S a n M at e o C o u n t y
January 2016
IN S ID E
S A N M AT E O C O U N T Y M E D I C A L A S S O C I AT I O N
Volume 5 Issue 1
Physician innovation & technology
Next-generation orthopedics: biologics
The best place on Earth
Online review sites
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S a n M at e o C o u n t y
Physician Editorial Committee Russ Granich, MD, Chair Judy Chang, MD Uli Chettipally, MD Sharon Clark, MD Edward Morhauser, MD Gurpreet Padam, MD Sue U. Malone, Executive Director Shannon Goecke, Managing Editor
January 2016 - Volume 5, Issue 1 Columns President’s Message: Innovation and technology..................................... 5 Michael Norris, MD
SMCMA Leadership
Executive Report: Help keep SMCMA leadership strong........................... 7
Michael Norris, MD, President; Russ Granich, MD, President-Elect; Alexander Ding, MD, SecretaryTreasurer; Vincent Mason, MD, Immediate Past President
Sue U. Malone
Alex Lakowsky, MD; Richard Moore, MD; Michael O’Holleran, MD; Joshua Parker, MD; Suzanne Pertsch, MD; Xiushui (Mike) Ren, MD; Sara Whitehead, MD; Douglas Zuckermann, MD; Dirk Baumann, MD, AMA Alternate Delegate; Scott A. Morrow, MD, Health Officer, County of San Mateo;
Editorial/Advertising Inquiries San Mateo County Physician is published ten times per year by the San Mateo County Medical Association. Opinions expressed by authors are their own and not necessarily those of the SMCMA. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted. Acceptance and publication of advertising does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised. For more information, contact the managing editor at (650) 312-1663 or sgoecke@smcma.org. Visit our website at smcma.org, like us at facebook.com/smcma, and follow us at twitter.com/SMCMedAssoc.
Feature Articles Next-generation orthopedics: biologics . . ................................................ 8 Carri Allen Jones, MD
The best place on Earth.......................................................................... 10 Uli Chettipally, MD, MPH
Online review sites: How to survive, thrive and manage your reputation....................................................................................... 13 Ashley Porciuncula
Of Interest SMCMA welcomes new members..........................................................12 Membership updates, index of advertisers..........................................14
© 2016 San Mateo County Medical Association
On the cover: “Light Lines” by Nathan Harper, 2008. https://www.flickr.com/photos/bottleleaf/2684002442. Used with permission under Flickr.com Creative Commons License.
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President’s Message
Innovation and technology Asking me to address innovation and technology in modern medicine is beyond my pay grade. As many who know me well will attest, I am probably the only member of SMCMA who still owns a flip-phone. To say I’m a Luddite is an understatement. Nevertheless, I have been impressed with recent innovative approaches to difficult problems, where traditional therapies were “good enough,” but now can be made better.
Michael Norris, MD President
Pharmacological advances in the treatment of many cancers can now be guided by genetic analysis of the specific tumor. Melanoma is one lethal malignancy that is responding in many patients with advanced disease. Chemotherapy for breast and lung cancer has changed dramatically over the past several years. Following the lead of favorable outcomes seen in rapid diagnosis and intervention in STEMI cardiac patients, the same approach is being applied to stroke patients. The Telestroke program has allowed evaluation of patients in an ER by a stroke specialist, with guidance regarding management. Early diagnosis, imaging studies, and intervention, either via fibrinolysis or catheter thrombectomy, have shown improved outcomes in patients treated in the early hours post onset of symptoms. Recent studies in Europe have demonstrated that catheter thrombectomy may be superior to fibrinolytic therapy alone in selected patients. These modalities simply did not exist a few short years ago.
The passing of the torch...
Patients with significant Aortic Stenosis may be too frail to undergo open aortic valve replacement. Now, we have the TAVR technique, transcather aortic valve replacement. The early results have been quite dramatic, in patients in their late 70s and 80s. I recently saw a woman of 90 who had the procedure done with an overnight stay and minimal down-time. Cooperation between clinicians and the biomedical engineers have advanced the development of this technology. We are now entering the era of tissue engineering and regenerative medicine. Stem cells are being investigated in the the fabrication of new tissues lost or damaged through disease or injury. New bone, cartilage, even organs are on our horizon. Advanced 3-D imaging is used in the manufacture of custom replacement “parts” in orthopedics and other fields. Facial transplantation, a science fiction theme until recently, has been advanced via the use of templates of the missing tissues, including maxillary and cranial bone, so the donor tissues may be matched to the recipient defects.
