September 2016 by San Diego Physician

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Advancing Awareness, Prevention and Treatment of Cardiovascular Disease

2016 Sharp Grossmont Hospital Heart and Vascular Conference

8 a.m. to 4:30 p.m., Saturday, Oct. 15, and 8 a.m. to 1 p.m., Sunday, Oct. 16, 2016

Cardiovascular disease is the leading cause of mortality in the U.S. As the prevalence of this condition continues to rise, so does the need for primary care physicians and multidisciplinary clinicians to have comprehensive knowledge about available treatment modalities and their role in managing at-risk patients.

The US Grant Hotel 326 Broadway San Diego, CA, 92101

Sharp Grossmont Hospital is hosting a conference recognized as one of the region’s premier events for cardiovascular disease education. The 2016 conference will feature a range of experts who will address topics related to medical management, interventional therapies, and surgical options for heart and vascular conditions.

This activity has been approved for AMA PRA Category 1 Credit™. Registration Free for all physicians, physician assistants, nurse practitioners and Sharp HealthCare employees. Fee is $250 for non-Sharp-affiliated nurses and allied health care professionals. To register, visit www.sharp.com/heartconference or call 1-800-82-SHARP (1-800-827-4277).

SAN DIEGO PHYSICIAN.org

September

Contents Volume 103, Number 9

SDCMS-CMA MEMBERSHIP SDCMS-CMA MEMBERSHIP

DATE

BENEFIT DATE

BENEFIT

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: James Santiago Grisolía, MD • Mihir Parikh, MD • Robert E. Peters, MD, PhD • J. Steven Poceta, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder

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OFFICERS President: Mihir Y. Parikh, MD President-elect: Mark W. Sornson, MD Secretary: David E. J. Bazzo, MD Treasurer: James H. Schultz Jr., MD Immediate Past President: William T-C Tseng, MD, MPH (CMA Trustee)

features

GEOGRAPHIC and GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD (Alt) • Jay P. Mongiardo, MD • Venu Prabaker, MD • Kosala Samarasinghe, MD Hillcrest: Gregory M. Balourdas, MD • Kyle P. Edmonds, MD (Alt) • Thomas C. Lian, MD Kearny Mesa: Sergio R. Flores, MD (Board Rep) • 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 • Wayne C. Sun, MD (Alt) North County: Neelima V. Chu, MD (Alt) • Michael A. Lobatz, MD • Patrick A. Tellez, MD South Bay: Maria Carriedo, MD (Alt) • Reno D. Tiangco, MD • Michael H. Verdolin, MD

SDCMS Membership: How It Made a Difference in My Life y james santiago b grisolía, md

Put Your SDCMS-CMA Membership to Work!

departments

riefly Noted: Calendar • North County B Healthcare • The Right to Treatment of Pain • Welcome New and Returning Members • In Memoriam • And More …

AT-LARGE and AT-LARGE ALTERNATE DIRECTORS Lase A. Ajayi, MD • Karrar H. Ali, DO, MPH • Steven L-W Chen, MD, MBA (Alt) • Stephen R. Hayden, MD • Vimal I. Nanavati, MD (Alt) • Alexexandra E. Page, MD • Robert E. Peters, MD, PhD (Alt) • Carl A. Powell, DO (Alt) • Peter O. Raudaskoski, MD • Albert Ray, MD (Alt) • Thomas J. Savides, MD • Karl E. Steinberg, MD (Alt) • Erin L. Whitaker, MD (Alt) • Marcella (Marci) M. Wilson, MD (Alt) • Holly B. Yang, MD (Board Rep) • Nicholas J. Yphantides, MD OTHER VOTING MEMBERS Communications Chair: J. Steven Poceta, MD Delegation Chair: Robert E. Peters, MD, PhD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Michael C. Hann, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: David Li

8 Yes on 56 — Save Lives California

OTHER NONVOTING MEMBERS Young Physician Alternate Director: Heidi M. Meyer, MD Resident Physician Alternate Director: Zachary T. Berman, MD Retired Physician Alternate Director: Mitsuo Tomita, MD SDCMS Foundation President: Albert Ray, MD (Delegation Vice Chair) (At-large AMA Delegate, Appointed by CMA) Delegation Chair: Robert E. Peters, MD, PhD CMA Speaker of the House: Theodore M. Mazer, MD (At-large AMA Delegate, Appointed by CMA) CMA Past Presidents: James T. Hay, MD (AMA Delegate) • Robert E. Hertzka, MD (Legislative Committee Chair, At-large AMA Delegate, Appointed by CMA) • Ralph R. Ocampo, MD CMA Trustee: Bob E. Wailes, MD AMA Alternate Delegate: Lisa S. Miller, MD

Leadership Series: Thomas R. Moore, MD

by sherry nooravi, psyd

inding a Balanced Assessment of Our F Competence by helane fronek, md, facp, facph

ANDOR Toolkit: Physicians Now Have C the Right Tools to Do the Right Thing After an Adverse Event by robin diamond, msn, jd, rn

Physician Marketplace: Classifieds

UC San Diego Medical Students: Shaping Healthcare Policy in Sacramento

by cecilia bonaduce, msii

september 2016

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// IN THE COMMUNITY

calendar

North County Healthcare

SDCMS-CMA CALENDAR

For further information or to register for the following, contact Jen at (858) 300-2781 or at JOhmstede@ SDCMS.org. 2016 Ballot Measures: How Your Vote Can Increase Access to Care (webinar) SEP 28: 12:15PM–1:15PM 3rd Annual Solana Beach Sunset 5K Run/ Walk (event) OCT 1 at Fletcher Cove Park in Solana Beach CHPI Physician Quality Rating Program: Navigating the Review and Corrections Process (webinar) OCT 5: 12:15PM–1:15PM OMSS Annual Assembly and Education Conference OCT 14 at the Sacramento Convention Center

HEALTHCARE CONFERENCES

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. 27th Annual Southern California Alzheimer’s Disease Research Conference SEP 30 at the Irvine Marriott Hotel People, Planet, Purpose: Global Practitioners United in Health and Healing OCT 3 – NOV 3 at Paradise Point Resort & Spa

september 2016

CMA House of Delegates (event) OCT 15–16 at the Sacramento Convention Center 2016 CMA and CMA Foundation President’s Reception & Awards Gala OCT 15 at the Sacramento Memorial Auditorium

Future of Medicine Gala After-party OCT 15 at Chops Steak and Seafood Bar in Sacramento Is Your Practice at Risk for a HIPAA Security Breach? (webinar) NOV 2: 12:15PM–1:15PM Physician Networking Opportunity & Mixer (social) NOV 3 at Rock Bottom Restaurant & Brewery La Jolla

