Central Valley Physicians - Summer 2017

Summer 2017

This is What a Surgeon Looks Like The History of Women in Healthcare Letter to a Young Female Physician Yosemite Conference UCSF Fresno Graduates Valley Children’s Pediatric Residents

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800.356.5672 CAPphysicians.com/quote Summer 2017

VOLUME 2, NUMBER 3 • SUMMER 2017

16 20 24 28 36 48

{FEATURES} THE HISTORY OF WOMEN IN HEALTHCARE

{DEPARTMENTS}

LETTER TO A YOUNG FEMALE PHYSICIAN

52 PUBLIC HEALTH UPDATE:

YOSEMITE CONFERENCE

26 CLASSIFIEDS

Communicable disease investigation

55 IN MEMORIAM

THE CHANGING FACE OF THE VALLEY SURGEON UCSF GRADUATES VALLEY CHILDREN’S PEDIATRIC RESIDENTS

Summer 2017

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Letter From The Executive Director

EVERYONE IS SEEKING BALANCE. When you google how to balance life and work you get 41,400,000 responses. Which tells me no one has figured it out, and this include me.

I was a single mom for 16 years out of my 23 yearold daughter’s life. Most of time I didn’t know if I was coming, or going and when I was going I was usually 10 minutes late. I was in my 20’s and like most 20-something my goals were easy, become a CEO, make a lot of money and raise the next generation of NICOLE BUTLER greatness. I am not sure where the turning point for me to realize I was not going to accomplish these goals before I was 30, I think I was around 33.

PRESIDENT Alan Kelton, MD PRESIDENT-ELECT Trilok Puniani, MD VICE PRESIDENT Cesar A. Vazquez, MD TREASURER Alan Birnbaum, MD PAST-PRESIDENT Hemant Dhingra, MD BOARD OF GOVERNORS Christine Almon, MD, A.M. Aminian, MD, Jennifer Davies, MD, Joseph Duflot, MD, William Ebbeling, MD, Don Gaede, MD, David Hadden, MD, Christina Maser, MD, Katayoon Shahinfar, MD,

That was really the first time I googled ‘How to balance life and work…’ but once I did I needed to see what was out there.

Roydon Steinke, MD, Janae Barker, DO, Uma Swamy, MD,

FORBES is the first site I visited… #1 let go of perfectionism. I agree with this statement now, but back then my competitive OCD personality wanted everything to be perfect. From the projects that I took on outside of my job description so I could be “seen” in a sea of GenXers in the technology industry to my daughters’ 3rd birthday party (you know because I am sure she remembers it).

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FORBES #2 and #3 Unplug and Exercise/Meditate… Moving on to the next website, both important, but I can’t talk to either since both of those I do intermittently. And neither is part of my balance today.

Next site is Fast Company, on a side-note I remember when this magazine launched and thinking this magazine just stepped way outside the Business Media box. It was edgy in 1995.

This article was similar to the Forbes article, Make deliberate choices in life, turn-off distractions, set parameters, set goals, etc. Bottom line I still haven’t figured out balance, nor do I think I will find it in an article or blog. Today I am closer to understanding what balance is compared to when I was 20-something, but it is still a struggle. These days I am on time more so than not, my oldest daughter leaves for veterinary school in August, and my career has had more ups than downs. Today I am working on a better balance between, work, my amazing level-headed husband, and daughter number two and myself. It’s a work in progress and I am always open to ideas and improvement.

In October, the Medical Society is planning its second Women in Medicine event by hosting Kathy Davies from Stanford Life Design Lab (yes they have an entire department that teaches courses, delivers programs and tools, and conducts research applying the innovation principles of Design Thinking to the problems of life). Davies will be hosting a workshop and lecturing on the topic Designing your Life.

We are still in the early planning stage of the event, but I will be held on Saturday, October 7 at Toca Winery in Madera. We will be sending out information on this event soon, but in the meantime google Designing your life women (which only yields 54,500,000 sites of interests) and take a look at what to expect.

Alfred Valles, MD

EDITOR Don Gaede, MD MANAGING EDITOR Nicole Butler EDITORIAL COMMITTEE Don Gaede, MD - Chair, Alan Birnbaum, MD - Associate Editor, Ranjit S. Rajpal, MD, Hemant Dhingra, MD, Roydon Steinke, MD, Cesar Vazquez, MD, Nicole Butler CREATIVE DIRECTOR www.sherrylavonedesign.com CONTRIBUTING WRITERS Don Gaede, MD, Alan Kelton, MD, Tianna Arredondo, Gagandeep Rajpal, Roydon Steinke, MD Erin Kennedy, Ken Bird, MD, CONTRIBUTING PHOTOGRAPHERS Nicole Butler CENTRAL VALLEY PHYSICIANS is produced by Fresno Madera Medical Society PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: Central Valley Physicians 255 W. Fallbrook, Suite 104 Fresno CA 93711 Phone: 559-224-4224 • Fax: 559-224-0276 Email Address: nbutler@fmms.org

Maybe I have been seeking balance before design?

MEDICAL SOCIETY STAFF Executive Director, Nicole Butler Events and Membership Coordinator, Nicole Tenorio Receptionist, Becky Gentry

PS- One another note it was brought to my attention in the last issue of the magazine that I had left off the MD after Dr. Voris name in the ‘In Memoriam’ section of the magazine and I want to apologize for that error. In that section of the magazine we pull the content from the local newspaper obituaries and change very little. That said, her title should have been added on and for that I apologize. Dr. Voris was an amazing leader, physician and women and I would never intentionally discount her life accomplishments in her career.

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Matt Isman, comedian, Emmy-winning host of American Ninja Warrior and licensed physician. Isman is a physician and a professional comedian who captivates audiences with his hilarious presentations that revolve around his real-life experiences as a physician.

Friday, August 4, 2017 Clovis Veterans Memorial Building 808 4th St, Clovis, CA 93612 Cocktails - 6 pm Dinner & Live Auction - 7 pm Comedian Matt Isman - 8 pm Table of 8: $700 Sponsorship Packages & Individual Tickets Available Attire: Cocktail/Business For tickets call (559) 224-4224 or online at www.FMMS.org

A message from our Editor > Don H.Gaede, MD

Letter To A Young Male Physician

ABOUT THE AUTHOR ­ Dr. Gaede is a Fresno native and is board-certified in Internal Medicine and specializes in Vascular Medicine, with an expertise in the treatment of varicose veins, circulation problems, blood clots, and advanced techniques using ultrasound and sclerotherapy.

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The New England Journal of Medicine recently published an article by Suzanne Koven entitled, “Letter to a Young Female Physician.”

The author writes a letter to her younger self about the things she wished she had known when she was just starting her career. We have reprinted it here on page 20. As I read her letter, I began asking myself what advice I would give my younger self . . .

Dear Young Male Physician, Congratulations—you have just achieved what so many people only dream of achieving. And yet you are aware—painfully so--that for as much medical knowledge you now have, you actually know so little.

You will never be perfect, and you will do some things during your career that, in retrospect, seem ridiculously stupid. That’s ok; forgive yourself and go on. Acknowledge that although you are very educated, you

cannot possibly know everything, and never will. When you are uncertain, consult your references, but don’t hesitate to reach out to your colleagues for advice. They will be f lattered, and you will be enhanced.

As a male physician, you may experience some of the benefits of “male privilege” which, for example, may mean that you get paid more than your equally qualified female colleagues. That injustice will hopefully soon change.

Meanwhile, you could stand to learn some things from your female colleagues. I always suspected that they were more nurturing in their interactions with patients, but never thought it made a real difference-other than slowing me down when trying to stay on schedule.

But a recent study suggested that hospitalized patients cared for by female physicians lived a bit longer

Summer 2017

and were re-admitted a bit less compared to patients treated by male physicians.

No explanation was given, but some speculated that female docs are better communicators, more nurturing and maybe have more emotional intelligence, and that translated into better outcomes.

Ouch. Whether this study is confirmed by other studies or not, it should serve as a learning opportunity for you. My advice: Don’t be afraid to empathize with your patients— yes, even if you have to fake it at first.

If someone tells you about a life of recurrent headaches, don’t just proceed to your next question. Offer something like, “Wow, that must be really tough!” Take your hand off that doorknob, sit down, look them in the eye, and really listen to their story. At the end of the visit, if it seems right, give them a hug or a touch on the shoulder on the way out. They’ll feel better, and so will you.

Women are known (and sometimes feared) for their intuitive powers, but we men have them too; we just need to listen to them more. Your gut feelings can tell you things that your logical mind will never disclose. Don’t ignore them.

“People skills” also will be valuable in the brave new world of artificial intelligence. We physicians will not be immune from its intrusion, and its threat to our livelihood. Whether you know it or not, is already nibbling away at the edges of medical practice. You may not be able to compete with “big data,” or its medical equivalent, “big differential diagnosis.” The only thing

Summer 2017

Health Care Leaders Denounce Withdrawal from Paris Climate Accord In an official statement, Richard J. Gilfillan, CEO of Trinity Health, one of the largest Catholic health care systems in the United States (including St. Agnes Medical Center), wrote: “We are deeply disappointed in President Trump’s decision to withdraw America’s commitment to the Paris Agreement and its international partners. Participating in the carbon reduction agreement is the right thing to do for the health and security of our country.”

Kaiser Permanente CEO Bernard J. Tyson remarked on the health consequences of a changing climate: “Climate change is already causing health effects that will dramatically worsen unless action is taken to reduce greenhouse gas emissions.” He urged other organizations to reduce emissions and combat climate change.

Health care providers understand the dangers climate change poses to human health, hospital infrastructure, and their bottom line.

In conjunction with the 2015 Paris Climate Conference that led to the Paris Agreement, several U.S. health care systems hosted a Healthcare Climate Leadership Roundtable to plan steps to address climate change.

Some announced commitments to the 2020 HealthCare Climate Challenge, and Dignity Health presented its plans at the UN event.

Prior to Trump’s Announcement, the Heath Care Climate

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“Our Nation’s Clean Air Protections are at Risk” Join California doctors and health professionals to preserve our lifesaving clean air laws and protect lung health.

Jennifer Abraham, MD Bakersfield

Alpha Anders, MD Bakersfield

Amir Berjis, MD Bakersfield

Jose Joseph-Vempilly, MD Fresno

Alex Sherriffs, MD Fowler

Daya Upadhyay, MD Fresno

To learn more, visit www.doctorsforclimatehealth.org Join the conversation on Twitter @CALungPolicy #SaveOurLungs Lung.org/California | 1-800-LUNGUSA (1-800-586-4872) 8 CENTRAL VALLEY PHYSICIANS

Summer 2017

that will keep you a step ahead of the robots is an understanding, nurturing, human touch.

Remember that the thing you have which robots will never have is your humanity. So f launt it. Don’t be afraid to show your inner warm, caring self to your patients, and they will ref lect that warmth and caring back to you.

Although American society is changing, you may still feel that it’s mostly your job to bring home the bacon, and it’s mostly your wife’s responsibility to raise the children.

Question that feeling. It is not the 11th commandment, and it is not an integral part of being a guy. You can cut back on your hours to spend more time with your family; yes, especially when your kids are young.

Remember that money does not necessarily bring more happiness, in life or in your career. According to a 2015 Medscape survey, orthopedic physicians make about twice as much money as pediatricians and psychiatrists, but have less career satisfaction.

Don’t worry--you will make plenty of money during your career. Your happiness will not depend on the exact amount of that money--unless you’ve convinced yourself that it will.

But your happiness may indeed depend on how you think about your career. Now you sense that the practice of medicine is more than just a job, but more importantly, a calling. Hold on to that feeling. During your career, hurting people will look to you for help--possibly even a cure--and you are in the position to do something about it (while getting well-paid to do so).

Enjoy your good fortune, and make the most of it!

Council, representing 19 leading U.S. health systems, had urged the president to stick with the accord, stating: “Transitioning to an economy driven by clean energy will save millions of dollars in health care costs, create jobs, and prevent catastrophic damage caused by extreme weather. We know that reducing our reliance on fossil fuels is the best way to protect the health of our patients and our communities over the long term.”

Associations Warn of Public Health Crisis Along with leading health care systems, U.S. medical associations, representing thousands of health professionals, also warned of the impending health crisis.

The newly formed Medical Society Consortium on Climate and Health, made up of 12 leading medical associations representing over 400,000 physicians, wrote: “President Donald Trump’s decision to withdraw from the historic 2015 Paris Agreement on climate change is the wrong choice that puts Americans at unnecessary risk. Climate change is the greatest public health challenge of our time and harms the health and wellbeing of some of the most vulnerable citizens — especially the elderly and children.”

The American College of Physicians said, “The United States’ withdrawal from the Paris climate agreement will greatly undermine the global effort to prevent and mitigate the devastating impact of climate change on human health.”

And its president, Jack Ende, MD, cautioned, “Today’s decision therefore greatly increases the chances that the global effort to reduce carbon emissions will be insufficient to avert catastrophic consequences for human health.”

The American Academy of Pediatrics called the U.S. withdrawal “a dangerous step backward to protecting public health.” Trump’s decision, they said, “signifies a detrimental reversal in our country’s commitment to addressing global climate change.”

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President Report > Alan Kelton, MD

Hello Summer

ABOUT THE AUTHOR ­ ­ ABOUT THE AUTHOR AlanDr. Kelton, MD, is board and Ronald Morton is acertified board-certified specializes in Internal Medicine.

He earned his ophthalmologist who practiced in medical degree from University Nevada’ Bakersfield for over 30 yearsofand is s School of Medicine wasCounty awarded the a past presidentwhere of thehe Kern Outstanding StudentHe in Internal Medicine Medical Society. is currently retired and and the Endorcine Society Medical Student enjoys traveling with his wife of 46 Achievement Award. He completed residencies years, Ingrid. at University of Utah School of Medicine and UCSF Fresno. Dr. Kelton enjoys camping, visiting Yosemite and spending time with his family.

