December 2012

“Physicians United For a healthy san diego”

oFFicial PUblication oF the san diego coUnty medical society december 2012

Reaching

8,500 Physicians

Every Month

GuidinG the Way

Our mentOrs …

B SAN DIEGO PHYSICIAN.OrG OctOber 2011

Our passion protectsyour practice

* We’ve lowered our rates in Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa

Barbara, and Ventura counties. Premium impact varies by factors such as medical specialty and practice location.

We’re lowering our rates for Southern California — save up to 37% (effective October 1, 2012, for new and renewal business).

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ANNOUNCING LOWER RATES FOR SOUTHERN CALiFORNiA PHySiCiANS

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OctOber 2011 SAN DIEGO PHYSICIAN.OrG 1

Our passion protectsyour practice

* We’ve lowered our rates in Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa

Barbara, and Ventura counties. Premium impact varies by factors such as medical specialty and practice location.

We’re lowering our rates for Southern California — save up to 37% (effective October 1, 2012, for new and renewal business).

NORCAL Mutual is renowned for great customer service, industry-leading risk management and outstanding claims expertise. And now with more competitive rates, there has never been a better time to join us.

What do our LoWEr ratEs mEan to you? Call 877-453-4486. Visit norcalmutual.com/start for a premium estimate.

ANNOUNCING LOWER RATES FOR SOUTHERN CALiFORNiA PHySiCiANS

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2 d ec em b er 2012

MANAGING EDItOr: Kyle LewisEDItOrIAl BOArD: Van L. Cheng, MD, Theodore M. Mazer, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Roderick C. Rapier, MDMArkEtING & PrODuCtION MANAGEr: Jennifer RohrSAlES DIrECtOr: Dari PebdaniArt DIrECtOr: Lisa WilliamsCOPY EDItOr: Adam Elder

SDCMS BoarD of DireCtorSoffiCerSPrESIDENt: Sherry L. Franklin, MD (CMA TRUSTEE)

PrESIDENt-ElECt: Robert E. Peters, PhD, MDtrEASurEr: J. Steven Poceta, MDSECrEtArY: William T-C Tseng, MD, MPHIMMEDIAtE PASt PrESIDENt: Robert E. Wailes, MD (CMA TRUSTEE)

geographiC anD geographiC alternate DireCtorSEASt COuNtY: Alexandra E. Page, MD, Venu Prabaker, MDHIllCrESt: Theodore S. Thomas, MD (A: Gregory M. Balourdas, MD)kEArNY MESA: John G. Lane, MD, Jason P. Lujan, MD (A: Sergio R. Flores, MD)lA JOllA: Geva E. Mannor, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD)NOrtH COuNtY: Niren Angle, MD, Douglas Fenton, MD, James H. Schultz, MD (A: Anthony H. Sacks, MD)SOutH BAY: Vimal I. Nanavati, MD, Michael H. Verdolin, MD (A: Andres Smith, MD)

at-large DireCtorSKarrar H. Ali, MD, David E.J. Bazzo, MD, Jeffrey O. Leach, MD (DEL-

EGATION CHAIR), Mihir Y. Parikh, MD (EXECUTIVE COMMITTEE BOARD REP), Peter O. Raudaskoski, MD, Kosala Samarasinghe, MD, Suman Sinha, MD, Mark W. Sornson, MD (EXECUTIVE COMMITTEE BOARD REP)

at-large alternate DireCtorSJames E. Bush, MD, Theresa L. Currier, MD, Thomas V. McAfee, MD, Carl A. Powell, DO, Elaine J. Watkins, DO, Samuel H. Wood, MD, Holly Beke Yang, MD, Carol L. Young, MD

other voting MeMBerS COMMuNICAtIONS CHAIr: Theodore M. Mazer, MD (CMA SPEAKER)

YOuNG PHYSICIAN DIrECtOr: Van L. Cheng, MDrEtIrED PHYSICIAN DIrECtOr: Rosemarie M. Johnson, MDMEDICAl StuDENt DIrECtOr: Suraj Kedarisetty

other nonvoting MeMBerS YOuNG PHYSICIAN AltErNAtE DIrECtOr: Renjit A. Sundharadas, MDrEtIrED PHYSICIAN AltErNAtE DIrECtOr: Mitsuo Tomita, MDSDCMS FOuNDAtION PrESIDENt: Stuart A. Cohen, MD, MPHCMA PASt PrESIDENtS: James T. Hay, MD (AMA DELEGATE), Robert E. Hertzka, MD (LEGISLATIVE COMMITTEE CHAIR, AMA DELEGATE), Ralph R. Ocampo, MDCMA truStEE: Albert Ray, MD (AMA ALTERNATE DELEGATE)

CMA truStEE (OtHEr): Catherine D. Moore, MDCMA SSGPF DElEGAtES: James W. Ochi, MD, Marc M. Sedwitz, MDCMA SSGPF AltErNAtE DElEGAtES: Dan I. Giurgiu MD, Ritvik Prakash Mehta, MD

OpiniOns expressed by authors are their own and not necessar-ily 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 unso-licited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services 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 sub-scriptions, email [email protected]. [san DiegO COunty MeDiCal sOCiety (sDCMs) printeD in the u.s.a.]

departments4 Briefly Noted Calendar•RealEstateTrends•ClinicalTrials• And More …

8 Happy Holidays From Your SDCMS/F Support Teams!

10 Stressed out During the Holidays? Try These Tips to Avoid Burnout by THe dOcTOrS cOmPANy

12 Practice Makes Practice by dANIeL J. breSSLer, md

14 The Greatest Gift of All by HeLANe FrONeK, md, FAcP, FAcPH

16 HIPAA Is Not Dead: Top 10 Questions for the Physician Leader by dAVId GINSberG

18 $65,149 Ways SDCMS and CMA Are Working for You!

20 San Diego Kaiser Permanente Officially Enters the World of Residency Training by SHerWIN GALLArdO, md, ANd KATHerINe H. bALAZy, md

22 The House on the Hill: The New Palomar Medical Center by mIcHAeL H. cOVerT, FAcHe

34 Physician Marketplace Classifieds

36 Congratulations Carol Carney: Outstanding Office Manager for 2012

26

this month

VolumE99,NumbER12

featuresOur mentOrs … GuIdInG tHe WAY 26 Introduction by JAmeS SANTIAGO GrISOLÍA, md

27 Honoring Dereck J. DeLeon, MD by SHerWIN GALLArdO, md, ANd KATHerINe H. bALAZy, md

28 Honoring Andrew G. Israel, MD by KAreN A. HerbST, md

28 Honoring Martin T. Stein, MD by JOHN A. KAFKA, md, FAAP

29 Honoring Paul Brucker, MD by JAmeS T. HAy, md

29 Honoring Bryan A. Liang, MD, PhD, JD by KImberLy m. LOVeTT, md

30 Honoring Abdool R. Moossa, MD by AdAm S. FIerer, md

8

80+ SPECIALTIES OnE numbEr855-543-0555 gives you access

Physician Access is a dedicated line that allows you to speak directly with one of our physicians at UC San Diego Health System. This number gives you real and immediate access to a fellow physician, and a trusted partner. So whether you want to talk about a particular case, facilitate a transfer or refer your patient for highly specialized care, our physicians are standing by to take your call.

855-543-0555 | health.ucsd.edu/access

ADVANCED HEART FAILURE. ALLERGY & IMMUNOLOGY. ANESTHEAUDIOLOGY. BLOOD & MARROW TRANSPLANT. CARDIOLOGY. CARTHORACIC SURGERY. CARDIOVASCULAR SURGERY. COLON & RECSURGERY. CONCIERGE MEDICINE. CRITICAL CARE MEDICINE. DEREMERGENCY MEDICINE. ENDOCRINOLOGY. ENDOVASCULAR SURGEGASTROENTEROLOGY. GENERAL SURGERY. GERIATRIC MEDICINE. GYNECOLOGIC ONCOLOGY. HEPATOLOGY. HEMATOLOGY. HYPERBAMEDICINE. INFECTIOUS DISEASES. INTEGRATIVE MEDICINE. INTERADIOLOGY. LARYNGOLOGY. MALE INFERTILITY. MATERNAL-FETAMEDICAL ACUPUNCTURE. MEDICAL GENETICS. MEDICAL ONCOLONEONATAL & PERINATAL MEDICINE. NEPHROLOGY. NEUROSURGERNEUROCRITICAL CARE. NEUROLOGY. NUCLEAR MEDICINE. MINIMAINVASIVE SURGERY. OBSTETRICS & GYNECOLOGY. OCCUPATIONAENVIRONMENTAL MEDICINE. ONCOLOGY. OPHTHALMOLOGY. ORTHSURGERY. OSTEOPATHIC MEDICINE. OTOLARYNGOLOGY. PAIN MAPALLIATIVE MEDICINE. PATHOLOGY. PELVIC FLOOR DISORDERS. PNERVE. PHYSICAL MEDICINE & REHAB. PLASTIC SURGERY. PSYCPSYCHOLOGY. PULMONARY DISEASE. RADIATION ONCOLOGY. RADREPRODUCTIVE ENDOCRINOLOGY. RHEUMATOLOGY. SPORTS MEDSURGICAL CRITICAL CARE. SURGICAL ONCOLOGY. THORACIC SURTOXICOLOGY. TRANSPLANT SURGERY. TRAUMA. URO-GYNECOLOG

4 d ec em b er 2012

brieflynotedSDCMS ContaCt inforMation5575 Ruffin Road, Suite 250, San Diego, CA 92123t (858) 565-8888 F (858) 569-1334E [email protected] W SDCMS.org • SanDiegoPhysician.orgCEO • EXECUTIVE DIRECTOR Tom Gehring at (858) 565-8597 or [email protected] • CFO James Beaubeaux at (858) 300-2788 or [email protected] OF ENGAGEMENt Jennipher Ohmstede at (858) 300-2781 or [email protected] OF MEMBERSHIP SUPPORT • PHYSICIAN ADVOCATE Marisol Gonzalez at (858) 300-2783 or [email protected] OF rECruItING AND rEtENtION Brian R. Gerwe at (858) 300-2782 or at [email protected] OF MEMBErSHIP OPErAtIONS Brandon Ethridge at (858) 300-2778 or at [email protected] OF COMMuNICAtIONS AND MARKETING • MANAGING EDITOR Kyle Lewis at (858) 300-2784 or [email protected] MANAGER • DIRECTOR OF FIRST IMPrESSIONS Betty Matthews at (858) 565-8888 or [email protected] tO tHE EDItOr [email protected] SuGGEStIONS [email protected]

SDCMSf ContaCt inforMation5575 Ruffin Road, Suite 250, San Diego, CA 92123t (858) 300-2777 F (858) 560-0179 (general)W SDCMSF.orgEXECUTIVE DIRECTOR Barbara Mandel at (858) 300-2780 or [email protected] ACCESS PrOGrAM DIrECtOr Francesca Mueller, MPH, at (858) 565-8161 or [email protected] CArE MANAGEr Rebecca Valenzuela at (858) 300-2785 or [email protected] CArE MANAGEr Elizabeth Terrazas at (858) 565-8156 or [email protected] DEVELOPMENT DIRECTOR Nicole Hmielewski at (858) 565-7930 or [email protected] PrOJECt MANAGEr Rob Yeates at (858) 300-2791 or [email protected] PrOJECt MANAGEr Victor Bloomberg at (619) 252-6716 or [email protected]

Your SDCMS and SDCMSF Support Teams Are Here to Help!

get in touch

sdcms seminars, Webinars & eventsSDCMS.org/eventFor further information or to register for any of the following SDCMS seminars, webinars, or workshops, visit www.SDCMS.org/event or contact Jen at (858) 300-2781 or at [email protected].

the electronic health information age: Challenges and risks (webinar)JAN 17 • 11:30am–12:30pm

the Duals Dilemma (seminar/webinar)JAN 24 • 11:30am–1:00pm

advocacy training (workshop)JAN 26 • 8:00am–12:00pm

preparing to practice (workshop)FEB 2 • 8:30am–4:00pm

cmA WebinarsCMAnet.org/eventsCalifornia’s new Coordinated Care initiative for Dual eligiblesDEC 19 • 12:15pm–1:15pm

hipaa and Meaningful Use: What You need to Do for a legal attestationJAN 9 • 12:15pm–1:15pm

Medi-Cal application forms training and regulations UpdateJAN 16 • 12:15pm–1:45pm

Understanding arC and CarC revenue CodesJAN 23 • 12:15pm–1:15pm

Keys to Successful ContractingJAN 30 • 12:15pm–1:15pm

calendar

SdcMS Member Physicians:

If you are interested in learning more about possibly joining the San Diego

Physician editorial board, please email [email protected].

