March 2015

“Physicians United for a healthy san diego”

official publication of SDcMS March 2015

Leadership

management

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North County’s most affluent demographics

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5 0 , 0 0 0 S F existing medical office building

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WE ARE PLEASED TO ANNOUNCE

Pain Management Specialists • Doonan Urgent Care Carlsbad Imaging Center • Great Smiles • PharmacyFUTURE TENANTS AT NORTH COAST MEDICAL PLAZA

6 0 1 0 H i d d e n Va l l e y R o a d , C a r l s b a d , C A 9 2 0 1 1

TRAVIS IVESAssociate DirectorLic. # [email protected]

CUSHMAN & WAKEFIELD OF SAN DIEGO, INC.CA License No. 13299634747 Executive Drive, 9th Floor San Diego, CA 92121

V I S I B L E

363 FEET linear frontage on Palomar Airport Road

(43,492 CARS PER DAY )

A C C E S S I B L E

1 MILE from Interstate 5(202 , 572 HOUSEHOLDS

WITHIN 20 MINUTE DRIVE)

S T R AT E G I C

North County’s most affluent demographics

($98 ,614 AVG HOUSEHOLD INCOME IN A 5 MILE R ADIUS)

5 0 , 0 0 0 S F existing medical office building

3 9 , 0 0 0 S F proposed build-to-suit

opportunity

NORTH COUNTY’S NEWEST AND MOST COVETED MEDICAL CAMPUS

FOR MORE INFORMATION, PLEASE VISIT WWW.NORTHCOASTMEDICALPLAZA.COM

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and informa-tion sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or ser-vices advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to [email protected]. All advertising inquiries can be sent to [email protected]. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email [email protected]. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

VolUme 102, nUmber 3contentsMarch

features

Leadership & managementBY TOM GEHRING, EXECUTIVE

DIRECTOR AND CEO, SDCMS

10 Introduction

12 The Art of the Big Picture

14 What Does the Boss Really Do?

16 Your Strategic Plan: Keep It Simple and Short

18 Contextual Decision-making: What Do You Know?

20 “I Don’t Have Enough Time to Get It All Done!” Important vs. Not Important — Urgent vs. Not Urgent

22 Effective Meetings: 15 Rules to Conduct By

24 I Hate Email: Taking Control of Your Inbox

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle LewisEDITORIAL BOARD: Sherry L. Franklin, MD, James Santiago Grisolía, MD, Theodore M. Mazer, MD, Robert E. Peters, PhD, MD, David M. Priver, MDMARKETING & PRODUCTION MANAGER: Jennifer RohrSALES DIRECTOR: Dari PebdaniART DIRECTOR: Lisa WilliamsCOPY EDITOR: Adam Elder

SDCMS BOARD OF DIRECTORS

OFFICERSPRESIDENT: J. Steven Poceta, MDPRESIDENT-ELECT: William T-C Tseng, MD, MPH (CMA Trustee)TREASURER: Mihir Y. Parikh, MDSECRETARY: Mark W. Sornson, MDIMMEDIATE PAST PRESIDENT: Robert E. Peters, PhD, MD

GEOGRAPHIC AND GEOGRAPHIC ALTERNATE DIRECTORSEAST COUNTY: Venu Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD, Alt: Susan Kaweski, MD (CALPAC Treasurer)HILLCREST: Gregory M. Balourdas, MD, Thomas C. Lian, MD, Alt: Thomas J. Savides, MDKEARNY MESA: Sergio R. Flores, MD, John G. Lane, MD, Alt: Anthony E. Magit, MD, Alt: Eileen R. Quintela, MDLA JOLLA: Geva E. Mannor, MD, Marc M. Sedwitz, MD, Alt: Lawrence D. Goldberg, MDNORTH COUNTY: James H. Schultz, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD, Alt: Anthony H. Sacks, MDSOUTH BAY: Reno D. Tiangco, MD, Michael H. Verdolin, MD, Alt: Elizabeth Lozada-Pastorio, MD

AT-LARGE DIRECTORSLawrence S. Friedman, MD, Karrar H. Ali, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Stephen R. Hayden, MD, Peter O. Raudaskoski, MD, Vimal Nanavati, MD (Board Representative), Holly B. Yang, MD

AT-LARGE ALTERNATE DIRECTORSKarl E. Steinberg, MD, Jeffrey O. Leach, MD, Toluwalase A. Ajayi, MD, Phil Kumar, MD, Wayne C. Sun, MD, Kyle P. Edmonds, MD, Carl A. Powell, DO, Marcella M. Wilson, MD

OTHER VOTING MEMBERSCOMMUNICATIONS CHAIR: Sherry L. Franklin, MD (CMA Trustee)YOUNG PHYSICIAN DIRECTOR: Edwin S. Chen, MDRESIDENT PHYSICIAN DIRECTOR: Jane Bugea, MDRETIRED PHYSICIAN DIRECTOR: Rosemarie M. Johnson, MDMEDICAL STUDENT DIRECTOR: Spencer D. Fuller

OTHER NONVOTING MEMBERSYOUNG PHYSICIAN ALTERNATE DIRECTOR: Daniel D. Klaristenfeld, MDRESIDENT PHYSICIAN ALTERNATE DIRECTOR: Diana C. Gomez, MDRETIRED PHYSICIAN ALTERNATE DIRECTOR: Mitsuo Tomita, MDSDCMS FOUNDATION PRESIDENT: Albert Ray, MD (CMA Trustee, AMA Delegate)CMA SPEAKER: Theodore M. Mazer, MDCMA PAST PRESIDENTS: James T. Hay, MD (AMA Delegate), Robert E. Hertzka, MD (Legislative Committee Chair, AMA Delegate), Ralph R. Ocampo, MDCMA TRUSTEES: Robert E. Wailes, MD, Erin L. Whitaker, MDCMA SSGPF DELEGATE: James W. Ochi, MDCMA SSGPF ALTERNATE DELEGATES: Dan I. Giurgiu, MD, Ritvik Mehta, MDAMA ALTERNATE DELEGATE: Lisa S. Miller, MD

8

28departments

4BrieflyNoted:Calendar•CommercialRealEstate•WelcomeNew Members•AndMore…

8 We Are All Physician Leaders BY HELANE FRONEK, MD, FACP, FACPh

26 Physician Marketplace: Classifieds

28 The Ever-present Possibility of Loss BY DANIEL J. BRESSLER, MD, FACP

2 March 2015

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4 March 2015

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

Healthcare Facility Employee OSHA & Safety Training (seminar/webinar)apr 16: 11:30am–1:00pm

Physician Networking Opportunity and Mixer (social)apr 24: 5:30pm–8:00pm

Work-Life Balance Workshop for PhysiciansMaY 2: 9:00am–12:00pm — [email protected]

Financial & Legal Life Skills Workshop for PhysiciansJun 6: 8:00am–12:00pm

SDCMS White Coat Gala (event)Jun 13: 6:00pm–11:00pm

The Leader’s Toolkit (workshop)Jul 11–12: 8:00am–4:00pm & 8:00am–12:00pm

calendar

Briefly noted

Community Healthcare Calendarto submit a community healthcare event for possible publication, email [email protected]. Events should be physician-focused and should take place in or near San Diego county.

