March 2019 by San Diego Physician

MARCH 2019

Official Publication of SDCMS

SAN DIEGO BLOOD BANK: Changing the Course of Life

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MARCH

CONTENTS

VOLUME 106, NUMBER 3

Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; Robert E. Peters, MD, PhD; William T-C Tseng, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: David E. J. Bazzo, MD President-elect: James H. Schultz, MD Secretary: Holly B. Yang, MD Treasurer: Sergio R. Flores, MD Immediate Past President: Mark W. Sornson, MD, PhD GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD East County #2: Rakesh R. Patel, MD East County #3: Jane A. Lyons, MD Hillcrest #1: Gregory M. Balourdas, MD Hillcrest #2: Thomas C. Lian, MD Kearny Mesa #1: Alexander K. Quick, MD La Jolla #1: Laura H. Goetz, MD La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Veena A. Prabhakar, DO South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD GEOGRAPHIC ALTERNATE DIRECTORS East County: Heidi M. Meyer, MD Hillcrest: Kyle P. Edmonds, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County: Franklin M. Martin, MD South Bay: Karrar H. Ali, DO AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Paul J. Manos, DO; #3: Alexandra E. Page, MD; #4: Nicholas J. Yphantides, MD (Board Representative to Executive Committee); #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); #8: Robert E. Peters, MD

ADDITIONAL VOTING DIRECTORS Communications Chair: William T-C Tseng, MD Finance Committee Chair: J. Steven Poceta, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Margaret Meagher

feature

ADDITIONAL NON-VOTING MEMBERS Alternate Resident Physician Director: Zachary T. Berman, MD Alternate Retired Physician Director: Mitsuo Tomita, MD San Diego Physician Editor: James Santiago Grisolia, MD CMA Past President: James T. Hay, MD CMA Past President: Robert E. Hertzka, MD (Legislative Committee Chair) CMA Past President: Ralph R. Ocampo, MD, FACS CMA President: Theodore M. Mazer, MD CMA Trustee: William T-C Tseng, MD CMA Trustee: Robert E. Wailes, MD CMA Trustee: Sergio R. Flores, MD

San Diego Blood Bank: Changing the Course of Life

departments 4 Briefly Noted: Calendar • Medical Students in Sacramento • SDCMS Social Mixer • New and Returning SDCMS Members

10 The Risks of Screen Time for San Diego’s Children & Adolescents BY JAMIE FRIEDMAN, MD

12 Be Cyber Aware to Be Cyber Secure BY CHRISTOPHER A. LONGHURST, MD, MS

CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MPH Sergio R. Flores, MD

16 Ear, Nose, & Throat = Joyful Hearts BY ADAMA DYONIZIAK

AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Mihir Y. Parikh, MD At-large AMA Delegate: Albert Ray, MD At-large AMA Delegate: Theodore M. Mazer, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD

What’s in a Name? BY HELANE FRONEK, MD, FACP, FACPh

18 Physician Classifieds

CMA’s Foundation: New Name, New Staff, and Aggressive New Agenda

BY JAMES T. HAY, MD

BY DANIEL J. BRESSLER, MD, FACP

MARCH 2019

AT-LARGE ALTERNATE DIRECTORS #1: Karl E. Steinberg, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Susan Kaweski, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD

Temporary (Like a Dog)

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

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An applicant must have, or open prior to closing, a checking or savings account with Bank of America. Applicants with an existing account with Merrill Edge®, Merrill Lynch® or U. S. Trust prior to application also satisfy this requirement. Eligible medical professionals include: (1) medical doctors who are actively practicing, (MD, DDS, DMD, OD, DPM, DO), (2) medical fellows and residents who are currently employed, in residency/fellowship, or (3) applicants who are medical students or doctors and are about to begin their new employment/residency or fellowship within 90 days of closing. Must be actively practicing in their field of expertise. Those employed in research or as professors are not eligible. For qualified borrowers with excellent credit. PITIA (Principal, Interest, Taxes, Insurance, Assessments) reserves of 4 – 6 months are required, depending on loan amount. 2 Minimum down payment requirements vary by property type and location; ask for details. 3 Additional documentation is required. Credit and collateral are subject to approval. Terms and conditions apply. This is not a commitment to lend. Programs, rates, terms and conditions are subject to change without notice. Bank of America, N.A., Member FDIC. Equal Housing Lender. ©2018 Bank of America Corporation. ARY89JD7 | AD-07-18-0108 | HL-112-AD | 02-2018 1

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 //////////////////////////////////////////////////////////////////////// CALENDAR

MARCH 21–22: 4th Annual Critical Issues in Child and Adolescent Mental Health Conference at Double Tree Hotel, Hazard Center. APRIL 18: SDCMS Physician Mixer; 5:30 pm-8:30 pm, BJ’s Restaurant and Brewhouse, La Mesa APRIL 27: Integrated Care Across the Lifespan Conference, Rady’s Children’s Hospital, Education Office Building APRIL 28–MAY 1: AAPC HEALTHCON, Las Vegas MAY 23: SDCMS Gala, Paradise Point Resort JUNE 30: Champions for Health’s Inaugural Soiree, “Awakening Wellness,” Japanese Friendship Garden, Balboa Park, 5:00-8:00 pm

MARCH 2019

MEDICAL STUDENT UPDATE

San Diego Medical Students Study Public Policy in Sacramento DR. ROBERT HERTZKA and SDCMS CEO Paul Hegyi led a total of 22 San Diego medical students on trips to Sacramento to meet with state legislators and learn firsthand about the legislative process and California public policy. Dr. Alex Quick and Dr. Holly Yang each accompanied Hertzka on a trip and the students met with Assemblymembers Todd Gloria, Lorena Gonzalez, Shirley Weber, Tasha Boerner Horvath, Joaquin Arambula, Sydney Kamlager-Dove, Evan Low, Cottie Petrie-Norris, and Jim Wood, and state Senators Brian Jones, Ling-Ling Chang, and Richard Pan.

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TrusT

SDCMS EVENTS

Successful Social Mixer at National Geographic Fine Art Gallery 1

1. Dr. James Grisolia, Dr. Mihir Parikh, Dr. Krupa Patel, and Dr. Arush Patel. 2. Dr. Cherine Moazam and Dr. Holly Yang. 3. Dr. Mark Shalauta, Dr. David Bazzo, Dr. Lori Taylor, and Sabrina Bazzo.

San Diego County Medical Society members enjoyed appetizers, wine, and a private viewing at the National Geographic Fine Art Gallery in La Jolla during the most recent successful Physician Mixer. Thank you to our sponsor, Cooperative of American Physicians.

A Common sense ApproACh To InformATIon TeChnology Trust us to be your Technology Business Advisor

MEMBERSHIP

Welcome New and Returning SDCMS Members! New Members

Rejoining Members

Narat Eungdamrong, MD Dermatology North County (858) 309-3160

Peter Aldrich, MD Internal Medicine La Jolla (858) 592-1330

James Gehrig, MD Nephrology North County Carmel Murphy, MD Pediatrics North County (760) 471-2100 Benjamin Saltman, MD Otolaryngology Kearny Mesa (858) 939-6621 Neema Shakibai, MD Internal Medicine Hillcrest (858) 499-2711 Jung Yi, MD Anesthesiology Kearny Mesa (858) 565-9666

Dayna Arnstein, MD Internal Medicine La Jolla (858) 764-3345 Michael Bannach, MD Family Medicine La Jolla (760) 753-5594 Amy Chang, MD Endocrinology, Diabetes and Metabolism La Jolla (858) 824-5335 Alberto Chavira, MD Cardiovascular Disease North County (760) 510-1808

Isabel Cheon, MD Internal Medicine La Jolla (858) 605-7902 Leslie Hsieh, MD Pediatrics La Jolla (858) 457-2043 Ryan Mcintyre, MD Family Medicine South County (619) 422-8338 Alejandro Paz, MD Family Medicine North County (760) 291-6700 Warren Pleskow, MD Allergy and Immunology North County (760) 436-3988

Raymond Plodkowski, MD Endocrinology, Diabetes and Metabolism La Jolla (858) 794-1250 Michael Preziosi, MD Infectious Disease La Jolla (858) 824-5484

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Frank Tsai, MD Ophthalmology Kearny Mesa (858) 499-2777 Jennifer Tuteur, MD Family Medicine La Jolla (858) 495-1370 Melissa Wolinski, DO Internal Medicine North County (858) 554-3200

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SAN DIEGO BLOOD BANK Changing the Course of Life

MARCH 2019

IMPACT*

ou know better than anyone — moments matter. Critical decisions about patient care can shape their future. At the same time, the moments that lead up to your moments matter too: The spark of inspiration that encourages someone to donate blood for the first time. The personal touch that leads to a repeat donation. And the precision and expertise that get blood products to your hospital when they are needed. Taken together, these moments change the course of life for people in our community.