Remaining HOD Resolutions Schedule: Event

Quarter 4

Resolution Submission Deadline

July 8

30-day Testimony Period

Aug. 5 – Sept. 4

Council Meetings

Sept. 5–12

Comment Period

Sept. 13 – Oct. 10

Board of Trustees Meeting

Oct. 14

Workers’ Compensation (SDMGMA) OCT 12 at SDCMS 2nd Annual Advanced Therapeutic Interventions to Optimize Obesity and Diabetes Care OCT 21–22 at the Hilton La Jolla Torrey Pines San Diego’s 11 Annual Emergency Care Summit OCT 27 at Scripps Memorial Hospital, Schaetzel Center, Great Hall th

Top Doctors Celebration 2016 OCT 29 at Coasterra in San Diego

2016 San Diego Day of Trauma (They Brought Knives to the Gunfight: Surgeons Went to War and Changed Everything in the Care of the Injured) NOV 4 at the Kona Kai Resort, San Diego Social Media for the Healthcare Administrator (SDMGMA) NOV 9 at SDCMS AMA House of Delegates Interim Meeting NOV 12–15 in Orlando, Florida

SDCMS CEO Paul Hegyi spoke at the Aug. 5 North County Health Care Summit at the Kaiser Permanente San Marcos Medical Center — an occasion to showcase healthcare in the North County corridor and to “check in” with North County healthcare leaders on industry trends, life after the ACA, and the future of healthcare. Other speakers included Irma Cota, CEO of North County Health Services, Bob Hempker, CEO of Palomar Health, Wayne Knight, chief strategy officer at Tri-City Medical Center, Barbara Price, corporate senior vice president at Scripps Health, and Paul Bernstein, MD, medical director for Kaiser Permanente in San Diego. Attendees included elected officials from the North County region, city staff representing police, fire, and city managers, and community leaders from the nonprofit sector. Dimitrios Alexiou, HASDIC CEO, served as panel moderator with Chuck Matthews, director of the County of San Diego HHSA North Coastal and North Inland Regions, giving the keynote address.

ERRATUM

PAVE Telephone # In the July 2016 issue of San Diego Physician, the telephone number for PAVE — Physician Advocates for Veterans — was incorrectly printed in Dr. Rosemarie Marshall Johnson’s “Do You Take a Military History?” article. PAVE’s correct number is (858) 753-5873. Our apologies for the error.

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TrusT

BIOETHICS

The Right to Treatment of Pain SDCMS’s Bioethics Commission met again on July 27 to discuss “Patients’ Right to Treatment of Pain and Physician and Institutional Response in the Opioid Epidemic Era,” a presentation led by Lynette Cederquist, MD, and Paula Goodman-Crews, MSW, LCW. Before the presentation, the group shared their experiences to date with the End of Life Option Act, which went into effect this past June 1. This coming Oct. 13, San Diego Coalition for Compassionate Care will hold an all-day workshop at SDCMS on the End of Life Option Act. The workshop’s objectives will include the following: • Discuss key aspects of the End of Life Option Act, including patient eligibility and required provider actions. • Describe how ethical considerations impact personal and organizational participation. • List three important things to consider when patients ask about their dying process.

“

• Implement conversation skills to help patients discuss end of life. • Apply cultural congruency theory to care conversations in the setting of serious illness. Future SDCMS Bioethics Commission meetings are scheduled for Oct. 26, 2016 (where “Dementia and Patient Rights” will be discussed), Jan. 25, 2017, April 26, 2017, July 26, 2017, and Oct. 25, 2017. Our Bioethics Commission comprises physicians, nurses, pastors, social workers, professors, attorneys, students, and others from across the county who meet quarterly to promote best and innovative practices in bioethics, including clinical, organizational, systems issues, and bioethics committee functions. Meetings begin at 6 p.m. and end at 8 p.m., and are held at SDCMS’s offices — with dinner available. If you would like more information on how you can get involved, email Kyle Lewis at KLewis@SDCMS.org.

”

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/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// MEMBERSHIP

Welcome New and Returning SDCMSCMA Members! New Members Hassan K. Bencheqroun, MD Pulmonary Disease San Diego • (760) 459-5009 Ezra Cohen, MD Medical Oncology La Jolla • (858) 534-6161

John S. Parrish, MD Pulmonary Critical Care Medicine San Diego • (619) 532-6400 Ernest J. Prochazka, MD Occupational Medicine San Diego • (619) 499-2600 Returning Members

Rita K. Gupta, DO Family Medicine Oceanside • (619) 528-5000 Timothy P. Holden, MD Internal Medicine San Diego • (619) 851-5770 Cody R. Jackson, MD Aerospace Medicine San Diego • (858) 577-9907 Lisa A. Johnston, MD Obstetrics and Gynecology Chula Vista • (858) 499-2702 Derek D. Kwan, MD Anesthesiology San Diego • (619) 528-5000 Amanda A. Lloyd, MD Dermatology Cardiff • (760) 436-8700 Nikolas J. S. London, MD, FACS Ophthalmology Poway • (858) 451-1911 Gordon C. Luan, MD Family Medicine San Marcos • (858) 663-1014 Kristi A. K. Maas, MD Obstetrics and Gynecology San Diego • (858) 505-5500 Ghassan A. Moasis, MD Thoracic Surgery San Diego • (858) 455-6330

Marcus Contardo, MD, MPH Pathology Oceanside • (760) 634-3230 Brian Kim, MD Family Medicine San Diego • (619) 278-3300 Alan M. Krystal, MD Geriatric Medicine Vista • (619) 507-4857 Jane A. Lyons, MD Pediatrics San Diego • (858) 353-2648 Savita Malik, MD Obstetrics and Gynecology Rancho Santa Fe • (858) 7746905 Veena M. Mandava, MD Diagnostic Radiology San Diego • (800) 290-5000 Arash Mozayan Isfahani, MD Ophthalmology Encinitas • (760) 300-3270 Adrienne A. Nassar, MD Endocrinology, Diabetes, and Metabolism San Marcos • (619) 528-5000 Michael L. Pomerantz, MD Hand Surgery Chula Vista • (619) 421-3400 Ujwala D. Rajgopal, MD, FACS General Surgery San Diego • (760) 753-5667

AAP STUDY

Children’s Experiences of Epilepsy: A Systemic Review of Qualitative Studies Children with epilepsy experience vulnerability, disempowerment, and discrimination. Repeated treatment failure can raise doubt about the attainment of remission. Addressing stigma, future independence, and fear of death may improve the overall wellbeing of children with epilepsy. Article published online Aug. 10, 2016, by the American Academy of Pediatrics.

