Inside This Issue: a Week in the Life

Vol. 16, No. 3 California The Journal of the Osteopathic Physicians & Surgeons of California Inside this Issue: A Week in the Life... Page 4

Fall Legislative Update Page 5 DO

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TABLE OF CONTENTS

PRESIDENT’S MESSAGE: New California Osteopathic Schools ...... 2

EDITOR’S REPORT: Creating a Legacy ...... 3

© 2016 by the Osteopathic Physicians & Sur- EXECUTIVE DIRECTOR’S MESSAGE: geons of California Association, Inc. All material “A Week in the Life ...” ...... 4 subject to this copyright may be photocopied only for noncommercial educational or scien- LEGISLATIVE UPDATE: tific uses. Permission to reprint articles or por- tions of articles may be obtained by writing to Fall Legislative Update ...... 5 the managing editor. Proper credit and copyright Legislator Profile: Assembly Member Rudy Salas ...... 7 notice should accompany all reprinted material. We reserve the right to edit material submitted FEATURE: for clarity and length. Opinions expressed by individuals in the pages of this journal do not Gun Violence: A Public Health Concern ...... 8 necessarily represent the official position of the Osteopathic Physicians & Surgeons of California. MEMBERSHIP: In Memoriam: Dr. William J. Ryan ...... 11 California DO is published three (3) times a year, as the official publication of the In Memoriam: Dr. Ernest H. Agresti ...... 11 Osteopathic Physicians & Fall Conference Wrap-Up ...... 12 Surgeons of California. Board Recap ...... 13 2015 H Street Sacramento, CA 95811 Decisions ...... 13 Welcome New Members ...... 14 Subscriptions are included in membership dues. DO Leader Highlight: Susan Melvin, DO ...... 15

All original papers and other correspondence COLLEGE UPDATES: should be directed to the managing editor. Student DO Highlight: Pradhab Kirupaharan ...... 17 [email protected] Touro Dean’s Report ...... 18 Telephone (916) 822-5246 or toll-free in California (800) 638-6772 Touro Students’ Report...... 19 www.opsc.org Western U/COMP Dean’s Report ...... 20 Western U/COMP Students’ Report ...... 20

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California DO Vol. 16, No. 3 1 PRESIDENT’S MESSAGE New California Osteopathic Schools

} Abraham Pera, DO, President OPSC 2016 CALIFORNIA DO EDITORIAL TEAM he OPSC was recently asked to comment on an Osteopathic Medical school to be EDITOR started in the Fresno area of the Central Valley. This region has been a chronic physician shortage area. Multiple members of the OPSC board met with the representa- David Canton, DO, MPH, JD T Editor-in-Chief tives of the proposed school at the House of Delegates meeting in Chicago this last summer. We subsequently researched and discussed the proposed school. We felt that our members needed to be informed of our letter sent to the Council on Osteopathic College Accreditation PUBLICATIONS COMMITTEE (COCA) concerning our decision to not support this proposed school. I will include excerpts Melissa Arbar, OMS from the letter in quotations. Scott Glickman, DO, PhD, MPH Our concerns about the school were based on the Our concerns about the Mohammad Jamshidi-Nezhad, DO, inadequate availability of clinical clerkship opportunities school were based on the FACS, FASA in the state for students already matriculated in our two Kay Kalousek, DO, MS, MSHPE osteopathic schools. In addition, our concerns expanded inadequate availability Brian Loveless, DO to post graduate (residency) training opportunities for of clinical clerkship Abraham Pera, DO the students already in our state and the entire country opportunities in the state for students already Les Tsang, DO in the context of the recently adopted Single Accreditation System under the ACGME. It should also be noted that in matriculated in our two Stephanie White, DO spite of multiple requests for documentation of the clinical osteopathic schools. Dania Youssef, OMS rotation opportunities to be used by the new school none Elaine Yu, DO were offered by them. Our communication to COCA focused on concerns about availability of rotation/residency OPSC STAFF slots affected by (1) competition from U.S. allopathic medical schools (2) competition from Karl Baur, CMP offshore medical schools (3) competition from International Medical Graduates (4) challenges Kathleen S. Creason, MBA growing and expanding GME in the State of California and (5) competition from unbridled growth of the osteopathic medical schools. In addition, comments were included concerning lack of evidence supporting specific COCA standards. 1. There are 2 osteopathic medical schools and 11 allopathic medical schools already established in California, (the latest in 2015 in the Sacramento area). There are 2 additional allopathic medical schools in the pipeline for our state. These include the California School of Sciences and Medicine (CSSM) which will be located in Colton, California and the Kaiser Permanente School of Medicine which is anticipated to open their doors in Pasadena in 2019. 2. Caribbean schools of medicine are expanding their reach into the United States. Rela- tive to California, the Ross University School of Medicine has established rotations at two hospitals: California Hospital Medical Center (Los Angeles) and Kern Medical Center (Bakersfield). As these schools expand into the state they pay large amounts of money to hospitals, displacing both US allopathic and osteopathic students from the hospitals. Continued on page 22 }

2 California DO Vol. 16, No. 3 EDITOR’S REPORT Creating a Legacy

} David Canton, DO, MPH, JD, Managing Editor

n our last edition, Dr Pera, in his president’s column, discussed Certainly, there is a place Apparently, for at least creating a legacy. He challenged us all to think about the legacy we for patient satisfaction surveys. I were building within the organization. Some of us have a hard time 47 percent of us, it is Based on a recent survey, many of us may need to be working on providing good care in a per- time to look seriously at that legacy sooner rather than later. The Physicians Foundation con- sonable manner, but there is the professional legacy ducted a survey of more than 17,000 U.S. physicians. In the survey, room for not making everyone we will be leaving. 46.8 percent said they plan to retire sooner than originally planned. In happy. It has always seemed to Perhaps it would be me that if half of the comments that same survey 80 percent reported being at capacity with regard to good for all of us to look being able to accept new patients. In addition, 62.8 percent reported said I walked on water and the at what attracted us to a negative outlook on the future of medicine and 48 percent reported other half said I was the devil osteopathic medicine a sense of burnout often or always. incarnate I was probably pro- What is it that makes so many of us feeling the need to get out of viding appropriate care overall. in the first place. What medicine? In talking to colleagues, some cite the pressure of elec- Still other physicians have is it that gives you the tronic medical records. While electronic medical records have many told me they are tired of feel- satisfaction of practicing benefits, many feel they have become as much secretary as clinician. ing pressured to do more for medicine? Personally, I complete the record in the exam room with the patient less. In the Central Valley, sev- present. This allows me to ensure that my exam and what we discuss eral physicians have told me is fully included in my note and not left to my memory for later of having to see 10 percent more patients to receive 10 percent less inclusion. Unfortunately, this means much of the time in the room in compensation. With this mathematical equation, it is easy to see is spent engaged with the computer instead of the patient. I know that with a reasonable investment strategy, it quickly becomes more lucrative to not work for the same income as continuing to try and being a data entry technician was not what I entered medicine to do. do more for less. At the recent conference in Monterey, there was a presentation Still others cite the increasing complexity of Maintenance of Cer- on the new Medicare Access and CHIP Reauthorization Act (MACRA) tification (MOC). The pressure by health organizations and payers to rules. When it came to the question and answer section, it became maintain board certification has made the MOC nearly critical. The obvious that many attendees were feeling stressed over the changes American Board of Internal Medicine has made the decision to re-work and what it would take to meet the new requirements. their MOC process after somewhat of a rebellion by a core group of Other colleagues cite the demands of patient satisfaction surveys. their constituency. In addition, some states, seeing the pressure MOC Many organizations build compensation on the results of patient has created on physicians and the potential to drive physicians out of satisfaction survey results. Some physicians have expressed they feel practice, have recently passed laws that preclude organizations from they are pressured to “give the patient what they want” instead of what using board certification as a criteria for credentialing. they need, so as to keep their satisfactions scores high. Apparently, for at least 47 percent of us, it is time to look seriously We are all programmed to score high on everything we do. After at the professional legacy we will be leaving. Perhaps it would be good all, that is what got us into medical school. However, in the end is for all of us to look at what attracted us to osteopathic medicine in the conflict between scoring high and doing what’s right justified? the first place. What is it that gives you the satisfaction of practicing What would really happen if our patient satisfaction scores were not medicine? at the maximum level? Would the satisfaction of providing good care What factors drive you to stay in medicine? What is the legacy you override the satisfaction of a slightly higher salary from a higher hope to leave? satisfaction score? Continued on page 22 }

California DO Vol. 16, No. 3 3 EXECUTIVE DIRECTOR’S REPORT “A Week in the Life…”

