Focus on UCSF Fresno Newsletter April 2020

Teach

UCSF Fresno Teaches Residents Techniques That Empower Patients to Make Healthy Lifestyle Changes

Stutee Khandelwal, MD

Stutee Khandelwal, MD

By Barbara Anderson

Lifestyle is a proven influence on health and quality of life, and counseling patients on changing behaviors to lose weight, stop smoking, and eat healthier is among the duties physicians take seriously. At UCSF Fresno, Stutee Khandelwal, MD, MPH, a UCSF Fresno Internal Medicine physician and UCSF assistant clinical professor, is teaching Motivational Interviewing (MI), an evidence-based technique for helping individuals make behavioral changes.

“MI is very well established in the literature – psychiatry, primary care, and specialty care and across inpatient and outpatient settings – and whether it’s smoking cessation, weight loss, substance abuse or medication compliance, studies have shown that MI is more effective than standard patient counseling techniques,” Dr. Khandelwal said.

The key to the success of motivational interviewing is a patient-centered interaction, she said. “The goal is to bring out the patients’ own motivation for behavior change and to let patients tell their own stories, make their own goals, etc., rather than physicians telling them what to do.”

Dr. Khandelwal developed an innovative, interactive MI curriculum to engage UCSF Fresno Internal Medicine residents and faculty. Residents begin by completing an online pre-assessment to gauge their understanding of motivational interviewing and then watch videos to familiarize themselves with the technique. At a workshop, they watch a patient interaction video that Dr. Khandelwal produced and filmed. Then they are given cases in which they role play by taking turns as provider, patient and observer. Faculty serve as facilitators. After each case there is a debriefing.

Through the workshop, the residents learn the four basic principles of MI: open ended questions, affirmation, reflection and summarizing (OARS). Dr. Khandelwal also incorporates an assessment of the patient’s stage of change (pre-contemplation, contemplation, preparation, action, maintenance/relapse). “It all depends on where the patients are in their journey. You are not there to impose what you think. You are there to help them to move forward on their journey.”

As an example, a patient saying she wants to quit smoking to live long enough to see her grandchildren go to college is a more compelling reason than the physician telling the patient that smoking can cause silent damage to the heart. “MI empowers the patient with their own reasons to change rather than reasons being imposed on them,” Dr. Khandelwal said. “When patients hear themselves talk about their motivation to change, their successes and barriers to success, they come up with goals themselves that they are more likely to adhere to.”

The next step for the physician is helping the patient develop a S.M.A.R.T goal (Specific, Measurable, Accountable, Realistic, Time-bound). For example, the patient says she is willing to stop smoking and then sets a goal realistic for her such as cutting down by two cigarettes a day. She has a friend who agrees to hold her accountable and she agrees to try and follow the plan for two weeks.

“Research has shown when patients set these small, proximal, realistic goals they are more likely to achieve the larger goal,” Dr. Khandelwal said. “And when physicians write this S.M.A.R.T. goal as a prescription, the patient is more likely to take it seriously.”

Dr. Khandelwal developed a template (.counsel) for the electronic medical record that is a step-by-step guide for physicians to use to record their interviews with patients. “The last piece of the template is the goal that the patient and the physician will develop together and that then goes into their after-visit summary, which is actually their prescription for that behavior change,” Dr. Khandelwal said.

MI is so well-established in medical literature as a successful technique that it is one of the clinical competencies that residents are evaluated on routinely,” she said.

Kevin Gandhi, DO, a third-year resident in Internal Medicine, participated in an MI workshop led by Dr. Khandelwal last year. It was his introduction to motivational interviewing. “This concept is pretty new to most of us. In medical school training, I had never heard about motivational interviewing,” he said.

It took some time to incorporate MI into his day-to-day practice, Dr. Gandhi said. A refresher course this year helped. “Now I’m doing it without realizing that I’m doing it,” he said. “It’s embedded in my conversations with patients.”

Post-workshop polls show an increase in confidence using MI after training, Dr. Khandelwal said.