IN MEMORIAM The following physicians were recently discovered to have passed away in 2016. Our sincere condolences go out to each of their families and all of their friends. Robert J. Hye, MD, 12-year SDCMS-CMA member, passed away on Feb. 22, 2016. Martin E. Sodomsky, MD, 8-year SDCMS-CMA member, passed away on March 31, 2016. Richard L. Serwin, MD, 41-year SDCMS-CMA member, passed away on April 4, 2016. Blake S. Talbot, MD, 53-year SDCMS-CMA member, passed away on July 28, 2016.

september 2016

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P UBL I C H E A LT H

YES on

California’s Proposition 56 Will Raise Tobacco Yes on 56 — Save Tax to Save Lives, Protect Children Lives California California’s Proposition 56willWill Tobacco In November, Californians haveRaise a vital opportunity Tax to Save Protect Children to standLives, up to tobacco companies and save lives.

Protect Kids. Higher tobacco taxes are proven to reduce youth smoking, yet California’s tobacco The leading cause of preventable death in ourtax state and is among the the nation, tobacco kills 40,000 Californians annually. lowest in the nation.

Proposition 56 will raise the tax on cigarettes and Each year, tobacco causes more deaths than guns, car other tobacco products, including electronic cigarettes accidents, HIV, alcohol and illegal drugs combined. Fight Cancer. Prop. containing nicotine, which medical experts warn are Meanwhile, Californians spend $3.5 billion each 56dollars pays for healthcare, those who don’t smoke. In November, Californians will have a creating a major public health threat toeven children. year treating cancer and other tobacco-related diseases cancer treatment, The leading cause of preventable death vital opportunity to stand up to tobacco smoking prevention, through Medi-Cal. in our state and the nation, tobacco kills companies and save lives. Proposition 56 and research to cure Taxing tobacco saves lives and gets people to quit 40,000 Californians annually. Each year, will raise the tax on cigarettes and other cancer and tobaccosmoking. Taxing tobacco is proven to prevent wouldOnly those who use tobacco products will pay this tobacco causes more deaths than guns, car tobacco products, including electronic related diseases. be smokers nicotine, – including youth – from ever starting.HIV, Andalcohol, simple user fee. The vast majority of funds generated accidents, and illegal drugs cigarettes containing which combined. Meanwhile, spend to be up to $1 billion annually medical experts warnwho are creating major or start only those choose toacontinue this deadly byCalifornians Prop. 56 (estimated If You Don’t Smoke, $3.5 billion each year treating cancer and$1 billion in federal matching public health children. andthreat costlyto habit will pay. with an additional You Don’t Pay. other tobacco-related funds) diseases through Taxing tobacco saves lives and gets will go to pay for health care for low income Medi-Cal. California taxpayers people to quit smoking. Taxing tobacco The California Medical Association has joined the Californians through Medi-Cal. Medi-Cal now serves Only those who use tobacco products will is proven to prevent would-be smokers — spend $3.5 billion American Cancer Society Cancer Action Network, over 12 million people, almost one third of the state’s pay this simple user fee. The vast majority of including youth — from ever starting. And each year on tobaccoAmerican Lung Association in California andgenerated Americanby Prop. population and half of all California children. funds 56 (estimated to be only those who choose to continue or start related diseases. Association in sponsoring Prop. up 56,tobecause $1 billion annually, with an additional this deadlyHeart and costly habit will pay. Prop. 56 works like tobaccoMedical hurts allAssociation Californians – even those who in don’t Prop. 56 directs additional funds to the University $1 billion federal matching funds) will go The California a useroffee, taxing to pay for healthcare for low-income Cali- medical education, tobacco has joined the American Cancer Society smoke. California for graduate Denti-Cal,to help pay fornians through Medi-Cal. Medi-Cal now Cancer Action Network, American Lung the California Department of Public Health andtobacco-related the these Association in California, and American Heart Association in sponsoring Prop. 56, because tobacco hurts all Californians —

serves more than 12 million people, almost one-third of the state’s population and half of all California children.

Join the Fight to Save Lives at Yeson56.org 8

september 2016

health care costs.

Maximizing the bottom line, one office at a time. Services: Paid for by Yes on 56-Save Lives California, a coalition of doctors, dentists, health plans, labor, hospitals and nonprofit health advocate organizations. Major funding by California Hospitals Committee on Issues (CHCI). Sponsored by California Association of Hospitals and Health Systems (CAHHS) and California State Council of Service Employees Issues Committee.

Prop. 56 directs additional funds to the University of California for graduate medical education, Denti-Cal, the California Department of Public Health, and the California Department of Education for smoking-prevention programs, and the University of California for medical research into tobacco-related diseases. Prop. 56 will protect children. Studies show that 90% of smokers start as teens. This year alone, an estimated 16,800 California youth will start smoking, one-third of whom will eventually die from tobaccorelated diseases. Tobacco companies are aggressively marketing youth-themed, candy-flavored electronic cigarettes containing nicotine to hook a new generation of young consumers. Teen use of e-cigarettes tripled in a single year, and flavored tobacco products are creating a dangerous new public health threat, particularly to youth and minorities. Teens who use e-cigarettes are twice as likely to start smoking traditional cigarettes. It has been proven that higher tobacco taxes reduce teen smoking, yet California’s tobacco tax is among the lowest in the nation. Prop. 56 will keep kids from becoming addicted to nicotine. Prop. 56 will safeguard children and improve California’s communities, economy and healthcare system. Although we have made some great strides, we cannot stand down from combating tobacco’s deadly addiction. Learn more at YesOn56.org.

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SAN DIEGO PHYSICIAN.org

L e a d e r s hip — 6 th in a S e r i e s

Thomas R. Moore, MD, CEO, UC San Diego Faculty Practice by Sherry Nooravi, PsyD

Dr. Thomas Moore, a 20-year member of SDCMS-CMA, is board-certified in obstetrics and gynecology, as well as maternal-fetal medicine, and is CEO of UC San Diego Faculty Practice. The UC San Diego Health network includes 117 primary care physicians and 741 specialists, and provides care to more than 50,000 patients. Dr. Moore can be reached at (619) 5438300 or at trmoore@ucsd.edu.