35th Annual Radiology Reviewapr 5–11 at the hotel del coronado (ucsd.edusymp.com/product/brochure/52)

Ulnar Collateral Ligament Injuries: An Epidemic?apr 15 at Scripps Green hospital (www.scripps.org/sparkle-assets/documents/sports_medicine_seminar_2015.pdf)

Oral Pathology: Helping You Guard Your Galaxyapr 17 at the Manchester Grand hyatt San Diego (www.sdcds.org/continuingeducation/course/78479)

Emerging Therapeutic Trends to Optimize Diabetes Careapr 17–18 at the holiday inn San Diego, bayside (www.scripps.org/events/emerging-therapeutic-trends-to-optimize-diabetes-care-april-17-2015)

16th Annual Sharon’s Ride.Run.Walk for Epilepsyapr 26 at De anza cove (sharonsride2015.kintera.org/faf/home/default.asp?ievent=1118436)

16th Annual UC San Diego Stroke Conference: Stroke 360MaY 2 at the Skaggs School of pharmacy and pharmaceutical Sciences (cme.ucsd.edu/stroke)

Spine Injuries in SportJul 15 at Scripps Green hospital (www.scripps.org/sparkle-assets/documents/sports_medicine_seminar_2015.pdf)

Critical Care Summer Session 2015Jul 23–25 at paradise point, San Diego (cme.ucsd.edu/criticalcare)

Pan-Pacific Biomedical Informatics Training CampauG 3–13 at the uc San Diego biomedical research facility ii, la Jolla (cme.ucsd.edu/bioinformatics)

Advanced Therapeutic Interventions to Optimize Obesity and Diabetes CareSEp 25–26 at the San Diego Marriott la Jolla (www.scripps.org/events/advanced-therapeutic-interventions-to-optimize-obesity-and-diabetes-care-september-25-2015)

Surgical Stabilization and Rehabilitation of the Unstable ShouldernoV 18 at Scripps Green hospital (www.scripps.org/sparkle-assets/documents/sports_medicine_seminar_2015.pdf)

San Diego Medical Office Report: Q4 2014By Chris Ross

It’s official: Countywide medical office vacancy has fallen below the 10% benchmark. Rental rates are now steadily rising. The market is showing consistent signs of improvement, with some properties achieving record sale prices and rental rates. Investment properties have recently traded for as much as $729 per square foot. Unique owner-user properties have reached upward of $500–$600 per square foot. And the new high-water mark for Class A medical office rent is $4.00 NNN. Comps in this range are limited to very specific properties and submarkets, the point being that acquisi-tion and occupancy costs are breaking new barriers. The wiser investors, developers, and occupiers of healthcare real estate are strat-egizing and planning accordingly.

As the evolving healthcare environment be-comes more competitive, providers are placing a higher value on visibility, space functionality, and aesthetics. A growing number of physi-cian groups are forging new partnerships and strategic relationships, allowing them to gain economies of scale with payers, streamline staffing needs, and add new services and tech-nology. Additionally, these new relationships often allow practices to consolidate into larger and more efficient space with reduced overhead per provider while improving the patient expe-rience through a more appealing environment for care.

As a result, medical tenants continue to vacate Class B- and C buildings and move into Class A and B+ properties. So while county-wide vacancy has dropped a healthy 120 basis points over the past year, the Class A and B+ MOB market has improved more substantially. Class A vacancy has been cut in half over the past two years, dropping from 13.3% at the end of Q4 2012 down to 6.6% today.

The countywide average asking rate is now at $2.54 per square foot, up 2.7% from 12 months ago. This upward trend has only just begun since increases in rental rates tend to lag vacan-cy compression and reduction in concessions, two trends that have been steadily occurring over the past 24 months.

Mr. Ross is vice president of healthcare solutions for Jones Lang LaSalle. He is a commercial real estate broker specializing exclusively in medical office and healthcare properties in San Diego County. To receive the complete Q4 2014 report, call Mr. Ross at (858) 410-6377 or email him at [email protected].

commercial real estate

Barry Masci, CFA, CMT, CMFC, CLU®, CFP®First Vice President – Investments11512 El Camino Real, Suite 210, San Diego, CA 92130858-720-2365 • [email protected] bmasci.wfadv.com

Wells Fargo Advisors, LLC, Member SIPC, is a registered broker-dealer and a separate non-bank affiliate of Wells Fargo & Company.© 2013 Wells Fargo Advisors, LLC. All rights reserved. 0514-03415 [74036-v4] A1272 (1194411_372510)

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”

“Things may come to those who wait, but only the things left by those who hustle.— Abraham Lincoln

quote of the month

San DiEGo phYSician.orG 5

sdcms-cma membership

David P. Gallus, MDGeneral SurgerySan Diego(619) 532-7577

Dan O. Harper, MDfamily MedicineSolana beach(858) 755-1126

Jared H. Heimbigner, DODiagnostic radiologypoway(619) 280-4213

Veronica Nicholas Mahon, DOobstetrics and GynecologySan Diego(619) 280-4213

Welcome New and Returning SDCMS-CMA Members!

Edward S. Rotunda, MDEmergency Medicinecarlsbad(760) 439-1963

Kenneth C. Vitale, MDphysical Medicine and rehabilitationSan Diego (619) 543-2539

WeLCOme retUrning memBer

Beth Ann Zelonis-Shou, MDEmergency Medicinecarlsbad (760) 439-1963

neW memBers

David W. Cline, MDDiagnostic radiologycoronado (619) 532-6854

Tina J. Dhillon-Ashley, MDobstetrics and Gynecologyoceanside

Ariana N. Dillman, MDEmergency Medicinecarlsbad(760) 439-1963

Colin M. Dougherty, MDEmergency Medicinecarlsbad(760) 439-1963

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sdcms-cma membership

Dennis f. coughlin, MD • 42George D. Gibson, MD • 42Edward M. Goldstein, MD • 42Danny l. Keiller, MD • 42thomas G. neglia, MD • 42William a. pitt, MD • 42carlos J. Sanchez, MD • 42David J. Shaw, MD • 42Dee E. Silver, MD • 42lawrence p. bogle, MD, facr • 41frank E. corona, MD • 41Yaroslav Kushnir, MD • 41Jerome S. litvinoff, MD • 41John b. Marino iii, MD • 41Joseph Shurman, MD • 41James p. tasto, MD • 41John M. casey, MD • 40ronald E. feldman, MD, facG, facp • 40henry E. Golembesky, MD • 40richard Greenfield, MD • 40Vincent J. Guzzetta, MD • 40Michael i. Keller, MD • 40Steven M. leshaw, MD • 40Stuart c. Marshall, MD • 40G. Douglas Moir, MD • 40Kenneth ott, MD, facS • 40bruce M. prenner, MD • 40Stephen l. reitman, MD • 40William f. resh, MD • 40thomas r. Vecchione, MD • 40richard l. buccigross, MD • 39Douglas h. clements, MD • 39nicholas r. frost, MD • 39theodore G. Ganiats, MD • 39harry c. henderson iii, MD • 39p. lance hendricks, MD • 39leonard M. Kornreich, MD • 39leland D. lapp, MD • 39Marc J. lebovits, MD • 39Marshall J. littman, MD • 39peter h. b. Mccreight, MD • 39robert S. Scheinberg, MD • 39Jeffrey W. Selzer, MD • 39paul f. Speckart, MD • 39Michael J. thoene, MD • 39

Congratulations and Thank You to the Following Physicians Who Have Been Paid SDCMS Members for a Third of a Century and Longer!

patricia c. b. Vennwatson, MD • 39arthur b. Warshawsky, MD • 39Eric c. Yu, MD • 39robert E. brucker Jr., MD • 38James E. bush, MD • 38paul b. Dean, MD • 38Stewart l. frank, MD • 38Daniel Gardner, MD • 38Mitchel p. Goldman, MD • 38Gary l. isley, MD • 38Wayne l. iverson, MD, Mba, facp • 38adrian M. Jaffer, MD • 38Michael K. Kan, MD • 38richard a. Katz, MD • 38Donald c. lipkis, MD • 38Jon h. lischke, MD • 38Merritt S. Matthews, MD • 38howard G. Milstein, MD • 38rodrigo a. Muñoz, MD • 38robert c. pace, MD • 38Edward l. racek, MD • 38ruth M. robles-Goche, MD • 38robert J. Santella, MD • 38barry M. Scher, MD • 38Edward l. Singer, MD • 38Seung-Yil t. Song, MD • 38robert M. Stein, MD • 38richard l. Stennes, MD • 38John randolph backman, MD, facc, facp, facSM • 37lawrence D. Eisenhauer, MD, facoG • 37leon fajerman, MD • 37theodore l. folkerth, MD • 37athanasios J. foster, MD • 37richard G. friedman, MD • 37James t. hay, MD • 37roy a. Kaplan, MD • 37Jerry Kolins, MD • 37charles r. Kossman, MD • 37William p. Mann, MD • 37leslie a. Mark, MD • 37thomas E. page, MD • 37arthur c. perry, MD • 37Scott a. riedler, MD • 37Jeffrey M. rosenburg, MD • 37Steven M. Steinberg, MD • 37robert S. Yuhas, MD • 37William t. chapman, MD • 36Gregory t. czer, MD • 36Victor M. Dalforno, MD • 36blaine a. fowler, MD • 36Edward b. friedman, MD • 36paul M. Goldfarb, MD • 36Michael Gordon, MD • 36James Santiago Grisolía, MD • 36James a. helgager, MD • 36