“Overall, the evaluations have been very positive from both attendings and residents,” she said. “They particularly liked the videos and the role play. I see them actively using motivational interviewing in clinic, and both faculty and residents are asking for more sessions.”

 

Nicholas Levine, MD

Care

UCSF Fresno Neurosurgeons Uniquely Trained to Handle Complex Cases, Keeping Valley Patients Close to Home

Nicholas Levine, MD

By Barbara Anderson 

The headache began the day after Katherine Bell delivered her newborn daughter. Physicians first suspected it was an effect of an epidural anesthesia given at the birth, but her headache persisted and by six weeks postpartum the pain had become unbearable.

“It felt like somebody was just smashing the side of my head with a sledge hammer,” Bell, 35, said.

Scans of her brain on Aug. 12 found a mass that was a stage 3 anaplastic astrocytoma tumor. It was essential the cancerous mass be removed quickly. “It was growing into the middle of my brain, and it was getting ready to affect my motor skills,” Bell said.

Nicholas Levine, MD, a UCSF Fresno neurosurgeon, performed a 7 ½-hour surgery on Aug. 13 to remove the fist-sized tumor. Bell came home three days later to her newborn, Maelynn Raeann Bell and to husband, Johnny Bell, and son, Marshall Lavell, 11.

“Dr. Levine was absolutely amazing,” Bell said. “I couldn’t have asked for a better doctor.”

Katherine Bell and family

Katherine Bell and family

Dr. Levine is fellowship trained in skull-based and vascular neurosurgery, endoscopic and open skull base surgery and specializes in neuro-oncologic surgery. He is a member of a highly-skilled team of UCSF Fresno neurosurgeons who make it possible for patients in the San Joaquin Valley who have brain tumors and complex spine conditions to have surgeries locally instead of traveling three to four hours for treatment.

“We cover pretty much everything and there’s really no need to travel to San Francisco or Los Angeles or Palo Alto,” Dr. Levine said.

UCSF Fresno neurosurgeons have sub-specialty training in specific areas of neurosurgery, where after routine residency they do fellowships to add to their skill sets and learn various techniques in a particular part of neurological surgery, said Yu-Hung Kuo, MD, Chief of Neurosurgery at UCSF Fresno. Dr. Kuo also treats brain and pituitary tumors and is fellowship trained in stereotactic radiosurgery, a technique often referred to as “knifeless surgery” that uses targeted radiation to selectively treat brain tumors as an alternative to open surgery. “Sometimes we opt to do that instead of actually doing open surgery to get to areas of the brain that we can’t openly operate on,” Dr. Kuo said. “In some cases, it can be just as effective as open surgery, and patients don’t have a long recovery time. It’s actually done as an outpatient — they come in for a 30- to 40-minute treatment and go home.”

Drs. Kuo and Levine both have expertise in performing awake craniotomies – brain surgery that is performed while a patient is awake to allow more of a mass to be removed without affecting brain function.

The surgeons operate at Community Regional Medical Center (CRMC), which has a special intensive care unit for neurology and neurosurgery patients.

CRMC has two operating rooms with special angiography equipment for treating vascular malformations and aneurysms in the brain. “It makes things not only as a work flow pattern smoother, but as a surgeon you can immediately check your work before you close to make sure that the aneurysm or arteriovenous malformation is completely gone,” Dr. Kuo said.

The UCSF Fresno neurosurgeons also are skilled in endoscopic neurosurgery, a minimally invasive procedure that allows for the identification and removal of masses deep within the brain with less disruption to brain tissue. Endoscopic neurosurgery was a new technique to Fresno when Dr. Kuo came to UCSF Fresno about five years ago.

Complex spine surgeries also are now performed by UCSF Fresno neurosurgeons that in the past required patients to leave the Valley for treatment.

Derek Taggard, MD, focuses on spine and complex spine surgery and offers surgery for adult scoliosis, a side-to-side curvature of the spine — a fairly common condition — but one that requires a specialized expertise to surgically treat.

