October 2016 by San Diego Physician

October 2016 official publication of SDCMS

INSIDE: Ta-Nehisi and I Both Have Black Sons PAG E 10

White Coats for Black Lives PAG E 11

New Member Benefit

November 8, 2016 CMA Ballot Measure Positions PAGE 22

PAG E 12

Poetry and Medicine PAG E 16

Leadership Series: Dr. Mihir Parikh PAG E 18

Meaning in Medicine PAG E 21

Office Manager Contest PAG E 28

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October

Contents

Volume 103, Number 10

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 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)

feature

November 8, 2016: CMA Ballot Measure Positions Y THE CALIFORNIA B MEDICAL ASSOCIATION

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

departments 4

Briefly Noted: Calendar • Mongolian Doctors Visit • Featured Member • Vectorborne Diseases Survey • Website Spotlight • Commercial Real Estate • Welcome New Members • LTTE • And More …

Be There San Diego

hared Responsibility for S Preventing Malpractice Suits

Y SUSAN SHEPARD, MSN, RN, AND B CAROL MURRAY, RHIA, CPHRM

BY JAMES SANTIAGO GRISOLÍA, MD

White Coats for Black Lives

BY EVELYN C. ROSS, MEDICAL STUDENT

onnecting With the C Meaning in Medicine BY HELANE FRONEK, MD, FACP, FACPh

ractice Management P Tip of the Month

BY MICHAEL T. VALENTI

Y THE CALIFORNIA MEDICAL B ASSOCIATION

Looking for a Business Loan?

So Much of This Is Random

BY DANIEL J. BRESSLER, MD, FACP

Leadership Series: Mihir Y. Parikh, MD BY SHERRY NOORAVI, PSYD

BY KITTY BAILEY

etween the World and Me: Ta-Nehisi B and I Both Have Black Sons

October 2016

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

26 Physician Marketplace: Classifieds 28

SDCMS’s 8th Annual “Outstanding Medical Office Manager” Contest Is Now Underway

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 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

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.]

J L L T E A M

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Our team, your win. SAN DIEGO PHYSICIAN.org

/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// calendar SDCMS-CMA CALENDAR

healthcare abroad

For further information or to register for the following, contact Jen at (858) 300-2781 or at JOhmstede@ SDCMS.org.

San Diego’s 11th Annual Emergency Care Summit OCT 27 at Scripps Memorial Hospital, Schaetzel Center, Great Hall

Is Your Practice at Risk for a HIPAA Security Breach? (webinar) NOV 2: 12:15PM–1:15PM

Top Doctors Celebration 2016 OCT 29 at Coasterra in San Diego

Physician Networking Opportunity & Mixer (social) NOV 3 at Rock Bottom Restaurant & Brewery La Jolla

People, Planet, Purpose: Global Practitioners United in Health and Healing OCT 30–NOV 3 at Paradise Point Resort & Spa

Nondiscrimination Statements: A Detailed Guide to Compliance (webinar) NOV 9: 12:15pm–1:15pm Medicare: Managing Change and Facing the Future (seminar/ webinar) DEC 1: 11:30AM–1:00PM

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.

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 Spiritual Care and the Wellbeing of the Healthcare Provider NOV 12 at the Old Mission San Luis Rey in Oceanside AMA House of Delegates Interim Meeting NOV 12–15 in Orlando, Florida

(Dr. Parikh: sitting, far left; Dr. Tseng: sitting, second from right)

Mongolian Doctors Visit sdcms A delegation of 13 Mongolian doctors and healthcare officials visited San Diego Aug. 20–23 to learn about San Diego’s healthcare delivery system. SDCMS president Dr. Mihir Parikh and immediate past president Dr. William Tseng met with the delegation at SDCMS to discuss SDCMS’s history and the services we provide to our members. The visit was part of cultural/educational partnerships that the North Park neighborhood of Switzer Highland has with neighborhoods in Baku, Azerbaijan, and Riga, Latvia, as well as Ulaanbaatar.

“

”

We’re all human, aren’t we? Every human life is worth the same, and worth saving. — J.K. Rowling, Harry Potter and the Deathly Hallows

featured member

Nicholas “Dr. Nick” Yphantides, MD, MPH By Nick Macchione, Director, County of San Diego HHSA

Nicholas “Dr. Nick” Yphantides, 11-year member of SDCMS-CMA, has moved into a full-time role as the County of San Diego HHSA’s chief medical officer starting Sept. 2. Dr. Nick had already been serving the agency in the same role on a part-time, advisory basis for the past seven and a half years. I look forward to having Dr. Nick champion our Live Well San Diego vision and aspirations on a fulltime basis. I am confident that he will continue to provide visionary leadership in our clinical initiatives and to our clinical leaders throughout the county. Dr. Nick has a gift for bringing people to the table and working collaboratively to solve some of the region’s greatest challenges without sacrificing our commitment to quality in everything we do. Congratulations, Dr. Nick!

October 2016

/////////////////////////////////////////////////////////////////////////////////////////////////// Vector-Borne Disease Survey

Please Take 15 Minutes to Complete This County Survey The County of San Diego HHSA has asked SDCMS to promote a survey it’s conducting to gauge the current knowledge, attitudes, and practices among clinicians and other healthcare providers about endemic and emerging mosquito-borne diseases. The survey should take no longer than 15 minutes to complete, and all responses will be anonymous. Results will be used to improve communication and guidance to healthcare providers about mosquito-borne viruses in our border region. If you would like more information on how this survey will be used, please contact Dr. Eric McDonald at eric.mcdonald@sdcounty.ca.gov. If you would like to be entered into a drawing for either an iPad or a $400 donation to a charity of your choice, provide your email address at the end of the survey. Your email address is collected only as means for notifying a winner of the drawing, and will not be used for any other purpose. Visit www.surveymonkey.com/r/Vectorborne to take the survey. Your participation is greatly appreciated and is completely voluntary!

