july 2014

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t h e p h y s i c i a n w e l l n e s s i s s u e : M e n ta l h e a lt h • s l e e p • Va c at i o n p l a n n i n g

LACMA Welcomes 143rd President

Dr. PeDrAM SALiMPour

A N o r c A l G r o u p co m pA N y

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juLY 2014 | w w w. p h ys i c i a n s n e w s n e t wo r k .com 1

Volume 145 Issue 7

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Advertising rates and information sent upon request.

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10 lacMa WelcOMeS PReSidenT PedRaM SaliMPOuR, Md

More than 375 LACMA members, sponsors, ven-dors and associates attended the June 19 event that ushered in Dr. Pedram Salimpour’s term as the 143rd president of the Los Angeles County Medical Society.

PhYSician WellneSS 6 early intervention for Physician Mental health

8 Why Physicians don’t Know how Sleepy They are

12 Sleep hygiene: What’s Keeping You awake at night?

14 Risk Management in Your Vacation Planning

FroM your association

4 PReSidenT’S leTTeR | PedRaM SaliMPOuR, Md

16 ceO’s leTTeR | ROcKY delgadillO

16146

A N o r c A l G r o u p co m pA N y

NORCAL Mutual is owned and directed by its

physician-policyholders, therefore we promise

to treat your individual needs as our own. You

can expect caring and personal service, as you

are our first priority. Visit norcalmutual.com, call

877-453-4486, or contact your broker.

SubScriptionSMembers of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.

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Physicians news networklos angeles county Medical association707 Wilshire Boulevard, Suite 3800los angeles, ca 90017Tel 213.683.9900 | fax 213.226.0350www.physiciansnewsnetwork.com

LAcMA officErS Pedram Salimpour, MdPeter Richman, MdVito imbasciani, MdWilliam averill, MdMarshall Morgan, Md

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The Los Angeles County Medi-

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LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at [email protected] or 213-226-0304.

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4 p h ys i c i a n m aG a Z i n e | juLY 2014

Medicine aS The indiSPenSaBle PROfeSSiOnIn regards to doctors and medicine, I have come to have two beliefs: one, that medicine is the indispens-able profession and, two, that doctors have to lead.

By any measure, medicine continues to attract the best and the brightest. Doctors are better trained and better prepared to meet their patients’ clinical needs than at any other time in human history or in any other place in the world. Those who argue oth-erwise — who suggest that doctors are somehow in decline or have seen their position slip away — are talking about something other than doctors. They’re

talking about the healthcare system. And they might be right, because more and more, doctors operate in a volatile, uncertain, complex, and am-biguous business environment. These situations are invitations for inaction—people are perplexed by uncertainty and don’t act or act from a place of fear. But in business, in any business, your competition has a vote. To suc-ceed, you have to act, and your leaders have to lead.

Doctors have already spent de-cades facing down challenges to their clinical management of patients, chal-lenges that have gone from appearing to be bugs in the system to becoming features of the system.

At least for thirty years, there have been those who warned against the situation we face today. True to those predictions, while the number of phy-sicians has seen a modest percent-

age increase in the past few decades, the number of administrators in healthcare has gone up twenty-fold. And that explosive growth in bureaucracy has become corrosive to the practice of medicine--for doctors, and also for patients. And it has left people asking, who’s in charge? Doctors ask this. Patients ask this. The courts ask this.

To help answer that call, LACMA has grown into a Best Ideas organization: We are a principled group, but no principle trumps every other consideration. There are ideas and ideals, but there is no ideology, there is no preference to men or women or to any one group. Just look at what’s been built in the past few years alone. We have the Latino Physicians’ Advi-sory Board, the African American Physicians’ Advisory Board, the Women Physicians’ Advisory Board, and others. This kind of disciplined organization can help be the decisive vote in elections. It creates leadership that is demanding of doctors and sympathetic to our day-to-day struggles. Because having elections and winning them can help to eliminate volatility, uncer-tainty and ambiguity. Because medicine as the indis-pensable profession has to find a way to lead.

But perhaps we should take a step back to exam-ine our leadership. Some say that conflicts between

different healthcare entities are not our issues to solve. A different view says that ignoring these dis-putes not only violates our conscience but also invites an acceleration of interference.

I believe neither view fully speaks to the demands of this moment.

LACMA doesn’t have a solution to every problem. But we do have an interest in pursuing our ideals. Life and business and politics, the worlds that LACMA oc-cupies, are complex, but our challenges are not insur-mountable. We have to act on behalf of all doctors and patients; we just have to be deliberate about our engagements. We are not an impulsive profession. We are not an impulsive organization. But today, we are postured toward action.