Most patients with complex spinal conditions no longer need to leave Fresno for care, Dr. Taggard said. “Between patients I consult on in the hospital, as well as my elective practice, I probably encounter 1,200 to 1,500 patients a year, and only one or two need to be sent out of Fresno.”

Dr. Taggard performs one to two surgeries a month for adult scoliosis. Offering the surgery in Fresno spares patients and families from being out of town for three weeks or longer, he said. Patients typically have a week hospitalization; and the vast majority go into an acute rehabilitation setting for a couple of weeks.

In addition to his expertise in complex spine surgery, Dr. Taggard is a trauma specialist. He responds to trauma calls for spine and head injuries at (CRMC), which has one of the busiest trauma centers in the country. Dr. Taggard had extensive experience in trauma training during a nine-year active duty service as a surgeon with the U.S. Air Force, where he was deployed to Iraq in 2005 and to Afghanistan in 2009 and 2011. “After both of those experiences, there’s really nothing that can come into my emergency room that scares me or intimidates me,” Dr. Taggard said.

UCSF Fresno neurosurgeons are so busy that researchers at the UC San Francisco School of Medicine tapped them for help building a prospective database for a study of spinal cord injuries, called TRACK SCI. “We had so many patients here we were rapidly able to help them increase their database,” Dr. Kuo said.

“One of the things that people don’t always realize is we are a branch campus of UCSF and we share many of the facilities, including to some extent the research offices,” Dr. Kuo said. “This makes it conducive for research studies that are going on in one campus to expand to another, taking advantage of large patient populations in both and fusing them to create an even larger database.”

In addition to Kuo, Levine and Taggard, physicians in the UCSF Fresno Department of Neurosurgery are Nathan Deis, MD, neurosurgery; Samia Ghaffar, MD, spine and orthopaedic surgery; Amir Khan, MD, endovascular surgical neuroradiology; and R. Loch Macdonald, MD, neurosurgery.

Dr. Ghaffar who grew up in Fresno/Clovis and is the first female spine surgeon in the Valley, performs a full range of spine conditions from the upper cervical spine to the sacrum, including spine trauma, tumors, infection, degenerative spine conditions such as stenosis and spine deformities such as scoliosis.

Dr. Khan has expertise in the treatment of brain aneurysms, stroke, intracranial hemorrhage, vascular malformations and carotid stenosis. He is the first physician in the Central Valley to perform a minimally-invasive procedure to treat brain aneurysms by implanting a WEB® Aneurysm Embolization System device to treat brain aneurysms. The procedure obliterates the aneurysm, preventing a rupture.

Dr. Macdonald specializes in open neurovascular surgery which involves brain hemorrhages, certain types of stroke, ruptured aneurysms and blood vessel malformations.

Dr. Deis is fellowship trained in spine surgery and critical care medicine. He has been an Advanced Trauma Life Support instructor and lectures on head trauma and clinical skills to physicians, as well as making presentations on management of acute head trauma.

“I think we pretty much cover the gamut of what neurosurgery entails,” Dr. Kuo said.

“We work very closely together,” Dr. Levine said. “It’s a large enough department that we can take care of everyone, and it’s small enough that there’s cohesiveness and we can have complementary discussions and care of patients.”

The partnership between UCSF Fresno and CRMC enables patients to receive a full line of neurosurgery services so they do not need to leave the Valley for treatment and care, he said.

 

Research

UCSF Fresno Expo Highlights Family and Community Medicine Research

Paul Mills, PhD, and Phuoc Vu, DO; Andy Nguyen, DO


L to R: Paul Mills, PhD, and Phuoc Vu, DO; Andy Nguyen, DO

By Brandy Ramos Nikaido

One in about 13 children and teens under 18 will die early from a smoking related illness if cigarette smoking continues at the current rate among youths in the U.S. Startling statistics like this motivated a UCSF Fresno Department of Family and Community Medicine team to look at the effectiveness of school-based tobacco use prevention programs.

The research, one of 10 projects presented by teams (before the COVID-19 pandemic)  at the 23rd Annual UCSF Fresno Family Medicine Research Expo, took first place.

