November 2017 by San Diego Physician

NOVEMBER 2017 OFFICIAL PUBLICATION OF SDCMS

San Diegoâ&#x20AC;&#x2122;s

DR. TED MAZER

Takes the Reins at CMA

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NOVEMBER

CONTENTS

VOLUME 104, NUMBER 11 EDITOR: James Santiago Grisolía, MD EDITORIAL BOARD: James Santiago Grisolía, MD • Mihir Parikh, MD • Robert E. Peters, MD, PhD • J. Steven Poceta, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: Mark W. Sornson, MD, PhD President-elect: David E.J. Bazzo, MD Secretary: James H. Schultz Jr., MD Treasurer: Holly B. Yang, MD Immediate Past President: Mihir Y. Parikh, MD GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD East County #2: Rakesh R. Patel, MD East County #3: Jane A. Lyons, MD Hillcrest #1: Gregory M. Balourdas, MD Hillcrest #2: Thomas C. Lian, MD Kearny Mesa #1: Sergio R. Flores, MD (Board Representative to Executive Committee) Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Geva E. Mannor, MD, MPH La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Michael A. Lobatz, MD South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD

SDCMS President Dr. Mark Sornson, CMA President Dr. Ted Mazer, and District I Delegation Chair Dr. Steve Hayden

4 Briefly Noted: Calendar • Salute to Veterans • Volunteer Opportunities • 2-1-1 Can Help • And More…

6 Let’s be Grateful for Gratitude BY HELANE FRONEK, MD, FACP, FACPh

14 Real-life Malpractice Claims ROBIN DIAMOND, THE DOCTORS COMPANY

CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MP AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Lisa Miller, MD At-large AMA Delegate: Albert Ray, MD (appointed by CMA) At-large AMA Delegate: Robert E. Hertzka, MD (appointed by CMA) At-large AMA Alternate Delegate: Theodore M. Mazer, MD (appointed by CMA)

House of Delegates Wrap Up BY KATHERINE BOROSKI, CMA SENIOR DIRECTOR OF COMMUNICATIONS

26 Physician Marketplace: Classifieds

CMA’s 2017 Legislative Wrap Up

BY JANUS L. NORMAN, CMA SENIOR

Flying Falling Home

VICE PRESIDENT

BY DANIEL J. BRESSLER, MD, FACP

NOVEMBER 2017

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

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

feature

departments

AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Karrar H. Ali, DO, MPH; #3: Alexexandra E. Page, MD; #4: Nicholas J. Yphantides, MD; #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); #8: Robert E. Peters, MD

ADDITIONAL VOTING DIRECTORS Communications Chair: J. Steven Poceta, MD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Meghana Pagadala

San Diego’s Dr. Ted Mazer Takes the Reins at CMA

GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD Hillcrest: Kyle P. Edmonds, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County #1: Neelima V. Chu, MD South Bay: Paul Manos, DO

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

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SALUTE TO SERVICE

San Diego County Medical Society Salutes Veterans

Taking Control of Your Diabetes Conference November 18, 2017 San Diego Convention Center National Healthcare Coalition Preparedness Conference November 28-30, 2017 San Diego Sheraton Hotel and Marina Bioethics Training Conference November 29, 2017 SDCMS Conference Room AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic January 8-11, 2018 Hard Rock Hotel San Diego

SDCMS Social Events 2018

Mark your calendars for next year! Feb 22 (Thurs) Physician Networking Mixer April 26 (Thurs) Vendor Fair July 14 (Sat) Family Pool Party Oct 25 (Thurs) Physician Networking Mixer *dates subject to change.

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VOLUNTEER OPPORTUNITIES

Looking for a short-term volunteer opportunity? Healthcare providers are needed in Haiti

Who is needed? Physicians, mid-level providers and nurses for one-week, primary-care medical clinics in rural Haiti in February, June, and October 2018. This is a rewarding and fun opportunity to work with the people of Haiti and provide care in a rural clinic in a medically underserved area. Seattle-King County Disaster Team (a U.S.-based nonprofit) has been operating these clinics since 1998. We coordinate all in-country travel and logistics. Please contact Bob Downey at (619) 905-7157 or at labboy@earthlink.net if you are interested in applying. Visit www. skcdteam.org for further information.

Veterans Day will be observed on November 11. Not to be confused with Memorial Day when we recognize those who made the ultimate sacrifice, Veterans Day is a day for Americans to celebrate and acknowledge all United States military veterans. Originally named “Armistice Day,” it was adopted November 11, 1919. In Woodrow Wilson’s address to the country commemorating the day, he made the following statement: “To us in America the reflections of Armistice Day will be filled with solemn pride in the heroism of those who died in the country’s service, and with gratitude for the victory, both because of the thing from which it has freed us and because of the opportunity it has given America to show her sympathy with peace and justice in the councils of nations.” The San Diego County Medical Society salutes the veterans in San Diego County and across the country and world who defend our freedoms each and every day.

QUOTE OF THE MONTH

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

NOVEMBER 2017

— Maya Angelou (1928–2014)

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

Welcome New and Returning SDCMS-CMA Members! Welcome New Members! Rachel Abbott, MD Family Medicine San Diego (619) 528-5000 Steve Aguilar, MD Emergency Medicine San Diego (619) 528-5000 Christopher Aquino, MD Neuroradiology San Diego (619) 528-5518 Alison Celis, DO Emergency Medicine Escondido (760) 739-3000 Natasha Conley, DO Rheumatology San Diego (619) 528-5000 Rebecca Ensley, DO Gastroenterology San Diego (858) 621-4145 Derek Hauser, DO Hospice and Palliatative Medicine San Diego (619) 528-5000

Nina Liu, MD Medical Oncology San Diego (619) 528-5000 Matthew Lutch, MD Otolaryngology San Diego (619) 528-5000

Adam Schwartz, MD Emergency Medicine Coronado (619) 528-5009

Igor Medic, MD Medical Oncology San Diego (619) 644-4500

Thomas Wang, MD Sports Medicine San Marcos (619) 528-5000

Lucila Moreira, DO Pediatrics San Diego (858) 495-0500

Melanie Wuerstle, MD Urology San Diego (619) 528-5000

Alan Mortezaie, MD Radiology La Mesa (619) 460-2770

Catherine Yao, MD Pediatrics San Diego (858) 495-0500

Diana Mosquera, MD Pediatrics San Diego (858) 495-0500

Shabnam Zargar, MD Pediatrics San Diego (858) 636-4300

Brett Partridge, MD Gastroenterology San Diego (619) 528-5000

Welcome Returning Member!

Laurie Rubenstein, MD Pediatrics San Diego (619) 528-5000

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Jordan Sinow, MD Plastic Surgery San Diego (619) 528-5000

Michael Bogue, MD Anesthesiology San Diego (858) 565-9666

Wendy Hunter, MD Pediatrics San Diego (858) 495-0500

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HEPAPITIS A RESOURCE

2-1-1 CAN HELP If you are needing a resource for your patients during the Hepatitis A Outbreak, 211 San Diego can help. San Diego County Medical Society is an active partner with 211 San Diego. The organization has a mission to serve as a nexus to bring community organizations together to allow people to access the resources and services they need. You can get more information about 211 San Diego and how it can help you and your patients at www.211sandiego.org.

