August 2014
32
JOIN US, SAY NO TO PROP 46 “PHYSICIANS UNITED FOR A HEALTHY SAN DIEGO” OFFICIAL PUBLICATION OF SDCMS AUGUST 2014
description
The August 2014 issue of San Diego Physician highlights the No on 46 campaign and the work of the SDCMS Foundation.
Transcript of August 2014
JOIN US, SAY NO TO PROP 46
“Physicians United for a healthy san diego”
official publication of SDcMS august 2014
B SAN DIEGO PHYSICIAN.OrG OctOber 2011
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V I S I B L E
363 FEET linear frontage on Palomar Airport Road
(43,492 CARS PER DAY)
A C C E S S I B L E
1 MILE from Interstate 5(202,572 HOUSEHOLDS WITHIN
20 MINUTE DRIVE)
S T R A T E G I C
North County’s most affluent demographics
($98,614 AVG HOUSEHOLD INCOME IN A 5 MILE RADIUS)
6 0 1 0 H i d d e n Va l l e y R o a d , C a r l s b a d , C A 9 2 0 1 1
9 0 , 0 0 0 S F
CAMPUS
TRAVIS IVESAssociate DirectorLic. # [email protected]
CUSHMAN & WAKEFIELD OF SAN DIEGO, INC.CA License No. 1329963
4747 Executive Drive, 9th Floor San Diego, CA 92121
5 0 , 0 0 0 S F existing medical office building
3 9 , 0 0 0 S F proposed build-to-suit
opportunity
NORTH COUNTY’S NEWEST AND MOST COVETED MEDICAL CAMPUS
FOR MORE INFORMATION, PLEASE VISIT WWW.NORTHCOASTMEDICALPLAZA.COM
JOIN US, SAY NO TO PROP 46
Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and informa-tion sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or ser-vices advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to [email protected]. All advertising inquiries can be sent to [email protected]. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email [email protected]. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]
VolUme 101, nUmber 8ContentsaUg.
12Choosing Wisely: Five Things Physicians and Patients Should QuestionBY tHE aMERICaN sOCIEtY OF
CLINICaL ONCOLOgY
16Fate: Life Is Measured OutBY DaNIEL J. BREssLER, MD, FaCP
18Be a Role Model for Your Patients! Learn How the SDCMS Foundation Can HelpBY BaRBaRa MaNDEL aND
KatHLEEN KRaMBERg
26Physician Marketplace: Classifieds
28Choose Freedom: When Will You Take a Stand for Your Life?BY HELaNE FRONEK, MD, FaCP, FaCPH
MANAGING EDITOR: Kyle LewisEDITORIAL BOARD: Theodore M. Mazer, MD, James Santiago Grisolía, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Van C. Johnson, MD, Roderick C. Rapier, MDMARKETING & PRODUCTION MANAGER: Jennifer RohrSALES DIRECTOR: Dari PebdaniART DIRECTOR: Lisa WilliamsCOPY EDITOR: Adam Elder
SDCMS BOARD OF DIRECTORS
OFFICERSPRESIDENT: J. Steven Poceta, MDPRESIDENT-ELECT: William T-C Tseng, MD, MPH (CMA Trustee)TREASURER: Mihir Y. Parikh, MDSECRETARY: Mark W. Sornson, MDIMMEDIATE PAST PRESIDENT: Robert E. Peters, PhD, MD
GEOGRAPHIC AND GEOGRAPHIC ALTERNATE DIRECTORSEAST COUNTY: Venu Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD, Alt: Susan Kaweski, MD (CALPAC Treasurer)HILLCREST: Gregory M. Balourdas, MD, Thomas C. Lian, MD, Alt: Thomas J. Savides, MDKEARNY MESA: Sergio R. Flores, MD, John G. Lane, MD, Alt: Anthony E. Magit, MD, Alt: Eileen R. Quintela, MDLA JOLLA: Geva E. Mannor, MD, Marc M. Sedwitz, MD, Alt: Lawrence D. Goldberg, MDNORTH COUNTY: James H. Schultz, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD, Alt: Anthony H. Sacks, MDSOUTH BAY: Reno D. Tiangco, MD, Michael H. Verdolin, MD, Alt: Elizabeth Lozada-Pastorio, MD
AT-LARGE DIRECTORSLawrence S. Friedman, MD, Karrar H. Ali, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Stephen R. Hayden, MD, Peter O. Raudaskoski, MD, Vimal Nanavati, MD (Board Representative), Holly B. Yang, MD
AT-LARGE ALTERNATE DIRECTORSKarl E. Steinberg, MD, Jeffrey O. Leach, MD, Toluwalase A. Ajayi, MD, Phil Kumar, MD, Wayne C. Sun, MD, Kyle P. Edmonds, MD, Carl A. Powell, DO, Marcella M. Wilson, MD
OTHER VOTING MEMBERSCOMMUNICATIONS CHAIR: Sherry L. Franklin, MD (CMA Trustee)YOUNG PHYSICIAN DIRECTOR: Edwin S. Chen, MDRESIDENT PHYSICIAN DIRECTOR: Jane Bugea, MDRETIRED PHYSICIAN DIRECTOR: Rosemarie M. Johnson, MDMEDICAL STUDENT DIRECTOR: Spencer D. Fuller
OTHER NONVOTING MEMBERSYOUNG PHYSICIAN ALTERNATE DIRECTOR: Daniel D. Klaristenfeld, MDRESIDENT PHYSICIAN ALTERNATE DIRECTOR: Diana C. Gomez, MDRETIRED PHYSICIAN ALTERNATE DIRECTOR: Mitsuo Tomita, MDSDCMS FOUNDATION PRESIDENT: Albert Ray, MD (CMA Trustee, AMA Delegate)CMA SPEAKER: Theodore M. Mazer, MDCMA PAST PRESIDENTS: James T. Hay, MD (AMA Delegate), Robert E. Hertzka, MD (Legislative Committee Chair, AMA Delegate), Ralph R. Ocampo, MDCMA TRUSTEES: Robert E. Wailes, MD, Erin L. Whitaker, MDCMA SSGPF DELEGATE: James W. Ochi, MDCMA SSGPF ALTERNATE DELEGATES: Dan I. Giurgiu, MD, Ritvik Mehta, MDAMA ALTERNATE DELEGATE: Lisa S. Miller, MD
2 au gus t 2014
18
feature14 Vote No on 46: Increased Costs • Losing Your Doctor • Threatening Your PrivacyBY RICHaRD tHORP, MD,
PREsIDENt, CMa
departments4 Briefly Noted: Calendar • Welcome New Members • And More …
6Report From AMA’s Annual Meeting: June 2014
8Rising Number of Infectious Disease Cases Creates Patient Safety IssuesBY tHE DOCtORs COMPaNY
10Sports Physical Goal: Reduce Liability Risks While Assessing Student FitnessBY tHE DOCtORs COMPaNY
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4 au gus t 2014
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SDCMS Seminars & Webinars SDCMS.orgfor further information or to register for any of the follow-ing SDcMS seminars, webinars, workshops, and courses, email [email protected].
How to Hand Reportable Events such as abuse, Loss of Consciousness, and the Impaired Provider (seminar/webinar)SEp 11: 11:30am–12:30pm
Physician Networking Opportunity & Mixer at the Rock Bottom Restaurant & Brewery in La Jolla (social)SEp 12: 5:30pm–8:30pm
taming Microsoft Outlook (workshop)SEp 13: 8:30am–11:30am
Covered California: What Your Healthcare team Needs to Know (seminar/webinar)SEp 18: 11:30am–1:00pm
Calendar
briefly noted
HIPaa Compliance update (webinar)SEp 25: 11:30am–1:00pm
sDCMs Leader’s toolkit (workshop)SEp 27–28
Payor Denials & appeals: Effective Management and Best Outcomes (seminar/webinar)oct 9: 11:30am–1:00pm
Free Work-Life Balance Workshop for Physicians (workshop)oct 11: 9:00am–12:00pm
Covered California: What Your Healthcare team Needs to Know (seminar/webinar)oct 16: 11:30am–1:00pm
Covered California: What Your Healthcare team Needs to Know (seminar)oct 16: 5:30pm–7:00pm
Pain Management strategies to Decrease Liability Risk (seminar/webinar)noV 13: 11:30am–12:30pm
CMa WebinarsCMAnet.org/events
HIPaa update: are You Compliant With the Final Omnibus Rule?SEp 10: 12:15pm–1:15pm
Managing Difficult Employees and Reducing Conflict in the PracticeSEp 17: 12:15pm–1:15pm
Informed Consent for Psychotropic Medications: What’s Required of Physicians, Hospitals, and Nursing HomesSEp 25: 12:15pm–1:15pm
Family Medicine: Frontline of Careoct 1: 12:15pm–1:15pm
Protect and Preserve Your Patient Relationshipsoct 8: 12:15–1:15pm
Managing up! For Managersoct 29: 12:15pm–1:15pm
Community Healthcare Calendarto submit a community healthcare event for possible publication, email [email protected]. Events should be physician-focused and should take place in or near San Diego county.
