March 2016 by San Diego Physician

official publication of SDCMS March 2016

Medical Students Advocate for Change

“Physicians United for a Healthy San Diego”

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March 2016

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From San Diego Cardiologist Brian E. Jaski, MD

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STAGE B

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STAGE D

At high risk for HF but without structural heart disease or symptoms of HF

Structural heart disease but without signs or symptoms of HF

Structural heart disease with prior or current symptoms

Advanced HF

Features: – Includes over 200 color figures and tables – Specific recommendations backed by clinical trial data – Practical algorithms for diagnosis and therapy Topics include: –New therapies: Entresto, ivabradine –Prevention of heart failure –Reversing decompensated heart failure – How to combine lifestyle changes, medications, and devices to improve outcomes – Indicators of advanced heart failure and appropriate treatment options – Outpatient pulmonary artery pressure-guided HF management –Heart transplant, LVAD

Brian E. Jaski, MD, FACC

Director of Clinical Research, San Diego Cardiac Center Medical Director, Advanced Heart Failure and Cardiac Transplant, Sharp Memorial Hospital, since 1985 Team Coach, Sharp Memorial Heart Transplant Recipients, 2012 San Diego Triple Crown 1/2 Marathon Finishers (third from left)

Available at cardiotextpublishing.com and Amazon in print or e-book editions. SAN DIEGO PHYSICIAN.org

March

Contents

Volume 103, 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, 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

features

departments

The Lifecycle of Legislation: From Idea Into Law

Y THE CALIFORNIA MEDICAL B ASSOCIATION

Briefly Noted: Calendar • Volunteer Opportunities • In Memoriam • History Thumbnails • Your SDCMS at Work • Commercial Real Estate • Practice Management Tip • Welcome New and Returning Members

UC San Diego Medical Students Turn out in Force to Show Their Support for AB 2121

HOW20A BILL BECOMES A LAW 8 tudent Legislative Trip: S February 29, 2016

Leadership Series: Steven A. Green, MD, ABFP, FAAFP BY SHERRY NOORAVI, PSYD

BILL IS INTRODUCED

CMA Legislative Advocacy Day: April 13, 2016

Smile! The Doctor Is on Camera: The Pros and Cons of Recording Office Visits and Procedures

BY RICH CAHILL

COMMITTEE HEARINGS COMMITTEE HEARINGS

IF PASSED (SENT TO OTHER HOUSE)

FLOOR ACTION

26 Physician Marketplace: Classifieds The Stories and Rules We Live By

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 FLOOR ACTION RETURNED TO ORIGINAL HOUSE

IF PASSED WITH AMMENDMENTS IF PASSED WITHOUT AMMENDMENTS

BILL GOES TO GOVERNOR IF ORIGINAL HOUSE CONCURRS

IF NOT VETOED

MOST BILLS BECOME LAW JAN. 1 OF THE NEXT YEAR

Cover Photos: See pages 20–22 for cover photo captions.

March 2016

16 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.]

/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// giving back

calendar SDCMS-CMA Webinars, Seminar, and Social

For further information or to register for the following, contact Jen at (858) 300-2781 or at JOhmstede@ SDCMS.org. MACRA Implementation: A Review of the CMS Proposed Rule (webinar) APR 6: 12:15–1:15pm Aces for Health Golf and Tennis Tournament (event) APR 18 at Lomas Santa Fe Country Club How to Reduce Overhead Expenses and Increase Profitability (webinar) APR 20: 12:15–1:15pm Physician Networking Opportunity & Mixer (social) APR 26: 6:30–8:30pm at the Reuben H. Fleet Science Center

Contract Renegotiations: How to Get Past “No” With a Payor (webinar) MAY 4: 12:15–1:15pm How to Increase Workers’ Compensation Revenue (webinar) JUN 8: 12:15–1:15pm

“

Physician Networking Opportunity & Mixer (social) AUG 5: 5–8pm at 57 Degrees in Mission Hills

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. Butters-Kaplan West Coast Neuropsychology Conference APR 7–10 at the Hyatt Regency La Jolla, San Diego Vascular Disease and Stroke Management: From Prevention to Intervention APR 9 at Paradise Point Resort & Spa 36th Annual Radiology Review Course 2016 APR 10–16 at Hotel del Coronado Fighting Parkinson’s Step by Step: 2016 5K Fun Run & Walk APR 16 at NTC Park, Liberty Station North County Winds Concert to Benefit the American Lung Association APR 24, 4–6pm, at the Foothills United Methodist Church

San Diego Pulmonary, Critical Care and Sleep Medicine Case Conference & Clinical Updates (Pulmonary Medicine Content) APR 25 at VA San Diego, Room 3004 (sjamil@ucsd.edu) San Diego Psychiatric Society’s 57th Annual Installation and 2-day Conference JUN 3 (Installation) & 4–5 (Conference) at the Marriott La Jolla. The installation will include a dinner, entertainment, and great company. The conference — Integrating Mental and Physical Health — is an accredited CME/CEU event for physicians, nurse practitioners, psychologists, social workers, marriage and family therapists, and other mental health professionals, and will include experts from around the country and state. For complete details, visit www. sdpscme.com. SDAFP Annual Family Medicine Update JUN 24–26 at Paradise Point Hotel in Mission Bay Superficial Anatomy and Cutaneous Surgery JUL 9–17 at the San Diego Marriott Del Mar

For the sword outwears its sheath, and the soul wears out the breast. And the heart must pause to breathe, and love itself have rest.

”

— Lord Byron, English Poet (1788–1824)

March 2016

VOLUNTEER OPPORTUNITIES Email Your Physician Volunteer Opportunities to Editor@SDCMS.org SDCMS Foundation Project Access: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology. 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, contact Andrew Gonzalez at (858) 300-2787 or at Andrew.Gonzalez@SDCMS. org, or visit www.SDCMSF.org. Help Spread the Message of Health by Making a Brief Presentation in Your Community: Educate children, adults, seniors, and employees on how to improve their lives and take charge of their health through the Live Well San Diego Speakers Bureau. Email Andrew.Gonzalez@SDCMS.org at the SDCMS Foundation to say YES, you will volunteer just one or two times a year, quarterly, or however your schedule allows.

IN MEMORIAM SDCMS extends our deepest sympathies to the friends and families of Drs. Alberton, Lowe, and Tarzy, longtime SDCMS-CMA members who were recently discovered to have passed away. Paul Gregory Alberton, MD, 34-year member of SDCMS-CMA, passed away on Aug. 27, 2014. D. Howard Lowe, MD, 30-year member of SDCMS-CMA, passed away on Feb. 27, 2014. Bruce Tarzy, MD, 34-year member of SDCMS-CMA, passed away on July 27, 2015.

/////////////////////////////////////////////////////////////////////////////////////////////////// YOUR SDCMS AT WORK History Thumbnails

Dr. Charlotte Baker, SDCMS President in 1898 By Betty L. Peabody Charlotte Baker, MD, was the first woman to be elected president of SDCMS in a so-called “gynocratic revolution” in 1898. She shared the slate with two other women: Dr. Latto, vice president, and Dr. Nelson, secretary-treasurer. Men were allowed to remain as members, but one stomped out, refusing to serve under a woman. Dr. Baker’s physician husband, Fred, was president in 1891. Their origins and arrival in San Diego will be the subject of a future thumbnail.

