JANUARY 2016 - cdn.ymaws.com€¦ · Mark Notash, MD, FACEP Maria Raven, MD, MPH, FACEP Vivian...

lifelinea forum for emergency physicians in california

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JANUARY 2016

The Four Horsemen of the Physician Burnout Apocalypse

4 PRESIDENT’S MESSAGE

7 ADVOCACY UPDATE

9 GUEST ARTICLE

11 GUEST ARTICLE 16 ANNOUNCEMENTS

17 UPCOMING MEETINGS & DEADLINES

18 CAREER OPPORTUNITIES

9

California ACEP Board of Directors & Lifeline Editors Roster2015-16 Board of DirectorsMarc Futernick, MD, FACEP, President Lawrence Stock, MD, FACEP, President-ElectAimee Moulin, MD, FACEP, Vice PresidentChi Perlroth, MD, FACEP, Treasurer Vikant Gulati, MD, SecretaryMichael Osmundson, MD, MBA, FACEP, Immediate Past PresidentJohn O. Anis, MD, FACEPRodney Borger, MD, FACEP, At-LargeKevin Jones, DOStephen Liu, MD, FACEPJohn Ludlow, MD, MBACameron McClure, MD, FACEPValerie Norton, MD, FACEPMark Notash, MD, FACEPMaria Raven, MD, MPH, FACEP Vivian Reyes, MD, FACEPEric Snyder, MD, FACEPSybil Zachariah, MD, CAL/EMRA President

Advocacy FellowshipAimee Moulin, MD, FACEP, DirectorJohn Coburn, MD, Advocacy FellowNicolas T. Sawyer, MD, MBA, Advocacy Fellow

Lifeline Medical EditorRichard Obler, MD, FACEP, Medical Editor

Lifeline Staff EditorsElena Lopez-Gusman, Executive DirectorRyan P. Adame, MPA, Deputy Executive DirectorLucia Romo, Education CoordinatorKelsey McQuaid, MPA, Government Affairs Associate

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JANUARY 2016 Index of AdvertisersAnaheim Regional Medical Center Page 18

Collective Medical Technologies Page 6

Emergency Groups’ Office (EGO) Page 8

Emergency Medical Management Associates (EMMA) Page 12

Emergency Medical Society of Orange County Page 18

Emergency Physicians Management Page 18

Huntington Emergency Group Page 18

Independent Emergency Physicians Consortium (IEPC) Page 12

Kaiser Permanente Page 18

MMC Emergency Physicians Medical Group Page 18

Newport Emergency Medical Group Page 18

Ohio ACEP Emergency Medicine Board Review Courses Page 14

Philip J. Fagan, MD Page 18

Salinas Valley Memorial Healthcare Page 18

St. Jude Medical Center Page 18

FACIAL NERVE PALSY IN CHILDREN

TABLE OF CONTENTS |

Central Coast Emergency Physicians

Emergent Medical Associates

Emergency Medicine Specialists of Orange County

Front Line Emergency Care Specialists

Loma Linda Emergency Physicians

Napa Valley Emergency Medical Group

Newport Emergency Medical Group, Inc at Hoag Hospital

Pacific Emergency Providers, APC

Tri-City Emergency Medical Group

University of California, Irvine Medical Center Emergency Physicians

Phawanjit K Demos DODevin Alan Harper MD

Daniela Morato MD

Tabitha Cheng MDJennifer Y Fang

Christopher Katsura MDWilliam A Lee

Garrett M MorganNahal G NikrooElizabeth Rubin

WELCOME new members!

100% GROUPS

JANUARY 2016 | 3

PRESIDENT’S MESSAGE |

By Marc Futernick,MD, FACEP

This is an area where our organization excels. The longevity of the senior staff at California ACEP, including prior service at the Capitol, is extremely valuable and gives us great historical perspective and insight. These long-term relationships

also provide us access to the most current information and activity. In addition, we have a very engaged group of Past Presidents of the Chapter whose experience helps to guide us. They are able to better see the whole forest, not just the redwoods right in front of us, and remember well their successes and failures, providing tremendous insight into potential actions we are considering.

For practicing emergency physicians, I believe you should empower yourself as much as possible by learning about the environment in which we practice, beyond the walls of your ED. From the local hospital and medical staff, to the practice structures of the various groups, to the activity of the local, state, and federal lawmakers. The more you educate yourself about the world of emergency medicine, the more power you will have to steer your career in a direction that will provide you job satisfaction and longevity.

Of course, to say that “knowledge is power” applies to our clinical practice is a gross understatement. We all know that knowing the right drug to give or procedure to perform, in the right moment, is literally lifesaving. I applaud each of you for learning the art and science of emergency medicine, and for changing lives every day.

However, there is a knowledge gap today that is short-changing our patients. We need to have immediate access to more historical information about our patients across the board. Some of our patients are very aware of their medical conditions and treatment, but most are not, particularly among our most vulnerable populations. Knowing specific diagnoses a patient carries up front is incredibly powerful.

Just last shift I was trying to figure out what was causing my patient’s weakness, shortness of breath, and chest pain. He said he had some kind of “heart thing” but couldn’t tell me any more, despite several minutes of questions about various interventions, including asking if he’d ever been poked in the groin area to look at his heart. He thought maybe they had put him on blood thinners, but he wasn’t sure and wasn’t taking them. My evaluation determined that he had a large left ventricular thrombus, a blood clot within the largest chamber of the heart, and I presume that not taking his blood thinners allowed it to progress. Imagine the value of knowing his history of an LV thrombus when I walked in the room (or up to his chair in the hall in this particular case). What if he had decompensated before I was able to make this diagnosis? LV thrombus was certainly not at the top of my list of potential diagnoses.

Even in more minor situations, timely information can save time, money, and effort, in addition to optimizing patient care. For instance, if I am evaluating an asymptomatic, hypertensive patient, per ACEP policy, I don’t need to order any studies to look for end organ damage. However, the caveat is that if patients lack regular care (many of my patients do), it might be reasonable to look for renal impairment, and possibly anemia. If I have immediate access to their last lab results, including if any were performed, I can make a more informed decision about whether these tests might be useful, rather than just wasteful. Similarly, if I find a serious abnormal value in a patient’s results, unrelated to their current issue, I should be able to rapidly determine if this is chronic or new, which might change my management. With our current technical capabilities, it’s hard to believe that we don’t have access to this information, readily and easily.

There are so many areas where a little bit of timely information would go a long way. I think the systems we implement should strive to

KNOWLEDGE IS P WER

This common phrase really speaks to me, and I find myself thinking it often. In nearly every situation, having more insight, experience, and information can be leveraged to your advantage. As I’ve moved up the ranks at California ACEP, as well as within my medical group, I’m continually reminded how valuable experience is, as well as in-depth information about the options being considered. Historical information explains how we got here, and what has been tried before, and current analysis helps to define the choices before us.

4 | LIFELINE a forum for emergency physicians in california

include them all, and the ability to keep growing as our needs change. Another area where push notification (information provided to you without your seeking it) can have a huge impact is in workplace violence prevention. Knowing immediately that a patient has been violent towards health care workers could save a coworker’s life. Maybe nothing would happen during that encounter, but I think we can all agree that this is an area where knowledge is power, and prevention is the goal. In fact, I believe patients learn quickly how systems work, and once fully implemented these notifications may even serve as a deterrent because it will become common knowledge that if you punch one ED nurse, every ED in the area will know about it when you show up there for help. Making our patients aware of these systems will enhance their utility.