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Mosquitoes are one of the deadliest creatures on earth; they have the potential to spread many different viruses like West Nile, dengue, chikungunya, and Zika. There are more than 3,000 species of mosquitoes in the world; 26 of these species are found in San Diego County, some of which are potential spreaders of these viruses. The Vector Control Program monitors, tests, and controls mosquitoes and provides education and outreach. In order to keep you, your family, and your neighbors safe from mosquito-borne diseases, follow these three simple steps: • Prevent mosquito breeding around your home. • Protect against mosquito bites by using mosquito repellents and wearing long sleeves and pants. • Report mosquito breeding sites like green swimming pools and other standing water in your neighborhood.

Endorsed by

SAN DIEGO PHYSICIAN.org

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

San Diego Medical Office Snapshot | Q2 2016 By Chris Ross

By the Numbers

7.2%

Countywide Direct Vacancy

38,340

Market Conditions and Trends The San Diego healthcare community as a whole continued to show growth in the first half of the year. Several new medical buildings have been recently completed, are under construction now, or are expected to break ground soon — albeit at a pace that is not expected to keep up with demand. Demand for medical office space is steady, with several submarkets throughout the county seeing new life in terms of leasing and sale activity. Landlords continue to push rents at a moderate pace, a trend that is expected to continue until the market responds in one way or another. Negotiating leases is as challenging as ever at the moment, as ten-

MEMBERSHIP

Welcome New SDCMS-CMA Members! 6

October 2016

YTD Net Absorption (s.f.) 55,559 s.f. (Q2 2016)

12-month Rent Growth $2.70 FS Average Asking

291,680 Total Under Construction (s.f.)

ants point to the impact growing rents have on their businesses while landlords redirect the conversation to market trends and comps. Both parties’ positions are justified, and it usually comes down to which party needs the deal more. There are still good opportunities to be found, but the better spaces in well-located buildings are generally not sitting vacant for very long. The recovery for Class A medical office buildings in particular has been astounding. While the Class B vacancy rate is only half of what it was at its last peak of 15.0% in 2009, the Class A vacancy rate is only a fifth of its 2009 peak of 33.3%. Additionally, medical office buildings 50,000 square feet or larger are outperforming medical office buildings smaller than 50,000 square feet by greater than one percentage point in vacancy and over two percentage points in overall availability. Forecast Seven of the nine submarkets in the county have very healthy vacancy numbers between 5% and 8%, and only one of those is over 7%. To no one’s surprise, this is causing further lift in rental rates. Technically, the statistics may not show any growth in average asking rent across the county, but on the front lines rents are no doubt on the rise. News and Updates Scripps Health has opened its 175,000-square-foot outpatient clinic next to its cardiovascular hospital tower in La Jolla. The John R. Anderson V Medical Pavilion cost $130 million and is the first in California to contain cardiac catheterization labs outside of an acute-care hospital. The clinic will house more than 50 physicians in 17 medical specialties, including neurology, endocrinology, gastroenterology, family medicine, and imaging. Scripps Health has launched the Scripps Health Network to collaborate with outside free-standing hospitals and physician

Bernard A. Feigenbaum, MD Allergy and Immunology San Diego (619) 291-5800

Clara L. Polak, MD Family Medicine Chula Vista (619) 427-3361

Christopher I. Scott, MD Emergency Medicine San Diego (619) 528-3100

/////////////////////////////////////////Maximizing /////////////////////the /////// / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / bottom line, one office at a time.

groups in order to expand its reach without having to purchase those facilities and to create a better continuum of care for its patients. The network is similar to UC San Diego Health’s partnerships recently established with hospitals in El Centro, Palm Springs, and Oceanside. Additionally, Scripps is working with Sistemas Medicos Nacionales S.A., a health insurance company that serves Californians working across the border in Mexico, which is planning to build a full-service medical center in Tijuana. Palomar Health and Kindred Healthcare have announced their collaboration to build a 58,000-square-foot, 52-bed, acute rehabilitation facility near Palomar Medical Center. When the new facility opens in 2019, Palomar’s existing inpatient rehabilitation program, run by Kindred since 2000, will be moved from the old Palomar Hospital in downtown Escondido. A jury unanimously decided that Tri-City Medical Center pay $19.7 million to Medical Acquisition Co. for a 57,000-squarefoot medical office building that was built in 2013 and has since remained vacant. The dispute was over the lease entered by TriCity to lease the building that was built by Medical Acquisition Co. on land owned by the Tri-City Health District. The settlement figure was based upon the jury valuing the building at $16.8 million and adding $2.9 million for breach of contract. San Diego Family Care expanded its Linda Vista Health Care Center to nearly double its size by annexing and converting a neighboring grocery store. The center should accommodate an additional 40,000 patients per year and contains primary care services, dental clinic, and a separate space for mental health. It works directly with Sharp Memorial Hospital by receiving direct referrals from the ER for follow-up care with patents to be seen within 24–48 hours. Mr. Ross is senior vice president of healthcare solutions for Jones Lang LaSalle. He is a commercial real estate broker specializing exclusively in medical office and healthcare properties in San Diego County. To receive the complete Q2 2016 report, call Mr. Ross at (858) 410-6377 or email him at chris.ross@am.jll.com.

