July 2014
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“PHYSICIANS UNITED FOR A HEALTHY SAN DIEGO” OFFICIAL PUBLICATION OF SDCMS JULY 2014 COVERED CALIFORNIA THREE BIG THINGS YOU NEED TO KNOW!
description
Our July 2014 issue of San Diego Physician looks at the three big things physicians need to know about Covered California.
Transcript of July 2014
“Physicians United for a healthy san diego”
official publication of SDcMS July 2014
Covered California
three Big things yoU need to Know!
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
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
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 7ContentsJUly
10Welcome Dr. Poceta, SDCMS President for 2014–15
14Protecting Access to Quality Health Care and Ensuring Patient Privacy: Oppose the MICRA MeasureBy RichaRd ThoRp, Md
16Summer PondBy daNiEl J. BRESSlER, Md
18Closing or Leaving a Practice? Make Appropriate Arrangements for Medical RecordsBy ThE docToRS coMpaNy
26Physician Marketplace: Classifieds
28Be the Genius You AreBy 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 j u ly 2014
10
8
features20 Covered California: Three Big Things You Need to Know!By ThE caliFoRNia MEdical
aSSociaTioN
departments4 Briefly Noted: San Diego Medical Office Overview • Calendar • Welcome New & Returning Members • And More …
8Thank You, Dr. Peters, SDCMS President for 2013–14
4 j u ly 2014
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Market Conditions and TrendsReal estate activity among the county’s larger health systems remains steady. In particular, Scripps Health, Sharp Health-care, and UC San Diego Health System have been relatively active in the leasing, acquisi-tion, and/or construction of both acute care and outpatient facilities, especially over the past 24 months.
The county’s demand for healthcare real estate is coming not only from large medical groups and other traditional tenants, but also a growing pool of entrepre-neurial and self-pay provid-ers such as plastic surgeons, wellness centers, age man-agement clinics, liposuction and other laser centers, and other cosmetic and cash-based practices whose prevalence is reemerging with the gradually improving economy. Most of these tenants prefer Class A buildings given their target clientele.
Vacancy and Rental RatesCountywide vacancy at the end of Q1 2014 came in at 10.4%, virtually no change from that of Q4 2013 and down from the Q1 2013 rate of 11.3%, a positive sign for the market. With almost no construc-tion in the pipeline for 2014, continued steady demand will result in a decline in vacancy throughout the rest of the year.
The average gross asking rent was at $2.47 per square foot at the end of Q1 2014, unchanged from Q4 2013 and slightly down from $2.53 per square foot a year ago. Most of this decline is attributed to Class B medical buildings, whose average rate dropped more significantly than Class
By Chris Ross
A and C space. This is a result of nearly 70% of the county’s vacancy lying among Class B MOBs, primarily due to the recent flight to quality into newer Class A develop-ments. Class A vacancy shows continued improvement, settling in at 7.5%, reflecting continued tenant demand for quality space and resulting in a 9.5% increase in Class A rental rates since 2011. Asking rents among Class C buildings also increased, up 4.8% over the same period, while asking rents for Class B buildings decreased 8.4%.
AbsorptionIn the first quarter of 2014, net absorption was slightly negative at 1,739 square feet — a classic example of how market statistics “on paper” can be misleading. A num-ber of sizeable transactions stalled in Q1 and will likely be consummated in the second and third quarters. Once this takes place, the overall 2014 numbers will be representative of current demand levels.
Surveying San Diego Submarkets
Escondido/San MarcosLeasing activity remains tapered in Escondido/San Marcos, not unlike the rest of the greater inland North County area, although there are signs that this could change throughout 2014. Nordahl Medical Centre, approxi-mately three-quarters of a mile north of the new hospital, has reintroduced its ability to sell individual Class A medical condos. Owner-user opportu-nities are something all tenants should consider as a solution for long-term cost containment.
CommerCial real estate tips & trends
SAN DIEGO MEDICAL OFFICE OVERVIEW: Q1 2014
The jury is still out as to how much movement this submar-ket is still expected to see, but we wouldn’t be surprised if more relocation and expansion plans are announced.
Oceanside/VistaThe Tri-City area is still mak-ing its gradual recovery, one small lease or sale at a time. Net absorption was essentially flat in 2013, and at $2.30 per square foot, the submarket’s average rental rate is $0.18 below the county average of $2.47. Pre-mier Crossing and Vista Pointe Medical Plaza on Melrose Drive, and Creek View Medical Park on Via Centre Drive have reduced pricing enough to see better activity from providers looking for low-cost alterna-tives with relatively good value — somewhat of a trend that is taking place, particularly among private practices and in certain areas.
North County CoastalVacancy in coastal North County is extremely tight — by far the lowest in the county at 4.5% and a little more than half of its 8.0% peak from 2008. This continues to limit transaction volume since relo-cation alternatives are scarce. Though net absorption was essentially flat in Q1, it was +74,000 SF in 2013, which is highest in the county and about 50% more square foot-age than what the submarket has vacant today (51,000 square feet). Rental rates are now starting to climb, as evidenced by the county-high
average rental rate of $3.30 per square foot (up from $3.24 in Q4 2013).
I-15 CorridorBy the end of 2014, we still expect the three most recently completed buildings — 4S Health Center in 4S Ranch, Pinnacle Medical Plaza in Scripps Ranch, and Pomerado Outpatient Pavilion in Poway — to be nearly all leased up (4S is full now). It is still generally a stable but quiet submarket, but Sharp Rees-Stealy, Palo-mar Health, and Arch Health all seem to be expanding so as not to lose any ground in this area, as it is one with steady growth and relatively strong demographics.
La Jolla/UTC/SorrentoLeasing activity is strong in the greater UTC submarket. Scripps’ 383,000-square-foot Prebys Cardiovascular Insti-tute celebrated the completion of its “skin” in September and is scheduled for completion in spring 2015. Scripps also com-menced construction of its six-story, 80,000-square-foot MOB earlier this year. UCSD’s new Jacobs Medical Center had its topping out (when the last steel beam is placed) in October and will open in 2016. While UTC ranked second in net absorption in 2013, behind North County Coastal, it was only the opening of the new Sharp Rees-Stealy in Del Mar that was the difference. UTC also ranked second in average rental rate at $3.08 per square foot in Q1, a number that is
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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].
hipaa update (seminar/webinar)auG 14: 11:30am–1:00pm
CMA WebinarsCMAnet.org/events
What to Expect From a Medi-cal auditJul 30: 12:15pm–1:15pm
hipaa Breach Notification and california RequirementsJul 31: 12:15pm–1:15pm
Workers’ compensation advanced part 1: Tips and Tricks for Workers’ compensation BillingauG 5: 12:15pm–12:45pm
Workers’ compensation advanced part 2: Second Bill Review plus Managing Third-party BillersauG 12: 12:15pm–12:45pm
Calendar
SA N D I EGO P H ySI C I A N .O rG 5
Workers’ compensation advanced part 3: Requests for authorization, dispensed pharmaceutical and dMEpoS Billing for Workers’ compensationauG 19: 12:15pm–12:45pm
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 primary care Summer conferenceauG 1–3 (www.scripps.org/sparkle-assets/documents/primary_care_summer_2014.pdf)
25th annual cardiovascular interventionsoct 21–24 (www.sdcms.org/portals/18/assets/pdf/seminars/cardiovascularinterventions brochure2014.pdf)
The 2014 San diego day of TraumanoV 7 (www.sdcms.org/portals/18/assets/pdf/seminars/trauma%202014%20brochure-.pdf)
“
”
it is easy in the world to live after the world’s opinions; it is easy in solitude to live after your own; but the great man is he who in the midst of the crowd keeps with perfect sweetness the independence of solitude.
— Ralph Waldo Emerson (1875–1965)
expected to rise as vacancy tightens throughout the year.
Kearny Mesa/Mission ValleyKearny was the only submarket in the county to experience negative net absorption in 2013, but it bounced back in Q1 2014 with +3,150 square feet of net absorption and a slight increase in average asking rate. A new 90,000-square-foot Class A development known as Mission West was recently announced. It will be located at 1904 Hotel Circle North and is scheduled to deliver early 2016. New vacan-cies are in the process of being announced at Rady’s 7910 Frost Street medical buildings. It will be interesting to see if they can achieve the lofty rents they are quoting (±$4.25 gross, plus parking charges) and how flex-ible they are as to whom they are willing to accommodate.
East CountyThanks to nearly 10,000 square feet of positive net absorption in the fourth quarter of 2013 and another 3,199 square feet in the first quarter, East County is now down to 9.6% vacancy. With MOBs, achieving single-digit vacancy is typically the bench-mark for a healthy submarket, although we need to see steadier activity and a recovery in rental rates before we would describe East County as “healthy.” The leasing of midsize and large blocks of space is playing a large role in the overall strength of the county’s healthcare real estate market; but while East County is the largest submarket by total inventory, the average transac-tion size has been among the smallest.