I find many patients expect us to have immediate access to their medical information, routinely. How often have you asked a patient for information and they respond that it’s all in their chart? We need access to a concise version of “the chart” wherever the patient goes, including episodic, primary, and specialty care settings. Although it’s valuable to get information directly from the patient, it’s also valuable to have a more objective source. How many healthy 30 year olds have told you they have a history of having a heart attack, despite never having had an intervention nor prescribed long-term medication? Wouldn’t it be ideal to see the discharge diagnosis from those encounters?

How about when a patient returns with a worsening infection after completing recent treatment? It would be so valuable to see what they had been taking, and even a simple prescription list would tell you. How about culture results from outside facilities? Ideally, we would be able to drill down deeper and deeper into each episode of care, as needed. Every bit of information adds value. It’s great to know that a patient was recently seen in a nearby ED, but more valuable to know the diagnosis, and more valuable still to see the prescribed drugs, and even better to see the specific lab and radiology results, when desired.

Some of us have great in-system programs that make it easy to find the information we need, but even those usually do not communicate with the hospital or clinic across the street. For the majority of us, obtaining this valuable information is time-consuming, frustrating, or sometimes impossible within the time frame of an emergency visit. We need to push for systems capable of delivering this information to us in a clinically meaningful way.

We should demand the highest level of performance for these systems. There are numerous programs and applications on the market today that process large amounts of information and then deliver it to the user in a very useful and efficient manner. Just think about GPS and traffic programs that instantly deliver in-depth information about the individual’s surroundings, as it relates to their individual destination. These apps then display this in a manner so succinct and efficient that a mere glance allows the user to know which way to go and how long it will take. Isn’t our performance at work infinitely more important than our drive to work? We should have superior tools at our disposal to optimize the care delivered to our patients.

Of course, we also need to be careful to use this information properly, which may require additional education in this new arena. Many of us haven’t had routine access to complete prescription histories before, so they must be interpreted with care and caution. Previous diagnoses may not be accurate, and patients can be inaccurately pigeon-holed or inappropriately labeled in the past. However, as in other areas, knowledge is power, and having more is better, we just need to be mindful of the true value of the information, and to utilize it wisely for the benefit of the patient before us.

Many of the new buzzwords in health care today, such as coordination of care and population health, depend upon robust, timely information and having systems in place to act upon that information. Such systems should include the primary caretakers and support team, such as specialists, social workers, and case managers for complex patients. These systems should allow us to notify everyone on the team about patient needs and changes in their medical condition. We should know when patients have care plans in place, and we should be able to contribute to those plans as needed.

There is a new system operated by ACEP that has a planned release of Spring 2016 that is focused on ED Care Coordination. The National Emergency Visit Reporting System (NEVRS) is an ED care coordination system that will track ED visits and share ED care plans. Many hospitals in California are already utilizing a program called EDIE (ED Information Exchange), which integrates into the Electronic Medical Record to rapidly deliver many of the items above directly to the provider upon opening the patient’s electronic chart. The company that runs EDIE, Collective Medical Technologies, also has an IT product for insurers that aids in the actual coordination and management of selected patients with automatic notifications and care plan sharing.

California ACEP strongly supports the implementation of systems that deliver clinical information to the care team. It is important that these systems are either universal or inter-operable. Whatever system your hospital chooses should allow you to get information from all surrounding facilities. Although partial information is better than none, ideally you would know that you were getting all the key information from all outside sites of care, pharmacies, insurers, and possibly law enforcement and other agencies that could provide beneficial information to the care team. For example, an electronic POLST (Physician Orders for Life-Sustaining Treatment) registry should be available in the near future, and all information exchanges should have access to this essential information and alert the physician when a POLST is in place.

California ACEP wants to help you get the information you need to take optimal care of our patients. We look forward to the day that this information is routinely delivered to clinicians and easily analyzed due to superior user interface platforms. I expect we’ll soon be wondering how we managed so long without this essential medical tool.

Please share your thoughts and feedback with us on this topic, particularly if you have experience with such systems. n

JANUARY 2016 | 5

2016

ADVOCACY UPDATE |

It’s that time again! The SB 1773 portion of the Maddy Fund, which includes pediatric trauma funding, is set to expire on January 1, 2017. That means California ACEP will be sponsoring legislation this year to extend the program.

SB 1733 provided for a local option to counties to assess up to an additional $2 per $10 of base fines and established “Richie’s Fund”, which requires 15% of monies collected through this increase in penalties to be spent on pediatric trauma projects. If the extension of SB 1733 is not reauthorized in 2016, the Maddy Fund could lose upwards of $50 million in funding, nearly half of the total fund.

Unfortunately, this year’s battle will be even more challenging than what we faced in 2013. Not only is Governor Jerry Brown opposed to penalty assessments in general, but in 2015 the Legislature has been exploring ways to eliminate penalty assessments all together.

Governor Brown has made clear his dislike of using penalty assessments to pay for programs that he feels should be paid for by taxpayers generally, not just those who pay traffic fines, though he has also expressed support for the goals of the programs themselves – including emergency care funding.

In 2011, Governor Brown took the unusual step of allowing AB 412, which was sponsored by California ACEP and which renewed the Santa Barbara County Maddy Fund, to become law without his signature. The Governor even went so far as to send a

message to the Legislature to accompany his “action”, which is normally reserved for vetoes, in which he stated his support for the program, but not the funding mechanism. Again in 2013, Governor Brown signed SB 191 to extend Richie’s Fund, but expressed his dislike of the funding mechanism.

The Legislature’s dislike for penalty assessments became evident during the 2015 session. Senator Beall authored SB 326 to renew penalty assessments under the Emergency Medical Air Transportation Act used to augment emergency medical air transportation reimbursement payments made through the Medi-Cal program. The Assembly Committee on Appropriations forced the following amendments into the bill at the end of August:

Author: Elena Lopez-Gusman & Kelsey McQuaid, MPA

LEGISLATION SPOTLIGHT: LEGISLATION SPOTLIGHT: Fighting to Save the Maddy Fund

JANUARY 2016 | 7

The Legislature finds and declares all of the following:

(a) Penalty assessments have been used to fund an increasing number of programs that should properly be funded by broad-based financing mechanisms.

(b) The ever-increasing reliance on penalty assessments to fund core state programs is a regressive financing mechanism, and is particularly harmful to individuals who can least afford these assessments. High fines and assessments can perpetuate a cycle of poverty and inequality, given that individuals with lower incomes are more likely to miss payments and suffer the consequences.

(c) It is in the state’s interest to ensure funding for emergency medical air transportation is sufficient to maintain access to these critical services for Medi-Cal beneficiaries and all individuals in California.

(d) Therefore, it is the intent of the Legislature

to identify alternative funding sources for emergency medical air transportation and cease reliance on penalty assessment revenue to fund these services.

(e) Accordingly, it is the intent of the Legislature to cease the collection of penalty assessments on January 1, 2018, pursuant to the Emergency Medical Air Transportation Act.

The amendments by the Assembly Committee on Appropriations make clear that we face a hostile environment and large uphill battle to renew the Maddy Fund and Richie’s Fund this year.

In 2013, over 90 organizations supported the Maddy Fund renewal and California ACEP will be reaching out to each and every one of them to ask for their support again this year. California ACEP is hopeful that a large coalition of supporters will help make the case that the Maddy Fund is a beneficial

program that must be preserved, regardless of the general dislike of the funding source.

Ultimately, the key to renewing the Maddy Fund is you! In the coming months, we will be contacting our members via email and here in Lifeline with ways that you can help make the compelling argument that the Maddy Fund and Richie’s Fund is worth saving. Your calls and emails made the difference in 2013, and they will be even more important in 2016.

