February 2018 by San Diego Physician

FEBRUARY 2018 OFFICIAL PUBLICATION OF SDCMS

TREATING DOMESTIC VIOLENCE AS A MEDICAL PROBLEM

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FEBRUARY

CONTENTS

VOLUME 105, NUMBER 2 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 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: Neelima V. Chu, MD South Bay: Paul Manos, DO 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

8 You’ve Been Served: Lawsuit Survival Tips for Physicians BY DOUGLAS MCCULLOUGH, ESQ.

New Anthem Anesthesia Policy Can Have Blinding Consequences BY CALIFORNIA MEDICAL ASSOCIATION,

feature

Who won Office Manager of the Year? Check page 28 to find out!

PHYSICIANS AND SURGEONS AND THE CALIFORNIA SOCIETY OF ANESTHESIOLOGISTS

Treating Domestic Violence as a Medical Problem

California Physicians: Working to Keep our Citizens and Economy Healthy

BY ANNA GORMAN

BY THEODORE M. MAZER, M.D.

departments

Her Sister’s Keeper: Caring for a Sibling with Mental Illness

Briefly Noted: Calendar • Giving Back • Student Legislative Trips • Hepatitis A Update • Politics

Nick Macchione Named Baldridge Leadership Award Recipient FEBRUARY 2018

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 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 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: Mihir Y. Parikh, 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)

BY JENNY GOLD

26 Physician Marketplace: Classifieds

CALIFORNIA ACADEMY OF EYE

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

28 SDCMS Office Manager of the Year

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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/////////BRIEFLY /////////////////NOTED //////////////////////////////////////////////////////////////////////// CALENDAR

MARCH 1-2: Future of Genomic Medicine, La Jolla Mayo Clinic Gastrointestinal Cancers, Mar 1-3, 2018. Hyatt Regency La Jolla at Aventine. 13th Annual Brain Injury Rehabilitation Conference, Scripps. Mar 2-3, 2018 San Diego Marriott Del Mar MARCH 3: Colorectal Cancer Alliance’s San Diego Undy Run/Walk, Mission Bay Endocrinology for Primary Care, Medical Education Resources (MER). Mar 9-11, 2018 Hotel del Coronado American College of Osteopathic Emergency Physicians Spring Seminar, American College of Osteopathic Emergency Physicians (ACOEP). Apr 3-7, 2018 Loews Coronado Bay Resort The American Society of Addiction Medicine (ASAM) 49th Annual Conference - Innovations in Addiction Medicine and Science. Apr 12-15, 2018 Hilton San Diego Bayfront APRIL 18: CMA Legiuslative Advocacy Day, Sacramento May 23: The 30th Annual Western States Regional Conference on Physicians’ WellBeing, at UC Riverside Extension Center

SDCMS Social Events 2018 March 27 (Tues) ”Hippocratic 18 Experiments in Gently Shaking World” Reception and Private Film Screening, UCSD MET Auditorim May 5 (Sat) SDCMS White Coat Gala, Paradise Point Resort July 14 (Sat) Family Pool Party Oct 25 (Thurs) Physician Networking Mixer *dates subject to change.

FEBRUARY 2018

GIVING BACK

VOLUNTEER OPPORTUNITIES Email Your Volunteer Opportunity Ads to Editor@SDCMS.org 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: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology. We are seeking these specialists throughout all regions of San Diego to support those that are uninsured and not eligible for Medi-Cal receive short term specialty care. Commitment can vary by practice. The mission of the

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Champions for Health’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Will you be a health CHAMPION today? For more information, contact Andrew Gonzalez at (858) 300-2787 or at Andrew. Gonzalez@ChampionsFH.org, or visit www.ChampionsforHealth.org. SHORT-TERM MEDICAL VOLUNTEERS NEEDED FOR HAITI: We are looking for 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 under served 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

QUOTE OF THE MONTH

Healthy citizens are the greatest asset any country can have. — Winston Churchill

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/////////////////////////////////////////////////////////////////////////////////////////////////// STUDENT LEGISLATIVE TRIPS

Student Legislative Trips to Sacramento with Dr. Hertzka and SDCMS CEO Paul Hegyi

1 POLITICS

1. From left to right: Athena Hsu, Mi Song Kim, Alina Nguyen, Payton Ottum, Lawrence Wang, Shawn Ali, Senator Joel Anderson, SDCMS Legislative Committee Chair Dr. Robert Hertzka, Sonya Gleicher, Brendan Berenger, Margaret Meagher, Jonathan Cunha, SDCMS President Dr. Mark Sornson, and SDCMS CEO Paul Hegyi. 2. UCSD medical students with Senate President Pro Tem Toni Atkins. 3. UCSD medical students with San Diego Assemblywoman Shirley Weber.

HEPATITIS A UPDATE

Hepatitis A “Crisis” Ends in San Diego County On Jan. 23, the San Diego County Board of Supervisors voted unanimously to end the “emergency status” for the Hepatitis A outbreak in our region — which for the past five months has been the third largest of such an outbreak nationwide in more than 20 years. There was a collaborative effort among government, nonprofits and the healthcare industry (including SDCMS) to aid in these efforts to help get people vaccinated and treated for this deadly virus.

California Medical Association Endorses Eleni Kounalakis for California Lt. Governor The California Medical Association (CMA) recently endorsed Eleni Kounalakis’ 2018 bid to become California’s next Lieutenant Governor. “The California Medical Association is proud to support Eleni Kounalakis for Lieutenant Governor,” says CMA President Theodore M. Mazer, M.D. “Today’s political environment demands leaders focused on pragmatic solutions to improve quality access to healthcare, address our looming physician shortage crisis, and champion public health initiatives. We believe Eleni has the passion, temperament, and experience to best represent California’s citizens and interests.” “I am so honored to receive the endorsement of the California Medical Association,” says Kounalakis. “Physicians are critical stakeholders in ensuring that we achieve affordable and accessible health care for all. As lieutenant governor, I will fight for universal healthcare, and I look forward to working with the California Medical Association and stakeholders to achieve healthcare access for all.” Kounalakis is a businesswoman and diplomat. She was appointed by President Barack Obama as ambassador to Hungary in 2010. She is a lifelong Democrat and five-time delegate to the Democratic National Convention; she has also worked as an advocate for early childhood education as a member of California’s First 5 Commission and the Blue Ribbon Commission on Autism. SAN DIEGO PHYSICIAN.ORG

