January 2015

“Physicians United for a healthy san diego”

Improving Health, Changing Lives

official publication of SDcMS January 2015

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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 102, nUmber 1ContentsJan.

2 ja n ua ry 2015

featuresYour SDCMS Foundation: Improving Health, Changing Lives

10 SDCMS Foundation Timeline

12 James T. Hay, MD: The Man of Every HourBy aLBErT ray, MD, anD

CarLOS MEDIna

13 A Toast to James T. Hay, MD!By aLBErT ray, MD

14 Improving Health, Changing Lives: One Physician and One Patient at a TimeBy THE SDCMS FOunDaTIOn

15 Project Access San Diego Outcomes Since 2008

16 Advocacy Training Teaches Medical Students the Benefits of Organized MedicineBy SHErry L. FrankLIn, MD,

anD CarLOS MEDIna

18 SDCMS Foundation Scholarship Recipients: Where Are They Now?By CarOL L. yOunG, MD

20 Diabetes Increase Concerns Physicians: Jump Start for HealthBy THE SDCMS FOunDaTIOn

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle LewisEDITORIAL BOARD: Sherry L. Franklin, MD, James Santiago Grisolía, MD, Theodore M. Mazer, MD, Robert E. Peters, PhD, MD, David M. Priver, 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

On the COver: The County of San Diego partnered with the SDCMS Foundation for its inaugural Solana Beach Sunset 5K in September 2014. L–R: Nicholas J. Yphantides, MD, Chief Medical Officer, HHSA; Nick Macchione, Director, HHSA; County Supervisor Dave Roberts; Theodore M. Mazer, MD; Barbara Mandel, Executive Director, SDCMS Foundation; James T. Hay, MD; Tom Gehring, Executive Director, SDCMS.

20 Community Health Education Efforts Rely on Physicians: Live Well Speakers BureauBy BarBara ManDEL

21 What Physicians Need to Know About the Health and Safety of the San Diego Water Reuse and Purification Project

22 Alzheimer’s and Dementia on the Rise: San Diego RespondsBy BarBara ManDEL

departments4 Briefly Noted: Calendar • Physician Announcements • Covered California • And More … 6 An Interview With Dr. Jason LujanBy VIMaL I. nanaVaTI, MD, FaCC, FSCaI

8The Promise and Limits of “Personalized Medicine”: An Introduction to n=1 By DanIEL J. BrESSLEr, MD, FaCP

26 Physician Marketplace: Classifieds

28Diagnostic Error Identified as the Most Common Allegation in Malpractice Lawsuits By THE DOCTOrS COMPany

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SDCMS Seminars & Webinars SDCMS.orgfor further information or to register for any of the following SDcMS seminars, webinars, workshops, and courses, email [email protected].

HIPaa & EHrs (webinar)fEb 19: 11:30am–1:00pm

Covered California: What you need to know to Inform your Patients (seminar/webinar)fEb 26: 11:30am–1:00pm

Media Training (workshop)fEb 28: 8:00am–12:00pm

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.

Structural Heart Intervention and Imaging 2015: a Practical approachfEb 4–6 at the Marriott Del Mar (www.scripps.org/events/structural-heart-intervention-and-imaging-february-4-2015)

Calendar

briefly noted

“Mighty things from small beginnings grow.— John Dryden, English Poet (1631–1700)

quote of the month

physiCian announCements

CoVered California

Pregnancy and Lactation in Women With autoimmune Diseases: Sharing knowledge across DisciplinesfEb 6–7 at the courtyard Marriott at liberty Station (cme.ucsd.edu/plwad)

Clinical Hematology & OncologyfEb 14–17 at the Hyatt Regency la Jolla at aventine (www.scripps.org/events/scripps-35th-annual-conference-clinical-hematology-oncology-february-14-2015)

Bridging the Hearts & Minds of youth: Mindfulness and Compassion in Clinical Practice, Education, and researchfEb 27–MaR 1 at the catamaran Hotel, San Diego (bridgingconference.org)

The Future of Genomic Medicine VIIIMaR 5–6 at the Scripps Seaside forum in la Jolla (www.scripps.org/events/the-future-of-genomic-medicine-viii-march-5-2015)

new Treatments in Chronic Liver DiseaseMaR 20–22 at the Estancia la Jolla (www.scripps.org/events/new-treatments-in-chronic-liver-disease-march-20-2015)

Thomas J. Savides, MD, Named Chief Experience OfficerDr. Savides, SDcMS-cMa member for 15 years, has been named the first chief experience officer at uc San Diego Health System. in the newly created role, Dr. Savides will be responsible for the strategy, leadership, and implementation of the plan to improve the total healthcare experience of patients, families, providers, and staff.

Kelly J. Bethel, MD, Named an Editor of New Cancer Journal

Scripps clinic pathologist and researcher Kelly J. bethel, MD, SDcMS-

cMa member for three years, has been selected as a founding editor of

Convergence Science Physical Oncology, a new journal of iop publishing that is the first and only interdisciplinary

title dedicated to bringing together all researchers in the field of cancer research

from a physical sciences perspective.

Email your physician announcements to [email protected].

COvErED CaLIFOrNIa OpEN ENrOLLMENT ENDS FEBruarY 15For 2015, Covered California’s open enrollment deadline is February 15 rather than the later deadline in 2014. Patients should check their enrollment options at CoveredCA.com, as plan rates may have changed, and physician practices may want to inform patients if they are no longer contracting on particular plans. Patients and their families who do not want or qualify for a subsidy should buy directly from a health plan. Whether the plan is purchased through CoveredCA or directly from the health plan, the plan benefits at identical tiers (bronze, silver, gold, and platinum) remain the same.

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)

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Sa n D I EGO P H ySI C I a n .O rG 5

vOLuNTEEr SpECIaLTY pHYSICIaNS NEEDED FOr prOJECT aCCESS: Contact Ana Seda at (858) 565-8161 or at [email protected], or visit www.sdcmsf.org.

FaMILY MEDICINE / GEN-EraL INTErNaL MEDICINE pHYSICIaNS NEEDED to serve as role models and teachers to UCSD first- and second-year medical students in their Ambulatory Care Ap-prenticeship Program. Contact Rusty Kallenberg, MD, at (619) 838-8047 or at [email protected].

HuMaNITarIaN TEaMS NEED MEDICaL vOLuN-TEErS FOr HaITI: Contact Bob Downey at (619) 905-7157 or at [email protected].

uCSD paCE prOGraM IS rECruITING praCTICING pHYSICIaNS aBOvE aGE 50 FOr a COMpENSaTED paCE aGING pHYSICIaN aSSESSMENT (papa) pI-LOT STuDY: Contact Patricia Reid, MPH, at (619) 471-0569.

giVing baCk risk management

pHYSician VoluntEERS nEEDED!Email Your Physician Volunteer Opportunities to [email protected]

Get patient Safety Insights Delivered to Your InboxSDCMS invites you to sign up for The Doctor’s Practice, a complimentary monthly newsletter brought to you by

our exclusively endorsed partner, The Doctors Company. Each issue of The Doctor’s Practice features a new article or video in a simple, one-click email. These articles feature expert tips to help you reduce malpractice risk, avoid claims, and make the practice of medicine more rewarding. Sign up at www.thedoctors.com/TheDoctorsPractice. The insightful content in The Doctor’s Practice is part of The Doctors Company’s commitment to defending, protecting, and rewarding the practice of good medicine.

