware of social media — do not post anything that is even remotely socially questionable. Invariably, your boss will end up seeing it (or worse, your patients), and it could cost you your job. Ask yourself: How would your mother feel about the way you conducted yourself if she read about it in the newspaper?

Academic Endeavors The pitfall is not learning the art of saying both yes and no. • It is important to go that extra mile when you are just starting out in academics (e.g., reviewing, research, taking on the med student rotation, etc.). • Learning to say no is an art form; however, do not say no too often early in your career because the offers may stop coming. Rather learn to say yes to the right things and seek out something you can become passionate about and can take you places. That one random ‘‘yes’’ could lead to a niche you never would have thought possible. Create a niche for yourself. • Talk to your chairperson early; ask for help getting involved in important

december 2015

departmental activities, but at the same time limiting them so you can focus on becoming comfortable with your new role as a clinical attending physician. Professional Development The pitfall is not placing a high enough priority on it. • Do not forget that the first day after graduation is the beginning of a process in which you actually learn how to practice your specialty, not the end. • Get involved with hospital committees, county and state medical societies, etc. Get involved at a local/regional and national level. You will feel more engaged. • Get on your departmental or hospital quality assurance committee — it’s a good way to learn your clinical processes and what the standards of care are for your institution. Also, always best to learn from others’ ‘‘mistakes.’’ • Consider a leadership development program. • Find good mentors and continue mentor relationships from residency. • Give back to your specialty; this results in a great deal of personal satisfaction. Passing Board Certification Examinations The pitfall is not allowing enough time to prepare for them. • Do not slack in studying: you are not really done until you pass your Boards. • Seriously review for your board examination regardless of your last in-service score. Every program director can relate a story about an excellent, competent resident with a great final in-service examination score that then flunked the written or oral certification examination! Discussion The advice contained in this paper represents the cumulative experience of EM program directors and educators among the community of physician members of CORD. While the respondents came from the specialty of EM, most of the advice is generic and potentially applicable to graduating residents in any specialty. The advice in some categories bears further discussion. For residents, emphasis is often placed on patient load and procedural competency, while the merits of compassionate care are pushed aside. The advice shared by the members of CORD re-emphasizes the need to approach patients with compassion in the emergency department (ED), and warns new graduates of the pitfalls of indifference. This marks a return to the ideals that lead many residents into a career

in medicine, and should serve as inspiration at the end of their careers as residents. Clinical practice skills are honed over the course of residency. New graduates must be prepared to practice these skills with confidence while assimilating into environments where standard practice may vary from one’s home institution. As residents, clinical practice was guided by the attendings. As new graduates, they will be forced to redefine themselves clinically and professionally as they hone their skills as practicing emergency physicians. Over the course of residency, priorities are forced to shift toward work and away from personal interests, such as family life and hobbies. Many residents feel that they have forgotten what made them ‘‘interesting’’ before residency started. The advice of the CORD members urges new graduates to find a healthy balance between work and play: re-exploring old passions and carving out time for loved ones. Program directors urge new graduates to plan for upcoming expenses and for a new income tax bracket. The allure of the first paycheck can easily drown out these words of advice. Retirement plans, disability insurance, and college funds may seem like foreign ideas to the seasoned resident, but many residency programs hold seminars to help prepare residents for their financial future. Residents at all training levels should take advantage of these opportunities. One of the most challenging aspects of any clinical practice environment is navigating interpersonal interactions. Teamwork between nurses, support staff, and physicians in the ED is paramount to positive patient outcomes, be it during a code situation or managing a difficult patient. After three or four years of residency, it is easy to forget the time and effort that went into navigating and shaping these skills within their own ED. As a new attending, the members of CORD urge residents to continue to be a team player and to cultivate positive relationships within that team. Professional development as a resident involves participation in national conferences, networking with potential employers, developing the knowledge base to stand alone as an attending physician, and much more. CORD members urge residents to continue to focus on professional development as an attending physician — getting involved in committees, considering leadership positions, and finding ways to give back to the specialty. This process will not only make graduates stronger physicians, but also will increase their awareness of the challenges faced by the specialty of EM as a whole, and provide avenues to confront those challenges.

Of note, this work was not intended to be a formal structured survey of program directors in EM. By design we wanted to encourage CORD members to provide detailed, subjective, and personal responses that mirror actual conversations with graduating residents. We chose to simply summarize and combine similar advice. Furthermore, all respondents were from the specialty of emergency medicine, which has the potential to limit the applicability of the information to other specialties, although by nature most of the guidance is generic and may cross disciplines. Conclusion In summary, the transition from senior emergency medicine resident to attending physician is exciting but is accompanied by a number of challenges. Program directors and other faculty members often find themselves in the position of offering advice to graduating residents. Members of the CORD in EM were asked what advice they offer and what pitfalls residents should avoid in making the transition to the practice setting. Residents are encouraged to find the optimum work–life balance and rediscover a passion outside of their clinical practice. They should not live beyond their means now that they are receiving a real paycheck. There is a steep learning curve after residency, and graduates should never lose their humility or be too proud to ask for assistance or consultation. Similarly, they should never lose their compassion or forget why they went into medicine in the first place. Time should be taken to make a true connection with a minimum of one patient per day and as many staff members and colleagues as possible. Remember that the first day after graduation from residency marks the beginning of a process in which physicians actually learn how to practice EM — not the end. We look forward to hearing more from Journal of Emergency Medicine readers and establishing a dialogue that can further aid graduates and program directors in the transition to practice. Dr. Hayden, four-year member of SDCMSCMA, is professor of emergency medicine at UC San Diego, and editor-in-chief of The Journal of Emergency Medicine. As well, Dr. Hayden sits on the SDCMS board of directors. Dr. King, four-year member of SDCMS-CMA, graduated from the UC San Diego emergency medicine residency program and now works full time for Sharp Rees-Stealy. Acknowledgments: The authors would like to thank the members of the Council of Residency Directors for their contributions.

