Dr.D

Dr.D

Mission Statement

Our objective is to train full spectrum Addiction Specialists who provide addiction services across all age groups and in all settings.

Objectives

The fellow will learn how to act as a consultant in Addiction Medicine in their primary care home as well as managing a primary care practice with a focus on health leadership and advocacy. The graduate will be able to lead the transformation and integration of addiction medicine in the primary care setting – also serving as a consultant for more nuanced substance use disorders.

We are recruiting for 2 fellows. The fellows will work with Addiction specialists in multiple settings, including the inpatient and ambulatory sites of Ventura County Medical Center and with the Behavioral Health Department of Ventura County. Alcohol Drug Treatment Specialists (ADTS) will be utilized as part of a team-based treatment approach.

Our accreditation application is currently being reviewed by the ACGME and we expect a positive answer by the end of October 2018. In the meantime, we are proceeding with taking applications for the fellowship for 2019-2020 and anticipate accreditation by that point. The graduate will be able to procure the hours necessary and able to sit for the ABPM Addiction Medicine board examination.

How To Apply

Submit the following:

  • CV
  • 1-2 page personal statement stating your goals as well as career plans
  • At least 2 Letters of Recommendation that address your suitability for a career as an Addiction Medicine specialist

The letters of recommendation should be sent directly via e-mail or by mail to our program coordinator.

Submit all documents to:
 
Yvette Cortez, Primary Care Addiction Medicine Fellowship Program Coordinator
Medical Education Office – Ventura County Medical Center
300 Hillmont Ave
Bldg 340, ste 120
Ventura, CA 93003
Tel: 805-652-6228
Fax: 805-652-6606
This email address is being protected from spambots. You need JavaScript enabled to view it.

We look forward to your application!

Tipu V. Khan, MD, FAAFP
Fellowship Director

Background

There are over 20 Million people struggling with addiction in the United States – yet there are only 4,400 addiction specialists available to care for these patients1. Abuse of illicit drugs, alcohol, and tobacco cost our country more than $740 billion annually2. The County of Ventura experiences 14 deaths per 100,000 people due to addiction disorders and overdoses. 5.7 per 100 people in our county struggle with Opiate Use Disorder (OUD) – that’s 5.7% of our population! To combat this public health epidemic, we need more addiction trained primary care physicians in Ventura County. CHCF estimates that adding at least 108 buprenorphine providers will double our current number and fill the treatment gap.
1 https://www.asam.org/resources/public-resources/what-is-an-addiction-specialist#6e71a99c-f793-414e-8b25-5ef736e7fdc9
2 https://www.drugabuse.gov/related-topics/trends-statistics

Experience

Trainees will gain expertise in:

  • Assessment and management of patients with various substance use disorders.
  • Assessment and management of co-occurring psychiatric co-morbidities.
  • Understanding the different levels of care, as defined by ASAM: including Intensive Outpatient Programs (IOP), Partial Hospitalization Programs (PHP), Hospital Care, Residential Treatment Centers (RTC), Social Model Detoxification Centers, Sober Livings, etc.
  • Gain comfort in managing acute withdrawal and intoxication states.
  • Management of chronic pain, especially in the setting of addiction.
  • Management, including the treatment of, HIV/AIDS and Hepatitis C.
  • The various counselling strategies from cognitive behavioral therapy to peer and groups to 12 steps.
  • Management of addiction during pregnancy including medication assisted treatment.
  • Management of Neonatal Abstinence Syndrome in the NICU and outpatient methadone tapers.
  • Harm reduction strategies such as naloxone distribution, clean needle exchange, etc.
  • Teaching the fundamentals of addiction to primary care residents at the Ventura County Family Medicine Residency Program and other clinics and health care facilities in our county.
  • Managing sobriety through medication assisted treatment.
  • Research: There will be allocated time for a research project during the fellowship. Fellow will present their research project to the VCMC community via Grand Rounds prior to completion of fellowship.
  • Leadership: Participate in hospital, clinical, insurance, and other local committees such as the MERIT (Medication Error Reduction Team), CORE Committee (Chronic Opiate Review and Evaluation), Gold Coast HCP Opioid Committee.
  • Experience locations include:
    • Emergency Department and Inpatient Training including the inpatient consultation service: Ventura County Medical Center
    • Outpatient training: Addiction Clinic for the Homeless, Academic Family Medicine Center Primary Care Clinic, and our satellite primary care clinics.
    • Behavioral Health Training: Rotating with Ventura County Behavior Health Alcohol and Drug Program, Psychiatry, Psychology, and AA/NA.
    • Residential Treatment Centers/Detox Centers: Multiple community stakeholders and organizations including Prototypes Women’s Center, Changing Tides, and others.
    • Methadone: Rotations with Aegis Treatment Centers.
    • Pain Management: Rotations with Pain Specialist at VCMC – inpatient consultations and outpatient.
    • Obstetrics: VCMC and Prototypes.
    • Neonatal: VCMC NICU and outpatient clinics.
  • Academics: Precepting and Teaching at the Academic Family Medicine Center Family Medicine Residency Clinic.

