December 2008

Quality and Cross-Cultural HealtHCare p.26

emerging miCrobial resistanCe in san diego County p.34

“ P H y s i C i a n s u n i t e d F o r a H e a lt H y s a n d i e g o ”

disCover our endorsed

Partners P.30

attend our 2009 seminars and events P.34

be sure to take advantage oF

our otHer member beneFits P.36

official publication of the san diego county medical society • december 2008

SDCMS bringS you anDyour Staff

gooDS anD ServiCeS

Physician-Centric

S A N D I E G O P H Y S I C I A N . o r g | O C T O B E R 2 0 0 8B

O C T O B E R 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 1

S A N D I E G O P H Y S I C I A N . o r g | D E C E m B E R 2 0 0 82

VOL. 95 | NO. 12

[ F e a t u r e s ]

Contents

• Your SDCMS Support Team: Here to Help• Political Advocacy: Physicians Fighting Hard • SDCMS Member Benefits: Policies and Procedures • SDCMS’ Endorsed Partners: Members Save Time and Money• SDCMS’ 2009 Seminars/Webinars and Events• Take Advantage of SDCMS’ Other Members-only Benefits

26Bringing You and Your Staff Physician-centric Goods and Services All Year Round

SDCMS Member Benefits:

[ D e p a r t m e N t s ]

SDCMS bringS you anD

your Staff

gooDS anD ServiCeS

Physician-Centric

468

1012

ContriButorsThis Issue’s Contributing Writers

Editor’s Column Palmetto and Other Problems

Community HEaltHCarE CalEndar

ask your PHysiCian advoCatE

BriEfly notEdNew and Rejoining Members, and More …

18 tECHnology mattErs XP5, Vista6, or Windows 7

20 PuBliC HEaltH Flu Vaccine and Hand Washing

24 on lEadErsHiPLearn, Anticipate, and Adapt!

40 PHysiCian markEtPlaCEClassifieds

44 mEdiCal studEnt PErsPECtivE From the Wards

D E C E m B E R 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 3

Vitas_SD Physician_08:Layout 1 11/12/08 12:10 PM Page 1


Contributors

send your letters to the editor to [email protected]

EDITORmANAGING EDITOR

EDITORIAl BOARD

Joseph scherger, md, mPHkyle lewis

adam dorin, md robert Peters, Phd, md david Priver, md roderick rapier, md Joseph scherger, md, mPH

EAST COuNTY DIRECTOR

HIllCREST DIRECTOR

KEARNY mESA DIRECTOR

lA JOllA DIRECTOR

NORTH COuNTY DIRECTOR

SOuTH BAY DIRECTOR

AT-lARGE DIRECTOR

YOuNG PHYSICIAN DIRECTORRESIDENT PHYSICIAN DIRECTORRETIRED PHYSICIAN DIRECTORmEDICAl STuDENT DIRECTOR

William tseng, mdWoody Zeidman, mdroneet lev, mdthomas mcafee, mdadam dorin, mdsherry Franklin, mdsteven Poceta, mdWayne sun, mdJames schultz, mddouglas Fenton, mdarthur blain, mdvimal nanavati, mdanna seydel, mdJeffrey leach, mdrobert Peters, Phd, mddavid Priver, mdWayne iverson, mdPaul kater, mdJohn allen, mdkevin malone, mdmihir Parikh, mdkimberly lovett, mdglenn kellogg, mdgeraldine kang

PRESIDENTPRESIDENT-ElECT PAST PRESIDENT

SECRETARYTREASuRER

COmm. CHAIRDElEGATION CHAIR

BOARD REP.BOARD REP.

lEGISlATIvE CHAIRExECuTIvE DIRECTOR

SDCmS CmA TRuSTEES

OTHER CmA TRuSTEES

AmA DElEGATES

AlTERNATE DElEGATE

stuart Cohen, md, mPHlisa miller, mdalbert ray, mdrobert Wailes, mdsusan kaweski, mdJoseph scherger, md, mPHJeffrey leach, mdsherry Franklin, mdrobert Peters, Phd, mdrobert Hertzka, mdtom gehring

theodore mazer, mdalbert ray, mdrobert Wailes, md

Catherine moore, mddiana shiba, md

James Hay, mdrobert Hertzka, md

albert ray, mdlisa miller, md

sdCms eXeCutive Committee

PRESIDENTPuBlISHER

DIRECTOR, BuSINESS DEvElOPmENT & mARKETINGmARKETING & PRODuCTION mANAGER

Jim Fitzpatrickmaureen sullivanHeather backJennifer rohr

ACCOuNT ExECuTIvEPROJECT DESIGNER

ADvERTISING ART DIRECTORCOPY EDITOR

dari Pebdanilisa Williamsgeneen montgomeryadam elder

1450 Front Street • San Diego, CA 92101 • 619-230-9292 • Fax: 619-230-0493 • 800-600-CITY (2489) • www.sandiegomagazine.com

oPinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCmS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and 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 subscriptions, email [email protected]. [san diego County mediCal soCiety (sdCms) Printed in tHe u.s.a.]

Published by

Harrison BoltEr Mr. Bolter is the health information specialist for the County of San Diego Health and Human

Services Agency’s Immunization Branch.

mattHEw BroCkwEll Mr. Brockwell is a third-year medical student at the UC San Diego School of Medicine.

tom gEHring Mr. Gehring is CEO and executive director of the San Diego County Medical Society (SDCMS).

marisol gonzalEz Ms. Gonzalez is your SDCMS physician advocate. She can be reached at (858) 300-2783 or at

[email protected] with any questions you may have about your practice or your membership.

JosEPH E. sCHErgEr, md, mPH Dr. Scherger is clinical professor of family medicine at UCSD. He is also medical direc-

tor of AmeriChoice, which administers San Diego County Medical Services. Dr. Scherger, along with editing San Diego

Physician, is chair of the SDCMS Communications Committee.

ofEr sHimrat Mr. Shimrat is founder and CEO of Soundoff Computing Corporation, a consultancy specializing in IT

products and services.


IHS_SD Physician_08:Layout 1 11/12/08 11:58 AM Page 1

the Palmetto is the state tree of South Carolina, known for its large and nutritious leaf bud.

The palmetto bug is actually a cockroach, but don’t tell that to the people of Florida who allow them to coexist on their prop-erty. Saw palmetto is good for the prostate gland. But to the physicians of San Diego County and the rest of California, Palmet-to is now a big problem.

Palmetto GBA is the new Medicare fiscal intermediary taking over this year from NHIC, and many physicians are not getting paid for their services. In large numbers, physicians are turning to SD-CMS and CMA for help, and organized medicine is willing and able to help its members. Some physicians have recently joined SDCMS just in order to get help dealing with Palmetto. Membership has its benefits, yet sometimes it takes a crisis to remind physicians they are better off not being alone out there.

Executives of Palmetto GBA recently came to the CMA House of Delegates and apologized for all the problems. They agreed to work hard to fix the problems, and CMA and SDCMS will hold them accountable and be the source of current information. SDCMS continues to send out its e-newsletter, “News You Can Use” (to SDCMS members only), with the lat-est information. Members got answers to these 14 key problems:

1. I can’t get through to Palmetto GBA’s call center. When I do get through, I’m on hold for a long time.

2. Palmetto now has a message that al-lows us to go to voicemail and leave a request for a return call. It says we will get a call back within 24 to 48 hours. It has been two days, and I have not yet received a call.

3. I am trying to get a status of my en-rollment application. Who do I call?

4. How do I get the status of my claims?

5. How do I know if checks have been issued, and how much is approved to pay once the payment floors have been reached?

6. I submitted my application to NHIC, and it still has not been completed. I am not getting paid.

7. How long will it take my enrollment application to be completed once I


By Joseph e. scherger, mD, mpHeditor’s Column

Why you Need SdCMS aNd CMa

Palmetto and Other Problems


submit it to Palmetto?8. I still have not received my submitter

password. I was previously submit-ting claims electronically to NHIC, so I am not new.

9. I am a new submitter to EDI. How long will it take for me to get my submitter number and password?

10. All of a sudden my claims are reject-ing under message Y1C. Why?

11. How can I find out what issues Pal-metto has had with the transition?

12. I haven’t been paid since Palmetto took over.

13. I am getting denial or rejects for services (procedure codes/modifier invalid) that NHIC used to pay. Why?

14. My claims were going through with my NPI and PTAN before transi-tion, and now they are not. Why?

But dealing with Palmetto GBA is only one small reason to be a member of SDC-MS and CMA. Any practice management concern is addressed to Marisol Gonzalez, your full-time SDCMS physician advo-cate. Marisol’s job is to help physicians suc-ceed in practice. No expensive consulting fees. You and your staff may call as often as you like, and the service is concierge.

Your San Diego County delegation to the recent CMA House of Delegates (HOD) again demonstrated that we are the best county in California for organized

medicine. Led by Encinitas physician Jim Hay, the HOD spent three days address-ing every conceivable issue facing medical practice. San Diego County physicians demonstrated reason and calm in the face of higher emotions elsewhere. We are the problem solvers and peacemakers, while still being innovative with issues such as soccer head protection and membership. We shined by having the highest voluntary participation in CAL-PAC, CMA’s politi-cal action committee.

Every year, about 3,000 bills are in-troduced into the California Legislature. CMA looks at all of them and addresses every one that is health related in great detail. Every year there is a bunch of bills from psychologists, nurses, podiatrists, optometrists, chiropractors, and every

other nonphysician provider seeking to expand their scope of practice into practic-ing medicine. Every year CMA’s lobbying team beats these off. Frequently, these bills have strong personal interest among legis-lators, who learn the power of CMA.

The centerpiece of California law for physicians is the MICRA protections of li-ability abuse. We continue to have afford-able liability insurance in this expensive and litigious state due to MICRA. CMA is the wall of defense of MICRA, and every year the trial lawyers test its strength. We know the position on MICRA of every state legislator, and if it is not on our side, we help take them out of office whenever possible.

These are just some of the things your dues dollars are doing for you. SDCMS and CMA are a small investment com-pared with all the savings organized medi-cine provides to physicians in all practices, small, medium, and large. The discounts on various services alone more than pay for the dues. The work in Sacramento and with Palmetto is extra money in your pocket.

This is December, and if you have not done so already, go to www.SDCMS.org and pay your 2009 dues. We are “Physi-cians United for a Healthy San Diego.”

aBOut tHe autHOr: Dr. Scherger is clinical professor of family medicine at UCSD. He is also medical director of AmeriChoice, which administers San Di-ego County Medical Services. Dr. Scherg-er, along with editing San Diego Physician, is chair of the SDCMS Communications Committee.

suCCess story #1: Right af-ter the transition from NHIC to Palmetto, one of our member hematology oncology groups began to have “delay of pay-ment” reimbursement issues with Palmetto. This delay of payment had a severe impact on their practice, and they were worried that they were going to be forced to admit patients to a hospital for treatment as it became increasingly cost-prohibitive to provide the care they needed in their office.

SDCMS and CMA were able to review the check amounts with Palmetto, including those claims that were to be released after the 14-day payment floor (CMS mandatory hold). We were able to get this practice’s claims released for payment, as well as provide them with the status of their “pending amounts” (claims that need to be manually processed and are within the required payment period).

suCCess story #2: A solo member physician was hav-ing difficulty getting his en-rollment application through Palmetto’s system. He had submitted his application long before the intermediary tran-sition. His billing company wasn’t able to begin billing for him due to this problem. After several unsuccessful attempts to get a status on his applica-tion with Palmetto’s provider enrollment, he called SDCMS for assistance.

SDCMS and CMA were able to get his enrollment application expedited through Palmetto’s system. The billing company is now successfully billing claims for this physician.

SdCMS PalMetto SuCCeSS StorieS

Every year, about 3,000 bills are introduced

into the California Legislature. CMA looks

at all of them and addresses every one

that is health related in great detail.

CMA is the wall of defense of MICRA,

and every year the trial lawyers test its strength.

diagnosis and trEatmEnt of vitamin d dEfiCiEnCy sEminarDec. 2 at the Liebow Auditorium, UCSD. Visit http://grassrootshealth.org/events/seminars.php.

2008 uPdatE in rHEumatologyDec. 6 at the Rebecca and John Moores UCSD Cancer Center, Goldberg Auditorium. Visit http://cme.ucsd.edu/rheumatology/index.html.

anEstHEsia uPdatE 2009State-of-the-art elements in all the anesthesia subspecialties and important new problems and their solutions. Jan. 14–17 at the Kona Kai Resort, San Diego. Visit http://anes-som.ucsd.edu/up-date1.htm.

natural suPPlEmEnts:an EvidEnCE-BasEd uPdatEPractical information for healthcare profession-als who make nutritional recommendations or manage dietary supplement use. Jan. 22-25 at the Paradise Point Resort and Spa, San Diego. Contact (858) 652-5486 or [email protected].

mElanoma 2009: 19tH annual CutanEous malignanCy uPdatEDesigned for healthcare professionals with an in-terest in, and basic understanding of, skin cancer. Jan. 24 at the Omni San Diego. Contact (858) 652-5486 or [email protected].

uPdatE in urology 2008Physicians in the field of oncology, surgery, and urology encouraged to attend this informational conference. Feb. 20–21 at The Lodge at Torrey Pines, La Jolla. Visit http://cme.ucsd.edu/events.cfm for details.

wEst Coast gEriatriC PsyCHiatry ConfErEnCEUp-to-date, clinically relevant information to assist psychiatrists, primary care physicians, and

other health professionals in delivering quality care for the older person. Feb. 25–28 at the Catamaran Resort Hotel. Visit http://cme.ucsd.edu/geriatricpsych.

tHE futurE of gEnomiC mEdiCinE iiExamines the salient progress and challenges in the field of genomics. Feb. 27–28 at the Neurosci-ences Institute Auditorium, Scripps Research Institute, La Jolla. Contact (858) 652-5486 or [email protected].

toPiCs and advanCEs in intErnal mEdiCinETopics include neoplastic diseases, rheumatol-ogy, geriatrics, infectious diseases, and hospital medicine, among others. Mar. 5–11 at the Hilton San Diego Resort. Visit http://cme.ucsd.edu/internalmed/index2.html.

