December 2016 by San Diego Physician

December 2016 official publication of SDCMS

Medical Missions to the Himalayas, Nigeria, and Fiji

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December

Contents

Volume 103, Number 12

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)

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

features

18 The Himalayas: Hiking Between Villages, Setting Up Clinic Tents, and Seeing Patients Y JAMES H. SCHULTZ, MD, MBA, B FAAFP, DIMM

Nigeria: March 2015 BY JAMES SANTIAGO GRISOLÍA, MD

22 The Mission at Natuvu Creek, Fiji

BY MIHIr Y. PARIKH, MD

BY HELANE FRONEK, MD, FACP, FACPh

Qamea, Fiji With the Loloma Foundation BY TOLUWALASE AJAYI, MD

departments 4

Briefly Noted: Calendar • Physician Socials • Volunteer Opportunity • Medical Students • Real Estate • In Memoriam • And More …

Awe: An Antidote for Burnout

C San Diego School of U Medicine Class of 2020 BY WILLIAM A. NORCROSS, MD

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 President-elect: 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

Physician Marketplace: Classifieds

Put Your SDCMS-CMA Membership to Work!

On the cover:

BY DANIEL J. BRESSLER, MD, FACP

Dr. Jim Schulz examining young monks at Phugtal Gompa in northern India

December 2016

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

Dog Beach

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

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

PHYSICIAN SOCIALS HEALTHCARE CONFERENCES

To submit a community healthcare event for possible publication, email Editor@SDCMS. org. Events should be physician-focused and should take place in or near San Diego County.

SDCMS-CMA CALENDAR

For further information or to register for the following events, contact Jen at (858) 300-2781 or at JOhmstede@SDCMS.org. Preventing Burnout: Individual and Organizational Intervention (webinar) JAN 11: 12:15pm–1:15pm Medicare Changes: 2017 and Beyond (webinar) JAN 25: 12:15pm–1:15pm Physician Networking Opportunity & Mixer (social) FEB 9 at B.J.’s Brewhouse in La Mesa MA Legislative Advocacy Day (conference) APR 18 at the Sheraton Grand in Sacramento Western Health Care Leadership Academy (conference) MAY 5–7 at the Marriott Marquis San Diego Marina

“

Melanoma 2017: 27th Annual Cutaneous Malignancy Update JAN 21–22 at the Loews Coronado Bay Resort Structural Heart Intervention and Imaging 2017: A Practical Approach FEB 8–10 at the San Diego Marriott La Jolla The 30th Annual Practicing Physician’s Approach to the Difficult Headache Patient Feb 17-20 at the Omni La Costa Resort Landmark Clinical Trials Revisited: 3 and 5 Year Results FEB 24 at the La Valencia Hotel SDCMS Members Receive 50% off Registration Fee

32nd Annual New Treatments in Chronic Liver Disease MAR 31–APR 2 at the Estancia La Jolla Hotel

”

(“Qu’est-ce que le bonheur sinon l’accord vrai entre un homme et l’existence qu’il mène?”) — Albert Camus, French Philosopher, Author, and Journalist (1913–1960)

December 2016

Thank you to our sponsor Genesis Healthcare

Biomarker Summit 2017 MAR 20–22 at the Hilton San Diego Resort & Spa

But what is happiness except the simple harmony between a man and the life he leads?

More than 100 physicians and their guests came out to have a great time at our Nov. 3 physician networking opportunity and mixer at Rock Bottom Brewery in La Jolla. Our quarterly socials are a great opportunity for you to mingle, socialize, and network with your physician colleagues and their spouses/significant others — with complimentary hors d’oeuvres and drinks always provided. Mark your calendars to join us for our next SDCMS physician social on Thursday evening, Feb. 9, at B.J.’s Brewhouse in La Mesa — register at SDCMS.org.

VOLUNTEER OPPORTUNITY

Connect With a Vet Vets’ Community Connections (VCC) is a community-based initiative designed to involve a greater number of individuals in veteran reintegration efforts. It provides individuals who want to do more than say “thanks for your service” the channel to use their own professional experience and expertise to respond to veteran and military family relocation and reintegration questions in a wide variety of fields: education, health, business, recreation, arts, community service, and a host of other areas which collectively make up the communities in which we live. Through VCC, veterans and their families get answers to a whole host of reintegration questions that fall outside the realm of veteran service organizations — answering anything from where do I find home/car repair experts, to can you help me figure out what this profession is actually like? For further information, visit www. vetscommunityconnections.org.

/////////////////////////////////////////////////////////////////////////////////////////////////// MEMBERSHIP

Welcome Our New and Returning Members! Aysun Azimi, DO Pediatrics San Diego (559) 499-6520

Milagros Jacobs-Kleisli, DO San Diego (858) 636-4300

Andrew Mohr, MD Anesthesiology San Diego (619) 543-5897

Sandy Chuan, MD Reproductive Endocrinology/Infertility San Diego (858) 794-6363

Lauren Knecht, MD Critical Care Medicine (Anesthesiology) San Diego (619) 543-5897

Charles Redfern, MD Medical Oncology San Diego (858) 637-7888

Lindsey Hagstrom, MD Surgery of the Hand San Diego (858) 715-9200

Camela McGrath, MD Escondido (760) 745-1363 James Mckerrow, MD, PhD Anatomic Pathology San Diego (858) 822-7801

Jeffrey Schweitzer, MD Neurological Surgery San Diego (619) 810-1010 Dhwanil Vyas, MD Nephrology San Diego (858) 810-8000

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The Student National Medical Association (SNMA) would like to thank SDCMS for its support of our annual Regional Medical Education Conference at UC San Diego on Nov. 4–6. We welcomed more than 100 minority pre-medical and medical students to La Jolla for a memorable weekend as we explored the theme “Changing the Narrative: Rediscovering the Barriers to Health Equity.” Thanks to SDCMS’s generosity, conference attendees were able to participate in a variety of workshops, learn from highly accomplished speakers, and network with physicians and other students across the region. All of the Region I board members deeply appreciate SDCMS’s monetary contribution to the conference, and its physical presence at the Exhibitors’ Fair Saturday afternoon. We look forward to continuing a relationship with SDCMS as SNMA grows and flourishes in the coming years.