Services: Accounts Payable Auditing Billing Services Business Growth Contracting Credentialing Electronic Medical Record Executive Assistant Financial Management Information Management Operational Management Practice Assessment Practice Management Relocation Management Technological Advances

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CMA Member Help Line! Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262

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/////////////Briefly /////////////////Noted ///////////////////////////////////////// LETTER TO THE EDITOR From: Timothy A. Murphy, MD, DFAPA, Immediate Past President, California Psychiatric Association Date: Aug. 30, 2016 Subject: Dr. Hertzka on ACA

Physician Networking Opportunity & Mixer

Congratulations on the excellent interview with Dr. Hertzka appearing in the August edition of San Diego Physician. The article gave me a clearer picture of what is going on with the ACA than anything I have read in the popular press. Personally, I am not dismayed that the majority of the additionally insured are poor individuals for whom the government is paying the tab. It certainly makes sense that income and savings from the ACA may run short of covering it. Nor is it surprising that the poor are expensive to cover. Many are poor precisely because their illnesses make it hard to earn incomes sufficient to purchase their own insurance. In a civilized society, those of us blessed with good health, and the ability to pay for our own medical needs, find a way to provide healthcare to those less fortunate. Does Dr. Hertzka have a better idea of how to provide healthcare for this population? If he thinks the ACA’s federal subsidy is too expensive, how could care be provided more efficiently? Timothy A. Murphy, MD, DFAPA

Dr. Hertzka’s Response … Dr. Murphy:

NOVember 3, 5:00-8:00pm at Rock Bottom Restaurant & Brewery La Jolla S ponsored by

Thank you for taking the time to review the article and to submit such a thoughtful note. I approach my analysis of the ACA from the perspective of a 30-year physician advocate, which has made me very conscious of how our state and federal governments approach healthcare spending. State governments — California in particular — have always been stingy with physicians when it comes to their Medicaid programs (Medi-Cal in California), and payments to physicians from the Medicare program have barely increased in the past 20 years. Enter the ACA, which can now not only be stated with certainty to be another government program that is overpromised and underfunded, but also one with some uniquely irrational funding mechanisms. Yes, it is true that as many as 15 million additional people are now covered by Medicaid, including more than 3 million in California. But it is important to remember that the first three years of the Medicaid expansion (2014–16) were paid for entirely by the federal government, and so most in state government have appeared oblivious to the fiscal ramifications. Effective in 2017, states start to pick up some of these costs, and, as of today, it is probable that by early in the next decade the state share of this spending will reach 20%, costing California as much as $5 billion per year, the funding for which currently does not exist. Are there alternatives to providing coverage for low-income populations? Absolutely. One simple one would be to expand our currently robust networks of federally qualified community clinics, including an increase in their hours of operation until midnight and a strengthening of their alliances with academic and community institutions. This would cost less than half of what the ACA is costing and would actually be more likely to produce better overall population health than the far more expensive ACA Medicaid expansion. Beyond that, I would remind our readers that during the time that the ACA was being deliberated, many experts, including most notably the dean and CEO of the Johns Hopkins School of Medicine, called for systems such as what is called Priority Partners in urban Baltimore. These culturally competent and integrated systems are challenging to create but have consistently had better outcomes than the ACA model, which, in essence, is one where we have just handed millions of people a Medicaid card, declared victory (politically), and then handed the patients to local physicians at unacceptably low reimbursement rates. Bob Hertzka, MD

October 2016

////////////////////////////////////////////////////////////////////////////////////////////////// PUBL I C H E A LT H

Be There San Diego by Kitty Bailey, Executive Director, Be There San Diego

Be There San Diego is a unique partnership of healthcare and community leaders with the audacious goal of making San Diego a “Heart Attack and Stroke Free Zone.” Progress was presented at the Be There San Diego annual summit on July 27, 2016, including national and local speakers. Building on the energy of the annual summit, the participating healthcare organizations are taking part in monthly meetings to share best practices and data. Arch Health, six community health centers (including La Maestra Family Health Centers, Neighborhood Health Center, North County Health Services, Operation Samahan, San Diego Family Care, and Vista Community Clinic), Kaiser Permanente, Multicultural Medical Group, Scripps Clinic, Scripps Coastal, Sharp Rees-Stealy, and UC San Diego have committed to uniform data collection to demonstrate improvements in the treatment of diabetes, hypertension, and other risk factors for stroke and heart attack. Data being collected include: • % of patients with DM with LDL < 100 • % of patients with DM with BP < 140/90 • % of patients with DM with HbA1c < 8.0% • % of patients with DM with HbA1c < 9.0% • % of patients with CVD with BP < 140/90 • % of patients with CVD with LDL < 100 In addition to the healthcare organizations, a network of community organizations, including churches and mosques, provides sites for education and screening for hypertension and other risk factors. Within the community, the emphasis is on screening, diet changes, exercise, smoking cessation, and community-clinical linkages. Given the reality that nationally, 1 in 3 adults with hypertension is undiagnosed, and that 82% of undiagnosed hypertensives have health insurance, we believe that this proactive and collaborative model is an opportunity for real change in health outcomes.

Further Information: Be There San Diego Website: betheresandiego.org July 27 Heart Attack & Stroke Free Zone Summit 2016 Presentations (download at betheresandigo.org/ summit): • Ann Albright, PhD, RD: “Making Type 2 Diabetes Prevention a Reality: The National Diabetes Prevention Program” • Anthony DeMaria, MD: “Better Community Health by Building Trust and CommunityClinical Linkages” • Jerry Penso, MD, MDA: “Working Together to Improve Diabetes Care” Southeastern San Diego Cardiac Disparities Project: sdheartjustice.org Twitter: @BeThereSanDiego

SAN DIEGO PHYSICIAN.org

PUBL I C H E A LT H

Chris Veal, Medical Student

Between the World and Me Ta-Nehisi and I Both Have Black Sons by James Santiago Grisolía, MD

“I do not believe that we can stop them, my son, because they must ultimately stop themselves.” From Between the World and Me — New York Times #1 bestseller and winner of the National Book Award — which records the heartfelt words of essayist Ta-Nehisi Coates to his teenage son about the perils and tragic beauties of being black in America. The writing seems to just tumble out, on the occasion of the decision not to charge the policeman in the death of Michael Brown in Ferguson, Mo., one of many recent, highly publicized black deaths at the hands of law enforcement. Coates warns his son, and the reader, that the black body is always in danger here. This danger arises not by accident but as the unspoken consequence of a system that began with slavery and continues to keep black people in “their place” through economic and legal constraints*. This includes a higher chance of any police interaction resulting in death for a black person, whether the officer is white, black, or brown, male or female. Filtered through his own experiences, including the death of a college friend during an apparently pointless police action, Coates’ writing is meant to be extreme enough to punch holes in our denial.