31st annual uCLa Intensive Course in geriatric Medicine & Board ReviewSEp 10–13 [los angeles airport Marriott, geronet.ucla.edu/ic, (310) 312-0531]
sDCMs Foundation solana Beach sunset 5K Run/WalkSEp 27 (sdcmsf.org/events/5k)
the Heart Course: Emergencyoct 2–5 (aria Resort and casino in las Vegas, www.theheartcourse.com)
25th annual Cardiovascular Interventionsoct 21–24 (www.sdcms.org/portals/18/assets/pdf/seminars/cardiovascular interventionsbrochure2014.pdf)
Physicians of Exceptional Excellence (top Doctors) galanoV 1 (birch aquarium)
the 2014 san Diego Day of traumanoV 7 (www.sdcms.org/portals/18/assets/pdf/seminars/trauma%202014%20brochure-.pdf)
Essential tools in serving Diverse PopulationsnoV 18 (Scottish Rite Event center on camino Del Rio South, registration open in September)
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sa N D I EgO P H YsI C I a N .O rg 5
“
”
it is in moments of illness that we are compelled to recognize that we live not alone but chained to a creature of a different kingdom, whole worlds apart, who has no knowledge of us and by whom it is impossible to make ourselves understood: our body.— Marcel Proust, French Novelist, Critic, and Essayist (1871–1922)
SDcMS features member physicians for their noteworthy accomplishments in these pages. if you would like to be considered for our next “featured Member” spotlight, please email [email protected]. thank you for your membership in SDcMS and cMa!*featUred
MeMber
Barry Masci, CFA, CMT, CMFC, CLU®, CFP®First Vice President – Investments11512 El Camino Real, Suite 210, San Diego, CA 92130858-720-2365 • [email protected] bmasci.wfadv.com
Wells Fargo Advisors, LLC, Member SIPC, is a registered broker-dealer and a separate non-bank affiliate of Wells Fargo & Company.© 2013 Wells Fargo Advisors, LLC. All rights reserved. 0514-03415 [74036-v4] A1272 (1194411_372510)
Investment and Insurance Products: NOT FDIC Insured NO Bank Guarantee MAY Lose Value
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SdCMS-CMa MeMberShip
Welcome Our New Members!
Karen J. Hanna, MDGeneral SurgeryVista (360) 621-8795
swati Lavu-Rao, MDEmergency MedicineSan Diego(760) 846-2389
stephen W. Munday, MD, MPHoccupational MedicineEl centro(760) 482-4429
Eric J. M. Reed, MDpediatricsla Mesa(858) 499-2701
6 au gus t 2014
Note: James T. Hay, MD, SDCMS-CMA member since 1979, and Robert E. Hertzka, MD, SDCMS-CMA member since 1984, are both delegates to AMA. Albert Ray, MD, SDCMS-CMA member since 1984, and Lisa S. Miller, MD, SDCMS-CMA member since 1992, are both alternate delegates to AMA.
on JUne 7, 2014, the AMA Annual Meeting convened in Chicago. Delegates Jim Hay and Robert Hertzka and alternate delegates Al Ray and Lisa Miller represented San Diego in the Pacific Rim Delegation. Some of the important takeaways from the meeting included:
report from aMa’s annual MeetingJune 2014
aMa
would also study the requirements and por-tability of state licensure as it impacts the provision of telemedicine services.
3 New policy opposing the sale and marketing of electronic cigarettes to minors in a stricter, more compre-
hensive fashion than previous AMA policy.
4 Call for further review of mainte-nance of certification and mainte-nance of licensure requirements,
including the time and dollar costs these recertifications have on physician practices as well as the impact on workforce, patient safety, and outcomes.
5 Policy aimed to improve electronic data interchange, calling on the fed-eral government and EHR vendors
to improve transparency and the exchange of data through different systems. Ad-ditional new policy called for EHR vendors to address issues with the EHR–physician interface to improve the usability of EHRs.
6Other issues addressed during the meeting included:
• health insurer code of conduct• public reporting of quality and outcomes• the ACA grace period• ICD-10 transparency and conversion• alternatives to value-based modifiers• delays in Medicaid payments• the use of hospital observation status• network adequacy• models for medical healthcare teams• clinical data registries• lung cancer screening• mail order prescription copays• fairness in pharmaceutical pricing• e-prescribing and meaningful use• patient protection from forced switching
of patent-protected drugs• graduate medical education funding and
quality of resident education• nutrition labels• genomic-based approaches to the risk
assessment, management, and preven-tion of type 2 diabetes
• antibiotic use in food-producing animals• medical student debt
Further information regarding AMA and the Annual Meeting can be found on the AMA website at www.ama-assn.org/ama.
1 The decision to ask President Obama, as a means of relieving the access pres-sure for veterans to receive timely care
through the VA system, to allow veterans to obtain care through community physicians. This measure would address the cur-rent delays in the Department of Veterans Affairs healthcare system. The letter to the president would include a request to establish a registry of physicians willing to provide this care.
2 Policy establishing principles for the coverage and payment for services provided via telemedicine. AMA
sa N D I EgO P H YsI C I a N .O rg 7
90%
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8 au gus t 2014
rising number of infectious disease Cases Creates patient Safety issuesContributed by SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
RiSK ManaGEMEnt
phySiCianS are reporting communicable, or infectious, diseases that were thought to have been controlled in the United States. New cases of whooping cough (pertussis) and, most recently, measles (rubeola) are making headlines. During the first half of 2014, there were more reported cases of measles than for any year since the disease was eliminat-ed from the country in 20001.
• Complying with state laws for the provision of vac-cines to healthcare work-ers. For more information, go to www2a.cdc.gov/nip/statevaccapp/statevacc-sapp/default.asp.
• Notifying those who may have come in contact with an infected individual that they should see a physi-cian.
• Ensuring that all office staff members are trained in the use of personal protective equipment and on proper isolation tech-niques when working with patients who present with symptoms of an infectious disease.
Follow these tips if you or your staff suspects a patient has an infectious disease:
• Minimize risk of exposure by moving the patient from the waiting area and isolating him or her in an exam room.
• For airborne diseases, place a surgical mask on the patient and ensure that all office staff members wear protective equip-ment, including gloves, eye protection, masks, or an N-95 particulate respi-rator, if needed.
• Follow standard disinfec-tion and sterilization pro-cedures for exam rooms.
• Report suspected cases to the local health depart-ment and obtain speci-mens for disease testing.
• Consider making post-exposure prophylaxis available to those who have been exposed.
1) CDC: Highest number of U.S. mea-sles cases since 2000. CNN Health. http://www.cnn.com/2014/05/29/health/cdc-measles/. Published May 30, 2014. Accessed June 5, 2014.
In addition, newly classified in-fectious diseases are emerging, like Middle East Respiratory Syndrome.
To protect staff and patients, medical offices need to have established protocols that limit the exposure risk from indi-viduals who come into the office with one of these debilitating, if not fatal, conditions. Medical malpractice liability risk may grow as reports of infectious
diseases continue.Your practice can reduce
liability risks and promote patient safety by:
• Documenting all discus-sions with patients and parents of minors regard-ing infectious diseases, including the risks and benefits of inoculation.
• Documenting all discus-sions about serologic evaluations with patients who are unsure of their immunity status.
• Ensuring that all im-munization tracking is up to date so that patients remain on a timely immu-nization schedule.
• When possible, allowing only staff members who have demonstrated evi-dence of immunity to work with patients suspected of having a communicable or infectious disease.
10 au gus t 2014
Sports physical GoalReduce liability Risks While assessing Student fitness Contributed by SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
RiSK ManaGEMEnt
However, for the physician to be found at fault, it must be shown that the physician deviated from the standard of care. Generally, most courts have found that physicians who provide medical clearance for participating in competitive sports are not legally liable for injury or death caused by an undisclosed, asymptomatic cardiovascular abnormality, as long as the physician followed current consensus guidelines for conducting sports physical evaluations.
