April 2021

Official Publication of SDCMS APRIL 2021

SAN DIEGO COUNTY MEDICAL SOCIETY B OA R D OF DI R E C T OR S C A N DI DAT E S

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Contents APRIL

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 Art Director: Lisa Williams Copy Editor: Adam Elder

VOLUME 108, NUMBER 4

OFFICERS President: Holly B. Yang, MD President-Elect: Sergio R. Flores, MD Secretary: Toluwalase (Lase) A. Ajayi, MD Treasurer: Nicholas J. Yphantides, MD Immediate Past President: James H. Schultz, MD GEOGRAPHIC DIRECTORS East County #1: Heidi M. Meyer, MD (Board Representative to the Executive Committee) East County #2: Rakesh R. Patel, MD Hillcrest #1: Kyle P. Edmonds, MD Hillcrest #2: Steve H. Koh, MD (Board Representative to the Executive Committee) Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Preeti Mehta, MD La Jolla #2: David E.J. Bazzo, MD, FAAFP North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Kelly C. Motadel, MD, MPH South Bay #2: Maria T. Carriedo, MD AT-LARGE DIRECTORS #1: Thomas J. Savides, MD #2: Paul J. Manos, DO #3: Irineo “Reno” D. Tiangco, MD #4: Miranda R. Sonneborn, MD #5: Stephen R. Hayden, MD (Delegation Chair) #6: Marcella (Marci) M. Wilson, MD #7: Karl E. Steinberg, MD #8: Alejandra Postlethwaite, MD ADDITIONAL VOTING DIRECTORS Young Physician Director: Brian Rebolledo, MD Retired Physician Director: Mitsuo Tomita, MD Resident Director: Nicole Herrick, MD Medical Student Director: Lauren Tronick CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MPH Sergio R. Flores, MD 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: David E.J. Bazzo, MD, FAAFP At-large AMA Alternate Delegate: Kyle P. Edmonds, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD CMA DISTRICT I DELEGATES Karrar H. Ali, DO Steven L.W. Chen, MD, FACS, MBA Susan Kaweski, MD Franklin M. Martin, MD Vimal I. Nanavati, MD, FACC, FSCAI Peter O. Raudaskoski, MD Allen Rodriguez, MD Kosala Samarasinghe, MD Mark W. Sornson, MD Wayne C. Sun, 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.]

Feature

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SDCMS Elections: Candidate Statements: 2021–22 SDCMS Board of Directors

Departments

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Briefly Noted: Public Health • Practice Management • Payer Issues and Reimbursement • Advocacy

12

Overcoming Vax Hesitancy Is the Next Hurdle

By Sri Lekha Tummalapalli, MD, MBA, MAS, and Varsha Danda

14

New Guideline Lowers Age to Begin Colorectal Cancer Screening

By Diana Swift

16

A Fall to Grace: How I Learned to Better Serve Patients Through My Own Pain

By Michael Harkay, BCC

18

Let’s Choose Our Walls Wisely

By Helane Fronek, MD, FACP, FACPh

19

The Joy of Medicine

By Adama Dyoniziak

20

Classifieds SanDiegoPhysician.org 1

BRIEFLY NOTED 2

April 2021

PUBLIC HEALTH

CMA Joins #ThisIsOurShot Campaign to Promote COVID-19 Vaccines, Fight Misinformation THE CALIFORNIA MEDICAL ASSOCIATION (CMA) has joined #ThisIsOurShot, a national grassroots coalition to build vaccine trust for a COVID-free world by elevating healthcare voices as trusted messengers through stories, photos, and videos using evidence-based messaging.

The campaign grew organically as front-line workers turned to social media to document their own experiences receiving COVID vaccines.

“As a doctor, I answer patients’ questions every day,” says La Tanya R. Hines, MD, a Southern California-based obstetrician and gynecologist and leader in the #ThisIsOurShot movement. “But as a vaccine recipient, I have a very personal experience that I can share as well. I had questions. I had doubts. I did my research, got my shots, and now I want others to also.” #ThisIsOurShot also advocates for equitable distribution and administration of vaccines to help address historical and culturally specific barriers to vaccine acceptance. In the process, the group is working to empower patients while building deeper trust between patients and their healthcare providers.

“We know there are deep disparities and inequities throughout our healthcare system.

Issues of equitable access and mistrust are not limited to vaccines,” Dr. Hines says. “By working to strengthen that trust through vaccine distribution, we believe we can create lasting changes in the way we talk about, prioritize, and deliver healthcare to all Americans.” #ThisIsOurShot is also working to develop a parallel Spanish-language campaign, #VacunateYa. CMA will provide #ThisIsOurShot with inkind support to administer the campaign, and Physicians for a Healthy California (PHC) serves as the fiscal sponsor to facilitate and manage #ThisIsOurShot donations.

Learn more at thisisourshot.info. PHC encourages healthcare providers to join and donate to the campaign, share your story, access resources and connect on Facebook, Twitter, and Instagram (#ThisIsOurShot).

PRACTICE MANAGEMENT

Are You Experiencing Underpayments on COVID-19 Rapid Antigen Tests?

THE CALIFORNIA MEDICAL ASSOCIATION (CMA) has received several reports from practices very concerned that commercial payers are shifting the financial risk of critical COVID-19 diagnostic testing to physicians on the front lines by reimbursing far below the cost of the test itself. CMA has asked the California Department of Managed Care (DMHC) and the California Department of Insurance (CDI) to investigate these concerns as this practice appears to be inconsistent with DMHC’s emergency regulations and CDI’s guidance on COVID-19 diagnostic testing, as well as the federal Coronavirus Aid, Relief and Economic Securities (CARES) Act. The issue is specific to reimbursement of COVID-19 rapid antigen tests. These inexpensive tests are used at the point of care and return a result within approximately 15 minutes.

Each rapid antigen test kit costs physicians approximately $35–$40. However, CMA has heard from several physicians that Anthem and United Healthcare are reimbursing less than half of the physicians’ cost.

When payers shift the financial responsibility for COVID-19 testing to physicians, it becomes financially untenable for practices to utilize the rapid test for their patients. Ensuring physicians can administer rapid antigen tests is critical, particularly when experts are calling for more rapid tests to allow for the reopening of the economy and schools.

CMA has urged regulators to formally investigate and take appropriate action to ensure payers are not impeding patients’ access to appropriate and necessary COVID-19 testing in violation of state and federal law, and profiting at the expense of treating physicians.

If you have experienced underpayment of COVID-19 rapid antigen tests, CMA wants to hear from you. Please contact CMA’s Reimbursement Helpline at (888) 401-5911 or economicservices@cmadocs.org.

PAYER ISSUES AND REIMBURSEMENT

Providers Express Concern About Loss of Access to Remittances Through UHC Optum Pay THE CALIFORNIA MEDICAL ASSOCIATION (CMA) has received numerous complaints from physicians regarding the recent loss of payment remittance advice (PRA) access through the UnitedHealthcare (UHC) electronic payment solution, Optum Pay. As part of changes related to Optum’s rollout of Optum Pay Premium, a new paid subscription version of its free Optum Pay basic service, physicians not subscribing to Optum Pay Premium have reported they are unable to access all PRA information through the basic service. This contradicts information from UHC, which indicated that providers would always retain access to 30 days of claims payment data through the free basic portal.

CMA and other state and specialty societies have expressed concerns to UHC regarding the loss of access to this information. In response to stakeholder feedback, UHC has said it will be modifying the basic service and will provide more information on the changes in the very near future.

In January 2020 Network News, UHC advised that Optum was introducing Optum Pay Premium, a new paid subscription version of its free Optum Pay basic service meant to expand payment functionality and claim detail information for physician practices. The premium service allows access for an unlimited number of assigned users to all payment remittance advices in a PDF format.

However, the premium service comes with a subscription cost of 0.5% per payment ($5 for every $1,000 in payments).

UHC had offered all providers a free trial of the new premium version through Feb. 28, 2021, so they could decide whether to opt-in to the premium service or remain with the basic Optum Pay functionality. But providers were assured that they would continue to have access to 30 days of claims payment data through the free basic portal.

On March 10, UHC announced it would be making changes to Optum Pay’s basic functionality to address these concerns. CMA will publish an update as soon as the details are available.

In the meantime, UHC has advised that providers may also obtain payment information through the UHC Document Vault function through the UHC portal. CMA has confirmed with UHC that remittances can be located in Document Vault under the PRA folder by searching under Check ID, Creation Date, TIN, Expiration Date, Provider, or Check ID. For more information regarding Optum Pay, please see the Optum Pay website. For more information regarding UHC’s Document Vault or accessing remittance advice information, see UHC’s resource on obtaining PRAs.