} Kathleen S. Creason, MBA, Executive Director

Following is a sample of activities undertaken during a district where I live. He is bright and energetic, so it’s an enjoyable representative week in the life of OPSC’s Executive Director. meeting. Next, I hop in the car with our public relations consultant, Jane Einhorn, for a trip to San Francisco for some media introduc- Monday tions. We start by having lunch with Robert Hendren, DO who is This Monday morning starts with a very interesting conference doing great work in the area of autism research. We then meet with call - with President Barack Obama! The federal government is placing the general manager of a group of Bay Area television stations to talk an increased focus on the opioid misuse epidemic, so this morning’s about possible story ideas. The meeting reaffirms our decision to hire call is an update on the resources and activities being directed in this Jane as a PR consultant, as she shows herself to be creative, driven, effort. It’s an interesting call, as President Obama speaks to the group and well respected. During the long drive back to Sacramento, Jane with passion and sincerity about the issue. After the call, I head to the and I talk about a possible social media campaign as another tool to offices of the California Medical Association to join a meeting they’re bring attention to the osteopathic profession. As we near Sacramento, hosting with professional liability companies. The meeting begins I receive a call from a communications firm hoping to garner OPSC’s with a detailed presentation about legal challenges to California’s opposition to a ballot proposition related to pharmaceutical pricing. bell weather medical malpractice law, MICRA, and continues with a Pleased that OPSC’s position is being sought, I inform her that our discussion about future plans to protect the law from a legal perspec- Board will be discussing the issue at its upcoming meeting. tive. Back in the office late that afternoon, I review a letter about a proposed new osteopathic medical school in Fresno. Richard Riemer, Wednesday DO drafted a comprehensive and well-referenced letter articulating On Wednesday, legislative advocate Jennifer Snyder and I meet with the dire need for graduate and post-graduate education prior to the one of two physicians currently serving in the California legislature, creation of new student positions in the state. As I’m wrapping things Assemblyman Joaquin Arambula, MD. We have a nice conversation up for the evening, I answer a call from a panicked physician who is about his positive experiences working with DOs. Since he represents trying to verify that the osteopathic licensing board will be renewing the Fresno area, we discuss the potential new osteopathic medical her license before it expires in two days. The OMBC, with its limited school. He is supportive of the concept of a new medical school, personnel, is often unable to answer their phones during busy renewal recognizing that it would likely draw more physicians into the Cen- times. Fortunately, OPSC enjoys a positive relationship with OMBC staff tral Valley. After the meeting, I return to the office to deal with some and can - as a service to members - get a quick response to reassure administrative details; meeting with an arborist to ensure the trees the member that his/her license will be renewed in time. In this case, on our property are healthy and free of safety hazards, approving an the OMBC offices are already closed, so I commit to following through ad congratulating American Osteopathic Foundation award recipients first thing in the morning. from California (Alesia Wagner, DO; James M. Lally, DO and Anirudh Ramachandran, OMS), and making travel arrangements for the AOA Tuesday Board of Trustees meeting. That afternoon, I am interviewed by a reporter with the Sacramento Business Journal. During a moment As promised, the first thing I do when I arrive in the office this of weakness, I succumbed to Jane Einhorn’s persistence and agreed morning is contact the OMBC. They confirm that they are processing to the interview as another way of bringing media attention to the the physician’s renewal and the updated status will be reflected on- osteopathic profession. I am pleasantly surprised by the reporter’s line today. I convey this message to the member physician, who is insightful and well researched questions. Hopeful that I explained the greatly relieved. After responding to a few emails, I go to a local coffee differences/similarities between DOs and MDs well, I look forward to shop to meet with legislative candidate Kevin Kiley. One of the benefits reading the article. Wednesday evening features a Resolutions Commit- of our increased advocacy activities is the ability to meet candidates tee conference call during which the group works on narrowing down before they’re elected, to begin establishing a relationship early. I’m especially interested to meet with Mr. Kiley since he’ll represent the Continued on page 23 }

4 California DO Vol. 16, No. 3 LEGISLATIVE UPDATE Fall Legislative Update

} Kathleen S. Creason, MBA, Executive Director } Jennifer Snyder, Capitol Advocacy

2016 Legislative Session Ends their qualifications as a qualified medical examiner for the workers’ The Legislature worked just beyond the stroke of midnight on the compensation system. final day of the 2015-16 Legislative Session, adjourning in the early In addition, OPSC was involved in two pieces of legislation that morning hours of September 1st. As usual, a myriad of high profile could have adversely impacted licensure oversight of DOs. SB 1195 bills were considered in the final weeks of session, from farmworker would have established greater oversight by the Department of Con- overtime and holiday double-pay, to cap and trade and prescription sumer Affairs of the Osteopathic Medical Board of California. The drug pricing. Of the more than 2,300 bills introduced in 2016, ap- legislation was attempting to address issues raised in North Carolina proximately 1,300 passed out of the Legislature and were sent to the related to anti-trust. SB 1033 would have placed new requirements Governor. In the final week of session alone, lawmakers approved for physicians on probation causing disruptions in patient care. Both over 800 of those measures. of these bills did not move forward in 2016.

OPSC End of Session Successes Workers’ compensation bills impacting DOs OPSC was busy until the last day of session fighting against two Workers’ compensation continued to receive attention from high profile bills which would have expanded the scope of practice lawmakers in 2016. Jerry Brown signed AB 1244 by Adam Gray for naturopathic doctors (SB 538) and nurse midwives (AB 1306). (D-Merced), which seeks to reduce fraud in the workers’ compen- In the end, the physician community was able to defeat both bills by sation system, particularly after a recent report that the system has garnering enough ‘no’ votes to stop their passage. In 2016, OPSC been defrauded of approximately $1 billion. AB 1244 will require also assisted to finally defeat two additional bills expanding scope of the director of the Division of Workers’ Compensation to suspense practice for nurse practitioners (SB 323) and optometrists (SB 622). workers’ compensation doctors, hospitals and other providers if they have been convicted of healthcare fraud. In addition, the Governor Signed legislation impacting OPSC Members signed SB 1160 – a comprehensive workers’ compensation reform The Governor had until September 30th to sign or veto the over measuring attempting to improve utilization review and crack down 800 measures that had reached his desk. Governor Brown did end on inappropriate lien filings. up signing a number of bills that OPSC was supporting or watching closely. These included a bi-partisan compromise measure (AB 72) 2016 General Healthcare Outcomes which attempts to address billing for out-of-network services and also Not surprisingly, healthcare remained in the legislative limelight AB 2024 which allows “critical access hospitals” in rural areas the in 2016. According to a recent UCLA study, $367.5 billion is annually ability to employ physicians. The Governor also signed SB 482 which spent on healthcare in California, making it the biggest industry in requires physicians to consult the state’s CURES system to check on the state. Four of the 17 initiatives on the November general election patients’ prescription history prior to prescribing Schedule II, III and ballot pertain to healthcare, and dozens of bills were introduced this IV controlled substances for the first time. session that sought to impact healthcare policy. In addition to the healthcare measures closely monitored by OPSC, noteworthy bills OPSC 2016 successes directly impacting DOs signed by the Governor include: OPSC successfully amended two pieces of legislation which either • AB 1668 (Calderon), giving terminally ill patients the “right inadvertently excluded DOs or included language that improperly to try” experimental treatments; referred to DO educational qualifications. SB 1193 was amended • SB 908 (Hernandez), which will require consumers to be to appropriately refer to psychiatrist education and training with given 60 days written notice when their health insurance the American Osteopathic Board of Neurology and Psychiatry and premiums have been deemed “unreasonable” by the state, } AB 2086 was amended to broadly refer to both DOs and MDs and

California DO Vol. 16, No. 3 5 LEGISLATIVE UPDATE

Fall Legislative Update Continued from page 5

• AB 1386 (Low), which will allow businesses and public agen- Medi-Cal program. Below are the results of the initiatives impacting cies in California to keep epinephrine auto injectors on hand healthcare in California: to help treat emergency allergic reactions. Prop 52 “State Fees on Hospitals. Federal Medi-Cal Match- Lawmakers returned to the Capitol for one day to be sworn in on ing Funds” – PASSED. Prop 52 will make the Hospital Quality As- December 5, but January 4, 2017 marks the practical beginning of the surance Fee permanent. The fee, which is paid by private hospitals, 2017-18 legislative session. Until then, the focus in Sacramento will be is used to bring the state additional federal dollars for the Medi-Cal on the legislative races and ballot measures leading up to November 8. program. A two-thirds vote of the Legislature would be required to end the hospital QAF program going forward. Prop 52 had wide, bipartisan Budget Signed on June 27th support, including from CMA. Governor Brown signed the State Budget on June 27th keeping with his record for an on-time budget since his first year in office. The Prop 55 or “Tax Extension to Fund Education and Health- approved budget kept spending in check however several Democratic care” – PASSED. Prop 55 extends the Prop 30 income tax increases priorities received new funding, including preschool and child care, on high-income earners. Specifically, Prop 55 extends the tax increases higher education, and affordable housing. Except for increases in approved by voters in 2012 via Prop 30 on individuals who earn over caseload, funding for the Medi-Cal program remained stagnant with $250,000/year. Most of the revenues from the tax would continue to the 10% provider rate cut still intact from 2010. This stagnant Medi- fund education, and an additional $2 billion would go to the Medi-Cal Cal funding prompted the filing of two propositions on the November program and other healthcare programs in certain years. CMA was ballot - Prop 55 Income Tax Increase Extension & Prop. 56 Tobacco one of the proponents of Prop 55. Tax Increase – both include provisions to increase funding for health care services. Prop 56 also known as the “Cigarette Tax to Fund Health- care, Tobacco Use Prevention, Research, and Law Enforcement” Song Brown Program Funding Increased – PASSED. Prop 56 increases the tax on cigarettes by $2/pack, which Part of the main budget bill was an allocation of $100 million is significant compared to the current $0.87/pack tax. Equivalent in 2016/17 for the Song Brown Program, which OPSC supported. tax increases would be applied to other tobacco products. Revenues OPSC worked collaboratively with the California Medical Association from the tax would be allocated to increased funding for healthcare, and other physician groups to keep the Song Brown Program afloat including tobacco use prevention and control programs. CMA is one and enhance its funding to provide additional dollars for residency of the proponents of Prop 56. programs in the state. Prop 61, the “California Drug Price Relief Act” – FAILED. Healthcare Propositions on the November Ballot Prop. 61 sought to prohibit state healthcare programs, like Medi-Cal, An onslaught of initiatives filled the California ballot this year, rais- from paying more for prescription drugs than the lowest rates paid for ing a record $473 million in the months leading up to the election. the same drugs by the U.S. Department of Veterans Affairs. The well- The 17 ballot measures ran the gamut from prescription drug pricing funded opposition campaign led by the pharmaceutical industry was and sentencing reform to a tobacco tax and marijuana legalization. successful defeating the initiative. CMA was also opposed to Prop 61. Opponents of the tobacco tax, after raising nearly $41 million against the measure, were unsuccessful in stopping Prop 56. Conversely, In the primary, voters across the state seemed to have an appetite voters rejected Prop 61, which sought to control prescription drug for tax and bond measures, with at least 70 of the 89 local measures pricing. Voters did approve Prop 64, which will legalize recreational passing. That appetite did seem to have an impact on statewide bal- marijuana, as well as Prop 55, which will extend the Prop 30 income lot initiatives on November 8, as evidenced by the passage of Props tax increases on high-income earners. Combined, Props. 55 and 55 and 56. n 56 are expected to provide an additional $4 billion in funds to the