Team members were: medical residents, Phuoc Vu, DO; Andy Nguyen, DO; and Iris Price, MA, assistant adjunct professor and grant manager; and Mario Martinez, MD, former assistant program director of the Family and Community Residency Program.

The group found that previous studies evaluating effectiveness of tobacco use prevention programs were inconsistent. “Tobacco use remains the number one preventable cause of death in the U.S., yet millions of teenagers are smokers. In the past decade, many new tobacco products such as e-cigarettes have entered the market and become popular among adolescents, especially on social media, leading to multiple vaping-associated lung diseases,” said Dr. Vu.  “As family physicians, we wanted to prevent further tobacco-related morbidities and mortalities. Therefore, our study aimed at educating high school students on the harmful effects of tobacco products, how they are being portrayed on social media, and how to resist these social influences.” 

For its research, the team provided information and interactive activities to ninth-grade students at Clovis High School. An anonymous questionnaire was then given to gauge knowledge about smoking and self-perceived likelihood of smoking before and after the presentation. Two hundred forty-five students participated. Fourteen percent of respondents reported a history of smoking. Results indicated an increase in average score on knowledge, decrease in the reported likelihood of smoking and decrease in reported likelihood of trying tobacco in the next five years. Data indicated school-based programs incorporating both social competence and social influences instruction can increase knowledge and possibly decrease tobacco use in adolescents.

“For any research project at UCSF Fresno we always look for originality, relevance and of course rigorous scientific methods,” said Paull Mills, PhD, adjunct professor at UCSF Fresno and judge for the research expo. “The school-based program met those criteria. In addition, given the fact that 20% of all deaths each year in the U.S. are due to smoking and on average, smokers die ten years earlier than non-smokers, I thought that research on early intervention efforts aimed at local adolescents was especially appealing. By targeting local teenagers, the FCM investigators made a tremendous contribution to the prevention of tobacco-related deaths in future years.”

As a branch campus of the UCSF School of Medicine, research is a defining feature of UCSF Fresno’s training programs. During their three years of training in the UCSF Fresno Family and Community Medicine (FCM) Residency Program, residents must complete two scholarly projects: one on a topic of interest and another on a quality improvement project based on patient care during clinics.

To facilitate research, each UCSF Fresno Department has a research director. Susan Hughes, MD, is Family and Community Medicine’s research director and associate adjunct professor. She has worked for over 20 years supporting all aspects of research conducted in the department, including organizing the research expo.

Other projects presented at the expo included research on changing dietary habits in sixth graders; knowledge and attitudes regarding HVP and HPV vaccinations for adolescents;  opioid risk screening in an academic palliative clinic;  physician readiness to address transgender health; wellbeing among medical residents; screening for obstructive sleep apnea in resistant hypertension; sexually transmitted infections and HIV prevention education; and effect of vitamin D replacement in patients with impaired systolic function congestive heart failure on ejection fraction.

The Expo also included research projects submitted by the Valley Health Team Residency Program and Hanford Family Medicine Residency Clinic.

“Research projects are a vehicle for teaching principles of evidence-based medicine,” said Roger Mortimer, MD, associate chief, UCSF Fresno Family and Community Medicine.  “Evaluation of evidence is critical to the process and by residents engaging in projects, it focuses them on how research works and how questions can be validly answered.”

Besides being an Accreditation Council on Graduate Medical Education requirement, faculty projects keep us up to date on how medicine should be practiced, which makes it easier to teach how it should be implemented, Dr. Mortimer added.

 

 

DA and JDA students at Health Education and Leadership (HeaL) Conference Spring 2020 at Sunnyside High School.

Partner

UCSF Fresno Partnership with Fresno Unified, County Schools Celebrate Two Decades of Successful Health Professions Pipeline Programs

DA and JDA students at Health Education and Leadership (HEaL) Conference Spring 2020 at Sunnyside High School

By Barbara Anderson

Enrique Cazares-Navarro will start medical school this summer, realizing a goal that took root a decade ago in a freshman class at the UCSF Fresno Latino Center for Medical Education and Research (LaCMER) Doctors Academy program at Sunnyside High School.