Uptown/HillcrestThe Hillcrest submarket was incredibly flat in 2013, but we finally saw a slight increase in rental rates in the first quarter. The boring news is yet an-other quarter of near-zero net absorption, this time coming in at a mere +84 square feet. Few tenants have any reason to move, and as dynamic a community as the Hillcrest population is as a whole, we have been seeing very little expansion or new practices. With two strong hospitals and more than one million square feet of medical office invento-ry, the submarket is poised for improvement. We are already seeing a lack of mid to large blocks of available space.
South CountySix projects in South County contain nearly 70% of the submarket’s vacancy. Since these six MOBs are geographi-cally spread out, the leasing environment is less competi-tive among landlords than one would think. South County’s net absorption was flat in the first quarter, and it saw a slight uptick in average asking rent. In general, the submarket remains a quiet but stable one, while its population continues to grow.
Mr. Ross is vice president of healthcare solutions for Jones Lang LaSalle. He is a commer-cial real estate broker special-izing exclusively in medical office and healthcare properties in San Diego County. He can be reached at (858) 410-6377 or at [email protected].
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
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6 j u ly 2014
sdCms-Cma membership
Raheleh Esfandiari, Mdobstetrics and GynecologyEncinitas(760) 943-9994
Nicole E. Esposito, MdpsychiatrySan Marcos(760) 736-6700
pamela E. Fadul, MdanesthesiologySan Diego(858) 673-6100
david p. Fischbach, MdanesthesiologySan Diego(858) 673-6100
Maribel c. Flores, Mdfamily MedicineSan Diego(619) 428-4463
Megan R. Gatlin, doanesthesiologySan Diego(858) 673-6100
orna Gil, Mdobstetrics and Gynecologycarlsbad(760) 631-5000
Gwen E. Gleason-Rohrer, Mdfamily MedicineSan Diego(619) 563-0250
Mark S. Goldsworthy, MdanesthesiologySan Diego(858) 673-6100
Gary d. Gonsalves, MdanesthesiologySan Diego(858) 673-6100
peter d. Gougov, MdanesthesiologySan Diego(858) 673-6100
William G. Grant, MdanesthesiologySan Marcos(858) 673-6100
Jacob h. Gregerson, MdpediatricsSan Diego(619) 280-4213
Edward M. Gurrola, MdanesthesiologySan Diego(858) 673-6100
Welcome New and Returning SDCMS-CMA Members!
loraine M. Gutierrez, Mdfamily MedicineSan Diego(619) 280-4213
Mary Jo harbert, Mdchild neurologySan Diego(858) 966-5819
Ralph c. hernandez, Mdfamily MedicineSan Diego(619) 662-4100
alexander c-K hsu, MdRadiologySan Diego(619) 528-7752
chenggang hu, MdanesthesiologySan Diego(858) 673-6100
Nick S-c huang, Mdinternal MedicineEscondido(760) 520-8100
doreen i. ibrahim, Mdinternal MedicineSan Diego(619) 499-2600
Mickaila J. Johnston, Mdnuclear MedicineSan Diego(619) 532-8775
Setareh S. Jones, MdpediatricsSan Diego(858) 279-0925
Mihae G. Joo, Mdinternal Medicinela Jolla(858) 626-7780
hulya Kararli, MdanesthesiologyEncinitas(858) 673-6100
anne d. Kaufhold, Mdfamily MedicineSan Diego(619) 231-9300
Brian p. Keefer, MdanesthesiologySan Diego(858) 673-6400
omar M. Khawaja, MdanesthesiologySan Diego(858) 673-6100
Karen N. Kobayashi, doobstetrics and GynecologySan Diego(619) 267-8313
Michele a. lamantia, Mdinternal MedicineSan Ysidro(619) 428-4463
Justin E. laubach, MdanesthesiologySan Diego(858) 673-6100
Scott p. leary, Mdneurological SurgerySan Diego(858) 810-0386
Greg d. lewis, Mdinternal Medicinela Jolla(858) 626-7780
huabao B. lin, MdanesthesiologySan Diego(858) 673-6100
pierre R. lotzof, MdanesthesiologySan Diego(760) 746-1755
arthur S. lovgren-Moritz, Mdinternal MedicineSan Diego(619) 221-9534
peter M. lucas, MdanesthesiologySan Diego(858) 673-6100
Brian S. luschwitz, MdpediatricsVista(760) 631-5030
Michael l. MacMurray, Mdinternal Medicineoceanside(760) 631-5000
parvin Mani, Mdobstetrics and GynecologySan Diego(619) 583-7555
anastasios Mavrakis, Mdinternal Medicineimperial beach(619) 515-2300
Monique c. Mccormick, Mdanesthesiologycarlsbad(858) 673-6100
Jamie S. McReynolds, Mdfamily Medicinealpine(619) 445-1188
New MeMbeRS
Edita S. aguilar, MdpediatricsEscondido(760) 520-8330
liliana alvarez-Martinez, Mdfamily MedicineSan Marcos(760) 471-2100
Richard l. austin, MdanesthesiologySan Diego(858) 673-6100
andrelita d. Barrera, Mdfamily Medicinenational city(951) 662-4254
claudia castelnovi, MdpediatricsSan Diego(619) 280-4213
Surya R. chetlapalli, Mdinternal Medicinela Jolla(858) 626-7780
Myrna l. coronado, Mdfamily MedicineSan Ysidro(619) 428-4463
Kelly R. culwell, Mdobstetrics and GynecologySan Diego(619) 881-4500
alejandro l. diaz, MdpediatricsSan Diego(619) 280-4213
Jennifer W. doumas, doGeneral practicelemon Grove(619) 456-0033
Jay F. downey, Mdfamily Medicinechula Vista(619) 662-4100
cesar d. Gomez, Mdfamily Medicinechula Vista(619) 662-4100
Kekoa c. Ede, MdpsychiatryEscondido(619) 542-4300
devarshi Nath, Mdfamily MedicineSan Marcos • (760) 471-2100
Thays S. Novikoff, Mdfamily Medicinecarlsbad(760) 631-5000
lesley a. Nurse, Mdobstetrics and Gynecologychula Vista(619) 205-1366
donald l. ong, MdGeneral SurgeryVista (760) 631-5000
Sue a. park, MdpediatricsVista(760) 631-5000
anthony V. phung, MdanesthesiologySan Diego(858) 673-6100
Jennifer l. poast, dointernal Medicinechula Vista (619) 563-0250
ori Raz, MdanesthesiologySan Diego(858) 673-6100
Malini M. Reddy, MdanesthesiologySan Diego(858) 673-6100
pomai Roberts, Mdfamily Medicinenational city(619) 498-6200
Marco S. Robin, doanesthesiologycarlsbad(858) 673-6100
Gabriel Rodarte, MdpsychiatryEscondido(619) 542-4300
Javier Rodriguez, MdpediatricsSan Diego(619) 280-4213
Rogelio S. Samorano, MdpsychiatryEscondido(760) 560-8340
Karin R. Schiff, Mdfamily MedicineEscondido(760) 520-8100
Kevin J. Schwartz, MdanesthesiologySan Diego(858) 673-6100
Tina Shahidyazdani, MdpediatricsSan Ysidro(619) 428-4463
Joseph J. Sheridan, Mdchild and adolescent psychiatryla Mesa(619) 630-1036
Julie R. Sierra, Mdinternal MedicineSan Diego(619) 428-4463
loretta S. Stenzel, Mdfamily MedicineVista(760) 631-5000
alexander E. Stewart, MdotolaryngologySan Diego(619) 532-9600
Ramon S. Sy, Mdinternal MedicineSan Ysidro(619) 428-4463
Kulin R. Tantod, Mdfamily Medicinelakeside(619) 390-9975
Selmira Tellechea-Sanchez, MdpediatricsEscondido(760) 451-0070
paige a. Thiermann, Mdfamily MedicineEl cajon(619) 440-2751
Bertha F-c Tsai-Tulagan, dopediatricsEscondido(760) 690-5900
Keith K. Vaux, MdpediatricsSan Diego(858) 966-5840
Sharon F. Velasquez, Mdfamily Medicinenational city(619) 662-4254
Jonathan J. Walters, Mdfamily MedicineSan Diego(858) 279-0925
Stacy E. Wilson, Md, FacoGobstetrics and GynecologySan Diego(619) 516-6182
Mary c. yager, Mdinternal MedicineSan Diego(619) 694-8879
SA N D I EGO P H ySI C I A N .O rG 7
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doris a. yung, MdpediatricsRamona(760) 471-2100
Rensheng Zhang, MdanesthesiologySan Diego(760) 746-1755
irene M. Zink, Mdfamily MedicineSan Diego(619) 231-9300
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Mark c. adrian, Mdinternal Medicinela Jolla(858) 626-7780
William S. anapoell, Mdinternal MedicineSan Diego(619) 260-7125
Eugene J. Basiliere, Mdobstetrics and Gynecologybonita(619) 280-4213
arwinnah Bautista, Mdinternal MedicineSan Diego(619) 267-0553
James E. Boyd, Mdfamily Medicinela Jolla(858) 626-7780
paul J. cotten, MdanesthesiologySan Diego(858) 673-6100
Mayra M. dillon, Mdfamily Medicinenational city(619) 336-2300
Terence M. o. Gan, Mdinternal MedicineSan Diego(858) 626-7780
Brendan J. Kidder, Mdfamily Medicinenational city(619) 474-2284
anand S. Kunda, MdHematologySan Diego(858) 939-3660
Teri l. Kunin-Rida, Mdfamily MedicineEl cajon(619) 312-0347
leng T. Ky, MdanesthesiologySan Diego(858) 673-6100
Ronald M. levin, MdanesthesiologySan Diego(858) 673-6100
Ramona Master, Mdinternal Medicinela Jolla(858) 729-3050
Bill h. Mccarberg, Mdfamily Medicinepoway(760) 520-8100
deborah M. Mitchell, MdanesthesiologySan Diego(858) 673-6107
carie c. Nguyen, Mdfamily MedicineSan Ysidro(619) 428-4463
Margaret G. o’Byrne, Mdinternal MedicineSan Diego(858) 481-4888
Samuel i. poniachik, Mdinternal MedicineSan Marcos(760) 471-2100
Ravindra prabhu, Mdclinical cardiac Electrophysiologychula Vista(619) 482-4333
Timothy d. Sahms, MdpediatricsSan Ysidro(619) 428-4463
Jason d. Silva, Mdfamily MedicineSan Diego(619) 478-5254
Brian p. Snook, dofamily Medicinenational city(619) 428-4463
dean c. Tasher, Mdinternal MedicineEscondido(760) 743-6066
8 j u ly 2014
The following is outgoing president Dr. Peters’ speech given at the June 14 installation dinner and dance.