Grounded in Gratitude Since 1950, San Diego Blood Bank (SDBB), founded by the San Diego County Medical Society, has been our community’s steward of all the moments that ensure blood is ready and available for patients

61,804

who need transfusions. Every two seconds, someone in the U.S. needs blood. That’s a tall order when only 38 percent of the population is eligible to donate — and of those, less than 10 percent do. Heartfelt gratitude is a central pillar of SDBB’s approach to business, and it’s one of the things that keep blood donors dedicated to saving lives again and again. Not only is SDBB grateful for our community’s dedicated blood donors, hospital partners, and financial donors, but blood donors often share how grateful they are to give a part of themselves to help someone else. Take Paul Nysen. He has donated more than 27 gallons of blood since 1982, when a close friend needed blood. He now donates platelets every two weeks. “They said, ‘We need your blood for preemies (premature babies).’ I said,

individual donors, including

20,407

first-time donors

106,505 red blood cell

units delivered

hospitals served in Southern California, including Rady Children’s Hospital, Sharp HealthCare, Kaiser Permanente, and City of Hope

11,165

Ella’s Story

The impact of receiving the gift of health is on display in young people like Gabriella — “Ella” — Martinez, who battles beta thalassemia major. The first thing you notice about Ella is her bright smile. Behind that smile is a circle of givers — blood donors, phlebotomists, nurses, doctors, drivers, financial donors, medical technicians, and administrative professionals — who maintain the necessary blood supply Ella needs. Erica, Ella’s mom, didn’t know she carried the thalassemia trait until she was pregnant with twins. Still, the twins did not exhibit thalassemia during their newborn screenings. But then little Ella began to miss her regular growth milestones. At the suggestion of her caring doctors, baby Ella began receiving blood transfusion and started to improve. Ella calls blood “beautiful.” And donors who meet her feel the beauty in the process too. Ella often visits blood drives and donor centers to thank the courageous people who help her stay healthy.

ounces of mothers’ milk donated

1,546 umbilical cord blood donations *Based on FY18

‘Take it all.’” Thanks to generous blood donors like Nysen, SDBB collects more than 100,000 pints every year and operates six full-service regional centers. It also hosts more than 2,000 mobile blood drives annually, with 12 fully equipped bloodmobiles that travel throughout Southern California. Some notable drives are held in partnership with Comic-Con and the San Diego Padres. In the 42 years of Comic-Con’s annual Robert A. Heinlein blood drive, donors have given 18,500 units of blood. The annual Padres Summer Blood Drive, scheduled for June 18 this year, regularly collects hundreds of pints in one day. SDBB is known as a local resource for blood products, but its membership in a robust network of national blood banks allows it to serve as a national resource in times of need too. Thanks to a partnership with the U.S. Navy, SDBB was able to fly 380 pints of blood to New York City on September 11, 2001 — the first blood from outside New York to reach the city’s hospitals. SDBB is also designated by the California Emergency Medical Services Authority as the Southern California Regional Operations Center for the distribution of blood to Southern California in the event of a major disaster or act of terrorism in the State of California. One of the only constants in healthcare is change. While collecting and processing blood is at the heart of SDBB’s mission, enabling and supporting groundbreaking research to revolutionize how we diagnose and treat disease in the future is also paramount. SAN DIEGO PHYSICIAN.ORG

Enterprising Spirit of Discovery When David Wellis, PhD, joined San Diego Blood Bank as CEO in 2013, he brought more than 25 years’ experience in the life science industry, including developing tools for biomedical research and working in diagnostic and applied markets, such as Illumina, GenVault and Axon Instruments. He serves on the Executive Committee of the Clinical and Translational Research Institute at UC San Diego and holds board and committee roles in several national blood bank organizations and local biotechnology companies. Under Wellis’ leadership, SDBB collaborates with more than 100 research partners and universities on the design and execution of basic and clinical research efforts related to cancer, regenerative medicine, and more. From validating liquid biopsies and other blood-related diagnostic tests, to supporting cell therapy clinical trials for prostate cancer and melanoma, SDBB is a national blood bank leader in advancing wellness and the future of health. Decades of experience in regulatory and quality assurance, paired with a culture of discovery, make it possible for SDBB to develop custom solutions that save lives.

Advancing Cell Therapy In addition to delivering blood and blood components to hospitals, SDBB has been participating in cellular therapies for more than 10 years and is developing an umbilical cord tissue bank to pioneer the next era of regenerative medicine. The organization is the only 100% public umbilical cord blood banking program in California and facilitates lifesaving stem cell transplants to

DID YOU KNOW San Diego Blood Bank … 8

MARCH 2019

patients worldwide. SDBB also makes cord blood cell fractions, plasma, and related components available to researchers. It’s the same infrastructure and scientific talent that can be leveraged to enable mesenchymal stem cell (MSC)-based therapies that include other indications such as cardiac, neural, and autoimmune disorders.

Milk Banking In partnership with UC San Diego’s Mothers’ Milk Bank, SDBB has collected 11,165 ounces of mothers’ milk for babies in the neonatal intensive care units in San Diego. Mothers donate breast milk, which is then sent out for clinical testing and stored in reserves until it is needed at UC San Diego’s NICU.

Pioneering Research SDBB offers a variety of blood and cell-based research products and services for researchers in academia and biopharmaceutical companies. The organization is a cGMP compliant facility which performs a variety of assay and analytical services on blood and cell therapy products as well as capabilities to access blood and tissue samples for genomics-based analyses. SDBB has a top tier regulatory team that can assist with IRB protocol preparation, consent, regulatory and quality review and support activities to address cGMP, state, and federal compliance needs. Taken together, these efforts support breakthroughs on the path toward healthier futures.

Wellness Comes Full Circle

All of Us Research Program

The All of Us Research Program, supported by the National Institutes of Health, is a historic effort to gather data from 1 million or more people living in the U.S. to accelerate research and improve health. Taking into account individual differences in lifestyle, environment and biology, researchers will be able to home in on precision treatments for a variety of diseases. San Diego Blood Bank is partnering with Scripps Research Translational Institute and UC San Diego to enroll participants in the local San Diego area and through blood banks across the country. CEO David Wellis is a primary investigator for the study and on the executive committee for the program.

The health of the Southern California region and the future of health for generations to come

• is helping validate a new cancer immunotherapy that shrinks the size of tumors to make them operable, and is made using a small portion of the blood donation that was once considered medical waste? • is collaborating on a research study to improve the storage quality of blood and platelets? • helps company R&D teams test new medical devices related to blood products for both clinical and research use?

• partners with UC San Diego’s Altman Clinical and Translational Research Institute to conduct studies related to diabetes, cancer, and more? • produces a product called Platelet Lysate used by researchers to, for example, to grow cells for basic and clinical research efforts to develop new therapies for age-related disorders and cancer?

• supports a researcher developing a new cell sorting chip technology that will enable researchers to isolate cells that could be used to develop new cancer immunotherapies? • collaborates with a genetics-based company that developed an assay to screen men for prostate cancer risk?