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IN M E M

Rememb

Anne Baldock

UC San Diego M

As many of you are aware, UC San Diego Scho students this past spring at the hands of a dru Cornwell were truly, almost unfathomably wo community more broadly — have been rocked a silver lining out of a senseless tragedy, many preventing similar tragedies going forward.

Anne Baldock As a medical student, Anne Baldock was already an accomplished scientist with years of research and numerous publications. She was unapologetically dedicated to her work, and fervently pursued science, driven to give her life meaning and make significant contributions to medicine and patient care. The first target of Anne’s ambition was the currently incurable, rapidly fatal, and unpreventable brain cancer — a malignant tumor of the scaffolding that holds the brain together: glioblastoma. The main focus of her work was to identify clinically significant prognostic indicators in this disease. Her research was interdisciplinary in nature and spanned the fields of neuro-oncology, computational biology, molecular biology, biostatistics, neuroimaging, and informatics — and she was proficient in all of them. In this field alone, she has published at least

december 2015

six papers in top journals, including NeuroOncology and Cancer Research. Deciding to gain enriching experiences beyond neuro-oncology, Anne was about to begin her journey toward a PhD in the Pfaff lab at the Salk Institute, UC San Diego, studying spinal cord motor neurons. Her interest in glioblastoma and neuroscience stemmed from a fascination with healing the human brain that she has had ever since she was a little girl following the complete right-sided paralysis of her grandfather. This fascination with neurological illness and a desire to directly fix these conditions made the pursuit of neurosurgery a natural choice. She was passionate and even relentless in this pursuit. She traveled across the country for neurosurgery workshops and attended every available neurosurgery course. She took leadership of the neurosurgery inter-

est group at school and spent every spare moment away from her studies down in the neurosurgery anatomy lab to spend time learning from the physician attendings and residents. She was exceptionally talented, and, within no time at all, she learned how to do spinal fusions and craniotomies, and to tie knots with sutures so thin it could barely be seen without a microscope. Passionate, gifted, and caring, Anne was held in the highest regard by all she interacted with. She was a girl that you instantly knew would accomplish anything she wanted in life. She never compared herself to others and only wanted to be the very best that she could be. Anne truly was going to change the field of neurosurgery, both as a dedicated physician and as a brilliant scientist. The number of lives that will not be saved because of the contributions she would have made is a devastating realization.

M ORIA M

bering

Madison Cornwell

Medical Students

ool of Medicine lost two of its most promising unk driver. Anne Baldock and Madison onderful. UC San Diego — and the medical by this tragedy. In an attempt to manufacture y of us have devoted a great deal of time to

Madison Cornwell Madison Cornwell was one of the most special people anyone has ever met. She was loved by her family, her friends, and even people who had only just met her. Her passion was people, and that’s how she spent most of her time. Madison frequented coffee shops throughout medical school. The atmosphere was perfect because she could be around people even while neck deep in her work. When she wasn’t studying, she was with her friends. Making them tea, rock climbing, or just sitting on the beach listening to their lives. She cared very deeply about all of her friends and family, and not even the most pressing exam was an excuse to sacrifice time with those closest to her. Madison was very passionate about medicine. To her there could be no greater career. Being a doctor would provide an avenue for intense intellectual intrigue in the context

of helping the people who needed it most. She was very invested in medicine for the underserved. To this aim she worked both domestically and globally. In San Diego she worked with the USCD Student Run Free Clinic, helping provide care in the psychiatry clinic to the homeless and immigrant population nearby. During the summer after her first year of medical school, she traveled to Malawi to work for Project Peanut Butter, a program focused on battling malnourishment in children. Many have said Madison was the most obvious future pediatrician they had ever met. She had planned to spend the next year with the same group in Malawi as she did in her past summer. Her influence on children would have only been greater. In her short time with us, Madison gifted her friends and colleagues with a unique glimpse of the meaning of true passion for medicine, life, and the world community. All

of us who were close with her will continue to strive each day to emulate her remarkable approach to life and embody her humanistic view of medical care. With every patient interaction, the memory of her compassion and gentle understanding will sing through us. We can never replace her, but hundreds of us will keep her in our hearts through our careers and our lives.

SAN DIEGO PHYSICIAN.org

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 pm e n t

Take the Best of 2015 to Create an Even Better 2016 by Helane Fronek, MD, FACP, FACPh

“If you don’t know where you’re going, you might not get there.”