friends, family, fellow Members, Honored Guests, Medical Society Staff, thank you for joining us this evening.
It is my honor to have had the opportunity to serve as president of SDCMS, one of the best, if not the best, county medical societies in the United States. It has been my plea-sure, as the president, to work closely with so many of you as our Society continues its tradition of excellence.
The challenges to delivering quality patient care to each of our patients, on an individual basis, continue. Trial lawyer attacks, scope of practice expansions, declin-ing reimbursements, technology and reporting demands, the simple imperative of maintaining a focus on patient care without being impeded by bureaucratic entanglements … all diverting precious time from our primary purpose: patient care.
We must maintain the quality of patient care while expanding access by carefully expanding the health-care team to allow everyone to work to the capabilities of their respec-tive training, while keeping the best and most comprehensively trained individual, the physician, at the head of the healthcare team. This is not an easy position to take, but we must because no one else is going to take this position toward long-term, con-tinued delivery of optimal care and safety for our patients. We remain, at the end of the day, the guardians of patient care. Our primary goal and mission as physicians require it.
We must continue to adapt to an ever-changing practice environ-ment. In the midst of these changes, we cannot throw up our hands in frustration; rather, we must work with people forcing these changes
— who, in general, have good intent — to design and implement, and em-brace the new methods and mecha-nisms of patient care delivery. And, in the process, our job must be to also protect the quality of the patient care that is delivered. If not us, who will do this? It is our responsibility. Ours. We are, and must be, part of the solution to the American healthcare dilemma regarding cost, access, safety, and quality.
Your voice must be heard in the exam room, in San Diego, in Sac-ramento, and in Washington, DC. Many talk about protecting the qual-ity of patient care, but we have the perspective, experience, and knowl-edge to protect the most important person in the equation: the patient. We must not allow the changes be-ing implemented in our healthcare delivery system to be made by those whose primary focus is anything other than the patient-physician re-lationship and the most appropriate medical care for each patient.
You are the last line between your patient and lessened quality of care. It is your responsibility to keep the focus on patient care quality in the midst of rapid, continuing changes. “First do no harm” has moved from its historic location in the exam room to now include the requirement — and obligation — for us to be protect-ing our patients from the unintended consequences of well-meaning but too often not-thought-through health policy changes.
The challenges to physicians and to our patients will continue, and they will come from many fronts: well-meaning regulators and legisla-tors who, no fault of their own, will not understand the implications of their efforts without input from those of us with boots on the ground in day-to-day patient care; econo-mists who see medicine first as a general population business rather
thank you, dr. peters!SDcMS president for 2013–14
SDcMS lEaDERSHip
than a business built on proper care of each individual patient; a public struggling for access to affordable and reliably excellent care in an en-vironment of increasing regulatory burdens and technologies driving the costs of care higher rather than lower; and other professions (and I use the term loosely with regard to some) like malpractice trial attor-neys who seek to take a bigger piece of the pie away from patient care for their own gain by promulgating laws and initiatives that play on people’s emotions, such as the upcoming, ill-conceived, and grossly deceptive Medical Injury Compensation Re-form Act (MICRA) lawsuit initiative.
We, as leaders and practitioners looking out for our patients’ true best interests, have a responsibility and
1. california Senator Mark Wyland presenting Dr. peters with a resolution 2. SDcMS past presidents Dr. carol Young, Dr. Susan Kaweski, and Dr. Sherry franklin3. Mingling at the reception4. Dr. bob Hertzka, master of ceremonies for the evening5. barbara Mandel, SDcMS foundation executive director, Dr. alberto bessudo, SDcMS foundation “above & beyond” award winner, Dr. al Ray, SDcMS foundation president, and Dr. bret langenberg, SDcMS foundation “unsung Hero” award winner6. SDcMS past presidents being honored
1
2
4
3
5
6
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mandate to educate our patients and the public about the negative consequences of these types of actions, and to hold fast our com-mitment to our patients and to the future of medicine as a profession, not a job. As my last ask of you as SDCMS president tonight, I would first like to give a big thank-you to everyone who made possible the gathering of generous contribu-tions to help defeat the MICRA lawsuit initiative — with your commitment and dedication, I know that we can stop this mea-sure from passing. As the fight is far from over, I ask each of you and all of your colleagues to take the lead and be active in this battle in the next few months, and indeed long after that as new battles arise. We will, and must, prevail in protecting our profession in order that we will be able to continue to protect and serve our patients.
It has been my pleasure to serve this past year. I look forward to continuing to work with each of you as we move forward.
Thank you.
7
9
8
7. congress-woman Susan
Davis and Dr. peters 8 & 9. Enjoying dinner
The following is incoming president Dr. Poceta’s speech given at the June 14 installation dinner and dance.
Good eveninG, Ladies and Gentlemen.
We are here tonight not as the San Diego County Doctor Society, but as the San Diego County Medical Society. Just as doctors are a diverse group, the healthcare system is even more diverse. It takes a team to de-liver high-quality healthcare.
Despite this diversity, all of us in this room are a united group, united by one thing: a mission to provide healthcare to our patients and our community.
Before health insurance and before Medicare, when someone was sick, they saw the doctor. He had his own practice, sometimes out of his own home, which doubled as a hospital, and he even made house calls.
Now, there is about a 7:1 ratio of medical staff to patient whenever someone goes to the doctor. You need a receptionist to handle the appoint-ments, nurses to go over medicines, an MBA to negotiate contracts, biller/coders, IT people for the elec-tronic medical record, and, of course, the doctor to see the patient.
We stand at a pivotal time in the changing U.S. healthcare system.
It is wonderful that more people than ever have health insurance, and that no one can be denied insurance for a preexisting condition. Although we will have to work together to understand and to implement the Affordable Care Act, the practice of medicine and its devoted members have survived through the Great Depression, two world wars, and HMOs, and will continue with the ACA.
While how medicine does its job is changing, its main charge has not: to provide the best possible care for patients and community.
We come together tonight to
celebrate the efforts of all of us for this cause.
While I work in a large, multispe-cialty group, I know the situation faced by solo and small-practice physicians. Not only do you have to be a doctor, but a businessperson as well — both more than full-time jobs.
Solo practice doctors may or may not be the canary in the coalmine, but they are disappearing as our sys-tem consolidates into bigger and big-ger groups. But medicine is huge, and its needs many, and I believe there will always be solo practitioners as well as academic researchers. I want to welcome all of you to a medical society that fights for every doctor to do what we have trained for years to do: treat patients, relieve suffering, and cure disease.
For our nurses and medical as-sistants, you are a critical part of the team, and you have one of the tough-est jobs — you are on the front lines every day.
For our nurse practitioners and physician assistants, you enhance the quality of medicine delivered.
For those who run the hospitals — from the lawyers who help us inter-pret the law, to the boards’ making sure we have enough capital, and to the administrators and managers who support the physicians — we must be united and committed to that great goal, again, of serving our patients and community.
Unity can be hard to accomplish, even among doctors — such as dif-ferences between specialists and primary care physicians. True story: One day I was asked to see a patient in the hospital who had weakness of one arm after a surgery. The medi-cine intern was rotating on neurology and came with me. After I diagnosed a brachial plexus injury, the patient asked me about her constipation. “I’m sorry,” I said. “You’ll have to ask your surgeon or your hospital doctor.” Then she asked about her
welcome dr. poceta!SDcMS president for 2014–15
SDcMS lEaDERSHip
SA N D I EGO P H ySI C I A N .O rG 11
pain medicines. Again I said that I couldn’t give her a good answer. Then she asked about her IV site, which hurt. Again, “I’m sorry, you’ll have to ask your attending doctor.”
As we left the room, the intern said to me, “I can’t wait to specialize.”
In many ways the primary care physician has the toughest job, but our system does not incentivize medical students to go into general medicine or general surgery. I won-der if there is not more that we could do to support doctors of all types?
