April 2023

Celebrating Independent Physicians

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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

OFFICERS

President: Toluwalase (Lase) A. Ajayi, MD

President–Elect: Nicholas (dr. Nick) J. Yphantides, MD, MPH

Secretary: Steve H. Koh, MD

Treasurer: Preeti S. Mehta, MD

Immediate Past President: Sergio R. Flores, MD

GEOGRAPHIC DIRECTORS

East County #1: Catherine A. Uchino, MD

East County #2: Rakesh R. Patel, MD

Hillcrest #1: Kyle P. Edmonds, MD

Hillcrest #2: Stephen R. Hayden, MD (Delegation Chair)

Kearny Mesa #1: Anthony E. Magit, MD, MPH

Kearny Mesa #2: Alexander K. Quick, MD

La Jolla #1: Karrar H. Ali, DO, MPH

(Board Representative to the Executive Committee)

La Jolla #2: David E.J. Bazzo, MD, FAAFP

La Jolla #3: Sonia L. Ramamoorthy, MD, FACS, FASCRS

North County #1: Arlene J. Morales, MD

North County #2: Christopher M. Bergeron, MD, FACS

North County #3: Nina Chaya, MD

South Bay #1: Paul J. Manos, DO

South Bay #2: Maria T. Carriedo-Ceniceros, MD

(Board Representative to the Executive Committee)

AT–LARGE DIRECTORS

#1: Thomas J. Savides, MD

#2: Kelly C. Motadel, MD, MPH

#3: Irineo (Reno) D. Tiangco, MD

#4: Miranda R. Sonneborn, MD

#5: Daniel Klaristenfeld, MD

#6: Marcella (Marci) M. Wilson, MD

#7: Karl E. Steinberg, MD, FAAFP

#8: Alejandra Postlethwaite, MD

ADDITIONAL VOTING DIRECTORS

Young Physician: Emily Nagler, MD

Resident Director: Alexandra Kursinskis, MD

Retired Physician: Mitsuo Tomita, MD

Medical Student: Jessica Kim

CMA OFFICERS AND TRUSTEES

President: Robert E. Wailes, MD

Trustee: William T–C Tseng, MD, MPH

Trustee: Sergio R. Flores, MD

Trustee: Timothy A. Murphy, MD

AMA DELEGATES AND ALTERNATE DELEGATES

District I: Mihir Y. Parikh, MD

District I Alternate: William T–C Tseng, MD, MPH

At–Large: Albert Ray, MD

At–Large: Robert E. Hertzka, MD

At–Large: Theodore M. Mazer, MD

At–Large: Kyle P. Edmonds, MD

At–Large: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM

At–Large: David E.J. Bazzo, MD, FAAFP

At–Large: Sergio R. Flores, MD

At–Large Alternate: Bing Pao, MD

CMA DELEGATES

District I: Steven L.W. Chen, MD, FACS, MBA

District I: Franklin M. Martin, MD, FACS

District I: Vimal I. Nanavati, MD, FACC, FSCAI

District I: Peter O. Raudaskoski, MD

District I: Kosala Samarasinghe, MD

District I: James H. Schultz, MD, MBA, FAAFP, FAWM, DiMM

District I: Mark W. Sornson, MD

District I: Wynnshang (Wayne) C. Sun, MD

District I: Patrick A. Tellez, MD, MHSA, MPH

RFS Delegate: Rachel B. Van Hollebeke, MD

FEATURES

6 Candidate Statements –2023-2024 SDCMS Board of Directors

12 War and Enzymes

By

James Santiago Grisolia, MD

14

A Different Path to Medical School and Rubbing Shoulders with Some of California’s Most Powerful Politicians

By Jesse D. Garcia

DEPARTMENTS

14

2 Briefly Noted: SDCMS Membership

4 SDCMS Board Holds Retreat to Plan for Future

16 California Offers Bipartisan Road Map for Protecting Kids Online Even as Big Tech Fights Back By Mark Kreidler

18 The Impact of Feeling Valued By Helane Fronek, MD, FACP, FASLVM, FAMWA

19 Positive Energy By Adama Dyoniziak 20 Classifieds

BRIEFLY NOTED

Dr. Karl Steinberg Wins Prestigious Award

THE SAN DIEGO COUNTY MEDICAL Society is excited to congratulate one of our own, Dr. Karl Steinberg, for winning a prestigious award for advancing palliative care.

California State University San Marcos announced, “A nursing facility and hospice medical director who has served as a passionate advocate for palliative care in the San Diego region has been named the 2022 recipient of the Doris A. Howell Award for Advancing Palliative Care, presented annually by the CSU Shiley Haynes Institute for Palliative Care.

“A $25,000 gift in Howell’s honor from philanthropist Darlene Marcos Shiley accompanies the annual award and is bestowed on a local healthcare organization with ties to the selected recipient.”

“Karl Steinberg, MD, medical director for many San Diego-based agencies and facilities since the mid-1990s, is this year’s Howell honoree,” the Cal State San Marcos-based institute announced. Steinberg has served as medical director for organizations that include Hospice by the Sea, Carlsbad By The Sea Care Center, Beecan Health (35 facilities), Mariner Health Care (21 facilities), Shea Family Care, La Paloma Healthcare Center, and Scripps Coastal

Medical Center.

Steinberg was nominated for the award by Jennifer Moore Ballentine, CEO of the Coalition for Compassionate Care and the former executive director of the CSU Shiley Haynes Institute for Palliative Care.

“In his work with patients, Dr. Steinberg offers an expert and empathic bedside presence,” Ballentine said. “His authentic humility and devotion to the wellbeing of every person he encounters — whether in the facility, the classroom, or the legislative hearing room — are always to the fore. Dr. Steinberg is also a tireless advocate, teacher, writer, and leader who has significantly advanced palliative care in the San Diego region across many fronts. He has ‘worked the halls’ in the state Capitol, testified and advised on legislation affecting medical decision-making for and by frail elders, and lent his voice and strength to many causes with direct impact on people living with serious illness.”

The Howell award is named after the late Dr. Doris Howell, a legendary physician and pioneer in pediatric hematology, oncology, and community medicine who in 1977 founded San Diego Hospice and the Institute for Palliative Medicine (SDHIPM).

Sen. Atkins Honors Dr. Lase

Ajayi as Senate District’s Woman Making Herstory for Health Care Policy Leadership

EVERY YEAR, IN CELEBRATION OF WOMEN’S History Month, the legislature has a tradition of celebrating women from each senate and assembly district “who are accomplishing amazing things in their communities.”

Sen. Atkins’ office stated in part, “Dr. Ajayi is currently an assistant professor of pediatrics at UC San Diego and Rady Children’s Hospital San Diego, where she works as a hospitalist and pediatric palliative medicine physician. She serves as the director of diversity initiatives, director of clinical research, assistant professor of molecular medicine, and a senior staff scientist in digital medicine at the Scripps Research Translational Institute. She is also the co-medical director of adult palliative medicine at Scripps Mercy Hospital San Diego.

“Dr. Ajayi has a long history of leadership in policy-making and organized medicine at the American Academy of Pediatrics (AAP) and is an AAP delegate to the American Medical Association (AMA), where she advocates for the needs of children and those with serious illness. She is a former chair of the AMA and CMA young physician sections.

“Dr. Ajayi’s research focuses on opportunities at the intersection of novel digital medicine technologies and unmet needs in maternal fetal health as well as pain and palliative medicine.”

Dr. Preeti Mehta Appointed to California Respiratory Care Board by Sen. Atkins

SAN DIEGO COUNTY MEDICAL SOCIETY

Treasurer Preeti S. Mehta, MD, has been appointed by California Senate President Pro Tem Toni Atkins to the Respiratory Care Board of California, which oversees the 44,000 Licensed Respiratory Care Practitioners (RCP) in the state. RCPs regularly perform critical lifesaving and life support procedures prescribed by physicians that affect major organs of the body. Patients may be suffering from lung cancer, emphysema, asthma, or cystic fibrosis, or may be premature infants whose lungs have not yet fully developed.

SDCMS Board Holds Retreat to Plan for Future

THE SAN DIEGO COUNTY MEDICAL SOCIETY

board of directors recently held its annual retreat at the Omni Rancho Las Palmas Resort in Rancho Mirage. Board members were briefed on issues and the latest developments concerning health policy and physicians at a multitude of entities. They also underwent training in legislative and political advocacy.

As is tradition, the retreat was led by SDCMS’s Presidentelect, Nick Yphantides, MD, who provided one of the most effective ice-breaker exercises many of us have ever experienced to help board members get to know each other better and on a much more personal level.

Former CMA President Bob Wailes, MD, former SDCMS President Will Tseng, MD, MPH, former SDCMS President Sergio R. Flores, MD, and Tim Murphy, MD, all trustees on the California Medical Association Board, provided updates on the statewide organization’s latest activities and positions on a number of issues.