Please join the San Diego County Medical Society and your fellow physician colleagues on Tuesday, March 27, 2018 at the UCSD MET Auditorium. We will be hosting a private reception and exclusive screening of the film

HIPPOCRATIC

18 EXPERIMENTS IN GENTLY SHAKING THE WORLD featuring Dr. MR Rajagopal (or Dr. Raj as he is known), followed by an in person Q&A with Dr. Raj himself. This is a must-see documentary for all those interested in the power of the human spirit, human rights and social justice. It is essential viewing for anyone working in health care, medicine, nursing and public health. Space is limited and RSVPs are required so please visit www.tiny.cc/HippocraticFilm for more information and to register to attend!

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NICK MACCHIONE NAMED BALDRIGE LEADERSHIP AWARD RECIPIENT

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Macchione to Receive 2018 Harry S. Hertz Leadership Award

THE BALDRIGE FOUNDATION announced that the recipient of the 2018 Harry S. Hertz Leadership Award is Nick Macchione, agency director for the County of San Diego Health & Human Services Agency (HHSA). “Nick leads a large organization with nearly 6,500 employees, another 7,000 contract workers, and an annual budget of nearly $2 billion,” says Al Faber, president and CEO of the Baldrige Foundation. “Applying Baldrige leadership and management principles embodied in the Performance Excellence Framework, Nick and his team have developed a worldclass integrated service delivery system for health, housing, and human services, directly and positively impacting the lives of millions of clients.” “Leadership is building an organization that meets the needs of the communities it serves,” Macchione says. “For HHSA and the County of San Diego, that ideal

is embodied in Live Well San Diego, our county’s vision for a region that is healthy, safe, and thriving. Our commitment to the Baldrige core values and implementation of the Government, Healthcare, and Communities of Excellence frameworks transforms lives and makes Live Well San Diego a reality every day. I see our Baldrige journey as our path forward to becoming a leader organization, one that lays the foundation for operational resiliency and innovation that enables our success measured in life expectancy and quality of life.” The Hertz Award recognizes leaders that have inspired, encouraged, challenged, and empowered others to achieve performance excellence. The 2018 Harry S. Hertz Leadership Award was established in 2013 by the Baldrige Foundation with support from founding sponsor The Synergy Organization, and will be presented during the Foundation Awards Luncheon at the 30th Annual Quest for Excellence Conference in Baltimore on April 10, 2018. Baldrige is a leadership and management framework with a systemslevel, customer-driven organizational assessment and design approach that has proven to enhance the performance of organizations across every sector of the economy compared to their non-Baldrige peers. Baldrige generates an empirically documented return on investment of $820 in cost savings and performance enhancements for each $1 spent supporting the Baldrige Enterprise. To review the relevant data, visit https://www.nist.gov/ baldrige/how-baldrige-works/aboutbaldrige/baldrige-impacts

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YOU’VE BEEN SERVED Lawsuit Survival Tips for Physicians by Douglas McCullough, Esq.

A PHYSICIAN INCURS nearly $200,000 in medical student loan debt, graduates in the top 10 percent of her class, and dedicates the past 14 years to providing care to patients. One day, out of the blue, the local sheriff’s office serves her with a lawsuit. Perhaps it is regarding a familiar patient, or maybe a patient the doctor cannot recall. Either way, her mind immediately leaps to: “What did I do wrong?” After the initial shock, the physician is flooded with emotions — fear, anger, betrayal, frustration, anxiety, humiliation, embarrassment. Even shame. Chances are good that as a physician, you will find yourself in a similar situation. On average, each physician spends 50.7 months, or approximately 11 percent of an average 40year career, on resolving medical malpractice cases — the vast majority ending up with no indemnity payment. That’s the conclusion of a study by the RAND Corporation based on

FEBRUARY 2018

data provided by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.1 These findings suggest it is not a matter of if you’ll be sued, but when — undermining the medical-school whitecoat myth that if you do well in school and rely on your education, skill, and training, you needn’t worry about malpractice. By the age of 65, more than 75 percent of physicians in low-risk specialties and 99 percent of physicians in high-risk specialties have experienced a claim.2 Although it’s a reality that the majority of physicians will face a malpractice claim, few are prepared when served with a lawsuit. I routinely survey up to 50 physicians at seminars devoted to litigation preparation — only two or three say they received relevant information about medical malpractice in medical school. I make it a point to advise doctors to take these steps if a claim is filed against them:

• Contact your medical malpractice carrier. Typically, a lawsuit will name multiple defendants to include various treating physicians as well as medical facilities where alleged negligent care was rendered. The pool of defense attorneys who specialize in medical malpractice defense is a small one. Many malpractice carriers draw from the same pool of attorneys, so it is important to notify your carrier as soon as possible to ensure the right defense attorney is retained on your behalf. The defense team is referred to as a “three-legged stool,” including the physician, claim specialist, and defense attorney. All three need to work in unison to obtain the most favorable result. • Build your defense. The attorney representing your patient has likely already developed a good portion of their case before you were ever aware of its existence. Therefore, it is critical you be an active member of your defense team to begin building your defense. • Be prepared for extended periods of perceived inactivity. The legal process is inefficient and impossible to control. The litigation process typically lasts two to five years, with claims being filed a year to two years after a negative event of the date of discovery of an injury — depending on state laws. There will be flurries of activity, followed by long periods of perceived inactivity. Trust that your defense team is continuing to work on your behalf. Depositions are often scheduled, cancelled, and rescheduled. Trial dates are routinely continued beyond the control of defense counsel. Knowing in advance these inefficiencies and inconveniences occur may alleviate frustration in the process. • Understand the plaintiff’s strategy. Don’t believe that once you “educate” the plaintiff or, more importantly, the plaintiff attorney on the medical facts, they will drop the suit. The only time you will be given the opportunity to educate and explain the care you provided is at trial. The plaintiffs’ bar is very skillful at taking testimonial “sound bites” and portions of the medical records to fit their narrative. By understating the plaintiff’s strategy, you can assist in preparing an effective defense.