As 2015 nears its end, resolutions for 2016 come to mind. Exercise more, eat less red meat, create new templates so our EHR works better for us. Whatever you think might make 2016 happier, healthier, or more productive, let’s first take stock of what 2015 has taught us. • Who did I meet this year that’s now in my life? What do I value about this relationship? If a relationship brought something valuable to your life, it likely filled a hole you might not have realized was there. What else is missing that you want to find in the coming year? • What emotion caused me to grow? We physicians focus mostly on our thoughts and often suppress our feelings. Yet feelings don’t lie, and can tell us important truths we might not want to know. If becoming angry motivated us to change something for the better, other sources

december 2015

of anger may point to other situations that need to be changed. • What did I do that completely surprised me? Too often, we sell ourselves short. “I could never do that!” we say. It’s good to recognize we can try or accomplish something we never thought we could. Life is full of possibilities when we open our minds! • What was the biggest challenge I faced? What strengths of mine were helpful? What other strengths could have been helpful? While we may pass off our successes as “luck” or due to someone else’s help, we always have a role. Knowing what we called on — or could have called on — to help will allow us to more easily draw from those strengths in meeting future challenges. • In what area(s) of my life did I make progress? What contributed to that?

Recognizing how far we’ve come gives us faith and enthusiasm to continue moving toward a goal. Knowing what got us there reminds us of the many internal strengths and external resources we have available. • What am I most grateful for? Distracted by our busy-ness, we can lose sight of what matters most to us. Acknowledging those important people and activities and keeping them as integral parts of our lives assures they will continue to enrich us in the future. • What were the most fun times I had? It’s easy to be attracted to the headiness of achievement and forget about what lightens our lives with fun. By knowing what was truly fun, we can make sure something like it shows up again each year. • A year from now, how do I want my life to be different? How do I want it to be the same? We each have the power to create the lives we want to be living. Yogi Berra once said, “If you don’t know where you’re going, you might not get there.” Having an idea of what you want for 2016 will help you create a year of greater joy and fulfillment. Wishing you all a happy, healthy, and fulfilling 2016! Dr. Fronek, SDCMSCMA 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.com.

R i s k M a n ag e m e n t

8 Principles of an Effective Patient Safety Team

by Susan Shepard, MSN, RN

december 2015

Teamwork — an essential part of a safety culture — has come to the forefront as the most effective way of catching individual errors before they occur and of mitigating system failures. In the OR, for example, studies have shown that implementing team training is associated with a significant decrease in surgical mortality (1,2). The team approach is not new, but its value and definition are changing. Good communication, along with a focused team approach in dealing with problems, can make a positive difference in any outcome. A healthy culture focused on safety and effective communication is essential to developing a high-functioning team. It becomes challenging when factoring in each team member’s different personality, skills, agenda, style, and objectives. The team approach depends on each member’s ability to:

The team approach is not new, but its value and definition are changing.

• anticipate needs of others, • adjust to each other’s actions and the changing environment, • and have a shared understanding of how a procedure should happen in order to identify when errors occur and how to correct for these errors (3). The first step in developing a cohesive team is to recognize that teams are better equipped to handle challenges within a department. Decisions made through teamwork are significantly better than the decisions of a single person. Individuals who have been responsible for handling problems and making decisions in the past will usually have the most difficulty in embracing this concept. When something adverse occurs, it is not usually a small or isolated problem; it is a problem that has a significant effect on everyone in the room. Since any single negative event can potentially impact all members of the team adversely, the entire team should participate in resolving the problem. Characteristics of an Effective Team Improving patient safety through emphasis on the team approach requires an under-

standing of the factors that make a team successful. An effective team recognizes and accepts the following principles: 1. Each team member contributes his or her individual talent, skill, and experience and acknowledges other team member contributions. 2. When issues are complex, there is often more than one right way to solve a problem. 3. The team’s combined decision is greater than the needs of its individual members. 4. Any team decision must be just and ethical. 5. Once problem solving is complete and a decision has been reached, the decision must be implemented and monitored for effectiveness. 6. The team must be ready and open to change its action if the resolution proves ineffective. 7. Each team member is accountable for the team’s decisions, even if it was not his or her first (or individual) recommendation. 8. Open communication is necessary to promote empowerment in getting the job done and accepting team decisions. Effective Team Communication An important part of teamwork is the ability to communicate, especially in the OR. When was the last time you heard something like this in the operating room? • “I haven’t worked with this piece of equipment in a long time.” • “Last time, this machine wasn’t working correctly.” • “I’m worried about the blood loss.” • “This is an older patient; make sure the room is warm.” • “Keep the heart rate lower; this patient had a previous MI.” Effective team communication requires the exchange of concise and relevant information between team members. It demands good listening skills, with participants joining the conversation only after they have a thorough understanding of the issues. Standardizing communication practices facilitates stronger team communication. Tools — such as the team brief or “huddle” — can be implemented to promote information exchange and team cohesion. Huddles allow the team to meet briefly on a daily ba-