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P E R S O N A L & P R O F E S S I O N A L D E V E LO P M E N T

LET’S BE GRATEFUL FOR GRATITUDE by Helane Fronek, MD, FACP, FACPh

FALL IS IN THE AIR! Even in San Diego, leaves dazzle us with color and we enjoy the succession of festive holidays. The days grow shorter, reminding us that time is passing. This heightened awareness of life’s fleeting nature helps us appreciate what we have. The saying, “Happiness is not having what we want, but wanting what we have,” offers a lot of wisdom. This is one reason Thanksgiving is my favorite holiday. It gives us an opportunity to pause and feel grateful for what we have. Gratitude enhances our quality of life in many observable ways. Patients demonstrate improved outcomes when they participate in gratitude experiences, with greater adherence to treatment regimens and enhanced help-seeking behavior. Functional MRI studies even show distinct changes

NOVEMBER 2017

in connectivity between the amygdala and other important brain structures after experiences of gratitude. Take a moment now and imagine something you are grateful for — a special person in your life, recent experience, or even the beauty of the world we live in. By paying attention, you’ll notice your heart rate and breathing slow, the tension in your muscles diminishes, and you feel a sense of spaciousness. In this expanded, less constricted state, possibilities enter your mind and you become more hopeful. As a coach, I often witness the benefits when clients keep a gratitude journal, recording what they are grateful for each day. It sharpens their awareness so they begin to feel gratitude in real time when these experiences happen. If each positive occurrence could immediately slow your heart rate,

reduce your tension and open your mind to new possibilities throughout your day, imagine how your experience of life would change! And since our experience is determined by what we pay attention to, focusing more on what we’re grateful for leaves us with a more positive view of our life. This is not to say we should distort our vision with rose-colored glasses. We need discernment to recognize obstacles, injustices, and opportunities for improvement. Yet, too often, we allow our experience of life to be dominated by what we don’t have or don’t want. Years ago, a wise medical student noticed that, as she watched her grandmother’s personality and capabilities disappear with advancing Alzheimer’s, she was focusing only on what had been lost, rather than appreciating what was still left for her to enjoy. Clearly, a balance between what we value and what we still want is necessary for us to reap the full potential of our lives. As physicians, we are trained to always ask how things could be better. Doing this at the expense of recognizing the goodness around us is one reason why so many physicians are burned out. This Thanksgiving, let’s take stock of what we appreciate and are grateful for. Take the opportunity to tell the special people in your life what they mean to you. Let your breathing slow, your muscles relax, and your heart open to the beauty and hope around you. Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.com

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POLICY

CMA’S 2017 LEGISLATIVE WRAP UP by Janus L. Norman, CMA Senior Vice President

NOVEMBER 2017

“‘Impossible’ is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it.” —Muhammad Ali IN MODERN CALIFORNIA POLITICS, there is no more imposing figure than Governor Jerry Brown. Since his return to the Governor’s office, Brown and his administration have been able to develop and implement his policy agenda in a nearly flawless manner, overcoming every political obstacle in his way. Nowhere has Governor Brown’s dominance been more evident than

CMA this year pushed an aggressive legislative agenda through our package of sponsored bills, seeking to address a wide variety of our members’ issues.

in the crafting of the state budget. Prior to Governor Brown’s return and the passage of the majority-vote budget, the enactment of the state budget was a drawn-out clash of political wills — a battle of ideals and priorities. The governor would present his vision in January. The Legislature would take months reshaping and refocusing the governor’s budget proposal. Tense negotiations would yield significant legislative changes in the budget and a handful of gubernatorial line-item vetoes. During his second tenure, Governor Brown has worked to deliver on-time budgets that do not significantly

differ from his January proposals. This year, the state budget process was more critical than ever to the California Medical Association (CMA). The November 2016 election yielded another ballot measure victory for CMA and publichealth advocates across the Golden State with the passage of Proposition 56. CMA took on Big Tobacco and passed Prop. 56, which increased the tax on tobacco products by $2 per pack and stipulated that the new tobacco tax funds should increase access by improving provider payments. Despite being outspent, CMA and its partners in support of the measure got Prop. 56 passed overwhelmingly, providing an influx of new revenue to increase payments to Medi-Cal providers. Governor Brown, however, seeking to secure his legacy of fiscal prudence, sought to reinterpret the provisions of Prop. 56 to redirect the tobacco tax proceeds from Medi-Cal providers to the State General Fund. In his January budget proposal, Governor Brown didn’t include a rate increase for Medi-Cal providers. While there was an initial thought that the Governor was utilizing this proposal as a negotiation tactic to help shape the overarching discussion of the architecture for the state budget, it quickly became apparent that the governor did not intend to ever support a rate increase for Medi-Cal providers. Thus, the battle began! The governor’s intentions became more evident with the release of the Department of Finance’s May Revision. Just weeks before the constitutional deadline for the Legislature to pass the budget, the Governor doubled down on this earlier proposal and once again proposed no funding to support a Medi-Cal rate increase for providers. Restoring Prop. 56 funds was CMA’s

top budget priority, and we engaged the legislature through earned media, digital advertising, grassroots outreach and direct advocacy. CMA and its coalition partners, specifically the California Dental Association and Planned Parenthood, devoted the necessary resources to make sure that the legislature followed the will of the voters and used the tobacco tax money to improve access to care in our state. CMA’s county medical societies and individual physician members made calls, wrote letters and conducted in-person legislative lobbying visits. Our legislative champions, led by Senator Richard Pan, M.D., and Assemblymembers Joaquin Arambula, M.D., and Jim Wood, D.D.S., pushed both the State Senate and Assembly to reject the governor’s budget. The final budget, which Governor Brown signed, provides more than $1 billion ($546 million in state funds, with a federal match) to improve provider payments, and nearly $750 million ($375 million in state funds, with a federal match) will be available to physicians. This victory was a collective effort of the entire CMA. A budget team was assembled, comprising members of the Centers for Government Relations, Health Policy, Strategic Communications and Political Operations. Working in concert, this team successfully pushed the budget as CMA’s top legislative priority. Media coverage of the budget is always competitive, but the issue of Prop. 56 funding garnered a significant amount of attention, even among the sea of other budget fights, thanks to the persistence of the CMA Communications team. CMA’s Political Operations staff organized physicians and county medical society executives to engage in the fight, bringing the issue to the attention of their legislators at in-district meetings and to the Capitol on SAN DIEGO PHYSICIAN.ORG

POLICY

our Legislative Advocacy Day in April. The CMA Government Relations team, the face of the fight, came armed to each hearing and meeting with the expertise of the CMA Health Policy team. Although this fight will no doubt play out again in some future years and we will need to be vigilant to ensure continued funding, this year’s budget success seals the intent of the voters and will provide relief for California’s shamefully low Medi-Cal reimbursement rates. An Aggressive Legislative Agenda Amid the budget battle, the quotidian legislative work continued — as always. However, the routine was not without intensity. CMA this year pushed an aggressive legislative agenda through our package of sponsored bills, seeking to address a wide variety of our members’ issues. Two of our sponsored bills this year pertained to different aspects of the opioid crisis. SB 641 (Lara), which was put on hold for further discussion in the 2018 legisla-