6 ja n ua ry 2015

Dr. Jason Lujan, 19-year SDCMS-CMA member, is board-certified in anesthesiology. His views are his own and do not represent the views of Anesthesia Service Medical Group (ASMG) or the San Diego County Medical Society.

Dr. NaNavaTI: What brought you to SDCMS?

Dr. LuJaN: I was recruited by Dr. Tom Far-rell and Dr. Bob Hertzka to join the SDCMS board of directors a few years after joining ASMG in 1999. I had already been an SDC-MS member since arriving in San Diego — all ASMG members are required to be members of SDCMS. ASMG is a single subspecialty group composed of more than 200 anesthe-siologists servicing San Diego County.

When I joined ASMG, it was a time of mandated membership in organized medi-cine. As I gradually became more active in ASMG governance, I realized leadership develops a more visceral sense of duty and citizenship to the profession of medicine. What was once mandated passivity became more voluntary advocacy.

Our profession faces great challenges as nonclinical burdens occupy a dispropor-tionate share of our time and energy. To paraphrase a Wall Street Journal article, “We become frustrated treating the chart instead of the patient.” How we got to this point is not germane to this interview, however, we created this problem years ago when we physicians abdicated our histori-cal role of leadership and advocacy. SDCMS functions as a prescription for leadership and advocacy while concurrently educat-ing us physicians to see the bigger picture and regain a more proactive “situational awareness.”

Dr. NaNavaTI: You have been a leader as the Kearny Mesa representative to the board of directors for SDCMS for the past 10-plus years. In your opinion, why should a physi-cian in San Diego consider joining the San Diego County Medical Society?

Dr. LuJaN: Aside from the obvious tan-gible benefits of getting sizable discounts from malpractice carrier The Doctors Company, rental car benefits, and discounts on billing and collection services, there are nontangible benefits I didn’t realize until I actually joined: Joining SDCMS allowed me to meet colleagues from areas of San Diego I would never have met otherwise. Moreover, these were colleagues from other special-ties. I began to understand issues in medi-cine specific to their specialty and common to our profession.

I began to see that the medical profession

VoicES in MEDicinE

dr. Jason lujan

one in an occasional Series of interviews of SDcMS

physician leaders by Vimal I. Nanavati, MD, FACC, FSCAI

an interview With


globally has issues that all physicians can ral-ly around no matter their specialty or mode of practice. SDCMS became a fertile ground for ideas and afforded unique collaborative opportunities not available in any other local venue. San Diego is a unique medical com-munity comprising multiple, large federal, military, corporate, and hospital-based organizations. SDCMS is the only venue where physicians from all of these disparate organizations can meet and collaborate.

Dr. NaNavaTI: Aside from “civic duty” as a reason to join SDCMS, what other advan-tages, tangible or otherwise, does the indi-vidual physician gain in joining SDCMS?

Dr. LuJaN: Abstract concepts of “civic duty” rarely make for great talking points to increase membership. People demand specifics if they are to invest their time, talent, and treasure. As we so often re-hearse, some are motivated to join based on economies of scale. The math is hard to ignore and makes a great selling point for those struggling to make payroll, pay the mortgage, or feed the kids.

As a member of a significantly larger medical group, however, those promised benefits fail to close the deal despite my philosophical affinity for solo/small-group physicians. For me, what matters are the legislative and regulatory issues affecting practice management, scope of practice, and reimbursement. These three issues have consistently impacted our profession, and these three issues strongly resonate across the medical disciplines regardless of specialty, defying our profession’s propen-sity for politicized theater and self-inflicted existential crises.

To wit, “organized medicine” is adver-tised as a unified, harmonious voice for us physicians. That concept makes for great letterhead until one realizes we actually represent a diminishing minority facing ex-tinction and scrambling to stay relevant. In a brave new world where physicians prefer-entially identify themselves as employees of larger medical groups or hospital systems, we must rethink our role. Once again, it is a problem of our own making. Our compla-cency is only more apparent when reciting clichés about “being at the table versus being on the menu.” That was then, this is now. Not only has healthcare found a new menu, it dines in a different restaurant as we hold the old tab. We might as well be selling insurance policies.

Dr. NaNavaTI: As you eloquently stated above, physicians are becoming less rele-vant as the “industry of medicine” marches on. Knowing this, why do you keep coming

back year after year to SDCMS?

Dr. LuJaN: I know this is harsh. So why do I stay? SDCMS has done a remarkable job of stemming the current tide, but I see us as the exception rather than the rule. What must occur for the greater polity of orga-nized medicine is a strategic realignment, focusing not on maximizing the individual physician but rather emphasizing a limited set of core issues to which all can relate. Less becomes more as organized medicine re-earns the respect (and dues) of members who want to see clear purpose and value in what I still consider a noble profession. That is how we inspire and increase general membership. That is why I stay involved to argue for such a change.

Dr. NaNavaTI: What are the three main issues impacting medicine and healthcare delivery today?

Dr. LuJaN: First, too many rules and regu-lations. Federal, state, HMO/PPO, and other agencies have created too many “hoops” for physicians to have to jump through. This stifles patient-physician relationships and certainly paralyzes the physician from efficiently and effectively rendering care. In many ways, these regulations have “sucked the very soul out of medicine.” Unfortu-nately, the Accountable Care Act promises even more regulations, and I remain highly skeptical of any promised benefit.

Secondly, the profession of medicine is devolving into a trade. Physicians are no longer considered highly qualified profes-sionals but merely technicians or clerical workers focused on a particular task. Since when did we agree to forgo the title “doctor” and accept “provider”? The unique skill sets required to become a physician are achieved only through years of study, training, and sacrifice. Physician morale deteriorates and future generations are dissuaded from following the same path. I am reminded of a JAMA cover showing a child’s drawing of an office visit to the pediatrician: At the far end of the room, back to the child and her family, sits the doctor busy doing data entry into the computer. At least everyone has a smile on their face. Sad that we should passively accept this “new” norm.

And thirdly, beware the shift worker mentality. Physicians are being herded into shift work during residency, and this behav-ior is spilling into private practice. Although the intention was good to avoid fatigue, the cost has been a loss of ownership and re-sponsibility for the patient’s care whenever and wherever it was needed. “Sign-offs” to other physicians to cover “the next shift” turn patients into an interchangeable com-

modity where no one physician really gets to know the patient. As a result, multiple opportunities occur for errors in medica-tion, delayed treatments, or diagnostic tests not being ordered. Preliminary studies are beginning to show bad outcomes due to physicians working as “shift workers.” Our patients should not become dehumanized and put at greater risk.

Dr. NaNavaTI: What one thing would you do to benefit patient care?

Dr. LuJaN: Put patients back in control of their own healthcare dollars, and let them decide where they will spend it. We are con-stantly told that “fee for service is a terrible model for healthcare delivery,” and those who continue to espouse it are demonized. Nonsense. Our capitalist economy rests on fee for service and market forces to improve quality and keep costs down through competition. If you buy a car, remodel your home, or buy groceries or clothes, you shop around until you find the most value. Market forces work if you allow consumers to make an informed decision about their medical care provided that you also remove the middleman who interferes with the con-sumer’s ability to appreciate cost and value. Some contend that patients are unable to “understand” the complexities of their healthcare and should be prevented from making those decisions. I would say that that view is unfortunate and counterpro-ductive, suffering from low expectations.