Our Doctor Loan could help eligible medical professionals buy a home¹ • Become fully engaged in the process. The key to ensuring a successful defense is preparation. Those physicians who managed to survive litigation did so by becoming fully engaged in the process — approaching their case as an academic exercise as if they are sitting for a board exam. • Get professional coaching on how to be an effective defendant. Physicians routinely describe the litigation process as akin to a rollercoaster ride. Every physician will have some emotional reaction to becoming a defendant in a malpractice lawsuit. It’s important to identify and become aware of your emotions in order to develop appropriate coping mechanisms. Physicians who develop effective coping mechanisms have a greater chance of successfully navigating the rigors of litigation. • Work on alleviating stress. Remember you are not alone. Focus on the multitudes of patients you help daily. While you can’t divulge details of the litigation to family and friends, talk to them about how the claim is affecting you. And continue to participate in the personal interests and activities that provide you with joy. To be thoroughly prepared, you must know the medical record. You must also practice for your deposition, know your deposition testimony, and read depositions of other defendant physicians and experts — all while caring for your patients and yourself. This is no small task, but successfully defending your professional reputation is worth it. For more tips, read Malpractice Claims Consume Years of a Physician’s Career. Further insights from doctors who have experienced litigation are available in The Doctors Company’s What to Expect from Litigation video playlist. References 1. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. Health Affairs. 2013;32(1):1-9. 2. Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. 2011; 365:629636. doi: 10.1056/NEJMsa1012370. Mr. McCullough is assistant vice president, Claims, for The Doctors Company.

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NEW ANTHEM ANESTHESIA POLICY CAN HAVE BLINDING CONSEQUENCES Physicians’ groups call for immediate halt to recent policy limiting use of anesthesia during cataract surgery By the California Medical Association, the California Academy of Eye Physicians and Surgeons, and the California Society of Anesthesiologists

FEBRUARY 2018

A POLICY CHANGE made by health insurer Anthem, Inc. could result in increased risk for many patients — up to and including blindness — if not immediately rescinded, according to physicians’ groups. The California Academy of Eye Physicians and Surgeons (CAEPS) and the California Society of Anesthesiologists (CSA) have sent letters to Anthem, Inc. requesting that they immediately rescind a new policy that deems Monitored Anesthesia Care (MAC) “not medically necessary” during “routine” cataract surgery — a move seen as endangering patients. These were followed up with complaints to the California Department of Managed Health Care (DMHC) and the California Department of Insurance by the California Medical Association (CMA), and supported by the other groups. “The surgery is carried out in a tiny space about a third of the size of a thimble using a needle vibrating at ultrasonic speeds that can cause blindness if it contacts the wrong structures,” wrote Craig H. Kliger, MD, an ophthalmologist and CAEPS executive vice president, in a letter to Anthem. “Sedation is frequently vital to allow the patient to relax and avoid movement that could be catastrophic, thus minimizing risk.” “The policies around cataract surgery are vital to patient safety,” says David H. Aizuss, MD, an ophthalmologist and president-elect of CMA. “Anthem’s newest policy change falls below the standard of care, and it follows a disturbing pattern of putting patients at risk to make a profit.” Anthem appears to cherry-pick statements in the “Anesthesia” section of an American Academy of Ophthalmology (AAO) Preferred Practice Pattern on the issue to justify its move. “Unfortunately, we believe Anthem is misinterpreting that document, and that proper interpretation would lead to the opposite conclusion,” wrote Dr. Kliger in the letter, meaning that sedation and concurrent appropriate monitoring should instead be considered necessary for the safety of the patient. “If Anthem restricts payment for MAC services, thousands of patients either will

have to pay for the service themselves or will have to undergo surgery under suboptimal conditions. This guideline seems especially harsh toward fragile elderly patients, many of whom have other coexisting illnesses that complicate the use of sedation,” wrote Karen S. Sibert, MD, FASA, a physician anesthesiologist and CSA President, in CSA’s letter to the insurer. Although Anthem amended the policy on Feb. 1 to clarify that it did not intend to exclude “moderate sedation” from coverage, such sedation would have to be managed by the surgeon, which the AAO document explicitly says should not happen for cataract surgery because the procedure is very precise work, making it risky to divide time between the two tasks. Therefore, a qualified anesthesia provider would be both required and requested in all situations when sedation is anticipated to be needed (the vast majority of current cataract surgery cases),

making the activity “monitored anesthesia care,” which the policy still excludes except under extreme exceptions. “Anthem’s predatory practices and policies are increasing in intensity, frequency, and with complete disregard for their impact on California’s healthcare delivery system,” says Theodore Mazer, MD, president of CMA. “We urge the DMHC and the Department of Insurance to intervene when insurers functionally block access to services that are widely viewed as the standard of care.” Published by: The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit CMAnet. org, and follow CMA on Facebook, Twitter, LinkedIn, and Instagram.

The California Academy of Eye Physicians and Surgeons is the only statewide organization representing California ophthalmologists and their patients. CAEPS’ activities include public education about important eye healthcare concerns, legislative advocacy, interaction with third-party payers about reimbursement and coverage issues, and continuing medical education for ophthalmologists and their staffs. For more information, please visit www.caeps.org. The California Society of Anesthesiologists is a physician organization dedicated to promoting the highest standards of the profession of anesthesiology, to fostering excellence through continuing medical education, and to serving as an advocate for anesthesiologists and their patients. For more information, please visit www. csahq.org.

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CALIFORNIA PHYSICIANS: WORKING TO KEEP OUR CITIZENS AND ECONOMY HEALTHY By Theodore M. Mazer, M.D.

