April 2016 by San Diego Physician

official publication of SDCMS April 2016

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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

April

Contents

Volume 103, Number 4

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: 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 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

features

DCMS Foundation Changes S Name to Champions for Health BY BARBARA MANDEL, MBA

15 Project Access San Diego Since 2008 18

Champions for Health’s 2016 Health Heroes BY CARLOS MEDINA

he Alzheimer’s Project Supports T Community Physicians BY BARBARA MANDEL, MBA

Study Identifies Issues Facing Aging Physicians

BY DAVID E.J. BAZZO, MD, FAAFP, CAQSM

nd Annual Solana Beach Sunset 5K 2 Run/Walk to Sunset Diabetes

Medical Student and Resident Scholarships Support the Future of Medicine

YOU Are a Champion for Health

hampions for Health C Prevention Programs Target the Medically Underserved

Live Well Speakers Bureau’s Physician Volunteers: Improving Community Health Education

departments 4

Briefly Noted: Calendar • History Thumbnails • Welcome New and Returning Members

6 2016–17 SDCMS Board of Directors Candidate Statements

ces for Health Golfers Support Efforts A to Improve Health and Change Lives

elebration 10: Celebrating the C Commitment of James T. Hay, MD, to Community Health

23 White Coat Gala 2015 Honors Health Heroes 2

April 2016

Physician Marketplace: Classifieds

John Houkom, MD, Memorial Scholarship Fund

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 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

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 //////////////////////////////////////////////////////////////////////// History Thumbnails

calendar

Fred Baker, MD By Ralph R. Ocampo, MD

SDCMS-CMA Webinars & Events

For further information or to register for the following, contact Jen at (858) 300-2781 or at JOhmstede@ SDCMS.org. Contract Renegotiations: How to Get Past “No” With a Payor (webinar) MAY 4: 12:15–1:15pm Western Health Care Leadership Academy (conference) MAY 13–15 at the Hilton San Francisco Union Square CHPI Physician Quality Rating Program: Navigating the Review and Corrections Process (webinar) MAY 25: 12:15–1:15pm 2016 SDCMS White Coat Gala: Celebrating 146 Years of Healing (event) JUN 4: 6:00pm– 11:00pm at the Hyatt Regency La Jolla at Aventine

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. Clinical Management for Diabetes Care: New Approaches for the Real-World Practice MAY 20–21 at the Estancia La Jolla Hotel and Spa

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. Red Shoe Day to Support Family Care at San Diego’s Ronald McDonald House JUN 23 Across San Diego County 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

April 2016

Dr. Fred Baker was born in Norwalk, Ohio, in 1854, and his wife, Dr. Charlotte Baker, in Newburyport, Massachusetts, a year later. Fred graduated from Cornell and Charlotte from Vassar. Both met while attending medical school at the University of Michigan. The two young physicians practiced for a short time in Akron, Ohio, but moved first to Pie Town, then to Socorro, New Mexico, because of Dr. Charlotte’s malaria. Dr. P.C. Remondino, editor of National Popular Review, extolled the benefits of San Diego and its “air cleansing” eucalyptus trees. This may have prompted the Bakers to move here. When the Drs. Baker first arrived in San Diego, there was a major split between university-trained physicians and those trained by preceptorship. Two days after they arrived in San Diego, both became members of the Medical Society even before receiving their licenses to practice. W.N. Smart, MD, led the charge against the “eclectics” and served two years as president (1887–88). Dr. Fred is the only other person to serve two years as president (1891 and 1903). Dr. Charlotte became the first woman president in 1898. Dr. Fred practiced EENT and was the first to perform a tracheostomy in San Diego. Fred became a San Diego city councilman, president of the board of education, and trustee for the State Normal School (San Diego State University). In 1916, Dr. Fred responded to an article in the newspaper by Dr. Harry Wegeforth inviting anyone interested in founding a San Diego Zoo. The first meeting of the Zoological Society of San Diego was in the Baker home. Dr. Baker became a devoted naturalist from the time he took an undergraduate course at Cornell in zoology. As an avid amateur malacologist, he described and named several new species of mollusks. The Chamber of Commerce formed a “biological committee” at his behest and that of colleagues H.P. Wood and fellow physician Fred R. Burnam. This lead to the establishment of a marine laboratory in the boathouse of the Hotel del Coronado (1903) that was moved in 1907 to La Jolla and became the Scripps Institution of Oceanography. Fred became the first secretary of the institution and was named honorary curator of mollusks. Dr. Fred wished to be remembered for his success in bringing the Scripps Institution of Oceanography to San Diego. At his death in May 1938, he divided his then largest collection of marine shells in the United States between the Los Angeles Museum and the San Diego Museum of Natural History.

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

Welcome New and Returning SDCMS-CMA Members! NEW MEMBERS Amir A. Asgari, MD Hospice and Palliative Medicine Escondido (858) 224-8830 Alberto Bessudo, MD Medical Oncology Encinitas (760) 452-3340 Irene J. Buno-Brion, MD Dermatology Bremerton (760) 434-6060 Ian B. Butler, MD Critical Care Medicine (Internal Medicine) San Diego (442) 281-5000

Carlos E. JimenezGrillo, MD Internal Medicine Escondido (442) 281-5000 Ryan M. Johnston, DO Internal Medicine San Diego (442) 281-5000 Kanchan Koirala, MD Critical Care Medicine (Internal Medicine) San Diego (442) 281-5000 William O. Livingston, MD Urology San Diego (858) 272-2021

Amanda M. Caparso, DO Internal Medicine San Diego (442) 281-5000

Sasa Machala, MD Critical Care Medicine (Internal Medicine) Oceanside (442) 281-5000

Dana C. Chan, MD Ophthalmology Oceanside (760) 757-1144

Jayanthi Magesh, MD Internal Medicine San Diego (760) 739-3000

Arben Dashi, MD Internal Medicine San Diego (442) 281-5000

Christian D. McClung, MD Emergency Medicine Rancho Santa Fe (442) 281-5000

Steven G. Eisenberg, DO Medical Oncology San Diego (858) 649-5100 Anna Gelberg, MD Internal Medicine San Diego (858) 613-4000

“

Amer Moiduddin, MD Anesthesiology San Diego (630) 781-6071 Afshin A. Nahavandi, MD Internal Medicine San Diego (760) 739-2371

Cory S. Nelkin, DO Internal Medicine San Diego (760) 739-3000

Tsehaye U. Seare, MD Internal Medicine San Diego (442) 281-5000

Marjan Etesami, MD Internal Medicine San Diego (442) 281-5000

Brian J. O’Loughlin, MD Diagnostic Radiology San Diego (866) 558-4320

Leila Shabanian, MD Internal Medicine Carlsbad

Oscar F. Guzman, MD Physical Medicine and Rehabilitation San Diego (619) 686-4741

Tuan Phan, MD Internal Medicine San Marcos (442) 281-5000

Alan P. Shahtaji, DO Sports Medicine (Family Practice) San Diego (858) 657-8600

Regina Poudel, MD Internal Medicine San Diego (760) 739-3000

Todd T. Simmons, MD Emergency Medicine Rancho Santa Fe (442) 281-5000

Vikas R. Punjabi, DO Critical Care Medicine (Internal Medicine) Escondido (442) 281-5000

Scott D. Simon, MD Urology La Jolla (858) 458-0099

Baroon Rai, MD Critical Care Medicine (Internal Medicine) San Diego (442) 281-5000 Damian R. Rasch, DO Cardiovascular Disease Encinitas (760) 944-7300 Maltin Repishti, MD Internal Medicine Del Mar (760) 746-0303 Yuri Reznik, MD Family Medicine Escondido (442) 281-4047 Neha J. Sampath, MD Internal Medicine San Diego (760) 746-0303

”

Daniel C. Harrison, MD Internal Medicine Escondido (760) 739-3000 Mark D. Koenig, MD Emergency Medicine Chula Vista (619) 502-5800 Michael A. Kosmo, MD Medical Oncology Escondido (760) 747-7951

Joseph A. Tannous, MD Internal Medicine San Diego Arturo M. Tolentino, MD Internal Medicine San Diego (442) 281-5000 Prashant Vaswani, MD Family Medicine Escondido (442) 281-5000

Devon M. McGee, MD Internal Medicine San Diego (760) 753-0039 Asaf Presente, MD Pulmonary Disease San Diego (760) 753-1362 Sunny R. Richley, MD Internal Medicine San Diego (442) 281-5000