Dr. Charlotte helped form the local branch of the American Women’s National Medical Association and helped choose the site of the San Diego County General Hospital, overlooking Mission Valley, just north of the present Hillcrest UCSD Hospital. In quick succession she became honorary president of the YWCA, WCTU, and the San Diego Women’s Club. Charlotte stumped on the local street corners for women’s suffrage and traveled to Sacramento to lobby on its behalf. San Diego was the first city to pass the amendment on Oct. 13, 1911; she tried to register every day, but the City Clerk refused to allow it until the 16th when San Francisco approved it. Ironically, the amendment failed in her own precinct, Point Loma, where she and Fred had built an early, freestanding home. Charlotte loved medical politics. The first meeting of the Southern California Medical Society (excluding Los Angeles) was at the Bakers’ Rosecrans Street home. Charlotte boasted that she was first a physician and second a woman. As a member of the “Committee of 19,” she was responsible for closing the “Stingaree” and driving the girls in the oldest profession out of town. She lobbied for prison reform and to improve working conditions and welfare for women. Dr. Charlotte founded the Children’s Home in Balboa Park and was its only physician for the first year. She was a member of the School Board, Civil Service Commission, taught Sunday school at St. Paul’s, and exercised regularly with the “Y” girls. She met all the time-consuming challenges of her profession with consummate medical and surgical skills. Despite her busy life, she and husband Fred made the Baker house the scene of weekly Friday night dances. Charlotte was a superb obstetrician, reportedly delivering 1,100 babies without the death of a mother. Both she and Fred were always ready to see their patients first by boat or buckboard and later by wagon, cart, motorbike, or commercial launch, and finally by streetcar from the Baker Corner streetcar stop. Fred and Charlotte lived to celebrate their 50th wedding anniversary, surrounded by a bower of flowers and messages from friends far and near. They died within seven months of each other in 1937 and ’38. Charles Fletcher bought the Baker home and raised his family there for 20 years. In 1957 Homer Peabody became only the third owner. He was a pulmonary specialist and later medical director of the Rees-Stealy Medical Group. He was a visionary but loved history and group practice and recognized the value of preservation in writing Rees-Stealy Clinic: San Diego’s First Group Practice, published in 2004. Homer died in December 2005, but we have thoroughly enjoyed our home and the role it has played in perpetuating the rich history of medicine and the San Diego Community.

Coordinated Care Initiative San Diego County is one of seven counties in California selected to implement the State’s Coordinated Care Initiative (CCI), an improved system to coordinate the delivery of healthcare and long-term services and supports (LTSS) to San Diego County seniors and persons with disabilities who are either dually eligible for both Medicare and Medi-Cal benefits (dual eligibles or duals) or who receive Medi-Cal benefits only. CCI, which began April 1, 2014, in San Diego County, is supported by an Advisory Committee comprising 50 representatives from a vast array of constituency groups that are impacted by CCI. The CCI Advisory Committee, established by the CCI Health Plans (Plans), provides recommendations to the Plans regarding program operations, benefits, access to services, adequacy of provider networks, grievance processes, and consumer protections. Since its inception, the Advisory Committee has actively tracked CCI providers’ and consumers’ experiences and has brought identified barriers as well as success stories to the attention of the Plans, Department of Health Care Services (DHCS), and CMS to facilitate resolution and to share best practices. A subcommittee of the Advisory Committee, the CCI Communication Workgroup, has provided extensive CCI outreach and education to providers and consumers across the county. The San Diego County CCI Advisory Committee is deeply committed to the successful implementation of CCI and works collaboratively to improve the system of care across the continuum of healthcare and LTSS for seniors and persons with disabilities.

March 5 Undy Run / Walk During the Colon Cancer Alliance’s 2016 San Diego Undy Run / Walk on March 5, the SDCMS Foundation formed a team comprising staff, volunteers, and Project Access San Diego patients who were diagnosed with stage IV colorectal cancer, all of whom were — thanks to the Foundation — successfully treated and cured. Funds raised support SDCMS Foundation efforts to reduce the impact of colorectal cancer on medically underserved San Diegans. For information on how you can support the work of your SDCMS Foundation, visit sdcmsf.org.

Daniel “Stony” Anderson, MD (second from left), SDCMS Foundation Champion, with SDCMS Foundation patients before the race.

SAN DIEGO PHYSICIAN.org

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

San Diego Medical Office Snapshot | Q4 2015 By Chris Ross

Interesting Facts Market Conditions and Trends Medical office leasing and sale activity remains steady throughout most areas of the county, the Southwest region, and the United States. With improved employment rates and other economic conditions comes a generally better insured population, a higher percentage of patients seeking preventive medicine and elective procedures, and other trends that have resulted in improved revenue for many health practitioners. As a result, more space is being absorbed. That is not to say providers do not have plenty of challenges. In fact, many physicians’ net incomes are down and have decided to retire or join a larger group to get away from the grind of practice ownership. But the fundamentals that affect real estate demand are strong: Physicians and hospitals continue to consolidate or form strategic partnerships, and as a whole they are expanding programs, services, and geographic reach.

March 2016

7.8%

Countywide Direct Vacancy

204,183

2015 Net Absorption (s.f.) 64,527 s.f. (Q4 2015)

2.4%

12-month Rent Growth $2.70 s.f. Average Asking

259,018 Total Under Construction (s.f.)

Vacancy continues its gradual decline and now sits at 7.8%, down fairly significantly from 9.7% a year ago, with only two submarkets (Oceanside/Vista and Escondido/San Marcos) over 10%. Only 10 medical buildings in the county contain over 20,000 square feet of total available space. Forty-nine (49) of the 398 buildings in the county that are designated as “medical office” by JLL Healthcare Practice Group are considered Class A. Vacancy among these buildings is 6.6% — well below the five-year average of 11.1%. The average time on the market for this vacancy is currently 12.1 months, down from the fiveyear average of 18.3 months. Class B medical buildings are continuing their downward trend in vacancy (currently 7.9%) and gradual incline in asking rents ($2.56/SF full service). Class C vacancy is currently above 5- and 10-year averages but remains in the single digits at 9.1%. Class C average asking rent is currently $1.91/SF — a hair above the five-year average of $1.86. Forecast Healthcare providers are doing a good job educating consumers about the importance of regular checkups, wellness, healthy diets, exercise, new medical technology, other advancements in medicine, and other important information pertaining to health and care. San Diego in particular has some of the nation’s best physicians and hospitals, and our county will continue to benefit from that — as will the real estate in which these providers practice. New construction has remained remarkably limited, but this is bound to change as demand persists and rental rates reach unchartered territory. 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 2015 report, call Mr. Ross at (858) 410-6377 or email him at chris.ross@am.jll.com.