I want to take this opportunity to thank some friends and colleagues. First, I want to thank all the presi-dents who have served before me and, especially, those coming after me, and all the doctors who are members of the Medical Society and CMA.
I want to thank Ms. Shiraz Fagan, CEO of the Scripps Medical Founda-tion. She is a strong supporter of our Medical Society.
Scripps Clinic and Scripps Clinic Medical Group are an example of the partnership between the hospital and the doctor. Many of the Scripps team are here tonight, including Re-becca Cofinas, Brett Ringler, and Ken Leake. Thank you for being here.
I’d like to thank some of my own staff who kindly attended tonight and who make each of my days a pleasant experience. Celeste, Denise, Ruth, Chris, Mary, Joanie, Gina, Jane, please stand.
I’d like to thank all my physician colleagues at The Clinic, especially Bob Sarnoff, our president, who has supported the Medical Society con-sistently. Thank you, Bob.
I would not be here tonight with-out my wife and favorite person: Lori Poceta. Lori is a nurse practitioner also working at Scripps Clinic. Those who know her already know that Lori is one of the nicest people on the planet and is a great mother to our two children. Lori’s father is a retired internist — healthcare and service are in her DNA. Thank you, honey, for everything.
Two more people deserve special thanks: our CEO, Mr. Tom Gehring, and his wife, Dr. Cathy Moore. Over the last 12 years Tom has organized us into a viable business, and has grown the Medical Society into the largest in California. Without Tom Gehring, many of us would not be here tonight, and SDCMS would be a weaker Society. Tom does it all, from organizing our advocacy efforts to
managing the staff, the member ben-efits, the budget … and he has almost figured out how to herd cats.
Cathy has been a champion of medicine throughout her career. She has been president of the San Diego Psychiatric Society and a CMA trustee. Cathy and Tom’s involve-ment in our medical society has been transforming. It is not an exaggera-tion to say that Tom has made our medical society what it is today, and I doubt that he could have done it without Cathy. Tom and Cathy, with hope for many more years of partnership, please stand and accept our heartfelt thanks.
Part of our work as a group in-volves politics, and I will tread lightly on a couple of issues now.
There is a lot going on.
As we heard earlier, thanks to the Medical Society and CMA, working with our representatives, Washing-ton changed San Diego’s Medicare GPCI designation, which will soon bring millions of additional dollars into our community for healthcare.
This means that more doctors and healthcare practitioners will want to work in San Diego and that Medicare patients can feel secure knowing they will get the care they need.
The coming year is going to be a great year for medicine, but we will have some challenges.
Currently, Medi-Cal rates in California are almost the lowest in the nation, and few doctors can af-ford to see these patients. California must improve Medi-Cal rates — not cut them — so that the poorest in our community will have a doctor to see.
Also, although few of you know this, up in Sacramento we’ve got a race in November for a seat in the California State Senate. Believe it or not, a doctor running against a lawyer. In this race, one of our own, Assemblymember Dr. Richard Pan, is running against someone with a record of voting anti-medicine on almost every issue. One of my jobs — and many of yours — this year will be to help Richard get elected; it will be a tough race but we must win.
1. president for 2014–15, Dr. J. Steven poceta2. Drs. ted Mazer and bob Hertzka present congress-man Darrell issa with an honorary SDcMS member-ship certificate3. listening to congressman issa’s acceptance speech4. Dr. Jim Hay, SD-cMS foundation past president, and barbara Mandel, SDcMS foundation ex-ecutive director, with nick Mac-chione, SDcMS’s presidential “atlas” award winner
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12 j u ly 2014
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Most importantly this year, the Medical Injury Compensation Reform Act, or MI-CRA, is under attack. In November, voters will be faced with a so-called patient-safety initiative that will jeopardize the privacy of patients’ personal prescription medical information, drive up healthcare costs for patients across the state, and decrease access for patients that need it most. While the initiative may be masked with other provisions by proponents, we know it’s really about increasing the cap on MICRA and pulling money directly out of the healthcare delivery system and put-ting it into the pockets of trial attorneys.
Now more than ever, we must band together as a unified voice and commit to defeating this trial-lawyer-sponsored ballot measure to protect the future of healthcare and of our patients. We must prevail, and — you can be assured — I will not rest, nor will our Society rest, until this initiative is defeated.
It’s also going to be a great and exciting year because our SDCMS Foundation will increase its efforts in various community health projects. The Foundation facili-tates something that we all love to do: prevent illness before it happens.
The Foundation is partnering with San Diego Health and Human Services on its
initiative called Live Well San Diego! Live Well San Diego!’s vision is a healthy, safe, and thriving San Diego County, and it has the potential to transform health in our county. Together, we can make San Diego the healthiest county in America.
Going forward, I cannot promise a smooth path. But I know that all of us will be working for the good of medicine and for healthcare.
There will be changes to how medicine is practiced.
Yet ours is a group in San Diego that will stand together. Physicians of all specialties and modes of practice, doctors, nurses, and the hospital teams. We need each other going forward.
We live in San Diego. Medicine is our profession, and it must remain our goal to serve our patients and our community.
I want to thank each of you for at-tending tonight. I deeply appreciate this opportunity; thank you very much. Let’s start some music and dancing.
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5. california assemblywoman lorena Gonzalez at dinner6. california assembly-man brian Jones and his wife, Heather, at dinner7. Dr. Will tseng, SDcMS president-elect, his wife, angela Shiau, Dr. Daniel Klaristenfeld, SDcMS board member, county Supervisor Greg cox, and his wife, cheryl cox, mayor of chula Vista8. SDcMS past president Dr. Ralph ocampo, and his wife, bonnie
SDcMS lEaDERSHip
SA N D I EGO P H ySI C I A N .O rG 13
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ents
.
United
as
one v
oic
e, a
dvo
cati
ng
fo
r p
ati
ents
acro
ss t
he s
tate
, we c
an
d
efe
at
this
ballo
t m
easu
re in
novem
ber,
but
we n
eed
every
one t
o
co
mm
it a
nd
beco
me e
ng
ag
ed
alo
ng
the w
ay. t
hank y
ou in
ad
vance
for
all
that
yo
u d
o a
nd
all
that
yo
u’ll
co
nti
nue t
o d
o.
sin
cere
ly,
ric
hard
tho
rp, m
dP
resi
dent, c
alif
orn
ia m
ed
ical a
sso
cia
tio
n
dear
san d
ieg
o c
ounty
Physi
cia
n:
in ju
st a
few
sho
rt m
onth
s, v
ote
rs w
ill b
e a
sked
to
weig
h in
on t
he
mic
ra
(m
ed
ical i
nju
ry c
om
pensa
tio
n r
efo
rm a
ct)
healthcare
law
suit
m
easu
re, w
hic
h w
ill h
ug
ely
jeo
pard
ize t
he p
rivacy o
f p
ati
ents
’ pers
on
-al p
resc
rip
tio
n m
ed
ical i
nfo
rmati
on
.
the in
itia
tive w
ill f
orc
e d
octo
rs a
nd
pharm
acis
ts t
o u
se a
mass
ive
state
wid
e d
ata
base
kno
wn a
s th
e c
ontr
olle
d s
ub
stance U
tiliz
atio
n
revie
w e
valu
atio
n s
yst
em
(c
Ur
es
), w
hic
h is
fille
d w
ith p
ati
ents
’ p
ers
onal p
resc
rip
tio
n d
rug
info
rmati
on
. tho
ug
h t
he d
ata
base
alr
ead
y
exis
ts, i
t is
und
erf
und
ed
, und
ers
taff
ed
, and
techno
log
ically
incap
ab
le
of
hand
ing
the m
ass
ively
incre
ase
d d
em
and
s th
at
this
ballo
t m
easu
re
will
pla
ce o
n it
.
while
many o
f yo
u a
nd
yo
ur
co
lleag
ues
may
find
the
genera
l co
ncep
t o
f th
e c
Ur
es
data
base
help
ful,
this
bal-
lot
measu
re w
ill f
orc
e t
he p
rog
ram
to
resp
ond
to
tens
of
mill
ions
of
inq
uir
ies
each y
ear
— s
om
eth
ing
it s
imp
ly is
n’t
se
t up
to
do
in it
s curr
ent
form
or
functi
onalit
y. a
syst
em
uneq
uip
ped
to
hand
le t
hese
req
uir
em
ents
will
put
physi
-cia
ns
and
pharm
acis
ts in
the u
nte
nab
le p
osi
tio
n o
f hav
ing
to
bre
ak t
he la
w t
o t
reat
their
pati
ents
, or
bre
ak t
heir
oath
b
y r
efu
sing
so
me p
ati
ents
much n
eed
ed
med
icatio
ns.
mo
st c
oncern
ing
, the m
ass
ive r
am
p-u
p o
f th
is d
ata
base
w
ill s
ignifi
cantly p
ut
pati
ents
’ pri
vate
med
ical i
nfo
rmatio
n
at
risk
, and
the b
allo
t m
easu
re d
oesn
’t c
onta
in a
ny p
rovi-
sio
ns
or
fund
ing
to
help
up
gra
de t
he s
yst
em
or
incre
ase
th
e d
ata
base
’s s
ecuri
ty s
tand
ard
s.