The following interview is part six of an eight-part leadership series, with interviews conducted by organizational psychologist Dr. Sherry Nooravi. See the January issue for an interview with Dr. Paul Bernstein, medical director and chief of staff at Kaiser Permanente San Diego; the February issue for an interview with Dr. Wendy Buchi, CEO of IGO Medical Group; the March issue for an interview with Dr. Steven Green, CMO, Sharp Rees-Stealy Medical Group; the May issue for an interview with Dr. John Jenrette, CEO of Sharp Community Medical Group; and the June issue for an interview with Dr. James E. LaBelle, CMO of Scripps Health.

september 2016

Question: What is your leadership philosophy? Answer: I see the leader as servant, and it’s a two-part thing. First, having the ability to see what key changes are on the health horizon (economic, scientific, and clinical) and having an understanding of where we would like to go and must go. It is also about understanding the healthcare market’s pros and cons and our own strengths. The second is asking, “What about us? What do we want to become as a player in the Southern California healthcare region?” The leadership role involves taking that perception of the evolving horizon, understanding our unique strengths and value, and helping us get to the new place. However, in the end, it is not about just leaders; it is about all of us — clinicians, staff, and healthcare consumers — working together to define “best health” that fits our needs. Question: What should physicians do to prepare for the future of healthcare? Answer: The Centers for Medicare and Medicaid Services (CMS) is changing our health landscape. As the major single payer for health services in the United States, CMS is evolving new health-outcome

Points to Consider

guidelines emphasizing efficiency, cost, and population health rather than paying for doctors to “treat patients.” For example, we are pretty good about treating diabetes today, but what about preventing diabetes in the first place? In order to succeed in this new health delivery paradigm, we have to stay very current with medical science and attend our CME conferences and remain connected to our journals. Question: What advice do you have for young, incoming physician leaders? Answer: Start with setting a great example — in the treatment room, at the bedside, on the telephone and in the electronic medical record. Practice medicine in a way that involves getting to know your patient’s specific needs. Don’t be “transactional,” be personal. Don’t rush to the most common diagnosis by looking it up in two minutes. When you do this, you are putting your patient in a box and taking away his or her important individual context, which may critically affect the outcome. It’s not easy — the patient herself can go online and say, “What I really need is X.” Something gets lost in the transaction, and that is not going to create the next era of healthcare. Question: What does organizational culture mean to you, and how do you drive it? Answer: It is about walking the talk and having a willingness to speak up if something is not right. When we have our M&M conferences to determine what went wrong and what could have been prevented, physicians often do not want to call out colleagues’ errors or oversights, especially among those who refer to them. An example is if a physician’s performance is adversely affected by his or her own health — perhaps a tremor, a substance abuse issue, or a mood disorder — it needs to be identified out of respect for the physician and the patients. We need to have the courage to identify shortcomings in outcomes in a respectful but honest way, and that includes our own performance.

Keep Up to Date: What are you doing to stay current with medical science in your field? Do you attend CME conferences and remain connected to your journals?

The Courage to Speak Up: When things go wrong, do you have the courage to identify your own and others’ shortcomings in a respectful but honest way so that patient care is optimized and comes first?

The Patient Always Comes First: What types of behaviors and practices do you reward so your team drives a culture where the patient’s needs come first?

“Success is being the best you can be. Win on excellence, don’t try to win on margin. Striving for advantage in cost of healthcare will make you a victor for a week or month but you won’t have won anything of lasting value.”

Question: What has worked for engaging your staff that CEOs and leaders in other industries can learn from? Answer: Staff engagement in the enterprise vision is critical to success. Great cultures are respectful of each other and manage change horizontally rather than vertically. Communicating mutual caring among staff — all staff, not just physicians — is an essential part of delivering superb healthcare to patients and families. Creating an environment in which we can say “patient first, policy second” is a great goal and an opportunity to transfer good health practices to our wider society. Win on excellence, don’t try to win on margin. Striving for advantage in cost of healthcare will make you a victor for a week or a month, but you won’t have won anything of lasting value. Business fashions go up and down, styles and emphases change with time. It is important to maintain the quality reserves — human and financial — to keep producing excellence. Dr. Nooravi is an organizational psychologist and CEO of Strategy Meets Performance, a leadership consulting firm that focuses on helping CEOs of fast-growth companies shape engaging, innovative, and customer-driven cultures through executive coaching and senior team facilitation. She has been named “Trailblazer of the Year” for her research on the best practices of CEOs of high performing organizations. She can be reached at sherry@ strategymeetsperformance.com or at (312) 286-0325. SAN DIEGO PHYSICIAN.org

P e r s o na l & P r o f e s s i o na l D e v e lo p m e nt

Finding a Balanced Assessment of Our Competence by Helane Fronek, MD, FACP, FACPh

We each have our addictions. Mine is the drama in human lives. I’ll stay up all night reading a book, unable to interrupt the story before its culmination. I can’t stand the suspense of not knowing how the characters transcended their challenges or resolved their conflicts. So it’s no wonder that I’m hooked on the old TV series “Flashpoint,” with its complex characters and riveting drama. One benefit of this addiction: It guarantees I stay on the elliptical trainer for 42 minutes — a good thing for my cardiovascular fitness. 12

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What’s compelling about this series is the psychological tension balanced by the characters. In particular, Sgt. Greg Parker, the leader of a SWAT team, struggles to maintain his confidence in the face of the mistakes he makes. We see this difficulty over and over — Greg glosses over his many astute calls and the positive impact he has on so many people and focuses instead on the times that his “best just wasn’t enough” and people died in spite of his efforts. He seriously considers resigning because of these doubts. As physicians, our days are filled with decisions affecting the lives of others. While some result in life or death, most decisions have an impact on patients and their families, on our families, and on our staffs in less critical but no less important ways. Notice how many decisions you make that affect others during a day at work. It’s probably in the hundreds. How do we reconcile the inevitable mistakes we make, over the course of hundreds of decisions, with our belief in our competence, caring, and our commitment to “above all, do no harm”? One issue that creates this tension, explained by Valerie Young in Secret Thoughts of Successful Women, is our definition of success. Some of us believe we need to be perfect in everything we do. Does this sound familiar? If we fall short of this, we question our competence. Unfortunately, none of us is perfect. We all make mistakes, fail to integrate certain pieces of information, or misunderstand our patients or colleagues. Other physicians believe they must learn everything without effort, know everything, do it all alone or excel in everything they do, or they don’t feel competent. These are impossible standards to meet. We are taught to ask ourselves, “How could I have done this better?” While this practice of continual self-examination,

How do we reconcile the inevitable mistakes we make, over the course of hundreds of decisions, with our belief in our competence, caring, and our commitment to “above all, do no harm”? practiced personally and at institution-wide gatherings such as M&M conferences, is admirable and necessary, it is imperative that we also recognize our successes and make space in our minds and hearts for our inevitable imperfections. Periodically reading thankyou notes from grateful patients or keeping a journal of our successes can help us maintain a realistic view of our competence, especially when we feel we’ve made an error. Sharing what we appreciate about our colleagues helps them know we value them. Simple practices to shift our focus away from our mistakes to a more balanced assessment of our worth can be career-saving — or lifesaving. So let the last question we ask ourselves each night be, “What did I do well today?” Dr. Fronek, SDCMSCMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.com.