Fang Wu, MD Internal Medicine Escondido (442) 281-5000 RETURNING MEMBERS

James M. Sinclair, MD Medical Oncology La Jolla (858) 552-1410

Elena Y. Atchikova, MD Internal Medicine San Diego (858) 613-4000

Erin L. Whitaker, MD Internal Medicine San Diego (619) 519-9935

We should be too big to take offense and too noble to give it. — Abraham Lincoln (1809–1865)

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Candidate Statements 2016–17 SDCMS Board of Directors

Notes: • (inc.) After Name = Incumbent • Number in Parentheses (#) After Name = Term Length in Years OFFICERS President-elect: Mark W. Sornson, MD (1): It is a privilege to again ask for your support as I run for president-elect of SDCMS. I have served as an SDCMS at-large director for four years, four years as a representative on the Executive Committee, eight times as a CMA delegate or alternate delegate representing San Diego, and three years on the Insurance and Physician Reimbursement Reference Committee for CMA. I’m now serving on the CMA Council on Legislation, the Council on Medical Services, and the Subcommittee on Medicare. Through these experiences I have seen firsthand that when a medical society speaks with a unified voice and builds relationships, we can make a difference. I was a spokesperson for CMA’s No on 45 campaign, and it was a true pleasure to be a part of that successful advocacy effort. This year we’ll have another initiative campaign, and I look forward to assisting. When physicians come together, they are listened to. As president-elect, I will continue to be a voice for reasoned discussion, representing all physicians. I’ve greatly enjoyed my service on behalf of SDCMS and CMA, and I am honored to ask for your vote to continue. Secretary: David E.J. Bazzo, MD, FAAFP (1): I’ve had the privilege to serve on the SDCMS BOD since 2009. During this time, I’ve seen what advocacy through organized medicine

April 2016

can accomplish. This past year, the BOD elected me to serve as treasurer, allowing me to learn more about the inner workings of our wonderful association. SDCMS is second to none when it comes to representing the needs and interests of physicians in advocating to optimize our ability to help our patients. The politics of our state and nation have enormous impact on our capacity to keep our patients healthy and safe, and to keep costs controlled. As with any process, unless you have a seat at the table, your opinion is not heard. Well, through the work of your county and state medical societies, your voices are heard. Your interests are represented. The members of the board do have influence and work on your behalf to ensure that physicians have a say in the future practice of medicine. I am proud of my membership and position on the board, and view it an honor to volunteer to help our organization. I ask that you continue to place your trust in me to serve our organization by supporting my candidacy. Please grant me the privilege to continue to represent you as secretary. Thank you. Treasurer: James (Jim) H. Schultz Jr., MD, MBA, FAAFP, DiMM (1): Jim Schultz is a family physician who practices at Neighborhood Healthcare, a Federally Qualified Community Health Center serving about 70,000 of the underserved and medically needy. He sees outpatients in Escondido, Pauma Valley, and Temecula, and inpatients as part of the California Emergency Physicians hospitalist program. He has been chief medical officer of Neighborhood Healthcare since 2001, and is currently the medical director of the Council of Community Clinics and of Project Access San Diego. Prior to his role at Neighborhood Healthcare, Jim was medical director and practicing physician at Graybill Medical Group in Escondido, where he began his professional career in 1988. His goals at SDCMS

include fairly representing the interests of the physicians of North County and bringing in the voice and perspective of those physicians whose practice is predominantly that of the underserved. He is also a volunteer clinical professor at UCSD in the Department of Family and Preventive Medicine and hosts the Family Medicine Residency PGY-1 outpatient gynecology rotation. He recently completed his diploma in mountain medicine in order to be prepared for the next avalanche in San Diego. GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD (inc.) (3): As a primary care physician practicing in East San Diego County for more than 27 years, I have experienced a dramatic paradigm shift from a fee-for-service model to a managed-care model. At this juncture, we are entering the uncharted territory of healthcare reform, accountable care organizations, and patientcentered medical homes, where the interests of PCPs and the patients we care for are being undermined by economic and political forces. Now more than ever, we need strong leadership to represent us and our patients. Although a great challenge, I am excited to help pave the way for my fellow physicians during this time of instability in the healthcare arena. I am confident that with the help of the dynamic leaders that I have the pleasure of working with at the SDCMS board, we can convert the challenge into a great opportunity. I believe that my past leadership experiences and my dedication to our community make me the ideal candidate for East County geographic director. Prior to moving to San Diego, I served as an assistant director of the internal medicine residency program at Cleveland. I am or have served as voluntary clinical faculty in multiple educational institutions, including UCSD, USD, Western, Stanford, University of Arizona,

etc. I have attended three mini-executive MBA courses (two from UCI and one from UCSD), which have taught me how to effectively assume leadership roles. I was the past president (twice) and actively participated in leadership roles since the inception of the San Diego Association of Physicians of Indian Origin (SAPI), where I coordinated educational, charitable, and collaborative programs for its members. I have participated in three of Sharp’s physician leadership courses in the past 20 years. As an SDCMS board member for the past few years, I witnessed the amazing talents, leadership, and dedication of my colleagues, who work tirelessly on behalf of fellow San Diego County physicians. It would be my proud privilege to join this vibrant group for another term. Never before was there a more critical need for us to stand steadfast, to speak in one voice, and to safeguard the interests of our patients as well as our colleagues. Organized medicine is the only armor we have to shield ourselves from the political and economic onslaught ahead. I consider the opportunity to serve our esteemed organization, SDCMS, a great honor, and I pledge to be the voice of East County physicians as their geographic director.

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East County #2: Kosala Samarasinghe, MD (1)

Hillcrest #1: Gregory M. Balourdas, MD (inc.) (3): It has been a distinct pleasure to serve on the board of the San Diego County Medical Society over the last four years. I have been a member of the Medical Society since completion of my hand and microvascular fellowship at UCSD. During those 25 years, I have had the privilege to practice hand and upper extremity orthopedics in a traditional solo practice in the Hillcrest and Mission Hills area. In the last four years, I have received a valuable postgraduate education by participating through SDCMS as a delegate and participant in CMA’s annual legislative meetings. Despite the not-always-positive trends in the practice of medicine, I believe our best chance to effect desired changes for our profession is to unite on common ground and to advocate through these avenues. I will endeavor to effectively represent all the phy-

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sicians in my geographic community, as well as the perspective of solo and small-group practitioners and my orthopedic colleagues. Thank you for this opportunity. Hillcrest #2: Thomas (Tom) C. Lian, MD (inc.) (3)

North County #2: Eileen S. Natuzzi, MD (inc.) (3)

South County #1: Irineo (Reno) Tiangco, MD (inc.) (3): I would like to represent South Bay on the board of directors. I am a foreign medical graduate and am currently doing solo practice, internal medicine, in National City. Prior to that, I was the medical director of a hospital-based primary care group practice. Thus, I represent several aspects of medicine: primary care, internal medicine, South Bay medicine, solo practice, and foreign medical graduates. The latter two together have few representatives on the board. While the mix of all four, I doubt, is represented by anybody at all. I would like to lend my voice, to the best of my ability, to all these sectors. Thank you. GEOGRAPHIC ALTERNATE DIRECTORS Kearny Mesa #1: Anthony E. Magit, MD, MPH (inc.) (3): I appreciate the opportunity to continue my service on the SDCMS board of directors. Maintaining access to healthcare for our region’s children is a primary focus of my practice and advocacy activities, including being a member of the board of the Children’s Specialty Care Coalition (CSCC). The CSCC is a statewide organization representing physicians providing comprehensive medical and surgical care to children with special medical needs. My appreciation for the challenges facing medicine locally and nationally come from practicing pediatric otolaryngology for more than 20