“— Albert Einstein

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.

10th anniversary natural Supplements: an evidence-Based UpdateJAN 30–FEB 2 • Hilton San Diego Resort • www.scripps.org/events/natural-supplements-an-evidence-based-update-january-30-2013

aces for health golf tournamentFEB 28 • Del Mar Country Club • Benefitting the SDCMS Foundation’s Project Access • (858) 565-7930

rCMa’s “Cruisin thru CMe” — french Waterways: highlights of Burgundy & provenceJUL 1–13 • Call RCMA at (800) 472-6204

”nothing that i can do will change the structure of the universe. But maybe by raising my voice i can help the greatest of all causes: goodwill among men and peace on Earth.

SA N d I eGO P H ySI c I A N .O rG 5

brieflynoted

real eState trendS

The commercial real estate sectors of of-fice, industrial, and retail space continue to improve during the post-recessionary period. The medical office sector is in recovery mode as well but with one distinct difference: It has been relatively healthy for the last decade. So is the current condition of the market now in favor of landlords or tenants?

Ten years ago, medical office space was being gobbled up by the whole spectrum of providers. By 2005, countywide medical of-fice vacancy had reached an all-time low of 5.9%. The medical community’s needs for space continued, but, at the time, quality space and desirable medical buildings were hard to find, driving rents and sale prices into uncharted territory. Developers saw the need, seized the opportunity, and more than 1.5 million square feet of outpatient medical office space was completed from 2006 to 2009.

by chris ross

By 2010, with construc-tion financing nearly frozen and vacancy peaking at 13.2%, development of outpatient medical office buildings came to a near halt. Since there remained a modest amount of demand for space — particularly from larger health systems and medical groups — vacancy levels began to recover and have now returned to a more manageable 11.6%.

rentAl rAtesWhile the average medical office rental rate in San Diego County has gradually fallen since 2007, a leveling off has occurred. The countywide average rental rate currently sits at $2.52 gross; however, this is poised to rise based on current absorption levels and lack of speculative MOB construction.

FOrecAstAging baby boomers, the evolution of medi-cine and healthcare technology, and PPACA

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will all contribute to a significant increase in demand for medical space. Forecasting models show that San Diego County’s lack of developable, medically zoned land will cause vacancy levels to gradually return to record lows, which would push the average rental rate back toward $3.00/SF.

Providers should be particularly strategic — now more than ever — as to how they structure their leases and make acquisi-tions. Low rental rates, reduced pricing, and high tenant improvement allowances and concessions will not last much longer. Some markets are already experiencing a

tightening, including UTC, Coastal North County, and the I-15 Corridor. Tenants do still have the edge at the negotiating table, so if you are considering expansion, reloca-tion, or any other significant changes in your facility or office space, it is advised that you begin that process as soon as possible. There are too many indicators in the market to suggest otherwise.

Mr. Ross is vice president of healthcare real estate services at Colliers International. He is a commercial real estate broker, specializing exclusively in medical office and healthcare fa-cilities in San Diego County. He can be reached at (858) 677-5329 or [email protected].

6 d ec em b er 2012

brieflynotedclinical trialS

The medical advances we benefit from today are made possible by people who volunteer for medical research. by participating in a clinical trial, individuals may be able to access a potential new drug or therapy that treats their condition. Importantly, whether people enroll due to disease or as a healthy trial participant, they are helping to solve the bigger puzzle of chronic disease — for everyone.

To get started, individuals can join researchmatch — the process is confidential and convenient. Personal information is shared only with legitimate researchers, like those from universities and hospitals, in order to match individuals to an appropriate clinical trial. If invited to participate, individuals will receive helpful information up front and be assisted by a person who answers all their questions and monitors their health throughout the study. For further information, visit www.participate.ucsd.edu.

Help solve the PuzzleInform Your Patients About ResearchMatch Today!

featured MeMBer

FEaturEd mEmBEr!

SDCMS would like to feature some of our 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!

you could appear here next!

BECOME AN SDCMS

by Uc San diego Health Sciences

brieflynoted


LESS IS MORE.

T 866 558 4320 imaginghealthcare.com*In

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.

We’ve lowered radiation doses in CT scanning by 50 to 90%.As reported by the American College of Radiology, Imaging Healthcare Specialists emerged at the forefront of significant dose reduction when compared nationally* to other imaging centers.

We were the first outpatient imaging company in the nation to acquire SafeCT,™ an advanced technology for CT scanning that allows exemplary dose reduction while maintaining exceptional diagnostic quality.

We custom tailor smart CT protocols according to individual patient size to ensure each patient’s safety.

Our result—outstanding leadership in dose reduction and peace of mind.

Low Dose� Che�st Comparative� StudySame patient is represented in each image

3/24/2011 4/18/2012

2

4

6

8

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9.14 mSv 2.46 mSvPre Low Dose Post SafeCT/Low Dose

8 d ec em b er 2012

happy holidays From your sdCms and sdCms Foundation support tEams!

What’s Your Favorite Holidaymemory?

Pictured L–r: James, marisol, Victor, elizabeth, brian, Kyle, Nicole, rebecca, brandon, Jen, Jaime, barbara, Francesca, betty, and Tom.

“In the early ’60s, portable reel-to-reel tape recorders were a new invention. When I woke up in the wee hours on Christmas morning, Santa had left me a small recorder. I then proceeded to record the magic moments of that morning with all the laughter and surprises. It would be such a delight to be able to listen, 50 years later, to that recording, however that tape has been long lost.” — James

“Every Christmas our family has a talent show. It’s like attending a mini-concert every year. It’s nice to come from a musically talented family.” — Marisol

“Our family’s tradition is to participate in an ecumenical holiday season shelter program.” — Victor

“My favorite holiday memories are simply the times when I get to cook, eat, and spend time with family. Doesn’t get much better than that.” — Elizabeth

“That time of year — that is all too familiar — when my mom would overdress me to make sure I didn’t get sick, which is the reason I moved to Southern California!” — Brian


“Skiing from the top of Mammoth Mountain with my son on a ‘you can see forever’ day!” — Tom

“Christmas morning, when it was still dark and quiet, chilly and still, I would get out of bed and gingerly make my way down the hall to the stairs, carefully avoiding the floorboards I knew creaked. At the top of the stairs I’d stop, make sure the coast was clear, then carefully tiptoe down the six steps to the landing. From there I’d clutch the banister and stretch my skinny little boy body as far forward as it would go … and slowly take in the sight of the Christmas tree, blinking brilliantly in the far, dark corner of the living room, surrounded by mountains of color-fully wrapped presents for me and my eight brothers and sisters. That moment for me was magic.” — Kyle

“Although I knew it wasn’t the real Santa Claus, I would get so excited when my uncle walked in with his homemade Santa suit and a beard made out of cotton balls.” — Rebecca

“One Christmas Eve in high school, my friend and I stayed up all night at her house making stockings for every member of my family and filling them with candy. Then I sneaked back to my house and planted the goods. My mom was in on it, but everyone else was surprised.” — Betty

“My favorite holiday memory? It’s a tie for me between Dec. 25, 1978, when Santa brought me the Barbie shopping mall AND the Barbie catama-ran, and Dec. 24, 2004, the day my amazing husband, Marty, proposed to me!” — Jen “My favorite memory of the

holidays is the year I got my first two-wheel bicycle for Chanukah, but it was winter in Chicago, so my parents cleared out the basement so I could ride around. I felt like I was riding a horse into the distance — such a sense of freedom!” — Barbara

“My favorite holiday memories are of time spent out in nature with friends and family: snow-boarding, hiking, walking on the beach, playing games. My favorite part of the holiday season is the time we take to share experiences with the ones we love.” — Nicole

My fondest memory of Christmas as a child is questioning my parents as to how Santa Claus was able to sneak inside our home if there was no chimney. My parents would always come up with an animated excuse. — Jaime

“After spending last year in the cold and windy city of San Francisco, one of my fondest holiday memories is celebrating last Christmas basking in the desert heat of Palm Springs. It was 80 degrees during my trip, and I was able to brunch in shorts, lay out by the pool, and work on my tan. Who could ask for anything more?” — Brandon

“I really enjoy hearing choirs sing when my friends take me to their churches on Christmas Eve.” — Liz (not present)

“Celebrating the year with food, family, and friends, especially the traditional Swiss fondue Christmas Eve!” — Francesca

10 d ec em b er 2012

patiEnt saFEty stratEgiEs

stressed out during the Holidays? Try These Tips to Avoid Burnoutby THe dOcTOrS cOmPANy

human factor issue. Within those 114 cases, 14% dealt with conditions affecting the pro-vider, including fatigue, physical or mental impairment, distractions, multitasking, or interruptions.

Stress management skills are not traditionally part of the medical school curriculum. Most healthcare professionals are taught to put their heads down and per-severe. At a time when medical profession-als are increasingly in demand as millions of patients become newly insured, practices should consider steps to prevent physician burnout and stress.

Consider these tips to help reduce stress, especially around high-stress times such as the holidays:

•Ensure adequate staffing levels on holi-days and night shifts.

•Monitor staff schedules and curtail hours as needed to prevent undue fatigue.

•Call in additional physicians and staff to combat fatigue and stress.

•Provide an environment that sup-ports staff members so that they feel comfortable expressing concerns about their stress level and ability to function effectively.

•Allow staff members to express con-cerns to each other if they identify signs of fatigue or stress in their colleagues.

•Encourage all staff members to take 20-minute meal breaks and to get fresh air to clear their minds at least once per shift.

•Have regular one-on-one and group meetings with staff to learn their thoughts on how to make things run more smoothly.

•Encourage physicians and staff to put their focus on things they can change, not things they have no control over.

Contributed by SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, or to read more about the 2010 human risk factors evaluation, visit www.thedoctors.com/patientsafety.