NOTE: Current SDCMS-CMA Members as of March 10, 2015SDCMS Member Physician’s Name • Years of Membership

Joseph Deluca, MD • 67alanson a. Mason, MD • 60robert M. barone, MD • 57lino p. trombetta, MD • 55raymond Dann, MD • 53Ernest E. pund Jr., MD • 52Edward J. Sheldon, MD, faafp • 52Garry E. Goldfarb, MD • 49robert penner, MD • 48raymond M. peterson, MD • 48Myron Schonbrun, MD • 48richard n. learn, MD • 47allan h. rabin, MD, Dlfapa, Dfaacap • 47John a. berger, MD • 46allan h. Goodman, MD • 46George W. Kaplan, MD • 46leonard D. rutberg, MD • 46Miguel a. losada, MD • 45William l. nyhan, MD • 45robert M. thomas Jr., MD • 45Steven a. balch, MD • 44Elaine h. cohen, MD • 44h. Douglas Engelhorn, MD • 44James c. Esch, MD • 44Edwin b. fuller, MD • 44Sidney h. levine, MD • 44richard D. perlman, MD, Mph, facS • 44fernando a. Zamudio, MD • 44lawrence n. cooper, MD • 43franklin a. crystal, MD • 43anthony J. cuomo, MD • 43Steven r. Drosman, MD • 43thomas a. flanagan, MD, Dfapa • 43ronald J. Goldman, MD • 43leon r. Kelley, MD • 43Victor h. lipp, MD • 43William G. Moseley, MD • 43David r. Schmottlach, MD • 43russell S. Weeks, MD • 43o. Douglas Wilson, MD • 43

6 March 2015

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Save30%charles K. Jablecki, MD • 36r. bruce Johnson, MD • 36Joseph f. leonard, MD • 36louis J. levy Jr., MD • 36Dom antonio lopez-Velez, MD • 36Jose E. otero, MD • 36Michael J. rensink, MD • 36Steven r. ruderman, MD • 36Jeffrey a. Sandler, MD • 36Maurice p. Sherman, MD • 36paul l. treger, MD • 36bernard J. urlaub, MD • 36raymond M. Vance, MD • 36benito Villanueva, MD • 36Marvin J. Zaguli, MD • 36robert W. Ziering, MD • 36nicholas a. Zubyk, MD • 36lance l. altenau, MD • 35carroll D. bucko, MD • 35David c. campbell, MD • 35irene l. chennell, MD • 35Jorge M. Delaguila, MD • 35thomas r. farrell, MD • 35carla G. fox, MD • 35robert a. Ginsberg, MD • 35David p. hansen, MD • 35William p. hitchcock, MD • 35Marilyn c. Jones, MD, faap • 35rokay G. a. Kamyar, MD • 35Murray J. Kornblit, MD • 35Eva p.-S. leonard, MD • 35albert l. Martinez, MD • 35Jeffrey b. Mazin, MD • 35Gary p. Mcfeeters, MD • 35S. Michael Millbern, MD • 35James S. otoshi, MD • 35alexander rodarte, MD • 35nathaniel G. rose, MD • 35Eugene W. rumsey Jr., MD • 35laurence K. tanaka, MD • 35Donald p. tecca, MD • 35Gary Vandenberg Jr., MD • 35John E. Welton, MD • 35Michael c.-W. Wong, MD • 35John a. Wright Jr., MD • 35George G. Zorn iii, MD • 35thomas c. adamson iii, MD • 34Jorge t. arce, MD • 34Gonzalo r. ballon-landa, MD • 34frank D. bender, MD • 34Michael t. bennett, MD • 34Duane M. buringrud, MD • 34Kenneth W. carr, MD • 34harold copans, MD • 34Dennis l. costello, MD • 34John h. Detwiler, MD • 34


peter S. friend, MD • 34robert l. Gagnon, MD • 34Steven r. Garfin, MD • 34Jeffrey i. Gorwit, MD • 34Said M. hashemi, MD • 34robert E. hertzka, MD • 34paul V.b. hyde, MD • 34Gary M. Jacobs, MD • 34nancy Kollisch, MD • 34John a. lafata, MD, facp • 34David r. ostrander, MD • 34richard E. payne, MD • 34Glenn o. plummer, MD • 34Gary prodanovich, MD • 34Joseph E. Scherger, MD • 34paul r. Woody, MD • 34James M. amberg, MD, abfp • 33rosa M. D. arias, MD • 33William E. bowman Jr., MD • 33ira r. braverman, MD • 33Stephen h. carson, MD • 33Maria E. castillejos, MD • 33Edward S. cohen, MD • 33terrence W. crouch, MD • 33Violeta b. curbelo, MD • 33brian Datnow, MD • 33John W. fox Jr., MD • 33roger a. freeman, MD • 33frank J. Goicoechea, MD • 33Kuljinder S. Grewal, MD • 33Kenneth G. Gross, MD • 33ronald r. harrington, MD • 33Marc E. Kramer, MD • 33John M. Kroener, MD • 33Julian p. lichter, MD • 33Gregory b. Mahan, MD • 33thomas D. Martinez, MD • 33bernard a. Michlin, MD • 33William J. Mittendorff, MD • 33paul neustein, MD • 33laura a. o’Donnell, MD • 33Stanley W. perkins, MD • 33Michael G. plopper, MD • 33layne J. rasmussen, MD • 33Stephen n. rogers, MD • 33richard f. Santore, MD • 33Jerome l. Sinsky, MD • 33David p. Slack, MD • 33M. hertzel Soumekh, MD • 33randal J. Vecchione, MD • 33Michael J. Welch, MD • 33barry G. Zamost, MD • 33

YeARS Ago, I mistakenly believed that providing excellent medical care to patients was my only role. My employees were unengaged, communication faltered, and morale plummeted as I failed to involve my team and appropriately address certain issues. I didn’t realize that we physicians are leaders. We may not have thought we were signing up for that when we applied to medical school, but the truth is that we are often expected to lead — in our practices, families, and communities.

Unfortunately, medical education doesn’t teach those skills. Our training re-wards individual medical competence and an almost selfless devotion to our work — not much grist for leadership there. In their classic work, The Leadership Challenge, Kouzes and Posner define five competen-cies of effective leadership:

1. Challenging the Process in Order to Grow and Innovate

2. Inspiring a Shared Vision3. Enabling Others to Act4. Modeling the Way Through Behavior

That Reflects Shared Values5. Encouraging the Heart by Regularly

Recognizing Individual and Team Ac-complishments

How can we use these suggestions to become better leaders?

We begin by reflecting on what is important to us. What values do we want our practice to embody? Do we want to be known for compassionate care? Cutting-edge medicine? Integration of complemen-tary medical philosophies and techniques? Why is that important? Do we believe in the self-healing power of the human body, being the first to offer new and innovative

treatments in our community, providing tested, reliable approaches to our patients’ conditions? We then present our intentions to staff and colleagues and ask for their ideas, suggestions, beliefs. Together, we create a clear vision that all can commit to.

What needs to change in order to make this a reality? A great leader will criti-cally challenge the status quo in service of improvement or readiness for future chal-lenges. How can we do things better, more efficiently, and promote greater engage-ment? Although physicians have histori-cally operated as “lone wolves,” medicine is increasingly a team sport. By determin-ing the skills and interests of our team-mates, we can encourage them to use the abilities they possess and to grow by devel-oping new competencies, all in service of our shared vision. As wise leaders, we seek honest feedback on our own behavior. Is it congruent with our stated values? Does it reflect both confidence as well as openness to change and to the opinions of others? We seek help to hone new skills. Finally, we acknowledge the contributions of our team — both individuals and the group as a whole. We inspire more of the behaviors we reward. Recognizing effort and good work builds team spirit and commitment to shared goals.

