Fall 2017

ON THE Decision Medicine The Lifecycle of Legislation Top 10 Reasons to Be a Member Fall 2017

Credentialed. Customized. Committed.

4633 Quail Lakes Drive Stockton • 209.546.6100 641 Fulton Ave, Suite 200 Sacramento • 916.414.8282 Nick Salvetti, CFP®, CRPC®

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A.J. Salvetti, CFP®, CRPC®

Securities offered through Raymond James Financial Services Inc., Member FINRA/SIPC. The Salvetti Group is not a registered broker/dealer, and is independent of Raymond James Financial Services. Investment Advisory Services are offered through Raymond James Financial Services, Inc. Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, Certified Financial Planner™ and CFP® in the U.S.

VOLUME 65, NUMBER 3 • SEPTEMBER 2017

{FEATURES}

12 16 24 34 40 46 48 FALL 2017

LIFECYCLE OF LEGISLATION

{DEPARTMENTS}

TOP 10 REASONS

52 IN THE NEWS

DECISION MEDICINE

62 PRACTICE MANAGEMENT:

NEW SCHOOL ON THE BLOCK VACCINE & SCREEN YOUNG PHYSICIAN MIXER

New faces and Announcements Committed to Improving Quality Health Care

64 PUBLIC HEALTH

Prevent Smoking

67 NEW MEMBERS

MEDICAL SCRIBES

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PRESIDENT R. Grant Mellor, MD PRESIDENT-ELECT George Savage, MD PAST-PRESIDENT Kwabena Adubofour, MD SECRETARY-TREASURER Dan Vongtama, MD BOARD MEMBERS Aliya Gessling, MD, Alvaro Garza, MD, MPH, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Ramin Manshadi, MD, Benjamin Morrison, MD, Richelle Marasigan, DO

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Grant Mellor MD, Lisa Richmond

COMMITTEE CHAIRPERSONS DECISION MEDICINE Kwabena Adubofour, MD CMA AFFAIRS COMMITTEE Larry Frank, MD PUBLIC HEALTH Alvaro Garza, MD SCHOLARSHIP LOAN FUND Matthew Wetstein, PhD

MANAGING EDITOR Lisa Richmond CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS R. Grant Mellor, MD, James Noonan, Ashley M. Lewis, MPH, Alvaro Garza, MD, MPH, Brandon Piasecki

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Grant Mellor, MD,

THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society

Kwabena Adubofour, MD, Raissa Hill, DO, Ramin Manshadi, MD

SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00 AM to 5:00 PM Closed for Lunch between 12pm-1pm

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FALL 2017

Welcome

Stephen Howell, MD Orthopedic Surgeon

ALIGN WITH THE BEST Adventist Health Lodi Memorial welcomes world class orthopedic surgeon Stephen Howell, MD. Dr. Howell is the innovator of the kinematically aligned total knee replacement and performs more than 500 total knee procedures each year. According to ProPublica, Dr. Howell’s readmission rate for infections and complications after total knee replacement is among the lowest in the nation and he is in the top 3% of California knee replacement surgeons. His kinematic alignment approach offers patients consistent outcomes, including better function, shorter recovery and a quicker return to the things they love.

Learn more at DrSteveHowell.com or by calling 209-334-8535 today.

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EXECUTIVE DIRECTOR’S REPORT

PHYSICIANS LOVE PRACTICING IN SAN JOAQUIN COUNTY Our members truly love our community and their patients. Unfortunately, it should come as no surprise that it is difficult to recruit physicians, with no prior ties, to San Joaquin County. Last year, we began working on a video for all to use in their recruitment efforts. The video was left generic with regard to the physician’s specialty and medical group affiliation on purpose. If you haven’t seen it yet, we hope you will check it out on our San Joaquin Medical Society YouTube channel and Facebook page. Please share!

LISA RICHMOND

Due to the immediate needs of our community and long standing physician shortage, we know that the problem must have multi-pronged approach to the solution. Additionally, we realize that local students are far more likely to come back to serve our community, which is why we created Decision Medicine. The program has become hugely successful and each year brings a new crop of bright, motivated and community minded students who are interested in medicine.

Last year we began the arduous process of creating a master alumni list to track the students. We are reaching out to them through various methods including mail, email and social media. It has been exciting to learn that we have at least one in residency, six currently in medical school, two applying this year and 60 attending college with science/pre-med majors. We know that there are more we have yet to find, but it is a promising start. You can learn more about this year’s Decision Medicine class on page 42.

Earlier this year, I learned about a new medical school right up the freeway in Elk Grove. In speaking with others in our community, it seemed many were also not aware of this new school right in our backyard. It is exciting to learn about California Northstate University, College of Medicine and the opportunities we hope it will present for our local students and the healthcare community as a whole.

We introduce you to this medical school in this issue’s feature story.

Finally, while we will have a strong focus on students and medical education this year, we also have ambitious goals for new opportunities to engage our members. Keep an eye out for information regarding leadership and volunteer opportunities as well as our new Speakers Bureau in the next few months. We are thrilled to partner with the SJMS Alliance for our Family Picnic on Sunday, September 17. Bring your kids or grandkids for some fun and fellowship with friends and colleagues. Invitations should have been received in August or you may see enclosed advertisement for more details.

All the Best,

Lisa Richmond

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FALL 2017

FALL 2017

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RAPID

STRIDES. RECOVERY.

EXCELLENCE IN KNEE REPLACEMENT Rapid Strides Accelerated Recovery© Knee Replacement program uses state-of-the-art technology and innovative surgical techniques to ensure positive patient outcomes.

Key benefits include: • An all-encompassing, minimally invasive surgical approach that results in less pain than traditional knee replacement surgery • Multiple anesthetic techniques to significantly decrease joint pain and swelling • Computerized positioning technology for optimal accuracy • Accelerated recovery time, so patients can take their first steps almost immediately after surgery

Patients can find more information at DameronKneeReplacement.com.

Dameron Hospital will host free monthly information seminars, so potential patients can decide if this program is the right step to address their knee pain.

525 West Acacia Street Stockton, CA 95203 DameronHospital.org

For more information on the Rapid Strides program at Dameron Hospital, please call our Physician Outreach Liaison at 209-715-3618.

LIFE

Get Back To It

A message from our President > R. Grant Mellor, MD

The Mission of the San Joaquin Medical Society

ABOUT THE AUTHOR ­ R. Grant Mellor, MD- Pediatrician and Chief of Professional Development, Central Valley Service Area, The Permanente Medical Group and current President of the San Joaquin Medical Society

FALL 2017

The mission of the San Joaquin Medical Society is to promote the science and art of medicine, the care and well-being of patients, the protection of the public health and the betterment of the medical profession.

This year we’re giving special emphasis to the last part of the mission, “betterment of the medical profession,” by addressing two areas of opportunity in the local medical community: recruitment of new physicians, and the expansion of educational opportunities for medical students and residents.

Most of us reading this magazine face recruiting challenges in our practices. They are often due to Adjacent Geography Syndrome. AGS is characterized by an irrational awe of the Bay Area, leading the aff licted to desire living in tiny expensive houses (when they’re not sitting in traffic jams) and to ignore the opportunities for good living in San Joaquin, Calaveras, Alpine and Amador counties. In an attempt to alleviate this suffering, the SJMS has produced a video that promotes living and practicing in the Central Valley, for free use by any of the SJMS members.

Here’s the link: https://www.youtube.com/watch?v=LmUKK_601JE. Please use it to help us stamp out AGS, and recruit doctors to join your practices.

Of course, a more permanent fix to our recruiting challenge is to grow more of our own physicians. If we can create a more robust local premedical and medical teaching infrastructure, from high school through residency, we can ensure a ready supply of future doctors, and have the satisfaction of seeing our sons and daughters live and practice in our area.

Toward that end, the board has committed to the following.

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A message from our President > R. Grant Mellor, MD

a. C ontinue to support the SUSD’s Health Careers Academy, a charter high school in central Stockton. b. Continue to support, strengthen, and possibly expand the Decision Medicine program, now in its 17th year. It’s a program run by our medical society that gives 24 high school students each year a unique set of medical experiences, guidance, and encouragement to study medicine. By all accounts we had an excellent DM class this year, and we believe it will help inspire many students to pursue a medical career. c. S upport the new medical school in Elk Grove, California North State University. Yes, there is a new Medical school (offering the MD degree) just up the road in Elk Grove!

You may have already seen third-year North State students in our clinics and hospitals in the last few months. d. S upport the creation of new residency programs. San Joaquin General Hospital has led the way in local resident education This year we’re giving special emphasis to the last part of the for many years. we should mission, “betterment of the medical profession,” by addressing Now expect to see other two areas of opportunity in the local medical community: local institutions expanding the recruitment of new physicians, and the expansion of educational number of local residency offerings in opportunities for medical students and residents. our part of the valley in the next few years.

In addition, we must help simplify and demystify the process of preparing for and applying to medical school for the talented students in our counties. To accomplish this, we plan to do the following this year: Create a clearing-house for “Pre-Med” volunteering opportunities for high school and college.

Establish a mentoring program for those who apply to medical school, including college students, high school students (who seek admission to BS/MD or BS/DO programs), and local adults seeking to enter the field as a second career. This Fall we will be forming a group of interested SJMS physicians or physician family members who we will train to guide students successfully through the medical application and admission process. Please contact Lisa Richmond or me at the SJMS if you’re interested in joining this group.

If we’re successful, we’ll see more of the children of the San Joaquin and surrounding counties pursue medical training and return to us as physicians. (Or never leave: It is now possible to get a good college degree, a medical degree, and complete a residency all without leaving our part of the Central Valley!) Meanwhile, together we’ll fight the scourge of Adjacent Geography Syndrome and continue to attract the best and brightest new physicians to our area.