Beyond positive health outcomes, the greatest benefits to donors are sometimes intangible. Kathleen Winger is a shining example. The 29year old platelet donor found a reason to live by giving a part of herself to others. “Several years ago, I went through an incredibly devastating time when I was struggling to find a reason to stay alive,” she says. “The thought occurred to me that, although I may be useless in every other regard, as long as blood was running through my veins, I could be of help to someone in a very big way. Donating gave me a purpose for living and very quickly became my biggest passion.” Like many blood donors, Winger’s reasons for giving are simple: Because she can. Because people need it. Because saving lives is part of living her best life.

Partnering with the San Diego Blood Bank

Invest in the Future

Philanthropy fuels San Diego Blood Bank’s mission and is at the heart of everything the organization does — from funding lifesaving blood collection systems and state-ofthe-art equipment to supporting innovation in cell therapy and regenerative medicine. Financial donors are saving lives today and improving lives tomorrow. SDBB’s Grateful Patient Giving program provides grateful patients and family members an opportunity to make a gift in honor of a blood recipient or to thank a blood donor or medical professional who has made an impact. To learn more about ways to make a financial gift, contact Sherry Serio at (619) 400-8188 or sserio@sandiegobloodbank.org. Or visit SanDiegoBloodBank.org/give.

is being greatly impacted by San Diego Blood Bank. SDBB is dedicated to creating meaningful moments and supporting positive health outcomes for our entire community, including blood donors themselves. Blood donors receive a health checkup when they donate blood and can track their cholesterol, hematocrit and blood pressure in their online wellness tracker. In the future, SDBB plans to provide even more health-related data back to blood donors.

San Diego Blood Bank is proud to put the Southern California community first. Collaborations with hospital partners and physicians make it possible for donors to see the direct impact of their lifesaving gifts, and for the development of custom products and services that meet local needs. Consider partnering with SDBB by: • Referring patients who have received blood transfusions to share their story and inspire others to give. • Inquiring about custom product development and research collaborations. • Hosting a blood drive at your hospital or medical facility. Contact Claudine Van Gonka at cvangonka@sandiegobloodbank.org or (619) 400-8166. Or visit SanDiegoBloodBank.org to learn more. SAN DIEGO PHYSICIAN.ORG

C H I L D & A D O L E S C E N T D E V E LO P M E N T

The Risks of Screen Time for San Diego’s Children & Adolescents By Jamie Friedman, MD

EVERYWHERE YOU GO you will see it: people of all ages are on their phones. No, not talking on the phone — using a smartphone. Whether texting, using social media, playing games, or watching videos, smartphones have captured our attention. I see it all the time in my office, and not just the parents. Teens are getting Snapchat messages, young children are playing games, and babies and toddlers are watching videos. Yes, you read that correctly, babies and toddlers! Some of these babies are so addicted that the screams that occur when you take their screens away are earth shattering. Evidence shows that while traditional television viewing is decreasing among children, new platform use is increasing. This includes iPads and phones. In fact, 92% of

MARCH 2019

1-year-olds have used a mobile device and most 2-year-olds use a mobile device daily. But what does screen time mean for young children with developing brains? What does it mean for our teens, who need to learn how to navigate the real world as well as the virtual world? I will address both the risks and benefits of kids using screens, as well as offer suggestions for things you can do at home. Babies and Toddlers Right from birth, an infant has a rapidly growing and developing brain. Everything your baby is exposed to in their environment will shape who they become. We know that babies need three-dimensional interactive play, physical play, and direct conversation

in order to have proper cognitive, language, motor, and social-emotional development. In fact, we recommend reading to babies starting in the first months of life in order to build their vocabulary and encourage communication. Do screen time and media use help this development or hinder it? Research shows that babies younger than 24 months do not benefit from commercially available apps. Furthermore, screen use can replace essential activities like physical play, interacting with adults, reading, and sleep. There is emerging evidence, however, that babies as young as 24 months can learn words while interacting with an adult via video apps like Skype or FaceTime. The important component here is the interaction with an adult who is responding to the child’s cues.

Therefore, my recommendation is to limit, or avoid altogether, non-interactive screen use in babies. There is very little benefit, and potential harm to development, for children in this age group. Preschool Children ages 3–5 years are in a critical phase of social and language development. Free play at this age teaches children executive function, which will help them with emotional regulation, impulse control, creativity, and flexibility needed for school performance and social interactions. Independent screen use will not foster these skills. However, there is some evidence that well done apps, like the Sesame Workshop, teach literary skills and even healthy habits. Unfortunately, most all other apps are not proven to be educational, and any benefit from educational apps comes from interactions with adults. I will typically recommend playing age-appropriate games on a device with an adult so that the child gets the benefit of that interaction. The risks of screen use in this age group include obesity, decreased sleep, and language development delays. Watching television has repeatedly been shown to be associated with language delays, most likely because of decreased direct conversation with adults. Viewing inappropriate content geared toward adults is also a likely culprit in cognitive and social delays. Violent content has been associated with violent behavior, while prosocial content is associated with improved behavior. Furthermore, using screens results in less physical play, contributing to excessive weight gain, and the blue light from the screen makes it hard to initiate sleep. This means that both the act of viewing media as well as its content can have a negative impact on preschool-age children. School Age and Adolescents Children over age 8, on average, spend more than two hours watching television. Interestingly, when I ask children about TV viewing in the office, many say they don’t watch TV. However, they are still spending several hours per day on a mobile device watching YouTube videos or Netflix. I find it humorous that they don’t think this is TV but it’s a good teaching point for parents that all screen use needs to be monitored, both for quantity and quality. We know that media use is increasing among teens; threequarters own a smartphone. Furthermore,

76% use at least one social media platform. Kids and teens also use mobile devices for communicating, engaging in support groups and collaborative projects, and gaming. All of these come with risks and benefits. Even when media use is beneficial, it is still important to consider the effects of total time spent using electronic devices. Starting at an early age, media use is associated with negative health outcomes like obesity and poor sleep. Recent studies have shown that only 1.5 hours of television viewing per day is linked to obesity. This is likely multifactorial; causes include sedentary time, exposure to advertisements of junk food and media viewing while eating, which can reduce awareness of satiety cues. In addition, having a television in the bedroom has been associated with obesity. In fact, any device with a screen in the bedroom is also associated with decreased sleep. Sleep disturbance can occur with screen use right before bedtime, due to both delayed sleep as the child continues screen use and due to the emittance of blue light shutting off melatonin. Viewing violent content at bedtime is also associated with delayed sleep. Studies also show that any screen use during the delay is associated with sleep disturbance. Other risks of screen and media use in children include exposure to alcohol, smoking, and risky sexual behavior. This is true for television viewing as well as seeing this content on social media posts. In fact, social media viewing of risky behaviors, along with self-injury and disordered eating, can add to the peer pressure to participate in these activities. Long-term television use is also associated with lower self-esteem, especially in girls (black and white) and black boys. Similarly, social media use is associated with depression when there is moderate or more use. Teens can also experience issues with cyberbullying, sexting, and invasions of privacy. Media use allows children and teens to be targets of predators. Can media use be beneficial for kids and teens? Studies have shown that teens will use social media to form and maintain friendships. Many even benefit from finding groups to help them form their identity or find support. This is especially true for teens who are struggling with a disability, medical diagnosis, or their sexual identity. Most teens will also use the internet to learn new ideas, do research for school, and enhance their interests. Because teens spend so much time online, doctors

interested in social media (like me) play a big role in providing accurate and important health information, which can help them make healthy choices. How Can Parents Help? The American Academy of Pediatrics recommends no media viewing for children under 18 months. For children 18–24 months, interactive video chatting is acceptable and can help children learn language and form connections with family members. Children 2–5 years should have screen time limited to no more than one hour per day, and parents should be sure the content is high quality. Children in this age group will benefit most from co-viewing apps and programs with an adult who can explain to them what they are watching or learning. Young children should avoid violent and fast-paced content, and parents should avoid using screens to calm their children. Screens can sometimes come in handy like while traveling or at the doctor’s office, but as I stated at the beginning of this article, removing the device often results in a meltdown. Make sure to be very clear about the rules of using a device. For older children and teens, parents should monitor what their child is viewing, discuss privacy issues, and educate them on cyberbullying. Limits should be enforced so that screen time does not replace homework, reading, chores, or sleep. The AAP recommends having screenfree meals, zones in the home and times of the day. All screens should be off 30–60 minutes before bedtime. Pediatricians recommend that parents have a media/screen use contract with their kids. State the rules of use clearly and be sure to follow through with consequences if the rules are broken. Have expectations that homework, chores, and other activities like sports come first — and again, no screens at bedtime. With open communication and careful monitoring, kids can benefit from the connectedness of having a device. All data is directly from the American Academy of Pediatrics. No other sources were used.