Dr. NaNavaTI: What advice would you give to a medical student?

Dr. LuJaN: Follow the specialty you love and which speaks to your passion and intel-lectual interest. The career you choose no longer becomes just a job.

Medicine is a business. The students who understand this reality will better under-stand this brave new world of medicine and better appreciate the economic forces con-flicting with our Hippocratic tendencies: If they don’t, they will forever be controlled by those who do understand it.

Learning is a lifelong commitment, not just limited to the time of medical student education. Push yourselves to always ques-tion “tradition” and current knowledge for the benefit of yourself and your patients.

Dr. NaNavaTI: Thank you, Dr. Lujan, for your perspectives on medicine today. Although you stepped down from the board of directors of SDCMS, we certainly hope that you will continue to be available to contribute your considerable knowledge and experience in organized medicine.

8 ja n ua ry 2015

poEtRY anD MEDicinE

the term “personalized medicine” has come to mean medical care organized around specific molecular biomarkers. It is applied most commonly in oncology as a description of treatments adapted to cancer-specific mutations. Some promi-nent examples include the use of trastu-zumab (Herceptin) targeted to those breast cancer patients whose cancer overex-presses the HER2 growth factor receptor; the use of cetuximab (Erbitux) restricted to those metastatic colorectal cancer patients whose tissue KRAS gene is wild-type (i.e. unmutated); and mutational subtyping of CML in order to determine whether treatment with tyrosine kinase inhibitors will be effective. In the field of infectious diseases it has found multiple applications, such as guidance for the use of the anti-HIV drug abacavir for patients who have tested negative for the gene variant HLA B*5701. In cardiovascular medicine, war-farin dosing can be refined by knowledge of the genes that code for its metabolism. New therapeutic and diagnostic applica-tions are coming thick and fast in most branches of medicine, from psychiatry to transplant surgery.

The slogan of personalized medicine is “the right drug at the right dose for the right patient.” This phrase can be inter-preted as a biologically slanted resurrec-tion of the corny old Oslerian proverb that many of us were exposed to in medical school: “It is more important to know what sort of person has the disease than it is to know what sort of disease the person has.” Through pharmacogenomics, we can ask what sort of Cytochrome P450 variant is present in the patient with chronic pain who is about to be prescribed pregabalin (Lyrica.) We might inquire as to the geneti-cally determined clopidogrel (Plavix) me-tabolism in the patient with a recent stent. And with molecularly targeted therapy, we seek to know what sort of alteration of the tissue-specific “genetic self” has given rise to the patient’s cancer.

The variable “n” is, of course, the num-ber of subjects in an experimental trial. It is a principal determinant in calculating the statistical power of an experiment. In gen-eral, the greater the n, the more compelling the study’s conclusions. The gold standard of evidence-based medicine is the large, randomized, placebo-controlled clinical

an introduction to n=1by Daniel J. Bressler, MD, FACP

“

the promise and limits of personalized medicine”

n = 1

Science is based on statisticsThe scorecard when all’s said and doneBut all of its sums and logisticsStumble on n = 1

You give me the law of the averageI say that you’ve barely begunDoes wetness make it a beverage?Uniqueness makes n = 1

Seemingly sameness distinguishedIdentical twins? There are noneDifferences can’t be extinguishedIt all boils down to n = 1

You tell me the future’s geneticSequencing our latest top gunBut a lived life is epigeneticIt turns out that n = 1

We can measure the serum albuminWith a certainty certain to stunBut how do you measure a humanWhen each person’s n = 1?

We aim to be so formulaicOur flow charts show how it is doneBut a person is rare and mosaicEach life proves that n = 1

A cookbook’s an adequate masterWhen baking a cake or a bunBut recipes lead to disasterFor a person whose n = 1

Can I leave you with some kind of moralA word for your daughter and son?You must master your field without quarrelJust remember that n = 1


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INO

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“It is more important to know what sort of person has the disease than it is to know what sort of disease the person has.”

trial. The large refers to a high “n.”When one goes from a clinical study to

the clinic, however, n is always equal to 1. The fine print of a clinical study is made up of the inclusion and exclusion criteria. These are necessary for practical and safety purposes. But they limit the strict applica-bility of conclusions of the study to those patients who meet study criteria. And even among those patients, we can never be sure (only statistically inclined) that the reasoning of the study applies to the patient sitting in front of us. If the patient is somehow a perfect amalgam of the study group, we might be able to say that she has a 70% chance of a beneficial response and a 20% chance of serious side effects, just as has been shown in the clinical trial. But such a claim is ludicrous. Patients are not

statistical amalgams. The patient will ei-ther have the response or she won’t. She’ll either have the side effects or she won’t. A patient doesn’t live in the abstract world of probabilities. She lives in the world of flesh and bones where outcomes are actualities rather than likelihoods.

So, yes, large, randomized, placebo-controlled trials do give us protocols to follow. And, yes, the new molecularly based diagnostics and therapeutics will help make those protocols more precise. But even so, such protocols give us only starting places in the iterative process that is clinical medicine. They will refine therapies analogously to how culture-and-sensitivity techniques have refined our treatment of infections. Although a sig-nificant achievement, this refinement will not end the ongoing challenges in oncology, neurology, adverse drug reactions, or any other field of medicine.

As important as all these genetically and metabolically directed therapies are and will increasingly become, I like to believe that we all would be better off reserving the term “personalized medicine” for a kind of clinical relationship that is both molecu-

larly specific and humanistically specific. The Oslerian “sort of patient who has a dis-ease” cannot be adequately summarized in a proteomic signature or metabolic portrait no matter how detailed. It leaves out what makes us human as opposed to what makes us complex biological composites. What it leaves out is the essence of our humanity: our beliefs, our preferences, our fears, our goals, and our hopes. It leaves out where we come from, who we love, what we despise, and why we want to get better.

This little poem, n=1, is an attempt to draw the distinction between medicine as an inductive science that produces its conclusions from large groups and medi-cine as an application of that science to the life of an individual, idiosyncratic, and singular person. It is a reminder to myself, and perhaps to you, that being a practic-ing clinician will forever be a balancing act between these two medicines.

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.

10 ja n ua ry 2015

James t. Hay, MD, serves as president of SDcMS and begins the planning process, hiring a consultant to develop a framework based on learning from project access Dallas, one of the first coordinated volunteer programs in the country.

• tax-exempt 501c3 status is issued by the iRS. the SDcMS foundation begins supporting medical students, including loans and advocacy education.• the History of Medicine in San Diego project with retired physicians is launched.• the first executive director is hired.

• the SDcMS foundation’s new Emergency Department Medical Home project program, developed with the help of Steve carson, MD, finds medical homes for uninsured and underinsured patients who are utilizing emergency rooms for primary care.• a diabetes and obesity health education program is launched, later transitioned to the Hospital association of San Diego and imperial county’s community Health improvement project (cHip).

the San Diego association for Medical and paramedical Education and Research (aMpER) is changed to the San Diego county Medical Society foundation. James t. Hay, MD, is appointed the first SDcMS foundation president.

• James t. Hay, MD, and the SDcMS foundation board of directors create a vision for access to specialty care, founding project access San Diego (paSD). paSD is designed to fill gaps left by Reach out San Diego and a lack of resources for the uninsured.• carol Young, MD, is elected board president.