I look forward to working with you to reach these goals in the coming years.

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FALL 2017

Cardiologists practicing in the Central Valley

DR. STEVEN LAVIOLA DR. RAJAN HUNDAL

Dr. LaViola and Dr. Hundal are board certified cardiologists accepting referrals/new patients.

Fairmont Specialty Care 209-339-7825 845 S. Fairmont Ave., Ste. 8 Lodi AdventistHealthLodiMemorial.org FALL 2017

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HOW A BILL BECOMES A LAW Change is happening, and change will always happen. CMA remains focused on the future and will act boldly to shape the world of health care to support physicians and patients.

BILL IS INTRODUCED

Ruth Haskins, MD, CMA PRESIDENT

COMMITTEE HEARINGS COMMITTEE HEARINGS IF PASSED (SENT TO OTHER HOUSE)

FLOOR ACTION

FLOOR ACTION RETURNED TO ORIGINAL HOUSE

IF PASSED WITH AMMENDMENTS IF PASSED WITHOUT AMMENDMENTS

BILL GOES TO GOVERNOR IF ORIGINAL HOUSE CONCURRS

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IF NOT VETOED

MOST BILLS BECOME LAW JAN. 1 OF THE NEXT YEAR

FALL 2017

THE LIFECYCLE OF

n o i t a l s i g e L

FROM IDEA INTO LAW

The California Medical Association (CMA) is the largest, most influential medical organization in California, and an aggressive advocate for doctors and patients. CMA relies on the involvement of its members to communicate the physician vision of medical care to the public, to lawmakers and to the regulators who determine how medicine is practiced.

An idea is born: Ideas for new health policy are born in a number of places. One of them is in the hearts and minds of the physicians of California. CMA members can directly influence the association’s health care advocacy agenda by submitting a resolution for consideration to the CMA House of Delegates.

CMA policy is established: Resolutions are assigned to councils and subcommittees for study and development, then opened up for discussion by your physician colleagues before recommendations are developed for action by the CMA Board of Trustees. Many of CMA’s sponsored bills have their genesis in an idea submitted by our physician members. While not all CMA policies result in direct legislative action, they are used to guide CMA’s positions on the hundreds of health care bills that are introduced into the State Legislature each year.

Bills are introduced: The California Legislature operates on a two‐year session. Each year, primarily in January and February, bills are introduced by lawmakers for consideration.

The governor may also call a special session of the Legislature to deal with specific subjects.

CMA takes a position: Each year, with physician input, CMA monitors more than 500 bills and takes a public position on around 200 bills. Those positions include watch, support,

oppose, support if amended and oppose unless amended.

CMA also may choose to sponsor or co-sponsor legislation that is of critical importance to the physicians of California.

Bills move through the process: If a bill is to become law, it must be passed out of one or more committees, approved by a simple majority of both houses, and signed by the governor.

Laws ordinarily take effect on January 1 of the following year.

Briefly, a bill progresses through the following steps: 1. A bill is introduced. 2. The bill is heard in one or more committees in its house of origin (either Senate or Assembly), including public testimony. 3. If the bill passes out of committee(s), it goes to the house floor for a vote. If it passes out of the house, it is sent to the other house for consideration following the same process described above. 4. If approved by both houses, the bill goes to the governor for signing. 5. The governor has three choices: sign the bill into law, allow it to become law without his or her signature, or veto it. A governor’s veto can be overridden by a two-thirds vote in both houses.

CMA monitors and protects physician interests: CMA’s powerful government relations team works tirelessly with legislators to educate them on how legislation could enhance or threaten patients’ health or physicians’ ability to practice medicine. Their activities include reading and tracking bills and amendments, shaping bill language, meeting with legislators, testifying in committee, conducting research, and preparing policy papers and position letters. Every year, CMA not only supports and shapes the development of valuable health care policy, but the association also stops a number of harmful legislative proposals.

For more information on CMA’s legislative advocacy, and how you can get involved, visit www.cmanet.org.

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MEMBERSHIP

Top 10 Reasons to be a member When you become a member, you hire a powerful professional staff to protect your profession from legal, legislative, and regulatory intrusions. But that’s not all. Let’s countdown the top 10 reasons to be a member of the California Medical Association (CMA) and your local county medical society.

10. Protect the Profession Your membership affirms your commitment to the medical profession and ensures physicians remain in control of the practice of medicine.

9. Lead by Example

CMA and its county medical societies provide many opportunities to get involved, including opportunities to volunteer; serve on a committee, council or board; and shape the future of the medical profession.

8. Stay in the Know

CMA and its county medical societies produce publications to keep you up-to-date on the latest health care news

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and information affecting the practice of medicine in California.

7. Get Paid

Members receive one-onone assistance from CMA’s reimbursement experts, who have recouped $15.5 million from payors on behalf of CMA physicians in the past nine years.

6. Protect MICRA

CMA staunchly defends the landmark Medical Injury Compensation Reform Act (MICRA) year after year, saving each California physician an average of $75,000 per year in professional liability insurance premiums.

FALL 2017

MEMBERSHIP

CMA was founded in 1856 by a small group of physicians who knew it was their duty to fight for their patients and for their profession.

5. Collaborate with Colleagues

4. Promote Public Health

CMA and its county medical societies bring together physicians from all regions, specialties and modes of practice through leadership, collaboration, social and educational events, and community service.

From tobacco use and obesity to prescription drug abuse and vaccinations, your membership dollars support forward-thinking public health advocacy to improve the health of Californians.

NEW! Membership is easier than ever with new

Monthly payment plan

Membership in the California Medical Association (CMA) and your local county medical society is easy to maintain and hassle-free with automatically recurring monthly payments at an affordable monthly price. If you’re not already a member, enroll today at www.cmanet.org/monthly to start receiving your benefits! If you’re a current member, keep an eye out for your renewal invoices this fall and choose the monthly payment plan.

QUESTIONS? Contact CMA’s Member Service Center at (800) 786-4262 or memberservice@cmanet.org.

FALL 2017

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U

N

I

V

E

R

S

I

T

Y

P

A

R

K

A Place To Heal Inside and Out!

The preferred choice for the modern medical office! University Park is home to several medical facilities and within close proximity to both St. Joseph’s Hospital and Dameron Hospital.

Your staff and patients can step out of the office for a visit to the University Park World Peace Rose Garden, hike the one-mile Discovery Trail, or simply sit and enjoy the Heritage Oak trees and the beautiful lake and fountains...all on the University Park Campus.

A Sanctuary in the City

Available For: Build-to-Suit • Ground Lease • Historic Remodel For more information: Dan Keyser (209) 473-6201 • dkeyser@grupe.com or visit us at universityparkstockton.com • 612 E. Magnolia Street, Stockton, CA 95202 18

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FALL 2017

MEMBERSHIP

Ask yourself who will have the most impact on the way you practice “medicine - the government, or physicians in organized medicine through CMA? Be involved or be left behind. ” - J. Brennan Cassidy, M.D.

3. Head Seat at the Policy Table

Through aggressive political and regulatory advocacy, CMA and its county medical societies are positioned among the most influential stakeholders in the development and implementation of health policy.

Join or renew your membership today! www.cmanet.org/join

2. Shape the Future of Medicine:

Members receive direct access to our state and national legislative leaders to influence how medical care is provide today and in the future.

QUESTIONS? Contact our Member Service

1. Together We Are Stronger:

Center at (800) 786-4262 or memberservice@cmanet.org.

Together we stand taller and stronger as we fight to protect patients and improve the health of our communities.

We are a dominant force in health care – but all the great work we do wouldn’t be possible without the support of members like you.

10th Annual

INNER SAFARI Caregiver Conference Saturday, November 4, 2017 Registration: 8:00 AM Program: 9:00 AM – 4:00 PM

Robert Cabral Agricultural Center

2101 East Earhart Avenue - Stockton, CA 95206

Attire: Comfortable/Safari

Join me and other leading experts in Caregiving at the 10th Annual INNER SAFARI Caregiver Conference in Stockton, California on November 4th.

Learn more about the Fearless Caregiver’s experience to be better partners in patient care.

Gary Barg

CEO/ Editor in Chief Today’s Caregiver Magazine the leading national publication for caregivers

www.caregiver.com

FALL 2017

tickets are complimentary for all pre-registered caregivers (ALL EVENT PARTICIPANTS MUST BE REGISTERED)

Hosted by DEPARTMENT OF AGING

register: https://caregiverconference2017.eventbrite.com

for more information, call (877) 672-4480 ceu’s available for rn’s, lvn’s and social workers

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FALL 2017

Strong community partnerships lead to happier, healthier people

Celebrate Health Partnering today for a healthier tomorrow

With over 345,000 members and growing, Health Plan of San Joaquin continues to build relationships with health care providers, resource agencies and local businesses to deliver on our mission to improve wellness throughout the communities we serve.

FALL 2017

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Dinner

Jasbir Gill, MD Dr. Nguyen Vo

Award

Lifetime Achievement Young Physician

2017

OUR RETIREMENT PLAN:

DM DECISION MEDICINE

BY BRANDON PIASECKI

It is August 6th, 2017, and the sun is setting on the Delta through the large, polished windows surrounding the Stockton Golf and Country Club banquet hall.

The room is filled with an eclectic mix of students, parents, and health care professionals from all over San Joaquin County celebrating the end of the 2017 Decision Medicine program. A highlight video plays as people finish their dinners, reminding students of the laughter, friendships, lessons, and new discoveries that they made this past summer. A doctor who spoke to us at UC Davis said something in that video that sticks with me that really gets to the crux of why this program is so vital for the youth it serves: “Remember the two most important days in your life: the day you’re born and the day you find out why…” >>

For me, as an educator, it is a rare experience to work with a group of students that already have a sense of why they were born, a sense of their life’s purpose.