Dr. Friedman is a pediatrician with Children’s Primary Care Medical Group. She is the lead physician of her office in 4S Ranch and a member of the Board of Directors for CPCMG. Dr. Friedman sits on the American Academy of Pediatrics’ Council on Communications and Media, and is an official spokesperson for the AAP. SAN DIEGO PHYSICIAN.ORG

CYBERSECU RIT Y

Be Cyber Aware to Be Cyber Secure By Christopher A. Longhurst, MD, MS

AS A PRACTICING PEDIATRICIAN and chief information officer at UC San Diego Health, I am well aware of the impact technology has had on our individual practices, clinics, hospitals, and health systems. With increasing use of mobile devices and computers in our industry, we have unprecedented access to technology and tools that have allowed us to make improvements in the delivery of safe and effective care to our patients.1 But this technology has also opened us up to greater cyber-based risk. According to a recent report from the Department of Health and Human Services (HHS), four out of five U.S. physicians have experienced some form of a cybersecurity attack2, and the cost to the industry was nearly $408 per breached record in 2018.2 Yet these statistics do not reflect the harm to our own (or our organization’s) reputation,

MARCH 2019

as well as the potential health risks to our patients! Unfortunately, cybersecurity threats are all too common and are becoming more sophisticated every day. The same HHS report identified five key threats2 in our industry: • Email phishing, which is an attempt using email to trick you into disclosing your password or credentials to access your systems • Ransomware, or malware (malicious software) used to deny access to your own or your organization’s data until a ransom is paid • Loss or theft of equipment that may contain sensitive data • Accidental or intentional data loss • Attacks against connected medical devices that can put the health and safety of patients at risk

Safeguarding against these threats is not solely an issue for your IT team; it’s something we as physicians need to consider as part of our day-to-day activities. Whether you work in a small clinic or a multi-location health system, the first step to becoming more cybersecure is understanding how we can safeguard protected health information (PHI), while ensuring easy access to those who have a need to know, including our patients. Here are five tips to bear in mind: • Make it a priority to become more cyber-aware. Get trained in cybersecurity best practices. Create and use secure passwords. Be more discerning when opening emails, links, or attachments that may be hiding malware designed to get access to your network or that try to trick you into revealing your password. • Be aware of where PHI is kept at your workplace, who has access to it, and how it is protected. For instance, interoperability increasingly allows us to electronically share our notes with other providers — contributing to a holistic view of patient care. While this technology has made this transfer of PHI easier, following the policies and procedures at your workplace to encrypt, secure, and manage patient data appropriately can help reduce the risk of inappropriate access. • Make cybersecurity an integral part of your workflow and culture. This may include creating alerts in your electronic health record (EHR) system to proactively thwart actions that can lead to a breach, for example. • Keep your computing systems up to date. Some breaches may not be due to nefarious hackers; sometimes they occur due to poorly managed systems or user error. Taking the time to ensure that your software has been upgraded or patched to the latest operating system or version, and has been tested, can help keep patient data secure. • If you offer an electronic patient portal, encourage patients to use this option to communicate electronically with your office. Remind them that they are responsible for managing and protecting the data they keep. If they use a thirdparty application to track their health information on a mobile device, for example, they should review the policies and procedures of the app to understand how it protects and shares their data.3 Cybersecurity threats in healthcare are very real. Understanding your organization’s

According to a recent report from the Department of Health and Human Services, four out of five U.S. physicians have experienced some form of a cybersecurity attack, and the cost to the industry was nearly $408 per breached record in 2018. efforts to protect PHI, making important investments in healthcare cybersecurity tools, or even partnering with larger health systems to use electronic health records that have established cybersecurity controls can go a long way in protecting you, your organization, and your patients. This article was written in collaboration with UC San Diego Health’s Ken Wottge, director of information security, and Marissa J. Ventura, communications lead for Information Services. Dr. Longhurst is CIO and associate CMO of UC San Diego Health and a clinical professor of pediatrics and biomedical informatics. References: 1. Sitapati A, Clay B, Millen M. Why Doctors Love Their Computers. November 2018. https://cio.ucop.edu/why-doctors-love-their-computers/ 2. Health and Human Services. Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients. December 2018. https://www.phe.gov/ Preparedness/planning/405d/Documents/HICP-Main-508.pdf 3. Neinstein A, Longhurst CA. Empowering UC Health Patients with Apple Health Records. January 2018. https:// cio.ucop.edu/empowering-uc-healthpatients-with-apple-health-records/

PLACE YOUR AD HERE Contact Dari Pebdani at 858-231-1231 or DPebdani@SDCMS.org SAN DIEGO PHYSICIAN.ORG

COMMUNIT Y SERVICE

CMA’s Foundation New Name, New Staff, and an Aggressive New Agenda By James T. Hay, MD

PHC It’s not your mother’s CMA Foundation. We’ve got a new name (Physicians for a Healthy California), a new CEO, a revamped board, a growing staff, and an exciting new set of multimillion dollar projects that puts CMA and its physicians right at the front of the effort to address health access and disparity issues in our state. Check out our website www.PHCDOCS. org to watch our progress and for more detail. This report is a summary of what’s happening. Notice how well our projects fit our mission statement adopted over a year ago: “PHC is dedicated to improving com-

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munity health, growing a diverse physician workforce, and promoting health equity.” PROP 56 CMA led a coalition of parties to create and pass the tobacco tax initiative and included in it two provisions for the use of funds raised that will fuel our efforts: expanding California graduate medical education (GME) residency programs and helping pay down student loan debts for physicians serving the underserved. GME Recognizing the desperate need to train

more physicians in California, thereby keeping more of them in-state, Prop 56 allocated $40 million a year to fund new residencies, mostly those in primary care and emergency medicine. Where there are great needs, other specialties can be included as well. In cooperation with the University of California, CMA negotiated a management agreement for these funds to be administered by PHC. The priorities for granting them are clearly outlined in the initiative and include a preference for new residency positions in underserved areas. The first round of applications has already been received and the fruits of the effort will be realized by entering residents in 2019. One hundred and thirtyone programs requested $147 million to expand their numbers. With $38 million available ($2 million for administration), it is clear there is an even greater need in California than we can answer. In fact, PHC is awarding $38 million to 73 residency programs supporting 156 residents. Looking ahead, CMA was successful in encouraging the new governor to include at least this much funding in his first budget as an ongoing appropriation. LRP Prop 56 also allocated $220 million over five years to assist physicians and dentists ($30 million for dentists) serving the underserved who have student loan debts to encourage them to practice in California serving Medi-Cal beneficiaries. The Loan Repayment Program (LRP) payments will be made to applicants who are accepted over a five-year period, so the program actually extends to 10 years to assist those chosen in the fifth year. This program isn’t quite ready to accept applications as of this writing, but probably will be by the time you read this. We expect to open the application cycle in April. Please check the website for updates. Once again, and mostly unrelated to the GME program, PHC was selected to administer the LRP. Clearly it supports our mission of growing a diverse physician workforce and promoting health equity. NEPO The Network of Ethnic Physician Organizations continues to be one of PHC’s longest and most important projects. Summits each fall for the past 16 years