Current SDCMS President Lase Ajayi, MD, discussed the Strategic Framework for the County Medical Society as part of the organization’s ongoing plan for the future and also provided an update on recent activity from the Ameri-

can Medical Association.

SDCMS Legislative Committee chair Robert Hertzka, MD, a true veteran of the intersection of politics and medicine at both the local and statewide levels, offered a dynamic training session for the board on effective advocacy.

Steve Koh, MD, offered a sobering presentation on the difficult challenges facing San Diego County’s Behavioral Sciences Department and the growing crisis in mental health in our county.

Adama Dyoniziak, executive director of Champions for Health, the nonprofit group affiliated with SDCMS that provides services for the medically underserved, gave an extremely positive update on the successes of the past three years and the organization’s unprecedented achievements in dramatically increased services to San Diego County’s poor and minority communities.

SDCMS CEO Paul Hegyi provided the latest update on the political priorities of the California Medical Association heading into the 2024 election.

The board left the retreat with a renewed sense of purpose and a sense of optimism for what the next year will bring in protecting the rights of patients and their physicians.

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CANDIDATE STATEMENTS

2023–24

SDCMS

BOARD OF DIRECTORS

Note:

• (inc.) After Name = Incumbent

• Number in Parentheses (#) After Name = Term Length in Years

OFFICERS:

Candidate for President-elect: Steve H. Koh, MD, MBA, MPH (1)

It seems like yesterday when I first got involved in organized medicine as a resident at UCSD. It is humbling and an honor to be considered to become SDCMS’s president-elect. As we reflect back on these unprecedented times, I recall with pride seeing our physician leaders championing our patients’ needs and health, and always putting science first. As we face the post-COVID era, we must ensure that we support ourselves and colleagues in helping our fellow San Diegans. We

must support our future colleagues in their pathway to medical service and ensure wellbeing of ourselves. With the San Diego Psychiatric Society and American Psychiatric Association, I have served in numerous leadership positions. From these experiences I have learned the value of united physician leadership in healthcare. It is critical for us to work together in a common house of medicine that supports our profession and patients.

As an academic psychiatrist, I have significant interest in healthcare delivery models, workforce development and public sector population health. Currently, I serve as the chief of general psychiatry and the director of the community psychiatry program at UCSD. I believe that these academic interests align well with the goals and objectives of SDCMS. As physician leaders, we must continue to improve efficiencies in our care delivery, support enriching professional work environments, and champion quality healthcare for those underserved. It will be an honor and a privilege to serve as your SDCMS president-elect and I ask for your support.

Candidate for Secretary: Preeti S. Mehta, MD, MBBS (1)

I am honored to be nominated for the position of secretary at the San Diego County

Medical Society. Having served on the board and executive committee of SDCMS, I have grown to appreciate the tremendous asset that they are to the physician community. As I focus and promote physician wellness, growing physician relations is very important to me. I hope to bring our physician community closer, and give us a unified voice as we advocate for ourselves and our patients. In my role, I plan to continue to grow and build meaningful relationships within the physician community. I will advocate for increasing resources and awareness in our community.

I have been involved in several leadership positions throughout my career as an academic and private practice hospitalist. My experience on the board of Champions for Health has been rewarding as we reach and work for a very vulnerable population. The Physician Leadership Committee at Scripps continues to give me insight into the workings of a large organization which has shaped my personnel and management skills and has allowed me to bring my novel ideas to light. My past experiences make me uniquely qualified to fulfill my duties as secretary of SDCMS.

As the secretary and member of the board at SDCMS, I hope to continue supporting us physicians as a unified group. My passion is physician wellness and I hope to work in this area and promote other physician interests that benefit our medical community as a whole. Thank you for this nomination and I hope to continue to serve you to the best of my ability.

Candidate for

Treasurer: Maria T. Carriedo-Ceniceros, MD (1)

I am grateful to be considered for the post of treasurer of the San Diego County Medical Society. I have had the privilege to serve on the SDCMS board of directors for the past six years and have seen firsthand the valuable role advocacy plays in meeting the needs of our patients and our physicians. These past three years our united leadership helped San Diego navigate and lead through these

unprecedented times. While the pandemic shone the light on many of the health disparities that exist, I was proud of how physicians and organizations of all modes of practice worked together during the pandemic to protect the diverse communities of San Diego County. During this past year as a board representative to the executive committee, I have gained further knowledge about the work and responsibilities of SDCMS in ensuring the voices of our patients and physicians are heard and honored. Through my various leadership roles, I have continued to appreciate the value of collaboration and unity among our fellow colleagues. I have been the VP and chief medical officer for San Ysidro Health Center since 2012. Serving the underserved and addressing health disparities has been my passion throughout my career. Ensuring continued access for our communities has made workforce development an additional priority and led to my work in graduate medical

education. It will be an honor and a privilege to serve as your SDCMS treasurer and I ask for your continued trust and support. Thank you.

GEOGRAPHIC DIRECTORS:

Candidate for Kearny Mesa Director #2: Dustin H. Wailes, MD (3)

I am honored to be considered for the position of Kearny Mesa director on the SDCMS board of directors. I am a cardiac anesthesiologist in private practice at ASMG, covering many of the Sharp and Scripps locations. The importance of organized medicine has been clear to me since my involvement with SDCMS and the CMA, which started in medical school at UCSD. I have been blessed to have had many role models in the leadership of the SDCMS and CMA that have shown me how imperative it is that physicians work together with a unified voice to help shape healthcare policy in order to better serve our patients and our profession. I look forward to taking an increasingly active role in SDCMS in advocating for our professional and patient community.

Candidate for La Jolla Director #2: David E.J. Bazzo, MD, FAAFP, CAQSM (inc.) (3)

It has been my honor to serve you and the San Diego County Medical Society. Having held many officer positions, including president, I have witnessed firsthand the great work that our society does. I want to continue my involvement and am asking you to support my candidacy as director. The San Diego County Medical Society is second to none when it comes to representing the needs and interests of physicians in advocating to optimize our ability to help our patients. The politics of our state and nation have enormous impact on our capacity to keep our patients healthy. And, as with any process, unless you have a seat at the table, your opinion is not heard. Through

the work of your county and state medical societies, your voices are heard and your interests are represented. The members of the board do have influence and work on your behalf to insure that physicians have a say on the future practice of medicine. I am proud of my membership and position on the board, and view it an honor to volunteer to help our organization. I ask that you continue to place your trust in me to serve our organization by supporting my election. Thank you.

Candidate for South Bay Director #2: Latisa S. Carson, MD, FACOG (3)

Thank you for your consideration to elect me to the board of the SDCMS. I grew up in the south county of San Diego and returned home in 2001 to practice medicine. I have had privileges at Sharp Chula Vista, Scripps Chula Vista, and Paradise Valley Hospital. I have served on several hospital committees and on the Sharp Quality Committee. I have been in solo private practice as an obstetrician gynecologist in the south county of San Diego for over 20 years. I am also board certified in obesity medicine and have a special interest in improving the health of those in my community. I will bring the perspective of providing care to a large portion of the underserved and the struggles of being a private practice physician in this current challenging medical and political climate. It will be an honor and privilege to represent you in this county, state, and nationally.

AT-LARGE DIRECTORS:

Candidate for At-large

Director #1: Rakesh R. Patel, MD, MBA, FAAFP, CPE (3)

I am a family physician and the CEO of Neighborhood Healthcare, a federally qualified community health center serving about 90,000 of the underserved and

medically needy. I am also a CMA delegate representing the Medium Size Group Practice Forum as well as serve on the Council of Legislation. My background in family medicine allows me to speak of the various challenges of primary care: access, reimbursement, administrative burdens, staffing, etc. I also understand the many challenges of running a healthcare organization. My overarching goals are to improve the health of our community while continuing to advocate for the under- and uninsured.

cians. I first became involved in the SDCMS on the Wellness Committee and continue to serve on this committee. I believe strongly that only by maintaining physicians’ ability to be happy and well in their careers can we maintain the excellence of our profession.

Candidate for At-large Director #6: Alexander K. Quick, MD (3)

It has been a privilege serving on the board of directors for the San Diego County Medical Society and it would be an honor to continue. I believe SDCMS does an amazing job of advocating for patients and their physicians, and I hope to help the collective effort.

Candidate for At-large Director #8: Alejandra Postlethwaite, MD (inc.) (3)

Dear colleagues, I appreciate the opportunity to continue my service as director-at-large for the San Diego County Medical Society Board of Directors. I am Alejandra Postlethwaite, MD, DFAACAP, a community child and adolescent psychiatrist, and associate medical director of behavioral health at Neighborhood Health Care. I also am medical staff at Rady Children’s Hospital, San Diego.

