November 2012

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“Physicians United For a healthy san diego”

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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•LegislatorBirthdays• New/RejoiningMembers•AndMore…

8 Stopping Time and Seeing Through a New Lens by DAnIeL J. breSSLer, mD

10 Windows 8: Window Dressing or Game Changer? by oFer SHImrAT

14 November Is National COPD Awareness Month by Lynn GoDWArD

16 The Power of Perspective by HeLAne Fronek, mD, FACP, FACPH

34 Physician Marketplace Classifieds

36 Featured Member: Bruce Potenza, MD by mICHeLLe brubAker

10

this month

VoLuMe99,NuMBeR11

8

featuresINFLUeNCING LeGISLATIoN 20 Political Advocacy: Who Cares? What Difference Does It Make? Why Bother? by Tom GeHrInG

22 One Must Imagine Sisyphus Happy: CMA’s 2012 Legislative Wrap-up by JoDI HICkS

26 CMA’s Legislative Hot List and Regulations Quick List by CmA

28 You’re Either at the Table or You’re on the Menu: 10 Pretty Good Rules by Tom GeHrInG

30 Success in a New Era: CALPAC Continues to Thrive Under State’s New Election Policies by rICHArD THorP, mD

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4 n ov em b er 2012

brieflynotedSDCmS Seminars, Webinars & eventsSDCMS.org/event

For further information or to register for any of the following SDCMS seminars, webinars, and events, visit SDCMS.org/event or contact Rhonda Weckback at (858) 300-2779 or at [email protected].

2012: a Critical Year for Changes in tax law (seminar/webinar)NOV 8 • 11:30am–1:00pm

the (physician) leader’s toolbox (workshop)NOV 10 (8:00am–4:00pm) and NOV 11 (8:00am–12:00pm)

top 10 patient Safety issues for office practice (seminar/webinar)NOV 15 • 11:30am–12:30pm

advocacy training (workshop)DEC 1 • 8:00am–12:00pm

CmA WebinarsCMAnet.org/events

Understanding arC and CarC revenue CodesNOV 7 • 12:15pm–1:15pm

2013 Updates to Meaningful UseNOV 8 • 12:15pm–1:15pm

State Disability insurance online for Your patients and YouNOV 14 • 12:15pm–1:15pm

Successful Medi-Cal provider enrollmentNOV 15 • 12:15pm–1:45pm

Understanding the CBaS transition for Dual eligiblesNOV 28 • 12:15pm–1:15pm

essentials for iCD-10-CM: part 1NOV 29 • 7:45am–8:45am or 12:15pm–1:15pm

California: a physician Melting potNOV 29 • 12:15pm–1:15pm

impact of iCD-10DEC 5 • 12:15pm–1:45pm

essentials for iCD-10-CM: part 2DEC 6 • 7:45am–8:45am or 12:15pm–1:15pm

Successful Medi-Cal provider enrollmentDEC 12 • 12:15pm–1:45pm

essentials for iCD-10-CM: part 3DEC 13 • 7:45am–8:45am or 12:15pm–1:15pm

Community Healthcare Calendar

To 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.

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, 2013 • Call RCMA at (800) 472-6204

calendar

BIrTHdaY: nOVeMBer 11U.S. Senator Barbara Boxere:(viawebsite)boxer.senate.govWashington, DC, Office:T:(202)224-3553•F:(202)228-3863San Diego Office:600BSt.,Ste.2240, SanDiego,CA92101T:(619)239-3884

BIrTHdaY: nOVeMBer 24State Assemblyman Kevin Jeffries (District 66)e:(viawebsite)arc.asm.ca.gov/member/66e:[email protected] Office:StateAssembly,Sacramento,CA95814T:(916)319-2066•F:(916)319-2166Murrieta Office:41391KalmiaSt.,Ste.220, Murrieta,CA92562T:(951)894-1232•F:(951)894-5053

one way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday!

legIslaTOr BIrTHdaYs

sdcMs Member Physicians:

If you are interested in learning more about possibly joining the

San Diego Physician editorial board, please email

[email protected].

“sometimes our light goes out but is blown into flame by another human being. Each of us owes deepest thanks to those who have rekindled this light.”

— Albert Schweitzer (1875–1965)

SA n D I eGo P H ySI C I A n .o rG 5

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 TOucHsdcMs MeMBersHIP

NeW memberS

Joanna E. Adamczak, MDmaternal and Fetal medicineSan Diego • (858) 966-8567

Julie S. Block, MDPediatricsEncinitas • (760) 753-7143

Elion Brace, MDHospital medicineSan Diego • (619) 499-2600

Holly L. Casele, MDmaternal and Fetal medicineSan Diego • (858) 541-6880

Chunjai P. Clarkson, MDobstetrics and GynecologyVista • (760) 630-5487

Christine Clotfelter, DOFamily Practice (and OMT)Encinitas • (760) 942-0118

Jill S. Cottel, MDInternal medicinePoway • (858) 312-1672

Michelle S. Dern, MDPediatricsEncinitas • (760) 753-7143

Guia-Lynn P. Escuro, MDPediatricsEncinitas • (760) 753-7143

Frederick M. Frumin, MDPediatricsEncinitas • (760) 753-7143

Gary P. Gross, MDPediatric Hematology-OncologyEncinitas • (760) 753-7143

Nona L. Hanson, MDFamily medicineVista • (760) 630-5487

Pha C. Le, DOemergency medicineescondido

Nicholas B. Levy, MDPediatricsEncinitas • (760) 753-7143

Patrick M. McGinty, MDInternal medicineEncinitas • (760) 944-7300

Diego Mendez, MDobstetrics and GynecologySan Diego • (858) 268-0300

Martin M. Nielsen, MDPulmonary DiseaseOceanside • (760) 758-7474

Kevin P. O’Leary, MDPediatricsEncinitas • (760) 753-7143

Airisha P. Ramirez, MDFamily medicineSan Diego • (619) 499-2600

Lauren A. Robertson, MDobstetrics and Gynecologic SurgerySan Diego • (858) 455-7520

Rajiv Roy, MDendocrinology, Diabetes, and metabolismChula vista

Richard C. Smith, MDInfectious DiseaseVista • (760) 806-9263

Neha A. Trivedi, MDobstetrics and GynecologySan Diego • (858) 966-8567

Masami C. Wood, MDPediatricsEncinitas • (760) 753-7143

Victoria K. Young, MDobstetrics and GynecologySan Diego • (858) 618-1156

Gordon C. Zink-Brody, MDDiagnostic radiologySan Diego • (858) 658-6500

rejoINING memberS

Enrique Espinosa-Melendez, MDnephrologyNational City • (619) 477-7779

Diana E. Hoppe, MDobstetrics and GynecologyEncinitas • (760) 635-5600

Valerie P. Rubin, MDPediatricsEncinitas • (760) 753-7143

Vernon M. White, MDFamily medicineChula Vista • (619) 498-1100

Welcome our New and rejoining SDCmS-CmA members!

6 n ov em b er 2012

brieflynotedrIsk ManageMenT

The adoption of telemedicine is growing as physicians seek innovative ways to provide clinical healthcare to patients who are at a distance, have a disability, or face other barriers that can impede access to quality care. Telemedicine can improve efficiencies, but security and confidentiality must be addressed.

The Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, has identified Health Professional Short-age Areas (HPSAs), i.e., geographic regions with an inadequate number of primary care physicians. Physicians who practice in

Telemedicine Creates efficiencies, requires CautionBy SDCMS-endorsed The Doctors Company (www.thedoctors.com/patientsafety)

these areas can meet the rising demand for care from a vast patient population by tak-ing advantage of affordable technology, the convenience of webcams and web-based portals like Skype, secure internet connec-tions, and high-speed links via satellite. Physicians who are not located in HPSAs are incorporating this technology into their practices to help manage increasing patient volume.

The Centers for Medicare and Medicaid Services (CMS) reimburses physicians and hospitals that offer telemedicine to patients in HPSAs, remote sites, and rural areas. Last year, CMS also amended the Medicare

Conditions of Participation for hospitals and critical access hospitals, updating the process that facilities can use for credential-ing and granting privileges to practitioners who deliver care through telemedicine. In addition, many payers are reimbursing phy-sicians who offer virtual consultations.

While the benefits of telemedicine are vast, its use and adoption must be tempered with caution. Physicians must be aware of the risks associated with access, such as patient and staff privacy, inaccuracies in self-reporting, and symptoms that may only be caught in person. Additional legal considerations for online interactions, such as licensure compliance, must be addressed for the protection of the physician and the patient. According to the Federation of State Medical Boards, only 10 states have pro-vided special-purpose licenses to allow for cross-border telemedicine, while most states require complete licensing if the patient is in their jurisdiction. Additional consider-ations include:•Employing secure computer network

systems with approved security codes designated under HIPAA compliance.