PErCutanEous CatHEtEr aBlation of atrial fiBrillationDirected at those interested in incorporating percutaneous catheter ablation into their clinical management of patients with atrial fibrillation. Mar. 7 at the Hilton La Jolla Torrey Pines. Contact (858) 652-5400 or [email protected].

advanCEs in tHE nEuroPsyCHologiCal assEsmEnt and trEatmEnt of sCHool-agEd CHildrEn witH CognitivE dEfiCitsPresentation of the latest findings on the assess-ment and remediation of cognitive and behavioral impairments in school-aged children. Apr. 2–5 at the Hilton San Diego Resort. Visit http://cme.ucsd.edu/neuro.

2nd annual suddEn CardiaC arrEst Apr. 25–26 at the Hilton San Diego Resort. Visit www.scripps.org/health-education.

amEriCan oCCuPational HEaltH ConfErEnCE 2009Topics include occupational medicine/research, infectious disease, toxicology, workers’ compensa-

tion, ergonomics, and environmental pollution. Apr. 26–29 at the Manchester Hyatt Hotel in San Diego. Visit www.acoem.org.

EssEntial toPiCs in PEdiatriCs 2009May 14-15 at the Catamaran Resort Hotel. Visit http://cme.ucsd.edu/events.cfm.

2009 amEriCan tHoraCiC soCiEty intErnational ConfErEnCEEducational program for clinicians and research-ers in adult and pediatric pulmonary, critical care, and sleep medicine. Sample a broad spectrum of topics or concentrate on critical care, sleep, allergy/immunology or other specialties related to respiratory medicine. May 15–20. Visit www.thoracic.org.

alzHEimEr’s disEasE: uPdatE on rEsEarCH, trEatmEnt, and CarEMay 21–22 at the Omni San Diego Hotel. Visit http://cme.ucsd.edu/events.cfm.

rivErsidE County mEdiCal assoCiation: 5tH annual “Cruisin’ tHru CmE” (EastErn mEditErranEan)Jul. 6–17. Call (800) 745-7545.

20tH annual Coronary intErvEntionsOct. 28–30 at the Hilton La Jolla Torrey Pines. Visit www.scripps.org/health-education.


Community Healthcare Calendar

to submit a community healthcare event for possible

publication, email [email protected].

all events should be physician-focused and should take place

in san diego County.


Alliant_SD Physician_08:Layout 1 11/12/08 11:30 AM Page 1

Lauren Wendler, your SDCMS office manager advocate, is on staff and ready to help your office manager with any questions he or she may have. Feel free to contact Lauren at (858) 300-2782 or at [email protected] for help.

DOes YOuR OFFICe MANAgeR HAVe A QuesTION TOO?


QuEstion: i have a patient who happens to be a physician and who is medicare insured. Can

i extend a professional courtesy to them for services?Answer: Under federal law, “profession-al courtesy” is broadly defined as “the provision of free or discounted health-care items or services to a physician, his or her immediate family members, or office staff.” That said, professional courtesy offered by an entity (such as a solo practice, partnership, or medical

corporation) to a physician, a physician’s immediate family member, or physi-cian’s office staff would not constitute an improper referral under the federal prohibition if the following six require-ments were met:1. The professional courtesy is offered

to all physicians on the entity’s bona fide medical staff (i.e., physi-cian recipient’s office staff) or the entity’s local community or service area without regard to the volume of referrals or other business generated

between the parties;2. The professional courtesy includes

only those services regularly offered by the practice;

3. The professional courtesy policy is set out in writing and approved in advance by the entity’s governing body;

4. The professional courtesy is not of-fered to a physician (or immediate family member) who is a federal healthcare program beneficiary, un-less there has been a good-faith showing of financial need (presum-ably this requirement also includes office staff); and

5. The arrangement does not violate the anti-kickback statute or any federal or state law or regulation governing billing or claims submission.

It is very difficult for physicians to provide any professional courtesy ser-vices to a physician-patient who is a Medicare beneficiary without violat-ing the law. For further information on this topic, SDCMS member physicians may obtain CMA ON-CALL document #0624, “Professional Courtesy,” free of charge from the San Diego County Medical Society.

QuEstion: a patient of mine has stopped taking their medication, and, due to some

violent history in their past, they may be a threat to their family. i want to warn the family of this, but the patient has not allowed me to do so. what can i do?

Answer: According to CMA ON-CALL document #0815, “Physician’s Duty to Warn,” in Tarasoff V. Regents of the UC (1976), the California Supreme Court held that when a psychothera-pist determines, or,

• Professional Courtesy • • threateNiNg PatieNtS • • License Renewal •

ask Your physician advocateBy marisol Gonzalez

Your Physician Advocate Has the Answers!


A P R O F E S S I O N A L L AW C O R P O R AT I O N

Rosenberg, Shpall& Associates, APLC

If your medical license or privileges are on the line…

Members Of The Firm: David Rosenberg, J.D. Tomas A. Shpall, J.D.Annette Farnaes, J.D.

Steven H. Zeigen, J.D.Corey Marco, M.D, J.D.Jason L. Nienberg, J.D.

Amy C. Lea, J.D.

Wells Fargo Bank Plaza

401 “B” Street, Suite 2209

San Diego, California 92101

Telephone: (619) 232-1826

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• More than 50 years of combined experience inMedical License/Hospital Privilege Disputes

• Medical Board accusations• Hospital privilege disputes• Wrongful termination• Civil actions/Independent counsel for medical

malpractice claims• Provider Membership Disputes/Exclusion• Medical Corporations/Partnership

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Rosenberg, Spall_SD Phy(1)_508:Layout 1 6/10/08 3:21 PM Page 1

in accordance with the standard of care, should determine that a patient presents a serious danger of violence to another person, the psychotherapist has a duty to use reasonable care to protect the in-tended victim from the danger. Other healthcare providers are similarly sub-ject to certain duties to warn and pro-tect. This ON-CALL document goes on to talk about these instances as well as other situations. Physician members can contact the San Diego County Medical Society to obtain this ON-CALL docu-ment free of charge.

QuEstion: my medical license has expired, and i was never notified by the medical Board

of California. what can i do?Answer: The license to practice medicine in California must be renewed every two years. It is illegal to practice medicine with an expired license. The license ex-pires at midnight of the expiration date, which is the last day of the physician’s birth month. To renew a license, the physician must apply on or before the expiration date. The renewal must be on the Medical Board’s renewal form and must include the current renewal fee. Please allow 4–8 weeks for processing. If a renewal notice is not received, the license must still be renewed before the expiration date on the license.

If you have not submitted your re-newal notice within two weeks of the expiration date, you may submit it to the following address:

Medical Board of California2005 Evergreen Street, Suite 1200Sacramento, CA 95815(916) 263-2637You may also renew online at www.

mbc.ca.gov — click on the “Licensees” tab then scroll down and click on the “License Renewal” hyperlink.

aBOut tHe autHOr: Ms. Gon-zalez is your SDCMS physician advocate. She can be reached at (858) 300-2783 or at [email protected] with any questions you may have about your prac-tice or your membership.

Allscripts is pleased to announce that it will offer preferred pricing to SDCMS members on the award winning Allscripts Professional Practice Management and Electronic Health Records solution. This integrated PM and EHR solution offers state of the art technology that includes:

For more information please contact Jamie Smolin at 619.955.6929 or at [email protected]. Visit us online at www.allscripts.com

Announcing Allscripts as a Preferred Vendor of the San Diego County Medical Society

Allscripts_SDP_08:Layout 1 10/15/08 11:54 AM Page 1

Dec

em

be

r s

tats


Noted

I t is easy to ignore the need to plan ahead for emergencies, but you are putting your patients and your staff

at risk when there has been no prepara-tion to handle these challenging events.

Chances are, upon close inspection of your offices, you will discover there are certain areas — whether it is equipment, supplies, or training — that could use improvements. While it is neither pos-sible to anticipate every contingency nor practical and affordable to put every con-ceivable precautionary measure in place, it takes relatively little time and effort to predict the most likely problems and in-stitute basic reaction plans.

Ask yourself the following questions: Are you and your staff ready to respond quickly and efficiently if a child collapses in your waiting room? What would you do if a patient undergoing a routine pro-

cedure went into cardiac arrest? When was the last time your office carried out a fire drill, or even discussed what to do in case of fire?

Untoward events take many different forms, but a uniform basic approach can be used to plan for all of them. Consider the following steps:

• Identify potential crises.• Decide which to prepare for.• Develop basic contingency plans.• Procure needed resources.• Train staff to carry out the plans and

reinforce the training with periodic drills.

Always remember: If an unexpected event involves injuries to patients or staff members, the immediate priority and focus should be on clinically treat-ing and emotionally supporting those individuals.

rIsk tIpEmergencies: Are You Prepared?

By the Doctors Company

Briefly

One in seven (14%) Americans report that they “saw” and “used” comparative health quality information for health insurance plans, hospitals, or doctors in the past year … down from roughly one in five in both 2006 (20%) and 2004 (19%).

— Kaiser Family Foundation 2008 Update on Consumers’ Views of Patient Safety and Quality Information


Humana_SDP_1008:Layout 1 9/22/08 11:07 AM Page 1

Dec

em

be

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uo

te

s

”“The holiest of holidays are those kept by ourselves

in silence and apart; the secret

anniversaries of the heart.

— HENRy WADSWORTH LONGFELLOW, AMERICAN POET (1807–1882)

”“In the depth

of winter, I finally learned

that within me there lay an invincible

summer. — ALBERT CAMUS, FRENCH AUTHOR,

PHILOSOPHER, JOURNALIST, AND 1957 NOBEL PRIzE LAUREATE (1913–1960)

”“Adversity draws

men together and produces beauty and

harmony in life’s relationships, just

as the cold of winter produces

ice flowers on the windowpanes,

which vanish with the warmth.— SOREN KIERKEGAARD,

DANISH PHILOSOPHER AND THEOLOGIAN (1813–1855)


NotedBriefly

For access orange County and Project access san diego Work

Daniel “stony” anderson, mD, receives Volunteer award

Daniel S. Anderson, MD, re-ceived the Volunteer Award at the inaugural Molina Health-

care of California Community Cham-pions Awards dinner. Dr. Anderson was among 10 of San Diego’s unsung heroes who were honored at the event.

Molina Health-care Commu-nity Champions Awards was created in 2006 to recog-nize individuals in the community who inspire others through selfless-ness and extraordi-nary service. Each year, Community Champions are nominated by com-munity-based orga-nizations and cel-ebrated at a dinner in honor of Molina Healthcare’s physi-cian founder, C. David Molina, MD. “The champions all share a common vision: to help those in our community who are the most vulnerable,” said Lisa Rubino, president of Molina Healthcare of California.

Dr. Anderson, a gastroenterologist, a retired partner of Southern California Permanente Medical Group, and a re-tired member of the San Diego County Medical Society (SDCMS), remains ac-

tive as a volunteer in the community and as a champion for safety-net patients and for access to specialty care.

As a leader in the San Diego County Medical Society Foundation (SDC-MSF), he has been instrumental in implementing Project Access San Diego

and the county’s first Surgery Day, to be held December 6, 2008. SDCMSF is partnering with Kaiser Permanente to provide up to 20 free surgeries for San Diego County patients who do not have health in-surance and who fall within 250 per-cent of the federal poverty level. Dr. Anderson’s passion and collaboration will enable pre-screened, indigent

patients to receive services that they might not otherwise be able to afford.

As the Volunteer Award winner for the Molina Healthcare Champions, Dr. Anderson received a check for $1,000 to be donated to the charity of his choice. SDCMSF would like to thank Dr. An-derson for donating his award to the Foundation in support of its Project Ac-cess San Diego. Congratulations!


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Personal:• Income Tax Planning• Wealth Management

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CPA’s and Consultants

AKT_SDP_08:Layout 1 8/22/08 3:52 PM Page 1

James V. Dunford, MD, board president of the San Diego Di-vision of the American Heart

Association, has been honored as the American Heart Association’s 2008 Physician Volunteer of the Year, an award that honors the physician vol-unteer who demonstrates the most dis-

tinguished commitment to the mission of the American Heart Association and who shows outstanding achievement in advancing the objectives of the Western States Affiliate during the year and over time.

Dr. Dunford is a leading advocate for improving patient quality of care. His work is most evident through his lo-cal leadership as a STEMI and Stroke Champion, including his involvement with the ST Elevation Heart Attack (STEMI) Medical Oversight Commit-tee and the San Diego County Stroke Committee that is nearing the rollout of improved stroke destination protocols.

“The thing I am most proud of is our

work in building teams that have suc-cessfully translated cutting-edge scien-tific advances in heart attack, stroke, and cardiac arrest into everyday care here in San Diego,” Dr. Dunford said when notified of the honor. “The American Heart Association has helped me real-ize a regional cardiac receiving system for STEMI, a regional public access to defibrillation program for cardiac ar-

rests, and a soon-to-be regional stroke system,” he explained, adding, “In turn, these regional successes have been am-plified to the state level where our best local practices are now being emulated.”

Dr. Dunford is medical director for the City of San Diego, a UCSD emer-gency physician, and longtime member of the San Diego County Medical Soci-ety. Congratulations, Dr. Dunford!