6 California DO Vol. 16, No. 3 LEGISLATIVE PROFILE Meet Assembly Member Rudy Salas

ssemblyman Rudy Salas is the new chair of the Assembly Busi- Assemblyman Salas is ness, Professions and Consumer Protection Committee, which an active member of the A oversees legislation regulating scope of practice and licensing Legislature and is supportive and is responsible for establishing the policy and practice parameters of measures that would of healthcare providers in California. He assumed the chairmanship positively impact patient of the committee in March 2016, succeeding Assemblywoman Susan Bonilla (D-Concord). Salas is also co-chair of the Moderate Democrat care and patient safety. Caucus, which often plays a pivotal role in the legislature. Assemblyman Salas was elected in November 2012 to represent California’s 32nd Assembly District, which comprises all of Kings County and parts of Kern County and includes the Central Valley cities program are serving low income populations in medically underserved of Bakersfield, Delano and Hanford, among others. communities. OPSC was an active proponent of AB 565 (Salas). Born and raised in Central California, Salas worked in the oil and Assemblyman Salas is an active member of the Legislature and is grape fields in the southern half of the state’s Central Valley, which supportive of measures that would positively impact patient care and yields a third of all of the produce grown in the United States. He patient safety. In addition to his Physician Corp Program legislation, he worked his way through college and graduated from the University of has supported other measures to increase residency slots in under- California, Los Angeles. Upon graduation, Salas worked in the White served communities. In his role as co-chair of the “New Democrats,” House for then-Vice President Al Gore before returning to California to also known as the Moderate Democrat Caucus, he is often integral in work as a college counselor at California State University, Bakersfield, stopping or significantly amending legislation that would be harmful and as a Senior Consultant and District Director for former Senator to business owners if enacted. The Moderate Democrats have become Dean Florez (D-Bakersfield). Salas was elected as the first Latino to the increasingly influential at the Capitol, where Republicans are the Bakersfield City Council in 2010, working to improve the community minority in both houses. he represented by combatting crime, abating trash and graffiti, and As chair of the Assembly Business and Professions Committee, maintaining fiscal prudence. Assemblyman Salas will consider many issues relevant to OPSC over In his first year in the Assembly, Assemblyman Salas authored the course of his tenure. OPSC looks forward to working closely with nine bills that were signed into law, including AB 565, which increases Assemblyman Salas to ensure that patients are protected and that access to primary care physicians in rural and underserved areas. physicians are supported, not hindered, in their efforts to expand Specifically, AB 565 revised the criteria for applicants of the California access to care and meet the needs of the State’s expanding insured Physician Corps Program to ensure that physicians participating in the populations. n

CME Credits for DOs Now Available Online

OPSC has joined with other state osteopathic associations to provide DOs with more opportunities to acquire CME credits. https://DOcme.org

California DO Vol. 16, No. 3 7 FEATURE Gun Violence: A Public Health Concern

} Gail Feinberg, DO, FACOFP, M.Ed, Professor and Chair, Primary Care Department Touro University California – College of Osteopathic Medicine

n one year on average in the United States, over 111,000 people are 2010. These costs included loss of productivity, medical and mental shot in murders, assaults, suicides and suicide attempts, uninten- health care costs, criminal justice costs and the value of pain, suf- tional shootings and police intervention. Of those, almost 33,000 fering and lost quality of life.5 I 1 die, and another 79,000 survive. Under any other circumstance, There is also a notable racial disparity. Of the 30 Americans with over 111,000 preventable deaths, State and Federal legislators murdered with guns every day on average, roughly 50% are African and public health officials would jump at the opportunity to make an American men, who comprise just 6% of the US population. A majority impact. Gun related incidences, however, are often met with politi- of these men of color come from poor segregated neighborhoods. cal resistance due to potential impingement on second amendment Looking at the pediatric population, someone under the age of rights. This article will be a discussion regarding the public health 18 has been shot and killed at a rate of more than twice a day. These issues concerning gun violence and those preventable deaths, and children are more likely to die from guns held by family members and will in no way be a discussion of the second amendment.2 acquaintances than strangers. In addition, children younger than 3 years of age have gotten hold of an unsecured gun and shot someone What is the extent of the public health impact of at least 59 times in 2015. This is an average of an American toddler firearms in the United States? shooting someone more than once a week. These toddlers most often Every day on average, 48 children and teens (0-19 years old) are injure or kill themselves, but more than 12 shot other people. shot in murders, assaults, suicides and suicide attempts, uninten- Gun safety must look at gun security. In 2015, more than 400 tional shootings and police intervention. Seven of these children die firearms were stolen from cars in a single county in Florida. 60% from gun violence while 41 are shot and survive. Of those 41 who were from unlocked cars. Several states are starting to look at owner survive, 8 are shot unintentionally (32 are shot in an assault and 1 responsibility. One man was charged in Connecticut with misde- survives a suicide attempt). This adds up to over 17,300 children meanor reckless endangerment after he reported his loaded .38 shot annually, with over 2,600 deaths therefrom. In 2015, 75% of caliber revolver stolen from his unlocked truck. The issues with guns these deaths were children under the age of 12. In 2015, there were being stolen from vehicles have led to several groups petitioning for no 372 mass shootings3 in the United States, killing 475 and wounding “gun free zones”, which will “solve the problem” by allowing owners 1,870. And although mass shootings attract heavy media coverage, to carry their guns with them at all times. Regardless of which side it’s the shootings that take place in parking lots, bars, bedrooms and of that issue you fall, the bottom line is to be responsible and keep street corners that are responsible for most gun injuries and deaths.4 your personal weapon locked. There are approximately 11,200 homicides in the United States annually. This is far greater than in other developed countries; the What is the link between mental health and gun- next closest being Italy at 333. Adjusted for US population, the rate related suicide? is 3.55/100,000, with the next closest country being Portugal at How does the presence of the gun impact the patients’ risk of sui- 0.66/100,000. cide? A high proportion of suicides occur in the setting of psychiatric There are approximately 88 firearm related suicide deaths in the US illness (exact numbers range from 47-74% depending on the study). daily, with the past two years seeing more gun related suicide deaths Depression and bipolar disorders are the most common illnesses, than our armed forces suffered by gunshot in the entire Vietnam with depression being the most significant risk.6 In contrast, only War, and 10 times the number of American soldiers lost in Iraq and 3-5% of people committing criminal gun violence have underlying Afghanistan wars during the past 15 years. mental health disorders. It is important, therefore, to identify and treat Between 1968 and 2011, the number of Americans who died from mental health and substance use disorders which should reduce the gunfire in the United States is greater than all wars ever fought by the risk of firearm related suicide. country (1.4 million vs. 1.2 million from 1776-2011). The cost of Suicide itself is second only to unintentional injury as a cause of nonfatal firearm injuries to the US was estimated at $174 billion in death in Americans under 40 years of age. It is often an impulsive act,

8 California DO Vol. 16, No. 3 FEATURE

with a consistent 80-90% case fatality rate (if a gun is the instrument of a lawfully-possessed firearm….in the residence…of an used), so the availability of a gun is an important factor.7 individual; or (b) the lawful use, possession or storage….by Blanket laws that prohibit firearm purchase based solely on the an individual presence of a mental health diagnosis are not desirable, and do pull 2. Limitation on Data Collection – None of the authorities us into a Second Amendment debate. Among patients with mental provided to the Secretary under the Patient Protection and health disorders, only a fraction poses any risk of harm to themselves Affordable Care Act…shall be construed to authorize or may or others. The American Psychiatric Society prefers restricting the ac- be used for the collection of any information relating to…” cess to guns to “persons whose conduct indicates that they present a the lawful ownership, use or storage of a firearm or ammuni- heightened risk of violence to themselves or others, whether or not tion they have been diagnosed with a mental disorder.”8 And further language notes that one cannot create a data bank to What counseling might be provided to patients and record possession, nor may individuals be required to disclose any their families to reduce the chance of intentional or information under any data collection relating to the lawful ownership, unintentional firearm injury? use or storage of a firearm or ammunition. How a gun is stored is an important variable in the likelihood of Looking at the State level, in Florida, for example, the Firearm injury by a firearm. A loaded, unlocked gun is more likely to be used Owner’s Privacy Act prohibited physicians from asking about gun in a suicide attempt by children or be involved in an unintentional ownership and recording it in the medical record. A physician could injury or death. Specific behaviors associated with a higher risk of potentially be fined or lose his or her license. This act was enacted after firearm related injury include keeping the gun in an unlocked area, a pediatrician discharged three children from their practice whose keeping the gun loaded, storing the ammunition in the same area as mother declined to answer questions about firearms, and was just the gun, and storing the ammunition in an unlocked area. Primary overturned in February, 2016. Other States have statutes addressing care physician organizations recommend counseling about firearm firearm information acquired by health practitioners; however these safety as part of a discussion about healthy lifestyles and accident do not include a gag provision. prevention as discussions occur around seat belt use, helmet use, Federal and State laws do not prohibit a clinician from asking having smoke detectors in the home, etc. A survey of internists in about gun ownership and safety if the information is relevant to the 2014 noted that 85% thought firearm violence was a public health care of the patient, the patient’s safety, or the safety of others. This issue and worse than 10 years earlier, and 66% agreed the physicians information is directly relevant to the health of an individual patient have a role in counseling patients. That being said, over 50% never and the patients’ close contacts under three general conditions: (1) discussed whether guns were in the home and 77% never discussed The patient provides information or exhibits behavior suggesting an ways to reduce the risk of firearm-related morbidity and mortality.9 acute increase for violence – e.g., suicidal or homicidal ideation/ Why the discrepancy? Physicians may not be comfortable talking intent, (2) The patient presents with or has risk factors for engaging about guns due to a lack of familiarity themselves. Similarly, patients in future violence – e.g., history of violence, certain phases of mental do not generally consider physicians to be a good source of informa- illness, first psychotic episode, certain cognitive disorders, and (3) tion about firearms. There have also been government imposition/ High risk groups – for suicide, middle aged or older Caucasian males; 10 regulations to counselling. The Affordable Care Act, in fact, has for homicide, young African American males. specific language regarding protection of Second Amendment rights. Specifically: What can be done with counseling? New 1. “ Wellness and prevention programs – A wellness and health approaches? promotion activity… may not require the disclosure or collec- It might be helpful to view gun owners as belonging to a particular tion of any information relating to (a) the presence of storage cultural group. Explain the reason for bringing up the topic (and }

California DO Vol. 16, No. 3 9 FEATURE

Gun Violence: A Public Health Concern Continued from page 9

if you can, bring up the topic during a particular hunting season, 2. Poisoning – Childproof safety packaging and decreasing for example). Make sure you are using non-judgmental, respectful the number of pills per prescription bottle has significantly counseling behaviors individualized to your patient. You might have decreased accidental poisonings both in adult and pediatric a different message to a parent with a young child than you would to populations. Locking devices on guns and decreasing the the spouse of a cognitively impaired suicidal patient.11 number of bullets per magazine clip may be the corollary here. Are there strategies that have been successful in the 3. Motor Vehicles – There have been a series of interventions Public Health Arena that may be successful here? related to driver safety which has reduced the number of fatalities per mile of driving by 90%: Auto safety inspections, First, this issue needs to be framed as a public health issue. wearing of seatbelts and use of car seats, use of motorcycle Sociocultural, behavioral and product safety concerns need to be ad- helmets, driver’s education, licensing and age requirements, dressed, not gun ownership. The difficulty comes with gun ownership and drunk driving penalties. Corollaries here would be being specifically written into our Constitution. There is no question periodic firearm safety inspections (which might include that Americans have a right to own a gun; however what is not being documentation of home storage and safety measures), safe sufficiently addressed is the unnecessary loss of life that has been storage of guns and ammunition, education, licensing and addressed in other forums.12 age requirements, and penalties for violating gun safety laws 1. Tobacco – What has worked to decrease death from tobacco related illnesses has been taxation, changing sociocultural In summary, it is important that we distinguish between ownership norms, media campaigns and education counselling. Taxation and violence and the conditions that lead to violence as we move this has provided income for education and prevention efforts. discussion forward toward sensible policy. The goal is not limitation Media efforts eliminated cigarette advertising and eliminated of gun ownership, but the reduction of needless death and injury. n scenes in television shows of actors smoking. It will be more challenging dealing with video games; however, there might be an effect if there is systematic alteration of the depiction of Editor’s Note: This article is presented as a follow-up to Dr. gun violence in movies, television and video/internet games. Feinberg’s presentation at the 2016 OPSC Fall Conference. Any Of note, obscenities and sex are now limited from younger opinions presented herein are solely those of the author. References television movie viewers while violence is not. available upon request.