DURING SOME OF THE WORST wildfires in the Golden State’s history, medical professionals stepped up to the plate to provide aid to neighbors and strangers alike. The incredible response from California’s healthcare providers is a testament to our collective strength — heroes like Dr. Michael Witt, who risked personal safety to help evacuate babies from Sutter Santa Rosa Regional Hospital, or hospital staff at Kaiser Santa Rosa who helped evacuate patients attached to IVs as flames threatened the hospital. And a new report illustrates how physicians do more than diagnose, cure, or heal — they go beyond patient care by providing millions of jobs and generating billions in tax revenues and economic activity. According to the American Medical Association’s (AMA) 2018 AMA Economic Impact

FEBRUARY 2018

Study, California physicians generate $232 billion in direct and indirect economic activity for the state — with each physician responsible for an average of $2.6 million. In total, physicians across the United States produced $2.3 trillion in economic activity for the country. For comparison, the gross domestic product for the entire country of Brazil is $2.14 trillion. In California, physicians generate $11.2 billion in state and local tax revenue — an average of $124,752 per physician. And behind every doctor is an employee support system filled with Californians who have good-paying and secure jobs. According to the AMA study, Golden State physicians support a total of 1.2 million jobs — an average of 13.3 jobs per physician – including those in the medical field and across other industries. Those jobs provide nearly $135.3 billion in direct and indi-

rect wages and benefits. This is a significant contribution for California’s nearly 90,000 physicians, and one that benefits all our communities. A strong California economy means strong communities that can provide for its neighbors and ride out any harsh waves that may hit — whether natural or financial. However, despite the clear economic benefit that California physicians provide, there are still barriers that prevent recruitment and hurt patient access to care. The U.S. is projected to have nearly 100,000 fewer physicians than the country needs by 2030. And because physician training can take up to a decade, a physician shortage in 2025 is a problem that needed to be addressed in 2015. The physician shortage crisis is especially acute in California, which is expected to get exponentially worse as the population continues to grow and our aging physician workforce moves toward retirement. We rank 32nd in physician access and need 8,243 additional primary care physicians by 2030 — a 32 percent increase. Six of nine regions are facing a primary care provider shortage, and 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. What does a physician shortage mean for patients? Long(er) delays for appointments, trouble finding a specialist and having to travel long distances to receive care. What’s more, California fills nearly 100 percent of its residency slots each year. Considering that 70 percent of those who complete their graduate medical education in-state end up practicing medicine here, establishing more residency positions would enable California to attract more than 7,000 unmatched medical school graduates and ultimately expand our physician workforce. This report demonstrates why tackling our state’s physician shortage and supporting graduate medical education are so critical. The data is clear: More physicians will help keep our state’s health and economy strong. This article was originally printed in The San Diego Union-Tribune. Dr. Mazer is president of the California Medical Association.

2018

White Coat Gala AN EVENING CELEBRATING 148 YEARS OF HEALING

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W. Sornson, MD, for thanking Mark His Service As Immediate Past President

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DOMESTIC VIOLENCE

Treating

DOMESTIC VIOLENCE

As a Medical Problem BY A N N A G O R M A N

FEBRUARY 2018

FANNY ORTIZ, A MOTHER OF FIVE who lives just east of downtown Los Angeles, spent nearly a decade married to a man who controlled her and frequently threatened her. Then, she says, his abuse escalated. “He would physically hit me in the face, throw me on the wall,” she recalls. Ortiz, 43, eventually left the marriage, taking her children with her. A few years later, she learned that the East Los Angeles Women’s Center offered domestic-violence services at the Los Angeles County+USC Medical Center, near her home. Now she goes to the hospital campus for weekly therapy sessions, which she says have helped stop her suicidal thoughts. “I was afraid to talk,” Ortiz says. “Now I am more open to talk about things that I was holding in.” Nearly one in four women has experienced serious physical violence at the hands of a partner. They often end up in the emergency room or the doctor’s office. But they don’t typically volunteer the reason for their injuries, and doctors don’t always ask about abuse in the home. That failure of communication means patients may miss out on the help they need. A growing number of health providers and anti-abuse agencies in California and around the country are collaborating to identify victims and get them help. More doctors now screen their patients for signs of abuse, and more agencies place victims’ advocates inside health centers. Education and counseling for people experiencing violence are also more widely available in clinics and hospitals. About four years ago, the East Los Angeles Women’s Center opened offices on the campus of L.A. County+USC, a busy public hospital. Since then, center staff members have trained more than 2,500 doctors, nurses, social workers, and others to identify victims of domestic violence. They also respond quickly to calls from the medical center’s emergency room, inpatient hospital and outpatient facilities to help patients in crisis. Today, the women’s center has embarked on an innovative approach: In February, it plans to open a short-term shelter for abuse

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victims on the medical center grounds. The 10-bed shelter fills a serious need, says Deirdre Anglin, an emergency room physician at L.A. County+USC. “We sometimes have patients in the emergency department who don’t have a place to go, and in the evenings and nights all the shelters in L.A. will be filled,” Anglin says. Victims of abuse can suffer long-term health problems, including chronic pain, frequent headaches, depression, diabetes, and asthma. And they have higher healthcare costs than people who have not experienced abuse. So “it makes complete sense to have the healthcare providers acting as allies and partners in treating domestic violence,” says Peter Long, CEO of the Blue Shield of California Foundation. (The foundation provides support for Kaiser Health News coverage in California.) The foundation has funded 19 partnerships between health centers and domestic violence agencies around the state, including the L.A. County+USC office of the East Los Angeles Women’s Center. Similar partnerships operate in Illinois, Maryland, and other states. Last year, the East Los Angeles Women’s Center served 600 victims of domestic

violence at the L.A. County+USC hospital campus. Nearly one-third were homeless or couldn’t go back home for safety reasons. Advocates say that hospitals and clinics are ideal settings to respond to the needs of abused women. In the San Gabriel Valley, the YWCA sponsors domestic-violence support groups at a community clinic, while the clinic offers health education for survivors of abuse at the YWCA. In Sacramento, a Native American health center works closely with a domestic violence group a few blocks away. Doctors have an “unprecedented opportunity to promote prevention and to respond because they are seeing patients that may not ever reach out to a domestic violence agency or police for help,” says Lisa James, director of health for Futures Without Violence, which runs a national resource center dedicated to improving the response of medical professionals to domestic violence. “They can provide this critical lifesaving intervention.” The proximity of the East Los Angeles Women’s Center to the hospital and clinic buildings on the L.A. County+USC