When conducting a sports physical, it is essential to take a complete medical history. This can help reduce the risk of claims for missed or delayed di-agnosis of cardiovascular condi-tions. Patients with a personal or family history of the following may be at increased risk for cardiovascular conditions:
• exertional chest pain/dis-comfort
• syncope/near-syncopal episodes
• excessive, unexpected shortness of breath
• excessive, unexplained fatigue with exercise
• heart murmur• elevated systemic blood
pressure• cardiovascular diseaseThese exams also give
physicians the opportunity to establish a cognitive func-tion baseline that can be used to improve outcomes in the event of future head injury. It is important to establish this baseline because head injuries are becoming more common in young athletes. In the event of a head injury, the record of base-line cognitive function can not only help improve a student’s outcome but can also serve as a factor in determining whether the student is ready to return to play after injury. These are important steps to reduce the liability risks associated with treating concussions.
SUMMer iS the tiMe for sports physicals. Physicians should be aware, however, of the potential malpractice risks of these examinations, especially in cases where no physician-patient relationship exists.
Depending on the legal venue, courts may hold that merely conducting a sports physical serves to create a physician-patient relationship with the same legal duties as that of an established, private practice patient. In these cases, physicians should explain the precise nature and scope of the physician-patient relationship, emphasizing that it is related solely to the examination and does not replace an annual well-child exam performed by the student’s primary care phy-sician. In all cases, physicians should ensure that the parents or legal guardians provide consent for the student to be evaluated.
Cardiovascular screening, including failure to discover a latent, asymptomatic car-diovascular condition, is a major area of liability risk when performing a sports physical.
sa N D I EgO P H YsI C I a N .O rg 11
TOP DOCTORSTHE ISSUE
On newsstands this OctoberReserve your ad space by
August 29, 2014
ISSUE & GALA
THE GALANovember 1 ,2014
Birch AquariumTickets go on sale September 10, 2014
FOR MORE INFORMATIONCall 619.744.0501
or email [email protected]
VISIT sandiegomagazine.com/events
TOP DOCTORSTHE ISSUE
On newsstands this OctoberReserve your ad space by
August 29, 2014
ISSUE & GALA
THE GALANovember 1 ,2014
Birch AquariumTickets go on sale September 10, 2014
FOR MORE INFORMATIONCall 619.744.0501
or email [email protected]
VISIT sandiegomagazine.com/events
12 au gus t 2014
public HEaltH
SDCMS is publishing various Choosing Wisely® lists of “Things Physicians and Patients Should Question.” Choosing Wisely — see page opposite — is an initiative of the ABIM Foundation to help physicians and patients engage in conversations to reduce overuse of tests and procedures, and support physician efforts to help patients make smart and effective care choices.
Originally conceived and piloted by the National Physicians Alliance through a Putting the Charter Into Practice grant, leading medi-cal specialty societies, along with Consumer Reports, have identified tests or procedures commonly used in their fields whose necessity should be questioned and discussed. The resulting lists of “Things Phy-sicians and Patients Should Question” will spark discus-sion about the need — or lack thereof — for many frequently ordered tests or treatments.
How the List on Page 13 Was CreatedThe American Society of Clinical Oncology (ASCO) has had a standing Cost of Cancer Care Task Force since 2007. The role of the Task Force is to assess the magnitude of rising costs of cancer care and develop strategies to address these challenges. In response to the 2010 New England Journal
Choosing Wisely an initiative of the american board of internal Medicine (abiM) foundation
of Medicine article by Howard Brody, MD, “Medicine’s Ethical Responsibility for Health Care Reform — the Top Five List,” a subcommittee of the Cost of Cancer Care Task Force began work to identify common prac-tices in oncology that were both common as well as lacking suf-ficient evidence for widespread use. Upon joining the Choosing Wisely campaign, the members of the subcommittee conducted a literature search to ensure the proposed list of items were supported by available evidence in oncology; ultimately the proposed Top Five list was ap-proved by the full Task Force. The initial draft list was then presented to the ASCO Clinical Practice Committee, a group composed of community-based oncologists as well as the presi-dents of the 48 state and re-gional oncology societies in the United States. Advocacy groups were also asked to weigh in to ensure the recommendations would achieve the dual purpose of increasing physician-patient communication and changing practice patterns. A plurality of more than 200 clinical oncolo-gists reviewed, provided input, and supported the list. The final Top Five list in oncology was then presented to, discussed, and approved by the Executive Committee of the ASCO Board of Directors and published in the Journal of Clinical Oncology. ASCO’s disclosure and conflict of interest policies can be found at www.asco.org.
For more information or to see other lists of Five Things Physicians and Patients Should Question, visit www.choosing-wisely.org.
sa N D I EgO P H YsI C I a N .O rg 13
Don’t use cancer-directed therapy for solid tumor patients with the following characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anticancer treatment. • Studies show that cancer-directed treatments are likely to be ineffective for solid tumor patients who meet the above stated criteria.• Exceptions include patients with functional limitations due to other conditions resulting in a low performance status or those with
disease characteristics (e.g., mutations) that suggest a high likelihood of response to therapy.• Implementation of this approach should be accompanied with appropriate palliative and supportive care.
Don’t perform PEt, Ct, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.• Imaging with PET, CT, or radionuclide bone scans can be useful in the staging of specific cancer types; however, these tests are often
used in the staging evaluation of low-risk cancers, despite a lack of evidence suggesting they improve detection of metastatic disease or survival.
• Evidence does not support the use of these scans for staging of newly diagnosed low grade carcinoma of the prostate (Stage T1c/T2a, prostate-specific antigen (PSA) <10ng/ml, Gleason score less than or equal to 6) with low risk of distant metastasis.
• Unnecessary imaging can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.
Don’t perform PEt, Ct, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.• Imaging with PET, CT, or radionuclide bone scans can be useful in the staging of specific cancer types; however, these tests are often
used in the staging evaluation of low-risk cancers, despite a lack of evidence suggesting they improve detection of metastatic disease or survival.
• In breast cancer, for example, there is a lack of evidence demonstrating a benefit for the use of PET, CT, or radionuclide bone scans in asymptomatic individuals with newly identified ductal carcinoma in situ (DCIS), or clinical stage I or II disease.
• Unnecessary imaging can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.
Don’t perform surveillance testing (biomarkers) or imaging (PEt, Ct, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.• Surveillance testing with serum tumor markers or imaging has been shown to have clinical value for certain cancers (e.g., colorec-
tal). However for breast cancer that has been treated with curative intent, several studies have shown there is no benefit from routine imaging or serial measurement of serum tumor markers in asymptomatic patients.
• False-positive tests can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.
Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20% risk for this complication.• ASCO guidelines recommend using white cell stimulating factors when the risk of febrile neutropenia, secondary to a recommended
chemotherapy regimen, is approximately 20% and equally effective treatment programs that do not require white cell stimulating factors are unavailable.
• Exceptions should be made when using regimens that have a lower chance of causing febrile neutropenia if it is determined that the patient is at high risk for this complication (due to age, medical history, or disease characteristics).
five things physicians and patients
Should Questionby the American Society of Clinical Oncology
cHooSinG WiSEly: an initiatiVE of tHE abiM founDation
Note: These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
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. 4
6 a
nd
co
nclu
ded
that
it c
ould
incre
ase
sta
te a
nd
local g
ove
rnm
ent
healthcare
co
sts
by “
hund
red
s of
mill
ions
of
do
llars
annually
.”
