Doctor honored for mentoring, using technology

By Keith Darcé
UNION-TRIBUNE STAFF WRITER
http://www.signonsandiego.com/

A seemingly simple change at Dr. Ada Marin’s office has placed the San Diego family physician at the forefront of the health care industry’s technology revolution.

Special notes in electronic records for her patients with diabetes remind office workers to ask the patients to remove their shoes and socks before they meet with the doctor.

The bare feet are a gentle reminder to Marin to perform a foot examination, an important procedure for diabetics who often suffer from foot ailments that can lead to more serious conditions or even to amputations.

“In a busy day, you’re seeing 29 patients,â€? said Marin, 48, who co-owns Metro Family Physicians Medical Group. “If (a diabetic patient’s) shoes are off, you’re going to do the exam. If they’re not, you will probably delay it until the next visit.â€?

About 80 percent of Marin’s diabetic patients now receive foot exams when they visit her office in the Kearny Mesa area of San Diego – more than double the previous rate.

Ada Marin

Career: co-owner, Metro Family Physicians Medical Group, 2002-present; associate director and director, Sharp HealthCare Family Practice Residency Program, 1996-2002; medical director, Sharp Metro Family Medical Center, 1995-97; medical director, Escondido Community Health Center, 1987-93

Education: Bachelor of science degree from St. Peter’s College, Jersey City, N.J., 1979; medical degree from New York Medical College, Valhalla, N.Y., 1983; residency in family medicine at University of California San Diego Medical Center, 1986; master’s degree in public health from San Diego State University, 2001

Personal: 48 years old; born in Havana, Cuba; immigrated to the United States in 1968; lives in Clairemont with partner, Linda Clark

Hobbies: Travel, photography, scrapbooking, stamp collecting and writing
That change helped Marin earn the title of 2007 California Family Physician of the Year from the California Academy of Family Physicians.

Dr. Jeff Luther, an Orange County physician who served on the academy committee that chose the award winner, said Marin’s use of technology in her practice made her stand out from other nominees as did her mentoring of students from the University of California San Diego School of Medicine who shadow her at work as part of their education.

“It was a combination of her devoting herself to a fairly full-scope family practice and giving back in terms of teaching and education,� Luther said.

Heidi Meyer, a third-year med school student at UCSD, said working a rotation under Marin’s supervision for the last year helped her decide to become a family physician who cares for everyone from children to the elderly.

“Dr. Marin is the definition of what a family doctor should be,� Meyer said. “She is constantly learning from her patients. She wants to know about their lives.�

As a youngster growing up in the Havana, Cuba, suburb of Marianao, Marin seemed destined for a career in health care. Her mother, a pharmacist, and father, a wholesale drug salesman, operated three pharmacies, and an uncle was a physician.

But her life was interrupted in the early 1960s after Cuban leader Fidel Castro started seizing private businesses and took control of her parents’ pharmacies, Marin said. Her mother was put to work in another drugstore, and her father was left unemployed.

The family first applied to leave Cuba in 1961, but permission didn’t come for six years. By that time, Marin’s uncle was living with other Cuban exiles in Florida, but he only had enough money to sponsor the immigration of three family members.

So 9-year-old Marin, her father and her older sister boarded a plane for Spain in February 1968 and left behind her mother and a younger sister. “I had a doll at the airport, and a guard ripped the head off to see if we were trying to get anything out of the country,� Marin recalled. “That was horrible.�

Life in Spain wasn’t much better than it had been in Havana, Marin said. Locals treated the family poorly and her father had little money, forcing them to rely on soup kitchens for many meals. “We absolutely hated Spain,â€? she said.

A few months later, the family was reunited in Florida after Marin’s mother and younger sister managed to leave Cuba. The family resettled in New Jersey, where laws allowed her mother to start working as a pharmacist more quickly than in other states.

Marin entered the fourth grade unable to speak English, but she quickly picked up English after frequent tutoring sessions with her teacher. Two years later, Marin’s school work was good enough to allow her to skip a grade.

Meanwhile, her father held down a day job with a pharmaceutical company and worked nights making bread in a bakery, Marin said. “In two years they bought a house,� she said.

Marin said her dreams of becoming a doctor started when she was 8 years old. “I liked science. I became a candy striper in high school. I always thought I would be a neurosurgeon.�

But those plans took a turn when Marin started learning about the immense complexity of the brain while taking an anatomy class as a premed undergraduate at St. Peter’s College in Jersey City, N.J. “It took about four days of anatomy for me to change my mind,â€? she said.

While attending New York Medical College at Valhalla, N.Y., in the early 1980s, Marin worked a clinical rotation at a family medicine practice.

“It was wonderful,� she said. “You got to see the entire family. You got to see the whole continuity of care.�

However, most of Marin’s classmates were gravitating toward specialties that offered the potential for higher salaries and greater recognition. Out of a class of 187 graduates in 1983, Marin and two other classmates were the only ones who pursued careers in family medicine.

That trend has only increased in more recent years, creating a growing shortage of medical school graduates to fill the void left by family physicians who retire or die.

The percentage of medical school graduates in residency in California who practice family medicine fell from 17.4 percent in 1998 to 10.3 percent in 2005, according to the California Academy of Family Physicians.

And the number of family medicine residency positions nationwide fell 15 percent between 2001 and 2007 (from 3,074 to 2,603) largely because of the closure of family medicine residency training programs, according to the National Residency Matching Program.

Marin chose to do her medical residency at UCSD Medical Center. “I wanted to go somewhere different . . . where I could speak Spanish, and I knew this was a border town.

“It felt like home right away,� she said.

While working in the late 1980s as medical director of Escondido Community Health Center, a clinic that cared for a large number of immigrants, Marin started taking medical students into a squatter camp hidden in a canyon east of Del Mar. They offered basic medical treatment to illegal migrant workers too fearful to seek care in more formal settings.

Marin, who entered the United States legally as a child and became a citizen, said she was never conflicted over the legal status of the migrant workers.

“These are people who have been sustaining this country longer than I have been here,� she said. “What makes them illegal? A little piece of paper.�

“They’re paying taxes. They’re doing work Americans don’t want to do. How can we say these people don’t deserve health care?â€? she said.

In more recent years, Marin has focused on bringing the benefits of technology to her private practice patients.

She was among the first family physicians in the state to undergo special training provided by the California Academy of Family Physicians through its New Directions in Diabetes Care Collaboratory. Among other things, the sessions taught Marin how to set up an electronic registry of her 400 diabetic patients to identify them from among her other 3,000 patients.

With the registry, Marin and her staff can periodically print lists of diabetic patients who are due for exams and tests crucial to keeping them healthy and preventing problems, such as blindness and foot infections, that can be brought on by the chronic disease.

“It really helps me manage these patients much, much better,� she said.
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