California ACEP is currently searching for an author for this legislation, and has until Friday, February 19th to do so. We will continue to update you on this legislation and on our complete legislative package for 2016 in future issues of Lifeline.

If you have any questions, please contact us at [email protected] or by calling the Chapter office at (916) 325- 5455. n


PEDIATRIC Merry-Go-Rounds

GUEST ARTICLE |

Assessment: A careful neurological exam is imperative to assure there is no central cranial nerve (upper motor neuron) involvement or other CNS findings, and to minimize use of CT and MRI for brain imaging. Outcome is dependent on underlying etiology and severity of physical findings on presentation. Remember, all facial nerve palsy is not Bell Palsy. In kids, a central cause is more likely than in adults. As always, your exam should be conducted with the preschool child sitting on the caregiver’s lap.

Common causes of facial nerve palsy (Key diagnoses in italics):

Idiopathic - Bell Palsy is the most common

cause, as in adults, and is responsible for 40-70%

of pediatric cases.

Infection - Otitis media, meningitis, mastoiditis,

parotitis, EBV, Lyme (in endemic areas), Ramsey-

Hunt (zoster)

Inflammation - Kawasaki Disease, Henoch-Schonlein Purpura

Trauma - Fractures of the temporal bone or skull, trauma to parotid or cheek, barotrauma

Malignancy - Leukemia, parotid tumor, brainstem mass, cholesteatoma (benign)

Other - Diabetes, hypertension, hemophilia, Guillan-Barre, immunizations (rabies, polio, tetanus, and influenza)

Facial nerve palsy in kids includes Bell Palsy as well as multiple other conditions associated with entrapment of the peripheral facial nerve. Viral disease, most often herpes simplex, is the commonest associated problem. It is less common in children than adults, and is quite rare in kids under 2 years of age. Sometimes the physical findings are subtle and may only involve mild weakness in closing one eye. The House-Brackmann Facial Nerve Grading System assigns six different levels of severity that reflect the wide spectrum of disease--from mild dysfunction (with eye closure asymmetry only) to total inability to close the eye or move the face. Altered taste and sound sensitivity may also be present. A good sign is the Bell phenomenon (when the eye turns up and out with attempted closure.)

By Ron Dieckmann MD, MPH, VEP Director of PediatricsProfessor Emeritus of Emergency Medicine and Pediatrics, UCSF

FACIAL NERVE PALSY IN CHILDREN

NOTE: This article is reprinted with the permission of Dr. Dieckmann. The views and opinions expressed are not necessarily those of California ACEP.

JANUARY 2016 | 9

Special considerations:

1. If the palsy worsens over three weeks or does not improve after three months—consider malignancy.

2. If the findings are bilateral--consider Lyme, EBV, or Guillan-Barre.

3. If aural symptoms are present--consider otitis media, cholesteatoma, Ramsey-Hunt (look for vesicles).

4. Obtain brain imaging by CT or MRI for suspected malignancy or trauma, central cranial nerve findings, cholesteatoma, or if there is progression after three weeks or no improvement after three months.

Treatment: If not Bell Palsy, treat the underlying condition. For Bell Palsy cases, prescribe eye care with artificial tears during day and eye ointment (e.g., lacrilube) during sleep. This is the most important intervention. Children typically recover quickly, and there is no proven benefit of acyclovir or steroids (unlike adults). If you elect to treat severe cases, use prednisolone 1 mg/kg (max 60 mg) x 7 days and then taper x 3 days. Begin steroids early for better effect but be careful with diabetes, hypertension and leukemia. Obtain at least a CBC before steroid treatment.

C-reactive protein and procalcitonin for prediction of serious bacterial infection in kids in the EDThe Pediatric Infectious Disease Journal, 10/30/2014

Approaches to assessment of the febrile child have evolved markedly over the last decade as vaccines have continued to diminish the incidence of serious bacterial infection (SBI), especially from virulent strains of Hemophilus Influenza type B and pneumococcus. However, streptococcal and staphylococcal disease, including MRSA, as well as gram negative disease from UTIs, continue to cause SBI. Newborns and infants under 3 months of age are particularly vulnerable, and often

require laboratory tests and bacterial cultures for evaluation. This paper explores the utility of the laboratory markers C-reactive Protein (CRP) and procalcitonin (PCT) as predictors of SBI in children. Investigators conducted a prospective study of 1,084 febrile children 1 month to 16 years old. Both CRP and PCT were strong predictors of SBI. Length of fever had no relationship to probability of SBI.

Bottom line: Identification of SBI in young children is often difficult. Physical findings may be nonspecific, and length of fever has no known predictive value. The younger the child, the higher the probability of SBI, especially children < 3 months of age. Children < 36 months continue to be the highest risk group overall, and sometimes diagnostic testing is needed, in addition to careful physical exam. PCT and CRP are both well validated laboratory adjuncts to CBC in predicting SBI. A PCT level > 0.5 ng/mL is probably more sensitive and specific than CRP or leukocytosis on CBC.

VEPeds Vignettes: CURIOUS CASE RECORDS of KIDS in VEP EDsCase Study: Infant bronchiolitis

A three month old girl was brought to the ED by parents because of cough, unwillingness to breast feed and difficulty breathing. The infant appeared ill and was unwilling to engage. The child had audible wheezes and increased work of breathing (retractions with flaring.) Temperature was 38.3 C, RR was 65/min and SA02 was 88%. CXR showed hyperinflation. The child was treated with ceftriaxone IV, albuterol and prednisone, then transferred to Childrens Hospital with a diagnosis of bronchiolitis.

Comment: Bronchiolitis is the most common reason for hospitalization of infants. This disease, usually caused by Respiratory Syncytial Virus (RSV), is a major pathogen of childhood and is distinguished clinically by cough, fever, respiratory distress (retractions, flaring) and wheezing. Bronchiolitis is a clinical diagnosis and most children with mild disease do not require CXR, laboratory testing or antibiotic treatment. Virological testing is only useful if it will change management (e.g., to avoid antibiotics, or further testing). Treatment

is supportive (oxygen, fluids), and most kids in the ED do not need labs, CXR, steroids or antibiotics. The only intervention with proven efficacy is nebulized hypertonic saline (3%). Clinical improvement in ED from hypertonic saline is unlikely, but studies indicate decreased length of stay for admitted patients who continue to receive 3% saline. A trial of nebulized albuterol is harmless, but beta agonists will not usually improve the child’s clinical status unless the child is older and there is an atopic component. Admit children with: young age (<1 mos), comorbidities (e.g., bronchopulmonary dysplasia), apnea, hypoxia (SA02 <93%), toxicity, dehydration, or an inadequate home care situation.

Questions CornerWhat is the best ED treatment for migraines in kids?

Migraine is a common complaint among children in EDs. The characteristic clinical picture in older children and adolescents is recurrent, unilateral throbbing headache with nausea, photophobia or phonophobia, sometimes associated with an aura (visual symptoms, paresthesias, dysphasia.) Younger children get constant, bi-frontal headaches and are less likely to have an aura. Tension headaches are sometimes confused with migraine. Careful neurologic exam is negative with migraines. Initial ED treatment includes a dark, quiet room and a trial of ibuprofen or acetaminophen. Triptans and opiates tend to be less useful in children, and diphenhydramine may worsen headaches when used with antiemetics. A recent review demonstrated the best drug for young kids who fail initial treatment is probably prochlorperazine (Compazine), which performed marginally better than metoclopramide (Reglan).