We are now entering the era of tissue engineering and regenerative medicine. Stem cells are being investigated in the fabrication of new tissues lost or damaged through disease or injury. New bone, cartilage, even organs are on our horizon.
Living and practicing in the cradle of nanotechnology and biotech gives us an excellent perspective on the constant evolution of new modalities. Give me time, and I may yet get a smart phone and join you all in the 21st century. ■ JANUARY 2016 | SAN MATEO COUNTY PHYSICIAN 5
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6 SAN MATEO COUNTY PHYSICIAN | JANUARY 2016
Executive Report
Sue U. Malone Executive Director
Help keep SMCMA leadership strong The San Mateo County Medical Association offers its members several opportunities to get involved in association governance. This is a great opportunity to develop leadership skills and have a voice in the issues that affect the practice of medicine in San Mateo County. The SMCMA Nominating Committee will soon be meeting to develop recommendations to the Executive Commitee and Board of Directors to fill positions on the Board and the SMCMA Delegation to the CMA House of Delegates. The SMCMA Board meets monthly, with the exception of June and August, on the second Tuesday of each month. Meetings commence at 6:30 p.m., last approximately two hours, and include dinner. Board terms are for two years, renewable for a maximum of two terms. There are also opportunities to serve on the SMCMA Delegation to the CMA House of Delegates, CMA’s legislative body that establishes the policies that govern the association and elects CMA’s president. The House meets during the CMA annual meeting each October, alternating year-to-year between Sacramento and Anaheim; the 2016 meeting will take place October 14-16 in Sacramento. Throughout the year, virtual meetings are held to discuss resolutions proposed for House consideration, and to consider opinions on each resolution offered by CMA Reference Committees. San Mateo County is part of District VII, which also includes Santa Clara, Monterey, Santa Cruz, and San Benito Counties.
Getting involved in SMCMA governance is a great way to develop leadership skils and have a voice on the issues that affect the practice of medicine in San Mateo County.
Current SMCMA members are invited to apply for either or both of these opportunities. Members can self-nominate or suggest other members who are interested in serving. Please apply by Friday, February 19, 2016, by emailing SMCMA Executive Director Sue U. Malone at smalone@smcma.org. ■
JANUARY 2016 | SAN MATEO COUNTY PHYSICIAN 7
NEXT-GENERATION ORTHOPEDICS: BIOLOGICS Unlocking living architecture potential and engineering fitness
Digital health innovations have made it possible for us to use portable devices to access medical information, monitor vital signs, take tests at home and carry out a wide range of tasks. A recent article in the New England Journal of Medicine cited physician concern that these innovations can come at the expense of the human connection at the core of the patient physician relationship of trust, given the vanishing need of a stethoscope. The diagnostic utility of the stethoscope is obvious, but some will ask, will the loss of the symbolic and ritual connection change the perception of trust? by Carri Allen Jones, MD In a parallel fashion, could orthopedic procedures such as arthroplasty become obsolete, or the arthroscope, a historic instrument found in the Smithsonian? Many in sports medicine agree the advancement in arthroscopy over the last few decades has been one of the greatest innovations in orthopedics. More recently stem cell applications, tissue engineering, and 3-D bioprinting have emerged as the next generation of orthopedics. The potential benefit of orthobiologics and stem cells in sports medicine gained public interest in 2009 with the news story on Pittsburgh Steeler player Hines Ward’s ability to return and play in the Super Bowl after sustaining a MCL tear two weeks prior. His treatment with PRP (platelet rich plasma) heralded an expedited recovery. Subsequently, a parallel rise in public and practitioner interest and usage occurred. Stem cell therapy is gaining momentum as a clinical option in orthopedics. However, high level research on the technology’s efficacy has not been completed and long-term safety unknown. The general scarcity of information from large randomized controlled trials emphasizes the need for rigor when considering stem cells for treatment in orthopedic conditions. Bioethics and regulatory concerns remain, as clinical usage of stem cell therapy is outpacing the evidence. The Center for Biologic Evaluation and Research, a division of the FDA, released preliminary guidelines for regulation in 2014. Most likely a heightened wave 8 SAN MATEO COUNTY PHYSICIAN | JANUARY 2016
of regulation will occur within the next few years, yielding a capitulation of clinic closures due to non-compliance, poor quality assurance, and unsubstantiated claims. The corollary, improved concentrated rigor in orthopedic regenerative medicine should emerge to further advance tissue engineering, 3-D bioprinting, and gene therapy.