Every summer, since the program was founded in 2001 by Dr. Adubofour and Dr. Khoury, Decision Medicine seeks to tap into driven high school students who have a sense of purpose rooted in serving their home communities as physicians someday. Having grown up in Stockton, I look forward to being a part of this program every summer because it opens up an opportunity to help channel sincere passion for change and plant seeds for the betterment of our community for years to come.

We had an enthusiastic group of students this summer that gelled and bonded more quickly than I have ever seen with a Decision Medicine cohort!

As a staff, we were incredibly happy to see this swift camaraderie.

The students came from a wide range of backgrounds and interests, from varsity football and wrestling standouts to theater, music, and many different clubs and organizational involvements.

The cohort was an excellent representation of San Joaquin County, totaling 24 students from 16 different high schools with an average grade point average of 4.24. This elite group of students demonstrated exceptional prowess in their academic and extracurricular achievements, and confidently executed their interviews in the final round of

applications, which consisted of a panel of several top physicians in San Joaquin County (not the easiest of groups to banter with!).

The program itself is an intense, packed, 2-week survey course on many of the different types of medicine that one can practice, and the different settings in which physicians can practice like community clinics, private practice and major medical groups.

Through it all, students gain invaluable knowledge and networking opportunities to learn what concrete steps they can begin to take now as high school students to set themselves up for success in undergrad and eventually medical school. This past summer, students were able to go on rounds with residents and learn about internal medicine at San Joaquin

General Hospital. Students enjoy this because they say it is “just like Grey’s Anatomy” and other hospital shows they see on television but “without all of the drama”. Students were exposed to community medical clinics and learned about homeless medical outreach through the Gleason House and Community Medical Clinics. There were many memorable hands on educational experiences like typing their own blood at Dameron Hospital and learning the ins and outs of the cardiovascular system through a pig heart dissection at California Pacific Medical Center in San Francisco, with

one-on-one help from cardiologists, medical students, and fellows. Students were taught how to suture by medical students at UC Davis in a popular lab activity that involved students stitching up a sliced banana peel.

Thanks to St. Joseph’s Medical Center, all 24 students are now CPR certified. They even had an opportunity to engage in a mock childbirth in the simulation lab at Kaiser Permanente in Modesto!

Besides generous financial support from partners like Kaiser Permanente and Health Plan of San Joaquin, this program requires much input and planning from all

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parties involved in providing the highest quality experience possible for these students.

It truly is an investment, but a necessary one, as recently it has been reported by the California Health Care Foundation that the San Joaquin Valley has 25% fewer primary care physicians than the state average. The overarching goal of Decision Medicine program is to help San Joaquin County grow its own doctors. Due to the time-intensive nature of medical school and the road to becoming a full-fledged physician, we are just now beginning to reap the rewards from this program. There is currently one Decision Medicine alum in residency, and eight alumni who are in medical school at this very moment, planning on eventually making their way back to their roots to practice medicine in the community that raised them.

Our students showed a strong passion for community in their attitudes and their outspoken desire to return home after earning

FALL 2017

D’Angelo Martinez & Maha Siddiqui

HPSJ HEALTH CAREERS SCHOLARSHIPS DECISION MEDICINE STUDENTS HONORED

During the 2017 Decision Medicine Celebration Banquet, at Stockton Golf and Country Club, HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD, presented $2,500 HSPJ Health Careers Scholarships to DM 2016 graduates Maha Siddiqui who will attend University of California, Berkeley and hopes to be an OB-GYN, and D’Angelo Martinez who will attend University of California, Davis and plans to be a physician.

Each student was joined by their HPSJ DM program

mentors, HPSJ Project Management Director Fran Hattner and HPSJ Health Promotions and Cultural & Linguistics Manager Jenny Dominguez.

Dr. Dhanvanthari told the students, “We are proud of both the excellence of your academic records and your ongoing commitment to service. We believe the potential you continue to show will bring you back to the Central Valley and outstanding careers that will markedly improve the health care of our community.”

SJMS PRESENTS SCHOLARSHIP IN MEMORY OF DECISION MEDICINE VOLUNTEER During the recent celebration banquet, Tatum Halligan presented 2016 DM Alum, Si Hao (Jackey) Tang with a $2500 scholarship in memory of her father, Rick Halligan. Jackey will be studying Neuroscience at UCLA this Fall and plans to become a physician. Rick Halligan was a Diagnostic Imaging Supervisor at San Joaquin General Hospital. He was the DM program coordinator for SJGH and one of the most passionate volunteers.

“Rick will always be remembered for his incredible sense of humor and enthusiasm for his profession and our Decision Medicine students” said Lisa Richmond, Executive Director of the San Joaquin Medical Society.

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Si Hao Tan

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2017 DM STUDENTS

ABREFI ADUBOFOUR

Saint Mary’s High School

ARDREY ANNE BANGUIS

Cesar Chavez High School

AVA BEDNAREK

Saint Mary’s High School

DE’ANGELO CALDERA

Manteca High School

LEWIS CATAPANG

Bear Creek High School

TIMOTHY GUTIERREZ

Stockton Accelerated Institute of Learning

TIFFANY HUYNH

Stockton Early College Academy

SHUBNAZ JAGPAL

East Union High school

WILLIAM JONES

Lincoln High School

KATE LAGERA JASMINE LOUIE

their medical degrees.

“I want to be a part of the solution,” says Kate Lagera, regarding her desire to come back someday and practice in San Joaquin County. Students like Kate are going to be shaping the landscape of healthcare in our community.

Decision Medicine is a necessary program to help polish the raw desire that our driven, motivated youth have to make an impact in the field of health care in our community. This program is helping cultivate our retirement plan: the youth of our community.

On August 6th, as the sun was setting on the San Joaquin Delta, 24 white coats were handed out to 24 high school students as the end of the latest group of who’s who students completed the Decision Medicine program.

Hopefully these white coats are the first of several more that they will wear throughout their future careers, and that they will serve as an important first step in a longer journey of lifelong commitment to bettering the lives of our community.

FALL 2017

Bear Creek High School Stockton Early College Academy

ANNA LUCOSTIC

Linden High School

HARRAH LUNA

Edison High School

NAVINA MANN

Manteca High School

YOJAIRO MORALES

Franklin High School

MAHA SHAIKH HEIDI SOLIS JULIA SPENCER MUHAMMAD TARIQ CYNTHIA TORRES ANDREW VILLALOBOS BRITNEY VU

John C. Kimball High School Millennium High School Pacific Law Academy Lodi High Linden High School Edison Sr. High School Bear Creek High School

JASMINE WOOLSEY Stockton Collegiate International

NICK YANG

Secondary School Franklin High School SUSD

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FCCU 2012 ad with printer marks.pdf 1 2/2/12 2:25 PM

The

REMEDY for all your

Financial

NEEDS

As a member of the San Joaquin Medical Association, you’re privy to an exclusive benefit—Financial Center Credit Union membership for you and your staff !

In a time when the safety and soundness of funds is at the forefront of everyone’s minds, Financial Center membership is the perfect prescription for peace-of-mind. Voted Best Of San Joaquin, Financial Center is the most trusted credit union in the Valley. Time and time again, we offer our members the lowest rates on their loans as well as the safest place to save their money.

Follow the doctor’s orders and call us today. And don’t forget to pass this message onto your staff – they (and their wallets!) will thank you.

209-948-6024

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•

www.fccuburt.org Federally insured by the NCUA.

FALL 2017

TAKING CARE OF BUSINESS Experience the benefits of working with an award-winning local community bank.

Build a relationship with experienced banking professionals who listen to your needs. Benefit from customized banking solutions and cutting-edge technology.

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California Northstate University College of Medicine

NEW SCHOOL ON THE BLOCK California Northstate University College of Medicine is the state’s newest medical school, and one that hopes to mint a generation of physicians dedicated to serving patients right here in the Central Valley

PHOTOGRAPHY BY DALE GEOFF AND HOWARD YOUNG, MD STORY BY JAMES NOONAN

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For many California communities, news of a nationwide physician shortage will come as no surprise.

IN TODAY’S HEALTH-CARE dominated media cycle, alleged horror stories regarding a lack of access to care, or a threat of not enough providers to go around, are used to capture attention spans of viewers and readers on a near-daily basis.

Here in San Joaquin County, with a population that the statewide Office of Health Planning has designated medically underserved in virtually every measurable category, the effects of this physician shortage are more than just a catchy headline, they’re a fact of life that deeply impacts thousands of residents in need of care.

In every challenge, however, there exists an opportunity, and these circumstances are the very ones from which the California Northstate University College of Medicine was born. >>

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53,042 21,030 According to the American Association of Medical Colleges, a total of 53,042 students applied for a spot at one of the country’s roughly 180 medical schools.

Only 21,030 of these applicants went on to enroll in a program for the 2016-17 academic year.

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First accredited in June of 2015, the new medical school, which is based just shy of 40 miles north of Stockton in the community of Elk Grove, was founded with desire to address the region’s growing physician shortage, while bringing a fresh, and innovative, approach to medical training to California’s Central Valley.

“It’s not every day that a new medical school pops up in your backyard. It’s all very exciting,” said Dr. Peter Yip, senior chair of clinical sciences for the university.

Yip’s excitement is understandable, especially when one considers the enormous amount of potential that is currently going unrealized the nation’s existing medical schools.

According to the American Association of Medical Colleges, a total of 53,042 students applied for a spot at one of the country’s roughly 180 medical schools. Only 21,030 of these applicants went on to enroll in a program for the 2016-17 academic year.