2001

2004

2007

2005

2006


SDCMS FounDation

tiMeline

incoming SDcMS president, Robert Hertzka, MD, and SDcMS’ board of directors identify a need to reach out into the community, and discuss how to expand SDcMS’ impact and reach. a charitable arm of SDcMS is created to recognize efforts of area physicians. the seeds of the SDcMS foundation are planted.

199

9

a major goal for the new organization is to connect physicians to coordinated volunteer medical services, recognizing that physicians have been providing volunteer care in the community throughout their careers.

Reach out San Diego, established in 2001 by local physicians to provide referrals to low-cost specialty healthcare services, is folded into the SDcMS foundation after its initial grant funding expires.

2002

2003 Maria Gonzalez overcame her painful, 15-year struggle with varicose veins thanks to Kaiser Permanente volunteers Edgar Garcia, vascular technician, Timothy Canty, MD, and Maria Miller, LVN.

$168,493

2008 2009 2010 2011 2012 2013 2014

$901,421

$2,414,307

$4,700,969

$6,485,269

$8,043,542

$8,987,092

19

183

707

1,380

1,984

2,369

2,797

Total in physician donated care

Total patientsserved


• the first Saturday Surgery Day is held, in partnership with Kaiser permanente and the Southern california permanente Medical Group; 19 patients are provided $180,000 in donated services.• More than 50 physicians attend each of the four Retired physicians Society meetings.

• Rosemarie Marshall Johnson, MD, medical community liaison, receives the 10news 2011 leadership award for her work with paSD.• the SDcMS foundation is honored with the prestigious 2011 adarsh S. Mahal, MD, access to Health care and Disparities award by the cMa foundation.• the Retired physicians Society is relaunched to support the connection of retired physicians to the medical community.• the SDcMS foundation provides physicians with technical assistance to achieve meaningful use of EMRs.

• carol Young, MD, is named 2014 Healthcare cham-pions finalist by the San Diego Business Journal.• the affordable care act is fully implemented with covered california, and the SDcMS foundation pro-vides physicians with patient educa-tion support.• the SDcMS foun-dation collaborates with physicians and the county HHSa on the alzheimer’s project clinical Roundtable to develop standards of practice on diag-nosis and dementia treatment.• the SDcMS foun-dation is named a Live Well San Diego partner by the county of San Diego HHSa, and launches the inau-gural Solana beach Sunset 5K Run/Walk to promote healthier lifestyle habits.

• project access San Diego is offi-cially launched. the SDcMS founda-tion recruits private practice spe-cialty physicians, anesthesiologists, and radiologists willing to provide pro bono medical services in their offices.• the Specialty care access initia-tive, in partnership with the council of community clinics, is launched to increase access to specialty care at the community health centers.

• Daniel “Stony” anderson, MD, a longtime SD-cMS foundation volunteer, receives the public Health champions theme award from San Diego county’s Health & Human Services agency.• the SDcMS foundation initiates the immunize San Diego collaborative with the county of San Diego Health and Human Services agency (HHSa), volunteer nurses, and other partners.• the foundation hosts the california public protec-tion and physician Health meeting to convene physician wellness commit-tees.

• the aces for Health Golf tournament is initiated at the Del Mar country club.• Wendy buchi, MD, Rosemarie Marshall Johnson, MD, imaging Healthcare Specialists, Kaiser permanente, Surgeryone, and aSMG receive the SDcMS foundation’s inaugural Health Heroes awards.• partnering with grassroots efforts, the SDcMS foundation oversees free breast mammograms for 2,200 uninsured women.• al Ray, MD, is elected board president.

• The San Diego Business Journal recognizes the SDcMS foundation with its Health care champions award.• text4baby, a mobile health program, is launched nationally and in San Diego by the SDcMS foundation.• econsultSD is also launched, increasing the capacity of primary care physicians to receive electronic consultations with specialty care physicians.• Stuart cohen, MD, MpH, is elected board president.

20102011

2013

2008

2012

2009

2014

Cecilia Piemental suffered from an umbilical hernia for 10 years before meeting long-time physician volunteer and surgeon Adam Fierer, MD.

$168,493

2008 2009 2010 2011 2012 2013 2014

$901,421

$2,414,307

$4,700,969

$6,485,269

$8,043,542

$8,987,092

19

183

707

1,380

1,984

2,369

2,797

Total in physician donated care

Total patientsserved

The Impact of Project access San Diego


12 ja n ua ry 2015

James T. Hay, MD, is a catalytic leader whose commitment to community health can be seen in every organiza-tion in which he has been involved.

“I’m a great initiator,” says Dr. Hay, “which is a skill I utilize when guiding transitions.” On Feb. 7, 2015, the Celebration 10 gala will commemorate Dr. Hay’s pioneering work to establish the San Diego County Medical Society Foundation (SDCMS Foundation) and its flagship program, Project Access San Diego. The SDCMS Foundation is proud to honor the man behind the mission to improve community health and wellness, access to care for all, and support for physi-cians through engaged volunteerism.

THE MOvE TO MEDICINEDr. Hay grew up in Philadelphia and was inspired by humanitarian Thomas An-thony Dooley III, MD, to pursue a career in family medicine while in high school. He recognized the rewarding relationships physicians enjoy: a special combination of care, clinical expertise, and biomedi-cal knowledge to improve someone’s life. During medical school at Thomas Jefferson University, Dr. Hay joined the Navy and came to San Diego for his internship at the Navy Hospital and residency at Camp Pend-leton. It was in 1978 that Dr. Hay started his private family practice, North Coast Family Medical Group, growing it into one of the top five medical groups in San Diego (U-T San Diego Reader’s Poll, 2014).

a CarEEr OF SErvICEDr. Hay’s career as a healthcare leader began as a board member of the San Diego Acad-emy of Family Physicians in 1983 and as chief of staff at Scripps Memorial Hospital, Encinitas, in 1984. His capacity as a leader was illuminated at the California Medical Association (CMA), where he facilitated some of CMA’s biggest changes, including implementing CMA’s Hospital Medical Staff Section in 1986, and chairing the Reengi-neering Task Force in 1999. In 2011, Dr. Hay was elected CMA president and mobilized efforts to reevaluate the business model of organized medicine, encouraging special-interest groups of physicians to more tightly align for the good of the profession, which meant for the good of patients.

“Jim Hay handled the leadership of the

JaMeS t. HaY, MDThe Man of Every Hour

By aLBErT ray, MD, anD CarLOS MEDIna


CMA extremely well,” says colleague Robert Hertzka, MD. “He has great organizational skills. CMA is one of the largest state asso-ciations and a national trendsetter. American Medical Association leaders from California have great reputations, and Jim is a prime example. These are skills Jim will bring as AMA’s vice speaker of the House of Del-egates, hopefully upon election this June.”

SOwING THE SEEDS OF THE SDCMS FOuNDaTION; rEapING THE HarvESTBrainstorming for the SDCMS Foundation and Project Access San Diego began in 1999, during the San Diego County Medical Soci-ety (SDCMS) presidency of board member Robert Hertzka, MD. Dr. Hertzka remembers “the goal was to create a vehicle to engage physician volunteers.” In 2001, as SDCMS president, Dr. Hay visited agencies across the country, providing fee-free specialty medi-cal care to the underserved to formulate the plans for Project Access San Diego. Dr. Hay’s five-year vision came to fruition in 2004, as founding president of the SDCMS Founda-tion. It took four more years to mobilize the needed resources to launch Project Access.