campus makes it easier for doctors to ask their patients about violence, says Rebeca Melendez, director of programs for the center’s office at the medical center. The medical providers know where to turn for guidance — and that the help is nearby. “They don’t need to know all the answers,” she says. “They just need to call us.” This growing collaboration between the medical profession and anti-abuse agencies is driven in part by the Affordable Care Act, which requires that health plans cover domestic violence screening and counseling. The U.S. Preventive Services Task Force recommends doctors routinely question women about violence in the home and refer them to services if needed. The task force concluded in 2013 that intervention could reduce violence and abuse as well as mental and physical health problems. Organizations such as the American Congress of Obstetricians and Gynecologists and the American Medical Association also recommend routine screening and counseling for domestic violence. In the past, patients would go to health centers with such problems, but providers did not feel comfortable asking questions about abuse at home, says Long, of the Blue Shield of California Foundation. “They didn’t feel they had the time and they didn’t feel they had the resources to do something about it,” he says. Nor did they always have a place to send patients who were abuse victims. Treating patients who are in abusive relationships is “very challenging,” says Anglin, the ER physician. “There is no pill to give.” But asking about violence needs to be part of a physician’s job, she says. “Part of what we need to do is try to identify patients who may be in a dangerous situation … so we are not just sending these patients back to the same situation they were in only to come back worse off another time.” Anna Gorman is a Senior Correspondent for Kaiser Health News. She joined the team from the Los Angeles Times, where she worked for nearly 15 years covering health care, immigration and the Mexican border. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

FEBRUARY 2018

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HER SISTER’S KEEPER

CARING FOR A SIBLING WITH MENTAL ILLNESS BY JENNY GOLD

FEBRUARY 2018

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hen sisters Jean and Ruby were growing up in Harlem, they invented a game of make-believe called “Eartha.” The little girls would put on their prettiest dresses and shiniest shoes and sit down to tea as grown-up ladies. They discussed details of their hoped-for husbands and children, and all the exciting things they would do together. But 45 years later, the sisters’ lives are nothing like they imagined. Ruby Wilson, 54, has paranoid schizophrenia and lives in an assisted living facility in North Carolina. Her sister Jean Moore, 57, is her legal guardian. “You have all these thoughts about how things should be, could be, how you’d like them to be. And they’re just not going to be,” says Jean, a nonprofit consultant who lives in Maryland. Few bonds are as tight as those between sisters, and, despite everything, Jean and Ruby remain close. “Our bond is inseparable,” Jean says. “It feels like more than just two separate things bonded together. It feels like you’re really in there — you know when you put sugar in tea and it dissolves? Yeah, it’s like that.” But their relationship, marred by mental illness, has not been simple. Being Ruby’s guardian and caretaker is an enormous responsibility, and even all these years later, Jean still mourns the loss of the life her sister might have had. Tight-Knit and ‘Always on Time’ On a sunny day this winter, Jean made the five-hour drive from Maryland to see her sister in the small town of Clinton, N.C., just east of Fayetteville. Ruby sat in her room alone, wearing a denim dress with her hair piled high on her head and her nails painted red. She gave her sister a wide, gummy grin. After 30 years cycling in and out of hospitals, group homes, assisted living facilities and sometimes the street, Ruby has lost most of her front teeth. Jean smiled back, squeezing Ruby’s shoulders. These days, Ruby has few other visitors.

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/////////////////////////////////////////////// “There are times when Ruby will say I’m not her sister. So this is a good day.”

“Jean is splendid,” Ruby says. “She’s always on time. She’s very considerate. She’s very caring. She’s very nurturing. She’s really like a mother figure to me.” Jean was surprised by Ruby’s words of praise. “There are times when Ruby will say I’m not her sister. So this is a good day,” she says, and gave a half-hearted laugh. Things Come Undone On the back patio of the facility, surrounded by a chain-link fence, Ruby said that she and her sister, just two years apart, were raised “almost like twins.” “They used to say our name as JeannieandRuby. It was like one person,” says Jean. They dressed in identical outfits and went together to piano lessons and ballet classes. But when the girls became teenagers, their lives began to diverge. Jean was focused on school, while Ruby was more of a social butterfly. In high school, Ruby started spending time with kids their mother worried were a bad influence, and started experimenting with drugs. Ruby had her first baby at age 17 and quickly fell into a depression. As sadness descended into psychosis, she was diagnosed with paranoid schizophrenia. Whenever Ruby had a psychotic episode, she would be hospitalized. But her treatment was scattered and inconsistent over the next 35 years, and she continued to spiral downward. Schizophrenia affects about 1 percent of Americans and is believed to be caused by a

FEBRUARY 2018

combination of genetic and environmental factors. Patients often suffer from hallucinations, delusions, and difficulty focusing; usually, symptoms begin between 16 and 30 years old. Ruby moved with the baby from New York to the small city of Washington, N.C., where the sisters’ grandmother lived. Two years later, Ruby lost custody of her son, and he was sent back to Harlem to live with her mother. Ruby stayed in North Carolina, and ended up homeless. She was self-medicating with illicit drugs, eating at food kitchens and staying in shelters. But for Jean, one thing is certain: “Ruby’s a survivor.” On average, women with schizophrenia die 12 years earlier than the general population. Meanwhile, Jean went to college, got married and spent a decade in the military overseas, where, inspired by her sister, she

asked to work in behavioral health for military personnel and their families. She went to law school, got divorced and spent a few years doing development work in Africa. By the time Jean returned to the United States and met her second husband, Ruby had become estranged from the family and was living on her own in North Carolina. “I just couldn’t stand knowing she was in that condition and not getting the help she needed,” says Jean. So she drove down to North Carolina to find her sister. It’s a small town, and after asking around, she found Ruby walking the streets. ‘Like Staying on a Wild Horse’ An estimated 8.4 million Americans are caregivers to adult loved ones with a mental illness, most often a son or daughter, parent, spouse, or sibling. “Caregiving situations for siblings pack