We k
now
that
these
incre
ase
d c
ost
s w
ould
red
uce f
und
ing
availa
ble
fo
r vital s
tate
and
local g
ove
rnm
ent
serv
ices
like p
olic
e, fi
re, s
oci
al s
erv
ices,
park
s, li
bra
ries
… a
nd
the li
st g
oes
on. R
eally
, this
is ju
st a
noth
er
exa
mp
le o
f tr
ial a
tto
rneys
pulli
ng
mo
ney d
irectly o
ut
of
the h
ealthcare
deliv
ery
syst
em
and
our
com
munitie
s to
line t
heir o
wn p
ocke
ts.
as
physi
cians,
it is
our
job
to
pro
vid
e c
are
fo
r and
pro
tect
our
patients
— b
ut
pro
p. 4
6 d
oes
just
the
op
po
site
. taxp
ayers
acro
ss t
he s
tate
will
be o
n t
he h
oo
k fo
r hund
red
s of
mill
ions
of
do
llars
in in
cre
ase
d
state
and
local g
ove
rnm
ent
cost
s each y
ear
and
co
uld
lose
critical s
tate
and
locally
pro
vid
ed
serv
ices
that
so m
any c
ount
on.
that’s
just
how
pro
p. 4
6 w
ill im
pact
state
and
local g
ove
rnm
ent
co
sts.
an in
dep
end
ent
stud
y e
stim
ate
s th
at
this
pro
po
sitio
n w
ill in
cre
ase
healthcare
co
sts
acro
ss a
ll se
cto
rs b
y a
lmo
st $
10 b
illio
n a
nnually
. H
ow
do
es
that
aff
ect
patients
thro
ug
ho
ut
calif
orn
ia?
it t
ransl
ate
s to
ab
out
$1,0
00
per
year
in h
igher
healthcare
co
sts
for
a f
am
ily o
f fo
ur.
fo
r m
any f
am
ilies,
that’s
the d
iffe
rence b
etw
een b
ein
g a
ble
to
aff
ord
g
roceries
or
healthcare
each m
onth
.
if y
ou h
aven’t s
igned
up
to
op
po
se p
rop
. 46
, ple
ase
vis
it n
oo
n4
6.c
om
and
join
the c
oalit
ion t
od
ay —
the
price t
o o
ur
patients
is t
oo
gre
at
to r
isk it
.
pro
p. 4
6 w
as
writt
en b
y t
rial a
tto
rneys
for
tria
l att
orn
eys
— n
ot
for
the p
atients
of
calif
orn
ia w
ho
will
be
forc
ed
to
pay
, pla
in a
nd
sim
ple
.
if y
ou h
aven’t s
igned
a “
no
on p
rop
46
co
mm
itm
ent
card
” o
r p
led
ged
to
be a
co
ord
inato
r at
yo
ur
ho
spital,
vis
it c
manet.o
rg/m
icra
and
sig
n u
p t
od
ay.
as
we fo
rge a
head
to
Ele
ctio
n D
ay, i
ask
each o
f yo
u r
ead
ing
this
to
take
actio
n a
nd
get
invo
lved
in t
he
no
on p
rop
. 46
cam
paig
n. t
o fi
nd
out
mo
re in
form
atio
n a
bo
ut
the is
sue a
nd
how
yo
u c
an h
elp
ed
ucate
yo
ur
colle
ag
ues,
patients
, and
neig
hb
ors
, vis
it n
oo
n4
6.c
om
to
day
.
Sin
cere
ly,
Ric
hard
tho
rp, M
Dp
resi
dent, c
alif
orn
ia M
ed
ical a
sso
cia
tio
n
*P
le
as
e P
os
t i
n P
hy
sic
ian
co
mm
on
ar
ea
s*
Dear
San D
ieg
o C
ou
nty
Physi
cian
:
As ph
ysici
ans,
it is
our j
ob to
pr
ovide
care
for
and p
rote
ct ou
r pa
tient
s — bu
t Pr
op. 4
6 do
es
just t
he op
posit
e.
on n
ov.
4, 2
014
, vote
rs w
ill b
e a
sked
to
weig
h in
on p
rop
osi
tio
n 4
6, a
co
stly
ballo
t m
easu
re t
hat
will
make
it e
asi
er
and
mo
re p
rofita
ble
fo
r la
wyers
to
sue d
octo
rs, c
om
munity h
ealth c
linic
s, a
nd
ho
spitals
, resu
ltin
g
in b
illio
ns
in in
cre
ase
d h
ealthcare
co
sts
annually
.
pro
p. 4
6 is
bein
g d
isg
uis
ed
by t
he t
rial l
awyer
spo
nso
rs a
s a m
easu
re t
hat
will
“in
cre
ase
patient
safe
ty,” b
ut
we k
now
it’s
really
just
ab
out
seeki
ng
chang
e t
o a
curr
ent
law
that
will
allo
w p
rop
onents
to
file
mo
re m
ed
ical
law
suits
ag
ain
st h
ealthcare
pro
vid
ers
.
if t
he t
rial l
awyers
get
their w
ay, m
ed
ical l
awsu
its
and
pay
outs
will
skyro
cke
t and
so
meo
ne w
ill h
ave t
o p
ay t
he p
rice.
calif
orn
ia’s
no
np
art
isan l
eg
isla
tive
analy
st h
as
take
n a
clo
se lo
ok a
t p
rop
. 4
6 a
nd
co
nclu
ded
that
it c
ould
incre
ase
sta
te a
nd
local g
ove
rnm
ent
healthcare
co
sts
by “
hund
red
s of
mill
ions
of
do
llars
annually
.”
We k
now
that
these
incre
ase
d c
ost
s w
ould
red
uce f
und
ing
availa
ble
fo
r vital s
tate
and
local g
ove
rnm
ent
serv
ices
like p
olic
e, fi
re, s
oci
al s
erv
ices,
park
s, li
bra
ries
… a
nd
the li
st g
oes
on. R
eally
, this
is ju
st a
noth
er
exa
mp
le o
f tr
ial a
tto
rneys
pulli
ng
mo
ney d
irectly o
ut
of
the h
ealthcare
deliv
ery
syst
em
and
our
com
munitie
s to
line t
heir o
wn p
ocke
ts.
as
physi
cians,
it is
our
job
to
pro
vid
e c
are
fo
r and
pro
tect
our
patients
— b
ut
pro
p. 4
6 d
oes
just
the
op
po
site
. taxp
ayers
acro
ss t
he s
tate
will
be o
n t
he h
oo
k fo
r hund
red
s of
mill
ions
of
do
llars
in in
cre
ase
d
state
and
local g
ove
rnm
ent
cost
s each y
ear
and
co
uld
lose
critical s
tate
and
locally
pro
vid
ed
serv
ices
that
so m
any c
ount
on.
that’s
just
how
pro
p. 4
6 w
ill im
pact
state
and
local g
ove
rnm
ent
co
sts.
an in
dep
end
ent
stud
y e
stim
ate
s th
at
this
pro
po
sitio
n w
ill in
cre
ase
healthcare
co
sts
acro
ss a
ll se
cto
rs b
y a
lmo
st $
10 b
illio
n a
nnually
. H
ow
do
es
that
aff
ect
patients
thro
ug
ho
ut
calif
orn
ia?
it t
ransl
ate
s to
ab
out
$1,0
00
per
year
in h
igher
healthcare
co
sts
for
a f
am
ily o
f fo
ur.
fo
r m
any f
am
ilies,
that’s
the d
iffe
rence b
etw
een b
ein
g a
ble
to
aff
ord
g
roceries
or
healthcare
each m
onth
.
if y
ou h
aven’t s
igned
up
to
op
po
se p
rop
. 46
, ple
ase
vis
it n
oo
n4
6.c
om
and
join
the c
oalit
ion t
od
ay —
the
price t
o o
ur
patients
is t
oo
gre
at
to r
isk it
.
pro
p. 4
6 w
as
writt
en b
y t
rial a
tto
rneys
for
tria
l att
orn
eys
— n
ot
for
the p
atients
of
calif
orn
ia w
ho
will
be
forc
ed
to
pay
, pla
in a
nd
sim
ple
.
if y
ou h
aven’t s
igned
a “
no
on p
rop
46
co
mm
itm
ent
card
” o
r p
led
ged
to
be a
co
ord
inato
r at
yo
ur
ho
spital,
vis
it c
manet.o
rg/m
icra
and
sig
n u
p t
od
ay.
as
we fo
rge a
head
to
Ele
ctio
n D
ay, i
ask
each o
f yo
u r
ead
ing
this
to
take
actio
n a
nd
get
invo
lved
in t
he
no
on p
rop
. 46
cam
paig
n. t
o fi
nd
out
mo
re in
form
atio
n a
bo
ut
the is
sue a
nd
how
yo
u c
an h
elp
ed
ucate
yo
ur
colle
ag
ues,
patients
, and
neig
hb
ors
, vis
it n
oo
n4
6.c
om
to
day
.
Sin
cere
ly,
Ric
hard
tho
rp, M
Dp
resi
dent, c
alif
orn
ia M
ed
ical a
sso
cia
tio
n
16 au gus t 2014
poEtRy anD MEDicinE
in the MytholoGy of ancient Greece, the Fates were envisioned as three sisters. Clotho spun the thread of life. Lachesis measured out the specific length allocated to a person. Atropos — the most feared of the sisters — cut the life-thread when their time had come. So powerful was their work that even the Olympian Gods had to defer to them. The words “fatal” and “fatalism” carry the meaning into English.