James Dunford, MD,

Honored as Physician

Volunteer of the Year

By the American Heart Association


neW members

rashad abdel-kader ansari, md• Rheumatology • Internal medicinevista, (760) 724-6100

kevin neil antonio, md• Internal medicineSan Diego, (858) 499-2703

akash bajaj, md• Pain medicine • AnesthesiologySan Diego, (858) 581-8255

lauren denise bales, md• Obstetrics and GynecologySan Diego, (858) 277-9378

Julie lynn barone, do• SurgerySan Diego

robert angelo bei, md• Emergency medicineSan Diego, (619) 287-3270

mark robert bell, md• Emergency medicineSan Diego, (619) 287-3270

ratana grace bhardwaj, md• Diagnostic RadiologySan Diego, (858) 454-4235

Jason Patrick bronner, md• Internal medicinela Jolla, (858) 657-6848

brian vuong tran Chu, md• PediatricsSan Diego, (619) 662-5122

Christina youngmo Chung, md• SurgerySan Diego

Jessica michelle Coullahan, md• PediatricsSan Diego, (858) 566-4444

gabriela moreno dilauro, md• Obstetrics and GynecologyEscondido, (760) 745-7060

luis aristides Fiallo, md• Internal medicine• Pulmonary Disease• Critical Care medicineChula vista, (619) 421-4000

amy Colleen French, md• Obstetrics and GynecologySan Diego, (858) 277-9378

Jonathan s. gallen, md• AnesthesiologyPoway, (858) 444-5781

Paulo guillinta, md• Internal medicine • Cardiovascular DiseaseSan Diego, (858) 939-6561

stephen bradford Hulse, md• Diagnostic RadiologySan Diego, (858) 454-4235

michael brian Jacobson, md• PediatricsEl Cajon, (619) 442-2560

david alexander kaminskas, md• Internal medicine • Cardiovascular Disease • NeurologyDel mar, (858) 353-6049

radmila kazanegra, md• Obstetrics and GynecologyEscondido, (760) 745-7060

katrina lynn kelly, md• Obstetrics and GynecologyEncinitas, (760) 753-5594

shafi m. khalid, md• Internal medicine • Geriatric medicine • Pain medicinePoway, (858) 485-7246

roya kohani, md• Internal medicinela Jolla, (858) 459-2040

Jan kulhanek, md• Internal medicine • Cardiovascular Diseasela Jolla, (858) 457-1234

Hiten k. lakhani, md• OphthalmologySan Diego, (858) 442-1634

thomas edward lawrie, md• Internal medicine • Pulmonary Disease • Critical Care medicineSan Diego, (858) 939-3366

lillian Catherine lee, md• OphthalmologyPoway, (858) 451-8600

agnes deborah letai, md• Emergency medicineSan Diego, (619) 287-3270

martin Wayne lunceford, do• General PracticeCamp Pendleton, (760) 763-1831

ronald James macCormick, md• Emergency medicineEncinitas, (760) 230-2252

Joel eduardo mata, md• AnesthesiologySan Diego, (858) 874-0033

John Paul mcHugh, md• Obstetrics and GynecologySan Diego, (619) 675-4071

Chetan amritlal mistry, md• PediatricsChula vista, (619) 426-7910

anthony Paul morocco, md• Emergency medicine • medical ToxicologySan Diego, (619) 287-3270

Joel david myers, do• SurgeryFallbrook, (760) 728-4597

david keith naugle, md• Diagnostic RadiologySan Diego, (858) 454-4235

rahul ramesh Patel, md• Diagnostic RadiologySan Diego, (858) 454-4235

sayjal Jitendra Patel, md• OphthalmologyCarlsbad, (619) 532-6702

tony Huy Pham, md• OphthalmologySan Diego, (619) 298-2733

Harold giovanni Pimenta, md• Diagnostic RadiologySan Diego, (858) 454-4235

valencia booth Porter, md• Public Health• General Preventive medicineCarlsbad, (760) 494-1600

ghazala amjad rehan, md• PsychiatryEncinitas, (760) 753-7341

sunny renee richley, md• Internal medicineSan Diego, (858) 288-7705

Parag r. sanghvi md• Radiation OncologySan Diego, (619) 230-0400

andrew ira schwartz, do• Family medicine • Osteo manipulative medicine • Sports medicineSan Diego

geoffrey Feher sternlieb, md• PsychiatrySan Diego, (619) 785-5943

Christopher William sterrett, md• Emergency medicineSan Diego, (619) 287-3270

Jo ann lee stewart, md• Internal medicine• Geriatric medicinela Jolla, (858) 554-6158

reza Hakimzadeh tirgari, md• Internal medicineSan Diego, (619) 287-3270

NotedBriefly

Welcome New and Rejoining SDCMS-CMA Members!


kelly leighanne van den Heuvel, md• Obstetrics and GynecologySan Diego, (619) 688-0770

timothy scott Watt, md• Emergency medicineSan Diego, (858) 939-3411

daniel ethan Zelac, md• Dermatologyla Jolla, (858) 764-3000

reJoining members

Faith H. barnett, md• Neurological Surgeryla Jolla, (858) 554-8920

enrique espinosa-melendez, md• Internal medicine • NephrologyNational City, (619) 477-7779

James robert Hemp, md• Cardiac Surgery• Thoracic and vascular SurgerySan Diego, (619) 297-5600

kevin michael kelly, md• Emergency medicineSan Diego, (619) 287-3270

Herbert Clifford kimmons, md• PediatricsSan Diego, (858) 966-8567

tom Christopher lian, md• PsychiatrySan Diego, (619) 220-8114

nathan arthur miller, md• Anesthesiology • Pain medicineCarlsbad, (760) 753-7127

Jonathan nissanoff, md• Orthopedic SurgeryPoway, (858) 451-2280

William J. Padilla, md• Family medicineChula vista, (619) 422-1324

Paul Jeffrey rickards, md• Diagnostic Radiology • vascular and Interventional RadiologySan Diego, (858) 454-4235

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Computers and effective com-puting are an integral part of any successful medical prac-

tice. Like any good tool, proper use of computers can greatly enhance business processes, while improper computing practices can adversely affect the overall well-being of any practice regardless of its size. This issue of San Diego Physician launches a new monthly column that

will analyze information technology, examine computing trends, and recom-mend best practices. We welcome your questions or comments at [email protected].

Windows 7, wryly named as such more for the historical sequence of Windows versions than for any brilliant marketing campaign, is out but only in “pre-beta

build” — an industry term that denotes “in testing” and not quite ready for com-mercial use. It was delivered to software developers and industry pundits at the 2008 Microsoft Professional Develop-ers Conference held at the Los Angeles Convention Center on October 27-30.

It is already having an impact on the information technology (IT) landscape.

Businesses of all sizes are eagerly awaiting more details about Windows 7 features, how it works with their exist-ing software applications, and what the hardware requirements will be.

With the less-than-favorable coverage on Windows Vista — known as Win-dows 6 — perception is larger than re-ality, leading observers to conclude that Microsoft wishes to release Windows 7 sooner rather than later. Rumored re-lease dates vary wildly, but knowledge-able sources hint at somewhere between the third quarter of 2009 and the first quarter of 2010. Interest is so high in Windows 7 that industry watchdogs like the Corporate IT Forum (TIF) re-port that more businesses are currently investigating or analyzing updating to Windows 7 (30 percent) rather than up-dating to Windows Vista (14 percent).

But wait, some of you just went out and outfitted your offices with Win-dows Vista. You were told that your older hardware did not have sufficient horsepower to handle Vista and that you needed all new equipment, which you faithfully went out and purchased.

And now Windows 7 will be out ... a new operating system so soon? How can that be?

Let’s go back in time, shall we? Mi-crosoft Windows XP — known as Windows 5 — was released in October 2001. You read right: seven years ago. Windows XP has gone through numer-ous patches and three service pack up-dates. It is a very stable operating system still in use by approximately 75 percent of businesses in the United States.

Windows Vista was released in Janu-ary 2007, which represents a five-year gap between operating system releases. It has also gone through numerous patches

technology matters


Xp5Vista6Windows7oR

Perception vs. Reality

By Ofer shimrat

and one service pack update. With new hardware, it is a stable operating sys-tem currently in use by approximately 10 percent of businesses in the United States.

In other words, Microsoft’s seven-year old operating system is in use by 75 percent of businesses, and its two-year-old operating system is in use by only 10 percent of businesses — not what you would call an enthusiastic adoption rate.

The slow Vista adoption rate has caused Microsoft to vow that there will never again be so lengthy a gap between its operating system versions.

My take is that Windows XP has been around long enough and is stable enough that the slow Vista adoption rate has more to do with the lack of business requirement to move to Vista than any pre-defined artificial gap between oper-ating systems. You and I know that, but Microsoft wants to “fix” that with its

early release of Windows 7.But as “fixes” go, this is a good fix.

Based on all the fanfare at the Octo-ber Microsoft Professional Developers Conference, Windows 7 promises to be faster, simpler, and easier to implement. Good news for all of us.

The bottom line:• Those of you still utilizing Windows

XP should consider skipping Win-dows Vista entirely and continue to amortize your existing hardware. Then switch to all new equipment and systems once Windows 7 ar-rives.

• Those of you who recently made the new hardware investments for Win-dows Vista should stay put since an upcoming service pack 2 will fur-ther improve on core functions and speed.

Then there are those of you on the cut-ting edge that will want to stand in line until midnight and purchase Windows

7 as soon as it is released in a store near you. As I am a beta tester, I will probably be analyzing Windows 8. So I may not be in line with you.

aBOut tHe autHOr: Mr. Shimrat is founder and CEO of Soundoff Computing Corporation, a consultancy specializing in IT products and services. Originally an applications developer, he brings database methodology approaches to network implementations. Mr. Shimrat combines practical experience as a thrice business owner with best practices in pro-viding organizations with needs analy-sis, business logistics, IT infrastructure, and proactive maintenance. Visit www.soundoffcomputing.com or reach Ofer at (858) 569-0300.


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In much of the United States, in-fluenza season is again underway. The Centers for Disease Control

and Prevention (CDC) estimates that every year 5–20 percent of the U.S. population gets this very contagious and potentially life-threatening illness. Influ-enza can worsen chronic heart disease, lung disease, and diabetes, and can lead to bacterial or viral pneumonia. CDC estimates that as many as 200,000 per-sons will be hospitalized because of flu-related complications, and up to 36,000 people will die from flu.

influenza vaccine as Primary tactic to reduce influenza incidenceYearly influenza vaccination is the best way to help protect against this disease. Influenza vaccine is recommended to all persons who want to reduce the risk of becoming ill with influenza or of trans-

mitting influenza to others. Up to 146 million doses of vaccine will be available from currently licensed manufacturers in the United States, so plenty of vaccine will be available this influenza season.

The groups for which vaccination with inactivated influenza vaccine (TIV) is recommended are listed below:

• all persons aged ≥50 years;• all children aged ≥6 months to 18

years of age (new recommenda-tion this year); (Children aged 6 months–8 years who have not been vaccinated with influenza vaccine or only received one dose previously have special recommendations. Please see MMWR Recommendations and Reports, Aug. 8, 2008: Preven-tion and Control of Influenza, Vol. 57, RR-7, pp. 26–27 for the current recommendations.);

• women who will be pregnant dur-

ing the influenza season (NOTE: California law prohibits flu vaccine with >1mcg mercury per 0.5mL for pregnant women or children under 3 years old);

• children and adolescents (aged 6 months–18 years) who are receiv-ing long-term aspirin therapy and, therefore, might be at risk for Reye syndrome after influenza infection;

• adults and children who have chron-ic pulmonary (including asthma), cardiovascular (except hyperten-sion), renal, hepatic, hematological, or metabolic disorders (including diabetes mellitus);

• adults and children who have im-munosuppression (including immu-nosuppression caused by medica-tions or HIV);

• adults and children who have any condition (e.g., cognitive dysfunc-

From the County public Health Officer

FLuVaccineHand Washing AND

Complementary Tactics in the Fight Against Influenza

By Harrison Bolter


tion, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise re-spiratory function or the handling of respiratory secretions, or that can increase the risk for aspiration; and,

• residents of nursing homes and oth-er chronic-care facilities.

To prevent transmission to persons identified above, vaccination with TIV or LAIV (live, attenuated influenza vac-cine) also is recommended for the fol-lowing persons:

• healthy household contacts (includ-ing children) and caregivers of chil-dren aged <5 years and adults aged ≥50 years, with particular emphasis on vaccinating contacts of children aged <6 months; and

• healthy household contacts (includ-ing children) and caregivers of per-sons with medical conditions that put them at higher risk for severe complications from influenza.

All healthcare professionals (HCPs), as well as those in training for healthcare professions, should be vaccinated annu-ally against influenza. This includes:

• physicians, nurses, and other work-ers in both hospital and outpatient-care settings;

• medical emergency response work-ers (e.g., paramedics and emergency medical technicians); and

• employees of nursing home and chronic care facilities who have con-tact with patients or residents.

HCPs are asked to remind their pa-tients that the flu season often lasts until spring, and therefore getting immunized against the flu in December, January, or later is not too late. And, as indicated above, vaccine supply is not an issue this year.

Both inactivated influenza vaccine (TIV) and live attenuated influenza vaccine (LAIV) are contraindicated in persons with life-threatening allergies to eggs, severe allergy to any vaccine

component, or who have had a severe reaction to a previous dose, including Guillain-Barre Syndrome of influenza vaccine. Additionally, the LAIV (nasal spray) should only be given to healthy persons 2–49 years of age who are not pregnant.

There are a number of myths about the flu vaccine that providers are en-couraged to dispel. Three of the most common are:

1. The vaccine causes illness;2. The patient feels he or she is not at

risk for influenza; and3. The vaccine doesn’t work.Each of these myths can be debunked

with facts.1. Influenza vaccine, made either

with killed (TIV) or weakened live (LAIV) influenza virus, is unable to cause significant illness. Any illness that follows influenza immuniza-tion is either not influenza (many other respiratory diseases are circu-lating among the population at any given time) or a different strain of influenza not contained in the vac-cine.

2. Influenza is highly contagious, and the CDC estimates that every year, between 5 and 20 percent of the U.S. population becomes ill with it. Many of those who get influenza are otherwise healthy people, not frail or chronically ill. Tens of mil-lions of people get sick each year from influenza.

3. The vaccine has been intensively studied and is effective in prevent-ing influenza in most people, or at least greatly reducing its severity. Even some protection against in-fluenza is better than no protection at all.

Proper Hand Hygiene is a Complementary tacticThe practice of hand washing (hand hy-giene) is another simple but powerful tac-tic to help control the spread of flu and other contagious diseases, not just during flu season, but all year long.

December 7–13, 2008, is National Hand Washing Awareness Week (an ob-servance to encourage hand washing in promoting health and preventing disease) and a good time to emphasize the im-

portance of hand washing as a tool in flu prevention campaigns. Thorough hand washing, done regularly with plenty of soap and warm water, can help reduce the spread of contagious diseases such as in-fluenza, as well as colds, hepatitis A, men-ingitis, and norovirus. Hand washing can also play an important role in maintaining overall good health, especially when com-bined with other behaviors such as getting enough sleep; exercising regularly; and eat-ing a healthy, balanced diet with plenty of fresh fruits and vegetables.