In California, the pool of untapped potential is one of the largest in the nation, with roughly 3,800 of 6,400 applicants failing to matriculate into any U.S. medical school. Another 1,600 or so of those applicants went on to matriculate into an out-of-state institution, greatly reducing the odds that they will one day help to

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KP’S MICHAEL NGUYEN, MD WITH CNU 3RD YEAR MEDICAL STUDENT LETITIA PIRAU 36

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alleviate the physician shortage here in California. presented with hypothetical cases on a weekly basis, a Only 964, less than 15 percent of the total pool of patient experiencing chest pain, for example, and the applicants, began their medical training in their home course of instruction seeks to link specific scientific state. concepts to these real-world medical problems that So far, California Northstate University has students may one day see in the field. bucked this trend, Yip said, pointing out that “Before my time here, I hadn’t seen a curriculum opportunity being presented by the state’s newest like that,” Yip said. “It was fascinating to me, and in my medical school is one that’s being seized largely by homegrown candidates.

“Roughly 85 percent of our students come from right “Roughly 85 percent here in California,” he said, noting that many are of our students come products of the University of California or California from right here in California,” he said, State University systems. noting that many are products of the University of California or California State University systems. opinion, it’s really creating physicians who have the In addition, a good number of the university’s strong critical thinking skills needed to be successful.” students, which are currently spread across first-, Yip adds that the curriculum also demands quite a second- and third-year classes, have roots right here bit from the students. in the Central Valley, and represent the vastly diverse At the end of the week, each group of students is population for which California is known. Roughly required to present their findings on the hypothetical half of the university’s students are of Asian descent, case, running their classmates and instructors while only a third of students identify as White or through their preferred methods of treatment, Caucasian. Nationally, white students make up more including any tests they may have ordered or drugs than 56 percent of all medical school enrollees. they may have potentially prescribed. Their decisions “It’s a very diverse group of students,” Yip said. are then probed by their classmates and instructors, “They absolutely mirror the populations we serve here leaving the presenting students to defend their in California.” decisions.

In addition to hoping to alleviate the state’s “When you have to present something like that, shortage of medical providers, the founders of you better know your stuff,” Yip said. “Doing this California Northstate University also sought to bring week after week, we’re developing some rather strong an integrated approach to medical instruction, one skills.” that aims to combine basic and clinical sciences from While the methods may be unorthodox when day one. compared to other universities and colleges, Rather than undergo the traditional model of California Northstate University’s unique approach medical instruction, which dedicates the first two to medical training has already delivered promising years of instruction to basic sciences learned in a results. classroom setting and reserves clinical studies for The school’s third-year students, which made up the third and fourth years, students at California the institution’s inaugural class back in the 2015-16 Northstate University have their instruction broken school year, are currently in the point of their training down into “units” that cover area of medical study where they must complete the United States Medical such as cardiology, hematology or nephrology.

Licensing Examination, Step 1 exam. Known for From the very beginning of these units, students are being rigorous, the Step 1 exam is designed to FALL 2017

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CNU 3RD YEAR MEDICAL STUDENT YOUNG LEE, WITH KP’S KHALED DIAB, MD

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assess whether students possess and understand the vital scientific concepts that are basic to the practice of medicine.

To date, roughly a third of students in this class have taken the exam, and all have passed.

“When you link these clinical studies with a scientific concept, students are going to remember that concept so much better,” Yip said. “So far, our students have met the challenge head on.”

Outside of the classroom, the faculty of California Northstate University is working diligently to foster a connection between the school’s 240 future physicians and the surrounding medical community.

Already, partnerships are being built with organizations like KaiserPermanente, while future inroads will hopefully be made with other major players in the region such as Sutter and Dignity Health. Currently, there are 14 third-year California Northstate University students completing their clerkship rotations at Kaiser-Permanente facilities throughout the Central Valley, gaining hands on experience in departments ranging from surgery to pediatrics.

Yip also notes that the school plans to develop relationships with surrounding hospitals, such as San Joaquin General and St. Joseph’s Medical Center, and build a connection between the students and their community as early as possible.

“We want to build that connection,” Yip said. “As we have students rotating through these institutions, it’s important that they feel that connection and that they’re having a great experience there.”

Yip and his colleges hope that these relationships, that will hopefully translate into clerkships and intern opportunities for California Northstate University students, will help address another leading factor in the region’s physician shortage problem - the fact that California medical FALL 2017

students go on to pursue residency opportunities in far off states, only to settle down and never return home.

“If students are having a great experience in their clerkships, the hope is that they’ll want to one day go back to that organization,” Yip said. “The more we affiliate and create partnerships with the surrounding medical community, the better chance we have a creating a pipeline that sees our medical students staying here in California, or even right here in the Central Valley.”

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American Cancer Society Urges Simple PCP Plan

BY KATHERINE V ROW, AMERICAN CANCER SOCIETY

KATHERINE materials V ROW, AMERICANcall CANCER SOCIETY For more information andBYpatient 800-227-2345 or visit cancer.org.

Primary care practices are uniquely positioned to counter spiraling rates of head and neck cancers and prevent many colon cancers. Collective action is needed.

HPV Vaccination Adolescent HPV vaccines prevent most cervical, vaginal, vulvar, and anal cancers, and are expected to prevent most penile and oropharyngeal cancers, yet rates of several of these cancers are increasing. It is not often we can prevent multiple cancers with a single tool. Concerted efforts are needed to increase vaccination so this opportunity is not lost.

While other adolescent vaccine coverage in the US increased from 2007-2014, HPV vaccination rates did not, despite overwhelming evidence of safety and effectiveness. Only 1-in-3 girls and 1-in-5 boys in the US are fully vaccinated, compared to 70+% in Australia, Canada, and the United Kingdom and 97% in Rwanda.

In October 2016, the CDC reduced the recommended number of doses from three to two for

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ages 9 to 14. Ages 15 to 26 still require three doses for full protection. If the 84% of unvaccinated girls who received at least one other vaccination at/after age 11 received concurrent HPV vaccine, coverage for at least 1 dose would have been over 91%.

Increased vaccination can reduce racial and socioeconomic disparities in cervical and other HPV-associated cancers: Vaccination rates are lowest where cervical cancer rates are highest, in Appalachia, Southern and Mexican border states. Black and Hispanic women have higher cervical cancer incidence and mortality rates. African American, American Indian/Alaska Native, and low-income girls are least likely to complete the multiple-dose vaccine series. >>

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Understand the power of your

recommendation as a primary care physician. The American Cancer

Society’s five things PCP/healthcare providers can do:

1. Recommend colorectal cancer

Increasing HPV vaccine uptake requires leadership and collaboration of the cancer, immunization and primary care communities. Successes in other countries and parts of the US, including Rhode Island and Philadelphia, indicate that increasing vaccine uptake is achievable. Consistent messaging during every well-child visits about the vaccine’s safety and efficacy, and the long-term protection against multiple cancers is needed.

screening to patients ages 50

and older and younger patients at increased risk.

2. Measure the colorectal cancer

screening rate in your practice, it may not be as high as you think.

3. Use evidence-based practice

changes to systematize screening in your office. More screening doesn’t have to mean more work for you.

4. U nderstand colorectal cancer

screening options. Educate your

patients and staff on the various,

often less expensive testing options.

5. M ake sure patients and staff

understand that most insurance

companies and Medicare are required to cover colorectal cancer screening.

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Colorectal Cancer Screening Colorectal cancer is the third most common cancer in the US and the second deadliest, yet it is one of the most preventable, when precancerous polyps are detected and removed during regular screening. The number of colorectal cancer cases is dropping thanks to screening, but we can prevent more: About 1 in 3 adults between 50-75 years old – some 23 million people – are not getting screened.

Risk for colorectal cancer increases with age, nearly 90% of cases diagnosed are in adults age 50 years or older. For those at average risk, screening should begin at 50. African Americans are at highest risk with increased rates among Alaska natives, some American Indians and Ashkenazi Jews. Those with a first-degree family history of colon cancer, a personal history of inflammatory bowel disease and polyps are at increased risk.

“My doctor never talked to me about it” is a leading patient-reported reason for procrastinating.

Low awareness of colorectal cancer as a personal health threat and of the screening benefits are common. Many procrastinators are unaware of screening options, basing decisions to delay on fears of colonoscopy with its onerous prep, discomfort, and assault on modesty.

Primary care physicians play a key role in ensuring adults age 50 and older are regularly screened for colorectal cancer with reminders during annual checkups. Recommended screening test options include colonoscopy, stool tests (FOBT), guaiac fecal occult blood test and (FIT) fecal immunochemical test, and sigmoidoscopy. Screening saves lives, but only if people get screened. The best test is the one that gets done!

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& Dentist Mixer

San Joaquin Dental Society • San Joaquin Medical Society

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TAKE NOTE

The widespread adoption of electronic health records (EHRs) has led to a number of unintended consequences— particularly a negative effect on doctor satisfaction and practice workf low. Medical practices have tried many different solutions to help alleviate the burden, and one of the most common solutions is the adoption of medical scribes.

How does this affect the delivery of care? A number of studies suggest that scribes can enhance physician efficiency, improve physician satisfaction, and increase billing in a variety of clinical settings. Patient satisfaction can also increase, due to improved physician-patient interactions during office visits.

BY JEFFREY A GOLD, MD, PROFESSOR OF MEDICINE, DIRECTOR OF SIMULATION, OREGON HEALTH AND SCIENCE UNIVERSITY

A LACK OF TRAINING AND STANDARDIZATION In spite of the rapid growth and potential benefits of scribes, the healthcare community has generated very little regulation or standardization for scribe training, and researchers haven’t conducted any assessment of scribes’ ability to safely interface with the EHR. Dedicated scribe organizations, which provide scribes for individual practices and healthcare organizations, may train recruits on basic medical terminology, note structure, documentation, and EHR basics. Other scribes may receive on-the-job training from the doctor who is their employer.