•Clearly defining proper protocols for webcams and web-based portals.

•Using mechanisms to protect the privacy of individuals who do not want to be seen on camera (including staff members, other patients, or patients’ families).

•Understanding how web-based portals send encryption keys so that hackers can’t access the stream and decrypt the conversation.

•Developing a method to ensure that the person you are communicating with is not an impersonator.

•Considering the effects that telemedicine may have on your relationship with your patients and developing strategies to ensure they feel valued.

brieflynoted


8 n ov em b er 2012

PoEtry and mEdicinE

Stopping Time and Seeing Through a New LensAn Introduction to the “Poetry and Medicine” Seriesby DAnIeL J. breSSLer, mD

I don’t know about you, but my days go by in a blur. When I take my white coat off for the last time in the evening, but also when I raise a glass of champagne to celebrate the turning of a year, or when I sing “Happy Birthday” to a family member, I feel bewilderment along with satisfaction and joy. Where did it go, this day, this year, this decade? (And with the quiet, unspoken addenda, this career, this life?)

During my working day as a primary care doctor, I dictate office visits and other clinical notes on a pocket recorder that is transcribed and inserted into the elec-tronic health record. I also carry around a second pocket recorder that I use to capture snippets of my day, some phrase that strikes me as profound or funny, some seemingly new or original thought that pops into my head. At home I jot down the entries from the second recorder. Sometimes it contains little nuggets I call

is really about. Honesty catalyzes change. The purpose of art, paraphrasing Rilke, is to change your life.

San Diego Physician magazine has been kind enough to set aside some space in to publish a series of poems that have grown from poemseeds over the past few years. I will introduce them with a few lines relat-ing them to my practice and life, and hope-fully also to yours.

Time and Heat WavesAs a practicing doctor, time in both its cy-clical/seasonal aspects and its linear/projec-tive aspects affects how I look at the world. The time of year determines the likelihood of certain (especially infectious) diseases. The number of years a person has accumu-lated dramatically affects the differential diagnosis of a presenting complaint. Chest pain means something very different if you’re 60 than if you’re 20.

In my own life, this past summer was especially poignant. My son turned 18 and left for college, the last by a year or two in the cohort of friends on our little cul-de-sac with whom he grew up. The street is now much quieter. With heat waves, I often awake early and sit in the dining room, luxuriating in the pre-dawn coolness. Before the business of the day begins, this dark, still time provides a context for me to reflect on the last year and the last 20. Where did they go? Asking imponderables is, I suppose, one form of therapy for my “early morning awakening.” Sometimes, I even get a poem out of it. Here’s one of them, called “September Song.”

September SongThe gardenias are floating in waterThe water’s suspended in airThe air is supporting my porcelain cupThe floorboards supporting my chair

I hear it’s the summer from cricketsI feel it’s the summer from sweatI hope in my dreams I’ll be wickedWith the mermaids who swim in my head

The street that I live on’s grown quietThe children have all moved awayIf the past was for sale I would buy itAnd release just a minute a day

“poemseeds.” These I put in a journal. Sometimes they germinate.

Poetry, like all art, provides a provoca-tion that can do more than merely amuse. There’s nothing wrong with amusement. It is a form of soothing. It can be a wonder-ful diversion and certainly it can break tension. But poetry “as art” can — beyond relief — actually change how we see the world. It can even change who we are. It is an attempt, through words, to help us see new things. Moreover, it guides us to see things that were always there but some-how previously overlooked. Poetry can give us a new lens with which to take in the world. Just as the microscope revealed a new world of the tiny and the telescope revealed the world of the cosmic, the po-etic lens offers the possibility of perceptual and emotional revelation. Art can pull from the blur of time an honest snapshot of who you really are and what your life


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But August has turned to SeptemberAs summer is fading to fallSunday dissolves into MondayLike it never existed at all

I look toward the past and can’t find itLike the scent of a trail that’s grown coldI take yesterday’s snapshot and grind itTo a mixture of strychnine and gold

The summer is too quick forgottenLike all of the seasons beforeThe gardenia blooms have gone rottenAnd the screeching chair scratches the floor

It seems like a misapprehensionTo expect any season to stayOr to hope that the kids remain childrenFor more than a year and a day

The moral’s not clear from this storyThough I rub my eyes open to seeIf my dreams brought some new allegoryLike an overnight package for me

But the porch has no new gift upon itOld toys in the bin gather dustWhat’s this worn jump rope worth if I pawn it?Seems the basketball hoop’s gone to rust

Ah well, take a breath and release itAh well, take a shower and shaveThe day like the autumn is comingLike a rising tide, wave upon wave

Time takes all things and all creaturesAll children, all toys and all streetsAnd haphazardly changes their featuresTill their transformation completes

The future awaits on my doorstepRespectful, its hat in its handBut as soon as I venture one more stepThis future assumes its command

The future’s a mystery waitingTomorrow’s a mist and a fogAnd if you insist on more detailYou may as well talk to my dog

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

10 n ov em b er 2012

tEchnology mattErs

Metro, Azure, Mountain Lion, Snow Leopard, Hon-eycomb, and Jellybean … you would think these were the latest color schemes, window dressing, or drink names in trendy restaurants at the most chic downtown hangouts. In fact, they are code names for operating systems (OSs) and platforms from the likes of Microsoft, Apple, and Google, respectively. Mountain Lion came out for Apple on July 25, 2012. Not to be outdone, the newest Microsoft OS, called Windows 8, debuted on Oct. 26, 2012.

Windows 8 and its new Metro desktop interface, just recently

renamed Modern (but we will keep calling it Metro), represent the most

radical departure for an OS built by Microsoft since the paradigm shift of Windows 95. That system was launched back in 1995 with The Rolling Stones’ “Start Me Up” — remember? Incidentally, the current theme song for the Windows 8 launch is “I Only Want You” by the Eagles of Death Metal — don’t ask.

Windows 8 has a totally revamped look and feel, and it pushes the technology envelope through the use of touch-centric tiles on any device built to support it: desk-tops, tablet computers, smartphones, car navigation systems, kiosks, wide panels, laptops, refrigerators … you name it — both on the local device and in the cloud, synchronized with the Microsoft platform called Azure.

Microsoft is acutely cognizant of the consumerization trend in IT. For the last three to four years, consumers and busi-nesses have acclimated themselves to the whole “touch” paradigm, coupled with internet access anywhere, everywhere, and on any device. This “experience” has transformed hardware and software technologies, and manufacturers have succumbed to the demands of this market that just five short years ago did not exist.

As a matter of fact, the Pew Research Center recently indicated that half of American adults have mobile internet ac-cess via a tablet or smartphone. You could successfully argue that Microsoft has been behind the times in those form factors. To its great detriment, the OSs on the vast majority of those devices have not been Windows but rather Apple iOS or Google Android instead.

So if Microsoft has its way, Windows 8, subsets thereof, and the tiled Metro inter-face, will become the new standard in OSs across all devices. To support that message, it is spending well over $1 billion on an ag-

8Windows Window Dressing or Game Changer?by oFer SHImrAT


gressive marketing campaign — launched as we speak — that attempts to drastically shift all things mobile in its favor.

A bevy of new devices and form factors is due to be released fourth quarter 2012 into first quarter 2013 by hardware manufac-turers featuring the new Windows 8 OS or subsets thereof — some of that hardware, surprisingly, directly from Microsoft. Among the notables:•business-ready Microsoft Surface tablets

with built-in physical keyboards•Windows mobile phones by most smart-

phone manufacturers on most phone carriers

•ultrathin laptops that wirelessly extend video signal to secondary monitors nearby

•all-in-one desk or wall-mounted moni-tors with built-in computers with touch

•sync functionality for the entire line of Ford cars and trucks that feature naviga-tion

•Xbox and Kinect functionality built-in and redesigned for touchAnd that is just the start: Later in 2013

we will see the advent of very large touch presentation plasma screens, retail kiosks, projection systems, airline reservations,

financial dashboards, gaming applica-tions, industrial controls, embedded logic systems, medical devices, paper-thin Mylar displays, etc. — all loaded with Windows 8 or subsets thereof. All in an attempt to once again regain the market share that Microsoft used to enjoy in the mobile space before the arrival in 2010 of Apple iPhones, iPads, and, subsequently, Google Android devices.

The new tiled interface and user interaction across all devices will make dissimilar hardware look and feel consistent. Navigating a standard graphical user interface across laptops, desktops, smart-phones, and tablets will acceler-ate adoption of Windows 8 and reduce the learning curve to use them.

