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Young Ophthalmologists
YO Spotlight: Diana Shiba, MD

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Diana Shiba, MD, is a resident at the University of California, San Diego, who has already been active in California politics, as well as the AMA. The following interview highlights Dr. Shiba’s philosophy about the practice of medicine, as well as her drive and dedication to preserve the sanctity of medicine for doctors and patients alike.

YO Info: Where did you attend medical school and where are you currently doing your residency?
Diana Shiba: I went to Georgetown for my undergraduate work, and then the University of California, Davis for medical school. I completed a transitional year at Scripps Mercy Hospital in San Diego, and am about to start my last year of residency at the Shiley Eye Center at UC San Diego.

YI: What drew you to the practice of medicine?
DS: I felt medicine was the best way I could give back to the world and those around me. I have had so many good people in my life … and I feel fortunate to have had the opportunity to go to good schools, to follow my dreams, to have had supportive people in my life along the way. I also feel that the ability to practice medicine is not only a duty, but also a privilege. I love every minute of it.

YI: When did you first get involved in advocacy work? What drew you to it?
DS: What initially drew me to advocacy was a sense of duty. It all started with the letter I received from my local county society (San Diego County Medical Society) to join their membership and become involved. After I joined locally, I became active at the state level and joined the Resident and Fellow Section (RFS) of the California Medical Association (CMA), since I was interested in issues pertaining to residents like me. I eventually became a Governing Council member, and was later elected as a trustee to the Board of Trustees for CMA.

At the same time, I started getting involved in the AMA because issues that were pertinent to residents in California needed to be represented at the national level. I was elected Region 1 council chairwoman of the AMA Resident and Fellow Section in 2007, which oversees approximately 35 delegates from the 13 western states. And, as of mid-June 2008, I was elected to the Governing Council as the vice-speaker for the AMA Resident and Fellow Section.

But I am also fortunate to be in a residency program that is so supportive of the advocacy work I do. There are many other residents and fellows who would very much like to be involved, and feel passionate about the same issues as I do, yet are unable to attend the meetings and are therefore unable to advocate at the same level as I do.

Given this, I feel I need to represent the voices of those residents and fellows who are unable to voice their own. I am especially passionate about this duty to represent their voice on their behalf.

An example of this came when a poor, overworked intern who was working in the surgical ICU came to me on the wards as I was working on an ophthalmology consult. He voiced his frustration and concern regarding his residency program and their compliance with the ACGME (Accreditation Council for Graduate Medical Education) duty-hour standards. When I heard this, as well as the despair in his voice, I took this issue to the other residents on the Governing Council at CMA, and wrote a resolution requesting a national study on this issue. I then took this to the CMA House of Delegates (an annual meeting composed of physicians representing all MDs in California), where it passed and was then forwarded to the AMA House of Delegates. It passed there as well, and now a major study looking into call and duty hours will be conducted by the AMA/ACGME.

This is a great example of why I believe that change can be made. That belief brings me back year after year to try to implement the changes that I feel will benefit those around me. Granted, policy-making is not easy, but once done, really stands to benefit many.

As an added benefit, the meetings allow me to meet other residents, fellows and staff who are as passionate about the issues as I am. It is exciting and inspiring to work with other physicians who also feel a sense of duty when it comes to representing their colleagues, who are dedicated and who always have great ideas and experiences to share. I have met residents who have been involved at the national (AMA) level for 15 years, and a senior physician who has been to 99 AMA meetings. I find this just simply amazing and admirable.

YI: What advocacy work do you now do for both ophthalmology as well as the medical community as a whole?
DS: One of my great mentors in medical school, Dr. Michele Lim at the Department of Ophthalmology at UC Davis, predicted that I would become involved in advocacy. Well, she was right. My current program director, Dr. Leah Levi, has actually participated in the Academy's Leadership Development Program, and when she discovered that I was involved in general resident advocacy issues at the local, state and national levels, she guided me towards also becoming involved at the specialty level.

Thanks to Dr. Levi, I was fortunate to be the recipient of a fellowship from the California Academy of Eye Physicians and Surgeons that covered all costs so I could attend the Academy Mid-Year Forum in Washington, D.C., last year via the Academy's Advocacy Ambassador Program. At the MYF, I was amazed at the issues that ophthalmology was facing, and what our field stands to face in the future. During the MYF, I also met with my own congressional representatives and advocated for issues related to research funding, scope of practice and access to care.

Upon my return, I made a presentation about my experiences at the MYF to my fellow residents at a Grand Rounds. I believe that sharing these types of experiences with our fellow residents is a great way to educate them on current issues and inspire them to get involved. After the MYF, I was nominated to become a trustee with the CAEPS Board. In this role, I work with resident councilors from each ophthalmology department in the state, and work closely with senior CAEPS members on ophthalmologic issues at the state level.