Unfortunately, observation indicates that hand washing may not be as widely practiced as it should be. In a 2005 sur-vey (sponsored by the American Society for Microbiology and the Soap and De-tergent Association), 91 percent of adults said they always wash their hands after using public restrooms; however, just 83 percent were observed doing so. The sur-vey reported that Americans who said they “always wash their hands” after using the bathroom in their home (83 percent) and before handling or eating foods (77 percent) was reported. However, smaller percentages of Americans always wash af-ter petting a dog or cat (42 percent), after coughing or sneezing (32 percent), or after handling money (21 percent).

It is estimated that some bacteria and viruses can live from up to 20 minutes to two hours or more on surfaces like door-knobs, desks, and cafeteria tables. The log-ical conclusion is that poor hand washing (or a lack of hand washing) plays a factor in the spread of contagious diseases like in-fluenza and others.

Hand washing is most effective at reduc-ing the chances of getting and spreading disease if it is done properly and often — especially after using the restroom, before preparing food and eating, and anytime the hands get dirty. The following are tips physicians and other health professionals

From the County public Health Officer

It is estimated that that some bacteria and viruses

can live from up to 20 minutes to two hours or

more on surfaces like doorknobs, desks, and

cafeteria tables.

Influenza A (H3N2) viruses, which have been associated with higher

mortality, predominated in 90 percent of influenza

seasons during 1990–1999, compared with 57

percent of seasons during 1976–1990.


can use to inform their patients about prop-er and thorough hand washing and related prevention steps:

1. Wet hands with warm running water.2. Apply liquid or clean bar soap.3. Away from the running water, rub

hands together vigorously and make a soapy lather. Scrub all surfaces — the front, the back, between the fingers, under your fingernails, and around the wrists. Take about 15–20 seconds; a fast splashing does not remove germs.

4. The soap and scrubbing action dis-lodges the germs.

5. Rinse well under warm running water to remove the germs and dry hands with a clean towel. Turn off the water with a paper towel.

6. The paper towel should be thrown in a wastebasket when finished.

7. Keep your hands away from your eyes, nose, and mouth.

8. Avoid touching surfaces that are con-stantly being touched by others.

If soap and running water are not avail-able, hand-wash gels containing at least 60 percent alcohol significantly reduce the numbers of germs on skin and are fast-acting. Some hand-wash gels also contain ingredients to moisturize the skin.

Adults and children should be advised not to sneeze or cough into their bare hands, but to use a tissue (and dispose of it immediately) or their sleeve, whenever

possible, and to avoid putting their fingers into their eyes, nose, or mouth.

Healthcare professionals as well as the general public benefit from proper and frequent hand washing. Studies have shown that proper hand washing (hand hygiene) is the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of healthcare-asso-ciated infections. However, research also has shown that hand hygiene practices in healthcare personnel may be less than op-timal. A 2004 Annals of Internal Medicine

Yearly influenza vaccination is

best way to help protect against

this disease.


article indicated that physicians’ adherence to hand hygiene was low in most hospitals. Developing a positive attitude about hand hygiene by healthcare staff is important to promote these behaviors in patients.

Increased acceptance and use of influ-enza immunization, in combination with proper hand washing technique, gives communities the potential to prevent transmission of influenza and reduce mor-

bidity and mortality for those at highest risk of complications from the disease.

aBOut tHe autHOr: Mr. Bolter is the health information specialist for the County of San Diego Health and Human Services Agency’s Immunization Branch.

Kindred_Physician_Dec08:Layout 3 11/19/07 3:16 PM Page 1

San DiegoCounty Statistics

• Rates of serious illness and death from influenza and its complica-tions are highest among persons aged ≥65 years, children aged <2 years, and persons of any age who have medical conditions that place them at increased risk for compli-cations of influenza (1).

• Influenza A (H3N2) viruses, which have been associated with higher mortality, predominated in 90 percent of influenza seasons during 1990–1999, compared with 57 percent of seasons during 1976–1990 (2).

To request additional health sta-tistics describing health behaviors, diseases, and injuries for specific populations, health trends and comparisons to national targets, please call the County’s Commu-nity Health Statistics Unit at (619) 285-6479. To access the latest data and data links, including the Com-munity Regional Profiles, go to www.sdhealthstatistics.com.

References:1. CDC, MMWR Recommendations and Reports, Vol. 56, RR-6, Prevention and Control of Influenza, Recommendations of the Advisory Committee on Immuniza-tion Practices (ACIP), 2007, pp. 1–2.2. Ibid., p. 5.


my love of history, and in particular military history, started as a serving naval

officer. Why, I asked, is success routine for some organizations and failure rou-tine for others?

I recently read a very detailed analysis of the Battle of Midway, one of the most important naval battles in both U.S. and Japanese histories. The Battle of Mid-way, which was fought in the early days of June 1942, occurred at a time when Japan, with its superior naval capacities, could choose when and where to attack. They decided to attack the Midway atoll, the next step on their way to Hawaii. The Japanese invasion fleet was escorted by

the cream of their carrier aviation. The Americans, forewarned by cryptologists’ breakthroughs, surprised and ambushed the Japanese fleet, and thereby stopped the domination of the Japanese Navy. After Midway, the two opposing fleets were essentially equals, and the United States soon took the offensive.

The authors examined the battle strict-ly from the perspective of the Japanese. Though they did provide fascinating de-tails, the authors focused their analysis on a fundamental question: Why was an organization, i.e., the Imperial Japanese Navy, which, after Pearl Harbor, ran un-checked the length and breadth of the Pacific and Indian oceans, defeated so

soundly in a battle they should not have lost? Why did the Japanese lose all four of their large flattops, while the Ameri-cans lost only one of their three aircraft carriers?

As physicians — and almost all of our readers are — you’re probably asking yourself why in the heck this is relevant to you. I want you to think about three principles when you are faced with diffi-cult decisions in your practices: the prin-ciples of learn, anticipate, and adapt.

learn From tHe PastThose who do not understand and learn from history are doomed to repeat it — a principle as applicable in medicine as it is in business, warfare, and politics. But the principle demands more than rote memorization of the events of the past. The seeds of defeat (and victory) are often planted many, many years in the past, when an organization or an indi-vidual learns the wrong (or right) lessons based on an honest and thoughtful as-sessment of what went wrong and what went right. Physicians are taught this kind of thinking, sometimes brutally, at morbidity and mortality conferences. I would suggest that you take this concept outside of the hospital, the operating room, and the exam room, and apply it in your daily decisions and strategic thinking. What did I learn from this mistake? What went wrong with this contract? Why? Why? Why?

antiCiPate tHe FutureRegretfully, life does not come with a crystal ball. However, an honest and forthright assessment of future possibili-ties is mandatory for an organization as well as for an individual. This is really about creating a spectrum of options for the future, assessing relative probabilities and risks to these possibilities, and then planning for the likeliest and/or riskiest of these possibilities. One cannot plan for everything, but only a fool assumes that his competitors (or enemies) will do what he thinks they should. In the late ’80s, many physicians hopped on board the managed-care bandwagon, hoping (wrongly as it turned out) that signing

On Leadership

By tom Gehring

LeARN, (about the past) ANtiCiPAte, (the future) AND ADAPt (in the present)PrinCiPles to lead by


contracts that reduced rates in exchange for volume would not turn into a finan-cial death spiral. The Japanese Navy, in the early summer of 1942, planned to take Midway, having assumed that the three remaining American carriers in the Pacific would be nowhere to be found. Interestingly, during the Japanese pre-battle war game, the officers assigned to emulate the Americans performed ex-actly as the Americans did one month later. The Japanese admiral supervising the war game deliberately and blatantly disregarded this harbinger of disaster. Likewise, many of the people who work for you, if allowed to speak up, will point out that perhaps your rosy vision of the future is disconnected from reality.

adaPt to CHanges in tHe PresentMy father was fond of quoting Carl von Clausewitz, the early nineteenth cen-

tury Prussian military thinker, who said (paraphrasing) that no plan ever survives first contact with the enemy. Even if you learned your lesson from the past, even if you properly anticipated the future, you still need to recognize that you have to change your plans based on the reality of the moment, not the wishful thinking that went into these plans. Physicians are trained to do this, and this is one of the great strengths of a doctor in a clinical environment. However, in business or political environments, physicians must become as fluid in adapting to different realities as they are in adapting in the operating room.

On June 4, 1942, no one in the Japa-nese leadership noted that the torpedo bombers swarming their fleet could only be carried on American flattops, thereby disproving the underlying assumption of no American carriers. The Japanese plans continued to operate as though

there were no American carriers nearby. If you’re paying attention to even the subtlest signals that tell you your plan isn’t, in fact, as effective as you thought, then you can and should change it — adapt to current realities.

Think about, analyze, and learn from the past. Anticipate what the future could look like, develop your plans ac-cordingly, and be ready to change those plans when things don’t turn out exactly the way you thought they might.

aBOut tHe autHOr: Mr. Geh-ring is CEO and executive director of the San Diego County Medical Society (SD-CMS).

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your sdCms suPPort team

SDCMS MEMBERS-ONLy BENEFITS

We're Here to Help!tom GehringChief Executive Officer Executive Director

T: (858) 565-8597 (desk)T: (619) 206-8282 (cell)F: (858) 569-1334W: [email protected] Tom should you have

questions about what SDCMS is doing locally, in Sacramen-to, and in Washington, DC, on the political advocacy front, or if you have general questions, complaints, or concerns about what SDCMS is doing or can do for you as a San Diego County physician.

James BeaubeauxChief Operations Officer Chief Financial Officer

T: (858) 300-2788 (desk)T: (619) 851-1235 (cell)F: (858) 569-1334E: [email protected] James should you have questions

about SDCMS finances and operations.

Kyle LewisDirector of Communications and Marketing Managing Editor

T: (858) 300-2784 (desk)T: (619) 991-9242 (cell)F: (858) 569-1334E: [email protected]

Contact Kyle should you have questions about San Diego Physician magazine, SDCMS’ email newslet-ter (“News You Can Use”), SDCMS’ website, or our annual pictorial membership directory. Contact Kyle as well should you like to be contacted by San Diego County media for your expertise in certain medical issues, should you like to place a classified ad (free of charge for member physicians) or display ad (discounted for member physicians) in San Diego Physician magazine.

Janet LockettDirector of Membership Development

T: (858) 300-2778F: (858) 569-1334E: [email protected] Janet should you have questions about your SDCMS membership benefits, as well as if you have ideas or suggestions as to how SDCMS can increase the value of your membership and thus serve you better.


Karen DotsonSpecialty Society Advocate

T: (858) 300-2787F: (858) 569-1334E: [email protected] Karen to learn how SDCMS can work with your spe-cialty society to lower operational costs through economies of scale.

your sdCms suPPort teamWe're Here to Help!

Marisol GonzalezDirector of Membership Operations and Physician Advocate

T: (858) 300-2783F: (858) 569-1334E: [email protected]

Contact Marisol should you have questions about your SDCMS membership status or dues, if you need to change or update your contact information, or if you need assistance with any political, legal, or economic advocacy issue you’re facing.

Jennipher ohmstedeDirector of Engagement

T: (858) 300-2781F: (858) 569-1334E: [email protected] Jen should you have questions about SDCMS committees and leadership, CMA councils and committees, SDCMS events, or how you can become more involved with your San Diego County Medical Society.

Lauren WendlerOffice Manager Advocate

T: (858) 300-2782F: (858) 569-1334E: [email protected] office manager can contact Lauren should they have questions about SDCMS’ regularly scheduled office manager forums, if they would like to sign up to receive the office manager e-newsletter, or should they need assistance with coding, billing, legal, compliance, or any other issue they are facing.

Dareen NasserOffice Manager

T: (858) 300-2786F: (858) 569-1334E: [email protected] Dareen to request a mailing list and labels, to receive SDCMS’ e-newsletter (“News You Can Use”), to order additional copies of the SDCMS

pictorial membership directory, or should you have any questions pertaining to SDCMS.



• Balance Billing• Pre-authorization for Diagnostic Testing• Economic Profiling and Pay-for-Performance• Payment for Services of Non-contracted Physicians• Disclosure of Health Insurance Payment Recipients • Support for Non-contracted Physicians • State Vaccine Registry Interfaces • Elimination of Medicare TAR Program • Medicare Part B Contractor Changes • Definition of Abortion and Access to Contraception• Internet Submission of Medicare Claims • Payor Fee Schedules and Medicare Rates• Performance of History and Physical by a Podiatrist• Scope of Practice in Licensed Health Facilities• MRSA Active Surveillance Testing• Influenza Vaccine Distribution• Disposal of Unused Pharmaceuticals• Full Payment for Medicare Recipients’ Care• Medi-Cal Managed Care Drug Coverage• Public Service Message on Impact of Medicare Cuts

Hundreds of California physicians convened in Sacramento this past October for the 2008 House of Delegates, the California Medical As-sociation’s annual meeting. Each year, physicians from all 53 Califor-

nia counties, representing all modes of practice, meet to discuss issues related to healthcare policy, medicine, and patient care.

The following is but a partial list of action priorities adopted by this year’s House, with “Balance Billing” receiving the highest priority. This partial list only hints at the breadth and depth of the nearly 100 issues that the member physicians of the California Medical Association will be actively addressing in 2009 in order to protect and defend all physicians and their patients in California.

PhYSICIAnS FIGhTInG hARd!

AdvocacyPolitical

www.SdCMS.org www.SdCMS.org www.SDCMS.org www.SdCMS.org www.SdCMS.org


Happy Holidays

From your SDCMS and SDCMS Foundation

Support Teams!

Back Row, Left to Right: Tana Lorah, Kyle Lewis, Janet Lockett, Lauren Wendler, Lee Forrester, Kitty

Bailey, James Beaubeaux

Middle Row, Left to Right: Dareen Nasser, Karen Dotson, Marisol Gonzalez, Brenda Salcedo, Barbara

Rodriguez, Jennipher Ohmstede

Front: Tom Gehring

www.SdCMS.org www.SdCMS.org www.SDCMS.org www.SdCMS.org www.SdCMS.org

sDCmsJOIN

oNLiNe toDAY!

partner benefitsS A N D I E G O P H Y S I C I A N . o r g | D E C E m B E R 2 0 0 830


Bringing You and

Your staff

Goods and services

Physician-centric

We at the San Diego Medical Soci-ety (SDCMS) have standardized our processes and procedures

for selecting those companies with which we choose to partner to bring to you and your staff those physician-centric goods and services that you have indicated you want. SDCMS intends to keep you, our member physicians, first and foremost in all decision-making when it comes to selecting benefits partners. To that end, we have implemented the following policies and procedures:

• CHOICE: SDCMS members will, when-ever possible, be given a choice of benefits partners, i.e., SDCMS will not normally enter into exclusive relationships.