Strategically, Microsoft views Win-dows 8 and the ensuing Windows-based ecosystem as strengthening its position in the OS market for desktops and laptops — already a robust 70% share according to WikiMedia. Combining the desktop OS segment with the huge potential gains in the mobile and tablet markets will, if the company’s tactics pan out, place Microsoft back at the top of overall OS markets for a

decade or more.For Microsoft, this is a game changer

and a huge risk for a company that has had previous dominance in the desktop, laptop, server OSs and Office productiv-ity suites — hence the massive marketing campaign to tap into all your senses.

In addition, Windows 8 is optimized to work seamlessly with cloud services on any

device. Microsoft, and for that matter Apple, Google, et al, want consumers and businesses to work and play in the cloud. The con-vergence of local hardware devices

with cloud services represents the holy-grail for Microsoft — and the technology world overall — for continued growth of their revenue stream based on cloud-based perpetual subscription licensing models.

So what does Windows 8 do, and why should your medical practice follow its release? For the purposes of this article, it would be impossible to delve deeply into all the new features of Windows 8. So, besides the aforementioned items, we list

Half of American adults have mobile Internet access via a tablet or smartphone.


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the most notable features, improvements each with a short description:•Windows 8 Is Faster: On same recent

hardware Windows 8 boots faster, works faster, transfers files faster, hibernates faster, wakes up faster, and shuts down faster as compared to Windows 7, Vista, and Windows XP.

•Cloud Services: Tight integration with all types of cloud services from Microsoft and other cloud vendors with offerings like Office 365, Skydrive, and X-Box.

•File Explorer: Formerly known as Windows Explorer, improves on and incorporates the same consistent ribbon interface present in Office 2010 and soon-to-be-released Office 2013. New functions include the ability to mount ISO files, virtual machines, preview panes on document formats, pause and resume file copy while viewing multiple operations at once.

•Powerful Search Function: Search for anything across all document formats, files, folders, emails, email attachments, and media files with preview panes.

•Built-in Virtualization: The ability to spin up a whole new virtual machine within the physical machine is now included in Windows 8 through the use of Microsoft Hyper-V technology. The possibilities and applications are endless for a development, production environ-ment, and legacy applications, such as EMR software, billing, and schedul-ing applications.

Navigating a standard graphical user interface across laptops, desktops, smartphones, and tablets will accelerate adoption of Windows 8 and reduce the learning curve to use them.

tEchnology mattErs

•File History: Present in previous ver-sions of Windows but underutilized, this function is now at the forefront of the OS. Incremental backups are automatically created and stored on a pre-designated backup target such as an external hard drive, network share, or online service.

•Multiple Wired and Wireless Moni-tor Support: Taskbar can be shown on multiple displays, and each display can have its own customized taskbar, Metro interface, wallpaper, Charms Bar, Menu Bar, or Application assigned.

•New Lock Screen: Allows access back to system through touch “gestures,” four-digit pin, text, or picture. It includes a date and time as well as the ability to display tiled notifications from any ap-plication while “locked.”

•Internet Explorer 10: Completely opti-mized for touch, full screen, drag-and-drop, flip ahead, and Flash integration within the browser on the local device and the cloud.

•Windows To Go on a USB Flash Drive: With Windows 8 Enterprise, this new feature allows users to create a bootable flash drive that includes their own applications, programs, profiles, settings, and files, and use it anywhere on any other recent machine.•Windows Store: A secure and high-quality vetted digital distri-bution platform built into the OS, similar to Apple’s App Store and

Google Play.

The bottom LineAs we approach the holiday season, tablets will be the first to quickly adopt the new OS. Anticipating demand, Microsoft is


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manufacturing about 4 million Surface tablets pre-loaded with Windows 8 and built-in keyboards to be sold in fourth quarter 2012. If all those millions of tablets sell out in the fourth quarter, Microsoft will have an instant hit on its hands, as they are priced less than Apple’s iPad offer-ing and are more powerful.

Timing is of the essence as, for the first time, consumers and businesses will have real choices between a native Windows tablet with Word, Excel, Outlook, Power-Point, et al, and all other tablet offerings with other OSs from Apple and Google. On the mobile front, phone carriers will be dovetailing their Windows Mobile 8 smartphone marketing strategies with Microsoft’s campaign. I know, as soon as it releases, I will quickly be swapping my two-year old Motorola Droid Pro for the new Nokia Lumia 1000 running Windows Mobile 8.

However, it is expected that the demand for desktops and laptops with Windows 8 in medical practices and other businesses will grow less quickly. Offices will transi-tion away from legacy Windows XP and Vista, skip over Windows 7, and more methodically embrace Windows 8 on new hardware that supports touch. As we welcome 2013, more and more EMR offer-ings will start supporting Windows 8 and design their interfaces to be more produc-tive by incorporating the touch features.

By summer 2013 we will have apprised ourselves of the real-world business impact of Windows 8. By then it will be clear whether the Metro interface was window dressing, or a game changer worth the risk that Microsoft is taking.

Until then, always follow the best-practic-es IT rule: The recommended requirements of your line-of-business software or EMR application initially determine the ensuing

hardware and OS, in that order. By the time your medical practice or office does deploy Windows 8 — because your EMR supports it — your staff will have had months of train-ing using it on their own consumer mobile devices and be aligned with the technology — a good outcome.

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Public hEalth

November Is National CoPD Awareness monthby Lynn GoDWArD

known by many names, COPD (chronic obstructive pulmonary disease) is a serious lung disease that is now the third leading cause of death in the United States. It is, according to the COPD Foundation, one of the nation’s largest healthcare concerns and is severely under-diagnosed and undertreated. More than 12 million people are currently diagnosed with COPD, and it is estimated that another 12 million may have COPD but not realize it. And, accord-ing to the CDC, in 2005 COPD caused an estimated 126,005 U.S. deaths in people older than 25.

COPD prevention begins with reducing or eliminating smoking initiation among teens and young adults, and encourag-ing cessation among current smokers. Approximately 75% of COPD cases are at-tributed to cigarette smoking. You can take an active role in talking to your patients about smoking cessation and provide them with resources to help them: the California Smokers Helpline at www.nobutts.org/Information/p.shtml or at 1 (800) NO-BUTTS, where they will be connected with a person to counsel them on cessation options.

Although tobacco use is a key factor in the development and progression of COPD, asthma, exposure to air pollutants in the home and workplace, as well as genetic factors and respiratory infections also play a

role. Some of those occupational exposures are to chemical fumes, gases, vapors, and dust. If your patient works with this type of lung irritant, suggest they talk to their supervisor about the best ways to protect themselves, such as wearing a mask.

A simple Spirometry test can be used to measure pulmonary function and detect COPD in current and former smokers 45 years and older and to anyone with breath-ing problems due to environmental expo-sure to smoke or occupational pollutants.

By taking steps now and talking with your patient about smoking cessation, treatment options, and symptoms such as coughing or wheezing, many of these con-ditions can be treated with medications. If your patients have respiratory infections, they should be treated with antibiotics, if appropriate. Antibiotics are not recom-mended except for use in the treatment of bacterial infections.

RESOURCES•For more information, go to the CMA

Foundation’s website at www.aware.md/PatientsAndConsumers/EdMaterials.aspx

•The COPD Foundation has a handy pocket guide for diagnosing and manag-ing COPD available at www.copdfounda-tion.org/Resources/EducationalMateri-als/COPDPocketConsultantGuide.aspx.

•The CDC website has a list of estimated prevalence by industry at www2a.cdc.gov/drds/WorldReportData/FigureTable-Details.asp?FigureTableID=950&GroupRefNumber=T10-03.

Ms. Godward is senior project coordinator for the CMA Foundation.

CMA Foundation Publishes 2013 AWARE Provider ToolkitThe cma Foundation’s alliance Working for antibiotic resistance education (aWare) project has published its sixth annual antibiotic awareness toolkit for physicians and other clinicians. The toolkit contains an array of clinical resources and patient education materials to help reduce inappropriate antibiotic use. The 2013 toolkits were mailed to 28,000 providers. Physicians are encouraged to utilize the toolkit to educate patients about antibiotic resistance. The toolkit can also be downloaded at www.aware.md. Physicians are also encouraged to take a brief survey to let us know what we can do to improve future versions of the toolkit: www.zoomerang.com/survey/Web22ghrJXVcQ4.

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Physician-PatiEnt communications

The Power of PerspectiveGiving Ourselves Choiceby HeLAne Fronek, mD, FACP, FACPH

In their enthusiasm to raise nonviolent children, many parents refuse to purchase toy weapons for their kids. To their dismay, a stick, a piece of cardboard, even a sandwich bitten into the shape of a gun can be wielded as their imaginative child shouts, “pow, pow, pow!” What children do so naturally is see possibilities. Somewhere along the way, however, we forget we have this capacity. We view each situation as immutable and allow others to define the limits of our lives. “That’s just the way it is,” we say. But what if we returned to the expansive thinking we had as children and considered what else might be possible? The easiest gate to that path lies in changing our perspective.