October 2016

This book became urgent reading for me because we now have a black son, Chris. Chris was best friend to my stepson, Alex, sharing giddy, impulsive last days with our beautiful son in Vermont, before Alex took his own life and plunged us into an alternate universe: one where a brilliant, energetic public health advocate, living in the genteel Vermont of Bernie Sanders and Ben and Jerry’s, could suddenly lose two teammates in Burundi and die in solidarity with them. We invited Chris to visit before starting medical school at the University of Vermont. Alex helped with his med school applications and cheered him through the interviews. Chris is tall and beautiful, both strong and fragile. Besides losing Alex, he’s suffered other deaths and losses this year, including estrangement from his father. After a few days of bonding, introducing him to local black role models, and reconnecting him to church, he told us he was adopting us. So we have a new son, on loan until his father comes around. Coates writes clearly about how fragile, how contingent it feels to grow up in a black body. Of course, in his focus on his own son, he misses how fragile all bodies can be, which doctors know and Alex forces us to relive again, daily. But in the season of Eric

Garner, of Trayvon Martin, of Tamir Rice, America needs to meditate deeply. Even Donald Trump, famously a law enforcement advocate, has seen the video and publically questioned the recent shooting in Tulsa. In this issue, UC San Diego medical students remind us of the nexus between Black Lives Matter and medicine. Responding “No, all lives matter” denies generations of needless black deaths. Far better for us to say, “Black lives matter as much as mine.” Coates reminds us that race is not very biological at all—it’s socially constructed, one of the more surprising facts I learned from human genome researchers. But constructed identities still carry medical consequences, mediated through chronic stress, poverty, diet, smoking, work injuries, and differential treatment by doctors. Our young colleagues at UC San Diego address these issues at the curriculum level. Be There San Diego created a unique town-gown partnership to focus on heart attack and stroke prevention in southeast San Diego. Its recent conference highlights partnerships to improve community health awareness, while removing barriers to healthcare delivery for a fragile, stressed community. Between the World and Me has serious limitations. It’s an angry cry, and a word of warning. But Coates refuses growth or transformation; he doesn’t talk about a way forward, or even the possibility of progress. He allows no out: Fair for us, but I’d like better for his son, Samori. And for our new son, Chris. Also, he’s turned away from any spiritual depth, but is insightful enough to wonder if he’s cheated his son. As he writes to him: “I often wonder if … I’ve missed something, some notions of cosmic hope, some wisdom beyond my mean physical perception of the world, something beyond the body, that I might have transmitted to you …. ” Limitations aside, this book is gorgeously written, the anguished words of a sharp intelligence. And now that God has sent us a black son, we feel inspired to reach out, to do more. Dr. Grisolía, SDCMS-CMA member since 1980, is editor of San Diego Physician magazine. *Coates does not cite statistics at all to make his points, but, for example, according to the BBC, the U.S. incarceration rate is 724 per 100,000, well ahead of human-rights abusers like Russia and China. Just our rate of imprisoning African-Americans alone would be 37% of that total, or 268 per 100,000, which would place us just ahead of Poland and right behind human-rights paradises like Ukraine and South Africa.

PUBL I C H E A LT H

White Coats for Black Lives by Evelyn C. Ross, Medical Student

“Today, the members of Medical Students for Justice invite you all to reflect on racism, its effects on health, and thus why we as future physicians must fight against … its current presence in our community … our greater UCSD community, our San Diego community.” — UCSD White Coats for Black Lives (#WC4BL) Rally, Dec. 10, 2015 Racial injustices plague our communities, leading to poorer health outcomes and hindering success. For black residents of San Diego County, the risk of chronic disease is more than double that of San Diego County overall (1). As future physicians, we cannot overlook these realities. It is imperative that we change the broader contexts in which our patients live in order to compassionately support their health. This includes ensuring that we — the medical profession — are equipped to combat racial health disparities. The medical profession is not immune to the societal pull of racism, anti-blackness, and discrimination. Mainstream media and the systems in which we exist influence the unconscious biases we carry. Numerous studies have documented explicit and implicit biases of health providers against African Americans (2) and the ensuing poorer health outcomes for major chronic and preventable diseases, such as cardiovascular disease, diabetes, and cancer. Medical Students for Justice (MS4J) is a student-led organization at the UCSD School of Medicine. We act within our own institution to advocate

for a social justice curriculum that will provide us with tools to eliminate health disparities. Over the last two years, we have pushed for implicit-bias training for medical students and faculty, curriculum changes that offer structural competency skills to address the health impacts of structural violence, and increased racial, ethnic, and sexual diversity of admitted students and instructors. We have held numerous teach-ins on topics around justice that our curriculum has failed to address. As our medical superiors and colleagues, you have a strong voice in determining the course of medicine and how future physicians are trained. Join us as we navigate the evolving terrain of medicine and pave the way for inclusive patient care and health equity. Because Black Lives Matter, these are steps you can take: 1. Hold implicit bias training at your workplace, and discuss unconscious racial bias. 2. Increase recruitment, retention, and hiring of medical students, residents, and physicians who are underrepresented in medicine. 3. Make the five commitments in “A Letter to Our Patients on Racism.” References: 1. www.sandiegocounty.gov/ content/dam/sdc/hhsa/programs/phs/CHS/Health%20 Equity%20in%20San%20 Diego%20County.pdf 2. www.medicalnewstoday. com/releases/242975.php

Five Commitments From “A Letter to Our Patients on Racism” (via medium.com)

1. We commit to support Black Lives Matter.

2. We commit to dismantling the structural racism embedded in the healthcare system.

3. We commit to learn how to provide traumainformed care, and to teach this approach to our students, trainees, and fellow providers.

4. We commit to healing communities ravaged by discriminatory criminal justice practices through engaging public health systems.

5. We commit to using our power as constituents and leaders to insist that every major medical society and association develop a policy on racial justice.