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Greetings to all. Welcome to the summer edition of Central Valley Physician. We hope that you continue to enjoy the outstanding articles of our newer quarterly format. Once again, there are many issues affecting healthcare and the practice of medicine about which I could comment. Instead, I would like to talk about some happy coincidences.

As of last week the most famous person I have ever met is a 12 yearold young woman. She is the Scripps National Spelling Bee Champion for 2017, Ananya Vinay. Ms. Vinay is the daughter of a fellow FMMS member physician, who is also my partner in the internal medicine faculty practice at UCSF-Fresno, Dr. Anupama Poliyedath. Ananya has been widely celebrated as being from Fresno, a fact about which we all have taken great pride in telling our friends, family and acquaintances. Truthfully though, she is foreign-born, that is born in Chicago,

Illinois. Maybe we can keep that part quiet.

Ananya came with her parents to Fresno as her father Vinay Sreekumar transferred to the Olam office of Fresno, California. Anupama Poliyedath, her mother, was practicing academic medicine in a Dartmouth related program well across the country before moving to the area.

Fortunately for me and our program, she wanted to find herself in a teaching program in the Fresno area. Our office has benefitted greatly from this happy coincidence that Dr. Poliyedath was coming to Fresno, our city has benefitted from associating ourselves with this young champion.

Ananya worked hard to win the competition, the third national event of her young life. Remarkably, she was self-motivated to study hard both independently and via an online group-many in the group were her competitors. Such cooperative

Summer 2017

Ananya worked hard to win the competition, the third national event of her young life. Remarkably, she was self-motivated to study hard both independently and via an online group-many in the group were her competitors.

competition seems to be rare in healthcare, business, education, sports and life in general. Just look at recent years in the Fresno healthcare market. Cooperative competition? It doesn’t look that way. Is there a way for us to improve without pretending that patients are a scarce resource?

I would also like to give a “print-out” (don’t think we can “shout-out” in a quarterly printed magazine) to Dr. Tejal Pandya who graduated from UCSF Fresno General Surgery and who won the 2017 Fresno-Madera Medical Society Steven Parks award for leadership. Dr. Pandya is a Porterville native and a second-generation surgeon who developed a leadership program specifically for the surgery residents at UCSF-Fresno.

Not only that, she led relief efforts for Porterville residents when wells went dry and people were in dire need. Dr. Pandya

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had tremendous competition from other residents and fellows for this award yet had to prove herself capable at working across training years, across training programs, with private and academic physicians to be worthy of this award. Wow, another young woman of whom I can be proud to know, about whom I can brag to others and from whom I can learn to be a better me.

Maybe the theme is not serendipity but is instead cooperative competition? Can we do it in healthcare?

Another possible theme is heroes. Who are yours and from where do they come? For now my heroes are from Fresno (one via Porterville) Ananya Vinay and Dr. Tejal Pandya.

Congratulations to both, may we all learn from their example.

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Guest Editorial > Gagandeep Singh Rajpal

A Vision for the Next Generation of Central Valley Physicians

ABOUT THE AUTHOR ­ Gagandeep Singh Rajpal is currently a fourthyear medical student at the UC Davis School of Medicine and recipient of a Fresno Madera Medical Society Scholarship

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My roots are grounded firmly in the Central San Joaquin Valley—it is the place of my birth, the place where I grew up, the place where I went to school, the place where my dearest friends and family continue to live—it is the place that I am proud to call my home. Our Valley is a very special place, rich in spirit and forged with a unique vitality, reflected in its vibrant people and communities.

As a region, it is distinguished by the warmth and generosity of its people, renowned as the gateway to the aweinspiring Sierra Nevada, respected for its outstanding universities, acclaimed for its world-class hospitals and healthcare infrastructure, and celebrated for its reputation as the nation’s epicenter of agricultural industry and innovation—indeed, for these and so many other reasons, this Valley of ours is a very special place to call home. Our Valley now stands at a pivotal moment, as it undergoes rapid growth and transformations as one of

the great socio-cultural and economic hubs of California. The possibilities for our Valley are truly limitless, but to reach our fullest potential we must work to advance the health interests of our communities. As I near the end of my medical school training and embark upon a path in medicine, I would like to share some of my thoughts for the next generation of Central Valley physician leaders.

The people of the Valley face a wide spectrum of challenges to health and wellness at both an individual and communal level— from “food deserts” and inadequate health literacy, and the consequential epidemics of cardiovascular disease, diabetes, and obesity, to environmental issues such as air pollution and their medical sequelae, including asthma, COPD, allergies and Valley Fever. Many of our neighbors also face continued challenges of socio-economic hardship which perpetuate the

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epidemics of substance abuse and violence that ravage our communities.

Certainly, the landscape of problems facing Valley communities is complex, and the next generation of Valley physicians must be bold and tenacious in setting the agenda for addressing these challenges.

I can remember when I was in grade school--our daily school lunches were packed with sugar laden drinks and highly processed foods—and fruits and vegetables were seldom on the menu.

Sadly, in many schools and communities throughout our Valley today, the same problem persists, despite the fact that our fertile Valley is the breadbasket of the nation, creating the bulk of the nation’s fresh fruit, nut and vegetable produce.

How is it then, that the Central Valley has some of the highest rates of childhood obesity and diabetes in the state? The medical community must work with local school boards and policy makers to empower our young people with the knowledge and tools they need to make healthy eating choices and simultaneously advocate for systemic changes, such as ensuring that school lunch programs provide students access to fresh fruits and vegetables grown locally. In addition, we ought to build upon and expand the reach of educational and outreach programs like “Walk With a Doc” to promote the benefits of walking and exercise and to foster greater civic engagement between Valley physicians and the communities they serve.

As someone with first-hand experience working in the agricultural sector, I recognize how vitally important agriculture is as the lifeblood of Valley communities. I believe that the next generation of physician leaders must develop stronger collaborations with the leaders of agricultural industry to innovate solutions to improve air quality, including working to reduce particulate matter in our Valley’s air and protect our local environment and water supplies from pesticide runoff and leaching. As an example, we can advocate alongside agricultural leaders to financially incentivize best environmental practices in agriculture to encourage farmers to transition to more environmentally sustainable methods.

From a medical standpoint, the relationship between pollution (including particulate matter) and the prevalence of chronic pulmonary diseases such as asthma, COPD, allergies, and Valley Fever in our region is well established.

Therefore, it is imperative that we ensure that our future physician workforce is thoroughly trained in the diagnosis and management of these diseases. Furthermore, these conditions are largely underdiagnosed and undertreated, and we must

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make institutionalized changes such as increased screening for these diseases--especially in our rural clinics that serve at-risk patients and those disproportionately impacted by these conditions (e.g., immunocompromised patients, those employed in agriculture, and children with a family history of asthma).

The cosmopolitan tapestry of our Valley is one of our greatest assets, and the next generation of Valley physicians should embrace diversity in all its forms by partnering with community leaders to increase access for the medically underserved and promote health care literacy and a culture of preventive medicine to better serve our eclectic populations.

In doing so, we can help address health disparities and challenges pertinent to each community, including issues such as substance abuse and violence, establishing healthy dietary guidelines within traditional cuisine, and extending access to specialized care including mental health services, prenatal care and maternal health services.

We must recognize that none of the challenges described exist in a vacuum and identifying intersections and addressing larger social determining forces will be vital to this endeavor.

The next generation of Central Valley physicians will inherit the enormous responsibility of setting the healthcare agenda for a region with rapid shifts and transitions underway, and so they will be tasked with forging greater community partnerships and drawing epistemic connections between physicians and those traditionally seen as outside the ambit of healthcare--including civic leaders, farmers, business innovators, teachers, lawyers, technologists and a host of other vital community members to engineer novel approaches to address healthcare problems which have persisted for generations in Valley communities. This will require that we move beyond our practices and medical groups etc., and stand united through organized medicine to uplift the healthcare interests of our communities. We must activate our collective scholarship and cultivate leadership within ourselves and our communities to advance substantive policies geared towards engendering structural and systemic change.

Though these challenges may at times seem intractable and insurmountable, they do not define us, rather they will propel the next generation of Valley physicians to pave new paths of innovation and collaboration. This is a vision of hope and greater community engagement for the future of health and healthcare delivery for the people of the Central Valley and the next generation of Valley physicians must come together in common cause for this very special place, our home.

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3 Steps to Responding to Negative Online Comments

Because online reviews can affect your practice—both positively and negatively—the issue certainly warrants a plan of action. Developing one can help prepare you for when you become the target of negative online comments and help you avoid an emotional response in favor of a more measured one.

These steps can also help improve your online ratings, mitigate the effects of negative online comments and guide your response to negative ratings before you ever face a crisis.

Remember: Always maintain compliance with HIPAA and other privacy laws. Do not reference patient information, the medical record or other protected information in public forums.

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Be Proactive: Develop a digital and social media plan for your practice. To proactively build your online reputation, consider monitoring online comments and requesting reviews from patients. Also, creating your own practice website and social media presence can help you control your message. Also consider the information and suggestions in this article to develop guidelines for responding to online reviews. Other helpful tools include office surveys and patient complaint processes to help you understand and address the needs and concerns of your patients.

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Don’t Panic: Objectively assess the situation that led to the comments. Avoid an emotional, off-the-cuff response. Review the medical record for potential issues, but never reference the medical record in your response. If there are significant issues, contact your professional liability insurance carrier and inform a representative about the situation. If the issue directly affects patient care and you therefore have interactions with the patient, document all communication and follow-up in the medical record.

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Maintain Professionalism: Keep your tone professional and put the patient’s needs first.

If you decide to respond, remember your response becomes part of your online reputation.

Follow group practice guidelines if you’re part of a group practice. Always maintain compliance with privacy laws and don’t directly or personally attack the individual posting the comment.

Attempt to move the discussion to a private forum with a response like, “I’m sorry you had this experience. I’d like to discuss it with you. Please contact my office.”

For the full report visit negativecomments.norcalmutual.com.

©2017 NORCAL Mutual Insurance Company. All rights reserved.

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Summer 2017

By Tianna - Renee Arredondo Carmo

Women

The History

of

in Healthcare Throughout the past 150 years women have contributed to the improvement and growth of the healthcare industry. Healthcare was considered a woman’s strength in many ancient civilizations and early medical practices globally.

Women have been relied on for their medical expertise for hundreds of years.

In the most recent decades of American history, women have regained recognition and respect within the healthcare field.

While there are still many issues regarding access, education, representation, or opportunity; it is evident that the women of today are smarter and stronger than ever. Women have sustained a presence in the medical field which may have seemed impossible less than 100 years ago. Within the last 5 years in America: 36% of the physician workforce is female California and New York is considered home for a little over 20% of female physicians in the United States

Women make up more than 50% of practicing physicians regarding: pediatrics, obstetrics/ gynecology, child psychiatry, endocrinology, and dermatology nationwide 46% of medical residents are female

47% of medical students are female

The opportunities that women have today are based on the actions of courageous women who went before the world and worked hard to achieve their dreams. In 1849 Elizabeth Blackwell beat impossible odds when she became the first female physician. Dr. Blackwell faced many hurdles being the first female to complete a medical training program only offered to men at that time. In 1881 Clara Barton, founded and laid the foundation for the Red Cross that we know today. >>

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Women

day

The modern

in Healthcare

Modern women have the opportunity to become involved in

Marlene Bengiamin, Ph.D., is the research director of

the healthcare field in many different capacities and roles.

the Central Valley Health Policy Institute which has contracts

Within the California Central Valley many initiatives are in the

with institutions such as: The Center for Disease and Control,

of process improving and advancing:

The California Endowment, and National Institute of Health.

Dr. Bengiamin has worked for over 20 years within the field of research methodology.

Community Health

Medical Technology

Healthcare Policy

Helda Pinzon - Perez, Ph.D., R.N., M.C.H.E.S., M.P.H.

Environmental Health

has served for more than 20 years as a health advocate in the

Mental Health

California Central Valley and internationally. Dr. Pinzon - Perez

Healthcare Access

is currently serving as a teacher at California State University,

Prenatal Care

Fresno. She has more than 30 publications, completed hundreds

of hours of community service globally, and has completed

Central Valley, healthcare leaders work collaboratively through

comprehensive research projects advancing the health of

the many career intersections of healthcare and medicine to

communities around the world.

provide a healthier future for families. These Central Valley leaders contribute the lasting change and healthcare reform in

Tania Pacheco - Werner, Ph.D., is a medical sociologist and

Madera and Fresno alike.

healthcare advocate working in Fresno, Madera, and Merced.

Dr. Pacheco - Werner’s work focuses on research methodology,

Lauren Lessard, Ph.D., MPH is a biostatistician and

health life-course, social determinants of health, health policy,

research scientist working for the Central Valley Health Policy

and health seeking behavior. She also leads many local health

Institute. She works to identify health inequalities, improve

initiatives focused on community health and policy change.

reproductive health opportunities for obese women, and create access to family planning.

Suzanne Kotzin-Jaszi Ph.D., MPH, is a teacher at California State University, Fresno. Dr. Kotzin-Jaszi has over 20 years of teaching experience at UC, State, and International education facilities. Her experience is comprehensive she has multiple degrees and publications. She also implemented healthcare programs and served as the Director of the New Mexico Health Policy Commission.

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In the 1920s women began to have a voice, they were responsible for delivering care and realized disparities that needed to be addressed. Women were known to take care of the sick in their home. If someone was sick and didn’t have anywhere to go, many turned to poor houses, also ran by women, known to care for the sick, dying, or elderly. In 1921 women organized successfully and communicated the need for healthcare funding to Congress. The Sheppard - Towner Act was passed, allowing State funding to be matched

by Federal dollars which created more sustainable and accessible healthcare. The success was short lived as the Great Depression hit and lasted for an entire decade only 9 years later.

