Reflections on Leaving San Diego

San Diego is a very special medical community. The problems that seem to plague other communities are rare here. We have physicians in medical groups of all sizes that get along with each other. We have one of the top medical school faculties in the country that integrates well with community physicians. We have large and powerful health systems that compete for market share, yet the physicians among them are colleagues. Maybe it is our nice weather or relaxed atmosphere, but San Diego County physicians mostly blend with each other in agreeable partnership. We are physicians united for a healthy San Diego.

It has been my great privilege for the past three and a half years to serve as editor of San Diego Physician and as your Communications Committee chair for the SDCMS. Representing you to the public has been fun and challenging. I receive nothing but positive feedback for my editorials, even when I challenge the status quo. I like to be provocative, to push the envelope, to embrace the future over the present, yet in San Diego I never get the animosity I sometimes receive when I speak or publish elsewhere.

This summer I am taking a new position that moves my professional work out of San Diego County. By the time you read this, I will be at Eisenhower Medical Center in Rancho Mirage as vice president for primary care. I will be launching a new, personalized medical home primary care practice in La Quinta that may become a model for the region. I will get to “walk the walk” about practice redesign that I have published in San Diego Physician. I will also be the academic officer guiding the development of a new, regional medical education campus with residency training in family medicine, internal medicine, and a fellowship in geriatrics. These specialties are in short supply and in great need, yet few are choosing them. We plan to help change that by developing an attractive and well-compensated model of practice that emphasizes care coordination outside of visits and the use of health information technology (HIT) including secure online communication.

The practice of medicine has entered a period of rapid change. The traditional appointment-based delivery system does not meet today’s expectations of “on-demand” service and the ability to improve the health of whole populations. Like other service industries in this new information age, new models of care are emerging. In general, medical groups in San Diego have been slow to change. Most large and small practices have yet to implement advanced information systems and online communication and care. Kaiser has made the transition with their new HealthConnect platform, and over 500,000 people in San Diego County are experiencing that. UCSD has also moved forward with its MyChart application of the Epic record system. Some small practices have implemented advanced HIT and online communication, but most have not. This is understandable since, nationwide, HIT application is still less than 30 percent. With the new HITECH funding from the Obama administration, $44,000 per physician, this is likely to change quickly over the next three to five years.

The San Diego County Medical Society (SDCMS) stands out among the medical societies in California as being proactive and aggressive in helping physicians adjust to change. Organized medicine has a reputation for staunchly defending the status quo, and sometimes this is important, but when inevitable change is happening, SDCMS helps physicians rather than fight futile battles.

I am not really leaving San Diego. We are keeping our home here and will return on weekends. Not a bad life to have a home in San Diego and one in Palm Desert. I welcome any of you to visit Eisenhower Medical Center and see what we are doing. I will continue as a volunteer clinical professor at UCSD, so I may be reached at: jscherger@ucsd.edu or jscherger@emc.org. It has been my honor and pleasure to serve you these past three and a half years.