ADVOCACY

CMA Supporting Bill Requiring Payers to Reimburse Physicians for PPE WHILE PHYSICIANS CAN BILL payers for certain CPT codes for personal protective equipment (PPE) and other COVID-related supplies, most payers are not reimbursing for them, leaving physicians to bear the full brunt of these costs. For months, the California Medical Association (CMA) and the American Medical Association (AMA) have been urging payers across the nation to adopt and pay for the new CPT codes that have been established for supplies and expenses related to the ongoing public health emergency.

CMA is now sponsoring a bill in California (SB 242, Newman) that would require health plans and insurers to reimburse its contracted healthcare providers for business expenses that are medically necessary to render treatment to patients, to protect healthcare workers, and to prevent the spread of diseases like COVID-19.

CMA is urging all physicians to contact legislators and urge them to vote yes on this important bill.

CMA’s most recent survey found that 87% of physician practices are still worried about their financial health, with revenue down by one third. And, while revenue is down, practice costs have gone up 14%, with practices having to purchase PPE, comply with public health disinfecting guidelines, implement telehealth, and make other changes due to the pandemic.

These increases in uncompensated costs are exacerbating the burden placed on the already strained healthcare system. SB 242 is essential to addressing and alleviating the significant financial pressures placed on physicians by the COVID-19 pandemic, and to ensure that our healthcare system remains open and accessible to patients across the state and nation.

SanDiegoPhysician.org 3

SDCMS ELEC TIONS

CANDIDATE STATEMENTS 2021 –2 2 SD CMS B OARD OF DIREC TORS

Note: • (inc.) After Name = Incumbent • Number in Parentheses (#) After Name = Term Length in Years

OFFICERS Candidate for President-Elect: Toluwalase (Lase) A. Ajayi, MD (1) I have had the honor of serving on the SDCMS board of directors for the past seven years and on the SDCMS Executive Committee for the past four years. I consider it an honor to serve our medical community and I have the privilege to again ask for your support as I run for president-elect of SDCMS. I served as an SDCMS at-large director for four years, and joined the executive committee in 2017 where I served as treasurer in 2018–2019 and secretary during our exciting 2019–2020. I have been very active bringing the voice of the community physician and the patients we serve to the California Medical Association. Through my active involvement with SDCMS, I have represented San Diego physicians at the CMA, on the Council of 4

April 2021

Legislation, the Ethnic Minority section, the young physician section, and as the chair of the Council on Medical Services. I take these responsibilities seriously and work passionately in these roles because I believe that our San Diego County Medical Society provides a vital opportunity for our physician community to be able to speak as a singular “voice” to the public and to the politicians in the city, county, state, and federal government.

We have seen our California Medical Board, the CDC, and CMS react to the opioid epidemic in ways that may not truly benefit

the patients we are trying to help and place restrictions on the practicing physicians.

We have seen and continue to see the cost of medical education increase leading to an increased debt burden on young physicians.

EHR interoperability and scope of practice continue to place a burden the patientphysician-payer relationships.

Additionally it has been an honor to serve on the Justice Equity Diversity and Inclusion committee as we as a larger medical society grapple with systemic racism and discrimination within our healthcare system. Given this

reality, it will be critical that we as practicing physicians represent, with a unified voice, the medical care interests of our patients. I have worked to help our Medical Society speak with that united voice and continue to work on the ground to help ease these tensions and much more. I would truly appreciate your support as I seek election to the SDCMS board of directors as its president-elect.

Candidate for Secretary: Nicholas “Dr. Nick” J. Yphantides, MD, MPH (1) No Statement

Candidate for Treasurer: Heidi M. Meyer, MD (1) My time so far serving on the SDCMS Board has been a wonderful reminder of the power physicians have to impact the health of our communities.

I look forward to the opportunity to

SDCMS BOARD CANDIDATE STATEMENTS

continue to work with the movers and shakers of organized political medicine in the state of California. As a family physician, I consider defending the health of the public part of my mission, and the SDCMS Board more than helps me fulfill this mission. My past work on the Arizona and American Academy of Family Physicians boards, as well as my past experience as president of the San Diego Academy of Family Physicians board has been a great compliment to this one. I also enjoy being a voice for the large group practice as I am employed by the Permanente Medical Group.

GEOGRAPHIC DIRECTORS

Candidate for Kearny Mesa Director #1: Anthony E. Magit, MD, MPH (inc.) (3) I appreciate the opportunity to continue my service on the SDCMS board of directors. Maintaining access to healthcare for our region’s children is a primary focus of my practice and

advocacy activities.

I currently serve on the CMA Council on Legislation, the Prop 56 Physician Loan Repayment Advisory Council and serve as the chairperson for the California Telehealth Policy Education Committee. Advocating for the health of all Californians has been a part of my career for more than 25 years while practicing pediatric otolaryngology in San Diego.

No photo available

Candidate for La Jolla Director #3: Sonia L. Ramamoorthy, MD (3) It is an honor to be nominated to serve as the La Jolla Geographic Director. I am a colorectal surgeon who has practiced at UCSD since 2004.

I have served on our hospital’s Board of Governors and our Clinical Compensation committee. Nationally, I am on the board of the American Society of Colon and Rectal Surgeons (ASCRS).

I am a division chief who works in both the inpatient and ambulatory environment. I am

passionate about quality, teaching, and wellness. I have seen the impact that our profession can have on the wellbeing of our community, and it is powerful. I am eager to work with colleagues in SDCMS throughout San Diego to continue to positively impact our profession and the public we serve.

Thank you for your consideration.

Candidate for North County Director #1: Arlene J. Morales, MD (3) I am honored to be nominated as North County Geographic Director for the San Diego County Medical Society. I am a reproductive endocrinologist/ infertility specialist and founded Fertility Specialists Medical Group in 2000. I have been involved with the SDCMS since 2000 in several long-term capacities ranging from Bioethics to Physician Wellness Committees as well as several leadership positions throughout my career in both academics and hospital systems.

The SDCMS provides

a vital forum/tool for physician voices to be heard by the public and government bodies both locally and statewide. These voices are critical in today’s changing medical landscape, where the physicianpatient relationship is being influenced by many other stakeholders. SDCMS’s focus on physician wellness magnifies our commitment to our patients’ health. Thank you for this nomination and I hope to serve on the SDCMS board to represent my fellow physicians.

Candidate for North County Director #3: Nina Chaya, MD (3) I am humbled by my nomination to serve as one of the North County Geographic Directors. It is an honor to serve our community as not only a physician but a vocal patient advocate as well. As a native San Diegan and the daughter of Lebanese immigrants, I was fortunate to have access to a public-school education and world-class publicschool educators that paved the way for my success at becoming a physician anesthesiologist. The decision to pursue medicine was borne out of my desire to serve and care for others. I am a regular volunteer with the Mercy Outreach Surgical Team (MOST), which travels to Mexico to provide pediatric surgery to underserved communities, and I also enjoy helping our four-legged friends by fostering/rescuing shelter pets.

I became a member of SDCMS in 2012 when I was hired to work at Anesthesia Service Medical Group (ASMG) and joined the Tri City Medical Center (TCMC) subgroup in 2013. At TCMC I have served as the Blood Utilization Committee Chair, Department of Anesthesiology Chair, and Quality Improvement Committee representative. My leadership roles within the ASMG organization include serving as chair of the Insurance Committee, as well as having been a member of the Claims, and Quality Improvement and Compliance Committees.

During the most recent U.S. election I ran for and was elected to the Tri-City Healthcare District Board of Directors and I intend to utilize that platform to focus on community outreach.

I am grateful for the support of the SDCMS BOD during my candidacy for TCHD BOD and am honored to have the opportunity to serve alongside other physician leaders within our San Diego community.

SanDiegoPhysician.org 5

SDCMS BOARD CANDIDATE STATEMENTS

Candidate for South Bay Director #1: Paul J. Manos, DO (3) No Statement Candidate for South Bay Director #2: Maria T. Carriedo-Ceniceros, MD (inc.)(3) I am a family physician from San Ysidro Health Center, a Federally Qualified Community Health Center serving over 100,000 of the culturally diverse population in the South Bay, East County, and Southeast San Diego. I have been the VP and chief medical officer for San Ysidro Health Center since 2012. My goals at SDCMS include not only providing the perspective of a physician working in South County with an underserved and culturally diverse population, but in addition, working together with physicians from throughout the county to build a healthier community. I also look forward to working with a team of physicians to address the important issues of health equity, physician workforce shortage, and payment reform. Throughout my years at San Ysidro Health Center, I have actively been involved with training of students and residents, and take great pride in helping in the training of our future physicians.