Reference:1. Shanafelt TD, Boone S, Tan L, et al. Burn-

out and Satisfaction With Work-Life Bal-ance Among U.S. Physicians Relative to the General U.S. Population. Arch Intern Med. 2012;172(18):1-9.

stress and fatigue caused by working longer hours and inadequate staffing levels can put physicians at risk of burnout — and can raise the risk of negative patient outcomes. During the holiday season, physicians may face added stress as employees and col-leagues have more personal commitments and practices may be short-staffed.

The rate of physician burnout is signifi-cant. A recent study by the Mayo Clinic found that nearly 1 in 2 doctors in the Unit-ed States (45.8%) have at least one symptom of burnout (1). According to the study, being asked to see more patients, having less time with each patient, and short patient release timelines are major stressors for physicians. Physician burnout can decrease quality of care, increase risk of errors, push physicians into early retirement, and cause problems in physicians’ personal lives.

In 2010, The Doctors Company began tracking human factors as risk management issues, and evaluated the influence of hu-man factors in 862 closed liability cases. Of those cases, 114 (13%) included at least one


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Practice makes Practiceby dANIeL J. breSSLer, md

cognitive dissonance is the unpleasant feeling that occurs from trying to maintain contradictory or opposing ideas. Imagine the headache from trying to be both politically conservative and liberal or even from trying be simultaneously a die-hard Padres and Giants fan.

For as long as I remember, I’ve heard the phrase “practice makes perfect” and internally nodded in agreement as if assenting to an abstract universal law of human progress. But the idea of perfection always struck me as incompatible with the real world, the world I actually inhabit. This strikes me as increasingly obvious and impor-tant the longer I “practice” medicine. It’s not just that the science and technology keep changing at breakneck speed; it’s also that I continu-ously discover that I’ve been applying past knowledge incorrectly or, at least, “suboptimally.”

As I’m sure many times a patient of yours has responded to some error by pointing out — imagining that you’ve never heard it before — “Well, Doc, I guess that’s why they call it the practice of medicine.” He’s right, of course, even if the joke is a tired one. We “merely” practice our craft in all its varied dimensions: technical, psychologi-cal, logistical, collegial. We might have moments where we “nail it”: perform a procedure flawlessly, prescribe just the right cocktail of drugs, say just the right word, adjust the settings just right, etc. But the flawless pearl sits on our professional necklace along with a bunch of rather more homely stones. We get better (we hope), but we don’t get perfect.

I’ve responded to the cognitive dissonance between my child-hood’s “practice makes perfect” and my adulthood’s recognition of perfection’s unreachability with this little poem. I hope it speaks to the part of you that finds a kind of pleasure in the relentless pursuit of improvement for our patients and ourselves.

1.Practice makes perfectOr so I was toldHard work rewardedWith ribbons and gold.

Practice makes perfectI heard someone sayKeep your nose to the grindstoneYou’ll be honored one day.

Practice makes perfectIs easily saidIt trips off the tongueLike a prayer before bed.

Practice makes perfectIs a hope and a dreamThe quest of a heroThe vow of a king.

Practice makes perfectA glint and a sparkA flickering candleA guide in the dark.

2.But practice makes perfectIs a ruse and a lieA fake bill of goodsA lunatic’s cry.

Practice makes perfectIs an idiot’s storyIt signifies nothingA crusade without glory.

Practice makes perfectIs deceitful and wrongPretty words, maybeBut a conjurer’s song.

Practice makes perfectSimple and falseA map to no treasureA mismeasured waltz.

Practice makes perfectIs yesterday’s newsA sweet childhood taleA saccharine excuse.

3.Practice makes practiceDispatch from the worldThere is no perfectionNo banner unfurled.

Practice makes practiceThe evidence indicatesDispelling perfectionExperience vindicates.

Perfection’s a rumorPractice a factLife’s demonstrationAct-upon-act.

Practice makes practicePermit me to sayGive up on perfectionPractice today.

Practice makes practiceI’m here to reportA brick house’s blueprintNo timeshare resort.

4.Practice makes perfectDraws life in a linePractice makes practiceIs a spiral design.

Practice makes perfectSays the fool to the wiseWith a lilt in his voiceAnd a glint in his eyes.

Practice makes practiceSays the wise to the foolYou learn this with timeOr you’ll go back to school.

Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical Ethics Committee at Scripps Mercy Hospital and longtime contributing writer to San Diego Physician.

Practice Makes Practice


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physiCian-patiEnt CommuniCations

The Greatest Gift of Allby HeLANe FrONeK, md, FAcP, FAcPH

As the holidays approach, many of us begin to fret about finding that perfect gift for our loved ones, friends, and colleagues. Did we give her a book last year? Would he enjoy movie tickets? Is a gift certificate too impersonal? In fact, what most people truly want is to be seen — for who they are and what they contribute to our and other people’s lives. Most of us want lives that are meaningful and satisfying. We want to make a difference. We want to know that we matter.

Many years ago I attended my brother-in-law’s funeral. Just 48 years old, he had developed a cardiomyopathy and collapsed at home on his 18th wedding an-niversary. On returning home, I was told that Dr. Eugene Bernstein, a prominent vascular surgeon, had been hospitalized with an acute deep vein thrombosis. Filled with the awareness that life can be short and that our next minute is never guar-anteed, I went to visit him that night. In addition to wishing him a speedy recovery, I wanted to tell him how instrumental he had been in my career and to thank him for his guidance during a crucial period.


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We had a lovely chat and I left him to rest for the night. Unfortunately, that night he suffered a pulmonary embolism and passed away.

When I think of that conversation, I feel grateful that I took the opportunity to repay his gift of guidance and encourage-ment by letting him know that he had made a difference — that he mattered to me. As I recall our talk, I consider the many other people in my life who matter to me, and I try to continually let them know that they do. So as you are deciding what gift to buy for those who matter to you, consider giving one of the most precious gifts of all: the gift of acknowledgment.

A friend, a busy ED physician, wanted those he worked with to know how im-portant they were to him. He thought of one trait that he admired or appreciated in each person and found a photo that represented that characteristic. For one nurse, he selected an image of a beautiful, still pond. Her calm in the face of the stress and chaos in the ED allowed everyone else to function efficiently and with great teamwork. After finding pictures for all of his staff, he presented them to each person, with the explanation of the trait that he valued so much in them. His relationship with them and the morale in the entire ED grew even stronger.

Acknowledgement can come more sim-ply in the form of a declarative statement. “You are so organized.” “I appreciate how kind you are to patients.” “You’re a great listener.” By noticing what a person does that makes a difference to you or to others, and by stating it clearly and without ex-planation or embellishment, you give the person a unique and precious gift. A gift that will never get old, wear out, or be used up. A gift that will encourage the person to show that quality more often and in more situations. To be seen by another person is rare and has the potential to change our outlook, our behavior, and even our life. Sounds magical — but isn’t that what the holiday season is all about?

Dr. Fronek, SDCMS-CMA member since 2010, is a certified physician development coach, certified professional co-active coach, and as-sistant clinical professor of medicine at the UC-San Diego School of Medicine. You can read her blog at helanefronekmd.wordpress.com.


praCtiCE managEmEnt

HIPAA Is not deadTop 10 Questions for the Physician Leader by dAVId GINSberG, cO-FOUNder ANd PreSIdeNT, PrIVAPLAN ASSOcIATeS, INc.

Do you have a named HIPAA Privacy Official and Security Official with written job descrip-tions?

Do you train your staff in a timely manner after a new hire and periodical-ly on (a) HIPAA Privacy and Security basics; and (b) your specific Privacy and Security practices?

Do you have up-to-date, specific written HIPAA policies and procedures?

Have you conducted a HIPAA Security Risk analysis within the past two years?

Have you had a breach in the past two years that required patient notifica-tion? If so, did you also notify the Department of Health and Human Services? Does your staff understand how to recognize a breach?

BackgroundHIPAA enforcement has increased in the past year; additionally, the Office of Civil Rights is completing 115 random audits and will be updating its audit protocol. ¶ The audit protocol released earlier this year can be quite onerous for most medical practices; at the same time, an audit failure or noncompliance as a result of an investigation can bring substantial fines and/or corrective action. Recently, a cardiology practice was fined $100,000 and required numerous corrective actions as a result of an audit after it was found that they used an Internet scheduling system that had limited safeguards to unauthorized access.

Do you have a contin-gency plan for your EHR or other software that holds electronic protect-ed health information?

Have you updated your business associate agree-ments since the HITECH Act went into effect?

Do you periodically audit access to your EHR or other application that holds electronic protected health information?

Do you have a formal process to handle HIPAA complaints and incidents?

And the 10th

HIPAA question: Have you attested for meaningful use without answering yes to all of these questions?

In our next edition we will continue our top 10 list and provide resources.

1

6

2

7

3

8

4

9

5

Every SDCMS member practice should be able to answer yes to the following top 10 questions:



politiCal advoCaCy

Specialty MICRA SAVINGS San Diego County FL-NY-MI Average Dade County, FL Long Island, NY Wayne County, MI

Allergy $13,375 $3,931 $17,306 $24,183 $10,826 $16,909

Anesthesiology $32,102 $10,472 $42,574 $48,367 $37,657 $41,697

cardiology (INVASIVe) $54,077 $13,408 $67,485 $95,007 $40,738 $66,711

cardiovascular Surgery $124,318 $32,123 $156,441 $172,739 $121,665 $174,918

dermatology (LIPO/cOSmeTIc) $16,433 $21,897 $38,330 $54,413 $36,779 $23,797

emergency medicine $60,373 $19,993 $80,366 $95,007 $58,971 $87,121

Family Practice (NONSUrGIcAL) $27,760 $7,447 $35,207 $44,912 $26,817 $33,893

General Surgery $119,889 $35,273 $155,162 $200,377 $121,665 $143,445

Internal medicine (NONINVASIVe) $30,678 $9,730 $40,408 $50,094 $36,779 $34,350

Neurosurgery $201,959 $55,364 $257,323 $248,744 $321,713 $201,512

Ob/GyN $136,346 $41,128 $177,474 $200,377 $196,111 $135,935

Ophthalmology (LASIK/cOSmeTIc) $30,532 $10,963 $41,495 $50,094 $36,437 $37,955

Orthopaedics $117,518 $28,342 $145,860 $146,828 $146,084 $144,667

Otolaryngology (cOSmeTIc) $63,907 $19,468 $83,375 $60,459 $108,110 $81,556

Pathology $20,976 $8,759 $29,735 $44,912 $24,769 $19,524

Pediatrics (NONSUrGIcAL) $19,767 $9,179 $28,946 $31,093 $26,817 $28,928

Plastic Surgery $74,586 $23,641 $98,227 $95,007 $108,110 $91,565

Psychiatry (NONSHOcK) $12,909 $4,712 $17,621 $24,183 $10,826 $17,853

radiology (NONINVASIVe) $55,123 $12,010 $67,133 $95,007 $61,100 $45,293

Thoracic Surgery $110,320 $32,123 $142,443 $172,739 $100,500 $154,089

Urology $45,185 $14,947 $60,132 $60,459 $64,281 $55,655

Average All Specialties $65,149 $19,758 $84,907 $95,952 $80,798 $77,970

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MICRA’S KEY PROVISIONS:

The Medical Injury Compensation Reform Act (MICRA) is California’s hard-fought law to provide for injured patients and stable medical liability rates. California’s trial lawyers are continually launching attacks to undermine MICRA and its protections, and we need your help.