This year, the state budget process was more critical than ever to the California Medical Association. tive session, is a supplement to Senator Lara’s SB 482 from last session, requiring use of the Controlled Substance Utilization Review and Evaluation System (CURES) for Schedule II–IV controlled-substance prescriptions. Our bill would improve privacy protections in the mandated use of CURES. To deal with how opioids are prescribed, Assemblymember Joaquin Arambula, M.D., introduced AB 1048, which allowed for partial fill of Schedule II prescriptions and removed the requirement for evaluating pain as the fifth vital sign. These changes will alleviate some of the pressure on physicians to prescribe and reduce the number of opioids given to patients. CMA also successfully pushed a cleanup bill for last year’s AB 2883 (authored by

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the Committee on Insurance), a workers’ compensation bill that inadvertently created hundreds of thousands of dollars of new, burdensome costs to physician practices. CMA’s bill — SB 189 (Bradford) — completely exempted physician practices from the workers’ compensation coverage requirement established by AB 2883, provided they have health insurance coverage. SB 189 will dramatically reduce the administrative cost of running a medical practice. Our highest profile legislative fight was over the Medical Board of California sunset review. This was the legislature’s scheduled review of the medical board, during which it can make changes to the board’s policies and procedures and, cru-

SAN DIEGO PHYSICIAN.ORG

POLICY

cially, extends the board past its “sunset” — that is, dissolution — date. What should have been an uneventful, perfunctory bill became a fight for CMA because of the inclusion of several provisions eroding physicians’ rights. We secured amendments to remove harmful provisions from the bill, including ones that would have reestablished a cost recovery program for the board, provided the board with new authority to issue cease practice orders, and required certain physicians to notify their patients of their probation status. As ever with the two-year legislative cycle, the bulk of the first year’s work sets the stage for the second year’s. Discussions will resume in January over a host of issues, and CMA is well positioned in those conversations to protect the interests of physicians and their patients. Our strength this year builds our strength for next year. In Unity, Janus L. Norman Below are details of the major bills that cma followed this year.

CMA-Sponsored Legislation AB 315 (WOOD): PHARMACY BENEFIT MANAGER TRANSPARENCY This bill requires pharmacy benefit managers (PBMs) to obtain a license from the Department of Managed Health Care before conducting business in California and to renew the license on an annual basis. It also requires PBMs to make quarterly disclosures regarding information with respect to prescription product benefits specific to the purchaser for all retail, mail order, specialty, and compounded prescription products. Status: Held on the Inactive File of the senate

AB 505 (CABALLERO): RESTORING TRUST IN MEDICAL BOARD PROBATION This bill would have prevented a physician or surgeon charged with certain serious allegations from entering into a stipulated settlement that included probation as one of the settlement terms.

NOVEMBER 2017

Status: Held in the Senate Business, Profession, & Economic Development Committee

AB 1048 (ARAMBULA): IMPROVED OPIOID MANAGEMENT This bill allows Schedule II controlled substances to be partially filled at the request of the patient or the prescriber. It also removes the requirement that hospitals assess pain as the fifth vital sign, retaining the assessment but providing hospitals the flexibility in determining the best approach. These provisions ensure that healthcare providers can provide appropriate medical care while reducing excess opioid supply. Status: Signed by the governor (Chapter 615, Statutes of 2017)

AB 1221 (GONZALEZ FLETCHER): RESPONSIBLE BEVERAGE SERVICE TRAINING PROGRAM This bill would require California bartenders, servers, and managers to receive responsible beverage service training (RBS) through a program that must be administered or approved by the Department of Alcoholic Beverage Control or offered by a training provider that has been accredited by an accreditation agency. AB 1221 seeks to help individuals who serve alcohol to meet their statutory requirement not to serve obviously intoxicated patrons and minors and reduce drunk driving. Status: Signed by the governor (Chapter 847, Statutes of 2017)

SB 189 (BRADFORD): WORKERS’ COMPENSATION FIX This bill provides a clarification to AB 2883 (Insurance Committee, 2016), which had allowed shareholder-employees with at least a 15 percent ownership stake in a corporation to exempt themselves from coverage. SB 189 reduces the 15 percent ownership threshold to 10 percent and explicitly exempts physician owners of medical corporations from workers’ compensation requirements regardless of percentage of ownership, as long as they have health insurance coverage.

Status: Signed by the Governor (Chapter 770, Statutes of 2017) SB 457 (BATES): OUT-OFHOSPITAL BIRTHS This is a comprehensive approach for California licensees assisting out-of-hospital births (M.D.s, CNMs, and LMs) to establish proper protocols, increase patient safety, and clarify the appropriate scope of practice for both CNMs and LMs assisting births outside a hospital. CMA is co-sponsoring this legislation with ACOG. Status: Held in the Senate Business, Profession, & Economic Development Committee

SB 641 (LARA): PRIVATE PROTECTIONS FOR THE CURES DATABASE This bill clarifies that law enforcement must get a warrant to obtain information from the Controlled Substance Utilization Review and Evaluation System (CURES), which aligns the CURES privacy protections more closely with those provided in a patient’s medical record. Status: Held in the Assembly Public Safety Committee

SB 647 (PAN): SILENT PPO AND HEALTH CARE PROVIDERS’ BILL OF RIGHTS In 2003, the legislature enacted the Health Care Providers’ Bill of Rights, in part to ensure that third-party payers are automatically bound by the terms of the original health plan/provider contract. Recently, the appellate court decision in the UFCW & Employers Benefit Trust v. Sutter Health (2015) ruled that a third-party payer was not bound by the terms of the original health provider/health plan contract even though that payer had benefitted from the lower provider rates in the contract. The UFCW case has undermined protections that were established by a CMA-sponsored bill. We will be working with the California Hospital Association to sponsor legislation to reestablish the automatic binding of a third-party payer to the original health plan/provider contract. Status: Held in the Senate Health Committee

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R I S K M A N AG E M E N T

PHYSICIANS ARE ALWAYS SEEKING ways to enhance patient safety. Taking a close look at research into real-life malpractice claims and incorporating some of the findings into their practices is one way physicians are reducing risks of adverse events. Studies provided by The Doctors Company provide insight into thousands of closed claims and shine a light on preventive actions. The following are examples of doctors who learned from these malpractice closed claims studies and, as a result, took patient safety in their practices and hospitals to the next level.