There is no licensure requirement for scribes.

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SURVEY SHOWS VARIABLE ROLES AND FUNCTIONS To better understand the role and functionality of scribes, The Doctors Company, the nation’s largest physicianowned medical malpractice insurer, and Oregon Health and Science University (OHSU) conducted a national survey of The Doctors Company’s members. This survey, with 335 respondents, suggested that scribes are supplied from different sources, have disparate backgrounds, and their training is highly variable:

• 55 PERCENT OF SCRIBES ARE TRAINED BY THE DOCTOR.

• 44 PERCENT OF SCRIBES HAVE HAD NO PRIOR EXPERIENCE.

• ONLY 22 PERCENT OF SCRIBES HAVE HAD ANY FORM OF CERTIFICATION.

• AROUND 24 PERCENT OF PRACTICES THAT USE SCRIBES HIRE THEM AS EMPLOYEES.

• NEARLY 13 PERCENT OF PRACTICES USE SCRIBE STAFFING AGENCIES.

The study also revealed wide variability in the tasks scribes are performing, including pure note writing, data entry (such as updating allergies), data extraction (such helping the doctor find information in the EHR), and order entry.

THE RISK OF ‘FUNCTIONAL CREEP’ The combination of rapid growth in scribe use, lack of director of the Pulmonary Critical Care and Critical standardized training, variability in scribe experience, Care Fellowships, and associate director of the Adult and variability in both EHR exposure and EHR Cystic Fibrosis Center at OHSU. workf lows raises the concern that scribes may introduce potential negative unintended consequences to either workf low • • or documentation.

In addition to concern over the wide variance in scribe activities, healthcare providers are worried about “functional creep”—scribes being granted the authority to perform more complex functions in the EHR over time. Given the already large number of negative safety issues associated with We Can Help. these complex EHR functions, The environment of health care is changing—you have the it’s imperative that the healthcare opportunity to not only become sustainable but to succeed. Our community create methodology team will help you become ADEPTSM at the business of health care. to ensure scribes can be effectively trained and their competency Irv Barnett, MBA, CMPE ibarnett@V2VMS.com assessed for safe and effective use of 916.747.9611 the EHR. v2vms.com

It Pays To Be The Best QUALITY COST SERVICE

Are You Ready?

Dr. Gold is director of the OHSU Simulation Center, program

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SACRAMENTO | ATLANTA | BELLINGHAM | LEWISTON

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Gill Obstetrics & Gynecology Thank you for voting us BEST OB/GYN Practice!

90,000 HEALTHY BABIES DELIVERED

The physicians and staff at Gill OB/GYN congratulate Dr. Jasbir Gill on receiving the lifetime achievement award from the San Joaquin Medical Society. This is a testament to Dr. Gill's commitment to clinical medicine, academic teaching and public

Experience matters

leadership. We thank him for being a pillar of our practice and a champion for this community.

With 60 years of experience and roots dating back to 1953, Gill Obstetrics has a rich history of serving generations of women throughout San Joaquin County. We offer clinical expertise and compassionate care in a welcoming environment where women can feel comfortable and secure, knowing that we put our patients needs first. After all...each woman needs are unique and you deserve special care!

Gill OB/GYN thanks you for entrusting us with your healthcare needs.

It is our great privilege to bring new life in the world and share in your happiness.

We have cared for the women of this community for over sixty years and look forward to becoming the first to welcome the next generation in your family and in our area.

Gail Joseph, M.D.

Ofelia Ortiz, M.D.

COMPLETE PREGNANCY CARE Healthcare Just as Unique as You!

Introducing the San Joaquin Medical Society MemberCard!

As part of your membership with San Joaquin Medical Society you will receive quality discounts on dining, attractions and more with the brand new SJMS Membercard!

• Enjoy discounts on dining at more than a dozen local restaurants.

• Save when visiting participating area attractions and wineries!

DIRECTORY RSHIP OF MEMBE BENEFITS

• Earn reward points at over 11,000 online retailers nationwide.

Merchants honoring the SJMS MemberCard: • Midgley’s Public House • Papapavlo’s Bistro & Bar • Ben Mackie Fitness • Mettler Family Vineyards • ...and many more!

Plus gain access to the MemberCard Mobile App available for both Android and iPhone devices. The App allows you to find available discounts, map to participating businesses and redeem benefits directly on your phone!

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In The News

IN THE

NEWS SJMS is Creating a Speakers Bureau The San Joaquin Medical Society occasionally receives requests for physicians to speak to students at local schools and other various events. In response, we are creating a Speakers Bureau. We hope to build a diverse list of physicians, both geographically andSh with regard to areas of expertise. If you would like to be included, please email Lisa Richmond, Executive Director at Lisa@sjcms.org or visit our website at www.sjcms.org and click the Speakers Bureau link to fill out the form.

New Partnership Convenes to Address Healthcare Workforce Needs The Northern Central Valley faces a critical shortage of qualified healthcare workers. At the same time, many community residents are eager to enter into health careers but lack the clear road maps and support they need to do so.

In response, an innovative partnership of healthcare employers, educational and workforce development providers, and community leaders is working to develop a San Joaquin Area Healthcare Sector Partnership. The partnership will address employer needs for healthcare workers and increase access to healthcare career pathways for community residents.

Participating employers include Dameron Hospital, Doctors Hospital of Manteca, Kaiser Permanente, Lodi Memorial Hospital, San Joaquin General Hospital, St. Joseph’s Medical Center, and Sutter Tracy Community Hospital. Other employers include Community Medical Centers and skilled nursing facilities. Sponsors include San Joaquin Delta College, the Delta Sierra Regional Alliance,

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Providing staff, physicians, and patients with relevant & up to date information

and the Community Health Leadership Council.

The initiative launches in September, when the partnership convenes to begin development of an organizational model and to identify its priority workforce needs. The partnership is expected to begin operations in the first half of 2018.

For further information, please contact Lita Wallach at (209) 210-8898 or email lita.wallachconsult@gmail.com.

Lodi Health is now Adventist Health Lodi Memorial Effective immediately. Lodi Health is now Adventist Health Lodi Memorial. Earlier this year, Adventist Health unveiled a new brand direction for its entire system, including an expanded mission statement and core values that support its vision of transforming the health experience, outcomes and status of the communities the system serves. Today, the system has announced a key milestone on its branding journey; the naming across all the hospitals and clinics within Adventist Health has been updated to truly ref lect the various parts of the system coming together under one brand.

As a result, the Lodi community will see changes in Adventist Health Lodi Memorial’s external advertising and, over the next year, its signage at the hospital and more than 20 outpatient locations. What will not be changing is the faith-based whole-person care Adventist Health Lodi Memorial provides to the community. As a more closely connected health system, leaders of Adventist Health’s 20 hospitals will be able to share successes with each other to ensure that patients get the best care available and have the excellent experience they deserve—every time.

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Adventist Health Lodi Memorial Proudly Welcomes Five New Physicians Adventist Health Lodi Memorial is pleased to announce the addition of five new physicians to its medical staff.

Stephen Howell, MD – Orthopedic Surgery

World renowned orthopedic surgeon Dr. Stephen Howell, MD, joins Adventist Health Lodi Memorial with more than three decades of experience as a clinician, researcher, and innovator in total knee replacement (TKR), Stephen Howell, MD anterior cruciate ligament reconstruction and meniscal surgery. Now, residents of the Central Valley will no longer need to leave the community to receive internationally recognized orthopedic care.

Howell completed his medical degree at Northwestern University and went on to accomplish his orthopedic residency at Thomas Jefferson University. He is a retired military professional who served the United States during such critical times as Operation Desert Storm.

In his new practice with Adventist Health Lodi Memorial, Dr. Howell will offer complete care for the knee joint.

Dr. Howell has trained physicians on five continents and worked with industry experts on his patented approach to customized knee surgery – the kinematically aligned knee.

The kinematic approach naturally aligns the knee by custom positioning the implants to the native joint line of the knee, like it was before arthritis developed. Dr. Howell performed the first kinematically aligned total knee replacement in January 2006 and now performs more than 500 per year. The approach allows for shorter lengths of stay, quicker return to prior function and consistent and reproducible outcomes for his patients.

Located at both 1235 W. Vine St, Suite 22, in Lodi and at 8120 Timberlake Way, Suite 112, in Sacramento, his practices accept most insurance plans and appointments can be scheduled by calling 209-334-8535.

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Rajan Hundal, MD – Cardiology

Dr. Rajan Hundal, MD is board certified in cardiology and internal medicine. He received his medical degree from University of Nevada School of Medicine, and completed his residency and fellowship at California Pacific Rajan Hundal, MD Medical Center in San Francisco.

Dr. Hundal is a passionate physician who feels it is a privilege to be an integral part of his patients’ lives as they journey toward better health. “I love being able to go out of my way for my patients and make them feel cared for,” he said. Dr. Hundal chose to practice at Adventist Health Lodi Memorial because the organization embraces similar beliefs that faith and kindness are integral parts of the healing process.

In his free time, Dr. Hundal enjoys reading, gardening, sports and spending time with his loved ones, including his dog Manny.

Dr. Hundal practices at Fairmont Specialty Care, 845 S. Fairmont Ave., Suite 8, in Lodi. For an appointment, please call 339-7682.

Ruby Srao Gill, MD – Family Medicine

Dr. Srao Gill is Board Certified in Family Medicine and practices at Millsbridge Family Care. She completed her undergraduate degree at California State University, Hayward and her medical degree at Ross University School Ruby Srao Gill, MD of Medicine. From a very young age, Dr. Srao Gill wanted to be a doctor. Her mother, who is a nurse, heavily inf luenced her to pursue a career in

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In The News

IN THE

NEWS medicine, primarily because of the positive impact one can have on people every day. Dr. Srao Gill aims to form true partnerships with her patients to optimize their health and wellbeing. She enjoys working with patients to find nonnarcotic solutions for pain management.