bring together physicians from all over the state to learn about and address issues important to a diverse patient population not always receiving as much attention as other issues. PHC and NEPO leaders are also working to coordinate year-round activities these organizations do to promote population health. All physicians, PAs, NPs, etc. are invited to attend the next summit Aug. 23 and 24 in Pasadena. Watch for the announcement. Wellness While CMA and Stanford University have created a new organization to assist physicians, physician groups, and medical staffs to promote wellness and avoid burnout, PHC has recently completed a study funded by the Physicians’ Foundation to investigate the issues leading to burnout in ethnic women physicians. With a very large response to a scientifi-

cally validated survey, and with 4 regional focus groups, NEPO and PHC have added to the data needed to address this epidemic in one part of the American physician workforce. Look for our published report when it becomes available. AWARE Starting in 2000, the CMA Foundation launched the Alliance Working for Antibiotic Resistance Education (AWARE) program. One of PHC’s longest running projects, it is still valuable enough to continue attracting funding to educate the public and our physicians about the risks of antibiotic overprescribing. Wild Fires PHC has been the vehicle for receiving and distributing contributions made to assist physicians and their families who lost their homes and offices in the past two

years’ wildfires. An application process for the more recent ones will be announced soon. The Future PHC is totally immersed in implementing its two new multimillion dollar programs, but within this year will look to our future and consider other ways this “public health arm” of the CMA can fulfill its mission and make California a healthier place for all. Please feel free to contact me with any feedback. I hope you are as excited as we are about your “Foundation.” Dr. Hay is a practicing family physician in Encinitas for more than 40 years, current chair of the Board for Physicians for a Healthy California, a former president of SDCMS (2001) and CMA (2012), and a former president of Champions for Health.

YOU’RE A DOCTOR, NOT A COLLECTION AGENCY CAP’s FREE New Guide Lets You Focus More on Medicine and Less on Billing Request your free copy today: 800-356-5672 CAPphysicians.com/SDBG1 The Cooperative of American Physicians (CAP) provides California’s finest physicians with superior medical malpractice coverage and supplemental benefits. The Physician’s Action Guide to Smarter Billing is just one of the many benefits.

Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.

SAN DIEGO PHYSICIAN.ORG

C H A M P I O N S F O R H E A LT H

Ear, Nose, and Throat = Joyful Hearts By Adama Dyoniziak

WHEN TALKING WITH Dr. Moses Salgado and Dr. Hernan Goldsztein of Pacific ENT Medical Group about their volunteer time with Project Access patients, their specialty is clear: They are all ears, they get the answer on the nose, and we are left with feelings of joy and a lump in our throat. Dr. Salgado was born and raised in San Diego and the first in his family to attend college. When it came time to apply to medical school, he refused to listen to naysayers and never gave up. Now as a surgeon, he loves doing what makes him happy: helping people and working with his hands. Dr. Salgado fondly remembers starting his volunteer time at Scripps Memorial Hospital, later in medical school at a free medical clinic in Sacramento, and especially performing cleft lip and palate surgeries in the Philippines and Africa, as the most rewarding experiences of his career. He wanted to continue that effort in his hometown of San Diego through Project Access. “When Project Access approached me, I was more than happy to get on board,” Dr. Salgado says. “Providing medical care to patients who don’t have access is very important to me. My most memorable experience thus far was the excitement that a Project Access patient had after I removed a large facial mass and everything went well. That euphoric feeling stays with you.” Dr. Salgado credits his ability to do this

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work to his amazing wife and three daughters, ages 5 years, 3 years, and 10 months old, who are central to his life. While he serenades them with his guitar or ukulele, he dreams of eventually returning to some of his passions: scuba diving and flying sailplanes. Dr. Goldsztein has also been on the move all his life: from Argentina to Aruba to Boston to San Diego. His passion for soccer has led him to play for the U.S. Men’s Medical Soccer Team in the World Cup for Physicians in Austria and the Czech Republic. Dr. Goldsztein is a third-generation ENT who loves the combination of clinical and surgical practice. He gets to establish a long-term relationship with a patient and also have the immediate results with surgery which changes people’s lives. His first volunteer stint was in his homeland of Argentina after terrorist attacks. He wanted to be involved in whatever way possible, even in high school. During his medical training and residency, he volunteered in Cambodia and Peru doing cochlear implants. “As a practicing physician, volunteering for Project Access is perfect,” Dr. Goldsztein says. “There is so much unmet need in San Diego. The process is simple. You receive medical information in advance to optimize the patient and physician time during consultations. You get to provide state-of-the-art care in top-notch hospitals. I still receive Christmas cards from

Project Access patients I had years ago. It is so rewarding to transform people’s lives.” One of Dr. Goldsztein’s most recent Project Access patients is Sylvia M. “When I saw Dr. Goldsztein, he told me it was born in him, this purpose that he had (to help others),” Sylvia says. “Since that day, I blessed Dr. Goldsztein. And it gives me great joy that there are still such good people. And I ask God that we are never missing those kind of people who give with their donations or with their work, it’s something very beautiful.” According to Dr Goldsztein, there was complex decision-making in her care, with multiple discussions to understand all available options. Sylvia made a decision she was comfortable with on how to proceed due to this patient-centered, caring interaction with her team of physicians (including Dr. Moses Salgado, ENT, Dr. Danielle Weiss, endocrinologist, and Dr. Cynthia Davis, ENT). Aidé, Sylvia’s daughter, adds, “The doctor explained it very well. We were worried. But then after the surgery and how fast she recovered, thanks to the attention she received with Project Access, the worries ended — because without Project Access we wouldn’t have been able to do anything about her condition. I don’t have the words to express for so much help.” Sylvia has been able to go on with her life and enjoy it even more, especially when playing with her many grandchildren. A person is more than their ears, nose, or throat, and the doctors at Pacific ENT Medical Group have known this long before they became physicians. These doctors listen, they work with their patients to get to the best solution, and both patient and doctor get to feel the joy that better health brings. If you who would like to volunteer with Champions for Health to provide pro bono specialty care for Project Access San Diego, or to be a presenter in our Speaker’s Bureau, please contact Adama Dyoniziak at (858) 300-2780 or adama.dyoniziak@championsfh.org. Ms. Dyoniziak is executive director of Champions for Health.

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

What’s in a Name? By Helane Fronek, MD, FACP, FACPh

gloss over its unique nature with a generalized term. How many things in our life do we fail to really see, simply because we think we already know them, having seen them before? Throughout our lives, we actually assume many different names. Each can act as a beacon, illuminating what we might aspire to. Colleague, mentor, and doctor all imply a role we play in someone’s life and can inspire us to live into its meaning. I was named for my paternal grandfather, a humble, honest and hard-working man. On his deathbed, he told his children, “I don’t leave you much, but what I leave you is a good name.” As his namesake, I felt the torch had been passed to me to “leave a good name.” Honesty and integrity became

Colleague, mentor, and doctor all imply a role we play in someone’s life and can inspire us to live into its meaning.