Each step requires reflection, inten-tion, and action. If we are to become the leaders to effectively guide our practices and organizations through the evolving future of healthcare, we need to approach leadership as we did our medical compe-tencies, accept its increasing importance in our careers and our lives, and take action to acquire these valuable competencies. After all, don’t we want physicians leading the future of healthcare?

Dr. Fronek, SDCMS-CMA member since 2010, is as-sistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician develop-

ment coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronek-md.wordpress.com.

Personal & Professional deVeloPment

We are all Physician leaders

by Helane Fronek, MD, FACP, FACPh

8 March 2015

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10 March 2015

Physician Leadership

managementLEADERSHIP, EXCEPT FOR THE singularly blessed, is a learned art. Very few physicians have the time or the opportunity to learn leadership during their medical training. A decade ago, when SDCMS real-ized that we could help train tomorrow’s leaders, we created the Leaders Toolkit, a day and a half intense but fun Socratic seminar on how to lead — and how to man-age! As of this past March 14–15, we have exposed 247 healthcare leaders to the prin-ciples and basic concepts of leadership.

The following articles highlight some of the key skills that every leader must master, no matter how small or large the organiza-tion. These seven articles are not meant to be inclusive or particularly detailed; they are meant to give you an overview, and a taste of what you could learn during the Leaders Toolkit. The next two seminars are July 11–12 and September 19–20; please email me if you are interested — the most typically heard comment at the wrap-up is, “I wish I had taken this course earlier.” If you need any references or any other ideas on how to improve your leadership skills, do not hesitate to contact me at (619) 206-8282 or at [email protected].

Lead on!

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

introductionBy Tom Gehring


Table of ConTenTS

The Art of the Big Picture

12Contextual Decision-making

18

Your Strategic Plan

16

Effective Meetings

22

I Hate Email

24

What Does the Boss Really Do?

14

“I Don’t Have Enough Time to Get It All Done!”

20

12 March 2015


THE BOSS HAS TO HAVE THE BIG picture! As well, the boss has to have a grasp of (some) critical details. Managing these sometimes-conflicting perspectives — see-ing the forest for the trees, as well as the microscopic detail on the trees — is a critical leadership skill.

By design, the CEO is the only person who has access to everything in the organization. In addition, the leader has the senior-level contacts outside the organization to sense the context, the environment. From these many sources and many pieces of information, you must create a (big) picture of what’s happen-ing to you and your organization.

An important caution is in order: Just because you can have all the information does not mean you should. You have to be selective or else you’ll drown in (not helpful) data. You should have written instructions on what data or information you expect to get at what frequency — and that should be very carefully thought through.

A sophisticated leader must differentiate between data and actionable intelligence. Having a lot of numbers is nice, but being able to draw conclusions from those num-bers is the goal.

In today’s numbers-obsessed world, it’s important to remember that qualitative or subjective analysis can be just as impor-tant as numerical data. In fact, the more complex the system, the more it requires non-numerical data to truly understand.

The overworked metaphor, “connecting the dots,” is just another way of saying that you interpolate between many sources/many data points to build a picture, a

model, of what is happen-ing now, as well as what happened in the past.

But it is not enough to simply interpolate the data, looking at the past and creating a coherent picture of the present. It is just as important to extrapolate, to project into the future. Yogi Berra famously said that it’s tough to make predictions, particularly about the fu-ture; however, that’s part of your job description as the leader.

The scenario-planning process is particularly helpful for prognostication because, while very few people have the ability to absolutely determine what’s go-ing to happen in the future, many are able to create multiple, realistic possible sce-narios. The essence of scenario planning is understanding what the possible future realities are, and identifying the signposts that tell you which reality/scenario is com-ing to fruition.

Understanding when the current reality is dramatically changing is another way of saying that you are looking for inflection points. Many companies, many industries, many civilizations change very quickly,

and the leader’s role is to antici-pate change by spotting the early signs of an inflection point.

While many of us are trained to look for data or information, one of the most sophisticated skills of a leader — which often comes with experience — is looking for the absence of data or infor-mation. Said differently, what should’ve just happened that didn’t? A sophisticated leader will be able to tell just as much from what just didn’t happen as what just did — the absence of normal.

Finally, it is so important that the leader get the bad news, the data that indicates that something bad is happening. The sur-est way for a leader to fail is when data or in-formation about things not going right does not make it to her. When something goes wrong, the CEO must clearly and funda-mentally understand the “why” of what just happened, what I call “turning over every rock.” But in order to do that introspection, she has to know about it in the first place.

For me, developing the big picture and using it to inform decisions is one of the most critical skills in leadership.


the art of the Big PictureBy Tom Gehring

The surest way for a leader to fail is when data or information about things not going right does not make it to her.


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14 March 2015


AS SDCMS’ CEO, I HAVE TO constantly ask myself what my job consists of; what, in general, my board expects me to do. Not the penny-ante stuff, but the really, really important stuff. This is a question that should run (frequently) through the mind of every leader, from the CEO of GE to the physician leader of a solo practice.

I would argue that the leader has six non-negotiable responsibilities:• Sense the big picture.• Articulate the vision.• Make sure people have the tools to

achieve the vision.• Set the boundaries.• Make the really big decisions.• Accept responsibility.

Let’s look at each of these in a little bit of detail.

The only person who has access to all the information in the organization is you! You have to build, from many sources and many pieces of information, a (big) picture of what’s happening to you and your organiza-tion. That involves interpolation, extrapo-lation, sensing inflection points, looking

By Tom Gehring

Make sure your team has the tools to get there. And we’re not talking pens and paper. We’re talking hardware, software, warm-ware (the right people necessary to accom-plish the tasks), the resources (money), and the environment that supports your team.

If we’re going to bring in 180 net new SD-CMS physician members, we have to have a recruiting budget — asking SDCMS staff to accomplish this goal without a recruit-ing and retention budget is straight out of Dilbert.

Set the boundaries, but set them smart. Make the boundaries clear but not restric-tive. Make sure your team knows that they must challenge/push the boundaries, but never, ever exceed your boundaries without your permission. While some of these boundaries are ethics- and morals-based (we will not lie, cheat, or steal), many are very simple. And, if one of your team vio-lates a boundary that you as the boss did not

for the absence of data as information, and, finally, being able to tell the forest from the trees. One of the most important traits of an effective leader is the ability and willingness to, when something goes wrong, clearly and fundamentally understand the “why” of what just happened — what I call “turning over every rock.”

If you don’t know where you’re going, any path will get you there. You, as the boss, have to be able to say strategically, and often tactically, “This is where we’re going,” and, “Oh, by the way, this is how we’ll know when we’ve gotten there.” You have to ar-ticulate, in simple (read: short) terms, what you want the group to achieve.

For example, SDCMS staff has set a goal of 180 net new physician members in this fiscal year. A goal that’s easy to understand, easy to measure every action against, easy to state, hard to accomplish, but it’s a target we’re all collectively working toward.

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Make the (Big) decisions

What does the Boss Really do?

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articulate, you can only blame yourself.

For example, anyone on the SDCMS staff may commit up to

$500 in resources without asking me first.

You have to be able to make the really big decisions. Hiring, firing,

committing major resources, stopping a project, the list could go on and on.

Many bosses recognize that a big deci-sion has to be made, but then they make

two cardinal errors: They either can’t make the decision, or they make the decision in an erroneous manner (more on how to make decisions in the next installment).

Let’s say you just caught your most valuable employee red-handed in a major lack-of-integrity problem. Do you have the gumption to fire him? Only you can do so (and firing him may not be the answer until you fully investigate the issue), and if you make the wrong move, everyone will know.