• MEMBER INPUT: Goods and services SDCMS members want and need will be identified and prioritized using secondary research, focus groups, one-on-one inter-views, and surveys.

• NEGOTIATIONS: SDCMS will negotiate with all potential benefits partners to ac-quire the best possible deals for our mem-bers.

• BENEFITS ACCRUE TO MEMBERS: All contracts will be entered into with the ex-pressed understanding that all financial gain will accrue to SDCMS’ member physicians and not to SDCMS.

• MEMBER DISCRIMINATION: SDCMS members will receive a better value or a lower cost of goods and services than non-members.

• EASE FOR MEMBER: Little or no work will be required by SDCMS members to take advantage of any and all benefits part-ners’ goods and services.

• STANDARDIzED VETTING: Benefits part-ners must have current SDCMS members as customers. SDCMS member feedback will be solicited to ascertain acceptable ben-efits partners. SDCMS member feedback will be reviewed annually. Benefits partners will be asked for proof of solvency. Ben-

efits partners’ local Better Business Bureau membership status will be queried.

• MARKET SEGMENT DISCRIMINATION: Market segments will be identified using mode-of-practice data, and goods and ser-vices will be identified for each segment, with the intent of offering comprehensive benefits for each of our member market segments.

• FEEDBACK AND TRACKING: A feedback tracking system will be implemented for both benefits partners and SDCMS mem-bers in order to provide benefit dollar values to SDCMS members. SDCMS members and benefits partners will be routinely sur-veyed to gauge SDCMS member satisfac-tion with benefits partners.

If you would like to suggest any other policies or procedures, or a specific SDCMS member benefit, please contact Janet Lockett, your SDCMS director of membership develop-ment, at (858) 300-2778 or at [email protected].

Member Benefits Policies and ProceduresProfessional Liability insurance

31partner benefits

Physician-centric

Insurance Products and servicessdCms members-only beneFitSDCMS members receive discounts on a comprehensive portfolio of insurance products and services, including savings of 5–10 percent or more off the cost of insurance, or cash rebates related to practice size, a savings of 7–12 percent on long-term disability income protection, and no-cost human resources consulting.

about our endorsed PartnerAlliant Insurance Services, Inc., is California’s largest, premier specialty insurance broker, ranking among the 13th largest in the United States.

endorsed Partner ContaCt inFormationContact Mark Allan, first vice president, at (800) 654-4609 or at [email protected]. Contact Alliant Insurance Services at (888) 849-1337 or online at www.alliantinsurance.com.

sdCms ContaCt inFormationContact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at [email protected].

Potential value: $1,000–$2,500

Contract Analysis and Revenue optimizationsdCms members-only beneFitSDCMS members receive a free contracting analysis, a discount on hourly rates, and a package price on services for contract negotiations, including health plan contracts.

about our endorsed PartnerCoastal Healthcare Consulting Group, Inc., is a specialty consulting firm that assists clients with managed care contracting, health plan contract negotiations, physician credentialing, revenue optimization, and strategic planning. Coastal Healthcare helps physicians increase net revenue and streamline business administration by reevaluating their health plan contracts. After a complete contract review, Coastal Health-care provides a strategic plan to renegotiate or terminate health plan contracts. By implementing the plan, most practices realize a four-fold return on investment within one year of service.

endorsed Partner ContaCt inFormationContact Kim Fenton, president, at (949) 481-9066 or at [email protected], or visit www.healthcareconsultant.org for more information.

sdCms ContaCt inFormationFor consultation scheduling, contact Marisol Gonzalez, your SDCMS physician advocate, at (858) 300-2783 or at [email protected].

Potential value: 10% or more imProvement in net revenue

take Advantage of Your SDCMS eNDoRSeD PARtNeR BeNefitS!

D E C E m B E R 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g

sdCms members-only beneFitBesides giving SDCMS members a 5 percent discount on their professional liability insurance, The Doctors Company has just lowered its premium rates, effective January 1, 2009, an aver-age of 14.5 percent. As well, claims free credits of 12.5 percent for primary care and 17.5 percent for surgical specialties are in addition to the premium reductions.

about our endorsed PartnerThe Doctors Company is fiercely committed to advancing, protecting, and rewarding the practice of good medicine. With $3 billion in assets, 43,000+ members, an A- rating (excellent) by A.M. Best Company, and an A (Strong) by Fitch Ratings, we are the nation’s leading physician-owned medical liability insurer. To learn more about our aggressive claims defense, superior financial and organizational strength, and unrivaled financial rewards, visit www.thedoctors.com.

endorsed Partner ContaCt inFormationTo learn more, contact Bob DeSimone at (858) 452-2986 or at [email protected], or contact Mark Allan at Alliant Insur-ance Services at (800) 654-4609 or at [email protected] ContaCt inFormationContact Janet Lockett, your SDCMS director of membership development, at (858) 300-2778 or at [email protected].

Potential value: $500–$2,500

Professional Liability insurance



Banking Products and ServicessdCms members-only beneFitApproved SDCMS members receive no-fee lines of credit, $1,000 fee discounts on commercial real estate loans, waived monthly maintenance fees on personal accounts for practice partners and employees up to $10/month, free first order of standard checks for personal accounts, increased deposit interest rates, waived monthly maintenance fee for business online banking and bill pay services, ATM fees waived up to $15/month, and free courier service or remote deposit service.

about our endorsed PartnerTorrey Pines Bank is familiar with the business challenges facing medical professionals. Its goal is to be a “low-maintenance” bank, meeting business owners’ high expectations, with the absolute minimum time and effort required of them. The bank offers a full array of banking services.

endorsed Partner ContaCt inFormationContact Benjamin Pimentel at (858) 259-5317 or at [email protected].


Potential value: $2,500

Billing SolutionssdCms members-only beneFitSDCMS members receive a 50 percent discount on startup fees and a $33 per-physician-per-month services credit, 10 percent off of outsourced IT support, 10 percent off of already discounted Dell hardware solutions, and a free coding hotline.

about our endorsed PartnerCHMB Solutions provides outsourced medical billing, revenue cycle management services, information technol-ogy support and hardware solutions to physician practices, clinics, and multispecialty organizations.

endorsed Partner ContaCt inFormationContact Ron Anderson at (760) 520-1340 or at [email protected]. Email your coding question(s) to SDCMS at [email protected].



sdCms members-only beneFitSDCMS members receive a 10 percent discount on monthly charges.

about our endorsed PartnerTSC Accounts Receivable Solutions has provided personalized, innovative collection and total accounts management services since 1992. This local, San Diego family-owned business management team has combined experience of more than 50 years in the healthcare billing and collection field. TSC now provides its clients with 24/7 online access to their accounts portfolio.

endorsed Partner ContaCt inFormationContact Catherine Sherman at (888) 687-4240, ext. 14, or at [email protected]. Visit TSC online at www.tscarsolutions.com.


Potential value: $350–$500

Collections Services

partner benefits


Accounting ServicessdCms members-only beneFitSDCMS members receive a 15 percent discount on standard rates for professional services, with an unconditional satisfac-tion guarantee: “SDCMS members who are not completely satisfied with the work AKT performs for them pay only what they thought the work was worth.”

about our endorsed PartnerAKT CPAs and business consulting LLP has provided audit, tax preparation and planning, accounting assistance, and business consulting to San Diego County clients for more than 50 years. AKT understands physician practices, and their per-sonal, local, and global services can help you achieve success.

endorsed Partner ContaCt inFormationContact Ron Mitchell at (760) 268-0212 or at [email protected].


Potential value: $500–$2,000

information technologysdCms members-only beneFitFree site inspection and subsequent infrastructure recommenda-tions. Free inventory and assessment of network and hardware computing assets. Free analysis of Internet/telco/data activity and subsequent ROI recommendations.

about our endorsed PartnerSoundoff Computing Corporation provides best-of-breed hard-ware/software/network technologies for your practice, and utilizes best practices for all aspects of IT implementations, including needs analysis, network design, installation, electronic medical systems, backups, security, proactive maintenance, training, and support. Soundoff Computing Corporation recommends and re-fines computing infrastructure solutions that will handle present and future requirements as your practice grows and matures.

endorsed Partner ContaCt inFormationVisit www.soundoffcomputing.com or contact Ofer Shimrat at (858) 569-0300 or at [email protected].



sdCms members-only beneFitSDCMS members receive practice-management consulting discounts on productivity and patient flow, personnel, gover-nance and management, market strategy and tactics, practice acquisitions, and sales and mergers, (equal to 10 percent or $500, whichever is larger), free half-day seminars at SDCMS (watch your faxes and emails), and a free one-year subscription to their newsletter, UnCommon Sense®.

about our endorsed PartnerPractice Performance Group (PPG) provides high-performance medical practice management services for physicians, includ-ing consulting, expert witness, workshops, speaking, and a monthly newsletter.

endorsed Partner ContaCt inFormationContact Jeffrey Denning or Judy Bee at (858) 459-7878 or at [email protected], or visit www.PPGConsulting.com.


Potential value: $500

Practice Management Consulting

tamper-resistant Prescription PadssdCms members-only beneFitSDCMS members receive discounts on tamper-resistant prescription forms.

about our endorsed PartnerAmerican Security Rx is a California Department of Justice and California Board of Pharmacy-approved Security Printer (SP-9), providing tamper-resistant California security prescription forms for controlled medications.

endorsed Partner ContaCt inFormationContact American Security Rx at (877) 290-4262 or at [email protected]. Visit American Security Rx online at www.americansecurityrx.com.


Potential value: $300

Banking Products and Services

partner benefits


QueStion: when are most sdCms seminars and events held?Answer: Most are held during lunch-time or dinnertime, with lunch and din-ner provided free of charge. Lunchtime seminars usually target office staff, and dinnertime seminars usually target physi-cians, though all member physicians and their office staff can attend all of our semi-nars.

QueStion: where are the seminars held?Answer: Most SDCMS seminars are held at the San Diego County Medical Society meeting room at 5575 Ruffin Road, Suite 250, San Diego 92123. Call SDCMS for directions at (858) 565-8888. For those who can’t get away from the office to at-tend our seminars in person, SDCMS now offers to our member physicians and their staff the ability to “attend” our semi-nars as webinars, i.e., you can attend from wherever you are — all you need is access to the Internet!

QueStion: do i need to register?Answer: Yes. Our seminars and events require attendees to pre-register.

QueStion: How much does it cost to attend sdCms’ seminars?Answer: There are two courses for office managers during the year (the “Certi-fied Medical Coder (CMC)” course and the “Certified Medical Office Manager (CMOM)” course that require a fee); oth-erwise, all SDCMS seminars are free to member physicians and their office staff.

QueStion: who should i contact if i have further questions?Answer: For further information about SDCMS seminars or events, watch your emails and faxes, visit www.SDCMS.org, call SDCMS at (858) 565-8888, or email SDCMS at [email protected]. De-tails may change as seminars and events approach — please contact SDCMS to confirm.

SDCMS Seminars/Webinars and eventssdCms members-only beneFitSDCMS strives to build a robust schedule of free seminars and events for our member physicians and their office staff. All SD-CMS member physicians and their office staff attend SDCMS seminars free of charge (including Office Managers Forums). Our seminars cover a broad range of practice management topics, including legal issues, HIPAA, risk management issues, contract negotiations, and more.

sdCms ContaCt inFormationFor further information about any of these seminars and events, watch your emails and faxes, visit SDCMS’ website at www.SDCMS.org, or contact Lauren Wendler at (858) 300-2782 or at [email protected].

Potential value: $100 Per attendee Per seminar


2009seminars/Webinars and events

SDCMS

partner benefits

frequently Asked Questions About SDCMS Seminars and events

Free to Member Physicians and Their Office Staff!