10 California DO Vol. 16, No. 3 MEMBERSHIP

In Memoriam OPSC 2016-17 ASSOCIATION OFFICERS OFFICERS Abraham Pera, DO, President Greater Sacramento Osteopathic Medical Association Brian Loveless, DO, President-Elect San Bernardino County Osteopathic Medical Association Dr. William J. Ryan John Kowalczyk, DO, Immediate Past President Los Angeles County Osteopathic Medical Association The family of Dr. William J. Ryan sadly announces his pass- Richard Riemer, DO, Vice President ing on August 24, 2016. Dr. Ryan graduated from Kansas City Greater Sacramento Osteopathic Medical Association Minh Nguyen, DO, Secretary-Treasurer University of Medicine and Biosciences in 1962. He was a third San Diego Osteopathic Medical Association generation osteopathic physician, and his love of the profession DIRECTORS was eventually shared by his daughter, which continued his Mohammad Jamshidi, DO legacy and created a four generation osteopathic family. San Diego Osteopathic Medical Association Michael Luszczak, DO After completing his internship in Oklahoma, he joined his Greater Sacramento Osteopathic Medical Association father in private practice in Garland, Texas. In 1967, he then Wadsworth Murad, DO San Bernardino County Osteopathic Medical Association joined the Navy, becoming one of the first 100 osteopathic physi- Alexandra Myers, DO San Diego Osteopathic Medical Association cians to join the military. His military service spanned several Clarence Nicodemus, DO decades beginning as a Marine during the Korean Conflict, continuing with his service as a Central Coast Osteopathic Regional Society Minh Nguyen, DO military physician during the Vietnam War, and eventually serving as physician in the United San Diego Osteopathic Medical Association States Naval Reserve during Operation Desert Shield/Desert Storm. Dr. Ryan served an honored Patricia Rehfield, DO Greater Sacramento Osteopathic Medical Association career as a military physician, and eventually retired at the rank of Navy Captain. Frederick White, DO Dr. Ryan joined Kaiser in Riverside, California in 1974. He was the first DO hired by Kaiser. Riverside County Osteopathic Medical Association Blake Wylie, DO Dr. Ryan obtained full partnership with Kaiser in 1985 and aside from a recall to serve his San Diego Osteopathic Medical Association country during Operation Desert Shield/Desert Storm in 1990, he continued to serve his patients RESIDENT BOARD MEMBER as a family physician at Kaiser until his retirement in 1995. Dr. Ryan was a true gentle giant Sarah B. Fang, DO and a humble trail blazer for the osteopathic profession. While he never sought recognition, his contributions to the profession were noted when he received the Osteopathic Physicians STUDENT BOARD MEMBERS Zachary Anderson, OMS, Touro University and Surgeons of California (OPSC) Lifetime Achievement Award in 2010. Anirudh Ramachandran, OMS, Western University/ He is survived by his beloved wife, Sandra, daughters, Dr. Susan Mackintosh and Mrs. Lori COMP Weber, seven grandchildren and eight great-grandchildren. DIRECTORS (EMERITUS) Ethan R. Allen, DO Los Angeles County Osteopathic Medical Association Gary A. Gramm, DO Greater Sacramento Osteopathic Medical Association Lionel B. Katchem, DO Dr. Ernest H. Agresti San Bernardino Osteopathic Medical Association Donald J. Krpan, DO Ernest H. Agresti, Jr., DO went to be with the Lord on November 9, Los Angeles County Osteopathic Medical Association 2016 after a brief illness. “Dr. Ernie” was a family physician. He had Norman E. Vinn, DO Orange County Osteopathic Medical Association his initial practice in Erie, PA with his two sisters, Tina Agresti, DO and Joseph A. Zammuto, DO Linda Agresti, DO; he worked as Emergency Room physician as well. He Bay Area Osteopathic Medical Association moved to California, where he continued his private practice in family EX-OFFICIO MEMBERS medicine with his sisters for the last 27 years. He is survived by his wife Michael Clearfield, DO, Touro University Michele (Bernhardt) Agresti and two daughters Christina and Gabriella Paula Crone, DO, Western University/COMP

Agresti, as well his two sisters. He was a graduate of Gannon University and Kirksville College of CENTRAL OFFICE STAFF Osteopathic Medicine. His accomplishments include Physician of the Year of the Osteopathic Kathleen S. Creason, MBA, Executive Director Physicians and Surgeons of California, Past President of the American College of Family Physi- Karl Baur, CMP, Director of Meetings & Publications Cassandra Mallory, Director of Membership cians of California, and Fellow of the American College of Osteopathic Family Physicians. His Annette Wood, Administrative Assistant family asks that any donations be made to World Vision International, P.O. Box 9716, Federal Way, WA 98063. Condolences may be expressed at www.bruggerfuneralhomes.com.

California DO Vol. 16, No. 3 11 MEMBERSHIP

This year’s Fall Conference took place a little later than usual, though that did not stop us from having a great conference. The Fall Conference drew more than 500 attendees, which is above the Fall Conference OMM/ historical average. Below are just a few of the highlights: OMT Educators • In spite of the rains that greeted many of us in Monterey on Thursday and Friday, Saturday was beautiful and clear, letting us once again have lunch outside – a welcome break from OPSC thanks Melissa Pearce, DO and Jesse Sanchez, DO the lecture hall! for their work coordinating the Open Osteopathic Education sessions at the 2016 Fall Conference. • A total of 20 hours of category 1A CME were available for Our thanks also go out to those physicians who donated DOs, thanks to the efforts of the Education Committee and their time and knowledge as Volunteer Educators for the Open Program Chair, Richard Riemer, DO. This year’s Chairs of the Education Sessions. Our Volunteer Educators for the 2016 Day were Zachary Anderson, OMS (Friday), Sam Marthinsen, Fall Conference were: OMS (Saturday), and Kim Hower, OMS (Sunday). All three are students at Touro University COM. Chelsea Chung, DO Michael Davis, DO • Public Health served as the main theme of this year’s Confer- Elaine Ho, DO ence, with talks covering a wide variety of issues that directly, Melissa Pearce, DO or indirectly, affect the health of the American public. See page Andrew Pomazal, DO 8 for a follow up article from one of our outstanding faculty. Elizabeth Sasaki, DO Joseph Zammuto, DO • Attendees had the opportunity to explore the Monterey area with an open evening on Saturday. If you are interested in serving as a Volunteer Educator at the 2017 Annual Convention, simply check the appropriate OPSC’s 56th Annual Convention and Exposition will take place box on the registration form when you register or contact February 15-19, 2017 at the Hyatt Regency Mission Bay in San Diego. Karl Baur, CMP at (916) 822-5246 or [email protected] Online registration is now available at www.opsc.org/event/AC17. to be included. Please see the inside back cover for details. The Fall Conference will return to the Monterey Plaza Hotel in 2017, with the event taking place on September 8th through the 10th. Information and links will be posted on the OPSC web site as it becomes available.

2017 Annual Convention February 15 - 19 Hyatt Regency Mission Bay SAVE THE DATE! San Diego, CA

12 California DO Vol. 16, No. 3 MEMBERSHIP

Board Recap Decisions } Alexandra Myers, DO, Chair of Membership Committee The OPSC Board of Directors met on Friday, October 28 at the Monterey Plaza Hotel in Monterey, California and took the following actions: The fall election cycle revealed many differences of opinion in 1. Encouraged osteopathic residency programs to apply our country and in our profession. Like the USA, the osteopathic for $100 million in new state funding for residencies profession has made several major decisions in the past year that may change the course of our profession. Many heartfelt and contentious 2. Agreed to communicate with the Medical Board of discussions have occurred over the past several years regarding the di- California about using DOs as expert medical review- rection of osteopathic medicine. Those discussions seem quite similar ers to those occurring nationally with regard to issues like immigration. 3. Approved the positive financial statements for the Within the AOA and OPSC, the question has been raised if MDs fiscal year ending June 2016 should be welcomed as members of each society. DOs train alongside 4. Heard a report on a community paramedicine pilot MDs in the ACGME programs, so why should MDs be excluded from project our professional societies? The ACMGE single unification system has discussed the issue of how to have an “osteopathically focused 5. Received an update on OPSC’s CME Strategic Plan program” which includes MDs. Can we teach MDs how to think os- 6. Nominated the following candidates for OPSC office: teopathically? Is it just OMT or is it the four tenets of our profession President-elect: Richard Riemer, DO which distinguish us? These questions are similar to those surround- ing immigration in our country – what makes an American truly Vice President: Minh Nguyen, DO American? How do we integrate foreigners into our society? Opinions Director, exp 2019: Michael Farrell, DO on both these topics vary widely. Director, exp 2019: Alexandra Myers, DO As we face these potential changes in our profession, OPSC has Director, exp 2019: Marc Lynch, DO spent a great deal of time asking ourselves exactly what OPSC is. We are Resident member: Brian Marcoux, DO a body that represents osteopathic physicians’ rights within the State of California. We protect the ability of DOs to practice in California. But 7. Voted to write a letter to the California Medical As- what else are we? We also lobby at the state level for various causes sociation agreeing to continue working cooperatively that affect practice rights and patient safety. We deliver high quality 8. Approved a proposal to provide the Nevada Osteopathic educational programming to DOs from across the country to our Medical Association with administrative support for conferences. We create a home for DOs new to California. Can we do an upcoming CME program the same for our MD counterparts? Or will that dilute our society? That 9. Created a task force to assess the feasibility of an is the ultimate question, and I encourage you to share your thoughts osteopathic regional management plan with the Board. Please email me at [email protected]. Let me help our Board make decisions that will allow OPSC to continue serving its membership as effectively as possible. n