sis to discuss patients’ needs and determine what tasks need to get done and by whom. Maintain vigilance by promoting situational monitoring among team members. When team members actively scan and assess what’s going on, they gain information about the situation and can identify deviations. Conveying this information to fellow team members can prevent small errors from becoming big errors. In the OR, part of this approach includes a statement by the surgeon encouraging communication, such as, “If you see, suspect, or feel that something is not right, please speak up.” Communicating in a closed-loop fashion ensures the entire team is aware of what is occurring and helps to retain the shared mental model. Acknowledging comments and questions ensures that communications have been heard and understood. Repeating back essential information confirms that the sender’s message has been received. Conclusion Communication and teamwork within a safety culture remain the foundation for preventing harm and are two of the most important facets of patient safety. Organizations must address risk perception, leadership involvement, assertive staff communications, consistent process implementation, teamwork, and human factors. Adopting a safety culture reduces errors and better protects patients. Using teamwork to resolve problems and concerns can foster a better understanding of the problem and ensure a more unified, informed approach to problem resolution. The result is a safer and improved environment for all patients and staff. Ms. Shepard is director of patient safety education for SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety. References: 1. Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, Mazzia LM, Paull DE, Bagian JP. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693-1700. 2. Young-Xu Y, Neily J, Mills PD, Carney BT, West P, Berger DH, Mazzia LM, Paull DE, Bagian JP. Association between implementation of a medical team training program and surgical morbidity. Arch Surg. 2011;146(12):1368-1373. 3. Agency for Healthcare Research and Quality, TeamSTEPPs Fundamentals Course, Module 1. SAN DIEGO PHYSICIAN.org

S M C D S r u Yo hysician P e t a c o Is Here v Ad to Help! SDCMS MEMBER BENEFITS

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december 2015

Your SDCMS physician advocate, Marisol Gonzalez, has been helping member physicians of all practice modes, sizes, and specialties — as well as their office staff — with their practice management questions for almost 10 years. If you or your office staff have a question or an issue you need help with, feel free to contact Marisol for assistance at (858) 3002783 or at MGonzalez@SDCMS.org. Below you’ll find a small selection of the hundreds of questions Marisol has received this year alone, along with her answers.

Member Question: I want to register for CURES to meet the July 1, 2016, deadline. It seems like a very difficult process. Can you explain the process to me?

CURES Member Question: What is CURES, and what is it used for? Marisol’s Response: The Controlled Substance Utilization Review and Evaluation System (CURES) is a database containing information on Schedule II through IV controlled substances dispensed in California. The California Prescription Drug Monitoring Program (PDMP) maintains the CURES database. The PDMP allows authorized users — including licensed healthcare prescribers eligible to prescribe controlled substances, pharmacists authorized to dispense controlled substances, law enforcement, and regulatory boards — to access patient controlled substance history information maintained in CURES. The PDMP is committed to assisting in the reduction of pharmaceutical drug diversion without affecting legitimate medical practice or patient care. Through online access to CURES, authorized prescribers and pharmacists can quickly review information via Patient Activity Reports (PAR) in an effort to identify and deter drug abuse and diversion through accurate and rapid tracking of Schedule II through IV controlled substances.

Marisol’s Response: In order to obtain access to the CURES/ PDMP system, prescribers can use a notary-free, no-appointment process to complete their applications via the San Diego County Public Health Officer. The following are steps to complete: 1. Preregister online at https://pmp.doj. ca.gov/pmpreg. 2. Print the registration confirmation and compile the supporting documents, which include copies of your medical license, DEA registration, and government-issued identification. 3. Reply to the email verification within 72 hours. 4. Submit your completed application package to the County Public Health Officer in person at Public Health Services, Office of Vital Records, 3851 Rosecrans Street, Suite 802, San Diego, CA 92110 — (619) 6925550. The office is open Monday through Friday, 9 a.m. to 5 p.m., and no appointment is necessary.

Member Question: I’m having a hard time registering for CURES online. I think I may already be registered as it’s giving me an error stating that my name is already in the database, but I don’t remember registering. What can I do? Marisol’s Response: You can contact the CURES help desk at (916) 227-3843 from 8 a.m. to 5 p.m., Monday through Friday. The Department of Justice has added phone lines and support staff to make sure users gain quicker access to assistance when needed.

Billing Member Question: Our office submitted a Treatment Authorization Request (TAR) over a month ago, and we have not heard back from Medi-Cal. Who can we call to get a status on this? Marisol’s Response: You can contact Medi-Cal at (800) 541-5555 or DHCS at (916) 5529110 and request a resource supervisor.

Member Question: Do all physicians need an NPI to bill? Marisol’s Response: Yes, all physicians need a National Provider Identifier (NPI) to bill health plans.

Member Question: I’ve misplaced my password to access Noridian’s Endeavor system to verify eligibility for my Medicare patients. What should I do? Marisol’s Response: Call Noridian directly at (855) 6099960 and ask to speak to the user security department. They can verify your identity and provide you with the information needed to obtain your password.

Member Question: I need to send one of our patients to a collection agency but I’m worried about violating HIPAA. Should I be concerned? Marisol’s Response: Under the Confidentiality of Medical Information Act (CMIA), a physician has authority to disclose medical information to any person or entity that provides billing services for the physician; however, the law specifically provides that no information so disclosed shall be further disclosed by the recipient (i.e., the collection agency) in any way that would violate the CMIA. Therefore, if you use a collection agency or any billing agent, make sure that these agents know of, and comply with, the requirements of laws relating to patient confidentiality.