Benefits

  • $75,000 per year, to be paid monthly as employee of Ventura Faculty Associates
  • Malpractice insurance (covered under VCHCA)
  • 15 business days (3 weeks) of paid vacation
  • 5 business days (1 week) of paid CME
  • 9 paid county holidays
  • CME budget: $1000
  • Health insurance: VCHCP Bronze Plan
  • Worker’s compensation insurance

Eligibility Requirements

  • Successful completion of an ACGME accredited residency training program with board certification or anticipated board certification prior to the start of fellowship.
  • Family or Internal Medicine preferred. Other specialties will be considered.
  • Have an unrestricted California Medical License and DEA.
  • It is preferred that the applicant obtain their DEA X-waiver prior to the fellowship program but training will be provided during fellowship if needed.
  • Must be eligible to be a Medi-Cal (Medicaid) and Medicare provider.

Sample Schedule - Inpatient Block

  Monday Tuesday Wednesday Thursday Friday
AM

Inpatient/ED Consults

 

Longitudinal Learning

Inpatient/ED Consults

 

Longitudinal Learning

Inpatient/ED Consults

 

Longitudinal Learning

Inpatient/ED Consults

 

Longitudinal Learning

Inpatient/ED Consults

 

Longitudinal Learning

PM

Continuity Clinic

VCBH/ADP

Longitudinal Learning

Addiction Medicine Clinic

 

Prototypes

Changing Tides

Precept AFMC

Sample Schedule - Outpatient Block

  Monday Tuesday Wednesday Thursday Friday
AM

Precpt AFMC

VCBH/ADP

Rotating Satellite
Addiction Medicine Clinic

Aegis Treatment Center

Pain Management

PM

Addiction Medicine Clinic

HCH Addiction Medicine Clinic

Longitudinal Learning

Continuity Clinic

Precept AFMC

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Set Up Powerchart Touch

Powerchart Touch FAQs

What do I need to use Touch?

You will need an iphone, ipod or ipad with iOS 10.2 or greater or Android device with OS4.4 or greater. We are not providing devices for using with Touch, but if you get an educational allowance, you may be able to use that to purchase one.

Should I use an ipad, or an iphone?

The ipad version of the app has fewer clicks for several functions, and allows graphing for labs, vitals and growth chart. There is generally a slight preference for the ipad in the outpatient setting, and for the iphone in the inpatient setting, but both work well and people clearly have individual preferences. If you see kids, you may prefer to use an ipad. You are welcome to try, and use both. Android devices have more limited functionality at the present time.

How do I get started?