/////////////////////////////////////////////////////////////////////////////////////////////////// PRACTICE MANAGEMENT TIP

Improving Front Desk Collections By George S. Conomikes, President, Conomikes Associates, conomikesg@conomikes.com The recent escalation of patient deductibles and copays has made it more difficult for the patient to be ready to pay for services at your practice. It is important for the practice to educate and guide the patients regarding their copays and deductibles. The clue to improve your front-desk collections is preparation. If your front desk does not collect from the patient while at the practice, then your later results will be less revenue and weaker cash flow coupled with more work. Here is how to maximize your results: • Step 1 — Two Days in Advance: Review the accounts receivable with the names of scheduled patients. Patients with still-outstanding balances should be given a reminder call or email that includes a reminder on the outstanding balance. Those messages ask these patients to call, by name, a billing staff member to confirm their appointment. When these patients call, they are reminded of the outstanding balance. With larger balances due that are starting to age patients are often asked to deal with these accounts in order to keep their appointments. This is why these reminder emails/calls need to be clear about the name and number of the key contact person in your billing staff. • Step 2 — One Day in Advance: You may prefer to couple this with Step 1. All accounts of those scheduled should be reviewed. Note: Your clearinghouse can assist with most of the following three activities. For each established patient: °° Determine their eligibility. Check to determine if they are still actively in the plan. If not, a billing staff call to the patient should get more current data. And patient data can be updated at that time. °° Determine if any deductible is due. If so, this should be noted in the appointment schedule. °° Determine the amount of the co-payment. This should be noted in the appointment schedule. • Many practices are unaware that their clearinghouse systems can provide data on patient eligibility, deductibles, and copays. The following leading clearinghouse companies provide the usual claims submission functions, but also provide the data being sought in Step 2. Their customary charges, including all these services, are usually in the range of $80 to $125 per physician, per month. Clearinghouse companies: RealMed; Gateway; Navicure; and ZirMed. These preparatory steps will lessen pressures on your front-desk staff and will improve collections results.

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SDCMS-CMA Membership

Welcome New and Returning SDCMS-CMA Members! NEW MEMBERS Jennifer D. Berngard, MD Family Medicine La Jolla (619) 499-2600 Luke F. Bremner, MD Orthopaedic Surgery Encinitas (760) 943-6700 Laura L. K. Desadier, DO Neurology Carlsbad (760) 631-3000

Ricardo A. Indacochea, MD Pediatrics San Ysidro (619) 662-4100

Laurie J. Han-Conrad, MD Family Medicine San Diego (858) 499-2703

Stephanie P. Joseph, MD Neurology Carlsbad (760) 631-3000

Jefferson C. Hendrix, MD Family Medicine San Ysidro (619) 428-4463

RETURNING MEMBERS

Veena A. Prabhakar, DO Family Medicine San Diego (858) 521-2015

Karla J. Garcia, MD Family Medicine San Diego (619) 205-6349

Endorsed by

SAN DIEGO PHYSICIAN.org

L e a d e r s h i p — 3 rd i n a S e r i e s

Steven A. Green, MD, ABFP, FAAFP by Sherry Nooravi, PsyD

Dr. Green, CMO, Sharp ReesStealy Medical Group

The following interview is part three of an eight-part leadership series, with interviews conducted by organizational psychologist Dr. Sherry Nooravi. See the January 2016 issue for an interview with Dr. Paul Bernstein, medical director and chief of staff at Kaiser Permanente San Diego, and the February 2016 issue for an interview with Dr. Wendy Buchi, CEO of IGO Medical Group. DR. GREEN, 28-year member of SDCMSCMA, is board certified in family medicine, and is CMO of Sharp Rees-Stealy Medical Group, which includes more than 200 primary care physicians and 300 specialists, and provides care to more than 258,000 members. Dr. Green can be reached at (619) 446-1530 or at steven.green@sharp.com. Question: What is your leadership philosophy? Answer: To motivate our physicians and to describe a vision where I think we need to be going. It’s much more effective if people have an idea of what they are a part of. Be transparent, resources will be thinner and revenue per patient will be going down. It’s important that physicians aren’t insulated from these facts. I try to be fair and consis-

March 2016

tent. I make sure people know what they can and cannot do. People are willing to do something difficult if they know everyone is treated the same. Working as a float physician really helps me. I can better see what is going on in the group when I am seeing patients — and there is no substitute for that. I believe it is important to listen to what physicians and staff have to say. We listen to patient complaints. They are working for us by telling us. The truth can sometimes hurt, but we learn from it. Question: What should physicians do to prepare for the future of healthcare? Answer: One of the givens of the future is that in order to be successful, you will have to be patient-focused. It is easy to say and hard to do. Set your schedule around what will be the easiest thing for the patient. Does the patient need to see me versus email or call me? Over 100,000 of our patients are using our email portal, and this can be a

“Be careful with technology as a leader. You are working with people, and the relationships are very important. People aren’t going to take a lead from someone who is not communicating well. Texting and email are easy and quick; however, if you have to have a conversation that is difficult or around a sensitive issue, do it in person or, the next best thing, on the phone.”

great way to provide care. With email, you see what is going on in the patient’s own words. Be efficient and ask yourself if you really need a particular test. You have to be ready to look at new innovation. It will no longer be, “Do it like last year because it’s comfortable.” You must be willing to look at new ways for people to get their care. Do some reading about accountable care organizations and managed care. Question: What advice do you have for young/incoming physician leaders? Answer: Be careful with technology as a leader. You are working with people, and the relationships are very important. People aren’t going to take a lead from someone who is not communicating well. Texting and email are easy and quick; however, if you have to have a conversation that is difficult or around a sensitive issue, do it in person or, the next best thing, on the phone. Be respectful: Keep an even keel with colleagues, staff, and patients. It is never OK to yell. Set clear expectations, and be specific when you are giving feedback. If you want people to change, make the case for it. Leadership has a lot of parallels to sales. You are trying to explain what’s in it for them. Find a mentor, or more than one. Find someone who has been in the organization for a while and is well respected, and discuss your challenges. You can learn a lot from people who have been there. Question: What does organizational culture mean to you, and how do you drive it? Answer: The two doctors who started this group, Drs. Rees and Stealy, believed in putting the patient first, and we still do our best to live it. That’s why this group has grown. When you are making decisions, the first question must be, “Is this the right thing to do for our patient?” Our culture is to provide efficient, high-quality, convenient care, and we are proud of our state and national quality awards. Our monthly staff meeting with 300 people is a chance for us all to be in the same room, see our colleagues, and chat with them. We also have a yearly CME retreat in Indian Wells for physicians across specialties. Question: What has worked for engaging your staff that CEOs and leaders in other industries can learn from? Answer: Having annual educational retreats and dinner events as well as nonmedical events. These are useful for helping people feel that they are more a part of something. Educating and motivating people for why we need to make a change and be better. If you can, stay in the trenches. If you are

Points to Consider

actually there side by side working with your colleagues, it educates and brings credibility. It also allows you to go to different offices and get ideas on what is and isn’t working. Sharp HealthCare has an all-physician assembly with videos of patient stories, speakers, and discussion of what’s up and coming. It reminds people why they are here when we share stories of successes that have changed people’s lives. Dr. Nooravi is an organizational psychologist and CEO of Strategy Meets Performance, a leadership consulting firm that focuses on helping CEOs of fastgrowth companies shape engaging, innovative, and customer-driven cultures through executive coaching and senior team facilitation. She has been named “Trailblazer of the Year” for her research on the best practices of CEOs of high-performing organizations. She can be reached at sherry@ strategymeetsperformance.com or at (312) 286-0325.