Basic science of treatment Stem cells may be derived from allogeneic and autologous sources. Allogeneic mesenchymal cells (MSCs), for example, can be derived from the placenta, umbilical cord, or umbilical cord blood. Autologous stem cells include endothelial progenitor cells sourced from bone marrow or peripheral blood, hematopoietic stem cells, adipose-derived stem cells, and the most commonly used type, MSCs, derived from bone marrow. Both the ideal type and number of stem cells needed to treat specific clinical conditions is unknown. Bone marrow-derived MSCs are the most reported stem cell type used in the literature. It is estimated more than 100,000 U.S. adults receive cellular therapy each year in which clinicians use a point of care same-day procedure to harvest bone marrow aspirate, concentrate the aspirate by centrifugation, followed by injection of the cells into the treatment area. The number of stem cells harvested varies depending on the practitioner isolation technique, donor age, donor health status, and medical device used for processing. Also, the cell count number is limited to the retrieval harvesting passages and cannot be expanded in cell culture in the United States.
The ability of stem cells to replicate over long periods, and their extended life span, are the features that generate the most enthusiasm. Once delivered, these multipotent cells can differentiate into bone, cartilage, tendon, ligament, and endothelium. They also release a number of bioactive factors stimulating tissue repair and wound healing, along with other paracrine signaling behavior for daughter cells and possible homing. Cellular analysis and characterization of the graft material confirm the pluripotent nature, allow cell sorting and surface marker identification, genomic sequencing, along with the number of nucleated cells prior to implantation. Platelet-rich plasma (PRP) is plasma enriched with a 3-5 fold higher concentration of platelets than baseline whole blood. PRP is considered an orthobiologic and has gained support in orthopedics for its utility in restoring function more quickly, hastening recovery. Platelets and white blood cells are a rich source of bioactive growth factors that can modulate the healing process. When activated they release growth factors that act locally to recruit undifferentiated progenitor cells to the site of activation, trigger mitosis, and initiate tissue regeneration and remodeling. Further classification of PRP has been recommended to influence greater inter- and intra-operative clinic reliability for uniformity of reporting and tracking data. This includes PRP with or without leukocytes, and PRP with or without activation. Also, one step further that may be considered is the number and type of white blood cells given different characteristics of granulocytes, lymphocytes, and monocytes. Growth factor concentration in any PRP preparation is directly proportional to the amount of platelets captured. The greater the growth factor amount, the greater the response and recovery of the target tissue. Many do not realize all PRP is not equal. The amount of platelets collected may vary with speed of venipuncture, processing equipment, centrifugation time, radius distance from center of the centrifuge, soft versus hard spin, anticoagulant, and use or no use of an agonist activator. The mechanism of some of the key growth factors involved in the healing process include upregulating other growth factors as a chemo attractive for stem cells (Platelet Derived Growth Factor, PDGF), stimulating angiogenesis and neovascularization (Vascular Endothelial Growth Factor, VEGF), stimulating migration and adhesion of progenitor cells (Stromal Derived Growth Factor), and promoting cell mitosis and differentiation for connective tissue and bone (Transforming Growth Factor Beta, TGF-B). One of the most important functions of platelets is their role in promoting angiogenesis, as the re-establishment of blood flow through angiogenesis is critical for healing. Recent studies indicate the optimal platelet concentration to stimulate angiogenesis ranged from 1.5 million to 3.0 million platelets per microliter (Giusiti et al, Transfusion, 2009).
Stem cellular biologics injected precisely under live dynamic ultrasonography or fluoroscopy into the area of an incomplete tendon or ligament tear, meniscal tear, subchondral bone marrow lesion, osteoarthritic joint, or lumbar disc annular tear has revealed promising results with diminished pain, improved function, and in some cases, improved living architecture radiologically. The limitations of the studies are the lack of robustness, methodology, study power, and often confounding variables and potential bias.
Augmented reality: Osteoarthritis as a health rift Pain is an enormous global public health problem. One of the leading causes of pain is the escalating prevalence of osteoarthritis that is associated with an extremely high economic burden. This burden is largely attributable to the effects of disability, comorbid disease, and the expense of treatment. The occurrence of OA is increasing due to an aging population and obesity. approximately one-third of direct osteoarthritis (OA) expenditures are for pain medications. Another half of the cost is for hospitalizations for arthroplasty. Emerging technologies can be immersive to solve the burden of this disease. Can augmented reality illustrate the role of new technologies, touring the individual amongst treatment regimens while empowering their decision for engineered fitness and avoidance of pain and disability? Can the reality of the pathogenesis of osteoarthritis be altered through genetic engineering? Can behavioral modeling through gamification challenge extreme detrimental joint activity? Can we incorporate protective wearable alarms? Can we be a molecular anthropologist and unlock the heritable multi generational forces that shaped the individuals epigenomic information?
