Reflections from an H1B Physician in Rural America

As a pediatrician and H1B visa holder, I feel compelled to share my perspective on the current situation many international medical graduates face. While we dedicate ourselves to serving communities, we continue to grapple with the uncertainty of living in the U.S. on a temporary status.

I came to this country in 2011, and since 2016 I have been serving rural America. Despite my commitment, each time I leave the country, I fear whether I will be allowed to return. I worry about whether my children,both U.S. citizens, will be able to continue school uninterrupted. This constant uncertainty weighs heavily on many immigrant physicians like myself.

The backlog in the green card process, particularly for applicants from India, has left countless physicians in limbo. India, now the most populous country, has a large number of skilled workers, especially in the technology sector, who apply for permanent residency. Because there is a fixed annual quota of green cards per country, the sheer number of applications means that physicians, though few in number, are caught in the same decades-long wait as tech professionals....continue reading...

Sireesha Palkamsetti, MD, FAAP

South Valley Area Director, AAP-CA1

Pediatric Mental Health in Challenging Times

As pediatricians, we have witnessed and tried to address the crisis in youth mental health over the past several years. The AAP-CA1 Strategic Plan recognizes Member Health as a priority equal to Child Health and Chapter Health. Over the past nine months, events on the national stage have brought unprecedented challenges for pediatricians, leading many of us to experience anxiety, overwhelm, and at times feelings of hopelessness. As was the case five years ago with the COVID-19 pandemic, many pediatricians may be experiencing moral injury, this time from feeling unable to protect our patients from the fear of being separated from their parents, trauma of more overt racism and xenophobia, fear of losing health coverage, and attempts to normalize cruelty. Faced with the disruption of things we previously thought of as constants, such as the scientific method as a foundation for discussion, it can be hard to know where to start.

In her September 27 address to the National Conference and Exhibition Plenary Session, AAP President Dr. Susan Kressly acknowledged the challenges pediatricians have faced over the past nine months, while pointing out that “with disruption comes opportunity.” Dr. Kressly also called upon one of the most effective resources for combating collective trauma: community. Speaking to the Plenary audience, she described how many times in the past nine months, and especially in the past week (since the administration’s comments about acetaminophen and autism), she had felt like screaming. She then invited the audience members, which I estimated to be at least 2,000 pediatricians, to join her in a collective scream. They did...continue reading...

Elizabeth Grady, MD, FAAP

Co-Chair, Mental Health Committee, AAP-CA1

President's Column:

Board Retreat

The AAP-CA1 Board Retreat was held on September 7 at Kaiser Permanente in Oakland. Chapter leaders joined both in person and virtually to reflect on our accomplishments, plan for the future, and review our comprehensive five-year strategic plan.

We received updates from Committee Chairs, Area Directors, Chairs, and Representatives. Yolanda Ruiz provided an overview of chapter membership, finances, grants, recent activities, and upcoming events. Highlights included our contributions at the AAP-CA Advocacy Day, Wellness Workshops by Cera-ve, and the AAP Leadership Conference in Itasca.

Several grant-supported initiatives were highlighted:

Pediatric Mental Health Care Access Program – Diane Dooley, MD, FAAP & Lisa Leavitt, MD, FAAP
Suicide Prevention Ambassador Program – Renee Wachtel, MD, FAAP
Partnership with Cal-MAP – Diane Dooley, MD, FAAP
HP 2030 Collaborative District IX Grant
Virtual Learning Collaborative on FASDs – Billy Burroughs, MD, FAAP

Nora Pfaff, MD, FAAP provided an update on SGA advocacy efforts and collaboration with AAP-CA, emphasizing the importance of continued advocacy for child health.

We celebrated the outstanding contributions of our colleagues with Chapter Achievement Awards. We are deeply grateful for their inspiring work and encourage everyone to become familiar with their accomplishments:

Jeff Ribordy, MD, FAAP
Amanda Milstein, MD, FAAP
Resham Kaur, MD, FAAP
With special recognition for Diane Dooley, MD, FAAP.

The afternoon focused on reviewing and refining our strategic plan, including the development of an implementation roadmap. It was a busy but highly productive day, setting the stage for the coming year. Stay tuned as we share the results of this giant and comprehensive effort.

I extend heartfelt thanks to the Executive Committee, Executive Director Yolanda Ruiz, and staff members Arathzy Portillo and Sana Sayyid for their outstanding leadership and support.

The retreat provided structure, vision, and inspiration for a busy and impactful year ahead.

Neel Patel, MD, FAAP

President, AAP-CA1

The Ultra-Processed Food Crisis in Children: A Modifiable Risk Factor

A study published in the New England Journal of Medicine — Simulation of Growth Trajectories of Childhood Obesity into Adulthood — underscores the lifelong impact of early weight gain in children. Researchers from the Harvard T.H. Chan School of Public Health pooled over 176,000 height and weight observations from five nationally representative U.S. cohorts to simulate BMI trajectories from childhood into adulthood. Their findings were striking: more than half of today’s children (57.3%) are projected to be obese by age 35, with the majority of severe adult obesity cases originating in childhood.