Bottom line: Distinguish migraines from tension headaches. Treat mild migraine headaches in kids with ibuprofen or acetaminophen and a dark, quiet room. If the migraine headache is severe, use prochlorperazine. Avoid opiates and diphenhydramine. Triptans may be a good option in adolescents if used early. n


GUEST ARTICLE |

In my work with hundreds of over stressed physicians I have isolated one of the major invisible causes of burnout - the pervasive mental conditioning of our training process. Call it our “brainwashing” if you will. In this article I will show you four “flavors” of this conditioning - how and why they develop and how they contribute to the physician burnout epidemic.

THE BRAINWASHING OF MEDICAL EDUCATION

Yes, indeed, we are most certainly brainwashed by our medical education. There is a set of attitudes and behaviors that are expected of us while in training that become subconscious and automatic by the time we are board certified. To most doctors these behavior patterns are invisible and unrecognized. You will see in a second why they virtually guarantee physician burnout in your 40’s and 50’s if they continue to sit in your blind spot.

THE FOUR HORSEMEN OF THE PHYSICIAN BURNOUT APOCALYPSE

Here they are in all their glory. See if they feel familiar to you…

WORKAHOLIC SUPERHERO PERFECTIONIST LONE RANGER

Before they became subconscious conditioning, we learned each of these as distinct and very useful skill sets. Let’s face it—there were hundreds of times in your medical education the skills of a workaholic or perfectionist came in handy. In fact, you could not have become a physician without them.

In an ideal world, you would have been taught to use them the way a carpenter uses the tools on his belt. You pull out a hammer when it

By Dike Drummond MD, CEO TheHappyMD.com

“The Four Horsemen of the Physician Burnout Apocalypse”

Physician Burnout is a constant, prevalent, looming threat over doctors everywhere. The

question is why? Yes, the nature of our work is difficult, stressful and draining... and there is

much more here than just the stress of the clinical practice of medicine.

NOTE: This article is reprinted with the permission of Dr. Drummond. The views and opinions expressed are not necessarily those of California ACEP.

JANUARY 2016 | 11

is the best tool for the job at hand. You use it to drive in that nail, and then you slide it back into the loop on your tool belt where it belongs. When you are done with your tool, you go ahead and put it away.

When you are done with work, you take your tool belt off and put it away until your next day on the job.

Those are healthy boundaries.

Early in our training, we hone and practice these skill sets constantly. We become experts in their use, even as pre-meds. We need them just to survive the training process of medical school and then residency.

Here is one of the differences between a doctor and a carpenter: no one ever showed you how to let go of your tools and put them away. We have no tool belt we can simply unclip and hang on a hook when we get home.

Very early in our education, we actually become our tools.

We literally become workaholic superhero perfectionist Lone Rangers. Without knowing how to turn them off and put them away, we start to live our whole lives this way.

People outside of medicine look at doctors and think, that’s just the way doctors are. What they are really seeing is this deep, comprehensive, and subconscious conditioning. This is one of the prices we pay to survive the education process. It sets us up for burnout down the road.

Recognizing Your Programming

You can recognize your workaholic programming when your only solution to any problem is to work harder, and you get angry at people who don’t work as hard as you.

You can recognize the superhero when you feel you should save everyone or get very upset when you can’t.

You can recognize the perfectionist when you agonize over details that are not clinically relevant or chastise patients and your staff – even your family - for minor imperfections.

You can recognize the Lone Ranger when you are stuck in the maze of doing everything yourself, despite having a team around you.

• Excellent Opportunities for Emergency Physicians

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Contact Debbie Corn for more information(909) 634-3172 or email CV to [email protected]

Southern CaliforniaJOB OPPORTUNITIES


HOW DEEPLY ARE WE BRAINWASHED?Basic training in the military is 8 weeks. In that time they can condition an 18 year old to take a bullet on command. Medical education is a minimum of 7 years. Take a second to count up how long it took you from your first day in medical school to your first day in private practice. Do you think that in all those years you were just a little bit conditioned? I believe there is no more thorough conditioning program on the planet than becoming a practicing doctor.

IF YOUR ONLY TOOL IS A HAMMER, EVERY THING LOOKS LIKE A NAIL That is the problem. Not everything in a doctor’s world is a nail … especially after you graduate to private practice and the rest of your life. Burnout results when these four become “overused strengths”.

Being a workaholic superhero perfectionist Lone Ranger is an absolute requirement to make it through a 72 hour shift in your residency and it is NOT a great way to

BE IN A LOVING RELATIONSHIP RAISE YOUR KIDS GET YOUR OWN NEEDS MET OR LIVE YOUR LIFE

I help my clients see this conditioning when it appears as automatic behavior that is driving their physician burnout ... when they are using this set of hammers to drive things that are NOT nails.

For most of us these four horsemen and their automatic behaviors are deeply subconscious. Remember that you spent a minimum of 7 years installing them in your psyche – deliberately, consciously, through thousands of hours of dedicated study and on the job training. No wonder they poke there heads into all areas of your life – and not always in a good way. AND this is not the only risk factor for physician burnout.

NEXT STEPS:Here’s a simple way to expose your own brainwashing and lower your physician burnout risk.

Whenever you find an area of your practice or life that is NOT WORKING the way you would like … I have found a 95% probability that one of the horsemen is at least partly to blame.

When you notice a major problem at work or at home … stop … ask yourself:

“How am I perhaps acting like a workaholic superhero perfectionist Lone Ranger here?”

POWER TIP:If you really want to get some feedback on your programming, tell your significant other about this issue and ask them how they think your programming might be playing a role. They will have some fresh input for you I am certain.

When you notice one of the four horsemen as the source of your automatic behavior in this area …

Ask: “If I was to STOP behaving like a workaholic superhero perfectionist Lone Ranger here… what might I do differently to get more of what I really want?” Again, your significant other is a great source of input here.

In the end, all of us must recognize and rise above our programming to build the practice and life we dream of. Remember Einstein’s insanity definition? “Doing the same thing over and over and expecting a different result”. That’s crazy, right? I want you to know that doctors sit in this insanity trap all the time. It is a major cause of physician burnout.

Being stuck in your workaholic programming is one of the major reasons people come to me for coaching. They work harder and harder doing the same things they have always done, quietly praying they will get a different result this time – while their energy level slowly spirals downward.

Now you know about the four horsemen. Your eyes are wide open. I sincerely hope you recognize when they are driving your behavior and notice the other choices available to you. It takes new actions to get new results. Everything can change from this point forward.

PLEASE LEAVE A COMMENT. What is your “favorite” horseman and how would it lower your stress levels to let it go?

Dike Drummond MD is a family physician, executive coach, trainer and consultant specializing burnout prevention and treatment services for physicians. Find over 117 separate ways to prevent burnout at his website, The Happy MD. n

California ACEP is once again offering a FREE 1 hour practice session via video chat for current California ACEP members preparing for the Spring 2016 oral boards.

There is an art to test taking, and this video chat session will help prepare our members for the nuances of the oral boards. California is home to many of the specialty’s leading educators, lecturers, and clinical minds. Take advantage of living in a state rich with experience and team up with a California ACEP member who will help you prepare for the exam.