SAN DIEGO PHYSICIAN.org

SDCMS MEMBER BENEFITS Member Question: I’ve received numerous requests from Aetna to enroll into their EFT program. They have sent me a letter informing me that they are automatically enrolling me into the Transend Pay program on Jan. 1 if I don’t enroll into their EFT program. I don’t want to share my private banking information with them. What can I do? Marisol’s Response: Aetna has been moving forward with EFT for some time now. There has always been a limited opportunity to opt out, but that window has become exceedingly small each year. If you continue to choose not to enroll in the EFT program, you will be seeing a 1.5% reduction on each of your claims through Transend Pay. Other medical practices have set up unique bank accounts for health plan

EFT deposits and have found that it is easy and payment is quick. You will need to have your staff develop a system to pull up EOBs and cross-check amounts in order to keep track of reimbursements.

Member Question: I know that Medicare will be allowing ICD-10 “flexibilities” so long as I use a valid ICD-10 code from the right family on my claims on and after October 1, 2015. Will MediCal and private insurers follow Medicare’s lead with this flexibility? Marisol’s Response: For now it seems as if Medicare is the only one which will allow for these flexibilities. If Medi-Cal or private insurers follow Medicare’s lead, we will communicate this to our members.

Member Question:

Member Question: We’ve had a few patients who have canceled or missed their appointments. Can we charge them for this? Marisol’s Response: Unless a physician has entered into a contract with a payer that prohibits these charges, a physician may charge a patient when he or she misses an appointment or does not cancel in sufficient time to allow another patient to fill the appointment slot — if advance notice of such procedure is given. You should be aware, however, that payments for missed appointments will generally not be a covered benefit under health plan or insurance policies, which means your patient will be personally responsible for the charge. For more information on this topic, see CMA ON-CALL document #7600, “Billing Patients.”

My physicians have been using unspecified ICD10 codes on their Medicare claims. These claims have all been denied so far. They shouldn’t be using these codes, correct?

Marisol’s Response: With the expansion from 17,000 ICD-9 codes to more than 140,000 ICD10 codes, there should be very few reasons to use unspecified codes as the first code of choice.

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Tracy Zweig Associates A

REGISTRY

PLACEMENT

FIRM

Physicians

Nurse Practitioners Physician Assistants

Seeking Family Medical and Internal Medicine Physicians in Vista and Riverside Position: Full-time, part-time and per diem Family Medicine and Internal Medicine Physicians. Malpractice coverage is provided by clinic. Requirements: California license, DEA license, CPR certification and board certified in family medicine. Bilingual English/Spanish preferred. Send resume to: hr@vistacommunityclinic.org or fax to 760-414-3702

Vista Community Clinic is a private, nonprofit outpatient community serving people who experience social, cultural or economic barriers to health care in a comprehensive, high quality setting.

www.vistacommunityclinic.org EEO/AA/M/F/Vet/Disabled

december 2015

Locum Tenens Permanent Placement V oi c e : 8 0 0 - 9 1 9 - 9 1 4 1 o r 8 0 5 - 6 4 1 - 9 1 4 1 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

t z we i g @ t r a c y z we i g . c o m www. t r a c y z we i g . c o m

TrusT Medical Records Member Question: I have a patient who has an outstanding balance with us, and they are requesting a copy of their medical records. Can I refuse this request until they pay their bill? Marisol’s Response: No. There are no allowances for withholding records until the bills are paid. In fact, Health & Safety Code §123110 provides expressly that “any healthcare provider who willfully withholds patient records or summaries of patient records because of an unpaid bill for healthcare services” is guilty of unprofessional conduct. Member Question: We have a patient who is moving out of the country, and, rather than requesting a copy of their medical record, they are requesting the original. Is it OK to fulfill this request? Marisol’s Response: No. It is generally advisable to provide a copy of the records rather than the original, as the original record should remain at the practice for future reference.

Member Question: Which parts of the medical record do patients have access to? Marisol’s Response: Patients have a right of access to their patient records defined as “records in any form or medium maintained by, or in the custody or control of, a healthcare provider relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient” (Health & Safety Code §123205). Patient records include not only the information in a patient’s medical chart, but also billing records and medical records prepared by other healthcare providers or health facilities. For more information on this topic, see CMA ON-CALL document #4205, “Patient Access to Medical Records.”

Member Question: How much can I charge patients for copies of their medical record? Marisol’s Response: Copying costs should not exceed $0.25 per page or $0.50 per page for records copied from microfilm, or reasonable costs, not exceeding actual costs, for reproduction of oversized documents or those that require special processing. In addition to copying costs, reasonable clerical costs incurred in locating and making the records available can also be charged.

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SDCMS MEMBER BENEFITS

Member Question: My physician is looking into taking CME classes. He mentioned a certain amount of his CMEs need to be in pain management, but he didn’t know the specifics. What is the requirement?

Marisol’s Response:

Member Question: I’ve received a subpoena from the state of Texas for a copy of medical records, and they are also requesting that the records be notarized. Can I pass this notary charge along to the requestor? Marisol’s Response: Yes, you can include this in your clerical costs.

Member Question: Our patient is requesting a copy of their medical records, but is demanding that the copies be made available at the time of their visit, which is tomorrow. Do we have to fulfill this request? Marisol’s Response: According to Health & Safety Code §123110(b), if the patient or patient’s representative requests copies, the provider must ensure that the copies are transmitted within 15 days after receipt of the written request.

december 2015

YOUR Medical License Member Question: I am looking to retire soon. Should I keep my license active, or should I change to a retired status? Marisol’s Response: Many physicians opt to keep their license active and current, as they find themselves continuing to prescribe medication, or they end up working part-time. If you choose this option, you will continue to renew your license and keep up with your CMEs. If you decide to retire your license, you will be exempt from payment of the renewal fees and CME requirements. You will, however, have to pay for two mandatory fees. One is a $25 fee for the Physician Loan Repayment Program and the $12 mandatory fee for the CURES/PDMP program.