Endorsed by

SAN DIEGO PHYSICIAN.org

Briefly Noted commercial real estate

San Diego Medical Office Snapshot | Q3 2016 By Chris Ross

Regarding rental statistics, countywide average asking rental rates continue to rise with a 2.2% year-over-year increase, and are projected to continue moving upward at a similar pace for the foreseeable future. News, Facts, and Updates Sale Transaction of the Quarter. The 38,665 SF medical office project at Coast Medical Center (3444 Kearny Villa Road in San Diego) sold in July for $12.45 million (approximately $322 per SF). The building was 44.7% leased at the time of sale and was purchased by Genesis Healthcare Partners PC and a private practice orthopedic surgeon.

Market Conditions and Trends San Diego medical office occupancy increased in six of eight San Diego submarkets. Kearny Mesa/Mission Valley posted only slightly negative net absorption numbers, while La Jolla/UTC/Sorrento saw the only significant negative net absorption. The lion’s share of the negative absorption came from two UTC properties: University Pacific Centre and The Campus at Villa La Jolla (formerly known as La Jolla Village Professional Center) — both of which had a significant amount of space vacated by office (nonmedical) tenants. The vacancy rate for Class A and Class B medical office remains below the marketwide level of 7.5%. The I-15 Corridor is currently the area with the lowest vacancy at 4.7%. With conditions that tight, and given the population growth the area is seeing, it is not surprising that Sharp HealthCare acquired 4.3 acres at the Del Sur Corporate Center for future expansion despite the fact that the group currently has a 100,000-square-foot medical building under construction in Rancho Bernardo.

December 2016

By the Numbers

7.5%

Countywide Direct Vacancy

-57,662

Q3 Net Absorption (s.f.)

2.2%

12-month Rent Growth $2.76 FS Average Asking

302,312 Total Under Construction (s.f.)

Health System Event of the Quarter. Scripps Health and the University of Texas MD Anderson Cancer Center have partnered to create a comprehensive and clinically integrated cancer program in San Diego. Named the Scripps MD Anderson Cancer Center, the program is part of the MD Anderson Cancer Network, which collaborates with hospitals and health systems worldwide and will expand San Diego patients’ access to the best treatment protocols, standards of care, extensive clinical trials and transitional research. Tip of the Quarter Contractor Selection. With construction costs being at perhaps historic highs, it is as important as ever to select the right TI contractor. When negotiating a lease, landlords tend to prefer that tenants use one of their GCs, while tenants often like to select their own. One middle-ground solution is writing mutually approved contractor names directly into the lease contract. This allows the tenant to control costs by having a say in who is doing the bidding, and it gives the owner the opportunity to review the contractors’ qualifications. A provision can also be added that allows both parties to have additional GCs bid on the project provided both parties agree. Mr. Ross, Senior Vice President at JLL, is a commercial real estate broker and advisor specializing exclusively in medical properties in San Diego County. To receive more comprehensive JLL Healthcare Practice Group market reports, contact Mr. Ross at (858) 410-6377 or chris.ross@am.jll.com.

Champion Spotlight

Kevin Yoo, M.D. San Diego Neurosurgery

To join our team of champion physicians, please contact: 858-300-2780 I Barbara.Mandel@ChampionsFH.org or visit: www.ChampionsForHealth.org.

Longtime Champions for Health volunteer, Dr. Kevin Yoo, recently saved one of our patients from eventual paralysis. Hilda Mancilla, 46, had been experiencing back and neck pain for years. Sometimes, it became so extreme, she suffered from numbness in her upper extremities. Hilda figured the persisting problem was due to a motor vehicle accident she had been involved in years prior. However, it turns out her symptoms had nothing to do with her previous injury. Imaging revealed that Hilda had a spinal tumor. If left untreated, it would have eventually led to paralysis. Dr. Yoo reviewed Hilda’s case and generously agreed to volunteer his expertise to remove the tumor. The highly specialized procedure went well and Hilda is currently regaining full mobility through physical therapy. We are tremendously grateful to Dr. Yoo for saving Hilda’s life and also for being a champion for some of our other patients’ health, too. Since 2010, Dr. Yoo has performed two other cranioplasty procedures for patients with traumatic head injuries, who otherwise wouldn’t be able to afford this extensive medical care. Champions for Health relies entirely on a network of physicians, like Dr. Yoo, who volunteer their specialized skills to heal our community’s most vulnerable patients. SAN DIEGO PHYSICIAN.org

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â&#x20AC;Ś TO YOU AND YOURS FROM THE SAN DIEGO COUNTY MEDICAL SOCIETY

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IN MEMORIAM

Richard Butcher, MD 1939–2016 SDCMS mourns the loss of Dr. Richard Butcher, 48-year member, past president, and family practitioner dedicated to combating chronic disease in low-income neighborhoods in southeastern San Diego. Dr. Butcher suffered a fatal heart complication while attending the annual meeting of the American Medical Association in Orlando; he was 77. Dr. Butcher is survived by his wife, Vickie, their five children, and six grandchildren. The Multicultural Health Foundation, which is dedicated to finding community-based, innovative solutions to health disparities in the San Diego region, and which Dr. Butcher co-led the effort to create, is establishing a memorial fund in his honor to offer medical school scholarships. Information on how to donate will be posted on the foundation’s website at mhfwellness.org. To read and listen to more about Dr. Butcher’s contributions to San Diego’s medical, philanthropic, and sports communities … • Listen to “Southeastern San Diego Ponders a Future Without Dr. Richard Butcher” at soundcloud.com/ inewsource/20161123-cc-butcher. • Read “Discrimination Couldn’t Deter Dr. Richard Butcher, and Southeastern San Diego Healthcare Reaped Benefits” at inewsource. org/2016/11/23/richard-butcherdoctor-san-diego. • Read “Dr. Richard Butcher, Champion of the Underserved, Dies at 77” at sandiegouniontribune.com/news/ health/sd-me-richard-butcher20161116-story.html.