Modern medicine is assigned the task of interrupting the work of these sisters. Reproductive technologies allow the life thread to be spun where it would other-wise not be possible. Day-to-day medicine and surgery extends the length of the life thread of patients with everything from abdominal aortic aneurysm to zoster. Emergency interventions in the ED, OR, and ICU push away the horrible scissors of
fatelife is Measured out by Daniel J. Bressler, MD, FACP
Atropos, at least for a while.And yet we know our medical victo-
ries are only temporary. Sometimes I only half-jokingly say to my long-term primary care patients that medicine doesn’t really prevent anything, it just delays things. Our work puts off fate — the Fates — for another day, but only does that. The patient whose unstable angina has been relieved by a stent or bypass is still at high risk for progressive atherosclerosis. The cancer patient in remis-sion knows all too well that hidden chemo-resistant malignant cells pose a recurrence threat. Even the most successful total hip replacement has a limited durability. In medicine we know that we will eventually lose the war with disease. It is our particular and distinct assignment to win as many battles as we can on the way to that loss.
Life Is Measured Out is an acknowledge-ment that all human endeavors operate inside the limits prescribed by the fates of our genes and our circumstances. We learn, along with the proud and powerful Olym-pian gods, that the Three Sisters will have their due.
Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Com-mittee at Scripps Mercy Hospital and a longtime contributing writer to San Diego Physician.
life is Measured outLife is measured out in stringEach day a portion’s severedNo prayer or magic spell can bringThe separate ends together
Life is measured out in threadA hidden spool unravelingInfluencing till you’re deadThe boundaries of your traveling
Life is measured out in ropeSilken bits and knottedFashioned into dream and hopeAnd wrapped round your carotid
Life is measured out in stringEach day you get your sectionA fickle circumstantial thingSent off in one direction
Life is measured out in threadSome longer, others shorterAll your rush to get aheadWill scarce affect that order
Life is measured out in ropeA final length is scissoredYears of “yes” then one last “nope”You’re off to see the Wizard.
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18 au gus t 2014
Be a Role Model foR YouR Patients!
P u b l i c h e a lt h
Learn How the SDCMS Foundation Can Help by barbara manDel anD Kathleen KramberG
sa N D I EgO P H YsI C I a N .O rg 19
the key to creating a healthier so-ciety starts in the doctor’s office. Patients look to their physicians for guidance on how to take care
of themselves, very often emulating their doctors’ actions. With this in mind, physi-cians are critical to improving community health.
“Physicians serve as role models to their patients, their staff, and even their friends and family,” says Mihir Parikh, MD, a volunteer physician with Project Access San Diego, the SDCMS Foundation’s flagship program. “Their sphere of influence extends beyond the office they practice in, so it’s very important for doctors to use this influ-encing force and serve in the communities in which they practice and reside. It’s very easy: Just get involved! Run in the local 5K, speak up at health events, volunteer in com-munity groups. I think doctors who do this will very quickly realize this is even more satisfying and rewarding than their ‘day job.’ Improving the health of the commu-nity builds a more vibrant, active, engaged population.”
Physicians advocating healthier habits and improving community healthThe important role that physicians play in community health has led the SDCMS Foundation to create opportunities for phy-sicians to become more actively engaged in advocating healthier habits and improving community health. The SDCMS Foundation is moving from its origins of only treat-ing illness to creating wellness through new programs that focus on education and prevention.
In 2010, the County of San Diego Health and Human Services Agency released a study showing that primarily preventable, chronic diseases are playing a significant role in the deaths of people living in San
20 au gus t 2014
chronic diseases such as type 2 diabetes are seen all too frequently. “As the saying goes, an ounce of prevention is worth a pound of cure. If we can prevent patients from becoming diabetic with the complications that could ensue, we are providing them with a recipe for a longer and healthier life,” says Dr. Ray. Patients are coming to the Project Access program sicker and in need of more intensive treatment. It has become clear that preventive healthcare services are imperative to improving the health of the community.
Eileen Natuzzi, MD, another Project Ac-cess San Diego volunteer, was instrumental
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Diego County. In fact, they discovered that three behaviors — diet, exercise, and to-bacco use — contributed to the four diseases that caused 50% of the deaths in the county. The report emphasized the importance of changing these behaviors and the profound impact such a change would have not only on the lives of San Diego residents but for the community as a whole.
Since then, the County of San Diego has launched its Live Well San Diego initiative, focused on improving the health, safety, and wellbeing of all residents. With prevention playing such a huge role in this initiative, physicians can serve as health role models for patients while at the same time offering their expertise and guidance to the commu-nity. The SDCMS Foundation has created two new programs, aligned with Live Well San Diego, to provide physicians with the opportunity to do just that.
Jump start for healthJump Start for Health will focus on helping patients adopt healthier habits to prevent diabetes. The majority of patients seen through Project Access are suffering from many co-occurring conditions, with diabe-tes being the most prevalent. Complications from diabetes, such as cataracts, are one of the most frequent illnesses Project Access patients are treated for. Changing three habits — eating healthier foods, increas-ing physical activity, and ceasing tobacco use — can go a long way to help prevent chronic diseases like certain cancers, heart disease, stroke, type 2 diabetes, and respira-tory conditions. Al Ray, MD, president of the SDCMS Foundation, works as a family medicine physician where preventable
the important role that physicians play in community health has led the sDcms Foundation to create opportunities for physicians to become more actively engaged in advocating healthier habits and improving community health.
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sa N D I EgO P H YsI C I a N .O rg 23
“if we can prevent patients from becoming diabetic with the complications that could ensue, we are providing them with a recipe for a longer and healthier life.”
in the creation of Jump Start for Health. Through her work as a general surgeon and her volunteer efforts overseas, she saw firsthand the important role a physician plays in assisting their patients in living healthier lives. She is especially vocal about the increased need for specialty physicians, specifically surgeons and emergency room physicians, to educate patients on wellness and healthy living.
Dr. Natuzzi believes that when a patient is seen at a specialty healthcare appointment or presents in the emergency department, a critical teaching moment occurs. Unlike at a routine physical where there are usually no health issues to address, patients being seen by a specialist or in the emergency department are worried about their health. Advice from a doctor at that point in time can be very persuasive. Dr. Natuzzi believes specialists and emergency physicians have a duty to use this moment to benefit the patient. Dr. Natuzzi believes these acute care situations provide “opportunities to initiate healthy behavior education during this receptive ‘teachable’ period.”
Because of this, Dr. Natuzzi helped the SDCMS Foundation create Jump Start for Health to focus on helping at-risk patients prevent diabetes through an initial inter-vention in the emergency department. After the intervention, patients will be connected to a health coach at the SDCMS Founda-tion who will guide them through gradual behavior changes designed to improve their health.
Jump Start for Health will begin through a partnership with the UC San Diego Health System emergency department. Physi-cians there will be trained in interventions with patients that present with symptoms indicative of a predisposition to develop-ing diabetes. Patients will work one on one with specially trained health coaches over a period of one year and will eventually be trained to serve as health coaches for others in the community.
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“Physicians are the obvious leaders to promote health and wellness, and, if each doctor made their community better by being a good role model, i think we can make san Diego the healthiest and finest city in america.”
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Live Well San Diego speakers bureauThe SDCMS Foundation is also partner-ing with the County of San Diego Health and Human Services Agency to provide physicians with another avenue to further promote wellness within the community. Through the Live Well San Diego Speakers Bureau, physicians will speak throughout the county on topics focused on wellness, prevention, and other related healthcare issues. During the first year, the SDCMS Foundation hopes to partner with at least
my patients about healthy habits if I am liv-ing them too. Doctors really need to practice what they preach. This is why I am happy to be the captain of Team IGO, a team of physi-cians, staff, and patients for a healthier San Diego.” Funding from the 5K will benefit the Jump Start for Health program.
Physicians are encouraged to sign up teams. For more information on creating teams, please contact Kathleen Kramberg at [email protected] or at (858) 565-7930.
conclusionThrough each of these initiatives, the SD-CMS Foundation hopes to make it easy for physicians to improve community health. Perhaps Dr. Parikh sums the impact physi-cians can have on community health best by saying, “Physicians are the obvious leaders to promote health and wellness, and if each doctor made their community better by be-ing a good role model, I think we can make San Diego the healthiest and finest city in America.”
Ms. Mandel is executive director of the SDCMS Foundation, and Ms. Kramberg is its grants and communications manager.