For the immediate future, the most direct ques-tion for doctors, nurses, hospitals and our patients remains uncertainty of the new legislative landscape. But a strategy that involves unilateral confrontation is naïve.

I believe we have to shift our strategy to more ef-fectively partner with organizations who are also af-fected by these challenges, to forge partnerships that will help us achieve our objectives and theirs.

Many of those organizations joined us at the instal-lation, including Allied Physicians, a powerful and uni-fied force that understands the critical role that legisla-tors play in our lives and on the lives of our patients, and USC’s leadership, an organization with thousands of doctors and now a member of LACMA. There are hundreds of other coalition members in support of MICRA alone, including the California Hospital Asso-ciation, the Service Employees International Union, the California Medical Association, my friend Dr. Azizza-deh of La Peer Surgery Center and other surgery cen-ters and the California Teachers Association.

Of course, partnerships don’t eliminate the need to take direct action. But it sure is nice to have a co-alition. It’s the right investment. It’s the right way for doctors to lead.

In healthcare, doctors have to lead, and today, that’s what LACMA stands for. When bad things are starting to happen, when doctors need help, our fire department, our cops, our ambulance, our 911, is LACMA.

I moved to this city when I was 12. As a teenager I remember my then-middle-aged dad redoing his residency at Cedars to once again be able to practice medicine. We came here because my parents want-ed a better life for their kids. But I can’t imagine how I can ever be a better doctor than my dad has been to his patients. I am proud to have had the privilege of practicing medicine with him and my brother almost every day of the past eleven years.

The story of doctors is the most beautiful of sto-ries because it is the most human of stories, the most American of stories. Doctors are the people who find new ways to new places, and now we have to find new ways to bring everyone else along. Medicine is the indispensable profession. Doctors have to lead.

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just as in medical care, the same principle holds true for mental health symptoms: Early intervention is best. unfortunately, many people—including physi-cians—ignore this reality and put off attending to their mental health needs. Barriers to mental health care for physicians can include lack of time, stigma (both social and internalized as shame) and concerns about con-fidentiality. While these barriers are real, and cause for concern, the cost of ignoring the problem is often worse: Ruptured family relationships, disciplinary ac-tions at work and substance abuse are frequent results. Furthermore, patient care is likely to be affected by unaddressed mental health symptoms of their provider (Ruitenburg, Frings-Dresen & Sluiter, 2012). Would you refer a family member to a colleague who has an alcohol problem or angry outbursts?

The demands placed on physicians—and there-fore, the need to attend to their own mental health—have never been higher. The bureaucracy of man-aged care and other administrative challenges have resulted in alarmingly high rates of physician burnout

(Shanafelt, et al., 2012). Multiple studies have also shown compassion fatigue to have a significant nega-tive effect on doctors. Further, the threats of work-place violence and malpractice lawsuits are addi-tional layers of stress. Being a physician is already an incredibly difficult job. In light of these emotional oc-cupational hazards, it is no wonder that anxiety, de-pression and suicide are risks for physicians (Moutier, et al., 2012).

Some signs that you may need to reach out include:• Consistentlystrugglingtosleep• Havingdifficultyseparatinghomeandworklife• Strugglingtofocusatwork• Bringing to mind memories of a traumatizing

event frequently or to the point of distraction• Lashingoutinanger• Feelinglessabletoconnecttoyourpartner,chil-

dren or spouse• Notfindingjoyinactivitiesyoutypicallylike• Relying on substances to “unwind” or “decom-

press”

The Importance of Early Intervention for Physician Mental Health mArY BETh jAmES, mA, LmFT

The need fOR early intervention in healthcare is ubiquitous. It’s so well researched and un-

derstood that early intervention will aid the success of treatment that it has become obvious,

part of the air we breathe. In some cases, patients lack access to care and can’t obtain it

until it’s too late. In other circumstances, patients are in denial about their symptoms, or too

stubborn to seek help. I imagine that most, if not all, of you reading this have lost a patient

(perhaps many) due to delayed care.

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• Realizing that the onlything that defines you is your work

• Feelingasenseof“deper-sonalization,” or not likeyourself

• Obtaining prescriptionsfor any psychotropic medication from a col-league, or writing them yourself

• Engaging in risky behav-iors as an escape

Fortunately, there are resources and options to address every type of mental health symptom. just as there are often different medications for the same disease, there are a variety of strategies that improve emotional well-being. Mental health requires main-tenance just as our physical bodies, relationships, homes and cars do!