April 2016

years in San Diego and interacting with all of the health systems in our region, as well as participating in the development of clinical guidelines through national pediatric and specialty organizations. SDCMS has a critical role in supporting physicians representing the entire spectrum of medical practices in San Diego County. South County #1: Maria T. CarriedoCeniceros, MD (3): I am honored to be a candidate for SDCMS alternate director. I am a family physician from San Ysidro Health Center Healthcare, a Federally Qualified Community Health Center serving about 90,000 of the medically underserved and culturally diverse population in the South Bay and southeast San Diego. I have been the VP and chief medical officer for San Ysidro Health Center since 2012. My goals at SDCMS include not only providing the perspective of a physician working in South County with an underserved and culturally diverse population, but, in addition, working together with physicians from throughout the county to build a healthier community. I also look forward to working with a team of physicians to address the important issues of payment reform and physician workforce shortage that we are facing. Throughout my years at San Ysidro Health Center, I have actively been involved with training of students and residents. In addition, working as preceptor with the Scripps Chula Vista family residency program, I take great pride in helping in the training of our future family medicine physicians. I have been a board member with the San Diego Academy of Family Practice and enjoyed collaborating with physicians from various modes of practice. It would be an honor to have a seat on the board of SDCMS so that I may serve on behalf of all physicians. I ask for your support. AT-LARGE DIRECTORS #3: Alexandra (Alexe) E. Page, MD (3): Serving for four years on the SDCMS board of directors has offered me the chance to build relationships with other San Diego County physicians, understanding and representing their views as a delegate to the California Medical Association. I have used the opportunity to transcend specialty interests and work on a united physician voice defining how healthcare will evolve. After 16 years with Kaiser, I have moved into private practice, which gives me a broad view of the

challenges facing physicians in different modes of practice. But regardless of specialty or practice environment, paradigms of healthcare delivery from patient-centered medical homes, to ACOs, to bundled payments can change the patient-doctor relationship. Physicians can protect the care we give our patients by proactively defining how these new healthcare models will evolve in our community. My knowledge and experience in health systems have evolved from serving as a member and now chair of the Health Care Systems Committee of the Orthopaedic Academy (AAOS), a role that keeps me on the cutting edge of system-level changes that will affect San Diego physicians. A cum-laude graduate of Harvard Medical School, after residency in New York, I have practiced orthopaedics in San Diego since 1998. As a member of the SDCMS board of directors, I hope to continue communication among physicians of all disciplines to enhance consensus-building and present a stronger front to other stakeholders in the healthcare system. #4: Nicholas (Nick) J. Yphantides, MD, MPH (1): I am thankful for your support of my service as a director of SDCMS. For seven years I have been blessed with the opportunity to be the chief medical officer (CMO) of the County of San Diego’s Health and Human Services Agency. My life and passion is to be an advocate and catalyst to improve the health and well-being of our entire region. Prior to my service with the County, I served as the CMO of Neighborhood Health Care, the publicly elected board chair of Palomar Health, and the CMO of the Council of Community Clinics. I currently serve on the board of the SDCMS Foundation, and as vice chair of our regional health information exchange (HIE), known as San Diego Health Connect. We are in a very dynamic and strategic time of collaborative partnership between SDCMS and its physician leaders with the County of San Diego through the nationally recognized Live Well San Diego vision. As a director, I eagerly look forward to strengthening our regional collective impact even further, as we strive to improve the wellness of our patients and their families throughout San Diego. #5: Stephen R. Hayden, MD (inc.) (3): For most of my career in the fields of emergency medicine and hyperbaric medicine at UC San Diego, I have been involved in national

academic affairs. With the landscape changing so quickly in healthcare, I believe it is as important as ever for community physicians and academic physicians to partner and face the current challenges in medicine together. For over 20 years, I have been directly involved in national specialty societies and the American Board of Emergency Medicine, and these experiences will allow me to contribute to SDCMS’s advocacy efforts. After a tour of duty as senior flight surgeon for the Naval Strike Warfare Center NAS Fallon, Nevada, I completed my emergency medicine residency at the University Medical Center at Stony Brook, New York, where I served as chief resident. I am the previous associate dean for graduate medical education at UC San Diego, after serving as the program director of the emergency medicine residency. I am a past president of the national Council of Emergency Medicine Residency Directors, and, in 2006, I was selected as the editor-in-chief of The Journal of Emergency Medicine. In 2005 I was the recipient of the American Academy of Emergency Medicine’s (AAEM) Residency Director of the Year Award and was recogProject4:Layout 1

9/22/08

nized in 2005–2007 as one of America’s Top Physicians. In addition, I was fortunate to receive the American College of Emergency Physicians (ACEP) National Faculty Teaching Award. I am a primary author/editor for a major textbook in emergency medicine, The Five-Minute Emergency Medicine Consult, as well as numerous textbook chapters, peerreviewed publications, and over a hundred invited national and international speaking engagements. I am married with three children and have a third-degree black belt in Tae Kwon Do. I would consider it a privilege to continue to serve the San Diego County Medical Society and its members. AT-LARGE ALTERNATE DIRECTORS

11:22 AM

#1: Karl E. Steinberg, MD, FAAFP (inc.) (3): I’m a family physician, geriatrician, and hospice physician, and I have been a nursing home and hospice medical director in coastal North County

continuously since 1995. My passions are providing compassionate care to the frail elderly and others with serious or chronic illnesses, and helping to educate patients and healthcare providers about palliative care. In addition to patient care, I am editor-in-chief of the periodical Caring for the Ages, published by Elsevier and AMDA (the American Medical Directors Association), and I am chair of AMDA’s public policy committee. I am chair of the Compassionate Care Coalition of California (the people who brought you POLST), and a past president and current secretary of CALTCM (the California Association of Long Term Care Medicine); I also currently serve on the government relations committee of CAHF (the California Association of Health Facilities). I provide long-term care consulting and medico-legal services, and I’m medical director of three North County skilled nursing facilities (Life Care Center of Vista, Carlsbad by the Sea, and Village Square). I am volunteer faculty for UCSD and Camp Pendleton’s family medicine residency programs, and serve as adjunct faculty for Case Western Reserve University’s Graduate School of Biomedi-

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sdcms elec tions

Election Opens April 12 and Closes May 6, 2016

cal Engineering. I am also affiliate faculty at CSUSM’s Institute for Palliative Care. At SDCMS, I’ve been on the Bioethics Commission for the last seven years, and have been active on the POLST Coalition and TDC’s Physician Advisory Board. In my spare time, I take my dogs to the nursing homes with me, and play tennis and guitar marginally. My experience has given me a broad exposure to multiple sectors within the healthcare arena, not just locally but statewide and nationally as well. I believe we have a long way to go in getting incentives aligned to optimize care (for example, taking care of ill nursing home residents in the nursing home instead of shipping them to the hospital), increasing awareness of palliative care and advance care planning, and helping our patients get the care they want (and not get the care they don’t want). By participating in the political process, I hope I can help move things along — with the assistance of many other committed individuals within SDCMS and other involved organizations. Thanks for your support in allowing me to continue my service on this board. #2: Steven L-W Chen, MD, FACS, MBA (inc.) (3): It is an honor to be considered for a reelection to a position on the SDCMS board of directors. As a surgical oncologist in independent practice with offices in Mira Mesa and Encinitas, I have privileges in the Scripps, Sharp, and Palomar systems, allowing me to get a broad overview of county issues. Although I consider myself still relatively new to San Diego, in the past two years I have worked toward building relationships with physicians all over the county. I have been an academic

April 2016

physician while serving as chief of breast surgery, an employed physician at City of Hope in Los Angeles, and now in independent practice, I have developed experience in multiple practice modes and will ensure that our policies take all modes into account. My experience in organized medicine has spanned serving on the board of the Los Angeles County Medical Association and the Sierra Sacramento Valley Medical Society, as well as nationally including serving on the board of the American Society of Breast Surgeons, as prior service on the Governing Councils of the Young Physicians Section of the AMA and the Young Fellows Association of the American College of Surgeons. I continue to serve on the legislative committees of the American College of Surgeons and the American Society of Breast Surgeons and thus stay up to date on the issues facing the professional practice of medicine. I fully believe that if we do not defend the profession and act as professionals, we will lose the right to be a profession. SDCMS and organized medicine are key links to ensuring that being a physician continues to mean being a professional. I ask for your support to allow me to help represent you and your concerns. YOUNG PHYSICIAN DIRECTORS Edwin S. Chen, MD (inc.) (1): Healthy and happy physicians take better care of healthy and happy patients. In the dramatically changing healthcare landscape, SDCMS provides a meeting place and a launching platform from which we can advocate for ourselves and our patients. New physicians often find themselves immersed in a healthcare world they never imagined. I have had the honor and privilege of serving as the young physician director for the past year, and it has been a wonderful experience. As a young physician who recently started a solo practice, I look forward to collaborating with all of you in sharing our knowledge and experience so that we can better advocate for the medical community and the patients that we serve. Alternate: Heidi M. Meyer, MD (inc.) (1): My first experience with SDCMS was as a medical student delegate to CMA while at UCSD. As a resident, I served as the resident member of both the Arizona Academy of Family Physicians and the American Academy of Family Physicians national board of directors, which exposed

me to the politics of medicine on both a state and federal level. I am currently presidentelect to the San Diego Academy of Family Physicians, after four years of serving on its board. I am a primary care physician at Kaiser Permanente, a unique practice environment that needs representation — along with all other styles of practice — in our medical society. My first year on the board was a wonderful one, and I hope to earn further time to represent physicians on a local and state level. RESIDENT PHYSICIAN DIRECTORS Michael C. Hann, MD (inc.) (1): I am psychiatry chief resident at Naval Medical Center San Diego, and I am running for re-election as the resident physician director. I am a dual-degree graduate of the Florida International University (FIU) Herbert Wertheim College of Medicine and FIU Chapman Graduate School of Business in Miami, Florida, where I earned my MD and Healthcare MBA. I entered the Navy through the Health Professions Scholarship Program after completing the Navy’s Officer Development School (ODS), where I served as the division officer. I was recognized as the honor graduate upon completion of ODS and was further recognized with the George T. Smith Award for Military Leadership. I currently serve as Naval Medical Center San Diego’s House Staff Council representative for the Directorate of Mental Health, as well as a committee member on the Graduate Medical Education Committee (GMEC) / CLER Pathways Patient Safety Committee. I was humbled to be selected for the prestigious American Psychiatric Leadership Fellowship and to serve on the APA Council for Advocacy and Government Relations. In addition, I was also one of only 12 psychiatry residents in the United States and Canada to be distinguished as a 2016 Laughlin Fellow. My professional interests include advocacy in government and healthcare systems, and it would be a sincere honor to continue to serve the SDCMS board of directors. Alternate: Zachary T. Berman, MD (1)