Cazares-Navarro grew up in Parlier, the first child in his family to be born in the United States and the first to learn English. An interest in medicine developed early from translating for his parents at doctor appointments, and by middle school he was determined to attend the UCSF Fresno Doctors Academy (DA).

Top: Katherine Flores, MD and Emy Phillips Below: Mark Fowler, Caruthers High School principal; Stephanie Huerta Alvarez, DA and JDA coordinator at Caruthers

Top: Katherine Flores, MD and Emy Phillips, EdD.
Bottom: Mark Fowler, Caruthers High School principal; Stephanie Huerta Alvarez, DA and JDA coordinator at Caruthers

“I knew the Doctors Academy would provide me with the academic rigor I wanted to get from high school to prepare me for an undergraduate degree,” Cazares-Navarro said.

Since graduating from DA in 2014, he has earned a Biology degree in the Smittcamp Family Honors College at Fresno State and this spring is completing a master’s degree in Community Health and Prevention Research at Stanford University School of Medicine. Two medical schools in the Midwest have accepted his applications and have offered scholarships. He will start medical school in August.

Cazares-Navarro said he has a desire to return to the San Joaquin Valley. “I would love one day to come back to Fresno and come back to serve my community. There are a lot of health disparities and health inequities in Fresno that I would like to resolve as a physician and as a public health advocate.”

The DA started in 1999 at Sunnyside High School as a partnership between LaCMER and Fresno Unified School District (FUSD) and the Fresno County Office of Education to strengthen the educational pipeline of under-represented or disadvantaged students interested in health careers. From the beginning as a rigorous academic and college preparatory program, DA also has emphasized community service. Its mission has been to help students to focus on careers in health and medicine who will ultimately return to the Valley and provide culturally competent health services to the medically underserved.

Pathway programs are critical to addressing the health care needs in the Valley and California, said Katherine Flores, MD, associate clinical professor in Family Medicine at the UCSF School of Medicine, and the founder and director of LaCMER. “If we’re going to diversify the workforce and increase the number of students who believe that they can become a health professional, we have to support them along their journey.”

The partnership between UCSF Fresno and the schools has created a unique program that over the past two decades has grown into one of the largest, if not the largest academic and college preparatory program of its kind in California and nationwide. Each year, a total of about 600 students are enrolled in DA and Junior Doctors Academy (JDA) for middle school students.

Having a tie with UCSF School of Medicine has been critical to the credibility of the program, Dr. Flores said. “But in order to be successful, this had to be a partnership,” she said. “It had to include the school districts, because these are their students. They have invited us into their schools and allowed us to run a program conjointly with them to do the things that we believe are important.”

Three high schools in Fresno County – Sunnyside, Caruthers and Selma – have DA programs. (Caruthers and Selma were added in 2007). A JDA in 2000 added students at Kings Canyon, Sequoia, Terronez and Caruthers middle schools.

Flores gets inquiries all the time from schools interested in opening a DA. More could be added if funding were available to help with startup and sustainability, she said.

Each school district contracts with DA for an on-site coordinator, pays for administrative staff time and each school provides the teacher for the DA class. UCSF Fresno, a branch campus of UCSF, provides funding to help support a team to work with the schools. UCSF Fresno also offers access to medical residents and faculty to be mentors for students during clinical clerkships, as well as being guest speakers at DA and JDA classes. Incoming senior DA students spend six weeks in the summer shadowing a provider. They also complete a research project.

The time that DA students spend in clinical settings sets the program apart from others, said Emy Lopez Phillips, EdD, DA associate director and UCSF Fresno library director. Other programs offer students two weeks of clinical exposure, at most, or participation in a longer experience is available to only a handful of students, she said.

School officials credit the DA program for creating a healthy academic competition on campuses that has helped boost academic opportunities and successes for non-DA and DA students alike.

DA students are required to take Advanced Placement and Honors courses throughout their four years in high school.  All students need to complete A-G coursework to be considered for admission to a UC or CSU and at Sunnyside High, Vice Principal Michele Anderson said this has led to more students on campus taking the necessary courses as A-G completion rates have increased in the past 10 years from roughly 30% A-G course completion to now nearly 60%.