as
many o
f yo
u k
no
w, t
he c
Ur
es
data
base
co
nta
ins
hig
hly
sensi
tive p
ati
ent
info
rmati
on
, inclu
din
g p
ers
onal
and
po
tentially
stig
matizi
ng
deta
ils a
bo
ut
their
health
. P
resc
rip
tio
n in
form
ati
on
, inclu
din
g m
ed
icati
ons
use
d t
o
treat
ob
esi
ty, n
arc
ole
psy
, co
nd
itio
ns
rela
ted
to
cancer
and
aid
s, a
sth
-m
a, a
nd
oth
er
sensi
tive in
form
ati
on
, is
all
co
nta
ined
within
the c
Ur
es
d
ata
base
. the b
allo
t m
easu
re’s
mass
ive r
am
p-u
p o
f th
e c
Ur
es
data
-b
ase
co
mes
with n
o f
und
ing
fo
r te
chno
log
ical i
mp
rovem
ents
and
will
le
ad
to
unin
tend
ed
pro
ble
ms.
in r
ecent
weeks
and
mo
nth
s, t
he c
oalit
ion t
o o
pp
ose
the m
icr
a
healt
hcare
law
suit
initia
tive c
onti
nues
to g
row
. teachers
, healthcare
w
ork
ers
, lo
cal c
om
munit
y g
roup
s, a
nd
hund
red
s o
f o
thers
hav
e
ple
dg
ed
to
vo
te n
o o
n P
ro
P 4
6 in
novem
ber
because
they t
oo
und
ers
tand
the im
plic
ati
ons
this
measu
re w
ould
hav
e o
n p
ati
ents
, ta
xp
ayers
, and
co
nsu
mers
acro
ss t
he s
tate
.
we k
no
w t
hat
if t
his
measu
re p
ass
es,
it w
on’t
just
be p
utt
ing
pati
ents
’ p
ers
onal m
ed
ical i
nfo
rmati
on a
t ri
sk, b
ut
malp
ractice la
wsu
its
and
p
ayo
uts
will
als
o s
kyro
cke
t, a
dd
ing
“hund
red
s o
f m
illio
ns
of
do
llars
” in
new
co
sts
to s
tate
and
local g
overn
ments
, acco
rdin
g t
o a
n im
part
ial
analy
sis
co
nd
ucte
d b
y t
he s
tate
’s l
eg
isla
tive a
naly
st. s
tate
and
local
govern
ments
face h
igher
co
sts
in t
wo
way
s:•
they p
rovid
e h
ealthcare
fo
r curr
ent
and
reti
red
em
plo
yees;
• t
hey p
rovid
e h
ealthcare
fo
r lo
w-i
nco
me r
esi
dents
thro
ug
h m
ed
i-c
al a
nd
oth
er
locally
run h
ealthcare
pro
gra
ms
like c
om
munit
y
clin
ics
and
ho
spit
als
.s
om
eo
ne w
ill h
ave t
o p
ay f
or
these
incre
ase
d c
ost
s, a
nd
that
som
e-
one is
pro
vid
ers
, taxp
ayers
, and
co
nsu
mers
.
the c
am
paig
n o
pp
ose
d t
o t
he in
itia
tive —
“P
ati
ents
and
Pro
vid
ers
to
P
rote
ct
access
and
co
nta
in h
ealth c
ost
s” —
is a
div
ers
e a
nd
gro
w-
ing
co
alit
ion o
f tr
ust
ed
do
cto
rs, c
om
munit
y h
ealth c
linic
s, h
osp
itals
, fa
mily
-pla
nnin
g o
rganiz
atio
ns,
local l
ead
ers
, pub
lic s
afe
ty
offi
cia
ls, b
usi
ness
es,
and
wo
rkin
g m
en a
nd
wo
men
fo
rmed
to
op
po
se t
his
co
stly
, dang
ero
us
ballo
t p
rop
osi
-tio
n t
hat
wo
uld
make
it e
asi
er
and
mo
re p
rofi
tab
le f
or
law
yers
to
sue d
octo
rs a
nd
ho
spit
als
. a f
ull
and
up
date
d
list
of
gro
up
s o
pp
osi
ng
the c
am
paig
n c
an b
e f
ound
at
No
on
46
.co
m.
yo
u’v
e b
een h
eari
ng
ab
out
the c
am
paig
n t
o o
pp
ose
th
e c
ost
ly m
icr
a h
ealthcare
law
suit
initia
tive f
or
many
mo
nth
s no
w, s
o h
ow
can y
ou g
et
eng
ag
ed
?
hav
e y
ou s
igned
up
to
be a
ho
spit
al c
oo
rdin
ato
r in
yo
ur
are
a? w
e’re a
lway
s lo
okin
g f
or
info
rmed
and
eng
ag
ed
p
hysi
cia
ns
to h
elp
ed
ucate
ab
out
the d
ang
ers
of
this
in
itia
tive. V
isit
cm
a’s
mic
ra
reso
urc
e p
ag
e t
o s
ign u
p
tod
ay w
ww
.cm
anet.
org
/iss
ues-
and
-ad
vo
cacy/
cm
as-
top
-is
sues/
mic
ra/j
oin
-the-fi
ght.
is y
our
nam
e o
n t
he g
row
ing
list
of
ind
ivid
uals
and
g
roup
s o
pp
ose
d t
o t
he m
icr
a h
ealthcare
law
suit
initia
tive?
if
no
t, a
dd
it
at
No
on
46
.co
m t
od
ay.
need
mo
re in
form
atio
n?
check o
ut
the c
am
paig
n w
eb
site
at
N
oo
n4
6.c
om
to
learn
mo
re a
bo
ut
the im
pacts
this
ballo
t m
easu
re
wo
uld
hav
e o
n h
ealthcare
and
yo
ur
pati
ents
.
United
as
one v
oic
e, a
dvo
cati
ng
fo
r p
ati
ents
acro
ss t
he s
tate
, we c
an
d
efe
at
this
ballo
t m
easu
re in
novem
ber,
but
we n
eed
every
one t
o
co
mm
it a
nd
beco
me e
ng
ag
ed
alo
ng
the w
ay. t
hank y
ou in
ad
vance
for
all
that
yo
u d
o a
nd
all
that
yo
u’ll
co
nti
nue t
o d
o.
sin
cere
ly,
ric
hard
tho
rp, m
dP
resi
dent, c
alif
orn
ia m
ed
ical a
sso
cia
tio
n
united
as
one v
oic
e,
ad
vocating
fo
r p
atients
acro
ss
the s
tate
, we
can d
efe
at
this
b
allo
t m
easu
re
in n
ovem
ber,
but
we n
eed
every
one
to c
om
mit
and
beco
me
eng
ag
ed
alo
ng
th
e w
ay.
16 j u ly 2014
poEtRY anD MEDicinE
i Used to live in a house in Mission Hills whose side yard held an old but active fishpond. The koi did endless lazy laps under the lily pads. The water alternated between a light and a murky green depending on the season and on my attention to its cleanliness.
Each June, the summer began officially with the arrival of the frogs’ nightly call-and-response. Every year they somehow found their way back from wherever they hatched and tadpoled. What brought them back every year? And why did they begin croaking on that one particular night? Was it a simple thermal switch that their amphibian hypothalamus read as “game time”? Was it an osmostat in their frog proto-kidneys that detected a level of dissolved solids? Did their eyes transmit a signal to their little froggy pi-neal gland based on the angle of the sun? Did their tongue or nose pick up a pheromonal signal from fly larvae or female frogs? As a non-frog-biologist, I only speculated.
Clinical medicine contains a concept called Readiness to Change. It first emerged out of studies of alcoholism and has been subsequently applied and validated to a host of health-related behaviors such as drug use, nutrition, sexual activity, sedentariness, and medication compliance. Validated question-naires have been developed to assess such readiness and to assign a patient to one of the stages labeled as pre-contemplation, contemplation, preparation, action, main-tenance, and termination. The literature suggests that change is most effectively achieved by interventions appropriate to the person’s stage.
As physicians, we ourselves tend to be action-oriented and assume that patients are at the action stage on this scale. We advise patients to simply “start exercising,” or “give up Twinkies” or “always use condoms.” Often patients are not at an action stage, and our words, however earnest, urgent, and scientifically correct, fall on deaf ears.
And yet, recognizing that a patient isn’t
summer pond by Daniel J. Bressler, MD, FACP
summer pondSunrise on the summer pondRipples yield to rounded edgesFertile water feeds the fishesReflecting fronds.
First among the natural laws:Life moves where the sunlight kissesIn the dark where sunlight missesLife must pause.
Unrelenting green caressBudding strings from plant to podSwirling algal streams of fogWaves of photosynthesis.
Hummingbird hovers overWhirling blur of contradictionMovement, stillness, flight and frictionTranslucence sips a flower.