REAL-LIFE MALPRACTICE CLAIMS Doctors Examine Injury Risks with Malpractice Closed Claims by Robin Diamond

NOVEMBER 2017

Cardiology • Doctor spotlight: Sandeep S. Mangalmurti, MD, JD, cardiologist at the Bassett Healthcare Network in Cooperstown, New York. • Risk trend: The Cardiology Closed Claims Study outlines liability pitfalls of improper medication management. Cardiovascular medications have inherent risks even when used correctly. • Solution: This risk led Dr. Mangalmurti to change his daily practice when managing certain high-risk medications such as anticoagulants. “Coumadin, in particular, is associated with high-liability risk because of the risk of bleeding and its narrow therapeutic window,” Dr. Mangalmurti says. To avoid medication mishaps or breakdowns in communication, he makes a point to be very clear about whether the general practitioner or cardiologist will manage the anticoagulant medication. Emergency Medicine • Doctor spotlight: Roneet Lev, MD, FACEP, chief of the emergency medicine department at Scripps Mercy Hospital in San Diego. • Risk trend: The Emergency Medicine Closed Claims Study identified the need for rapid recognition of stroke patients and treatment for tissue plasminogen activator (tPA). • Solution: Across the entire hospital system, Scripps Mercy Hospital now ini-

tiates its emergency protocol for potential strokes when the call is placed to 911. The patient is taken straight to the CT scan without stopping at an emergency department bed. This expedites patient care as they activate the stroke team. Hospital Medicine • Doctor spotlight: John D. Nelson, MD, internal medicine hospitalist at Overlake Medical Center in Bellevue, Washington. • Risk trend: The Hospitalist Closed Claims Study reveals spinal epidural abscess — a disease relatively uncommon in the general population — is appearing in medical malpractice claims more frequently. A diagnosis-related error involving spinal epidural abscess can lead to dire consequences, including paralysis. • Solution: “This study should serve as a strong reminder for hospitalists of the importance of maintaining a very high index of suspicion for spinal epidural abscess,” Dr. Nelson says. Problems with back pain, leukocytosis, and fever are red flags, but Dr. Nelson states the literature isn’t so simple. These symptoms alone do not equate with epidural abscess. It requires a great deal of judgment to decide which cases are deemed appropriate for this diagnosis. “If you think a patient could have it, and it’s worth pursuing, you should pursue it now rather than later. So, for example, get an MRI tonight rather than tomorrow.” Internal Medicine • Doctor spotlight: Howard Marcus, MD, internal medicine physician in Austin, Texas. • Risk trend: The Internal Medicine Closed Claims Study found that 39 percent of claims resulted from a diagnosis-related allegation (failure, delay, or wrong). • Solution: Dr. Marcus has conducted small-group discussions with physicians in his multispecialty medical group of more than 300 doctors to improve understanding of the underlying methodological reasons leading to cognitive error. “Diagnosis in medicine is often challenging,” Dr. Marcus says. “There

are more than 8,000 diagnostic entities listed by the National Library of Medicine and every patient is unique. It is helpful to understand the effect that psychological biases such as ‘overconfidence bias’ or ‘anchoring bias’ may play in medical decision making.” Obstetrics • Doctor spotlight: Marcus Tower, MD, obstetrician at the Cleveland Clinic’s Hillcrest Hospital in Cleveland. • Risk trend: The most common patient allegation identified in the Obstetrics Closed Claims Study is delay in treatment of fetal distress — specifically, failure to act when presented with Category II or Category III fetal heart rate tracings. • Solution: Upon learning of this trend, Hillcrest Hospital now offers physician and nurse classes, providing the opportunity to learn how to identify heart rate tracings in a wide spectrum of scenarios. “From [the classes] we had a standardization process,” Dr. Tower says. “Everyone became a patient advocate. Everyone focused their attention on, for that moment, identifying something that could be ominous so that we could act in a very timely manner.” Orthopedics • Doctor spotlight: Ralph A. Gambardella, MD, orthopedic surgery and sports medicine specialist with the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. • Risk trend: The Orthopedics Closed Claims Study reveals patient factors contributed to injuries in 29% of claims. It found that patient nonadherence was more likely when there was inadequate communication between the patient or family members and the physician. The study also notes that determining whether a patient is an appropriate candidate for a procedure is an important part of providing good care. • Solution: With communication being a prominent pitfall, the practice identified two areas where it could influence behavioral change:

1. Incorporating a smartphone application to improve doctor-patient communication. 2. Having the patient work directly with a financial advisor in-office and at the hospital to better understand financial responsibilities. The hospital also adopted a preoperative screening assessment to identify comorbidities, thereby improving the surgery selection process and lowering risk. Plastic Surgery • Doctor spotlight: Phillip Haeck, MD, a plastic surgeon at The Polyclinic in Seattle. • Risk trend: The Plastic Surgery Closed Claims Study notes that 10 percent of claims against plastic surgeons involved miscommunication between the patient or family members and the doctor. • Solution: Dr. Haeck presented the study to his six partners and 35 staff members where they reviewed communication practices. As a result, the practice administered changes to communication protocols among physicians, staff, and patients. It now has clear guidelines to identify each communication, when it took place, and what resulted. All communications — including social media exchanges between patient and staff — are now entered into the EHR to alert the surgeon of new communication. By leveraging technology, implementing new protocols, and being better equipped to address scenarios that could negatively impact patient safety, these practices and hospitals are taking steps in advancing patient care. Further insights from doctors who are learning from malpractice claims are available in The Doctors Company’s Innovations in Patient Safety video playlist. Contributed by The Doctors Company (thedoctors.com) Robin Diamond is senior vice president of patient safety and risk management for SDCMSendorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety. SAN DIEGO PHYSICIAN.ORG

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2017 MAJOR ISSUES

2017 House of Delegates California Medical Association delegates set policy and elect officers at annual meeting BY K ATHERINE BOROSK I

undreds of physicians, residents and medical students met October 21–22 in Anaheim for the 146th annual meeting of the California Medical Association (CMA) House of Delegates (HOD). During the meeting, the delegates discussed major issues affecting the practice of medicine, installed new officers, and recognized the recipients of CMA’s annual physician awards. Before debating the major issues — which this year were mental health, healthcare reform and physician workforce, the delegates heard from experts in each major issue area, with continuing medical education (CME) credit offered for these educational sessions. The House also installed a new president, San Diego otolaryngologist Theo-

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dore M. Mazer, M.D., while Los Angeles ophthalmologist David Aizuss, M.D., was tapped as president-elect. The full 2017–2018 CMA Executive Committee includes: • President: Theodore M. Mazer, M.D., San Diego • President-Elect: David H. Aizuss, M.D., Los Angeles • Chair of the Board: Robert E. Wailes, M.D., Oceanside/Encinitas • Vice-Chair of the Board: Shannon L. Udovic-Constant, M.D., San Francisco • Speaker of the House: Lee T. Snook, Jr., M.D., Sacramento • Vice-Speaker of the House: Tanya W. Spirtos, M.D., Redwood City • Immediate Past President: Ruth E. Haskins, M.D., Folsom

CMA physician delegates establish broad policy on current major issues that have been determined to be the most important issues affecting members, the association, and the practice of medicine. This year’s major issues were: Healthcare Reform: While the future of federal healthcare reform remains unclear, CMA continues to work with federal and state lawmakers to ensure that the healthcare system works for physicians and patients. The CMA House of Delegates discussed recommendations and regulations that will assist with federal healthcare reform, and debated how single payer or public healthcare options might work. Physician Workforce: Maintaining a physician workforce that ensures all patients have sufficient and timely access to quality medical care continues to be a challenge for California. The delegates discussed barriers that impact the practice of medicine in California and analyzed various strategies and policies to address the physician workforce problem. Mental Health: For decades, CMA policy has strongly supported adequate funding and provisions for high-quality mental healthcare. However, despite raised awareness, mental illness continues to go unrecognized and underfunded in California; many people with mental illnesses do not receive the help they need. The delegates discussed significant factors affecting the mental health system including access and infrastructure, and established policies to support and improve the mental health system. Final reports detailing the actions taken by delegates are posted now at www.cmanet.org/hod.