20 physicians. Through this program, physicians will have the chance to offer their expertise and engage community members outside of the medical profession.
inaugural solana beach sunset 5K run/WalkThese wellness initiatives will kick off with the SDCMS Foundation’s inaugural Solana Beach Sunset 5K on Saturday, September 27. The family fun run/walk on the beach at sunset will be followed by a wellness expo featuring local businesses that focus on healthy living. Physicians are encouraged to sign up teams composed of their patients and office staff. Each physician team of 20 or more will receive free personalized team t-shirts. Similar to “Walk with a Doc” pro-grams, run/walk teams where physicians participate alongside their patients will allow physicians to motivate their patients to get active and live healthier lives.
Wendy Buchi, MD, another Project Ac-cess San Diego volunteer physician, has al-ready signed up a team. “People’s behaviors, especially good diets and exercise, can affect health as much if not more than medical treatments,” says Dr. Buchi. “As a doctor, I know that it is much easier for me to counsel
all san diego CountY PhYsiCians
Join sdcms for a networking oPPortUnity and mixer
fRidaY, sePteMBeR 125:30 P.M. to 8:30 P.M.
Rock Bottom Restaurant & Brewery8980 Villa La Jolla Drive, La Jolla, CA 92037
all physicians are welcome and encouraged to attend. come mingle, socialize, and network with your fellow
San Diego county physicians! complimentary hors d’oeuvres and drinks will be served!
sa N D I EgO P H YsI C I a N .O rg 25
to RsVP, email your name and telephone number to Jen at
[email protected]. Questions? Call Jen at (858) 300-2781.
26 au gus t 2014
tO suBMIt a CLassIFIED aD, email kyle lewis at [email protected]. sdcms members place classified ads free of charge (excepting “services offered” ads). nonmembers pay $150 (100-word limit) per ad per month of insertion.
claSSifiEDS tified a plus. Please email CV to [email protected]. [262]
PHYSICIAN WANTED — LA MESA / EL CAJON: Busy internal medicine practice with strong focus in geriatric pa-tients is currently hiring a physician. Efficient, team player with compassion towards patient care is expected. Ability to use computerized EHR is important; Speech recognition Program is available for efficient documentation. Weekly / biweekly education program, including specialists’ topic discussion as well as patient case presentation are provid-ed. Hard work, dedication, compassion, and communica-tion skills are required. Job satisfaction will be guarantied. Opportunity to enhance the income by rounding at Gross-mont Hospital and skilled nursing facilities is provided . In-ternal medicine work experience is desired; compensation is competitive and partnership opportunity is offered. You can apply with your CV to [email protected]. [261]
JOIN HOUSE CALL DOCS INC., a dynamic group of pio-neering healthcare practitioners striving for excellence while developing sound socioeconomic models of health-care delivery. Our mobile / primary care / specialty prac-tice complements our panoramic outpatient practices in primary care, pain management, oncology, cardiology, gastroenterology, infectious diseases, and psychiatry. Pay is among the best in the country, with part-time in-come in the 150K range (exclusive of incentives/bonuses). A good fit is essential. Interview questions should be di-rected to Dr. Wolfram Forster, Senior Partner, House Call Docs Inc., at 1855 B Street, Suite 200 B, San Diego, CA 92101; phone (619) 793-7988; or email [email protected]. [260]
SEEKING P/T PEDIATRICIAN to join fun, well estab-lished pediatric practice. Opportunity to grow and long-term commitment for the right candidate. Office has EMR and stable staff. No nighttime call and occasional week-end clinic. Great family location. For more information, send CV to [email protected]. [259]
OPHTHALMOLOGIST NEEDED: Part-time to work in a North County office, 2 to 3 days per week. Potential for full-time or buy-in. If interested, please respond to [email protected]. All replies confidential. [257]
BE IN CHARGE OF YOUR OWN DESTINY! If you are a general internist interested in becoming your own boss, this may be the opportunity for you. Patients from the practice of a retiring general internist on the campus of Scripps La Jolla need a new physician. You would be shar-ing an office and overhead with another general internist who is well established on the campus and can help you make all the connections to accelerate and grow your practice. Part-time practice is even possible. Interested? Please email [email protected]. [254]
PART-TIME INTERNIST NEEDED: Work in an outpatient office on the campus of Scripps La Jolla. Must be board certified and have had experience treating in the primary care setting. Available immediately, with flexible hours and days. For more information, please send a CV or request for more information to [email protected]. [255]
DERMATOLOGIST NEEDED: Board-certified or board-eligible dermatologist is needed for busy, well-established East County San Diego (La Mesa) private practice. We currently have an immediate opening for a CA-licensed dermatologist to work 2–3 days per week with the potential for full-time covering for existing phy-sicians, whenever needed. We are a full-service derma-tology office providing general, cosmetic, and surgical services, including Mohs surgery, and are seeking a candidate with a desire to provide general dermatology care to our patients, but willing to learn laser and cos-metics as well. If interested, please forward CV to [email protected]. [253]
LOOKING FOR FULL-TIME FAMILY PRACTICE PHY-SICIAN: Neighborhood Healthcare is an award-winning organization that is known for excelling at its mission. The mission has remained the same over the years: to provide quality healthcare and promote wellness to everyone in our communities. We are looking for a full-time family practice physician to provide comprehensive medical ser-vices for members of the community, regardless of age or sex, on a continuing basis at our busy healthcare clinic
PHYSICIAN POSITIONS WANTED
LOOKING FOR PART-TIME POSITION IN PEDIATRICS: My name is Rafael Garcia, and I have been a board-certi-fied pediatrician since 1996. I am looking for a part-time, outpatient position in pediatrics. I can work Tuesdays from 1pm to 11:00pm, and I can also work evenings from 5pm to 11:00pm (Monday–Wednesday). I have been in practice for 20 years, recertified in pediatrics in April 2013. My phone number is (619) 990-6218 (I can be reached after 5pm), and my email is [email protected]. [246]
PHYSICIAN POSITIONS AVAILABLE
PSYCHIATRY PHYSICIAN OPPORTUNITIES: South Bay practice seeking a B/C, B/E psychiatrist licensed to prac-tice medicine in the state of California. Opportunity for clinical research / clinical trial duties in an outpatient office setting. Professional liability insurance required. Contract salary of $200,000, or commensurate with experience. Please send CV/resume to [email protected]. [274]
SEEKING LICENSED PRIMARY CARE, INTERNAL MEDICINE, EMERGENCY ROOM, AND FAMILY PRAC-TICE MD’S: American Correctional Solutions (ACS) is cur-rently seeking licensed primary care, internal medicine, emergency room, and family practice MDs to work within California State facilities. Named one of INC Magazine’s fastest growing private companies, ACS offers healthcare professionals full-time, part-time, and per-diem opportuni-ties. Our primary care, family medicine, or internal medi-cine physicians will provide primary care medical services at a facility housing patients with high-risk chronic care issues. Typical patients have multiple medical problems, including chronic hepatitis C virus (HCV) infection, cirrho-sis of the liver, hypertension, diabetes, and chronic pain disorders. Our PCPs will also treat common illnesses man-aged in an adult urgent care setting. Send CV to [email protected] or call (877) JAIL-DOCS. To hear why physicians enjoy working for ACS, please view our tes-timonials video at www.correctionalsolutions.com. [269]
LOOKING FOR EXPERIENCED GENERAL PRACTICE / EMERGENCY MEDICINE PHYSICIAN: Full-time or part-time position available for experienced general practice / emergency medicine physician in a busy urgent care cen-ter. Must be available to work days, evenings, weekends, and holidays. Please send your CV along with references to [email protected] or fax to (858) 274-9614. Pacific Beach Urgent Care established since 1982. Open week-days 8–8 / weekends & holidays 8–4. [271]
PSYCHIATRISTS NEEDED: Full-time or part-time posi-tions available for a well managed program at San Diego County correctional facilities. Telepsychiatry position also available. Flexible hours with very competitive pay. Send CV to [email protected] or call (619) 885-3907. [272]
PRIVATE PRACTICE, PART-TIME IM/FP OPPOR-TUNITY: Unusual and exceptionally attractive private practice, primary care opportunity in beautiful North San Diego County. Well-established, collegial, single-specialty internal medicine group with >30 years in the community, exceptional office staff, and very high quality patient care set this far apart from many other situations. Option for 1–2 days/week with flexible scheduling; very attractive op-portunity as an add-on to other part-time work. Interested in board-certified IM or FP applicants with EHR experi-ence. Please email CV to [email protected] or call (619) 248-2324. [263]