I have been a board member and past president of the San Diego Academy of Family Physicians and enjoyed collaborating with physicians from various modes of practice. It has been an honor to have a seat on the board of SDCMS so that I may serve on behalf of all physicians. I ask for your support.

AT-LARGE DIRECTORS Candidate for At-large Director #2: Kelly C. Motadel, MD. MPH (3) I have been a member of SDCMS for over 10 years.

Born and raised in San Diego County, I knew from a young age that I wanted to practice medicine in this community. I was a pediatrician and the chief medical officer of Vista Community Clinic 6

April 2021

and on staff at Tri City Medical Center for over 15 years before becoming the child health officer for the County of San Diego, Health and Human Services Agency. Just as I enjoyed caring and advocating for the vulnerable population that VCC serves, my new role allows me to champion the health needs for children now throughout the county.

Over the last few years, I have become increasingly engaged in fighting for access to quality care for all patients and fair treatment of those who care for them.

Beyond my clinical and administrative duties at VCC, I was a founding member of Time’s Up Healthcare, a national organization founded to fight for a safe, fair, and dignified workplace for women of all kinds. I was recently appointed to the Medi-Cal Children’s Health Advisory Panel for the state.

I view myself as an activist in striving for healthcare for all and I would be honored to serve as an At-Large Director on the SDCMS Board of Directors.

Only in combining efforts with other likeminded physicians

can we make the changes needed to care for our patients the way we know best.

Candidate for At-large Director #7: Karl E. Steinberg, MD, FAAFP (inc.) (3) I’m a family physician, geriatrician, and palliative care physician, and I have been a nursing home and hospice medical director in coastal North County continuously since 1995. My passions are providing compassionate care to the frail elder population and others with serious or chronic illnesses, and helping to educate patients and healthcare providers about palliative care.

In addition to patient care, I am a past chair of the Compassionate Care Coalition of California (the people who brought you POLST), and incoming president of AMDA, The Society for PostAcute and Long-Term Care Medicine, a national organization with AMA delegates (of which I am one) representing nursing home physicians and

medical directors.

I’m a past president of their state chapter, CALTCM (the California Association of Long Term Care Medicine); I also currently serve on the government relations committee of CAHF (the California Association of Health Facilities). I am also vice president of National POLST. I provide long-term care consulting and medicolegal services, I’m chief medical officer for two small California nursing home chains, and I’m medical director of two North County skilled nursing facilities (Life Care Center of Vista and Carlsbad by the Sea). I’ve been medical director of Hospice by the Sea in Solana Beach since 1995. I do home visits for complex case management patients for Scripps and have been an employed physician with Scripps Coastal and its corporate predecessors since 1990. I do a fair amount of speaking around town and at statewide and national meetings, mostly on topics of geriatrics, dementia, advance care planning, palliative care, bioethics, and medicolegal affairs.

At SDCMS, I’ve been

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SDCMS BOARD CANDIDATE STATEMENTS

on the Bioethics Commission for over 10 years, on the Communications Committee for several years, have served as an alternate director on the BOD and a delegate for the CMA HOD since 2014, and have been chair of the San Diego Coalition for Compassionate Care, for which I still serve on the Executive Committee. I’ve also contributed to a number of projects through Champions for Health, including the Alzheimer’s workgroup that created the AlzDxRx app, and have represented SDCMS on the Prescription Drug Task Force and some county COVID workgroups. I believe we have a long way to go in getting incentives aligned to optimize care (for example, taking care of ill nursing home residents in the nursing home instead of shipping them to the hospital), increasing awareness of palliative care and advance care planning, and helping our patients get the care they want (and not get the care they don’t want).

I’ve testified before several California Assembly and Senate committees about pending legislation on behalf of organizations 8

April 2021

I represent. By participating in organized medicine and the political process, I hope I can help move things along — with the assistance of many other committed individuals within SDCMS and other involved organizations.

Thanks for your support in allowing me to continue my service on this board.

YPS DIRECTOR

Candidate for YPS Director: Brian J. Rebolledo, MD (inc.) (1) This past year there have been significant challenges experienced because of COVID. However, I am proud to be a part of the physician leaders in SDCMS that have helped guide our community through such a rough period. I currently work as an orthopaedic sports surgeon at Scripps Clinic in Torrey Pines, and participate within the administration for Scripps Clinic Ambulatory Surgery Centers. My participation as YPS director and SDCMS

board member has been a rewarding experience to be a part of this dynamic group.

RESIDENT DIRECTOR

Candidate for Resident Director: Nicole L. Herrick, MD (inc.) (1) It is a privilege to ask for your support to continue as the resident director for the San Diego County Medical Society Board of Directors.

I am currently a third-year combined internal medicine and pediatrics resident at UC San Diego, planning to pursue a career in adult congenital cardiology.

I became involved in health policy and organized medicine as a first-year medical student at UCSD in Dr. Hertzka’s Politics in Medicine course and later worked closely with the CMA and Assemblymember Gonzalez to draft, and subsequently pass, the Responsible Beverage Service (RBS) Training Act of 2017 (AB 1221, Gonzalez). It was a privilege to serve as

the CMA District 1 Resident delegate in the 2018– 2019 session and now as the resident director on the San Diego County Medical Society Board of Directors for the last two years. I came down to San Diego in 2008 as an undergraduate and hope to stay in our wonderful city through fellowship and beyond. During my time in Sacramento I experienced firsthand the strong influence organized medicine can have on health policy and am excited to continue to be a part of the positive change we are all working toward. I would be honored to continue serving our community as the resident representation on the SDCMS board of directors.

AMA DISTRICT I DELEGATE Candidate for AMA District I Delegate: Mihir Y. Parikh, MD (3) It is a privilege to ask for your support as I am now running for a three-year term as AMA delegate.

I have been on the SDCMS board, holding various titles along the way from young physician delegate to county president. I have participated in numerous local and state advocacy events, fundraisers and membership drives. I have had the amazing opportunity to work with numerous other physician leaders in San Diego, in California and now in the U.S. on projects from running for elected office to educating the public on healthcare policy. I am currently serving on the CALPAC board as well. Thus, I have found leveraging this cumulative experience at the AMA level and representing the San Diego physicians and the California delegation on a national level is not only helpful but worthwhile and professionally satisfying. I have been the alternate AMA delegate for the past three years and I am now the vice chair for our “hospitality committee,” which is a great way to show the strength of our CA and PAC West delegations and promote regional doctors who are running for AMA offices. It is a time commitment to remain locally engaged as well nationally involved, but I remain motivated and highly interested, and, most importantly, passionate.

I humbly ask for your continued support and appreciate the long-term relationship. Thank you.

SDCMS BOARD CANDIDATE STATEMENTS

CMA DISTRICT I DELEGATES Candidate for CMA District I Delegate: Karrar H. Ali, DO, MPH (inc.) (3) I am honored to run for the board of the San Diego County Medical Society again. As an emergency physician at Sharp Chula Vista Medical Center and a partner with Vituity, I am a physician who seeks to improve medicine at micro and macro levels for our patients, healthcare providers, administrators, and communities. I have worked at several hospitals in Southern California, including San Diego, Los Angeles, Fresno, and Riverside, and so I realize the dynamics of our healthcare in California. Most recently, I am one of the instructors of the Vituity resiliency program, where I help teach physicians on resiliency and burnout, a major initiative of CMA. I have been a member of SDCMS for 13 years and it has been a distinct pleasure to serve on the board over the last 10 years. I have also enjoyed serving as a delegate and participant in CMA’s annual legislative meetings. Despite the not-always-positive trends in the practice of medicine, I believe our best chance to effect desired changes for our profession is to unite on common ground and to advocate through these avenues. I will endeavor to effectively represent all my physician colleagues as a delegate. I thank you for your continued support.

Candidate for CMA District I Delegate: Franklin M. Martin, MD, FACS (inc.) (3) I am a general surgeon practicing in North County Inland for the past 28 years and recently transitioned to an administrative medicine position in Utilization Review for Palomar Health in North County. I have been a member of SDCMS, CMA during that time and would like to give back by serving as a delegate.

My leadership experience includes a CMA Large Group delegate for two years, OMSS delegate from Palomar Medical Center, chief of staff at Palomar Medical Center, past COS for Pomerado Hospital and presently serving as a member of the BOD of SCMG for 10 years. I trained at Georgetown University Medical School, residency at Bethesda Naval Hospital, served until 1992 in the Navy and

Marines, and have been in private practice ever since. The SDCMS and organized medicine as a whole are our best advocates for our profession and our freedom to take care of our patients to the best of our ability.

Candidate for CMA District I Delegate: James H. Schultz, MD, MBA (3) Thank you for considering me for the District 1 candidate position. I have been on our Board for a number of years and was the first recent Community Health Center representative selected for the SDCMS Board.