Unlimited economic damages

Unlimited PUnitiVe damages

$250,000 limit on non-economic damages

limits attorney contingency Fees

statUte oF limitations on claims

binding arbitration oF disPUtes

Periodic Payments oF FUtUre damages

eVidence oF collater-al soUrce Payments

reQUires adVance notice oF a claim


Specialty MICRA SAVINGS San Diego County FL-NY-MI Average Dade County, FL Long Island, NY Wayne County, MI

Allergy $13,375 $3,931 $17,306 $24,183 $10,826 $16,909

Anesthesiology $32,102 $10,472 $42,574 $48,367 $37,657 $41,697

cardiology (INVASIVe) $54,077 $13,408 $67,485 $95,007 $40,738 $66,711

cardiovascular Surgery $124,318 $32,123 $156,441 $172,739 $121,665 $174,918

dermatology (LIPO/cOSmeTIc) $16,433 $21,897 $38,330 $54,413 $36,779 $23,797

emergency medicine $60,373 $19,993 $80,366 $95,007 $58,971 $87,121

Family Practice (NONSUrGIcAL) $27,760 $7,447 $35,207 $44,912 $26,817 $33,893

General Surgery $119,889 $35,273 $155,162 $200,377 $121,665 $143,445

Internal medicine (NONINVASIVe) $30,678 $9,730 $40,408 $50,094 $36,779 $34,350

Neurosurgery $201,959 $55,364 $257,323 $248,744 $321,713 $201,512

Ob/GyN $136,346 $41,128 $177,474 $200,377 $196,111 $135,935

Ophthalmology (LASIK/cOSmeTIc) $30,532 $10,963 $41,495 $50,094 $36,437 $37,955

Orthopaedics $117,518 $28,342 $145,860 $146,828 $146,084 $144,667

Otolaryngology (cOSmeTIc) $63,907 $19,468 $83,375 $60,459 $108,110 $81,556

Pathology $20,976 $8,759 $29,735 $44,912 $24,769 $19,524

Pediatrics (NONSUrGIcAL) $19,767 $9,179 $28,946 $31,093 $26,817 $28,928

Plastic Surgery $74,586 $23,641 $98,227 $95,007 $108,110 $91,565

Psychiatry (NONSHOcK) $12,909 $4,712 $17,621 $24,183 $10,826 $17,853

radiology (NONINVASIVe) $55,123 $12,010 $67,133 $95,007 $61,100 $45,293

Thoracic Surgery $110,320 $32,123 $142,443 $172,739 $100,500 $154,089

Urology $45,185 $14,947 $60,132 $60,459 $64,281 $55,655

Average All Specialties $65,149 $19,758 $84,907 $95,952 $80,798 $77,970

$65,149 WAYs sdcms And cmA Are WOrkInG FOr YOu!

Your SDCMS-CMA Membership Has Never Been So Valuable!

MICRA’S KEY PROVISIONS:

The Medical Injury Compensation Reform Act (MICRA) is California’s hard-fought law to provide for injured patients and stable medical liability rates. California’s trial lawyers are continually launching attacks to undermine MICRA and its protections, and we need your help.

Unlimited economic damages

Unlimited PUnitiVe damages

$250,000 limit on non-economic damages

limits attorney contingency Fees

statUte oF limitations on claims

binding arbitration oF disPUtes

Periodic Payments oF FUtUre damages

eVidence oF collater-al soUrce Payments

reQUires adVance notice oF a claim


physiCian training

san diego kaiser Permanente Officially enters the World of residency trainingby SHerWIN GALLArdO, md, ANd KATHerINe H. bALAZy, md

On July 2, 2012, Kaiser Permanente in San Diego entered the world of graduate medi-cal education when its inaugural class of six family medicine residents began its first official day of training at Kaiser’s Family Medicine Residency Center in Clairemont Mesa. Though the postgraduate training program in family medicine is the first for Kaiser here in San Diego, Kaiser Perman-ente has a long history of training family medicine residents in Southern California, with five other programs located in Orange County, Riverside, Fontana, Woodland Hills, and Los Angeles. Affiliate residents

Kaiser will be able to offer its new residents opportunities in direct patient-care, drawing from the resources of about 500,000 geographically and culturally diverse patient members. Using KP Health-Connect, the residents will have access to potential research and population data from Southern California Kaiser’s 3 million-plus members. The residents will also have their collective eye on the future, looking to incorporate new technologies into patient care, such as the use of patient-simulation labs. They will experience innovative, cutting-edge healthcare delivery models, such as tele-dermatology, and virtual consultations/appointments with special-ists. The residency program is also proud of its relationship with two of the community clinic organizations in the county: La Maes-tra and Neighborhood Healthcare.

The family medicine residency may be the first for Kaiser Permanente in San Diego, but it certainly will not be the last, with an emergency medicine training program slated to begin in 2014 and poten-tially other residencies to follow soon after-ward. Under the leadership of Kaiser San Diego’s medical director, Paul E. Bernstein, MD, SDCMS-CMA member since 2000, and residency director Dereck J. DeLeon, MD, SDCMS-CMA member since 1996, the program is already looking to add fellowship training positions in commu-nity medicine and sports medicine, and potentially fellowships in geriatrics and palliative care. Ready to outgrow its present location, the Family Medicine Residency Center is looking to occupy a new medical office building in Clairemont Mesa within two years. And, of course, the new Kaiser Permanente San Diego Medical Center will be located just a couple of miles east down Clairemont Mesa Boulevard not too long afterward.

The new Division of Graduate Medical Education at Kaiser Permanente in San Diego is living up to its slogan: Teaching Tomorrow’s Medicine Today.

Dr. Gallardo, SDCMS-CMA member since 2008, is the assistant program director of the Kaiser San Diego family medicine residency program. Dr. Balazy, SDCMS-CMA member since 2012, is a faculty member of the Kaiser San Diego family medicine residency program and physician director of networking and development for Kaiser San Diego.

from nearby UC San Diego and the United States military have also been rotating through Kaiser San Diego for several years. Many students from the UC San Diego School of Medicine also do their rotations at Kaiser.

In the face of inevitable healthcare reform and the subsequent projected shortage in primary care physicians, Kaiser is proud to join San Diego County’s other family medicine residency programs in the important task of training these future family physicians. Being a brand-new training program did not frighten prospec-tive interns, with nearly 600 applicants vying for the initial six positions approved by Accreditation Council for Graduate Medical Education (ACGME).

With one of the largest, most respected departments of family medicine in the nation, highly talented faculty who have completed numerous presentations region-ally and nationally, skilled and supportive specialty faculty, and, of course, the prime location in America’s Finest City, the program is poised to become one of the most sought-after in the country. Fol-lowing the vision of its founding fathers, Henry J. Kaiser and Dr. Sidney Garfield, Kaiser Permanente has long been a leader in wellness, integrated care, and preven-tive health. The broad curriculum of the residency program will incorporate these essential elements, as well as aspects of the patient-centered medical home (PCMH), population-based medicine, and the elec-tronic medical record (KP HealthConnect).

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hEalthCarE systEms

Nearly 10 years ago, Palomar Health conceived an idea to build a health system for the future. The first piece of the master plan would be a new hospital infused with a sense of healing, innovation, and flexibility — a place built entirely around the needs of patients and their families, and a place where highly skilled physicians and staff are provided every capability to deliver their finest care.

Today, that once hopeful idea stands high on a hill in western Escondido and is a testament to forward thinking, generos-ity, and the desire to meet the medical needs of a growing community. The new Palomar Medical Center opened its doors for care on Aug. 19, 2012, making it the first new hospital in North County San Diego in more than 30 years, and one of the proudest moments in my 40-plus year career in healthcare in terms of what it means for the people we serve.

The House on the HillThe New Palomar Medical Centerby mIcHAeL H. cOVerT, FAcHe, PreSIdeNT ANd ceO, PALOmAr HeALTH, [email protected]

My purpose in writing this column is to share with the physician community a bit about our labor of love and to introduce some of the architectural and techno-logical advancements that make Palomar Medical Center one of the best places to practice medicine today.

Our JOurneYIn 2004, taxpayers supported a $496 mil-lion construction bond, known as proposi-tion BB. Their nod of approval allowed for the development of a master plan that would help shape the future of healthcare throughout Palomar Health’s 850-square-mile district.

The vision for the new Palomar Medical Center crystallized through an extensive planning process involving physicians, nurses, staff, board members, donors, com-munity leaders, and volunteers who voiced heartfelt opinions and proposed creative, beyond-the-box solutions. We also sought advice from some of the nation’s leading healthcare futurists to combine these ideas into plans for a structure that is widely known as the best example of 21st century healthcare design.

As our expansion plans evolved, the concept of sustainable and flexible health-care design was adopted. This innovative approach would provide for the best heal-ing environment while reducing environ-mental impact, optimizing patient safety, and creating a facility that would stand the test of time.

A unanimous vote by the Escondido City Council gave the green light for the new hospital to be located at the Escondido Research and Technology site on Citracado Parkway. Ground was broken in December 2007, and the construction project became

the largest in the history of Escondido and even the country at the time.

Thousands of caring hands labored for the next four and a half years to build the 11-story facility, using 25 million pounds of structural steel and more than 5 mil-lion feet of electrical cable. The result is a 740,000-square-foot architectural and technological masterpiece.

InnOvAtIOns FOr tOdAY, tOmOrrOWA primary goal was to build a facility that can easily adapt to future technologies and innovations. At the heart of this ef-fort is the new Palomar Medical Center’s Advanced Surgery and Procedures Depart-ment that currently houses 11 expansive surgical suites, four cardiac catheteriza-tion/interventional radiology suites, and 47 pre-operative and recovery spaces.

The structural steel truss system used in the Surgery and Procedures area features open floor plates and minimal vertical obstructions so that operating rooms can be easily modified as the practice of medicine changes. Major equipment is ceiling-mounted on booms to optimize available space for the surgical team and reduce floor-based equipment. We even

Palomar Medical Center DiRECToRyofSERViCESThenewPalomarmedicalCenterprovidesforsuperiorclinicalcareinapeaceful,healingenvironment.Primaryservicesinclude:• EmergencyandTraumaServices• CardiologyandCardiacCatheterization• CardiothoracicSurgery• VascularSurgery• orthopedicSurgery• Neurosurgery• NeuroscienceServices• RoboticSurgery• oncology• interventionalRadiology• PulmonaryTesting• laboratoryServices• imaging



have structural capability to install intra-operative MRI equipment in the future — a feature of our planned hybrid OR suite.

The imaging services at Palomar Medical Center are among the most advanced in the country, including dedicated spaces for MRI, CT, radiology/fluoroscopy, nuclear medicine and diagnostic ultrasound. Our portable X-ray machines are filmless and digital with instant image display. Three imaging rooms (one CT and two X-ray) are located within the Trauma Center and Emergency Department to assure immedi-ate availability for critical patients.

Another unique element of the Surgery and Procedures area is the use of “clean cores.” Two clean core spaces allow surgical teams to access multiple operating rooms without ever having to leave the sterile environment. Within each clean core are high-tech features, such as a pneumatic tube system station and flash sterilizer room to help staff be more efficient.

emerGencY And trAumA cArePalomar Health has the largest trauma district in California, serving more than 540,000 residents living in a 2,200-square-mile region. Our two new trauma suites are self-contained for quick response, with a dedicated trauma elevator from the rooftop heliport and easy access from the ambu-lance bay. Each suite is configured for three treatment stations but can accommodate up to five patients each in the event of a major emergency.

