Skinlines

SPRING 2016 PRESIDENT’S MESSAGE

Harness PAD’s Strategic Objectives President’s Message....................1 49th PAD Annual Meeting.........2

By: Glen H. Crawford, MD

Skyrocketing Cost of Generic Drugs...............................3

It is my distinct pleasure to serve as your president for 2016. Having been a member of the board of directors for more than a decade, I have come to appreciate the unique value that our organization provides to our members, to our partner organizations, and to our patients. Last year, the Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD) accomplished a tremendous amount of good work, and our organization and several key members were recognized on a local, state, and national level for these achievements. You will find many of these stories outlined in this newsletter. Going forward in 2016, I hope to build on these accomplishments and harness the energy of our board and committee members toward our strategic objectives of Education, Advocacy, and Engagement. Please review the summary of our key programs and objectives for 2016.

Geisinger Department of Dermatology.............................4 Melanoma Wednesday...............5 Grants Awarded to PAD Members...............................6 Practitioner of The Year Award..............................................6 Model State Award......................7 Sun Shade Essay Winner...........8 Legislative Update.......................9 New Members.............................. 11

The principal reason for the founding of the organization in 1966 was to provide meaningful and accessible continuing medical education opportunities for dermatologists in Pennsylvania. Your organizational leadership continues to provide outstanding learning programs culminating every year in our annual meeting in the Fall. This past meeting in the wonderful Hershey Hotel exceeded expectations. We look forward to an even more exciting and diverse curriculum for our next meeting at the picturesque Bedford Springs Resort scheduled for the weekend of September 16 – 18, 2016. Details of this meeting can be found in the article

by Dr. Laura Ferris on page 2. We also educate our members through email blasts and periodic newsletters, with the goal of keeping members abreast of legislative updates, coding issues, and other pertinent news that affects our specialty.

One of the areas in which the PAD truly excels is in the advocacy front. For our efforts in 2015, the AAD recognized the PAD with the Model State with CONTINUED ON PAGE 11

49th PAD Annual Meeting Update By: Laura K. Ferris, MD, PhD Plans for the 2016 49th Annual PAD Meeting are underway.

The lineup of speakers is terrific with a variety of topics of interest to our membership. The meeting is being held at the historic Bedford Springs Resort in Bedford, PA, on September 16-18, 2016. Our meeting will kick off with registration and breakfast at 7:30 am on Friday, September 16th.

Speakers from Pennsylvania will include Dr. Robert Micheletti from the University of Pennsylvania who will be speaking about Stevens-Johnson Syndrome and Other Severe Drug Eruptions and Dr. Carrie Kovarik, also from UPenn, who will give the Hugh Crumay Memorial Lecture on the landscape of teledermatology. We are honored to have Dr. Boris Lushniak, the former Surgeon General of the United States, presenting the Duhring Lecture.

Dr. Mark Jackson of Louisville, KY will present an update on the rapidlyevolving field of psoriasis and novel therapies.

Dr. Chris Baum of the Mayo Clinic will present on surgical dermatology, his talk is entitled, “High Risk Squamous Cell Carcinoma.” Dr. Libby Edwards of Charlotte, NC will speak on the topic of genital dermatology. As part of the diverse curriculum of this meeting, Dr. Alan Rockoff from Boston will speak about medical satire. The meeting will also feature oral and poster

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Bedford Springs Resort presentations from resident members and, new this year, a “Mole Bowl” in which all attendees can sharpen their dermoscopy skills and earn MOC credits.

The meeting will be full of information relevant to our practices with 14.25 hours of CME credit available.

Bedford Springs is a beautiful and family-friendly resort rich in history. It is the home of the first indoor pool in the United States and has hosted several of our country’s presidents. During breaks from the meeting you can enjoy the spa, play tennis or golf, or enjoy

s’mores by the fire pit. I hope to see you there.

For updated information, visit www. padermatology.org.

About the Author Dr. Laura Ferris is an associate professor of dermatology at the University of Pittsburgh where she is the director of clinical trials and directs the pigmented lesions and psoriasis clinics.

She serves as co-chair of the PAD’s Annual Meeting Scientific Committee.