I am your immediate past president and have helped coordinate the initial responses to the latest attack on MICRA, among other things, and was “at the helm” when COVID hit.

I have helped initiate, produce, and re-initiate Covid Town Halls for San Diego physicians in conjunction with Dr. Yang, Paul Hegyi, and the folks for the County, and have been one of the behind-the-scenes advisors and sounding boards for County

medical personnel during the COVID crisis. I also helped coordinate some cross-border support for our colleagues in Tijuana and Mexicali, with UCSD and Sharp and Scripps physicians, nurses, and support staff doing much of the follow-up work.

I am proud to have been a North County representative up to this point and hope to continue to represent SDCMS well as a District 1 delegate as we seek to maintain and increase SDCMS’s relevance and importance in the lives of physicians in all practice modes.

Candidate for CMA District I Delegate: Wynnshang (Wayne) C. Sun, MD (inc.) (3) I am a general internist in private practice on the campus of Scripps La Jolla and have served on the Board of Directors of the San Diego County Medical Society for the past several years. While on the Board, I’ve seen the importance of all physicians speaking with one voice to work toward what is best for

San Diego physicians and their patients.

Whether physicians practice individually, as part of a large group, or in an academic setting, much more can be accomplished when we have a united voice because there are changes in healthcare that affect all of us. If chosen to serve on the Board again, I see my role as one in educating private practice physicians about the importance of being part of organized medicine, as well as helping to make SDCMS an organization that all physicians want to join.

Candidate for CMA District I Delegate: Patrick A. Tellez, MD, MHSA, MPH (3) I am Patrick Tellez; I am privileged to be considered as a candidate for the Board of SDCMS in 2021.

While in practice in allergy-immunology in Sacramento from 1984 to 1995, I was a member of the CMA’s Council on Legislation (1988–1995), Scientific Advisory Council on Allergy & Immunology (1989– 1992) and was active within the California SanDiegoPhysician.org 9

SDCMS BOARD CANDIDATE STATEMENTS

Society of Allergy and Clinical Immunology (president, 1991–92).

Since 1995, I have served in various roles of medical leadership within multispecialty group practice in both FFS and full capitation settings.

Most recently, after 13 years dedicated to community medicine (with the last seven as CMO of North County Health Services, now True Care), I am currently serving in the role of CMO of

Community Health Group, a Medi-Cal managed care health plan serving 280,000 who call San Diego home.

Today, we face many challenges in healthcare; none the least of which relate to assuring health equity and the design of a system that will be sustainable over the long term. As physicians, we have great opportunities to serve as the architects of change. My passion

is to advocate that the ethics of “First do no harm”; Beneficence: seeking to optimize health; Autonomy: providing for informed decision making, and Justice: assuring that access to acceptable standards of care are equitable for all — that these attributes, together, serve as our “true north” as we design and implement sustainable improvements to our healthcare system.

CMA RFS DELEGATE Candidate for CMA RFS Delegate: Rachel B. Van Hollebeke, MD (1) I was born and raised in San Diego and returned home for medical school at UCSD. I am currently completing my family medicine residency at Scripps Mercy Hospital in Chula Vista. I’m very excited about the resident delegate position as a way to learn more about health policy and give back to the San Diego community that I care so deeply about. As a former member of the U.S. Women’s National Soccer Team and two-time Olympic gold medalist, I hope I can share my passion for healthy living and utilize the leadership skills I have developed in both my soccer and medical careers.

Thank you for considering me for this role.

PLACE YOUR AD HERE FEBRUARY 2020

Official Publication of SDCMS

Celebrating 150 Years

Seeking FM/DO/IM/ Psychiatrist in San Diego County 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

Vista Community Clinic is a private, nonprofit outpatient community serving people who experience social, cultural or economic barriers to health care in a comprehensive, high quality setting.

www.vistacommunityclinic.org EEO/AA/M/F/Vet/Disabled

10

April 2021

MARCH 2020

Official Publication of SDCMS

NOVEMBER/DECEMBER 2019 Official Publication of SDCMS

Celebrating 150 Years

Artificial Intelligence and Medicine THE DEBATE

PREVENTION DIABETES Reversing the Risks

DEMENTIA Reducing the Burden How to Engaging Patients GUN SAFETY

BUILD TRUST

BREAST CANCER Preventing Deaths

in 15-Minute Office Visits

Contact Jennifer Rohr 858.437.3476 • Jennifer.Rohr@SDCMS.org

INFECTIOUS DISEASE: VACCINES

Overcoming Vax Hesitancy Is the Next Hurdle A Framework for Tailoring Messages and Improving Vaccine Confidence

by Sri Lekha Tummalapalli, MD, MBA, MAS, and Varsha Danda

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April 2021

A

S COVID-19 CASES FALL,

variants are emerging and the race to vaccinate continues.

What can we learn from behavioral science to change the hearts and minds of vaccine-hesitant individuals?

The health belief model is one of the most widely used frameworks to study health behaviors. It describes six factors: perceived susceptibility and perceived severity, perceived benefits and perceived barriers, cues to action, and self-efficacy. Applying this model can

help us understand people’s decisionmaking to get the vaccine.

Perceived Susceptibility and Perceived Severity How likely am I to get COVID-19, and how bad will it be if I get it? Here, we can apply lessons from seasonal flu vaccines.

The CDC tracks flu vaccination rates on FluVaxView using data from nationally representative telephone surveys, such as the Behavioral Risk Factor Surveillance System. Among the general

groups, translating into higher perceived benefits of the vaccine.

Similarly, lower perceived severity of COVID-19 could decrease the likelihood of getting the vaccine. Of individuals who do not foresee themselves requiring hospitalization if they contracted COVID-19, 52% state they would not receive the vaccine. An individual’s perceived susceptibility stems from their knowledge about the specific condition. Therefore, the spread of digestible, accurate information is crucial for instilling vaccine confidence.

Engaging community leaders to halt the spread of false information and correct misconceptions about the susceptibility and severity of COVID-19 will also be beneficial, especially with marginalized and vulnerable populations.

population, higher age groups are more likely to receive a flu vaccine (69% among adults ages 65 years and older compared to 51% for those ages 18 to 49 years).

This mirrors COVID-19 vaccine willingness: a poll conducted by the Pew Research Center indicates that 75% of adults over 65 years old would definitely or probably receive the COVID-19 vaccine, compared with only 53% of adults ages 30 to 49. These trends by age could be in part explained by higher perceived severity of viral illnesses in older age

Perceived Benefits and Perceived Barriers Perceived risks of the vaccine also play a key role. A survey by the Kaiser Family Foundation found that among those who would definitely or probably not get the COVID-19 vaccine, 59% were worried about possible side effects, 55% did not trust the government to ensure the vaccine’s safety, and 53% were concerned about the vaccine’s novelty and wanted to assess its effects on others before receiving the vaccine themselves.

Interestingly, while women are approximately 8% more likely than men to get a flu vaccine, a recent national study reports that women are less likely to get the COVID-19 vaccine. Understanding if this relates to perceived risks, perceived benefits, or other factors could help us tailor counseling to encourage vaccine adoption. Importantly, perceived benefit of the vaccine is a modifiable factor. One study found that information about efficacy, duration of protection, and CDC and WHO endorsement influenced the likelihood a person would be willing to take the COVID-19 vaccine. Harnessing traditional and social media to deliver this information could help promote vaccine confidence.

Barriers, both real and perceived, have received significant attention as vaccines have rolled out. Concerns regarding conflicting eligibility criteria, confusing web platforms, and long waitlists have surfaced. Digital literacy, limited English

proficiency, access to care, and other barriers could further exacerbate racial/ ethnic and socioeconomic disparities in vaccine administration. Groups face different barriers, so mitigation strategies should be targeted specifically toward the specific barriers faced.

Cues to Action Cues to action are internal and external triggers for initiating positive health behaviors. Cues such as “push” strategies — like emails or text messages to make a vaccine appointment — could encourage COVID-19 vaccine adoption once supply exceeds demand. Notably, for the flu vaccine, healthcare personnel with employer requirements had a 94.4% vaccination rate, compared with 69.6% for those without such a requirement, perhaps due to greater cues to action such as workplace requirements. CMS states that new quality measures for COVID-19 vaccination rates among healthcare workers and patients are being developed, which could serve as cues to action and motivate higher vaccination rates.

Self-Efficacy Lastly, self-efficacy, defined as “how well one can execute courses of action required to deal with prospective situations,” influences the likelihood of adopting health interventions. For groups uncertain about how to obtain the vaccine, instilling confidence that they can navigate the sign-up process will be an important step to encouraging vaccine adoption.