Accept responsibility. Be in charge in time of crisis (and avoid the urge to be in charge of everything — that’s called micro-management). Physicians get this on a clini-cal level, i.e., you know to be in charge when the patient is crashing. Your non-clinical responsibilities are no different. You cannot delegate decision-making when the world is crashing down around you. Be in charge!

During the 2007 wildfires, County Supervisor Ron Roberts and Mayor Jerry Sanders were on television three, some-times four times a day. Everyone in San Diego County knew who was making the decisions, and we wanted that!

So remember: Sense the big picture, ar-ticulate the vision, provide the tools, set the boundaries, make the decisions, and accept responsibility.


16 March 2015


I AM A BIG BELIEVER IN KISS: KEEP It Simple and Short.

Your strategic plan starts with the envi-ronment. Absent a clear understanding of the world you inhabit, everything is wishful thinking. Using SWOT analysis to clearly articulate your strengths and weaknesses, and the opportunities and threats inher-ent in the world you cannot control, will go a long way toward clearly understanding the environment that you are unlikely to change.

You must understand your mission — what you do, who you do it for, and how you do it — so that you have a baseline from which to start. Often the mission is part of

either statutory or bylaws language, which you may not be likely to change.

Your vision must be a compelling state-ment about where you want to be at some point in the future — months, years, or decades.

Guiding principles are the rules you want to live by as you are getting to your vision.

Strategies are vectors, tasks, actions, methods — in fact, anything that gets you from here to there — that takes you from what you are doing today, your mission, to where you want to be tomorrow, your vision.

Priorities are the sequence of strategies.Metrics are how you measure the accom-

plishment of strategies.Finally, outcomes measure the achieve-

ment of the vision.A little bit of common sense and some

hard work and you’re ready to start your strategic plan.


Priorities

guiding PrinciPles

environMent

strategies

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visionWhere you want to be

Metrics

outcoMes

MissionWhat you do

strengths opportunities

Weaknesses threats

your strategic PlanKeep it Simple and Short

By Tom Gehring


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18 March 2015


MANY THINK ABOUT DECISION-making by assuming that all decisions are made in essentially the same manner. In this article I’ll discuss why decisions need to be made in context.

Let me start with an example: A patient comes into the ER with severe trauma. While the outcome may not be preordained, the protocols are clear — the decision-making is (nearly) straight line, i.e., cause and effect, because in this case we are dealing with (mostly) “known knowns,” and there is usually one “right” answer. This in no way diminishes the skill necessary to do the right thing; becom-ing an effective trauma surgeon takes decades. However, the process of making decisions in this case is referred to by David Snowden and Mary Boone in their Harvard Business Review article as “The Simple Context — The Domain of Best Practice” (“A Leader’s Framework for De-cision Making” by David J. Snowden and Mary E. Boone, Harvard Business Review, November 2007). Since I don’t want to fo-cus on medical decision-making, let’s try another example: executing a budget. The facts are (usually) clear, and the actions to

be taken if off budget are (usually) clear. We adhere to best practices. What should the leader do in this context? Avoid mi-cromanaging, make sure people don’t become com-placent by ensuring every anomaly is investigated, and make sure processes are adhered to.

What happens if there are multiple right answers? This is the realm of “known unknowns.” Rather than make a simple cause-effect decision, we need to inves-tigate multiple options and choose between them. There is often incomplete and even conflicting information. Experts are often helpful in providing the information neces-sary to make decisions. What must the lead-

contextual decision-MakingBy Tom Gehring

What Do You Know?

The single most important message for the reader is to understand which context you are in and then apply the appropriate decision-making style.

er do? Investigate all the options, ensure that all the experts are heard from, make sure the “wild and crazy” ideas of the non-experts are considered, avoid analysis paralysis, and, in the end, as all leaders must do, make the decision. The best medical example would be a patient who comes in with multiple, undif-ferentiated symptoms. In this case, the treating physician must marshal all of the relevant experts to come up with a diagnosis, often in the face of incomplete information and multiple strong opinions. Snowden and Boone

refer to this as the “complicated context — the domain of experts.”

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and often a complete lack of understanding (except in retrospect) of what is going on? Then we are in the domain of “unknown unknowns” — the most challenging deci-sion-making environment for a leader, and the context in which we increasingly find ourselves. Consider two problems: repairing a Prius and building a power line through a desert preserve.

A Prius is a complicated machine and takes an expert to fix, but there are technical manuals, there are a finite number of parts, and, in the end, the Prius is the sum of its parts. The ecology of the desert preserve, on the other hand, is never the same: There is constant change, there are many stake-holders, and there is conflicting science, i.e., the whole is more than the sum of the parts. Snowden and Boone refer to this as the “complex context — the domain of emergence.” For leaders used to the dictum “don’t just stand there, make a decision,” the complex context is nerve-racking because it calls for the leader not to make snap decisions, not to try to impose order (or a tried-and-true model) on a situation that is oh-so-unclear, to foster creativity and experimentation, and to be patient.

Finally, we have a “chaotic context —

the domain of rapid response.” Quoting Snowden and Boone, “In a chaotic context, searching for the right answer would be pointless. The relationships between cause and effect are impossible to determine be-cause they shift constantly and no manage-able patterns exist, only turbulence. This is the realm of the unknowables. The events of September 11, 2001, fall into this category. The leader’s task is obvious — and the exact opposite of the complex context: commu-nicate and direct in a “top-down” manner (there is no time for input or committee meetings) to establish order. Paradoxically, the leader must look and listen for signs that stability is emerging and then revert to the leadership styles of the complex context.

Having reviewed the four basic contexts of decision-making — simple, compli-cated, complex, and chaotic — the single most important message for the reader is to understand which context you are in and then apply the appropriate decision-making style. Applying the right style for the given context is just using the right tool for the task!


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unknoWaBles: chaoS

20 March 2015


IF THERE IS ONE CRY HEARD throughout the working world, it has to be “I don’t have enough time to get it all done!” Well, people are right: There is never enough time to get it all done. But let me challenge the assumption that all needs to get done!

Stephen Covey, in his numerous books, explains that any task can be parsed along two axes: important vs. not important, and urgent vs. not urgent.

We spend a huge percentage of our time in category 3: items that are urgent but not important! The best examples are phone calls and emails. Most, if not all, phone calls and emails are urgent (usually by someone else’s definition) but, fundamentally, not important!

Category 4 tasks, which are not urgent and not important, are usually obvious and require little talent (but much willpower because they are often fun) to push to the bottom of the pile or straight into the trash.

Similarly, category 1 tasks — important and urgent — are easy to spot; I refer to these as firefighting tasks.

The real genius in Stephen Covey’s analy-sis of our tasks, and how we allocate time to them, is in recognizing that, unless trained or naturally brilliant, people spend little if any time on category 2 tasks: not urgent but important. Category 2 is where actions with strategic and/or long-term impact are ac-complished. These tasks require significant thinking and unconstrained time. Unless you force yourself to make time for these tasks, they will never get done because there will always be something more “urgent” to consume your limited time.

Self-awareness is critical to effectively managing your limited time. I am most effective early in the morning before the phones start to ring and everyone starts responding to last night’s emails. When I need to do category 2 work, I do it early in

“i don’t have enough tiMe to get it all done!”

By Tom Gehring

important vs. not important — urgent vs. not urgent

The real genius in Stephen Covey’s analysis of our tasks, and how we allocate time to them, is in recognizing that, unless trained or naturally brilliant, people spend little if any time on category 2 tasks: not urgent but important.


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the morning. My wife is the exact opposite: She does her best work late at night. The key is to know when you are most effective and to allocate that time for the important and not urgent tasks.

Is this really a crisis? Being in charge (or thinking you’re in charge) affords one the option of saying, “No, that’s not a crisis. I can do that later.” Turn off the phone, turn off the computer, and shut the door. In a world were multitasking is the norm, try single-tasking by eliminating the distrac-tions. Again, being in charge affords one the luxury of saying, “Do not interrupt.”

In a later article, I talk about the four Ds — Do, Delegate, Delay, or Delete — as they apply to emails. When something comes across your desk, do it, delegate it (and, if necessary, use a tasking or tracking mecha-nism), delete it (the trash is a wonderful management tool), or delay the task based on assignment to category 3 or 4.