J. Kevin Johnson, MD – Internal medicine

Dr. Johnson is an internal medicine physician practicing at Trinity Family & Specialty Care in Stockton. He is board certified in internal medicine. Dr. Johnson completed his undergraduate work at the University of J. Kevin Johnson, MD Colorado at Boulder and his medical degree at University of Colorado Health Sciences. He decided to pursue a career in medicine because of his desire to help others and interest in health science. He enjoys connecting with his patients and the opportunity to continue learning within the medical field.

Mohammad A. Kazmi, MD- Neurology

Dr. Kazmi is a neurologist practicing at Tokay Specialty Care. He joined Lodi Health from Lake Havasu, Arizona, where he practiced neurology for 27 years. He has held numerous leadership positions throughout his career, including Chief of Neurology at Tracy Community

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Providing staff, physicians, and patients with relevant & up to date information

Hospital. His areas of expertise include Neurosonology, hospice, palliative care, Alzheimer’s disease and Parkinson’s disease. Dr. Kazmi is well-known for his bedside manner. He has been called “a true caregiver and healer” and receives praise from his patients, students Mohammad A. Kazmi, MD and fellow physicians.

He completed his undergraduate studies at Dow Medical College and then completed a neurology internship and residency at St. Louis University Hospital.

Evaluation shows San Joaquin County Public Health Services Breastfeeding Initiative successfully supports breastfeeding-friendly environments The San Joaquin County Public Health Services Breastfeeding Initiative, funded by First 5 San Joaquin, launched in 2008 with a focus on systems change within the county’s health centers and maternity hospitals to create environments that support and encourage breastfeeding. A recent evaluation of the Breastfeeding Initiative from 2008 to 2016 shows how the Initiative supports these hospitals and health centers in implementing breastfeeding policies and increasing breastfeeding rates.

A key component of the Initiative is the technical

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assistance it provides to hospitals in their efforts to implement the California Department of Public Health’s (CDPH) Model Hospital Breastfeeding Policies and the Baby-Friendly Initiative’s Ten Steps to Successful Breastfeeding. These policies include providing breastfeeding education and support to mothers, limiting unnecessary formula supplementation, and training all health care staff. Upon proving that the facility meets all standards of the Baby-Friendly Ten Steps, a hospital earns the designation of Baby-Friendly. When the Breastfeeding Initiative began, there were no Baby-Friendly designated hospitals in the County. Now there are three, accounting for 67% of births here.

The evaluation of the Initiative indicates that implementation of Baby-Friendly and CDPH breastfeeding policies, as well as opportunities for provider and staff collaboration and training, have contributed to a rise in breastfeeding rates. The in-hospital exclusive breastfeeding rates for all hospitals in the county increased from 43% in 2010 to 61% in 2015. All of this helps to ensure healthier babies and healthier communities.

New Senior Vice President Named for Kaiser Permanente in Central Valley Area Corwin Harper, a health-care leader with more than 30 years of experience in healthcare operations and multiple senior leadership roles, has been named Senior Vice President and Area Manager for Kaiser Permanente’s Central Valley Area.

Harper will be responsible for the medical centers in Modesto and Manteca, as well as health plan services, hospital operations, and services provided to members outside of the hospital setting including continuing care, pharmacy, and health plan regulatory services. In addition, he will have leadership responsibility for Kaiser Permanente’s partnership with St. Joseph’s Medical Center in Stockton.

Harper previously served as Senior Vice President, Chief Diversity and Inclusion Officer for Kaiser Permanente Northern California the past year. Prior to that, he was Senior Vice President and Area Manager for Kaiser Permanente’s Napa Solano Service Area.

He comes to the Central Valley during a time of robust growth in an area that serves more than 330,000 members

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in Stanislaus and San Joaquin counties. Harper held the position of Senior Vice President and Area Manager from 2005 to 2014, during which he led the opening of the Modesto Medical Center and focused on quality, strong membership growth, and Kaiser Permanente’s support for the community. He previously held a number of leadership roles at Kaiser Permanente Fresno Medical Center, including Senior Vice President and Area Manager, and Medical Group Administrator.

Harper, who started June 19, succeeds Deborah Friberg, who led the effort to partner with St. Joseph’s Medical Center, the plan hospital for members in Stockton, which is jointly owned by Kaiser Permanente and Dignity Health.

Friberg retires effective July 1.

“I’m excited to serve in the Central Valley Area where our hospitals, health plan and medical group are respected for delivering high-quality patient care,” Harper said. “I look forward to serving our growing membership, working with our dedicated employees and physicians, and getting involved in the community.”

Harper is a Fellow in the American College of Healthcare Executives, has a Master’s degree in Healthcare Administration from Baylor University and received his undergraduate degree from The Citadel, in Charleston, South Carolina.

Mohammad Haghdoost, M.D Mohammad Haghdoost, M.D. joins the Doctors Hospital Manteca General Surgery team as the first general surgeon in the city of Manteca. He completed his medical education at Isfahan University of Medical Sciences in Iran.

Mohammad Haghdoost, M.D He worked through his residency at Stanford University and UC Riverside.

Some of Dr. Haghdoost’s past work experience and training includes work at Saint Barnabas/Rutgers Hospital in New Jersey, Riverside County Regional Medical Center, Stanford University Hospital, and University Hospital

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In The News

IN THE

NEWS Lewisham in London, England, where he has been a part of the General Medical Council of the UK since 2000. He has also worked as an acute care and emergency room physician in numerous areas in Iran before pursuing his dream of coming to the United States, or as he calls it, “the Land of Freedom.” Dr. Haghdoost is now accepting new patients.

The American Cancer Society’s Annual ‘Making Strides Against Breast Cancer’ Walk Scheduled for October 8 in Stockton On Saturday, October 7, 2017 The American Cancer Society is hosting its Sixth annual Making Strides Against Breast Cancer at Nelson Park. The event is a 5k walk that honors survivors, provides information and raises funds for the Society’s breast cancer services as well as research toward preventing, curing and treating breast cancer.

These services include “Look Good, Feel Better,” which provides those undergoing treatment with free wigs and makeup tips and “Reach to Recover,” where newly diagnosed breast cancer patients are paired with survivors to help them through their journey. Additionally, the Society funds groundbreaking research, which has led to advances such as Herceptin, Tamoxifen and the use of mammography as the standard in breast cancer detection.

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Available Space to Lease for Medical Office: For Medical office in Weber Ranch Professional park, 1801 East March Lane, Stockton, CA; call today at (209) 951-8830 or (209) 951-8395; 1367 sq. ft. fully finished ready to move in with 4 exam rooms, Doctor's Chamber with separate bath room. Manager's room, work station for MAs, Patient's bath room, storage room, and Reception (waiting room).

Those interested can form teams or walk as individuals.

Since there is no registration fee, participants are encouraged to fundraise. For more information please visit http://MakingStridesWalk.Org/Stockton, e-mail: StocktonCAStrides@cancer.org or contact Kellie Ryan at 209.941.2677.

College and then completed a neurology internship and residency at St. Louis University Hospital.

Ramana Adapa, MD, MPH photo Ramana Adapa, MD, MPH, joins Dameron Hospital as dedicated Occupational Medicine Specialist Ramana Adapa, MD, MPH, has joined Dameron Hospital as Ramana Adapa, MD, MPH its new Occupational Medicine Specialist. Dr. Adapa is a member of the American College of Occupational and Environmental Medicine (ACOEM), and is one of the only physicians in the area with board-certification in Occupational Medicine. He is also a Medical Review Officer (MRO) certified by the Medical Review Officer Certification Council (MROCC), and a State of California-appointed Qualified Medical Evaluator. After completing his Masters in Public Health at the University of Pittsburgh, Dr. Adapa did an Internship in Preliminary Surgery at St. Vincent’s hospital in Manhattan,

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and then went on to complete his residency in Occupational Medicine at the University of Pittsburgh.

He has been practicing Occupational Medicine for over 25 years, and focuses his practice at Dameron Hospital in the areas of work-related musculoskeletal injuries, workplace exposures to chemicals and toxins, DOT, pre-employment, physicals and MRO services.

Health Plan of San Joaquin Strategic Plan – Road Map to the Future Thanks to thoughtful consideration and mission-driven dedication by their commissioners (including provider members), staff, community, member representatives and provider stakeholders - together with a practical scan of the health care environment - Health Plan of San Joaquin has created a three-year Strategic Plan flowing from our five essential anchors: Empowered and engaged membership Robust and accountable provider networks Stability, growth and innovation Recognized community leader Skilled and committed workforce As HPSJ moves forward, in pursuit of their mission, the new HPSJ Strategic Plan provides the governing board – with the participation of physician commissioners, staff and community partners with a common focus and perspective.

Front of mind and unchanging: Health Plan of San Joaquin’s commitment to nearly 350,000 members.

Health Plan of San Joaquin’s Palliative Care Options Expands – HPSJ Early Start to Likely 2018 California State Mandate In September 2016, funded in part by a California Health Care Foundation grant, Health Plan of San Joaquin and their partner, San Joaquin General Hospital, opened a palliative care program within a SJGH clinic. That program now provides patient- and family-centered care for HPSJ patients with endstage liver disease, advanced cancer, end-stage congestive heart failure or end-stage chronic pulmonary disease. With support from HPSJ’s Medical Management team, SJGH offers patients and their families four options: home visits from certified nurses, hospital outpatient clinic visits, a telephone care program with a certified social worker or any combination

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of these.