PRESENTED BY:

THE DOCTORS INSURANCE AGENCY Bob DeSimone

SAN DIEGO PHYSICIAN.org

Ri s k Manag e m e nt

CANDOR Toolkit Physicians Now Have the Right Tools to Do the Right Thing After an Adverse Event by Robin Diamond, MSN, JD, RN

In the past, hospitals and physicians could appear cold and distant after adverse events. The fear of malpractice lawsuits created a culture in which physicians were expected to avoid most contact with a patient or family who might have reason to sue — and physicians certainly weren’t supposed to accept blame. The actual effect of this way of thinking was just the opposite of what hospitals and doctors desired. Rather than shielding them from liability, patients and family members perceived this culture of silence as callous and uncaring, in some cases encouraging them to file lawsuits. That was then. Over the past decade the healthcare community has embraced the idea that saying, “I’m sorry this happened,” or at least acknowledging that an unanticipated adverse event occurred with genuine sympathy and concern, can go a long way toward healing the relationship between the healthcare provider and patient. Physicians have moved progressively toward a culture that expects an adverse event — a medication error, for instance, or a death during routine surgery — to be followed by a full disclosure of the facts to the patient and family.

september 2016

This is not just the right thing to do; it also helps the hospital and physicians avoid malpractice litigation, especially the lawsuits motivated not by actual errors or substandard care but by patients and family members who were left angry and abandoned. The Agency for Healthcare Research and Quality (AHRQ) developed the Communication and Optimal Resolution (CANDOR) Toolkit (www. ahrq.gov/professionals/ quality-patient-safety/ patient-safety-resources/ resources/candor/introduction.html) with the input of healthcare professionals who studied the different tools, policies, and procedures in use at various hospitals, including the disclosure resources offered by The Doctors Company. (www.thedoctors.com/ knowledgecenter/patientsafety/disclosureresources/ index.htm). David B. Troxel, MD, medical director at The Doctors Company, served on the oversight committee, and I served on the technical advisory committee, which assessed expert input and lessons learned from AHRQ’s $23 million Patient Safety and Medical Liability grant initiative launched in 2009. CANDOR calls for a prompt response and specific actions after an adverse event. Within

one hour, specially trained hospital staff should: 1. Explain the facts, and what might still be unknown, to patients and family members. 2. Contact the clinicians involved and offer assistance because the stress and grief of the healthcare professionals can easily be overlooked in these incidents. 3. Immediately freeze the billing process to avoid further stressing the patient with a bill for the services that may have caused harm. CANDOR calls for the hospital to complete a thorough investigation within two months, keeping patients and relatives fully informed along the way. When the investigation is complete, the patient and family are provided with

the findings and engaged in a discussion of how the healthcare organization will try to prevent similar adverse events in the future. The investigation will not always find that the physician or other clinicians failed to meet the standard of care, and in those cases the patient and family members can still benefit from understanding what happened. In many cases, they will not sue despite their loss because they are satisfied that the hospital and physicians did their best and were forthcoming with information. Ms. Diamond is senior vice president of patient safety and risk management for SDCMSendorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

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SDCMS

SDCMS Membership How It Made a Difference in My Life

by James Santiago Grisolía, MD

hen we chalk up the benefits of SDCMS membership, I have to count relationships and enhanced sense of meaning even higher than the economic benefits. For me, membership has enriched my medical and personal life. Staying connected through “News You Can Use” and the occasional mixers keeps me in contact with docs in other specialties and systems that I normally wouldn’t see. As a consultant, I labor in my own little office every day, sometimes interacting with colleagues and residents at the hospital. Seeing something of what goes on at our county and state level gives me a bigger picture to see where my own struggles fit in. This includes not only my work with patients, but all the admin and payment hassles I confront every day. It feels better knowing why some of these aggravating things happen and what my medical society and CMA are doing to improve our working conditions. Over the years, I’ve made valuable friends at SDCMS who mean the world to me. Some have treated me or my family, but I treasure a lot of more personal moments too. Friends who’ve helped me through times of deep sorrow and cheered me through times of success. And we just have some brilliant folks among us. I think of listening rapt to Bob Hertzka talk about health policy, Ted Mazer talk about economics, or Al Ray talk about the spiritual side of patient care. And I’m always meeting new people with new, stimulating ideas. Just get Paul Hegyi started about barbecue, politics, or the Venn intersect between the two! I’ve had the good fortune to have really special experiences with CMA, serving on the board of trustees for several years.

september 2016

Please let us know at Editor@SDCMS.org what your experiences I ran bills with our CEO, Dustin Corcoran, back when he was the junior governmentrelations guy, behind the late, great Steve Thompson. Both are revered as legends in Sacramento for the amazing work they’ve done representing you and me. And San Diego physician leaders carry amazing throwweight, not only in CMA but even at AMA. So it’s easy to feel that what we do locally can make an impact as far away as Washington. It just gives more meaning and context to what I do every day. Please let us know at Editor@SDCMS.org what your experiences have been, and how membership has impacted your life. We’d love to print some varied responses. Dr. Grisolía, SDCMS-CMA member since 1980, is editor of San Diego Physician magazine.

have been, and how membership has impacted your life. We’d love to print some varied responses.

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Did you know? When you join SDCMS you join CMA as well, and together we are stronger. Both SDCMS and CMA are aggressively defending the practice of medicine, but the benefits of organized medicine extend well beyond these universal protections. Members can offset the price of their annual dues when using SDCMS and CMA membership services and discounts. Thanks to our group buying power, members receive deep discounts on everything from magazines to office supplies to insurance products. From physician practice websites to waste management, our discount programs will save you time and money. Many SDCMS-CMA members save more than their annual dues!

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Need to know how to terminate a physicianpatient relationship? How to challenge your quality rating in a pay-for-performance program? How long to retain medical records? What you can do regarding a negative online review? What restrictions apply to e-prescribing of controlled substances? Whether there are laws that govern physician advertising? CMA is your best source of knowledge to effectively answer difficult questions about practicing medicine in California. Members have free access to CMA ON-CALL (CMA’s online health law library with nearly 5,000 pages of documents and valuable information for physicians and their staffs), access to CMA legal staff through the legal information line, and more.

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CMA’s website lets you customize your website content and receive personalized updates on the issues that matter most to you and your practice. First, activate your web account. Then sign up for custom content alerts on the topics that are of interest to you (e.g., public health, practice management, breaking healthcare news). You will then be notified anytime there is new content posted in one of your interest areas. You can also sign up for “content update” alerts on any webpage to be notified anytime the content on that page is updated.

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CMA produces a number of resources to help practices of all sizes run smoothly. These resources include legal handbooks, HIPAA compliance toolkits, practice management guides, patient forms, and patient education materials. Many of these are free or deeply discounted for members. Visit the resource library for more details.

CMA www.cmanet.org/resource-library

Publications

CMA produces a number of publications to keep members up to date on the latest healthcare news and information affecting the practice of medicine in California: CMA Alert, CMA Capitol Insight, CMA Practice Resources, CMA Press Clips, Legal Case List, Legislative Hot List.

