To: Executive Directors, Component Medical Societies

July 2, 2012

Executive Directors, California Medical Specialty Societies

Staff: Mode of Practice Forums, Ethnic Medical Organization Section,
Organized Medical Staff Section, Young Physicians Section,
Resident and Fellow Section, Medical Student Section

Fr: Leland Whitson, MD, Chair

CMA Physicians’ and Dentists’ Confidential Line

Re: Request for Nominations for the Gary S. Nye, MD Award

For Physician Health and Well-Being

The CMA Physicians’ and Dentists’ Confidential Line Committee, acting as the nominating committee to the House of Delegates for the Gary S. Nye, MD Award For Physician Health And Well-Being, is seeking your recommendations for CMA member physicians who have made significant contributions toward improving physician health and wellness. The recipient of the award will be recognized at the 2012 CMA House of Delegates in Sacramento, CA.

The Gary S. Nye, MD Award for Physician Health and Well-Being was established by the CMA House of Delegates in 2009 in recognition of Dr. Gary S. Nye, who has been a leader in bringing attention to and developing solutions to the issue of physician impairment and rehabilitation. Throughout his career, Dr. Nye has demonstrated commitment to his fellow physicians through service with organized medicine and well-being committees, and was instrumental in the development of the Medical Board Physician Diversion Program.

The attached award nomination form should be filled-out and emailed back to CMA. Nominations will not be considered unless the nomination form is completed in its entirety. Please include the nominee’s experience in the field of physician health and wellness. All pertinent information must be provided within the space provided on the form. Please enclose executive curriculum vitae (no more than 5 pages).

DEADLINE FOR NOMINATIONS:

August 10, 2012

As always, we appreciate your assistance and cooperation in identifying individuals who have demonstrated their commitment to improving the health and well-being of California physicians.

Please return all nominations by the above deadline to:

Yvonne Choong

Email:

California Medical Association

1201 J Street, Suite 200

Sacramento, CA 95814

916/551-2884 (voice)

916/551-2044 (fax)

Attachments:

Nominations Form

Gary S. Nye, MD Award For

Physician Health and Well-Being

Nomination Form

E-mail the completed form with required documentation by Friday, August 10, 2012 to: , fax at 916-551-2044 or mail to:

Yvonne Choong, CMA, 1201 J Street, Suite 200, Sacramento, CA 95814.

Nominee Information

Name:
First / Middle Initial / Last
Address:
Street Address
City/State:
City / State / Zip Code
Telephone: / Fax:
Daytime Phone
E-mail address: / Date of Birth:
(mm/dd/yyyy)
Medical School:
Graduated: / Medical Specialty:
Board Certification(s):

Submitted By:

Name of person/organization submitting the nomination
E-mail address: / Telephone:
E-mail address and telephone of person submitting the nomination

1. Description of Nominee’s Experience RELEVANT to Physician Health and Wellness:

(i.e., with clinical and academic appointments; hospital medical staff leadership activities; service with component and specialty societies as well as related health organizations at county, state and national level; government agency, board and committee participation; affiliation with civic organizations. Please include dates of service.)

NOMINATION INSTRUCTIONS

Gary S. Nye, MD Award for Physician Health and Well-Being

1. Nominees must be active members of the CMA at the time of nomination.

2. Nominations for the award should be presented on the award nomination form.

3. All pertinent information must be provided within the space provided on the form. Please complete multiple forms for multiple nominations. If more than one nominee is submitted for the award, please indicate order of preference.

4. Enclose executive curriculum vitae (no more than 5 pages) for the nominee with the nomination form. You may submit letters of recommendation (endorsement) if available. Endorsements are welcome, but not required.