Visit: californiaacep.org/events

ORAL BOARDS PRACTICE OFFERED Looking for Examinees and Examiners

JANUARY 2016 | 13

THE OHIO ACEP EMERGENCY MEDICINE BOARD REVIEW COURSE

Newport Beach Marriott Hotel & Spa Newport Beach, California

February 8 - 12, 2016

2016FEBRUARY

WWW.OHACEP.ORG/EMREVIEW

COMPREHENSIVE. RELEVANT. ESSENTIAL

REGISTRATION INCLUDES

FOR MORE INFORMATION ON LOCATIONS & ACCOMMODATIONS: WWW.OHACEP.ORG/EMRHOTEL

February 8 - Day 1 (7 am - 8:05 pm) Orientation/Test Taking Psychology Endo, Metabolic & Nutritional Disorders I & IIRenal/GU Emergencies Hematologic DisordersInfectious Disorders I & IICardiovascular Disorders I & II ECG Review

February 11 - Day 4 (7 am - 7:10 pm)e-Learning Review (Trauma Focus)Pediatric Medical Illnesses I & IIPediatric Surgical Illnesses Pediatric Rapid Review Rapid Fire Board Prep II Oncologic EmergenciesMusculoskeletal Illnesses Obstetrical DisordersPsychobehavioral Disorders Emergency Medicine Immersion Rapid Review

February 9 - Day 2 (7:30 am - 7:10 pm)Nervous System Disorders Cardiovascular Disorders III & IV Geriatrics Cutaneous Disorders I & II Abdominal & Gastrointestinal Disorders I & II Ear, Nose , Throat & Dental Disorders Comprehensive Rapid Review February 12 - Day 5 (7 am - 5:25 pm) e-Learning Review (Pediatrics Focus) Female Urogenital DisordersToxicologic Emergencies I & IIThoracic Respiratory Disorders I & IIToxicologic Emergencies III Toxicology Rapid ReviewThoracic Respiratory Disorders III Clinical Pharmacology I & II

February 10 - Day 3 (7:30 am - 7:15 pm)Traumatic Disorders Traumatic Disorders C-Spine Ocular Emergencies Pelvic, Back & Lower Extremity Musculoskeletal Injuries Rapid Fire Board Prep I Environmental Emergencies I & II Ultrasound in EMUpper Extremity Musculoskeletal & Hand InjuriesTrauma & Environmental Rapid Review

COURSE AGENDA

TRUSTED FACULTY

Eric Adkins, MD, FACEP, MSc Thoracic Respiratory Disorders I-III

Brian Browne, MD, FACEPCutaneous Disorders I & II

Ken Butler, DO, FACEPEar, Nose, Throat and Dental Disorders, Pelvic, Back & Lower Extremity Musculoskeletal Injuries

Ann Dietrich, MD, FACEPE-Learning Review

Fred Hustey, MD, FACEPEndocrine, Metabolic & Nutritional Disorders I & II

Colin Kaide, MD, FACEP, FAAEMRenal/GU Emergencies, Hematologic Disorders

Randall King, MD, FACEPOrientation, Test Taking Psychology, Traumatic Disorders C-Spine, Musculoskeletal Illnesses, Rapid Reviews

Nicholas Kman, MD, FACEPEnvironmental Emergencies I & II

Joseph Martinez, MD, FACEP, FAAEMAbdominal & Gastrointestinal Disorders I & II, Comprehensive Rapid Review, Ocular Emergencies

Amal Mattu, MD, FACEPCardiovascular Disorders I-IV, ECG Review, Nervous System Disorders, Geriatrics

Michael McCrea, MD, FACEP, FAAEMPregnancy Disorders, Psychobehavioral Disorders, Urogenital Disorders

Ryan Mihata, MD, MPH, CPE, FACEP Clinical Pharmacology I & II

Michael Omori, MD, FACEPInfectious Disorders I & II

Laura Sells, MD, FAAP, FACEPPediatric Medical Illnesses I & II, Pediatric Surgical Illnesses, Pediatric Rapid Review

Ramin Tabatabai, MD, FACEPOncologic Emergencies

Jerry Tasset, MD, PhD, FACEPToxicologic Emergencies I-III, Toxicologic Rapid Review

Howard Werman, MD, FACEPUpper Extremity Musculoskeletal & Hand Injuries, Trauma & Environmental Emergency Rapid Review

Sandra Werner, MD, RDMS, FACEPTraumatic Disorders, Rapid Fire Board Prep I & II, E-Learning Review, Ultrasound in Emergency Medicine

These activities have been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American College of Emergency Physicians and Ohio ACEP. The American College of Emergency Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

THE OHIO ACEP EMERGENCY MEDICINE BOARD REVIEWThe American College of Emergency Physicians designates this live activity for a maximum of 50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Approved by the American College of Emergency Physicians for a maximum of 50 hours of ACEP Category I credit.

CME ACCREDITATION

WHO SHOULD ATTEND?

Residents preparing for an inservice or qualifying exam! Individuals looking for a comprehensive review of Emergency Medicine!

Advanced practice providers who treat urgent medical conditions! Those seeking a valuable CME resource!

COURSE MATERIAL• Extensive Daily Course Syllabus. A powerful, comprehensive tool for review.

Printed and electronic web-based versions provided.• Pre, Post & Daily Tests totaling over 400 questions.• Key Facts (50+ pages) to reinforce key concepts of Emergency Medicine. Covering

26 topics this is the perfect tool for every stage of your review process.• Online access to Ohio ACEP’s Pharmacology/Toxicology Case Studies workbook

with 60 cases for review.

ONLINE STIMULI & E-LEARNING WEB SITE (WWW.OHACEP-ELEARNING.ORG)• Web access to 1,400+ full color diagnostic photos, radiographs and ultrasounds,

complete with case questions organized into 23 categories.• Case questions e-mailed periodically to guide your studies before attending

the course.

ADDITIONAL REVIEW OPPORTUNITIES• Focused, team led rapid review and .• Faculty reviews of select cases and images from Ohio ACEP’s online stimuli Web site.

COURSE EXTRAS• A continental breakfast will be available to those staying at the hotel.• Complimentary Wi-Fi access in guest rooms at the hotel.

THE OHIO ACEP EMERGENCY MEDICINE BOARD REVIEW COURSE

Newport Beach Marriott Hotel & Spa Newport Beach, California

February 8 - 12, 2016

2016FEBRUARY

WWW.OHACEP.ORG/EMREVIEW

COMPREHENSIVE. RELEVANT. ESSENTIAL

REGISTRATION INCLUDES

FOR MORE INFORMATION ON LOCATIONS & ACCOMMODATIONS: WWW.OHACEP.ORG/EMRHOTEL

February 8 - Day 1 (7 am - 8:05 pm) Orientation/Test Taking Psychology Endo, Metabolic & Nutritional Disorders I & IIRenal/GU Emergencies Hematologic DisordersInfectious Disorders I & IICardiovascular Disorders I & II ECG Review

February 11 - Day 4 (7 am - 7:10 pm)e-Learning Review (Trauma Focus)Pediatric Medical Illnesses I & IIPediatric Surgical Illnesses Pediatric Rapid Review Rapid Fire Board Prep II Oncologic EmergenciesMusculoskeletal Illnesses Obstetrical DisordersPsychobehavioral Disorders Emergency Medicine Immersion Rapid Review

February 9 - Day 2 (7:30 am - 7:10 pm)Nervous System Disorders Cardiovascular Disorders III & IV Geriatrics Cutaneous Disorders I & II Abdominal & Gastrointestinal Disorders I & II Ear, Nose , Throat & Dental Disorders Comprehensive Rapid Review February 12 - Day 5 (7 am - 5:25 pm) e-Learning Review (Pediatrics Focus) Female Urogenital DisordersToxicologic Emergencies I & IIThoracic Respiratory Disorders I & IIToxicologic Emergencies III Toxicology Rapid ReviewThoracic Respiratory Disorders III Clinical Pharmacology I & II

February 10 - Day 3 (7:30 am - 7:15 pm)Traumatic Disorders Traumatic Disorders C-Spine Ocular Emergencies Pelvic, Back & Lower Extremity Musculoskeletal Injuries Rapid Fire Board Prep I Environmental Emergencies I & II Ultrasound in EMUpper Extremity Musculoskeletal & Hand InjuriesTrauma & Environmental Rapid Review