The adjacent Emergency Department has 44 treatment rooms divided into three bays, each with a central nursing station. In addi-tion, four Rapid Medical Evaluation (RME) rooms are designed to minimize wait times and expedite access to the appropriate level of care for further treatment.

HeAlInG envIrOnmentFrom the moment you step into the new Palomar Medical Center, you will recog-nize that you have entered a world-class healing environment. While the goal is to create a sense of calm for all who enter the building, a variety of evidence-based de-sign features help to speed up the healing process, improve safety, enhance staff well-being, and even reduce medical errors.

Ample research shows that exposure to natural light is beneficial to all of these goals. Rain or shine, night or day, our

patients, physicians, and staff have the ability to enjoy outside views without ever leaving the building thanks to expansive windows, skylights, solar tubes, and acces-sible outdoor terraces on every floor. Mas-sive light wells are used to funnel natural daylight into areas located deep within the interior of the building, including the clean cores. And large windows in each operating room provide expansive views of the Escondido Valley or interior court-yards, while adjoining hallways are bathed in natural light.

PAtIent rOOmsPalomar Medical Center was built with a patient-centric focus. So, it’s no surprise that perhaps one of the most highly antici-pated features of our new facility is the all-private patient rooms. We currently have 288 patient rooms that average 320 square feet in size and include a private bathroom,

hEalthCarE systEms

family visiting area, and sleeper couch. These larger rooms accommodate portable medical equipment and help minimize the need to move patients throughout the hos-pital. In fact, all of our rooms are designed to be acuity adaptable.

Another feature that is a favorite among physicians is the distributed nursing sta-tions located outside every patient room. This design enables nurses to be closer to the bedside and to respond more quickly to patient needs. Windows provide visual contact with patients in the two rooms on


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either side of the workstation.Each workstation is wired as a commu-

nications hub for maintaining electronic medical records, which are accessible to physicians and staff through a secure, wire-less network, providing current and com-plete information about each patient. In addition, over-head paging is pri-marily limited to emergencies. Staff and physicians are alerted through text or voice mes-sages to their PDAs or mobile phones. Physicians can also electronically alert a nurse to their presence in a patient room.

Communication is enhanced for the patient as well. A bedside control panel allows patients to manage their own

environment, change lights, temperature, or airflow, adjust their window shades, use the flat-screen television, or call their nurse. For families, numerous family consult rooms are located throughout the building to provide loved ones with an

area to speak privately with a physician. And multidisciplinary rooms located on each patient wing provide physicians, nurses, and ancillary staff with additional work-space as needed.

lOOkInG AHeAdWhile the opening of the new Palomar Med-ical Center is certainly

a major milestone in our journey to create the health system of the future, our work is far from done.

The Palomar Health Downtown Cam-

pus remains a vibrant hub of healthcare in central Escondido, with many planned renovations and upgrades over time. Con-struction is under way for the new Ramona Ambulatory Care Center to be operated by our physician group, Arch Health Part-ners. Two new Palomar Health expresscare centers opened this year inside Albertsons/Sav-on Pharmacy locations in Temecula and San Marcos. And work has begun to build a pedestrian bridge that will connect Pomerado Hospital with Pomerado Outpa-tient Pavilion.

The future is bright at Palomar Health. I invite you to learn more about us by scheduling a tour of the new Palomar Medical Center. We value our affiliated physicians and the superior level of care they provide to our patients in the “House on the Hill” and throughout the Palomar Health system.

In Good Health,Michael H. Covert

Are you a physician interested in a tour of the new Palomar Medical Center? Contact Lisa Hudson, director of business and physician development, at (760) 740-6364 or at [email protected].


Our mentOrs …

GuidinG the Way

I n t r O d u c t I O n bY JA m e s sA n t I AG O G r I s O l Í A , m d, s d c m s - c m A m e m b e r s I n c e 1983

The following are personal statements and do not necessarily reflect the position of SDCMS.


Becoming a physician demands a long, hard road. We study facts and techniques, shorn of context, in journals and texts. From these odd, lost data we must stitch together a coherent profes-sion and find our way to become professional in it. “Profession” implies developing character and wisdom, and employing that wisdom for our patient, even against our own interests.

Like Dante, we find ourselves in a selva oscura, and we need a Virgil to lead us out. Our Virgil could be a chief resident or an attending we strive to emu-late. But we must find an older, more experienced soul to teach us how to become who we want to be. Young Sigmund Freud studied with the superb neurologist Charcot in Paris, then evolved his own theories on hysteria. Even in Turkey, the great Hulusi Behçet, discoverer of Behçet’s disease, was mentored along his way.

In this issue, some of our SDCMS members laud their own special men-tors with stories of relationship and growth, both personal and professional. Coaching only helps you master the immediate task. On the other hand, men-toring implies development of character, which may help the task at hand, but prepares the mentee for much more. At its best, mentoring creates a rich discipleship relation between a seasoned teacher and an eager student, giving us both disciple and discipline. The mentor models behavior and a way of life, embedding isolated facts in a context of values, hence wisdom.

Our brains are designed to work this way. Simple learning and conditioning happen with one-celled organisms and all the way up the evolutionary chain. Nikolaas Tinbergen and other ethologists described simple imprinting of parental behavior: the baby geese honking along behind the mother, or honk-ing along behind Dr. Tinbergen if they imprinted on him instead. Higher mammals have developed extensive prefrontal cortex, with rich connections to older structures like the anterior cingulate cortex and the limbic system. Somewhere in that circuitry lies our “theory of mind,” where we construct an image of other people, what they think when they say such-and-such, and what they probably will do next. This complex simulation of others is best developed in the human cortex, making us the masters of social learning from parents, from teachers, from the “wrong sort” of schoolmates, and eventually from one or more mentors. “Show and do” betters “teach and watch,” because learning by doing with a mentor engages our attention and action, personal-izes data that seemed irrelevant or boring, corrects us gently with an under-standing of our personal weaknesses and strengths, and begins to grow us into a more exalted role.

When I think about my own mentors, just in neurosciences, many names crowd in: Mike Kasman, Randall Smith, Burt Wiederholt, Marge Seybold, Robert Nichols. Each provided a different view of the nobility and commit-ment that went with neurology, giving me the happy task of synthesizing from each. And many wonderful primary care and specialist docs gave me little pieces of how to become a physician. My former partner, the neurosur-geon Manuel Barba, schooled me in patience, in the importance of placebo in all we do, in the shamanic aspects of ministering to the soul who thought his problems were “only” neurological.

And then Manuel and others led me to “The Great Physician,” Jesus Christ, the Master of a long Judaic tradition of discipling others. His example has helped me to better love and accept the careless, the forgetful, the noncom-pliant, and even those who disagree with my treatment or point of view. His example reinforces that healing doesn’t dig down in unless I address the soul issues as well as the physical.

As you enjoy your colleagues’ stories below, I invite you to reflect back on your own spiritual and professional formation, and where you have found your own models and sources of personal strength. And remember with grati-tude your own mentors along your journey.

Honoring Dereck J. DeLeon, MD, SDCMS-CMA Member Since 1996By Sherwin Gallardo, MD — SDCMS-CMA Member Since 2008 — and Katherine H. Balazy, MD — SDCMS-CMA Member Since 2012

starting kaiser Permanente San Diego’s first full residency training program needed the leadership and vision of a great mentor. The program’s first direc-tor, Dereck DeLeon, MD, qualifies.

He has always placed great importance on medical education. Prior to serving as residency program director, he was Kaiser San Diego’s co-director for continuing medical education and has taught medical students from UCSD for years.

More importantly, as his fellow faculty members, we have come to witness firsthand the importance Dr. DeLeon places on open communication, hard work, and integrity, yet demonstrates what he believes is very crucial: Family always comes first.

At times we have seen him pull a residency project to completion simply by sheer will. Yet his transparent, positive collaboration style has brought together numerous departments and leaders to meld a group of specialist faculty liaisons and various nonclinical departments and leaders necessary for the successful launch of the residency program.

No matter the workload or situation, patients, staff, medical students, residents, and faculty alike continue to pledge their all to Dr. DeLeon.


Honoring Martin T. Stein, MD, SDCMS-CMA Member Since 2010By John A. Kafka, MD, FAAP — SDCMS-CMA Member Since 2010

I would like to recognize the influence that Dr. Martin Stein, who recently celebrated his 70th birthday, has had on the pediatric community here in San Diego.

Marty grew up in Southern California, completed his pedi-atric training in New York, and served for a time in the Navy at Balboa. By the time I was a third-year medical student, in 1976, he was already running the pediatric clinic at UCSD and in charge of teaching general pediatrics to medical students and residents. He subsequently, along with Suzanne Dixon — an-other excellent clinician and teacher — established the devel-opmental/behavioral pediatrics training program at UCSD.

Marty personifies what a good doctor should be. He seems to remember everything he’s ever seen or learned. He devel-ops rapport with children and families, and he has excellent hands-on clinical skills. His patients receive thorough care that, beyond dealing with acute illnesses, is also attentive to psychosocial and family issues and the role they play in the child’s health.

Besides being a great doctor, Marty is also a great teacher. Since so much of clinical pediatrics involves teaching parents and kids, it’s no surprise that Marty’s skills as a clinician are also apparent in his ability to convey clinical skills and passion for great care to his trainees. He consistently has done this in a positive way that promotes clinical ability and self-confidence.

The most striking thing about Marty, though, is his passion for both practicing and teaching high-quality care. Watching him in the clinic, it is clear that he is not going through the motions but rather that every patient is important and deserves comprehensive care. I’m sure he has inspired many to do their best to practice in this way. He is also a national leader in promoting developmental/behavioral pediatrics as an important subspecialty.

While I’m at it, I want to name the other pediatricians who taught several generations of pediatricians how to take great care of kids: Dr. William Nyhan, who established the pediat-ric department at the UCSD School of Medicine and seems to know everything about everything; Dr. James Connor — watching him at the bedside is like watching Jascha Heifetz play violin; the late Dr. Lou Gluck, a pioneer in neonatology who conveyed his passion for giving no-compromise care for tiny babies; and Dr. Suzanne Dixon, whom I mentioned above — every brilliant sentence she says sounds like she spent hours writing it.

San Diego and its pediatric community are very fortunate to have had these fine people as clinicians, teachers, mentors, and role models.

Honoring Andrew G. Israel, MD, SDCMS-CMA Member Since 1980By Karen A. Herbst, MD — SDCMS-CMA Member Since 2010

my name is karen Herbst, and I have been a local internist in the Hillcrest area since 2008. I have had the honor and pleasure of working with Dr. Andrew Israel and received the information about an opportunity to honor him in one of the issues. I would like to do just that.

As medical residents, we all hoped and prayed for someone to take us under their wing, show us what to do, where to go, how to find answers, and how to enjoy ourselves while we are doing it. I was lucky enough to have met Dr. Andrew Israel my first year of internship, and since that day I have had an amazing mentor and dearest friend.