Candidate for At-large Director #4: Miranda R. Sonneborn, MD (inc.) (3)

I am honored to have served as an at-large director on the San Diego County Medical Society board of directors since 2020, and especially to be reconsidered for this role now. I am a family medicine physician with a passion for the wellbeing of physi-

I recently ended my two-year term as president for the California Academy of Child and Adolescent Psychiatry, during which I led the effort of sponsoring a bill improving the lives of foster-care children that is now state law.

I am also an assembly delegate for the American Academy of Child and Adolescent Psychiatry (AACAP), and an active member of AACAP’s Diversity and Culture Committee.

Prior to joining Neighborhood Healthcare, I was the Behavioral Health Services director at La Maestra Community Health Centers, and associate training director for UCSD’s Community Psychiatry Fellowship Program.

I was born and raised in Mexico, went to medical school at the Universidad Autonoma

of Guadalajara, did my general psychiatry residency at Harvard Medical School South Shore Program and UCSD, and my child psychiatry fellowship at UCLA. I am married and have three active boys.

I consider it an honor to serve our medical community and advocate for the best healthcare for our patients.

YPS DIRECTOR:

Candidate for YPS

Director: Emily A. Nagler, MD (inc.) (1)

It has been a privilege to serve as the Young Physician Section director position for SDCMS over 2022–2023, and I would be honored to continue this position over the next year as well. My time with SDCMS has been an opportunity for tremendous growth, and I recognize more than ever how we must continue to work together as physicians to impact policy. I hope to continue to promote SDCMS in the community and forge more connections next year, and be an ongoing mentor to physicians starting their journey in medicine in San Diego. Thank you for your consideration!

RESIDENT DIRECTOR:

Candidate for Resident

Director: Alexandra O. Kursinskis, MD, MD (inc.) (1)

While I am still very early on in my career, organized medicine has already become a huge passion of mine. Throughout medical school and residency I have engaged with health policy and advocacy through organizations such as AMSA, ACEP, CMA, the government relations team at my institution, and most recently SDCMS. My aim is to bring that passion to the next generation of young physicians through the role of resident director. Although residency is filled with many clinical hours, studying, and research (and even occasionally sleep!) I believe now more

SDCMS BOARD CANDIDATE STATEMENTS

than ever residents want to have a say in where the future of medicine is headed. As a representative, I hope to bring that perspective to the board and increase awareness about important policy issues that affect trainees, early-career physicians, and their patients.

CMA DISTRICT I DELEGATES:

these settings are important but come with different patients and different needs — all of which must be accounted for in our leadership. I take the role of physician as advocate for my profession seriously, and have served in various leadership positions with the San Diego Psychiatric Society, sat on the board of my state specialty society (California State Association of Psychiatrists), chair the American Psychiatric Association’s Caucus on the Social Determinants of Mental Health, and am a delegate in the AMA’s House of Delegates. Additionally, I have worked as a senior policy advisor for U.S. Congressman Tony Cárdenas (CA-29) where I reviewed and wrote a number of health-related bills and provisions that garnered bipartisan support and have now been signed by the president. In all of this, I have seen firsthand the need for physicians to advocate for their patients and profession, and the harm that arises when our voices are not heard. It is my plan to raise that voice. Thank you again for considering me to be your SDCMS delegate.

Candidate for CMA

Candidate for CMA District I

Delegate: Eric L. Rafla-Yuan, MD (3) It is an honor to be considered as a delegate representing SDCMS. I am a board certified psychiatrist with broad experience in both the clinical, policy, and political arenas. As a psychiatrist, I have practiced in emergency rooms, inpatient units, general medical floors, federally qualified health centers, public county clinics, the VA San Diego system, and private practice. As you know, all of

District I Delegate: Peter O. Raudaskoski, MD (inc.) (3)

I have had the pleasure of serving on the SDCMS board for the last 12 years. During this time, I have come to appreciate that SDCMS and CMA are the best organized and strongest advocates in organized medicine that support both physician concerns and ultimately patient access to quality care. I went to medical school at the USC School of Medicine in Los Angeles and did my residency at the UCLA School of Medicine, where I also served as the chief resident. Soon after training, my family and I moved to San Diego, where I joined Anesthesia Service Medical Group (ASMG).

I have served as the President of ASMG (over 270 physician anesthesiologists in San Diego) and currently serve as the chief medical officer. I am also the only anesthesiologist that serves on the Medical Audit Committee, which oversees the trauma system in San Diego County. While

serving in these roles, there have been several times when the SDCMS and CMA were able to assist our group on many levels both in the local arena as well as at the state level. While our state and national societies do excellent work in our given specialties, SDCMS supports all physicians despite their specialty or group size. It is for these reasons I would like to continue to serve as a director on the SDCMS board. As more changes in our healthcare system are sure to be coming our way, I would appreciate the opportunity to continue providing input that supports our ability to do what we do best: provide excellent medical care to our patients.

Candidate for CMA District I Delegate: Randall J. Young, MD, FAAEM, FACEP, MMM (3)

I am honored to be considered for a position as a District I delegate.

I have been a practicing emergency physician in Southern California for the past 13 years, working in a mixture of academic and private hospitals, most recently with Southern California Permanente Medical Group (SCPMG) in San Diego County since 2012. In addition to my full-time clinical practice at the Zion and San Diego Medical Center campuses, I have held a variety of other roles within SCPMG such as: the co-chair of both the Emergency Operations Committee and the Emergency Management Committee for the San Diego service area, physician in charge of urgent care services for southern San Diego County, and faculty with the first KP emergency medicine residency program. I have worked with our residents on process improvement and career development and currently lead the effort for our residents to get more involved in advocacy.

My own journey into advocacy began in 2003, when as a second-year medical student I was the recipient of an American Medical Association Foundation Leadership Award. I received this award for my work as co-founder of the UC Davis School of Medicine Saturday Academy, which later was transitioned into a UC Davis

School of Medicine pipeline program to encourage underrepresented minorities to consider careers in healthcare. I was very humbled to be one of only 15 medical students from across the country selected for this honor. At the time I was an aspiring physician and was absolutely in awe of the power of organized medicine. I traveled to Capitol Hill to lobby for patient rights on behalf of the AMA and met privately with Supreme Court Justice Antonin Scalia, Senate Majority Leader Bill Frist, and President George W. Bush. I learned firsthand how vital the voice of the physician is to our country’s leaders. By organizing together, we can affect millions of patients at a time.

Outside of SCPMG, I currently serve as a volunteer oral examiner for the American Board of Emergency Medicine, and director on the board of the California Chapter of the American College of Emergency Physicians (California ACEP). As a director, I am involved in state legislation aimed at

supporting all emergency physicians and providing the highest quality of care to all patients. I have also served as an ACEP councilor on the national level, advocating for issues vital to our state’s interests. In my first year as a director, I was appointed to the position of chairman of the membership committee, with the goal of improving membership retention and engagement.

I believe that my experience working on the state and national level with California ACEP and the AMA has given me the perspective to understand the complexities of our current system, as well as the tools needed to advocate for initiatives aimed at improving the health of all San Diegans.

I thank you for your consideration and would greatly appreciate your vote.

Candidate for CMA

District I Delegate: Ran Regev, MD (3)

No Statement

Candidate for CMA

District I Delegate: Kosala Samarasinghe, MD (inc.) (3)

I am asking for your support as I run for a District I delegate seat at SDCMS. It has been my privilege to serve as an at-large alternate director for the past six years. Previously, I served as your East County geographic director. For the last three years, I have had the honor of serving on the SDCMS board of directors to help improve healthcare access to patients while advocating for physician rights. I am an internist and have been in the San Diego Medical community for nearly 20 years. I started my career in Southern California working with Neighborhood HealthCare, a federally qualified clinic caring for the lives of the underserved population in northeastern San Diego. My career later led me to a private practice in East County with Alvarado Medical Group. As my professional career in East Coun-

ty began to grow, I too found great rewards by being part of organized medicine. I quickly became involved at Alvarado Hospital and rose up the leadership ladder to become the chief of medicine at Alvarado Hospital. Being the chief of medicine is what ultimately led me to wanting to be more than a practicing physician. I currently work for Scripps Coastal Medical Group in Hillcrest. I have served on their board of directors for nearly four years.

Because the work that was being done at SDCMS by local doctors was very inspiring to me, I involved myself and eventually became a board member. My involvement on the SDCMS board has enabled me to represent patients and physicians in San Diego as well as the rest of California. There has been a drastic paradigm shift in healthcare reform during the past decade and the next few years will continue to be challenging. We continue to struggle with how the pandemic has transformed the medical profession into its current state but hopefully the worst is behind us. The medical profession was quickly able to adapt and open up new modes of healthcare delivery like telemedicine to allow our patients access to healthcare. We continue to struggle with our work-life balance as the expanding EMR capabilities challenge our patient care time. We are working diligently with those who have a stake in physician wellness to help us succeed in delivering quality care to our patients. It is imperative that physician voices be heard not only to protect our profession, but also to protect the rights of our patients. My interest in medicine has also allowed me to help shape the minds of young physicians. I have been privileged with the honor of proctoring first- and second-year medical students from UCSD and continue to participate in their careers pathway program. This has been a very rewarding experience. I wish to continue contributing not only to the young physicians in our community but also to the experienced physicians as well. Please allow me to continue to serve on the SDCMS board of directors to represent physician and patient interests.