COURSE AGENDA

TRUSTED FACULTY

Eric Adkins, MD, FACEP, MSc Thoracic Respiratory Disorders I-III

Brian Browne, MD, FACEPCutaneous Disorders I & II

Ken Butler, DO, FACEPEar, Nose, Throat and Dental Disorders, Pelvic, Back & Lower Extremity Musculoskeletal Injuries

Ann Dietrich, MD, FACEPE-Learning Review

Fred Hustey, MD, FACEPEndocrine, Metabolic & Nutritional Disorders I & II

Colin Kaide, MD, FACEP, FAAEMRenal/GU Emergencies, Hematologic Disorders

Randall King, MD, FACEPOrientation, Test Taking Psychology, Traumatic Disorders C-Spine, Musculoskeletal Illnesses, Rapid Reviews

Nicholas Kman, MD, FACEPEnvironmental Emergencies I & II

Joseph Martinez, MD, FACEP, FAAEMAbdominal & Gastrointestinal Disorders I & II, Comprehensive Rapid Review, Ocular Emergencies

Amal Mattu, MD, FACEPCardiovascular Disorders I-IV, ECG Review, Nervous System Disorders, Geriatrics

Michael McCrea, MD, FACEP, FAAEMPregnancy Disorders, Psychobehavioral Disorders, Urogenital Disorders

Ryan Mihata, MD, MPH, CPE, FACEP Clinical Pharmacology I & II

Michael Omori, MD, FACEPInfectious Disorders I & II

Laura Sells, MD, FAAP, FACEPPediatric Medical Illnesses I & II, Pediatric Surgical Illnesses, Pediatric Rapid Review

Ramin Tabatabai, MD, FACEPOncologic Emergencies

Jerry Tasset, MD, PhD, FACEPToxicologic Emergencies I-III, Toxicologic Rapid Review

Howard Werman, MD, FACEPUpper Extremity Musculoskeletal & Hand Injuries, Trauma & Environmental Emergency Rapid Review

Sandra Werner, MD, RDMS, FACEPTraumatic Disorders, Rapid Fire Board Prep I & II, E-Learning Review, Ultrasound in Emergency Medicine

These activities have been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American College of Emergency Physicians and Ohio ACEP. The American College of Emergency Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

THE OHIO ACEP EMERGENCY MEDICINE BOARD REVIEWThe American College of Emergency Physicians designates this live activity for a maximum of 50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Approved by the American College of Emergency Physicians for a maximum of 50 hours of ACEP Category I credit.

CME ACCREDITATION

WHO SHOULD ATTEND?

Residents preparing for an inservice or qualifying exam! Individuals looking for a comprehensive review of Emergency Medicine!

Advanced practice providers who treat urgent medical conditions! Those seeking a valuable CME resource!

COURSE MATERIAL• Extensive Daily Course Syllabus. A powerful, comprehensive tool for review.

Printed and electronic web-based versions provided.• Pre, Post & Daily Tests totaling over 400 questions.• Key Facts (50+ pages) to reinforce key concepts of Emergency Medicine. Covering

26 topics this is the perfect tool for every stage of your review process.• Online access to Ohio ACEP’s Pharmacology/Toxicology Case Studies workbook

with 60 cases for review.

ONLINE STIMULI & E-LEARNING WEB SITE (WWW.OHACEP-ELEARNING.ORG)• Web access to 1,400+ full color diagnostic photos, radiographs and ultrasounds,

complete with case questions organized into 23 categories.• Case questions e-mailed periodically to guide your studies before attending

the course.

ADDITIONAL REVIEW OPPORTUNITIES• Focused, team led rapid review and .• Faculty reviews of select cases and images from Ohio ACEP’s online stimuli Web site.

COURSE EXTRAS• A continental breakfast will be available to those staying at the hotel.• Complimentary Wi-Fi access in guest rooms at the hotel.

CALIFORNIA ACEP SPONSORED CONFERENCES

• Emergency Medicine in Yosemite*, January 13-16, 2016

Yosemite, CA

• The Ohio ACEP Board Review*, February 8-12, 2016

Newport Beach, CA

ENDURING MATERIALS - ONLINE CME

SonoSim®* Enduring Materials - Computer Software (Modules)

Info: (310) 315-2828 www.sonosim.com

• SonoSim® Ultrasound Training Solution -

Aorta/IVC: Core Clinical Module


Bladder: Core Clinical Module


FAST Protocol: Core Clinical Module


Fundamentals of Ultrasound: Core Clinical Module


Intestinal/Biliary: Core Clinical Module


Musculoskeletal: Core Clinical Module


Ocular: Core Clinical Module


Rapid Ultrasound in Shock: Core Clinical Module


Soft Tissue: Core Clinical Module


Vascular Access: Core Clinical Module

*Approved for AMA PRA Category I CreditsTM

The California Emergency Medicine Advocacy Fund (CEMAF) has transformed California ACEP’s advo-cacy efforts from primarily legislative to robust efforts in the legislative, regulatory, legal, and through the Emergency Medical Political Action Committee, political arenas. Few, if any, organization

of our size can boast of an advocacy program like Califor-

nia ACEP’s; a program that has helped block Medi-Cal pro-

vider rate cuts, stop the $100 million raid on the Maddy

EMS Fund, and fight for ED overcrowding solutions – and

that’s just the last year! The efforts could not be sustained

without the generous support from the groups listed be-

low, some of whom have donated as much as $0.25 per

chart to ensure that California ACEP can fight for emergen-

cy medicine. Thank you to our 2014-15 contributors (in alphabetical order):

• Alvarado Emergency Medical Associates• Antelope Valley Emergency Medical Associates• Beach Emergency Medical Associates• Berkeley Emergency Medical Group• CEP America• Chino Emergency Medical Associates• Coastline Emergency Physicians Medical Group• Culver City Emergency Medical Group• Eden Emergency Medical Group• EMP Management Group• Grossmont Emergency Medical Group• Hollywood Presbyterian Emergency

Medical Associates• Mills Peninsula Emergency Medical Group• Montclair Emergency Medical Associates• Napa Valley Emergency Medical Group• Orange County Emergency Medical Associates• Pacific Emergency Providers• Pacifica Emergency Medical Associates• Riverside Emergency Physicians• San Dimas Emergency Medical Associates• San Francisco Emergency Medical Associates, Inc.• Sherman Oaks Emergency Medical Associates• South Coast Emergency Medical Group, Inc.• Tarzana Emergency Medical Associates• TeamHealth• Tri-City Emergency Medical Group• Valley Emergency Medical Associates• Valley Emergency Physicians • West Hills Emergency Medical Associates

CEMAFDonors ANNOUNCEMENTS |


For more information on upcoming meetings, please e-mail us at [email protected]; unless otherwise noted, all meetings are held via conference call.

| CALIFORNIA ACEP UPCOMING MEETINGS & DEADLINES

JANUARY 2016

SUN MON TUES WED THURS FRI SAT

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

31

FEBRUARY 2016


1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29

MARCH 2016


1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

JANUARY 2016

12th at 9 am Reimbursement CommitteeConference Call

13th – 16th Emergency Medicine in YosemiteYosemite, CA

14th at 10 am Government Affairs CommitteeConference Call

15th at 10 am Practice Management CommitteeConference Call

22nd at 10 am Member Services CommitteeConference Call

FEBRUARY 2016

4th Board of Directors MeetingSacramento, CA

8th – 12th Ohio Chapter Board Review CourseNewport Beach, CA

MARCH 2016

1st at 9 am Reimbursement CommitteeConference Call

9th Government Affairs SubcommitteesConference Call

16th at 10 am Government Affairs CommitteeConference Call

18th at 10 am Practice Management CommitteeConference Call

31st at 10 am Government Affairs CommitteeConference Call

JANUARY 2016 | 17

CAREER OPPORTUNITIES |

ANAHEIM, CALIFORNIA: Anaheim Regional Medical Center’s Democratic ED Physician group has immediate part time/full time positions available for BC /BE Emergency Physicians. We have a busy, high acuity department with 44,000 annual visits. Shifts are 9-10 hours long with night shift/holiday differential and double coverage during peak hours. We offer a competitive salary, paid malpractice and full partnership opportunities. Interested physicians E-mail your CV and references to [email protected], [email protected] or call us at 714-999-5112.