My work though, is not just within ophthalmology. I am also an advocate for the medical community as a whole. I recently had the opportunity to travel once again to Washington, D.C., and meet with key Capitol Hill staff at the offices of my state senators and the Speaker of the House. I traveled with the president and board Chairman of the CMA, and spoke strongly against any further cuts in Medicare reimbursement, advocated for changes in the SGR (sustainable growth rate, a formula that factors into Medicare reimbursement) and discussed how these issues affected patient access to care. Best of all, I had the opportunity to reinforce the need for continued federal funding for graduate medical education.

As a delegate to the AMA from the state of California, I also have the opportunity to represent the concerns of all physicians in my state at the national level. The issues discussed at the national level are far-reaching, and include not only physician reimbursement, but also span areas that include medical ethics, medical law and even public health issues, such as the problem of the uninsured and health care reform.

YI: Do you think ophthalmologists should get involved in AMA advocacy?
DS: Ophthalmologists should definitely get involved in the AMA at the national level because we are all still doctors in the great house of medicine. As we delve deeper into issues like scope of practice, joining with other specialties that are also dealing with similar scope issues makes us all stronger. I truly believe in the AMA's motto, "Together, we are stronger." And this is not just in terms of scope of practice, but also on issues of reimbursement, federal funding, patient access to care, etc.

YI: Do you believe that physicians have a responsibility to their communities?
DS: Again, I believe being a physician is a duty and a privilege. I changed from a finance major to pre-medicine at Georgetown because I felt strongly about giving back to those around me through medicine. This philosophy drives me to not only be a doctor, but also drives me to advocate on behalf of my physician colleagues.

That’s why, when I heard the call for the need for physicians to go to Qualcomm Stadium during the San Diego fires to serve the needs of the thousands of evacuees there, I grabbed my stethoscope and drove quickly there. At that point, I was one of three physicians on site. Colleen Buono, MD, an amazing ER physician from UCSD, was busy coordinating the entire set-up of the medical effort, and quickly asked me to start seeing patients. I saw an infant with pneumonia, an elderly wheelchair-bound woman with a urinary tract infection and a woman with end-stage stomach cancer on a pain-medicine pump with chest pain, among many others. As more health care providers arrived, we were able to set-up a triage area, designate areas for specific specialties and divide the unit to include an "inpatient" area. And when I called to area ERs to transfer patients who needed more invasive or extensive care than could be offered at our unit, I was amazed at how responsive the whole process was. I was able to get a patient into an ambulance and to an ER within 15 minutes! Simply put, the effort at Qualcomm was just awe-inspiring … to see how people came together during times of crisis.

This experience led me to join DMAT CA-4, the Disaster Medical Assistance Team of San Diego, which is a deployable medical unit under the Department of Health and Human Services. I also see patients through Volunteers in Medicine and offer free ophthalmology consults to the working uninsured.

YI: How do you decide what to get involved in?
DS: I pretty much get involved in whatever I feel passionate about. Advocacy is time-consuming and takes a lot of energy. This is all compounded by the fact that I am still a resident and need time to learn and read! But again, when I feel a particular issues stands to wrong either my fellow physicians or my patients, it's likely to be an issue I will get involved in. 

YI: What can residents and newly practicing ophthalmologists do to get involved?
DS: Join your state ophthalmology societies! The state societies would be the most current on the specific ophthalmologic issues facing that state, and would know best on how to specifically get involved. From a professional standpoint, joining your state society will not only keep you updated and apprised on what's relevant to your current or future practice, but could also be beneficial in terms of networking opportunities and contacts that could be made.

I also suggest donating (login required). Even as a resident, I give what I can to my political action committees (PACs). Much of what we do with our politicians is dependent on PAC financing. More than anything else, we need more Eye M.D.s to become involved, but for those who perhaps cannot give as much personal time as they’d like toward advocacy, I would encourage them to help out with PAC donations.

As for residents, try to get involved at your own program or university. I have met other residents in other departments who feel the same way as I do, and have met many via my work on the Graduate Medical Education Committee. Getting involved with the local academic or university committee is usually very easy, not to mention a great way to start meeting people and get familiar with issues specific to your program and/or university.

Your program director will also know how to get more involved with your state ophthalmology society, as well as with the Academy. I’ve found that state societies (and medical societies as a whole) have been very welcoming of residents and fellows and truly want to hear from the nation's young doctors. Because, in essence, it's our future, and the future of our patients, that are going to be affected by the issues and policies we work on today. And we need more advocates — for our colleagues and especially for our patients.

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