SDCMS BOARD CANDIDATE STATEMENTS

CMA RFS DELEGATE:

AMA DISTRICT I ALTERNATE DELEGATE:

Candidate for AMA

District I Alternate

Delegate: William T-C Tseng, MD, MPH (inc.) (3)

Candidate for CMA RFS Delegate: David J. Savage, MD, PhD (1) Thank you for considering me for the RFS Delegate position on the SDCMS board of directors!

I am a second-year hematology-oncology fellow at Scripps and I have been involved in organized medicine since 2009, when I started medical school in Texas and joined the AMA. Over the years I have found immense joy from the friendships I have made in organized medicine, and I look forward to my year of service to the San Diego medical community. During my term I will work hard to advocate for the needs of trainees and to get more of my peers involved in SDCMS.

It is an honor to be your AMA candidate. For over two decades, I have practiced in San Diego and witnessed firsthand impacts of numerous policy decisions on patient care. I believe that active participation in the AMA House of Delegates is critical to advocating for continued and positive changes in patient care.

If elected, I will bring a collaborative and proactive approach to representing our physician’s interest at the House of Delegates. I am committed to working closely with my colleagues to understand their concerns and priorities, and to advance policies that promote evidence-based medicine, equitable access to health, and physician wellbeing.

In particular, I am passionate about advocating for policies that address social determinants of health, reduce health disparities, and promote health equity. I believe that AMA has a critical role to play in addressing such complex issues, and I am eager to work with my colleagues, locally and with AMA, to identify innovative solutions.

I am also committed to promoting physician leadership development, particularly among medical students and residents. Without a doubt, AMA can serve as a powerful platform for mentoring and inspiring the next generation of physician leaders, and I am eager to play a role in this effort.

Thank you for considering my candidacy for AMA alternate delegate. I am committed to serving as a strong and effective advocate for San Diego and look forward to working with my colleagues to help align and advance the mission of the AMA.

War and Enzymes

By James Santiago Grisolía, MD

THE ANCIENT GOTHIC COLUMNS OF LA LLOTJA1

rang with praise for the late physician Santiago Grisolía: words from King Felipe of Spain, the Nobel laureate Roger Kornberg, and local leaders of Valencia. A survivor of the brutal Spanish Civil War, Santiago dedicated his life to bringing science to medicine, relieving the needless cruelties and coarse medicine he saw as a teen.

Santiago, my father, grew up in the remote, medieval walled town of Cuenca, in the mountains outside Madrid. When war broke out between Spanish fascists and defenders of the republic, he began volunteering at the local hospital from the age of 14. The hospital’s stones were first laid by the military order of St James in 1182, later expanded in 1720 and after. When civil war broke out in 1936, the antiquated facilities were unprepared for wounded soldiers arriving by the truckload.

As a green orderly, Santiago tended wounded republicans, both Spaniards and fighters from the International Brigades, dressing horrific injuries with peroxide or permanganate, their only supplies. The wards echoed with the groans of wounded soldiers and reeked of sweat, of drying blood, and of feculent abdominal wounds.

One day, Santiago was cleaning a pussed-out axilla on a frightened soldier. He patiently cleaned the wound, not knowing the surgeons were afraid to dig out the embedded shrapnel for fear of lacerating the axillary artery. Somehow, he removed the shrapnel without triggering the uncontrollable arterial bleed they feared. After that, the surgeons promoted him to the operating room. There, Santiago’s job was makeshift anesthesiologist, holding an ether-soaked cotton over a soldier’s nose and mouth during amputations, thoracotomies, abdominal surgeries, and whatever the surgeons dared to try with their limited equipment.

After the war he entered medical school at age 16, uncommonly early even for those days. Transferring from Madrid to Valencia, he came under the spell of José García Blanco, the engaging chair of physiology, who put him to work in his lab and published some early research with him. García Blanco opened the world of a life dedicated to research, but

cautioned that to become “first class,” he must study outside of Spain. When Santiago gained one of the few Spanish scholarships to study in the U.S, he immediately took his professor’s advice.

Arriving in New York in 1945, he searched for Severo Ochoa, whom García Blanco told him was “the best prepared” of the young Spanish researchers. Santiago began studying enzymes at New York University, before Ochoa even had his own lab. Entering at the dawn of the golden age of biochemistry, he purified and crystallized many enzymes and contributed to working out the urea cycle.

Ochoa notably became the first biochemist to chair the pharmacology department at NYU. Santiago and the other lab workers had to trundle all the equipment and lab reagents down the street to their expanded bench space in pharmacology. Oddly, to reach the new, well-appointed labs, one had to enter through pathology, past the autopsy suite.

In later years, Dad told me that walking by those slabs in the morgue focused his thinking on research that would be clinically relevant, that would answer the wordless questions posed by those silent bodies. How do we create a medicine that better answers their untimely deaths? And better helps the practicing doctors who cared for them? Behind it all, he clearly was still thinking of the wounded and dying bodies he’d seen in wartime.

In his mid-fifties, he stepped down as founding chair of biochemistry at the University of Kansas Medical School, retaining a distinguished professorship. Soon after, he accepted an offer to run a research institute in Valencia2, the city of his birth.

The year 1977 was a promising time to return to Spain, with the dictator Franco dead and the new King, Juan Carlos, pushing for a constitutional monarchy with an elective democracy. Santiago provided new direction and energy to the basic researchers. His wife and our mother, Francis

Thompson, had completed a PhD in physiology and five years of postdoc before becoming a homemaker in 1950s America. With the move to Valencia, she took an unpaid position at the institute, editing the researchers’ papers in English, which enhanced their acceptance in the most prestigious scientific journals.

When Santiago first heard whispered interest in sequencing the human genome, he arranged financing for the first international workshops on the Human Genome Project, bringing together leading researchers from across the globe. At his second meeting in Bilbao, Spain, Craig Venter and Hamilton Smith met and began a collaboration that ultimately finished the first genome map ahead of schedule and under budget.

Santiago then chaired the Human Genome Committee for UNESCO, where he worked to include developing countries in the

This picture was taken at a Rei Jaume Prize Ceremony on Nov 9, 2018. From left to right are Javier Quesada, CEO of the Rei Jaume Prize Foundation; Joan Ribo, mayor of Valencia; Ximo Puig, president of the Valencian government; Felipe VI, king of Spain; Pedro Duque, then minister of science for the Spanish government; Vicente Boluda, president of the prize foundation; and Santiago Grisolia, founder of the Rei Jaume Prizes.

genome revolution, so their societies could also reap the transformative benefits in medicine and agriculture.

In many meetings at every level of business or government, and in hundreds of op-eds and interviews in Spanish newspapers, Santiago argued for more funding for basic research as the most efficient way to find unexpected answers to major human questions.

Most importantly for Spain, he began the Premios Rey Jaime I (or in Valencian Spanish, les Premies Rei Jaume I), major prizes that honor Spanish leaders in the fields of basic research, medicine, economics, environmental science, new technologies, and entrepreneurism. Each jury selecting the Spanish prizewinners includes both Spanish experts and international authorities, often Nobel prizewinners in the relevant fields. In the 34 years of awarding the Premios, 170 prizewinners have received 12 million euros in prize money, while 65 Nobel laureates have participated on the juries. By stimulating original research in the

Spanish universities, these awards foment excellence in the areas that form the pillars of modern society.

The prizes helped to radically transform the Spanish system, creating world-class economists and scientists, as well as physicians who continuously research how to do each procedure better, less invasively, or with better results.

Last November brought the 34th annual prizes and the first ceremony since Santiago’s unexpected death from COVID, just five months before his 100th birthday. While each winner was praised, their accomplishments lauded, the speakers returned, again and again, to the striking absence of the driving force behind these prizes. Leaders like Joan Ribó, the mayor of Valencia, cited the importance of science to break down barriers to diversity and inclusion and to fight violence against women. Ximo Puig, the president of the regional government of Valencia, mourned Santiago’s absence, but said this “great void was full of energy for the future.”

Roger Kornberg, a Nobel laureate in chemistry 2006, lauded Santiago with the perspective of longtime service on the Rey Jaime juries and a dear family friendship. His father, Arthur Kornberg, worked with Santiago in Severo Ochoa’s lab and shared the 1959 physiology or medicine prize with Ochoa for discovering the first RNA polymerase. (The Kornbergs are one of four father-son Nobel dyads.) King Felipe noted that his personal relationship with Santiago dated from 1990, when he awarded him the Prince of Asturias Prize in scientific research, and that they had a long relationship, both before and after his ascent to the throne.