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SAN DIEGO PHYSICIAN.org

Poetry and Medicine

Dog Beach This ocean is my ashram This river is my church These seabirds gaunt parishioners Who come to sing and search

Dog Beach

by Daniel J. Bressler, MD, FACP

There is literature on pet therapy (now most commonly called animalassisted therapy) going back decades. The presence of pets in various institutional settings has been found to be physically and psychologically helpful to children with cancer, children and adults undergoing procedures, and elderly with and without memory problems. A recent article comes from Marcus et al from the Department of Anesthesia at the University of Pittsburgh. The authors of “Animalassisted Therapy at an Outpatient Pain Management Clinic,” published in Pain Medicine in 2012, vol. 13, pages 45–57, in their two-month study of 282 patients, concluded that there were significant improvements in pain, mood, and other measurements of distress with meaningful

December 2016

pain relief (≥ 2 points on an 11-point scale) in 23% of those who had a dog therapy visit but only 4% in the waiting room controls. There is also medical literature on the beneficial effects of being out in nature. The most developed interest comes from Japan, where there is a cultural tradition called Shinrin Yoku, translated as “taking in the forest” or “forest bathing.” A number of studies have looked at the psychological and physiologic effects of an immersive forest walk and included findings of reduced blood pressure, reduced pulse, and reduced circulating cortisol. See, for example, the review article by Park et al, “The Physiological Effects of Shinrinyoku (Taking in the Forest Atmosphere or Forest Bathing): Evidence From Field Experiments in 24 Forests Across Japan,”

The barking dogs are prophets The silent dogs are saints The inlet flow meets salty wave Like a swirling mix of paints I come to breathe my cares away To feel the sand and laugh To erase my life’s dense sentences In a timeless paragraph A smell is worth a thousand words Says one dog to another They sniff each other’s derrières And voila: my sis’ or brother Their squabbles only transient Dogs can’t hold a grudge They don’t demean or stigmatize Nor do they blame or judge So be prepared to say goodbye To twisted funks and griefs These dogs create a buffer from Our humankind beliefs It’s hard to keep a heavy heart In this canine paradise Watch your step and bring a bag Is my only stern advice

A number of studies have looked at the psychological and physiologic effects of an immersive forest walk and included findings of reduced blood pressure, reduced pulse, and reduced circulating cortisol. from Environmental Health and Preventive Medicine, 2010. Jan: 15 (1): 18–26. And not just forests. The book Blue Mind has the following subtitle: The Surprising Science That Shows How Being in, on, or Under Water Can Make You Happier, Healthier, More Connected, and Better at What You Do. Its author, Wallace J. Nichols, is a marine biologist who reviews the medical literature and also offers many compelling anecdotes to support his thesis. Drawing on the musings and observations of brain scientists, Nichols proposes that that there are three mental organizational states, two of which — “red” (anxious, stressed, and overactive) and “grey”

(numb, lethargic, and unmotivated) — are a common fate of modern urbanized people. The “blue mind” state, which arises from close proximity to water, is, in contrast, one of settled focus, productivity, and peace. He tells the moving stories of programs that bring injured and traumatized people to various watery settings for their rehabilitation. He quotes neurologist John Hart, who is the medical science director of the Center for Brain Health in Dallas and who works with veterans suffering from PTSD in a program called Heroes on the Water: “Water impacts all five senses at the same time with a very powerful, positive image and memory.” Ocean Beach’s Dog Beach is known among dog owners and OB denizens as a place of frolic and freedom. It is the only dog beach in San Diego County that is leash-free year-round. It is naturally circumscribed

between a rocky spit on the south side and the outlet of the San Diego River on the north. On any particular day, I’ll see poodles running with pit bulls and tiny chihuahuas barking and sniffing at Great Danes. I bring Izzy, my 9-year-old, 32-pound rescue mutt (dachshund and Australian Shepherd) there most weekend mornings for the blend of quiet and the noise, for the close focus of the dogs by the surf and the distant focus of the clouds and the horizon. In this poem, “Dog Beach,” I try to capture the mixture of images, thoughts, and feelings that draw me to this place, this little ragged and rugged utopia. At this beach the formula of dog + nature + water equals a direct experience of the medical findings of stress relief, pain reduction, and blue mind that the literature predicts. Dr. Bressler, internist and SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and a longtime contributing writer to San Diego Physician.

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P e r s o n a l & P r o f e s s i o n a l D e v e lo p m e n t

Yosemite National Park’s Tenaya Lake Photo by Dr. Fronek

Awe

An Antidote for Burnout by Helane Fronek, MD, FACP, FACPh

A California resident for 24 years, I was embarrassed to admit I had never been to Yosemite. During a recent visit there, my embarrassment quickly gave way to an overwhelming sense of awe. The grandeur of El Capitan, the magnificence of Lake Tenaya, and the striking view of the iconic Half Dome took my breath away. I stared over and over again, not quite believing what I was seeing.