First, download at least one of the Cerner apps from the app store. The iOS apps are Powerchart Touch, Camera Capture, Message Center and Instanote. Camera Capture, Instanote and a limited version of Message Center are available for the Android OS. You can download and use as many as you want. You can take clinical photos with both the Camera Capture app and the Powerchart Touch app. Then, follow this link and login here using your Cerner username and password (the one you use for the second/small blue login box on the desktop).

https://cernercentral.com/device-access/tenants/8cf1bb66-7b18-4eaa-b641-538f19feb923/user/

Click the "Request Access" button on the right side of the blue banner bar and an access code will be sent to you. When you get your access code, enter it in one of the apps and get started. Access codes expire in a week, so try to use them right away, or you will have to request one again. Each code is good for one device. If you have an additional device that you would like to use, go to the website and request a second code. You can use as many devices as you would like. You have to login with your own username to request a code for yourself, you cannot request a code for someone else.

Who Can Use Powerchart Touch?

This is currently a physician supported project for providers. We are allowing access to a limited number of non-providers who will use Powerchart Touch to assist their providers. Non-providers must be sponsored by a current provider user who has been using Powerchart Touch regularly. The sponsor must be willing to be the primary point of contact for that user and responsible for making sure they know how to get access codes (with the link), training (YouTube videos) support (#1=you, #2=Outlook Group, #3=Dr Patterson or Dr. Brecht-Doscher). The non provider should list the name of their sponsor in their access code request.

I requested a code with that link and didn’t get one, what should I do?

Look in your Clutter or Spam folder for an email from Millennium+. This is your activation email. If you are an Outlook user I can almost guarantee this will go to Clutter. You can also log back into the site above after a day or so and check for a code and it will probably be there.

How do I learn how to use Touch?

The app is quite intuitive, and some people have started without any training. We do recommend some training in order to get the most from the apps. There are introductory training videos available here

https://www.youtube.com/playlist?list=PL6psK6r4RFx07oh2sZkHyp9W0DmdCU6RJ

If you are interested in a training session, contact This email address is being protected from spambots. You need JavaScript enabled to view it.

Can I dictate into my device using Touch?

The dictation is one of the major strengths of the apps. There is no voice training or additional setup required for dictation within Powerchart Touch. Use the microphone button that is above the keyboard for your dictation.

Can I use my Dragon voice templates in Touch?

Dragon voice templates can be imported from our desktop version but cannot be created, or updated within Touch. These are voice commands that you would use for commonly dictations (things like normal physical exam, ROS, procedure notes). Dr. Patterson has created several standard templates that have been uploaded to your Touch profile. You can review what is available on your profile in Touch by holding down the microphone button in the app.

If you have custom templates you have created within the desktop version of Dragon, these can be imported into Touch. If you have custom templates and have changes or additions you have been thinking of making, it would be best to spend some time making those changes before you export them into Touch.

To add your custom commands to Touch, first activate the Touch app(s) with your access code, then send an email to This email address is being protected from spambots. You need JavaScript enabled to view it. requesting that your Dragon voice commands are imported into Powerchart Touch (you can expect that it will take about a week for this to occur).

Can I use my dot phrases in Touch?

You can not use .phrases in Touch. If you save your note (instead of signing it), you can add them to the note on the desktop (this is very useful for things like lab templates). If you would like to create voice commands from your text .phrases on the desktop, you can create them in the Dragon desktop using copy and paste by following the instructions here https://www.youtube.com/watch?v=R2jn9Oy-vn0 and then request that your commands are imported to Touch as described above.

What kind of notes can I create?

You can create notes using Dynamic Documentation in Powerchart Touch. You can also complete Dynamic Documentation notes started on the desktop as long as they were saved and not signed. You can not add addenda to already signed notes. If you use the HPI, ROS, PE and A&P fields on the Review page in Touch they will pull in to those sections on the desktop (Workflow pages and in Dyn Doc), and vice versa (if you type in those fields on the Workflow pages, those sections will pull in to Touch.) You can also dictate into the fields listed below on the Review page in Touch and then include dictated text to any location in any note type on the desktop by using the .phrases:

.history_of_present_illness

.review_of_systems

.physical_exam

Where can I view the images I took with the apps?