Blue Shield insurances plans were offered The Department of Heath and Human Services was created

Alice Hamilton was a toxicologist know for her help in identifying the science of industrial health. Hamilton was the first woman to be elected to Harvard University’s faculty in 1919 to teach on the subject of Industrial Medicine. Only a decade later, a student of Johns Hopkins University, Florence Sabin was so passionate about studying the fetal lymphatic system and brain stem, that she was the first woman elected to the National Academy of Science in 1929.

From the 1930s up until the 1950s many advances were made in healthcare, due to the organizing and coming together of women. Many major achievements have contributed to the state of American healthcare and medicine today:

Hill-Burton Act was enacted, creating separate but equal health facilities so that all American’s would be served

A federal ruling allowing medical benefits to be included in collective bargaining successfully passed

While there were many set backs, sufferings, and obstacles for the latter half of the century women continued to be an active presence in American communities. Dr. Virginia Apgar, MD, created the Apgar System which helped diagnose infants prior to present day monitors and clinical tests. Dr. Apgar was also the first female full professor at Columbia University’s College of Physicians and Surgeons in 1949.

It is truly amazing to be alive during a time where the courage, determination, and hard work of women in healthcare is noticeable concerning past achievements; yet also made clear through the endless opportunities women now have in the healthcare industry. During the latter half of the 1900s quality of healthcare improved noticeably: hospital accreditation requirements improved, social security benefits were made available, the Department of Health Education and Welfare was created, and the federal government supported the privatization of healthcare. In the 1960s medicaid, medicare, and military healthcare coverage was also provided and guaranteed millions of American’s access to healthcare.

Since the 1960s the American Healthcare System has changed vastly; fee schedules, insurance coverage options, procedures, and accessibility are unrecognizable from what they once where.

Rosalyn Sussman Yalow was responsible for what is now today as a blood transfusion. The medical physicist and geneticist won a Noble Prize in 1977 for her work. Patricia S. Goldman, MD, was the first neuroscientist and researcher to map the frontal lobe of the brain. Throughout the 1980s she began her teaching career at Yale and taught neuroscience for the remainder of her career. Decades later in 1997 Nancy Dickney, MD, was elected as the first female President of the American Medical Association.

Thought the early 2000s until now, female healthcare leaders of our nation have come together to create opportunity, access, and health equity for all. While our nation continues on the path to healthcare reform, we can acknowledge all that women have done to contribute to the bigger picture in America today.

Sources: Women in Health Care and Pediatrics: Historical Perspectives. (Apr 1983) Volume 71 (Issue 4) 681-687; http://pediatrics.aappublications.org/content/71/4/681

health/faculty-staff/faculty/kotzin-jaszi.html & http://fresnostate.edu/chhs/publichealth/faculty-staff/faculty/pinzon-perez.html

F ocus on Health Reform. The Kaiser Family Foundation. White Paper. Publication #7871. (March 2009) ; https://kaiserfamilyfoundation.files.wordpress. com/2013/01/7871.pdf Central Valley Health Policy Institute Career Profiles. Website; https://www.fresnostate. edu/chhs/cvhpi/about/faculty-staff/ Fresno State Faculty Career Profiles. Website; http://fresnostate.edu/chhs/public-

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Healthy Living: 50 Women Who Shaped America’s Health. Huffington Post.

Article. (May 2013) ; http://www.huffingtonpost.com/2013/03/18/50-women-inhealth_n_2879370.html Women in Medicine: A Review of Changing Physician Demographics, Female Physicians by Specialty, State and Related Data. Staff Care. White Paper. ; https:// www.amnhealthcare.com/uploadedFiles/MainSite/Content/Staffing_Recruitment/ Staffcare-WP-Women%20in%20Med.pdf

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Summer 2017

LETTER TO A YOUNG FEMALE PHYSICIAN (A perspective reprinted from The New England Journal of Medicine)

This past June, I participated in an orientation session during which new interns were asked to write self-addressed letters expressing their hopes and anxieties. The sealed envelopes were collected and then returned 6 months later, when I’m sure the interns felt encouraged to see how far they’d come.

This exercise, in which the intern serves as both letter writer and recipient, both novice and veteran, offers a new twist on an old tradition. In 1855, James Jackson published Letters to a Young Physician Just Entering Upon Practice. More recent additions to this epistolary canon include Richard Selzer’s Letters to a Young Doctor, which appeared in 1982, and Treatment Kind and Fair: Letters to a Young Doctor, which Perri Klass published in 2007 on the occasion of her son’s entry into medical school. >>

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hysician: Dear Young Female P xism, some “There will be more se ely annoying. A s a infuriating, some mer quired about my pregnant resident, I in ave policy for house hospital’s maternity le at it was a great of ficers and was told th t one. Decades into idea and I should draf a prescription, some practice, when I call in r the name of the pharmacists still ask fo doctor I’m calling for.”

When I started my internship 30 years ago, I wasn’t invited to share my hopes and anxieties in a letter — or anywhere else, for that matter. In fact, I recall no orientation at all, other than lining up to receive a stack of illfitting white uniforms, a tuberculin skin test, and a hasty and not particularly reassuring review of CPR. Perhaps the memory of my own abrupt initiation explains my response as I sat at the conference table watching the new interns hunched earnestly over their letters: I was filled with longing. I wanted so much to tell them, particularly the women — more than half the group, I was pleased to note — what I wished I’d known. Even more, I yearned to tell my younger self what I wished I’d known. As the interns wrote, I composed a letter of my own.

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Dear Young Female Physician: I know you are excited and also apprehensive.

These feelings are not unwarranted. The hours you will work, the body of knowledge you must master, and the responsibility you will bear for people’s lives and wellbeing are daunting. I’d be worried if you weren’t at least a little worried.

As a woman, you face an additional set of challenges, but you know that already. On your urology rotation in medical school, you were informed that your presence was pointless since “no self-respecting man would go to a lady urologist.”

There will be more sexism, some infuriating, some merely annoying. As a pregnant resident, I inquired about my hospital’s maternity leave policy for house officers and was told that it was a great idea and I should draft one. Decades into practice, when I call in a prescription, some pharmacists still ask for the name of the doctor I’m calling for.

And there will be more serious and damaging discrimination as well. It pains me to tell you that in 2017, as I’m nearing the end of my career, female physicians earn on average $20,000 less than our male counterparts (even allowing for factors such as numbers of publications and hours worked)1 ; are still underrepresented in leadership positions, even in specialties such as OB– GYN in which we are a majority2 ; and are subjected to sexual harassment ranging from unwelcome “bro” humor in operating rooms and on hospital rounds to abuse so severe it causes some women to leave medicine altogether.3 But there’s also a more insidious obstacle that you’ll have to contend with — one that resides in your own head. In fact, one of the greatest hurdles you confront may be one largely of your own making. At least that has been the case for me. You see, I’ve been haunted at every step of my career by the fear that I am a fraud.

This fear, sometimes called “imposter syndrome,” is not unique to women. Your male colleagues also have many moments of insecurity, when they’re convinced that they alone among their peers are incapable of understanding the coagulation pathway, tying the perfect surgical knot, or detecting a subtle heart murmur.

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I believe that women’s fear of fraudulence is similar to men’s, but with an added feature: not only do we tend to perseverate over our inadequacies; we also often denigrate our strengths.

A 2016 study suggested that patients of female physicians have superior outcomes. The publication of that finding prompted much speculation about why it might be so: perhaps women are more intuitive, more empathic, more attentive to detail, better listeners, or even kinder? I don’t know whether any of those generalizations are true, but my personal experience and observations make me sure of this: when women do possess these positive traits, we tend to discount their significance and may even consider them liabilities. We assume that anyone can be a good listener, be empathic — that these abilities are nothing special and are the least of what we have to offer our patients.

I have wasted much time and energy in my career looking for reassurance that I was not a fraud and, specifically, that I had more to offer my patients than the qualities they seemed to value most.

Early on, I believed that displaying medical knowledge — the more obscure the better — would make me worthy. That belief was a useful spur to learning, but ultimately provided only superficial comfort. During my second-year clinical skills course, an oncologist asked me to identify a rash. “Mycosis fungoides!” I blurted out, since it was one of the few rashes whose name I knew and the only one associated with cancer.

My answer turned out to be correct, causing three jaws to drop at once — the oncologist’s, the patient’s, and my own — but the glow of validation lasted barely the rest of the day.

A little further on in training, I thought that competence meant knowing how to do things. I eagerly performed lumbar punctures and inserted central lines, and I applied for specialty training in gastroenterology — a field in which I had little

interest — thinking that I could endoscope my way to selfconfidence.

My first few years in practice, I was sure that being a good doctor meant curing people. I felt buoyed by every cleared chest x-ray, every normalized blood pressure. Unfortunately, the converse was also true: I took cancer recurrences personally. When the emergency department paged to alert me that one of my patients had arrived unexpectedly, I assumed that some error on my part must have precipitated the crisis.

Now, late in my clinical career, I understand that I’ve been neither so weak nor so powerful. Sometimes even after I studied my hardest and tried my best, people got sick and died anyway. How I wish I could spare you years of self-flagellation and transport you directly to this state of humility!

I now understand that I should have spent less time worrying about being a fraud and more time appreciating about myself some of the things my patients appreciate most about me: my large inventory of jokes, my knack for knowing when to butt in and when to shut up, my hugs. Every clinician has her or his own personal armamentarium, as therapeutic as any drug.

My dear young colleague, you are not a fraud. You are a flawed and unique human being, with excellent training and an admirable sense of purpose. Your training and sense of purpose will serve you well. Your humanity will serve your patients even better.

Sincerely, Suzanne Koven, MD Harvard Medical School Massachusetts General Hospital Boston, MA

1 Jena AB, Olenski AR, Blumenthal DM. Sex differences in physician salaries in U.S. public medical schools. JAMA Intern Med 2016;176:12941304 CrossRef | Web of Science | Medline 2 Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex differences in academic rank in US medical schools in 2014. JAMA 2015;314:11491158 CrossRef | Web of Science | Medline 3 Lowes R. Most female physicians report sexual harassment at job. Medscape (http://www.medscape.com/viewarticle/866853).

4 Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med 2017;177:206213 CrossRef | Web of Science | Medline

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sixty-six-years and counting another successful Postgraduate Institute

YOSEMITE CONFERENCE

By Roydon Steinke, MD

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“In just three days we experienced about 22 different kinds of weather, many gigantic water falls, deeply moss-covered trees, and Half Dome with about 30 feet of snow on its crown...”

The annual Yosemite Conference was a resounding success. For those physicians who get their Continuing Medical Education credits online, from hospital programs, or medical journals, you missed out! Yosemite is an incredible venue, a broad spectrum of topics, information for all specialties, a superb Ansel Adams photography presentation and this year for the first time an electrifying illusionist.

In just three days we experienced about 22 different kinds of weather, many gigantic water falls, deeply moss-covered trees and Half Dome with about 30 feet of snow on its crown, it was a photographers paradise. All of the audience stayed to the end of the conference listening to estimable speakers while their families were well entertained.

Next year the conference will be held February 23-25, 2018, which happens to coincide with the collusion of the sun’s rays with Bridal Veil Falls creating the spectacular “Fire Falls”. You should attend and make sure to bring your camera.

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CL

DS

F I S IE S A

FOR RENT

Home lease/office across Clovis Community Hospital.2.5 acres,horses/ fruit trees,~1800sf, 3bd/3ba. $1K referral fee for MD tenant! Small pets OK. Call 559-321-7972

POSITIONS AVAILABLE Veteran State Home Fresno (CalVet) Has openings for a full-time and part-time physicians. This is a State position with State benefits. For more information or if you are interested please email asha.sidhu@calVet.ca.gov or call 559-681-7800 or apply online at calhr.ca.gov Medical Consultants Needed for Fresno Field Office This is an excellent opportunity to help your community and to obtain valuable experience.

The Department of Consumer Affairs, Division of Investigation, and Health Quality Investigation Unit is seeking well-qualified individuals to be a Medical Consultant for the Fresno Field Office.

Are you interested in being an integral part of the Medical Board of California enforcement process? Do you have the ability to conduct interviews, exercise sound judgment in reviewing conflicting medical reports and preparing opinions, analyzing problems, and taking appropriate action? Interested individuals must submit an application for examination.

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Visit jobs.ca.gov/JOBSGEN/5CACC.PDF for additional information and instructions.

If you have any questions please contact Herbert Boro, MD, F.A.C.P. with the Health Quality Investigation Unit in Fresno at (559) 447-3045 or by email at herbert.boro@mbc.ca.gov.

Family/ General Practice Physician Needed A multi-disciplinary organization is looking for a FP/GP/DO/Medical Director for our Fresno medical office.

Candidates must have an active CA license. As a member of our team you will enjoy a Monday-Friday workweek, no weekends, late nights, or hospital calls. Part time and full time available!!

Benefits include 401K, health, dental and vision insurance. Great-pay, potentialto bonus by performance criteria and protocol. 100% employer paid malpractice. For immediate consideration please submit your CV by email to matt@firsthealthmedical.com or by fax to (559) 435-3462.

Premium medical office 3500sf with completed tenant improvements.

Maple/Herndon, easy access to Herndon/Rte 41/168. Next to MRI, specialists and Saint Agnes Hospital. $1.55/sq ft negotiable. Call (559) 322-7766 between 3 pm-5 pm.

Medical or Business office space Medical office space, 1331 square and 1319 feet. Many new exterior improvements.

1046 and 1060 E. Shields Ave. Contact Shannon Mar, (559) 999-6165 or smar@guarantee.com.

FOR SUBLEASE

Class A Medical Office Space, approximately 1500 square feet. 1781 East Fir Avenue, Suite 102, available 7/1. Rent: $2250 plus security deposit.

Contact Robert at (559) 800-7476 or administration@cvphysiatry.com

If you would like to submit a listing to our Classifieds, contact nbutler@fmms.org. Listings are free for members with reasonable rates for nonmembers.