December 2016

Awe, according to Rachel Remen, MD, creator of The Healer’s Art course for medical students, is not an idea but an experience of being in the presence of something larger than ourselves: “Something more universal than what is happening in the room at the time.” We are suddenly filled with inspiration, possibility and gratitude for being alive. Research shows that awe binds us together and makes us more collaborative. Astronauts report “an intense … state of oneness with humanity” as they gaze down on Earth from

Fortunately, awe is all around us in our work. space. It helps us see things in new ways. Albert Einstein felt that feelings of awe were “the source of all true art and science.” Awe makes us nicer and happier. After experiencing awe, study subjects were more likely to help someone who had dropped something than subjects who had not had an experience of awe. The stress levels of veterans with PTSD dropped by 30% when they were in nature and experiencing awe. And awe is associated with lower levels of inflammatory cytokines. Fortunately, awe is all around us in our work. A patient whose entire life

centered on faith and family came in, distraught. Her son had decided to share his life with a woman whose own life reflected disregard for everything that was important to my patient. For months, my patient struggled with the conflict between rejecting her son’s choice and potentially drifting away from him, and accepting a woman whose choices seemed to dishonor her deeply held values. The grace and love with which she resolved this conflict and accepted her son’s choice was stunning, and inspires me to patiently find my own way through conflicts. Another

patient developed a foot drop after treatment. An avid runner, she now found herself at home more, where she began to appreciate the extra time with her children. Again, I felt awe for her resilience, her ability to “turn lemons into lemonade.” It made me wonder where in my own life I could be more positive and resourceful. Yet another patient bravely agreed to a painful procedure. “5 out of 10,” she rated her pain. I’m sure it was at least an “8.” I felt awe at her courage and determination to improve her health. We physicians are surrounded by examples of courage, resilience, grace, kindness, and love. If only we will allow ourselves even a moment to experience the awe that comes with them, we can feel a renewed sense of connection, strength,

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MEDI C AL STUDE N TS

UC San Diego School of Medicine Class of 2020 White Coat Ceremony by William A. Norcross, MD

Note: Dr. Norcross gave the following speech to incoming medical students, fourth-year medical students, and their families and friends in September upon receiving the 2016 Leonard Tow Award for Humanism in Medicine. I. Welcome. I welcome the UC San Diego School of Medicine Class of 2020 and your families and friends. Having four children of my own, I especially welcome the mothers and fathers here today and invite you to feel the wellearned sense of pride, and perhaps relief, which must be yours. Welcome Class of 2020 not only to our great school, but to the noblest of professions: medicine. I graduated from the Duke University School of Medicine in 1974 and have spent the intervening 42 years here as a resident and then a member of the faculty, so I can attest from firsthand observation over many years to the excellence of our school and the dedication of our faculty, house staff, and students.

December 2016

II. The Profession A profession is not a job. A profession like medicine is a way of life; it is a calling. You may finish a shift, but you are a doctor henceforth every minute of your life. There will be happy milestones along the way; however, starting today you begin the lifelong journey of becoming a good doctor. You have already set sail on that big adventure. Medicine is a process of becoming. In my opinion the good doctor never arrives at the destination of pure excellence, but, rather, continuously strives for it. Many years ago the dean of my medical school, as a preventive measure against egotism and hubris, told us this: “When you have arrived at a place of supreme confidence and believe that you have learned everything about medicine and that you are the best doctor in the world, cup your hands before you and imagine you hold solids, liquids, and gases in that cup. Can you separate the fingers on the bottom to allow only the gases to escape? Of course you cannot. But the anal sphincter can.”

When you woke up this morning, most likely you were part of a culture in which prying into the personal matters of others might be considered rude or offensive. Well, not anymore! Taking a history from a patient remains the cornerstone of medicine; fully 80% of diagnoses can be made from the patient history and 100% of doctor-patient relationships are founded on the history. Learn to do this well. You will have good teachers. When you woke up this morning, most likely you were part of a culture that had very strict rules about personal physical touch, especially with strangers. Well, not anymore! To be certain, there are rules for physicians regarding personal touch, and you will learn these, but you will also learn how to perform a thorough and sensitive physical examination, even of those most sensitive parts of the human body. Learn to do this well. You will have good teachers. When you woke up this morning, you were just embarking on the journey of medicine, but here at our school we will give you the knowledge and skills to perform a good history and physical examination, request laboratory and imaging studies judiciously, and, using your newfound knowledge, construct a differential diagnosis, the thoughtful and well-reasoned list of possible diagnoses that best explains your patient’s problems. Adding experience with the knowledge and skills you will be taught, you will often be able to reason through your differential diagnosis and develop an effective treatment plan. Medicine is a wonderful, sometimes exhausting, and often exciting journey. Class of 2020, take a moment to look at your classmates. When you woke up this morning, it is likely that most of your classmates were strangers to you. I can assure you that as you look about you, some of the people you see will become among the best friends you will ever know throughout your entire life. You will come to admire your classmates and be inspired by them, and, in turn, you will be admired by them and lift them up. It is possible that one of them may save your life. Each of you has worked hard to get here, and, although I do not yet know you personally, I have worked here for 42 years and I’m no dummy: Every UC San Diego School of Medicine student is brilliant, dedicated, and incredibly hard-working. Through innate intelligence, but, more importantly, through phenomenally hard work, sacrifice, and diligence, and, let’s face it, competitiveness, you have bubbled to the surface of your generation to be, in the words of one of my faculty, the cream of the cream of the cream of the crop.

That is the good news, but there is also a downside: You got here at least in part because of competitiveness, and now you are a member of the incoming class of one of the best and most selective medical schools on the planet, and all of your classmates are the cream of the crop too. You will be a brilliant student and you will do excellent work, but so will all of your classmates. Let me offer you a good solution to this dilemma. Competitiveness is good and I won’t ask you to forego it entirely (not that we could, if we wanted to), but I want to ask you to take some of the energy and enthusiasm you have devoted to competition, and consciously place it in a new virtue, a virtue of supreme importance for the doctor of the future: teamwork. Teamwork makes life fun, and all it requires is a good attitude and the willingness to be a team member. III. The Healthy Medical Student The life of a medical student, resident, and physician is filled with hard work and long hours. I can support you in this journey, but shame on me if I were to tell you it was easy. It is not. But if we all look out for one another, pull on the oars at the same time in the same direction, and buoy one another up, we will have wonderfully gratifying lives. If this presentation could be distilled down to one sentence, I would have it be, “Look out for one another.” The average human being works eight hours per day, sleeps for eight hours per day, and does everything else (family, friends, hobbies, personal hygiene, etc.) for the remaining eight hours. Not only that, the average human being has Saturday and Sunday off. You and I are not average people. Society’s expectations from us are not average. For the time you are in training, at the very least, you will often be asked to work more than eight hours per day. Doing the math, it’s clear that some sacrifice must be made in the allocations to sleep and everything else. My point to you today is that to remain healthy and happy, you must plan for these allocations. This requires forethought. Do not allow them to “just happen to you.” You begin to think like this: If I take five minutes to shower instead of 10, I save water (good for the environment), and I get five extra minutes of sleep. When you woke up this morning, you probably did not think that way, but here you are. If you are not already a sleep worshipper, convert to that following soon. When you are on call, you may not have that much control over your sleep hours, but you certainly do when you are not on call, and the resilient