Why the Skyrocketing Cost of Generic Drugs and How to Cope With It

SPRING 2016

By: Bruce A. Brod, MD The price of a drug on any given day is the price of the drug on any given day. When a prescription is issued for a patient by a dermatologist it is a roll of the dice whether the cost of the drug will be prohibitive for that patient. When it comes to the high cost of dermatologic drugs there are two main issues. One is the unpredictable cost of generic drugs and the other is the high cost of specialty drugs such as the biologics. Because of the complexity this article will focus solely on generic drugs. Dermatologists and patients are understandably frustrated when a 60 gm tube of clobetasol ointment costs a patient over $300 and a one-month supply of doxycycline comes in over $200 since both were at one time low cost medications.

The reason for the high cost of generic drugs and the murky pricing is multi-faceted but basically comes

down to lack of competition in the marketplace. Many of the generic companies are merging into larger entities. In addition, the FDA has been enforcing compliance with good manufacturing practices, which is forcing some of the generic companies out of business due to the costs associated with compliance. The FDA approval process for generic drugs is slow, antiquated and costly which further reduces the incentive to bring new generics to the market. Before getting clearance to make a drug, the companies must demonstrate to the FDA that their topical medications are absorbed through the skin in the same quantities as the brand-name drug. This process is much more costly than demonstrating equivalence of an oral generic drug. Further reducing competition is that pharmacy benefit managers will often only deal with the larger generic companies so that smaller companies that can offer lower prices have trouble breaking into the market. To add further strain, some of the raw materials used to make the generics are in short supply,

which further limits competition. The generally high cost of drugs overall has also influenced the generic market as it is causing this market to revert to the new norm of expensive when it comes to medications.

There is no easy solution. One simple answer is to become aware of the average retail price of all the generic drugs in any given category. For example, there can be a huge disparity between the cost of augmented betamethasone dipropionate ointment and clobetasol ointment. Some of the retail pharmacies such as Walmart and Walgreens as well as others will make this data available to you or you can assign someone in your office to find out this information. In addition there are companies such as goodrx. com that offer pricing information and discounts on generic and branded drugs specific to geographic areas. For more comprehensive information you can review and compare the NADAC or National Average Drug Acquition Costs on data, on a daily basis but the information is encylcopedic and does not always translate into the average retail cost. For example, desonide ointment may be prohibitively expensive but hydrocortisone valerate ointment may be affordable and these disparities are often a moving target.

At the federal level the Government Accounting Office is investigating the relationships that the pharmacy benefit managers have with the CONTINUED ON PAGE 5

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RESIDENCY PROGRAM CORNER

Geisinger Department of Dermatology By: Lorraine L. Rosamilia, MD Nestled in rural Danville, PA is a vibrant dermatology residency program with enviable academic opportunities and a quality training environment. The program includes 12 residents and additional fellowship positions in dermatopathology and dermatologic surgery.

Dr. Eric Hossler, the program director for Geisinger, states that ‘my favorite parts of the program are the focus on continuity clinic for the residents from the first month of training and the attending-led daily didactic schedule.

Our faculty is enthusiastic about teaching!’ Chief resident, Dr. Ryan Andrulonis had much to say about his training, ‘rigorous dermatopathology

teaching and quizzes with attendings happen on a weekly basis, and we finished in the top 4 in the Dermpath Bowl at the AAD this year. Our attending teaching breadth includes quality Mohs experiences at multiple practice sites and exposure to worldrenowned specialists in contact dermatology, pediatric dermatology, podiatry, melanoma, and particularly wound care.’

What always emerges in discussion about this program and this department culture is the support and collegiality. I was impressed this year at the AAD to see countless members of the faculty and co-residents at colleagues’ talks, posters, and symposia. They have a strong sense of community and family, and every department event is well-planned for inclusion of children.

As a satellite campus member of this department, I am consistently impressed with this group’s dedication to learning and teaching, the patient experience and continuity of care, and keenness as to the importance of work and home ‘families’.

About the Author Dr. Lorraine Rosamilia practices dermatology at Geisinger Scenery Park State College. She currently serves as Secretary of the PAD and is the editor of SkinLines.

The PAD hopes to highlight a residency program or individual resident of note in future editions. If you want your program to appear in future editions of SkinLines, send your submission to paderm@pamedsoc.org.

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SPRING 2016

WHY SKYROCKETING COST Continued from page 3 generic drug manufacturers which may trigger legislation to regulate these relationships. There is also federal legislation pending that could streamline the generic review process.