Photos by Yasmin Aghajan

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n e w MEMBER BE N E F I T

SDCMS Memberexclusive Benefit

Looking for a Business Loan …

… to Purchase Real Estate/Leasehold Improvements, Business Acquisition/ Partner Buyout, Business Start-up, or Debt Refinancing? by Michael T. Valenti, Senior Vice President, San Diego Private Bank

The U.S. Small Business Administration has programs for qualifying small-business owners that might make securing a loan a lot easier, and are especially tailored to the needs of physicians. The most common of these SBA loan programs is the 7(a). Here’s what you need to know about them. What Is a 7(a) Loan? A 7(a) loan doesn’t come directly from the SBA. Instead, an authorized SBA lender makes the loan, and the SBA guarantees a portion of it, mitigating much of the risk for the lender. With the SBA guaranteeing a large portion of the loan, the lender can lower its lending standards, allowing small-business owners with less established credit histories or less cash flow to qualify. How Do I Know if I Am Eligible? Since these loans originate from private financial institutions, the SBA doesn’t determine borrower eligibility, but, according to the agency, you must meet these guidelines: 1. Operate as a for-profit entity. 2. Meet the SBA’s definition of a small business. 3. Have personally invested equity in the company. 4. Be able to demonstrate a need for the loan. 5. Use the loan for sound business purposes. 6. Not be delinquent on any debt obligations to the U.S. government.

For SDCMS member physicians, San Diego Private Bank will pay 1% out of the total SBA guarantee fee percentage. For example, if an SDCMS member physician takes out an SBAguaranteed loan for $500,000 with San Diego Private Bank, and the SBA guarantees 75% of that, or $375,000, the guarantee fee will be $11,250 (3% of $375,000). San Diego Private Bank will then pay 1% out of the 3% guarantee fee, or $3,750 of the $11,250. In other words, in this example, this SDCMS member physician would save $3,750 by banking with San Diego Private Bank!

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What Are the Terms of a 7(a) Loan? • 7(a) loans can be as large as $5 million, with a minimum of $150,000. • Term 10–25 years determined by loan type; all loans fully amortized. • Interest rates are negotiated between the applicant and the lender. • Payments are made monthly and include a combination of principal and interest, just like a traditional loan. • The SBA assesses a guarantee fee that is charged to the borrower. How Do Lenders Judge My Eligibility? Lenders apply the same criteria they would with a traditional loan, but, thanks to the SBA guarantee, standards might be more relaxed. According to the SBA, the lender will judge you based on these standards: 1. Equity Investment: The more “skin in the game” you have, the better your chances. 2. Earnings: Do you have enough cash flow to meet all of your debt obligations? You’ll probably have to provide a report detailing your current and future cash flow. 3. Working Capital: What is left over after you subtract liabilities from assets? 4. Collateral: What do you have of monetary value that the lender can use as collateral if you default on the loan? (This includes personal collateral.) 5. Resource Management: The SBA defines this as how you manage your day-to-day affairs. This may take into account all of the above criteria as the lender makes a judgment of your character.

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P o e t r y and M e dicin e

So Much of This Is Random The quip says troubles come in threes They also come in tandem Your parents felled by rare disease So much of this is random. Rewarded with the perfect job And then the boss just canned him Dismissed by a malicious slob So much of this is random.

So Much of This Is Random by Daniel J. Bressler, MD, FACP

A wise woman recently told me of the great tragedy of her life. Years before, her only child, a son, was stricken with Amyotrophic Lateral Sclerosis as a young man. Before his illness, he had been handsome and successful. He traveled broadly, exercised fanatically, and kept the company of beautiful women. During the first few years of his illness, he grew increasingly angry at his fate. He became sullen and spiteful with his family, friends, and doctors. Finally, just before he died, as she was cleaning his atrophied body, she asked how he answered the question, “Why me?” As she tells it, something happened to him at that moment. He turned his face to her, smiled, and answered with

October 2016

a question of his own: “Who else but me?” From that moment until he died a month later, he was a different person. His body continued to deteriorate, but his mind, his heart, and his spirit had become peaceful. This poem is dedicated to him, his parents, and to everyone to whom life has doled out a bitter, undeserving portion. Dr. Bressler, SDCMSCMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and a longtime contributing writer to San Diego Physician.

She climbed the slippery pole of fame And gloated in her fandom She slid to jealousy and blame So much of this is random. Please catch the last train from Berlin They missed that memorandum Their swirl of acrid smoke rose thin So much of this is random. Promoted to the privileged clique To learn she couldn’t stand ’em Break me out of this place quick So much of this is random. The patterns of your cancer genes Someday we’ll understand ’em We don’t yet fathom what they mean So much of this is random. She took his silence for goodbye His notes she only scanned ’em Leaving him to wonder why So much of this is random. Helo, fixed wing, water bird He could fly and land ’em The freakish fire you must have heard So much of this is random. Angry words and bitter breath Despite what we would hand him He finally smiled before his death So much of this is random.

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L e ad e r s hi p — 7 t h in a S e r i e s

Dr. Mihir Y. Parikh President of the San Diego County Medical Society by Sherry Nooravi, PsyD

The following interview is part seven of an eightpart 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; the June issue for an interview with Dr. James E. LaBelle, CMO of Scripps Health; and the September issue for an interview with Dr. Thomas R. Moore, CEO of UC San Diego Faculty Practice.