physician will learn to approach sleep with the same discipline he/she approaches the profession. Plan meals and nutrition the best you can. Food is our fuel and the high-functioning human body requires good choices. Prepare to eat well. Befriend and respect your colleagues, especially nurses, interns, and residents. You should do this simply because it is the right thing to do, but, on a practical level, I can assure you that your life will be so much better if the nurses, interns, and residents you work with genuinely like and trust you. Exercise — this is so important. Work out regularly, and, even when you are at work, take the stairs. Find ways to keep those muscles moving and the endorphins flowing. Right now you are asking yourself, “Is this man, who appears to have consumed more than his share of donuts in his day, actually lecturing us about nutrition and exercise?” The short answer is, yes. Continue to do the things that have always made you happy: Have friends; read books; listen to music; enjoy life. Live your spiritual values; if you belong to an organized religion, attend your place of worship. Learn mindfulness and practice mindfulness. IV. Regarding the White Coat Itself If you wear your white coat during clinical activities, above all, it must be perfectly white. If you drop a blot of tomato sauce on your white coat, you will know it comes from a pizza, but your patient will not. If you fumble with a piece of chocolate cake at lunch and examine a patient that afternoon, you will know the stain on your sleeve is chocolate icing, but, I can assure you, your patient will make a different assumption. Always present your best self. You only have one opportunity to make a first impression. V. On Caring All of this, your education, your hard work, your parents’ devotion, love, and sacrifice, striving for excellence, all of this is really for one grand purpose: the health and well-being of our patients. The Hippocratic Oath is a remarkably brief, but powerful, statement, and the centerpiece sentence reads: The health and life of my patient will be my first consideration. Nearly 90 years ago, in closing a lecture to his medical students at Harvard, the great Dr. Francis W. Peabody said the following: “Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms

the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” Just five years ago, the great cardiologist J. Willis Hurst, MD, at age 90, but still on rounds at Emory, asked 10 trainees (students, interns, and residents) if they thought that “caring” for the patient was still important (Hurst JW. Texas Heart Institute Journal 2011; 38:4, 327–329.) Happily, all 10 of them vigorously asserted that caring was important. Dr. Hurst then asked a wonderful question: “If caring is important, how does a doctor show a patient that he/she cares?” One resident said: “The doctor should smile, sit down, and know the patient’s name; also, the patient should know the doctor’s name.” Dr. Hurst agreed, saying, “No patient likes a gloomy doctor.” He said it is also during the taking of the history that a patient decides if the doctor is a robot or a human being. He elaborated: “Machines don’t comfort people.” He said that doctors should speak to everyone in the room and address all of the patient’s worries, even the nonmedical ones. He said that doctors should spend time explaining everything clearly and explain again if the patient does not understand! Dr. Hurst’s summary statements are the most profound: “Every action and comment made by the doctor must be genuine. Doctors must not simply memorize their actions and comments like actors do when they act in a play. Remember, patients can identify the doctor who is not sincere.” I will now close by sharing a secret about myself: I love the science and mystery of medicine, too. I believe I have been chosen to be here today because some of my colleagues know that I care deeply about my patients. However, I make a full confession that I also love the science of medicine and I love the sleuthing involved in making an accurate diagnosis. I love talking to my patients, and I love reading The New England Journal of Medicine. I love it all. I love the friends I have made along the way. I love the colleagues who have time and again saved my life. Class of 2020, I salute you and I hope you love medicine, too. Remember that you are not alone, that we are all on this journey together, and the journey itself is wonderful. Live every moment of it fully. Dr. Norcross, 23-year member of SDCMSCMA, is clinical professor of family medicine at UC San Diego School of Medicine and director of the UCSD PACE Program. SAN DIEGO PHYSICIAN.org

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The Himalayas Hiking Between Villages, Setting Up Clinic Tents, and Seeing Patients

Monks “hangin’ out” at Phugtal Monastery.

n August I had the privilege of being one of the two attending physicians/team leaders on a medical mission with Himalayan Health Exchange (himalayanhealth.com) to a very remote area of the Himalayas. This trip involved supervising and teaching about two dozen medical students, PA students, and residents from around the country, the U.K., and Canada as we trekked through the Zanskar Valley area of Jammu-Kashmir in India (en.wikipedia.org/ wiki/Zanskar). This region is roadless and without power; we had to hike over Phirste-La Pass (18,250 feet/ 5,550 meters) to access the several villages we

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visited. We spent a month walking between small hamlets and setting up clinics to serve the villagers who have no easy access to medical care. Access in this region involves walking or riding a mule for several days at altitudes above 12,000 feet, over a 16,750-foot pass (Shingo-La), then taking a bus for 1–2 more days just to get basic medical care. For many, our trip is the only time they have access to a physician all year. Over the month time we saw nearly all of the population of several villages — about 600 visits in total — as well as many of the Buddhist monks residing in Phugtal Monastery built high into the side of a cliff (phuktalmonastery.com). Life in this region is brutally difficult. The passes into and out of the valley are blocked by snow and ice seven months out of the year, leaving the inhabitants cut off from civilization and access to basic goods and services. For the other five months, the people work from dawn to dusk growing what they need to keep themselves and their animals (yaks, goats, mules) alive through the brutal winters. At the altitude of this valley, which ranges from 12,000 to 15,000 feet, the growing season is short and harsh, and they can only grow barley, a little wheat, and potatoes. The people here are mostly of Tibetan descent and predominantly Buddhist; there were also many abjectly poor Nepalese families who, jobless and destitute in Nepal and generally of the lowest Dalit caste, came to work on some road building project using hand tools only. Language was a difficult barrier in some villages as the local language is Ladakhi — more closely related