IT’S NOT UNCOMMON for people to be confused by my name. Helen, Elaine, Helena — those are understandable names. Somehow, mine is not. It gives me cause to wonder when I’m addressed by the wrong name. Is it the person’s lack of attention to detail, difficulty hearing, or simply the natural way we tend to see or hear only what we’re used to? When someone gets my name right, it matters to me. It signals that I am worth acknowledging, perhaps even getting to know. Certainly, patients notice. Nothing says “you don’t matter” more than not knowing a patient’s name. If we want to develop rapport and trust, we’re wise to spend a moment clarifying our patients’ names. Yet poet David Whyte cautions us not to name things too soon. When we begin a re-

lationship, program, or adventure, we often want to define it before allowing time to discover how it may expand or contract around us and what treasures might be waiting for us. Names may also diminish complexity and deny the importance and richness of nuance in our lives. During the 2016 presidential campaign, nicknames given to many candidates prevented us from gaining an accurate appreciation of their true potential, as they were instantly reduced to someone of “low energy” or short stature. In fact, each morning in Byron Katie’s School for the Work, participants walk through the grounds and assign a new name to what they see. A bush might become a turkey, a walkway might be called an airplane. It’s fascinating how we begin to see each thing anew when we refuse to

core values that guided my decision making and provided the courage to make difficult choices and hold difficult conversations. Just as my grandfather’s name served to guide me, we can employ the power of names as we go through life. As an introductory exercise, I often ask my clients to imagine that it is 20 years in the future and someone is giving a speech about them. What would they like the person to say? We can all ask ourselves: What would we like to be known for? How will we act, and what decisions will we make, if we want this to be our name? Dr. Fronek, SDCMS-CMA 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. SAN DIEGO PHYSICIAN.ORG

CLASSIFIEDS PHYSICIAN OPPORTUNITIES IMPERIAL RADIOLOGY - RADIOLOGIST NEEDED: Our Facility is an outpatient Diagnostic facility located in Imperial, CA and we are in search of a Part-Time/ Full-Time Radiologist. All candidates must have an active California Medical License. Pay to be determined. Please contact us at info@carlsbadimaging.com if this job is of interest to you. FAMILY MEDICINE PHYSICIANS NEEDED: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners. We currently have full-time openings in our Ramona and Valley Center locations (solo practices). Current CA and DEA licenses required. Must be BC/BE. Conduct medical diagnosis and treatment of patients in an outpatient setting. Bilingual in English/Spanish helpful. We offer a competitive compensation and benefit package including malpractice coverage and shareholder opportunity. Check out a full list of our benefits under Careers at www.graybill.org. Send CVs to ssnodgrass@graybill.org, apply online, or fax (760)738-7101.

OUTPATIENT PRIMARY CARE OPPORTUNITY San Diego Internal Medicine Associates (SDIMA) is looking for a strong MD candidate to join our 6 physicians and 6 physician assistants in providing excellent care in a private practice setting. SDIMA is a well-established office with board certified internists and med/peds physicians. No hospital call. Please send your CV, or any questions you may have to Jared.Kowerski@SDIMA.com.

FAMILY PRACTICE/INTERNAL MEDICINE PHYSICIAN NEEDED: Our company is looking for a board certified primary care physician. Time will be split between our La Mesa and National City locations. Hours are 8-5 Monday – Friday no night calls or weekend. Please email your CV to lara.encompass@gmail.com. CARDIOLOGIST POSITION AVAILABLE: Seeking a cardiologist to work part-time in an outpatient cardiology practice in North San Diego County. Practice opportunities from Mon.-Friday. Hours are from 8 to 5 p.m. There is no night calls, or holidays work days. The contracted cardiologist would decide from the days available which days to work. Please fax resume to 760.510.1811 or via e-mail at evelynochoa2013@yahoo.com. FAMILY PRACTICE MD/DO: Family Practice MD/DO wanted for urgent care and family practice office in Carlsbad, CA. Flexible weekday and weekend shifts available for family practice physician at busy, wellestablished office. FAX or email CV to (760) 603-7719 or gcwakeman@sbcglobal.net. PRACTICE OPPORTUNITY: Internal Medicine and Family Practice. SharpCare Medical Group, a Sharp HealthCare-affiliated practice, is looking for physicians for our San Diego County practice sites. SharpCare is a primary care, foundation model (employed physicians) practice focused on local community referrals, the Patient Centered Medical Home model, and ease of access for patients. Competitive compensation and benefits package with quality incentives. Bilingual preferred but not required. Board certified or eligible requirement. For more info visit www.sharp.com/ sharpcare/ or email interest and CV to glenn.chong@ sharp.com. FAMILY PRACTICE/INTERNAL MEDICINE PHYSICIAN NEEDED: Primary care physician wanted for established private practice in San Diego. La Jolla Village Family Medical Group has been caring for patients of all ages for 29 years in the UTC/La Jolla area of San Diego. We provide comprehensive preventive medicine, illness management, travel medicine, sports medicine, evidence-based chiropractic care, weight management, and more. Call responsibilities minor,

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hours consistent with a healthy work/life balance. Our office is modern, clean, and well appointed. Our staff is supportive, cohesive, and friendly. This a real family practice. Board-certified, California licensed MD and DO physicians who are passionate about medicine and interested in this opportunity should send their CV and cover letter addressed to Tricia at officemanager@ ljvfmg.com. Let us grow your practice according to your unique specialty interests and style. Responsibilities include: Provide excellent care, become part of a cohesive team, light call, maintain accurate and detailed medical records using EHR, comply with all laws applicable to family practice/internal medicine, including HIPAA, recommend lifestyle changes as appropriate to improve quality of life, Full-time, Part-time. (Posted 8/16/2018) PHYSICIAN NEEDED: Family Practice MD. San Ysidro Health is looking for an MD for our Family Practice center. The Family Practice MD manages and provides acute, chronic, preventive, curative and rehabilitative medical care to patients and determines appropriate regimen in specialized areas such as family practice, prenatal OB/GYN, pediatrics and internal medicine. Bilingual preferred but not required. Medical school graduate, CPR, CA MD and DEA License, board certified or eligible in primary care specialty. For more info on San Ysidro Health, visit: http://www.syhealth.org/ If interested, please email CV to Meagan.underwood@ syhealth.org. DERMATOLOGIST NEEDED: Premier dermatology practice in beautiful San Diego seeking a full-time/ part-time BC or BE eligible Dermatologist to join our team. Existing practice taking over another busy practice and looking for a lead physician. This is a significant opportunity for a motivated physician to take over a thriving patient base. Work with two energetic dermatologists and a highly trained staff in a positive work environment. We care about our patients and treat our staff like family. Opportunity to do medical, cosmetic and surgical dermatology (including MOHs) in a medical office with state of the art tools and instruments. Please call Practice Administrator at (858) 761-7362 or email jmaas12@hotmail.com for more information.

SURGEONS NEEDED FOR EXPANDING NATIONWIDE SURGICAL PRACTICE FT/PT positions available. Competitive pay and flexible schedule with complete autonomy. Add revenue to your current practice. For more information, contact us: P: 1-877-878-3289 F: 1-877-817-3227 or email CV to: JOBS@ADVANTAGEWOUNDCARE.ORG www.AdvantageWoundCare.org

OUTPATIENT PRIMARY CARE OPPORTUNITY: San Diego Internal Medicine Associates (SDIMA) is looking for a strong MD candidate to join our 6 physicians and 6 physician assistants in providing excellent care in a private practice setting. SDIMA is a well-established office with board certified internists and med/peds physicians. No hospital call. Please send your CV, or any questions you may have to Jared.Kowerski@SDIMA.com. PRACTICE FOR SALE INTERNAL MEDICINE PRACTICE OPPORTUNITY: Internal Medicine practice in North San Diego County, Tri-City community, established for over forty years, available for full or part-time physician. This practice has an established EMR system, exceptional office staff and shares overhead with five other Internists. Inpatient activity available at your option. Please email:jalafata@ aol.com, or call North County Internal Medicine at 760726-2180. (Posted 1/14/2019). RHEUMATOLOGY SOUTH SAN DIEGO MEDICAL PRACTICE FOR SALE: Located in Chula Vista and has been in existence for >30 years. Established patient base and excellent insurance contracts including HMOs, PPOs, and Medicare with rates that have been negotiated over