You can view these images in the Media Gallery on the Review section of Powerchart Touch, or the Dashboard/Summary and Workflow pages on the desktop. You can also add them to any location in a note - for Dynamic Documentation, see this video https://youtu.be/Lf_vW-Jngoo and for Powernotes, see this one https://youtu.be/QiSG3oV8DMw . At this time, you will need to add the images to the notes on the desktop (if you would like to dictate your note in Powerchart Touch, Save, but do not Sign it before trying to add the images on the desktop).

What should I do about upgrades?

As new Powerchart Touch features are developed by Cerner, these are available via updates to the apps. You can take upgrades to the app as soon as they are available to use the new features, and will be required to update after a short period of time (typically 30 or 60 days.) When a new iOS operating system is released (ie 11 to 12), it is recommended that you do not upgrade your iOS until Cerner announces that it is safe to do so. We will let you know when that occurs. Minor iOS upgrades (ie 10.2 to 10.3) can be taken at any time.

If I have questions about using Touch what should I do?

Please ask your questions on the Outlook Powerchart Touch group (or browse to see if it was already asked and answered). If you do not have an Outlook account, you can email This email address is being protected from spambots. You need JavaScript enabled to view it. We will be sending out announcements about Touch to the Outlook group, or to your email address, please ensure these do not go to your spam or clutter boxes.

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Dorothy DeGuzman, M.D., M.P.H.

Attended Emory University School of Medicine and graduated in 2007 with a joint MD/MPH in global health. She then completed residency at Lawrence Family Medicine Residency in 2010 and stayed on an extra year to complete a high risk OB fellowship. After completing training she and her husband moved to rural western North Carolina, she worked there for 6 years doing full spectrum family medicine including C-sections. She enjoys hiking, cooking and spending time with her two young sons.
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Antidepressants Grid 2018

An antidepressant gird with dosing and side effects.  

PDF file is loading ...

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Release Notes and Updates

Release Notes and Updates published that have updates on dot phrases, Acute Workflow pages, etc.

2018

2017

Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)

CDC Infection Control Isolation Guidelines PDF

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Ian Wallace, M.D.

Dr. Wallace completed a BA in Geology at Carleton College in 1995 and then worked in software engineering for several years.  He attended medical school at the Univeristy of Colorado School of Medicine from 2006-2010 involved extensively in the rural medicine training program.  He completed his residency at Ventura County in 2013 followed by 6 months of fellowship training in advanced procedures for endoscopic skills.  From 2014-2016 he worked and taught with the family medicine faculty at Contra Costa Regional Medical Center.  He joined the Ventura Family Medicine Residency Faculty in June of 2016 to help develop an endoscopic training program for the residents.  When not in the GI lab or the clinic he enjoys being at the beach with his family exploring the tide pools.

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Daniel Cox, M.D., M.S.

After completing a BS and MS in Earth Sciences at Stanford University in 2004, Dr. Cox worked in a vascular surgery research lab before attending medical school at the University of California, San Francisco. He subsequently completed a residency in Internal Medicine at UCSF in 2014 before working in homeless primary care in downtown LA. He joined the VCMC family after completing a 1-yr fellowship in Hospice & Palliative Medicine at UCSF in San Francisco. He enjoys teaching communication skills to rotating residents on the Palliative Care Team. When at home in Ojai, he enjoys yoga, trail running, and spending time with his wife and growing family. 
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Ventura Global Health Fellowship

Mission

The Ventura faculty group is proud to partner with Ventura Global Health Project in offering a fellowship in global health. Our fellowship is designed to provide a hands-on global health experience at several domestic and international locations. Our goal is to support high quality, sustainable medical care in the communities we serve.