“My two fondest memories,” says Dr. Hay, “were an early meeting to discuss the birth of the organization, including Project Access San Diego, supporting medical students, and working with retired physicians; and the first Project Access San Diego surgery day in 2008,” providing free surgeries and proce-dures to low-income individuals.

“Jim is a man of extraordinary strength and finesse, who has a quiet and warm demeanor,” says Barbara Mandel, executive director of the SDCMS Foundation. “He is the go-to guy to ignite significant change. The San Diego County Medical Society Foundation would not be where we are today without his leadership.”

a COMMITMENT TO pHYSICIaNSIn Dr. Hay’s 35-plus years in community health, he has seen expectations change for physicians. “Now, physicians are trained to work in teams, rather the previous, one-on-one interactions with patients,” he says, “and physician-led teams are important. Also, community health education is increasingly critical to minimizing doctor’s visits so the healthcare system stays feasible.”

In 2009, Dr. Hay’s concern for physicians facing medical, substance-use, psychologi-cal, behavioral, or emotional issues lead him to catalyze the formation of California Public Protection and Physician Health, Inc. (CPPPH); remaining sensitive to the needs of the healthcare community. “In the 25 years I have known Jim,” reflects Dr. Hertzka, “I can honestly say he is one of the few people who will never let you down. If someone — friends, family — needs a physi-cian’s help, Jim’s there, no questions asked.”

waLKING THE waLK“Dr. Hay has been a linchpin leader as president of the California Medical Associa-tion, the San Diego County Medical Society, and founding president of the San Diego County Medical Society Foundation,” says Tom Gehring, CEO of SDCMS and SDCMS Foundation. “Never has one person been so dedicated to our two visions of ‘physi-cians united for a healthy San Diego,’ and ‘improving health, changing lives.’”

Currently, Dr. Hay resides in Del Mar with his wife of 32 years, Patricia Jones Hay, whom he credits for fueling his success. Tricia compliments Jim when she says, “Jim has such a way of getting things done, but shies away from the recognition. He just wants to know that something he believed in happened, and that he contributed to it.”

Jim is an avid runner and believes “we need to encourage healthy communities by highlighting the benefits of adopting healthier habits.” He, and North Coast Family Medical Group, demonstrated com-mitment to encouraging healthier commu-nities by having a major presence at the SD-CMS Foundation’s inaugural Solana Beach Sunset 5K Run/Walk in September, and by partnering with the SDCMS Foundation on Love Your Heart Day last February. It is clear Dr. Hay enjoys immense satisfaction with being a physician: “I love what I do as a physician. I get more from my patients every day than I could ever give them.” For all of Dr. Hay’s work as a catalyst leader in community health, his legacy will be char-acterized by his commitment to patient and physician wellness.

Dr. Ray, 23-year SDCMS-CMA member, is presi-dent of the SDCMS Foundation. Mr. Medina is its grants and communications manager.

A Toast to James T. Hay, MD!by albert Ray, MD

the celebration 10 gala toasts James t. Hay, MD, founding president of the San Diego county Medical Society foundation (SDc-MS foundation) and founder of its flagship program, project access San Diego. the event’s honorary chairs, bob Hertzka, MD, Roxana foxx, al Ray, MD, and cheryl Ray, invite you to take pride in SDcMS foundation’s 10 years of service to the community.

SDcMS members have much to celebrate since SDcMS formed the nonprofit 10 years ago:

• More than $8.7 million in pro bono specialty medical care has improved the health of more than 2,700 uninsured, low-income adults.

• Medical student advocacy training supports the future of medicine.

• Several preventive care programs have been launched to improve community health.

• outcomes include improved patient health, reduced emergency department visits and inpatient hospital stays, and increased capacity of primary care providers.

Celebration 10 will be held on Saturday, Feb. 7, 2015, at 6 p.m., at the Del Mar country club in Rancho Santa fe. Entertain-ment will feature vocalists Janice Edwards and nathan fry, and the cocktail hour will feature a special silent auction of original artwork by San Diego artists that build on the heartfelt theme of the SDcMS foundation. funds raised will ben-efit project access San Diego and the Medical Student advocacy training programs.

individual tickets are available for $200 (friends) or $300 (Vip); tables of eight are available for $1,600 (friends) or $2,500 (Vip). to purchase tickets or for more information, please contact carlos Medina, Grants and communica-tions Manager, at (858) 565-7930 or at [email protected], or visit www.SDcMSf.org.

14 ja n ua ry 2015


iMproving HealtH,

CHanging liveSOne Physician and One

Patient at a Time

By THE SDCMS FOunDaTIOn

according to the SDCMS Founda-tion, every one of the more than 625 physicians who volunteer their time and expertise for its flagship program,

Project Access San Diego, are Health He-roes. Countless Project Access volunteers have provided care for those most vulner-able in our community, and helping these people regain their health, employment, and their lives is why many physicians chose their profession.

Representing the efforts of the many physician volunteers, the SDCMS Founda-tion presented Bret Langenberg, DO, and Alberto Bessudo, MD, with its 2014 Health Heroes Awards.

Dr. Langenberg, a general surgeon, received the Unsung Hero award for his dedication to patients requiring colorectal surgeries. “Treating Project Access patients has been very rewarding; these patients are very appreciative of the care we can provide,” says Dr. Langenberg. “They have been stuck in a spin cycle of not getting the care they need, and they realize someone does care.”

Oncologist Dr. Bessudo, recipient of the Above and Beyond Award, agrees. “We see many patients without insurance, and hav-ing no funding for cancer treatment is very problematic. Volunteering is really a plea-sure, and it just takes a bit of your time. Yet it makes all the difference to the patients.” Dr. Bessudo called on all his colleagues to volunteer when receiving his award last May at the SDCMS White Coat Gala.

One fortunate recipient of this pro bono care is Joaquin Morales, a National City

L–R: Barbara Mandel, Executive Director, SDCMS Foundation; Alberto Bessudo, MD, 2014 Health Hero; Albert Ray, MD, President, SDCMS Foundation; and Bret

Langenberg, DO, 2014 Health Hero — Presented at the 2014 SDCMS White Coat Gala


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resident. For years, Joaquin’s cataracts prevented him from maintaining stable employment. “It was becoming harder to support my wife and two daughters,” he says. Joaquin’s family is extremely grateful to Project Access San Diego for connecting him with bilateral cataract surgery, through a Saturday Surgery Day at Kaiser Perma-nente, that he otherwise could not have afforded. Joaquin has regained his eyesight and returned to working full-time to sup-port his family. Equally as important, he can drive his daughters to school every morning. “I get to enjoy time with my family,” says a thankful Joaquin.