On a positive note the backlog of approvals for generic drugs by the FDA has already lessened. At a local level I urge dermatologists to reach out to pharmacy benefit managers and to become involved in the development of formularies that include a choice of generic topical steroids, oral antibiotics, and topical anti-neoplastic creams at an affordable level for patients by partnering with your local commercial carriers.

The AAD has a resource website available to members and patients at www.aad.org/advocacy/drug-pricingand-availability.

This is the first in a series on drug pricing.

About the Author Dr. Bruce Brod currently practices at Dermatology Associates of Lancaster. Dr. Brod is a Clinical Associate Professor of Dermatology at the University Of Pennsylvania School Of Medicine where he teaches and supervises at the Contact Dermatitis Clinic on a regular basis. Dr. Brod is currently a Board Member of both the PAD and the American Contact Dermatitis Society. He is a Fellow of the College of Physicians in Philadelphia and is on active staff at Lancaster General Hospital.

Melanoma Wednesday –

May 18th, 2016 By: Joslyn R. Sciacca Kirby, MD May is Melanoma Awareness month and the Pennsylvania Academy of Dermatology and Dermatologic Surgery will hold a free skin cancer screening and prevention event at the State Capitol on Wednesday, May 18th.

We know skin cancer is preventable and treatable when caught early. The signs of skin cancer are visible on the surface, so we need to involve patients and all clinicians in spotting skin cancer – to call when you see something unusual, growing, or changing on your skin. The Pennsylvania Academy of Dermatology and Dermatologic Surgery is committed to reducing the incidence of and mortality from skin cancer. Public education and tanning

legislation are the key. By educating the public about how to reduce their risk of skin cancer and how to spot skin cancer, we can help change behaviors and save lives.

Please visit the American Academy of Dermatology website to take action – protect minors from the dangers of tanning. Right now you can support the restriction of indoor tanning and dangers of sunlamps.

About the Author Dr. Joslyn Kirby is an Associate Professor of Dermatology at Penn State Hershey Medical Center.

She serves as chair of the PAD’s Skin Cancer Screening Committee.

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Bruce A. Brod, MD Wins Practitioner of the Year Award

Dermatology Foundation President Dr. Michael Tharp presents award to Dr. Brod.

In 1976, the Dermatology Foundation established the Practitioner of the Year Award. It is given each year to a member of the specialty who demonstrates exemplary service as a practitioner, teacher and/ or researcher, and is active in other professional organizations, especially dermatologic organizations.

For a complete list of award qualifications, please contact the Dermatological Foundation at dfgen@ dermatologyfoundation.org.

AAD/Pfizer Grants Awarded to PAD Members By: Joslyn R. Sciacca Kirby, MD The PAD has received a grant cosponsored by the American Academy of Dermatology and Pfizer to develop an application to help clinicians prescribe topical steroids.

The proposal, led by Dr. Joslyn Kirby at Penn State Milton S. Hershey Medical Center, aims to improve patient care by creating an evidence-based app to help providers make steroid selections – suggesting an appropriate strength, amount, and vehicle for each patient.

Choice overload – there’s an app for that!

Jules Lippoff, MD from the University of Pennsylvania also received a grant through this program. His project will be featured in our next edition of SkinLines.

Choices, choices, choices!

Steroid class…tube size….gel, lotion, or solution…

Too many choices of topical steroids can lead to choice overload!

What’s choice overload? Think about a long menu – too many choices – our eyes moving back and forth, mind racing… then we end up with our ‘old standby’, rather than making a thoughtful (tastier?) decision.

The same thing happens in medicine – For primary care providers, the choice of a topical steroid is a complex process that leads to choice overload!

Work has already begun and we’ll need your help!

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We want to ensure the app is smart and sleek – so look for announcements, we’ll need your feedback on the app content and appearance as it’s developed. If you have an interest in being on the research and development team, please contact the PAD office at paderm@pamedsoc.org.

About the Author Dr. Joslyn Kirby is an Associate Professor of Dermatology at Penn State Hershey Medical Center.

She serves as chair of the PAD’s Skin Cancer Screening Committee.