Function follows form Biodesign and tissue engineering have lead to the potential of 3-D bioprinting in orthopedics. This innovative technology allows the creation of organized 3-D tissue constructs via a “layer by layer� deposition process. This process also allows the combination of cells and biomaterials in an ordered and predetermined way. Current research applications are focused on cartilage bioprinting and regeneration. The capability to re-grow living tissue at the core of the complexity remains a major challenge due to the differences in cell types, matrix components, and organization for hyaline cartilage regeneration. A more recent promising approach is using mesenchymal stem cells or chondroblasts as the cellular matrix in the scaffold structure. Designing the formed scaffolding with the chondrocytes embedded would change their function and morphology based on the extracellular matrix. Influenced by design, with function following the form.
Continued on page 11 JANUARY 2016 | SAN MATEO COUNTY PHYSICIAN 9
the best place on earth
After I completed my residency in Los Angeles, my wife and I were looking for a place to relocate. LA was great but, after living there for five years, we wanted a change of scene. A place with less traffic, better air quality, and cooler weather. That is how we ended up in the San Francisco Bay Area. I took a stable job, we bought a house and started a family, settling in a quiet neighborhood on the Peninsula. by Uli Chettipally, MD, MPH Twenty-five years later, after going through a few boom-andbust cycles, the Bay Area is now bustling with activity. When we moved here, we did not realize how much this area was going to change, with this unexpected growth of the local economy. It became a shining example of a place where dreams can come true. With the internet boom, people from all over the country and the world, started coming in for a piece of the action and startups started popping up everywhere. We all know of neighbors who suddenly became millionaires. Unicorns were being born and bred here! In the late 1990s, I was curious enough to get in on the action and worked for a start-up for a year. It was an exhilarating ride. The fact that someone would give you a half million dollars to build on your idea was thrilling. My excitement was short-lived. The market crashed and my one-year sabbatical came to an end and took with it my dream of becoming an entrepreneur. I was lucky enough to be able to do what I did, at a time in history when doing a start-up was relatively easy. I went to the other side and came back alive. My friends get a kick out of listening to the stories of the dot-com roller coaster ride. Little did I realize how this place and the experiences would change me. When I was growing up, I always wanted to be a scientist. I wanted to invent things and discover cures for bad diseases. These days, I think and talk about feasibility, market fit, valuation and scalability. I have learned a lot just by living in the Bay Area. Having friends, neighbors and co-workers working, growing, and crashing in this economy has taught me a lot about the business of start-ups and the life of an entrepreneur in gen10 SAN MATEO COUNTY PHYSICIAN | JANUARY 2016
eral. I can understand what drives people to take such huge risks and how they feel when they do not succeed. I can also understand the disdain some feel when they are not enjoying the benefits of this start-up economy. I have seen firsthand the pain of physicians who, after completing their training, come to the Bay Area for jobs and are not able to afford to buy a house. With the huge student loan debt on one’s back, even renting a place becomes challenging. These are some of the smartest, most hardworking individuals, who have postponed their gratification for years, in order to have a good life. Becoming a physician is one of the toughest careers one can chose. The years and years of study, the high intensity of focus and the grueling training—only to realize that there is no pot of gold at the end of the rainbow. I have known many who had to leave the Bay Area as it became unaffordable. No wonder more than 50 percent of recent medical graduates in the Bay Area do not go into residency training. The turmoil continues as healthcare is also going through enormous changes. Traditional medical practices cannot survive the onslaught of new technology, new regulation and new business models. We hear more and more about physician burnout, how senior physicians are quitting practice and retiring. How can one cope with this high velocity of change, both outside and inside? There is hope. We as physicians are ingenious at solving problems. We take care of patients with really complex pathology. We navigate a system that will make any normal person shudder with fear. We have found cures, eradicated diseases and brought hope to the suffering patient. There is a lot of innovation happening in healthcare, particularly in the Bay Area. According to Rock Health, $4.5 billion went into digital health investments
The best place on Earth
Next generation orthopedics: Biologics
Continued from page 10
Continued from page 9
in 2015 alone. This is on top of $4.3 Billion that was invested in 2014. Nearly half of the startups are in the Bay Area!