Application Timeline

  • Applications accepted - September 15th
  • Deadline for application submission - November 15th
  • Announcement of positions - December 15th

Positions

  • Up to 2 fellows per year

Timeline

  • Up to six months abroad and six months at base location in Ventura. Minimum of three months at each international location. Locations
  • We will work with fellows to develop the best mix of location and duration at each site.
    • Location options
      • Ventura, California
      • Santo Tomás La Unión, Guatemala
      • Monrovia, Liberia
      • N'Djamena, Chad
      • Ethiopia

Locations 

Ventura - Primary Contact - Wallace Baker MD, Ventura County Family Medicine Program

Educational and clinical experience in Ventura California. This experience will include work in local clinical setting an average of 3 days per week with additional elective educational opportunities an average 2 days per week in ultrasound training, inpatient infectious disease and outpatient TB and HIV clinic. Call opportunities for inpatient medicine and ER may exist. The core urgent care setting is in an urban underserved location with a moderate sized Mixteco population. Fellows will also be expected to lead residency interest group meetings and provide didactics on global health topics at residency core conference. We strive to be flexible and cater our on-site curriculum to the educational and career goals of the fellow as much as possible.

Guatemala - Primary Contact - Zack Self MD, M.D., FAAFP

This experience takes place in the rural Guatemalan community of Santo Tomás La Unión, Suchitepéquez- a town of approximately 15,000 inhabitants. Despite the relatively small size of the base community, the patient catchment area easily exceeds 100,000- as many patients travel significant distances to seek accessible, compassionate, high quality, modern healthcare.

The host site is a unique purpose built model hybrid health center consisting of two outpatient clinic rooms, two inpatient beds, obstetric delivery bed, fully equipped operating room (with LED OR lights), and a state-of-the-art resuscitation area (which boasts- among other resources- an Oxylog 3000 ventilatorLUCAS mechanical CPR, and Ambu fiberoptic intubation scope). Ultrasound is the diagnostic imaging modality of choice- with handheld devices for use in the outpatient setting and a robust portable ultrasound for more comprehensive evaluations. There is an in-house laboratory- granting access to immediate point-of-care labs via the iSTAT handheld blood analyzer. A well-stocked pharmacy is on site. Patient care is documented on an iPad based EMR. The site is an authorized distributor of Ecofiltro point-of-use water filters (supported by CLEAN International).

The fellow will be heavily involved in every component of patient care: outpatient clinic, inpatient/hospitalist medicine, emergency medicine, resuscitation and critical care, obstetric care- including operative obstetrics when indicated.

Educational opportunities include: high fidelity in-situ simulation, hands-on ultrasound training (from basic POCUS to advanced echo), and airway training (gaining familiarity with direct and video laryngoscopy, as well as fiberoptic airway management).

Research opportunities exist.

Fellows will reside on-site at a newly remodeled penthouse suite, which sits atop the clinic structure and provides amazing views of the surrounding lush mountains.

Spanish language capability is strongly preferred, but not strictly obligatory (translation services available for Spanish and K’iche’ languages as needed).

Chad - Primary contact - James Appel MD

This experience takes place in in the N'Djamena Chad, the capital city with a population of 2 million. The host site, Guinebor Hospital, has 40 beds and performs 100-150 deliveries and 80-100 major surgeries per month. The patient population is mostly Muslim and Arabic speaking while the staff speaks French and Arabic and several other dialects.

The clinical experience will consist of obstetrics in limited resources settings (c-section, c-hysterectomy, repair of uterine rupture, symphysiotomy, vacuum assisted deliveries, etc.) Fellows will actively participate in primary surgery in a limited resources settings (ex-lap, strangulated hernia, suprapubic catheter, amputations, treatment of open long bone fractures, osteomyelitis including sequestrum/involucrum, etc.) There is a broad range of tropical disease presentation (malaria, typhoid fever, filiariasis, malnutrition, giardia, amebiasis, schistosomiasis, mycetoma, etc.) which fellows will diagnose and treat.

Fellows will be encouraged to create a curriculum and/or process for mentoring of young doctors straight out of medical school without residency training. This might serve as a research project. Language translation will be provided.