to Tibetan than to Hindu. We frequently had to draft some of the school kids (whom we were also seeing as patients) to translate for us! Our days were spent either in hiking between villages or in setting up clinic tents and seeing patients. We encountered a lot of knee and back pain, poor vision, gastric reflux and ulcer disease, and some unusual things like spinal tuberculosis, chlamydia conjunctivitis, unusual abscesses, and lots of rashes of various types. Many of our own group suffered from altitude sickness, but none severely — and lots of the usual food-borne traveler’s gastrointestinal issues. We stayed in tents and had no “facilities” other than a hole in the ground and a canvas mess tent. Our temporary physical hardship was put in perspective by the people we were taking care of — despite their very difficult life, they were cheerful and friendly and could not have been nicer to us. Our students learned some medicine, learned how to work without having labs and MRI machines at their beck and call, learned how to take care of themselves in harsh conditions, but most of all learned a perspective on life that only comes from traveling, living, and working with people in a place with such limited resources. I’ll be going back again in 2017!

Rebecca Shuttleworth, U.K. medical student, with monk.

Mom and daughter in our clinic tent, Sarchu.

Dr. Schultz, 26-year member of SDCMS-CMA, is chief medical officer of Neighborhood Healthcare and current treasurer of the San Diego County Medical Society.

Buddhist monks, Phugtal Gompa.

Devin Rigg, MS4, Colorado, me, Gina Zarella, PGY-2, UCSD, and Kenny Rodriguez, MS4, Colorado — Phirste La Pass, 18,250’.

Life in this region is brutally difficult. The passes into and out of the valley are blocked by snow and ice seven months out of the year, leaving the inhabitants cut off from civilization and access to basic goods and services.

Julia Clemens, PA student, Toronto, and Elliot, PGY-2, South Carolina.

SAN DIEGO PHYSICIAN.org

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Nigeria T

he children sang joyfully amid the trees, grateful to be safe from Boko Haram. They sang in Hausa, the language of the North, but they shouted “Hallelujah” to our delighted ears. These tiny refugees, singing their hearts out to us, remain among our most haunting memories of Africa. During its brief lifetime, the Oral Roberts University’s School of Medicine produced many committed Christian doctors, none more dedicated than Mark Babo, MD, and his wife Doreen Babo, MBA, DPH, who have worked for nearly 30 years to bring modern healthcare to Africa [www. facebook.com/healourworld]. After several years in Kenya, they have spent 25 years in Nigeria, building three hospitals in different cities. They invited their medical classmates from the Class of ’83 for a mini-reunion of service and gratitude in March 2015. Our party included Carla Stayboldt, MD, pathologist at Scripps Mercy Hospital, and myself, a non-ORU alum but married to Dr. Stayboldt. Other ORU alumni included Paul Davis, cofounder of the Family Medicine Residency at the University of Alaska and a veteran of the U.S. Public Health Service there; Nancy Wespetal, a full-time medical missionary in Russia and Ukraine; Brian Kilpatrick, board certified in both internal medicine and pediatrics, now practicing in West Pawlet, Vt., and also personal trainer Ian Davis, son of Paul Davis. We were hosted by the

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March 2015

Idahosa family, founders of Church of God Mission International. Our mission trip centered on the Faith MediPlex in Benin City, the second-largest Christian hospital in Africa, built by Mark and Doreen more than 25 years ago, in partnership with the Idahosa’s church. We enjoyed morning devotionals there, attended by doctors, nurses, and all staff, including custodians. Afterward, we toured the hospital and examined patients with the Nigerian doctors, providing Western insights while learning about local diseases such as malaria. This hospital of more than 100 beds provides an expanding array of medical, obstetric, and surgical services, with a kidney dialysis unit to open soon. In partnership with local doctors, we did medical outreach clinics, including to an outlying village that had not seen doctors in more than 10 years. Among the villagers, we found an elderly lady who was HIV positive, many undiagnosed diabetics and hypertensives. Most memorable was our outreach clinic to a camp for refugee children orphaned by the terrorist group Boko Haram. Safely in the Christian South, these refugees from the Muslim North of Nigeria were traumatized but glad to be safe, with food, water, and dry sleeping quarters. In the weeks prior to our visit, the camp rapidly doubled from 600 to 1,200 children. They sang and played joyfully, while we treated them for leprosy, scabies, malaria, filariasis, and more common

They sang and played joyfully, while we treated them for leprosy, scabies, malaria, filariasis, and more common childhood diseases.

childhood diseases. Since we left, the camp has reportedly doubled again in population. We coincided with a national family medicine conference, where we taught alongside our Nigerian colleagues on varied topics, including the neurological exam, epilepsy, breast cancer and colon cancer screening. Our audience of residents and practicing doctors responded with Nigerian warmth and humor to our talks, and they presented each of us with traditional ebony carvings as mementos for our efforts. We left with a warm feeling for the Nigerian people, vibrant and energetic, and a strong desire to return, soon. Dr. Grisolía, SDCMS-CMA member since 1980, is editor of San Diego Physician magazine.