2 1 Why Are They Complaining? Do you consistently seek feedback from your customers? Do you take complaints seriously and see it as a big opportunity for improvement?

Tough Conversations Do you gravitate toward email and text when you have a tough conversation (or avoid the whole thing altogether?), or do you push yourself out of your comfort zone to drive these important conversations?

Why Change? Do you make the case for change and get input from your team, or do you mandate it and hope it will stick?

SDCMS Physician Networking Opportunity and Mixer Join us for a

Physician Appreciation event organized by the San Diego County Medical Society.

April 26, 6:30–8:30pm at the Reuben H. Fleet Science Center

Seeking Family Medical and Internal Medicine Physicians in San Diego, Riverside and Orange Counties 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.

Contact Jen Ohmstede at (858) 300-2781 to RSVP. This event is complimentary for SDCMS member physicians and their guests.

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

SAN DIEGO PHYSICIAN.org

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

Smile! The Doctor Is on Camera The Pros and Cons of Recording Office Visits and Procedures by Rich Cahill

“Doctor, can I record our conversation today?” Have you ever heard that question from a patient or a patient’s family member? Or have you ever been worried a patient might record the visit without asking permission? As smartphones have become ubiquitous — giving patients a video and audio recorder that’s always at hand — the question of whether or not these devices should be allowed in the clinic or hospital setting is becoming increasingly common. A high-profile case involved a patient who accidentally recorded his colonoscopy, capturing derogatory remarks from the anesthesiologist while he was under anesthesia. The patient sued for malpractice and was awarded $500,000 (1). While this case is extreme, it has raised the importance of addressing the issue in each practice and hospital. Patients: To Record or Not to Record? The issue of allowing patients to record their appointments requires balancing potential privacy and liability risks with the potential

March 2016

benefits of improved patient recollection of instructions and treatment adherence. Patient pamphlets and other educational materials handed out at office visits are often lost or forgotten, and patients forget or remember inaccurately a significant portion of information shared at doctor visits. Patients who have a better and more complete understanding of their condition and the treatment plan are more likely to be actively engaged and involved in their healthcare. Despite these potential benefits, it’s typically not the best course to allow patients to record the appointment. The recording devices could be disruptive and could be potentially intimidating to physicians and staff. In addition, these recordings — unlike the electronic health record — can be altered or manipulated to create an inaccurate portrayal of what actually occurred. These recordings can also easily be streamed or posted online, raising the issue of patient and staff privacy and HIPAA compliance. In addition, recording the visit may inhibit the flow of information between the doctor and patient. Patients may be less likely to be

open about sensitive health issues because of the fear that the recording might be listened to by an outside party. If a patient records a visit without the doctor’s permission, that can result in a loss of trust, which is the basis of a strong physician-patient relationship. Only about a dozen states nationwide prohibit electronic recordings done without the explicit consent of all participants in the encounter. It is important to know the specific laws concerning recordings in the jurisdiction where you practice. Regardless, it is recommended that patients be advised unequivocally that digital recordings by handheld devices such as smartphones are prohibited on the premises in order to protect the privacy of other patients and staff in compliance with federal and state privacy laws. Post this notice clearly on your practice website, in the conditions of treatment signed by the patient at the outset of the relationship, and as office signage near the reception window. Suspected violations should be handled immediately. If this policy is violated, meet with the patient in a confidential setting to discuss the issue and reiterate the office policy. Depending on the circumstances and the status of the patient’s current episode of care, advise the patient that further violations may result in termination of the physician-patient relationship. If patients ask to record the visit, encourage them instead to take notes or to have a trusted family member or friend join them for the office visit to help take notes, remember information, and ask questions. Doctors can also encourage patients to be engaged in the conversation with “Ask Me 3,” a program that promotes clear communication through these three main questions: 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this? Doctors should also ask patients to repeat back the information shared, and then correct any misunderstandings. Important Policies for Recording Surgical Procedures Practices and surgical centers also must decide whether they should video-record clinic visits or operative procedures. Office practices may want to record patient encounters to document when the informed consent occurred. Surgical centers may want to record surgeries for educational purposes. It is important to note that this additional documentation will become a part of the record and can be subsequently accessed

by government agencies responsible for healthcare oversight, such as state medical boards, the Centers for Medicare and Medicaid Services, and the Office of the Inspector General for the United States Department of Health & Human Services, among others. Law enforcement will also be able to secure a copy with a search warrant or other court order. A patient may also obtain the recording with a valid HIPAA-compliant authorization. If a medical group or healthcare facility is considering doing audio or video recordings, it is recommended that several factors be considered and implemented: 1. The practice or facility should create a written protocol detailing under what circumstances a digital recording — whether audio, video, or both — may be done. 2. The policy should also indicate how the digital recording will be stored, where it will be retained and by whom, and for how long it will be kept. 3. Any such protocol should reference the manner in which the digital document will be destroyed, consistent with federal and state privacy laws. 4. Patients should be advised in advance that a digital recording is being considered. The patient should sign a written release that explains the reasons for the recording. As with all consent forms, the signed authorization should be placed in the chart as part of the permanent record. 5. The practice or facility should put a procedure in place to ensure that the policies are being followed and that a responsible administrator conducts a periodic review to ensure the effectiveness of the protocols. Adopting and following these procedures helps to protect the practice or facility in the event of a subsequent inquiry as to the validity and completeness of the patient’s chart. Mr. Cahill is vice president and associate general counsel for SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www. thedoctors.com/patientsafety. Reference: 1. Video in the Exam Room: Should You Allow Patients to Record Visits? Medical Economics. September 22, 2015. http:// medicaleconomics.modernmedicine. com/medical-economics/news/ video-exam-room-should-you-allowpatients-record-visits?page=0,0. Accessed January 19, 2016.

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HOW A BILL BEC po l iti c a l a dvoc acy

The Lifecycle

of Legislation

From idea into law

COMMITTEE HEARINGS

BY THE CALIFORNIA MEDICAL ASSOCIATION

The California Medical Association (CMA) is the largest, most influential medical organization in California, and an aggressive advocate for doctors and patients. CMA relies on the involvement of its members to communicate the physician vision of medical care to the public, to lawmakers, and to the regulators who determine how medicine is practiced.

FLOOR ACTION

An idea is born: Ideas for new health policy are born in a number of places. One of them is in the hearts and minds of the physicians of California. CMA members can directly influence the association’s healthcare advocacy agenda by submitting a resolution for consideration to the CMA House of Delegates. CMA policy is established: Resolutions are assigned to councils and subcommittees for study and development, then opened up for discussion by your physician colleagues before recommendations are developed for action by the CMA Board of Trustees. Many of CMA’s sponsored bills have their genesis in an idea submitted by our physician members. While not all CMA policies result in direct legislative action, they are used to guide CMA’s positions on the hundreds of healthcare bills that are introduced into the State Legislature each year. Bills are introduced: The California Legislature operates on a two-year session. Each year, primarily in January and February, bills are introduced by lawmakers for consideration. The governor may also call a special session of the Legislature to deal with specific subjects.