AMA ALTERNATE DELEGATE Lisa S. Miller, MD (inc.) (3)

J. Steven Poceta, MD (3): I am running for alternate delegate to the American Medical Association (AMA) from San Diego for the upcoming term. I respect and appreciate Lisa Miller, our current alternate, but I believe that I will better represent you at AMA. I have been a member of SDCMS since I came to San Diego in 1987. I have served on their board of directors and have been president. I have also been head of the Division of Neurology at Scripps Clinic, and I have learned a lot about leadership. I am dedicated to the pursuit of medicine,

and I believe in a pluralistic approach to the practice. All physicians have a role to play in the optimal delivery of healthcare to our fellow community members. The respect that we receive from our patients is great, and it not only serves to enrich our lives, but also to indicate our value to the community. No specific healthcare delivery system is innately better than another, considering the changes that have occurred since our profession was founded. That is, the practice of medicine has survived since long before the Depression of the 1930s, the creation of Medicare, the HMO, and the current trend toward consolidation. All doctors are important — from those in academics to those in solo practice — and I support them all. The backbone of the system remains the same: doctors who study, train, and work hard to take care of people who are sick and to understand the causes of disease. We need a system that fosters the most capable young people to go into our profession, rewards them appropriately, and provides career and personal satisfaction. This may be in jeopardy. I believe that we can meet these goals even under the uncertainties of the current system.

Where are your patients coming from? Each month, every practicing physician in San Diego County receives a copy of San Diego Physician magazine. What better way to ensure that other physicians know about your medical practice than through a referral advertisement in this highly regarded publication? Advertising packages are available at very attractive price points, and for a limited time SDCMS member physicians receive 50% off by mentioning this ad.

Contact Dari Pebdani today to get your campaign started. DPebdani@SDCMS.org or 858-231-1231

While president of SDCMS, I undertook many challenges, including facing the retirement of our longstanding CEO and recruiting our current CEO. I reformed our investment policy. Working with CMA, I led the charge against Proposition 46 and won. I worked with constituents to make reforms to the maintenance of certification process, and in all of these was successful at some level. I now want to turn my efforts to the national level through the most effective voice that we physicians have: the American Medical Association. This association is a proven, effective, and nonpartisan voice in Washington, DC. Although certain specialty societies have a voice of their own, AMA speaks for all physicians and is by far the most recognized voice that we physicians have. It works with state organizations such as CMA to represent us and our vocation to help patients. Again, although not without its challenges and problems — including the fact that most doctors are not members — AMA is now and will remain our best chance to influence policy at the national level. I look forward to trying to help. I ask for your vote as alternate delegate from San Diego to AMA.

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April 2016

//////////////////////////////////////////////// SDCMS Foundation Changes Name to

Champions for Health New Branding Illuminates Physicians’ Role in Community Health by Barbara Mandel, MBA

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hampions for Health” was unveiled as the new name for the SDCMS Foundation at the Health Heroes Awards event on April 18, culminating the annual Aces for Health golf and tennis tournaments. “Physicians exemplify the word ‘champions,’” said Albert Ray, MD, president of the Champions for Health board of directors. “Our new branding will help us tell the story in the community more effectively regarding the critical role of physicians not only in healthcare, but in health and wellness.” When SDCMS’s physician leadership conceived of the creation of a nonprofit organization to facilitate physician volunteerism in 1999, it was not clear which direction the new organization would take. Medical student loans led to a medical student scholarship fund. In 2005, a roast of San Diego anesthesiologist Robert Hertzka, MD, funded the initiation of support for medical student trips to Sacramento for advocacy training. James T. Hay, MD, served as the first president of the board of directors of the SDCMS Foundation and led efforts to launch Project Access San Diego, providing specialty care health services to uninsured, low-income adults, in late 2008. “Throughout the development of the organization and even more today, I reiterate to the SDCMS leadership and members that Champions for Health is their organization, created by physicians to facilitate what we love to do most: care for patients,” says Dr. Hay.

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“Project Access would not exist without the dedication of more than 600 physicians who provide pro bono specialty care to uninsured, low-income adults in our community,” says James Schultz, MD, CMO of Project Access and board member of both Champions for Health and SDCMS. Not all physicians have the opportunity to volunteer with Project Access, as it provides specialty care alone. The SDCMS Foundation explored opportunities for primary care physicians and physicians in foundation-model health systems to get involved, as providing these opportunities was one of the guiding principles for establishing the 501c3 organization. The organization has increased the scope of services in the community, from access to specialty care through Project Access San Diego to a variety of preventive and early detection programs. Physicians are critical role models and voices of authority to community residents, and physician involvement is core to Champions for Health’s future as the organization implements these preventive services. In 2012, then-board president Stuart Cohen, MD, identified the urgent need to increase flu immunization. A pediatrician, Dr. Cohen understood that one flu shot

April 2016

might reduce the risk of potentially fatal illness in the entire family. Partnering with the County of San Diego’s HHSA, the San Diego National Association of Hispanic Nurses, the American Red Cross of San Diego/Imperial Counties, and the Nursing Education Department at Palomar College, the SDCMS Foundation facilitated more than 1,100 free flu shots in community locations to adults and children who may not have a medical home or who may not seek regular medical care. A similar need to expand mammography was identified in 2013; while uninsured women were covered for breast exams and mammography, many women did not avail themselves due to transportation issues, time, or simply not knowing the services were available without charge. Partnering with a grassroots organization in South Bay, along with a number of community clinics, the SDCMS Foundation received initial funding from Susan G. Komen San Diego to launch a mobile mammography program. The program has expanded throughout North County, and, in 2015, 1,370 women received clinical breast exams and mammograms close to home. More than 100 physicians have volunteered to be a part of the Live Well Speakers Bureau, providing the message of

“Our new branding will help us tell the story in the community more effectively regarding the critical role of physicians not only in healthcare, but in health and wellness.”

health and wellness to school children, parents, seniors, members of service organizations, and members of faith communities. Champions for Health not only exemplifies our partners, but will also help the organization be more recognizable in the general community. At least weekly, someone asks if we gave away money because our name included “Foundation,” or people assumed we raise money for physicians. Both of these misnomers made fundraising in the community difficult. With the need for broad-based financial support to assure that the tremendous donation of time and talent of physicians can be operationalized, it was time for a name that meant more in the public eye. “Our goal aligns with that of the Medical Society — to create the healthiest community in the nation,” says Will Tseng, MD, board member of Champions for Health and president of SDCMS. “The two organizations continue to be united; the SDCMS Foundation, now Champions for Health, has facilitated the public health portion of the Medical Society’s mission.” As the community builds on the momentum of health, not just healthcare, Champions for Health is ready to pursue its mission with passion! Ms. Mandel is CEO of Champions for Health.

//////////////////////////////////////////////// $10.8 TrusT 4,622 Project Access San Diego Outcomes Since 2008 Million in Donated Care, Thanks to Physicians, Hospitals, Surgery Centers, and Ancillary Healthcare Providers

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Champions for Health’s

2016 Health Heroes by Carlos Medina

Champions for Health honored its 2016 Health Heroes at an awards ceremony on April 18. The organization’s honorees shared the following about their involvement in improving health and changing lives of vulnerable San Diegans: Legacy Award: Kaiser Permanente Saturday Surgery Team: Daniel “Stony” Anderson, MD, FACP, Paul Bernstein, MD, FACS, Sandra Lynn Freiwald, MD, and Shreya Shah Sasaki, MPH

Approximately 25% of the surgeries needed have been done through a Saturday Surgery Day at one of the Kaiser Permanente facilities, with up to 150 physicians and medical staff volunteering to provide life-changing procedures for Project Access patients. Medical director Paul Bernstein, MD, commented on the benefits for the KP team, “I’ve seen at Kaiser Permanente that all of our physicians and staff have been more energized about Project Access over the years. They look at it as an opportunity to give back to the community.”