2017 Fall Conference 2018 Annual Convention 2018 Fall Conference September 8 - 10 February 21 - 25 September 7 - 9 Monterey Plaza Hotel Hyatt Regency Mission Bay Monterey Plaza Hotel Monterey, CA San Diego, CA Monterey, CA

California DO Vol. 16, No. 3 13 MEMBERSHIP Welcome New Members

Active Mark Ignatius, DO, San Francisco, Pain Patricia Rochette, DO, Berkeley, Adult Amardeep Aulakh, DO, Fresno, Hematology & Management-Rehab Medicine | Reconstruction | Anatomic Pathology | Oncology | Oncology Rehabilitation Medicine | Spine Medicine Internal Medicine Alexander Aversano, DO, Pomona, Neurology Robert Jamieson, DO, Roseville, Orthopedic Francisco Rodriguez, DO, San Gabriel Charles Ballard, DO, Eastvale, Family Practice Surgery Maryjoe Romando, DO, San Diego, Psychiatry Mariedel Barroga-Schlegel, DO, Salinas, Family Carrie Janiski, DO, MS ATC, NASM-PES, Turlock, Don Rose, DO, Shingle Springs, Family Practice Practice Family Practice | Family Practice/OMM | | Urgent Care-Family Practice Abraham Betre, DO, Tulare, Ob-Gyn Neuromusculoskeletal Med/OMM | Sports Nicholas Roueiheb, DO, MPH, Woodland Hills Nicholas Birlew, DO, Stockton, Family Practice Medicine | Sports Medicine-Family Practice Michael Runge, DO, Fresno Dove Cai, DO, Roseville, Family Practice Elizabeth Jensen, DO, San Francisco, Internal Kristen Sharpe, DO, Lancaster, Ob-Gyn Tony Carey, DO, Taft, Internal Medicine Medicine Brian Shaw, DO, Dana Point, Family Practice Luanne Carlson, DO, Palm Springs, Family Practice Stephanie Jones, DO, Madera, Surgery-General Jason Spears, DO, Sacramento, Family Practice Robert Castro, DO, Irvinerdiology | Internal Sumita Kalra, DO, San Mateo, Family Practice Brandan Stark, DO, Chico, Addiction Medicine-FP Medicine | Interventional Cardiology Jaspreet Kaur, DO, Clovis James Thompson, DO, Modesto, Lisa Chai, DO, Sacramento, Internal Medicine | Rebekah Kim, DO, Vallejo Anesthesiology Palliative Medicine Kathleen King, DO, Concord, Family Practice Nam Tran, DO, Modesto, Anesthesiology Diane Chandler, DO, Concord Warren Klausner, DO, Santa Cruz, Family Practice James Trietsch, DO, San Carlos, Pediatrics Rudolph Chang, DO, Union City, Family Practice Joshua Krol, DO, Vacaville, Internal Medicine Linda Truong, DO, BS, Oakland, Neonatal- Katrina Chapman, DO, Roseville Kelly Kynaston, DO, Redding Perinatal Medicine Anusha Chari, DO, BS, San Francisco, Hansen Le, DO, Berkeley, Anesthesiology Felipe Villena, DO, Gold RIver, Anesthesiology Emergency Medicine Diana Lee, DO, Vallejo Teresa Vitro-Braccini, DO, M.P.H., Oakland, Colin Crowne, DO, Pomona, Psychiatry Hyojik Lee, DO, Santa Clara, Internal Medicine Internal Medicine Hasib Danai, DO, Turlock Michelle Lim, DO, Vacaville, Internal Medicine Jason Wasche, DO, Watsonville, Family Practice Brian Davia, DO, Watsonville, Anesthesiology Jennifer Lin, DO, Santa Clara, Family Practice/OMT Franci Wong, DO, Fremont, Anesthesiology- Treasa Davis, DO, North Hollywood, Family Practice Sherry Lopez, DO, Fresno, Internal Medicine Pain Management Charles De Mesa, DO, MPH, Sacramento Michael Lucas, DO, Walnut Creek, Emergency Harold Woo, DO, Antioch Linda Deppe, DO, Grand Terrace, Family Practice Medicine Vincent Wu, DO, Alhambra, Family Medicine Tinny Dohn, DO, Los Gatos, Family Practice Jennifer Markin Scalici, Centralia, WA Occupational/Environmental Med, Family Alexandra Duffy, DO, Sacramento, Neurology Michele Martin, DPM, Redding Practice Michael Dunn, DO Robin Matias, DO, Vacaville, Pain Management- Andrea Young, DO, San Francisco, Family Practice Steven Ellis, DO, Aptos, Family Practice/OMT Rehab Medicine | Physical Medicine & Rehab Harry Yuan, DO, Anchorage, AK Larry I. Emdur, DO, San Diego, Pulmonary Maria Militante-Miller, DO, Oakland Jeffrey Zwerin, DO, Novato Medicine Kurt Moehring, DO, Redding, Family Practice Lindsey Faucette, DO, Santa Maria Anya Myers, DO, Roseville Out of State Associate Gail Feinberg, DO, FACOFP, M.Ed., Vallejo, Larisa Nadukhovskaya, DO, San Francisco, Todd Anderson, DO, Hancock, MI, Family Practice Family Practice Emergency Medicine Thomas Bozzuto, DO, Albany, GA, Undersea Howard Feinberg, Vallejo Son Nguyen, DO, Albany Medicine Robin Fisher, DO, Moreno Valley, Emergency Joseph Nolan, DO, Davis Merrie Anne Hamburg Eylers, DO, MSHPE, Medicine Kaveri Patel, DO, Fremont, Family Practice Mesa, AZ, Anesthesiology Dana Forman, DO, Sacramento, Abdominal Nicole Pena, DO, Vallejo, Neuromusculoskeletal Bichhoa Nguyen, DO, Winslow, AZ, Family Practice Surgery | Critical Care-Surgery | Critical Med/OMM, Neuromusculoskeletal Med/OMT Mark Rybczynski, DO, St. John, IN, Family Practice Care-Trauma | Multidisciplinary Critical Care Julie Pham, DO, Davis | Surgery-General | Surgical Critical Care | Kevin Pham, DO, Clovis, Surgery-General Retired Trauma Surgery Jeanine Phan, DO, San Jose, Family Practice, Bill Delo, DO, Rancho Cucamonga, Family Practice Terry Fotre, DO, Woodside, Urgent Care-Family Geriatric Medicine-FP Warren Goff, DO, Carlsbad Practice Donald Portocarrero, DO, Monterey Park, Leslie Kramer, DO, Encinitas, Dermatology Robert Gabbay, DO, Santa Rosa, Family Practice Gastroenterology | Internal Medicine William Sieper, DO, San Francisco, Radiation Valerie A. Gibson, DO, Friant Kemi Price, DO, Pico Rivera, Family Practice Oncology Stu Glassner, DO, Fresno, Critical Care-Neuro Alan Ragland, DO, Bakersfield Surgery | Neurology Karen Ramstrom, DO, MSPH, Sacramento, Sustaining Karine Hajyan, DO, Martinez, Ob-Gyn Preventive Med-Public Health Tina Mason, MD, MPH, Vallejo Susan Harvey, DO, San Diego, Psychiatry Richard Rattin, DO, MPH, Ukiahrdiology Daniel Wilson, MD, PhD, Pomona Miranda Haskins, DO, MSR, San Francisco, |Cardiovascular Diseases | Cardiovascular Internal Medicine Imaging | Interventional Cardiology Amanda Holthouse, DO, Napa Mark Reader, DO, Porterville, Stella Huang, DO, Vallejo, Obstetrics & Otorhinolaryngology Gynecologic Surgery Elise Resnick, DO, Culver City, Psychiatry

14 California DO Vol. 16, No. 3 DO LEADER HIGHLIGHT Meet Susan Melvin, DO

What position do you currently hold? At what organization? I am currently serving as the Chief Medical Officer for Long Beach Memorial Hospital, a 458 bed Not-For-Profit hospital which is part of the MemorialCare Health System. I also serve as a member of the MemorialCare Physician Society Board.

What was your motivation to take a leadership position? Patients need a voice in all healthcare systems and, as a physician, I feel it is my duty to be their voice. The healthcare system is changing rapidly and physicians need to be at the table in the development of future care delivery models. We need to partner with patients, physicians, hospitals and health plans to have a healthy dialogue that is bal- anced and works effectively, remembering that the goal is to deliver value based care to our communities while keeping them safe and healthy.

What path led you to this position? My mantra is to consistently say yes to opportunities. I was in the fourth grade when I decided I wanted to be a physician. The reason I stated at that time was simple, I wanted Osteopathic Medical School: to make a difference; my upbringing had led to the the development of a “service heart.” Western University of Health As a physician, people allow you into their most sacred places. You see life come into Sciences the world and you respectfully support people in the transition out of this world. It is a Year of graduation: 1984 place of privilege. In the process of saying yes, I gained more and more experience in Internship: Pacific Hospital of Long leadership. I didn’t start with this end in mind, yet it evolved to where I am today. Beach

What steps did you take to prepare for your current position (eg – additional Residency: Family Medicine, Riverside General Hospital education)? Saying yes and being able to deliver on different opportunities gave me some practical Certification/Fellowship: Geriatrics experience but I did seek additional training. When I joined the residency faculty at Long Specialty: Family Medicine/ Beach Memorial I realized to be effective I needed to be more comfortable speaking publi- Geriatrics cally. At the time we had a Toastmasters group at the hospital which I joined. It was very Awards: helpful. I then had the opportunity to do a fellowship in Geriatrics/Faculty Development Munzer Family Award for Excellence at East Carolina University. A few years later I started to take on more responsibilities for in Teaching and Research 1999 the business aspects of our faculty group and found it helpful to complete a Certificate CAFP Barbara Harris Award for in Management Development through the USC School of Business. Most recently, after Educational Excellence 2008 accepting the CMO position at Long Beach Memorial, I found a home with the American Becker’s Hospital Review: 131 Association of Physician Leadership (AAPL). It is a wonderful organization that prepares women hospital and health system physicians to be organizational leaders. I recently completed my qualifications and test- leaders to know 2015 ing as a Certified Physician Executive. I continue to look for specific classes through the Becker’s 101 hospital and health AAPL that will fill areas of need in my learning. system CMOs to know 2016 Family: Married to Lydia Vaias, M.D. What do you find rewarding/challenging about serving in a leadership role? General Surgeon with Southern It is rewarding to make changes and find paths to change that keep the patient’s best California Kaiser Permanente Group. interest at the center of the decision making. I enjoy the development of systems and care teams that provide high quality, value based care. I also enjoy being a conduit for practicing physicians who have good ideas and helping to find resources to support their ideas.