October 2016

Dr. Mihir Parikh, board certified in ophthalmology and 13-year member of SDCMS-CMA, is key surgeon of NVISION Eye Centers, La Jolla, president of the San Diego County Medical Society, and team ophthalmologist for the San Diego Chargers. Dr. Parikh can be reached at (858) 480-6872 or at DrParikh@Max.Vision. Question: What is your leadership philosophy? Answer: I like to know who the audience or team is and influence them by tailoring the message. Sometimes you have to be a leader by being vocal and sometimes by being silent. If a group doesn’t know what they are doing, be an educator. If a group knows what they are doing, let the team discover the best solution. They may know the topic but need assistance in the final vision. A leader identifies where the missing pieces are and helps fill them in. There are three things that I believe help me lead any time I’m working

with a group. First, I learn who my audience is, and I take the time to listen to their concerns and ideas, both individually and as a group. Second, I’ll learn what their strengths and weaknesses are and how I can help them work toward their goals and the organization’s goals. Last, I make sure that everyone shares a common final goal. At the San Diego County Medical Society, it is to create a medical society that unites the voice of all physicians by having a membership that is constantly growing. In our medical office, the mission is to be the best ophthalmology practice in San Diego. It is also very important to have diversity on your team. Conceptually, having a team that is uniform makes discussions short and meetings quick. With a diverse team, you get more challenges and longer meetings before final conclusions are reached. The final product, however, tends to have broader appeal to the mass population because it has been vetted by a diverse team.

Points to Consider

Question: What should physicians do to prepare for the future of healthcare? Answer: I predict there will be a lot of change in healthcare and how it is delivered. It is currently too expensive, and patients aren’t happy. In the next 10 years, there will be many new layers of technology, and, as physicians, you don’t want to be the “Barnes and Noble” practice. Ask lots of questions to people who might know the answers. Rather than commiserating and complaining with your colleagues, talk to the leaders of innovative healthcare solutions, band with other people who are in your mode of practice, and join CMA and AMA and participate in the political process. Question: What advice do you have for young/incoming physician leaders? Answer: Be excellent at what you are doing, be passionate, and know your field of medicine better than any nonphysician. Accept that medicine is a business — it’s the dark side of the field. Learn how your employer is recruiting patients, how the cash flows in your business, and who is looking at these arrangements (doctors or MBAs) and making sure that doctors and patients are protected. Also ask if you can have access to the financials. At big groups, they may just give you quality metrics and the number of patients you need to see, etc. There is a financial metric tied to everything, including patient quality. You need access to the financials behind the quality metrics. Question: What does organizational culture mean to you, and how do you drive it? Answer: Organizational culture is about setting the tone, the mood, and the expectation. What is the vibe? Do you have a winning culture or a losing culture where every day is the same? I personally like to have a winning, innovative, cutting-edge culture. Whether at the office or on the board of the Medical Society, I want people

to say, “What a great team. These people seem to know what they are doing.” I like to push hard and demand excellence. I always ask, “How can we be better?” In my practice, when I go to conferences, I try to meet interesting people who are implementing new ways of delivering better eye care. In terms of the Medical Society, we are always trying to discover new ways to recruit new members, like hosting social events so doctors can meet their colleagues from other healthcare systems. Question: What has worked for engaging your staff that CEOs and leaders in other industries can learn from? Answer: You have to build a product that people want. If the business slows down, reevaluate the situation and explore if the product or the branding needs to be strengthened. Have a rollout plan and demand excellence. Ask, “Is it possible to be the leader in this space, and what is it going to take to get us there?” Sell that vision with positive energy and knowledge to your team, and be willing to change if your team says your idea is weak. When you decide to make a change, people may be hesitant or even reluctant to accept it. But change can be good; it’s an opportunity to get better. 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.

That’s a Good Idea. Do you have openness to listen to your group’s ideas? Do you create a forum for them to share and brainstorm new possibilities?

Diversity Brings More. Do you choose team members who are like you and easy to work with, or do you opt for more diverse members who can present different views that you may not have considered?

What’s Going on Out There? What are you doing to learn more about new technology? Do you attend conferences, talk to your colleagues, and get involved in your local and political systems, or do you complain that “things just aren’t the way they used to be”?

“In the next 10 years, there will be many new layers of technology, and, as physicians, you don’t want to be the ‘Barnes and Noble’ practice. Ask lots of questions to people who might know the answers. Rather than commiserating and complaining with your colleagues, talk to the leaders of innovative healthcare solutions, band with other people who are in your mode of practice, and join CMA and AMA and participate in the political process.”

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Ri s k Manag e m e n t

Shared Responsibility for Preventing Malpractice Suits by Susan Shepard, MSN, RN, and Carol Murray, RHIA, CPHRM

Each member of a healthcare team plays an important role in reducing the number of incidents that cause patient dissatisfaction, injury, and lawsuits. The basic emotions leading to any medical liability action are surprise, disappointment, and anger. These reactions can be triggered by a wide variety of causes, particularly miscommunication. Telephone Conversations With Patients For many members of a professional medical or dental staff, the telephone is often the primary mode of patient communication. All medical and dental professionals should note the following points: • Be courteous and maintain professionalism. Remember that you cannot read your patients’ nonverbal cues. Use your best listening skills.

October 2016

• Make sure that any member of your healthcare team who has the slightest doubt about giving instructions or advice to a patient first checks with the provider. If the provider is not immediately available, the staff member should assure the patient that his or her call will be returned as soon as possible and should verify later that the patient’s call was returned. • Make sure that staff members obtain as much detailed information as possible on a patient’s health problem and its degree of urgency before conveying it to the provider for evaluation. • Establish procedures in your practice for providers and patient care staff to effectively manage urgent problems, scheduling difficulties, and unexpected visits.

Tips for Face-to-Face Encounters • Initiate personal contact with the patient by expressing cordial, individual attention. • Make a favorable impression through your demeanor. Any interaction with any member of the team may represent the patient’s first, last, and most enduring impression of the provider, hospital, or office. • Explain unavoidable delays in the office schedule to the patient. If appropriate, offer to reschedule the appointment. Most patients will appreciate being informed. • Maintain strict confidentiality. Do not discuss any patient problems outside the hospital or office practice. Even when discussing a matter pertaining to a patient with another staff member, do not do so in a public area or within hearing range of other patients. • Staff should always alert providers to disgruntled or hostile patients so that the situations can be defused immediately. Patients frequently share information with healthcare support staff that they will not tell providers, so be sure providers are informed of any significant statements. • Staff members should never give advice beyond their competencies or scopes of practice. Assure any patient of a prompt response to an inquiry and follow through as soon as possible to ensure the patient gets the appropriate information or referral. • Encourage patients to write down their questions for providers or questions regarding the provider’s instructions. Studies have shown that patients remember only a small portion of what they are told. Furnish written instructions or educational information to patients for review at home. Ms. Shepard is senior director, patient safety and risk management education, and Ms. Murray is patient safety risk manager II, both for SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors. com/patientsafety.