April 2016

Dr. Bernstein removed a significant tumor from the forehead of a young Somali refugee at one of the first Surgery Days. “The tumor created a lot of angst for him and affected his ability to get a job and be seen in public,” he added. “It was really a privilege to remove his growth and transform him into an individual who was more outgoing, who could actually get a job and do well. A lot of people fly thousands of miles to participate in medical missions when there are people right here in San Diego who need our help, people that are uninsured, and for whom we can make a difference in all their lives.” Sandra Friewald, MD, has served as lead surgeon since 2008. “One of the things that I’ve noticed as time has passed is that other surgeons are coming up to me with ideas about patients that we might be able to serve in addition to the ones we’ve been serving so far,” says Dr. Friewald. “The bottom line is that everybody wants to be healthy and work.” “One of my first Project Access patients was a young man with rectal bleeding for years, causing iron deficiency and anemia,” says Daniel “Stony” Anderson, MD. “He had an obvious colon cancer and hundreds of polyps. It turns out he had familial adenomatous polyposis, and we got him genetically tested and treated for his cancer. Of his two children, his son also tested positive for the gene, so now his son can have the necessary surveillance and never develop colon cancer. That’s two lives saved through this program. I find it hard to imagine how difficult it must be to be uninsured and have something that you know is wrong and not be able to afford the diagnostics or necessary treatment.”

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

DOES YOUR MEDICAL MAL INSURER Spirit Award:KNOW WHICH ME Bob DeSimone FREQUENTLY LINKED TO A INBobCLAIMS AGAINST DeSimone, principal of The HOSP

Champion Award: Hernan Goldsztein, MD, and Moses Salgado, MD

Above and Beyond Award: James Santiago Grisolía, MD

Dr. Grisolía, a neurologist, was recognized for his longtime commitment to the organization as an early board member, as well as his commitment to take on challenging Project Access cases. “My personal commitment to Project Access arises from being a doctor,” says Dr. Grisolía. “I’m a stealth Latino, I speak Spanish, and I’m pretty bicultural. So I have special gifts to help people in the Latino community, but I believe in reaching out to all communities here in San Diego. Heaven knows we’re a crossroads and we’ve got a lot of communities here that need help.”

Drs. Goldsztein and Salgado, ENT specialists, have seen and treated dozens of uninsured Project Access patients with health issues, many due to a lack of iodinated salt in their diet. “We see more advanced disease in Project Access patients given a history of lack of access to healthcare,” says Dr. Goldsztein. “I remember a lady who had a very, very sick child, and all her resources, her time, were dedicated to that child, and she neglected herself. She had a growth in the thyroid, and we were able to take the growth out, and fortunately it was a benign disease. She was so happy; she was one of the most grateful patients we have had. What’s really gratifying from the Project Access patients is that they are extremely grateful. Giving back is what reminds me every day why I went to medical school and why I completed 18 years of training.” “My primary motivation to volunteer with Project Access is, it may sound hokey, but it’s the right thing to do,” adds Salgado. “My most memorable Project Access patient was a lady who had a massive goiter from her chest to her chin, taking over her entire neck. It was essentially choking her, she had trouble eating, and she couldn’t sleep or breathe well. It was hard to believe that this had gone on for eight to 10 years. After surgery she was super grateful to be living a normal life again. That’s why we get into medicine, to help people, and these really are the people who need it the most. Project Access is really focused on helping that invisible population, and it’s some of the most rewarding work that I do.”

Doctors Insurance Agency, has served in several capacities on the Champions for Health board of directors since 2011. Under his leadership, the organization has Asbeen the nation’s able tolargest grow physician-owned through the inmedical malpractice insurer, we have an auguration of two signature anunparalleled understanding of liability nual events: the Aces for Health claims hospitalists. When your Golfagainst and Tennis Tournament, reputation livelihood areSunset on the 5K and theand Solana Beach Run/Walk. Through his energy, line, only one medical malpractice enthusiasm, andthe dedication insurer can give you assurance the that organization raisedenvironment more today’s challenginghas practice than $400,000 over the past four demands—The Doctors Company. “I am proud we’ve been To years. learn more, call our Los Angeles ableatto888.536.5346 raise over a couple hunoffice dred thousand dollars to help the or visit WWW.THEDOCTORS.COM. Foundation,” says Mr. DeSimone. “I work with physicians to provide medical malpractice insurance, and so it was a perfect fit. It was a way for me to give back to the community.” Volunteer Medical Interpreter of the Year: Stephanie Rosas Corporate Partner of the Year: The Doctors 5173_CA_SDCMS_EIS_HOSPITALIST_Dec2015_flat_ISUU_f.indd 1 Company Language is a major barrier for many immigrants in need of medical care. Champions for “We’re so grateful for The Health initiated a volunteer Doctors Company’s partnermedical interpreter program ship to inaugurate our Aces for in 2014 to address the need Health golf tournament and in a cost-effective manner. our Solana Beach Sunset 5K Stephanie Rosas quickly beRun/Walk,” says Champions came one of the first and most for Health CEO Barbara Manprolific volunteers. “I became del. “In addition to providing a volunteer medical interpreter event sponsorship, The Docbecause my grandma would go tors Company has been very to her medical visits, and she involved with patient safety, needed help,” says Ms. Rosas. so we also partner with them “I saw that there was a great to provide continuing medical need when she was trying to education credits for active and express her health issues, what retired physicians. Their comshe was feeling, and her pain. mitment to the medical comIt made her feel comfortable munity has been huge.” to open up more, and once I thought, maybe there’s someMr. Medina is communications thing I can do. Maybe I could manager for Champions for help others who don’t have this Health. kind of assistance.”

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//////////////////////////////////////////////// ALZHEIMER’S CLINICAL ROUNDTABLE

PHYSICIANS IMPROVING HEALTH, CHANGING LIVES

The Alzheimer’s Project Supports Community Physicians BY BARBARA MANDEL, CEO, CHAMPIONS FOR HEALTH

RECOMMENDED SCREENING ALGORITHM FOR ADULT COGNITIVE IMPAIRMENT NOTE: Cognitive screening may be a part of a regular annual physical exam.

SCREENING VISIT

10 WARNING SIGNS

Generally due to concerns about cognition or function, noted by Patient, Family or Physician

1 Memory loss disrupts daily life

History

RED FLAG CONDITIONS

Changes in cognition and/or function Ask about 10 Warning Signs

Conduct Cognitive Screen Assess for Red Flags Mini-Cog ≤3

Rapid Progression (w/in 6 mos) Recent Sudden Changes Young Onset (<65)

2 Challenges in planning or problem solving 3 Difficulty completing familiar tasks 4 Confusion with time or place 5 Trouble understanding visual images or spatial relationships 6 Problems with words

Optimal

IF FAIL COGNITIVE SCREEN OR RED FLAGS

Conduct Informant Screen AD8 ≥2

IF PASS

ASSESS REVERSIBLE FACTORS

Reassure Patient & Family

• Depression - eg PHQ2 • Delirium • Alcohol • Medications • Uncontrolled illness or infection

Note: Passing cognitive screen does not preclude a mild, early or subclinical problem. Consider rescreening in 12 months, or sooner if changes become more noticeable.