We show we are capable of changing our perspec-tive when we see a situation through another’s eyes. We might feel frustrated when our patient hasn’t taken his medication as we suggested, but we can understand that the cost, side-effects, or inconvenience impact his adherence. When we feel “stuck” in situations in our own lives, considering other perspectives can be just the grease to get us going again.

A busy OB-GYN felt bur-dened as she attempted to guide her residents toward completing their research projects. Not having done research at this institution, she felt as if she was a tourist lost without a map. No won-der she didn’t know how to begin! By examining the task from the perspective of an explorer, many ideas suddenly seemed possible, and she was able to easily construct a plan to achieve her goal. What would it be like to see your difficult situ-ation through the lens of an explorer? What possibilities open up?

Several years ago I was asked to plan a symposium on work-life balance for a group of physician leaders. I wanted the program to be meaningful and practical so that the attendees would gain the tools to make a difference in their lives. What would be the perfect combination of expe-riences to achieve that goal? Not knowing the personal goals or situations of the in-dividuals or the culture of the institution, I felt as though I was looking for a needle in a haystack. As I thought about the pro-gram, my gaze settled on two white double doors. A door! I realized that I could be a door for them — I could show them ways of finding their “true north” and introduce them to strategies to eliminate or reduce those aspects of their life that didn’t serve or fulfill them. It was then up to them whether they decided to walk through the door, into a more balanced life. Planning


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the seminar became exciting, and the participants had many enthusiastic com-ments about the program. We physicians often feel responsible for everything and everyone in our lives. How much more in-vigorated would you feel if your role was to open a door so others could see new ideas or information rather than being respon-sible for their actions or realizations?

Perspectives can come from loved ones, people who inspire us, or from nature. Even inanimate objects can be tapped

for their unique approach to our life’s dilemmas. The trick is to first consider what that person or object represents to us, then view our situation through that lens. My grandfather was

a risk-averse person who valued integrity above all else. Looking at a situation from his perspective would give me different ideas than if I saw it from the perspective of our dog, Elvis, who was loyal, extremely social, and eager to engage in any activity we were doing. To Elvis, life was all about relationship and fun. And what if I used a pizza perspective? Pizza is made of a bland, flat base with different, tasty items placed on top. It suggests that the solution to my situation might be to look for a stable

Perspectives can come from loved ones, people who inspire us, or from nature. even inanimate objects can be tapped for their unique approach to our life’s dilemmas. The trick is to first consider what that person or object represents to us, then view our situation through that lens.

foundation with some variety added in smaller doses. Once you’ve considered several perspectives, decide which one feels most energizing or “right,” and see what ideas come to mind. Usually, you will immediately find a few that will at least get you started moving in a more satisfying direction.

As a coach, I am always impressed by the power of changing my clients’ perspec-tives. Although playful and at times silly, it’s a fun exercise that engages our creativ-ity and allows us to see possibilities where none appeared before. It gives us choice in our life, and the result is always a life that is more uniquely ours.

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.

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InFLuenCInGLeGISLATIoN

As physicians struggle with the day-to-day chal-lenges of healing patients and run-ning a business, it’s tough to remember that advocacy really matters. After all, advocacy is some-thing someone else does, and physi-cians almost never see the results today.

We want to remind you that advocacy matters to every physician — and it matters a lot!

First, the results are often hidden. In his short story “Sil-ver Blaze,” Sherlock

Holmes speaks of the guard dog that didn’t bark as the clue to solving a murder. Often, the “dog that didn’t bark” is the bad legislation that wasn’t enacted, the poor decision that was stopped, and the awful ruling that was never made. We all see the affirmative suc-cesses, but we seldom see the averted disasters.

Second, advocacy results often take years to show them-selves. Consider that every can-didate for state and national office from San Diego County is interviewed, educated, and contacted in a way that, as candidates, they understand physician issues, and, as office

holders, they are frequently reminded. They may not al-ways agree with every position we have, but they sure as heck understand the issues and their impacts.

Third, advocacy is not an arena where everything goes your way. So while a particular issue may not go exactly the way one would like, sometimes organized medicine has to compromise. Remember: It’s not the operating room where the doctor has the final say!

Fourth, when you speak, the politicians listen. When you are quiet, the voices of our op-ponents win. So when we ask you to call your congressional representative or U.S. senators, to fax your California assem-blymember or senator, or to contribute to a campaign, your participation matters, and your failure to participate is noticed.

Fifth, rarely does legislation get passed the first time. So our “batting average” may look low, but remember that we often have to build consen-sus and support over years to change bad behavior or to implement good ideas.

Last, we need you, all of you! Advocacy is the voice of one or two, but with a chorus behind them. That chorus is physician membership. It is the power of one to speak for many. Absent the many, we who do this all the time are just empty voices. We need your membership, we need your contributions to CALPAC, and we need you to get involved when we ask you to. Contact me anytime on my cell at (619) 206-8282 or email me at [email protected] to discuss how you can get involved!

Mr. Gehring is CEO and executive director of the San Diego County Medical Society.

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In years past, CMA has defended physicians in battles waged by hospitals, health plans, and mid-level practitioners, but this year we ini-tiated a few fights of our own. CMA did what physicians do best: We fought to protect patients.

CMA fought to keep patients out of the middle of bill-ing disputes, to edu-cate parents about immunizations, to require mandatory flu vaccinations for healthcare workers, to remove sugared beverages from

schools, to create a physician health program, to expand residency programs, and a last-minute effort to save the Healthy Families Program.

Sponsoring legislation is the equivalent of pushing rocks up a hill … or, rather, big, righteous boulders. CMA’s Government Relations team

struggled to push those rocks up the legislative hill while fighting off the enemies trying to get in the way, and at the same time stopping the many other rocks being thrown down at physicians. Sounds dramatic, but by all accounts it was a crazy, precarious, conten-tious, hazardous, and dramatic pathway to the finish line. We ended with some big wins, and, although we lost a few along the way, CMA fought for physicians and their patients until the very end.

CMA came out of the gate swinging in January. We intro-duced AB 1742 (Pan), which would have enabled patients to assign their benefits directly to the provider furnishing medi-cal services. Sounds simple enough, but the bill soon came under attack from the health plans and culminated in what was described on one blog as the “juiciest” health commit-tee hearings of the year. After much back and forth, the bill came up one vote short before reaching a legislative deadline to move the bill. That same week, CMA battled the unions, championing a bill through both a health and labor com-mittee that would mandate flu vaccines for healthcare providers in hospitals. Against all odds and much opposition, SB 1318 (Wolk) moved through the Senate in a decisive win for public health. Though CMA was able to maneuver this contentious bill all the way through the Legislature, it was subsequently vetoed by the governor.

CMA also joined a large co-alition of healthcare providers in a valiant attempt to create a physician health program in California. The coalition worked tirelessly to address the opposition’s concerns sur-

CMA’s 2012 Legislative Wrap-up

b y j o D I H I C k S , v I C e P r e S I D e N T , C m A G o v e r N m e N T r e L A T I o N S

imagineOne Must


sisyphus Happy


rounding funding, oversight, and standards. The bill made it all the way through both committee hearings and was on its way to the floor when it stalled. Despite the coalition’s diligence, the overwhelming demands of the opposition damaged the bill beyond repair before the last legislative deadline. Despite an end to this bill, we are confident that the conversation can continue, and this will be an issue CMA will look to advance next year.

And then came Rob Schneider. CMA, along with the American Academy of Pediatrics, the Health Officers Association of California, and the California Immunization Coalition, sponsored AB 2109 (Pan) in an attempt to decrease the number of parents exempt-ing their children from being vaccinated before entering public schools. Hundreds of anti-vaccine activists flooded the committee hearings to op-pose the measure and eventu-ally were joined by Saturday Night Live alum Rob Schneider. Now armed with “celebrity” status, the opposition was able to secure public rallies, televi-sion time, and social media to oppose our efforts. Despite attempts at negative media attention by the opposition, Governor Brown signed AB 2109 into law hours before the deadline.