Building on this success, and with an additional CHCF grant for staff education, outreach, program development, oversight and evaluation, in July of this year, HPSJ launched a pilot project for outpatient palliative care. Offering in-home consultation and 24/7 telephonic support through SJGH and two of our palliative care agency partners, this pilot expands local care expertise and capacity for this important branch of medicine. HPSJ’s agency partners are Transitions Palliative Care, a service of Hospice of San Joaquin (San Joaquin County) and Community Care Choices - Palliative Care Program of Community Hospice (Stanislaus County).

HPSJ, which is funding the cost of this pilot project for clinical services, elected to offer outpatient palliative care services for HPSJ members as a head start to state-mandated palliative care. Such care will be a new Medi-Cal member benefit starting in early 2018.

Palliative Care refers to patient- and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional and social, as well as spiritual, needs. Such care can be provided concurrently with curative care.

Hospice Care supports a delivery system geared to patients with limited life expectancy who are in the terminal state of an illness. While assisting patients, and family members, with a limited life expectancy, this care helps patients and family members cope as death nears.

Opioid Marathon – Health Plan of San Joaquin Joins with Local Partners to Get Ahead of this 21st Century Epidemic Opioid overdoses continue to increase at alarming rates, resulting in more visits to emergency rooms, increased hospitalizations and deaths.

Thanks to support from California Health Care Foundation (CHCF) grants, HPSJ and their local partners – San Joaquin General Hospital, Community Medical Centers (CMC) and San Joaquin County Behavioral Health Services – are deep into an 18-month pilot project to assess gaps in local care and training.

At the same time – as they continue to care for HPSJ members, including rigorous reviews of prescription patterns for each member – HPSJ and partners are

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CALIFORNIA MEDICAL ASSOCIATION

AB 72

WHAT PHYSICIANS NEED TO KNOW

AB 72 HAS TAKEN EFFECT On July 1, 2017, a new law (AB 72) took effect and has changed the billing practices of non-contracted physicians providing nonemergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law, signed in 2016, was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor.

CMA is aware of the potential adverse impacts of the new law on our physician members and has dedicated significant resources in order to achieve the best possible outcomes for physicians in light of the new billing restrictions.

AB 72 RESOURCES • Webinar (9/27/17): How to Challenge the Interim Payment for Out-Of-Network Services at In-Network Facilities • CMA FAQ: “A Physician’s Guide to AB 72: Questions and Answers” • Instructions and Sample Form for Obtaining Patient Consent Under California’s New Law on Billing and Payment for Out-of-Network Services at In-Network Facilities

• Sample letter to appeal to the payor for additional reimbursement • Billing Requirements Under California’s New Law on Billing and Payment for Out-of-Network Services at In-Network Facilities • Webinar (recorded on 5/17/17): Assembly Bill 72: What Physicians Need to Know About the New Law on Payment and Billing for Out-Of-Network Services • CMA On-Call Document #7508: “Non-Contracting Physicians”

JOIN NOW!

These materials are exclusively designed for members of CMA and component medical societies.

Call the CMA Member Resources line during normal business hours to join and have immediate access to this toolkit: (800) 786-4262. Ask about our new monthly payment plan for membership.

Access to CMA’s reimbursement experts is a FREE, members-only benefit.

Need help? Call (800) 786-4262 or email economicservices@cmanet.org.

58 SAN JOAQUIN PHYSICIAN FALL 2017

In The News

connecting with other equally concerned local providers and institutions to establish a vigorous, regional approach that can be a model to strengthen the entire provider network.

HPSJ leadership says that at the end of the day, they will know the coalition has succeeded when comprehensive options are commonly offered for two sets of patients: (1) those who are susceptible and become addicted; and (2) those who are overly dependent on opioids, but unaware of far safer, more effective ways to control their pain or chronic condition.

NEW Service from Health Plan of San Joaquin – HPSJ Health Articles Library A growing repository of timely health articles created

by HPSJ is available on their website, https://www.hpsj. com/health-articles/. At least one new article is added monthly. Health care providers are invited to draw from this library and provide to patients, or include these in practice eNewsletters and other practice social media. There is no charge for the articles which, so far, range from “Women’s Health – Stay informed and be in Control!” and “Men’s Health Month - Exams and Screenings” to “How to Stop Tooth Decay in Your Baby.” To receive regular updates on new HPSJ Health Library Articles, subscribe to the monthly CommuniteNews from HPSJ, at http://hpsj.us13.listmanage2.com/subscribe.

St. Joseph’s Now Offers 3D Mammography St. Joseph’s Women’s Imaging Center now offers 3D Mammography, also known as tomosynthesis.

Tomosynthesis is a three-dimensional imaging technology that provides a clearer, more accurate view when compared to 2D mammography alone. Conventional 2D mammography produces one image of overlapping tissue.

Tomosynthesis performed with digital mammography, takes multiple images of the entire breast, allowing radiologists to see through layers of tissue and examine areas of concern from all angles.

Digital breast tomosynthesis benefits include earlier detection of small breast cancers, a greater likelihood of detecting multiple breast tumors, which occur in 15% of breast cancer patients, improved imaging of dense breast

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tissue, and decreased call backs for additional imaging and biopsies, all with no increase in radiation exposure over 2D. St. Joseph’s Women’s Imaging Center, located at 3439 Brookside Road in Stockton, is part of St. Joseph’s Breast Center of Excellence, which is accredited by the National Accreditation Program for Breast Centers.

St. Joseph’s Recognized by the American Heart Association for Commitment to Quality Stroke and Heart Attack Care St. Joseph’s Medical Center has recently been recognized by the American Heart Association for outstanding stroke and heart attack care, receiving the Get With The Guidelines®Stroke Silver Quality Achievement Award and the Mission: Lifeline® Silver Receiving Quality Achievement Award.

“St. Joseph’s is proud to have a long legacy of excellence in the acute treatment of both stroke and heart attack patients,” said Don Wiley, Hospital President and CEO. “This recognition from the American Heart Association/ American Stroke Association is a direct ref lection of our team’s hard work and dedication to providing the best care possible to our patients.”

St. Joseph’s earned the Get With The Guidelines®- Silver Quality Achievement Award, by meeting specific quality achievement measures designed to help hospital teams follow the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. This award recognizes St. Joseph’s commitment and success ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines.

St. Joseph’s has also received the Mission: Lifeline® Silver Receiving Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks.

More than 250,000 people per year experience an ST elevation myocardial infarction (STEMI), the most deadly type of heart attack, which requires timely treatment.

St. Joseph’s has met specific criteria and standards of performance for the quick and appropriate treatment of STEMI patients by providing emergency procedures to reestablish blood f low to blocked arteries when needed.

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In The News

IN THE

NEWS

Providing staff, physicians, and patients with relevant & up to date information

Shriners Hospitals for Children

St. Joseph’s Behavioral Health Center to Host Behavioral Health Care Symposium Physicians involved in private practice, emergency medicine, and psychiatric care and those wishing to expand their knowledge of behavioral health are invited to attend St. Joseph’s Behavioral Health Center’s first annual Behavioral Health Care Symposium. This one-day symposium will focus on psychiatric crisis care. Participants will gain insight from expert speakers about contemporary approaches to caring for patients experiencing a psychiatric crisis, the value of tele-psychiatry, the importance of medication stabilization and current treatment options for crisis intervention.

The symposium will be held on Saturday, September 23, from 8:00 a.m. – 1:30 p.m. at the Stockton Golf and Country Club. The cost is $49 per person and includes lunch. For more information and to register, please call 209.467.6331.

St. Joseph’s Honors Physicians with Humankindness Each quarter, St. Joseph’s Medical Center recognizes physicians in the community that go beyond clinical excellence to deliver healing with compassion and kindness, also known as humankindness.

Most recently, St. Joseph’s honored Dr. Shiraz Buhari, MD, Family Practice, Dr. Anh Le, MD, Orthopedics, Dr. Manuel Orellana, MD, Internal Medicine, and Dr. Vincent Pennisi, MD, OB/GYN, who were recognized by their patients and peers for listening, explaining, and displaying genuine kindness to their patients.

St. Joseph’s invites you to nominate physicians practicing humankindness at St. Joseph’s or in the community to receive recognition. Call 209.467.6486 or email Catherine.

Swenson@dignityhealth.org for more information.

Photo

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combination of clinical data and reputation with pediatric Shriners Hospitals for Children – Northern specialists. Eighty-three hospitals ranked in at least one California Ranked as Leader in Pediatric specialty, based on a combination of clinical data and Orthopaedics by U.S. News & World Report reputation with pediatric specialists. Shriners Hospitals for In the most recent U.S. News and World Report best Children - Northern California is recognized in both of its hospital survey, Shriners Hospitals for Children - Northern programs that are eligible for U.S. News and World Report California ranks nationally as one of the top 20 pediatric ranking. hospitals.

The Northern California Shriners Hospital is ranked 18th in pediatric orthopaedics in the U.S. News & World Report’s 2017-2018 rankings of children’s hospitals in the United States. It also shares a ranking of 26th in pediatric urology together with the UC Davis Children’s Hospital.

Lawyers Who Solve the Legal Issues “We are proud to be in the Confronting Physicians elite group of the nation’s top 20 Malm Fagundes LLP offers the strength and resources of pediatric hospitals for orthopaedic attorneys and professional staff experienced in a range care. Clearly, it is a ref lection of our of services. Our attorneys provide advice and counsel in medical malpractice litigation, business, real estate, and medical expertise and quality of care personal needs of physician clients. we provide children. The ranking also Joe Fagundes provides experienced, successful speaks to the growth in the volume representation of physicians and other health care providers in defending malpractice suits, and complexity of our programs,” protecting hospital privileges, and answering said Margaret Bryan, administrator medical board inquiries. He also provides guidance and assistance in real estate and and CEO at Shriners Hospitals for financial matters.

Children ─ Northern California.