March 2016

IF (SENT TO

RETURNED TO ORIGINAL HOUSE

IF PASSED WITH AMMENDMENTS

BILL GOES TO GOVERNOR IF ORIGINAL HOUSE CONCURRS

COMES A LAW CMA takes a position: Each year, with physician input, CMA monitors more than 500 bills and takes a public position on around 200 bills. Those positions include watch, support, oppose, support if amended, and oppose unless amended. CMA may also choose to sponsor or co-sponsor legislation that is of critical importance to the physicians of California.

BILL IS NTRODUCED

COMMITTEE HEARINGS

F PASSED O OTHER HOUSE)

FLOOR ACTION

IF PASSED WITHOUT AMMENDMENTS

IF NOT VETOED

MOST BILLS BECOME LAW JAN. 1 OF THE NEXT YEAR

Bills move through the process: If a bill is to become law, it must be passed out of one or more committees, approved by a simple majority of both houses, and signed by the governor. Laws ordinarily take effect on Jan. 1 of the following year. Briefly, a bill progresses through the following steps: 1. A bill is introduced. 2. The bill is heard in one or more committees in its house of origin (either Senate or Assembly), including public testimony. 3. If the bill passes out of committee(s), it goes to the house floor for a vote. If it passes out of the house, it is sent to the other house for consideration following the same process described above. 4. If approved by both houses, the bill goes to the governor for signing. 5. The governor has three choices: sign the bill into law, allow it to become law without his or her signature, or veto it. A governor’s veto can be overridden by a two-thirds vote in both houses. CMA monitors and protects physician interests: CMA’s powerful government relations team works tirelessly with legislators to educate them on how legislation could enhance or threaten patients’ health or physicians’ ability to practice medicine. Their activities include reading and tracking bills and amendments, shaping bill language, meeting with legislators, testifying in committee, conducting research, and preparing policy papers and position letters. Every year, CMA not only supports and shapes the development of valuable healthcare policy, but the association also stops a number of harmful legislative proposals. For more information on CMA’s legislative advocacy, and how you can get involved, visit www.cmanet.org. CMA also publishes a “Legislative Hot List” during the legislative session, which provides a summary and the current status of CMA-sponsored bills, as well as the progress of other significant legislation. To subscribe, visit www.cmanet.org/ newsletters.

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po l iti c a l a dvoc acy

UC San Diego Medical Students Turn Out in Force to Show Their Support for AB 2121 At noon on Friday, Feb. 19, California Assemblywoman Lorena Gonzalez (D-San Diego) was joined by UC San Diego medical student Nicole Herrick, SDCMS President William T-C Tseng, MD, MPH, San Diego Police Officers Association President Brian Marvel, and Steve Lykins, executive director of Mothers Against Drunk Driving (MADD), San Diego Affiliate, at a news conference to discuss Assembly Bill 2121, which would require restaurant and bar servers to undergo Responsible Beverage Service training for anyone selling or serving alcoholic beverages, and to detail both its implementation and potential life-saving impact. In May of 2015, UC San Diego medical students Anne Baldock and Elizabeth Cornwell were killed by a wrong-way drunk driver in Mission Valley. The drunk driver was leaving a local restaurant when he went the wrong way on State Route 163 and caused the collision that killed Anne and Elizabeth and injured three other students. In the wake of the accident, classmates of the victims worked with Assemblywoman Gonzalez and her office to develop legislation that would better equip servers to identify signs of overconsumption and intervene before tragedy strikes.

March 2016

1: Assemblymember Lorena Gonzalez at the podium. 2: Assemblymember Lorena Gonzalez. 3: Television crews filming the news conference. 4: UC San Diego medical student Nicole Herrick at the podium. 5: Nicole Herrick and Assemblywoman Gonzalez. 6: Assemblymember Lorena Gonzalez introducing Dr. Tseng, SDCMS president. 7: SDCMS president Dr. Will Tseng at right.

Dr. Tseng: “On behalf of the San Diego County Medical Society and the California Medical Association, I want to thank Nikki and Dan for taking the initiative to move this important issue forward. The tragic loss of their classmates and friends last year has moved them to create better public policy and to protect their community from these dangers in the future. It is that zeal and dedication that reminds me of my own time in medical school and the very reason we all set out to become physicians. “I’d like to also thank Assemblymember Gonzalez for her vision and devotion to this bill and her community. AB 2121 will hugely increase the safety of those here in San Diego and across California, and, while the impetus came from tragedy, the result will certainly be far reaching and impactful. “As a primary care physician, I all too often see patients in follow-up that have been victims of drunken driving accidents. This bill will help to reduce those injuries, provide safer communities for everyone, and prevent the terrible stories that brought us here to this place. “We’re proud to stand together with a strong coalition as the bill is introduced today, and we look forward to supporting the efforts of this group through the legislative process.”

SAN DIEGO PHYSICIAN.org

po l iti c a l a dvoc acy

9 10

March 2016

8: Nicole Herrick. 9: Brian Marvel, San Diego Police Officers Association president, saying a few words. 10: Steve Lykins, executive director of Mothers Against Drunk Driving (MADD), sharing his thoughts. 11: SDCMS president Dr. Will Tseng at the podium. 12: Assemblywoman Gonzalez with some closing thoughts.

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P O L ITI C A L A DVO C AC Y

Student Legislative Trip February 29, 2016

Each year, SDCMS sends a group of first-year UCSD medical students to Sacramento to meet with state legislators, as well as senior staff from the California Medical Association (CMA). This past February 29, 18 students made the trip, accompanied by Drs. Robert Hertzka, Sherry Franklin, William Tseng, and Mihir Parikh, and SDCMS CEO Paul Hegyi. The students met with Senator Dr. Richard Pan, Senator Joel Anderson, Assemblymember Lorena Gonzalez, Assemblymember Brian Maienschein, Assembly Speaker Toni Atkins, and Assemblymember Shirley Weber.

March 2016

4 5

6 7

8 1: Pictured on the cover, standing in front of the public entrance to the governor’s Capitol office (L–R): Mihir Parikh, MD, Paul Hegyi, Michelle Keyser, Megan Fischer-Colbrie, Robby Turk, Kevin La, Shawn Kim, Tyler Werbel, David Li, Cecilia Bonaduce, Robert Hertzka, MD, Mandeep Bajwa, Nick Cardillo, Daniel Trujillo, Elizabeth Doyle, Jared Rosen, Pavan Upadhyayula, Sherry Franklin, MD, Cong Dinh, Michelle “Shelley” Tibbs, Chetna Pathak, William Tseng, MD, and Abhishek Kumar. 2: Talking with Senator Joel Anderson. 3: Talking with Senator Dr. Richard Pan. 4: In the Senate Chamber with Senator Joel Anderson. 5: In the Senate Chamber with Senator Joel Anderson. 6: Talking with Senator Dr. Richard Pan in his office. 7: Chatting with CMA’s Janus Norman, senior vice president, Centers for Government Relations and Political Operations. 8: Dr. Tseng, SDCMS president, shares some advice with the students.