PRIORITIZE RUTHLESSLY: There are many systems to prioritize: A, B, C; 1, 2, 3; or red, yellow, green. The pitfall in prioritizing is having the preponderance of your tasks as A’s or 1’s or reds. Dilbert’s boss (the cartoon character) is a caricature of the boss whose priorities are all A’s.

KEEP A LIST: It’s so obvious that people often fail to do so. Whether that list is virtual, physical, on paper, or on 3x5 cards doesn’t matter. The key is to have an under-standing of the totality of your tasking.

THE DE FACTO STANDARD FOR TIME MANAGEMENT is Microsoft Outlook. The most underutilized feature in Outlook is task management. While the system is rudimentary, it does afford one the ability to drag an email directly to the task module. In addition, you have the ability to prioritize and categorize tasks within Outlook.

TOUCH EACH TASK ONLY ONCE: If you allow work to pile up in your physical or virtual inbox because you make multiple, small attempts to complete the task, you will have an overflowing work list. If pos-sible — and it may not be — complete each task when you start it.

PERIODICALLY, RUTHLESSLY GO THROUGH YOUR ENTIRE INBOX, and make sure your trash can is close at hand!


Urgent not Urgent

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2 2 March 2015


The only phrase heard more frequently than “I hate these meetings” is “Why are we having this *&^%$#@ meeting?” I want to shed some light on how you can chair effective meetings. ¶ I have written this from the perspective of the person convening the meeting — the assumption is that you are in charge of the meeting. If you aren’t, as physicians, you are usually in a position to influence, so even if you are only a participant, I would argue the below rules are applicable. ¶ Here are 15 rules about meetings that I have found to be extremely useful.

1.clearly identify the purpose of the meeting well in advance. at the start of every meeting, i ask participants, “What is the purpose of this meeting?” and, just as important, “What are the expected deliverables?”

2.Start and end on time. My standard question at 11 o’clock, is, “What time is the 11 o’clock meeting starting?” as the leader, be in a position to observe the clock, without being obvious.

You owe it to the participants to manage the meeting so it ends on time. i announce the schedule and the end time of the meeting right up front, and ask everyone’s help in making it so.

3.Designate the scribe. in almost every situation, a scribe should record decisions reached and actions assigned, versus a verbatim transcript. the scribe should not be one of the principals, as taking notes detracts from their participation.

4.have an agenda. Seems obvious, yet the number of meetings without an agenda is amazing.

5.Stick to the agenda. Seems even more obvious, yet absent a firm hand, your meeting can easily wander off into uncharted territory.

6.if the right people can’t make it, reschedule the meeting. be very careful of accepting substitutes who are not fluent in the issue.

effective MeetingsBy Tom Gehring

15 rules to conduct by

7.if you (and more importantly, if the participants) are not prepared, reschedule the meeting.

8.listen. if the purpose of the meeting is to make a decision, and you’re in charge, then stop talking until everyone, particularly the junior participants, has opined.

9.if you don’t have all the information you need to make the decision, then adjourn until you do.

10.Do not tolerate inappropriate or rude behavior. if someone personalizes an issue, if someone prattles on, or if someone’s behavior is inappropriate, then the meeting participants expect you to stop it. if you don’t, this aberrant behavior will be perceived as the norm, and will multiply.

11.Make the decision. after all the opinions have been heard, and after a

consensus has been reached, decide. if it is clear that there has been no consensus, then you have to make the decision to adjourn until more data is obtained or decide without a consensus. Don’t “kick the can down the road” unless you are missing key data.

12.assign action items and, more importantly, deadlines.

13.Summarize the results of the meeting and schedule the next meeting (if appropriate). failure to state, publicly and succinctly, the outcome of the meeting can result in people leaving with incorrect (sometimes deliberately so) assumptions.

14.Get the minutes out, quickly.

15.have a shared norm for use of handheld devices, including phones and computers, during the meeting.



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24 March 2015


I HATE EMAIL! NO, I LOVE EMAIL. No, I hate email! Sound familiar? Love it or hate it, physicians today no longer have the option of ignoring email.

On an average day, I receive between 100 and 150 non-spam emails. How to deal with the onslaught? First, read the email tech manual. The book Send: The Essential Guide to Email for Office and Home by David Shi-pley and Will Schwalbe is probably the best description of how to effectively use email and avoid its many pitfalls. I have given it to every member of my team and every physi-cian in SDCMS leadership — that’s how good it is.

Email is divided into two broad catego-ries: reading and sending. Here’s my routine for an email reading session:•First, I go through every email in my

queue and read every subject line, ruth-lessly deleting — without opening or reading the text — every email that looks like junk or appears irrelevant, based only on the sender, the subject line, or both. If it’s junk, don’t forget to teach Outlook to ignore all future emails from that sender.

•Then, I triage every incoming email into

one of four categories: requests for action, information for me, requests for informa-tion from me, or scheduling. If it does not fit into one of those categories, it’s most likely junk, and I will delete it.

•Now I go back to the top and open each email (most recently received first) and ruthlessly apply the 4Ds: Do, Delegate, Delay, or, my favorite, Delete.

•If, when I open the email, it turns out to be junk, that’s easy: I delete it.

•If it’s information for me, I read it, as-similate it, then either delete it or move it to a folder (see below on folders). I’m ruthless — I don’t leave it in my inbox.

•If it’s a request for action (sometimes embedded in information emails), I then do it, delegate it, or delay it. Once I do it, I delete it from my inbox. If I delegate it, then I move it to a folder for the individual for whom I’ve delegated it. If I delay it, then I either assign it as a task or as an event, at which point I move it to a folder labeled “Pending.”

•If it’s a request for information, see item above.

•If it’s scheduling, then I respond and

move it directly to my calendar — I do not leave it in my inbox. Outlook is very powerful about dragging and dropping from email to calendar.I have a simple metric for my inbox: If

it’s empty, that’s fabulous. If it has between three and five extremely high priority current items, that’s OK. If it has more than 10 items, then I need to go back to the triage cycle.

I’m a big fan of this simple rule: Touch every email exactly once. Hard to do in practice — and there will be exceptions — but, in general, if you follow the rule, you’ll stop wasting time.

Develop a useful hierarchy of folders, including in each several broad categories: actions you’ve delegated to others, actions you’ve delegated to yourself (pending items), event-driven folders (e.g., CMA’s next House of Delegates), and broad catego-ries of information.

Here are some suggestions for sending emails:•Prior to sending an email, ask yourself

before anything else, “Is this email really necessary?” Then ask the same question again.

i hate eMailtaking control of Your inbox

By Tom Gehring

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•Keep it simple and short.•Keep emails totally — and I mean abso-

lutely totally — free of negative emotions. If you’re using adjectives or adverbs that are pejorative, that’s a great indicator that you should not be sending the email.

•Check your tone: Is this what you would say, and how you would say it, if you were face-to-face with the recipient?

•Remember that emails, once sent, are immortal. No matter how clever you are, somewhere there is a record of your com-munication — and that has gotten many, many people in trouble!

•Check your recipient list: Got everyone? Got too many?

•With one exception, never blind carbon copy (BCC). It’s a recipe for disaster.

•The exception to not BCCing is if you want to ensure privacy for the email ad-dresses for a large group of recipients.

•If there’s action requested, say so in the subject line, e.g., “Action Requested.”

•Make sure the subject line is clear and compelling. Be entertaining — it’s the hook to get someone to open your missive.

•Use dates, not “tomorrow” or “today” or “yesterday.”

•Spell check.•Syntax check.•Read the email from beginning to end at

least twice before sending.•Make sure the attachments, if there are

any, are attached.•Before you hit the Send key, ask yourself

what would happen if this email were published verbatim in the U-T San Diego. If there is any doubt in your mind, then listen to the voice in the back of your head and reconsider the email.A short note on smartphones and the

habit we’ve gotten into of sending emails from them. Many busy professionals now have a smartphone that allows them to download their emails continuously while they are away from their desks. I use my smartphone to keep me informed and to ruthlessly delete anything that is junk so that when I get back to my computer, I am able to rapidly take action as above.