While rotating and working with Dr. Israel as a resident, I saw how amazing private practice can be. His personal touch with patients inspired me. I let him know I was interested in emulating his practice when setting out on my own after residency. His group was extremely nice and made room for me in their already packed of-fice. What a blessing that has been for me.

Dr. Israel taught me the power of touch — that shak-ing someone’s hand when you go out to the waiting room to get them calms nerves. His patients felt they were visiting a trustworthy, knowledgeable friend, rather than a cold physician. Daily I would knock on his door with my famous “can I ask you a question” that ranged anywhere from diagnosis assistance with a patient to treatment management, or even how to run the office.

Transition into private practice has been incredibly smooth for me. I have had someone next to my side the entire time leading me and pointing me in the right direction. Before making any big decisions, I hear his voice in my head with his advice, like “don’t spread yourself out too thin” and “make sure your first appoint-ment with your patient matters. This is the one that you will always remember and base a lot of decisions off of.” Or “take vacation. It is crucial to your ability to love what you do.” And my favorite: “It’s OK to say no sometimes.”

He has taught me how to run an office, work with office staff, and to be a great boss. He has rejoiced with me with family excitements and been there for me in my tragedies. He has allowed me to call him on his off hours because I wasn’t sure what path to take with a sick patient in the hospital and needed advice. He has been a true mentor. I have fallen in love with medicine thanks to his guidance. I hope to be able to return the mentoring to someone someday as well as he has for me.


Honoring Paul Brucker, MDBy James T. Hay, MD — SDCMS Member Since 1985

When I was growing up, I received all my medical care from a small group of won-derful family physicians in Ambler, Pa. One of them was Paul Brucker, a graduate of the University of Pennsylvania and as articulate and intellectual a man as I have ever known. Dur-ing medical school, I was very fortunate to do a summer pre-ceptorship in their office and forever had dispelled the notion that GPs saw only sore throats and sprains. I was amazed at the breadth of clinical issues they dealt with, and, especially in Dr. Brucker’s practice, the expert way they handled them. He also had that Marcos Welby style of 100% atten-tion to people, their needs, and their feelings. No one I have known before or since was any warmer or more caring.

About the same time, we created a Family Practice Club at Jefferson for those of us who were interested. It became known that Jefferson was about to establish a Division of Family and Community Medi-cine under the Department of Medicine, and our club was actually asked if we had sugges-tions for who should head it. The choice was obvious to me, and not only did Dr. Brucker take that post, but he eventual-ly went on to become president of the university a few years later, and for a lengthy and quite successful tenure. I am so very proud of my old family doctor, and he is one of my heroes who had a profound influence on who I am.

Honoring Bryan A. Liang, MD, PhD, JD, SDCMS-CMA Member Since 2004By Kimberly M. Lovett, MD, SDCMS-CMA Member Since 2009

Perhaps once in a lifetime, if lucky enough, one is taken under the wing of an outstand-ing mentor, an individual who ferrets out aspirations, sees clearly through the clutter of surrounding ideas, and uses his energy, intelligence, web of contacts, and hours of hard work to not only help a mentee achieve her dreams but also to help her learn to change the world. As a young physician, frustrated by a medical system woefully falling short of the needs of patients and physicians, I struggled to find an avenue to focus my passion for improving the system.

That was before I met Dr. Bryan A. Liang at California Western School of Law’s Institute of Health Law Studies. I had trepidations about approaching Dr. Liang. He is well known as a brilliant scholar; he is tantamount to a celebrity in the patient safety movement; and his work is cited among that of the most elite experts. He also impressively serves on the AHRQ Study Section for Patient Safety. I was thus pleasantly surprised when Dr. Liang humbly and kindly welcomed me into his circle and showed me the same level of care he consis-tently shows to all of his students, colleagues, and society.

That meeting with Dr. Liang changed the course of my life. He was breaking new ground on issues of counterfeit drugs and online access. I was interested in the effect of direct-to-consumer Internet advertising for medical devices and tests. Dr. Liang not only showed me how my ideas would fit within the work of Center for Patient Safety and Institute of Health Law Studies, but he also taught me how to craft my arguments and advocate for change.

A little over a year later, I am working on my 19th publication; I have been honored to have my ideas published in some of the best journals in the world (e.g., JAMA, Nature Re-views Cancer, Contraception); I have traveled around the country presenting my ideas; I have assisted the Illinois attorney general with prosecutions based on our work; I have written an amicus curie brief on patient safety; I have had the honor of having my opinion sought by the media and my published work; and I have started my first year of law school at Stanford University School of Law so that I can more effectively join Dr. Liang in changing the world. I feel as if I have gone from “zero to hero” almost overnight. And all of this be-cause of the attention and efforts of one person — Dr. Bryan A. Liang — helping a student discover her pathway of life and professional calling.

However, my path is merely a fraction of the amazing impact that Dr. Liang has had on students and colleagues. He is an academic superhero. He uses his research, his words, and his endless energy to pursue justice within the medical system. He takes no money from industry but is willing to co-opt anybody into producing good work. For example, the Partnership for Safe Medicines was started primarily as an attempt to grapple with intellectual property issues and prevent importation of medicine from outside the U.S. supply chain. However, under Dr. Liang’s influence it has been morphed into a highly successful collaborative anti-counterfeiting, public health organization, focusing on the perpetrators who manufacture extremely dangerous counterfeit pharmaceuticals and particularly target vulnerable patient populations. Dr. Liang has identified the issue clearly as one of patient safety, and he has cut across political and ideological boundaries, creating public-private partnerships and bringing together stakeholders who would normally be on opposite sides of the issue with his clear message: “It’s not about profits … it’s about patients.”

There are very few individuals who both believe in their power to change the world and have the drive and skill to do so. Dr. Bryan A. Liang is one of the few. The world is a different and better place because Dr. Liang cares enough to make it so. And, as someone benefitting from his tutelage, I can say that his efforts will only exponentially multiply as his mentees develop the same passion for evolving and improving medical and global health systems.


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Honoring Abdool R. Moossa, MDBy Adam S. Fierer, MD, SDCMS-CMA Member Since 2003

It was with great shock and sadness that I learned of the se-rious illness of Dr. A.R. Moossa. Dr. Moossa was the chair-man of the Department of Surgery at UC San Diego for 20 years, including the six years I spent there as a surgical resident. Although he wasn’t exactly the gentle-shoulder-to-cry-on type of person, and although the years under him were some of, if not the, toughest years of my life, I quickly recognized how important his lessons were once I was out in practice for myself.

There are many “Moossa-isms” that we residents heard over the years, but many of them turned out to be little pearls of wisdom that, if heeded, wound up making me a better surgeon and my patients better off for it. One of my favorites was that “you can’t unscrew a patient by re-screwing them.” I never really understood this one until I had to deal with my own patients’ complications and realized that you have to put your ego and anxieties aside and do what’s right for the

patient and not what might make you look better, thereby “re-screwing” them.

He was the master at not rushing in to difficult situations so as to avoid making a rash and often poor decision. This was particularly true when others, including the patient, felt something had to be done quickly. I have always tried to emulate his calmness and certainty when making surgical decisions. He also had the most exquisite operative technique — one that emphasized the importance of exposure and the way to set up and execute an operation. Knowing how to get your assistant to help you better turned out to be a most valuable lesson.

As is often true of parents and their children, the lessons I learned from Dr. Moossa were not recognized while I was struggling to develop my own identity as a surgeon and to just survive my residency, but they quickly entered my consciousness when I suddenly became the person at the end of “the buck stops here.” I will never forget them nor forget to pass them on, and I can’t thank Dr. Moossa enough for passing on his wisdom and skills that allow me to do what I love to do most: operate!


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Get InvolvedSan Diego County Medical Society Foundation needs you! Join us to volunteer for Project Access, or provide specialty consultations to primary care physician colleagues through eConsultSD, our HIPAA-compliant, web-based system from the comfort of your home or office. Attend an event, assist us to recruit fellow physicians, or provide educational opportunities for primary care physicians or medical students. Our first annual Golf Tournament is scheduled for Thursday, February 28, 2013 at Del Mar Country Club; we hope you can join us! To register or for more information, go to sdcmsf.org/golf. Please consider making a contribution to SDCMS Foundation to support our efforts at www.sdcmsf.org, or call us at 858.300.2777.

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classifiedspraCtiCe annOunCeMents

neW DerMatOlOgy praCtiCe: Board-certified derma-tologist and dermatopathologist, Heidi Gilchrist, MD, practic-es medical dermatology for all age groups. She offers same-day and next-day appointments, including Saturdays, and accepts all major insurance plans. Dr. Gilchrist emphasizes a holistic and integrated approach to skin health and disease prevention, and she is open to patients who prefer natural or alternative approaches. She specializes in individualized care and spends at least as much time listening as she does talking. Cosmetic services are also available upon request. 345 Sax-ony Road, Suite 201, Encinitas, CA 92024; office (760) 230-2537; fax (760) 230-5386; gilchristdermatology.com; [email protected]. [100]

physiCian pOsitiOns aVailaBle

MiD-Career peDiatriCian: Great opportunity for a mid-career pediatrician with kind manner and strong en-trepreneurial spirit to work FT/PT in small solo progressive practice. This position is a partnership track. Night call is minimal but must be willing to work some Saturdays and one evening/week to help grow the practice. Space available to expand. Nice mix of parents in great school area. Salary DOE. Nice, stable office staff with EMR. Send CV to [email protected]. [057]

physiCians: Retired with license? Want to cut back to two or three days a week? Alternative care office in San Diego area looking for California licensed MD for consultative work. Part time, excellent compensation. Contact James at (760) 703-3767 or at [email protected]. [098]

three COntraCt physiCians: Profil Institute for Clini-cal Research is looking for three clinical contract physicians. Requirements: One year of clinical experience in adult medi-cine and/or equivalent + unrestricted California MD license. Research experience not necessary. Responsibilities: Per-form medical histories, physical exams, admit, discharge, and monitor subjects, including reviewing labs results, EKGs and telemetry as part of clinical research trials. Weekend shift hours (Saturday) + occasional weekday shift. Interested parties please apply online at www.profilinstitute.com under “Career Opportunities” — search for position under “Contract Physician,” and apply to the job online. [097]

ChieF, Maternal anD ChilD health: The County of San Diego Health and Human Services Agency is seeking a qualified medical doctor to fill the position of chief, Mater-nal, Child, and Family Health Services (MCFHS) branch. The chief is responsible for the management and administration of public health programs that improve the health of moth-ers, children, and their families. For more information on the position, including minimum requirements and how to apply, please visit www.sdcounty.ca.gov. [092]

aDult psyChiatrist — part tiMe: The County of San Diego’s Health and Human Services Agency is seeking a psychiatrist for 10-hour weekdays, part-time shifts for adult outpatient clinic work. Our psychiatrists work with a dynamic team of medical and nursing professionals to provide out-patient treatment, telepsychiatry, inpatient and emergency services, and crisis intervention. More information about psy-chiatrist positions can be found at www.sdcounty.ca.gov/hr. Interested candidates may contact Lita Santos at (619) 563-2782 or email a CV to [email protected]. [091]

aDult psyChiatrists: County of San Diego’s Health & Human Services Agency seeks FT/PT psychiatrists for key components in the Behavioral Health Division’s continuum of care. Our psychiatrists work with a dynamic team of medical and nursing professionals to provide outpatient treatment, telepsychiatry, inpatient and emergency services, and crisis intervention. More information about psychiatrist positions can be found at www.sdcounty.ca.gov/hr. Interested candi-dates can contact Gloria Brown at (858) 505-6525 or email CV and cover letter to [email protected], and Marshall Lewis, MD, Behavioral Health clinical director, at [email protected]. Please specify clinical area of interest. [090]