During 2014, Project Access assisted more than 400 patients to improve their health, bringing the tally of lives changed since 2008 to more than 2,700. With one in five adults in our community remaining uninsured, Project Access is a critical com-munity resource; feasible only through the generosity of physicians, hospitals, surgical centers, and ancillary healthcare providers. To date, these providers have contributed more than $8.7 million in care to community residents without other resources.

project access San Diego Outcomes Since 2008

2,797

LIVES SaVED

Patients With Improved Health

twenty-two$8.7+

Million in Donated care thanks to physicians,

Hospitals, Surgery centers, and ancillary Healthcare providers

75% Reduction in Workdays Missed

89% REDuction in ED ViSitS

9,428 specialty healthcare appointments897SurgerieS

and gi ProcedureS

16 ja n ua ry 2015


aDvoCaCY training teaCHeS MeDiCal

StuDentS tHe BeneFitS oF organizeD MeDiCine

By SHErry L. FrankLIn, MD, anD CarLOS MEDIna

training the physicians of the future is core to the missions of both SDCMS and SDCMS Foundation, and, thanks to Bob Hertzka, MD, an important part

of the UC San Diego Medical School cur-riculum. Dr. Hertzka has taught “Introduc-tion to Politics of Medicine” to first- and second-year medical students for the past 26 years, opening their minds to the health-care policy issues that play critical roles in their future professional careers. Since the SDCMS Foundation’s beginnings, medical students have had travel expenses to Sac-ramento paid through the Simon/Hertzka Fund, established in 2005 to support medi-cal student education.

Dr. Hertzka, SDCMS board member and former CMA and SDCMS president, says that “the creation of advocacy training on health policy for emerging physicians has been one of the most rewarding parts of my career. First-year medical students evolve into informed future physicians.” Each spring, groups of medical students walk the halls of the state capitol and meet with legislators on timely health policy issues, learning the nuances of political advocacy from experienced physicians such as Dr. Hertzka and other District 1 delegates.

“Educating our elected leaders on the physicians’ perspectives of various issues has kept the practice of medicine strong in California,” says SDCMS president Steve Poceta, MD. “Bob’s class at UC San Diego has developed medical student leader-ship, resulting in a stronger delegation with huge representation of medical students, residents, and younger physicians.” Adds Dr. Hertzka, “After our students see policy in practice, they get it. They understand why being a part of organized medicine is so important to the profession.”

Dr. Franklin, 14-year SDCMS-CMA mem-ber, chairs SDCMS’s Communications Com-mittee. Mr. Medina is grants and communi-cations manager for the SDCMS Foundation.

Front St.

1st Ave.

Albatross St.

ScrippsMercy

Hospital

5

5th Ave.

UCSDMedicalCenter

School

Washington St.

University Ave.

8

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UC San Diego medical students travelling to Sacramento in March 2014 to meet with San Diego legislators, accompanied by Dr. Robert Hertzka, center back, and Dr. Sherry Franklin, far right.

Front St.

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ScrippsMercy

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18 ja n ua ry 2015


Where Are They Now?

By CarOL L. yOunG, MD

kimberly Smith, MD: 2011 resident Scholarship recipientIs now a fourth-year resident at UCSD, spe-cializing in obstetrics and gynecology, and plans to work in the community as a general OB/GYN by next year. Dr. Smith says, “If I could ask for advice from mid-career physi-cians, I would ask for lessons to manage loan debt.”

Steven rojas, MD: 2012 resident Scholarship recipientIs a second-year resident at Scripps Mercy Hospital, Chula Vista, with a specialty in family medicine. “My future plan is to continue working in a community-based setting, providing care to the underserved,” says Dr. Rojas, “and conducting health education presentations for school-age youth and adults. If I could ask for advice from mid-career physicians, I would ask for suggestions to maintain an interest in medicine, as well as tips for maintaining a family/work balance.”

Mike Heffner: 2014 Medical School Scholarship recipientIs a first-year medical student at UCSD. Prior to matriculation, he worked for Teach for America as a 10th grade chemistry teacher. “I would love to learn more about the pros and cons of specific specialties,” says Heffner, “and the route physicians took in choosing their path. I will keep a focus on expanding medical access to underserved populations.”

Dr. Young, 36-year SDCMS-CMA member, is a founding SDCMS Foundation board member and member of the Medical Student Scholarship Committee.

L–R: Barbara Mandel; Will Tseng,

MD; Rosemarie Johnson, MD;

Mike Hefner; Mary Roberson, Esq.;

Al Ray, MD

Christopher Reid, MDSDCMS FounDation SCHolarSHip reCipientS

the SDCMS Foundation created the Medical Student Scholarship Program in 2007 to support incoming/first-year medical students and residents whose

personal beliefs, actions, and community service align with helping the medically un-derserved. Get to know the recent recipients of the Medical School Scholarship Program and their plans to improve community health and access to care for all:

Christopher reid, MD: 2011 resident Scholarship recipientStarted his general surgery residency at UC San Diego in 2011, and recently transitioned to UCSD’s advanced fellowship in plastic surgery. “I hope to be on faculty at UCSD,” says Dr. Reid, “because I am drawn to the academic model, and I look forward to serv-ing San Diego County residents and educat-ing the physicians of the future. I am very interested in understanding the complexi-ties of medical systems, and I would like to develop solutions.”

Get to know the recent recipients of the Medical School Scholarship Program and their plans to improve community health and access to care for all

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20 ja n ua ry 2015

the percentage of Americans with diabetes is growing at an alarming rate. According to the Center for Disease Control and Prevention, by 2050, the number of Americans with diabetes will

more than triple. This silent epidemic is growing to epic proportions, affecting patients — and their families and caregivers, who are often one and the same.

# u.S. adults with diabetes (now)

# u.S. adults with diabetes (2050)


DiaBeteS rate inCreaSe ConCernS

pHYSiCianSJump Start for Health

By THE SDCMS FOunDaTIOn

Jump Start for Health is the San Diego County Medical Society Foundation’s effort to prevent diabetes among pre-diabetic and pre-hypertensive adults, utilizing individualized lifestyle interventions. Research has shown that maintaining a healthy diet and moderate exercise, along with access to qual-ity medical care, has the power to stop diabetes in its tracks. For more information, visit SDCMSF.org. B

eginning in early 2015, San Diego County area residents will be able to learn more about how to improve their health from physicians in their communities, thanks to the Live Well Speakers Bureau, a collaboration between the San Diego County Medical Society

Foundation (SDCMS Foundation) and the County of San Diego Health & Human Services Agency (HHSA). Community physicians have answered the call, and more than 40 physicians have volunteered to speak on a variety of health and lifestyle topics to assist community members in improving their health and the health of their family.

Programs are being designed to target youth, adults/parents, seniors, and the business community, and will be given where people work, play, shop, and pray. As dates are confirmed, information will be available on the SDCMS Foundation website, www.SDCMSF.org. Says SDCMS Foundation president Dr. Al Ray, “This is another example of how physi-cians are engaged in the community, and the collaboration between the County HHSA and SDCMS and the SDCMS Foundation. The SDCMS Foundation will facilitate an easy way for physicians to volunteer.”

CoMMunitY HealtH eDuCation eFFortS relY

on pHYSiCianSLive Well Speakers Bureau

By BarBara ManDEL, EXECuTIVE DIrECTOr, SDCMS FOunDaTIOn


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22 ja n ua ry 2015

physician leaders in San Diego County have taken on the challenge of ad-dressing the increasing number of patients diagnosed with Alzheimer’s

disease and other dementias (ADOD), through the County of San Diego-sponsored Alzheimer’s Project. This project began in May 2014 through the leadership of County Supervisor Dianne Jacob.