Sunnyside has become tightly linked to DA since the program started at the same time as the high school campus opened in 1999. Having DA at the school is a source of pride for Sunnyside, Anderson said. “We’re connected to UCSF, which really does bring prestige to the program.”

DA has had a profound effect on Caruthers High School in the rural community of 2,500 in southwest Fresno County, said Principal Mark Fowler. He taught the first DA class at the 600-student high school in 2007. He calls DA “the life blood of the campus.”

From a principal’s perspective, “it changes your entire campus,” Fowler said.

Caruthers High had four AP classes when Fowler taught the DA class 13 years ago. Today, there are 10 AP classes. AP Biology was added this year, and the principal said “the reality is half of the students in that class are not DA, but they’re friends with DA kids. And now they want to compete academically with DA kids. So the trickledown effect of that is you almost triple your AP classes offered because now kids want to compete academically.”

Goals for students have changed in the community, too. “The new norm is the expectation that kids go to four-year universities and that was not true 15 years ago,” Fowler said.” Graduation from high school used to be the finish line for some of our kids and now it’s just another step in the process.”

Fowler has been a staunch supporter of DA and pushed for JDA in Caruthers, where eighth graders in academic good-standing automatically are accepted into DA as high school freshmen. “I had seen what it had done for us academically here, he said. “I also knew there was not another seventh through 12th grade pipeline in the entire state and we could be the first.”

DA and JDA have flourished over the past two decades, accomplishing more than Flores said she had hoped for when she started the DA at Sunnyside. “I was hoping to be able to help kids develop some self-confidence, to develop study skills,” Flores said. “I wanted them to believe that they could go to college and know how that process works to get into college. I believe we’ve done that well,” she said. “We have 100% of our kids who graduate from high school and about 90% matriculate into a four-year university.”

DA alumni are returning to give back to the community,” Flores said. “They want to come and talk to the DA kids. They want to be tutors when they are in college at their home campuses. They are wanting to give back not just to the school, but to the community at large.”

Stephanie Huerta Alvarez is a Caruthers DA alumna, graduating from the school’s first cohort. In 2016, she returned to take on the role of coordinator of the DA and JDA programs at Caruthers. A first generation college student, she graduated from the University of California, Santa Cruz with a bachelor of science in human biology and has a master degree in public health from UC Berkeley. “All 11 of us from the first cohort at Caruthers have bachelor’s degrees,” Alvarez said. “That speaks to how we were prepared.”

The DA has 865 alumni, and many are still in college, but the program has been able to track some of its college graduates. There are 360 known alumni who have earned bachelor’s degrees; 60 who have master’s degrees and 18 who hold doctorate degrees (nine of the 18 have medical degrees, three are dentists, two are pharmacists and one is a physical therapist.)

Sunnyside DA alum Amitoj Singh, 23, of Fresno, said he wants to return to serve the community after finishing medical school and residency. Singh is one of six medical students admitted this past summer to the first class of the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME). The program is designed for future physicians who are committed to providing high-quality, culturally competent and accessible medical care that addresses the Valley’s unique health needs. “It (DA) taught me how prevalent health disparities were in the Valley,” Singh said.

Monique Atwal, MD, 29, a native of Selma and 2008 Sunnyside DA graduate, is completing her first year as a resident in psychiatry at UCSF Fresno. She has been asked to be a presenter at the DA Awards ceremony this year. Dr. Atwal left the Valley to get her bachelor’s degree at UCLA and then was accepted to the UC Davis SJV PRIME. She is the first in her family to go to medical school, and the staff at DA helped with her medical school applications, she said. “They were really good in helping support me.” In return, Dr. Atwal has made time to talk to DA students. Her plan is to stay in Fresno after residency.