Feel free to contact me at any time at [email protected] or on my cell at (619) 206-8282.


sdcms members: Attend Our Saturday, Aug. 22 Taming Outlook Seminar

this three-and-a-half-hour sdcms members-only seminar is a must for those busy physicians looking to make microsoft outlook their servant and not their master. this will be a very, very practical and user-focused seminar. Physicians will come away with a greater un-derstanding of microsoft outlook and its versatility as a desktop information manager. as well, you will have a new appreciation for a system that enables you to be more efficient, productive, and in control. details:• Title: microsoft outlook seminar• Date/Time: saturday, aug. 22, 2015, 8:30 a.m.–12 p.m.

• Presenter: tom gehring, ceo and executive director, sdcms

• RSVP: email [email protected]


26 March 2015

TO SUBMIT A CLASSIFIED AD, email Kyle lewis at [email protected]. sdcms members place classified ads free of charge (excepting “services offered” ads). nonmembers pay $150 (100-word limit) per ad per month of insertion.

claSSifiEDS URGENT CARE PHYSICIAN — PER DIEm BC/BE: Arch Health Partners is an award-winning medical foundation affiliated with the Palomar Health System in North San Diego County. Hours: 9:00am–9:00pm. Send CV to [email protected] or fax to (858) 618-5820. [312]

GENERAL, FAmILY, OR INTERNAL mEDI-CINE PHYSICIAN NEEDED ImmEDIATELY: This opening is an independent contractor po-sition. We are a house call practice located in beautiful North San Diego County. We will also provide paid training on our EMR. 8–5, Mon-day–Friday, 10–12 patients per day, and on-call pager 1 week every 3 weeks, telephone call only. No rounds or hospital duties. If interest-ed please submit your CV to [email protected]. We are very anxious to fill this position, and we look forward to hearing from YOU! No agencies please. [311]

FULL-TImE PRImARY CARE POSITION IN SAN DIEGO: Outpatient only office, no calls, no weekends. Please send CV to [email protected]. [308]

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

BOARD-CERTIFIED PHYSICIANS, PHYSI-CIAN ASSISTANTS, AND NURSE PRAC-TITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right can-didate. Must possess a current California medical license and ACLS certification. Please email or fax CV to (619) 569-2590. Visit www.DoctorsExpressSanDiego.com for more infor-mation. [229a]

PRImARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fast-growing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transpor-tation and personal assistant provided. Call Chris Hunt, MD, at (619) 992-5330 or email CV to [email protected]. Visit www.thehousecalldocs.com. [037]

PHYSICIANS NEEDED: Internal medicine and family medicine physician positions cur-rently open. Vista Community Clinic is a pri-vate, nonprofit, outpatient clinic serving the communities of North San Diego County with openings for full-time, part-time, and per-diem positions. Current CA and DEA licenses required. Malpractice coverage provided. Bi-lingual English/Spanish preferred. Forward resume to [email protected] or fax to (760) 414-3702. Visit our website at www.vistacommunityclinic.org. EEO Employer / Vet / Disabled / AA [912]

SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERmANENT FOUR-DAYS-PER-WEEK POSITION: Private practice in La Mesa seeks pediatrician four days per week on partnership

PHYSICIAN POSITION WANTED

LOOKING FOR PART-TImE FAmILY PRAC-TICE: D. (Doyle) Eugene Johnson, family phy-sician with a wealth of experience, looking for part-time position, preferably in North County. Have been a full-time practicing certified fam-ily physician for 50+ years and would like to continue seeing patients part-time. Had one of the largest solo family practices in San Diego for 25+ years. Excellent references! Continually certified in family practice, ACLS, BLS, regularly use computerized records. Will consider locum tenens. Please email [email protected] with particulars. [301]

PHYSICIAN POSITIONS AVAILABLE

PHYSICIAN POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at loca-tions throughout San Diego. A national lead-er among community health centers, Fam-ily Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. We offer an excellent, comprehen-sive benefits package that includes malprac-tice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email [email protected]. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org. [046a]

SEEKING A FOOT/ANKLE SPECIALIST OR HAND SURGEON: Well-established, highly respected, four-physician group, private prac-tice in San Diego seeking a foot/ankle special-ist or hand surgeon. Our group is expanding to meet high volume of cases and planned ex-pansion. Potential opportunity for any estab-lished subspecialist looking for a permanent practice location. We have a broad-based pri-mary care referral base, mature EHR, digital X-ray, ultrasound, and DME program. Interest-ed parties, please email your CV in confidence to [email protected]. [326]

PART- OR FULL-TImE PRImARY CARE PHY-SICIAN WANTED: Busy pain management practice in Mission Valley seeking a primary care physician to work with our growing prac-tice. Please fax CV to (858) 756-9012. [322]

SEEKING PART-TImE PRImARY CARE / URGENT CARE PHYSICIAN: For a busy, well-established primary care family prac-tice / urgent care medical practice in Pacific Beach. This position could lead to an associate physician position of the practice for the right person. The candidate must be able to provide compassionate care in a fast-paced environ-ment. Knowledge of musculoskeletal medi-cine and X-Ray is required. Must be able to suture and have experience with wound care. We have a state-of-the-art medical facility. Please send your CV in confidence for consid-eration to [email protected]. Compensation: Excellent Pay Rate [317]

track. Modern office setting with a reputation for outstanding patient satisfaction and reten-tion for over 15 years. A dedicated triage and education nurse takes routine patient calls off your hands, and team of eight staff provides at-tentive support allowing you to focus on direct, quality patient care. Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, rounding on newborns, and occasional admission, NO de-livery standby or rushing out in the night. Ben-efits include tail-covered liability insurance, paid holidays/vacation/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disability and life insurance. Please con-tact Venk at (619) 504-5830 or at [email protected]. Salary $ 102–108,000 annually (equal to $130–135,000 full-time). [778]

OFFICE SPACE AVAILABLE

mEDICAL SPACE FOR RENT / LEASE: Ap-proximately 2,000ft2. Available for lease, in best location of Imperial County. Negotiable. Please contact Dr. Maghsoudy at (760) 730-3536. [328]

SUBLEASE PART-TImE SPACE ON SCRIPPS LA JOLLA CAmPUS: A beautiful office space is available a few times a week for someone looking for a part-time satellite office or some-one who only has clinic a few times a week. We are located in HM Poole building on the campus of Scripps Memorial La Jolla, two-minute walk from the hospital. Office reception, two exam rooms, and a conference room/break room are available. Our staff use is negotiable. Rates will depend on the needs and usage. Please contact Olga at [email protected] for more information. [325]

SUBLEASE AVAILABLE IN DEL mAR: Beau-tifully remodeled, state-of-the-art office space in affluent Del Mar off 5-freeway. Share rent. 2,100ft2 in professional building. No nnn/util-ity costs. Great opportunity in very desirable area. Existing cosmetic surgeon tenant relocat-ing and space is available now. Call (858) 342-3104. [320]

NORTH COUNTY / LA COSTA-CARLSBAD OFFICE SPACE FOR SUBLEASE: Beautiful, new 2,300ft2 office space available for sub-lease. Minor procedure room, 5 exam rooms. Lasers available. Located in Bressi Ranch off of El Camino Real. Perfect for dermatology, OB/GYN, wellness / weight loss. Perfect location for North County expansion. Please call Melissa at (760) 707-5090. [318]

BANKER’S HILL OFFICE SPACE: Office space available in beautiful, updated Banker’s Hill medi-cal office that also houses a fully accredited am-bulatory surgery center. Great opportunity for a plastic surgeon, facial plastic surgeon, oculoplas-tic surgeon or dermatological surgeon. Office is conveniently located minutes from freeway ac-cess and downtown San Diego. Please contact via email at [email protected]. [313]

1,701FT2 OFFICE SPACE AVAILABLE: Ap-proved for medical or business use. Fully built out. First floor with extensive window line. Two entrances. Excellent highway access. Short- or long-term lease available. Easy patient/client parking. 5330 Carroll Canyon Road, Suite 140, San Diego, CA 92121. Contact [email protected] or (619) 218-8980. [310]