The year wouldn’t be com-plete without CMA’s revisit-ing some oldies but goodies, physical therapy and MICRA being no exceptions. Unfin-ished business from 2011, SB 924 (Steinberg/Price) would have fixed the ambiguity in law as to whether or not medi-cal corporations can legally employ physical therapists, but it would also have allowed patients to directly access

physical therapy treatment for 30 business days, at which time a physician would have to sign off on a physical therapy treat-ment plan. CMA had an offi-cial “Oppose Unless Amended” position on the bill, asking for amendments that would have required a medical diagnosis after 30 days of direct treat-ment. The Assembly Appro-priations Committee passed the bill, adding in medical diagnosis as a requirement for direct access. The California Physical Therapy Association again amended the bill on the floor, changing the language so that instead of requiring a diagnosis it would require an examination or a diagnosis … and as the semantics game wore on, the bill was quickly sent to Assembly Rules Com-mittee, where it stayed until its demise.

Two bills that would have weakened MICRA protec-tions, SB 1528 (Steinberg) and AB 1062 (Dickenson), were amended the last week of session, adding to the flurry of the chaos in the final days. The provider community strongly opposed both bills, and, thanks to letters and phone calls from physicians across the state, they were ultimately killed with astoundingly low vote counts.

The legislative session of-ficially ended early Saturday morning, Sept. 1, 2012, and CMA’s Government Relations team was at the Capitol until the very end. In the waning hours of the 2011–12 Legisla-tive Session, CMA successfully negotiated key amendments into the workers’ compensa-tion bill and proudly fought to reinstate the Healthy Families program as part of a multipart deal that died sometime after 1 a.m. Despite bipartisan support for our efforts, the Healthy Fam-

ilies program became collateral damage to partisan politics. CMA continues to work with stakeholders on the transition of kids to Medi-Cal. More to come on this issue …

Albert Camus’ The Myth of Sisyphus tells us that toil is not futile and that hard work can be noble. CMA toiled through-out the year for physicians, honoring the labor physicians do for their patients every day. The struggle to push those legislative rocks up the hill was performed with pride, and, as the essay reads, “The struggle itself toward the heights is enough to fill a man’s heart. One must imagine Sisyphus happy.” Of course, Sisyphus was not pushing the rock while simultaneously fighting labor lobbyists or Rob Schneider, but I still imagine him happy.

Below are details on the major bills that CMA followed this year.

Legislation Sponsored by CmA

Despite bipartisan support for our efforts (AB 826 and SB 301), the Healthy Families program became collateral damage to partisan politics. CMA continues to work with stakeholders on the transition of kids to Medi-Cal. More to come on this issue …

CMA introduced AB 1742 to enable patients to assign their benefits directly to the provider furnishing medical services. Sounds simple enough, but the bill soon came under attack from the health plans and cul-minated in what was described on one blog as the “juiciest” health committee hearings of the year. After much back and forth, the bill came up one vote short before reaching a legisla-tive deadline to move the bill.

With AB 1746, CMA tried to remove sugared beverages from schools. Unfortunately, it failed in committee.

AB 1848 would have, among other things, authorized the state to discipline or deny li-censure to physicians who offer deceptive or fraudulent expert witness testimony related to the practice of medicine. Unfortunately, it failed in com-mittee.

CMA attempted, with AB 2064, to require healthcare service plans or health insur-ers that provide coverage for childhood and adolescent immunizations to reimburse a physician or physician group in an amount not less than the actual cost of acquiring and administering the vaccine. Unfortunately, it failed in com-mittee.

Childhood Immunizations (AB 2109), which the governor signed into law, requires a parent or guardian seeking a personal belief exemption for their child to obtain a docu-ment signed by themselves and a licensed healthcare practitio-ner stating that the healthcare practitioner has informed the parent or guardian of the benefits and risks of the immu-nization, as well as the health risks of the diseases that a child could contract if left unvac-cinated.

CMA battled the unions, championing a bill (SB 1318) through both a health and labor committee that would mandate flu vaccines for healthcare providers in hospi-tals. Against all odds and much opposition, SB 1318 moved through the Senate in a decisive win for public health. Though


CMA was able to maneuver this contentious bill all the way through the Legislature, it was subsequently vetoed by the governor.

CMA attempted with SB 1416 to expand residency programs in the state, but the bill failed in committee.

CMA joined a large coali-tion of healthcare providers in a valiant attempt to create a physician health program in California (SB 1483). The coalition worked tirelessly to address the opposition’s concerns surrounding funding, oversight, and standards. The bill made it all the way through both committee hearings and was on its way to the floor when it stalled. Despite the coalition’s diligence, the overwhelming demands of the opposition damaged the bill beyond repair before the last legislative deadline. Despite an end to this bill, we are confident that the conversation can continue, and this will be an issue CMA will look to advance next year.

Prior CMA-sponsored legisla-tion now provides $1 million per year in funding for the Steve Thompson Loan Repayment Program, giving physicians up to $105,000 in loan repayment if they agree to practice in an underserved area for at least three years. Medical School Scholarships (AB 589), which the governor signed into law, mirrors the loan repayment program by creating the Steve Thompson Scholarship Pro-gram, providing scholarships to medical students who agree to practice in one of California’s medically underserved areas upon completion of residency.

Legislation opposed by CmA

Elder Abuse / MICRA (AB

1062), which CMA killed, would have encouraged use of the elder abuse law to get around the MICRA cap and plaintiff attorney fee limits.

Physical Therapists: Direct Access to Services / Profes-sional Corporations (SB 924), which CMA killed, would have provided a framework where physical therapists might treat a patient directly without first seeing a physician. While CMA may wish to consider allowing a certain amount of treatment prior to diagnosis, there must be a diagnosis requirement at some point, and 30 business days is just too long.

Healthcare Coverage: Out-of-Network Coverage (SB 1373), which CMA killed, would have required a healthcare provider to inform an enrollee in writing, prior to providing out-of-network services, that the provider is out of network and that the health plan may not cover some of the services; to provide an estimate of the cost of the services; to direct the enrollee to contact the health plan for a list of contracted providers; and more!

Damages: Medical Services (SB 1528), which CMA killed, would have allowed an injured party of medical services to be compensated based upon the reasonable value of services rather than the amount actu-ally paid, thereby dramatically increasing economic damage awards in all personal injury cases.

bills of Interest

Step Therapy Reform (AB 369), which CMA supported but the governor vetoed, would have limited a health plan’s or health insurer’s ability to use step therapy or “fail first” proto-

cols for the treatment of pain.

Healthcare Coverage: Cancer Treatment (AB 1000), which CMA supported but the gover-nor vetoed, would have helped ensure that cancer patients are not denied the most appropri-ate and effective treatment by putting costs above care.

International Medical Graduates (AB 1533), which CMA supported and the governor signed into law, will allow the UCLA International Medical Graduate program to create a five-year pilot for participants to engage in physician-supervised patient care activities as part of an ap-proved and supervised clinical clerkship/rotation at UCLA, thereby increasing the number of licensed physicians practic-ing in the state.

Workers’ Compensation (SB 863), which CMA supported and the governor signed into law, directs the state to adopt the Medicare fee schedule as well as establish Independent Medical Review and Indepen-dent Bill Review in an effort to utilize third-party processes, instead of the court system, to adjudicate treatment and billing disputes. CMA was able to secure many important changes to the bill, including medical provider network reforms, expanding categories of payment for physicians as well as increasing the entire funding allocation for physi-cian services, and protecting physicians’ ability to own an ambulatory surgery center.

Nurse Practitioners (SB 1524), which the governor signed into law, deletes the statu-tory requirement that nurse practitioners complete at least six months of physician and surgeon supervised experience

We ended With some big

Wins, and, although We

lost a feW along the Way, cma

fought for physicians

and their patients until

the very end



in the furnishing or ordering of drugs and a course in pharma-cology covering the drugs that will be furnished. CMA recom-mended accepted amendments that clarify that the physician may include a six-month (or longer) supervised experience requirement in the standard-ized protocol between the physician and the APRN.

Mammograms (SB 1538), which the governor signed into law, will require physi-cians to notify mammography patients with highly dense breasts about the density of their breast tissue. CMA took a neutral position after physi-cian advocates were able to secure amendments.

bills Impacting Healthcare reform

Medi-Cal Eligibility (AB 43), which failed in commit-tee, would have required the Department of Health Care Services to establish, by Jan. 1, 2014, eligibility for Medi-Cal benefits for any person who meets these eligibility require-ments to phase in coverage for those individuals.

Essential Health Benefits (AB 1453, SB 951), which CMA supported and the governor signed into law, will establish a set of essential health benefits that insurers and health plans in California’s Health Benefit Exchange will be required to cover.

Individual Market Reforms (AB 1461, SB 961), which CMA supported but the governor vetoed, would have con-formed state law to the ACA, establishing guaranteed issue, Exchange open and special enrollment periods, rating, and same regions as PERS.

Deceptive Marketing (AB 1761), which CMA supported and the governor signed into law, will prohibit deceptive marketing by outlawing “copy-cats” from representing them-selves as part of the California Health Benefit Exchange.