SUBMIT A RESOLUTION A recent change to the CMA governance process was the introduction of a year-round (quarterly) resolution process. Any CMA member may author a resolution and have it submitted to the Board of Trustees using the year-round process for consideration between annual meetings. This approach preserves the ability of individual members to participate in and influence CMA policymaking in a more timely way, rather

than waiting for a once-a-year opportunity at HOD. This allows CMA to be more nimble and effective in making decisions on critical issues that are important to physicians. If you have a resolution you would like to submit, email it to resolutions@cmanet.org. Please visit www.cmanet.org/hod and read the guidelines before submitting a resolution. Resolutions that do not follow the guidelines will be rejected.

Elections CMA installs San Diego otolaryngologist as 150th president CMA installed San Diego otolaryngologist Theodore M. Mazer, M.D., as its 150th president. Dr. Mazer has been a CMA and San Diego County Medical Society (SDCMS) member for 29 years. He has served on the CMA Board of Trustees since 2002, as Speaker of the House of Delegates from 2013 to 2016, and chaired various committees, including those focused on medical services and access to specialty care. Dr. Mazer is a past president of SDCMS and a delegate to the American Medical Association. “I take the role of leading this organization as an awesome responsibility,” Dr. Mazer says. “I look forward to working hard this year to ensure practicing physicians have a seat at the table to promote policies that protect our patients, our practices and our ability to care for our communities.” A defender of patients’ right to access medical care, he has fought for Medi-Cal access all the way up to the Supreme Court and worked for more than a decade with Congress and CMA to correct improper Medicare payment rates in San Diego and throughout California. Dr. Mazer currently practices at SharpGrossmont Hospital, where he has served as chair of surgery, and at Alvarado Hospital Medical Center, where he has served as chief of staff. Dr. Mazer is a consultant to the Alvarado Hospital Medical Executive Committee and was a member of the national Physicians Advisory Commission at Anthem Blue Cross. He completed his residency at Baylor College of Medicine in Houston. Dr. Mazer is very active in San Diego’s medical community. He is founder and member of several Independent Prac-

tice Associations (IPA) and management groups. He served as a board member and medical director for several years with Mercy Physicians Medical Group. He presently serves as a director with Scripps Mercy Physicians Partners messenger model IPA and its management group, which provides integrative support services for small- and medium-size practices. He has been selected as a San Diego Top Doctor several times and awarded the San Diego Business Journal’s Health Leaders Award. “CMA can forge ahead with confidence with Ted Mazer at our helm,” says CMA Immediate Past President Ruth Haskins, M.D. “He has the will to get the job done, the data to back up his plan, the heart to steer us in the right direction, and the energy to move us steadily forward.” CMA presidents serve a yearlong term, starting and ending in October. Dr. Mazer was elected to serve as president for the 2017–18 year. You can view Dr. Mazer’s inaugural address to the CMA House of Delegates at www.youtube.com/cmaphysicians. CMA names Los Angeles ophthalmologist 2017-18 president-elect David Aizuss, M.D., a board-certified ophthalmologist practicing in Los Angeles, was selected as the association’s presidentelect. He will serve in this capacity for one year and will be installed as president at the conclusion of next year’s HOD. Through the David H. Aizuss, M.D., Medical Corporation, and the Ophthalmology Associates of the Valley Medical Surgical Group, a partnership of medical corporations, Dr. Aizuss focuses exclusively on direct patient care. He also serves as an assistant clinical professor of ophthalmology at the UCLA Geffen School of Medicine. Dr. Aizuss is a medical staff member at Tarzana Hospital and West Hills Hospital, in Los Angeles County, and belongs to several professional societies, including the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Cornea Society and the American Medical Association. He received his medical degree from Northwestern University Medical School and his bachelor’s degree in medicine from

Northwestern University. He completed his residency in ophthalmology at the Jules Stein Eye Institute in Los Angeles, where he also undertook a fellowship in cornea and external ocular disease from 1984 to 1985. He is a former president of the Los Angeles County Medical Association and the California Academy of Eye Physicians and Surgeons. Before being elected as president-elect, he served as the chair of the CMA Board of Trustees.

Other News CMA presents resolution honoring AMA for work in protecting medical staff rights CMA has been actively and aggressively supporting the medical staff at Tulare Regional Medical Center in their lawsuit against the hospital for illegally terminating and replacing the entire medical staff and its duly elected officers. If left to stand, the hospital’s actions will create a dangerous precedent that could have much broader implications for the fundamental rights of medical staffs and physicians’ ability to care for patients in hospitals. Recognizing the critical national implications of this case, the Litigation Center of the American Medical Association (AMA) has provided significant legal support and monetary contributions to this case. AMA President David O. Barbe, M.D., recently traveled to Anaheim to speak to the CMA House of Delegates about the unprecedented attack on medical staff selfgovernance in the Tulare case. AMA’s contributions to the litigation in this case represent the single largest legal contribution in the history of the AMA. CMA presented Dr. Barbe with a resolution recognizing AMA for its extraordinary commitment to protecting medical staff rights to independence and self-governance. This case was recently featured in a New York Times op-ed, which provides a good look at why this local conflict could have a dangerous effect on patient care in U.S. hospitals. If your medical staff is interested in contributing to CMA’s Legal Defense Fund, which is used to litigate cases of critical importance to physicians, email swolley@ cmanet.org.

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NOVEMBER 2017

Congratulations, Dr. Mazer! Dr. Theodore Mazer’s inauguration speech as CMA’s new president.

hank you, thank you all for the honor and trust you’ve placed in me as the next president of the CMA. In the words of the Bard (Prospero in The Tempest): “I will pay thy graces/home both in word and deed.” Leading this organization is an awesome responsibility, to represent CMA in the battles medicine faces in California and nationally; to promote policies that protect our patients, our practices, and our ability to care for our communities, while preventing regulations which often contribute to the ever-increasing problem of burnout amongst physicians, resulting in early retirement or career change, frustrations, and even suicides. Twenty-eight years ago, I demanded to know what my dues were paying for! Bad timing, I guess, because that episode introduced me to one of the greatest conscriptors in organized medicine, Dr. Bob Hertzka, who my wife (and I) blame for taking me to the depths of organized medicine and politics. And the rest is history. I found colleagues at SDCMS and CMA who believed in helping frame the future of medicine, fighting against those who would dismantle our profession for their own political or financial gain; a grassroots operation that actually acts on behalf of its members, rather than just complaining like so many of our colleagues do in the doctors’ lounge. I found many physician mentors like Drs. Jim Hay, David Priver, and Al Ray, and leaders from all around the state; CMA