ALISO VIEJO — 5 JOURNEY: Multi Tenant Medical Building with highly successful medi-


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

LA JOLLA (NEAR UTC) OFFICE FOR SUB-LEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main en-trance of the hospital between I-5 and I-805. Multidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127]

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

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

DEL mAR / CARmEL VALLEY mEDICAL OF-FICE TO SHARE: Available immediately. Class A medical building. 1,000SF. Two treatment / consultation rooms / office reception / photog-raphy room / break room. Full or shared occu-pancy. Unlimited free parking. Call (858) 481-4888 or email [email protected]. [252]

SCRIPPS XImED mEDICAL CENTER BLDG, LA JOLLA — OFFICE SPACE TO SUBLEASE AVAILABLE: Vascular & General Surgeons have space available. One room consult office available, with one or two exam rooms, to a physician or team. Located on the campus of Scripps Memorial Hospital, The Scripps Ximed Medical Center is the office space location of choice for anyone seeking a presence in the La Jolla/UTC area. Reception and staff may be available. Complete ultrasound lab on site for scans or studies. Full-day or half-day timeslots. For more information, call Irene at (619) 840-2400. [154]

NORTH COAST HEALTH CENTER, 477 EL CAmINO REAL, ENCINITAS, OFFICE SPACE TO SUBLEASE: Well-designed office space available, 2,100SF, at the 477-D Bldg. Occupied by Vascular & General Surgeons. Excellent and central location at this large medical center. Nice third-floor window views, all new exam tables, equipment, furniture, and hardwood floors. Full Ultrasound lab with tech on site, doubles as procedure room. Will sublease par-tial suite, one or two exam rooms, half or full day. Will consider subleasing the entire suite, totally furnished, if there is a larger group interest. Plenty of free parking. For more in-

PART- OR FULL-TImE NURSE PRACTITIO-NER WANTED: Busy pain management prac-tice in Mission Valley seeking a nurse prac-titioner to work with our growing practice. Please fax CV to (858) 756-9012. [323]

PART- OR FULL-TImE PHYSICIAN AS-SISTANT WANTED: Busy pain management practice in mission valley seeking a physician assistant to work with our growing practice. Please fax CV to (858) 756-9012. [324]

SEEKING PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Seeking PA with ex-perience in dermatology or wellness / weight loss to join busy cosmetic surgery practice in North County. Beautiful office and support staff. Full complement of cosmetic lasers. Please call Melissa at (760) 707-5090. [319]

SEEKING PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Part-time, with pos-sibility of full-time, mid-level provider position available in a primary care office in downtown San Diego. This is a wonderful opportunity to learn all aspects of primary care. Prior experi-ence with family medicine, sports medicine, oc-cupational medicine, and/or urgent care is pre-ferred, but new graduates can apply. Must be a certified PA or NP and possess a current Cali-fornia medical license. A DEA license is helpful, but not necessary. Must be comfortable using an EHR system, but will provide training on our specific system. Wages based on experience. Please email CV to [email protected] or fax to (619) 232-6012. [315]

BOARD-CERTIFIED PHYSICIANS, PHYSI-CIAN ASSISTANTS, AND NURSE PRAC-TITIONERS NEEDED FOR URGENT CARE: Part-time positions available but a full-time opportunity may be offered to the right can-didate. Must possess a current California medical license and ACLS certification. Please email or fax CV to (619) 569-2590. Visit www.DoctorsExpressSanDiego.com for more infor-mation. [229b]

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

PHYSICIAN ASSISTANT OR NURSE PRAC-TITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email [email protected]. Visit www.thehousecalldocs.com. [038]

formation, call Irene at (619) 840-2400 or at (858) 452-0306. [153]

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

POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467SF furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease / sat-ellite location, flexible days of the week. Con-tact Nerin at the office at (858) 521-0806 or at [email protected]. [873]

BUILD TO SUIT: Up to 1,900SF office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable. Contact [email protected] or (619) 504-5830. [835]

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

NONPHYSICIAN POSITIONS AVAILABLE

FNP AND PA POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at loca-tions throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, non-profit community clinic organization that is an integral part of San Diego’s healthcare safety net. We offer an excellent, comprehensive ben-efits package that includes malpractice cov-erage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email [email protected]. If you would like to fax your CV, fax it to (619) 876-4426. For more in-formation and to apply, visit our website and apply online at www.fhcsd.org. [046b]

SEEKING mEDICAL ASSISTANT: We are a private practice situated in Encinitas looking to hire a medical assistant. The medical assis-tant should be flexible and able to float from the front office (administrative area and re-ception) to the back office area (examination and treatment areas). Some primary duties involve scheduling, registering and rooming patients, taking vital signs and blood tests, keeping the entire office and storage spaces organized, safe, and clean. Requirements include at least three years of work experi-ence in this field with a high school diploma and medical assisting program certificate. Excellent computer knowledge as well as flu-ent written and verbal communication. Please email [email protected]. [327]

PlaCe your

aD Here contact dari Pebdani

at 858-231-1231 or [email protected]

INTRoDuCTIoNNo one is immune to tragedy. There is always the possibility of a loss that can pierce through our strongest defenses and pluck us from the bunker of our triumphs. I have known friends, colleagues, and patients whose successful lives collapsed after a devastating event: an illness, a lawsuit, a divorce.

When I see a bedraggled and unwashed man on the street corner asking for spare change, I wonder how far he has fallen. Did he once have a home and a family? Did he have friends, a fine career, and a promising future?

This poem is for him and for all of us fellow, vulnerable human beings.

Dr. Bressler, SDCMS-CMA member since 1988, is chair of the Biomedical

Ethics Committee at Scripps Mercy Hospital and a longtime contributing writer to San Diego Physician.

I AM BLIND AND IT IS SPRINgYou see me hunched beside the crowdA sullen and pathetic thingBut I once strutted puffed and proudI am blind and it is spring

My profile known throughout the cityA glamoured beauty wore my ringNow all I win are scorn and pityI am blind and it is spring

Confidence my charmed companionTrading toasts with queen and kingSo easily does luck abandonI am blind and it is spring

Sturdy fame mine for the takingTurned as flimsy as a stringI learned too late the ground was shakingI am blind and it is spring

Success and failure’s fickle arcA heedless and uncaring swingHas dropped me shivering in the darkI am blind and it is spring

My days a train of bright paradeAcrobats would dance and singLooking back: a masqueradeI am blind and it is spring

From noble wine to bitter brewDespair at what the days might bringThough this is me it might be youI am blind and it is spring

When I see a bedraggled and unwashed man on the street corner asking for spare change, I wonder how far he has fallen.

Poetry and medicine

the ever-Present

PossiBility of loss

by Daniel J. Bressler, MD, FACP

28 March 2015

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I AM BLIND AND IT IS SPRINgYou see me hunched beside the crowdA sullen and pathetic thingBut I once strutted puffed and proudI am blind and it is spring

My profile known throughout the cityA glamoured beauty wore my ringNow all I win are scorn and pityI am blind and it is spring

Confidence my charmed companionTrading toasts with queen and kingSo easily does luck abandonI am blind and it is spring

Sturdy fame mine for the takingTurned as flimsy as a stringI learned too late the ground was shakingI am blind and it is spring

Success and failure’s fickle arcA heedless and uncaring swingHas dropped me shivering in the darkI am blind and it is spring

My days a train of bright paradeAcrobats would dance and singLooking back: a masqueradeI am blind and it is spring

From noble wine to bitter brewDespair at what the days might bringThough this is me it might be youI am blind and it is spring

San Diego County Medical Society5575 Ruffin Road, Suite 250San Diego, Ca 92123

[ Return Service Requested ]

$5.95 | www.SANDIEGOPHYSICIAN.orgPrsrt std

U.s. Postage

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PROTECTIONPROTECTIONPROTECTIONPROTECTION

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IN CALIFORNIA, WE PROTECT OUR MEMBERS WITH THE BEST

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March 2015

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