California DO Vol. 16, No. 3 15 DO LEADER HIGHLIGHT

There is mutual reward when working with the hospital leadership need to be leaders on patient care teams, best practice teams, as and understanding what they need, and then finding opportunities medical directors and service line leaders. Right now there is a void in for the medical staff to work collaboratively, removing silos. At the leadership in medicine, why not fill those voids with physician leaders? end of the day there is great satisfaction feeling that you have made a difference in how care has been delivered, either through technology It is rewarding to make a difference. It develops skills that we use in and new programs or through communication and experience for the all aspects of our lives. Patients need us making decisions! It is a great patient. As challenging as healthcare is right now, the benefit is that we truth the saying, “if you are not at the table you are on the menu.” are all looking at new ways to provide care. The cost of healthcare is Come be at the table, for the patients’ sake. staggering and participating in a system to look at new paradigms of payment is overdue but has a specific stress especially to physicians. Recommendations for DOs thinking about leadership In general, leadership in healthcare is realizing that to accomplish positions. the provision of high quality care we need healthy physicians. The Say yes to opportunities you can deliver on; build new skill and experi- issue of burnout is very real and we are seeing the effects and start- ence. There are often leadership tracks/training at society meetings. ing to understand and develop plans to address the issue. The first Sometimes hospitals offer them to young leaders. The California major step is helping physicians understand and recognize it, but also Hospital Association offers an annual leadership training program. bringing understanding to health system leaders. The health systems There are several healthcare MBAs at local universities and on-line. that can recognize and effectively prevent burnout will be the winners There is a Masters in Medical Management that is offered through in the new healthcare model of the future. several universities and on-line. The American Association of Physi- cian Leadership has several certificate and degree programs as well Skills/traits required for successful physician leadership? as great training and a community of physician leaders. Additionally, Can these skills/traits be learned? a mentor can be a great resource especially in the area of balance I would say listening and communication are the most important. and the prevention of burn out. I do believe these skills can be learned. They come easier to some, but there are great training resources that a physician with a desire Why did you choose to become an osteopathic physician? to develop great leadership skills can access. I also believe that these As a teenager my mother had worked for a general practitioner in skills are part of what great physicians already do! A wise doctor told Sutherland, OR. He was described as a “Dr. Welby.” He was always me “if we listen to the patient they will tell us the diagnosis”. It really revered by my family. He was a DO. My goal was to be a primary care isn’t a lot different in the board room. Too often we want to speak physician, and I felt that osteopathic training would give me a skill before we really listen to understand. The other component of physi- set that was not available in other schools. cian leadership is the development of business skills. Especially being able to evaluate return on investment, looking at the harsh reality of What are your hobbies? financial reports, prioritizing projects, and using data effectively. Many I love to travel, it makes my world bigger! I also love to golf, although of these skills live far from the medical school classroom. I am not very good at it.

Why should physicians consider serving in leadership Why are you supportive of OPSC? positions? Professional organizations are our support networks and our voice. We need more physicians in leadership. If you look at hospitals and Collectively, through our organization we can make changes in the systems where physicians are CEO’s they have the best quality data. healthcare environment more nimbly. With the rapid changes hap- It is our responsibility to bring the patient into the decision making pening in healthcare, our organizations work on our behalf and the process. If you look at standardized approaches to “best practice” health of our patients. n the great outcomes we see come from collaborative decision-making, using data and a team based approach of doctors and nurses working together for the patient. Doctors don’t all need to be CEOs, but they

16 California DO Vol. 16, No. 3 STUDENT DO HIGHLIGHT Meet Pradhab Kirupaharan

Osteopathic Medical School: Western OPSC also values and empowers the next generation of osteopathic University of Health Sciences – COMP medical students, not only through mentorship but also through advocacy to ensure that my peers have every opportunity to compete Expected year of graduation 2017 and excel. Where did you grow up? North Brunswick, NJ Suggestions on how to improve the osteopathic profession What are your life goals? First things in California? I hope this doesn’t come off cliché, but I genuinely first, matching into residency. believe that we are in the midst of a truly dynamic period of unprecedented change and growth in the osteopathic profession. As What specialty are you leaning toward? Cardiology/ OPSC continues to break down barriers for its aspiring physicians, and Electrophysiology or Pulmonary Critical Care as our students and physicians continue to excel across the board, so too will our profession as a whole. So my suggestion is to continue Why did you choose to become an osteopathic physician? to mentor, continue to break down barriers and continue to flourish Though I was fascinated by science as an undergraduate, I was never while staying steadfast to the principles that make us unique. n truly convinced that healthcare would be right for me. My search ended while volunteering with Dr. Joanne Kalish, an early mentor and an osteopathic physician in NJ. Within a few short months my aspirations had become clear and my perception of healthcare had changed. The principles of osteopathic medicine, in addition to the DOs and PAs benefit of manipulative medicine, provided a lens to the patient and Working Together in Team Practice to healthcare I never truly appreciated. I was steadfast in my pursuit, only applying to osteopathic medical schools, and the rest is history. Learn More About Adding a PA to Your Practice!

Do you have relatives in the medical profession? I will be the first physician in my immediate family. 2016 Legislation Means Working with PAs Has Never Been Easier! Did you have a profession prior to medical school? I spent Documentation Requirements one year teaching, primarily elementary and middle school level Are Now Customizable and special education and mathematics. Streamlined.

What are your hobbies? I’m an avid fan of diverse cuisine and Teams may now decide if medical record review meetings, culture with plans to travel before starting residency. Other interests chart review or a combination of both are best suited for include basketball, cooking, fitness, sports/educational podcasts and their particular setting and team. exploring Southern California. Physicians may choose to countersign a minimum of 20% of CII medical records (reduced from 100% previously) Why are you supportive of OPSC? Despite the immense when the PA has completed a Controlled Substances Education Course, such as CAPA’s. impact physicians have on their patients in the hospital or office, we consistently lack this influence in the political forum. To ensure optimal care for our patients and fair practice for our physicians, it is Post a Job at capanet.org invaluable to strengthen our voice at a community, state and national CONTACT US level through organizations like OPSC. California Academy of PAs 2318 S. Fairview St., Santa Ana, CA 92704-4938 Ph: (714) 427-0321 Fax: (714) 427-0324 capanet.org

California DO Vol. 16, No. 3 17 COLLEGE UPDATES Touro Dean’s Report } Michael Clearfield, DO, Dean, Touro University College of Osteopathic Medicine

Campus News Event. The event showcased county healthcare programs, health

l A number of Campus buildings were renovated including the screenings, diabetes education and prevention, health/nutrition COM and COP Administrative buildings. TUCOM opened its Green education, OMT, food samples and food produce. Room recording studio which will enhance our campus ability to record presentations and provide flipped classroom presenta- Student News: tions. COM has also expanded into an ultrasound suite. l Congratulations to the following students: l Marissa Haberlach OMS III, recipient of the Northwest COM News: Osteopathic Medical Foundation Scholarship. l On May 31 TUCOM graduated its 15th COM class of 129 students l Amritha Parthasarathy OMS I, recipient of Napa Solano and 6th MSMHS class of 14 students. Medical Society Scholarship. l The COM Class of 2016 residency match has 57% of matched l Jeffrey Lin OMS II, recipient of Napa Solano Medical Society students pursuing primary care with a three year rolling average Scholarship. of 60%, which leads California medical schools. For the seventh l Olivia Kingsford OMS III, recipient of Napa Solano Medical consecutive year TUCOM is in the top 15 nationally for students Society Scholarship. choosing a primary care residency. l Katherine Specht OMS IV, recipient of Napa Solano Medical l On August 28, 2016 the Class of 2020 was welcomed to the Society Scholarship. practice of medicine through the inspiring keynote address by l Imran Masood OMS IV, recipient Pediatric Distinguished AOA President Boyd Buser and welcoming speech by Student Student Award. Doctor Kristoffer Chin, President of the COM Student Executive Council. We also wish to give an extra thanks to Dr. Pera for Department Updates speaking on behalf of the OPSC, Kathleen Creason, Executive OMM Director of the OPSC, and the OPSC as a whole for their great l Stacey Pierce-Talsma, DO was selected as the new Chair of generosity in providing our students with their White Coats. the Department of Osteopathic Manipulative Medicine (OMM). • The COM class of 2020 has set a new record, 79% of the 135 Prior to joining Touro in 2015, Dr. Pierce-Talsma was on faculty at students are from CA and have set a new standard for academic University of New England College of Osteopathic Medicine where rigor by collectively achieving the highest MCAT 30.9 (510.5 on she was the Program Director of the NMM/OMM +1 Residency new format) and GPA 3.57 in the history of our institution Program. • COM has achieved accreditation milestones. We received confirmation from the AOA for a 3 year Accreditation/ Level 3 Primary Care Accreditation with Commendation as a Category 1 CME spon- l Alesia Wagner, DO received the prestigious 2016 W. Douglas sor. Additionally, in March 2016 the Accreditation Council for Ward PhD Educator of the Year award from the American Osteo- the Continuing Medical Education (ACCME) approved our CME pathic Foundation. She was also acknowledged by the NBOME program with a Provisional Accreditation until March 21, 2018. for her work on the Clinical Decision making workshop. • Welcome to Howard Feinberg, DO who started in July as our l Dr. Shubrook and his diabetes prevention team have trained Regional Director of Medical Education and Clerkship Perfor- over 250 Touro coaches in the Diabetes Prevention Program. They mance in the Clinical Education Department. Dr. Feinberg comes have partnered with Solano County Public Health and 11 cohorts to us from the Pikeville College of Osteopathic Medicine where he currently in training. This team effort has put Solano County on served as Clinical Professor and formerly as Director of Medical top in California for DPP community cohorts per capita. n Education for Northern Kentucky and Dean of the Pikeville COM. • 80 OMS 1 & 2 students participated at the Stanford Ultrafest program. • Dr. Grace Jones and Dr. Clipper Young led TUC faculty and students in the highly successful Solano County Food Oasis