Current challenges
We have access to world-class universities and the cream of the talent pool. Biotechnology was born here. Silicon Valley breeds here. Sand Hill Road passes through here. Menlo Park is in our neighborhood. The greatest innovators the world has seen worked in their garages here. America is looking up to us to solve its problems. Can we become the change agents? Can we advocate, advise and administer the change? Can we become the innovators who will drive this change? We are the smartest and the brightest, and we understand the systems—both healthcare and human. We have the opportunity of a lifetime in front of us, right in our own backyard. We truly are living in the best place on Earth. ■
Although research in stem cell applications in orthopedics and cartilage bioprinting is growing exponentially, there is lack of robust and rigorous in vivo studies that can validate the long term capability of cells and material to regenerate. Osteoarthritis is becoming more recognized as a disease of the subarticular region and as a whole, an organ undergoing failure. Bench to bedside translation of cellular therapies is in its infancy. It represents great hope and a possible paradigm shift in the medical model of arthroplasty to the possibility of upstream measures where painful orthopedic conditions become rare and the socio-ecological forces of burden diminished. ■
About the author Carri Allen Jones, MD, is currently in practice About the author Uli Chettipally, MD, MPH, is an emergency physician, researcher and innovator at Kaiser Permanente Medical Center, South San Francisco. He is also co-founder of the Bay Area Chapter of the Society of Physician Entrepreneurs (SoPE), a nonprofit, global biomedical and healthcare innovation and entrepreneurship network.
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at Remedy Medical Group in Redwood City, and Peninsula Orthopedic Associates in Daly City. She is also Chief Science Officer at X Tech Ventures. Dr. Jones is board certified in physical medicine & rehabilitation, pain medicine, and sports medicine, and fellowship trained in tem Cell Regenerative Medicine & Orthobiologics. She has special interest in design thinking for the intersection of technology, medicine, and the social sciences.
MAY 13-15, 2016
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JANUARY 2016 | SAN MATEO COUNTY PHYSICIAN 11
SMCMA welcomes new members
Joshiah Ambrose, MD *Neurology Redwood City
Clarissa Doi, MD *Internal Medicine Redwood City
Christine Gorey, MD *Obstetrics-Gynecology Daly City
Michael Ho, MD *Cardiovascular Disease Redwood City
Yana Kriseman, MD *Neurology Redwood City
Sheila Chan, MD *Neurology Redwood City
Brian Dummett, MD *Internal Medicine, Hospital Medicine/SSF
Yiyi Gu, MD *Internal Medicine, *Rhumatology/SSF
Daniel Hsu, MD Neurological Surgery Redwood City
Christine Kwan, MD *Internal Medicine, Hospital Medicine Redwood City
James Chen, DO *Allergy San Mateo
Orin Eddy, MD *Emergency Medicine Redwood City
Sandeep Gupta, MD *Sports Medicine Redwood City
Alex Keedy, MD *Diagnostic Radiology SSF
Mindy Kwan *Obstetrics-Gynecology Redwood City
Melissa Chin, MD *Internal Medicine, Hospital Medicine Redwood City
Roberto Felix, MD *Cardiovascular Disease, *Internal Medicine Redwood City
Olga Hewett, MD *Psychiatry Redwood City
Meredith Kelly, MD *Psychiatry San Mateo
Kenny Lai, MD *Diagnostic Radiology Redwood City
12 SAN MATEO COUNTY PHYSICIAN | JANUARY 2016
ONINE REVIEW SITES How to survive, thrive, and manage your reputation by Ashley Porciuncula In the digital age we live in, doctor-patient communications don’t end when the patients steps out the door. People are constantly connected, socially and professionally, and the medical field is no exception. Now more than ever, patients are reviewing their doctors online, rating their experiences, and writing personalized testimonials about their visits on sites like Yelp, HealthGrades.com, Vitals.com, ZocDoc, and others. The results from a survey conducted by Dimensional Research emphasize the value of a good review. 90% of participants were swayed by positive reviews while 86% were swayed by negative reviews. Just as consumers rely on testimonials when making a purchase, potential clients consider prior patients’ feedback when choosing a doctor. Because online reviews are playing a bigger role in guiding decisions, doctors need to make that monitoring and evaluating their online presence a priority in order to manage and improve their practice’s reputation.