Summer 2017

Walk with a Doc Take a Step Towards Better Health Walk with a Doc is a FREE walking program for anyone who is interested in taking steps to improve their heart health.

Each walk is hosted by a friendly, local physician. In addition to numerous health benefits received just by walking, you will also get the chance to talk with a doc.

FRESNO

MADERA

Where: San Joaquin River Parkway & Trust 11605 Old Friant Rd Fresno, CA 93730 When: 3rd Saturday Time: 8:30 am Dates for Fresno January 21 February 18 March 18 April 15 May 20 June 17 July 15 August 19 September 16 October 21 November 18 December 16

Where: Lions Town & Country Park- Pavilion 2300 Howard Rd Madera, CA 93637 When: 1st Saturday Time: 8:30 am Dates for Madera January 7 February 4 March 4 April 1 May 6 June 3 July 1 August 5 September 2 October 7 November 4 December 2

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Join us for Walk with a Doc For more information or questions, please call (559) 224-4224 or visit www.fmms.org.

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These surgeons are gracious when patients mistake them for a nurse, when hospitals don’t provide doctor scrubs in their size or peers make wisecracks about their physiology and medical leaders actively discourage them. These surgeons are women.

By Erin M. Kennedy

They may wear smoky eye shadow and cameo earrings in the operating suite or cover their hair with girly flowered surgical caps. But just like their male counterparts, they cut out cancers and bullets, reroute digestive systems, and repair hernias, shoulders and hearts. Most would say besides appearances, there’s little difference between them and their male peers in the OR. But probe further and you’ll find a steely determination that has prompted some to switch residency programs because of rampant sexism or take extra call just to prove themselves as the only woman in their program.

They’ve all spent most of their prime reproductive years in medical school, residencies and fellowships, working crazy long hours perfecting their skills and knowledge. Because of it, many have opted not to have children or husbands in order to follow their passion – a choice their male “It happens a lot in the hospital when I explain a procedure counterparts rarely have and tell them what I’m going to do, then they look at me and had to make. say ‘Ok, so who is going to do the surgery?’ I think they are Anne Prentice, MD, FACS, of Valley surprised I’m the surgeon.”” - Dr. Prentice Vascular Surgery and a UCSF assistant clinical professor, tells the medical students who ask about her life and if she would recommend a surgical career that the profession is all-consuming and days are unpredictably long. But she also tells them to go for it, especially if they feel the same thrill she does. “You have to love it. I honestly do...It would be terrible to look back and have regrets. It’s exciting. I like finding a problem and fixing it,” she said.

Dr. Prentice was the only female in her medical school class in 1994 that went into general surgery, but she ended up in a residency with all women at UCSF Fresno.

Dr. Prentice encountered mostly encouragement in her training and later vascular

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“Even though it was not legal, at every single residency interview I had I was asked if I was married or had children or if I was planning to have children.”- Dr. Schulz fellowship. But after more than two decades performing surgery, she’s still sometimes treated like the clinical helper rather than the one in charge.

“It happens a lot in the hospital when I explain a procedure and tell them what I’m going to do, then they look at me and say ‘Ok, so who is going to do the surgery?’” said Dr. Prentice. “I think they are surprised I’m the surgeon.”

OUTNUMBERED 4 TO 1 IN SURGERY It’s no wonder. She’s still an anomaly. Just 35% of physicians nationwide are women and the percentages of women practicing surgery are even lower. The American Medical Association polls from December 2015 showed only 19% of general surgeons were female. The percentages of women surgeons shrink even further for specialties like neurosurgery or thoracic surgery. In Fresno and Madera counties there’s only one woman bariatric surgeon, Pearl Ma, and one woman cardiac surgeon, Sarah Minasyan.

Google “Fresno Madera orthopedic surgeons” and you’ll see nearly 60 names but only three women show up on that Google screen – a ratio far less than the 9% of board certified orthopedic women surgeons nationally. One of those three is Michele Schulz of Sierra Pacific Orthopedic Center, who does

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much of her surgery at Saint Agnes Medical Center and Fresno Surgery Center.

“The American Academy of Orthopaedic Surgeons thinks it’s the lack of women mentors. But I think it’s because the musculoskeletal system is under-taught in medical school. Orthopedics is an elective rotation so not everyone gets the exposure,” Dr. Schulz speculated on why there weren’t more orthopedic specialists like her. But she also acknowledged, “Of all the specialties, this really felt like it was the good old boys club. They do fit the stereotype of a big strong guy who used to be a college football player or jock. There’s really only a certain type of women who can put up with it.”

THE ‘BOYS CLUB’ REQUIRES THICK SKIN Dr. Schulz was not fussed by the raunchy jokes or boys club’ ribbing, she said. Mostly she took it in stride as “fun” but she also put up with a lot of inappropriate probing on her way to becoming a surgeon.

“Even though it was not legal, at every single residency interview I had I was asked if I was married or had children or if I was planning to have children,” shared Dr. Schulz who waited until after her training to have two children with her PhD cancer researcher husband. “I was the only woman from top to

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bottom in all of my training.

DOES GENDER MAKE A DIFFERENCE? “It was good, because you are forced to know what you’re Does the gender of a surgeon really make a difference? Some doing. All the attendings and chief residents knew my name argue women surgeons have smaller hands, more finesse and I got called on at every conference. It was always ‘all the and are naturally more collaborative. Medical schools and guys and Schulz’ and I would’ve got eaten alive as a woman in professional physicians’ organizations assert that it’s crucial to ortho if I wasn’t 100% sure of myself and what I was doing.” have a diversity of cultures and races – and gender – among That was in the mid to late 1990s at University of Southern healthcare providers because it helps improve the delivery of California and University of California, Irvine. Being on call care to a diverse patient population. is a huge part of residency, and when you’re in a small program Nicole Hill, MD, who specializes in breast surgery at Kaiser that might mean you’re rotating call with just one other person.

Permanente Fresno, notes that in her practice, being a woman So Dr. Schulz wasn’t offended when the only other orthopedic helps her patients be comfortable asking uncomfortable resident she was sharing call days with, a man, told her “You questions. “Breast surgery and breast cancer is very emotional,” better not get pregnant!”

She wasn’t discouraged either when in her first hospital experiences there “Lots of patients experience a loss of intimacy and sexual dysfunction were only pink nurses’ scrubs available after this kind of surgery. And it’s a difficult subject to bring up with a male to her. Her male counterparts had surgeon for many patients.”- Dr. Hill distinct surgeons’ scrubs and separate locker rooms from the male nurses.

“If it’s going to bother you then you said Dr. Hill. “Lots of patients experience a loss of intimacy and probably aren’t cut out for orthopedic surgery,” she said. sexual dysfunction after this kind of surgery. And it’s a difficult As soon as she finished her training at UC Irvine, Dr. Schulz subject to bring up with a male surgeon for many patients.” became a faculty member to help mentor those who wanted to She’s glad she didn’t heed the advice of those in medical blaze the same trail she did. “Ortho is a very physical surgery school. “People kept telling me ‘Whatever you do, don’t go into and there’s lots of power tools involved,” she said. “I’d tell surgery!’ ” she said. Even during her surgical residency at UC residents ‘You can either muscle it in or manipulate it.’ I can’t Irvine others tried to discourage her from her goal. “Another muscle it in, so I had to lean on technique.” (male) resident told me, ‘You know what they say about

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women surgeons? They’re either not very good women or very good surgeons.’ I shrugged it off at the time.”

It’s clear national leaders in surgical medicine disagree. In the American Association for the Surgery of Trauma’s inaugural newsletter in 2007, Donald D. Trunkey, MD wrote “51% of all medical students are now female, but only 7% apply to general surgery” and he lamented that a talented pool of possible candidates were never even getting into the trauma surgery pipeline.

In the past decade that number has more than quadrupled with 30% of all residents and fellows now women, but his insights remain valid. Dr. Trunkey asked, “The bottom line question is: How can we make this specialty more attractive to women? At the University of Melbourne in Australia, women are allowed more time to finish their surgical training and even fellowship training. Daycare, such as offered at the Medical College of Virginia, is also a very attractive perk that might be useful. Obviously, I think this needs more dialogue.”

FRESNO’S THE ANOMALY FOR WOMEN SURGICAL FACULTY Somehow, even without more time to finish their surgical training or onsite daycare options, UCSF Fresno has created a place that’s attracting twice as many women as other places. Six out of 10 trauma surgeons currently practicing at Community Regional Medical Center with UCSF Fresno medical education program are women.

“We have a lot of role models here,” said Trauma Surgeon Amy M. Kwok, MD, FACS, MPH, who is one of those role models now as associate program director of the UCSF Fresno General Surgery Residency Program. “The real anomaly is having a program director who is a woman … A lot of what we have here is because of Dr. (Jim) Davis (chief of trauma at Community Regional and program director of the critical care surgery fellowship at UCSF Fresno). He does not care about gender or political views, just about dedication and talent.”

A 2014 report from the Association of American Medical Colleges (AAMC) shows how much of an anomaly it is.

While nearly “The bottom line question is: How can we make this specialty more attractive to half of medical students and are women? At the University of Melbourne in Australia, women are allowed more female, women time to finish their surgical training and even fellowship training. Daycare, such as only make up offered at the Medical College of Virginia, is also a very attractive perk that might 38% of full-time academic faculty, be useful. Obviously, I think this needs more dialogue.”- Dr. Trunkey 21% of full-time professors, 15% of department chairs, and only 16 percent of medical school deans. In the field of surgery, women comprise only 22% of full-time faculty and only 1% of all department chairs.

“We have a long history of female faculty here,” said Mary Margaret “Meg” Wolfe, MD FACS. She became the director for the General Surgery Residency Program at UCSF Fresno in 2012. “Two years ago we had an entire class of female residents in surgery. That’s noteworthy even nationally.”

When Dr Wolfe finished her trauma/critical care fellowship at UCSF Fresno she stayed because of the culture, the commitment to diversity and the opportunities. During her residency at Loyola University Medical Center in Chicago she was asked if she “identified as a surgeon or as a female surgeon.” Dr. Wolfe thought it was a funny question because she never felt treated differently due to her gender. She wants to create that same egalitarian atmosphere here at UCSF Fresno. “I want them to be surgeons first and not female surgeons. But that said, we’re family-friendly for everyone. That’s the legacy of Steve Parks making this a very family-oriented residency.”

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Summer 2017

LEADING BY EXAMPLE TO CREATE A FAMILY FRIENDLY PROGRAM Steven N. Parks was the Chairman of Surgery and the Program Director for UCSF Fresno’s Surgical Residency before his death in 2010. He was a brilliant surgeon and a dynamic educator, but many remember him for his devotion to his two children and the way he managed to be at every school performance. Daughter Nancy Parks, MD, FACS, followed in his footsteps becoming a trauma surgeon at Community Regional and Associate Program Director for UCSF Fresno Surgical Critical Care and Acute Care Surgery Fellowship Program. She said her father never pushed her into medicine, but being able to shadow him at work and listening to him tell stories about his trauma patients at the dinner table solidified her doctor dreams early in life. “It always sounded so exotic and exciting,” she explained.

During medical school in Nebraska a woman surgeon warned Dr. Nancy Parks it wasn’t all exotic and exciting.

That woman mentor encouraged her to be “very purposeful” before choosing surgery, implying it would take toll on having a family. She got a different message during her residency at UCSF Fresno: “It’s always been an equal opportunity place.”

Andrea Long MD, the newest member of the UCSF Fresno trauma team, agrees that egalitarian tone is set from the top and by a man: “Dr. Davis said to me the first time I met him, ‘If you can’t work for a woman, you can’t work here,’” “It’s certainly different than my training” she said of the majority female team. “During my training in Georgia, I was the first female surgery resident in 15 years. But I never felt I was treated differently. During my fifth year, one of the residents had maternity leave and she had to go out pre-term so there was grumbling about covering for her. But another resident hurt his knee and people did the same amount of grumbling about covering for him.”

While she didn’t experience the subtle sexism that other woman surgery residents, Dr. Long noticed it. “I think I had more of an easy time as a woman surgeon because I’m a stronger personality,” said the self-assured and very out lesbian.

“I’m not the cute, dainty one. I had a friend who is and she’s always got called by her first name as a resident instead of Dr. So-and-so. And people would burst into her OR and treat her like she was the assistant. I really had no problems. The gay man had way more problems than me in training. ”

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MIXING MOTHERHOOD AND SURGERY Dr. Kwok says her discouragement was very direct. During her third year as a medical student when she declared her interest in surgery, Dr. Kwok said, “The chief resident told me, ‘Women aren’t supposed to be surgeons.’ This was 2003! He said, ‘You will always have one foot out the door. You will never be dedicated enough. If you want to have children, you’ll never have the time to come a great surgeon.’”

That’s the kind of statement that surgeon mothers scoff at.

Like most women with high-powered jobs they get creative and they become masters of multi-tasking.

Shana Ballow, DO, a UCSF Fresno clinical professor in surgery, illustrates how it’s done during a recent break in trauma cases at Community Regional. She walks into the UCSF surgery conference room with her oversized scrubs top pulled out of the waist band where she normally tucks it, a breast pump discretely suctioned on to both breasts, the portable pump’s battery slipped in her pocket. She chomps on an apple in one hand, checks her smart phone in the other and continues a conversation interrupted a few minutes before.

Dr. Ballow has a 3-year-old son and 7-month-old daughter.

She doesn’t have the luxury of a regular schedule, but pumps

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milk when she can to leave for the au pairs that fill in for her and her husband when they’re working. Because her child care help lives with them she’s easily able to take call in the middle of the night. “I hate to be the weak link on the team,” she said of her arrangement.

Like the majority of her peers she waited until she finished her residency in 2012 before trying for a family. Dr. Ballow says she didn’t think much about how she was going to manage. She knew there weren’t many how-to manuals for what she was attempting.

