Arévalo: Tireless Advocate for Underserved
April 9, 2014 No Comments Newsmakers, The Latest LPOC Organization

Dr. Arevalo Sac Biz JournalDr. José Arévalo knows what it’s like to live in a medically underserved community. He grew up in a low-income barrio in San Antonio, where his mother dispensed home remedies to the neighborhood, free of charge.

“I shied away from that,” Arévalo said. “Sick kids and grandparents worried me a lot.”

Not for long. Serving as a hospital corpsman in the U.S. Navy changed his perspective. He went on to become a family doctor for more than 30 years.

Although Arévalo’s day job is medical director at Sutter Independent Physicians, he wears many hats, including making hospital rounds at a community clinic. A new job this year is 140th president of the Sierra Sacramento Valley Medical Society. The local arm of the California Medical Association, the society has 3,000 members in Sacramento, El Dorado and Yolo counties.

Arévalo also founded the Sacramento Latino Medical Association and a statewide group, Latino Physicians of California. Both seek to narrow health disparities for Latinos and boost the number of Latino doctors in the state.

While Latinos represent 39 percent of the population in California, only 3.4 percent of doctors in the state last year — 3,547 out of 104,422 — identified themselves as Latino, according to data from the Medical Board of California.

“One of the first tenets of medicine is listen to your patient, take a history of what’s going on and come up with a plan of action. Communication in the language of the patient is key,” Arévalo said. “I’m not saying all doctors who serve this population need to be Latino, but there’s a long way to go before we reach reasonable representation.”

“It’s a huge issue,” said Dr. Sergio Aguilar-Gaxiola, a professor of clinical medicine at the University of California Davis School of Medicine and director of the health system’s Center for Reducing Health Disparities.”

“I’ve known Dr. Arévalo for several years and he’s a force of nature to reckon with — in a good way,” Aguilar-Gaxiola said. “He’s incredibly committed to underserved populations. Not just Latinos; he has a compassionate heart for those in need of health services, period.”

For Arévalo, heading up the Sierra Sacramento Valley Medical Society is a way to get the word out. It’s an opportunity to reach many doctors and “talk collectively about what we do, how we do it — and whether that’s best,” Arévalo said.

Issues that came up at last month’s meeting of the Sierra Sacramento Valley Medical Society ran the gamut from tobacco smoking and water fluoridation to proposed ballot initiatives on medical malpractice caps and health insurance rate regulation.

But Dr. Arévalo still works directly with patients. One weekend a month he’s on call for hospital rounds on behalf of Communicare, a Davis-based network of community clinics that serves low-income patients in Yolo County.

Arévalo admits, manages and discharges patients who show up at the emergency room during his weekend on duty. “We’re kind of a dying breed, docs who do a variety of things and still come into the hospital,” he said.

Things were quiet at Sutter Davis Hospital on a recent Saturday morning when Arévalo showed up to do rounds. The issue that day was a discharge plan for an elderly patient who wanted out but didn’t appear capable of managing on her own.

A variety of factors played into the mix: anxiety, depression, frequent falls and a handful of psychotropic medications that didn’t mix well with each other.

“She’s a night person who listens to music and paints,” Arévalo said. “At 70, she wants her woman cave and won’t give it up.”

“The real issue is competency,” Arévalo said. “I gave her three things to remember and she did. When a person is competent, he or she has a right to make bad decisions — and live with them.”

The key is setting up the right support process, he added. This can take hours. Or days.

The clincher for hospitals is they are held accountable when patients with certain conditions return to the hospital for the same problem within 30 days of discharge: They don’t get paid. Depending on the numbers, that can be “a huge hit — potentially millions of dollars.”

As medical director of Sutter Independent Physicians, Arévalo’s job is to oversee case management for patients admitted to local Sutter hospitals. That means coordinating care in and out of the hospital, with appropriate support services in place.

It’s another step in the career stairs that, ironically started as medical director at the San Antonio Neighborhood Health Center in Oakland right after Arévalo finished his residency in San Francisco.

Quality of care has been a central issue in his career, which includes seven years on the faculty at the UC Davis School of Medicine and stints as regional medical director at Prudential, UnitedHealthcare, Blue Cross and the Health Plan of the Redwoods.

“As a physician, I could help patients, but as a medical director, I could work with hospitals, health systems and doctors’ groups on quality of care,” he said.

The shift from “rescue care” to prevention makes 2014 a scary and exciting time to be in medicine, Arévalo said. Competition is fierce, but collaboration is growing.

“We knew 2014 would be a year of major changes in health care,” said Aileen Wetzel, executive director of the Sierra Sacramento Valley Medical Society. “José is a very gifted facilitator recognized for outreach and service. He has the leadership and professional skills to navigate the new paradigm.”

This article, “Dr. José Arévalo: Tireless Advocate for Underserved,” by Kathy Robertson, appeared in the March 21, 2014 edition of the Sacramento Business Journal. Photo by Dennis McCoy.

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