Nou Lee, 27, a doctor of pharmacy, was one of three DA alums who spoke at the Health Education and Leadership (HEaL) Conference Spring 2020). Dr. Lee graduated from UCSF School of Pharmacy in 2018. A first generation college student, Dr. Lee is one of eight siblings and the first to get a bachelor’s degree and doctorate degree. DA helped her build a stronger relationship with her parents, farmworkers in the Hmong community, she said. The program “is not all about the students; it’s about the students and their families,” she said. Dr. Lee received a scholarship to attend pharmacy school through the DA affiliation with UCSF. “It was a big motivation to finish school,” she said, “UCSF is a very prestigious school.” Dr. Lee completed a one-year post-graduate residency program at Community Medical Centers (CMC) and now is an ambulatory infusion center pharmacist with CMC.

Flores is proud of each and every DA alum. “Whether they’re an MD or whether they have a doctorate in public health or whether they chose to not go on and even get a master’s degree, what matters is they really took to heart what we taught them and they’re giving back,” she said.

 

Inspire

UCSF Fresno
People Spotlight
 

Rene Ramirez, MD

Rene Ramirez, MD

UCSF Fresno’s success and growth are a direct result of the dedication and inspiration of our faculty, staff, residents, fellows, students, alumni, partners, donors and friends. In each issue of Focus, we introduce you to the people who contribute to the greatness of UCSF Fresno through informal interviews.

This month, please meet: Rene Ramirez, MD, assistant clinical professor of Emergency Medicine, at UCSF Fresno

What is your name? Nickname? 

My name is Dr. Rene Ramirez. I don’t have a nickname.

Where did you grow up and where did you go to school?

I grew up in between Kerman and Tranquility in the San Joaquin Valley. I went to Kerman High School and Fresno State. Go Bulldogs! I earned my medical degree from Drexel University College of Medicine in Philadelphia. And I completed residency training in emergency medicine at UCSF Fresno.

Who or what inspired you to become a doctor and why did you pick your specialty? 

Witnessing my stepfather battle cancer and being given a six-month prognosis while I was a sophomore in high school sparked my interest in medicine. I became interested in emergency medicine while working as a scribe during college. My interest was solidified with the help of Janak Acharya, MD, assistant clinical professor of emergency medicine at UCSF Fresno. We met while I was doing a medical student rotation at UCSF Fresno/Community Regional Medical Center (CRMC), during which time I was actually applying to family medicine residency programs. I am forever grateful for Dr. Acharya in helping me resolve any internal conflict I had. 

What is the most difficult aspect of your job?

Rene Ramirez, MD and scribe

L to R: Rene Ramirez, MD and Scribe Allyssa Gomez

The most difficult aspect of my job is the non-clinical stuff and fighting the never-ending battles for our patients to receive proper health care and bearing witness to health access injustices and inequalities.

What is the most rewarding aspect or aspects of your job?

The most rewarding aspects of my job include seeing the fruits of labor, being able to help someone, a friendly smile and working with an awesome team.

If you didn’t take the career path you’re on now, what career would you have pursued and why?

If I weren’t a physician, I would still be doing something in health care. I’ve always enjoyed science and helping people. 

The zombie apocalypse is coming, which three people at UCSF Fresno would you want on your team and why?

I would want my residents, attendings and fellows on my team. Together, we can accomplish anything even overcoming a zombie apocalypse!

What do you like to do for fun? How do you find balance personally and professionally?

Spending time and traveling with my family is what I enjoy the most. I also enjoy going to the movies, exercising and Jiu-Jitsu and martial arts.  

Who do you admire most (living or deceased)? And Why?

I admire my wife and kids Andrew, Samantha, Danielle and our baby boy Ryan. They inspire me to always do my best and they give me hope for the future. My wife Veronica Ramirez, MD, is a pediatrician and volunteer faculty at UCSF Fresno.

What would you like people to know about your family?

My wife Veronica and I met the summer of our freshman year in band camp. She played the trombone and I played the saxophone. The Health Careers Opportunity Program (HCOP) at Fresno State was instrumental to us becoming physicians. We’re both first-generation students to attend medical school and I am a first-generation college student. Without HCOP mentoring us we wouldn’t be where we are today.