SEEKING FAMILY PRACTICE / INTERNAL MEDICINE PHYSICIAN: Join an exciting group with tremendous growth potential in a collegial atmosphere! Artemis Medi-cal Group is currently seeking a part-time possible full-time family practice / internal medicine physician to join our new medical group in Hillcrest. The right candidate will be at the forefront of launching this clinic. Candidate must be able to work independently, must have strong leadership skills and excellent communication skills. Able to provide supervision to mid-level providers. Knowledge of EMR/EHR and bilingual (English/Spanish) helpful. We offer a full benefit package. Competitive salary. Board cer-
in Temecula. Great benefits. Requirements: CA license, DEA license, CPR certification, obtain and maintain board certification. To apply please send your resume to [email protected]. [247]
PHYSICIAN WANTED, BEAUTIFUL NORTH SAN DI-EGO COUNTY: Ambitious and attention to detail general family medicine / geriatrics / long-term care physicians to join our team of professionals that make “housecalls.” We serve chronically ill patients in their homes. No hospital call, M–F, 8–5, independent contractor, occasional on-call pager, 10–12 patients per day. We are a very relaxed, pro-fessional practice environment. We very much look for-ward to your call at (760) 591-9975. [242]
SEEKING PER-DIEM, BOARD-CERTIFIED FAMILY MEDICINE PHYSICIAN: The Sycuan Band of the Kumey-aay Nation, located in east El Cajon, is seeking a per-diem family medicine physician for our medical clinic. Must have current, unrestricted CA and DEA licenses, at least three years of experience working as a medical physi-cian, and CPR certification. Bilingual English / Spanish preferred. Salary commensurate with experience, mal-practice coverage provided. Please email CV to Teresa Mogielnicki, MD, at [email protected] or fax to (619) 445-0988. [243]
LOOKING FOR A DERMATOLOGIST: Medical spa locat-ed in East County looking for a dermatologist who would like to buy into a very lucrative practice or willing to be a medical director. For more information, please call Dr. Shirin Dorin at (619) 456-4555. [238]
LOOKING FOR A RETIRED PHYSICIAN: Medical spa lo-cated in East County looking for a retired physician for a part-time position as a medical director. For more informa-tion, please call Dr. Shirin Dorin at (619) 456-4555. [239]
BOARD-CERTIFIED PHYSICIANS, PHYSICIAN ASSIS-TANTS, AND NURSE PRACTITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right candidate. Must possess a current California medical license and ACLS certification. Please email or fax CV to (619) 569-2590. Visit www.DoctorsExpressSanDiego.com for more information. [229a]
SEEKING A PART-TIME BC/BE INTERNAL MEDICINE PHYSICIAN: SHARP Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking a part-time BC/BE internal medicine physician to join our staff at our Genesee location. We offer a first-year compet-itive-compensation guarantee and an excellent benefits package. Please email CV to [email protected]. [204]
SEEKING A PART-TIME BC/BE INTERNAL MEDICINE / PEDIATRICS OR FAMILY MEDICINE PHYSICIAN: SHARP Rees-Stealy Medical Group, a 450+ physician multi-specialty group in San Diego, is seeking a part-time BC/BE internal medicine / pediatrics or family medicine physician to join our staff at our Carmel Valley location. We offer a first-year competitive-compensation guaran-tee and an excellent benefits package. Please email CV to [email protected]. [205]
FULL-TIME OR PART-TIME URGENT CARE PHYSI-CIAN: Busy practice in El Cajon, established in 1982, seeks a full-time and/or part-time physician. Good hours (mostly 9:00am–5:30pm weekday shifts with some weekends from 9:00am–4:00pm and closed on major holidays) plus good pay. Please send CV to [email protected] or fax to (619) 442-2245. [161]
PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 992-5330 or email CV to [email protected]. Visit www.thehousecalldocs.com. [037]
PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private nonprofit outpatient clinic serving the communities of North San Diego County, has opening for part-time, per-diem posi-tions. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English/Spanish preferred. Forward resume to [email protected] or fax to (760) 414-3702. Visit our website at www.vistacommuni-tyclinic.org. EEO Employer/Vet/Disabled/AA [912]
sa N D I EgO P H YsI C I a N .O rg 27
stalled. Free patient parking. Close to public transporta-tion and freeways. 969 square feet. $1,500/month. Con-tact [email protected]. [266]
DEL MAR / CARMEL VALLEY MEDICAL OFFICE FOR SUB-LEASE: Available October 2014 (4765 Carmel Mountain Rd., San Diego, CA 92130). 1,000SF. Two treat-ment / consultation rooms / office reception / photogra-phy room / break room. Unlimited patient free parking. Call (858) 481-4888 or email [email protected]. [252]
SCRIPPS XIMED MEDICAL CENTER BLDG, LA JOLLA — OFFICE SPACE TO SUBLEASE AVAILABLE: Vascu-lar & General Surgeons have space available. One room consult office available, with one or two exam rooms, to a physician or team. Located on the campus of Scripps Me-morial Hospital, The Scripps Ximed Medical Center is the office space location of choice for anyone seeking a pres-ence in the La Jolla/UTC area. Reception and staff may be available. Complete ultrasound lab on site for scans or studies. Full-day or half-day timeslots. For more informa-tion, call Irene at (619) 840-2400. [154]
NORTH COAST HEALTH CENTER, 477 EL CAMINO REAL, ENCINITAS, OFFICE SPACE TO SUBLEASE: Well-designed office space available, 2,100SF, at the 477-D Bldg. Occupied by Vascular & General Surgeons. Excel-lent and central location at this large medical center. Nice third-floor window views, all new exam tables, equipment, furniture, and hardwood floors. Full Ultrasound lab with tech on site, doubles as procedure room. Will sublease partial suite, one or two exam rooms, half or full day. Will consider subleasing the entire suite, totally furnished, if there is a larger group interest. Plenty of free parking. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. [153]
LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805. Mul-tidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127]
POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage therapist. Low rates. Email inquiries to [email protected]. [173]
SCRIPPS ENCINITAS CONSULTATION ROOM/EXAM ROOMS: Available consultation room with two examina-tion rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Receptionist help provided if needed. Contact Stephanie at (760) 753-8413. [703]
POWAY / RANCHO BERNARDO — OFFICE FOR SUB-LEASE: Spacious, beautiful, newly renovated, 1,467SF furnished suite, on the ground floor, next to main en-trance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease / satellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at [email protected]. [873]
BUILD TO SUIT: Up to 1,900ft2 office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics prac-tice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated park-ing spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable. Contact [email protected] or (619) 504-5830. [835]
SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reason-able rent. Please email [email protected] for more information. [867]
NONPHYSICIAN POSITIONS AVAILABLE / WANTED
LOOKING FOR A CLINIC SERVICE MANAGER: San Ysidro Health Center is a growing community-based health clinic. We are looking for a clinic service manager to join the organization. Under the supervision of the di-rector of clinics and the mandate of Federally Qualified Health Centers (FQHC), the clinic services manager (CSM)
SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT FOUR-DAYS-PER-WEEK POSITION: Private practice in La Mesa seeks pediatrician four days per week on partnership track. Modern office setting with a reputation for outstanding patient satisfaction and re-tention for over 15 years. A dedicated triage and educa-tion nurse takes routine patient calls off your hands, and team of eight staff provides attentive support allowing you to focus on direct, quality patient care. Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, round-ing on newborns, and occasional admission, NO delivery standby or rushing out in the night. Benefits include tail-covered liability insurance, paid holidays/vacation/sick time, professional dues, health and dental insurance, uni-forms, CME, budgets, disability and life insurance. Please contact Venk at (619) 504-5830 or at [email protected]. Salary $ 102–108,000 annually (equal to $130–135,000 full-time). [778]
PRACTICE FOR SALE
SOLO OPHTHALMOLOGIST PRACTICE FOR SALE IN NORTH COUNTY: Physician retiring. Earn-out possible. If interested, please respond to [email protected]. All replies confidential. [258]
LOW-STRESS, GYNECOLOGY-ONLY PRIVATE PRAC-TICE FOR SALE: Turnkey operation. One employee and low overhead, month-to-month lease. Minimal HMO. Per-fect part-time work or add obstetrics. Various arrange-ments available. Email [email protected]. [203]