D E C E m B E R 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 35partner benefits

January

15 Thursday 11:30AM–1:00PM CollectionsSeminar/Webinar(OfficeManagersForum)21 Wednesday 6:30PM–7:30PM RiskManagementWebinar:“DealingWithDemandingandChallengingPatients”22 Thursday 11:30AM–12:30PM RiskManagementWebinar:“DealingWithDemandingandChallengingPatients”28 Wednesday 6:30PM–8:30PM MarketingSeminar/Webinar29 Thursday 11:30AM–1:00PM MarketingSeminar/Webinar(OfficeManagersForum)

February

11 Wednesday 6:30PM–8:30PM ContractNegotiationsSeminar/Webinar12 Thursday 11:30AM–1:00PM ContractNegotiationsSeminar/Webinar(OfficeManagersForum)18 Wednesday 6:30PM–8:30PM CodingSeminar/Webinar19 Thursday 11:30AM–1:00PM CodingSeminar/Webinar(OfficeManagersForum)

marCH

18 Wednesday 6:30PM–8:30PM InsuranceServicesSeminar/Webinar19 Thursday 11:30AM–1:00PM InsuranceServicesSeminar/Webinar(OfficeManagersForum)

aPril

15 Wednesday 5:00PM–9:00PM PracticeManagementSeminar/Webinar16 Thursday 9:00AM–1:00PM PracticeManagementSeminar/Webinar(OfficeManagersForum)18 Saturday 8:30AM–3:30PM ResidentandNewPhysicianSeminar:“PreparingtoPractice: WhatYouNeedtoKnowBEFOREYouBeginYourPractice”22 Wednesday 6:30PM–8:00PM RiskManagementSeminar/Webinar:“HowtoHandleLegalNotices(Summons,NOI,Subpoenas)”23 Thursday 11:30AM–1:00PM RiskManagementSeminar/Webinar:“HowtoHandleLegalNotices(Summons,NOI,Subpoenas)”

may

6 Wednesday 4:00PM–8:00PM EMRRoadShow7 Thursday 9:00AM–12:30PM EMRRoadShow(OfficeManagersForum)20 Wednesday 11:30AM–1:00PM BillingSeminar/Webinar(OfficeManagersForum)

June

17 Wednesday 6:30PM–8:30PM LegalSeminar/Webinar18 Thursday 11:30AM–1:00PM LegalSeminar/Webinar(OfficeManagersForum)24 Wednesday 2:00PM–6:00PM CMAContractingSeminar/Webinar:“TakingCharge:StepstoEvaluating RelationshipsandPreparingforNegotiations—AFocusonPayorContracting”25 Thursday 9:00AM–2:00PM CMAReimbursementSeminar/Webinar(OfficeManagersForum): “BacktoBasics:AStep-by-StepGuidetoMaximizingYourCashFlow”

July

22 Wednesday 6:30PM–7:30PM RiskManagementWebinar:“WhoCanBeToldWhat?(CommunicatinginaHIPAAWorld)”23 Thursday 11:30AM–12:30PM RiskManagementWebinar:“WhoCanBeToldWhat?(CommunicatinginaHIPAAWorld)”

august

12 Wednesday 11:30AM–1:00PM HIPAAUpdateSeminar/Webinar(OfficeManagersForum)

oCtober

14 Wednesday 6:30PM–8:30PM FinancialIssuesSeminar/Webinar(IncludingEstatePlanning)15 Thursday 11:30AM–1:00PM FinancialIssuesSeminar/Webinar(OfficeManagersForum)23, 30, FiveFridays 8:00AM–4:00PM CertifiedMedicalCoder(CMC)CourseNov. 6, 13, 20

november

18 Wednesday 6:30PM–7:30PM RiskManagementWebinar:“ElectronicHealthRecords—AreYouReady?”19 Thursday 11:30AM–12:30PM RiskManagementWebinar:“ElectronicHealthRecords—AreYouReady?”21 Saturday 8:30AM–3:30PM ResidentandNewPhysicianSeminar:“PreparingtoPractice: WhatYouNeedtoKnowBEFOREYouBeginYourPractice”


SDCMS Physician Advocate on StaffsdCms members-only beneFitHave a question? Don’t know where to begin? Contact your full-time, SDCMS physician advocate, Marisol Gonzalez, free of charge, to get the answers to all your questions.

sdCms ContaCt inFormationContact Marisol Gonzalez at (858) 300-2783 or at [email protected].

SDCMS office Manager Advocate on StaffsdCms members-only beneFitLet your office manager and staff know that they have a full-time office manager advocate on staff at SDCMS ready to help them with any questions they may have, free of charge.

sdCms ContaCt inFormationContact Lauren Wendler at (858) 300-2782 or at [email protected].


Bringing You and Your staff

Goods and servicesPhysician-centric

Take Advantage of These Members-only Benefits!

partner benefitsD E C E m B E R 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 37

Members-only Website AccesssdCms members-only beneFitAccess, free of charge, the “Member Physi-cians” section of SDCMS’ website and the members-only section of CMA’s website to find valuable resources, such as a list of San Diego County physician NPIs, updated weekly. SDCMS member physicians can now build their own physician website with SDCMS, free of charge.

sdCms ContaCt inFormationContact Kyle Lewis, your SDCMS director of communications and marketing, at (858) 300-2784 or at [email protected].

SDCMS Annual Pictorial Membership DirectorysdCms members-only beneFitAppear in SDCMS’ annual pictorial mem-bership directory, which is used by thou-sands of physicians and patients across the county throughout the year. Receive a free directory each year, a 50 percent discount on any additional directories purchased, and discounts on display advertising in the directory.


San Diego Physician MagazinesdCms members-only beneFitReceive a free subscription to the voice of San Diego County’s physicians. Place free classified ads and discounted display ads.


SDCMS e-newsletter: “News You Can Use”sdCms members-only beneFitSDCMS members receive our email news-letter — “News You Can Use” — free of charge. “News You Can Use” keeps physi-cians up to date with the latest in medical, local, state, and federal news critical to your practice ... free of advertising.

sdCms ContaCt inFormationContact Dareen Nasser, your SDCMS office manager, at (858) 300-2786 or at [email protected].

Auto insurancesdCms members-only beneFitAlong with your spouse, receive discounts of 4.5 percent to 14 percent on all lines of coverage from the Automobile Club of Southern California.

sdCms ContaCt inFormationContact Janet Lockett, your SDCMS direc-tor of membership development, at (858) 300-2778 or at [email protected].

epocrates’ Clinical Reference GuidessdCms members-only beneFitReceive a 30 percent discount off of a one-year subscription and a 35 percent discount off of a two-year subscription to Epocrates’ clinical reference guides. Students and resi-dents receive a 50 percent discount.

sdCms ContaCt inFormationContact Epocrates at (800) 230-2150 or visit www.cmanet.org.

Legal HotlinesdCms members-only beneFitSDCMS members access free of charge CMA’s Legal Hotline.

sdCms ContaCt inFormationCall (415) 882-5144.

Hertz DiscountssdCms members-only beneFitSDCMS members can save up to 15 per-cent on daily Hertz car rental rates. Special international discounts are also available. Visit www.Hertz.com or call Hertz at (800) 654-2200. Frequent traveler miles and bonus points may be earned for qualifying rentals. An SDCMS-CMA members-only code is needed to take advantage of this discount.

sdCms ContaCt inFormationEmail [email protected] to receive your code.

Quality and Cross-Cultural HealtHCare p.26

emerging miCrobial resistanCe in san diego County p.34

2008 MAGGIE AWARD WINNER

OFFICIAL PUBLICATION OF THE SAN DIEGO COUNTY MEDICAL SOCIETY NOVEMBER 2008

“ P H y s i C i a n s u n i t e d F o r a H e a lt H y s a n d i e g o ”

Payperformancefor

How do you measure Quality?

interview witH stuart a. CoHen, md, mPH, sdCms President P.18

PHysiCian emPloyment agreements strongly reCommended P.22


Legal ServicessdCms members-only beneFitReceive a free consultation and discounts on corporate legal services.

sdCms ContaCt inFormationCall Ladd Young Attorneys at Law at (619) 564-6696. Contact Janet Lockett, your SDCMS director of membership develop-ment, at (858) 300-2778 or at [email protected].

San Diego County Physician Mailing ListssdCms members-only beneFitReceive one free physician mailing list annually and a discount on all additional mailing lists requested in the same year.

sdCms ContaCt inFormationContact Dareen Nasser at SDCMS at (858) 565-8888 or at [email protected].

San Diego MagazinesdCms members-only beneFitReceive a gift subscription (active physi-cian members) or a discounted subscription (resident physician members).

sdCms ContaCt inFormationTo sign up, contact Janet Locket, your SD-CMS director of membership development, at (858) 300-2778 or at [email protected]. To update your subscription address, contact San Diego Magazine at (888) 350-0963 or at [email protected].

investmentssdCms members-only beneFitInvest with Dunham & Associates and discount your SDCMS dues by $150.

sdCms ContaCt inFormationCall Jeff Dunham at (619) 308-9700, or contact Janet Lockett, your SDCMS direc-tor of membership development, at (858) 300-2778 or at [email protected].

free Coding HotlinesdCms members-only beneFitAccess a coding hotline free of charge (provided by CHMB Solutions).

sdCms ContaCt inFormationEmail your coding question(s) to SDCMS at [email protected]. Contact Janet Lockett, your SDCMS director of member-ship development, at (858) 300-2778 or at [email protected].

faxed and emailed emergency AlertssdCms members-only beneFitStay informed of the news that affects your bottom line and your patients’ health with faxed and emailed alerts sent by SDCMS to you, free of charge … and free of advertis-ing!

sdCms ContaCt inFormationContact Janet Lockett, your SDCMS direc-tor of membership development, at (858) 300-2778 or at [email protected].

CMA’s Weekly e-newsletter: “Alert”sdCms members-only beneFitReceive CMA’s e-newsletter, “Alert,” deliv-ered directly to you, free of charge, via email or fax.

sdCms ContaCt inFormationContact Katherine Gallia at CMA at (916) 551-2074 or at [email protected].


sandiegomagazine.comDECEMBER 2008

OUR NEXT GENERATION OF CIVIC POWER BROKERS

“ ”My real goal is to empower girls

to know they can be smart … and to do whatever they

want to follow their dreams.

DANICA MCKELLAR:

HOW LOCAL CELEBRITIES

EMBRACE THE SPIRIT OF GIVING

‘TIS THESeason

®

partner benefitsD E C E m B E R 2 0 0 8 | S A N D I E G O P H Y S I C I A N . o r g 39

Reimbursement HotlinesdCms members-only beneFitSDCMS members access free of charge CMA’s Reimbursement Hotline.


HiPAA CompliancesdCms members-only beneFitReceive a discount on a complete, do-it-yourself HIPAA privacy and security compliance toolkit (CD ROM).

sdCms ContaCt inFormationCall David Ginsberg at PrivaPlan at (877) 218-7707.

CMA oN-CALL DocumentssdCms members-only beneFitSDCMS members can access, free of charge, thousands of pages of medical-legal, regulatory, and reimbursement information, through CMA’s online library.

sdCms ContaCt inFormationContact CMA at (415) 882-5144, at [email protected], or visit www.cmanet.org.

California emergency Driving emblemsdCms members-only beneFitSDCMS members receive their first Cali-fornia physician emergency driving emblem free of charge, and any additional emblems at the discounted price of $10 each.

sdCms ContaCt inFormationContact Marisol Gonzalez, your SDCMS physician advocate, at (858) 300-2783 or at [email protected].

Legislative HotlinesdCms members-only beneFitSDCMS members access free of charge CMA’s Legislative Hotline.


Physician Confidential LinesdCms members-only beneFitSDCMS members access free of charge CMA’s Physician Confidential Line, a 24-hour phone service for physicians who may have an alcohol or other chemical dependence or mental/behavioral problem. Completely confidential. Using it will not result in any form of disciplinary action or referral to any disciplinary body.



The Building…• New 80,000-square-foot Class “A” Medical Office Build-ing• First floor is the new home to Sharp-Rees Stealy Medical

Group• Second floor available to independent medical practition-ers • New suites available from 1,200 to 11,000 square feet• Offices can be built to meet your exact long-term needs

Location, Location, Location• Located at 10672 Wexford Street, off the I-15 at Scripps

Poway Parkway (92131)• Strategic Scripps Ranch/Poway location perfectly situated

off the I-15 to serve the North County Communities of Scripps Ranch, Rancho Bernardo, Poway, Mira Mesa and Carmel Valley

• Minutes from SR-52 and SR56 for easy access to the coastal communities

Introducing

Medical Plaza

For more information, please call Ed Muna at 619-702-5655 or e-mail [email protected]. • www.PinnacleMedicalPlaza.com

Pinnacle

Lankford_SDP_08:Layout 1 10/27/08 1:22 PM Page 1

lankFord

ClassifiedsoffiCE sPaCE

mission Hills oFFiCe For sale: Why rent when

you can own? North mission Hills physician’s office for

sale. Beautifully restored house located in the West lewis

Planned District. Classic hardwood floors, stained glass,

craftsmanship woodwork throughout, recessed lighting,

complete exam rooms, two patient waiting areas, and four

offices. Neighborhood atmosphere; perfect for primary or

specialty practice. Ample street parking. mills Act designa-

tion with significant tax savings. Call Annamarie Clark at

(619) 962-2095 for photos and appointment. [610]

enCinitas mediCal oFFiCe sPaCe: Spacious,

ocean view office to share or sublease with three other

physicians. minutes from the 5 freeway and Scripps En-

cinitas Hospital. Office includes private bathroom and en-

trance, common waiting area, wireless Internet, and free

parking. labCorp and mRI center are located in the same

building. Contact DeeAnn Wong, mD, at (760) 753-7341,

ext. 2#. [650]

vista mediCal sPaCe For lease: 3,500ft2 for-

mer medical space. The space is built out nicely for a med-

ical practice or urgent care in an excellent location with

great visibility. The address is 1680 S. melrose Dr., Ste.

105–107, in the Shadowridge area just across from Rancho

Buena vista High School. Please call Steve at (760) 727-

0533 for more information. [649]

la mesa oFFiCe sPaCe to sHare: Over 6,000ft2

OB/GYN office of four doctors with one leaving, available

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fax letter of interest to (619) 463-4181. [648]

mediCal oFFiCe sPaCe For lease in enCini-tas: Available August 2009. Share space with established

physician-owner. Office located in new lEED-certified pro-

fessional office development on Encinitas Blvd., close to 5

freeway, Scripps Hospital, and public transportation. Free

parking, private bathroom, front desk area, and additional

storage space included. One to two offices 11x14 are avail-

able full or part time. Affordable lease rate in desirable

area. Contact Wendy Khentigan, mD, at (760) 845-0434

or at [email protected]. [646]

el Centro/imPerial mediCal or Commer-Cial building For lease/rent: New upscale

11,761ft2 building located in the northeast quadrant of Hwy.

86 and Aten Road, with Hwy. 86 visibility. Three phase

power with 800 amps ideal for medical imaging or busi-

nesses requiring additional power. The building is divisible

up to five suites, and bathrooms are stubbed in at each

location. Please call Patseay at (760) 562-1436 or email

[email protected] for further information. [643]

mediCal oFFiCe sPaCe: Beautiful turnkey medical

office space to share in the village of la Jolla with ocean

view. Available three days a week, including secretary on

two days. Space is suitable for physician, psychologist, or

therapist. All inclusive rent: $2,000 per month. Parking

in building. Contact Jane Reldan, mD, at (858) 454-5527.

[642]

la Jolla: Newly remodeled medical office space for

lease in la Jolla. Shared space with orthopaedic surgeons.