years. Gross collections >$450,000 with low overhead. Asking for $10,000 for medical records to be transferred and equipment. Would also ask that lease be taken until June 4, 2020 or you can negotiate longer with the manager of the building. Long term trained staff and Electronic Medical Record, which could be kept in place if needed. For immediate consideration, forward your details including your contact phone or email to: info@sdrheumatology.com. Run your own practice with potential earnings above and beyond an employed position without the bureaucracy and make your own schedule! (Posted 11/15/2018) HIGHLY PROFITABLE MEDSPA NOW AVAILABLE TO LICENSED PHYSICIAN: Southern California | Asking Price: $1,050,000 | Cash Flow: $410,419 | This profitable and expandable company performs non-invasive cosmetic procedures, including dermal fillers, Botox, and laser treatments. Experienced staff plans to stay, and protects current physician/owner at 30 hours/week max. If you’re ready to see online financials, a studio-quality video of their story, an industry-leading assessment, and more – visit: https://goexio.com/med-spa-landing-sd for a summary. Interested? Click on “Private Access” to sign an instant nondisclosure and unlock the entire story. Full financials available on request. Prefer a personal touch? Contact Doug Miller: (208) 762-3451. doug.miller@goexio.com. PRACTICE AVAILABLE IN EL CAJON: Mature board certified Family physicians grossing $ 1 million per year are selling this practice in El Cajon, California. This is a busy practice , on the Allscripts EHR in a busy neighborhood and contracted with local IPAs. I will lease the 1500 sqft office condo to you as well. Send an inquiry to Dennis O Dominguez dd489583@gmail.com or send text to 619 2464548 and I will call you. PRACTICES WANTED PRIMARY OR URGENT CARE PRACTICE WANTED: Looking for independent primary or urgent care practices interested in joining or selling to a larger group. We could explore a purchase, partnership, and/ or other business relationship with you. We have a track record in creating attractive lifestyle options for our medical providers and will do our best to tailor a situation that addresses your need. Please call (858) 832-2007. PRIMARY CARE PRACTICE WANTED: I am looking for a retiring physician in an established Family Medicine or Internal Medicine practice who wants to transfer the patient base. Please call (858) 257-7050. OFFICE SPACE / REAL ESTATE AVAILABLE

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE FOR 2-3 DAYS PER WEEK

In the 4520 Executive Drive bldg. Excellent location between I-5 and I-805 . Beautiful renovated office space with 2 exam rooms and large physicians office for consultations. Ideal for Vein and vascular, primary care, pain management, physical therapy, rheumatology, infectious disease, dermatology, orthopedics. Interested parties, please email missyphilip@gmail.com

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE FOR 2-3 DAYS PER WEEK: In the 4520 Executive Drive bldg.. Excellent location between I-5 and I-805. Beautiful renovated office space with 2 exam rooms and large physician’s office for consultations. Ideal for Vein and vascular, primary care, pain management, physical therapy, rheumatology, infectious disease, dermatology, orthopedics. Interested parties, please email missyphilip@gmail.com ENCINITAS OFFICE SPACE TO SHARE/SUBLEASE: Longstanding (38 years) allergist in Encinitas has a 3000 square foot office space available to share/ sublease. Six exam rooms and a permanent private office/consultation room. Office is available Tuesday morning and all day Wednesdays and Fridays. Office located on El Camino Real in Encinitas.Please contact wwpleskow@sbcglobal.net or call 760-436-3988.

MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in a small boutique office space located close to Moonlight Beach in Encinitas. First floor with 570 square feet and peek ocean views. Available February 1st. Physician/Dentist parking spot comes with lease and lease would be until December 31, 2020. Sinks in 2 exam rooms, office space for physician/dentist and laboratory storage area in addition to lobby/reception area. Asking: $2,000/ month. Terms are negotiable. This will rent fast so hurry! Please contact: dana@sdrheumatology.com | (858) 6032068. (Posted 11/18/2018)

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp Memorial and Rady Children’s hospitals. Suites ranging from 1,300-5,000 SF. For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org

small boutique office space located in the center of “Hillcrest/Bankers Hill”. Just renovated! The second story of this beautiful two story building is available for lease. A private gated entrance leads to a 1,139 square foot upstairs with 4 to 5 consultation rooms, waiting room with adjoining private deck and full bathroom. Additional security gate and mailbox. Separate address. Wood floors, refinished windows, natural light, quiet street, walkable to restaurants. On-site parking with up to 8 parking spaces available! Asking: $3,000/month. Terms are negotiable. This will rent fast so hurry! CLICK HERE for photos. Please contact: hillcrestofficerental@ gmail.com | (858) 775-5075

medically complex seniors. You must have experience providing medical care in Internal Medicine. In addition you need a DEA number, have familiarity prescribing Schedule II-V medications, be able to provide office gynecology, provide Tehehealth visits and perform basic dermatology procedures. Other duties may apply as deemed necessary. Spanish and/or experience with eClinicalWorks is a plus. Benefits include vesting into a 401k profit sharing retirement plan. Our office is located directly across the street from Scripps Mercy Hospital in the prestigious Mercy Building and we are staffed by two Internists and 8 additional staff. Salary $95,000$120,000 annually. Contact docpaul@sdmedgroup.com.

MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in an office space with other medical offices located in downtown Chula Vista close to Scripps Chula Vista hospital. First floor with ~1000 square feet. Available January 1st. 2 physician/dentist parking spots comes with lease and lease would be until June 4, 2020 or longer should you negotiate with the building manager. Sinks in 3 exam rooms, office space for physician/ dentist, bathroom, and laboratory area or additional exam room in addition to lobby/reception area. There is a long term subleasor on Fridays, so rent could be lower if you are willing to keep the subleasor, but asking: $2,000/month. Terms are negotiable. Please contact: dana@sdrheumatology.com | (858) 603-2068.

MEDICAL OFFICE MANAGER/CONTRACTS/BILLING PERSON: MD specialist leaving group practice, looking to reestablish solo private practice. Need assistance reactivating payer contracts, including Medicare. If you have that skill, contact ljmedoffice@yahoo.com. I’m looking for a project bid. Be prepared to discuss prior experience, your hourly charge, estimated hours involved. May lead to additional work.

OFFICE SPACE / REAL ESTATE WANTED SHARED OFFICE SPACE: Office Space, beautifully decordated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist. Please call 619-606-3046. OFFICE SPACE/REAL ESTATE AVAILABLE: Scripps Encinitas Campus Office, 320 Santa Fe Drive, Suite LL4 It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and ½ mile from Swami’s Beach. Contact Kristi or Myra 760-753-8413. View Space on Website:www.eisenhauerobgyn.com. Looking for compatible practice types. OFFICE SPACE AVAILABLE: 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 1-5 and 1-805. Multidisciplinary group and available to any specialty. Note we are in great need of a psychiatrist. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for Sofia or call Dr. Shurman, (858) 344-9024. (Posted 8/10/2018) OFFICE SPACE FOR RENT: Multiple exam rooms in newer, remodeled office near Alvarado Hospital and SDSU. Convenient freeway access and ample parking. Price based on useage. Contact Jo Turner (619) 7334068 or jo@siosd.com. SHARED OFFICE SPACE AVAILABLE: Established orthopedic group seeks additional orthopedic surgeon for partnership or overhead sharing opportunity. Our office is centrally located in Kearny Mesa near Highway 163 and Balboa, easy access to freeways, affiliations with Sharp, Scripps. Extensive referral base, EMR/”paperlight” office, experienced MA/surgery scheduler/ referral coordinator. Please call Terry Sanchez, practice administrator, at (858) 278-8300 or email tsanchez@ synergysmg.com. (posted 11/19/2018) SCRIPPS ENCINITAS CAMPUS OFFICE: 320 Santa Fe Drive, Suite LL4 It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and ½ mile from Swami’s Beach. Contact Kristi or Myra (760) 753-8413. View Space on Website: www.eisenhauerobgyn.com. Looking for compatible practice types. (Posted 4/4/2018) MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in a