Trustees and past presidents, who encouraged me to move forward, even when our opinions sharply diverged. I don’t know now where I get more satisfaction: my solo ENT practice, assisted by the finest office staff one could ask for; or my work with CMA. Like my office, CMA is staffed with some of the most dedicated people you will ever know. People working hard, on behalf of our goals, because they believe in those goals. Who, on their own, created a rallying cry, a credo declaring why they do what they do, to help us fulfil our mission. It’s a model of teamwork that we can follow. There is not one member of CMA staff that doesn’t deserve recognition. Hoping not to offend, I must acknowledge a few individuals, including Elizabeth McNeil, one of my first staffers as a committee chair, and now our mother duck as we traipse through DC; Michelle Chapanian, and her team: Michelle, you may not have felt that you were ready for this position, but you are incredible; Jodi Black and Economic Services, returning millions of underpaid claims dollars to physicians; our GR, Communications, policy, membership and legal teams. Thank you to all of the CMA staff for all you do. And to Dustin, Lance, Francisco, and Janus: my thanks for your leadership, guidance, and friendship! I believe all physicians are responsible to protect the profession of medicine in the present and for the future. And no one can do that alone. We can do it as a team, listening to our colleagues, especially where their insights

and needs differ from ours. I am so encouraged by talking to our medical students and young physicians, with their fresh ideas and outlooks, dedicated to the future of patient care. One of those students, Cecelia Bonaduce-Leggett, put it well when asked why busy medical students would get involved with medical politics, saying: “We believe the future of medicine should have a say in the future of medicine.” If only those who want to tell us how to practice our profession could take a leaf from her book! … Listening to those actually practicing medicine to inform public policies for the future. Fulfilling our mission to promote the science and art of medicine, the care and wellbeing of patients, the protection of the public health and the betterment of the medical profession, we must advocate for physicians as professionals, enabling us to do what is right for our patients. To support the supremacy of the physicianpatient relationship which allows the unfettered sharing of intimate information and decision making, aware of but unhindered by purely economic factors. We must support physicians in all specialties and modes of practice, so that patients can choose to receive care in whatever forum best suits them. Every idea starts with one person. The scholar Hillel said that a single candle can light a thousand other candles without diminishing itself. Each of us is such a candle. Each can inspire others to resist forces that impede our ability to care for patients, and each can promote positive

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1 2

1. Dr. Lase Ajayi of San Diego presenting the YPS Young at Heart award to Dr. Ruth Haskins. 2. Dr. Preeti Mehta (District I Delegate), Dr. Mazer, Dr. Aryan Fotros (RFS Alternate Delegate), and Dr. Ruth Haskins (CMA Past President) 3. Dr. Mazer and his family at the CMA Foundation President’s Gala.

changes. Each of us can encourage our colleagues to join us, whether actively or simply as members supporting our efforts. Our actions are for all physicians, and no one should be a bystander. There are many issues to address in healthcare, and I haven’t nearly enough time today to go through them now. (If you would like the full 45-minute version of this address, let me know and I will email it to you!) There are issues within our profession that we must be willing to deal fairly with. When we do not, we are hit hard by consumers and legislators who swing battle axes and take out good players along with the bad. Improved care models and electronic records have the potential to improve patient care. But records that serve as audit tools and take time away from patient care are not the answer; nor are models of care that are built around data for data’s sake or bean counting. We must eliminate what is just a resource and time suck, and replace these things with new approaches that reduce physician burden and improve care and efficiency. We need those who make the rules to

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recognize our role and to collaborate with us rather than dictate to us. Demanding that practicing physicians have a seat at the table for any new reforms is not self-serving … it is a necessary part of the process, to avoid pitfalls that occur when non-physicians try to modify the world we live in, the world of actual patient care. The to-do list is long: MACRA/MIPS. Appeals. Audits. DACA. The opioid epidemic. Medicaid funding. Medical staff autonomy fights. Network adequacy. EHRs designed not for patient care but as what I will define as “bullet-point-oriented billing checklists.” Myriad prior authorizations and my particular fave: interruptive, ridiculous peer-to-peer reviews, done at

the convenience of the reviewer while we are trying to care for our patients. We need to stop plans from requiring physicians, trained in medicine, to spend more time doing data entry and asking, “Mother, may I?” from untrained desk clerks, than we can now spare to spend face to face with a patient doing what we are trained to do best. Programs like MediCal are perennially overpromised and underfunded. Legislators must allocate proper resources to open doors to both primary and specialty care. Our successful fight with Governor Brown over prop 56 tobacco tax funds was not about increasing physician profit, but at making it more reasonable for physicians to accept MediCal patients, to reverse

years of poor access to care for those to whom the State promises medical services. These efforts must continue. Single payer discussions are in their infancy. In reviewing and informing proposals for alternatives for universal healthcare access, we must be watchdogs against policies that in the long term would be damaging to our patients or our profession … wary of solutions driven not by thoughtful construction, but by political expediency. We are faced almost daily with attacks on ACA: the cancelling of CSRs and the executive order regarding association health plans, and interstate sales of insurance without hard-fought state protections. This is a dangerous game, which fails to put patients first. We can have the discussion about repeal or fix, but we can’t accept willy nilly picking apart of regulations that damage the public and healthcare providers. When considering policy changes, all parties must heed Governor Brown’s response to this year’s single payer proposal when looking at proposed solutions: Ignotum per ignotius. Explaining the unknown by the more unknown, or in Jerry’s words: Taking a problem and saying you are going to solve it with something that’s even a bigger problem! On the public health front, we must continue to focus on educating the public about obesity, healthy choices in food and activities, and work to decrease and eliminate socioeconomic health disparities. Even minor changes are something to strive for. Prevalence of true celiac disease in America is 1%, with others choosing to eat gluten free. Vegetarians account for about 3% of the population. Restaurant menus commonly list gluten free items, and vegetarian options are usually available. Diabetics make up about 10% of the population. Food on restaurant menus can have a significant sugar content, yet it is rare to see any designation of low-sugar items. Even on request, it is hard to find a restaurant with desserts appropriate for a diabetic. Is it that hard to have even a dessert available for 10% of the population to enjoy? It would be a win-win for restaurants, who could sell more desserts and coffee, and for diabetics who wouldn’t need to sneak a dessert or feel

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4. CMA Past President Dr. Steven Larson congratulating Dr. Mazer. 5. At the CMA President’s Gala (from left to right) Dr. Will Tseng, SDCMS Past President, Dr. Venu Prabaker, SDCMS Board Member, Dr. Ted Mazer, CMA President, and Dr. Michael Butera, CMA Delegate. 6. CMA Trustee Dr Damodara Rajasekhar and District I Delegate Dr. Venu Prabaker with Dr. Mazer and his wife, Marcy.