COVID-19 vaccine willingness is a complex, multifactorial decisionmaking process. People weigh perceived risks and benefits and are influenced by barriers, cues, and self-efficacy. Addressing the way these factors manifest in diverse populations could spark a movement of vaccine confidence.

Dr. Sri Lekha Tummalapalli is a nephrologist, health services researcher, and assistant professor at Weill Cornell Medicine. Varsha Danda is a student at Washington University in St. Louis on the premedical track studying anthropology with a focus on global health and environment. This article first appeared in MedPage Today.

SanDiegoPhysician.org 13

GASTROENTEROLOGY: COLON CANCER

New Guideline Lowers Age to Begin Colorectal Cancer Screening Update Comes as Incidence Has Doubled in People Under 50 by Diana Swift

D

ATA ON COLORECTAL

cancer (CRC) screening gathered over the past decade have prompted the American College of Gastroenterology (ACG) to update its guidelines, last issued in 2009.

The new recommendations, published online in the American Journal of Gastroenterology, state that screening should start at age 45 for persons of average risk.

“We now know that the risk is higher than we appreciated for people from age 40 onward. Today, a 45-year-old has the same risk as a 50-year-old had 10 years ago,” said Aasma Shaukat, MD, MPH, of the University of Minnesota School of Medicine in Minneapolis, in an ACG introductory podcast to the new guidelines.

The update is timely in that 140,000 new cases of CRC are now diagnosed annually in the U.S., she said, with an alarming increase in people younger than 50. The disease is estimated to account for as much as 10% of all cancer deaths.

Screening has changed a lot since 2009, Shaukat noted, and CRC is unique in that there are now seven different screening modalities. Patients have a wealth of choices, ranging from two-step procedures such as guaiac fecal occult blood assays, stool DNA testing, and CT 14

April 2021

colonography, to one-step diagnosis with colonoscopy.

While the ideal test is safe, noninvasive, accurate, readily available, and inexpensive, “the best test is one that the patient is willing to have and the healthcare system is willing to give,” Dr. Shaukat said.

Despite the availability of multiple screening modalities and public health initiatives to boost CRC screening, nearly one-third of the eligible U.S. population remains unscreened, the authors noted.

“CRC screening rates must be optimized to reach the aspirational target of >80%,” they wrote.

And while CRC incidence has declined in those 50 and older, incidence rates have doubled in people ages 20 to 49.

It has been estimated that those born around 1990 have twice the risk of colon cancer and quadruple the risk of rectal cancer compared with those born around 1950, the authors noted.

The guidelines, based on varying degrees of evidentiary strength, were formulated in response to several key questions and are intended to reduce the incidence of advanced adenoma, CRC, and related mortality.

Guideline Highlights Age for starting CRC screening in average-risk men and women should

be lowered to 45 from 50, with routine screening still recommended to age 75. Screening beyond age 75 should be individualized to the patient.

African Americans in particular should begin screening at age 45, and special efforts are needed to improve screening rates and reduce disparities in treatment and outcomes. Compared with white patients, incidence rates are 24% higher in Black men and 19% higher in Black women, the authors noted.

Stage-adjusted CRC mortality is also disproportionately higher in African Americans, with rates 47% higher in men and 34% higher in women vs. their white counterparts.

Screening should be seen as either a

one-step process such as colonoscopy, which allows simultaneous diagnosis and treatment, or a two-step process such as stool-based testing followed by colonoscopy if positive.

Colon capsule endoscopy is an option for those unwilling or unable to undergo colonoscopy or fecal immunochemical testing (FIT). If this test is negative, screening may be repeated in five years.

For individuals with a family history of CRC or an advanced polyp in one firstdegree relative at age <60 years or CRC or an advanced polyp in two or more firstdegree relatives at any age, guidelines conditionally suggest initiating colonoscopy at the earlier age of 40 or 10 years before the youngest affected

relative (whichever is earlier).

The following intervals should be followed for different screening modalities: • FIT annually • Colonoscopy every 10 years • Multi-target stool DNA test every three years • Flexible sigmoidoscopy every five to 10 years • CT colonography and colon capsule endoscopy every five years A positive multi-target stool DNA test followed by a colonoscopy with no findings should not prompt any further workup, and repeat screening should be offered at 10 years.

The Septin 9 blood test is not recommended for screening.

Endoscopists should measure quality indicators for screening colonoscopy and achieve minimum benchmarks for cecal intubation rates (>95%), adenoma detection rates (>25%), and withdrawal times (>6 minutes). Those with adenoma detection rates of less than 25% should take remedial training.

Colonoscopists should spend at least six minutes inspecting the mucosa during scope withdrawal.

In terms of chemoprevention, the guidelines suggest using low-dose aspirin, in addition to CRC screening, in individuals ages 50 to 69 who have a cardiovascular disease risk of at least 10% over the next 10 years, who are not at increased risk for bleeding, and who are willing to take aspirin for at least 10 years to reduce CRC risk.

Organized screening programs should be developed to improve adherence to CRC screening and follow-up of two-stage screening if the first test is positive. This can be improved with patient navigation and reminders, clinician interventions, provider recommendations, and clinical decision support tools.

Dr. Shaukat does not expect the new guidelines to stir controversy among gastroenterologists. “But we did recommend against the blood-based test Septin 9 for screening, and there may be pushback against that,” she says.

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Diana Swift is a contributing writer for MedPage Today, where this article first appeared.

SanDiegoPhysician.org 15

MEDICINE AND FAITH

A Fall to Grace How I Learned to Better Serve Patients Through My Own Pain

by Michael Harkay, BCC

T

HE DAY BEGAN LIKE ANY

other morning. I rushed down the stairs on my way to work as a Mercy Hospital chaplain.

My foot caught on one of the stairs and I ended up hitting the concrete hard. I realized I was in bad shape and that I needed help immediately.

Once I arrived at the emergency department via ambulance, I had the feeling that I was not alone. I knew someone was watching over me. I was focused on the extreme pain and just wanted it to stop. Being in the place where I had ministered to people for many years, I had a sense of inner peace. It was hard to imagine what my situation would be without my faith in God. I knew deep down that Jesus was with me.

I had no idea how long and difficult this journey would be. While I waited for treatment, I observed other patients.

It was strange to be on the other side, as a patient. I knew I would have to make the best of this life-changing situation.

I heard a lot of negative comments from the hospital staff, saying I would be out for months and most likely not return to work for at least a year. This was very discouraging. I kept trust in God to be with me and heal me. This is what kept me going throughout the long days, weeks, and months that were ahead of me.

While I was a patient at Mercy, my faith in God was tested. I felt alone at

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times, yet I never gave up on getting better. My fellow chaplains visited with me. I would pray the rosary and watch the Catholic Mass on the Care Channel. I never let go of God. I remember a patient in the infusion center. After sharing her story with me, she noticed my cane. It’s interesting how a patient can suddenly change the direction of the conversation. I was providing pastoral, supportive listening then I became the subject matter. She asked what had happened to me. I shared my story and she was amazed I was even walking, yet alone working. I shared with her that during my ordeal I held onto the belief that I would eventually walk again normally. She recommended the book Suffer Strong by Katherine and Jay Wolf. She explained that the book talks

about hope and turning suffering into joy. One quote that has stuck with me is from the book jacket. It states Katherine and Jay offer the profound truth that we can survive anything by redefining how we think about everything. And with that shift comes the unexpected gifts of suffering: strengthened identity, courage in the face of fear, and the grace to flourish in the good and hard of life. Mrs. Wolf’s story of being paralyzed and in a wheelchair touched my heart.

During my time in my own workouts with both physical and occupational therapy, I really worked hard on making things positive, even transforming the pain I was in to become my friend instead of my enemy.

At the acute rehab center, I had many phone calls and video chats with

friends, family, and co-workers at Mercy.

These connections gave me hope. I was in the hospital for two weeks, at an acute rehab center for six weeks, and then spent an additional four weeks recuperating at home. I finally returned to work three months after my fall. Many people were surprised that I recovered that quickly, due to the severity of my injuries. I believe that this was a miracle and the answer to many prayers.

Now that I have been back to work for many months, I have discovered that the ordeal I experienced was for a reason.

It has made me a stronger man of God. I have experienced a tremendous sense of peace. I am able to be more present with patients and their families and I feel more empathy toward those I work with at the hospital. The opportunity to

share my story has provided me deeper opportunities to understand their situations. I can share the pain that I went through, pray with them, and be present to them.

I learned in Clinical Pastoral Education that a person can spot a fake right away.

This accident has allowed me to show my own brokenness with pain and endless visits with doctors, which to me seems never-ending. I share with patients and families that I have a choice to make: I can be negative and show resentment for my care or take it as a blessing from God that I have access to medical care and accept the grace God gives me to go through whatever treatment I have to experience.