Although I have not counted oneWhile skimming leaves I listen dailyA dream said: when the pond is readyThe frogs will come.
yet “there” doesn’t mean that guidance and suggestion are a waste of time and breath. One can plant seeds for change through ad-vice couched in a way that avoids setting the patient up for failure. One can, by meeting the patient where he is, strengthen the bond with him, and, through that bond, guide him through the stages of readiness. This move-ment often takes place unconsciously for the patient. Like our frog’s croaking, one day he’s not ready to change, the next day he is. If we have reached the patient’s rational uncon-scious and kept the bond with him respectful and intentional, we can promote the changes that are clearly indicated but not yet doable.
Human biology is built on the principles of threshold (think the action potential of neu-rons and myocytes), amplification (think of the immune system’s clonal response to a po-tent antigen), catalysis (think of the enzyme systems of the Krebs’ cycle), and cascade phenomena (think of the clotting system). These same principles apply in the psycho-logical process of change. Words, events, in-formation, relationship, and emotion all have the capacity to reach thresholds, amplify, catalyze, and create cascades, both conscious and unconscious. Just as we employ the biological principles in the biological portion of our practice, we can use the psychological correlates to promote healthy changes.
Now back to the frogs: One early morning, the frogs’ singing woke me from a dream. I had gone to bed that night ruminating on the old proverb, “When the student is ready, the teacher will come.” I awoke with a new prov-erb that became the final line of the poem (and, in some ways, the take-home message to the concept of change): “When the pond is ready, the frogs will come.”
Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Com-mittee at Scripps Mercy Hospital and longtime contributing writer to San Diego Physician.
SA N D I EGO P H ySI C I A N .O rG 17
(858) 259-2795 or visit www.fi rstrepublic.com New York Stock Exchange Symbol: FRC
Member FDIC and Equal Housing Lender
“ First Republic is always there for us – from remodels to equipment purchases – they are our partner in growth.”M U I R O RT H O PA E D I C S P E C I A L I S T S
Pictured left to right: John M. Knight, M.D.; George J. Tischenko, M.D.; Charles F. Preston, M.D.; Joseph X. Kou, M.D.
18 j u ly 2014
when a praCtiCe Closes, the physician or group is responsible for making appropriate arrangements for the disposition of all medical records — regard-less of whether the records are in paper or electronic format. The possibility of a lawsuit always exists after a physician has left or a practice has closed. To help defend against any future claims, proper retention of records is vital. To help reduce risks when making arrangements for medical records:
• Know the guidelines or laws in your state concerning the time period for retaining records.
RiSK ManaGEMEnt
• If you turn your practice over to anoth-er physician, have agreements in place that address recommended retention time and access capability.
• When choosing to destroy clinical records after a set period of time, use a record destruction service that guar-antees records are properly destroyed without releasing any confidential information.
• If you make custodial arrangements for retaining records, make sure these arrangements are in writing and guar-antee future access to the records for
Closing or leaving a practice?Make appropriate arrangements for Medical RecordsContributed by SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
both physicians and patients.When a practice closes and medical
records are transferred, notify patients that they may designate a physician or another provider who can receive a copy of the records. If a patient does not designate a physician to receive the records, the records may be transferred to a custodian (a physi-cian or a commercial storage firm). Custo-dial arrangements for retaining records are usually entered into for a fee.
Any arrangement for retaining records — either with a physician designated by the patient or with a custodian — should include the following points:
• The medical records will be retained for the amount of time required by the state.
• No one can access the information contained in the medical records with-out a signed release from the patient or an authorized representative or a properly executed subpoena or court order.
• The original physician or physician’s personal representative will be noti-fied of any change in the custodian’s or designated physician’s address or phone number.
• The terms apply to all persons in the custodian’s or designated physician’s employment and facility.
• Copies of medical records will be released to a person designated by the patient only with the patient’s written request.
• The custodian or designated physician will comply with state and federal laws governing medical record confidenti-ality, access, disclosure, and charges for copies of the records.
• There is an agreed-upon fee for main-taining the records (in the case of a custodian).
• The agreement includes language that addresses any personal practice deci-sions made by the custodian or desig-nated physician (such as retirement, selling, or moving) to ensure the safety of and continued access to the records by the original physician or physician’s personal representative
SA N D I EGO P H ySI C I A N .O rG 19
/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////
20 j u ly 2014
CoVeReD CAlifoRNiA
AThree big ThingS you neeD To Know
by the California Medical Association
at the close of this year’s open enrollment period, nearly 1.4 million consumers had completed the covered california enrollment process, which significantly surpassed initial expectations. this makes it critical that physicians and their staff understand these new insurance products to minimize the inevitable frustration and confusion that has resulted from such a large-scale change to the health insurance industry.
/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////It is important when scheduling to deter-mine in advance if the physician is indeed in the patient’s network. When scheduling an appointment, practices should request that the patient provide the office with a copy of the front and back of their insur-ance ID card. Having a copy of the ID card in advance will allow the practice to clearly identify whether they are in the patient’s network and also to verify patient eligibil-ity before the visit. Taking these steps could help patients avoid out-of-network costs for and frustration from patients when they are faced with larger-than-expected bills.
2 Be aware of Mirror productsEvery plan offered in the exchange must also be offered outside of the
exchange, using the same provider network. This has resulted in a number of practices unknowingly seeing patients out-of-net-work for products that use an exchange network, as these ID cards will not have the Covered California logo on them. The issue is specific to just Anthem Blue Cross and Blue Shield of California because they are the only two plans offering narrowed networks. Practices must review patient ID cards and eligibility information closely to identify whether the practice is in or out of network for that particular plan.
3 understand the Grace periodFederal law allows Covered California enrollees who receive
financial subsidies to keep their health insurance for three months after they have stopped paying their premiums. This is known as the “federal grace period.” In the first 30 days of the grace period, federal law requires plans to pay for services incurred, but in months two and three of the grace period plans can pend and deny claims. So it will be extremely important that practices
exchange Plans and Productsfor a detailed list of the exchange plans and products, see “Qualified Health plan networks for covered california” available in the cMa exchange resource center at www.cmanet.org/exchange.
(858) 569-0300www.soundoffcomputing.com
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emr ImplemenTATIonseCurITy supporT
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Endorsed by
1 Know your participation StatusIn late April 2014, the California Medical Association (CMA) sur-
veyed physicians about their contracting experience with Covered California plans. Eighty percent of respondents reported that they had been confused about their partici-pation status in a Covered California plan and that they believed such confusion had negatively impacted patient care.
Unfortunately, checking your practice’s participation status is not as straight-forward as it might seem. Plagued with inaccuracies, Covered California took down its cross-plan provider directory earlier this year. Add to that the fact that some exchange plans have used vague contract terms and amendments that rope physicians into participating in their exchange net-works, often without their express consent or knowledge, and you’ll see that “do you take my insurance” is not always an easy question to answer.
Physicians are encouraged to verify their participation status on the individual exchange plans’ online provider directories. When searching, it’s important to select the correct exchange product type, as Anthem Blue Cross and Blue Shield of California are utilizing significantly narrowed networks for their exchange products.
It is also important that front-office staff have a clear understanding of their physi-cians’ participation status. With all of the new exchange plans added to the mix, it is no longer satisfactory to simply accept “I have Blue Shield” as an indication of whether the patient can be seen in-network.
Checking your practice’s participation status is not as straightforward as it might seem.
SA N D I EGO P H ySI C I A N .O rG 21
/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////
22 j u ly 2014
ReSouRCeS AVAilAble To MeMbeRSThe following resources (and many more) are available free to SDCMS-CMA mem-bers at www.cmanet.org/exchange:
❚ covered california: Know your participation Statusthis document provides detailed instruction on how to check your participation status with the various exchange plans.❚ Surviving covered california Tip Sheetsthese documents contain tips on what to expect from and how to survive the first year of covered california.❚ Qualified health plan Networks for covered californiathis document will help both physi-cians and patients decipher the new exchange product networks.❚ covered california: understand-ing the Grace period for Subsidized Exchange Enrolleesthis document contains answers to frequently asked questions about the covered california grace period.❚ cMa’s Got you coveredcMa’s comprehensive exchange toolkit for physicians.❚ Frequently asked patient Ques-tions about covered californiaavailable in both English and Spanish, this document provides answers to the most common patient questions.
The following resource is available free to SDCMS-CMA members:
❚ a Matrix to help answer Ques-tions like “am i contracted to see covered california patients?” “Which health plans are participat-ing in covered california?” “how do i check my participation status with these plans?”Email [email protected].
The following resources are available to all physician practices:
❚ in-office Education for Staff provided by the SdcMS FoundationEmail [email protected].❚ covered california consumer Materials for your office Waiting Roomcall (858) 300-2789.
plan Name Grace period Eligibility Status indicator
(Days 31–90 of Grace period) “inactive pending investigation”
blue Shield of california “pended”
Health net “Eligibility Suspended”
if the patient is in months two or three of the grace period, the health plan should indicate that coverage is inactive or otherwise suspended.
verify eligibility on all exchange patients, ideally on the date of service, or as near the time of service as possible. If the patient is in months two or three of the grace period, the health plan should indicate that coverage is inactive or otherwise suspended.
Insurance cards for exchange enrollees do not indicate whether the enrollee is sub-sidized. Current enrollment trends predict that nearly 90% of those with exchange coverage will be subsidized and receive the three-month grace period. In other words, if you see a Covered California logo on the ID card, you should assume they will have the three-month grace period.