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The Mission at Natuvu Creek, Fiji natuvu.org

y family and I went on vacation last summer, with this one, unlike previous vacations, to be a vacation of giving. The idea was to donate our time and expertise to the people of Fiji and then to see a little bit of the country afterward. It turned out to be the most rewarding trip we’ve ever been on. We took so much more than we gave — the Fijians are the most amazing, grateful people I have ever encountered. The hugs, smiles, and thank-yous gave us energy and excitement, and filled us with pride in being in the healthcare field, in being doctors, and in being able to make a difference in someone’s life so far away. It was such an incredible feeling to connect in a global and meaningful way; I would recommend everyone experience it at least once in their lifetime, if not once a year! Our trip lasted from June 24 to July 5, 2016, with the medical mission taking place June 27 through July 1. Other than myself, my wife, Keerti Gurushanthaiah, MD, and our children, Nathan and Karina, we were joined by Thomas Tooma, MD, and Marta Tooma, DDS (founders of the mission), Richard Meister, MD, and his companion, Brenda (OR nurse), John Davidson, MD, and his fiancée, Natalie Contreras (OR nurse), Bradley Nelson, MD, from Loma Linda who runs International Medicine, and six medical students (four from Loma Linda, one from UC San Diego, and one from Virginia Commonwealth) — in preparation for the trip, all providers were licensed by the

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Fiji Medical and Dental Council. We flew from LAX to Nadi, Fiji, then on a smaller airplane to Labassa on Vanua Levu, with a final three hours on the ground to Natuvu Creek. In total, we had four ophthalmologists who performed 61 surgeries: 43 cataracts (phacoemulsifications), 16 pterygiums, and two anterior segment repairs — all with no anesthesiologist and no oral anesthesia medications. All pain control was with eye drops and peribulbar blocks (with expired medications). Every surgery was sight restoring — our patients couldn’t even see the big E on a vision chart with glasses, even if they had them. With our advanced techniques, many of the patients were 20/20 the next day. One to two surgeons operated while the other two were in medical clinic evaluating eye disease. We probably saw between 60 and 80 patients in medical clinic per day, in two exam rooms. My wife, Keerti, who ran an OB/GYN clinic, saw so many patients that she ran out of supplies. In the end, all the care provided was completely free, and privately run; there were no fees for the exams, reading glasses, eyedrops, or surgeries. If you are interested in making a donation or in going on a trip to the mission, please email Janet Walker, executive trip coordinator, at janet@ natuvu.org. Dr. Parikh, board-certified ophthalmologist and 13-year member of SDCMS-CMA, is the current SDCMS president.

It was such an incredible feeling to connect in a global and meaningful way.

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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M EDICAL M ISSIONS

Qamea, Fiji With the Loloma Foundation

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his was a heartwarming and very fulfilling mission trip I was able to be a part of thanks to the Loloma Foundation (www. lolomafoundation.org). This mission consists of a team of general medical specialists of which I was the only pediatrician. We traveled daily by boat to several rural Qamea island villages for the purpose of providing general medical care as well as screening patients as surgical candidates at the Taveuni Hospital in the following weeks. While at the villages, we set up our mini-clinics in whatever space the village could provide for us. Oftentimes these would be classrooms, or, for villages that didn’t have a school, one family would graciously give us their home to use. This team also includes a full dental operatory of general dentists who will work with the Foundation’s Aseptico units at a field operatory at Matangi Island Resort. All of the dental supplies are provided by the foundation. This team consisted of an oral surgeon, dentists, and their respective assistants. If anyone is ever interested in helping patients access care with a group that works with the local resources and builds community, please do not hesitate to reach out to me. We are always looking for pediatricians, family practice and internal medicine specialists. Email Editor@SDCMS.org.

Dr. Ajayi, four-year member of SDCMS-CMA, is a palliative care consultant with Scripps Health and pediatrician with Rady Children’s Hospital San Diego.

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classifieds PHYSICIAN POSITIONS AVAILABLE SEEKING PART-TIME PHYSICIAN: Part-time position with opportunity to take on more hours as needed for a busy clinical research site located in San Diego. Must be board-eligible or certified. Prefer internal medicine, OB-GYN, or family practitioner. Good hours, competitive salary and benefits. Please email CV or direct any inquiries to Karen Mylerberg at kmylerberg@mccresearch.com or call (619) 521-2830. [560]

Seeking Dermatologist for La Jolla practice Well established dermatology practice in La Jolla with extremely loyal patient base in need of an excellent board certified general and procedural dermatologist to round out our team. Cosmetic expertise and familiarity with lasers a plus. Our support staff is highly trained and our facilities are state of the art. Familiarity with Modernizing Medicine or EMA helpful. Requirements: . BC/BE in Dermatology . CA license Competitive compensation and benefits Please contact Stephen at 858-362-8800 stephen@torreypinesderm.com

OPPORTUNITY FOR INTERVENTIONAL PHYSIATRY / PHYSICAL MEDICINE SPECIALIST: Practice opportunity for parttime or full-time interventional physiatry / physical medicine specialist with well-established orthopaedic practice. Office located near Alvarado Hospital. Onsite digital X-ray and EMR. Interested parties, please email lisas@sdsm.net. [554] 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. [553] FAMILY PRACTICE MD/DO AND PHYSICIAN ASSISTANT WANTED IN BEAUTIFUL LA COSTA: Various shifts available at urgent care / family practice office. Nights, weekends, and day hours available. Please fax or email CV to (760) 603-7719 or gcwakeman@sbcglobal.net. [551] SEEKING PART-TIME PHYSICIAN: Anderson Medical Center is a busy primary care, sports and occupational medicine practice housed in a state-

of-the-art urgent care facility in Pacific Beach. We’re seeking a part-time physician. Experience in a busy practice, emergency department, or urgent care; with musculoskeletal medicine, X-Ray, and sutures/wound care required; and ability to provide compassionate care in a fastpaced environment necessary. We seek someone who values: integrity and quality medical care; with impeccable bedside manner, emotional/ professional maturity, ability to work well with patients/team members, easily manages multiple priorities/patients; detail-oriented and teamfocused. We’re open 8am–8pm, Monday–Friday, 8am–4pm weekends. Providers share day, night, and weekend coverage. [550] PUBLIC HEALTH MEDICAL OFFICER, TUBERCULOSIS CONTROL & REFUGEE HEALTH: HHSA. Anticipated range $145,000– $155,000. Excellent benefits package. For details, go to www.sandiegocounty.gov/content/dam/sdc/ hr/jobs/HHSA_TB_Control.pdf. [548] SEEKING A FEW GOOD PSYCHIATRISTS AND PHYSICIANS: The California Department of Social Services is seeking a few good psychiatrists and physicians who are interested in working with outside treating sources and other state professionals that evaluate medical evidence to determine its adequacy for making disability decisions as defined by Social Security regulations. On-the-job training is provided. Interested applicants must have a current CA MD/ DO License. Full-time salary ranges can start at $9,152.00 – $13,547.00 per month, depending on experience and credentials. If you are interested, please contact Ruby Chin at (916) 285-7593 or at ruby.chin@ssa.gov. [546] GENERAL FAMILY MEDICINE / GERIATRICS / LONG-TERM CARE PHYSICIANS / NPs wanted to join our team of professionals in beautiful North San Diego County. We are dedicated to making “housecalls” to serve chronically ill patients in their homes. No hospital call, M–F, 8–5 or part time available. Independent contractor position. We are a very relaxed, professional practice environment. We very much look forward to your call! No recruiters, please. Email your CV or résumé to mobiledoctor@sbcglobal.net. [545] 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 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]