CO-OPs (AB 1846), which the governor signed into law, authorizes the insurance com-missioner to issue a certificate of authority to CO-OPs, which,

called for by the ACA, are private, consumer-governed, nonprofit health insurance plans that will be operated by its community beneficiaries.

CalHEERS Horizontal Inte-gration (SB 970), which CMA supported but the governor vetoed, would have added hu-man services programs to those screened by the California Healthcare Eligibility, Enroll-ment, and Retention System, which will be used for Califor-nia Health Benefit Exchange and Medi-Cal enrollment.

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CMA produces a number of publications to keep members up to date on the latest healthcare news and information affecting the practice of medicine in California. Members can subscribe to any of these publications by visiting their account dashboard at www.cmanet.org. New

users can create a free web account at www.cmanet.org to manage their subscriptions.

CMA’s Legislative Hot List provides a summary and current status of CMA-sponsored bills, as well as the progress of other significant legislation followed by CMA’s Center for Government Relations. The Hot List represents only a small sampling of the hundreds of bills CMA follows every year.

CMA’s Regulations Quick List provides a summary and current status of significant regulations followed by CMA. The Quick List is circulated regularly on a monthly basis or more frequently, as needed.

legislative Sign up to Receive

hot list

Regulations Quick List

cma’s other publications

CMA Alert: biweekly e-newsletter to keep members up to date on critical issues affecting the practice of medicine in California.

CMA Capitol Insight: biweekly column reporting on the inner workings of the state Legislature.

CMA Practice Resources (CPR): monthly bulletin full of tips and tools to assist physicians and their office staff in improving their practice efficiency and viability.

CMA Press Clips: Daily reports on healthcare policy and medicine from newspapers and magazines throughout California and around the nation.

Legal Case List: monthly summary / current status of litigation in which CmA is a party or has filed an amicus curiae brief.

OMSS Advocate: Quarterly newsletter providing member medical staffs with updates on current events and issues.

CMA Reform Essentials: Provides readers with the latest developments on California’s implementation of federal healthcare reform.


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Over the past 11 years as your executive director, I’ve had the pleasure of meeting and learning from many excep-tional physicians and physician leaders. I want to share some of these pretty good rules about politics and advocacy, and start by thanking Drs. Bob Hertzka and Jim Hay, both past presi-dents of SDCMS and of CMA.

1 Look at politicians as either those who view physi-cians as part of the solution

or those who view physicians as part of the problem. In the world of political parties, we are seduced into thinking that the party affiliation drives “goodness” or “badness.” Not so. We in the leadership team use a very simple litmus test: Does the decision maker trust physicians or not? If they do, it matters not whether they are a Republican or a Democrat.

2 Respect the truth ... always. This rule can’t get any easier, and more

difficult to adhere to in the heat of the moment. Never, ever BS. Never, ever fudge. Your reputation, and that of your organization, can be destroyed in 30 seconds by being (even inadvertently) untruthful. And remember, few are more re-spected than those who say, “I don’t know, but I will find out,” and then actually find out and inform the legislator.

3 The most powerful spokesperson for your cause is someone who has

no direct stake in the outcome. When you speak to a decision maker, and you have a clear interest in the outcome, you will be politely listened to, but your words will be assessed in the context of a special

10 Pretty Good Rulesb y T o m G e H r I N G

the table You’re Either at

or you’re on the Menu


interest. When those same thoughts come from someone without a (perceived) conflict, those words become (magi-cally) much more compelling. So, for example, when a family physician speaks to the lunacy of letting optometrists operate on the eye, that’s a powerful statement — much more so than from the ophthalmolo-gist, who may in fact be mak-ing a much more fact-based argument (see rule No. 10).

4 Count your votes before the vote. Don’t find out you’re close (or behind)

during the vote. Do everything in your power to find out who is with you and who isn’t, then lobby the heck out of the issue.

5 Focus on the persuad-ables. While actual per-centages may vary, on

any given issue, about 30% will be in full-throated support, and roughly 30% are stridently opposed. Focus 90% of your energy on the 40% who are convincible.

6 No one bats 1.000 in ad-vocacy. If you expect to win every issue, you’ve

chosen the wrong avocation. It’s a game of percentages. Work for the long haul, and be patient.

7 It’s about the relationship, not about the issue. Varia-tion: When it’s a core

issue, then it is about the issueCorollary: Choose your core

issues very, very carefully.There are a million issues.

Choose the ones you’re will-ing “to die for” very carefully. So treasure the relationship. Those you lobby may not agree with you (see rule No. 8 below), but the value of the relation-

ship is that you get a fair and fast hearing. Being able to pick up the cell phone (and having the cell phone number) and calling a state legislature is incredibly useful.

8 Today’s opponent is tomorrow’s ally, and vice versa. Note, I did

not say enemy ... I said op-ponent (see rule No. 9 below). Alliances come and go; accept that the greater good some-times makes for strange bed-fellows. Therefore, never, ever personalize a disagreement because you may be looking for a partner someday soon!

9 Respect the elected officials, their staffs, and your adversaries.

You haven’t run for office. You haven’t had to fly to Sacramento or Washington, DC, every week. You haven’t spent interminable hours in meetings listening to ... well, let’s just say that our legisla-tors work incredibly hard, and every move they make is scrutinized, criticized, and second-guessed. Respect them for what they do and who they are.

The staff are just as, and sometimes more, important as the elected official. Never, ever, ever treat the staff with anything but respect. They may be young, they may be underpaid, they may work under very challenging condi-tions, but they have the ear of the decision maker. Make them your allies, even your advocates!

Badmouthing your oppo-nents (or worse, not respect-ing the truth) will invariably cause you to be ineffective. And the word gets around. Quickly!

10 It’s 90% on the poli-tics, only 10% on the merits. Corollary:

You don’t get to the merits until after you deal with the politics.

Deal with (and understand) the politics before you speak to the merits. Those of us educated in deterministic, objective, and data-driven disciplines (engineering in my case, medicine in my spouse’s) are resolutely convinced that the merits of any argument will always prevail. Sadly, in the world of politics and advocacy, that is rarely the case. In fact, many decisions are made in the absence of, or even contraven-tion of, the facts. Decision mak-ers have to do things, e.g., their party leadership may demand a vote, maybe they need to vote against something we like that is passing easily but they have a constituency to appease, the list goes on. Get over it! That’s the world we live in.

So who cares about advocacy and politics anyway? You do. If SDCMS and CMA are not building those relationships, making the case for physicians, walking the halls of power, then a nonphysician will tell you how to practice medicine and reach into your pockets — and directly affect your ability to provide patient care. Which brings me to the last and most important rule (with apologies to the famous line from the 1992 presidential campaign): It’s the patient care, stupid. Everything we do as advocates for physicians has to focus on the ultimate goal of healing the sick. Honestly framed as a patient care issue, it’s hard to lose an argument!

Mr. Gehring is CEO and executive director of the San Diego County Medical Society.

if sdcms and cma are not building those relationships, making the case for physicians, Walking the halls of poWer, then a nonphysician Will tell you hoW to practice medicine and reach into your pockets — and directly affect your ability to provide patient care.



Thanks to Proposition 11 (2008), district boundaries for the state Assembly and Senate were, for the first time in California’s history, drawn by a 14-member Citizens Redis-tricting Commis-sion rather than members of the Legislature them-selves. This his-toric shift meant that lawmakers were no longer able to protect one another through the creation of gerrymandered districts and so-called “safe seats” for their fellow incumbents.

Adding to the chaos was the fact that the June primary was also the first to implement the top-two system as a result of Proposition 14 (2010). The new rule calls for the top two candidates with the most votes to move on to the November general election, regardless of party affiliation. Together, these changes created a myriad of outcomes that would have been unheard of under the pre-vious rules. For the first time

in state history, it was imagin-able that two Democrats could be facing off in a November contest to represent a district that, historically, had belonged to Republicans. Despite the shake-ups, one constant from previous years remained intact: CMA’s Political Action Committee (CALPAC) was incredibly successful in sup-porting candidates that will go on to uphold the efforts of organized medicine.

In all, CALPAC engaged in a total of 32 contests. Of those, 30 races — or 94% of the con-tests we participated in — have CALPAC-supported candidates moving on to the November elections. Additionally, 13 CALPAC-supported candi-dates are moving on to the November general election as a prohibitive favorite in a safe seat. In short, these candidates are all strong favorites to be in the Capitol in 2013. Of the remaining CALPAC-backed candidates, 13 will be mov-ing into a November contest against a member of their own party, while the remaining four will be facing a competi-tive race against a member of the opposing party.