uncomfortable in a group at a restaurant. Simple, but aimed at a real health issue. For those of you attending tonight’s gala, if you seek a diabetic dessert we’ve asked Disney to create something special for you! At CMA, we seek ways to keep membership engaged in the new processes, to promote diversity throughout the organization, and to make our forums and sections more relevant and more involved with those they represent. A new website allowing two-way communications will improve our abilities to be representational and active in all aspects of CMA, including the year-round resolution process. I am committed to ensure that our new processes enhance rather than disenfranchise participation by all members and this House at every level of CMA. One of my favorite musicals (those of you who know me know I am a Broadway snob) is the show Pippin. Pippin, Charlemagne’s son, seeks out his corner of the sky, where he can fit in. But, seeking glory beyond reason, he learns that he needs others, needs family. I am blessed with several families. My own family, who I will proudly introduce to you in a moment. My office family, who are more than employees to me. My SDCMS family … love you guys! My Executive Committee family, sitting behind me, including staff. I am already thinking of how much I will miss them two years from now when I get pushed off the dais as the next President-Eject. And you, my sometimes dysfunctional HOD family, sitting in front of me. I have found one corner of my sky: The California Medical Association! Before I introduce my guests, let me close with this. Pippin sang a saying attributed to Aristotle. It’s an expression that I intend to use at a wedding for one of

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6 my kids (no pressure guys!). “They say the whole is greater than the sum of the parts it’s made of.” Pippin was referring to love, but it applies to us as well. We are much stronger and greater together than any one of us or any small group of us working alone could ever be. We will have different opinions, and, like a family, we may argue about those differences. But CMA is where we come together. We can disagree within our House, but once a position is debated and adopted, we present a united face to those who make the rules. That is the essence of our democratic process. I look forward to working hard this year on your behalf. I know that when we work together to find common ground on issues and solutions, regardless of specialty or mode of practice, we build an even stronger

CMA, and prove the whole greater than the sum of its parts. In the words of Sean Rowe’s closing song from The Accountant, we can leave something great behind for those who follow us. We should, and will, resist change when it is inherently damaging to the health of our communities and our profession. But when change is needed or inevitable to improve our abilities to care for the public, we must resist our own inertia and fears, and work to make such change positive for the betterment of those we serve and the medical profession. Here’s to an incredible, productive year! And here’s to a level 5 executive committee! Together we have a job to do, and we will do it as a team! HATS OFF to all of you … or rather, team hats on! Thank you all.

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WE ARE LOOKING FOR VOLUNTEERS TO PARTICIPATE IN CLINICAL TRIALS: Currently enrolling volunteers who suffer from rheumatoid arthritis, lupus, psoriasis, and psoriatic arthritis. Qualified volunteers may receive: no-cost investigational study medication, no-cost study-related care from a study doctor. There is compensation available for time and travel. All studyrelated care will be at no cost, and volunteers can continue seeing their primary care doctor during the study. Health insurance and doctor referrals are not required

PART TIME OR FULL-TIME SUB-INVESTIGATOR Work under the supervision of the Medical Director/Principal Investigator performing a variety of scientific clinical research activities to include the direct assessment of study participants and execution of protocol specific procedures. Required Education and Experience: M.D., Board Certification (or Board eligible) in Internal medicine, Family practice or Emergency Medicine, Prior clinical research experience preferred. Skills/Competencies: Excellent professional communication, punctual and responsible, friendly and outgoing demeanor, must demonstrate a passion for direct patient interaction. Demonstrate clinical competence, positive leadership and ability to work collaboratively with a multidisciplinary team. Send resume to: eliku@artemis-research.com

FAMILY PRACTICE/INTERNAL MEDICINE PHYSICIAN wanted for established private office in San Diego. La Jolla Village Family Medical Group has been caring for patients of all ages for 28 years in the UTC/La Jolla area of San Diego, adjacent to the UCSD campus. We provide comprehensive preventive medicine, illness management, travel medicine, sports medicine, evidence based chiropractic care, weight management, and more. Call responsibilities minor, hours consistent with healthy work/life balance. Friendly and upscale environment. Cohesive team. This a real family practice. Board-certified, California licensed MD and DO physicians interested in this opportunity should send CV to: triciaberkoff@gmail.com. 10/20 MULTI-ETHNIC GROSSMONT PEDIATRICS [private practice] in East San Diego seeks BC pediatrician, with 4+ years experience. Patient-engaged and clinically-interested in obesity, ADHD and asthma, and in care continuity. Grossmont Pediatrics has 20+ years reputation for family-oriented care and teaching parents. Office schedule three days per week is ideal for dedicated pediatrician wishing to balance work and personal life, while still nurturing close physicianpatient relationships. Salary $81,000 for BC pediatrician + $6,000 one hospital rounding and light after-hours call. Hospitals’ privileges, AAP, CME fees, tail-coverage included liability insurance included. Contactvenk@gpeds.sdcoxmail.com or 619504-5830. 10/10

TO SUBMIT A CLASSIFIED AD, email Editor@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

NOVEMBER 2017

SEEKING A FULL/PART-TIME DERMATOLOGIST to join a co-op situation at a brand new Medical and Day spa. Share space with two Licensed Massage Therapist and Esthetician in a new startup office on Miramar Rd/805. Opportunity to do Cosmetic, Cool sculpting, Botox, Fillers, and Laser procedures. 3,000 sq ft office with reception area, lobby, kitchenette, bathroom. Free parking, handicap access. Short term or up to a 5-year lease available. $1,300/per month. Have 3 extra large offices available. Please call (760) 815-3236 or email me at mpear4560@gmail.com. 9/4 FAMILY MEDICINE POSITION AVAILABLE: The Sycuan Medical Dental Center is a tribal health center, located on the Sycuan Indian Reservation in El Cajon, CA. This is a full-time position to provide outpatient care, no OB. Current CA and DEA licenses required. Student loan repayment possible. Must be BC/BE. Competitive compensation, full benefits. If interested, please email CV to Amy Laughner (ALaughner@sycuan.com) or apply online at www.sycuan.com. 7/21 PRACTICE FOR SALE

UNIQUE MEDICAL SPA FOR SALE-OWNER RETIRING Committed clientele, growing revenues/profits plus expansion possibilities. Bank pre-approved for SBA financing. Offered at $999,000 by Transworld Business Advisors of San Diego Central (CalBRE#02019152). Contact Robert Cunio MBA, (888) 604-8221/ rmcunio@tworld.com 10/11 OFFICE SPACE / REAL ESTATE AVAILABLE

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genessee Ave. Great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group and available to any specialty. Note we are in great need of a psychiatrist. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for Sandy. 10/23 LA MESA OFFICE SPACE AVAILABLE. East County San Diego. Spacious 4,675-square-foot office space to sub-let. Specialist suite. Recently updated. 10 exam rooms. Two waiting rooms. Main waiting area is newly renovated. Three in-suite restrooms. Diagnostic lab/service rooms. Conference/ lunch room. Lots of storage space. Large patient parking lot (free) with ample space. Walking distance to Grossmont Hospital. Centrally located in East County. Please contact Jennifer Hansen at lamesacardiac@ yahoo.com or cell (619) 249-8154. 10/10 SHARED OFFICE SPACE: Very attractive 3 exam room, medical office near Alvarado Hospital. Available for 1, 2 or 3 days per week. Reasonable rates. Call Pat at (858) 3445020. 10/10 MESA MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE: 1500 sq.ft Frost Street office with 2 exam rooms,