Unsubsidized exchange patients and those with a mirror product are not entitled to the 90-day federal grace period; rather, they only receive the 30-day grace period called for under state law.
CMA queried Anthem Blue Cross, Blue Shield of California, and Health Net — which account for approximately 75% of the total Covered California enrollees — on exactly what to look for in eligibility verification to identify patients who are in months two and three of the grace period. They report the following:
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Law Offices of Brian JiangPO Box 676285 • 16236 San Dieguito Rd., Ste.5-25Rancho Santa Fe, CA 92067Tel. 858-759-8398 Fax. 888-428-2761www.lawyerjiang.com • [email protected]
You are too busy building your practice to notice…FACT: average 401K runs out in 7 years; long term care cost will triple in 15 years; cost of college education doubles in 15 years; 90% of Americans cannot maintain current life style after retirement; cost of living and tax are going one way only—up…
You don’t have to be a victim to this mess if you take action now. PLAN your future, otherwise you won’t have one.
business planning (buy & sell agreement, exit plan, business valuation)retirement planningestate, trust, Will
SA N D I EGO P H ySI C I A N .O rG 23
“think SDCMS FiRSt!”
Start by contacting SDcMS at (858) 565-8888 or at [email protected].
24 j u ly 2014
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
This is the future you weren’t thinking about 10, or 20, or 30 years ago.As a financial advisor since 1982, I have the experience, knowledge, and research to help you grow and preserve your wealth. The sooner you start, the better you can manage whatever life has in store. I can help you make it happen. If you’d like to know how, I’d be glad to talk with about your future. There’s no cost and no obligation.
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Practices should have policies in place regarding how they will handle patients who are in months two or three of the grace period. Patients should ideally be made aware of this policy in advance. If a patient’s eligibility verification comes back indicating his or her coverage is not active, the practice should treat the situation as they would any other patient who has had a lapse in coverage. For non-emergent services, patients may be given the option to either pay cash at the time of service or reschedule to a later date when their coverage is effective. The office policy should include how patients will be triaged to determine whether their condition is emergent or urgent, and the policy should be approved by the physician.
/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////STill HAVe
QueSTioNS?SDcMS-cMa members
and their staff have free access to cMa’s
reimbursement helpline at (888) 401-5911 or economicservices@
cmanet.org.
SDcMS members and their staff can contact Marisol Gonzalez as well, your SDcMS
physician advocate, at (858) 300-2783 or at
Having Trouble finding an in-network Provider or facility?Patients who are having trouble finding an in-network physician or facility are encouraged to contact the Department of Managed Health Care’s Help Center at (888) 466-2219 for assistance.
We also ask that physicians notify CMA if they are experiencing difficul-ties finding in-network providers to whom they can refer patients so that we may raise the issue with Covered Cali-fornia and the appropriate regulator. Contact CMA’s physician helpline at (888) 401-5911 or at [email protected].
Current enrollment trends predict that nearly 90% of those with exchange coverage will be subsidized
and receive the three-month grace period.
SA N D I EGO P H ySI C I A N .O rG 25
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In Partnership With PRESENTED BY:
5575 Ruffin Rd., Ste 250, San Diego, CA 92123 www.sdcmsf.org/5K 858.300.2777
Physicians: You are a Health Role Model Model healthy living to patients and staff by inviting them toJOIN YOU at San Diego County Medical Society Foundation’s
Solana Beach Sunset 5K Run/Walk September 27!
Lead a team of 20 or more patients and staff and receive FREEyour own team t-shirts with your practice/team identification.
Visit www.sdcmsf.org/5K to sign up.For more information email [email protected].
Benefiting
Improving Health…Changing Lives
26 j u ly 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 on the campus of Scripps La Jolla need a new physi-cian. You would be sharing an office and overhead with another general internist who is well established on the campus and can help you make all the connec-tions 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 out-patient 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 exist-ing physicians, whenever needed. We are a full-service dermatology 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 cosmetics as well. If interested, please for-ward CV to [email protected]. [253]
PHYSICIANS: RETIRED WITH LICENSE? Alternative care office in San Diego area looking for California licensed MD for consultative work. One or two days a month. Part time, excellent compensation. Contact James at (760) 703-3767. [208]
LOOKING FOR FULL-TIME FAMILY PRACTICE PHYSICIAN: 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 services for mem-bers of the community, regardless of age or sex, on a continuing basis at our busy healthcare clinic in Tem-ecula. 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 DIEGO 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, indepen-dent contractor, occasional on-call pager, 10–12 pa-tients per day. We are a very relaxed, professional practice environment. We very much look forward to your call at (760) 591-9975. [242]
SEEKING PER-DIEM, BOARD-CERTIFIED FAM-ILY MEDICINE PHYSICIAN: The Sycuan Band of the Kumeyaay 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 expe-rience working as a medical physician, and CPR certification. Bilingual English / Spanish preferred. Salary commensurate with experience, malpractice coverage provided. Please email CV to Teresa Mo-gielnicki, MD, at [email protected] or fax to (619) 445-0988. [243]
LOOKING FOR A DERMATOLOGIST: Medical spa lo-cated 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]
PHYSICIAN POSITIONS WANTED
LOOKING FOR PART-TIME POSITION IN PEDIAT-RICS: My name is Rafael Garcia, and I have been a board-certified 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 num-ber is (619) 990-6218 (I can be reached after 5pm), and my email is [email protected]. [246]
PHYSICIAN POSITIONS AVAILABLE
PHYSICIAN WANTED — LA MESA / EL CAJON: Busy internal medicine practice with strong focus in geriatric patients is currently hiring a physician. Ef-ficient, 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 educa-tion program, including specialists’ topic discussion as well as patient case presentation are provided. Hard work, dedication, compassion, and communication skills are required. Job satisfaction will be guaran-tied. Opportunity to enhance the income by rounding at Grossmont Hospital and skilled nursing facilities is provided. Internal medicine work experience is de-sired; 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 pioneering healthcare practitioners striving for excellence while developing sound socioeconomic models of healthcare delivery. Our mobile / primary care / specialty practice complements our panoram-ic outpatient practices in primary care, pain manage-ment, oncology, cardiology, gastroenterology, infec-tious diseases, and psychiatry. Pay is among the best in the country, with part-time income in the 150K range (exclusive of incentives/bonuses). A good fit is essential. Interview questions should be directed 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 es-tablished pediatric practice. Opportunity to grow and long-term commitment for the right candidate. Office has EMR and stable staff. No nighttime call and occasional weekend clinic. Great family loca-tion. For more information, send CV to [email protected]. [259]
SEEKING EXPERIENCED URGENT CARE / PRI-MARY CARE PHYSICIAN (MD/DO) FOR AN UR-GENT CARE POSITION: You will be paid commen-surate with your level of experience. I will carry your malpractice (with tail) assuming you are insurable by our malpractice company. 33–40 hours per week. Po-sition is immediately available. Please email your CV to [email protected] or fax your CV to (619) 423-0120. [256]
OPHTHALMOLOGIST NEEDED: Part-time to work in a North County office, 2 to 3 days per week. Po-tential for full-time or buy-in. If interested, please respond to [email protected]. All replies confi-dential. [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. Pa-tients from the practice of a retiring general internist
LOOKING FOR A RETIRED PHYSICIAN: Medical spa located in East County looking for a retired phy-sician for a part-time position as a medical director. For more information, please call Dr. Shirin Dorin at (619) 456-4555. [239]
BOARD-CERTIFIED PHYSICIANS, PHYSICIAN ASSISTANTS, 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.DoctorsEx-pressSanDiego.com for more information. [229a]
SEEKING A PART-TIME BC/BE INTERNAL MEDI-CINE 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 competitive-compensation guaran-tee 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 guarantee and an excellent benefits package. Please email CV to [email protected]. [205]
FULL-TIME OR PART-TIME URGENT CARE PHY-SICIAN: 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 Phy-sicians (www.thehousecalldocs.com) is a fast-grow-ing 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.thehouse-calldocs.com. [037]
PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private non-profit 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 PEDIATRICIAN FOR PERMANENT FOUR-DAYS-PER-WEEK PO-SITION: Private practice in La Mesa seeks pediatri-cian four days per week on partnership track. Mod-ern office setting with a reputation for outstanding patient satisfaction and retention for over 15 years. A dedicated 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 deliv-ery standby or rushing out in the night. Benefits in-clude tail-covered liability insurance, paid holidays/vacation/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disabil-ity 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]
SA N D I EGO P H ySI C I A N .O rG 27
bonus. Our community 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]
MEDICAL OFFICE MANAGER / ADMINISTRA-TOR: General surgery practice consisting of five physicians actively searching for a medical office manager / administrator to join our fast-paced of-fice! The candidate will have a minimum of three years experience in healthcare management with an emphasis on the following: recruitment of office staff, on-boarding, and supervision; management of compliance; policy development and compliance; AP/AR functions, including patient billing and medi-cal coding; insurance contracting; maintenance of all office and medical equipment as needed; credential-ing; patient triage; management of medical practice needs and payments. Enjoy a competitive salary and benefits, including health insurance, 401(k) plan, and paid vacation. Qualified candidates please send re-sume to Cristina Montoya at [email protected] or fax to (619) 827-0400. [248]