SPRING 2016

PAD Wins Model State Award The Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD) received its 14th Model

State Society Award with Honors from the American Academy of Dermatology Association (AADA)

PAD President Dr. Crawford (center) and board members Dr. Winter, Dr. Elenitsas, Dr. Rosamilia and Dr. Brod proudly display the Model State Award.

during a March 4 reception held in conjunction with the AAD’s Annual Meeting in Washington, DC. The PAD received Special Recognition for Outstanding Media Event or Campaign relating to the series of radio ads and interviews designed to increase awareness about Act 41.

The Model State Award program was initiated in 2000 to recognize the significant accomplishments of state dermatology societies. These awards encourage state dermatology societies to develop or to continue to develop essential services to their membership, including leadership opportunities, involvement in state and federal legislation that affects dermatology and community service.

The Foundation of the Pennsylvania Medical Society cares for those who provide for the health of others, and your support can continue to make that possible.

Physicians can turn to us for guidance, support and advocacy during life’s most challenging moments.

We offer:

• Scholarship and loan programs at favorable interest rates for medical students.

• The Physicians’ Health Program that confidentially supports physicians who are at risk or require •

help addressing health concerns including those that arise from addiction and substance abuse.

LifeGuard® that offers unbiased clinical skills assessment and a personalized plan to assist those who have fallen behind in clinical skills.

Donate now at www.foundationpamedsoc.org

Contact Us The Foundation of the Pennsylvania Medical Society 777 East Park Drive P.O. Box 8820 Harrisburg, PA 17105-8820 717.558.7750

The official registration and financial information of the Foundation of the Pennsylvania Medical Society may be obtained from the Pennsylvania Department of State by calling the toll-free number within Pennsylvania, 1(800)732-0999. Registration does not imply endorsement.

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Update on the 2015 Sun Shade Essay Winner Crooked Billet Elementary School of Hatboro, PA submitted the winning essay in our 2015 Sun Shade Essay Contest. We recently contacted the school for an update on how they spent their $5,000 grant. Principal, Kelli

Sendel, reported that they purchased a large gazebo (with a roof and benches) that is now placed on their playground.

Students now have a shady place to relax during recess.

Your donations to the PAD Public Health Fund make this program possible. Please donate to ensure we can continue to support Pennsylvania schools in providing Sun Safe spots for their students.

Go to the Foundation’s online giving page to

MAKE YOUR GIFT to PAD’s Public Health Education Fund

Crooked Billet Elementary School used their grant to purchase a shady gazebo.

Your Donations Are Needed!

The PAD Public Health Education Fund which supports the annual Sun Shade Essay Contest is in need of funds. The PAD Health Education Fund was established to support grants and educational outreach regarding skin and sun safety. Your donation is tax-deductible.

Go to the Foundation’s online giving page to make your gift to PAD... Click the “Designating my gift” drop down menu and choose “PAD Public Health Education Fund” to donate to this fund.

The Foundation will acknowledge your tax-deductible gift.

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SPRING 2016 LEGISLATIVE UPDATE

Update on 2016 Primary Election Results By: Milliron and Goodman, LLC On April 26th voters across the Keystone State headed to the ballot box for Primary Day in Pennsylvania. Nationally, Donald Trump completed a five-state sweep, including Pennsylvania, in yesterday’s Republican presidential primaries while Hillary Clinton scored victories in four states. Bernie Sanders took a surprise win in Rhode Island.

Statewide, Pennsylvania Democrats picked former chief of staff to Governor Tom Wolf, Katie McGinty, to take on Republican incumbent U.S. Senator Pat Toomey in November. Pennsylvania voters also supported amending the state Constitution to abolish the Philadelphia Traffic Court. A question on the ballot asking voters to increase the mandatory retirement age of state judges from 70 to 75 was pushed back until the November 8 general election.

All 203 state House seats are up for election this year and half the Senate (25 seats). Republicans currently hold sizeable majorities in both chambers, and this year’s election is not expected to change that. With seven lawmakers running for a different office and nearly 30 incumbents faced with primary challengers, let’s take a look at some of the key races across the state. To view all races, visit the Department of State website.

Four Incumbents Lost Primary Challenges

special election in March to fill the seat left vacant by the resignation of Parker.

The state’s longest-serving legislator Philadelphia Democrat Mark Cohen was ousted by community organizer Jared Solomon. Solomon garnered 4,980 votes to state Representative Cohen’s 3,763. Cohen was elected to the 202nd Legislative District in 1974.

Solomon nearly unseated Cohen in the primary two years ago. Cohen is the Democratic Chairman of the House State Government Committee.