Most Californialicensed physicians are required to take, as a one-time requirement, 12 hours of CME on pain management and the appropriate care and treatment of the terminally ill. The 12 units may be divided in any way that is relevant to the physician’s specialty and practice setting. Acceptable courses may address either topic individually or both topics together. The Medical Board will accept any combination of the two topics totaling 12 hours. These 12 required hours would count toward the 50 hours of approved CME each physician is required to complete during each biennial renewal cycle.

Member Question: I want to retire my license, but I don’t want my home address publically listed on the Medical Board’s website. Is there a workaround for this? Marisol’s Response: According to the Medical Board, your only option is to have a PO Box listed as your address on its website, but you will still need to provide a confidential street address as well.

Member Question: As an endocrinologist, do I have to fulfill the 12 hours of pain management and the appropriate care of treatment of the terminally ill CME requirement? Marisol’s Response: Yes, only pathologists and radiologists are exempted from this requirement.

Termination of the Physician-Patient Relationship Member Question: We have a patient who repeatedly refuses to get their vitals taken for their appointments. We are not able to provide proper care without these vitals. Can we terminate our relationship with this patient because of this refusal? Marisol’s Response: Yes. You are not required to give a reason for the termination. Whether or not reasons are offered, the termination letter should not be accusatory or adversarial in tone.

Member Question: I’m looking for a few sample termination letters. Do you have any available to share? Marisol’s Response: Yes, a sample letter can be found in CMA’s legal library. There are certain standard elements that should be included in a letter sent to notify a patient of termination of the physicianpatient relationship. Physicians must be cautious when using a sample letter as each physician-patient relationship is unique and requires individual consideration if it becomes necessary to terminate the relationship. CMA strongly recommends that physicians consult their professional liability insurance carrier for assistance in drafting this letter.

Member Question: We were contacted by a problem patient we haven’t seen for a few years. They are looking to make an appointment with us, but we are hesitant to see them due to the problems we’ve had in the past with their care. Can we assume that the patient has terminated the relationship? We would like to refer them out to someone else. Marisol’s Response: The passage of time alone does not necessarily establish that a patient has terminated the physician-patient relation-

ship. You should not assume that because a patient has not made an appointment with you for a year or more that the patient does not expect to receive further services. A patient may still anticipate that the physician, particularly a primary care physician, will be available to treat the patient for future problems. In addition, a patient who visits a specialist for a particular disorder may expect to be able to return to that specialist for future unrelated problems that fall within the specialist’s area of expertise.

SDCMS Physician Networking Opportunity and Mixer Wednesday, February 4 , 5:00-8:00 p.m. Handlery Hotel, Mission Valley

R a f f l ei z e : r a r nd P

t stay at One nigh t Torrey a e g d o The L s dinner Pines, plu t A.R. o for tw a n Valentie

This event will provide an opportunity for physicians to learn about companies that offer practice management resources. Physicians (both SDCMS members and nonmembers) are encouraged to attend. Complimentary beer, wine, and light hors d’oeuvres will be served.

Interested in event sponsorship? Contact Dari Pebdani at (858) 231-1231.