PRACTICE FOR SALE: Comprehensive Sleep Medicine Practice with Integrated American Academy of Sleep Medicine-accredited Sleep Testing Center. 2013 revenue $550,000. Well-known for expertise in the diagnosis and treatment of sleep disordered breathing and offering the full range of treatment options (PAP therapy, dental ap-pliances, surgery). Both facility-based and home sleep testing performed with active referrals. Attractively furnished with up to date equipment and furnishings. Third-party appraisal available. Selling due to health is-sue, and offered for quick sale at a very attractive price. Small practice subset in minimally invasive nasal and sinus treatment may also be included in any transaction. Please contact [email protected]. [250]
OFFICE SPACE WANTED
BANKERS HILL PRIMARY CARE / HEALTHCARE PROFESSIONAL & RESEARCH OFFICE SPACE TO SUBLEASE: 50-year established primary care practice and clinical research office, with currently two internists, have space to sublease to another primary care or prima-ry care / subspecialist, or other independent healthcare professional, to help curb overhead and, if primary care, help with acute overflow patients’ needs. Also can provide opportunity to get into clinical research. Contact Jeff at [email protected]. [265]
3998 VISTA WAY, IN OCEANSIDE: Four medical office spaces approximately 1,300–2,800SF available for lease. Close proximity to Tri-City Hospital with pedestrian walk-way connected to parking lot of hospital, and ground-floor access. Lease price: $1.75+NNN. Tenant improvement allow-ance to customize the suites is available. For further infor-mation, please contact Lucia Shamshoian at (760) 931-1134, ext. 13, or at [email protected]. [234]
HAND SURGEON LOOKING FOR PART-TIME OFFICE LOCATION: Looking for space to share in La Jolla to Del Mar areas. Limited space and time needs. One-half to one day per week. We have flexibility to accommodate your schedule and staffing. Please contact me at [email protected]. [231]
OFFICE SPACE AVAILABLE
OFFICE SPACE AVAILABLE FOR SUBLEASE ON SHARP CHULA VISTA CAMPUS: One to four days per week available — currently leased to neurologist one day a week. 600 square feet, two treatment rooms, one con-sultation room, bathroom, reception — all rooms furnished. Beautiful view of the coast, short walk to the hospital lob-by. Pharmacy in the building. Free parking. Ideal satellite office to establish presence in the area. Cost $450/month/day. Contact Dr. Walter M. Shaw at (619) 472-1555. [268]
MEDICAL OFFICE IN LA MESA — LOW PRICE! Fully functional medical office, ready for move in. In perfect condition. Fully furnished or empty, depending on your needs. Large reception area, one office, two exam rooms, restroom. Lots of storage space. Internet, phones — in-
is accountable for the effective and efficient daily op-eration of the clinic(s) regarding patient satisfaction and business and financial matters. Requirements include a bachelor’s degree and four years of experience as a clinic manager or administrator in ambulatory health center or community health clinic. Please visit us at www.syhc.org and reference job number 14-0416. [270]
PSYCHIATRIC NURSE PRACTITIONER NEEDED: For part-time or full-time work at San Diego County cor-rectional facilities. Flexible hours and very competitive pay. Send CV to [email protected] or call (619) 885-3907. [273]
POSITION OPEN FOR A CALIFORNIA LICENSED PSYCHIATRIC PA/NP IN IMPERIAL COUNTY: The ideal candidate is a self-driven individual interested in relocating to Imperial County, who is able to communi-cate in Spanish, computer skilled, and likes the challenge of working in an underserved community. Experience is not required; we will train you. Relocation expenses are covered. Base salary plus productivity bonus. Our com-munity qualifies for loan repayment program. Part-time positions also available. For more information, contact Cruz Lopez-Castleberry at (760) 355-0161 or at [email protected]. [251]
BEHAVIORAL HEALTH CONSULTANT: The behavioral health consultant, as part of the primary care treatment team, identifies, triages, and manages primary care patients with medical and behavioral health problems. In addition, the BHC will provide skill training through psycho-education and patient education strategies and develop specific behavioral change plans for patients. The BHC assists primary healthcare providers in recog-nizing and treating mental disorders and psychosocial problems, assists in detection of “at-risk” patients, and assesses the clinical status of patients referred by the PCP. Education / Certification: PsyD/PhD in psychol-ogy or LCSW; CPR certification (including BLS). Contact Araceli Mercado at [email protected] or at fax (760) 736-870. [244]
SUPERVISORY RN — MISSION MESA PEDIATRICS: Under the direction of the health center director / prac-tice manager, and in collaboration with the nursing ser-vices director, supervise the delivery of quality medical care with optimal efficiency and patient satisfaction. Job Skills: Ability to relate to and work with people of all ages, social and ethnic backgrounds, and maintain patient con-fidentiality. Ability to work independently and as part of a team. Knowledge and Education: Current California state registered nurse license, current CPR certificate required. Bilingual (English / Spanish), baccalaureate level of con-ceptual thinking. Experience: Four or more year’s general nursing experience in ambulatory care, including one year supervisory experience. Please apply at https://rew31.ul-tipro.com/NOR1021/JobBoard/ListJobs.aspx. [241]
BOARD-CERTIFIED PHYSICIANS, PHYSICIAN ASSIS-TANTS, AND NURSE PRACTITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right candidate. Must possess a current California medical license and ACLS certification. Please email or fax CV to (619) 569-2590. Visit www.DoctorsExpressSanDiego.com for more information. [229b]
NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email [email protected]. Visit www.thehousecalldocs.com. [152]
PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email [email protected]. Visit www.thehousecalldocs.com. [038]
MEDICAL EQUIPMENT
MEDICAL CHART RACKS FOR SALE: We have five seven-foot-tall chart racks, each one three feet wide with seven shelves. They are sturdy and tan or putty-colored. Price negotiable. Call Linda at (760) 724-8749. [267]
ENT AND FACIAL PLASTIC EQUIPMENT FOR SALE: We have ENT general office and exam room as well as OR equipment available. Also many excellent plastic surgery instruments for sale. ENT chairs, powered exam table, ear microscope, Kay strobe and Endodigi video unit, au-toclave, ultrasonic cleaner, portable suctions, etc. Photos available. Call if interested: (858) 458-1287. [264]
28 au gus t 2014
fUnny thinG aboUt freedom. We Americans believe strongly in the concept of freedom and will risk our lives for freedom around the world. And yet, many people live day to day with no sense of freedom at all — they feel trapped in their own lives. What keeps us wrapped in a straightjacket of work and personal responsibili-ties, unable to create a life of our choosing?
Often we are lulled into the feeling that life will go on for-
ever and a better time will come for those things we want to do. Tomorrow, I’ll call that friend. I’ll finish that project next month. Next year, I’ll take that vacation. As we all know, time goes by in its stealthy way. We never get around to many things and feel heavy with regret. We had so many dreams when we were young — how did we let our life slip by without making them a reality?
In other ways, we feel as if we are living in a box, unable
Choose freedomWhen will you take a stand for your life?by Helane Fronek, MD, FACP, FACPh
pERSonal & pRofESSional DEVElopMEnt
voice weren’t filling your mind and defeating your spirit.
Reinforcing that box around us is the impression that we need to make big changes in order to create the shifts that will lead to a happier and more fulfilled life. It’s important to not let the perfect be the enemy of the good. Even small things can make a difference. And as our life becomes more fulfilling, we’ll have more confidence that we can accomplish even greater and more meaningful change.
So when will you take a stand for your life? Let’s all honor the revolutionary spirit of those who fought for our freedom by getting in touch with our own bravery and making choices that will mold our days into the life we want to be living. Pick one thing you have wanted to do. What needs to happen for you to make it a reality? What obstacles need to be moved? What steps can you take now to add it to your life? Once you’ve accomplished it, take a moment to savor how good it feels. Ac-knowledge your courage, your dedication to your own freedom and your own life. And then decide what you want next.
Dr. Fronek, SDCMS-CMA mem-ber since 2010, is assistant clini-cal professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.wordpress.com.
Acknowledge your courage, your dedication to your own freedom and your own life.
to penetrate beyond its walls where we imagine fun, excite-ment, and personal growth might reside. Instead, the responsibilities of work and life expand to fill our time. “It’s just the way it is,” we say to ourselves.
But if we look, we see people who have climbed over the walls of their boxes. They cast aside the same limitations that keep us contained and demanded the freedom that we yearn for.
What makes it possible for them and not for us?
One factor that keeps us stuck is the negative messages we tell ourselves. “You’ll never be able to do that.” “What gives you the right to do that?” Do these mes-sages sound familiar? Consider what you would really do if that
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