7 Misplacing items and inability to retrace steps 8 Decreased or poor judgment 9 Withdrawal from work or social activities 10 Changes in mood and personality

CONDUCT OR REVIEW RECENT LAB TESTS CBC, Comprehensive Metabolic Panel, TSH, B12

TREAT REVERSIBLE FACTORS

NO Reversible Factors

NO Improvement After Treating Reversible Factors

PROCEED TO EVALUATION

CONSIDER REFERRAL TO PSYCH IF SEVERE DEPRESSION

THE ALZHEIMER’S PROJECT

The Dementia Screening Algorithm assists primary care providers in assessing symptoms of memory loss and is the first pathway in the toolkit. DICE APPROACH TO BEHAVIORAL AND PSYCHOLOGICAL SIGNS AND SYMPTOMS OF DEMENTIA

Michael Lobatz, MD, making a presentation about The Alzheimer’s Project to San Diego County Board of Supervisors.

ith more than 62,000 San Diegans suffering with Alzheimer’s disease and other dementia, and only 900 neurologists, psychiatrists, and geriatricians in our region, primary care providers are tasked with screening, evaluating, and treating this complicated and terminal disease. Primary care physicians now have new tools at hand to assist their care of patients and their family caregivers. The Alzheimer’s Project, launched by County Supervisors Dianne Jacob and Dave Roberts in 2014, brings together experts in dementia to address the cure, care, and clinical aspects of the disease. Michael Lobatz, MD, Scripps Health neurologist and SDCMS board member, serves on The Alzheimer’s Project Steering Committee and cochairs the Clinical Roundtable with County HHSA medical director and Champions for

April 2016

Health board member Nick Yphantides, MD. “We have been working over the past year to develop standards of practice to be utilized across health systems,” says Dr. Lobatz. “These standards will assure that physicians have best practice tools to facilitate appropriate screening and diagnosis of dementia, and knowledge of resources to assist patients and their caregivers in the progression of this degenerative disease.” Neurologists, psychiatrists, and geriatricians met over a one-year period to develop and test algorithms. Pilot studies at several health systems informed the work to finetune the pathways, including recommendations for most effective screening and evaluation instruments. Physicians will be invited to learn these best practices and adopt usage in their practice over the next 18 months. Champions for Health is facilitating these efforts, including the development of a

DESCRIBE

INVESTIGATE (ASSESS)

Caregiver describes behavioral factors:

Look for:

• Social & physical environment • Patient perspective • Degree of distress to patient and caregiver

• Antecedents • Patterns • Context • Co-occurring events

Investigate possible causes of behavior Provider, caregivers, clinical team collaborate to create and implement a treatment plan

CREATE (TREATMENT)

Address physical problems and medical issues first Employ behavioral interventions Ensure that the environment is safe ASSUME patient does not have dementia

EVALUATE (AND RE-EVALUATE)

ASSESS psychiatric signs and symptoms

ALIGN symptoms to best fit psychiatric syndrome

Evaluate whether “CREATE” interventions implemented by caregiver(s) have been safe/effective

THE ALZHEIMER’S PROJECT

Treatment of the behavioral and psychological symptoms of dementia is addressed utilizing the DICE method: Describe, Investigate, Evaluate, and Create. Its effectiveness was first documented by Helen C. Kales, MD, and colleagues at the University of Michigan. Models have been created to address the most common behavioral issues of dementia.

toolkit for physicians. Funding is provided by the County of San Diego and by a federal grant led by San Diego State University. In addition to the work of the Clinical Roundtable, the Project includes the Cure, Care, and Public Awareness Roundtables. The Cure Roundtable has assembled $500,000 in funding that brings together researchers from UC San Diego,

Scripps Research Institute, the Sanford Burnham Prebys Medical Discovery Institute, and the Salk Institute to fast-track drug development. The caregiver community has developed recommendations at the Care Roundtable to support family and professional caregivers, and a public awareness campaign has launched to inform the public of available resources.

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Study Identifies Issues Facing Aging Physicians by David E.J. Bazzo, MD, FAAFP, CAQSM

s the national healthcare community has embarked on a nuanced discussion about aging as a risk factor for poor performance among physicians, a spectrum of approaches to screening has been put into practice that ranges from the expensive and aggressive to the cursory. The results of a pilot study on an inexpensive but inclusive screening battery for physicians, the PACE Aging Physician Assessment (PAPA), was recently shared at the Retired Physicians Society meeting hosted by Champions for Health. The initial rationale — based on experience in highstakes physician assessment — for each of the screening tools, how the study was conducted, and what has been learned about these tools from the study was reviewed, and the advantages and hurdles of properly implementing such a screening battery was discussed.

The percentage of practicing physicians age 65 or older in 1985 was 9.4%. In 2011, the percentage was 15.12%. It is estimated that by 2020, 18% of practicing physicians will be age 65 or older. The Coalition for Physician Enhancement, a bi-national association supporting and developing expertise in physician assessment and educational enhancement, held a conference on aging physicians in late 2011. Participants reviewed data on the effects of aging on health and practice, and the majority of the audience favored agebased screening beginning at age 70 to assess physical and mental health, and cognition. Identified risk factors affecting clinical competence other than aging include: • poor performance in medical school • solo practice • lack of hospital privileges • lack of ABMS board certification • out-of-scope practice • clinical volume • new knowledge/procedural skills • fatigue/stress/burnout • mental and physical health issues As a self-regulated profession, medicine is granted substantial societal privilege and, in return, is expected to set standards for entering practice, for sustaining privilege to practice, and for sanctioning and removing from practice physicians who neglect or abuse that privilege. Five to 10% of physicians fit the category of those who should be removed from practice. The survey of conference participants showed that 96% of physician responders agreed that impaired or incompetent physicians should be reported to the appropriate authorities, but that 45% reported they had encountered incompetent physician colleagues and failed to report them. While some health systems and medical practices have

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mandatory retirement ages, there are unintended consequences of age-based competence decisions and mandatory retirement. Such mandates contribute to the predicted physician shortfall as the population ages and need for medical care increases, there is a loss of medical wisdom and experience, and while age may be a risk factor, it is not the only one. The Age Discrimination in Employment Act (ADEA) should also be considered. The American Medical Association (AMA) published a report in 2015 titled “Assuring Safe and Effective Care for Patients by Senior/Late Career Physicians.” The report stated that physicians must develop guidelines and standards for monitoring and assessing both their own and their colleagues’ competency. Formal guidelines on the timing and content of testing of competence may be appropriate and may head off a call for mandatory retirement ages or imposition of guidelines by others. Many at the conference voiced the opinion that physicians need to monitor ourselves before another group decides they should. PACE conducted a recent study of San Diego physicians age 50 and older, based on participant Micro-CogTM Scores, which concluded that 27% needed or may need further evaluation. Of those, 75% were practicing physicians. While the study was small, it compared to studies in other regions. A 2001–10 study of 1,618 physicians conducted in Quebec, Canada, concluded that physicians over the age of 70 had three times higher rate of cancellation of licensure (31%) compared to the group less than 70 years old (10%). Physicians ages 65 to 69 showed only a slightly higher rate of cancellation (13%) than the younger average, but had

April 2016

nearly double the rate of need for refresher course or retraining or limitation than physicians younger than 65 (18% vs. 10%). Since the Medical Board of California discontinued their diversion programs, the California Public Protection and Physician Health Inc. (CPPPH) agency was founded to develop a comprehensive statewide physician health program, and organizes regular workshops for physician wellness committees throughout the state. Champions for Health hosts these meetings in San Diego three to four times a year as part of their support for physicians. CPPPH published a white paper in 2015 titled “Assessing Late Career Practitioners: Policies and Procedures for Age-based Screening” (available at www.cppph.org). The UC San Diego School PACE Program has developed standards for the UC San Diego Health System, including evaluation of mental and physical health regularly beginning at age 55, reliable assessment of actual performance to measure outcomes and processes, annual re-credentialing, licensure based on actual scope of practice, and proctoring of technical and procedural skills for new procedures and after age 60. Screening protocols will undoubtedly be implemented by each health system and large practice until standards are developed at the national or state level. Dr. Bazzo is a clinical professor of family medicine at the UC San Diego School of Medicine. He is director of the Fitness for Duty Program for the UC San Diego Physician Assessment and Clinical Education (PACE) Program. He also currently serves on SDCMS’s executive committee and board of directors, and has been an SDCMS-CMA member for 17 years.

 2nd Annual Solana Beach Sunset 5K Run/Walk 5K to Sunset Diabetes

Physicians and their families joined close to 650 runners and walkers at the second annual Solana Beach Sunset 5K Run/Walk and health expo on Nov. 14, 2015. The event enjoyed huge support from the medical community, including presenting sponsors The Doctors Company, The Doctors Insurance Agency/ Bob DeSimone, and the County of San Diego’s Health and Human Services Agency. The event raised close to $35,000 to support diabetes prevention targeting vulnerable populations living with pre-diabetes; only about one in eight people with pre-diabetes know they have the condition, according to a 2015 study in the American Journal of Preventative Medicine. “We’re here to get people running and walking to reduce their risk of developing diabetes,” said Barbara Mandel, SDCMS Foundation executive director. San Diego County Third District Supervisor Dave Roberts again served as honorary chair of the event and presented a certificate of recognition to the SDCMS Foundation for raising funds and awareness to sunset diabetes. The health expo featured dozens of booths promoting active living and healthy eating: free blood pressure tests from UC San Diego Health and free skin screenings from Arch Health Partners, as well as 24 Hour Fitness, Fitwall, and free samples from Naked Juice and Clif Bar.

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Aces for Health Golfers Support Efforts to Improve Health and Change Lives

L-R: Dr. Dicks, Dr. Pe, Patricia Coleman, and Dr. Bridge.