SAN DIEGO PHYSICIAN.org

classifieds PHYSICIAN POSITIONS WANTED SHORT-TERM LOCUMS AVAILABLE! D. (Doyle) Eugene Johnson, family physician with a wealth of experience, looking for short-term locums, preferably in North County. Have been a full-time practicing certified family physician for 50+ years and would like to continue seeing patients on a part-time basis. 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. Please email d.eugenejohnsonMD@gmail.com with particulars. [301] PHYSICIAN POSITIONS AVAILABLE SEEKING EXPERIENCED, HIGHLY MOTIVATED FAMILY PHYSICIAN: Federally qualified health center (FQHC) clinic site in Linda Vista seeks an experienced, highly motivated family physician with a vision for the future of community medicine. San Diego Family Care operates seven clinic sites in San Diego to serve the primary care needs of our diverse communities. PCMH model operational and EHR system in place. NCQA recognized. Visit our website at sdfamilycare.org. Must have CA license. Competitive salary/benefits with retirement match. Looking for a special doctor, committed to our mission! Send CV to Arthur “Tony” Blain, MD, MBA, FAAFP, Medical Director, at aablain@lvhcc.com, or call (858) 248-1509. [440] INTERNAL MEDICINE OR FAMILY PRACTICE PHYSICIAN to provide quality patient care for a full-time practice. The physician will provide outpatient evaluation, diagnosis, and treatment while representing the highest standards for clinical capability, professional education, quality improvement, and overall patient care. The incumbent must hold a current California license and be board certified or board eligible. Located in Liberty Station in Point Loma, we are a fast-paced, primary care clinic that uses Allscripts. Please email CV to erica.christensen@smartcaremd.com. [438] FAMILY OR INTERNAL MEDICINE PHYSICIAN: Graybill Medical is one of the region’s largest independent, multispecialty groups. We are currently looking for a general family medicine physician (Escondido or Temecula) and an internal medicine physician (Temecula) to provide quality patient care to all ages of patients in a full-time, traditional practice. Conduct medical diagnosis and treatment of patients, including surgical assist, flexible sigmoidoscopy, and basic dermatology. The incumbents must hold a current California license and be board-eligible; bilingual Spanish/English preferred. Check out a full list of our benefits at www.graybill.org. Send CVs to humanresources@graybill.org, apply online, or fax to (760) 738-7101. [436/437] 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. 8am–5pm, Monday–Friday, 10–12 patients per day. No rounds or hospital duties. If interested, please email 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. [435] PSYCHIATRISTS NEEDED: Full-time or parttime 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] KAISER PERMANENTE SAN DIEGO LOOKING FOR PEDIATRIC PER DIEM MDs: As many hours per week as you want! Shifts are available during the day, evenings, and/or weekends. We have 13 different locations across the county, and three main ones for evenings and weekends: San Marcos, Vandever, Otay Mesa. Competitive hourly rates! Please contact (619) 641-4324 if interested. [430] ED PHYSICIAN WANTED: Full/part-time opportunity for BC/BE emergency physician, 20-bed ED, GlideScope, ultrasound, mid-levels. Independent group with partnership tract. Send CV to ppiememergencyphysicians@yahoo.com. Call (619) 417-6581. [428] 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] INTERESTED IN BECOMING A PRECEPTOR FOR OSTEOPATHIC MEDICAL STUDENTS? Midwestern / AZCOM osteopathic medical school in Phoenix has third- and fourth-year medical students in San Diego looking for clinical rotations, particularly in pediatrics, psychiatry, general surgery, and OB/GYN. Requirements: Either MD or DO; physicians interested must commit to minimum one four-week rotation per year / or more as desired (2–3 preferable) and to FT hands-on training for each student as is reasonable for the duration of the rotation. Compensation and CME provided. If interested, please contact Dr. Kevin Considine at kconsidine@sbcglobal.net for more information. [408] SPANISH-SPEAKING FAMILY PRACTICE OR INTERNAL MEDICINE: Spanish-speaking family medicine or internal medicine physician for Borrero Medical Group located in south San Diego next to Chula Vista. The practice is growing and needs to hire a new physician. Borrero Medical Group is a well-established practice, 22 years in the community, exceptional office staff. Every member of our team plays an important role in improving the health of our patients. We offer an excellent comprehensive benefits package that includes malpractice coverage, health insurance, competitive and attractive salaries and bonus. If interested, please submit inquiry and CV to rosa10borrero@att.net. [384] 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]

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.

december 2015

LAST CLASS “A” MEDICAL OFFICE AVAILABLE, VISTA Upgrade to Class “A” medical office in TriCity’s leading outpatient health center. 1,250 RSF office for lease. 3 large exam rooms, MD office, nurse station, ADA restroom, and ample waiting. Will be completely rebuilt. Reserved physician parking & ample surface patient parking. One block from TriCity Medical Center. More than 40 physicians and strong primary care referral base. Contact Greg Petree at (858) 792-0696 x112 or visit www.vistamedicalplaza.com/ suite-265

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 fulltime, part-time, and per-diem 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] OFFICE SPACE AVAILABLE PSYCHIATRIC OFFICE TO SHARE / SUBLET: Ideal location and opportunity for early career or established psychiatrist seeking a furnished, well-maintained, UTC/La Jolla, class-A office at Regents/LJ Village Drive, close to UCSD/VA and Scripps. Plenty of sunlight streams into this thirdfloor office with waiting room, underground parking, and contemporary art and furnishings. Costs negotiable and could include receptionist services. Most important factor is personal and professional compatibility. Interested? Please email me at karl@karljacobsmd.com. [439] CAMPUS OF SCRIPPS ENCINITAS: One-half of 1,800ft2 office to share in nicest building (320). Available March 1, possibly earlier. Ob-gyn primary, but excellent for aesthetic physician / surgical specialty as it is abutting surgical center. Valet parking, imaging center, perinatology here. Vaginal laser and SculpSure laser presently being used. 220 volt available. Ultra hs Cox internet. New three-year lease with Scripps planned. Call Kristi at (760) 753-8413 for more info. [433] OFFICE ASSOCIATE TO SHARE SPACE WITH FULL-TIME PCP: Ideal for part-time PCP or fulltime subspecialist who needs presence near hospital. 2700ft2 beautifully appointed setup with four exam rooms, a cardiac testing room, two consultation rooms, and balcony in classy and wellmaintained, multi-use building. One block from Scripps Mercy Hospital in Hillcrest. Highly trained and service-oriented back- and front-office staff with time to spare. EHR fully set up and smoothly functioning. Friendly office dog. Costs negotiable. Most important factor for the associate is personal and professional compatibility. Interested? Send letter of inquiry with contact information to associate@personalprimarycare.com. [429] CENTRALLY LOCATED UTC/LA JOLLA MEDICAL OFFICE SPACE and Medicare/AAAASFaccredited surgery center available for sublease starting January 2016. Facility has three examination rooms, physician office space, full operating room, and recovery area. This is an excellent opportunity and location for a busy dermatologic, surgical, ENT, or internal medicine practice. Please contact drmofid@drmofid.com for further information. [425]