But in 2017, there’s social media and supportive Facebook communities for surgeon mothers that Dr. Ballow turns to for advice. “When I came back from maternity leave, my baby was refusing to take a bottle. The other surgeon moms told me not to worry; she’d eventually get hungry enough. And she did.”

Christina Maser, MD, FACS, didn’t think twice about balancing a family with her endocrine surgery career and UCSF Fresno teaching. But she knows her women colleagues do. “I think women carry that burden a lot more heavily than men.

Having a family doesn’t physically impact (male surgeons’)

baby and I couldn’t remember,” she said. “I felt so awful in that moment.”

She also seeks solace in the Facebook community of physician moms who share tales about missing a son’s championship soccer game because a surgery went late and studies about resiliency in children and how to juggle it all. “It’s so great to have a group of women who understand and have lived through it,” she adds.

A CHILD’S EYE VIEW OF MOMMY SURGEONS

“Really male or female, surgery is demanding, physically, emotionally and the difficult cases will keep us up at night,” said Dr. Hill. “There’s really a lot of emotional fatigue in American medicine today so you really need an anchor and a sense of something bigger than yourself. As mom’s we see that anchor every day when we come home from work. My daughter makes comments that ‘There are sick people in the world and mommy helps them.’ I hope she continues to witness that.”

Sarah Zhanna Minasyan, MD, a board-certified cardiothoracic surgeon with Community Foundation Medical “There’s really a lot of emotional fatigue in American medicine today so Group in Fresno and Division Chief you really need an anchor and a sense of something bigger than yourself. of Cardiothoracic Surgery at North Bay Medical Center in Fairfield, As mom’s we see that anchor every day when we come home from work. wondered if her own children My daughter makes comments that ‘There are sick people in the world and were witnessing the sacrifices and realizing the impact of her work. mommy helps them.’ I hope she continues to witness that.””- Dr. Minasyan Dr. Minasyan has four children – a 12-year-old daughter she delivered during her surgical training, and 4-year-old twin boys ability to do their job in terms of being pregnant and maternity and an 18-month-old daughter carried and delivered by the same leave,” she said. surrogate.

But the bigger burden, Dr. Maser suggested, is the emotional It’s an exhausting profession with long hours of physically tug of war women impose on themselves: “I saw a patient demanding work but Dr. Minasyan said there’s great satisfaction yesterday and she said to me, ‘Oh I think you had to cancel our in fixing the body, often literally saving lives. She wasn’t sure her last appointment because your kid was sick.’ And she said it very kids noticed. But when her seventh-grade daughter was assigned nonchalantly with no judgement. But the immediate guilt I felt to write an essay on someone who inspired her, Dr. Minasyan was ‘Oh I let this patient down, because I was doing something was shocked by the choice: “I was thinking she’d pick someone selfish by taking care of my sick 4-year-old.’ “ like Madame Curie or the first woman astronaut. ‘Nope,’ she Dr. Maser adds, “But that’s my internal struggle. I don’t think said, ‘I wrote about you.’ She read it to me and it was really that’s something men think about.” wonderful. In one sentence she’d write ‘Sarah’ and the next it’s Dr. Hill said she often has that internal struggle and there ‘Dr. Minasyan.’ are days she feels like the worst mother ever to her two small “After that I got matching tee-shirts for me and my daughter children. “One day I got off and I was post-call and excited to that read ‘This is what a surgeon looks like.’” be able to take my baby to the pediatrician’s office. Then the pediatrician asked me about the name of the formula we gave our

34

CENTRAL VALLEY PHYSICIANS

Summer 2017

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35

2017

UCSF FRESNO GRADUATES DOCTORS TO CA RE FOR VALLE Y PATIENTS AND TE ACH FUTURE PHYSICIANS MORE T H A N 10 0 PH YSICI A NS, INCLUDIN G MEDICA L RESIDE N T S IN EIGH T SPECI A LT IES, A ND F EL LOW S IN 12 SUB SPECI A LT IES GR A DUAT ED F ROM T HE UCSF F RESNO MEDICA L EDUCAT ION P RO GR A M L A S T MON T H.

“UCSF Fresno is dedicated to training doctors, caring for patients, researching solutions to Valley health issues and working with the community to improve health beyond clinics and hospitals,” said Michael W. Peterson, MD, associate dean at UCSF Fresno. “These pillars are the foundation for all of our training programs and it is with great pride that we send our graduating residents and fellows on their way to pursue their careers with the knowledge they are well prepared for the future.

“We are especially pleased that so many of our graduates will remain in the Central Valley to care for patients, continue their subspecialty training at UCSF Fresno or join the faculty at UCSF Fresno to teach the next generation of physicians,” added Dr. Peterson.

A FEW OF THIS YEAR’S GRADUATING CLASS INCLUDED:

Jessica Mason, MD, a theater student from Ventura County turned emergency medicine doctor, who is now at the intersection of medicine, education and entertainment.

Dr. Mason educates physicians across the U.S. and globe as a contributor and producer for the popular podcast for physicians, Emergency Medicine Reviews and Perspectives, and shares health information with the general public via a humorous medical podcast called “This Won’t Hurt a Bit.” Mason is completing a fellowship in emergency medicine education and will be staying on as faculty at UCSF Fresno. She earned her medical degree at the USC Keck School of Medicine and completed residency training at MetroHealth Medical Center and The Cleveland Clinic through Case Western Reserve University in Cleveland, OH. She enjoys working on educational projects with her husband David.

36

CENTRAL VALLEY PHYSICIANS

Summer 2017

L AWERENCE SUE, MD

GREGORY SIMP SON, MD

LEEN A JA LOTA, MD

Summer 2017

CENTRAL VALLEY PHYSICIANS

37

MOH A MED FAY ED, MD

Mohamed Fayed, MD, was born and raised in Cairo and conducted residency training at Wright State University in Dayton, OH. Dr. Fayed is completing a fellowship in pulmonary disease critical care and will be staying on as faculty at UCSF Fresno. Fayed is part of a high-level medical team at Community Regional Medical Center that uses technology known as ECMO to offer patients with lifethreatening respiratory or cardiac failure new hope for life. He credits his success to his wife Hoda. They have one daughter. He enjoys spending time with his family, playing squash and running in his free time.

Tejal Pandya, MD, a Porterville native is completing residency training in general surgery. Dr. Pandya is a second-generation surgeon, following her father. She will stay on as part-time faculty at UCSF Fresno and she plans to join her mother and father at his practice in Porterville. Known to her friends as Panda, she attended UC Davis where she earned a bachelor’s in human physiology and minors in contemporary leadership and English literature. She earned a medical degree from Temple University School of Medicine in Philadelphia, PA. Pandya enjoys gardening, cooking, traveling internationally and amateur photography.

Congratulations to this year’s UCSF Fresno graduating class, we wish you luck for the future.

HOUSESTAFF AWARDS

T E JA L PA NDYA, MD

Residents vote for members of the housestaff, faculty and non-physician staff who exemplify standards of teaching excellence deserving of special recognition.

Outstanding first year resident Outstanding resident teacher Outstanding attending teacher Outstanding non-physician teacher OUTSTANDING FIRST YEAR RESIDENT - MANAVJEET SIDHU, MD EMERGENCY MEDICINE (PHOTO ATTACHED)

Outstanding resident or fellow teacher - Micah Roberts, DO - Cardiology Outstanding attending teacher - Gregory Simpson, MD – Dermatology Outstanding non-physician teacher - Lee Hagerty, UCSF Fresno Simulation Center BORBA HOUSESTAFF & FACULTY RESEARCH AWARD

The Faculty Development and Scholarly Activity Committee reviews original research conducted by members of the faculty and house staff. Awards are given to recognize creative research judged to be the most significant and meritorious during the academic year.

Resident Award - Faye Pais, MD - Internal Medicine Fellow Award - Leena Jalota, MD - Pulmonary/Critical Care ICARE AWARD

This award recognizes the resident who exemplifies the abilities to communicate effectively, lead treatment teams that foster a culture of safety and uses data effectively when making decisions.

38

CENTRAL VALLEY PHYSICIANS

Summer 2017

Christine McElyea, DO - Internal Medicine UCSF FRESNO COMMUNITY SERVICE AWARD

This award, established by the Dizon family, recognizes the resident who best personifies the UCSF Fresno value of outstanding service to the community.

Priya Jayachandran, MD - Internal Medicine Leon S. Peters “Resident of the Year” In December 2011, the “Leon S. Peters Resident/Fellow of the Year Award” was established through funding received from the Leon S. Peters foundation in support of the first UCSF Fresno Resident Council. The Resident Council has selected one resident/fellow, nominated by his/her peers, who has demonstrated an outstanding job in patient and family care, research project success, has volunteered in the community to provide medical assistance where needed, and is overall a wellrounded physician concerned about his/her patients, research and community.

Steven N. Parks, MD, Leadership Award Steven N. Parks, MD was known for his vision, leadership and guidance, during his 35 years of practice in Fresno, Dr. Parks made many outstanding contributions to the medical community, the profession, the Fresno-Madera Medical Society and other professional organizations. His dedication and commitment to medicine continue through this leadership award, established by the medical society to recognize and encourage excellence in leadership development within organized medicine by residents and fellows and serves to stimulate similar efforts by other physicians in training.

Tejal Pandya, MD – Surgery KAISER AWARD FOR EXCELLENCE IN TEACHING

Each year the University of California, San Francisco, School of Medicine awards the prestigious Kaiser Award for Excellence in Teaching to four members of the clinical faculty. These awards recognize outstanding teaching and motivational skills and communication abilities.

Lawrence Sue, MD, FACS - Surgery

Alicia Kurtz, MD - Emergency Medicine

2017 GR ADUATING CL ASS ACUTE CARE SURGERY

Mark Navarro, MD

Nicholas Gastelum, MD

Rachel Caiafa, MD

MICHIGAN STATE UNIVERSITY COLLEGE

UNIVERSITY OF CALIFORNIA, SAN

INDIANA UNIVERSITY SCHOOL OF

OF HUMAN MEDICINE

FRANCISCO, SCHOOL OF MEDICINE

MEDICINE

Dr. Navarro will join a Cardiology Practice in Northern California

Dr. Gastelum will begin an Ultrasound Fellowship at UCSF Fresno in the Emergency Medicine Residency Program

Dr. Caiafa has accepted a position with Surgical Specialists of Colorado to cover St. Anthony Hospital, an ACS-verified Level I trauma center in Denver, CO. CARDIOVASCULAR DISEASE

Manminde Bhullar, MD GOVERNMENT MEDICAL COLLEGE,

Micah Roberts, D.O. THE COLLEGE OF OSTEOPATHIC MEDICINE OF THE PACIFIC AT WESTERN UNIVERSITY

Bryan Kaye, MD

OF HEALTH SCIENCES

UNIVERSITY OF ARIZONA COLLEGE OF

Dr. Roberts will begin an Electrophysiology Fellowship at University of Wisconsin, Madison

MEDICINE

AMRITSAR

Dr. Bhullar will begin an Interventional Cardiology Fellowship at UCSF Fresno

Summer 2017

Dr. Kaye has accepted a position at John C. Lincoln Medical Center in Phoenix, Arizona

EMERGENCY MEDICINE

Brian Blake, MD

Alicia Kurtz, MD

OREGON HEALTH SCIENCES UNIVERSITY

LOYOLA UNIVERSITY OF CHICAGO,

SCHOOL OF MEDICINE

STRITCH SCHOOL OF MEDICINE

Dr. Blake has accepted a position at Kaiser in Fresno

Dr. Kurtz will begin a CEP Administrative Fellowship in

CENTRAL VALLEY PHYSICIANS

39

FAMILY MEDICINE

Amarjot Rai, MD

Jihan Ansari Pirsaraei, MD

ST. GEORGE’S UNIVERSITY SCHOOL OF

ROSS UNIVERSITY SCHOOL OF MEDICINE

MEDICINE

Dr. Ansari Pirsaraei has accepted a position with United Health Centers of San Joaquin Valley

Dr. Rai has accepted a position with United Health Centers of San Joaquin Valley

Leslie Chen, D.O.

Sheena Edmonds, D.O.

TOURO UNIVERSITY NEVADA COLLEGE OF

THE COLLEGE OF OSTEOPATHIC MEDICINE

OSTEOPATHIC MEDICINE

OF THE PACIFIC AT WESTERN UNIVERSITY

Dr. Leslie Chen has accepted a position with Palo Alto Medical Foundation in Fremont, CA, practicing urgent care

OF HEALTH SCIENCES

Mario Gutierrez, MD

Danielle Malvini, D.O.

UNIVERSIDAD AUTÓNOMA DE

TOURO UNIVERSITY CALIFORNIA COLLEGE

GUADALAJARA

OF OSTEOPATHIC MEDICINE

Dr. Gutierrez will begin a Sports Medicine Fellowship at Texas Tech University

Dr. Malvini will join the UCSF Fresno Family & Community Medicine Dept. as Faculty

Mohsin Jawed, MD

Navpreet Gill, MD

ROSS UNIVERSITY SCHOOL OF MEDICINE

ROSS UNIVERSITY SCHOOL OF MEDICINE

Dr. Jawed has accepted a position at Kaiser Permanente in Sacramento, CA

Dr. Gill has accepted a position with United Health Centers of San Joaquin Valley

MEDICINE

Jasmine Lahel, D.O.

Zev Tovian, MD

Dr. Salsberg has accepted a position with Emergency Physicians of the Rockies in Northern Colorado.