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp & Rady Children’s. Ready-to-occupy suites ranging from 1,300-5,000 SF with mix of exam rooms and offices. Will consider short-term & long-term leases. For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org

CLASS “A” MEDICAL OFFICES, VISTA

Grow your business and upgrade to a new Class “A” medical office in TriCity’s leading outpatient health center. Collegial environment with more than 40 physicians in 15+ specialities. Strong primary care referral base. Fully renovated offices with today’s modern finishes. Close hospital proximity. Multiple sizes available ranging from 1,200-6,800 SF. For more information, including floor plans, please call Greg Petree at (858) 792-0696 x112 or visit www.vistamedicalplaza.com/leasing

2 offices, front office area, bathroom, kitchenette and lobby. Easy access to Sharp Memorial Hospital and Rady Children’s Hospital and the 163 and 805 freeways. Up to 4-month lease with possible extension. Please call (858) 467-1899. 8/3 POWAY OFFICE SPACE AVAILABLE – PART-TIME: Spacious 5 exam room office including large treatment room. Located across the street from Palomar Medical Center Poway (aka Pomerado Hospital).

Well suited for surgical or medical specialty. Contact bmorales@genhp.com. 7/21 MEDICAL EQUIPMENT / FURNITURE FOR SALE

USED OFFICE FURNITURE FOR SALE: Exam tables, stools, chairs, x-ray view boxes, executive desk, waiting room chairs, tables, filing shelves and cabinets. Please call (858) 467-1899. 8/3 NONPHYSICIAN POSITIONS AVAILABLE

CHAMPIONS FOR HEALTH EXECUTIVE DIRECTOR: Candidate should have a minimum of 5 years nonprofit or public management/leadership experience, with history of increasing responsibility. Seeking proven success in financial development, fostering and expanding innovative programs. Bachelor’s degree is required, with relevant advanced degrees desirable. To apply, email cover letter, resume, 3 professional references and optional letters of recommendation to jobs@ChampionsFH.org. POSITION AVAILABLE FOR DYNAMIC NURSE PRACTIONER OR PHYSICIAN ASSISTANT to join our team of Women Healthcare providers specializing in Reproductive Medicine. We are offering a competitive salary, excellent benefits and a flexible schedule. Requirements: Obtain detailed medical history, review medical records, and collaborate with physician in developing a thorough infertility evaluation and treatment plan. Perform transvaginal sonograms for follicular measurements and collect data to monitor IVF cycles. Perform early OB ultrasounds and monitor early preganancy lab values. Master’s in Nursing or equivalent. 2–4 years experience in OB/GYN. Fertility experience preferred. Please email klopez@cacrm.com or call (760) 274-2000. Visit our website at cacrm.com.

PART TIME OR FULL-TIME SUBINVESTIGATOR: Work under the supervision of the Medical Director/Principal Investigator performing a variety of scientific clinical research activities to include the direct assessment of study participants and execution of protocol-specific procedures. Required Education and Experience: M.D., Board Certification (or Board eligible) in Internal medicine, Family practice or Emergency Medicine, Prior clinical research experience preferred. Skills/Competencies: Excellent professional communication, punctual and responsible, friendly and outgoing demeanor, must demonstrate a passion for direct patient interaction. Demonstrate clinical competence, positive leadership and ability to work collaboratively with a multi-disciplinary team. Send resume to: eliku@artemis-research.com 7/28 RECEPTIONIST POSITION AVAILABLE: Solo private practice Menopause Management office in Hillcrest. Back-office experience is not required. Free parking is available onsite. Please fax CV and last two years work experience only to (619) 794-2942. 7/24 PRODUCTS / SERVICES OFFERED

PHYSICIAN OFFICES IN NEED OF ASSISTANCE FOR MEANINGFUL USE ATTESTATION of their electronic health records can avail themselves of technical assistance from Champions for Health, the sister organization to SDCMS. Practices attesting on the Medi-Cal Incentive Program with at least 30% of patients billed to Medi-Cal can receive free assistance thanks to a federal funding source. Medicare practices can receive the same great service at a very reasonable rate, and SDCMS-CMA members receive a discount. For more information, email Barbara. Mandel@ChampionsFH.org or call (858) 3002780. [559]

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

SAN DIEGO PHYSICIAN.ORG

POE TRY AN D M EDICIN E

FLYING FALLING HOME by Daniel J. Bressler, MD, FACP

AS PHYSICIANS, we all fly and we all fall. On good days, our skill and judgment rescue patients from death and pain. On bad days, our mistakes result in unnecessary suffering, what we call at our meetings “morbidity and mortality.” Most of us, most of the time, do a lot more good than harm. That’s what keeps us going. That’s what makes us able to tolerate the emotional and intellectual burden of our blunders. When I was a boy I had two recurrent dreams: one of flying and one of falling. In talking to friends over the years, I have discovered that flying dreams are quite common, falling dreams less so. I have used this poem to contemplate how these dreams may inform my medical life today. A holy man once told me, your dreams are also the dreams of everyone. Perhaps you will see yourself in this poem. Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and a longtime contributing writer to San Diego Physician.

NOVEMBER 2017

Flying Falling Home His 12-year-old body flings forward toward the blacktop. Just before impact, thermals hook his outstretched arms And hoist him first to clear the thin wooden fences Then high over the neighborhood to catalogue his rescuees. Boy classmates rough-housing into coercive pecking orders Girl classmates dance-practicing vicious exclusions Frustrated fathers rage-driving to cubicled clubhouses Desolate mothers fugue-rocking their formula-fed babies And his own nuclear family fissioning in the suburban ozone. He awakens windburned and triumphant: Sky Boy. Other nights, he tumbles downward into a pit of darkness One final attempt to evade the fangs of a horror film monster That his imagination has fashioned from weekend matinees. He remembers his mother skewering raw steak into shish kabob And his father slashing eucalyptus limbs with a toothed chainsaw. The boy considers his own body’s penetrable flesh He reckons the rate that his pursuer is gaining on him. He can smell its fetid breath and hear its claws’ clicking. The dream ends in suffocation and blackness. He awakens drenched and paralyzed: Die Boy. The child is father to the man. So says the Bible, the poet and the pop song. The boy wakes up decades past any dream of flying or falling, Shaves off yesterday’s graying stubble and slips on a clean dress shirt. He feeds the dog, drinks coffee, and exchanges pleasantries with loved ones. He does work that he was promised might make the world less sorrowful. Sometimes he succeeds, sometimes fails, but mostly he’s not sure. He has found a residence on the solid earth between triumph and terror Situated distinctly below the clouds but cautiously above the cataclysm. This place he has no choice but to call home.

Being a physician can be tough. At CAP, we try to make your job a little easier.

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You give your all to helping others live full, healthy lives. You go the extra mile to seek out answers and cures, knowing that sometimes even your best efforts aren’t enough. You’re a physician, and that’s how you do your job. At CAP, we salute your dedication and support you in every way we can — with protection to reduce the worry of professional liability lawsuits, but also with a host of value-added services to help manage your practice so you can focus on the highest quality professional care. Ask for a no-obligation quote and more information on CAP membership.

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