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 n t

Connecting With the Meaning in Medicine by Helane Fronek, MD, FACP, FACPh

An old Sufi story holds great power as we struggle to maintain enthusiasm for the practice of medicine. A man walking along the road came upon three stonecutters taking large stones of varying sizes and cutting them into uniform blocks. The man approached the first stonecutter and asked, “What are you doing?” This stonecutter angrily replied, “I’m cutting these stones into blocks. Any idiot can see what I’m doing!” When the man asked the second stonecutter, a smile came to the stonecutter’s face. “I’m cutting these stones to earn a living for my beloved family. I’m able to pay for food and clothing and a place for us to live.” The man then asked the third stonecutter, who looked up with radiance on his face. “Ah, I’m building a temple where people will come to worship, where they will join together in community.”

As a vein specialist, I treat a chronic, progressive medical condition. With my treatments, I relieve pain, prevent complications, and restore more normal hemodynamics in my patients. I feel great satisfaction when my patients’ legs no longer hurt. But the deeper meaning to my work is, by relieving my patients’ need to interrupt their activities to elevate their legs or helping them feel more confident showing their legs in public, my treatments restore my patients’ ability to live active lives that bring them joy and fulfillment. When we treat a patient’s cancer, we often witness profound results: The patient and their family are overjoyed that life will continue. But even when we treat a patient’s pneumonia, we can watch their delight as they return to their lives with interest and vigor. And when our treatments fall short of curing our patients’ medical conditions, our ability to listen to their concerns and show kindness and compassion may be a source of strength and healing that helps them to face what lies ahead. As the very wise Rachel Remen, MD, creator of the The Healer’s Art medical course that gives students an opportunity to find their own source of personal strength and meaning, says, “Nothing brings resiliency better than finding the meaning in what we do.” As our profession struggles with burnout, we can immunize ourselves against this scourge or heal ourselves if we have already fallen prey to it by pausing during our day to remind ourselves of the true meaning of our work. Yes, you just filled 20 prescriptions … but you also used your hard-

“Nothing brings resiliency better than finding the meaning in what we do.” earned knowledge to relieve the suffering of those patients. Yes, you just spent your lunch hour finishing your charts … but you can now see your afternoon patients with a clear mind and will get out in time to see your daughter’s soccer game. I’m not suggesting we stop advocating for changes in medicine that better support physicians — in fact, I believe we need to turn up the volume on this conversation. But by connecting with the meaning of our work, we will instantly feel greater satisfaction and joy in what we do. 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.

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ACCESS TO CARE

Nove m 8, 20 ber Ballo 16, t M CMeas A P ur os es itio ns

CMAâ&#x20AC;&#x2122;s board of trustees has approved positions on the following ballot measures for the Nov. 8, 2016, election. For further information on the statewide measures that have qualified for the November ballot, see the California Secretary of Stateâ&#x20AC;&#x2122;s website at www.sos.ca.gov/elections/ballot-measures/qualified-ballot-measures.

October 2016

CMA Supports Prop. 52

CMA opposes PROp. 53

State Fees on Hospitals; Federal Medi-Cal Matching Funds

Statewide Voter Approval for Revenue Bonds Above $2 Billion

Prop. 52 would lock in hospital fees to allow the state to draw down federal healthcare funds. It would add language to California’s constitution requiring voter approval of changes to the hospital fee program. This will prevent diversion of the funds from the original intended purpose of supporting hospital care to Medi-Cal patients and paying for healthcare for lowincome children.

Prop. 53 would require voter approval before the state could issue more than $2 billion in public infrastructure bonds that would require an increase in taxes or fees for repayment. This initiative could impact medical care by curtailing the ability of the State of California and local government entities to build or rebuild major infrastructure projects.

CMA Supports Prop. 55

Tax Extension to Fund Education and Healthcare

Prop. 55 would extend the current income tax rates on the wealthiest 2% of Californians — singles earning more than $250,000 and couples earning more than $500,000 a year — for 12 years. Funding would provide local school districts the money needed to hire teachers and reduce class sizes, and improve access to healthcare services for low-income children so that they can stay healthy and thrive.

Position: CMA opposes PROp. 61

State Prescription Drug Purchases; Pricing Standards Prop. 61 would prevent certain state agencies from entering into contracts for the purchase of prescription drugs unless the price paid is the same as or lower than the special discounts provided to the U.S. Department of Veterans Affairs. The measure could result in the invalidation of existing agreements between the state and pharmaceutical companies that already provide significant discounts to the state.

Prop. 56 — supported by a broad alliance of physicians, healthcare advocates, educators, and others — would raise California’s tobacco tax, which is currently among the lowest in the country, to $2.87 a pack. Designed as a user fee on cigarettes and other tobacco products, the majority of the money would be used for existing health programs and research into cures for cancer and other illnesses caused by smoking and tobacco products.

The Language Education Acquisition and Readiness Now (LEARN) Initiative

Prop. 58 would give local school districts and their academic staff the option of providing bilingual education. California needs a well-prepared and educated healthcare workforce that reflects our diverse society. Prop. 58 would break down barriers by removing outdated mandates, helping physicians provide the best patient care for all Californians.

CMA Supports Prop. 63

Firearms; Ammunition Sales Prop. 63 would prohibit the possession of large-capacity ammunition magazines and would require most individuals to pass a background check and obtain authorization from the California Department of Justice to purchase ammunition. CMA supports Prop. 63 to ensure our communities are safe and healthy places to live.