SAN DIEGO PHYSICIAN.org

P O L ITI C A L A DVO C AC Y

10 11

14 9: Talking with Senator Dr. Richard Pan in his office. 10: CMA’s Mark Lane, associate director, Center for Economic Services, sharing some advice. 11: Speaking with Nick Birtcil, CMA’s senior director, Center for Political Operations. 12: With Dustin Corcoran, CMA chief executive officer. 13: CMA’s Francisco J. Silva, general counsel and senior vice president, shares his thoughts. 14: Dr. Bob Hertzka leading the discussion.

March 2016

CALIFORNIA MEDICAL ASSOCIATION

PRACTICE MANAGEMENT:

MARCH

TIP OF THE MONTH

Are you using the two new CPT codes to report prolonged services provided by clinical staff? Under the direct supervision of a physician or other qualified provider (99415, 99416), these time-based services are reported in addition to a primary outpatient evaluation and management (E/M) service, 99201-99215. For more information, see the Coding Corner article in the March issue of the CMA Practice Resources (CPR) newsletter, available at www.cmanet.org/cpr.

Through its robust webinar series, CMA gives you the opportunity to watch live presentations on important topics from comfort of your WEBINARS • SEMINARS • PODCASTS • AND MORE home or office. Webinars are free to members and their staff and provide timely information to help you run a successful medical practice. DID YOU Check outKNOW? the current webinar schedule at www.cmanet.org/webinars.

TROUBLE GETTING PAID? WE CAN HELP! CMA’s Center for Economic Services is staffed by a team of practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice. Assistance ranges from coaching and education to direct intervention with payors or regulators. Access to our reimbursement experts is a FREE, members-only benefit. Call (800) 786-4262 or email economicservices@cmanet.org.

Meet Your Advocate: Jodi Black

Jodi is the Vice President of CMA’s Center for Economic Services. She has spent the past 11 years working through reimbursement issues and advocating on behalf of members of CMA and its county medical societies. Prior to her time at CMA, Jodi spent 15 years working with a group of emergency physicians.

“

We try to take the noise out of the system so that the physician can actually go back to practicing medicine.” Jodi Black, Vice President, CMA Center for Economic Services

TO OPT OUT OF FUTURE NOTICES, EMAIL MEMBERSERVICE@CMANET.ORG OR FAX (916) 551-2036. BE SURE TO INCLUDE THE FAX NUMBER YOU WANT REMOVED. SAN DIEGO PHYSICIAN.org

P O L ITI C A L A DVO C AC Y

CMA Legislative Advocacy Day April 13, 2016 The California Medical Association (CMA) will host its 42nd annual Legislative Advocacy Day on April 13. The conference will be held at the Sheraton Grand in Sacramento. Attendees will have the opportunity go to the Capitol throughout the day to meet with legislators on healthcare issues. The meetings will be scheduled and coordinated by local county medical societies. This is a unique event for California physicians and is free of charge to all CMA members. Plan to join more than 400 physicians, medical students, and CMA Alliance members who will be coming to Sacramento to lobby their legislative leaders as champions for medicine and their patients. In preparation for Legislative Advocacy Day, CMA’s Center for Government Relations hosted a special “Lobbying 101 and Legislative Training” webinar on March 23. This webinar reviews in detail CMA’s list of bills to be lobbied and effective advocacy tips, and covers other relevant program information (SDCMS members only). For more information, please contact Yna Shimabukuro, CMA Government Relations, at (916) 444-5532 or yshimabukuro@ cmanet.org.

March 2016

HEALTH HERO

As a Physician, You’re a Natural Educator

Join the San Diego County 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 25

classifieds PRACTICE FOR SALE PROFITABLE LASER TATTOO REMOVAL CLINIC FOR SALE: 15-year established clinic in great location with ocean view. Perfect opportunity for doctor/ medical practitioner looking for their own business. Owners have developed system that removes tattoos with better results in fewer visits. Equipment includes two FDA-approved, factory maintained lasers and dermal cooler. One-year free maintenance on lasers (excluding parts) included. Facilities have plenty of power, dedicated 220 power lines per laser. New owner can use existing lasers to expand into more cosmetic, dermatology services and/or convert to medical spa. Business has outstanding reputation, first-page Google ranking. Call today! (619) 3336296, lamar@fcbb.com. [475] INTERNAL MEDICINE PRACTICE FOR SALE: Established for many years. Ideally located on busy street near Alvarado Hospital and SDSU. Ideal for internists, family physicians, or other medical specialists. No agents, only for seriously interested parties. Please forward your specialty, name, and phone number to csmred2014@gmail.com. [454] PHYSICIAN POSITIONS AVAILABLE PART-TIME URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a part-time physician. Flexible hours, strong staff, and good compensation (based on experience). Please send CV to jeff@eastcountyurgentcare.com. [474] SEEKING EXPERIENCED, HIGHLY MOTIVATED FAMILY OR INTERNAL MEDICINE PHYSICIAN: Federally qualified health center (FQHC) clinic site in Linda Vista seeks an experienced, highly motivated family or internal medicine 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] SEEKING FULL-TIME URGENT CARE PROVIDER — PA OR MD: MD Today Urgent Care is dedicated to providing the highest quality care and experience to our patients. We are currently seeking a full-time provider with urgent care, family medicine, or emergency medicine experience for our new facility located in Carmel Valley. Competitive compensation with benefits. Please visit http://mdtoday.com for more information, and email CV to kevin@mdtodayurgentcare.com. [473a] 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. [469] FAMILY PRACTICE / INTERNAL MEDICINE PHYSICIAN WANTED FOR FAMILY PRACTICE LOCUM TENENS: One of our doctors to be on sabbatical for approximately four months, beginning 4/1/16. Busy,