The prize ceremonies offered a moment to reflect on hope amid chaos, from a devastating civil war to the waning days of our current pandemic. For Santiago, only the bright sunlight of science and reason can light up the dark, Goyaesque landscape of ignorance and despair.

References

1. La Llotja de la Seda, the ancient Silk Exchange in Valencia, built in 1482–1533 and now used for public ceremonies, while still a functioning mercantile exchange.

2. Then the Institute of Cytological Studies, more recently the Prince Phillip Research Center (Centro de Investigación Principe Felipe)

James Santiago Grisolía, MD, is chief of staff at Scripps Mercy Hospital in San Diego and a clinical neurologist. He is also an SDCMS member and editor of the San Diego County Medical Society’s San Diego Physician magazine.

A Different Path to Medical School and Rubbing Shoulders With Some of California’s Most Powerful Politicians

By Jesse D. Garcia

NEARING MIDNIGHT, ON NOV. 10, 2018, ASHES

showered the city of Chico as Paradise, California, continued to burn. Shoulder-to-shoulder, displaced men, women, and children huddled for warmth on the frigid floor of the East Avenue Church Evacuation Center, days after fires had destroyed their homes. I learned true fear here, as I witnessed emotions cripple good people, and sat helpless, at a loss for words, while so many endured unmedicated suffering. Though in a matter of days, military and local medical personnel took control of the situation; and as the momentum of the Camp Fire subsided, I was able to reflect on the work I’d done and began to give serious thought to a career in medicine.

At 19, and as an entry-level EMT, I half-expected the evacuation center to be a fast-paced, technical environment teeming with providers. Instead, what I walked into was a church gymnasium full of heartbroken people, and a team of locals doing their best to relieve the crushing heartache. I can still recall the eyes of countless survivors searching my face for a semblance of hope — it was an all too familiar look of vulnerability, a longing gaze I’d given doctors in the past. Collectively, these memories, and those that followed, serve as reminders of why I chose to enter a coalition of individuals equipped with the wisdom and collaborative spirit necessary to remedy society’s corporal and emotional needs.

However, lacking ties to healthcare and having hardly left my rural hometown, the idea of becoming a physician had always felt far-fetched. My sisters and I were raised in Colusa — a small, agricultural town north of Sacramento — by our parents, both first-gen trailblazers and children of Mexican immigrants. After graduating from my public high school in a senior class of 60 kids, I chose to attend California State University, Chico. While at Chico, I met dedicated faculty, worked alongside brilliant physicians, and was inspired by community leaders. After four transformative years I found myself completely invested in the wellness and restoration of my community. Doing so awarded me the opportunity to appreciate the life-changing effects and county-wide impacts afforded by outreach and advocacy. On the other hand, these experiences exposed me to the inequities that exist within

our healthcare system; including, but not limited to, poor reimbursement, recidivism rates, insufficient coverage, housing shortage, food insecurity, and general barriers when seeking care. All of which contributed to an increased interest in the economics and politics that shape our healthcare system, and the nature and quality of care it delivers.

Despite Chico State not being a pre-med catering institution, I found myself applying to medical school, and was blessed with the opportunity to be part of UCSD School of Medicine’s 2026 class and the PRIME Health Equity cohort. During my first quarter, it just happened to be that Anesthesiology 223, Health Policy, Politics, and Leadership was being offered by Dr. Robert Hertzka. An eight-week long, 1–5 p.m.

Monday elective that, arguably, became the highlight of my afternoons. Dr. Hertzka is a larger-than-life individual with an unrivaled personality and oneof-a-kind charisma. On top of exposing our class to the U.S. healthcare system, we learned from accomplished physicians and politicians, such as Senator Dr. Richard Pan, Assemblywoman Dr. Akilah Weber, CMA CEO Dustin Corcoran, SDCMS President Dr. Toluwalase Ajayi, Dr. Valencia Walker, Dr. Jess Mandel, and San Diego County Board of Supervisors chair Nora Vargas. Believe it or not, we even underwent media training and had the privilege to meet Paul Hegyi, SDCMS CEO. Overall, a remarkable and unexpected experience unique to UCSD; one compounded by our recent class trip to the state Capitol.

Waking up, showering, donning the good ’ol med school Zoom blazer, and heading south on the 5, all to snag a Sheraton bus headed toward Terminal

1 for a 6 a.m. flight made for an interesting Tuesday morning. Like something out of a movie, within 10 minutes of stepping onto NorCal soil, we were huddled together by Dr. Hertzka for an airport selfie with former L.A. Mayor Antonio Villaraigosa, and Assemblymembers Mike Fong and Wendy Carrillo. By 9 a.m. our group, accompanied by Dr. Holly Yang, made its way to our first meeting with the VP of government affairs for CMA, Stuart Thompson, who discussed several priority bills. Without missing a beat, our day continued and consist-

ed of walking to and from the Capitol, an off-site swing space, and the CMA HQ all within beautiful downtown Sacramento. Never in my life did I expect to meet, let alone discuss ongoing policy with a legislator. Thanks to Dr. Hertzka and CMA, this fantasy was fulfilled tenfold. We were hosted and informed by Assemblymembers Blanca Pacheco, James Gallagher, and Brian Maienschein, and State Senators Catherine Blakespear and Toni Atkins. Marjorie Swartz and Diane Griffiths, senior staff of Senator Atkins, were generous enough to share their insights on women’s health, and the challenges that exist within and outside of our state. For lunch, Physicians for a Healthy California President and CEO Lupe Alonzo Diaz presented on student loan repayment programs paid out of Prop 56, and shared heartwarming stories regarding said programs. In addition, Assemblymember Chris Ward took time out of his day to give us a Capitol tour and discussed current projects on his desk. And, as luck would have it, we met again with Dr. Akilah Weber, who asked us — all first-year medical students — what we hope to see discussed and acted on by our state legislature. Fatigue was setting in by 5 p.m., but spirits were lifted at dinner with burgers, boos, and Mountain Dew. By 9 p.m. we were homebound, most of us reminiscent but dreading our 8 a.m. Wednesday neuro case study and quiz.

My introduction into organized medicine could not have been more impressionable. To begin the life-long journey of unraveling our complex healthcare system, I chose to take Dr. Hertzka’s fall class, a decision that has enriched my education at UCSD in an unmatched sort of way. Through his mentorship, I was fortunate enough to have been chosen to represent UCSD as a delegate at CMA and AMA events. Most recently, I was invited to attend SDCMS’s retreat in Palm Springs; where, among very accomplished professionals, I was met with open arms and friendship. Words cannot express my gratitude. From Colusa to Chico, and now, med school in San Diego; more than ever, I look forward to what life has in store.

Jesse Garcia is a MS1 in UCSD School of Medicine’s 2026 class and Master’s PRIME Health Equity candidate. He was raised in Colusa, Calif., and acquired his bachelor of science degree in microbiology from California State University, Chico. He is currently interested in helping bridge the gaps of care within the adolescent and young adult populations, through means of exceptional clinical practice, translational science, and engagement within organized medicine.

California State Assembly Republican Leader James Gallagher and Assemblyman Vince Fong with Dr. Holly B. Yang and Dr. Robert Hertzka and medical students in Sacramento.

California Offers Bipartisan Road Map for Protecting Kids Online Even as Big Tech Fights Back

By Mark Kreidler

what’s best and safest for kids from the very start — meaning that companies will have to design their websites based on privacy rules to protect users.

“The privacy piece is truly noteworthy,” says Jennifer King, a privacy and data policy fellow at the Stanford University Institute for Human-Centered Artificial Intelligence. “It basically says, ‘You can’t collect data on kids under 18, and you have to consider that in the design of your product.’”

That’s precisely the sort of regulation online services want to avoid. Three months after Newsom signed the bill, the deeppocketed tech industry responded with a federal lawsuit in December to block the law from taking effect on July 1, 2024.

IN CALIFORNIA, A DEMOCRAT AND A REPUBLICAN

figured out how to pass the country’s toughest online privacy law protecting kids. If their experience is any indication, though, federal legislators can expect fierce pushback from Big Tech if they heed President Joe Biden’s call for similar action on a national scale.

The law, modeled after legislation in Great Britain, will ban websites from profiling users in California under age 18, tracking their locations, or nudging them to provide personal information. It will also require online services to automatically put privacy settings at their highest levels on sites that kids access when the law goes into effect next year.

Passed with unanimous bipartisan support, the measure presents a road map for federal lawmakers to stop social media companies from targeting kids. But the tech industry’s response, including a recent lawsuit that describes the law as having global ramifications, demonstrates how hard its powerful lobby will work to undermine or dilute regulation.