TOURO UNIVERSITY CALIFORNIA COLLEGE

UNIVERSITY OF OF ILLINOIS COLLEGE OF

OF OSTEOPATHIC MEDICINE

MEDICINE

Dr. Lahel has accepted a position at Kaiser Permanente in Sacramento, CA

Dr. Tovian plans to do rural clinic work in Watsonville, CA

Emeryville, CA and has accepted a full time position at San Leandro Hospital Eli Lessard, MD UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE

Dr. Lessard will continue his Air Force career stationed in Anchorage, Alaska Scott Owens, MD UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF MEDICINE

Dr. Owens will begin a fellowship in Global Emergency Medicine and Rural Health with the University of Washington Steven Riccoboni, MD WEILL CORNELL MEDICAL COLLEGE OF

Dr. Edmonds has accepted a position with Family Health Network in Visalia, CA

CORNELL UNIVERSITY - NEW YORK

Dr. Riccoboni will join the UCSF Fresno Emergency Medicine Dept. as faculty Jeremy Salsberg, MD UNIVERSITY OF CINCINNATI COLLEGE OF

Gabriel Schroeder, MD

GASTROENTEROLOGY

LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE

Shuang Lin, MD

Adnan Ameer, MD

Dr. Schroeder has accepted a position with Clovis Community Hospital

INDIANA UNIVERSITY SCHOOL OF

ROSS UNIVERSITY SCHOOL OF MEDICINE

MEDICINE

Dr. Ameer will begin an Advanced Endoscopy Fellowship at Harbor UCLA Medical Center in California

Dr. Lin will practice in Indiana Keith Wilson, MD UNIVERSITY OF CALIFORNIA, SAN

Patrick Polach, D.O.

FRANCISCO, SCHOOL OF MEDICINE

ARIZONA COLLEGE OF OSTEOPATHIC

Dr. Wilson will begin a Hospice and Palliative Medicine Fellowship at UCLA

MEDICINE

40

CENTRAL VALLEY PHYSICIANS

Dr. Polach will be doing locum tenens work in the San Joaquin Valley Summer 2017

Jagrati Mathur, MD

INTERNAL MEDICINE

Ai-Nhi Hoang, MD

KASTURBA MEDICAL COLLEGE, MANIPAL

Brady Bleicher , MD

UNIVERSITY OF CALIFORNIA, DAVIS,

Dr. Mathur has accepted a position with Dignity Health Medical Foundation Hospital in San Francisco, CA

UNIVERSIDAD CENTRAL DEL CARIBE

SCHOOL OF MEDICINE

ESCUELA DE MEDICINA

Dr. Hoang will begin an Anesthesiology Residency at New York University School of Medicine/ Langone Medical Center in New York

HOSPICE AND PALLIATIVE MEDICINE

Katherine DeGraaff, D.O. TOURO UNIVERSITY NEVADA COLLEGE OF

Lindsay Hwang, MD

John Thompson, D.O.

OSTEOPATHIC MEDICINE

CASE WESTERN RESERVE UNIVERSITY

KANSAS CITY UNIVERSITY OF MEDICINE

Dr. DeGraaff will begin a Physical Medicine and Rehabilitation Residency at MedStar Georgetown University Hospital/National Rehabilitation Hospital in Washington, DC

SCHOOL OF MEDICINE

Dr. Bleicher will begin a Research Fellowship in New York

AND BIOSCIENCES

Dr. Thompson has accepted a position as Hospice Medical Director for Sutter Care at Home in Sacramento

Dr. Hwang will begin a Radiation Oncology Residency at University of Southern California

Shane Lieberman, MD UNIVERSITY OF COLORADO SCHOOL OF MEDICINE

Dr. Lieberman will practice in Colorado INFECTIOUS DISEASE

Bakht Roshan, MD

Tracy Zweig Associates INC.

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Dr. Roshan plans to be a Infectious Diseases physician in the Central Valley

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Dr. Thu plan to be an Infectious Diseases physician in California

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CENTRAL VALLEY PHYSICIANS

41

Kyaw Lin, D.O.

Nahera Adams , MD

Priya Jayachandran, MD

A.T. STILL UNIVERSITY OF HEALTH

UNIVERSIDAD AUTÓNOMA DE

UNIVERSITY OF MICHIGAN MEDICAL

SCIENCES, COLLEGE OF OSTEOPATHIC

GUADALAJARA

SCHOOL

MEDICINE - ARIZONA

Dr. Adams has accepted a Hospitalist position at Sutter Gould Medical Foundation in Modesto, California

Dr. Jayachandran plans to practice in California

Dr. Lin will begin a Physical Medicine and Rehabilitation Residency at New York University School of Medicine/ Langone Medical Center in New York

Christine McElyea, D.O. Nabil Baig, D.O.

ARIZONA COLLEGE OF OSTEOPATHIC

TOURO UNIVERSITY NEVADA COLLEGE OF

MEDICINE

Manoj Mohan, D.O.

OSTEOPATHIC MEDICINE

TOURO UNIVERSITY CALIFORNIA COLLEGE

Dr. Baig will join the VA Hospital in Fresno, California as faculty

Dr. McElyea will be a Chief Resident in Internal Medicine at UCSF Fresno

OF OSTEOPATHIC MEDICINE

Dr. Mohan will begin a Physical Medicine and Rehabilitation Residency at University of Pittsburgh Medical Center in Pennsylvania Uyen Ngoc Mui, MD

Jarae Ng, D.O. Amarbir Bhullar, MD

ARIZONA COLLEGE OF OSTEOPATHIC

GOVERNMENT MEDICAL COLLEGE,

MEDICINE

AMISTRAR

Dr. Ng has accepted a Hospitalist position at Kaiser Permanente in Roseville, California

Dr. Bhullar will begin a Cardiology Fellowship at UCSF Fresno

UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON

Shilpi Gupta, MD

Dr. Mui will begin a Research Fellowship in Texas

SABA UNIVERSITY SCHOOL OF MEDICINE

Lorean Nwosu MD

Dr. Gupta has accepted a Hospitalist position at Good Samaritan Hospital in San Jose, California

NEW YORK MEDICAL COLLEGE

FRANCISCO, SCHOOL OF MEDICINE

Nasir Halim, MD

Deanna Oliver MD

Dr. Quezada will begin a Diagnostic Radiology Residency at University of Washington in Seattle

ST. GEORGE’S UNIVERSITY SCHOOL OF

AMERICAN UNIVERSITY OF THE

MEDICINE

CARIBBEAN School of Medicine

Dr. Halim will begin a Gastroenterology Fellowship at UCSF Fresno

Dr. Oliver will join the VA Hospital in Fresno, California as faculty

Maria Quezada, MD

Dr. Nwosu plans to practice on the East Coast

UNIVERSITY OF CALIFORNIA, SAN

Amit Reddy, MD

Hiral Patel, D.O.

THE UNIVERSITY OF IOWA ROY J. AND LUCILLE A. CARVER COLLEGE OF

Sanjay Hinduja, MD

DES MOINES UNIVERSITY COLLEGE OF

MEDICINE

BHARATI VIDYAPEETH MEDICAL COLLEGE,

OSTEOPATHIC MEDICINE & SURGERY

Dr. Reddy will begin an Ophthalmology Residency at University of Colorado in Denver

PUNE

Dr. Patel will be a Chief Resident in Internal Medicine at UCSF Fresno

Sukhkarn Bains, MD

Jennifer Hoang, D.O.

ST. GEORGE’S UNIVERSITY SCHOOL OF

NEW YORK UNIVERSITY SCHOOL OF

THE COLLEGE OF OSTEOPATHIC MEDICINE

MEDICINE

MEDICINE

OF THE PACIFIC AT WESTERN UNIVERSITY

Dr. Bains will begin an Anesthesiology Residency at the University of California, Davis

OF HEALTH SCIENCES

Dr. Pierce has accepted a Hospitalist position in Spokane, Washington

Dr. Hinduja will be a Chief Resident in Internal Medicine at UCSF Fresno

Ryan Pierce, MD

42

CENTRAL VALLEY PHYSICIANS

Dr. Hoang has accepted a Hospitalist position in the California Bay Area

Summer 2017

Miguel Risco, MD

Maria Bisaha, MD

INTERVENTIONAL CARDIOLOGY

UNIVERSIDAD PERUANA CAYETANO

STATE UNIVERSITY OF NEW YORK

Manmeet Singh, MD

HEREDIA

UPSTATE MEDICAL UNIVERSITY

MEDICAL UNIVERSITY, PLEVEN

Dr. Risco will begin a Hematology/ Oncology Fellowship at UC Irvine, California

Dr. Bisaha has accepted a Hospital position in the Central Valley

Dr. Singh will join a private practice in Sugar Land, Texas

Pooja Reddy, MD

MEDICAL EDUCATION

Nitin Thinda, MD

UNIVERSITY OF MISSOURI KANSAS CITY

Jessica Mason, MD

KASTURBA MEDICAL COLLEGE, MANIPAL

SCHOOL OF MEDICINE

KECK SCHOOL OF MEDICINE OF THE

Dr. Thinda will be a Chief Resident in Internal Medicine at UCSF Fresno

Dr. Reddy has accepted a Hospitalist position in the Central Valley

UNIVERSITY OF SOUTHERN CALIFORNIA

Jonathan Tse, D.O.

Ranjeet Singh, MD

TOURO UNIVERSITY NEVADA COLLEGE OF

CRIMEAN STATE MEDICAL UNIVERSITY

Anna von Reinhart, MD

OSTEOPATHIC MEDICINE

Dr. Singh has accepted a Hospitalist position at Community Hospital Medical Group in Fresno

SCHOOL OF MEDICINE AT MT. SINAI

Dr. Tse has accepted a Hospitalist position at El Camino Hospital in Mountain View, California

Dr. Mason will join the UCSF Fresno Emergency Medicine Dept. as faculty

Dr. von Reinhart will join the UCSF Fresno Emergency Medicine Dept. as faculty

Srilatha Venepally, MD

Premier Senior Living

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Dr. Venepally plans to be a Hospitalist

Assisted Living • Memory Care

Abbas Hasnain, MD UNIVERSIDAD AUTÓNOMA DE GUADALAJARA

Dr. Hasnain has accepted a Hospitalist & Private Practice position in Porterville, California Maria Yeh, D.O. TOURO UNIVERSITY NEVADA COLLEGE OF OSTEOPATHIC MEDICINE

Dr. Yeh has accepted a Primary Care position at Kaiser in Daly City, California

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CENTRAL VALLEY PHYSICIANS

43

MINIMALLY INVASIVE SURGERY

Nathalie Nguyen, D.O.

ORTHOPAEDIC SURGERY

Salim Abunnaja, MD

THE COLLEGE OF OSTEOPATHIC MEDICINE

Timothy Galan, MD

GARYOUNIS UNIVERSITY

OF THE PACIFIC AT WESTERN UNIVERSITY

UNIVERSITY OF MINNESOTA MEDICAL

Dr. Abunnaja will join a private practice

OF HEALTH SCIENCES

SCHOOL, MINNEAPOLIS, MN

Dr. Nguyen has accepted a position with Adventist Health in Glendale, California.

Dr. Galan will begin an Adult Reconstruction Fellowship at the Mayo Clinic in Jacksonville, FL

THE COLLEGE OF OSTEOPATHIC MEDICINE

Marian Pak, D.O.

OF THE PACIFIC AT WESTERN UNIVERSITY

ARIZONA COLLEGE OF OSTEOPATHIC

Kourosh Kolahi, MD SATE UNIVERSITY OF NEW York AT

OF HEALTH SCIENCES

MEDICINE

BUFFALO SCHOOL OF MEDICINE AND

Dr. Leung will join an OB/GYN practice in Burbank, California

Dr. Pak will join an OB/GYN practice in Los Angeles, California

BIOMEDICAL SCIENCES

Obstetrics and Gynecology Teresa Leung, D.O.

Helen Uong, MD CREIGHTON UNIVERSITY SCHOOL OF

Dr. Kolahi will begin a Hand & Upper Extremity Fellowship at the University of New Mexico, Albuquerque, NM

MEDICINE

Dr. Uong has accepted a position with Kaiser Permanente in Fresno

44

CENTRAL VALLEY PHYSICIANS

Summer 2017

Cody Pehrson, MD

Yelena Fenik MD

MEDICAL COLLEGE OF WISCONSIN,

EBERHARD KARLS UNIVERSITAT TUBINGEN

MILWAUKEE, WI

FACULTY OF MEDICINE

Dr. Pehrson will begin a Trauma Fellowship at Sonoran Orthopaedic Trauma Surgeons in Scottsdale, AZ

Dr. Fenik has accepted a per diem positon at Kaiser Permanente in Modesto and with the Pediatrics Department at UCSF Fresno

Central California Available Medical Office BAKERSFIELD - 10000 Stockdale Hwy. #102 Bakersfield, CA 93311 | Ph 661 631 3800

PEDIATRICS

Nermeen Baseer, D.O.

Rachel Manalo, D.O.

TOURO UNIVERSITY CALIFORNIA COLLEGE

TOURO UNIVERSITY CALIFORNIA COLLEGE

OF OSTEOPATHIC MEDICINE

OF OSTEOPATHIC MEDICINE

Dr. Baseer will join a private practice in Salt Lake City, Utah

Dr. Manalo will begin a Pediatric Cardiology Fellowship at the University of Miami

Clarisse Casilang, MD ST. GEORGE’S UNIVERSITY SCHOOL OF

Soe Maw, MD

MEDICINE

THE UNIVERSITY OF MIAMI MILLER

Dr. Casilang will join the David N. Pincus Global Health Fellowship at the Children’s Hospital of Philadelphia

SCHOOL OF MEDICINE

Allison Crisp, D.O.

Dr. Maw will become a Chief Resident for the upcoming year and has accepted a fellowship in Community Medicine with UCSF Fresno Pediatrics

TOURO UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE, VALLEJO

Kiran Patel MD

Dr. Crisp has accepted a position at a Federally Qualified Health Center in Napa, CA and will be working per diem with UCSF Fresno Pediatrics

AMERICAN UNIVERSITY OF THE CARIBBEAN SCHOOL OF MEDICINE

Dr. Patel has accepted a Hospitalist position at New York Presbyterian Hospital

For Sale or Lease 820 - 34th Street - Bakersfield , CA Located near the northwest corner of 34 and Q Streets in the Memorial Hospital Corridor, this 30,498 SF two story medical office building, with open atrium design, is within walking distance of Memorial Hospital and other medically related services. 8,607 sf is currently available for lease.