CMA (800) 786-4262 memberservice@cmanet.org www.cmanet.org/newsletters

Reimbursement Assistance

Questions about Covered California? Claims not being paid in a timely manner? Not being paid according to your contract? Receiving unreasonable requests for medical records? Receiving untimely requests for refunds or is a payer recouping money from your check without first notifying you in writing of a refund request? Need help with Medicare related issues? Claims being denied after obtaining prior authorization? Been presented with a managed care contract and you’re not sure if the terms are consistent with California law? Done everything you can to resolve an issue with a payer, but have hit a brick wall? CMA’s Center for Economic Services (CES) is staffed by practice management experts with a combined experience of more than 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice. Assistance ranges from coaching and education to direct intervention with payers or regulators. SDCMS-CMA members receive free assistance with payment, billing, and contracting issues.

CMA’s Center for Economic Services (800) 401-5911 economicservices@cmanet.org www.cmanet.org/ces

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classifieds PRACTICE FOR SALE Thriving San Diego med spa grossing over one million per year: Work part time! (760) 710-7085. [532] OFFICE OF GENERAL PRACTICE FOR SALE: Please contact Dr. Mary Raiszadeh at (858) 750-8984. [522] PHYSICIAN POSITIONS AVAILABLE PRIMARY CARE POSITION: San Diego area. Outpatient only. No calls, no hospital, and no weekends. Email sandiegoprimarycare@yahoo.com. [542] MEDICAL DIRECTOR-BEHAVIORAL HEALTH: The County of San Diego Health & Human Services Agency (HHSA), Behavioral Health Services (BHS), is seeking online applications and résumés from qualified individuals for medical director-behavioral health. As medical director-behavioral health, you will have significant responsibility for formulating policy and managing the overall activities within your assigned programs/facilities. This position will oversee the medical activities of the San Diego County Psychiatric Hospital, in addition to assigned clinical activities within Behavioral Health Administration. To apply, visit www.sandiegocounty.gov/hr. [537] IS INTERNAL MEDICINE YOUR CALLING AND NOT JUST YOUR JOB? If you’re tired of working in the bureaucracy of a large medical group and would like to be in charge of your own destiny, consider this unique opportunity. Looking for someone who wants to practice part time (with the ability to expand over time) and really take care of his or her patients. You would take over patients from the practice of a general internist that’s leaving the area, and you would be sharing an office and overhead with another internist on the campus of Scripps La Jolla, an environment that is in need of more primary care physicians. If you are at all interested in making this move, please send questions and your CV to XimedMD@gmail.com. [536] PER DIEM PHYSICIANS NEEDED: The County of San Diego Health and Human Services Agency is seeking physicians to work in tuberculosis (TB) clinic; clinic is located in Old Town. Applicants (MD or DO) must hold a current California medical license. Board certification in internal medicine, family medicine, or preventive medicine is desired but not required. Experience in infectious diseases and/or pulmonology is a plus. Applicants must be comfortable working with diverse patient populations and willing to work a minimum of two days per week. If interested, please email CV to janette. dubski@sdcounty.ca.gov or call (619) 692 8629. [535] PART-TIME PRIVATE PRACTICE IM/FP OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO COUNTY: Unique opportunity to enjoy outpatient medicine in a premier private practice setting. Practice is part of a well-established internal medicine group with a 30+ year history in the community, and has need for a part-time physician who enjoys providing thoughtful, personalized patient care. Exceptional office staff, flexible scheduling options, small-group environment, and very high quality patient care set this far apart from many other situations. Office is easily accessible from all parts of San Diego County, as well as Orange County. Interested in board-certified IM or FP applicants with EHR experience. Please email CV to portofino3@aol.com or call (619) 248-2324. [534] SEEKING DERMATOLOGIST TO TAKE OVER OFFICE: 15-year-old dermatology practice is looking for someone to take over business $20,000 or negotiate. Will train for dermatology if buyer has CA medical license. Leased office with two exam rooms overlooking Pacific Ocean. Current staff is looking forward to making the transition easy. Send CV to Elaine ereichl@aol.com. [533]

seeking urgent care clinicians: UC San Diego, Department of Pediatrics (www-pediatrics. ucsd.edu), and Rady Children’s Hospital of San Diego (www.rchsd.org) is seeking clinicians for our urgent care clinics, Division of Emergency Medicine & Urgent Care. Clinicians should be BC/BE pediatricians, with experience in general pediatrics and urgent care. Our main campus EM has a census of over 85,000 visits per year; the division also has four community pediatric urgent care centers with a combined census of about 54,000 visits per year. Salary will be commensurate with experience. Interested persons should contact Dr. Katherine Konzen, Director of Pediatric Urgent Care, at kkonzen@rchsd.org. [531]

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. [518]

Seeking Family Medicine physicians: Sharp Rees-Stealy Medical Group is seeking full-time or half-time (job share) BC/BE family medicine physicians to join our staff. Openings available in La Mesa, Downtown San Diego, Otay Ranch, and Kearny Mesa. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101, fax (619) 233-4730, or email lori. miller@sharp.com. [529]

Emergency (EMS) Medical Director: The County of San Diego invites qualified individuals to apply for the position of emergency (EMS) medical director. This unclassified management position will be responsible for ensuring efficient and timely delivery of quality emergency medical care via appropriate medical direction and monitoring of the County’s Emergency Medical Services (EMS) system operations and related support programs, such as pre-hospital services, trauma care services, and specialty care services. For more information about this position and to apply online, please visit our website at www. sdcounty.ca.gov/hr. [514]

Seeking internal medicine physicians: SHARP Rees-Stealy Medical Group is seeking full-time BC/BE Internal Medicine physicians to join our staff. Openings available in La Mesa, Otay Ranch, Downtown San Diego and Kearny Mesa. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101, fax (619) 233-4730, or email lori.miller@sharp.com. [528] Seeking occupational medicine physicians: SHARP Rees-Stealy Medical Group is seeking full-time BC/BE Occupational Medicine physicians to join our staff. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101, fax (619) 233-4730, or email lori. miller@sharp.com. [527] Seeking ob/gyn nocturnist physicians: SHARP Rees-Stealy Medical Group is seeking full-time and part-time BC/BE ob-gyn nocturnists to join our staff working at Sharp Mary Birch Hospital. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101, fax (619) 233-4730, or email lori.miller@sharp.com. [526] Dermatologist Needed: Dermatologist, with California license, needed for a well established, well respected dermatology practice in Encinitas, CA. Part-time or full-time position available immediately. Competitive salary. Must be trained in Mohs micrographic surgery. Exceptional new graduates are considered for the position. Please email CV to dermmd10@gmail.com or call (760) 612-7171. [523] SEEKING SPINE SURGEON: California Orthopaedic Institute in San Diego is seeking a board-certified / eligible, fellowship-trained spine surgeon to join our successful seven-physician independent practice, covering all aspects of orthopaedic care and surgery. Please visit our website at www.califortho.com for more details on our group and subspecialties. We offer onsite MRI, PT, OT, and DME ancillary services and a separately owned and operated outpatient ambulatory surgery center is also onsite. Please contact Dr. William Tontz, Jr., at billtontz@gmail.com or on his cell at (619) 578-4451, or contact Joan McComb, executive director, at (619) 291-8930, ext. 109. [520] Psychiatrist needed as Medical Director for large Psychiatric group: Previous experience in correctional medicine preferred. Previous experience as a director preferred. Competitive compensation. Please contact steve@ cpmedgroup.com or (619) 885-3907. [519]