18 California DO Vol. 16, No. 3 COLLEGE UPDATES Touro Student’s Report } Zachary Anderson, OMS

Upon writing this, the Touro students just completed what is widely to our students. Sam and I were outside selling merchandise for our thought of as the hardest week of block tests in Touro’s preclinical chapter, and were able to raise money for our students going down years! The class is starting to make their Level 1 study plans as we to San Diego for the conference in February. come into the last few weeks of our semester before winter break, The recent Monterey conference was also a huge success. Touro and the chapter is gearing up for some fantastic plans in that time! had 10 students that were able to come for part or all of the confer- We started this semester with the goal of chapter promotion. In ence. We had Zach, Sam, and Kim as the different Chairs of the Day that regard, we had our first club meeting with Dr. Alesia Wagner, throughout the conference, and we sold over $500 in merchandise our faculty advisor and OPSC past president, and Kathleen Creason, for chapter travel funds. Working again towards involvement and good OPSC’s Executive Director, on our second day back in school to dis- PR, the student chapters reached out to Natividad Medical Center and cuss what the chapter can do to welcome the incoming first years. My help at a local race being held by the Monterey fire departments. We main goal as president was making sure that the entire student body had a great time out in the sun teaching public health and safety to knows what OPSC is and how the organization works for DOs and our kids! One of Zach’s major accomplishments was finishing his project students. The board meeting also delegated out roles for each of our of rewriting the chapter bylaws for the campus chapters so that we can officers to different events we wanted to put on throughout the year. run more streamlined and methodical approaches in future terms. A few weeks after orientation, Touro puts on a Club Day for the Since Monterey, we’ve been planning the rest of our year. Touro’s entire student body. OPSC always has a table, and this year, with chapter does a yearly outreach connected with our Student Run Free Kathleen’s help, we were able to get 50 more names signed up for Clinic and Covered California to try and help our local disenfranchised OPSC in the first year class. Out of 130 total, we’ve gotten close to population at the clinic get health insurance. We’re also planning 75% of the student body signed up at this point! The other major some events for our student body, including another round of our draw we had was that everyone who signed up for OPSC on Club Day “Lemon Stories: Memorable Moments in My Medical Education” got a raffle ticket for a year’s subscription to a Board’s study site. We event, where our faculty and fellows speak to the preclinical students drew the winner the next day during our second chapter meeting about powerful times with patients. We are becoming more active while answering any additional questions about the OPSC and getting on social media, and have now are in our third month of “People of everyone signed up for the Monterey conference. Touro”, a collection of classmates and faculty testimonials. Overall, Another event early in the year at Touro is the celebrated white we’ve been very successful in our goal of outreach and promotion! n coat ceremony, and AOA President Dr. Buser was able to come speak

California DO Vol. 16, No. 3 19 COLLEGE UPDATES WesternU/COMP Dean’s Report } Paula M. Crone, DO, Dean, WesternU/COMP, COMP-Northwest

It’s hard to believe that 2016 is almost at an end. This has been patient-centered care throughout their careers. The creation of a quite a year. We’ve welcomed a new University President as well as the GHHS, Pomona chapter, signifies that WesternU is an institution that class of 2020. Here are more achievements and the members of COMP places high value on the interpersonal skills and attitudes that are who continue to make contributions to the Osteopathic community: essential for the highest level of patient care.

Faculty Spotlight Alumni Spotlight Co-principal Investigators Gail Singer-Chang, PsyD, and Mi- Alexandra Myers (COMP Class of 2010) was featured on Good chael Seffinger, DO, received grant funding from the American Morning San Diego on KUSI television where she provided expert Osteopathic Association (AOA) for their research titled “Identifying commentary on school sports and new concussion laws. Risk Factors Associated with Declining EQ Traits During DO Training.” Paula M. Crone, DO (COMP Class of 1992) was named the This large-scale project includes faculty and programs from across American Osteopathic Association’s Mentor of the Year during the the University campus and beyond. Additional research investiga- OMED Convention in Anaheim, Calif. She was selected from 119 tors from WesternU include Scott Helf, DO, MSIT, (COMP Class of nominees for helping shape the future of the profession by sharing 1999), Natalie Nevins, DO (COMP Class of 1997), Janice Blumer, her knowledge, skills and distinct philosophy. DO (COMP Class of 1991). Thought Leadership Student Spotlight COMP/WesternU hosted a roundtable discussion to learn about Arnold P. Gold Humanism Honor Society formed at COMP/ policy issues, concerns, and ideas related to the Zika virus. California WesternU. The mission of the Gold Humanism Honor Society (GHHS) Rep. Norma J. Torres was present and interested in learning how is to recognize individuals who are exemplars of humanistic patient vector control is reducing mosquito-borne diseases and how public care and who can serve as role models, mentors, and leaders in health professionals are preparing to confront Zika. The roundtable medicine. Gold Humanism Honor Society had their inaugural induc- included Robert Warren, DO (COMP Class of 2001), Chief Medical tion ceremony June 15. Thirty-four third and fourth year OMSs who Officer of the WesternU Medical Center and assistant professor of showed outstanding clinical and interpersonal skills were recognized family medicine and Nishita Patel, MD, COMP assistant professor and selected to be members of the GHHS. Those members will have of internal medicine, division of infectious disease. n a responsibility to model, support, and advocate for compassionate,

Western U/COMP Students’ Report } Anirudh Ramachandran, OMS

Hello again, I hope you all had a wonderful summer! My name is years. The goal of this event was to raise OPSC funds as well increase Ani Ramachandran and I am excited to catch you up on what’s going membership among first years. This event was a success and a great on at the WesternU Pomona campus. First and foremost, the students way to kick off the school year. of WesternU COMP would like to extend our sincere congratulations to In October, OPSC hosted Dr. Donald Krpan to come back to Dr. Paula Crone on her Mentor of the Year Award from the AOA. Dean campus to deliver a lecture on ethical concerns in the workplace. Crone has been a true inspiration to me personally, and I would like As you may have already known, Dr. Krpan is one of the leaders of to thank her for all her hard work. Since school started in August, the osteopathic profession. He has served as dean and provost of OPSC has been very involved on campus. In August, OPSC hosted WesternU; furthermore, he has also served as President of both OPSC a fundraiser and membership drive to recruit new incoming first and the AOA. It was a true honor to host Dr. Krpan as he returned

20 California DO Vol. 16, No. 3 COLLEGE UPDATES

to his home at WesternU to discuss his experiences regarding ethics “I am extremely thankful to OPSC for providing on the Osteopathic Medical Board of California. Prior to his lecture, us with such an opportunity to be involved with OPSC hosted a private lunch for Dr. Krpan, Dr. Connett, Dr. Crone, the organization and to interact with the amazing and various student leaders from our class. This experience provided physicians that attend their events. They do a lot a unique insight regarding the history of the school that the students to bring us into the fold and include us as students were extremely grateful for. I believe that this is one of the proud- and representatives of OPSC. The venue in est events OPSC has hosted. Dr. Krpan and his wife were extremely Monterey is simply fantastic and it was a pleasure humbled to come back to campus and meet with students and their to attend and participate in the conference.” gratitude is something I will never forget. The only reason this event Kian Behmanesh, OMS II was able to happen is due to OPSC and the opportunities it provides for students. Through OPSC, I was able to meet Dr. Krpan, build a relationship, and invite him back to the school. I am truly thankful to OPSC for allowing this to happen. from their experiences, it provides you with renewed energy and I am Near the end of October was the Annual Fall Conference OPSC grateful OPSC offers this opportunity to its students. hosted in the beautiful Monterey Bay, California. We were able to bring This November, OPSC will continue on its mission from last year ten students from WesternU to attend the conference. This conference to stress the importance of wellness. We will be hosting the second was a great success. The students had a great time and below I have lecture of the series on Wellness and OMM, presented by David Red- included some testimonials from students that attended. ding, DO. He will emphasize how OMM can be utilized to improve overall wellness. This was a popular lecture last year which covered “The OPSC Conference in Monterey was a great experience! From how sleep and proper digestion can increase your well-being. We look topics on Concussion to PTSD, the talks were engaging and interactive. forward to continuing these topics into this next lecture. This conference was a great way to get students involved in current In December, we begin a transition from the current WesternU and upcoming resolutions, as well as meet fellow students from other OPSC board to the incoming first years. It has been my honor and schools.” – Neda Arora, OMS II privilege to lead the WesternU OPSC chapter. I am grateful to the rest of my board members who have helped me throughout this process. “The OPSC conference was a great opportunity to meet medical These students are Parvane Barati, Neda Arora, Kian Behmanesh, students from Touro as well as practicing physicians! I learn a lot and Ishanee Dighe. about interesting and important topics such as substance dependency I would like to take a moment to talk about what OPSC has meant and the end of life option act. The presentations addressed informa- to me this past year. OPSC has opened my eyes and fueled a passion for tion that was beyond what we learn in classroom as students, and politics that has inspired me to stay involved no matter what. Because gave us a perspective of what physicians actually encounter in their of OPSC, I was able to attend OPSC board meetings, the AOA house practices.” – Nancy Robles, OMS II of delegates, conferences, and participate in committee meetings. I was able to meet people in leadership positions and learn about their Personally, I believe the conference was a great way to network experiences. Every single one of these events has helped inspire me and meet our future colleagues. By attending conferences like this, to get involved and stay involved. I am grateful for everything OPSC it provides students an eye-opening view into what life is like beyond has done for me and I look forward to the day I can give back. I hope medical school. It is sometimes easy to get overwhelmed by school everyone has a wonderful time during the holidays and keep a look and feel burned out, but by meeting practicing physicians and learning out for future OPSC events at WesternU! n