Ethiopia - Primary Contact - Michele Yates MD

This experience takes place in a 150-bed mission hospital located in the southern part of Ethoipia.  The hospital is a general acute care hospital.  There is a busy emergency room and outpatient department, adult ICU, NICU, inpatient peds, medicine and 100 deliveries per month.  There are two residency programs at the hospital, one in general surgery and the other in orthopedics. They are both affiliated with PAACS (Pan African Association Christian Surgeons).  We have multiple specialists on-site including national and international OB/gyn, Ortho, Surgery, Internal Medicine, Family Medicine, Pediatrics, Radiology, and Optho and 8-10 Ethiopian General Practitioners. The fellow’s focus will include learning to care for patients in a tropical, resource limited setting, as well as teaching GPs, nurses and midwives.  The fellow will participate in ER patient management, outpatient clinic care, team, rounds on pediatrics/NICU, medicine/ICU, and OB. We also have an active Rheumatic Heart disease screening program and work closely with two local children's homes. Patient documentation will be in English, but direct patient communication will be in one of Ethiopia's 83 languages. Translation will be provided. 

Additional Curricular Opportunities

  • Certification in tropical medicine through the West Virginia School of Tropical Medicine.

Requirements

  • Applicants will have successfully completed medical training in a US allopathic or osteopathic medical school and residency program.
  • Be eligible for medical license to practice in California in good standing
  • Be eligible for hospital privileging at Ventura County Medical Center
  • Be eligible for medical malpractice coverage
  • Have health Insurance prior to program commencement
  • Have Travel Insurance prior to international travel
  • Spanish language skills are preferred but not required

Financial

  • Compensation consists of a salary while performing urgent care shifts in Ventura (approximately $27,500), along with a Ventura Global Health Project Grant ($42,500) to offset all travel and living expenses at international sites.
  • An additional $5,000 stipend is available to fellows with a spouse as well as an additional $10,000 stipend available for fellows with children or spouse + children.
  • “Moonlighting” options may be available in Ventura for additional revenue
  • Vacation – Up to 6 weeks of vacation available per year. There is a one-week maximum to come from the time spent in Ventura with agreement from host clinical supervisor. Fellows are encouraged to take vacation time between rotations. Timing of all vacation with approval of host supervisor.
  • A $2600 stipend is available to cover textbooks and Butterfly iQ ultrasound transducer. Reimbursement upon receipt.

Contact

We welcome inquires! Please send all inquiries to:
This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it.

Applications

Please send all applications for the fellowship to both:
This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it.
This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it.

Applications should include a cover letter stating the reasons for your interest in the fellowship as well as your curriculum vitae and 3 references.

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Rheumatology Review of Systems

Rheumatologic ROS is negative for:
Malar rash, photosensitivity, alopecia, mucosal ulcers, Raynaud's phenomenon, SQ nodules, sense of skin tightening in hands, face or torso, other rashes
No hx of red eyes, photophobia, iritis, uveitis, conjunctivitis, redness or discoloration of sclera, dry eyes or dry mouth
Hx pleurisy, sharp chest pains that increase with deep breath, lung fibrosis, pneumonia, cough phlegm, hemoptysis, DVT, PE
Chest pains, Hx pericarditis, heart murmur
Abdominal pain, nausea, vomiting, diarrhea, constipation, melena, hematochezia, Hx hepatitis, tranfusions or drug use, ulcerative colitis, Crohn's Disease
Hematuria, proteinuria, renal failure, bladder infections, kidney stones, hypertension
Headaches, trouble finding words
Focal weakness, trouble combing hair or getting out of chairs
Burning or tingling in feet
Monocular blindness, dysarthria, dysphagia, seizures or stroke
History of Low WBC, low platelets, anemia 

 

 

Courtesy of Dr. Bob Gonzalez

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  • All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only.  Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient.  Merely copying and pasting a prewritten note into a patient's chart is unethical, unsafe, and possibly fradulent.