Consider: • Utilizingorimprovingself-care.Pickoneareato

start with, such as increasing your exercise or de-veloping healthy eating habits

• Settingaside timeathome thatyouareunavail-able (and not checking phone and email during this time)

• Improvingsleephygiene• Usingaccruedvacationtime• Increasing face-to-face social engagement with

friends, colleagues or family• Attendingawellnessprogramthroughyourfacil-

ity or in the community• Seekingoutatherapistforsupport• AttendinganAAorNAgroup• Attendingachurchorsynagogueordevelopinga

spiritual practice• Talkingtoyourdoctororpsychiatrist• Obtainingliteratureandeducatingyourselfabout

your particular concern or symptom• Beginning some type of mindfulness practice

(meditation, yoga)• Spendingmoretimeoutdoors

Early intervention can make a big difference to your mental health and overall sense of well-being. Do yourself, your patients and your loved ones a favor

and attend to your human needs, rather than ignore them.

Mary Beth James, MA, LMFT is a psy-chotherapist in private practice in Pasa-dena. Ms. James’ website is www.mftmb.com <http://www.mftmb.com> and her license number is MFC 51983. She can be reached at [email protected].

References: Moutier, C., Norcross W., Jong P., Norman M., Kirby B., McGuire T., & Zisook S. (2012). The suicide prevention and depression awareness pro-gram at the University of California, San

Diego School of Medicine. Academic Medicine, Vol. 87. No. 3. doi: 10.1097/ACM.0b013e31824451ad.Ruitenburg, M., Frings-Dresen, M., & Sluiter, J. (2012). The prevalence of com-mon mental disorders among hospital physicians and their association with self-re-ported work ability: a cross-sectional study. BMC Health Services Research 12:292. doi:10.1186/1472-6963-12-292.Shanafelt, T., Boone, S., Tan, L., Dyrbye, L., Sotile, W., Satele, D., West, C., Sloan, J., & Oreskovich, M. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. JAMA Internal Medi-cine 172(18):1377-1385. doi:10.1001/archinternmed.2012.3199.

Barriers to mental health care for physicians can

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Given their training, many physicians are con-vinced they’ve somehow overcome their need for sleep, pointing to the many years they’ve practiced without a problem as proof that they’ve somehow conditioned themselves to operate without sleep.

There’s some evidence that physicians can and do rise to the occasion on very little sleep. A 2013 study demonstrated that surgeons who worked the night be-fore an operation were no less effective and did not have a higher rate of complications in surgery than those who did not work the night before.2However,one commentator noted that this somewhat surprising result might be due to the fact that surgery isn’t boring.

Research suggests that it’s while performing rou-tine procedures that sleep-deprived physicians may put themselves and their patients at risk:

• A2012studyfromPennStatefoundsleepdepri-vation didn’t impair surgeons while performing operations in which they were already trained, but they experienced a total subjective increase in mental workload that left them less prepared to deal with unexpected events.3

• A2013study foundthatacutesleep lossdue toworking long on-call shifts significantly decreased daytime alertness and negatively affected the mood state of junior physicians. 4

Doctors are so conditioned to performing while sleep deprived that they’re not good at recognizing symptoms of, or impairment resulting from, sleep de-privation.

A Baylor university Medical Center study used the Multiple Sleep Latency Test (MSLT) to measure the physiologic sleepiness of anesthesiology residents—both when they were well-rested and had been on call: 5

• TheMSLTscoresforgroupsthathadbeenoncallin busy units were 4.9 minutes—scores of less than 5 minutes are considered pathologic daytime sleepiness.

• Whenaskedifthey’dfallenasleepduringthetest,only half gave the answer that corresponded to the EEG data.

• Among thosewho thought they’d stayed awake,68% were wrong.

SLEEP-DEPRIvED PHySICIAnS AT WORk:Why Physicians Don’t know How Sleepy They AreLiz FErrON, mSW, LiCSW

MOST PhYSicianS WOuldn’T dream of coming to work drunk, yet they feel a professional

obligation to report for duty even when seriously sleep-deprived. In a harvard business Re-

view article Dr. charles a. czeisler, the baldino professor of sleep Medicine at harvard Medi-

cal school, referred to a nonsensical “culture of machismo sleeplessness,” noting that going

24 hours without sleep, or a week of sleeping four or five hours a night, induces an impair-

ment equivalent to a blood alcohol level of .1%—a concentration that qualifies as “too drunk

to drive.”1

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Given this data, physicians have to question whether they’re really comfortable that the decisions they make when sleep-deprived have no adverse ef-fects on patient care.