well-established practice located in the UTC / La Jolla area of San Diego, near UCSD. We are closely affiliated with Scripps Memorial Hospital and UCSD Medicine. Physician to provide care for patients of all ages. Call responsibilities minor. Work four days/ week. Board-certified, California-licensed MD and DO physicians interested in this opportunity should send CV to triciaberkoff@gmail.com. [466] FAMILY PRACTICE / INTERNAL MEDICINE PHYSICIAN WANTED for vibrant private family medical practice in San Diego. La Jolla Village Family Medical Group has been caring for pediatric, adolescent, adult, and geriatric patients for 27 years. We are located in the UTC / La Jolla area of San Diego, near UCSD, and are closely affiliated with Scripps Memorial Hospital and UCSD Medicine. We provide comprehensive preventive medicine, illness management, travel medicine, sports medicine, evidence-based chiropractic care, weight management, and more. Call responsibilities minor, hours consistent with healthy work-life balance. This a real family practice, one of the last of its kind. We are not owned or managed by a hospital system. Excellent work environment, clean modern office suite, friendly staff with very low employee turnover. Going on three decades of continuous care for local families. Board-certified, California-licensed MD and DO physicians interested in this opportunity should send CV to triciaberkoff@ gmail.com. [465] FAMILY MEDICINE PHYSICIAN OPENING IN SAN DIEGO (COMPENSATION: SALARY NEGOTIABLE): The San Diego American Indian Health Center has an immediate opening for a full-time California-licensed and board-certified family medicine physician who will work under the direction of the chief medical officer. Responsibilities will include providing direct patient care to adults and children and supervising midlevel practitioners. The ability to provide OB care is desirable but not required. The family medicine physician will collaborate within a team-based, patient-centered medical home model integrated with behavioral health services. Knowledge and experience working with American Indians and the underserved / underinsured is preferred. Please contact hr@sdaihc.com. [463] PRIVATE PRACTICE IM/FP OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO GOUNTY: This is an unusual opportunity to practice medicine within a well-established internal medicine group that has a history of over 30 years of outstanding care in the community. Exceptional office staff, small group setting, and very high quality patient care set this far apart from many other situations. Option for 1–2 days/week with flexible scheduling, outpatient only. Interested in board-certified IM or FP applicants with EHR experience. Please email CV to portofino3@aol. com or call (619) 248-2324. [462] SEEKING A FOOT/ANKLE SPECIALIST: Well-established, highly respected, four-physician group, private practice in San Diego seeking a foot/ankle specialist. 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. [461] SEEKING EMERGENCY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multispecialty group in San Diego, is seeking full-time BC/BE emergency medicine physicians to join our urgent care staff. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email lori.miller@sharp. com. [459]

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.

March 2016

SEEKING FAMILY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multispecialty group in San Diego, is seeking full-time BC/ BE family medicine physicians for the South Bay. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 2334730. Email lori.miller@sharp.com. [458] SEEKING INTERNAL MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multi-specialty group in San Diego, is seeking full-time BC/BE internal medicine physicians for the South Bay. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 2334730. Email lori.miller@sharp.com. [457] SEEKING FULL-TIME PEDIATRICIAN: Busy pediatrics private office in El Centro — approximately two hours east of San Diego. Seeking a highly motivated pediatrician to join our staff. Great salary package. Please send CV to juliekapoorpediatrics@yahoo.com. [450] FAMILY PHYSICIAN NEEDED AT NORTH SAN DIEGO COUNTY URGENT CARE OFFICE: Day, night, and weekend hours available. We have a friendly, helpful staff at our busy office. You will see a variety of patients in a family practice setting. There is no call. Please email your CV to gcwakeman@sbcglobal. net or fax your CV to (760) 603-7719. [448] LOOKING FOR PSYCHIATRIST: Indian Health Council (IHC) is looking for a psychiatrist. IHC, a Native American healthcare facility located in North San Diego County, provides a full spectrum of onsite and outreach services and programs. The incumbent must hold a current California license and be boardeligible. Two days per week. Rate: $210–$240 per hour. Excellent benefits package and work environment. For consideration, please visit our website at indianhealth.com. Email résumé to dfreeman@indianhealth.com. [447] 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 one week every three weeks, telephone call only. 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] SEEKING FULL-TIME BC/BE OCCUPATIONAL MEDICINE PHYSICIANS: Sharp Rees-Stealy Medical Group — a 500+ physician multi-specialty group in San Diego — is seeking full-time BC/BE occupational medicine physicians to join our staff. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@sharp.com. [441] 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 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 OFFICE SPACE LOCATED IN HIGHLY SOUGHT AFTER COASTAL ENCINITAS, two-year lease for one office in 2nd floor view, two-office suite (with psychiatrist committed on lease in second office) and a dedicated waiting area. Centrally located with easy access from Solana Beach, Del Mar, La Costa, Carlsbad, and Rancho Santa Fe, as well as Scripps Encinitas Hospital. Office suite has a private technology-kitchenettestorage room, fiber optic connection hard wired in each office, and a dedicated wireless connection. Office is located in building with large pediatric practice and a diverse group of other businesses, including numerous health-oriented businesses. Contact Laurence.A.Denny@gmail.com for more info. [478] MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE/ SHARE IN UTC/LA JOLLA AREA: Established orthopedic surgeon seeks tenant to share office space. 4675ft2 in Chancellor Park, near Scripps Memorial Hospital. Completely rebuilt in 2009. Six exam rooms, digital X-ray onsite. Beautiful finishings, spacious waiting room, conference room, break room. Ample space for support staff and a private office for physician. Available immediately, full or part time. Ideal for primary or satellite office. Excellent freeway access (1-5 and 805), first-floor suite located off lobby near main building entrance. For further information, please contact Georgana Bradley at (858) 457-0050 or at gbradley@jpbamc.com. [477] MEDICAL OFFICE / SPACE FOR RENT / SUBLEASE NEXT TO ALVARADO HOSPITAL: Bright, recently remodeled. Three exam rooms and two “doctor’s” offices, front desk area for three secretaries, and storage area. Share waiting area with a neurologist. Plenty of parking for patients and designated doctor’s parking. Easy access to the freeways and trolley. Rates negotiable. Available now. Rent whole space or part of it. Call (619) 917-7040. [476] 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] MEDICAL OFFICE IN SOUTH BAY AVAILABLE TO SUBLEASE: Located next to Paradise Valley Hospital, this large, recently renovated office consists of six exam rooms and one procedure room. The office is currently utilized by orthopedic surgeons, a urologist, and a med legal specialist, but can accommodate any practice. Facility provides easy access to the PVH operating room, physical therapist, imaging center, laboratory, and wound care center, and has easy freeway access. Opportunity for orthopedic ER call at Paradise Valley Hospital and patient referrals. For more information, please contact Jeff Craven at jeff@sdmoiortho.com or at (858) 245-9109. [472] 2,000FT2 MEDICAL OFFICE SPACE AVAILABLE TO SHARE IN POWAY: Office space available as of April 2016 to share with orthopedic surgeon in Poway at professional medical building. Approximately 2,000ft2, separate reception, four exam rooms, part-time on Thursdays and Fridays or schedule to discuss. Utilities included, separate desk work area for one employee with separate phone line and internet. Rates will depend on usage, short- or long-time lease available. Newly remodeled, upbeat staff and environment, walking distance to Pomerado Hospital and other medical facilities nearby. For more information, email Anna at anna@pomeradoortho.com or call (858) 487-6440. [464] MEDICAL OFFICE SPACE FOR SUBLEASE WITHIN 4,000FT2 ESTABLISHED FAMILY PRACTICE IN UTC / LA JOLLA AREA: Ideal location between I-5 and I-805. Only a few blocks from UCSD and Scripps. Spacious ground floor space with ample parking within a professional medical complex. Up to two modern, private exam / treatment rooms available, nurses station, shared or own receptionist. Clean, contemporary design, ADA compliant, built-in laboratory. Excellent, in-house referral base from four