“Big Tech isn’t afraid to throw its weight around, that’s for sure,” says Jordan Cunningham, a Republican former California assemblymember who coauthored the bill. “That’s true in DC and Sacramento alike.”

Gov. Gavin Newsom last year signed the law, which imposes strict guardrails on online services that children use. Its greatest reach, some privacy experts believe, lies in the requirement that online services must consider

One of the industry’s most powerful trade associations, NetChoice, argues, in part, that the law violates free speech provisions of the U.S. Constitution.

Members of the association include giants like Google, Meta (which owns Facebook and Instagram), TikTok, and Twitter.

Biden, in his State of the Union address on Feb. 7, asked Congress “to pass bipartisan legislation to stop Big Tech from collecting personal data on kids and teenagers online” and to prevent targeted advertising to children.

“We must finally hold social media companies

accountable for the experiment they are running on our children for profit,” Biden says.

Multiple studies have found that targeted ads and pushes toward certain online content can be harmful to kids’ wellbeing, and a 2021 report found that Facebook’s own research indicated nearly a third of teenage girls felt worse about their bodies after using Instagram.

In California, Cunningham and Democrat Buffy Wicks overcame the fierce opposition of an industry that wields immense power in Sacramento by appealing to their colleagues not just as lawmakers but also as parents. The measure drew strong support from the international 5Rights Foundation, which pushed for its passage after it helped create the U.K. law, and from Facebook whistleblower Frances Haugen, whose testimony before Congress in 2021 sparked renewed scrutiny of the social media giant’s privacy practices.

“There is a lot of common ground for all of us, Democrats and Republicans, to come together and say, ‘OK, what’s really going on with our kids when they’re online?’” says Wicks, who has two young children. “Politically, this bill could serve as a model, especially in its bipartisan nature.”

Last year, the pair crafted an aggressive strategy to fend off the industry, authoring two bills that sought to hold social media companies accountable in different ways. Big Tech successfully blocked one bill, which would have permitted state prosecutors to sue companies that knowingly addict minors.

“We knew they had to oppose a bill that imposes liability, costs, and damages,” says Cunningham, a father of four who served in the Assembly for six years before declining to run for reelection last fall.

That left lawmakers room to approve the other measure, AB 2273, known as the California Age-Appropriate Design Code, with little pushback. The measure forbids online services from designing features on their websites that are harmful to children.

And its requirement that online services build safeguards into their sites, such as the default privacy settings for children, represents “an existential threat” to a tech industry that derives massive profit from its ability to mine and monitor user data regardless of one’s age, Cunningham said.

In its lawsuit, filed in the U.S. District Court for the Northern District of California in San Jose, NetChoice posits the case as one of unfair restriction on free speech guarantees. The association also claims all users will have to turn over far more personal data for online services to verify who is younger than 18.

Wicks called that assertion “fearmongering,” noting that many sites already use algorithms that assess age with

uncanny precision, and said she is “cautiously optimistic” the law will withstand a legal challenge because it focuses on product safety and not free speech. California Attorney General Rob Bonta’s spokesperson Joanne Adams told KHN that Bonta’s office would defend “this important children’s safety law in court.”

Newsom also weighed in after the industry filed a motion on Feb. 17 to block the law from taking effect this summer while the NetChoice lawsuit is pending. In his statement, the father of four said that no other state is doing more than California to protect kids.

In fact, some lawmakers want to go further. In February, state Sen. Nancy Skinner introduced a bill that would bar social media companies from using algorithms or other technical features that direct content to children and could prompt them to purchase fentanyl, inflict harm on themselves or others, engage in dangerous diets, or take their own lives.

NetChoice association counsel Chris Marchese said the industry supports national regulation rather than state action. “We just don’t support a patchwork of state laws, some of which will be very different from others,” Marchese says.

Critics of the industry say that’s because Big Tech wants an industry-friendly law from legislators in DC. In 2022, five of the tech industry’s biggest companies together spent nearly $69 million lobbying the federal government, according to public filings. That’s more than either the pharmaceutical or oil and gas industries spent, Bloomberg News reported.

This year, lawmakers have proposed bills to strip federal protections for online services that don’t do more to protect kids, but it’s unclear if they will fare better than past efforts. At a hearing in February, Senate Judiciary Committee Chairman Dick Durbin (D-Ill.) accused Facebook, Snapchat, and other social media companies of “doing everything they can to keep our kids’ eyes glued to the screens.”

If Congress does pass federal rules, California leaders hope they won’t override or weaken laws adopted in their state.

“We can see that this is tech’s next pivot, [but] we’ve got to get this right,” Cunningham says. “In 20 years, people in public health will look back and say, ‘Man, we just let these companies conduct the biggest social experiment ever on children. How did they get away with that?’”

Mark Kreidler is a journalist and author who wrote this article for Kaiser Health News (KHN), where it originally appeared, and which is a national newsroom that produces in-depth journalism about health issues and is affiliated with the Kaiser Family Foundation.

The Impact of Feeling Valued

By Helane Fronek, MD, FACP, FASVLM, FAMWA

I’ve been told — to be used and then replaced, like my optometrist. While physicians were initially blamed for burnout, we now know that faulty systems bear the biggest responsibility for this corrosion in our experience. What used to sustain physicians working even longer hours over decades of practice was the satisfaction of providing good care and fulfilling relationships with patients. Our current system impedes the achievement of these important goals. As a result, most physicians would not encourage their children to follow in their footsteps.

I’ve wondered whether systems that value the people who work in them are a thing of the past, outdated in our fast-moving, technologic world. A recent experience gave me hope and illustrated the positive outcome of feeling valued.

plauded. One housekeeper received a warm send-off to retirement, with acknowledgments of her excellent work and many smiles and hugs. The crew’s pride in their work had been obvious throughout the trip; each person provided superb attention to every aspect of their job. Among people who, like physicians, work with little time off over stretches of months, this level of service with a positive attitude struck me as difficult to maintain. As I watched their supervisors beam with admiration and the joy on the crew’s faces, I realized this was the result of a culture where workers feel valued.

READING THE LETTER STATING THAT MY optometrist was retiring, I was stuck that it said nothing about his many years of service, the excellent care he provided, or that he would be missed. I looked forward to my visits with this affable, conscientious, caring professional. I trusted him. It saddened me that his group had not valued him enough to acknowledge his contributions, and only felt the need to inform me who was replacing him.

The epidemic called burnout is worsening among physicians. We feel disappointed in a system that prioritizes profits over attentive care; that requires we invest years of our lives and significant finances learning skills and then deprives us of the time and resources to use those skills to care for patients. Instead, we spend time inputting data and billing information. Many physicians don’t feel valued: “We are like widgets,”

On the final evening of a cruise, as we casually gathered in the lounge, the atmosphere was surprisingly electric. Every member of the staff — the engineers, waitstaff, housekeepers, and expedition team — was dressed elegantly. As each division head stood proudly, the crewmembers paraded across the room and we enthusiastically ap-

If we truly respected and valued each physician on our staff, how would we treat them? How would we design their workload so they could focus on what was most important? What would we take off their plates? How would we acknowledge their value to us and to the patients we serve? While limited in its scope, this new perspective might begin to heal the culture we work in and restore physicians’ pride and satisfaction in their work. A positive impact on patient care and our profession is the likely result.

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

Positive Energy

By Adama Dyoniziak

JUAN WAS FEELING FREQUENT FATIGUE, exhaustion, sleepiness, and uncontrolled sweating. There was no relief from the symptoms, no matter his activity level or time of year. His endocrinologist diagnosed a tumor on his pituitary gland, which could eventually affect his optic nerve if he didn’t have surgery. Juan worked closely with the endocrinologist to monitor his condition and took medication for his symptoms.

“The endocrinologist asked me, ‘Why haven’t you had surgery? What are you waiting for?’” Juan says. He had explored the risks of the tumor on the internet, and he was aware of the ways in which people were impacted. He lived with these concerns daily. But follow-up visits every three to six months, bloodwork ($1,500), and MRIs ($800) eventually became an overwhelming financial burden, so surgery was not an option.

Juan credits his primary care physician with really being an advocate for him when he felt helpless. “He told me about Project Access and said that they were going to help,” Juan explains. Project Access staff connected Juan with Dr. Frank Coufal, a neurosurgeon with La Jolla Neurosurgery Associates, and Dr. Ritvik Mehta, an otolaryngology, otology, and neurotology specialist with California Health & Neck Surgery, both Project Access volunteers. Dr. Coufal confirmed both the diagnosis and the need for surgery. He said that the location of the tumor required a consultation with Dr Mehta, who would be assisting with the early stages of the surgery, an image-guided trans-nasal/endoscopic/trans-sphenoidal resection of pituitary tumor.

Dr. Coufal’s grandfather, a World War I veteran, and Harvey Cushing, the father of modern neurosurgery, were the sparks that lured Dr. Coufal to identify his true passion in life.