Career Longevity and Quality of Life:Medical Error Isn’t the Only Risk

In addition to not being immune from the effects of sleepiness, physicians aren’t immune from the negative health outcomes associated with insufficient sleep and circadian rhythm disruption, including:

• Obesity• Cardiovasculardisease• Highbloodpressure• Stroke• Reducedsexdrive• Neurologicandmemoryimpairment

In attempting to dispel the myth that poor sleep quality has nothing to do with health disorders, the Cleveland Clinic’s Sleep Disorders Center notes:

“More and more scientific studies are showingcorrelations between poor quality sleep and/or insufficient sleep with a variety of dis-eases. Blood pressure is variable during the sleep cycle. Interrupted sleep, however, can negatively affect the normal variability and may lead to hypertension and cardiovascular problems. Research indicates that insufficient sleep impairs the body’s ability to use insu-lin, which can lead to the onset of diabetes. Fragmented sleep can cause a lowered me-tabolism and increased levels of the hormone cortisol. Increased cortisol levels can result in an increased appetite and a decrease in one’s abilitytoburncalories.”6

AnewstudyfromPennMedicineshowsdisturbing evidence that chronic sleep loss may be more serious than previously thought and may even lead to irreversible physical damage to and loss of brain cells.7

Sleep also takes a toll on emotional health and well-being. When we ask phy-sicians suffering from depression or anxi-ety about their sleep habits, they often just laugh. They seem to think a good night’s sleep is a crazy pipe dream instead of one of life’s most basic needs.

However,wehavefoundthatwhenover-tired physicians are able to get more sleep, they often see an immediate improvement in

moodandanxietylevels.Insteadofjustsaying,“I’llgetmoresleepwhenlifeimproves,”theyfind,infact,that life improves when they get more sleep.

Liz Ferron, MSW, LICSW, is vice president of clinical services at Physician Well-ness Services in Minneapolis. She has been with the company for over 10 years, and has been in the employee assistance field for over 20 years. She has served three terms as president of the Minnesota Employee Assistance Program Administrators and Counselors (MEAPAC), and is a former adjunct faculty member at the College of St. Benedict. Liz has her MSW degree from the University of Minnesota and is a Licensed Independent Clinical Social Worker.

1 Brownyn Fryer, “Sleep Deficit: The Performance Killer, A Conversation with Charles A. Czeisler,” Harvard Business Review, October 20062 Christopher Vinden, MD1,2; Danielle M. Nash, MSc2; Jagadish Rangrej, MSc4; Salimah Z. Shariff, PhD2; Stephanie N. Dixon, PhD2,3; Arsh K. Jain, MD2; Amit X. Garg, MD2,3, “Complications of Daytime Elective Laparo-scopic Cholecystectomies Performed by Surgeons Who Operated the Night Before,” JAMA. 2013;310(17):1837-1841. doi:10.1001/jama.2013.2803723 Jonathan M. Tomasko, Eric M. Pauli, Allen R. Kunselman, Randy S. Haluck “Sleep deprivation increases cognitive workload during simulated surgical tasks,”The American Journal of Surgery, Volume 203, Issue 1 , Pages 37-43, January 2012 4 Wali Siraj O, Qutah Karimah, Abushanab Lujain, Basamh Roa’s«SQ»a, Abushanab Jolanar, Krayem Ayman , “Effect of on-call-related sleep deprivation on physicians’ mood and alertness,” Annals of Thoracic Medicine, Volume 8, Issue Number1, Pages 22-27, 2013 5 Howard SK, Gaba DM, Rosekind MR, Zarcone VP. The risks and implications of excessive daytime sleepiness in resident physicians. Acad Med. 2002;77:1019–1025.[PubMed] 6 “Myths and facts about sleep,” http://my.clevelandclinic.org/neurological_insti-tute/sleep-disorders-center/patient-education/hic-myths-and-facts-about-sleep.aspx7 Zhang Jing, Zhu Yan, Zhan Guanxia, Fenik Polina, Panossian Lori, Wang Maxime M, Reid Shayla, Lai David, Davis James G, Baur Joseph A, Veasey Sigrid, “Extended Wakefulness: Compromised Metabolics in and Degenera-tion of Locus Ceruleus Neurons,” The Journal of Neuroscience, 19 March 2014, 34(12):4418-4431

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1 0 p h ys i c i a n m aG a Z i n e | juLY 2014

LACMA WeLCoMeS 143rd PreSiDentDr. Pedram Salimpour

With a call for physician leadership, Pedram Salimpour, MD, ushered in his term as the 143rd president of the Los Angeles County Medical Association (LACMA). More than 375 LACMA members, sponsors, vendors and associates attended the Thurs-day evening event held at the Riviera Country Club in Pacific Pali-sades.

Clayton Patchett, MD, and Ralph DiLibereo, MD, led the instal-lation of the 2014-2015 officers, which, in addition to Dr. Salimpour as president, included Peter Richman, MD, as president-elect, Vito Imbasciani, MD, as treasurer and William Averill, MD, as secretary.