Michael Lobatz, MD, neurologist, SDCMS-CMA member and SDCMS board member, serves as the only physician on the Steering Committee, and co-chairs the Clinical Roundtable along with Nick Yphantides, MD, (SDCMS-CMA member). The Alzheimer’s Project brings together San Diego’s world-class researchers, healthcare providers, care providers, county and city elected leaders, public safety personnel, and many others to tackle the challenges posed by this debilitating and heartbreaking disease.

With more than 60,000 San Diegans liv-ing with dementia, the disease is currently the third leading cause of death in the re-gion, and the emotional and physical impact of the disease on caregivers is devastating. The Cure and Care Roundtables gave their recommendations at a Dec. 2 special Board of Supervisors conference. The Clinical Roundtable was formed in October 2014,


alzHeiMer’S anD DeMentia on tHe riSe

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By BarBara ManDEL, EXECuTIVE DIrECTOr, SDCMS FOunDaTIOn


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and the co-chairs reported on progress in two short months.

Says Dr. Lobatz, “The goal of the San Diego County Alzheimer Project Clinical Roundtable, consisting of expert MDs from around the county, is to develop evidence-based guidelines for use by both primary care and specialist physicians around the issues of screening, testing, diagnosis, and management of various aspects of Al-zheimer’s disease and related dementias.” Once practice standards are developed and vetted throughout the medical com-munity, education and outreach efforts to physicians will be made. Surveys are being conducted regarding current standards of care, and physicians have expressed the need for information on available commu-nity resources to share with patients and caregivers.

The Cure Roundtable presented a col-laborative strategy involving the Salk Institute, the Sanford-Burnham Medical Research Institute, the Scripps Research Institute, and UC San Diego, and a challenge fund has been developed to assist in getting potential drugs through the pipeline sooner. The Care Roundtable presented a number of recommendations, several of them directed at the Clinical Roundtable, which will be discussed throughout 2015. A fourth leg of the countywide initiative is a large public education campaign that has already been launched by the Alzheimer’s Association.

The number of people with ADOD is rising as the size of our elderly popula-tion surges, a demographic trend known as the “Silver Tsunami.” According to the Alzheimer’s Association, by 2050 there will be 16 million Americans with Alzheimer’s, with a million new cases each year. The number of those 55 years and older with ADOD in San Diego County is expected to increase to nearly 94,000 residents by 2030. For the baby boomers who do not contract the disease, many will be caring for a loved one who will. Eighty-five percent of dementia care is provided by family mem-bers or other unpaid caregivers; on average there are 2.3 caregivers per individual with dementia.

The San Diego County Medical Society and the SDCMS Foundation are heavily involved with the Alzheimer’s Project. Nu-merous SDCMS-CMA member physicians serve on the four Roundtables, and SDCMS President Steve Poceta, MD, and SDCMS CFO/COO James Beaubeaux officially repre-sent SDCMS. SDCMS Foundation executive director Barbara Mandel provides staffing and facilitation for Drs. Lobatz and Yphan-tides and the Clinical Roundtable.

24 ja n ua ry 2015

Sa n D I EGO P H ySI C I a n .O rG 25 Sa n D I EGO P H ySI C I a n .O rG 25

26 ja n ua ry 2015

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 safety net. Since 1970, our mission has been to provide caring, affordable, high-quality healthcare and supportive services to every-one, with a special commitment to uninsured, low-income, and medically underserved per-sons. Every member of our team plays an important role in improving the health of our patients and community. We offer an excel-lent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email [email protected]. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org [046]

PRIVATE PRACTICE, PART-TIME IM/FP OPPORTUNITY: Unusual and exceptionally attractive private practice, primary care op-portunity in beautiful North San Diego Coun-ty. 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 at-tractive opportunity as an add-on to other part-time work. Interested in board-certified IM or FP applicants with EHR experience. Please email CV to [email protected] or call (619) 248-2324. [263]

BOARD-CERTIFIED PHYSICIANS, PHYSI-CIAN ASSISTANTS, AND NURSE PRAC-TITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right can-didate. 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 infor-mation. [229a]

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. Transpor-tation 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, pedi-atrics, 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 positions. 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.vistacommunityclinic.org. EEO Employer/Vet/Disabled/AA [912]

SEEKING BOARD-CERTIFIED PEDIATRI-CIAN 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 satisfac-

PHYSICIAN POSITION WANTED

LOOKING FOR PART-TIME FAMILY PRAC-TICE: D. (Doyle) Eugene Johnson, family physician with a wealth of experience, look-ing for part-time position, preferably in North County. Have been a full-time practicing certi-fied family physician for 50+ years and would like to continue seeing patients part-time. Had one of the largest solo family practices in San Diego for 25+ years. Excellent refer-ences! Continually certified in family prac-tice, ACLS, BLS, regularly use computerized records. Will consider locum tenens. Please email [email protected] with particulars. [301]

PHYSICIAN POSITIONS AVAILABLE

SEEKING URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a part-time physician. Good pay and working conditions along with the potential to become a full-time position. Please send CV to [email protected]. [306]

FAMILY MEDICINE AND GENERAL INTER-NAL MEDICINE PHYSICIAN OPPORTUNI-TIES: Kaiser Permanente is seeking physi-cians who are interested in positions ranging from per diem to full-time to join our team. We have opportunities throughout the County of San Diego, so, if interested, please submit your CV to [email protected] or call (619) 528-7991. [304]

PSYCHIATRISTS NEEDED: Part-time or full-time psychiatrists needed to work at San Diego County jails. Work as an independent contractor with very competitive pay. Contact Steve at [email protected] or at (619) 885-3907. [302]

SEEKING FAMILY MEDICINE AND INTER-NAL MEDICINE PHYSICIANS: Sharp Rees-Stealy Medical Group is seeking full-time or half-time (job share) BC/BE family medicine and internal medicine physicians to join our staff. We offer a first year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax: (619) 233-4730. Email: [email protected]. [299]

SUPERB INTERNAL MEDICINE OPPORTU-NITY: Internist (BC, BE) coastal North County available July 2015. Single specialty seven phy-sician internal medicine group, well established and respected. With 30 years in the community, outpatient care only, minimal call, salary guar-antee, income well over median range for inter-nal medicine. Send CV to [email protected] or call (760) 846-0464. [297]

PHYSICIANS WANTED FOR OUR GROW-ING ORGANIZATION: Full, part-time, or per-diem flexible schedules available at loca-tions throughout San Diego. A national lead-er among community health centers, Fam-ily Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare

tion and retention for over 15 years. A dedicat-ed triage and education 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, rounding 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, uniforms, 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]

OFFICE SPACE AVAILABLE

MEDICAL FACILITY AVAILABLE FOR SUB-LEASE: Seeking physicians in the fields of orthopedic surgery, sports medicine, primary care, rheumatology, and physical medicine and rehab to sublease a 3,101ft2 office in Sor-rento Valley. Built in 2013, the facility includes five exam rooms, a treatment room, onsite X-ray machine, large conference room, doc-tor’s office, nurses’ station, receptionists’ station, large waiting room, break room, two staff work rooms, and a restroom. The office is also adjacent to a DME supplier and physi-cal therapist and is situated directly above an outpatient surgical center. Rates are negotia-ble with the terms of the lease. For more in-formation, please contact Jeff Craven at [email protected] or at (858) 245-9109. [300]