I have learned to trust God in all situations, even the difficult ones.

Sometimes patients or families do not want the services and support that a chaplain is able to provide. But when I present myself as someone who cares and is willing to be present for them, sometimes the doors start to open. I have discovered that I am a better listener because of my experience. When a patient or family member realizes that I am being open and honest, relationships can form and deepen.

My experience has allowed me to be more at peace, and I am more open to patients and their family’s needs. Patients notice my cane and I immediately can establish a relationship

with them. I have found that I enjoy being present with a patient and hearing their story. It is an honor to be available to people and offer them comfort and peace. I try to be open to what God would have me do in any given situation. Many patients have appreciated me giving time to them and it helped them feel more at peace knowing there is hope. Hope was what I held onto knowing God never abandoned me and was always there for me. This I thank Him for daily, I discovered long ago that it is a privilege to journey with patients. The journey opens up blessings on both sides. I learn from each encounter with patients and they can learn from me.

As a chaplain, I can see how each visit is a sacred moment. This accident has allowed me to be present in all sacred moments, whether good or bad. Now, I find it easier to pray about negative situations. I know the peace I mentioned brings a special presence to all situations.

I do realize I am a human being and have to take care of myself. When I am in a difficult situation it is nice to know that there are chaplains I work with who are willing to offer advice, prayer, or a listening presence. My accident has made me a better listener for patients and coworkers. My ordeal has taught me to be more compassionate with patients, staff, and families. When I enter a patient’s room as a chaplain, I am sized up by patients.

Being a calming presence brings in compassion and empathy. These are gifts everyone has. Spirituality brings these gifts alive. My accident and recovery have allowed me to be more compassionate in my daily encounters with people. I rely on God to cultivate these gifts within me so I can be the chaplain He wants me to be.

Michael Harkay began his career with Scripps Mercy San Diego in 1995 doing a year of residence of Clinical Pastoral Education (CPE), and became Board Certified by the National Association of Catholic Chaplains. He served as a full-time night shift chaplain for 18 years, before assuming the day shift for the past five years.

SanDiegoPhysician.org 17

PERSONAL AND PROFESSIONAL DEVELOPMENT

Let’s Choose Our Walls Wisely

by Helane Fronek, MD, FACP, FACPh

O

N HEARING ROSEMERRY WAHTOLA

Trommer’s beautiful poem One Morning, I was struck by her thoughts about the walls we build between us: “One morning we will wake up and forget to build that wall we’ve been building, the one between us / the one we’ve been building for years, perhaps out of some sense of right and boundary, perhaps out of habit.” Maybe it seemed relevant because of the wall along the southern U.S. border, so fiercely debated over the past few years, or because maintaining personal boundaries is so challenging for many of us. When do we want walls between us? And when are we better off without them? That depends on the context, the outcomes we desire, and our own particular skills. What is true across the board is that they deserve our attention so that we are aware of which walls we are erecting and what their impact might be.

We physicians are encouraged to maintain a certain distance from our patients. Becoming too involved can impair our professional judgment, causing over-treatment (I want this person to have every available treatment) or under-treatment (this treatment is uncomfortable — perhaps we can omit it). Yet showing that we care is an important component of earning our patients’ trust. We also walk a tightrope of self-disclosure:

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April 2021

Might it be helpful or harmful to share my views or experience? Regardless of where we fall on the spectrum of friendliness or self-disclosure, each of us must wrestle with this dilemma and find a place that feels reasonably comfortable, monitoring our approach to each patient to balance our objectivity and connection.

Sneakier are the personal boundaries we often fail to recognize — until they are crossed, and we feel angry, threatened, or hurt. How do you feel when someone shares your personal or contact information?

When asked to do noncompensated work that eats into your family time? When derogatory comments about people you know are made

in your presence? When fulfilling an extra patient request means you won’t have time to get to the gym?

Feeling guilty or fearful of upsetting others, we often ignore these boundaries, causing ourselves even more distress.

At times, holding our boundaries may be essential for our physical or mental health. In our medical culture, where “the patient always comes first” is an accepted edict and physicians are expected to add non-compensated tasks to our busy days, drawing attention to our boundaries can isolate us and label us “not a team player.”

There is clearly complexity to determining which boundaries we enforce. Yet when we name and enforce our important boundaries, our lives become infused with greater freedom and ease, and our relationships benefit from the absence of resentment and pretense.

People know what they can and cannot expect from us, and they usually adjust to that knowledge.

Which walls in your life do you want to dismantle?

Which do you want to honor? And which new walls do you want to erect?

Helane Fronek is an assistant clinical professor of medicine at UC San Diego School of Medicine and a Certified Physician Development Coach.

CHAMPIONS FOR HEALTH

The Joy of Medicine

by Adama Dyoniziak

W

hen asked why he volunteers for Project Access, Dr. Adam Fierer replied, “It is one of the most rewarding and purest forms of giving back to the community. It has brought the joy back into medicine. My path in life is to take care of people.”

“My father was an infectious disease specialist,” Dr. Fierer continues. “He was the ‘go-to’ doctor for family and friends.

I wanted to be that kind of doctor.”

Although his dream as a boy was to be a pitcher, Dr. Fierer didn’t have a curveball until he was older. In fact, he even won the Padres fastest pitching in medical school. “I loved sports, I was surrounded by internal medicine physicians, so I was leaning to do orthopedic surgery,” he explains. “But the first month of general surgery, I had a patient with appendicitis and the morning after surgery the patient said ‘Oh my God, I feel so much better!’ It all clicked — I want to do that! It was the perfect combination of medicine and surgery. I was the person people could call for answers.”

Dr. Fierer is a general surgeon with highly specialized training in minimally invasive laparoscopic surgery and robotic surgery. He is a fellow of the American College of Surgeons and is past president of the San Diego Society of General Surgeons. He has been a Project Access volunteer for many years.

“It is incredibly satisfying to change somebody’s life for the better,” Dr. Fierer explains. He had volunteered on medical excursions to Nicaragua, and wondered why this kind of opportunity didn’t exist in San Diego. One of his partners introduced him to Project Access, and Dr. Fierer has been volunteering ever since.

“Giving back is important part of our responsibility as physicians,” says Dr.

Dr. Adam Fierer with a Project Access patient and her husband

Fierer. “It is rewarding and provides a lot of satisfaction … and the world needs more kindness.” A recent 89-yearold patient with a complete colon obstruction was in Dr. Fierer’s care, and he had reservations about the surgery.

“She did amazingly well. She had a great attitude that got her through.” Together, patient and doctor used what was within them to a successful outcome.

A San Diego native, Dr. Fierer enjoys spending time with his family and friends, and stays active by participating in softball and football leagues, skiing, and surfing. He hopes to share the joys of travel with his family, just like he shares the joy of medicine with his patients.

Champions for Health is dedicated to providing access to critically needed healthcare for uninsured, low-income residents of San Diego County who would otherwise face insurmountable barriers to care. Since 2008, Project Access has served more than 6,709 uninsured San Diegans at or below 250% of the Federal Poverty Level with

Dr. Fierer with Project Access patient in recovery

care managers facilitating a smooth healthcare process for referring clinics, specialty physicians, and patients. Lyft transportation, medical interpreters, medication access, diagnostic tests, and intensive care management are all free to the patient. Pro bono consultations, procedures, and surgeries now total more than $21 million, and growing. For more information on how you can bring joy to Project Access patients, please contact Adama Dyoniziak at (858) 300-2780 or adama.dyoniziak@championsfh.org.

Ms. Dyoniziak is executive director of Champions for Health.

SanDiegoPhysician.org 19

CLASSIFIEDS CLINICAL TRIAL VOLUNTEERS NEEDED PARTICIPATION IN CLINICAL RESEARCH TRIALS: Physicians in the following specialties are needed for participation as Principal or Sub-Investigator in Pharmaceutical sponsored Clinical research trials involving COVID-19 vaccine, RSV vaccine, Flu vaccine, Migraine, Multiple sclerosis, Parkinson’s disease, Asthma, COPD, NASH, Diabetes studies. Prior Clinical Research Experience is preferred but not essential. Our team of Clinical Research Professionals will conduct the clinical trials under your supervision. Financial incentives and scientific publication opportunity. Will not take time away from your practice or increase liability. Primary care; Internal medicine; Pulmonology; Dermatology; Neurology; Gastroenterology. Please contact jsaleh@ paradigm-research.com or anguyen@paradigmresearch.com or Afalconer@paradigm-research.com.