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Denise Der, MD CHICAGO MEDICAL SCHOOL AT ROSALIND

Monica Ruiz-Cangco, D.O.

FRANKLIN UNIVERSITY OF MEDICINE AND

EDWARD VIA COLLEGE OF OSTEOPATHIC

SCIENCE

MEDICINE - VIRGINIA CAPMUS

Dr. Der has accepted a position with Permanente Medical Group in Fresno

Dr. Ruiz-Cangco has accepted a Hospitalist position at Valley Children’s Hospital

Daniel Ezroj, MD ST. GEORGE’S UNIVERSITY SCHOOL OF

Bonnie Singh, MD

MEDICINE

ST. GEORGE’S UNIVERSITY SCHOOL OF

Dr. Ezroj has accepted a Hospitalist & Community Pediatrician position in Ventura County

MEDICINE

Summer 2017

Dr. Singh will become a Chief Resident and junior faculty member in the UCSF Fresno Pediatrics Department

For Sale or Lease 820 - 34th Street - Bakersfield , CA Located near the northwest corner of 34 and Q Streets in the Memorial Hospital Corridor, this 30,498 SF two story medical office building, with open atrium design, is within walking distance of Memorial Hospital and other medically related services. 8,607 sf is currently available for lease.

For further information, contact: David A. Williams, SIOR 661 631 3816 Cameron Mahoney 661 631 3814 www.colliers.com

CENTRAL VALLEY PHYSICIANS

45

Ryan Tucker, D.O.

Leena Jalota, MD

SURGERY

LAKE ERIE COLLEGE OF OSTEOPATHIC

BHARATI VIDYAPEETH MEDICAL COLLEGE,

Yan Cho, MD

MEDICINE

PUNE

PENNSYLVANIA STATE UNIVERSITY COLLEGE

Dr. Tucker has accepted a Hospitalist position at Valley Children’s Hospital

Dr. Jalota has accepted a position with East Bay Pulmonary Associates in the East Bay, California

OF MEDICINE

SIERRA VISTA FAMILY MEDICINE

Rayan Eshaghian, MD

PSYCHIATRY

Carly Marshalla, MD

Dr. Cho will be practicing general surgery

GEORGE WASHINGTON UNIVERSITY SCHOOL

John Djabrayan, MD

OF MEDICINE

NEW YORK MEDICAL COLLEGE

YESHIVA UNIVERSITY

Dr. Marshalla plans to join the Outpatient Primary Care Mental Health Integration Team at the VA Hospital in Fresno

Dr. Djabrayan has accepted a position with the Valley Health Team in Central Fresno

Dr. Eshaghian will be practicing general surgery

Sarah Ghebrendrias, MD

SANTOSH MEDICAL COLLEGE

MEDICINE

Dr. Kahal has accepted a position with Asian Pacific Health Care in Los Angeles, CA

Dr. Lee will begin a Breast and Endocrine Surgery Fellowship in Melbourne, Australia

Mandeep Kaur, MD

Tejal Pandya, MD

ROSS UNIVERSITY SCHOOL OF MEDICINE

TEMPLE UNIVERSITY SCHOOL OF MEDICINE

Dr. Kaur has accepted a position with United Health Centers in the Central Valley

Dr. Pandya will join private practice in Porterville, CA

SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE

Dr. Ghebrendrias will begin a Child & Adolescent Psychiatry Fellowship at USC Sarah Sicher, MD BEN-GURION UNIVERSITY OF THE NEGEV ISRAEL

Dr. Sicher will begin a Child & Adolescent Psychiatry Fellowship at USC Saydra Wilson, MD SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE

Dr. Wilson will practice Outpatient Psychiatry

Amandeep Kahal, MD

Michael Klug, MD

ALBERT EINSTEIN COLLEGE OF MEDICINE OF

Elaine Lee, MD OHIO STATE UNIVERSITY COLLEGE OF

Kirellos Zamary, MD UNIVERSITY OF CALIFORNIA, IRVINE,

ST. GEORGE’S UNIVERSITY SCHOOL OF

COLLEGE OF MEDICINE

MEDICINE

Dr. Zamary will begin a Surgical Critical Care Fellowship at Stanford University in Palo Alto, CA

Dr. Klug will begin an Emergency Medicine Fellowship in Huntsville, Alabama

SURGERY CRITICAL CARE

Sleep Medicine Charlie Abraham, MD

Victoria Sharp, D.O.

PULMONARY DISEASE AND CRITICAL CARE

UNIVERSITY OF DAMASCUS FACULTY OF

COLLEGE OF OSTEOPATHIC MEDICINE

MEDICINE

Mohamed Fayed, MD

Dr. Abraham will practice Sleep Medicine and Internal Medicine at the VA Hospital in Fresno

Dr. Sharp will join the Beaumont Farmington Hills General Surgery and Trauma Program as faculty

UNIVERSITY OF CAIRO

Dr. Fayed will join the UCSF Fresno Pulmonary Critical Care Dept. as faculty Valentine Ifeacho, MD

LINCOLN MEMORIAL UNIVERSITY DEBUSK

WILDERNESS MEDICINE

Fredysha McDaniel, MD

Gregory Richardson, MD

HOWARD UNIVERSITY COLLEGE OF

CHICAGO MEDICAL SCHOOL AT ROSALIND

UNIVERSITY OF SOUTHERN CALIFORNIA

MEDICINE

FRANKLIN UNIVERSITY OF MEDICINE AND

KECK SCHOOL OF MEDICINE

Dr. McDaniel will practice Psychiatry and Sleep Medicine at Kaiser

SCIENCE

Dr. Ifeacho will practice Pulmonary Critical Care Medicine in Northern California

46

CENTRAL VALLEY PHYSICIANS

Dr. Richardson will join Saint Francis Hospital in Evanston, Illinois as faculty

Summer 2017

Now Enrolling

Certified Medical Coder Classes Certified Course and Exam Certification validates your achievement and demonstrates superior knowledge as an advanced coding professional.

Consecutive Wednesdays for 5 weeks August 16, 23, 30 September 6, 13, 2017 REGISTER TODAY $995 FMMS Members $1250 Non-Members For more information call (559)224-4224 ext 118 or visit www.FMMS.org

$100 OFF

Register by July 1, 2017

In today’s complex practice environment, certified coders are in high demand. More physicians need Certified Medical Coders who are capable of understanding the complexities of the reimbursement process. Improve your practice’s financial health. Your certification will help limit audit liability and decrease claim denials.

• Certification demonstrates to auditors, compliance officers, employees and peers that you have taken steps to attain advanced knowledge and skills.

• Certified Medical Coders are employed in thousands of medical practices across the country. The CMC certification is recognized by CMS and leading healthcare groups nationwide.

• Certification will help you communicate with improved confidence with physicians, third-party payers, patients and business associates.

This program includes classroom instruction, course manual, homework exercises, exam preparation handbook, and certification exam. Participants may take up to six hours to complete the CMC exam. A passing score of 70% or better will confer with CMC certification.

Fresno Madera Medical Society Board Room 255 W. Fallbrook, Fresno CA 8:30 am - 4:30 pm (lunch will be provided)

Recognition: PMI is recognized by the Centers for Medicare and Medicaid Services (CMS) as an example coding certification source for its Intermediary Provider Customer Service Program.1 This recognition by CMS and hundreds of Summer 2017 CENTRAL VALLEY PHYSICIANS 47 other healthcare organizations reinforces PMI’s position as a leading provider of certification for medical office staff.

Devon Goosen, MD receiving her long white coat during the introduction ceremony of Valley Children's inaugural class of pediatric residents.

48 CENTRAL VALLEY PHYSICIANS

Summer 2017

Valley Children’s Introduces Its Inaugural Class of Pediatric Residents

By Nicole Butler

Valley Children’s Pediatric Residency Program, Affiliated with Stanford University School of Medicine introduced its inaugural class on Tuesday, June 20 with a symbolic white coat ceremony. Thirteen medical students from around the country were greeted by hundreds of Valley Children’s physicians, nurses, and staff as they begin their resident training for at least the next three years. Of the 13 residents, four grew up in Central California and 10 are from this state or have deep roots to the region.

“I am absolutely thrilled with the talent and passion for pediatrics that we have been able to recruit for our inaugural class,” says Dr. Jolie Limon, Valley Children’s Chief of Pediatrics and Executive Director, Medical Education. “These are young physicians who are dedicated and committed to the kids of the Central Valley, and who will go on to serve as leaders for coming generations. We hope to keep as many of them in the Valley Children’s family after they complete their training.”

Valley Children’s Residency Program was the recent recipient of one of only four national Advocacy Training Grant Awards from the American Academy of Pediatrics (AAP). As part of the honor, two program leaders - Dr. Jolie Limon and Dr. Janae Barker - represented Valley Children’s at this week’s AAP Legislative Program in Washington, D.C. The grant recognizes residency programs seeking to strengthen advocacy training within their institutions, and Valley Children’s program – in its first year – was awarded the grant based on its innovation, interprofessional collaboration and desire to create a culture of advocacy for the Central Valley’s underserved children.

“With our new residency program and the state of the health of our local children, there is tremendous opportunity for teaching advocacy to our residents and creating awareness around our faculty,” Chief of Pediatrics and Executive Director of Medical Education Dr. Jolie Limon said. “We are looking towards a sustainable model that will be part of our training program and infiltrate our organizational culture.”

In addition to Dr. Limon and Chief Resident Dr. Barker attending the AAP event in Washington, D.C., Valley Children’s faculty-resident team will start implementing an educational project in collaboration with Valley Children’s AAP

Summer 2017

Fresno Native Returns to the Valley as one of Valley Children's first Pediatric Residents.

By Tianna - Renee Arredondo Carmo Fresno native Dr. Devon Goossen, recently graduated medical school from St. Louis University in St. Louis, Missouri. Only weeks after graduating, during our time together Devon explains her experience navigating through medical school as a recent graduate and shares her inspiration for becoming a pediatric physician.

T: When did you decide you wanted to become a doctor?

D: When I was a young girl during elementary school there was a kindergarten book buddies program where I would read to kindergartners.

I remember at that point in my life being aware that I loved teaching children and working with kids.Then in middle school I remember being so curious and excited to learn in my science classes. At that point in time my mom realized this and one day she asked me if I wanted to be a doctor when I grew up. A few years later when I was tasked with completing a leadership project explaining what I wanted to do for a future career, my goal of becoming a doctor was realized, my career path at that point became very solidified.

Throughout college I stuck with the idea of becoming a pediatric physician although during that time I didn’t really have any doctor friends or mentors in my life. My amazing mentor Dr. Alfred Valles, MD was the main reason I made it through the application process and into med school. He helped me know what I needed to do and what to look forward to. Once I was in medical school, I knew that it was my calling in my life to become a doctor.

CENTRAL VALLEY PHYSICIANS 49

chapter. In concert with that project, the Residency Program will host the Central Valley Healthcare Disparities Panel Discussion on July 13 at the Hospital. The panel will include AAP chapter leadership and focus on healthcare disparities in Central California.

The AAP’s Advocacy Training Grant aids Valley Children’s Pediatric Residency Program’s dedication to advocacy in local

communities as well as statewide and nationally. The Central Valley is one of the poorest areas in the nation and is severely underserved in terms of pediatric physicians, making this effort and our Residency Program critical to the 1.3 million children Valley Children’s serves.

Please welcome the newest members of the medical community, Valley Children’s inaugural residency class.

PGY-1 CLASS FROM LEFT TO RIGHT Cristina Vargas, Juan Torres, Albert Vu, Theodore Gross, Jessica Monk, Devon Goossen, Erica Neuhaus, Rebecca Filbrandt, Zahia Zayed, Daniel Merriott, Thanh Huong Nguyen, Daniel Ebbs and Tai Pham

Daniel Ebbs, A.T. Still University School of Osteopathic Medicine: Former paramedic in Madera, founded a non-profit to bring

Thanh Huong Nguyen, University of Colorado School of Medicine: From Aurora, Colo., also has master’s degree in public

healthcare training to rural communities

health, served as math and reading tutor for 11 years

Rebecca Filbrandt, American University – Caribbean School of Medicine: From Chico, has experience in rural health

Tai Pham, Tulane University School of Medicine: From

medicine, wants to practice medicine in rural communities

Milpitas, has master’s degree in public health, coordinated a clinic for a deeply underserved region of New Orleans, emphasis on social justice and cultural fluency in medicine

Devon Goossen, Saint Louis University School of Medicine: From Fresno, undergraduate degree from Fresno State,

Juan Torres, UCLA/Drew Medical Education Program: From

former Valley Children’s volunteer, wants to stay in Fresno and address critical health issues unique to the Central Valley

La Mesa, committed to addressing lack of medical needs among Latino populations

Theodore Gross, Tulane University School of Medicine:

Cristina Vargas, U.C. Irvine School of Medicine: From

From New Orleans, will practice as a pediatrician for the U.S. Air Force after completion of residency

Stockton, master’s degree in science in biomedical and translational science, research work in diabetes and underserved Spanish-speaking patients, instrumental in creation of Southern California program to help low-income schools meet diet and exercise requirements for students

Daniel Merriott, Tulane University School of Medicine: San Jose native, advocate for children’s health issues

Jessica Monk, Rowan University School of Osteopathic Medicine: From Livermore, has completed several rotations at Valley Children’s and worked on research projects with Valley Children’s pediatric specialists

Erica Neuhaus, Ohio State University College of Medicine:

Albert Vu, University of Colorado School of Medicine: From Irvine, worked for two years in a community clinic serving children in low-income areas Zahia Zayed, Frank H. Netter MD School of Medicine at Quinnipiac University: From Hickory Hills, Ill., established schoolbase

From Santa Clara, graduate of U.C. Merced, founded a neonatal and maternal-fetal medicine interest group and NICU “cuddler” program at Ohio State

50 CENTRAL VALLEY PHYSICIANS

Summer 2017

T: How did you get yourself to where you are today?