/////////////////////////////////////////////// an extra emotional punch for the caregiver,” says John Schall, who runs the Caregiver Action Network, a nonprofit organization that supports people providing care to loved ones. “It’s not unusual for us to think at some point of being the caregiver for our elderly parents, but it’s a whole different thing to be a caregiver for a sibling who we always thought of as equals.” When it comes to caring for Ruby, “Jeannie has always been the lead,” says Ardella Wilson, Jean and Ruby’s older sister. Jean visited North Carolina as often as possible to “scout Ruby out” and make sure she was surviving. “Jeannie knows how to talk to her,” adds Ardella. Ruby would sometimes make biting comments to both her sisters, but Jean always seemed to come up with the right response that allowed them all to move on. At first, Jean’s role caring for her sister

and trying to manage her medical treatment was unofficial. But in 2010, Jean got a call from a case manager: Ruby would become a ward of the state unless Jean wanted to become her legal guardian. So, Jean stepped up, formalizing the role she’d been serving for years. One in three caregivers of people with mental illness have some type of legal responsibility for a loved one, such as guardianship or power of attorney. The new role gave Jean more power to get access to Ruby’s health information and to help keep her safe, but finding the appropriate care for Ruby remained a challenge. “You have to be so proactive as a guardian,” Jean says. “It’s a full-time job.” In addition to her responsibilities for Ruby, Jean was trying to get her own career off the ground in Maryland. She wanted to pass the bar exam so she could become

a practicing lawyer, but there was always something else to handle. It wasn’t just her sister. Although Jean never had children of her own, she stepped in to help take care of Ruby’s now three children, supporting them emotionally and financially. The youngest came to live with her while in high school, and, over the years, Jean had become an important figure in the lives of Ruby’s grandchildren as well. In the past, hundreds of thousands of patients like Ruby were housed in state mental hospitals. Most of those hospitals were closed beginning in the 1960s, as part of the “deinstitutionalization” movement to get people with mental illnesses back into the community. Today, alternative housing arrangements can be scarce and imperfect, leaving many people with serious mental illnesses homeless or in jails or shelters. Jean didn’t want that for her sister.

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/////////////////////////////////////////////// But each time she tried to get help for Ruby, something seemed to go wrong. Ruby would refuse to take medication and then disappear for long periods, only resurfacing when she was arrested or sent to a psychiatric hospital. “For a while, it was like a revolving door in and out of the hospital,” Jean recalls. Every time Ruby was discharged, it was an enormous struggle to find somewhere for her to live. Part of Ruby’s mental illness is that she doesn’t recognize she is sick, which made her a difficult patient; she refused to take her medications and tried to run away several times. Some facilities refused to accept her because she was considered a flight risk. Others said they were full or did not accept her insurance. Others were unaffordable; the money Ruby gets each month from Social Security often wasn’t enough to pay for the cost of the private facilities where space was available. The hospital staff would call dozens of group homes and assisted living facilities before landing on one that would agree to accept Ruby. Those placements never lasted long. The facilities claimed to be secure, but Ruby would inevitably run away and end up back at another psychiatric hospital, only to repeat the process. “It’s like staying on a wild horse,” Jean says. She started to worry that the right place for Ruby might not exist. “The options [for mental health services] now are almost nonexistent in many ways,” says Jane Hamilton, a psychiatric nurse who runs Partners on the Path, an organization that provides support to caregivers. “People in rural settings have a harder time than people in an urban setting [because there are fewer facilities]. But the funding for mental healthcare is not adequate anywhere to meet the needs of the people who need support. So people fall through the cracks.” A Place for Ruby During a recent hospitalization, Ruby received an additional diagnosis of memory loss and was accepted into the locked memory unit of the assisted living facility in Clinton, which is usually reserved for dementia patients. It’s the most secure facility she’s been in so far, and Jean is pleased with her progress over the past year. Ruby has become more stable, even-tempered, personable and pleasant. Her old sense of good humor has started to return.

FEBRUARY 2018

“One in three caregivers of people with mental illness have some type of legal responsibility for a loved one, such as guardianship or power of attorney.”

Still, the situation at Ruby’s assisted living facility is not ideal. The other residents are elderly and many are nonverbal, ravaged by years of Alzheimer’s disease and dementia. Ruby is lonely. The sisters talk every week, but Jean has time to visit only every month or so, and then she can stay only a day. She worries it isn’t enough. Ruby has few other visitors. It’s hard for their 92-year-old mother to make the trek from the apartment in Harlem where she still lives. Ruby has 11 grandchildren and a great grandchild who live in North Carolina and Maryland, but she hasn’t seen them in years. That means Jean is Ruby’s last real link to the outside world, and her visits are the only time Ruby gets to leave the facility. The sisters tease each other, reminisce about playing dress-up as little girls and giggle conspiratorially about the oversized undergarments their mother sometimes sends. When Ruby drifts onto a tangent that can be hard to follow, Jean quickly brings her back. She seems to understand and follow Ruby’s logic, even when it seems convoluted. The Challenges of Caregiving Later, after dropping Ruby back at the facility, Jean explained that while she’d like to be closer to Ruby, she worries about finding the right facility in Maryland and fears that the state might not want to pay for a costly patient from another region. She has thought about moving to North