California DO Vol. 16, No. 3 21 CONTINUED

President’s Message Continued from page 2

3. According to data as of December 31, 2015, 10% of California While OPSC enthusiastically embraces a strong and robust GME spots are filled by IMGs (1,018) compared to 638 spots osteopathic profession, we do not believe this is accomplished (6.3%) filled by DOs. As the Single Accreditation System goes by unbridled growth. Our strength is not just in numbers, into full effect in 2020, some of the AOA accredited residency but in the quality and competency of our graduates. While slots may not transfer to the ACGME. This will further strain osteopathic medical students will soon represent one in four the opportunities for our DO students. of all medical students matriculating in the U.S., it is ever 4. As stated in the letter to COCA “Although California is the more important that the profession self-regulates its growth. most populous state in the U.S., we rank 31st in the country It would be irresponsible to our profession and the public to in ACGME programs per 100,000 population. Between 2004 enroll an increasing number of students who cannot be as- and 2014, California increased the number of Residency/ sured quality clinical clerkship rotations and whose graduates Fellowship ACGME training programs from 9,047 to 10,142, a outpace post-graduate residency and fellowship opportunities mere 12.1% increase. This ranks 40th in the US for the change within our state.” in the number of residents and fellows in ACGME-accredited programs, 2004-2014. This illustrates the challenges of grow- In conclusion “The educational experience and post-graduate op- ing GME in California.” The OPTI-West member colleges which portunities for the current DO students is challenged by many factors. include Western University and Touro University have sought These include competition for limited medical educational resources, to start multiple residencies under the AOA and now under nearly stagnant growth of ACGME residencies and fellowships in the ACGME accreditation, but with limited success. state for the past ten years, growth of the allopathic medical schools in 5. Quoted from the letter sent to COCA from OPSC, “The California, competition from affluent off-shore and for-profit medical osteopathic profession continues to grow at historically schools outbidding osteopathic medical schools, and continued influx unprecedented rates. The last decade has seen applicants to of international medical graduates. OPSC believes that a third College colleges of osteopathic medical schools, first-year enrollment, of Osteopathic Medicine proposed for the California Central Valley total enrollment and graduates, increase 45%, 48%, and will further exacerbate these challenges, and infringe upon tenuous 48% respectively. The Commission on Osteopathic College resources both in the Central Valley and beyond. While OPSC strongly Accreditation currently accredits 33 colleges of osteopathic supports a robust osteopathic profession, this is not merely defined by medicine offering instruction at 48 locations in 31 states. growing osteopathic physicians but ensuring that our graduates are of (Combined first-year enrollment at existing MD-granting and highest quality to serve the need of the public, which is part and parcel DO-granting medical schools is projected to reach 30,186 by of our profession’s social contract. For these reasons, OPSC is unable 2020-2021, an increase of 55% compared to 2002-2003. ) to endorse the application of the Central Valley COM at this time.” n

Editor’s Message Continued from page 3

The typical approach to burn out has been support groups. Some within our family, within our personal lives and within our profes- recent reports suggest that this approach is not working with physi- sional lives. Where is the contribution that makes us feel the best cians in the current environment. If you have overcome burnout what about ourselves and the legacy we leave? Each of us needs to answer worked for you? How did you readjust your life? that for ourselves. n Whether we like it or not, we are all dealing with the current healthcare environment and creating a legacy. We develop a legacy

22 California DO Vol. 16, No. 3 CONTINUED

A Day in the Life Continued from page 4

ideas to select three solid resolutions for submission by the California Friday delegation to the AOA House of Delegates. At 8:15, I finally call it a day. Friday morning finds me once again in the Bay Area, this time at Touro University to make my annual orientation presentation. I Thursday always enjoy the energy of new students. After the presentation, I join Thursday morning is spent reviewing member testimonial videos a lively meeting of the new Touro Student Club leaders and advisor which staff member Cassandra Mallory has brought to fruition. These Alesia Wagner, DO as they discuss plans for the coming year. On the are the final drafts of short videos edited from recordings of members way back to the office I stop by the gym; have to make sure I get in from the Annual Convention in San Diego. It’s heartwarming to hear my workouts to support my eating habit! Feeling refreshed when I how OPSC has impacted so many members; I hope that prospective return that afternoon, I work on several other presentations, includ- members will appreciate hearing their colleagues talk about the ing a high level discussion with my state executive director colleagues value of OPSC. The rest of the day is spent moving projects along and about the future of osteopathic CME and a review of our “Come making travel plans. I confirm arrangements for my participation in Home” marketing campaign which I’ll present during a meeting of upcoming Republican and Democratic legislative caucus events and the Osteopathic International Alliance. Toward the end of the day I review a management agreement with the Nevada Osteopathic Medi- work on drafting a letter to the CMA Board of Trustees in response to cal Association (NOMA). Having recently lost its long-time sole staff their memo suggesting that our two organizations work more closely person, NOMA has asked OPSC to help with administrative support together. OPSC’s leadership has agreed that we should continue to for their pending CME programs. The OPSC Board agreed to help build upon our cooperative relationship with CMA, while ensuring our sister state with the caveat that services to OPSC members must that the osteopathic profession remains autonomous. Finally, I spend remain at a high level. I’m reminded once again what a terrific team time preparing materials for the various committees which will be we have when Director of Meetings Karl Baur and the rest of staff meeting during the Fall Conference to ensure we keep projects moving readily agree to jump in and help a state in need. Later that evening, forward and maximize the use of volunteer time. I join a conference call of the OPSC Board of Directors. We’re trying As I drive home, I ponder the activities of the week and think about a new strategy of holding a conference call the week prior to Board the pending activities which still need to be tackled. There’s truly never meetings to review committee reports, with the goal of reserving a dull moment in my job. Many challenges lie ahead as the world of Board meeting time to focus on big picture policy issues. The Board is medicine rapidly evolves, but I am pleased to have a role in helping engaged during the call and excited about the new structure. Another to find solutions for our members. n energizing, albeit late, day.

New CME Reporting Guidelines Effective July 1, 2016, OPSC is required by the AOA to report credits earned for all CME programs within a limited time following an event’s conclusion. What does this mean for you? It means that OPSC will no longer be able to accept attestation forms for CME programs on an indefinite basis, as has been our policy in the past. In order to smoothly meet the AOA’s new policies and ensure accurate reporting to the AOA for all programs, physicians will have 60 days to attest hours for OPSC-sponsored CME events. Once 60 days has passed after a CME program, credits will no longer be reported to the AOA for that program. OPSC can still process your credits after 90 days but they will only be valid for state licensure CME requirements. The AOA will not accept them after that point. The quickest way to check to see if you have attested hours for a program is to see if we have posted your CME certificate for that program. Click on the “My CME” link under the CME menu on any www.opsc.org page (sign in is required) to view the certificates we have on file for you. The actual time from submission of your attestation to posting your certificate will vary by event and time of year, but most certificates are typically posted within three weeks of submission.n

California DO Vol. 16, No. 3 23 REGISTRATION FORM Payment Information: o Check enclosed (check must be made payable to OPSC representing payment for items checked) o Please call me for credit card information In an effort to protect against potential fraud activity, OPSC 56th Annual Convention and Exposition has initiated a policy of only accepting credit cards online or by February 15-19, 2017 phone. This form should only be used when paying by check. Hyatt Regency Mission Bay To register online, please visit www.opsc.org/event/AC17. San Diego, California Please transfer registration fees and additional ticket item selections to this section:

Name Registration $ Membership $ Adult Guest $ Additional Tickets $ AOA Number Child Guest $ Syllabus Hard Copy $ Preferred Mailing Address* o Home o Work Total Enclosed $

City State Zip o I would like to volunteer as an OMT Educator

Phone Fax Cancellations: All cancellation requests must be made in writing and received by OPSC by January 25, 2017. A $50 processing fee will E-mail (required to receive convention correspondence) be assessed on all cancellations. Registration fees are not refundable after January 25, 2017. College Year of Graduation Please see “Registration Categories” for more details. Unless otherwise noted, fees include: registration, lectures, workshops, Specialty exhibit show, all meal functions, social events, and CME. Guests (including children over four years of age) must register or purchase *Please note: All future correspondence will be sent to this address. individual tickets to participate in meals.

Registration Fees: Early Bird Regular Onsite Weekend Before Jan. 25 Jan. 25-Feb. 11 Feb. 12-19 Only OPSC Membership Fees OPSC Member o $545 o $595 o $620 o $450 o Join as a New Member Retired Member o $345 o $395 o $420 o $300 o Non-Member o $1,020 o $1,070 o $1,095 o $925 Renew my Membership Military o $545 o $595 o $620 o $450 o Active 3 or more years in practice $475 Allied Professional o $445 o $495 o $520 o $400 o Active in 2nd year of practice $350 Resident/Intern o $145 o $195 o $220 o $145 o Active in 1st year of practice $250 Resident/Intern “Auditing Courses”* o $0 o $0 o $0 o $0 o Retired $100 Student o $145 o $195 o $220 o $145 o Military $100 Student “Auditing Courses”* o $0 o $0 o $0 o $0 o Associate (out-of State DO) $75 Adult Guest (18+) o $145 o $145 o $145 o $145 Child Guest (4-18) o $85 o $85 o $85 o $85

Adult Guest Name/s: Special dietary requests and/or accommodations: Child Guest Name/s:

Additional Tickets: o Awards Luncheon (Thursday Afternoon) Qty. @$45 each o President’s Banquet (Saturday Evening) Qty. @$75 each o Hard Copy of Convention Syllabus - $30

* Participants Auditing Courses are not eligible to receive CME credits, nor may they participate in convention meal functions. TO SUBMIT YOUR REGISTRATION:

Mail this form to: Register online at 2015 H Street, Sacramento, CA 95811 Fax this form to: or (916) 822-5247 www.opsc.org/event/AC17 OPSC’S 56TH ANNUAL CONVENTION

OPSC WELCOMES YOU TO SAN DIEGO!

The OPSC Annual Convention returns to beautiful Mission Bay, San Diego February 15-19, 2017. The sea and sand await! February 15-19, 2017 At the 2015 Fall Conference we gathered to learn about Lifestyle Medicine. Together we explored Hyatt Regency Mission Bay exercise, dietary choices, the psychology of change, and metabolic dysfunctions in ways we hadn’t San Diego, California before. We had record breaking registration, and for the first time in our history we had to close the conference to on-site registration! Now we look forward to another assembly, where we will take our education to another level. We’ll dig into the Interconnectedness of our body systems, and highlight new and emerging concepts in health and disease. In Philosophy and Mechanical Principles of Osteopathy Dr. Still said, “We look at the body in health as meaning perfection and harmony, not in one part, but in the whole.” The perfection and harmony of the whole body is what unites us as osteopathic physicians. Let’s come together in San Diego in February to celebrate that harmony. See you there!

Brian Loveless, DO 2017 Annual Conference Chair

The 2017 Convention is anticipated to offer 34 Category 1A, AOA-approved CME credits for attendees who register and attend the full WHERE TO STAY Convention. OPSC has obtained a special rate for convention attendees at the Hyatt Weekend Only registrants qualify for a Regency Mission Bay ($209 single or double occupancy plus applicable maximum of 22 credits. taxes and fees). The number of rooms is limited, so book your room reservations early! You can reserve your room online at www.opsc.org or contact the Hyatt Regency Mission Bay at (888) 421-1442. Book your room before January 24, 2017 and don’t forget to mention OPSC to Register online: receive this special rate! www.opsc.org/event/AC17 Hyatt Regency Mission Bay, 1441 Quivira Road, San Diego, CA 92109

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