Assess and take control First things first: take stock of your existing Internet presence. Search for the name of your practice as well as the names of your staff and doctors to get a full picture of what people are saying about you. Some of the more popular websites for pre-existing client-made profiles, comments, and ratings are HealthGrades. com, Vitals.com, RateMDS.com, ZocDoc.com, Yelp, Google Reviews, and Facebook. Remember, it’s not possible to simply opt out of being reviewed. When creating your profiles, use it as an opportunity to shape the perception of your practice. By uploading brand elements, a description, a welcome message, and other information about your practice, you are taking the first step to controlling how your practice is viewed. Once setting up your profiles, examine all client-written reviews and see whether you can make any immediate changes to your practice to improve how it’s managed.
tice’s website and in emails, follow up on appointments with an email asking patients to rate their experiences, post flyers advertising where patients can find your practice’s profiles online, and, of course, provide your best services. Some practices even set up Wi-Fi in the office to make leaving a review easy before or after an appointment. Day to day, don’t be a stranger to your patients. Engage with them online through social media to show that you pay attention to their needs in and out of the office. They will be more likely to write a review if they think you will read and respond to it. Setting up social media profiles may sound unnecessary and time-consuming for some practices, but once they are up and running you will soon see their benefits. When you do get a positive review, reach out to the patient and thank them privately. A personal touch goes a long way in the office and online. Do not post your own or make patients write them for you. Reviews should always be optional. In fact, you can be liable for false reviews.
When bad reviews happen Even if you have an A+ relationship with your patients, few physicians are exempt from ever receiving a bad review. If you receive negative feedback, read it and then walk away to reflect for a while—a few hours or even a day. Then you can craft a polite and professional response instead of an impulsive one. Once you have taken time to write your response, reply to the user directly through the website, publically when possible, but do not acknowledge the patient is your patient. When writing a public response, remember that any and all personal patient information must be emitted to comply with HIPAA laws. The CMA legal department recommends the following: “Our practice takes patient concerns seriously. Federal laws preclude us from responding to [a] patient[’s] concerns publicly. If you are our patient, please contact our office directly at [your contact] so we can address your concerns confidentially.” Remember that negative reviews will happen, but your overall reputation will shine through. As long as you have positive reviews to balance it out, your reputation will not suffer.
Encourage positive reviews There are a number of ways to encourage patients to leave positive feedback: add links to your profiles on your pracJANUARY 2016 | SAN MATEO COUNTY PHYSICIAN 13
Online review sites
Google Alerts to send you an email whenever Google Search finds something new about you or your practice.
Continued from page 13 Remember that negative reviews will happen, but your overall reputation will shine through. As long as you have positive reviews to balance it out, your reputation will not suffer.
Monitor and maintain future reviews Be patient. A good profile requires time. As reviews accumulate, trends will emerge and the average rating will become consistent and more accurate. Dedicate a specific person to regularly monitor all of your profiles. The office manager is usually the best person for this position. When setting up your profiles, you can opt to receive notifications when new reviews are added. You can also set up
If your practice is small or there is not someone on your team who can handle the added work, there are professional consultants that can set up and monitor your profiles and social media campaigns. These service providers will be able to personalize a system that works for your practice and takes the stress off you and your team.
About the author Ashley Porcincula is a branding, logo, and website designer, blogger, and social media consultant to physician practices. See her work at www.plcpracticewebsites.com. This article previously appeared in the November/December 2015 issue of San Francisco Medicine.
RETIREMENTS The following SMCMA members have recently retired from practice: Waichi Chan, MD Manuel Luna, MD William Chung, MD Vincent Dilella, MD
Bohdan Makarewycz, MD
Lisa Dyer, MD
James O’Donnell, MD
Kim Feigon, MD
George Shorago, MD
Charles Goldberg
Richard Tanner, MD
Sharyl Hardiman, MD
Burton White, MD
Joseph Kahn, MD
Larry Yeager, MD
In Memoriam Charles Eid, MD November 28, 2015
Jack Kahoun MD August 4, 2015
14 SAN MATEO COUNTY PHYSICIAN | JANUARY 2016
INDEX OF ADVERTISERS Cooperative of American Physicians............................................ Inside Back Cover Institute for Medical Quality..................................................................................6 The Magnolia of Millbrae.........................................................Outside Back Cover Medical Insurance Exchange of California (MIEC)..................................................4 NORCAL.......................................................................................Inside Front Cover Tracy Zweig Associates........................................................................................14
Success. It’s what California’s finest physicians strive for... and what CAP can help you achieve. Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT). As a physician-directed organization, we understand the realities of running a medical practice, and are committed to supporting you with a range of valueadded programs and services. These include a 24hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.
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Request your free electronic or hard copy today! 800-356-5672 | CAPphysicians.com/ReputationPro