MEDICAL OFFICE SPACE SUBLET DESIRED NEAR SCRIPPS MEMORIAL LA JOLLA: Specialist physician leaving group practice, reestablishing solo practice seeks office space Ximed building, Poole building, or nearby. Less than full-time. Need procedure room. Possible interest in using your existing billing, staff, equipment, or could be completely separate. If interested, please contact me at ljmedoffice@yahoo.com. MEDICAL EQUIPMENT/FURNITURE FOR SALE HIGH TECH FACIAL IMAGING FOR SALE: New Reveal® Imager for sale. Ideal for MedSpa or cosmetic practice. The Reveal® Imager clearly demonstrates sun damage, brown spots, red areas and more. Create a personalized printed treatment record for the patient. Contact info@restoresdplasticsurgery.com or 858-2242281 if interested. MEDICAL EQUIPMENT AVAILABLE FOR DONATION: Carlsbad Imaging has medical equipment available for donation. Afinion HbA1c-Used, Siemens clinitek status+-Used, FastPack-Used. Please contact info@ carlsbadimaging.com if interested. (Posted 8/16/2018)

SEEKING PART-TIME FM AND UROLOGY PHYSICIAN ASSISTANT/NURSE PRACTIONER: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners. The PA or NP will provide direct, in office patient care; this will include examination and treatment of patients and completion of all necessary paperwork. We currently have a FM part-time opening in our Ramona office and a part-time Urology opening in Escondido. The Urology position is 2 days per week; preferably Mondays & Thursdays 8 am - 5 pm. Prior Urology experience highly preferred. Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Comfortable working independently. Bilingual in English/Spanish helpful. Send CVs to ssnodgrass@graybill.org or apply online at www.graybill. org, or fax (760)738-7101. SEEKING CARDIOLOGY PHYSICIAN ASSISTANT/ NURSE PRACTIONER: Graybill Medical Group is one of North San Diego County’s largest independent multispecialty groups with over 80+ physicians and advanced practitioners. We are looking for a Cardiology PA/NP to provide direct, in office patient care M-F, 8am-5pm in our Escondido office. Requirements will include examination and treatment of patients and completion of all necessary paperwork. Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Prior experience in Cardiology highly preferred. Bilingual in English/Spanish helpful. Send CVs to ssnodgrass@ graybill.org or apply online at www.graybill.org, or fax (760)738-7101. PRODUCTS / SERVICES OFFERED

NON-PHYSICIAN POSITIONS AVAILABLE POSITION AVAILABLE: This patient centered medical practice requires a skilled and professional individual with exceptional empathy, integrity, maturity and passion for patient care. You must have 5+ years of experience in the field as either an MA or LVN and be comfortable with front and back office work, be able to perform blood draws and injections, understand how to verify insurance, obtain prior authorizations, collect copays and balances. You are driven, diligent, organized, efficient, a clear communicator, honest and constantly wanting to improve. Please submit a detailed resume and 3 references from your last three positions to 92024medical@gmail.com. (Posted 11/19/18) PART-TIME, REMOTE MEDICAL CODING AND DATA ENTRY POSITION: Part-time, remote medical coding and data entry position available. All work is done remotely by logging into our EMR eclinical works. ICD-10 medical coding experience and familiarity with risk-adjusted diagnosis codes required. Experience with eclinical works a plus. Potential to increase work to fulltime possible. Please submit a letter of interest and your resume to docpaul@sdmedgroup.com. (Posted 11/19/18) NON-MEDICAL PROVIDER WANTED: San Diego Medical Group is a well-established and busy Internal Medicine practice. We seek an experienced NP to work independently as a primary care provider for our current NP’s patient panel who plans to leave the practice after 10 years for family needs. Work hours are Monday through Friday 7:30/8:30 AM to 4:30/5:30 PM. There is no call. After hours remote preparation for clinics and maintaining desktop duties (labs, imaging reports, consult notes, patient emessages, etc.) is required. Applicants must have prior experience in this capacity and be able to assume responsibility for patient care immediately. Patients range from healthy adults to

CLASSICS OF MEDICINE LIBRARY AVAILABLE: The Friends of the San Diego Public Library are in search of a good home for a Classics of Medicine Library [Gryphon Edition]. These collectible volumes are leatherbound, facsimile reprints of classics from Hippocrates and Galen, through Virchow, Lister, and Jenner. The books are BEAUTIFUL! This particular collection contains 60 titles in total, all in like-new condition. A full list is available upon request. We are asking $550 and would prefer to sell them as a complete set. 100% of proceeds from our book sales support the programs and collections of the San Diego Public Library. Please call Lisa Heinz at (619) 572-1274 or email lis_heinz@hotmail. com for more information. DATA MANAGEMENT, ANALYTICS AND REPORTING: Rudolphia Consulting has many years of experience working with clinicians in the Healthcare industry to develop and implement processes required to meet the demanding quality standards in one of the most complex and regulated industries. Services include: Data management using advanced software tools, Use of advanced analytical tools to measure quality and process-related outcomes and establish benchmarks, and the production of automated reporting. (619) 913-7568 | info@rudolphia.consulting | www.rudolphia. consulting A VALUABLE EDUCATIONAL RESOURCE: Extensive Medical Articles File for sale. Charts, illustrations, articles. Emphasis on Emergency Medicine and Internal Medicine. Collected since 1973. Fills a large filing cabinet. (Cabinet not included.) Would make a useful gift for a medical student or resident. Best offer takes. Will accept offers for 30 days after the publication of this newsletter. View in person at a North County location by appointment. (858) 451-6517

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POE TRY AN D M EDICIN E

Temporary (Like a Dog) By Daniel J. Bressler, MD, FACP

CONTEMPLATING DEATH has a long philosophical tradition. In the Maranassati Sutta, Buddha taught that it was the ultimate meditation. Plato, in The Phaedo, called it the very basis of wisdom. Renaissance painters would remind the viewer of the lurking presence of mortality by posing a skull in an otherwise beautiful setting, such as in the Still Life with Crystal Ball (1625) by Pieter Claesz seen above. Aging and mortality are constant houseguests in a long-term primary care medical practice such as the one I’ve been part of for the past 35 years. Inevitably many of my beloved patients have sickened and died. The frayed telomeres, the scarred conduction system, the thinning aneurysm, or the tired immune system trigger some final, fatal event. Ecologists are fond of saying “nature bats last.” In medicine we might say that time bats last. In the long run, our best efforts at prevention and treatment are doomed to failure. Medicinal interventions are, at most, a series of delaying tactics. A cure, seen in this gloomy light, is “nothing more” than a setup for the next crisis, and doctors are merely comic relief artists in the grand tragedy of life. Speaking of comic relief artists, how can I not mention Izzy, the 31-pound dachshund-cattle dog mix who has been my constant companion for the past eight years, both in and out of the clinic? He is a proudly uncertified service dog, a stoic listener, a meditation teacher, a snoring metronome and an effective foot warmer on cold nights. His whiskers, like mine, are gray now. We, like my 94-year-old father, like every one of my adult patients, are growing old together and apart.

MARCH 2019

Temporary (Like a Dog) Everything is temporary. That dogs age seven times as fast as we do Simply brings that fact into high relief. When we got you at 2, you became my second teenage son At 5, you were my junior colleague in the office At 8 years and 8 months, (according the the graph I drew) We celebrated turning 60 together Now, at 10, you are my wizened confidant. You can still make it onto the high master bed Although now, it’s front paws up and then a scramble Your hind legs tearing at the quilt during your ascent. I am eyeing the bed ramps at the pet store. In four years you’ll catch up to my father If you both make it. As I say, everything is temporary: your life, my life, my father’s life, my son’s life, this poem, and you, dear Reader.

This poem, “Temporary Like a Dog,” is a meditation on the process of temporal change. If the philosophers and artists are right, such meditation can bring — besides wistfulness — a measure of peace and even loving kindness. To imagine yourself aging along with Izzy will at the very least place you in very good company. Dr. Bressler, SDCMS-CMA member since 1988, is on the Biomedical Ethics Committee at Scripps Mercy Hospital and is a longtime contributor to San Diego Physician.

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Position: Full-time and part-time. Full benefits package and malpractice coverage is provided by clinic. Requirements: California license, DEA license, CPR certification and board certified in family medicine. Bilingual English/Spanish preferred. Send resume to: hr@vistacommunityclinic.org or fax to 760-414-3702

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