Carolina herself and possibly starting her own group home where Ruby could live, but she has her own husband, job, and life to consider. Psychiatric nurse Jane Hamilton said people often underestimate the emotional and physical cost of caregiving. Caregivers are twice as likely to be diagnosed with a chronic health condition, and Hamilton stresses that it’s crucial for caregivers to take care of their own physical, spiritual, and emotional needs. “It’s not a guilty pleasure. It’s not a nicety. It’s not selfish,” Hamilton says. Over the years, Jean has tried to embrace her many complex feelings by becoming active with the National Alliance on Mental Illness, a support and advocacy group for families of people with mental illness. “I think of it as a way to fight,” she says. “Becoming an advocate offers an avenue to vent.” Trying to plan for Ruby’s future remains a painful struggle, even after all these years. The sisters have a history of mental illness in their family, and sometimes Jean wonders why this illness befell Ruby and not her. “Ruby was always so full of life,” Jean says. “She was the more attractive one, more stylish, she knew all the people on our block, she was social. And she was the one who had the children.” More than anything, Jean says, she wishes she could have protected her little sister from the devastating effects of her illness. She pulled out an old family photo of the sisters playing Eartha: two skinny-legged little girls in tights and skirts, carefree and smiling as they clutch their cups of tea. JeannieandRuby, so close they could be twins. In Ruby, Jean sees the person she might have been had their fortunes been reversed. “What just kind of rises to the top for me is this enormous amount of love that I have for my sister,” Jean says. As painful as her visits to North Carolina can be, she says she wishes she could stay longer. “One day is not enough time to spend with my sister.” Jenny Gold is a Senior Correspondent for Kaiser Health News. She covers the health care industry, the ACA and health care disparities for radio and print. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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CHAMPIONS for HEALTH PHYSICIANS IMPROVING HEALTH CHANGING LIVES

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CLASSIFIEDS CLINICAL TRIAL VOLUNTEERS NEEDED 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 study-related 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 to participate. Please email Joy at joy@rheumSD.com for more information. [607] PHYSICIAN POSITIONS AVAILABLE MEDICAL CONSULTANT: The County of San Diego Health and Human Services Agency’s Behavioral Health Division is looking for Board Certified Family Practice or Internal Medicine physicians to provide care for residents at Edgemoor Distinct Part Skilled Nursing Facility (DP/SNF), an award-winning, 192-bed rehabilitation and care facility located in the San Diego suburb of Santee. The individual chosen for this vacancy will provide medical care for a younger Medi-Cal population, most of which have brain injuries and significant disabilities, as well as complex physical, social and psychological problems. Visit our website: www.sdcounty.ca.gov/hr for more information on how to apply. FAMILY PRACTICE MD/DO needed for urgent care and family practice office in Carlsbad. Flexible afternoon, evening and weekend shifts available for family practice physician. Exceptional office staff and flexible scheduling options at this busy, wellestablished private practice. Please fax or email CV to (760) 603-7719 or gcwakeman@ sbcglobal.net. PER DIEM PHYSICIAN NEEDED: The County of San Diego Health and Human Services Agency is seeking a physician to work with California Children’s Services (CCS). Applicants (MD or DO) must hold a current California medical license. Board certification in Pediatrics, Child Neurology, Orthopedic Surgery, Physical Medicine and Rehabilitation, Family Medicine or Preventive Medicine is desired, but not required. Applicants must have previous experience in providing medical care for children with disabilities and willing to work a minimum 60 hours per month. If interested, please email your CV to Dr. Marie Green, CCS Medical Director, at Marie.Green@ sdcounty.ca.gov or call (619) 528-4010. FAMILY PRACTICE OR INTERNAL MEDICINE: Spanish-speaking family medicine or internal medicine physician (Board Certified) for Borrero Medical Group located in South San Diego next to Chula

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, 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 Vista. The practice is growing and needs to hire a new physician. Borrero Medical Group is a well-established practice, 22 years in the community, exceptional office staff. Every member of our team plays an important role in improving the health of our patients. We offer an excellent comprehensive benefits package that includes Malpractice Coverage, Health Insurance, Competitive & Attractive Salaries, and Bonus. If interested, please submit inquiry and CV to rosa10borrero@att.net. PART TIME PHYSICIAN: Progressive Medical Specialists is an outpatient medication assisted treatment program located in San Diego, CA. We are currently in need of a parttime Physician to work 1-3 days per week. The Program Physician is responsible for providing the day-to-day medical care and treatment for all program patients. The Program Physician performs all duties in compliance with the California Code of Regulations for Narcotic Treatment Programs. Training is provided. Please send your CV to tboylan@pms911.com or call 619-286-4600. 12/5 OB/GYN POSITION AVAILABLE: A MultiSpecialty Group is seeking a full-time OB/GYN must be BC/BE to join a busy OB/GYN and Uro-gynecology practice, group of a physician and a nurse practitioner. Located in Southern California 1½ hours East of San Diego and Palm Springs; We offer a Competitive compensation, full benefits and opportunity for partnership. If interested, please e-mail CV to ekmoukarzel@ aol.com or fax to: 760-352-6221. Visit our website: www.feminacareouro-gyn.com for additional information on our practice. 11/30 INTERNAL MEDICINE POSITION AVAILABLE: Unique opportunity to practice outpatient internal medicine in beautiful North San Diego County. Practice is part of a well-established internal medicine group

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.

FEBRUARY 2018

with a long history of outstanding care in the community, seeking physician who enjoys providing thoughtful, personalized patient care. Exceptional office staff, small group environment, autonomy and very high quality patient care are among the many benefits of this opportunity. Office is located near San Diego coastal communities, accessible from all parts of San Diego County as well as Orange County. Seeking BC/BE applicants. Please send CV to portofino3@aol.com or call 619248-2324. 11/2 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 3 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. Contact venk@gpeds. sdcoxmail.com or 619-504-5830. 10/10

PRIMARY CARE PRACTICE WANTED

I am looking for a retiring physician in an established Family Medicine or Internal Medicine practice who wants to transfer the patient base. Please call 858-257-7050 PRACTICE FOR SALE FOR SALE. BUSY FAMILY PRACTICE POTENTIAL URGENT CARE: Established family practice for 27 years located in Chula Vista near H Street at 805 in upscale mall setting. Ideal location with free and easily accessible parking. Spacious 2600 ft. office space with CLIA Certified Lab and X-ray. Practice accepts and experienced in billing: Medicare; Tricare, Immigration Exams, DOT Certification; Workers Comp. Contact S.J.Anderson (858)736-5818 or email marva. winchi.garcia@gmail.com 11/3 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