FaMily praCtiCe physiCian: For a busy federally quali-fied health center. MHCS (www.mtnhealth.org) is a mission-driven organization that serves both rural and urban resi-

dents of San Diego County. We have been in business for over 35 years and offer a competitive salary, medical benefits, vacation, paid holidays, sick time, malpractice, life, AD&D, long-term disability, long-term care, monthly incentive, CME / license reimbursement, plus a sign-on bonus. Board certi-fied and bilingual English/Spanish preferred. Send CV to [email protected] or (619) 478-9164. You may contact HR directly at (619) 478-5254, ext 30. [089]

seniOr physiCian: The County of San Diego, Health and Human Services Agency’s HIV/STD/Hepatitis clinic has an im-mediate opening for a licensed physician with at least three (3) years of recent post-internship training or experience in internal medicine or as a general practitioner to manage a team responsible for planning and directing clinic services. Must be available to work flexible schedules at multiple sites, including some evenings is expected. Please read more about the senior physician job description, benefits, and application process at www.sdcounty.ca.gov/hr. Please include a copy of your CV along with your online application. For questions, please contact Gloria Brown, human resources analyst, at (858) 505-6525 or at [email protected]. [088]

physiCian tO staFF VariOus san DiegO Deten-tiOn FaCilities: The Department of Emergency Medicine (http://emergencymed.ucsd.edu) at UC San Diego, commit-ted to academic excellence and diversity within the faculty, staff, and student body, is initiating a search for a physician to staff various San Diego detention facilities. The applicant must have a background in family medicine, internal medi-cine, or emergency medicine and be eligible for a California medical license. Appointment level in the academic series will be commensurate with experience and qualifications, with salary based upon established UCSD salary scale. UCSD is an affirmative action / equal opportunity employer with a strong institutional commitment to excellence through diver-sity. Interested individuals should send their CV, a reference list, and separate statement summarizing their experience to [email protected]. [087]

physiCian anD psyChiatrist neeDeD FOr aMBula-tOry CliniC: Southern Indian Health Council is seeking a FT board-certified physician Mon–Fri, 8:00am–4:30pm, as well as a PT psychiatrist. Must have current CA medical license, DEA license, ACLS, BLS. We offer a competitive salary, health benefits, vacation, holidays, sick, CME and license reimburse, and malpractice coverage. Forward resume to [email protected] or fax to (619) 659-3145 or website at www.sihc.org. Contact [email protected] or HR phone (619) 445-1188, ext. 308 or ext. 307. [048]

OppOrtunity KnOCKs FOr BC/Be DerMatOlOgists: Live in one of the country’s most desirable locations and prac-tice with a premier San Diego multispecialty medical group! Sharp Rees-Stealy Medical Group is looking for BC/BE der-matologists. Competitive first-year compensation guarantee, excellent benefits, and shareholder eligibility after two years. Unique opportunity for professional and personal fulfillment while living in a vacation destination. Please send CV to Physi-cian Services, 2001 Fourth Avenue, San Diego, CA 92101. Fax: (619) 233-4730. Email: [email protected]. [084]

superB internal MeDiCine praCtiCe OppOrtu-nity: The position is available in August of 2013. You will be joining one of the premier internal medicine groups in North County San Diego. No hospital work or ER call. Competitive salary including benefits plus the opportunity to begin a partnership track if desired. Beautiful office building, excel-lent staff, ideal for either first year in practice or for an ex-perienced practitioner. Contact Jon LeLevier, MD, at (760) 310-2237 or Jeff Leach, MD, at (760) 846-0464 for more information. [081]

seeKing a FaMily praCtiCe physiCian: To join a small but growing group in North County San Diego, CA. The per-fect doctor for the position will be one who has strong com-munication skills and great bedside manner. The physician should have a good background in procedures (dermatologic, orthopedic, etc.). I am looking for a physician who will take personal pride in the growth of this unique practice. We em-phasize quality of time with the patients rather than the num-ber of patients seen. Hours will be 8–5 Monday–Friday with no hospital call. Once hired you will be provided with an LVN/scribe for all EMR notes and to assist in procedures. We are in-viting you to join an extraordinary clinic in a beautiful location

with a fantastic staff. Salary will be competitive for the region along with bonuses for exquisite performance. Please email me at [email protected]. [077]

COntrast superVising physiCian neeDeD: Indepen-dent diagnostic imaging facility seeks physicians to monitor patient examinations requiring contrast. We are looking for physicians to work various Saturday/Sunday shifts scheduled from 8am to 5pm on a per diem basis. Shifts are available on an ongoing basis. Please contact Eva Miranda at (858) 658-6589 for more information. [076]

MeDiCal DireCtOr: The County Psychiatric Hospital needs a full-time medical director. This is a key leadership role in our very physician-friendly, dynamic Behavioral Health system. Facility includes an inpatient unit and a very busy psy-chiatric emergency unit. Medical director does limited direct clinical care. Required: three years of psychiatrist experience, including one year of managing a psychiatric hospital or multi-disciplinary medical and mental health facility. Competitive salary and excellent County employee benefit package of-fered. San Diego combines the lifestyle of a resort community and the amenities of a big city. The hospital is centrally locat-ed, minutes from many recreational opportunities and great residential communities with wonderful year-round weather. CV can be submitted online at www.sdcounty.ca.gov/hr. For questions, please contact Darah Frondarina, human re-sources specialist, at (858) 505-6534 or [email protected]. [072]

sOuthern CaliF regiOnal MeDiCal DireCtOr (rMD): Your Neighborhood Urgent Care (YNUC) is recruit-ing two RMDs for its 10 urgent care clinic network in Orange County and San Diego County. BC in emergency medicine or in family practice, internal medicine with urgent care experi-ence required. Management/administrative experience in previous healthcare positions very desirable. Independent Contractor for two years, then equity available. Position is based at the MSO and is 20 hours per week clinical and 20 hours per week quality improvement. Very attractive hourly. Contact [email protected] now! [070]

superVising ChilD psyChiatrist, COunty OF san DiegO: BC child psychiatrist to serve as supervising child psy-chiatrist for Child, Youth and Families (CYF) Behavioral Health and as deputy to the clinical director of the Behavioral Health Division of County of San Diego Health & Human Services Agency (HHSA). Significant administrative/managerial expe-rience required; to provide clinical supervision in a variety of CYF County-operated programs. Applications and CVs must be submitted online at www.sdcounty.ca.gov/hr. For further information please email Marshall Lewis, MD, Clinical Director, at [email protected] or call (619) 563-2771, or email Katie Astor, Assistant Deputy Director, at [email protected], or email Lita Santos, Human Resources, at [email protected]. [068]

physiCian neeDeD — Full- Or part-tiMe sCheD-ules aVailaBle: Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. Since 1970, our mission has been to provide caring, affordable, high-quality healthcare and supportive services to everyone, with a special commitment to uninsured, low-income, and medically underserved persons. Every member of our team plays an important role in improving the health of our pa-tients and community. We offer an excellent comprehensive benefits package that includes: malpractice coverage; NHSC loan repay eligibility; and much, much more! For more infor-mation, please call Anna Jameson at (619) 906-4591 or email [email protected]. If you would like to fax your CV, fax it to (619) 876-4426. To apply, visit our website and apply online at www.fhcsd.jobs. [046]

priMary Care JOB OppOrtunity: Home Physicians (www.thehousecalldocs.com ) is a fast-growing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpa-tient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 279-1212 or email CV to [email protected]. [037]

physiCians WanteD: Vista Community Clinic, a private, nonprofit clinic serving the communities of North San Diego County, has openings for part-time and per-diem positions.


of free parking. For more information, call Irene at (619) 840-2400 or at (858) 452-0306. [041]

share OFFiCe spaCe in plastiC & reCOnstruC-tiVe surgery CliniC in utC: Office space and practice support for full- or part-time surgeon available immedi-ately. Equipped with two operating rooms accredited by the AAAASF, private entrance, three exam rooms, two of them also consults rooms, two private bathrooms, and staff room with kitchen. Ideal for orthopedic, urologist, plastic or general surgeon. Surgical center contracted with Anthem Blue Cross, United Health Care, Aetna, and workers’ comp. Call (858) 457-8686 or email [email protected]. [074]

Full- anD part-tiMe OFFiCe spaCe in utC: in 8th floor suite with established neuropsychologists and psychiatrists in Class A office building. Features include private entrance, staff room with kitchen facilities, active professional collegi-ality and informal consultation, private restroom, spacious penthouse exercise gym, storage closet with private lock in each office, soundproofing, common waiting room and park-ing. Contact Christine Saroian, MD, at (619) 682-6912. [862]

ClaireMOnt Mesa OFFiCe spaCe FOr lease: Claire-mont Mesa Medical Arts Center is a medical office building conveniently located in Kearny Mesa, close to the 15, 163, 52, and 805 freeways. Available for lease September 1, 2012. 520 square-foot suite, currently configured as three room (lobby, exam, and office), located on the second floor. Call Alex at (858) 268-1111, ext. 311, for inquiries and viewing. [066]

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. Receptionist help provided if needed. Contact Stepha-nie at (760) 753-8413. [703]

luXuriOus / BeautiFully DeCOrateD DOCtOr’s OF-FiCe neXt tO sharp hOspital FOr suB-lease Or Full lease: The office is conveniently located just at the opening of Highway 163 and Genesee Avenue. Lease price if very reasonable and appropriate for ENT, plastic surgeons, OB/GYN, psychologists, research laboratories, etc. Please contact Mia at (858) 279-8111 or at (619) 823-8111. Thank you. [836]

neW — eXtreMely lOW rental rate inCentiVe — eastlaKe / ranChO Del rey: Two office/medical spaces for lease. From 1,004 to 1,381 SF available. (Adjacent to shared X-ray room.) This building’s rental rate is marketed at $1.70/SF + NNN; however, landlord now offering first-year incentive of $0.50/SF + NNN for qualified tenants and five-year term. $2.00/SF tenant improvement allowance avail-able. Well parked and well kept garden courtyard professional building with lush landscaping. Desirable location near major thoroughfares and walkable retail amenities. Please contact listing agents Joshua Smith, ECP Commercial, at (619) 442-9200, ext. 102. [006]

pOWay / ranChO BernarDO — OFFiCe FOr suB-lease: Spacious, beautiful, newly renovated, 1,467 sq-ft furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease / sat-ellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at [email protected]. [873]

share OFFiCe spaCe in la Mesa: Available immedi-ately. 1,400 square feet available to an additional doctor on Grossmont Hospital Campus. Separate receptionist area, phy-sician’s own private office, three exam rooms, and administra-tive area. Ideal for a practice compatible with OB/GYN. Call (619) 463-7775 or fax letter of interest to La Mesa OB/GYN at (619) 463-4181. [648]