PHYSICIAN OPPORTUNITIES PRIMARY CARE PHYSICIAN POSITION: San Diego Family Care is seeking a Primary Care Physician (MD/DO) at its Linda Vista location to provide direct outpatient care for acute and chronic conditions to a diverse adult population. San Diego Family Care is a federally qualified, culturally competent and affordable health center in San Diego, CA. Job duties include providing complete, high quality primary care, and participation in supporting quality assurance programs. Benefits include flexible schedules, no call requirements, a robust benefits package, and competitive salary. If interested, please email CV to sdfcinfo@sdfamilycare.org or call us at (858) 810- 8700.

FAMILY MEDICINE OR INTERNAL MEDICINE PHYSICIAN: TrueCare is more than just a place to work; it feels like home. Sound like a fit? We’d love to hear from you! Visit our website at www.truecare.org.

Under the direction of the Chief Medical Officer and the Lead Physician, ensure the provision of effective quality medical service to the patients of the Health center. The physician is responsible for assuring clinical procedures are continually and systematically followed, patient flow is enhanced, and customer service is extended to all patients at all times.

PUBLIC HEALTH LABORATORY DIRECTOR: The County of San Diego is seeking a dynamic leader with a passion for building healthy communities. This is a unique opportunity for a qualified individual to work for a Level 3 Public Health Laboratory. The Public Health Services department, part of the County’s Health and Human Services Agency, is a local health department nationally accredited by the Public Health Accreditation Board and first of the urban health departments to be accredited.

NEIGHBORHOOD HEALTHCARE MD, FAMILY PRACTICE AND INTERNISTS/HOSPITALISTS: Physicians wanted, beautiful Riverside County and San Diego County- High Quality Family Practice for a private-nonprofit outpatient clinic serving the communities of Riverside County and San Diego County.

Work Full time schedule and receive paid family medical benefits. Malpractice coverage provided. Be part of a dynamic team voted ‘San Diego Top Docs’ by their peers. Please click the link to be directed to our website to learn more about our organization and view our careers page at www.Nhcare.org.

PHYSICIAN WANTED: Samahan Health Centers is seeking a physician for their federally qualified community health centers that emerged over forty years ago. The agency serves low-income families and individuals in the County of San Diego in two (2) strategic areas with a high density population of Filipinos/Asian and other low-income, uninsured individuals — National City (Southern San Diego County) and Mira Mesa (North Central San Diego). The physician will report to the Medical Director and provide the full scope of primary care services, including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance to patients.

For more information and to apply, please contact Clara Rubio at (844) 200-2426 EXT 1046 or at crubio@ samahanhealth.org.

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April 2021

DEPUTY PUBLIC HEALTH OFFICER - COUNTY OF SAN DIEGO: The County of San Diego is seeking a dynamic leader with a passion for building healthy communities. This is a unique opportunity for a California licensed or license eligible physician to work for County of San Diego Public Health Services, nationally accredited by the Public Health Accreditation Board. Salary: $220-230,000 annually and candidates may receive an additional 10% premium for Board Certification and 15% premium for Board Certification and Sub-specialty. For more information click here.

PUBLIC HEALTH MEDICAL OFFICER - COUNTY OF SAN DIEGO: Under the direction of the Deputy Public Health Officer or designee, this position will be responsible for providing medical oversight of health programs and service delivery, and for performing administrative and operational duties that include the guidance and approval of policy and procedure, developing strategy, and overseeing quality assurance and quality improvement efforts for County of San Diego health services programs. Salary: $190-200,000 annually and candidates may receive an additional 10% premium for Board Certification and 15% premium for Board Certification and Sub-specialty. For more information click here.

FULL-TIME CARDIOLOGIST POSITION AVAILABLE: Seeking full time cardiologist in North County San Diego in busy established general cardiology practice.

EP or Interventional also welcome if willing to hold general cardiology outpatient clinic also at least 50% of time while building practice. Please email resume to jhelmuth1220@gmail.com. Immediate opening.

INTERVENTIONAL PHYSIATRY/PHYSICAL MEDICINE SPECIALIST POSITION AVAILABLE: Practice opportunity for part time interventional physiatry/physical medicine specialist with wellestablished orthopaedic practice. Position includes providing direct patient evaluation/care of spine and musculoskeletal cases, coordinating PMR services with all referring providers. Must have excellent interpersonal and communication skills. Office located near Alvarado Hospital. Onsite digital x-ray and emr.

Interested parties, please email lisas@sdsm.net.

CARDIOLOGIST WANTED: San Marcos cardiology office looking for a part-time cardiologist. If interested, send CV to evelynochoa2013@yahoo.com or via fax to (760) 510-1811.

GENERAL FAMILY MEDICINE PHYSICIAN: to provide quality patient care to all ages of patient in a full-time traditional practice. The Physician will conduct medical diagnosis and treatment of patients using medical office procedures consistent with training including surgical assist, flexible sigmoidoscopy, and basic dermatology.

The incumbent must hold a current California license and be board eligible. Bilingual Spanish/English preferred.

Founded as a small family practice in Escondido 1932

by Dr. Martin B. Graybill, today we’re the region’s largest Independent Multi-specialty Medical Group. Our location is 277 Rancheros Dr., Suite 100, San Marcos, CA 92069. We are an equal opportunity employer and value diversity. Please contact Natalie Shields at (760) 291-6637/nshields@graybill.org. You may view our open positions at: https://jobs.graybill.org/.

BOARD CERTIFIED OR BOARD-ELIGIBLE PHYSICIAN DERMATOLOGIST: Needed for busy, wellestablished East County San Diego (La Mesa) private Practice. We currently have an immediate part-time opening for a CA licensed Dermatologist to work 2-3 days per week with the potential for full-time covering for existing physicians, whenever needed. We are a full-service Dermatology office providing general, cosmetic and surgical services, including Mohs surgery and are seeking a candidate with a desire to provide general dermatology care to our patients, but willing to learn laser and cosmetics as well. If interested, please forward CV with salary expectation to patricia@ grossmontdermatology.com.

DEPUTY PUBLIC HEALTH OFFICER: The County of San Diego is seeking a dynamic leader with a passion for building healthy communities. This is a unique opportunity

for a California licensed or license eligible physician to work for County of San Diego Public Health Services, nationally accredited by the Public Health Accreditation Board. Regular - Full Time: $220,000 - $230,000 Annually. For more information and to apply click here.

TEMPORARY EXPERT PROFESSIONAL (TEP) MEDICAL DOCTORS (MD’s) NEEDED: The County of San Diego Health and Human Services Agency is seeking numerous MD positions to work in a variety of areas including Tuberculosis Control, Maternal and Child Health, Epidemiology and Immunizations, HIV, STD & Hepatitis, and California Children’s Services.

Applicants (MD or DO) must hold a current California medical license. Applicants must be proficient in either Opioid Abuse Prevention and Treatment Strategies, Communicable Diseases and/or Healthcare Systems, and willing to minimally work three days a week. Hourly rate is $103/hour. If interested, please e-mail CV to Anuj.Bhatia@sdcounty.ca.gov or call (619) 542-4008.

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.

PHYSICIAN POSITIONS WANTED PAIN MANGEMENT POSITION WANTED: Pain Management Physician Position Wanted: Fellowshiptrained at MD Anderson Cancer Center, pain management with anesthesia background physician looking for a private practice, hospital, or academic position. Skilled in basic and advanced procedures, chronic pain and cancer pain management. Have CA, DEA, and Fluoro licenses. Please call/text (619) 9776300 or email Ngoc.B.Truong@dmu.edu.

PRACTICE FOR SALE PRACTICE FOR SALE IN ENCINITAS: A GYN-only practice for sale in Encinitas with a majority of the patients in North County. Insurance accepted are PPO, cash and some Medicare patients. Could be turnkey or just charts. Practicing is closing December 31st, 2019.

Please call Mollie for more information at (760) 943-1011.

PRACTICES WANTED PRIMARY CARE PRACTICE WANTED: Looking for a retiring physician in an established Internal Medicine or Family Medicine practice who wants to transfer the patient base or sell the practice. Please call (858) 281-1588.

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 TURNKEY OFFICE SPACE FOR RENT NEAR ALVARADO HOSPITAL: Turnkey office space for rent. Modern, remodeled and clean. We have a little space available or a lot, depending on your needs. We are located near Alvarado hospital. Conference room, nurses station and many exam rooms, along with Doctors and Admin spaces. To inquire or to schedule a showing, please contact Jo Turner (619) 733-4068.

OFFICE SPACE IN POWAY: Office in Poway. Centrally located. Close to Pomerado hospital. Radiology, pharmacy next door. Fully furnished, WiFi included.

Three exam rooms, reception area, waiting room. Half days to full time available. Ideal for specialist who wants to expand. Call Dr. Luna if interested: (619) 472-1914.

KEARNY MESA OFFICE FOR SUBLEASE: Kearny Mesa area sublease in our orthopedic office which includes: onsite x-ray available, storage space, space for 1-2 employees and free parking. Can discuss internet, phones, fax line, access to printer/copier, and more.