CMA Supports Prop. 64

CMA Supports Prop. 56

Cigarette Tax to Fund Healthcare, Tobacco Use Prevention, Research, and Law Enforcement

CMA Supports Prop. 58

Marijuana Legalization CMA’s board of trustees did not take a position on the following propositions: 51: School Bonds. Funding for K–12 School and Community College Facilities. 54: Legislature. Legislation and Proceedings. 57: Criminal Sentences. Juvenile Criminal Proceedings and Sentencing. 59: Campaign Finance: Voter Instruction. 60: Adult Films. Condoms. Health Requirements. 62: Death Penalty.

Prop. 64 would regulate and control the cultivation and use of nonmedical cannabis. The proposal would generate up to $1 billion in taxes for state and local governments, according to a fiscal analysis of the proposal. CMA believes that the most effective way to protect public health is to tightly control, track, and regulate cannabis, as well as comprehensively research and educate the public on its health impacts.

65: Carryout Bags. Charges. 66: Death Penalty. Procedures. 67: Referendum to Overturn Ban on Single-Use Plastic Bags.

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CALIFORNIA MEDICAL ASSOCIATION

PRACTICE MANAGEMENT:

TIP OF THE MONTH

OCT.

Make the most of appeals by knowing your rights. Thanks to a CMA-sponsored California law, payors are required to have a fast, fair and cost-effective appeal process to resolve provider disputes. Make the most of appeals by familiarizing yourself with the most common types of denials, underpayments and partial payments and learn how to most effectively respond using CMA’s “Know Your Rights: Quick Guide for Appeals.” Learn more at http://cal.md/kyr-series.

CMA’s online health law library contains thousands of pages of On-Call documents in hundreds of chapters containing valuable information for physicians and their staff. Access to the library is free to members in the resource library at www.cmanet.org/cma-on-call or by calling CMA’s member help center, (800) 786-4262. Nonmembers can purchase documents for $2 per page.

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

Becky Paplanus, who has been with CMA for 8 years, is the association’s Member Service Coordinator. In that role, Becky heads CMA’s live-person call center team, available during busines hours to help member physicians find the information they need. The Member Services team is here as the first stop for all your questions. They can be reached at (800) 786-4262 or memberservice@cmanet.org.

Don’t hesitate to call. We will help find answers to your questions even when you’re Becky Paplanus, Member Service Coordinator not sure what the question is.” TO OPT OUT OF FUTURE NOTICES, EMAIL MEMBERSERVICE@CMANET.ORG OR FAX (916) 551-2036. BE SURE TO INCLUDE THE FAX NUMBER YOU WANT REMOVED.

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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) 7508984. [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 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] Seeking Family Medicine physicians: Sharp Rees-Stealy Medical Group is seeking fulltime 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] Seeking internal medicine physicians: SHARP Rees-Stealy Medical Group is seeking fulltime 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 fulltime 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

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.

October 2016

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] 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 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) 5600242, ext. 101. [515] 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] 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] 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]

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 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 OFFICE SPACE TO SHARE: We are looking to share our office with another medical practitioner. We have three exam rooms, full equipment. Primary practice is cardiology. Our address is 5555 Reservoir Dr., #100, San Diego, CA 92120; telephone: (619) 265-0200; fax: (619) 287-2825; email: razicardiology@gmail.com. [544] 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] 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] 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]

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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]

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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]

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 more. Please submit CV with cover letter to claudia.steinermd@gmail.com. [506]

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] Physician Assistant / Nurse Practitioner (Bankers Hill): An opportunity for a physician assistant / nurse practitioner in pain management under the

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 FOR SALE LABORATORY FOR SALE: CGM-LABDAQ: 1. Piccolo (chemistry); 2. Sysmex XP-300 (hematology); 3. Qualigen Fastpack (immunoassay); 4. Clinitek Status (urinalysis); 5. Affinition (HbA1c). Please contact Afsaneh Maghsoudy, MD, Tue.–Fri., 10:00am–3:30pm, at (760) 730-3536. [543]

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

SAN DIEGO PHYSICIAN.org

Offic e Manag e r A dvo cac y

SDCMS’s 8th Annual “Outstanding Medical Office Manager” Contest Is Now Underway 2

Physicians: Nominate Your Office Manager Today!

5 SDCMS wants to recognize San Diego County’s most outstanding medical office manager: someone who goes above and beyond their job description, who anticipates problems before1they arise, who works efficiently with the practice’s time and resources, who strikes the right balance between control and morale while supervising staff, and who gives the physician(s) the support needed to do what they do best: see patients! SDCMS member physicians can nominate their office managers by explaining in writing (up to approximately 600 words) why their office manager is the best in San Diego County. We’re sorry, but staff cannot nominate their office managers — only nominations by SDCMS member physicians will be accepted. Send your nomination to SDCMS, Attn: Kyle Lewis, 5575 Ruffin Road, Suite 250, San Diego, CA 92123, or email it to Editor@ SDCMS.org. The winner will receive a $200 gift card and recognition as SDCMS’s “Outstanding Medical Office Manager” for 2016. Nominations will be accepted until Nov. 4, 2016, and contest results will be published in the December 2016 issue of San Diego Physician magazine. Contact Kyle with any questions at (858) 300-2784 or at KLewis@SDCMS.org.

October 2016

Previous Office Managers of the Year 1. 2009: Anne Billeter, Nominated by Dr. John LaFata, Member Since 1981 2. 2010: Sue Rose, Nominated by Dr. David Bodkin, Member Since 1990 3. 2011: Robert O’Meara, Nominated by Dr. Irwin Goldstein, Member Since 2007 4. 2012: Carol Carney, Nominated by Dr. E.L. Sakas, Member Since 2005 5. 2013: Pat Russell, Nominated by Internal Medicine Associates 6. 2014: Sheila Hendry, PhD, Nominated by Dr. Wendy Buchi, Member Since 1995 7. 2015: Deann Cooper, RN, Nominated by Dr. Ted Mazer, Member Since 1989

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

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