In his president’s remarks, Dr. Salimpour emphasized the essen-tial role medicine plays in the lives of all people, calling for physi-cians to take a leadership role in healthcare, stating that “medicine

is the indispensable profession … doctors have to lead,” a theme he repeated throughout his remarks.

Dr. Salimpour noted that medicine continues to attract the best and the brightest and that doctors are better trained to meet their pa-

tients’ clinical needs than in any previous time. Arguing against those who suggest that the medical practice is in de-

cline, Dr. Salimpour observed that physicians practice in a healthcare sys-tem that places doctors in an ever more “volatile, uncertain, complex and

ambiguous business environment.” The result, Dr. Salimpour noted, is that patients and physicians alike are asking, “Who’s in charge?”

In the face of this uncertain environment, Dr. Salimpour warned of unilateral confrontation by doctors, suggesting instead that physicians should form partner-

ships with organizations to help achieve the objectives of all partners. Noting that LACMA stands for physician leadership, Dr. Salimpour recognized the number of

organizations following LACMA’s leadership in support of the Medical Injury Com-pensation Reform Act (MICRA).

In closing, Dr. Salimpour noted that “doctors are people who find new ways to new places, and now we have to find new ways to bring everyone else along.”

Rabbi David Wolpe of Sinai Temple in Los Angeles offered the invocation in support of Dr. Salimpour’s leadership of LACMA.

Event keynote speaker was Antonio R. Villaraigosa, former mayor of Los Angeles, who spoke on the importance of equal educational opportunities for all people.

Richard Baker, MD, made the welcoming remarks, and Marshall Morgan, MD, outgoing LACMA president, called the evening to order.

Samuel Fink, MD, a former LACMA president, presented the Recognition of Lifetime Achievement award to Patrick Wade, MD, and recognized Dr. Marshall Morgan for his ser-vice to LACMA.

LACMA CEO Rocky Delgadillo gave brief closing remarks.


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Top Left: 143rd LACMA President Dr. Pedram Salimpour with outgoing president, Marshall Morgan, MD.Top Right: Dr. Salimpour being sworn in by Ralph DiLi-bero, MD and Clayton Patchett, MD.Middle Left: The Salimpour family enjoys the event.Middle Right: Event sponsors chat with LACMA physicians.Bottom Right: Event guests enjoy cocktail hour before dinner.Bottom Left: Friends, family, sponsors and fellow physi-cians honor Dr. Salimpour at the sold-out event.


In 2010, physicians at a major teaching hos-pital were surveyed about their personal life-style behavior.1 The survey showed:

• Both residents and attending physicians reported low levels of fruit and vegetable consumption and low levels of exercise.

• Only 8% of trainees and 12% of attending physicians reported a regular yoga practice—and just 6% of trainees and 10% of attending physicians reported regular meditation.

Not surprisingly, this combination of high stress, poor quality diet and lack of exercise often makes it difficult to fall asleep. Relying on medication or alcohol to quiet the brain can compound the problem when used on a regular basis.

A comprehensive approach to addressing the problem begins long before bedtime and has benefits not just for physicians but for their patients, as well. Research indicates that doc-tors with healthy lifestyles are more apt to rec-

ommend lifestyle changes to their patients.A national cross-sectional survey of 500

primary-care physicians2 found that physicians with normal body mass index:

• Were more likely to engage their obese pa-tients in weight loss discussions as compared to overweight/obese physicians

• Had greater confidence in their ability to provide diet and exercise counseling to their obese patients.

And, a 2012 survey of physicians found that doctors who exercised at least once a week or didn’t smoke were about twice as likely to recommend their patients eat a healthy diet, reduce salt intake, attain or maintain a healthy weight, limit alcohol use and exercise regu-larly.3

Sleep Hygiene for Physicians:Promoting Healthier Sleep Patterns

Create a sleep routine: When lying down

Sleep Hygiene: What’s Keeping You Awake at Night?Liz FErrON, mSW, LiCSW

in addiTiOn TO having insufficient time to sleep, many physicians have difficulty falling to

sleep—for a variety of reasons. Doctors have lifestyle issues that get in the way of good sleep

hygiene. they eat on the run, grab what’s available at the hospital—which is generally ter-

rible—and don’t make exercise, play or stress management a priority. It’s all about getting

the work done.

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to go to sleep, do some deep breathing and try to empty your mind instead of going over mistakes you made today or things you need to do tomorrow. With each breath, try to re-lease tension and relax.

Give yourself 20 minutes: If you haven’t fallen asleep in 20 minutes, get up and do something relaxing. Don’t lie in bed worrying about not sleeping.