CALIFORNIA EMERGENCY PHYSICIANS:

• Glenn Medical Center, Willows, California 73 miles north of Sacramento on the 5 ER 4000 visits/year, on-site lab & x-ray, CT & MRI Mon-Sat. All ICU transferred to 25 miles away ambulance (paramedics) on-site for all transfers

• Orange County, Orange, California 73 bed community hospital 8 bed ER Paramedic receiving. Volume low. 10 x 24hr = 240,000/yr +incentive

• East Los Angeles, California 120 bed community hospital urgent care (not paramedic receiving) volume 700/mo. Guarantee $100/hr

• Norwalk, California 50 bed hospital, 550-600 patients/mo. Paramedic receiving $100/hr

• Downtown Los Angeles Downtown Los Angeles Emergency Medicine - ABEM ABOEM or Eligible w/experience 5000 annual visits, STEMI, stroke, non-trauma center Physicians, PAs & NPs needed

Send CV to 213 482 0577 Or phone 310 678 7647 (Dr. Fagan)

CENTRAL COAST: MMC Emergency Physicians Medical Group at Marian Regional Medical Center-Santa Maria-seeking a qualified BC/BE Emergency Physician to join a stable, independent, single hospital, democratic group. Partnership opportunity available in this well-supported ED with growing census of >80,000 visits/year. New hospital/new ED opened in 2012. Practice alongside experienced colleagues at a STEMI receiving center, a Level III Trauma Center and a certified Stroke Center that offers 24/7 in-house hospitalists, OB laborists and intensivists in addition to a NICU, peds hospitalists and FP residents. Live on the beautiful Central Coast, anywhere from San Luis Obispo to Santa Ynez/Solvang, with easy commutes to work and easy access to beaches/mountains/wine country along with all types of outdoor recreation. This is the job your residency director told you to find.For more details, contact David Ketelaar, MD at [email protected] Phone (805) 440-0837

FULLERTON, CALIFORNIA: Join our ED team in beautiful north OC at St Jude Med Ctr. Our 36 bed state of the art ED serves >60K pts/yr with 54 hrs MD, 44 hrs PA and 100% scribe coverage per day, 9 hr shifts. We have held this stable contract for >36 years, have excellent back-up, 24hr in house Critical Care, OB, neonatologist and hospitalists. We are a STEMI receiving center and “Advanced Comprehensive Stroke Center” and provide excellent compensation with night differential. EM BC/BE mandatory. Interested physicians send CV to [email protected]

LOS ANGELES-CULVER CITY: Southern California Hospital at Culver City Rare opportunity to join a Westside LA ER group. Group seeks BC/BE emergency physician to work Part-Full Time as an independent contractor. Excellent compensation with malpractice paid. Nine hour shifts with PA double coverage. 90% nights already covered! Remodeled ER, Computerized Charting and PACS!Email CV and references to [email protected]. Phone 951-898-0823.

NEWPORT BEACH, CALIFORNIA: Newport Emergency Medical Group (NEMG) is accepting applications for an Emergency Physician position which will open in September, 2015. NEMG provides Emergency Physician staff for the Hoag Hospitals in Newport Beach and Irvine. Extremely stable group practicing at Hoag for 34 years. New group members gain financial and scheduling parity after three years. Competitive reimbursement.Contact Ray Ricci, MD at [email protected].

American Medical Response (AMR)Ken Bradford, Operations841 Latour Court, Ste D, Napa, CA 94558-6259Phone: (707) 953-5795Email: [email protected]

A Work Safe Environment Steve Bristow, EMTP3140 Aldridge Way, El Dorado Hills, CA 95762Phone: (925) 708-5377Email: [email protected]: www.worksafeenvironment.com

EMS AcademyNancy Black, RN, Course Coordinator1170 Foster City Blvd #107, Foster City, CA 94404Phone: (866) 577-9197Fax: (650) 701-1968Email: [email protected]: www.caems-academy.com

Compliance TrainingJason Manning, EMS Course Coordinator3188 Verde Robles Drive, Camino, CA 95709Phone: (916) 429-5895 Fax: (916) 256-4301 Email: [email protected]

CSUS Prehospital Education ProgramDerek Parker, Program Director3000 State University Drive East, Napa Hall, Sacramento, CA 95819-6103Office: (916) 278-4846 Mobile: (916) 316-7388 Email: [email protected]: www.cce.csus.edu

ETS – Emergency Training ServicesMike Thomas, Course Coordinator3050 Paul Sweet Road, Santa Cruz, CA 95065Phone: (831) 476-8813 Toll-Free: (800) 700-8444 Fax: (831) 477-4914 Email: [email protected]: www.emergencytraining.com

Looking for an ITLS course?

Please call 916.325.5455 or E-mail Lucia Romo: [email protected] for more information.EMREF is a proud sponsor of California ITLS courses.

Fast Response School of Health Care EducationLisa Dubnoff, MICP/RN, Paramedic Director2075 Allston Way, Berkeley, CA 94704Phone: (510) 809-3646Fax; (866) 628-5876Email: [email protected]: www.fastresponse.org

Loma Linda University Medical CenterLyne Jones, Administrative Assistant Department of Emergency Medicine11234 Anderson St., A108, Loma Linda, CA 92354Phone: (909) 558-4344 x 0 Fax: (909) 558-0102 Email: [email protected]: www.llu.edu

Medic AmbulanceJames Pierson, EMT-P506 Couch Street, Vallejo, CA 94590-2408 Phone: (707) 644-1761 Fax: (707) 644-1784Email: [email protected]: www.medicambulance.net

Napa Valley CollegeGregory Rose, EMS Co-Director2277 Napa Highway, Napa CA 94558Phone: (707) 256-4596Email: [email protected] Web: www.winecountrycpr.com

NCTI – National College of Technical InstructionLena Rohrabaugh, Course Manager333 Sunrise Ave Suite 500, Roseville, CA 95661Phone: (916) 960-6284 x 105 Fax: (916) 960-6296Email: [email protected] Web: www.ncti-online.com

Oakland Fire DepartmentSheehan Gillis, EMT-P, EMS Coordinator 47 Clay Street, Oakland, CA 74607Phone: (510) 238-6957Fax: (510) 238-6959 Email: [email protected]: http://www.oaklandnet.com/fire/

PHI Air Medical, CaliforniaGraham Pierce, Course Coordinator 801 D Airport Way, Modesto, CA 95354Phone: (209) 550-0884 Fax: (209) 550-0885Email: [email protected] Web: http://www.phiairmedical.com/

Riggs Ambulance ServiceGreg Petersen, EMT-P, Clinical Care Coordinator100 Riggs Ave, Merced, CA 95340Phone: (209) 725-7010Fax: (209) 725-7044Email: [email protected]: www.riggsambulance.com