One interesting race to look for in November will be held in Los Angeles County’s Assem-bly District (AD) 49, where Dr. Matthew Lin (R), a past presi-dent of the Los Angeles County Medical Association and current CMA member, will be working to win over a district that tends to lean Democrat. Dr. Lin managed to pick up an impressive 52.1% of the vote in a three-way contest that featured two Democrats, but will need further support from CALPAC members to help translate this performance into a November victory.

Further north, in Los An-geles’ AD 39, CALPAC-backed candidate Raul Bocanegra (D) put up an impressive perfor-

CALPAC Continues to Thrive Under State’s

New Election Policiesb y r I C H A r D T H o r P , m D

neW eraSuccess in a


mance, finishing first in a six-way contest with 36.1% of the total vote. Bocanegra, the current chief of staff for Assem-blymember Felipe Fuentes (D- Los Angeles), has never run for public office but will be facing off against former Assembly-member and current Los Ange-les City Council member Rich-ard Alarcon (D), who pulled in roughly 26% of the June vote. To say that these two differ in their stance toward organized medicine would be a severe understatement. Bocanegra is part of an Assembly office that has historically supported the efforts of CMA, while Alarcon is backed by trial attorneys and staunchly opposes MICRA. In short, CALPAC will continue to involve itself in this contest and help ensure that Bocaneg-ra is successful in November.

Successes such as these are certainly a cause for celebra-tion, but it’s also important to remember that they don’t come easy. In order to make sure that our candidates are successful, CALPAC members must stay active and continue to support our efforts. Con-tributions can range in both size and frequency, but every dollar goes to help bolster the voice of organized medicine in Sacramento. In a year of many changes, CALPAC candidates continue to look strong on their own. But together, we are stronger.

Dr. Thorp is chair of CALPAC, the California Medical Associa-tion’s Political Action Committee. CALPAC supports candidates and legislators who understand and embrace medicine’s agenda.

in order to make sure that our candidates are successful, calpac members must stay active and continue to support our efforts.

“THINk SDCmS FIrST!”Startbycontacting SDCMSat (858)565-8888orat [email protected].

Volunteer for Project Access San DiegoThrough our flagship program, Project Access San Diego, we have been able to assist over 1.700 uninsured adults in our community to improve their health through access to specialty healthcare services.

Join our more than 625 volunteer physicians to provide specialty healthcare services to those who most need our help. You decide how many patients a month or a year you are able to serve. We make your volunteer experience easier and more rewarding, and less taxing to your office staff with comprehensive patient care management, labs, imaging and other ancillary health services. Your consultations will be efficient for you and life-changing for your patients.

Volunteer in Your PajamasProvide your primary care physician colleagues HIPAA-compliant, web-based patient consultations from the comfort of home or office. eConsultSD increases the capacity of primary care physicians at our community health centers to maintain care of their patients by receiving answers to clinical questions from volunteer specialists. eConsultSD is an easy way for specialist physicians to volunteer when they are not able to provide direct patient care.

Get InvolvedSan Diego County Medical Society Foundation needs you! 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! Please consider making a contribution to SDCMS Foundation to support our efforts at www.sdcmsf.org, or call us at 858.300.2777.

BE OUR HEROgive access to healthcare for those without!

San Diego County Medical Society Foundation’s Mission Is To Improve Health, Access To Care, And Wellness For Patients And Physicians Through Engaged Volunteerism.

Lawrence Eisenhauer, MD HERONorth County OBGYN Dr. Lawrence Eisenhauer has helped numerous Project Access female patients to regain their health over the years, and recently performed four much-needed surgeries -- three in one day!

Dr. Eisenhauer’s dedication has helped women who have suffered for years with chronic conditions to improve their health, and get back to work and caring for their families. Elsa B said, “Dr. Eisenhauer was the light at the end of my tunnel. I didn’t know angels existed on earth!”

Thank you to all our our more than 625 volunteer physicians -- you are all our heroes!!

FIRST GOLF TOURNAMENTOur first annual golf tournament, benefitting Project Access San Diego, is set for Thursday, February 28, 2013 at Del Mar Country Club. Golfer fees, including cart, lunch and post-golf reception is $250. To register or for more information, go to sdcmsf.org/golf/

5575 Ruffin Road, Suite 250, San Diego, California 92123 n p: 858.300.2777 n f: 858.569.1344 www.sdcmsf.org

Each month, every practicing physician in San Diego County receives a copy of this magazine. What better way to ensure they know about your practice? We have advertising packages available at very attractive price points, and member physicians receive 50% off!

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To submiT a classified ad, email Kyle lewis at [email protected]. sdcms members place classified ads free of charge (excepting “services offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

classifiedsphysiCian pOsitiOns aVailaBle

Full- Or part-tiMe psyChiatrist neeDeD: Psy-chiatric Office Management, LLC, looking for a part-time or full-time psychiatrist to fill immediate occupancy. This person(s) will be a part of a busy, professional and friendly office in Santee. Enjoy a spacious office, friendly office staff, an answering service, booking and referrals for a small rental fee of 20% of money received. Office consists of independent practitioners. Please call Connie Dawson at (619) 258-6730 or Paul Liederman, MD, at (619) 871-9250. [095]

ChieF, Maternal anD ChilD health: The County of San Diego Health and Human Services Agency is seek-ing a qualified medical doctor to fill the position of chief, Maternal, 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 mothers, children, and their families. For more information on the position, including minimum re-quirements 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 seek-ing 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 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 candidates may con-tact 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 dy-namic 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 candidates 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 clini-cal area of interest. [090]

FaMily praCtiCe physiCian: For a busy federally qualified health center. MHCS (www.mtnhealth.org) is a mission-driven organization that serves both rural and urban residents 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, mal-practice, life, AD&D, long-term disability, long-term care, monthly incentive, CME / license reimbursement, plus a sign-on bonus. Board certified 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 immediate 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 prac-titioner to manage a team responsible for planning and directing clinic services. Must be available to work flex-ible 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 Medi-cine (http://emergencymed.ucsd.edu) at UC San Diego, committed 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 fa-cilities. The applicant must have a background in family medicine, internal medicine, 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 insti-tutional commitment to excellence through diversity. In-terested individuals should send their CV, a reference list, and separate statement summarizing their experience to [email protected]. [087]

physiCian anD psyChiatrist neeDeD FOr aM-BulatOry 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 com-petitive 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 DerMatOlO-gists: Live in one of the country’s most desirable loca-tions and practice with a premier San Diego multispecialty medical group! Sharp Rees-Stealy Medical Group is look-ing for BC/BE dermatologists. Competitive first-year com-pensation guarantee, excellent benefits, and shareholder eligibility after two years. Unique opportunity for profes-sional and personal fulfillment while living in a vacation destination. Please send CV to Physician Services, 2001 Fourth Avenue, San Diego, CA 92101. Fax: (619) 233-4730. Email: [email protected]. [084]

researCh physiCian / prinCipal inVestiga-tOr: Profil Institute for Clinical Research is looking for a research physician / principal investigator. Requirements: three years MD experience in clinical adult medicine + un-restricted California MD license. Research experience not necessary. Responsibilities: Serve as sub-investigator or principal investigator on studies. Perform medical histo-ries, physical exams, admit, discharge, and monitor sub-jects, including reviewing labs results, EKGs and telemetry as part of clinical research trials. Weekday shift hours + limited on-call hours and strong benefits plan. Interested parties please apply online at www.profilinstitute.com un-der “Career Opportunities.” If you have further questions, please contact Robyn Nielsen, recruitment manager, at (619) 419-2048. [082]

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. Com-petitive salary including benefits plus the opportunity to begin a partnership track if desired. Beautiful office build-ing, excellent staff, ideal for either first year in practice or for an experienced 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 perfect doctor for the position will be one who has strong communication skills and great bedside manner. The physician should have a good background in proce-dures (dermatologic, orthopedic, etc.). I am looking for a physician who will take personal pride in the growth of this unique practice. We emphasize quality of time with the patients rather than the number 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 inviting 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: In-dependent 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 psychiatric 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 offered. San Diego combines the lifestyle of a resort community and the ame-nities of a big city. The hospital is centrally located, min-utes from many recreational opportunities and great resi-dential communities with wonderful year-round weather. CV can be submitted online at www.sdcounty.ca.gov/hr. For questions, please contact Darah Frondarina, human resources specialist, at (858) 505-6534 or [email protected]. [072]

sOuthern CaliF regiOnal MeDiCal DireCtOr (rMD): Your Neighborhood Urgent Care (YNUC) is re-cruiting 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 experience required. Management/adminis-trative 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 psychiatrist for Child, Youth and Families (CYF) Be-havioral Health and as deputy to the clinical director of the Behavioral Health Division of County of San Diego Health & Human Services Agency (HHSA). Significant adminis-trative/managerial experience required; to provide clini-cal supervision in a variety of CYF County-operated pro-grams. 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 every-one, 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 patients and community. We offer an excellent comprehen-sive benefits package that includes: malpractice coverage; NHSC loan repay eligibility; and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email [email protected]. If you would like to fax your CV, fax it to (619) 876-4426. 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 inpatient 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 pri-vate, nonprofit clinic serving the communities of North San Diego County, has openings for part-time and per-diem positions. Five locations in Vista and Oceanside.