D: I come from a very tight knit family. I have amazing parents, 2 sisters, and a brother. My father used to work on houses and when I was 3 years old he fell off of a house and since then has been a quadriplegic, he has complete paralysis in all four of his limbs. I have always been so inspired by the way my family has come together to care for him and support him. His resilience makes me feel like anything is possible. Our family has remained happy and close through it all. I also have to credit my faith and prayer. In the hardest moments encouragement and prayer has gotten me through it.

T: What was the application process like for medical school?

D: It was a long process. I first focused on the MCAT’s, it’s one of the hardest parts. I studied so much and I had test anxiety the first time I took the test. My score was not competitive enough, and I ended up having to take it again. I was happy with my test score on the second try. In the meantime I was taking time to organize and prepare all of my medical school application requirements like my letters of recommendation, personal statement, and other documents that I would need. I was open to attending school anywhere and applied to many schools although I can’t list them off of the top of my head right now. Some of the medical schools only require one application and so I worked on my primary applications and submitted those right away.

Primary applications required you submit your personal statement, letters of recommendation, and scores. After I submitted my primary application I then had to follow up with some schools concerning their secondary applications. Secondary applications consist of additional essays, documents, or questions that are asked of you upon the university receiving your initial application. I received interview requests from two colleges, St. Louis University in St. Louis Missouri and a college in Ohio. I attended my interview at St. Louis University and while I was there everyone was so nice and welcoming. I knew it was the medical school program for me.

T: Did you get accepted into other programs?

D: I received an interview invitation from one other program but I decided to decline it once I was accepted into the St. Louis University program. I knew St. Louis University was the program for me. I was grateful to have gotten accepted because I understand how hard it is to get into medical school.

T: So I understand you have graduated from medical school officially.

Congratulations! Where will you be completing your residency at?

D: Thank you! I will be completing my pediatric residency at Valley Children’s Hospital in Madera, California.

T: Can you tell me about how you choose your Residency Program?

D: Well I always knew that I would go into pediatrics due to my love and passion for working with children. When you work with kids, every day is different. I completed a clerkship at Cardinal Glennon in St. Louis

Q&A

Missouri and during my time there I really enjoyed teaching the parents and children. Kids are so fun that it really doesn’t feel like work. Every age is so different but you can almost always play a game while you’re interviewing your patient.

Children are so resilient, it’s so rewarding to watch them get better within a few days — while they’re still excited about stickers and playing. I completed a month long rotation at Valley Children’s Hospital prior to applying for their residency program. During my rotation I met many encouraging doctors and the residency program director. Everyone there was so warm and inviting. I was inspired and excited, I was really hoping that I would get to interview at Valley Children’s Hospital for their residency program. In total I interviewed with 12 other residency programs and really put a lot of thought into each interview and experience. Choosing a residency program is a really big decision, other doctors would tell me, “When you know, you know.” I knew that Valley Children’s Hospital was the program for me.

T: What are your next goals?

D: Pursuing motherhood after I complete my residency. I also want to pursue a career in primary care after I finish my residency, somewhere here in the Central Valley. I don’t have a specific type of clinic in mind I just want to make sure I am somewhere in the valley. I also want to become more involved in the local school districts. I am really passionate about mental health, it’s really important and I want to invest in students somehow. I also would love to become involved with Fresno State and other local community work.

T: What are your highs and lows of this journey so far?

D: The highs, well I enjoyed the journey of going to St. Louis and living on my own and not knowing anyone. During med school, in year 3 you get to work with real patients and it was cool to see everything come together. I am also really proud that I graduated med school with really close relationships with my fiancé and my family. I put a lot of energy into maintaining those relationships. The lows were missing my family and fiancé so much, 4 years of living off of federal loans [never receiving a paycheck], and seeing patients die. They were each hard adjustments, I had to acknowledge these things and start each day new.

T: What would you tell other women looking to pursue a career in medicine?

D: I’ve seen a lot of friends interested in pursuing an MD decide not to because they don’t want to wait to have kids until 30-35 — don’t. I have friends who just started their residency program, after having their first kid at age 29/30. Times may be harder than others but you can do it.

Also know that medical school is hard, but you can get through it by reminding yourself that you are on the path to the right career. It just is what it is, but you can do it!

Devon started her residency program at Valley Children’s Hospital this month and looks forward to marrying her college sweetheart in the near future.

Summer 2017

CENTRAL VALLEY PHYSICIANS 51

Public Health

Update

Communicable disease investigation Ken Bird, MD Public Health Officer • Fresno County Department of Public Health

Communicable disease investigation continues to be the meat and potatoes of public health today. It remains one of the few activities carried out by local health departments that assures the health and wellness of the community which is not done by private enterprise.

Consider for a moment the effects on community health and health care if patients with active tuberculosis

52

CENTRAL VALLEY PHYSICIANS

are never contacted to identify individuals they have likely exposed, and those individuals are never evaluated for tuberculosis infection and disease. Similarly, what would happen if individuals exposed to known cases of meningococcal disease are never identified and prophylactically treated? What would be the result if individuals diagnosed with Escherichia coli 0157:H7

Summer 2017

were never interviewed as to the possible sources of their list, and clarifications) went into effect on May 24, 2016. The exposure and were never informed as to how to prevent the new list can be found at http://bit.ly/2qwKMZl. spread of this disease to others?

Each reportable disease listed has requirements as to how, Similar questions can be asked with regard to a vast number and how soon, the local health department should be notified of communicable and infectious diseases. and a form, the Confidential Morbidity Report (CMR), is Fresno County Department of Public Health, like health the proper means of notification of those diseases that do not departments throughout the nation, retains a cadre of require immediate notification by telephone. Suspicion of a public health nurses, communicable disease investigation case of any of these diseases is sufficient reason to report the specialists, and other staff well trained in the investigation of disease. such communicable diseases. The work they do is absolutely Once alerted to a suspect or diagnosed disease, health essential to maintaining the health of our community. department staff immediately begin their investigation and As critical as their work is to the protection of the health of response, which, in most instances, requires a call to your the community, it cannot be accomplished without timely, practice for further, more detailed, information in order to thorough, and appropriate information from you, the medical respond appropriately. Local health department staff are also provider, on patients known to have, or are suspected of having, “Complete and timely reporting of these diseases any of the reportable infectious is sufficiently important, to have prompted the diseases.

Many physicians are unaware Medical Board of California, in December of of the laws and regulations of the 1996, to adopt a procedure for citing and fining State of California requiring that certain communicable diseases physicians who fail to adhere to the reporting be reported to the local health laws and regulations of the State of California.” department. Other physicians assume it is the laboratory’s responsibility to report, or that it is the responsibility of a required to report these diseases to CDPH. referring provider to report. California Health and Safety Complete and timely reporting of these diseases is Code (HSC) § 120250 and California Code of Regulations sufficiently important, to have prompted the Medical Board (CCR), Title 17, § 2500 clearly state that the physician is of California, in December of 1996, to adopt a procedure for required to report the listed communicable diseases, regardless citing and fining physicians who fail to adhere to the reporting of specialty. laws and regulations of the State of California.

Patient consent is not required for reporting purposes. All Failure to report these diseases precludes any intervention states in the United States have similar laws. The information by local public health to prevent transmission to others. generated by these reporting requirements is used to identify Because of the public health significance of such actions, epidemics; interrupt transmission; establish risk factors for recurrent failure to report such diseases in a complete and disease; track trends in communicable diseases at the local, timely fashion, as specified in the laws and regulations, may state, and national levels; and develop policies for prevention of result in referral to the Medical Board. Such referral could disease. result in a citation and fine ranging from $100 to $2500.

This list of reportable infectious diseases is determined Citations issued may be disclosed to any inquiring member of and maintained by the California Department of Public the public.

Health (CDPH) Division of Communicable Disease Control I would like to thank each of you who have continued to (DCDC), in consultation with the California Conference assist and support us in our disease surveillance efforts. Your of Local Health Officers (CCLHO) and is reviewed and continued assistance in the timely and complete reporting updated by a highly qualified workgroup on a regular basis of these reportable diseases and possible outbreaks greatly (approximately every three years). facilitates our recognition of, and response to, outbreaks of The last amendments to the list of reportable diseases serious diseases in our community. (which included deletions from the list, new additions to the

Summer 2017

CENTRAL VALLEY PHYSICIANS

53

CME EVENTS EVENTS • WEBINARS

•

SEMINARS

•

PODCASTS

•

AND MORE

DID YOU KNOW? FMMS offers CME events Central Valley Diabetes Symposium (2.0 CME’s) Thursday, August 31, 2017 5:30 - 8:00pm Fort Washington Country Club 10272 N. Millbrook Ave. Fresno, CA 93730 For more information or to RSVP call Alvishia Johnson (559) 600-6449 or email ajohnson@co.fresno.ca.us

Lung Nodule Program Presents: The 6th Annual Lung Symposium Diagnostic Reform in Lung Nodules (4.75 CME’s) Saturday, September 23, 2017 8:00 am - 1:30 pm UCSF Fresno Center for Medical Education & Research 155 N. Fresno Street Fresno, CA 93725 For more information or to RSVP call 559.451.3660 or email gdeleon2@CommunityMedical.org

37th Annual Central Valley Cardiology Symposium (6.0 CME’s) Saturday, October 14, 2017 8:00 am – 3:00 pm Madera County Office of Education 1105 CA-145 Madera, CA 93637 For more information or to register visit www.fmms.org or call (559) 224-4224

In Memoriam R aymond Vincent Wizbowski, M.D

Raymond Vincent Wizbowski, M.D June 13, 1923 - May 12, 2017 Raymond Vincent Wizbowski, MD, 93 of Fresno, CA has entered his eternal peace on May 12, 2017. Dr. Wizbowski was Born June 13, 1923 in Detroit, MI to Walter and Maria Wizbowski. He earned his MD from the University of Michigan in 1952 after serving in WWII as a reconnaissance photographer as part of the Air Force Foreign Intelligence service. Dr. Wizbowski practiced general medicine and general surgery for over 50 years in Fresno. He was a devout Christian, long standing Rotarian, and avid global traveler. He loved the outdoors and possessed an adventurous spirit. He was a man of quiet strength who was loved by all and respected by his peers. Dr. Wizbowski is survived by wife Barbara, children David and Raymond Wizbowski Jr., Bob and Bill Brewer, six grandchildren, and seven great grandchildren.

Dr. Wizbowski was a member of the Medical Society for 49 years.

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CENTRAL VALLEY PHYSICIANS

Summer 2017

The California Medical Association and the Fresno Madera Medical Society

MONTHLY PAYMENT PLAN

TOGETHER, WE ARE STRONGER. It’s through a strong membership foundation that CMA remains a dominant force in health care, leading the charge on several fronts, including the following: Continuously defending the Medical Injury Compensation Reform Act (MICRA) Advocating for specialty scope of practice that protects patients , including decreasing youth smoking and passing a landmark immunization law Other benefits of membership include professional, personal and practice resources, which commonly dues. Learn more at www.cmanet.org/groupdiscounts.

88

JOIN TODAY FOR ONLY

$

/ MONTH

When you join the California Medical Association and your local county medical society, you join more than 43,000 members statewide who are actively protecting the practice of medicine and defending public health.

Together, we are stronger.

JOIN TODAY TO START RECEIVING YOUR BENEFITS! TO SIGN UP AT:

WEB:

www.cmanet.org/monthly

PHONE: (800) 786-4262

Summer 2017 Spring 2017

CENTRAL VALLEY PHYSICIANS 55 CENTRAL VALLEY PHYSICIANS 17

Fresno Madera Medical Society 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 30 Fresno, CA

State of the Sleep like Heart a

baby

SAINT AGNES CARDIOLOGY SYMPOSIUM 2016 Saturday, April 23 • 8 a.m.-2 p.m.

Saint Agnes Medical Center, Shehadey Pavilion 1303 East Herndon Avenue • Fresno, California Saint moms-to-be will doon exactly that, knowingdisease they’ve chosen ThisAgnes symposium focuses cardiovascular management and the emerging only area hospital backed by one of the nation’ s best in neonatology. paradigms in treating coronary and structural heart disease.

For more than 30 years, Saint Agnes Centermanagement has proudly partnered It will address practice gapsMedical in disease and provide education with Valley Children‘s Healthcare to provide expectant mothers to improve patient outcomes. and their babies the safest and highest quality of care

Speakers before, during and after delivery.

Andof now with our beautiful all-private rooms, Paradigms Revascularization for Chronic Coronary Artery Disease willMD, enjoy a good night’s rest.

Vergheseeveryone Mathew, FACC, FSCAI Consultant, Division of Cardiovascular Diseases and Department of Radiology Medicine, Mayo Clinic College of Medicine To learnProfessor more aboutofthe region’s most comprehensive maternity program, visit samc.com/maternity-services.

Protected PCI: Treating Complex Coronary Artery Disease in 2016 Anthony A. Hilliard, MD Assistant Professor of Medicine Director, Adult Cardiovascular Lab Loma Linda University International Heart Institute

Saint Agnes Medical Center Invasive Management of Intractable Angina Gurpreet S. Sandhu MD, PhD Director, Dr. Earl Wood Cardiac Cath Lab, Mayo Clinic Transcatheter Mitral Valve Therapies Oluseun O. Alli, MD Assistant Professor of Medicine University of Alabama at Birmingham School of Medicine

Preregistration is required • No charge Please register online at www.samc.com. Registration must be received by April 16, 2016, to be guaranteed a participant syllabus. If you have questions or problems registering online, email medicaleducation@samc.com or call (559) 450-7566.

Registration at the door is dependent on space availability.

TM

5 AMA PRA Category 1 Credits to be awarded