Please contact Kaye Spotz at kspotz@synergysmg.com for more information.

SAN DIEGO OFFICE NEAR SHARP FOR SUBLEASE OR TO SHARE: Rady Children’s Hospital medical office building at 7910 Frost Street. Central location near to both Rady Children’s Hospital and Sharp Memorial Hospital, between HWY 163 and I-805. Available to any specialty. The space available includes access to one office, two exam rooms and a nurse’s station / common area desk. Be close to excellent referral sources in the building and from the hospital campus. If you have an interest or would like more information, please call (858) 278-8300 x. 2210 or email nhughes@synergysmg.com REDUCED PRICE - EL CAJON MEDICAL OFFICE BUILDING FOR SALE OR LEASE: 3,700 square foot standalone medical building with 11 exam rooms & huge private parking lot available for sale or lease! Sink in all exam rooms, nurses station, break room, abundance of storage, etc. Building has been very well cared for and $200,000+ has gone into it since 2006. Prime location only three blocks from I-8 freeway exit right off of Broadway. Property also features oversized lot with 20+ parking spaces. Asking Sale: $950,000. Asking Lease: $5,500/month + NNN. Terms are negotiable. Seller financing is available. Please contact: Dillon.Myers@ TonyFrancoRealty.com | (619) 738-2318.

ESCONDIDO MEDICAL OFFICE TO SHARE: Medical office space available at 1955 Citracado Parkway, Escondido. Close to Palomar Medical Center-West, Two to three furnished exam rooms, 2 bathrooms, comfortable waiting room, lab space, work area, conference room, kitchen. Radiology and Lab in the medical building. Ample free parking. Contact Jean at (858) 673-9991.

MEDICAL OFFICE AVAILABLE FOR RENT: Furnished or unfurnished medical office for rent in central San Diego. Can rent partial or full, 5 exam rooms of various sizes, attached restroom. Easy freeway access and bus stop very close. Perfect for specialist looking for secondary locations. Call (858) 430-6656 or text (619) 417-1500.

MEDICAL OFFICE SPACE FOR SUBLEASE: Medical office space available for sublease in La Jolla-9834 Genesee Avenue, Suite 400 (Poole Building). Steps away from Scripps Memorial Hospital La Jolla. Please contact Seth D. Bulow, M.D. at (858) 622-9076 if you are interested.

SHARED OFFICE SPACE: Office Space, beautifully decorated, 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 half a 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 FOR RENT: Multiple exam rooms in newer, remodeled office near Alvarado Hospital and

SDSU. Convenient freeway access and ample parking.

Price based on usage. Contact Jo Turner (619) 7334068 or jo@siosd.com.

OFFICE SPACE / REAL ESTATE WANTED MEDICAL OFFICE SUBLET DESIRED: Solo endocrinologist looking for updated bright office space in Encinitas or Carlsbad to share with another solo practitioner. Primary care, ENT, ob/gyn would be compatible fields. I would ideally have one consultation room and one small exam room but I am flexible. If the consultation room was large enough I could have an exam table in the same room and forgo the separate exam room. I have two staff members that will need a small space to answer phones and complete tasks.

Please contact (858) 633-6959.

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 MEDICAL EXAM TABLES FOR SALE: Unfortunately for us, we are unable to utilize our medical exam tables which are in great condition. Our practice is going in a different direction, thus the need for us to provide these tables, which were barely used. The tables are approximately 70 x 30 inches and have black padding on top of a natural pine wood frame. Each table adjusts up and has a headrest with a pillow included. We are interested in moving these out of our office as soon as possible, since we are remodeling and need the space to complete the project. We can provide a picture and schedule time to see the tables between 9am - 5pm M-Th, or 9am - 2:00pm Friday. Price is negotiable and we are just looking for a reasonable donation for the tables. We can sell individually as well, but will provide a greater incentive for taking both. Please contact Rick at 619-795-6700 or email rick@manageyourage.com.

OBGYN RETIRING WITH OFFICE EQUIPMENT FOR DONATION: Retiring from practice and have the following office equipment for donation: speculums, biopsy equipment, lights, exam tables with electric outlets, etc. Please contact kristi.eisenhauermd@ yahoo.com or (760) 753-8413.

MEDICAL EQUIPMENT FOR SALE: 2 Electric tables one midmark, 3 Ultrasounds including high resolution Samsung UG-HE60 with endovag and linear probes, STORTZ hysteroscopy equipment, 2 NOVASURE GENERATORS ,ENDOSEE OFFICE HYSTEROSCOPY EQUIPMENT : NEW MODEL, OLDER MODEL, Cynosure laser equipment:MONALISATOUCH (menopausal atrophy), TEMPSURE Vitalia RF (300 watts!) for incontinence, ENVI for face, Cynosure SculpSure with neck attachment for body contouring by warm sculpting. Please contact kristi.eisenhauermd@yahoo. com or 760-753-8413.

FOR SALE: Nuclear medicine equipment including Ge Millennium MG system, hot lab, and sources Cs-137. Rod Std 2. Cs-137. DCRS 3. Cs-137. Spot 4. Co-57. Flood sheet.

Please contact us at (760) 730-3536 if interested in purchasing, pricing or have any questions. Thank you.

NON-PHYSICIAN POSITIONS AVAILABLE PRACTICE MONITOR WANTED: Practice Monitor wanted for San Diego Practice. Practice Monitor required for reviewing percentage of charts and reporting to Medical Board Monthly. Monitor can be remote. Time involved one hour or less a month. Up to $500 hourly depending on Monitors judgement. Please email DrMegabucks1@gmail.com.

PART-TIME BILLER POSITION AVAILABLE: Pain Management office looking for a part-time medical biller, will work directly with a variety of payors, healthcare providers and patients through the revenue cycle process to ensure claims are processed and paid

in a timely manner, review EOB’s, verifying patient coverage, and assist with patient billing inquiries.

Please email your resume to cestrada@steinermd.com.

DIRECTOR OF NURSING - PUBLIC HEALTH SERVICES - COUNTY OF SAN DIEGO: The Director of Nursing in Public Health Services (PHS) will lead the clinical nursing enterprise of PHS, serving on the Executive Team of the PHS Department. This position will directly oversee clinical nurse management and all nursing personnel for six programmatic branches within PHS, as well as directly oversee all Public Health Nurse Managers or Leads in each branch. This position will work with Public Health Nurses in other Health and Human Services Agency (HHSA) departments such Aging and Independence Services, Child Welfare Services, and Regional Operations. Additionally, this position will have a dotted reporting line to HHSA’s Chief Nursing Officer and receive direction from the Chief Nursing Officer to HHSA-wide nursing practices.

Salary: $124,092.80-$150,822.80 annually. For more information click here.

PART-TIME BILLER POSITION AVAILABLE: Pain Management office looking for a part-time medical biller, will work directly with a variety of payors, healthcare providers and patients through the revenue cycle process to ensure claims are processed and paid in a timely manner, review EOB’s, verifying patient coverage, and assist with patient billing inquiries.

Please email your resume to cestrada@steinermd.com.

EXECUTIVE DIRECTOR, STUDENT HEALTH AND COUNSELING SERVICES: California State University San Marcos (CSUSM) has announced a national search for a visionary and collaborative leader to serve as Executive Director of Student Health and Counseling Services. Selected candidate will be appointed into an Administrator III OR Administrator IV. Appointment will be determined by education and experience.

Selected candidate with an M.D. will be appointed as Administrator IV, and selected candidate without an M.D. will be appointed as Administrator III. For position specifications, benefits summary and to apply, please visit our website at https://apptrkr.com/1852486.

FINANCE DIRECTOR: San Diego Sports Medicine and Family Health Center is hiring a full-time Financial Director to manage financial operations. Primary responsibilities include monitoring of income, expenses and cash flow, reconciling bank statements, supervision of accounts payable, oversee billing department, oversee accounts receivables, payments and adjustments, prepare contracts, analyze data, prepare financial reports, prepare budgets, advise on economic risks and provide input on decision making.

MBA/Master’s and 5+ years relevant work experience preferred. Excellent references and background check required. Salary commensurate with skills and experience. To apply, please send resume to Jo Baxter, Director of Operations jobaxter@sdsm.com.

NON-PHYSICIAN POSITIONS WANTED 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.

PRODUCTS / SERVICES OFFERED 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. Please contact: (619) 913-7568 | info@rudolphia.consulting | www.rudolphia.consulting.

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$5.95 | www.SanDiegoPhysician.org San Diego County Medical Society 8690 Aero Drive, Suite 115-220 San Diego, CA 92123 [ Return Service Requested ]

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