Preferably part-time needs. Convenient location near the

Orthopaedic Surgery Center in la Jolla. Contact Jo Turn-

er for more information at (619) 733-4068 or email jo@

lajollaspine.com. [641]

aCross From sHarP CHildren’s HosPital: Beautifully furnished, fully equipped 2,000tf2 office with

five exam rooms. Share with a part-time physician. Please

call (619) 823-8111 or (858) 279-8111. [385]

san diego: A unique physician opportunity with a

highly successful and profitable multispecialty office lo-

cated in beautiful Bankers Hill. Enjoy the freedom of your

private practice in our luxurious medical office. Your per-

sonal office has incredible views of the harbor. We are a

leasing, reneWals and sales: Call the Healthcare Real Estate Specialists at Colliers International for a complete in-ventory of all available medical office space for lease or for sale in San Diego County. Use our knowledge and expertise to help you negotiate a new lease, re-newal, or purchase agreement to assure you obtain the best possi-ble terms. There is no charge for our consulting services. Contact Chris Ross at (858) 677-5329; e-mail [email protected].

fully equipped and fully staffed, ready to increase your

reimbursement from day one. let us help build or relocate

your practice! Open to all specialties. Call Eric Noll at (619)

233-4044. [637]

aFFordable overHead For your PraC-tiCe: large practice looking to share office space or total

overhead. Will consider sublease of space or combining

total overhead, including supplies and staff, to reduce cost

for all. Space is over 4,000ft2 and includes eight exam

rooms. located in metro region. Close to all major free-

ways and Sharp memorial Hospital. Room set-up/building

facilities could benefit any primary care and meet most

specialist needs. Call (858) 268-1111, ext. 311, for further

information. [632]

mediCal oFFiCe sPaCe available: Office lo-

cated in downtown San Diego. Two exam rooms and one

office. Please call (619) 985-0017. [631]

la mesa: medical office space available for sublease in

conveniently located la mesa building. Please call Debbie

at (619) 668-4700 for more information. [630]

oFFiCe sPaCe to sHare: modern, spacious medi-

cal office. Close proximity to Alvarado and Sharp Hospi-

tals. Call (619) 668-0900 for more information. [616]

mediCal oFFiCe sPaCe (sCriPPs enCinitas CamPus): OB/GYN-type consultation room and one to

two exam rooms with staff, receptionist, etc. Equipment

is available at extra cost. Surgical center next door. Free

parking. Perfect for low-volume hospital campus consulta-

tions one to five half-days per week. Email sbrooksrecep-

[email protected] or call (760) 753-8413. [557]

3998 vista Way, ste. 100 in oCeanside: Three

medical office spaces (approximately 2,000ft2 each) avail-

able for lease. Close proximity to Tri-City Hospital with

pedestrian walkway connected to parking lot, and ground

floor access. lease price: $2.40/ft2+NNN. Tenant improve-

ment allowance. For further information, please contact

lucia Shamshoian at (760) 931-1134 or at shamshoian@

coveycommercial.com. [556]

oFFiCe sPaCe available: Office space at the cor-

ner of 8th Ave. and Washington St. in Hillcrest. Surgical

center in building. Ample parking and simple freeway ac-

cess. Close proximity to Scripps mercy Hospital. Call (619)

297-6100 or email [email protected]. [555]

oFFiCe to sHare: Office available in desirable build-

ing on Scripps Encinitas lot. Share elegant office that

has just undergone complete interior design renovation.

Includes doctor’s desk, your own exam room, front desk,

common waiting area, staff bathroom (including shower),

and kitchen. Call us at the San Diego vein Institute at

(760) 944-9263. [546]

CosmetiC oFFiCe available to sHare: East

County location with accredited operating room. Ideal for

facial or general plastic surgeon to use as satellite office.

Central location with ample parking. For more informa-

tion, please call (619) 701-4786. [542]

oFFiCe sPaCe For sublease: Office available

part time for Scripps doctor in desirable Scripps/ximed

building in la Jolla. Share elegant office; available full day

mondays and Friday afternoons. Includes consultation of-

fice, two exam rooms, front desk, common waiting area,

staff bathroom, and kitchen. use of operating suite or use

on other days negotiable. Call Cindi at (858) 452-6226.

[535]

sHare mediCal oFFiCe sPaCe in Point loma area (oFF midWay): Share fully furnished,

six-exam-room/two-office suite with internist. Ample free

parking, great location. Contact Elaine Watkins at (858)

945-3813 or at [email protected]. [527]

oFFiCe sPaCe to sHare (soutH County): Chula vista-area family practice office to sublease at 340

4th Ave., Ste. 10, just north of Scripps mercy Chula vista

Hospital. Office includes three exam rooms and one treat-

ment room, and is 1,700ft2. Support staff available. Call Dr.

Jenkin or Dr. Tetteh at (619) 804-7252. [521]

oFFiCe sPaCe For lease (esCondido): Pre-

mier furnished medical office space for lease in Escondi-

do. Excellent location near Palomar medical Center. Please

call (760) 743-1033. [501]

sPaCe For lease (Coronado): Brand new build-

ing in Coronado. last space available: 1,105ft2, $2.75+NNN.

Call (619) 742-5555 or email [email protected].

[435]

beautiFul, neWly renovated oFFiCe sPaCe to sHare: located in Hillcrest/uptown San Diego. Phy-

sician with large suite seeking physician/healthcare pro-

fessional or other business professional to share offices

and/or exam rooms and receptionist. Parking spaces avail-

able for rent (off street, covered). Call (858) 354-9833 for

further information. [346]

neW doWntoWn oFFiCe sPaCe available: New cozy family medicine office space available to share.

Furnished office includes three exam rooms and one

bathroom. Office ideal for solo practitioner interested in

starting a new practice or in expanding to a new area.

Call (619) 200-9664. [658]

looking For beautiFul, brand-neW, state-oF-tHe-art, aFFordable oFFiCe sPaCe? For internist, podiatrist, surgeon, pain manage-

ment, chiropractor, or other healthcare specialist. Brand-

new office (River view mD Spa, a medical-Dental Spa) in

new development in Santee. Offering office space, ability

to share reception area, and a minimum of one beautiful

exam room (sometimes up to two rooms) to see patients.

$1,650/month rent plus shared expenses if applicable.

Call (619) 456-4555. [655]

PHysiCian Positions availaBlE

Family PraCtiCe Positions availble: Busy

family practice in Escondido is seeking one full-time and

one part-time, practice share physician. Please send Cv to

[email protected] or fax to (760) 745-0451. [644]

seeking board-CertiFied/board-eligible Family PHysiCan: To join a patient-centered practice

in Chula vista specializing in primary care and cosmetic

medicine. Successful candidate will be enthusiastic, car-

ing, with positive attitude, good work ethic, and able to

build practice with exceptional people skills. Bilingual in

Spanish preferred. Competitive compensation and ben-

efits package. Flexible, part-time schedule. Email Cv to

[email protected] or fax to (619) 422-1055. Call Ann

at (619) 422-1324 for more information. [640]

temPorary eXPert ProFessional (teP) md (general PraCtitioner) — County oF san diego PubliC HealtH: Examine patients and

make recommendations for further study, or treat pa-

tients with medical illnesses or complications and consult

with providers in the community on related cases. Assign-

ments may be in the HIv/STD/hepatitis, TB, or well child

exam clinics. TEPs may provide clinical supervision of cer-

tified nurse practitioner, public health nurses, staff nurse,

vocational nurses, and support staff. California medical

license desired. Fax Cv to (619) 236-1196. [634]

temPorary eXPert ProFessional (teP) md (internest) — County oF san diego: Ex-

amine patients and make recommendations for further

study, or treat patients with medical illnesses or compli-

cations and consult with providers in the community on

related cases. When assigned to the San Diego County

Psychiatric Hospital (SDCPH), candidate will serve as a

medical consultant to psychiatrists, nursing staff, and

medical director. California medical license desired. Fax

Cv to (619) 236-1196. [633]


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 $250 (75-word limit) per ad per month of insertion.

Classifieds

neW mediCal building along i-15: Pinnacle Medi-cal Plaza is a new 80,000 SF building recently completed off Scripps Poway Parkway. The location is perfect for serv-ing patients along the I-15 from Mira Mesa to Rancho Bernardo and reaches west with easy ac-cess to Highway 56. Suites are available from 1,000 -11,000 SF and will be improved to meet ex-act requirements. A generous improvement allowance is pro-vided. For information, contact Ed Muna at 619-702-5655, [email protected]; www.pinnaclem-edicalplaza.com

Class “a” mediCal building For sale or lease: 3-Story, 55,450/SF located at 838 Nor-dahl Road in San Marcos, CA. Suites from 1,000/SF. Premier location. Easy freeway access & close proximity to restaurants & Sprinter. Shower & locker facilities. Resort quality rest-rooms. Tropical landscaping. Koi ponds. Panoramic views. Latest in “green” building design stan-dards with utility cost savings. Scheduled for completion in April 2009. For more informa-tion contact Mark Avilla (760) 431-4223 / [email protected]. www.nordahlmedicalcentre.com / www.brecomercial.com


Classifiedsob/gyn PHysiCian Position: Private practice op-

portunity to join two board-certified OB/GYNs. Outstand-

ing earning potential. Perinatologists and NICu available

24/7. 1:4 on-call. Fax Cv to (858) 451-8473. [625]

internal mediCine/Family PraCtiCe Posi-tion: Seeking board-certified/eligible internist or family

practice physician with interest in holistic health for em-

ployment with an integrative medical practice located in

San Diego’s Bay Park community. Part- to full-time hours,

flexible schedule, generous benefits, light call. Please

email résumé to [email protected]. [617]

PHysiCian needed: Part-time or full-time position

for board-certified/eligible physician to help two physi-

cians in Chula vista. Cheerful work atmosphere, variety of

options (office, hospital, or nursing homes). very light calls

mainly over the phone. We are very flexible in job details.

Please call Suzi King at (619) 426-9731. [613]

interventional Cardiologist oPPortu-nity: Income potential well above national average. Im-

mediate opening to take over 20-year private practice in

North County. Excellent referral basis, limited HmO care,

new cath lab opening in July. One-in-three interventional

call, mature hospitalist program for other call. Office diag-

nostic services include: nuclear, holtor, accredited ECHO

lab. Fax Cv to office manager at (760) 940-8153. [607]

Primary Care Job oPPortunity: Home Physi-

cians is a fast growing group of doctors who make house

calls. Great pay ($60–$100+/hour), flexible hours, choose

your own days (full or part time). No weekends, no call,

transportation and personal assistant provided. Call Chris

Hunt, mD, at (858) 279-1212. [458]

Family PraCtiCe (CHula vista): Seeking a fam-

ily practice physician to cover solo physician practice one

week every two months. Contact Ann at (619) 422-1324 or

at [email protected]. [451]

Family PraCtiCe doCtors needed: Full time

and part time; days, nights, and weekends available. Fax

Cv to la Costa urgent Care at (760) 603-7719. [449]

Full-time Family mediCine and urgent-Care oPPortunities: At Kaiser Permanente

Southern California, we believe our achievements are best

measured by the health and wellness of the community

we serve. That’s why we provide a fully integrated system

of care guided by values such as integrity, quality, service,

and, of course, results. If you would like to work with an

organization that gives you the tools, resources, and free-

dom you need to get the best outcomes possible for your

patients, come to Kaiser Permanente. For consideration,

please forward your Cv to: [email protected] or

call Bettina at (800) 541-7946. We are an AAP/EEO em-

ployer. http://physiciancareers.kp.org/scal. [662]

PHysiCians needed: Full-time, part-time, and per-

diem opportunities available for family medicine, pediat-

ric, and OB/GYN physicians. vista Community Clinic is a

private, nonprofit outpatient clinic serving the communi-

ties of North San Diego County. must have current CA and

DEA licenses. malpractice coverage provided. Bilingual

English/Spanish preferred. Forward resume to hr@vista-

communityclinic.org or fax to (760) 414-3702. visit our

website at www.vistacommunityclinic.org. EOE/m/F/D/v

[659]

ob/gyn PHysiCian: Seeking board-certified/board-

eligible OB/GYN physician to join our group practice in

North San Diego County. Please email Cv to madrod1@

cox.net. [656]

kaiser Permanente is Hiring Per-diem and Full-time PHysiCians: We have current

openings for full-time and per-diem physicians in the

East County of San Diego. These positions are available

at our la mesa, Rancho San Diego, and Bostonia medical

offices. For more information regarding these opportu-

nities, please contact Kathy Dundovich, area operations

administrator at (619) 589-3206 or at kathy.l.dundovich@

kp.org. [653]

nonPHysiCian Positions availaBlE

mediCal assistant (ma) Job oPPortunity: mA wanted to work part time (25 hours) in Poway starting

November 12. Call (858) 521-0806 or email familyallergy@

cox.net for more information. [647]

registered nurse (rn): Family medicine office in

Torrey Hills seeking a full-time, experienced RN. Previous

clinical experience required. Salary and benefits are ne-

gotiable. Please call (858) 350-8100 or email résumé to

[email protected]. [577]

Part-time mediCal assistant/baCk oFFiCe: Two years experience required including phlebotomy. Busy

specialist office near Alvarado Hospital. Submit résumés

via email to [email protected]. [576]

PHysiCal tHeraPist: Part-time or full-time PT

needed for group orthopedic practice. Great opportunity,

benefits. Please fax Cv to (619) 229-3933. [565]

mediCal reCePtionist/Front oFFiCe: We are

looking for a front office receptionist for a busy OB/GYN

practice. Bilingual in Spanish and OB/GYN experience is a

must! Résumés can be faxed to (858) 565-0033. [563]

nurse PraCtitioner: Four-physician internal

medicine practice in Chula vista seeks part-time/full-time

nurse practitioner. Work with a quality group; reasonable

hours. Previous experience is preferable; salary negotia-

ble depending on experience. Call (619) 421-4470 or (619)

421-4000. [488]

nurse PraCtitioner/PHysiCian assis-tant: Flexible, part-time schedule. Patient-centered

practice specializing in primary care, neurology, cardiol-

ogy. Successful candidate will be caring, enthusiastic, and

with positive attitude and work ethic. Bilingual in Span-

ish preferred but not a condition. We’ll provide necessary

training, so newly graduates are welcome to apply. Good

fringe benefits. Email Cv to harmonymedicalgroup@ya-

hoo.com or fax: (619) 393-0830. [661]

nurse PraCtitioners needed: Part-time and

per-diem opportunities available for family medicine, pe-

diatric, and OB/GYN nurse practitioners. vista Community

Clinic is a private, nonprofit outpatient clinic serving the

communities of North San Diego County. must have cur-

rent CA license. malpractice coverage provided. Bilingual

English/Spanish preferred. Forward resume to hr@vista-

communityclinic.org or fax to (760) 414-3702. visit our

website at www.vistacommunityclinic.org. EOE/m/F/D/v

[660]

PHysiCian Positions wantEd

md seeking Part-time emPloyment: Elderly

mD in North San Diego with prior legal, weight, etc., ex-

perience seeking part-time employment. Call (949) 492-

0198. [651]

FP seeking emPloyment: Family physician look-

ing for temporary employment in the Northern San Di-

ego area from October through December and possibly

the first part of 2009. Has experience in urgent care as

well as a traditional outpatient setting. Open to hospital-

ist work if available. If you are looking to fill a temporary

position with someone who is ambitious, accountable, and

has a positive mental attitude, please email inquires to


temPorary Position Wanted: Board-certified

family physician looking for a part-time position from Sep-

tember to December to work in an outpatient setting. I

have my own insurance ad have experience working with

EmRs. Email [email protected]. [626]

mediCal oPHtHalmologist (Per diem): Board-certified medical ophthalmologist available two

days per week for per-diem or locums work in the San

Diego or nearby areas. Highest ethical standards. Experi-

enced and skilled in therapeutic and cosmetic Botox and

dermal fillers. Also experienced in clinical trials. Email


Cardiologist available: Non-invasive cardiolo-

gist (ex-professor) wants to work in office-based practice.