April 18 marked the date for the fourth annual Aces for Health golf tournament, joined this year with the inaugural tennis tournament. This year’s event was held at Lomas Santa Fe Country Club in Solana Beach. The golf and tennis activities were followed by the Health Heroes Awards reception and silent auction. Last year, on March 12, 2015, physicians and their friends supported the SDCMS Foundation at the third annual Aces for Health golf tournament at Del Mar Country Club. The tournament was followed by an evening reception and silent auction raising $81,000 for Project Access San Diego, which provides pro bono specialty care to low-income, uninsured San Diegans through a network of specialist and surgeon volunteers. Major sponsors for the events both years were presenting sponsors The Doctors Company and The Doctors Insurance Agency/Bob DeSimone, joined by Pettigrew Surgical Associates/Spinal Elements, UC San Diego, and Wealth Advisors.

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White Coat Gala 2015 Honors Health Heroes

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Celebration 10 Gala

Celebrating the Commitment of James T. Hay, MD, to Community Health The SDCMS Foundation honored its founding president, James T. Hay, MD, at Celebration 10, its 10th anniversary gala on Feb. 7, 2015. Event honorary chairs included Bob Hertzka, MD, Roxana Foxx, Al Ray, MD, and Cheryl Ray. Former State Assembly Speaker Toni Atkins, Congresswoman Susan Davis, County Supervisors Greg Cox and Dave Roberts, San Diego City Councilmember Todd Gloria, and more than 260 attendees toasted Dr. Hay’s remarkable efforts to improve health and change lives. “We’re now up over $9 million of free care given to patients in San Diego,” said Dr. Hay of the Foundation’s success. The gala’s cocktail hour featured a silent auction of original artwork by San Diego artists that built on the SDCMS Foundation’s heartfelt theme. Close to $100,000 was raised to support the SDCMS Foundation’s flagship program, Project Access San Diego, as well as health policy education for students at UC San Diego’s School of Medicine. Dr. Hertzka said of the health policy education, “After our students see policy in practice, they understand why being a part of organized medicine is so important to the profession.”

Stephen Bridge, MD, Brian Dicks, MD, and Mark Pe, MD, from Genesis Healthcare Partners were honored as the SDCMS Foundation’s 2015 Health Heroes at the SDCMS’s White Coat Gala on June 13, 2015. The event celebrated the SDCMS’s 145 years of caring. The Health Heroes Awards recognize physicians who volunteer to care for uninsured patients in need through Project Access San Diego. Patricia Coleman, a patient of the SDCMS Foundation’s Project Access San Diego, presented the Health Heroes Awards to Genesis Healthcare Partners’ physician volunteers. “Imagine having pain every day and not knowing what it’s from,” Coleman said. “Dr. Pe saved my life. Every time I see Dr. Pe, I try to tell him how much I appreciate their kindness and generosity.”

SAN DIEGO PHYSICIAN.org

//////////////////////////////////////////////// PHYSICIANS IMPROVING HEALTH, CHANGING LIVES

Champions for Health Prevention Programs

Targeting the Medically Underserved

 Medical Student & Resident Scholarships Support the Future of Medicine Michael Langley-deGroot was selected as the 2015 SDCMS Foundation resident scholarship winner. Michael is currently a psychiatry resident at UC San Diego. He completed his medical school training after a decade working to provide services to the homeless and mentally ill at several nonprofit organizations, and worked at the Department of Mental Health in Los Angeles on the psychiatric emergency response team. At UC San Diego, he completed several of his clinical clerkships with honors, including medicine, psychiatry, neurology, and primary care. His fourth-year evaluations included honors in palliative medicine and inpatient psychiatry. He began volunteering at the UCSD Student Run Free Clinic during his first year, and worked every year since, including during the summers when staffing is greatly needed. He was honored during his fourth year at UC San Diego with the Gold Humanism Honor Society membership. 2015 medical student scholarship recipients Jacqueline Lee and Michael Pimienta will receive financial support for the four years of their medical school training. Awards are granted annually on merit and the candidate’s personal beliefs and actions aligning with Champions for Health’s mission.

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YOU Are a Champion for Health Champions for Health is seeking your assistance to improve the health and wellness of community members. Make a few community presentations or provide care to a few patients a year. Provide leadership to guide the organization by serving on the Program Leadership Team. Play in the Aces for Health golf and tennis tournaments. Bring office staff, family, and patients to the Solana Beach Sunset 5K Run/ Walk. Make a contribution, either annually or monthly through automatic payments. Champions for Health is your organization, and is only as strong as your commitment.

Love Your Heart Day SDCMS president William Tseng, MD, promoting cardiovascular disease screenings, during the County of San Diego’s annual Love Your Heart Day (Feb. 11, 2016). During the one-day event, Champions for Health rallied physicians and nurse volunteers to provide and record 2,530 free blood pressure screenings to patients and the public, 47% more than in 2015. A total of more than 25,000 blood pressures were recorded countywide that day.

Immunizations During the 2015–16 flu season, Champions for Health nurse volunteers provided 1,135 free flu immunizations to medically underserved county residents at convenient locations, 100% more than the previous flu season.

//////////////////////////////////////////////// Live Well Speakers Bureau’s Physician Volunteers

Improving Community Health Education Physicians from across San Diego County are volunteering to build the public’s knowledge, skills, and positive attitudes about health through the Live Well Speakers Bureau (LWSB) at Champions for Health. The LWSB consists of pro bono interactive presentations to groups of youth, adults, seniors, employees, and community residents on a wide range of topics including: • Easy Ways to Eating Right for a Healthy Body and Mind • How to Live Your Best Life • Creating a Healthier Workforce • Athletics: Playing for Life (teen sports benefits and issues) • Recognizing Unhealthy Relationships • Reading Your Child’s Emotional Health Breast Cancer Screenings In 2015, Champions for Health facilitated 1,370 free community-based breast cancer screenings through partnerships with community clinics and Susan G. Komen San Diego, including 169 screenings at a one-day event at Qualcomm Stadium last October.

Toluwalase Ajayi, MD, educating college preparatory middle school students about “Easy Ways to Eating Right for a Health Body and Mind.”

Champions for Health provides adaptable presentation materials tailored to each audience’s age (ranging from 5 to 105) and interests. Because 75% of a person’s health is determined by their behaviors, these interactive presentations engage and initiate a dialogue on how individuals can improve public health, starting at home. The LWSB is made possible through a partnership with the County of San Diego’s Health and Human Services Agency.

CRC Screenings, Diagnostics, and In-service Daniel “Stony” Anderson, MD, California Colorectal Cancer Coalition (C4) board president and Champions for Health volunteer and leadership team member, with four Project Access colorectal cancer (CRC) survivors. Champions for Health provides in-service training to help community clinic physicians and staff improve CRC screening rates, and partners with Kaiser Permanente and Tri-City Medical Center for pro bono diagnostics and treatment for the uninsured.

In 2010, the San Diego County Board of Supervisors adopted the Live Well San Diego (LWSD) health strategy. LWSD involves partners from government to business, schools, and faith-based and community organizations, working together to plan and implement innovative and creative projects that improve the health, safety, and well-being of all county residents. Jeffrey Howell, MD, educating San Diego’s Retired Senior Volunteer Patrol, North DiviThe County of San Diego’s Board sion, about “Living Your Best Life.” of Supervisors recognized SDCMS Foundation/Champions for Health as a Live Well San Diego partner in 2014 and proclaimed “SDCMSF Live Well Day” on Sept. 27, 2014, the organization’s inaugural Solana Beach Sunset 5K Run/Walk. The event helped 650 attendees participate in fitness fun while learning about healthy eating and raising awareness about poor diet and physical inactivity to address diabetes among all San Diegans at risk. SAN DIEGO PHYSICIAN.org

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) 333-6296, 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 PSYCHIATRISTS NEEDED: Full-time or part-time positions available for a well-managed program at San Diego County correctional facilities. Telepsychiatry position also available. Flexible hours with very competitive pay. Send CV to steve@ cpmedgroup.com or call (619) 885-3907. [272] SEEKING EXPERIENCED, HIGHLY MOTIVATED FAMILY OR INTERNAL MEDICINE PHYSICIAN: Federally qualified health center (FQHC) clinic site in City Heights seeks an experienced, highly motivated family / 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. Excellent salary / benefits with retirement match. Looking for a special doctor, committed to our mission! Send CV to Diana Marquardt, MD, Medical Director, at dmarquardtmd@roadrunner.com or call (619) 321-2614. [487] 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] 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] 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 broadbased 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] SEEKING FAMILY MEDICINE PHYSICIANS: SHARP ReesStealy Medical Group, a 500+ physician multi-specialty 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) 233-4730. 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) 233-4730. 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] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of

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.