In the 192nd Legislative District, Philadelphia Democrat Morgan Cephas (7,423) defeated Steven Jones (3,567), new incumbent state Representative Lynwood Savage (2,444), Edwin Santana (2,117) and Jess Johnson (1,124). Lynwood Savage won the seat in a March special election. The seat was left vacant by the resignation of Louise Bishop.

State Representative Frank Farina (D-Lackawanna) has conceded to opponent and former state Representative Kevin Haggerty in the Democratic primary race for 112th Legislative District. Farina was first elected to the State House in the 115th District in 2012, and defeated Rep. Kevin Haggerty in the Democratic Primary for the redrawn 112th District in 2014. Farina is the Democratic Secretary of the House Game and Fisheries Committee.

With nearly 48% of the vote, Democrat Chris Rabb defeated recently swornin incumbent state Representative Tonyelle Cook-Artis (D-Philadelphia) in the Democratic primary race for the 200th Legislative District seat. CookArtis finished second with 40% while Bobbie Curry came in third with 12%.

Cook-Artis was the longtime chief of staff to former State Rep. Cherelle Parker. She was elected during a

6 of 7 Lawmakers Running for a Different Office Were Successful in Bid In the statewide race for Attorney General, former state House Representative and Montgomery County Commissioner Josh Shapiro defeated two prosecutors, Allegheny County District Attorney Stephen Zappala and Northampton County District Attorney John Morganelli. He’ll take on the Republican winner, state Senator John Rafferty of Montgomery County, in the general election.

Rafferty defeated Joe Peters, a veteran prosecutor from Wyoming County, for the nomination. Rafferty currently serves as the Chairman of the Senate Transportation Committee.

In a very close race in the 5th Senatorial District, Philadelphia Democratic incumbent John Sabatina (17,009) appears to have edged state CONTINUED ON PAGE 10

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LEGISLATIVE UPDATE Continued from page 9 Representative Kevin Boyle (16,337) for the seat of former Senator Mike Stack. Stack who is now Lt. Governor.

Sabatina was elected to fill the seat in a special election last year. Boyle remains on the ballot in November for his 172nd Legislative House District seat.

In a hotly contested four-way race for the open seat of retiring state Senator Pat Vance (R-Cumberland), state Representative Mike Regan (26,740) defeated former Philadelphia Eagles running back Jon Ritchie (15,737), dentist Brice Arndt (7,194) and attorney Scott Harper (1,457). Regan will run unopposed in the general election for the 31st Senatorial District seat. Vance is the current Republican Chair of the Senate Public Health and Welfare Committee and Vice-Chair of the Senate Communications and Technology Committee. She also serves on the Appropriations and Consumer Protection & Prof. Licensure committees. Republican Dawn Keefer won the Republican nomination for Mike Regan’s 92nd Legislative District House seat. With 5,144 votes, she defeated Anthony Pugliese (4,384) and Kraig Bruder (3,378). She will run unopposed in November.

State Senator Lloyd Smucker (R-Lancaster) won the Republican nomination for 16th Congressional District to replace retiring U.S. Representative Joe Pitts. With 54% of the vote, two-term state Senator defeated Manheim businessman Chet Beiler in a high profile and expensive race. Smucker will face Democrat Christina Hartman in November. The district includes parts of Lancaster, Chester and Berks counties. Smucker

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Affairs, Liquor Control and Insurance committees.

is the current Republican Chair of the Senate Education Committee and also serves on the Appropriations and Public Health & Welfare committees.

County Commissioner Scott Martin will face Democrat Greg Paulson to take Smucker’s place in Harrisburg. Paulson is an attorney who serves as chief of staff to state Rep. Mike Sturla.

Longtime Republican state Representative Tom Killion defeated Democrat Marty Molloy in a special election to fill the 9th Senatorial District seat vacated by Dominic Pileggi, who resigned to become a Delaware County Judge. Killion received nearly 57 percent of the vote, or 40,873 votes, to Marty Molloy’s nearly 43 percent, or 30,791 votes, according to unofficial results. As winner of the special election, he fills the seat through the end of the year. The district includes portions of Delaware and Chester Counties. It is expected he will be challenged again by Molloy on the November general election ballot. Killion currently serves on the House Appropriations, Consumer

State Representative Dwight Evans (D-Philadelphia) is set to go to Washington D.C. after winning the 2nd Congressional District Democratic Primary. With 42% of the vote Evans ousted incumbent U.S. Congressman Chaka Fattah (35%) who has held the seat for 11-terms. Fattah was indicted last July on federal racketeering charges. The district covers Philadelphia and parts of Montgomery County. Evans was once the ranking Democrat on the state House Appropriations Committee.