Single-purpose your bedroom: People who work in bed or watch TV in bed may have trouble sleeping in that room. If you’re hav-ing trouble sleeping, consider using your bed-room only for sleep. Equip your bedroom with shades that ensure complete darkness (partic-ularly if you sleep during the day) and keep the temperature on the cool side.

Delineate a nap space at work: Some doctors keep pillows in their desk drawers and can catch “power naps” on whatever flat surface is avail-able. Others need to reserve the call room, make a point of saying “do not disturb”—and leave their cell phones behind.

Permit yourself to “power nap”: A nap of 15-20 minutes can help restore cognitive function. It’s not a replace-ment for a good night’s sleep but a way to re-energize yourself when working a punishing schedule.

Get good and tired: Exercise cre-ates a tiredness that leads to better sleep. Don’t exercise right before bedtime, but make regular exercise a priority. If you don’t put it on your schedule, it won’t happen.

Pick a better nighttime snack: Re-search indicates that the less you sleep, the more you crave junk food.4 Instead of giving in to that craving, try a bowl of fresh fruit one to two hours before bedtime. Kiwi fruit is high in

antioxidants and serotonin that research indi-cates may improve sleep onset, duration and efficiency in adults with self-reported sleep disturbances.5 Bananas contain tryptophan, magnesium and potassium, a nutrient that—according to a 2007 article in the journal Neu-roscience—may promote a more restful sleep.6

1 Howe Micheal, Leidel Adam, Krishnan Sangeetha M, Weber Alissa, Ruben-fire Melvyn, Jackson Elizabeth A, “Patient-Related Diet and Exercise Counsel-ing: Do Providers’ Own Lifestyle Habits Matter?,” Preventive Cardiology (pages 180–185), August 20102 Bleich, S. N., Bennett, W. L., Gudzune, K. A. and Cooper, L. A. (2012), Impact of Physician BMI on Obesity Care and Beliefs. Obesity, 20: 999–1005. doi: 10.1038/oby.2011.4023 Hung, Olivia Y, et al, “Doctors practicing healthy lifestyles more likely to preach it to patients,” American Heart Association, March 2012 http://newsroom.heart.org/news/doctors-practicing-healthy-lifestyles-230084, retrieved March 23, 20144 Greer, SM, “The impact of sleep deprivation on food desire in the human brain,” Nature, August 20125 Lin HH, Tsai PS, Fang SC, Liu JF. “Effect of kiwifruit consumption on sleep quality in adults with sleep problems,” Asia Pac J Clin Nutr. 2011;20(2):169-74.6 Young, Simon M. “How to increase serotonin in the human brain without drugs,” J Psychiatry Neurosci. Nov 2007; 32(6): 394–399.

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risk tip

• Reviewmanaged care contracts for relevantcoverage requirements. Some managed care contracts contain very specific language on this topic, and many contain indemnification clauses that could expose you to the liability of the covering physician (as well as breach of contract).

• Whenever possible, make secondary cover-age arrangements. Confirm coverage arrange-ments via email or fax with the locum tenens who are covering your practice in order to avoid misunderstandings, possible uncer-tainty of dates or time frame, and exposure to abandonment.

• Ensure that the practice coverage arrange-ments include an understanding about patient billing practices in conjunction with any man-aged care contracts or plans.

• Choose coveringphysicianswho share yourmedical specialty and have privileges at the same hospitals that you do.

• Determineifcoveringphysicianscarryprofes-sional liability coverage and the limits of such coverage. While asking these questions could be awkward, you may be required to ask un-der certain managed care plans, provider agreements, and hospital bylaws.

• Before leavingonvacation,preparea listofpatients who are hospitalized or are in the midst of diagnostic work-up, or who have special medical problems or needs. Give this information to the covering physicians and document any specific advice you provide.

• Informtheattendingphysiciansorhospitalistsof any hospitalized patients you are following about your coverage arrangements, and docu-

Including Risk Management in Your vacation Planning Allows you to Relax BecauSe liaBiliTY neVeR takes a holiday, your vacation plans should include medical cover-

age arrangements for your practice, particularly when you use locum tenens. the following

tips will help reduce risks in your practice and promote the safety of your patients as you plan

your vacation:

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merage.uci.edu/go/HCEMBA

Lead the change in health care. Be a part of the solution.The Health Care Executive MBA program offers an academically challenging curriculum with a schedule that allows you to simultaneously advance your career in health care. A few unique aspects of the program are:

impact on the future delivery of health care

Executive MBA program

Join us for an information session, webinar, or schedule a personal consultation to learn more about our program.

merage.uci.edu/go/HCEMBA

Dr. Michael Miyamoto949.824.0561 [email protected]

ment the hospital chart to reflect these conver-sations.