sCripps enCinitas COnsultatiOn rOOM/eXaM rOOMs: Available consultation room with two examina-tion rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Receptionist help provided if need-ed. Contact Stephanie at (760) 753-8413. [703]

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

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

share OFFiCe spaCe in la Mesa: Available im-mediately. 1,400 square feet available to an additional doctor on Grossmont Hospital Campus. Separate recep-tionist area, physician’s own private office, three exam rooms, and administrative area. Ideal for a practice com-patible 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 Univer-sity 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, radiol-ogy, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable. Contact [email protected] or (619) 504-5830. [835]

neW — eXtreMely lOW rental rate inCentiVe — eastlaKe / ranChO Del rey: Two office/medi-cal 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 available. Well parked and well kept garden courtyard professional building with lush landscaping. Desirable location near major thorough-fares and walkable retail amenities. Please contact list-ing agents Joshua Smith, ECP Commercial, at (619) 442-9200, ext. 102. [006]

share OFFiCe spaCe in la Mesa Just OFF OF la Mesa BlVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reason-able rent. Please email [email protected] for more information. [867]

nOnphysiCian pOsitiOns aVailaBle

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 master’s degree in nursing, public health, business administration, public admin-istration, 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 look-ing 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 medicine practice in Hillcrest seeking a full-time (Monday–Friday) licensed nurse practitioner. Minimum of one (1) year nurse practitioner experience preferred. Experience with EMR helpful. Qualified candidate should submit a cur-rent CV or resume to [email protected]. Sal-ary based on knowledge and experience. No calls. [083]

physiCian assistant / nurse praCtitiOner: Gastroenterology 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 pa-tients, obtaining patient histories, and performing physi-cal exams. They would order/perform routine diagnostic procedures, develop treatment plans, and monitor the effectiveness of therapeutic interventions as directed by the physicians. Physician Assistant: Certified California State Medical Board for Physician Assistants. Nurse Prac-titioner: 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 can-didate will be dependable, detail-oriented, and a team player. Competitive salary and benefits. NM is responsible for accountability of clinical care and productivity, includ-ing assessing, implementing, and evaluating processes, technology, personnel, and facility needs required to achieve patient outcomes safely. Is responsible for coor-dination and direction of patient care services and other service areas in the facility. Responsible for quality im-provement, identifying opportunities to improve services, recommending and implementing actions to meet the goals of the facility. RN State of California. ACLS certifica-tion. Email Kathy Moore at [email protected]. [079]

FrOnt OFFiCe reCeptiOnist pOsitiOn: Derma-tologist in Hillcrest needs a special individual for com-puter billing, typing, front office, mature, experienced. Friendly environment. Email resume to [email protected]. [075]

nurse praCtitiOner WanteD: Nurse practitioner wanted for internal medicine and pediatrics practice in Coronado. Enthusiasm, dependability, and a love of learn-ing are musts! Full-time with benefits. Experience pre-ferred. 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]

Family medicine, OB/GYN medicine, pediatric medicine. Requirements: California license, DEA license, CPR, board certified, one (1) year post-graduate clinic experience. Bi-lingual English/Spanish preferred. Benefits: malpractice coverage. Email resume to [email protected] or fax to (760) 414-3702. Visit website at www.vistacom-munityclinic.org. EOE/M/F/D/V [035]

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

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

spaCe FOr suBlease in pOOle BuilDing On sCripps MeMOrial la JOlla CaMpus: Office on entry 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 assistant 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, of-fice 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 location 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 entire suite, totally fur-nished, if there is a larger group. Plenty 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 prac-tice support for full- or part-time surgeon available im-mediately. 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 collegiality and informal consultation, private restroom, spacious penthouse exercise gym, storage clos-et with private lock in each office, soundproofing, com-mon waiting room and parking. Contact Christine Saroian, MD, at (619) 682-6912. [862]

ClaireMOnt Mesa OFFiCe spaCe FOr lease: Clairemont Mesa Medical Arts Center is a medical of-fice 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 con-figured 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]

Place your

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FEaturEd mEmbEr

He is a tireless surgeon who brings gifts to patients who are hospitalized during the holidays; he holds the hands of mothers whose children are healing at UC San Diego Health System’s Regional Burn Cen-ter; and his life’s mission is to educate the public on burn injury prevention.

These are just a few of the many reasons why Bruce Potenza, MD, FACS, director of the UC San Diego Health System Regional Burn Center, professor of surgery at UC San Diego School of Medicine, and SDCMS-CMA member since 2005, was named a medical hero by the American Red Cross of San Diego/Imperial Coun-ties during their 10th annual Heroes Breakfast on the USS Midway. More than 500 people attended the event, a community celebration honoring 11 indi-viduals and organizations that have made a commitment to creating safer, stronger communities and providing help when disaster strikes. “It was truly an honor to be recognized by the American Red Cross for the work I love to do,” says Dr. Potenza.

Dr. Potenza leads a multidisciplinary team that responds to complex patient burns and works with prevention efforts like the Baby Be Safe Program to reduce the number of burn injuries to children under the age of 4. “Our staff has the training and skill needed for seriously injured patients who are dealing with both physical and emotional challenges,” says Dr. Potenza, who performs more than 450 surgeries for burn injuries each year.

The Burn Center team includes experts in plastic and reconstructive surgery, nutri-tion, social work, psychology, pain man-agement, child life, and physical and oc-cupational therapy. “Some of our patients are here for several months to a year and literally have to relearn how to eat, talk, and walk again after a burn injury,” said Dr. Potenza. “To see these patients transformed by our team is incredibly rewarding.”

Dr. Potenza is known by his peers as an excellent instructor and mentor, special-izing in general surgery, critical care, and burns. He has received numerous honors and awards from faculty and students, and is involved in community service and outreach programs to promote awareness and prevention surrounding burn injuries. “Watching Dr. Potenza at the bedside of every patient and teaching our team the latest techniques is what makes me want to come to work every day,” says Dubina. “I have learned so much from him over the years.”

In addition to his busy schedule, Dr. Po-tenza is a captain in the United States Naval Reserve and has traveled across the nation presenting lectures related to trauma and burn treatment. “The Burn Center is com-mitted to advancing our knowledge and awareness of burn injuries and prevention, and the American Red Cross award is a wonderful way to recognize the team that makes this happen every day,” says Dr. Potenza. To learn more about the UC San Diego Health System Regional Burn Center, please visit health.ucsd.edu/specialties/sur-gery/trauma-burn/burn-center.

bruce Potenza, mDby mICHeLLe brubAker, uC SAn DIeGo HeALTH SCIenCeS

“Dr. Potenza dedicates himself to educating the public on burn injuries, treatment options, and prevention,” says Janine Dubina, RN, nurse manager at UC San Diego Health System’s Regional Burn Center. “He is so deserving of this award. He treats every patient like they are a member of his family.”

The UC San Diego Health System Re-gional Burn Center is an American Burn Association-verified burn pediatric and adult burn center and provides compre-hensive burn services for San Diego and Imperial counties. It is internationally

recognized for burn research and advanced practice in areas such as skin grafts.

Deep burns require skin grafts for heal-ing, and the best skin grafts come from the patient’s own unburned skin. These grafts are unlikely to be rejected from the patient and have a better cosmetic result. However, if the patient does not have enough healthy skin, there are skin substitutes and skin banks to provide temporary coverings to allow time for the patient to stabilize. “Burn surgery requires patience to ensure grafts remain in place, the willingness to undergo the tropical heat of the operating room, and the stamina of standing for eight to 12 hours in one place for the best patient outcome,” says Dr. Potenza.

The promise of the future is in the world of biotechnology. Living skin cells may be taken from the burn patient and grown into new skin cells in sheets. The challenges of current technology are the fragility of the cells, cost, and time required to grow the cells. The advantages are the patient is less likely to reject the new covering. The center has an ICU, an intermediate unit, and a 24-hour clinic. As the only burn center in the region, it provides education and training to first responders and health-care professionals, and hosts burn support services and activities for burn survivors and their families. Each year, approxi-mately 450 burn victims are admitted and hundreds more are treated as outpatients in the burn clinics.

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

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November 2012

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