ALISO VIEJO — 5 JOURNEY: Multi Tenant Medical Building with highly successful medi-cal and dental practices. 2 ground floor medi-cal spaces approx. 2,135 and 2,225 rsf available for lease. $2.90 PSF NNN. Beautifully designed. Tenant Improvement Allowance to customize suite is available. For further information please contact Lucia Shamshoian @ 769-931-1134x13 or [email protected]. [298]

AVAILABLE IMMEDIATELY: 14ft x 12ft sunny room in a four-room office suite shared by a physician, several chiropractors, and an acu-puncturist. Located upstairs in Cardiff Town Center at the corner of San Elijo Avenue and Birmingham Drive one-half mile off I-5 and across Coast Highway 101 from San Elijo State Beach. Take advantage of Seaside Market, nu-merous restaurants, a post office, and a public library either onsite or across the street. Call (760) 436-7464. [294]

LA JOLLA (NEAR UTC) OFFICE FOR SUB-LEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main en-trance of the hospital between I-5 and I-805. Multidisciplinary 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]

3998 VISTA WAY, IN OCEANSIDE: Medical office space approx. 2,488 rsf available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground-floor access. Lease price: $1.75+NNN. Tenant improvement al-lowance to customize the suites is available. For further information, please contact Lucia Shamshoian at (760) 931-1134, ext. 13, or at [email protected]. [234]


plaCe your

ad here contact dari Pebdani

at 858-231-1231 or [email protected]

BANKERS HILL PRIMARY CARE / HEALTH-CARE PROFESSIONAL & RESEARCH OF-FICE SPACE TO SUBLEASE: 50-year es-tablished primary care practice and clinical research office, with currently two internists, have space to sublease to another primary care or primary care / subspecialist, or other independent healthcare professional, to help curb overhead and, if primary care, help with acute overflow patients’ needs. Also can pro-vide opportunity to get into clinical research. Contact Jeff at [email protected]. [265]

DEL MAR / CARMEL VALLEY MEDICAL OFFICE TO SHARE: Available immediately. Class A medical building. 1,000SF. Two treat-ment / consultation rooms / office reception / photography room / break room. Full or shared occupancy. Unlimited free parking. Call (858) 481-4888 or email [email protected]. [252]

SCRIPPS XIMED MEDICAL CENTER BLDG, LA JOLLA — OFFICE SPACE TO SUBLEASE AVAILABLE: Vascular & 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 Memorial Hospital, The Scripps Ximed Medical Center is the office space location of choice for anyone seeking a presence 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 information, 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. Excellent 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]

POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiro-practor, massage therapist. Low rates. Email inquiries to [email protected]. [173]

POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467SF furnished suite, on the ground floor, next to main entrance, 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 / sat-ellite location, flexible days of the week. Con-tact Nerin at the office at (858) 521-0806 or at [email protected]. [873]

BUILD TO SUIT: Up to 1,900SF office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server

ing and treating common dermatologic condi-tions, possess excellent interpersonal skills, be a caring and empathetic provider, and possess the highest of ethical standards. Being a team player and having a positive attitude is essen-tial for success! Please send your CV and salary history to [email protected]. We look forward to hearing from you! [290]

NURSE PRACTITIONERS WANTED FOR OUR GROWING ORGANIZATION: See ad #046 un-der “PHYSICIAN POSITIONS AVAILABLE.”

BOARD-CERTIFIED PHYSICIANS, PHYSI-CIAN ASSISTANTS, AND NURSE PRAC-TITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right can-didate. 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 infor-mation. [229b]

NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competi-tive benefits package and salary. Call (619) 992-5330 or email [email protected]. Visit www.thehousecalldocs.com. [152]

PHYSICIAN ASSISTANT OR NURSE PRAC-TITIONER: 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]

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: Two exam rooms and one minor OR room with potential to share other exam rooms in building. Medi-care certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email [email protected] for more information. [867]

NONPHYSICIAN POSITIONS AVAILABLE

PSYCHIATRIC NURSE PRACTITIONER: Part- or full-time psychiatric nurse practitio-ner needed to work at San Diego County jails. Work as an independent contractor with very competitive pay. Contact Steve at [email protected] or at (619) 885-3907. [303]

SEEKING NURSE PRACTITIONER: Internal medicine, part-time position available. Seek-ing nurse practitioner with primary care and EHR experience. Private practice located in beautiful North San Diego County, single specialty group, collegial work environment. Please contact (619) 248-2324 or email re-sume to [email protected]. [296]

PA NEEDED FOR DERMATOLOGY AND COS-METIC SURGERY PRACTICE IN ENCINITAS: Experience in general dermatology a must! Applicant must be knowledgeable in diagnos-

28 ja n ua ry 2015

RiSK ManaGEMEnt

tests, or consultations• failure to order appropri-

ate diagnostic tests• context errors• failure to follow diagnos-

tic protocols• system-related errors,

such as poor communica-tion or electronic health record design flaws

• human-factor errors, such as impaired judgment, fatigue, or distractions

In an effort to better under-stand the causes of diagnosis-related error, the Institute of Medicine has appointed a Committee on Diagnostic Error in Health Care. The com-mittee will examine a range of topics, such as the epidemiol-ogy of diagnostic error, the burden of harm and economic costs associated with diagnos-tic error, and current efforts to address the problem. The com-mittee will propose solutions that may include definitions and boundaries, educational approaches, behavioral/cog-nitive processes and cultural change, and health informa-tion technology.

To achieve the desired goals, the committee will devise con-clusions and recommendations that will propose action items for key stakeholders.

problems related to diagnostic error are the most common allegation in medical malpractice claims, according to industry sources such as the PIAA’s Data Sharing Project.

The Doctors Company reviewed 7,438 claims closed from 2007 to 2013. The claims involved 10 medical special-ties: pediatrics, emergency medicine, internal medicine, family medicine, hospital medicine, cardiology, general surgery, gynecology, ortho-pedics, and obstetrics. 25% of these claims (1,877 claims) were diagnosis-related. The analysis then focused on the variance between these medi-cal specialties in the incidence of alleged diagnosis-related error and the specific diagno-ses involved.

Overall, 34% of nonsurgi-cal specialty claims were diagnosis-related (the number one allegation in these claims). For surgical specialties, 14% were diagnosis-related (the third most common allegation

diagnostic error identified

as the most Common

allegation in malpractice

lawsuitsContributed by SDCMS-endorsed The Doctors

Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

in these claims).The top five diagnoses

for each medical specialty’s diagnosis-related claims in-volve commonly encountered conditions with differential di-agnoses that are well-known to most physicians. Furthermore, 52% of the top diagnoses are found repeatedly in different specialties, e.g., acute MI ap-pears in emergency medicine, internal medicine, family medicine, hospital medicine, and cardiology. This suggests that knowledge deficiency is not the primary cause of diagnostic error and that other factors play an important role.

The following are some of the factors that can lead to diagnostic errors. Physicians should keep these factors in mind when making a diagnosis to reduce risks and enhance patient safety:

• first-impression or intuition-based diagnoses

• narrowly focused diagno-ses influenced by a known chronic illness

• failure to create a differ-ential diagnosis

• impaired synthesis of diagnostic data from various sources, such as medical history, physical examination, diagnostic

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*Source: U.S. Department of Health and Human Services

January 2015

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