“Neurosurgery doesn’t feel like work. I find it exciting and challenging,” he says. Similarly, Dr. Mehta believes that mentorship in otolaryngology and surgery shaped his career and he was hooked from the beginning. Both Dr. Coufal and Dr. Mehta have volunteer experience with international medical missions, but decided to donate their talents to vulnerable populations in San Diego. Dr. Coufal loves volunteering for Project Access and considers it an honor. Dr. Mehta grew up in a poor region lacking healthcare in Kenya, so he believes that giving back is very important.

“The best thing about being a physician is interacting and talking with people to be a source of advice and support,” Dr. Mehta adds. “It is fun to improve patients’ lives and use your skills to help them. It is rewarding, and patients are very grateful.” Dr Coufal concurs. “I receive such positive energy from Project Access patients,” he says.

When asked about the changes in his life as a result of the surgery, Juan mentions “knowing that I no longer have a tumor. My family life is normal again because I am not constantly exhausted.” Juan is so grateful to so many within Project Access: “For the doctors for volunteering their time … they have kindness and many others who choose to donate for people to have their examinations, surgery, transportation, medicine. Thank you for all the people who stand behind this, that we do not know.”

“Seek more to hear, than to be heard” is a quote that Dr. Coufal lives by. Since 2008, Project Access has facilitated $27 million in care for 7,500-plus uninsured patients just like Juan by providing free consultations and surgeries — all thanks to the dedication of our volunteer specialty physicians. Hear the call to action — contact us to provide pro bono services by emailing adama.dyoniziak@championsfh. org, or call (858) 300-2780.

Adama Dyoniziak is the executive director of Champions for Health.

Top left: Dr. Frank Coufal, La Jolla Neurological Associates. Bottom left: Dr. Ritvik Mehta, California Head & Neck Specialists

Juan P., Project Access patient

CLASSIFIEDS

PRACTICE ANNOUNCEMENTS

PSYCHIATRIST AVAILABLE! Accepting new patients for medication management, crisis visits, ADHD, cognitive testing, and psychotherapy. Out of network physician servicing La Jolla & San Diego. Visit hylermed.com or call 619-707-1554.

VOLUNTEER OPPORTUNITIES

PHYSICIANS: HELP US HELP IMPROVE THE HEALTH LITERACY OF OUR SAN DIEGO COUNTY COMMUNITIES by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and help improve the health literacy of those with limited access to care. For further details on how you can get involved, please email Andrew.Gonzalez@ChampionsFH.org.

CHAMPIONS FOR HEALTH - PROJECT ACCESS SAN DIEGO: Volunteer physicians are needed in the following specialties: endocrinology, rheumatology, vascular surgery, ENT or head and neck, general surgery, GI, and gynecology. These specialists are needed in all regions of San Diego County to provide short term pro bono specialty care to adults ages 26-49 who are uninsured and not eligible for Medi-Cal. Volunteering is customized to fit your regular schedule in your office. Champions for Health is the foundation of the San Diego County Medical Society. Join hundreds of colleagues in this endeavor: Contact Evelyn.penaloza@championsfh.org or at 858-300-2779.

PHYSICIAN OPPORTUNITIES

CARDIOLOGY PHYSICIAN POSITION AVAILABLE: San Marcos cardiology office is seeking a part time cardiologist to work 1 to 2 days a week. Please e-mail CV to evelynochoa2013@yahoo.com.

MEDICAL CONSULTANT (MD/DO): The County of San Diego is currently accepting applications from qualified candidates for Medical Consultant-Public Health Services. Vacancies are in the Public Health Services, Epidemiology and Immunization Services Branch (EISB) and Tuberculosis (TB) Control and Refugee Health Branch. Salary: $183,747.20 - $204,900.80 Annually. An additional 10% for Board Certified Specialty and 15% for relevant Sub-Specialty. For job posting information CLICK HERE or visit https://www.governmentjobs.com/ careers/sdcounty?keywords=23416202PHS.

MEDICAL DIRECTOR, FULL-TIME: FATHER JOE’S VILLAGES: Join us in ending homelessness! We are a dynamic team that runs an FQHC. The Medical Director oversees clinical aspects of the primary care, psychiatry, dental and behavioral health. This position will be a mix of clinic and admin time and will have direct reports (Dental Director, Director of Behavioral Health, and frontline primary care/psychiatry providers). Reports to the Chief Medical Officer, who is responsible for all aspects of the clinic. The Medical Director is a counterpart to the Clinic Director (who oversees admin staff, MA/RN team, billing, PSRs, etc.). See FJV Jobs to apply.

SEEKING MEDICAL DIRECTOR: subcontracted position 4-8 hours per month. Responsibilities: 1. Support case conferences, refractory SUD, co-occurring conditions, specialty populations. 2. Conduct clinical trainings on issues relevant to staff (e.g., documentation, ASAM Criteria, DSM-5, MAT, WM, co-occurring conditions).

3. Provide oversight and clinical supervision. 4. Refer co-occurring conditions. 5. Lead Quality Improvement functions (e.g., Quality Improvement Projects, clinical team meetings, etc.)

6. Attend annually 5 hours of continuing medical education on addiction medicine. Required by contract with San Diego County BHS, position is for a Physician licensed by CA Medical Board or CA Osteopathic Medical Board. Contact Name: Jennifer Ratoff: e-mail: jratoff@secondchanceprogram.org, phone: 619-839-0950

PSYCHIATRIST SPECIALIST: The County of San Diego is currently accepting applications from qualified candidates. Annual Salary: $258,294.40. Note: An additional 10% is paid for Board Certification, or 15% for Board Certification that includes a subspecialty. Why choose the County? 1. Fully paid malpractice insurance. 2. 13 paid

holidays. 3. 13 sick days per year. 4. Vacation: 10 days (1-4 years of service); 15 days (5-14 years of service; 20 days (15+ years). 5. Defined benefit retirement program.

6. Cafeteria-style health plan with flexible spending. 7. Wellness incentives. Psychiatrist-Specialists perform professional psychiatric work involving the examination, diagnosis, and treatment of specialty forensics, children/ adolescents and or geriatric patients. This is the specialty journey level class in the series that requires a fellowship or experience in child and adolescent psychiatry or forensic psychiatry. For more information, visit our website at sandiegocounty.gov/hr or select this link to link to go directly to the Psychiatrist Specialist application.

PRIMARY CARE PHYSICIAN: Imperial Valley Family Care Medical Group is looking for Board Certified/Board Eligible Primary Care Physician for their clinics in Brawley & El Centro CA. Salaried/full time position. Please fax CV/salary requirements to Human Resources (760) 355-7731. For details about this and other jobs please go to www.ivfcmg.com.

ASSISTANT, ASSOCIATE OR FULL PROFESSOR (HS CLIN, CLIN X, ADJUNCT, IN-RESIDENCE) MEDGASTROENTEROLOGY: Faculty Position in Gastroenterology. The Department of Medicine at University of California, San Diego, Department of Medicine (http:// med.ucsd.edu/) is committed to academic excellence and diversity within the faculty, staff, and student body and is actively recruiting faculty with an interest in academia in the Division of Gastroenterology. Clinical and teaching responsibilities will include general gastroenterology. The appropriate series and appointment at the Assistant, Associate or Full Professor level will be based on the candidate’s qualifications and experience. Salary is commensurate with qualifications and based on the University of California pay scales. In-Residence appointments may require candidates to be self-funded. For more information: https://apol-recruit.ucsd.edu/ JPF03179 For help contact: klsantos@health.ucsd.edu

DERMATOLOGIST NEEDED: Premier dermatology practice in La Jolla seeking a part-time BC or BE dermatologist to join our team. Busy practice with significant opportunity for a motivated, entrepreneurial physician. Work with three 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/surgical and cosmetic dermatology in an updated medical office with state-of-the art tools and instruments. Incentive plan will be a percentage based on production. If you are interested in finding out more information, please forward your C.V. to jmaas12@ hotmail.com

INTERNAL MEDICINE PHYSICIAN: Healthcare Medical Group of La Mesa located at 7339 El Cajon Blvd is looking for a caring, compassionate, and competent physician for providing primary care services. We require well-organized and detail-oriented with excellent written and oral communication skills, and excellent interpersonal skills to provide high-quality care to our patients. We provide a competitive salary, paid time off, Health insurance, 401K benefits, etc. We provide plenty of opportunities to refine your clinical competency. Our CEO Dr. Venu Prabaker — who has 30 years of teaching experience as a faculty at multiple universities Including Stanford, UCSD, USC, Midwestern, Western, Samuel Merritt, Mayo, etc. — will be providing teaching rounds once a week. You will also get plenty of opportunities to attend other clinical lectures at many of the 4- to–5-star restaurants in San Diego. We also have once a wee, one-hour meeting for all the staff for team building and to create a “family atmosphere” to improve productivity and thereby create a win-win situation for all. Visit us at caremd.us.