BuilD tO suit: Up to 1,900ft2 office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign. Build-out allow-ance 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

nurse praCtitiOner Or physiCian’s assistant: Established, busy pain management practice in Mission Val-ley is looking for a nurse practitioner or physician’s assistant, preferably experienced in pain management or family prac-tice. Knowledge of controlled substance prescriptions and regulations is required. Interpretation of diagnostic tests and the ability to apply skills involved in interdisciplinary pain management is necessary. We offer a competitive salary and benefit package that provides malpractice coverage, CME al-lowance, as well as an excellent professional growth potential. Please email your curriculum vitae/resume to [email protected]. [094]

assistant MeDiCal serViCes aDMinistratOr: The County of San Diego is seeking an assistant medical services administrator for the Edgemoor Distinct Part Skilled Nursing Facility, located in Santee, to provide administrative oversight and operational accountability, as well as being in charge in the absence of the hospital administrator. Bachelor’s or mas-ter’s degree in nursing, public health, business administra-tion, public administration, or a closely related field; AND six (6) years of experience coordinating medical service delivery, three (3) years of which must have been in an institutional or in a community agency setting. Apply online at www.sd-county.ca.gov. [093]

MeDiCal assistant: Internal medicine practice looking to fill a full-time position for a busy internist in Poway. Position requires five-plus years experience in internal medicine, good communication skills, compassion toward seniors, electronic health record exposure a plus. Strong references. Please fax your resume to practice manager at (858) 618-5976. [086]

Full-tiMe nurse praCtitiOner: Busy internal medi-cine practice in Hillcrest seeking a full-time (Monday–Friday) licensed nurse practitioner. Minimum of one (1) year nurse practitioner experience preferred. Experience with EMR help-ful. Qualified candidate should submit a current CV or resume to [email protected]. Salary based on knowledge and experience. No calls. [083]

physiCian assistant / nurse praCtitiOner: Gas-troenterology specialty practice located in North San Diego County is seeking a PA or NP for our five-physician group. The candidate will be dependable, detail-oriented, and a team player. We offer a competitive salary and benefits. PA or NP will be responsible for assessing patients, obtaining patient histories, and performing physical exams. They would order/perform routine diagnostic procedures, develop treatment plans, and monitor the effectiveness of therapeutic interven-tions as directed by the physicians. Physician Assistant: Certi-fied California State Medical Board for Physician Assistants. Nurse Practitioner: Current licensure as RN in the State of California. Advanced practice degree. Email Javaid Shad at [email protected]. [080]

nurse Manager: Seeking nurse manager for our AAAHC GI facility in Oceanside, California. The ideal candidate will be dependable, detail-oriented, and a team player. Competitive salary and benefits. NM is responsible for accountability of clinical care and productivity, including assessing, implement-ing, and evaluating processes, technology, personnel, and facility needs required to achieve patient outcomes safely. Is responsible for coordination and direction of patient care services and other service areas in the facility. Responsible for quality improvement, identifying opportunities to improve services, recommending and implementing actions to meet the goals of the facility. RN State of California. ACLS certifi-cation. Email Kathy Moore at [email protected]. [079]

FrOnt OFFiCe reCeptiOnist pOsitiOn: Dermatologist in Hillcrest needs a special individual for computer billing, typ-ing, front office, mature, experienced. Friendly environment. Email resume to [email protected]. [075]

nurse praCtitiOner WanteD: Nurse practitioner want-ed for internal medicine and pediatrics practice in Coronado. Enthusiasm, dependability, and a love of learning are musts! Full-time with benefits. Experience preferred. Please send your resume to [email protected]. [067]

physiCian assistant Or nurse praCtitiOner: Needed for house-call physician in Coachella Valley (Palm Springs / Palm Desert). Part time, flexible days/hours. Com-petitive compensation. Call (619) 992-5330. [038]

Five locations in Vista and Oceanside. Family medicine, OB/GYN medicine, pediatric medicine. Requirements: California license, DEA license, CPR, board certified, one (1) year post-graduate clinic experience. Bilingual English/Spanish pre-ferred. Benefits: malpractice coverage. Email resume to [email protected] or fax to (760) 414-3702. Visit web-site at www.vistacommunityclinic.org. EOE/M/F/D/V [035]

seeKing BOarD-CertiFieD peDiatriCian FOr per-Manent FOur-Days-per-WeeK pOsitiOn: Private practice in La Mesa seeks pediatrician four days per week on partnership track. Modern office setting with a reputation for outstanding patient satisfaction and 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 pa-tient care. Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, rounding on newborns, and occasional admis-sion, NO delivery standby or rushing out in the night. Benefits include tail-covered liability insurance, paid holidays/vaca-tion/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disability and life insurance. Please contact Venk at (619) 504-5830 or at [email protected]. Salary $ 102–108,000 annually (equal to $130–135,000 full-time). [778]

praCtiCe WanteD

We Buy urgent Care Or reaDy MeD-CliniC: We are interested in purchasing a preexisting urgent care or ready med-clinic anywhere in San Diego County. Please contact Lyda at (619) 417-9766. [008]

OFFiCe spaCe / real estate

MeDiCal OFFiCe spaCe FOr lease: Medical office space of 1,846 square feet located at 15721 Pomerado Road, Poway, CA 92064 in the Gateway Medical Center available for im-mediate lease. This recently remodeled facility has a shared waiting room, medical records storage area, front desk recep-tion area, three exam rooms, nursing station, private office, shared bathroom. The larger space is shared with an internal medicine group and is blocks away from Pomerado Hospital. Imaging is located in an adjacent building. The lease rate is $1.69/SF NNN with a 3% annual increase. The NNNs are cur-rently running $0.73/SF. Tenant will be responsible for pro rata share of utilities and janitorial in addition to NNNs. Great opportunity in this affluent community. Call Angie at (858) 605-9966. [065]

MeDiCal OFFiCe spaCe in santee: Beautiful calming space in an office/business park located adjacent to a major shopping center in Santee. Newer building (2007), and re-cently remodeled into a premier medical office. Plenty of free parking, and nice outside courtyard includes a fish pond. The available space (approximately 1200 sf) consists of 3 large exam rooms, medical assistant/lab area, office and a shared waiting area. Other half of space is occupied by a family phy-sician. Rent is 2.50/sf and includes all utilities (electricity, internet, phone, security, water). Available 1/2/2013. Contact: [email protected]. [099]

3998 Vista Way, in OCeansiDe: Four medical office spaces approximately 1,300–2,800 square feet available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground-floor access. Lease price: $1.55+NNN. Tenant improvement allowance to customize the suites is available. For further in-formation, please contact Lucia Shamshoian at (760) 931-1134 or at [email protected]. [096]

spaCe FOr suBlease in pOOle BuilDing On sCripps MeMOrial la JOlla CaMpus: Office on en-try level facing main hospital, which is 50 yards away — BEST location on campus. Own consultation room and two shared exam rooms available at least two full days a week. Equipped for minor surgery / procedures. Receptionist and medical as-sistant help can be provided. Call Ilana at (858) 558-2272 for details. [085]

nOrth COast OFFiCe spaCe tO suBlease: North Coast Health Center, 477 El Camino Real, Encinitas, office space to sublease. Newly remodeled and beautiful office space available at the 477/D Building. Occupied by seasoned vascular and general surgeons. Great window views and lo-cation with all new equipment and furniture. New hardwood floors and exam tables. Full ultrasound lab and tech on site for extra convenience. Will sublease partial suite for two exam rooms and office work area or will consider subleasing the en-tire suite, totally furnished, if there is a larger group. Plenty


oFFiCE managEr advoCaCy

carol carney is the cornerstone of our department, filling in for virtually every position at some point during her career. She directly supervises 10 employees and provides indirect supervision and guidance for dozens of others. All of the clerical staff as well as the physicians call Carol when something needs to be accomplished quickly or a complicated problem or issue arises. She essential-ly never says “no” to anything we ask of her.

Carol routinely performs tasks such as tran-scription or records management when we are understaffed. Self-taught, she can troubleshoot computer or mechanical issues. She works on weekends to ensure processes are staged for the following week’s work. She even came in one weekend to move furniture for painters and flooring professionals. She has been spotted with tools on several occasions, repairing or adjust-ing air vents or unruly cabinets. Her work hours always exceed 40 per week.

Carol has long been the sole employee to handle complicated correspondence and autopsy

congratulations carol carneySan Diego County’s Outstanding Medical Office Manager for 2012!Nominated by E.L. Sakas, MD, SDCMS Member Since 2005

Previous medical Office

manager Winners

2011: Robert O’Meara

NominatedbyirwinGoldstein,

mD(SDCmS-CmAmemberSince2007)

2010: Sue Rose NominatedbyDavidJ.bodkin,

mD(SDCmS-CmAmemberSince1990)

2009: Anne Billeter

NominatedbyJohnA.lafata,mD(SDCmS-CmA

memberSince1981)

paperwork. She even communicates with family members of decedents with grace. Everyone from the top down looks to her for guidance when we have to undergo new procedures or acquire new physicians; she is without question our most knowledgeable employee. She is so important that when she is away from the office, an email message must be generated to warn everyone. New, junior personnel are comfortable with her as she is approachable and yet extremely busy.

She championed bigger spaces and improved office spaces for the transcriptionists and works as a transcription-ist herself at some point every week to maintain timelines and appropriate turnaround times for our patients and referring physicians.

Although she is not required to manage the needs of our fel-lows, she has become intimate-ly involved in organizing and tracking their programs.

When patients need slides submitted for second opinions (either to or from us), she hand-carries forms and necessary items to the doctors herself. She not only serves as a trusted ap-pendage to the pathologists, but

she is in constant contact with executives at our corporate offices, insurance companies, patients, surgical and cytopathology technologists and supervisors, attorneys, and referring physicians.

Carol has done so many things over the past decade to personalize her interaction with the administrative team; we wouldn’t be able to quantify it. She makes cakes for everyone’s birthdays and provides breakfast or snacks nearly every week. When employees are ill, she visits them and has even escorted one employee to the urgent care and waited until a family member arrived.

In short, I strongly believe Carol Carney is the Outstanding Medical Office Manager of the Year and urge you to select her.

Sincerely,

E.L. Sakas, MDChairman, Department of PathologyScripps Clinic Medical Group

A P r I L 2012 SA N d I eGO P H ySI c I A N .O rG 37 MAy 2011 SAN DIEGO PHYSICIAN.OrG 37

S a n D i e g o

o r a n g e

L o S a n g e L e S

P a L o a L T o

S a c r a m e n T o

800-252-7706 www.CAPphysicians.com

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For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like Irvine internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT). Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors. CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best. We invite you to join the more than 11,500 preferred California physicians already enjoying the benefits of CAP membership.

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PAIDdenVer, co

perMIt no. 5377

Richard E. Anderson, MD, FACPChairman and CEO, The Doctors Company

We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent practicing good medicine. Now,

the Tribute Plan has reached its five-year anniversary, and over 22,700 member physicians have qualified for a monetary award when

they retire from the practice of medicine. More than 1,300 Tribute awards have already been distributed. So if you want an insurer that’s

just as committed to honoring your career as it is to relentlessly defending your reputation, request more information today. The San

Diego County Medical Society has exclusively endorsed our medical malpractice insurance program since 2005. To learn more about our

program for SDCMS members, including the Tribute Plan, call us at (800) 852-8872 or visit www.thedoctors.com/tribute.

We do what no other medical malpractice

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that is entirely unmatched. We honor years

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Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.

Endorsed by

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December 2012

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