MEDICAL OFFICE FOR SUBLEASE / SHARE: Scripps Encinitas Campus, 332 Santa Fe Dr. — great location on the hospital campus directly off the I-5. Sublease Office Space: 2,745ft2 available January 1, 2016. Available Immediately to Share: MD and nurse station, 2–3 exam rooms, ADA restroom, ample waiting. High-speed wireless, and conference room onsite. Large parking garage for patient convenience. Please call (760) 943 -6700, ext. 676, for further information. [421] OFFICE BUILDING FOR SALE: Approximately 11,000ft2 building for sale. Established tenants producing income in 2,190ft2 and 3,010ft2 suites. Remaining suite approximately 5,800ft2 with large waiting room, six exam rooms, minor procedure room, PT area, digital X-ray suite, ample storage, and administrative offices. Free parking. Located near Sharp Memorial and Rady Children’s Hospital. Email lvista55@yahoo.com. [420] LA JOLLA (NEAR UTC) MEDICAL OFFICE FOR SUBLEASE OR SHARE: Scripps Memorial medical office building. Great location, steps to main hospital entrance. 9834 Genesee Ave. between I-5 and I-805. Up to four exam rooms and private or shared consult office available. Please call (858) 622-9076 and ask for Jennifer. [394] VISTA MEDICAL OFFICE SPACE FOR LEASE: Offered at $1.40/ft2. 1.1 miles from Tri-City Hospital. Ideal place for solo practitioner. Ground floor, 1,424ft2, has break room, which is leaded for radiology if needed, two bathrooms, two exam rooms, spacious waiting room, ample room for support staff, physicians private office, excellent parking with seven spaces per 1,000ft2. Also available in same building, office space to share with pediatrician. Ideal for solo practitioner, either family practice or pediatrics. Space portioned off with separate wing and includes three exam rooms, two offices, shared reception area and lobby with access to two bathrooms. Area under city renovation, and lots of new business starts surround. Contact Jill at (760) 630-4715. [393] NEW MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE IN KEARNY MESA: Brand new office suite located at 3750 Convoy Street with nine exam rooms and digital X-ray, hi-speed wireless, free parking for patients and staff, conference room in building. Several minutes from Sharp Memorial Hospital and Children’s Hospital. Convenient freeway access to 163 and 805. Multiple half-day clinics available days, evenings, and weekends. Please contact Lisa Vaughn at (858) 278-8300, ext. 210, for more information. [343]

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 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] ADMINISTRATIVE ASSISTANT NEEDED: Must be detailed-oriented. Know about credentialing. Microsoft Excel, Word. Organizational skills a must. Salary depends upon experience. Send resume to takur01@yahoo.com. [431] NURSE PRACTITIONER OR PHYSICIAN ASSISTANT: Looking for full-time nurse practitioner or physician assistant to see patients in various nursing homes. It can be salaried position (1099) or percentage of production depending on experience. Average $100–$120 per hour. Flexible hours, choose your own days and time. Lots of upward potential for the right candidate. Please email guharoysd@gmail.com or call (858) 430-6656. [424]

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] CLINICAL TRIAL VOLUNTEERS NEEDED BIPOLAR DISORDER CLINICAL TRIAL VOLUNTEERS NEEDED: UCSD is conducting a longitudinal study on how inflammatory biomarkers and mood fluctuations among those diagnosed with bipolar disorder may be predicting factors to decline in their cognitive functioning over time. We are recruiting people between ages 35–60 who are diagnosed with Bipolar I Disorder. They must consent to three blood draws a year, clinical assessments, neurocognitive batteries, and use of smartphone. There is monetary compensation for their participation. No medication is involved in this study. If you have any referrals or would like more information, please contact the study recruiter, Nana Kori, at nkori@ucsd.edu or at (858) 534-9439. [405] Legal Services Offered

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] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive

Medical Board and Hospital Peer Review Legal Representation Legal representation before Medical Board of CA; Medical staff privileges issues & peer review investigations, proceedings, and appeals. Harvard/Cornell Law School. Law Offices of David Young, Esq. 310.575.0308 dyounglaw@verizon.net

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]

Place your ad here

BUILD TO SUIT: 950SF 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 six gated parking spaces, two entryways, restrooms, lighted tower sign space. Build-out allowance to $10,000 for 4–5 year lease, rent $1,800 per month gross (no extras). Contact venk@cox.net or (619) 504-5830. [835]

Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

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) 320-0525 and ask for the secretary, Sandy. [127]

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

SAN DIEGO PHYSICIAN.org

Happy Holidays

Back Row, L–R: Barbara, Andrew,

Carlos, Betty, Kyle, Marisol, Jam es, Brian, Brandon Front Row, L–R: Melissa, Sarah, Rebecca, Jen, Liz, Tom

From Your SDCMS and SDCMS Foundation Support Teams!

december 2015

Success. It’s what California’s finest physicians strive for... and what CAP can help you achieve. 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, and are committed to supporting you with a range of value-added programs and services. These include a 24-hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.

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San Diego County Medical Society 5575 Ruffin Road, Suite 250 San Diego, Ca 92123 [ Return Service Requested ]

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PAID DENVER, CO PERMIT NO. 5377