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

December 2016

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) 2334730, 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. Training in Mohs micrographic surgery a plus. Exceptional new graduates are considered for the position. Please email CV to dermmd10@gmail.com or call (760) 612-7171. [523] 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] 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] OFFICE SPACE AVAILABLE / REAL ESTATE OFFICE SPACE TO SUBLET ON CAMPUS OF SHARP CHULA VISTA MEDICAL CENTER HOSPITAL: Located at 752 Medical Center Court. Half days to share available. Completely furnished, turnkey operation, pleasant environment. For additional details, please email Connie Espinoza, Business Office Manager, at conniee4@gmail. com. [561] LOOKING FOR OFFICE SPACE IN THE ENCINITAS AREA? I am looking to sublease a 2–3 exam room medical office and lobby area 2–3 days per week. I only plan to be there 1–2 days per

week, so you’d have access to the entire office and could store charts, etc., there if needed. Can use phone and internet lines. Price negotiable, but looking for $1,200–$1,500 based on number of days per month and schedule. There is parking right out front and bathroom in lobby area. First floor and parking under building for lessee. Please contact Dana at (858) 603-2068 or at dana@sdrheumatology.com. [556]

(858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127] POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage therapist. Low rates. Email inquiries to kathysutton41@yahoo.com. [173] BUILD TO SUIT: 950SF office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with six gated parking spaces, two entryways, restrooms, lighted tower sign space. Build-out allowance to $10,000 for 4–5 year lease, rent $1,800 per month gross (no extras). Contact venk@cox.net or (619) 504-5830. [835]

CLASS A MEDICAL OFFICE CONDO FOR SALE OR LEASE Encinitas • 781 Garden View Court 2,809 SF (divisible to 1,000 SF)

Rare opportunity to purchase or lease a first-class 2,809 SF medical office condominium in the heart of North County near Scripps Memorial Hospital Encinitas. The space can be easily reconfigured for a variety of medical uses and sizes, and is currently OSHPD-3 certified. The building has excellent parking and is located just off of N. El Camino Real near the vast number of highly-frequented retail and restaurant attractions and other healthcare providers. For more information, please contact Chris Ross at (858) 410-6377 or chris.ross@am.jll.com. MEDICAL OFFICE BUILDING FOR SALE: 1729 Palm Avenue is an approximately 2,433-squarefoot, freestanding, professional medical office building conveniently located in San Diego. The property can be occupied by an individual owner or as a two-tenant building, which would offer new owner flexibility in occupancy while receiving additional rental income. The property offers excellent exposure and visibility along Palm Avenue with approximately 38,000 ADT (Costar) and is minutes away from Imperial Beach and the Pacific Ocean. Please contact Chris Baumgart with Cushman & Wakefield for more information at (760) 431-3847 or at chris.baumgart@cushwake.com. [558] 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] 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

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]

resume with cover letter outlining salary history and references to Nicci Parker at nparker@sdcpms.com. [524] 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] OFFICE FURNITURE / MEDICAL EQUIPMENT FOR SALE NEARLY NEW OFFICE FURNITURE AVAILABLE BELOW MARKET PRICING: Conference room table (medium to light wood) with black leather high back chairs with arm rests, physician desks with matching hutch, waiting room chairs (navy blue leather with light wood), and exam room tables and chairs (black leather with light wood). Everything is in excellent condition and looks brand new. Please call Tracy at (619) 286-9480 for information. [549]

NONPHYSICIAN POSITIONS AVAILABLE ADMINISTRATIVE ASSISTANT NEEDED for busy family practice solo office in La Mesa. Knowledge of medical billing and coding a must. Front office experience a must! Full time with great benefits. Please email resume to p.fortuna@efpmg.com. [557] FAMILY PRACTICE MD/DO AND PHYSICIAN ASSISTANT WANTED IN BEAUTIFUL LA COSTA: Various shifts available at urgent care / family practice office. Nights, weekends, and day hours available. Please fax or email CV to (760) 603-7719 or gcwakeman@sbcglobal.net. [551] ADMINISTRATIVE ASSISTANT FOR BUSY WORKERS’ COMPENSATION MULTISPECIALTY PRACTICE: Must know work comp, multi-task, and be detail-orientated. Bi-lingual helpful. Full-time with great benefits. Please email rmcmurtrie@davidkupfermd.com with resume. [547] 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

LABORATORY FOR SALE: CGM-LABDAQ: 1. Piccolo (chemistry); 2. Sysmex XP300 (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] SERVICES OFFERED PHYSICIAN OFFICES IN NEED OF ASSISTANCE FOR MEANINGFUL USE ATTESTATION of their electronic health records can avail themselves of technical assistance from Champions for Health, the sister organization to SDCMS. Practices attesting on the Medi-Cal Incentive Program with at least 30% of patients billed to Medi-Cal can receive free assistance thanks to a federal funding source. Medicare practices can receive the same great service at a very reasonable rate, and SDCMS-CMA members receive a discount. For more information, email Barbara.Mandel@ChampionsFH.org or call (858) 300-2780. [559]

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

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