• Adviseyourpatientsofthe coverage arrange-ments and give them the covering physi-cians’ names.

• Make each hospitalwhere you have on-call responsibilities aware of the dates of your unavailability and the identity and phone numbers of the covering physicians. Give similar notice to your an-swering service and office staff.

upon returning from vacation, promptly con-fer with all covering physicians. Document what

you were told by the cov-ering physicians about any significant developments in patients’ clinical course or treatment while you were away.

Consider implement-ing these fundamental loss prevention measures for even brief periods when you are unavailable, such

as observance of religious holidays, attending medical conferences, personal illness, or a long weekend. unfortunately, vulnerability to claims is not diminished on these occasions.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

Confirm coverage arrangements via email or fax with the locum tenens

who are covering your practice in order to avoid

misunderstandings

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ceo’s letter

ThiS JulY iS marked with new begin-nings and LACMA’s continued advoca-cy for patients’ rights.

We welcome our new president, Dr. Pedram Salimpour, who, as the young-est president in LACMA’s history, will tackle new challenges and initiatives with a renewed vigor and energetic drive. We look forward to supporting him in all of his efforts.

I also want to thank Dr. Marshall Morgan, LACMA’s outgoing president, for his tremendous leadership. He has

catapulted our organization forward in many ways. His tireless workings on the dual-eligible demonstration project and the protection of MICRA laid much of the groundwork of what’s still ahead for the new leadership.

This summer, LACMA will closely follow new developments by the Depart-ment of veterans Affairs to help ensure that American veterans, who have sacri-ficed so much for our country, will be given the timely medical care they deserve.

We will keep a close eye on legislative efforts to reform the current VA health-care system.

According to a recent report released by the Department of veterans Affairs, the average wait time for new patients with a primary care doctor at the vA’s Greater Los Angeles Healthcare System averages 56 days.

The average wait time for new patients at other vA hospitals in California ranged from about 25 days in Fresno to about 44 days in Loma Linda, which is significantly longer than within the 14-day period the VA guidelines say a veteran should be able to see a primary care doctor.

We are hopeful that new legislation will open the doors for veterans to get the medical care they need and deserve by allowing our veterans to visit with a private primary care doctor.

Dr. Robert Bitonte, who was recently selected by Los Angeles Mayor Eric Garcetti to join the city’s Commission on Disability, will devote his efforts to serve our homeless veterans and advocate on behalf of patients who have been hurt by the current system.

The Board of Commissioners has the primary responsibility of working with the city’s Department on Disability to respond to the needs and concerns of our citizens, in particular, those with disabilities.

Given Dr. Bitonte’s tremendous track record of innovated leadership and ded-ication to saving and enhancing lives, his guidance as a physician on the Commis-sion on Disability will be a great contribution to the lives of our residents.

This 4th of July, we look forward to the Independence Day festivities in Los Angeles County as we pay tribute to our hometown heroes and military veterans.

A happy 4th also to all of our hardworking LACMA members and their families who dedicate their lives to serving the local community.

Rocky DelgadilloChief Executive Officer

S A N D I E G O

O R A N G E

L O S A N G E L E S

P A L O A L T O

S A C R A M E N T O

800-356-5672 www.CAPphysicians.com

Medical Professional

Liability Protection, and more!

JULY 2014 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 17

Membership is free for the duration of your training program

Los Angeles County Medical Association Activate your free membership by visiting

www.lacmanet.org/StudentsandResidents

Ability to influence healthcare policy through LACMA & CMA Leadership, Board of Trustees, and House of Delegates.

Access to members-only resources and publications

Access to discounts and services, including automobile, term life and other insurance available through LACMA’s marketplace and partner-ships, saving you hundreds annually

Networking opportunities available through free events and mixers, allowing you to make connections for future employment

Calling all Students, Residents & Fellows!

BENEFITS AVAILABLE TO STUDENT, RESIDENT & FELLOW MEMBERS INCLUDE:

Shape your future as a physician-in-training. Students, Residents, and Fellows have the opportunity to shape healthcare policy as they train to become the

future leaders of medicine in California.

Membership in LACMA and CMA is FREE for Students. Residents, and Fellows.

WIN ONE OF FIVE $100 AMAZON GIFT CARDS!

If you are continuing your training program as either a Resident or a Fellow, let us know your plans by

updating your membership profile.

Visit www.lacmanet.org/MyProfile to enter

1 8 p h ys i c i a n m aG a Z i n e | juLY 2014

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Psychiatrist MD or DO

Located in Vista, California, Vista Community Clinic is a private, non-profit outpatient community clinic located in North San Diego County serving people who experience so-cial, cultural or economic barriers to health care in a comprehensive, high quality setting.