What’s something people don’t know about you but you’d like them to know?

I’m really a big softie under my layer of crust. I’d also like people to know about the scribe program that I started in 2012 at CRMC. Our scribes work alongside our physicians and help them to chart, gather and sort clinical information so that our physicians can have more time for direct patient care. It’s unique in that every scribe who has fulfilled their time commitment with us is successful getting into medical school, physician assistant school or residency. We also are unique in that our scribes get to participate in clinical skills workshops, simulation sessions and research with UCSF faculty.

UCSF Fresno Doctors

Supporting UCSF Fresno

UCSF Fresno Answering Call, Protecting and Caring for Community Members Amid COVID-19

Some of the faculty and residents at UCSF Fresno on the frontlines

By Barbara Anderson and Brandy Ramos Nikaido

UCSF Fresno physicians are at the forefront of protecting public health and caring for COVID-19 patients. UCSF faculty and residents in the UCSF Fresno Department of Emergency Medicine remain on the frontline of health care and are poised to respond to the influx of COVID-19 patients. They currently are staffing adult, pediatric and pregnant patients’ tents outside of the emergency department at Community Regional Medical Center, evaluating and screening patients with respiratory illness for potential COVID-19. Other faculty and residents in Internal Medicine, Family and Community Medicine and Pediatrics and faculty and fellows in Pulmonary and Critical Care are caring for patients who have or are at risk for COVID-19 in the hospital and outpatient settings.UCSF Fresno Doctors

In addition, UCSF Fresno’s Rais Vohra, MD, and Simon Paul, MD, are leading efforts to contain and mitigate COVID-19 in their roles as public health officers at Fresno County and Madera County.

Dr. Vohra, UCSF professor of Emergency Medicine and Clinical Pharmacy at UCSF Fresno, earlier this year was appointed interim health officer for the Fresno County Department of Public Health by the Fresno County Board of Supervisors. A UCSF Fresno faculty member since 2009, Dr. Vohra continues his faculty appointment.

Sukhjit Dhillon, MD, a UCSF Fresno fourth-year emergency medicine resident physician, has been assisting Dr. Vohra with the COVID-19 response at the county health department. And other UCSF Fresno residents are helping the health department develop telemedicine for homeless populations; provide guidance to first responders as well as ­­track and research confirmed cases in the county.

Dr. Paul​ served as UCSF Fresno assistant dean for Academic Affairs until February and his recent appointment as public health officer for Madera County. Although no longer an assistant dean, Dr. Paul remains part-time faculty in the Department of Internal Medicine at UCSF Fresno.

Faculty and residents are assisting the Fresno County Health Department with translation of COVID-19 educational materials to Spanish, Punjabi and Hmong. They also are participating in virtual town hall meetings alongside state legislators to educate the public about the novel coronavirus. UCSF Fresno is working closely with the county public health departments and other clinical partners and is calling on the community for assistance.

“We already care for chronically ill patients and we’re preparing for the influx of COVID-19 patients we expect to see in the near future,” said Michael W. Peterson, MD, associate dean at UCSF Fresno. “The Valley has a well-documented shortage of physicians and this pandemic will likely sicken anywhere from 20 to 40% of our health workforce.”

The safety and well-being of trainees and faculty are UCSF Fresno’s top priorities. UCSF Fresno is working with clinical partners to assure faculty and trainees have adequate personal protection equipment. And we are providing alternative housing for those who are concerned about infecting a vulnerable family member. In addition, we developed wellness rooms where UCSF Fresno physicians can rest and decompress between long, demanding shifts.

We’re enlisting the community’s help to keep the caregivers safe by practicing social distancing, frequent handwashing and staying home.

These are unprecedented times, but working together even while we stand apart, we can get through this, said Dr. Peterson. And then we must be laser-focused on coming up with solutions that address the doctor shortages in our region and the health care needs of our diverse and rapidly growing population.

For details on how you can support UCSF Fresno and our faculty, residents, fellows, medical students and staff, please visit: http://www.fresno.ucsf.edu/give/