Scott Malm advises physicians and their “Regional referrals to our hospital in offices regarding business formation, employment and labor matters, Sacramento are at an all-time high, and personal estate planning. and our talented team of surgical specialists grows to meet that need.”

Among the thousands of children treated by the orthopaedic team are children with scoliosis, limb deficiencies, sports injuries, hand, wrist, elbow, and shoulder malformations, brachial plexus birth palsy, spinal cord injury, spina bifida, and cerebral palsy. The hospital also is engaged in clinical trials We welcome the opportunity to and scientific research to advance speak with you regarding your legal needs during a confidential orthopaedic care. consultation. Visit our website at The Best Children’s Hospitals malmfagundes.com and call us at 209-870-7900. rankings highlight U.S. News’s top 50 U.S. pediatric facilities in 10 malmfagundes.com specialties. Rankings are based on a

Representing and Advising Area Physicians for Over 30 Years

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practice manager Free to SJMS/CMA Members!

resources

The Office Manager’s Forum empowers physicians and their medical staff with valuable tools via expert led educational sessions from industry professionals who are committed to delivering quality health care.

For more than 130 years, the San Joaquin Medical Society (SJMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. SJMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice.

Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support.

The Office Manager’s Forum is held on the second Wednesday of each month from 11:00AM – 1:00PM at Papapavlo’s in Stockton and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($35.00 thereafter). Registration required.

For more information or to be added to the mailing list email Jessica Peluso, SJMS Membership Coordinator, at Jessica@SJCMS.org or call (209) 952-5299.

SEPTEMBER 13TH, 2017:

OCTOBER 11TH 2017:

11:00AM to 1:00PM

11:00AM to 1:30PM

“PRACTICE MANAGEMENT 101”

Join us and learn from the expert! CMA’s Physician Advocate Mitzi Young will help you identify opportunities for increased revenue and teach you best practices for implementing effective policies, procedures and processes into your medical office.

Topics Covered: • Three Strategies for Better Financial Outcomes • Common Practice Mistakes Costing You Money • Managing Patient Scheduling • Improving Patient Experience • Monthly Reports Every Practice Should Review • Effectively Processing Denied Claims • Marketing Your Practice for Success • Questions Every Office Should Ask Yearly ~Mark Lane, Associate Director in the CMA’s Center for Economic Services, began his career as a claims processor for plans such as Blue Shield and Health Net. Over the next 18 years, his experiences in claim operations, customer service, provider relations and contracting have allowed him to get a unique vantage point on the relationship between physicians and payors. Having experienced the physician-payor relationship from both ends, Mark is able to understand the needs and positions of the respective sides, making him an ideal candidate to educate providers on overcoming the ever-changing challenges of the healthcare landscape.

“CPR ON THE ROAD”

A 60 minute presentation of recent topics from the pages of CMA’s CPR (CES Practice Resources) newsletter which have an impact of physicians and their practices. The presenter provides the CMA Center for Economic Services’ account of various topics in healthcare highlighting concerns, challenges and advocacy efforts to address these issues. ~ Mitzi Young is the Physician Advocate, for the CMA, RCMA and SBCMS. Mitzi brings 25 years of experience and expertise in the health care industry.

Mitzi started her career working for a third party administrator as a claim and eligibility processor for San Bernardino county hospital’s medically indigent adult program. She went on to further her education and worked as operations and business manager for a specialty practices and for an ambulatory surgery center. Overseeing all personnel and business operations. She brings with her a vast knowledge of medical billing and collections, contracting, accreditation, and personnel and business management. She understands the needs of physicians and their staff, the challenges that face medical practices, and is very passionate about advocating on behalf of providers on succeeding in the ever-changing challenges of the healthcare landscape.

NOVEMBER 8TH 2017: “TBD”

11:00AM to 1:00PM

DECEMBER 13TH 2017:

ARE YOU READING CPR? CPR contains the latest in Practice Management Resources, Updates and Information.

SUBSCRIBE NOW

Sign up now for a free subscription to our e-mail bulletin, at www.cmanet.org/news/cpr

“MEDICARE UPDATES 2017”

11:00AM to 1:00PM

Join us for our annual Medicare Update workshop for physicians and office staff. This 2 hour seminar will cover relevant information about current, future and proposed changes for the coming year!

Cheryl Bradley~ Associate Director, CMA Center for Economic Services

Public Health

Update

Prevent Smoking Triangulum, Prevent Chronic Diseases Ashley M Lewis, MPH, and Alvaro Garza, MD, MPH Since the inception of the California tobacco control program in 1989, smoking rates continue to decline. California has the second lowest adult smoking rate in the U.S. With the recent passage of laws increasing the legal age to 21 years to buy tobacco products and the tax on these products, we continue our progress in controlling the tobacco use epidemic by reducing access to tobacco products and their paraphernalia by youth and young adults. Now, the legalization of marijuana for recreational use may be another threat to reducing tobacco use.

While cigarette smoking rates and the use of electronic smoking devices (ESDs) among teens and young adults are declining, marijuana use among them continues to rise. In 2016, 14% of California high school students reported using marijuana at least one day in the past month, and only 4% reported using cigarettes. Often described as a gateway drug for illegal substance use, marijuana is proving to be the same for use of tobacco and ESDs; 65% of California high school students

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reported having tried marijuana first, as opposed to cigarettes and other tobacco products.

Further, studies have shown that teenage marijuana smokers are more likely to initiate tobacco use later in life, and are often dual users of tobacco and marijuana. Upstream primary prevention of marijuana and tobacco dependency, early during the youth growth and development years, will have high impact in reducing the related adverse health outcomes and the accompanying health care costs decades later.

Moreover, with multiple methods available for marijuana consumption, ESDs are becoming a preferred method of choice because of the capability of devices to deliver higher concentrations of tetrahydrocannabinol. This, in turn, is creating a triangular relationship (triangulum) between tobacco, ESDs, and marijuana use.

Tobacco continues to be a leading cause of preventable death in the U.S., and we must address the triangulum to

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prevent marijuana users from also becoming victims to the tobacco statistics. Addressing the triangulum and its health consequences also provides an opportunity to reduce health care costs for smoking related diseases as well as to improve patient and community outcomes, especially in underresourced communities with high-risk populations such as Latinos, African Americans, and others of low socioeconomic status.

Although cigarette smoking rates are declining among teens in general, African Americans and Latinos have higher rates of smoking compared to their white counterparts. This, in large part, is due to the heavily targeted marketing of tobacco products in neighborhoods of low socioeconomic status and communities of color. In turn, this perpetuates the triangulum because it continues to normalize tobacco and related products, including ESDs, which are also used to consume marijuana. Marijuana is following this trend with a larger increase in its use among African Americans and Latinos. With its recent legalization in other states, marijuana retailers are more likely to open retail marijuana shops disproportionately in neighborhoods of color, easing access to these products. This is detrimental because, like tobacco, it will normalize the use of marijuana among populations that are already inequitably affected by diseases related to tobacco.

Teens and young adults are often aware of the health implications of tobacco use; however, their perceived risk towards marijuana is declining. Nationally, in 2015, 32% of high school seniors believed that marijuana smoking was harmful, down from 52% in 2009. This is disadvantageous to the health of marijuana users, especially African Americans and Latinos, because with increased use among this population, there has also been a direct increase in cannabis use disorders. Cannabis Use disorder affects an individual’s ability to carry out basic functions relating to work and school, and can lead to mental health disorders, such as psychoses and anxiety. Because of this, we can now expect the health consequences related to tobacco and secondhand smoke to be compounded by the social,

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behavioral, and mental health consequences related to marijuana use. Therefore, public policies and health care standards should address the harms of marijuana products, as well as tobacco and marijuana dependency.

Health care practitioners can play a vital role in addressing the triangulum and the perceived risks and health implications, by supporting policies that regulate access to tobacco and marijuana products, and also by incorporating screening for smoking into standard clinical care screenings. The “Treating Tobacco Use and Dependence – Clinical Practice Guideline” document, issued by the U.S. Department of Health and Human Services, recommends that physicians use the “5A’s” approach (figure) to screen and help treat smoking dependency.

This evidence-based approach requires physicians to 1) Ask about smoking; 2) Advise all users to quit; 3) Assess willingness to make a quit attempt; 4) Assist the patient to quit; and 5) Arrange follow-up contact with the patient. Incorporating this approach into routine care screening does not require physicians to become cessation experts, but efficiently addresses tobacco use as an important health concern, while simultaneously connecting patients to helpful and effective cessation resources.

This approach also allows physicians to open the conversation to address and reduce the use, dangers, and health consequences of the tobacco, marijuana, and ESDs triangulum.

California continues to be a leader in tobacco control. With the triangulum phenomenon, health care practitioners have an important opportunity to advocate for effective evidence-based and equitable prevention policies and for early screening in clinical care settings in all our communities.

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New Members

5 NEW

SJMS MEMBERS THIS FALL!

...and even more on the way.

Shahin Foroutan, M.D.

Hiral Desai, M.D.

Lauren Lomax, M.D.

Traumatic Surgery

Internal Medicine

Dermatology

500 W Hospital Road French Camp, CA 95231 (209) 468-6000 University of Vermont College of Medicine

7373 West Lane Stockton, CA 95210 (209) 735-4176 Deccan Pacific Medical School

2545 W Hammer Lane Stockton, CA 95209 (209) 957-3821 Morehouse School of Medicine

Philip Cheng, M.D. Neonatal-Perinatal Medicine (209) 467-6428

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Hesham Kamel, M.D. Pediatrics 2505 W Hammer Lane Stockton, CA 95209 (209) 957-3821 Alexandria Medical School

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San Joaquin Medical Society 3031 W. March Lane, Suite 222W Stockton, California 95219-6568

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