PositionPart-time Psychiatry MD or DO or part-time or full-time Family Medi-cine/Psychiatry MD or DO.

ResPonsibilitiesProvide consultation-liaison servic-es for patients suffering from both psychiatric and medical disorders by focusing on the evaluation and treatment of patients serving ado-lescents, adult, seniors and their families. Preferably able to serve children as well, but not required.

RequiRements· Graduation from a recognized

school of medicine· Valid California medical license

as MD or DO; Board certified or eligible

· Authorized to practice psychiatry in California

· Certified as a diplomat in the American Board of Psychiatry and Neurology in psychiatry

· Completion of a psychiatric resi-dency or family medicine/psy-chiatry residency in an ACGME approved residency program

· Psychiatrist with Medicare and California Medicaid numbers prior to start of employment

· Valid DEA certificate· 2 years experience working full-

time as psychiatrists and MD or DO in child and adult psychiatry

ContaCt us:

Visit our website at www.vistacommunityclinic.org

Forward resume to [email protected]

or fax resume to 760 414 3702. EOE/M/F/D/V

to place a classified ad visit www.physiciansnewsnetwork.com [email protected].

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PHYSICIAN – FAMILY MEDICINE

Located in Vista, California, Vista Community Clinic is a private, nonprofit outpatient community clinic located in North San Diego County serving people who expe-rience social, cultural or economic barriers to health care in a com-prehensive, high quality setting.

Position: Full-time, Part-time and Per Diem Family Medicine Physicians.

ResPonsibilities: Provides outpatient care to clinic patients and ensures quality assurance. Malpractice coverage is provided by Clinic.

RequiRements: California li-cense, DEA license, CPR certifica-tion and board certified in fam-ily medicine. Bilingual English/Spanish preferred.

ContaCt us: Visit our website at www.vistacommunityclinic.org Forward resume to [email protected] or fax resume to 760 414 3702.EEO/AA/M/F/Vet/ Disabled

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Join us for this extraordinary four-day conference designed for healthcare professionals to enhance their ability to care for older adults. With more than thirty case-based presentations, smaller in-teractive sessions and discussion with faculty on issues in geriatrics, emphasis is on the clinical “how to,” and Board Review preparation for phy-sicians and pharmacists.

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Exhibitor opportunitiEs availablE

seeKinG GlenDale entGlendale office seeking ENT associ-ate 2 or 3 days per week. Potential for partnership. Salary negotiable. Must speak Armenian. Please email resume to [email protected]

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City of Hope welcomes internationally acclaimed liver and pancreatic surgeon, researcher and au-thor Yuman Fong, M.D., as the new chair of the Department of Surgery. Come meet Dr. Fong at this special CME event and reception:

LIvER ANd PANCREATIC CANCER: LESS INvASIvE, MORE CURES

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For Joining LACMA and CMA Working together, the Los Angeles County Medical Association and the California Medical Association are strong advocates for all physicians and for the profession of medicine. Of the many reasons for joining LACMA and CMA, 10 stand out.

Legislative Advocacy

FREE Reimbursement Assistance

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Access to your Physician Advocate

LACMA and CMA are distinguished by their successes. Dual membership provides for unparalleled legislative advocacy at the local, state, and federal level on behalf of our members.

Tired of fighting with payors? CMA’s Economic Services experts recovered over $7.8 million for members since 2010.

Aimed at meeting both your professional and personal needs, LACMA offers you additional discounts and savings on Auto & Home Insurance, UPS services, Staples office supplies, Financial Planning, HIPAA Compliance Kits, and more!

CMA develops toolkits, guides, webinars, and resources on all things related to today’s changing healthcare landscape—all FREE with membership. In addition, LACMA provides access to important and local CME-accredited events.

Save time and money by consulting with a CMA legal expert before hiring a lawyer. Services include HIPAA Compliance, ACOs, Buying and selling a practice, Upkeep of medical records, and much more!

Information is power. LACMA and CMA produce several publications full of valuable information including the award-winning Physician Magazine, Physicians’ News Network, and CMA Practice Resources, full of tips and tools for your practice.

If you come across a challenge and you are not sure what to do, call 213-226-0356 to support your practice and professional needs.

Los Angeles County Medical Association o 707 Wilshire Blvd, Suite 3800 o Los Angeles, CA o 90017 o FAX: (213) 226-0353

For more information on member benefits and resources, visit lacmanet.org/Membership or call (213) 226-0356

is the best time to join LACMA and CMA

LACMA can help you:

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Socialize and network with members of the medical community

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july 2014

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