Rocklin Fire DepartmentChris Wade, Firefighter/Paramedic4060 Rocklin Road, Rocklin, CA 95677Phone: (916) 625-5311Fax: (209) 725-7044Email: [email protected]: www.rocklin.ca.us

Rural Metro AmbulanceBrian Green, EMT-P1345 Vander Way, San Jose, CA 95112Phone: (408) 645-7345Fax: (408) 275-6744Email: [email protected]: www.rmetro.com

Santa Rosa Junior College Public Safety Training CenterBryan Smith, EMT-P, Course Coordinator5743 Skylane Blvd, Windsor, CA 95492Phone: (707) 836-2907 Fax: (707) 836-2948Email: [email protected] Web: www.santarosa.edu

WestMed CollegeBrian Green, EMT-P5300 Stevens Creek Blvd., Suite 200, San Jose, CA 95129-1000Phone: (408) 977-0723 Email: [email protected] Web: www.westmedcollege.com

Search for upcoming courses: http://cms.itrauma.org/CourseSearch.aspx

American Health Education, IncPerry Hookey, EMT-P7300B Amador Plaza Road, Dublin, CA 94568Phone: (800) 483-3615Email: [email protected]: www.americanhealtheducation.com

Verihealth/Falck Northern California Ken Bradford, Training Coordinator2190 South McDowell Blvd, Petaluma, CA 94954Phone: (707) 766-2400Email: [email protected] Web: www.verihealth.com

Allan Hancock CollegeMike DeLeo, EMT – Course Coordinator800 S. College, Santa Maria, CA 93454Phone: (805) 878-6259Fax: (805) 922-5446Email: [email protected]: www.hancock.cc.ca.us



California EMS AcademyNancy Black, RN, Course Coordinator1170 Foster City Blvd #107, Foster City, CA 94404Phone: (866) 577-9197Fax: (650) 701-1968Email: [email protected]: www.caems-academy.com








Medic AmbulancePerry Hookey, EMTP, Education Coordinator506 Couch Street, Vallejo, CA 94590-2408 Phone: (707) 644-1761 Fax: (707) 644-1784Email: [email protected] Web: www.medicambulance.net


NCTI – National College of Technical InstructionLawson E. Stuart, RN, CEN, EMT-PLena Rohrabaugh, Course Manager333 Sunrise Ave Suite 500, Roseville, CA 95661Phone: (916) 960-6284 x 105 Fax: (916) 960-6296Email: [email protected] Web: www.ncti-online.com








EMREF offers the following California providers list:

















































To advertise with Lifeline and to take advantage of our circulation of over 3,000 readers, including Emergency Physicians, Groups, and Administrators throughout California who are eager to learn about what your business has to offer them, please contact us at [email protected] or give us a call at (916) 325-5455.

NORTHERN & CENTRAL CALIFORNIA: Kaiser Permanente is looking for excellent BE/BC Emergency Medicine physicians interested in full time or less than full time position with dynamic physician group throughout Northern and Central California.

The Permanente Medical Group, Inc. offers:

• Competitive salary• Recruitment bonus• Mortgage loan program (approval required)• Comprehensive benefits package, including excellent retirement plans• Malpractice insurance coverage• Cutting-edge technology

TPMG, Inc. allows you to combine a medical practice of which you can be proud and a quality of life you deserve. To apply, send your curriculum vitae to Narlyn Villaruel at [email protected] or call (800) 777-4912. http://physiciancareers-ncal.kp.org

RIVERSIDE, CALIFORNIA: PARKVIEW MEDICAL CENTER – Great opportunity to join a 14 year ER group. Group seeks BC/BE Emergency Physician to work Part/Full Time as an independent contractor. Excellent Top Tier Compensation based on productivity with malpractice paid. Ten hour shifts with MD double coverage and 12 Hour PA. Computerized equitable shift scheduling. Efficient Computerized Charting and PACS! Soon to break ground on New Emergency Department. Email CV and references to [email protected] | Phone (951) 898-0823

SANTA CRUZ/MONTEREY BAY/SALINAS, CALIFORNIA: Salinas Valley Memorial Healthcare System’s (SVMHS) well-established democratic emergency medicine group is seeking part-time/full-time applicants to staff a busy, high acuity emergency department with approximately a 60K annual volume (STEMI/Stroke receiving hospital). SVMHS is located in Salinas, California but most of our physicians/PAs live in Santa Cruz area or Monterey/Carmel. We use EMR/CPOE with assistance of medical scribes. Must be BC/BE Emergency Medicine. Competitive salary/benefits. 2-year partnership track with FT employment. Enjoy where you work, enjoy where you play! Interested applicants please send your CV to [email protected]

SOUTHERN CALIFORNIA: Huntington Emergency Group is seeking BE/BC Emergency Physician to work in prime Southern California location for a 65,000+volume ED. Home of the Rose Bowl and 10 min. drive to Downtown Los Angeles. Great Lifestyle! ED is generously staffed with top working conditions. Full-Time and Part-Time positions available. Group offers competitive compensation. Opportunity for partnership based on commitment and competency. For more details, please contact: Yvonne Quintero at: (626) 397-5116 or at: [email protected].

SOUTHERN CALIFORNIA – ORANGE COUNTY: Full time and part time independent contracting emergency physicians needed for high volume, high acuity practices. Chest Pain Center, Stroke Center, Pediatric Level II trauma center - large independent group with forty years of clinical excellence for two acute care facilities. Expanding group needs BC/BE emergency physicians and pediatric emergency physicians. Excellent compensation, malpractice paid, scribes, midlevel providers, 8 – 9 hour shifts, excellent call panel coverage.Email CV and references to [email protected], fax to 714-543-8914




EMS AcademyNancy Black, RN, Course Coordinator1170 Foster City Blvd #107, Foster City, CA 94404Phone: (866) 577-9197Fax: (650) 701-1968Email: [email protected]: www.caems-academy.com








Medic AmbulanceJames Pierson, EMT-P506 Couch Street, Vallejo, CA 94590-2408 Phone: (707) 644-1761 Fax: (707) 644-1784Email: [email protected]: www.medicambulance.net


NCTI – National College of Technical InstructionLena Rohrabaugh, Course Manager333 Sunrise Ave Suite 500, Roseville, CA 95661Phone: (916) 960-6284 x 105 Fax: (916) 960-6296Email: [email protected] Web: www.ncti-online.com









American Health Education, IncPerry Hookey, EMT-P7300B Amador Plaza Road, Dublin, CA 94568Phone: (800) 483-3615Email: [email protected]: www.americanhealtheducation.com

Verihealth/Falck Northern California Ken Bradford, Training Coordinator2190 South McDowell Blvd, Petaluma, CA 94954Phone: (707) 766-2400Email: [email protected] Web: www.verihealth.com






























































































OHIO ACEPEMERGENCY MEDICINE BOARD REVIEW COURSE

COMPREHENSIVE. RELEVANT. ESSENTIAL.

OHIO ACEP IS EXCITED TO ANNOUNCE A

NEW DATE & LOCATION IN PARTNERSHIP WITH

CALIFORNIA ACEP!

February 8 - 12, 2016 Newport Beach, CA

THE OHIO ACEP EMERGENCY MEDICINE BOARD REVIEW

February 8 - 12, 2016 (Newport Beach, California)

www.ohacep.org (614) 792-6506

Approved for AMA PRA Category 1 Credits TM.

lifelineCalifornia Chapter, American College of Emergency Physicians

1121 L Street, Suite 407Sacramento, CA 95814

PRSRT STDUS POSTAGE

PAIDCPS

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