busy and respected practitioners. Ideal for OB/GYN, dermatology, aesthetic medicine, neurology, ENT, or other complimentary specialty. Please email thbdesigninc@gmail.com or call (858) 999-5153. [453] $3,500 / 1,701FT2 MEDICAL OFFICE FULLY BUILT OUT: First floor with extensive window line. Two entrances. Excellent highway access. Option for aesthetic practice acquisition available. Easy patient / client parking. 5330 Carroll Canyon Rd. Contact Margaret O’Byrne, MD, at mobyrne61@gmail.com, (619) 218-8980 (mobile), or (858) 481-4888 (office). [444] 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] 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] 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] 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 SEEKING FULL-TIME URGENT CARE PROVIDER — PA OR MD: MD Today Urgent Care is dedicated to providing the highest quality care and experience to our patients. We are currently seeking a full-time provider with urgent care, family medicine, or emergency medicine experience for our new facility located in Carmel Valley. Competitive compensation with benefits. Please visit http://mdtoday.com for more information, and email CV to kevin@mdtodayurgentcare.com. [473b] PSYCHIATRIC NURSE PRACTITIONER OPPORTUNITY: South Bay and East County practice seeking a psychiatric nurse practitioner licensed to practice in the State of California. Opportunity to work with psychiatrist in primarily outpatient offices with some inpatient settings. Current professional liability insurance, current DEA certificate, current ACLS certification, and a master’s degree in nursing from an accredited program required. Minimum two years’ experience preferred. Contract salary commensurate with experience. Please send CV/resume to drbhatia@phwsd.com. [471] 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. [468]

NURSE PRACTITIONER WANTED FOR FAMILY PRACTICE LOCUM TENENS: One of our doctors to be on sabbatical for approximately four months, beginning 4/1/16. We are located in the UTC / La Jolla area of San Diego, near UCSD, and are closely affiliated with Scripps Memorial Hospital and UCSD Medicine. NP to provide care for patients of all ages. Call responsibilities minor. Work four days/week. Experienced, board-certified, California-licensed family, pediatric, or other complementary specialty nurse practitioners interested in this opportunity should send CV to triciaberkoff@gmail.com. [467] SEEKING NURSE PRACTITIONER: Internal medicine, part-time position available. Seeking nurse practitioner with primary care and EHR experience. Private practice located in beautiful North San Diego County, single specialty group, collegial work environment. Please contact (619) 248-2324 or email resume to portofino3@aol.com. [456] PHYSICIAN ASSISTANT / NURSE PRACTITIONER (BANKERS HILL): An opportunity for a physician assistant / nurse practitioner in pain management under the direction of the physician supervisor. Apply and modify the principles, methods, and techniques of medicine to provide comprehensive pain management, medical services, and procedures. Diagnose and treat a variety of injuries, chronic and acute pain symptoms. Provide leadership, direction, and coordination of all clinical activities involving professional medical judgment. Work closely with staff to ensure comprehensive quality patient care. This is a full-time position, Monday–Friday, with competitive salary, sign-on bonus, retention bonus, and vacation package bonus after one year. Please submit CV with cover letter to claudiaee50@yahoo.com. [452] PHYSICIAN ASSISTANT / NURSE PRACTITIONER NEEDED: Busy family medicine office is in need of a physician assistant / nurse practitioner to provide medical treatment and services customary to primary care medicine, including evaluation and treatment of new patients and revisits, performing physical examinations, diagnosing conditions, developing treatment plans, and providing health counseling, while maintaining patient confidentiality. Multi-generational, solo practice. Several years of experience preferred but not necessary. Graduate of accredited program with valid California State-issued certificate. DEA license eligible. Please respond with resume to p.fortuna@efpmg.com. [449] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www.thehousecalldocs.com. [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email drhunt@ thehousecalldocs.com. Visit www.thehousecalldocs. com. [038] MEDICAL EQUIPMENT / FURNITURE FOR SALE CLEARWAVE OFFICE WAITING ROOM CHECK-IN KIOSK WITH TABLETOP STAND: (eClinicalWorks Compatible) Decrease wait times, increase collections, and improve financial performance. Liberty Tabletop Kiosk with 17-inch, built-in, all-in-one touchscreen computer with privacy filter. Intel Celeron Dual Core, E1500, 202 GHz processor, 2GB RAM, 160GB hard-drive, ID Tech swipe magnetic credit card reader mounted on right side of the screen. Copays and accounts receivable payable upon check-in. Windows 7 OS, LogMeIn Pro2, IE 9, and McAfee. eClinicalWorks kiosk software included. Original cost new $5,199. Sell for only $2,199. Email KLewis@SDCMS.org. [443] EXECUTIVE DESK FOR SALE: Solid wood • no particle board • weight testimony to solid wood • three spacious file drawers • three regular drawers • 6x3x3ft. • custom-made glass cover • $500.00. Call (619) 585-0476. [442]

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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

The Stories and Rules We Live By by Helane Fronek, MD, FACP, FACPh

Does life happen to you, or are you an active participant in determining your life’s course?

A client explained that she grew up in a difficult family in which her parents argued a lot and her brother was a “loose cannon.” She quickly realized that her role was to be the peacekeeper. She would do whatever was necessary to appease her brother and calm her parents, even when this created unhappiness for her. She continued to play this role through a series of challenging personal and professional relationships with demanding and narcissistic people, until she saw that she had, in fact, made this a recurring choice. As humans, we are “meaning makers.” When events occur, we naturally construct stories to explain or create meaning from them. We use our past experiences as a lens through which we interpret comments,

March 2016

successes, or disappointments. We might have experienced a betrayal in our life that led us to believe that certain people cannot be trusted, or that nothing ever works out for us. When a similar event happens, we use it to reinforce this belief, rather than looking for other possibilities or finding more empowered ways of dealing with the situation. Frequently unaware of these controlling stories, we continue to see the world through those prisms. I recently saw the power of internal beliefs clearly demonstrated in the contrast between two patients. Just over a year after her husband died, the first patient reported that she had sold their house. “I have to move on,” she explained. She commented that the responsibility was hers to make a

new life. The second patient, 20 years after her husband and mother died, rejected any suggestion that might have improved her situation and reiterated that, “I would be a happy person if these things hadn’t happened to me.” As a professional coach, I work with people who are dissatisfied with at least part of their lives. They want to be happier or find a more satisfying way to live. Change comes as they examine the stories they’ve made up to explain what happened to them. As they uncover the rules they feel they must live by, they find greater power as they make other, more conscious, choices. Passion and joy follows. What are the stories and rules that fuel your choices? Do you believe that you must care for others before yourself? That you must continually strive to earn love, acceptance, or belonging? That you must temper your happiness, success, or enthusiasm? Does life happen to you, or are you an active participant in determining your life’s course? By bringing these ideas to the forefront, examining where they came from, and deciding whether we want them to run our lives, we regain more power to create the life we truly want. 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.

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 we are committed to supporting you with a range of valuable 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.

Prepare for Value-Based Compensation with CAP’s Free Guide As payers move toward a more value-focused model of reimbursement, your practice’s revenue stream may soon be tied entirely to clinical outcomes and patient experience. CAP’s Physician’s Action Guide to Value-Based Compensation is replete with valuable information and tips to help you stay ahead of the VBC curve and attain fair and prompt reimbursement from public and private payers.

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