BEHAVIORAL HEALTH CONSULTANT: The behav-ioral 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 recognizing and treating men-tal disorders and psychosocial problems, assists in detection of “at-risk” patients, and assesses the clini-cal status of patients referred by the PCP. Education / Certification: PsyD/PhD in psychology or LCSW; CPR certification (including BLS). Contact Araceli Mercado at [email protected] or at fax (760) 736-870. [244]
SUPERVISORY RN — MISSION MESA PEDIAT-RICS: Under the direction of the health center di-rector / practice manager, and in collaboration with the nursing services 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 confidentiality. Ability to work independently and as part of a team. Knowledge and Education: Current California state registered nurse license, current CPR certificate re-quired. Bilingual (English / Spanish), baccalaureate level of conceptual thinking. Experience: Four or more year’s general nursing experience in ambulatory care, including one year supervisory experience. Please ap-ply at https://rew31.ultipro.com/NOR1021/JobBoard/ListJobs.aspx. [241]
BOARD-CERTIFIED PHYSICIANS, PHYSICIAN ASSISTANTS, 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.DoctorsEx-pressSanDiego.com for more information. [229b]
PHYSICIAN ASSISTANT WANTED FOR SPORTS, SPINE, AND ARTHRITIS REGENERATIVE MEDI-CINE PRACTICE (ENCINITAS): Please reply with resume, letter of interest, and salary requirements to [email protected]. [199]
NURSE PRACTITIONER: Needed for house-call phy-sician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email [email protected]. Visit www.thehouse-calldocs.com. [152]
PHYSICIAN ASSISTANT OR NURSE PRACTITIO-NER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive com-pensation. Call (619) 992-5330 or email [email protected]. Visit www.thehousecalldocs.com. [038]
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 PRACTICE FOR SALE: Turnkey operation. One employee and low overhead, month-to-month lease. Minimal HMO. Perfect part-time work or add obstet-rics. Various arrangements available. Email [email protected]. [203]
PRACTICE FOR SALE: Comprehensive Sleep Medi-cine Practice with Integrated American Academy of Sleep Medicine-accredited Sleep Testing Center. 2013 revenue $550,000. Well-known for expertise in the di-agnosis and treatment of sleep disordered breathing and offering the full range of treatment options (PAP therapy, dental appliances, surgery). Both facility-based and home sleep testing performed with active referrals. Attractively furnished with up to date equip-ment and furnishings. Third-party appraisal available. Selling due to health issue, and offered for quick sale at a very attractive price. Small practice subset in min-imally invasive nasal and sinus treatment may also be included in any transaction. Please contact [email protected]. [250]
OFFICE SPACE WANTED
3998 VISTA WAY, IN OCEANSIDE: Four medical office spaces approximately 1,300–2,800SF available for lease. Close proximity to Tri-City Hospital with pe-destrian walkway connected to parking lot of hospital, and ground-floor access. Lease price: $1.75+NNN. Ten-ant improvement allowance to customize the suites is available. For further information, please contact Lu-cia Shamshoian at (760) 931-1134, ext. 13, or at [email protected]. [234]
HAND SURGEON LOOKING FOR PART-TIME OF-FICE 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 con-tact me at [email protected]. [231]
OFFICE SPACE AVAILABLE
DEL MAR / CARMEL VALLEY MEDICAL OFFICE FOR SUB-LEASE: Available October 2014 (4765 Carmel Mountain Rd., San Diego, CA 92130). 1,000SF. Two treatment / consultation rooms / office reception / photography room / break room. Unlimited patient free parking. Call (858) 481-4888 or email [email protected]. [252]
FREE MEDICAL OFFICE SPACE AVAILABLE (SAN DIEGO): Looking for a self-starting and highly motivated general practitioner who is a Tricare/United provider to share medical office with a chiro-practor. The doctor is needed to treat our existing and future medical patients. We are centrally locat-ed off 163 and Mesa College Drive by Sharp Memo-rial Hospital. This is great for a doctor who wants to have a satellite office. If interested, please email us at [email protected]. [249]
SCRIPPS XIMED MEDICAL CENTER BLDG, LA JOLLA — OFFICE SPACE TO SUBLEASE AVAIL-ABLE: Vascular & General Surgeons have space avail-able. 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. Com-plete 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 CAMI-NO REAL, ENCINITAS, OFFICE SPACE TO SUB-LEASE: 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 sub-leasing 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. 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]
NEW MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE IN KEARNY MESA: Brand new office suite located at 3750 Convoy Street with nine exam rooms and digital X-ray, hi-speed wireless, free parking for patients and staff, conference room in building. Several minutes from Sharp Memorial and Children’s Hospitals. Convenient freeway access to 163 and 805. Multiple half-day clinics available. Please contact Lisa Vaughn at (858) 278-8300, ext. 210, for more information. [235]
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 examination rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Recep-tionist help provided if needed. Contact Stephanie at (760) 753-8413. [703]
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 / 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 Uni-versity Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optom-etry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking 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 reasonable rent. Please email [email protected] for more information. [867]
NONPHYSICIAN POSITIONS AVAILABLE / WANTED
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 commu-nicate in Spanish, computer skilled, and likes the chal-lenge of working in an underserved community. Ex-perience is not required; we will train you. Relocation expenses are covered. Base salary plus productivity
28 j u ly 2014
after 12 years in GroUp practice, I opened my own office in August 1997. Laughingly, I told everyone that I spent the summer learning things I never had any interest in: OSHA regulations, how to create an employee handbook, accounting — the list was long but I dove in with great enthusiasm. But after struggling to set up the accounts in my new QuickBooks program, I knew I needed help. I found a young accountant and hired him to finish setting up the pro-gram. Initially impressed with what
I seemed to have done, he later told me that he quickly saw how badly I needed his skills. What I had done made no sense and it took him many hours to correct my errors. So much for omnipotence.
In the course of our career, we gain many competencies. We learn to diagnose and treat, perform procedures, communicate with dif-ferent people, and sometimes even manage employees and colleagues. This often makes us feel that there is nothing we cannot learn to do. And sometimes we feel as if we need to
be the Genius you are“if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”by Helane Fronek, MD, FACP, FACPh
pERSonal & pRofESSional DEVElopMEnt
do everything, that no one should be doing anything for us. But as Albert Einstein wisely remarked, “Every-body is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”
in what ways Are You a genius?Although we receive more feed-back focused on improving our shortcomings, research shows that people perform best when they play to their strengths. Make sure that your strengths show up often and in high profile in your life. A happy life includes lots of activities that make us feel competent or that honor our fundamental values. Values can be a part of your workday or you can include them in one of your outside activities. (To find out what your values are, see my blogpost (http://helanefronekmd.wordpress.com/2011/10/24/your-own-person-al-secret-to-work-life-balance/.)
Are There Trees in Your life That You Shouldn’t or Don’t Need to be Climbing?Take a look at all the things you’re doing in your life. Then make a list of those things that aren’t meaningful, fun, or interesting, as well as those that are a struggle because you’re just not good at them. If there are items on that list that you want to learn about or become better at, take them off your list. But with every-thing that’s left, ask yourself who might do them better than you. Who might learn something from being given that job? Then delegate or hire someone to take over and cross them off your list.
A happy life doesn’t just happen; we have to take time to know how we are feeling, look critically at how we are living, and then make choices to create the life we really want to be living. We don’t have to spend our lives struggling to climb a tree; we can happily swim in the ocean, feeling our competence and enjoying the sights, sounds, relationships, and activities that bring us the most joy.
Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical pro-fessor of medicine at UC San Diego School of Medicine and a certified physician development coach who
Sometimes we feel as if we
need to do everything,
that no one should
be doing anything
for us.
Special mortgage financing for physicians Our special home financing program is designed specifically to meet your needs as a busy physician for the purchase of your primary residence
All loans subject to approval, including credit approval. Eligible properties
must be located in Alabama, Arizona, California, Colorado, Central Florida,
North Florida, New Mexico or Texas where BBVA Compass has a market
presence. BBVA Compass is a trade name of Compass Bank, Member
FDIC.
Daniel SchroederVice President - Senior Mortgage Banking Officer Direct - [email protected]
Southern California District 4180 La Jolla Village Dr #530La Jolla, CA 92037
Low down payment available for purchase prices up to to $1,850,000Refinances with high loan to value also availableNo mortgage insurance requiredCompetitive fixed rates available No prepayment penalties or additional lender fees
NMLS #633034
San Diego County Medical Society5575 Ruffin Road, Suite 250San Diego, Ca 92123
[ Return Service Requested ]
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sure you’re prepared.
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For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner.
n Medical Malpracticen Workers’ Compensationn Health and Disabilityn Property and General Liability
n Employment Practices Liabilityn Directors and Officers/Management Liabilityn Errors and Omissions Liabilityn Billing Errors and Omissions Liability
Call (800) 852-8872 today for a quote or a complimentary insurance assessment.
www.thedoctors.com/TDCISCA License #0677182
*Source: U.S. Department of Health and Human Services