April 2016

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 MEDICAL OFFICE SPACE FOR RENT IN ENCINITAS: Convenient location five minutes from Scripps Encinitas Hospital. Close to 5 freeway. Features include two spacious exam rooms, private consultation / doctor’s office, lunchroom, private bathroom, and a spacious waiting room shared with one other doctor. Very affordable rent. Office located at the corner of Encinitas Blvd. and Manchester Ave. Call (858) 756-3021 or email ktagdiri@gmail.com for more information. [489] 3998 VISTA WAY, IN OCEANSIDE: Three medical office spaces approximately 2,000–2,500 square feet available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and groundfloor access. Lease price: $1.75+NNN. Tenant improvement allowance to customize the suites is available. For further information, please contact Lucia Shamshoian at (760) 9311134, ext. 13, or at shamshoian@coveycommercial.com. [480] 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 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-term 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) 9995153. [453] 1,701FT2 MEDICAL OFFICE SPACE AVAILABLE TO SHARE IN CLASS A MEDICAL OFFICE BUILDING: Turnkey, recently remodeled, first floor in Sorrento Valley with excellent highway access and easy, free parking. Flexible schedule options. Four exam rooms. Two entrances. Reasonable rates. Email or call for more information: (619) 2188980, mobyrne61@gmail.com. [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) 3200525 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 MEDICAL OFFICE ADMINISTRATOR: We are a one-doctor private practice looking to hire a front office with previous office experience. Must have warm caring demeanor, excellent interpersonal and customer service skills. Must have good computer skills and experience with electronic medical records. Experience with Athena net is especially helpful. Other important experiences are front office administrative tasks such as operational and customer service issues, coordinating employee resources and patient flow. Familiarity with back office task is a plus. Forward your resume and cover letter to ktagdiri@gmail.com. [490] PSYCHIATRIC NURSE PRACTITIONER NEEDED: For parttime 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] ACCOUNTING MANAGER: The accounting manager is responsible for general accounting functions, including general ledger, month end reconciliation’s, close, and financial preparation, cash management, and oversight of accounts payable and payroll functions. The accounting manager will manage and provide guidance to the accounts payable, staff accountants, and payroll. Qualifications: Bachelor’s degree in finance / accounting; 7+ years in senior-level accounting, with three years management experience; Strong knowledge base of finance, accounting, budgeting, payroll regulations, and cost analysis in accordance with GAAP required; Preferred knowledge base within healthcare and/or grants management accounting; Preferred database experience within Great Plains and ADP. Contact Joyce Nagel at (760) 736-8737 or at joyce.nagel@nchs-health.org. [483] RAMONA HEALTH CENTER MANAGER: The Ramona health center manager is responsible for the management and operation of the day-to-day activities of the health center, including employment. The manager will maintain the mission of NCHS to improve the health status of our diverse communities by providing quality healthcare that is comprehensive, affordable, and culturally sensitive. Qualifications: Bachelor’s degree or equivalent work experience in health services administration, public health, or related field; Knowl-

edge of medical terminology, legal and technical aspects of a medical records system, and ICD9 and CPT codes; 3-5 years’ experience in a medical, health, or social services setting; 3+ years’ management experience. Contact Joyce Nagel at (760) 736-8737 or at joyce.nagel@nchs-health.org. [484] LVN NURSE MANAGER: The LVN nurse manager is responsible for day-to-day activities of the health center. You will participate as a member of the leadership team to ensure effective quality medical services to patients. Health center manager assures that health center procedures are continually and systematically followed, patient flow is enhanced, and customer service is extended to all patients. Responsible for assisting in scheduling clinicians for optimal medical coverage. Able to maintain a high standard of confidentiality. Qualifications: High school diploma, GED or foreign equivalent; Graduate of an accredited LVN/LPN program; Current California state licensure LVN/LPN; Current IV cert required; Current CPR/BLS American Heart Association; Two years’ experience supervising staff in a healthcare setting. Contact Joyce Nagel at (760) 736-8737 or at joyce.nagel@nchshealth.org. [485] RN — BILINGUAL WHS: The Women’s Health Services registered nurse (RN), under the direction of the director of nurses, follows medical protocols and administrative procedures. WHS RN will run a NSt/AFI clinic, doing patient education and conducting triages for the department. Will also assist in preparing patients, perform laboratory procedures, and dispense and administer medication. You will be responsible for case management, and maintain the confidentiality. Qualifications: ASN, prefer BSN; Current California state registered nurse license; CPR/BLS American Heart Association, current; Two years’ nursing experience prefer in WHS; Required bilingual in English and Spanish. Contact Joyce Nagel at (760) 736-8737 or at joyce.nagel@nchs-health.org. [486] PHYSICIAN ASSISTANT NEEDED FOR BUSY MULTIDISCIPLINARY MEDICAL PRACTICE TO START IMMEDIATELY: Requirements: Must be CA licensed; Have high ability to work in a fast-paced environment and handle stressful situations; Must be compassionate and have great bedside manner. Please email or fax resume with salary requirements to jeannielanderos@yahoo.com or (858) 202-1548. To learn more about our company, visit us at www.paincarerehab. com. [481] 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) 9925330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [038] NONPHYSICIAN POSITIONS WANTED LOOKING FOR AN INTERNSHIP IN MEDICAL OFFICE: Motivated career professional is making a career transition and is seeking an opportunity to use medical coding skills. Professional has completed an ICD-10 Medical Coding Certificate Program through CSU, San Marcos. She also holds a BA in English and teaching credential from the University of San Diego. She enjoys music, travel, and walking! She is available M–F, full-time, with a paid internship, or T–TH as a volunteer intern. Contact Claire Carpenter at bentonclaire4@ gmail.com or at (619) 756-1582, or visit www.linkedin.com/ in/claire-carpenter-449a5511. [491] MEDICAL EQUIPMENT / FURNITURE FOR SALE COSMETIC LASER FOR SALE: Multi-wavelenth platform in very good condition. Used for tattoo removal, epidermal and dermal lesion removal. Candela Alex-Trivantage gently used low pulse count. Includes: two Hand-pieces (one for backup). Additional accessories: manuals; keys; three foot pedals; articulating arm; goggles; patient eye shields; 2mm 755nm Hand-piece attachment; 3mm 755nm Hand-piece attachment; 4mm 755nm Hand-piece attachment; white Orings; additional miscellaneous parts for hand-piece; handpiece holster; laser signage. Original price $90,000, asking $19,900. Call (858) 272-2021 or email info@trlaser.com. Additional pictures, viewing, and demo at clinic upon request. [488] 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 $1,899. Email KLewis@ SDCMS.org. [443] EXAM PROCEDURE LIGHT IN EXCELLENT CONDITION (GENTLY USED): Works well, with 12V halogen bulb. Bought new for $225.00, asking $50. Color is white with chrome. Has flexible goose neck. Base with 4 wheels for easy mobility and long cord. Plug-in is 3 prong. Perfect for medical procedures or skin care. If interested, please call (858) 272-2021. Located in a medical center near Interstate 5. [482] MEDICAL EQUIPMENT: Two Midmark 404 exam tables (excellent condition), including extra tabletop (brand new) $400.00 each. Two TAB file cabinets (3’x5’) at $200.00 each. X-ray file cabinet (3’x6.5’) at $200.00. X-ray view box $100.00. Finger Reduction system at $200.00. Cast cutting saw at $100.00. Health O Meter Mechanical Pediatric scale (nearly new) at $100.00. All offers can be best priced. Please call (619) 298-9938 if interested. [479]

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I n lov i n g m e m o r y

John Houkom, MD, Memorial Scholarship Fund by Al Ray, MD

Dr. Houkom and his wife, Alexe Page, MD.

April 2016

Dr. Houkom will be greatly remembered for his caring commitment to his patients as an orthopedic surgeon with Southern California Permanente Medical Group, as well as his charm and great dancing skills. Now his legacy and commitment to the medical profession will be memorialized through the establishment of the Memorial Scholarship Fund in his name, endowing a medical student scholarship each year. The SDCMS Foundation has provided UC San Diego School of Medicine student scholarships, as well as resident scholarships, for the past eight years. Dr. Houkomâ&#x20AC;&#x2122;s wife, Alexandra Page, MD, made the gift in her husbandâ&#x20AC;&#x2122;s honor last October. The John Houkom, MD, Memorial Scholarship Fund is the first endowment fund established by Champions for Health. Physicians can memorialize their legacy by making either a cash contribution or a legacy gift in their estate plan. For more information, contact Barbara Mandel at Champions for Health.

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.

Request your free electronic or hard copy today! 800-356-5672 | CAPphysicians.com/Value SAN DIEGO PHYSICIAN.org

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