Board eligible. Experienced in echo, stress test, stress

echo, nuclear and CT. Willing to work in academic posi-

tion. Call (760) 633-3044, or (858) 922-8354, or email


PraCtiCEs for salE

suCCessFul mediCal skin Care CliniC For sale: Small investment for 51 percent ownership. look-

ing for a new medical director. Call leonard Schulkind at

(619) 807-5485. [539]

del mar-area general PraCtiCe: Prime loca-

tion, huge potential for practice expansion in fast grow-

ing Carmel valley community. Established in 1990; terms

available. Inquiries call (858) 755-0510. [185]

Primary Care PraCtiCe For sale — san diego: Turnkey operation. large, nicely decorated, fully

furnished space with six exam rooms, two offices, spa-

cious waiting room, and large front office. Room to expand

with ancillary services, ample free parking, good location.

Reasonably priced. Interested parties email ejwatkins@

gmail.com. [654]

mEdiCal EQuiPmEnt

mediCal oFFiCe eQuiPment For sale: vein

practice, closing end of November, is selling off all assets

including: Terason portable ultrasound with 15 inch laptop

and levitator stand; midmark electric table; two Holga 6

shelve chart filing units; stools; office furniture; minolta

copier; fax machine; HP color laser jet printer; AT&T model

945 Small Bus. Speaker phone; desk with matching floor

hutch and two two-drawer files; lobby furniture; and more!

Contact [email protected] for more information, photos,

and pricing. [652]

CosmetiC laser eQuiPment For sale: Pre-

owned lasers in great condition for great prices! lumenis

Quantum SR/HR Intense Pulse light (IPl) system avail-

able for $13,000. Treats: photo facials, telangiectasias,

vascular and pigmented lesions. Reliant Fraxel SR 1500

laser (Fraxel II) available for $65,000. Treats: pigmented

lesions, facial rhytides, scars, melasma. Includes Zimmer

Cryo5 Chiller. Reliant Fraxel SR 750 laser (Fraxel I) avail-

able for $35,000. For more information, contact Dan Rich

at (858) 204-9802 or email drich@laserperfectioninc.

com. [627]

retired surgiCal PraCtiCe oPerating room/surgiCal eQuiPment: Perfect for plastic

surgery/oral surgery. Endoscopy, cameras, loupes, tools.

Waiting room furniture inventory list is available upon re-

quest. Email [email protected]. [506]


joined the army because that was what the other new arrivals were doing — one sure foothold in a foreign land for a newcomer who barely spoke English. He made it through Viet-nam, survived, returned, and now, forty years later, was being wheeled on a hospital gurney through the VA for a minor surgery.

After surgery, patients are returned to the post-anesthesia recovery room, and the nurses have six slots to put them in. They put a travel poster over each slot, to make it easier to roll the beds to the right place. “Hip replacement done — put him in Hawai’i!” they call out, and the gurney is rolled over underneath the big poster of Hawai’i.

When Ludvik came out from his surgery, guess where they sent him? That’s right, into the slot marked by a kitschy poster of dancing Russians, the kind you’d see in a high school Russian classroom. Which just goes to show: Symbols, posters, and empires may all eventu-ally fade, but people will survive. By hook, by crook, and sometimes by the concern of com-plete strangers, still they survive, and move on to a new chapter.

And then I met one of the greatest survival stories of all. I’ll call him Bill. Bill was in his mid-90s. Bill had served in World War II, and he was, to the best of his knowledge, the oldest still-living Marine Corps survivor of the battle for Iwo Jima. He’d gone out in March of 1945 — not part of the initial assault, but to take part in the fierce battles that followed. He’d returned to Southern California after the war, and opened a barbershop.

When the attending surgeon walked into the pre-op area to introduce himself, Bill looked him up and down and said, “Young man, when this surgery is over, I’d like to give you a haircut.” This is really only funny if you happen to know that the surgeon in question, while not completely bald, doesn’t have a whole lot of hair. He took the ribbing well, and told Bill he’d be happy to take him up on the offer.

We went over the details of the surgery with Bill. We all stood in a circle around his bed — the pre-op “huddle” of nurses, surgeons, anesthesiologists, and medical students. For a moment I wanted to take a picture of the scene and send it, a single time-defying postcard, in violation of all of the laws of physics, back to the younger Bill, as he sailed across the Pacific in 1945.

He must have been terrified. Who wouldn’t have been?

Lying in the belly of a troop ship, the throb of diesel engines around him, surrounded by salt, sweat, and fear — he knew exactly where he was going. In some units, as many as three out of every four marines were killed. Those

were the men he was going to relieve.The U.S. Air Force had bombed the islands

until they looked like the surface of the moon. In response, the Japanese had retreated to a net-work of tunnels that gave them complete cover as they picked off the Americans who were scrambling on the rocky surface above. This was their destination, and they all knew it.

I wanted to send a message back through time, telling him: Look, this is how it ends — not cut down by a bullet on the surface of the moon, but instead, more than 60 years later, in San Diego. Here, a team of compassionate and dedicated people will care for you, you will go home, and one day, you will experience a digni-fied, peacetime death.

But then I realized that there was no need. If Bill had faced Iwo Jima the same way he did his surgery, he already knew. It didn’t make a dif-ference — he had no control over how things turned out, but in his imagination, he was al-ready giving a haircut to the attending surgeon. Maybe that is what let him survive Iwo Jima — in his imagination, he could already see himself on the other side.

Because in the end, we don’t know what fate has in store for us — but if we live as if fate will be kind to us, at least we can make the most of every moment that we are granted.

And perhaps, in the end, that is what makes all of us fundamentally human: In the space between what we know and what we do not know, there is a gap. How we navigate that gap and stay afloat within this mysterious balance determines how we live and how we survive.

For Al, exploring the space between knowl-edge and mystery in mathematics blessed him with his greatest feelings of freedom. And for Ludvik, his life was probably saved by an anon-ymous man whom he’d never be able to thank — the mystery of that would remain with him forever. And for Bill, the very definition of his courage was in the divide between what he knew and what he did not, and how he faced that division while confronting danger.

And for me? From my experience with VA patients, I have learned that old words such as freedom, compassion, survival, and courage could mean more things than I ever expected. And when I hear people say, “The VA patients are all the same,” I know that I will never agree.

aBOut tHe autHOr: Mr. Brockwell is a third-year medical student at the UC San Diego School of Medi-cine.

continued from page 44medical student perspective

Reprinted from The Human Condition, a student-run annual publication of artwork, poetry, and prose contributed by members of the UCSD medical community.

mediCal eQuiPment For sale: Ritter 100

teal exam table, physician stool, plastic-encased pil-

low, and exam room chair(s). $500.00 each set. Call

(858) 485-6644. [662]

rEal EstatE

mission Hills oFFiCe For sale: Why

rent when you can own? North mission Hills physi-

cian’s office for sale. Beautifully restored house

located in the West lewis Planned District. Classic

hardwood floors, stained glass, craftsmanship wood-

work throughout, recessed lighting, complete exam

rooms, two patient waiting areas, and four offices.

Neighborhood atmosphere; perfect for primary or

specialty practice. Ample street parking. mills Act

designation with significant tax savings. Call Anna-

marie Clark at (619) 962-2095 for photos and ap-

pointment. [610]

meXiCo villa: Sell or rent. Fifty-year trust.

Ocean front. Twenty-five miles to border. Two bed-

rooms. Two baths. Two alcoves. Sleeps eight. Secu-

rity. Pool. Spa. Furnished. Rent $1,500/month. Sell

$595,000. (619) 659-9555. [657]

sErviCEs offErEd

mediCal billing ConneCtion (mbC): Af-

ter your patients’ care, the most important aspect of

your business is your billing. mBC provides full-prac-

tice management to ensure your billing and collec-

tions are optimal. With mBC, expect great services

and great results! The difference is our service … let

mBC make the difference for you. Call (800) 980-

4808, ext. 102. [575]

PraCtiCe FinanCing For PHysiCians: up to 100 percent financing available for physicians!

Includes purchase of a practice, equipment, partner

buyout, working capital, and real estate. Contact

monica Coburn at CBN Financial at (702) 310-7111 or

at [email protected]. [522]

billing, Consulting, outsourCing: We

are committed to maximizing your bottom line! Our

billing service uses state-of-the-art technology to

ensure charge capture, code validation, electronic

submission and remittance, payment postings, pa-

tient statements, structured follow-up and appeals,

electronic document storage and meaningful report-

ing. Supplemental services include online appoint-

ment scheduling, automated call reminders, scan

systems, and other technological advances. Con-

sulting services include accounts payable, auditing,

business development, electronic medical record se-

lection and implementation, credentialing, contract-

ing (payor, physician, and staff), executive assistant,

financial management, information systems, opera-

tional management, practice assessment, practice

management, relocation management, and other

technological advances. Contact us today for your

free consult! Contact Kena Galvan at (619) 326-0700

or at [email protected]. [452]

rmC vinyl rePair Plus: medical equipment

upholsterer. Expert in repair and replacement of

medical fixture upholstery, including exam room

equipment and waiting room furniture. Free esti-

mates and mobile service! Call (619) 443-4060.

[400]

I t is an oft-repeated cliché among students at my medical school that the patients at the Veterans Affairs hospitals all tend

to look the same after a while. Men, usually in their 40s or older, with chronic health problems brought on by lifetimes of smoking and alcohol use — casebook presentations of hypertension, diabetes, high cholesterol — these patients are the bread and butter of our rounds each morn-ing.

Clichés have a way of hiding more than they reveal, though, and this proved to be true for me over the nine weeks that I spent on the VA’s surgery rotations. Perhaps it started with my conversations with Al, a homeless Vietnam vet who spends a lot of his time in the vicinity of the hospital.

In what was perhaps my second conversation with him, Al let slip that he was interested in mathematics. This caught my attention right away because my dad is a mathematician, and I grew up studying math. Al explained that he was

interested in the repetend problem.If you take the reciprocal of any prime num-

ber expressed as a decimal, it will repeat itself. For instance, if you write “1/7” as a decimal, it will be “0.142857142857 …” with the last six digits repeating endlessly, ad infinitum. But, for any given prime, is it possible to predict how long the string of repeating digits (the “repe-tend”) will be?

Al had been hanging out on campus, attend-ing the occasional campus event, eating the cheap food offered by the Hare Krishnas, and thinking about this problem. He explained to me that when he solved a math problem he felt completely unfettered and free — that his mind could relish a triumph that depended on nobody else’s approval, that he felt ecstatic and blessed. By the time he shared his problem with me, it became apparent that he had grown sophisti-cated in his mathematical thinking.

For the next few months we played tag team, meeting occasionally at the VA cafeteria, to dis-

cuss the problem. Neither of us figured out the answer, but we did discover something interest-ing.

In mathematical terms, for a given prime p, the decimal expansion of 1/p will always in-clude a repeating string of length (p-1). In other words, expand 1/7, and you will find a repetend of length 6. Expand 1/19, and there will be an 18-digit repetend. And so on. Apparently this follows from a theorem that Pierre de Fermat came up with in 1640, known to mathemati-cians as “Fermat’s Little Theorem.”

It gets more complicated, though. There’s no way to tell if that repetend is itself composed of smaller, repeating strings of digits. Take the number 13 — it’s supposed to have a repetend length of twelve, as Al and I predicted — and it does. But those twelve digits consist of a dou-bled-up string of six digits. Neither of us has yet discovered how to tell in advance which primes do that.

But we’re working on it. And I have a feeling that it will be Al who will figure it out first, sit-ting outside somewhere on campus, homeless, living among the elements, but nonetheless a king in his own domain, for a moment, privy to the thoughts of God in a way that few people ever can be.

As I left Al to navigate the mysteries of the mathematical phenomenon, I came across an-other veteran who wrestled with his own per-sonal mystery. In the same nine-week period, I met a Czech man in his 50s, I’ll call him Ludvik, who was in the hospital for surgery. My attend-ing surgeon explained, “If you meet a Czech who came here in ’68, they came here because of the Prague Spring.” Ludvik was a teenager in 1968 when President Dubcek launched the reforms that were answered months later when Brezh-nev ordered Soviet tanks to roll into the streets of Prague. Three hundred thousand people fled, among them Ludvik, who never saw his parents again.

He’d tried to join the resistance. Who could blame him? He was probably like any other teenage boy at the time: He had heard stories of Molotov cocktails being thrown in the narrow streets of the Czech capital, saw his uncles and older brothers and friends taking up arms, and wanted to contribute to the defining struggle of his time.

But when he lined up to receive a weapon, he reached the front of the line, and the man hand-ing out weapons looked him up and down and said, “Kid, I appreciate your spirit, but you’re too young for this,” and turned him away, probably saving his life.

He fled, made it to the United States, and

medical student perspective


FrOm tHe WarDs

Lessons in Mathematics, Survival, and Courage (Life Lessons From Patients of the VA)

By matthew Brockwell, ms III

Continued on page 43


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