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.

september 2016

SEEKING OCCUPATIONAL MEDICINE PHYSICIAN: Full-time, part-time, or independent contractor for busy workers’ compensation specialist practice. Located in San Diego. Competitive salary. Please email CV or direct any enquiries to Robynne McMurtrie, manager, at rmcmurtrie@davidkupfermd.com or call (858) 560-0242, ext. 101. [515]

Physiatrist (Physical Medicine & Rehabilitation): Seeking full- or part-time board-certified physiatrist to join our privately owned orthopaedic surgery practice in San Diego. Position includes providing direct patient evaluation / care of spine and musculoskeletal cases, coordinating PMR services with all referring providers. Must have excellent interpersonal and communication skills. Existing CA license preferred. Interested parties email your CV in confidence to lisas@sdsm.net. [510] Clinical Research Physician Wanted: Profil Institute for Clinical Research, Inc., is an early phase clinical research organization and innovator of research methodologies for diabetes and obesity. We are seeking a physician who will provide medical leadership, oversight, and management of human clinical trials while ensuring the integrity of the studies and the safety and wellbeing of human subjects. Must have current unrestricted license to practice medicine in the State of California. Experience in clinical trials and/or drug development preferred. For more information and to apply, please visit our website at www.profilinstitute. com/careers/career-opportunities. [507] HIRING PHYSICIANS, NPs, AND PAs: Clinicas de Salud del Pueblo, Inc., is hiring California-licensed physicians, nurse practitioners, and physician assistants. We are a successful and longstanding nonprofit organization that offers a full range of benefits, including excellent and competitive compensation. Our current need is to serve patients that live in the following communities: Blythe, Brawley, Calexico, Indio, and Mecca. It would be wonderful to hear from you. Please email us at work@cdsdp.org or call us at (760) 344-9951, ext. 120 or 121. [502] Seeking Family Medicine Physicians: Graybill Medical Group, an independent physician group of 80 + physicians, is seeking full-time BC/BE family medicine physicians for its offices in Escondido, San Marcos, and Ramona. We offer a competitive compensation package and shareholder opportunity. Please send CV to Jackie Craw, Director Human Resources, via fax at (760) 738-7101 or via email at humanresources@ graybill.org. [499] Seeking Cardiologists: Graybill Medical Group is seeking full-time interventional cardiologists and non-invasive cardiologists for its Escondido office. We have a significant patient base and offer competitive compensation packages. Please send CV to Jackie Craw, Director Human Resources, via fax at (760) 738-7101 or via email at humanresources@graybill.org. [498] FULL- AND PART-TIME FAMILY MEDICINE PHYSICIAN POSITIONS: North County Health Services (NCHS) • Job Title: Family Medicine Physician • Location: Multiple Locations • Job Status: Full Time and Part Time. We have several open family medicine physician positions. Must have active California state license (MD/DO), CPR, board certified or board eligible.

Full benefits package, malpractice liability insurance included, CME allowance, and license reimbursement. NCHS is proud to be an equal opportunity workplace and is an affirmative action employer. Contact Araceli Mercado, www.nchs-health.org, araceli.mercado@ nchs-health.org, (760) 736-6780. [497]

Office space for rent with wellestablished orthopaedic practice: Located near Alvarado Hospital. Onsite digital X-ray. Ideal for specialties such as pain management, rheumatology, foot/ankle, spine. Interested parties, please email lisas@sdsm.net. [493]

PART-TIME URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a parttime physician. Flexible hours, strong staff, and good compensation (based on experience). Please send CV to jeff@eastcountyurgentcare.com. [474]

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127]

SEEKING A FOOT/ANKLE SPECIALIST: Wellestablished, highly respected, four-physician group, private practice in San Diego seeking a foot/ankle specialist. Our group is expanding to meet high volume of cases and planned expansion. Potential opportunity for any established subspecialist looking for a permanent practice location. We have a broad-based primary care referral base, mature EHR, digital X-ray, ultrasound, and DME program. Interested parties, please email your CV in confidence to lisas@sdsm.net. [461] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fastgrowing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 992-5330 or email CV to drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [037] PHYSICIANS NEEDED: Family medicine and pediatric physician positions currently available. Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County, Riverside County, and Orange County. We have openings for full-time and part-time physicians. Current CA and DEA licenses required. Malpractice coverage provided. Full benefits packet. Forward resume to hr@vistacommuntyclinic.org or fax to (760) 414 3702. Visit our website at www. vistacommuntyclinic.org. EEO Employer / Vet / Disabled /AA [912] OFFICE SPACE AVAILABLE LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE FOR 2–3 DAYS PER WEEK: In the 4520 Executive Drive bldg. Excellent location between I-5 and I-805. Beautiful, renovated office space with two exam rooms and large physicians office for consultations. Ideal for primary care, pain management, physical therapy, rheumatology, infectious disease, dermatology, orthopedics. Interested parties, please email missyphilip@gmail.com. [541] Medical Office Available for Sublease UTC / Sorrento Valley: Seeking physicians in the fields of orthopedic surgery, sports medicine, podiatry, primary care, rheumatology, and physical medicine and rehab or related fields to sublease a large medical office in Sorrento Valley. Built in 2013, the facility consists of two suites and includes eight exam rooms, two procedure rooms, onsite X-ray machine, onsite DME supplier, two waiting rooms, and a large conference room. The office is also adjacent to a physical therapist and is situated directly above an outpatient surgical center. Rates are negotiable with the terms of the lease. For more information, please contact Jeff Craven at (858) 245-9109 or at jeff@ sdmiortho.com. [539] Considering a branch office in the South Bay? This is an opportunity to work with like-minded, independent, board-certified physicians in the same building who wish to work and grow together, providing an integrative approach to provide comprehensive patient care in one setting. Call (619) 585-0476 and ask for Vanessa. [538] 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. [530]

POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage therapist. Low rates. Email inquiries to kathysutton41@ yahoo.com. [173] BUILD TO SUIT: 950SF office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with six gated parking spaces, two entryways, restrooms, lighted tower sign space. Build-out allowance to $10,000 for 4–5 year lease, rent $1,800 per month gross (no extras). Contact venk@cox.net or (619) 504-5830. [835] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: Two exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@SDCMS. org for more information. [867] NONPHYSICIAN POSITIONS AVAILABLE Seeking Per Diem Physician Assistants or Nurse Practitioners: Graybill Medical Group, an independent physician group of 80+ physicians and midlevel practitioners, is seeking a PA or NP for our Escondido location every other weekend and a float for our North Coastal locations of Carlsbad, Oceanside, and Tri-City. Provide direct patient care in an urgent care / extended family practice setting; this will include examination and treatment of patients, recommendations and supervision of health concerns, and completion of all necessary paperwork. The incumbent must hold a current California (PA or NP) license and be ACLS and CPR certified. Two years prior experience in an urgent care or ER required. Bilingual in English / Spanish preferred. Send CVs to humanresources@graybill.org, apply online at www. graybill.org, or fax (760) 738-7101. [525] PHYSICIAN ASSISTANT: Comprehensive Pain Management Specialists are seeking a physician assistant for our La Jolla, Rancho Bernardo, and Escondido locations. The physician assistant will provide direct patient care in an outpatient setting; this will include examination and treatment of patients, recommendations and supervision of health concerns, and completion of all necessary paperwork. The incumbent must hold a current California PA and DEA license and be ACLS and CPR certified. Candidates with previous experience in pain management are highly desirable, but recent graduates are welcome to apply and will be considered. We are willing to train the right candidate. Please submit resume with cover letter outlining salary history and references to Nicci Parker at nparker@sdcpms.com. [524] PSYCHIATRIC NURSE PRACTITIONER NEEDED: For part-time or full-time work at San Diego County correctional facilities. Flexible hours and very competitive pay. Send CV to steve@cpmedgroup.com or call (619) 885-3907. [517] Seeking Nurse Practitioner: 2–3 days per week in busy IM practice in Kearny Mesa. Must have experience and be able to work independently. Please fax resume to Monica at (858) 277-0690. [508]

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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, signon bonus, retention bonus, and more. Please submit CV with cover letter to claudia.steinermd@gmail.com. [506] Medical Office Staff: We are a private family practice located in downtown San Diego looking to hire a front office staff member. This position requires excellent organization skills, customer service and interpersonal skills, including outstanding verbal and written communication. Knowledge and understanding of EMR systems and MS Office skills are preferred. Experience with insurance companies, including IPAs, HMO, PPO, and work comp, and familiarity with billing and coding are ideal, but not required. Familiarity with back-office duties or medical assistant certification is an additional benefit. If interested, please forward your resume to office.mcmc@gmail.com. [505] HIRING PHYSICIANS, NPs, AND PAs: Clinicas de Salud del Pueblo, Inc., is hiring California-licensed physicians, nurse practitioners, and physician assistants. We are a successful and longstanding nonprofit organization that offers a full range of benefits, including excellent and competitive compensation. Our current need is to serve patients that live in the following communities: Blythe, Brawley, Calexico, Indio, and Mecca. It would be wonderful to hear from you. Please email us at work@cdsdp.org or call us at (760) 344-9951, ext. 120 or 121. [502] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email drhunt@ thehousecalldocs.com. Visit www.thehousecalldocs. com. [038] MEDICAL EQUIPMENT / FURNITURE FOR SALE CLEARWAVE OFFICE WAITING ROOM CHECK-IN KIOSK WITH TABLETOP STAND: (eClinicalWorks Compatible) Decrease wait times, increase collections, and improve financial performance. Liberty Tabletop Kiosk with 17-inch, built-in, all-in-one touchscreen computer with privacy filter. Intel Celeron Dual Core, E1500, 202 GHz processor, 2GB RAM, 160GB harddrive, 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 $1,499. Email KLewis@SDCMS.org. [443]

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MED I C A L S T UDE N T S

Back Row (L–R): David Li, Cong Dinh, Mandeep Bajwa, Daniel Trujillo. Front Row (L–R): Abhishek Kumar, Kevin La, Cecilia Bonaduce, Robby Turk.

UC San Diego Medical Students Shaping Healthcare Policy in Sacramento by Cecilia Bonaduce, MSII, UC San Diego School of Medicine

This article has been edited for length. You can read Ms. Bonaduce’s complete article at medium.com/@cmaphysicians. When you hear the phrase “medical interns,” your mind may conjure up a scene from “Grey’s Anatomy,” but for those working at the California State Capitol, it means the annual arrival of medical students ready to intern with members of the Legislature. The UC San Diego School of Medicine has been setting the bar for medical student engagement in politics for the past several years. Under the direction of Dr. Bob Hertzka, medical students like me have the opportunity to take a course on healthcare policy, which includes two trips to the Capitol to lobby legislators

september 2016

on healthcare issues and culminates in a one-of-a-kind summer internship in Sacramento. This internship placement, possible with support from CMA, provides us with a completely immersive experience in state policymaking. This summer, medical student interns were placed with all types of legislators — from Republican to Democrat, rural to urban, and northern to southern members — including Speaker Emeritus Toni Atkins, Assemblymembers Shirley Weber and Brian Maienschein, and State Senators Joel Anderson and Dr. Richard Pan, among others. Interns are working on developing new bill ideas, drafting letters to the governor, and/or working with legislative offices on issues like sudden cardiac arrest in student

athletes and dementia. Second-year medical student Robby Turk is working with Assemblymember Shirley Weber on AB 2298 (related to the recent CalGang audit) that exposed serious inadequacies in the criminal intelligence database. With only one free summer during the medical school process, it’s natural to wonder why medical students would dedicate their only time off to taking on an internship related to state politics instead of working in a clinic/lab or simply taking a vacation. Bottom line? We believe that the future of medicine should have a say in the future of medicine. Coming from Washington, DC, I thought my understanding of the political process was fairly astute, but my time in the Capitol introduced me to a much more complex legislative world than I could have ever imagined. This is a place where real progress requires flexibility, creativity, and collaboration with people across the aisle and industries, including medical experts, educators, business owners, and mission-driven nonprofit organizations. It’s important work, and I urge all medical students to get more involved in the legislative and political process so we can ensure future policies protect the practice of medicine and provide all Californians with quality healthcare.

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.

The 6 Most Common HIPAA Violations Revealed in CAP’s Free Guide. CAP’s new compliance guide, The 6 Most Common HIPAA

Violations, not only explains how to avoid such mistakes, but cites the accompanying penalties for these common – yet easily avoidable – violations. With the right procedures in place, you can focus on practicing medicine and serving your patients instead of worrying about penalties.

For Your Protection. For Your Success.

Request your free copy today! 800-356-5672 | CAPphysicians.com/Compliance SAN DIEGO PHYSICIAN.org

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