In the race for the Democratic nomination for the 8th Congressional District, state Representative Steve Santarsiero (50,367) defeated scientist and businesswoman Shaughnessy Naughton (33,810). Santarsiero will face Republican Brian Fitzpatrick, brother of Republican incumbent Rep. Mike Fitzpatrick. The congressional district serves Bucks County, along with portions of Montgomery County. Republican Mike Fitzpatrick has represented this district since 2011 and is not seeking another term. Santarsiero currently serves on the state House Education and Transportation committees among others.

As we get closer to the general election, we’ll provide you with an analysis of key races to watch. If you have any questions, please do not hesitate to contact us.

The PAD retains Milliron & Goodman, LLC for strategic guidance in our political advocacy efforts. Learn more at www.millirongoodman.com.

SPRING 2016

PRESIDENT’S MESSAGE Continued from page 1 Honors award at the national meeting in Washington, D.C. in February.

Several momentous achievements that contributed to this prestigious award include our initiative and partnership with the PAMED regarding drug pricing and transparency that ultimately led to an AMA resolution to make generic drug pricing a priority issue. The PAD received grants of over $300,000 from AAD and Pfizer to support member research projects at Penn State Hershey and the University of Penn to work on two projects on access to medications. Already in 2016, your leadership has been on the forefront in Pennsylvania in developing strategy and supporting PAMED in its negotiations with Highmark. As many of you are aware, Highmark recently released a sudden and unprecedented announcement to hastily and dramatically cut physician fees for all of their ACA products effective April 1, 2016. Please see our letter that was sent in response to this announcement, which forcefully related our opposition.

In this rapidly changing medical landscape, member medical organizations have to innovate and adapt in order to provide value to members. We understand that it is difficult for members to choose which organizations they will support each year as the options and costs for society membership continue to expand. Through our increased efforts to engage our members, we hope to better communicate all the value that we as an organization bring to the dermatologists in Pennsylvania.

Several of our board members serve in critical roles in the AAD, PAMED, AMA, and local societies. Through engagement in this broad arena, the PAD advocates for you and the interests of our profession and our patients.

I am proud to serve in this role as your president for 2016. I hope to carry the torch of outstanding accomplishment that this organization has achieved over the past 50 years. The PAD is a volunteer organization, and only

through participation and commitment of our members have we been able to accomplish so much in the recent and more distant past. I call on you to get involved and do your part. We face great challenges in the years ahead.

Through innovation, adaptability, and providing value, we can continue to serve our members, our patients, and our partnering specialty organizations in meaningful ways.

About the Author Dr. Glen Crawford is the founder of the Pennsylvania Centre for Dermatology, serves as Section Chief of Dermatology at the Pennsylvania Hospital, and he is a Clinical Associate Professor at the University of Pennsylvania where he co-directs the contact dermatitis specialty clinic.

He began his term as PAD President on January 1, 2016.

Welcome New Members

Sara J. Heilig, MD

Gina M. Caputo, DO

Arthur C. Huen, MD, PhD

Stacy F. Cohen, MD

Susan L. Lovett, MD

Mary Collins, MD

Early Career Physician Members

Damon McClain, MD

Jill K. Henley, DO

Susannah E. McClain, MD

Megan R. Joint, DO

Melissa A. Pugliano-Mauro, MD

Geoffrey F. Lim, MD

Heather L. Salvaggio, MD

Mona Sadeghpour, MD

Adam B. Woldow, MD

Aurora Shehu, MD, PhD

Jules Benjamin Lipoff, MD

Timothy J. Patton, DO

Silvia S. Song, MD

Fellow

Resident Fellow

Nadia K. Sundlass, MD, PhD

Brittany S. Barros, MD

Suzanne J. Tintle, MD

Christina Nicole Lawson, MD Julian M Ngo, DO Sara A Jurado, MD

Kara D. Capriotti, MD Emily Y. Chu, MD, PhD

Alison M. Spiker, MD

Kristin P. Bibee, MD, PhD

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