RADY CHILDREN’S HOSPITAL PEDIATRICIAN POSITIONS: Rady Children’s Hospital of San Diego seeking board-certified/eligible pediatricians or family practice physicians to join the Division of Emergency Medicine in the Department of Urgent Care (UC). Candidate will work at any of our six UC sites in San Diego and Riverside Counties. The position can be any amount of FTE (fulltime equivalent) equal to or above 0.51 FTE. Must have an MD/DO or equivalent and must be board certified/ eligible, have a California medical license or equivalent, PALS certification, and have a current DEA license. Contact Dr. Langley glangley@rchsd.org and Dr. Mishra smishra@rchsd.org.

PER DIEM OBGYN LABORIST POSITION AVAILABLE: IGO Medical Group is seeking a per diem laborist to cover Labor and Delivery and emergency calls at Scripps Memorial Hospital in La Jolla. 70 deliveries/month. 24-hour shifts preferred but negotiable. Please send inquiries by email to IGO@IGOMED.com.

MEDICAL CONSULTANT, SAN DIEGO COUNTY:

The County of San Diego, Health and Human Services Agency’s Public Health Services is looking for a Board Certified Family Practice or Internal Medicine physician for the Epidemiology and Communicable Disease Division. Under general direction, incumbents perform a variety of duties necessary for the identification, diagnosis, and control of communicable diseases within the population. This position works closely with the medical and laboratory community, institutional settings, or hospital control practitioners. Learn more here: https://www.governmentjobs.com/careers/ sdcounty?keywords=21416207

KAISER PERMANENTE SAN DIEGO PER DIEM

PHYSIATRIST: Southern California Permanente Medical Group is an organization with strong values, which provides our physicians with the resources and support systems to ensure they can focus on practicing medicine, connecting with one another, and providing the best possible care to their patients. For consideration or to apply, visit https://scpmgphysiciancareers.com/specialty/physical-medicine-rehabilitation. For questions or additional information, please contact Michelle Johnson at 866-503-1860 or Michelle.S1.Johnson@kp.org. We are an AAP/EEO employer.

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.

NEIGHBORHOOD HEALTHCARE MD, FAMILY PRACTICE AND INTERNISTS/HOSPITALISTS: Physicians wanted, beautiful Riverside County and San Diego County- High Quality Family Practice for a privatenonprofit 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 lowincome, 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.

CLASSIFIEDS

PHYSICIAN POSITIONS WANTED

PSYCHIATRIST AVAILABLE! Accepting new patients for medication management, crisis visits, ADHD, cognitive testing, and psychotherapy. Out of network physician servicing La Jolla & San Diego. Visit hylermed.com or call 619-707-1554.

PRACTICE FOR SALE

GASTROENTEROLOGY GI PRACTICE FOR SALE: Looking to expand? or Move? Established 25+ years

Gastroenterology GI office practice for sale in beautiful San Diego County, California. 500 active strong patient relationships and referral streams. Consistent total gross income of $600,000 for the past couple years; even through pandemic. Located in a professional-medical building with professional contract staff. All records and billing managed by a professional service who can assist with insurance integration. Office, staff & equipment are move-in ready. Seller will assist Buyer to ensure a smooth transition. Being On-Call optional. Contact Ferdinand @ (858) 752-1492 or ferdinand@zybex.com.

OTOLARYNGOLOGY HEAD & NECK SURGERY SOLO

PRACTICE FOR SALE: Otolaryngology Head & Neck Surgery solo practice located in the Ximed building on the Scripps Memorial Hospital La Jolla campus is for sale. The office is approximately 3000 SF with 1 or 2 Physician Offices. It has 4 fully equipped exam rooms, an audio room, one procedure room, one conference room, one office manager room as well as in-house billing section, staff room and a bathroom. There is ample parking for staff and patients with close access to radiology and laboratory facilities. For further information please contact Christine Van Such at 858-354-1895 or email: mahdavim3@gmail.com

OFFICE SPACE / REAL ESTATE AVAILABLE

LA JOLLA/UTC OFFICE TO SUBLEASE OR SHARE: Modern upscale office near Scripps Memorial, UCSD hospital, and the UTC mall. One large exam/procedure room and one regular-sized exam room. Large physician office for consults as well. Ample waiting room area. Can accommodate any specialty or Internal Medicine. Multiple days per week and full use of the office is available. If interested please email drphilipw@gmail.com.

ENCINITAS MEDICAL SPACE AVAILABLE: Newly updated office space located in a medical office building. Two large exam rooms are available M-F and suitable for all types of practice, including subspecialties need-

ing equipment space. Building consists of primary and specialist physicians, great for networking and referrals. Includes access to the break room, bathroom and reception. Large parking lot with free parking for patients. Possibility to share receptionist or bring your own. Please contact coastdocgroup@gmail.com for more information.

NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023

W. Vista Way, Suite C, Vista CA 92082. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, decor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele. Just a few blocks from Tri-City Medical Center and across from the urgent care. Includes: multiple exam rooms, access to a kitchenette/break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is not included. For inquiries contact hosalkarofficeassist@ gmail.com or call/text (858)740-1928.

PHYSICIAN OFFICE SPACE FOR LEASE. 1500 Sq ft. 3 exam room. Large private office. Large reception area and patient prep room. New upgraded flooring. Private entrance. Located in Rancho Bernardo in prime central location. Easy access to interstate 15. Palomar /Pomerado within 10 min. Security card access during off hours. $2500/month. Contact: (619) 585-0476. Ask for Peg.

SUBLEASE AVAILABLE: Sublease available in Del Mar off 5 freeway. Share rent. 2100 sq ft office in professional building. Utilities included. Great opportunity in a very desirable area. 858-342-3104.

CHULA VISTA MEDICAL OFFICE: Ready with 8 patient rooms, 2000sf, excellent parking ratios, Lease $4000/ mo. No need to spend a penny. Call Dr. Vin, 619-4056307 vsnnk@yahoo.com

OFFICE SPACE AVAILABLE IN BANKERS HILL: Approximately 500 sq foot suite available to lease, includes private bathroom. Located at beautiful Bankers Hill. For more details, please call Claudia at 619-501-4758.

OFFICE AVAILABLE IN MISSION HILLS, UPTOWN

SAN DIEGO: Close to Scripps Mercy and UCSD Hillcrest. Comfortable Arts and Crafts style home in upscale Mission Hills neighborhood. Converted and in use as medical / surgical office. Good for 1-2 practitioners with large waiting and reception area. 3 examination rooms, 2 physician offices and a small kitchen area. 1700 sq. ft. Available for full occupancy in March 2022. Contact by Dr. Balourdas at greg@thehanddoctor.com.

OFFICE SPACE IN EL CENTRO, CA TO SHARE: Office in El Centro in excellent location, close to El Centro Regional Medical Centre Hospital is seeking Doctors of any specialty to share the office space. The office is fully furnished. It consists of 8 exam rooms, nurse station, Dr. office, conference room, kitchenette and beautiful reception. If you are interested or need more information please contact Katia at 760-427-3328 or email at Feminacareo@gmail.com

OFFICE SPACE / REAL ESTATE WANTED

MEDICAL OFFICE SPACE WANTED IN HILLCREST/ BANKERS HILL AREA. Mercy Physicians Medical Group (MPMG) specialist is looking for office space near Scripps Mercy Hospital. Open to lease or share office space, full time needed. Please respond to rjvallonedpm@sbcglobal.net or 858-945-0903.

NON-PHYSICIAN POSITIONS AVAILABLE

PROJECT SCIENTISTS: Project Scientists (non-tenured, Assistant, Associate or Full level): The University of California, San Diego, Office of Research Affairs https:// research.ucsd.edu/, in support of the campus multidisciplinary Organized Research Units (ORUs) https:// research.ucsd.edu/ORU/index.html is conducting an open search. Project Scientists are academic researchers who are expected to make significant and creative contributions to a research team, are not required to carry out independent research but will publish and carry out research or creative programs with supervision. Appointments and duration vary depending on the length of the research project and availability of funding. https://apol-recruit.ucsd.edu/JPF03262/apply

OFFICE MANAGER: 1. Hiring, Training, Managing staff on procedures/policies. Monitors continuing compliance and office statistics. Oversee stocking/ maintenance of supplies, retail. Equipment/ facilities management. Daily bookkeeping, collections.2. Ensure smooth/efficient patient flow with increasing production/collections.3. Create a friendly environment where patients expectations are exceeded, where staff can work together as a team. 4. Ensure staff working at maximum productivity/efficiency. Salary: $60-70K depending on experience/qualifications. Benefits: health care reimbursement, PTO, retirement, employee discount, bonuses, commission. Contact: info@manageyourage.com.