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 MEDICAL OFFICE SPACE, SUBLEASE HM POOLE BUILDING SCRIPPS LA JOLLA CAMPUS: Very attractive, comfortable suite with two offices, two exam rooms and two person receptionist area, and beautiful waiting room. Excellent location on the campus of Scripps Memorial Hospital La Jolla. Large windows with open, peaceful garden views, available for full time rental with the option to rent time at the adjacent surgical suite. Rent also includes small kitchenette with sink, electricity, and janitorial service. Call- 858344-7342 OFFICE SPACE/REAL ESTATE AVAILABLE IN SOUTH BAY: Available for monthly sublease, 3 exam room, medical office, 5 days per week. Reasonable rates. Directly across from Scripps Mercy Hospital, Chula Vista. If interested, please call 619-422-2000. SOUTH BAY: Available for monthly sublease; pulmonary specialist for busy practice in South Bay. This is a great sublease opportunity for pulmonologist. If interested, call: 619-585-0476. Ask for Judith. 11/3 SCRIPPS ENCINITAS CAMPUS OFFICE to share starting Jan.1. It is a beautifully decorated, 1600 sq.ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Ob-gyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and 1/2 mile from Swami’s beach. Contact Kristi or Myra 760-753-8413. View space on website: www. eisenhauerobgyn.com. Looking for compatible practice types. 11/3 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 insuite 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 858-344-5020. 10/10 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 MA OR LVN POSITION AVAILABLE: This patient centered medical practice requires a skilled and professional individual with exceptional empathy, integrity, maturity, and passion for patient care. You must have 5+ years of experience in the field as either an MA or LVN and be comfortable with front and back office work, be able to perform blood draws and injections, understand how to verify insurance, obtain prior authorizations, collect copays and balances. You are driven, diligent, organized, efficient, a clear communicator, honest and constantly wanting to improve. Please submit a detailed resume and 3 references from your last three positions to 92024medical@gmail.com.

and reports directly to the CEO. This position ensures that the medical practice is running smoothly, effectively and efficiently rendering a high standard of quality and customer service. Accountable for operational systems, processes and policies in support of the organization’s mission. Required Education and Experience: Requires at minimum 3 years of significant work related experience in a private or group medical practice setting; supervised at least 10 F.T.E.’s and ability to collaborate with a minimum of 4 physicians in a practice setting. Preferred Education and Experience: AA or higher in Health Management or Business Administration education; Familiarity with health care laws, regulations and standards; Proficient in Excel and Word. We are offering a competitive salary, excellent benefits. Please email resume to businessofficemanager2017@ gmail.com. 11/3 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 MediCal can receive free assistance thanks to a federal funding source. Medicare practices can receive the same great service at a very reasonable rate, and SDCMS-CMA members receive a discount. For more information, email Barbara.Mandel@ChampionsFH.org or call (858) 300-2780. [559]

PLACE YOUR AD HERE

PART-TIME PHYSICIAN ASSISTANT: Looking for a part-time Physician Assistant for a rheumatology office in Escondido. 20-30 hrs a week. Spanish desired. To start as soon as possible. Please send resume and references to info@rheumSD.com. 12/5 MEDICAL ASSISTANT IN BUSY RHEUMATOLOGY OFFICE. FULL TIME. Wonderful opportunity for learning and growth. We are looking for someone who is organized, capable of multitasking, takes instruction well, and has a positive helpful attitude. Tasks include, but are not limited to: Front desk answering phones, make calls to patients, collect fees, set appointments and filing. Back office: Rooming patients and taking vitals, helping with therapy, keeping things organized and running smoothly, and cleanup. Spanish desired. Salary is based on experience. Please email info@rheumSD.com 11/30 SEEKING A DYNAMIC BUSINESS OFFICE MANAGER for a busy medical practice located on Convoy Street, close proximity to the 163/805 freeways. Responsible for the overall operations of the medical practice

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

O F F I C E M A N AG E R AWA R D

OFFICE MANAGER OF THE YEAR NOMINATED BY DR. GEORGINE NANOS, 12-year Member of SDCMS-CMA: Louisa Creech is an outstanding office manager and one of the most outstanding human beings I know! Louisa has been with our practice, North Coast Family Medical Group, for nearly three years. In the short time she has been with us, she has brought positive change to nearly every aspect of our practice at a time when we needed it most. In my opinion, Louisa’s talents may truly be infinite, but I’m only limited to a few hundred words, so I’ll stick with the highlights. Louisa is an exceptionally skilled communicator. She can create enthusiastic rapport and manage the support staff just

FEBRUARY 2018

as easily as she can understand the complex needs and expectations of the doctors and PAs in the group. One of her best talents is flawlessly bridging the equally demanding worlds  of providers, staff and patients. She can diffuse any situation by delivering exactly the right message every time, no matter how tense or stressful it might be. Furthermore, her well of compassion runs deep. She cares immensely about everyone and it’s obvious in the way she treats those around her with respect and dignity. Even when she is delivering a reprimand, it is done with kindness, support, and optimism for a better tomorrow. If there is any conceivable method of

improving the efficiency of our business, Louisa is already thinking about it, working on it, and has several creative ways to approach the issues. She is constantly and diligently working on our behalf to optimize our relationships with vendors, contractors, insurance companies, phone companies, and anyone else who impacts our business. She is always anticipating and preparing  for our next steps. Furthermore, her hiring acumen has reduced staff turnover and brought talented, enthusiastic people to our team who are a joy to work with. And when things go wrong, as they inevitably do, she’s always right there with solutions and a plan, whether it’s the weekend or the middle of the night. Her reliability and commitment are second to none. If being wise and brilliant isn’t enough, Louisa also has beautiful style and is downright hilarious fun. She transformed our ordinary staff Christmas luncheon in our patient waiting area into a festive and delightful event, the likes of which we had never experienced in our office. Similarly, for Halloween she decorated her door to a Pinterest level of fabulousness: Patients were taking pictures of her door and literally posting them on Pinterest. Louisa loves to laugh and make others laugh with her approachable and dry sense of humor. Every day when I see her smiling face in the office, I feel a sense of calm and peace knowing that she will expertly take care of any challenge that comes our way that day. She is, hands down, one of my favorite people. All of the physicians and staff at North Coast Family Medical Group universally hold the same sentiments about our amazing Louisa. We are so honored and thrilled to have her selected as Office Manager of the Year and look forward to our continued success with her guidance.

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