Why It Matters for Pediatric Practice

This research reinforces the American Academy of Pediatrics’ 2023 Clinical Practice Guidelines, emphasizing early identification, family-based behavioral treatment, and longitudinal support. For clinicians, it highlights that prevention cannot wait until adolescence — intervention must begin in the preschool years to alter future trajectories....continue reading...

Sushma Chamarthi, MD, FAAP, DABOM

Obesity Prevention Committee Chair, AAP-CA1

Developing Concerns: Does Leucovorin Cure Autism?

On September 22, 2025 HHS Secretary Kennedy announced that “Today, we are taking bold action…to confront the nation’s autism spectrum disorder (ASD) epidemic" opening the door to the first FDA-recognized treatment pathway, informing doctors and families about potential risks, and investing in groundbreaking research. We will follow the science, restore trust, and deliver hope to millions of American families The FDA is publishing label update for leucovorin for cerebral folate deficiency, which has been associated with autism. This action establishes the first FDA-recognized therapeutic for children with cerebral folate deficiency and autistic symptoms.”

What is cerebral folate deficiency (CFD) and how does it relate to autism spectrum disorders (ASD)?

The concept behind CFD is that there is a deficiency of folate (an essential B vitamin) in the brain, even when the folate levels in the rest of the body are normal. This is thought to be due to inherited mutations or autoantibodies. The rare genetic form is thought to affect 1 in 1,000,000. The prevalence of autoantibodies is extremely controversial, since the current ability to measure them is quite inconsistent. CFD presents in early childhood with severe neurological symptoms (seizures, movement disorders) and developmental delay. Some individuals with CFD have been diagnosed with ASD. CFD is the result of the loss of function of the cerebral folate receptor alpha protein, causing low levels of folate in the CSF and brain.

What is leucovorin and does it improve ASD?...Continue reading...

Renee Wachtel, MD, FAAP

Chair, Committee on Developmental & Behavioral Pediatrics and School Health Committee, Area Director, Alameda County, AAP-CA1

Chapter Events

Two-Part Series: Pediatric Nutrition Webinar

The California Society of Pediatric Dentistry (CSPD) is pleased to present a two-part continuing education webinar series focused on pediatric nutrition and its impact on oral and overall health.

Part 1: More Chocolate: The Fun Biochemistry of Cavity Prevention

Wednesday, Nov 4 | 6:00–7:30 PM | Dr. Roger Lucas

Learn how pediatric nutrition impacts dental development, cavity prevention, and long-term oral health.

Part 2: Beyond the Scale: Addressing Pediatric Obesity in Every Practice

Wednesday, Nov 18 | 6:00–7:30 PM | Dr. Sushma Chamarthi

Gain practical tools to recognize and manage pediatric obesity using the 2023 AAP Guidelines, nutrition counseling, and insights on ultra-processed foods.

Deadline to register is November 3rd!

Tentatively offering 3 CME credits!

Events Page

San Francisco - Life After Residency In-Person Mixer

Join us to meet fellow pediatricians and potential mentors as you prepare to begin your journey beyond residency! AAP-CA1 Board Members and Area Directors are excited to host regional informal and in-person mixer sessions designed to help residents connect with pediatrician leaders across Northern California.

Please RSVP below to confirm your attendance and share any dietary restrictions or food allergies so we can plan accordingly. If you have any questions, please contact Sana at projectcoordinator@aapca1.org.

Date: Wednesday, November 5

Time: 6:00-7:30 pm

Location: Ballast Point (705 16th St, San Francisco, CA 94158)

📍RSVP for any of our other in-person mixer events for:

Palo Alto/San Mateo - Pinstripes (36 Hillsdale Mall, San Mateo, CA 94403)
Fresno - (Casa de Tamales 805 E Olive Ave, Fresno, CA 93728)
Sacramento - location pending (you may still RSVP)
Oakland - location pending (you may still RSVP)

RSVP Here

Events Page

Committee Meeting: Mental Health Committee

We would like to invite you to join our next Mental Health Committee meeting virtually on Wednesday, November 12 from 6:30-7:30 P.M! AAPCA1’s Mental Health Committee invites you to a virtual meeting focused on sharing mental health resources and strategies for both patients and providers. We'll discuss ways to better support individuals facing mental health challenges, highlight available community resources, and explore opportunities to strengthen care in your practice.

Date: Wednesday, Nov. 12

Time: 06:30 p.m. – 07:30 p.m. PDT

Location: via Zoom

RSVP Here

Events Page

Chapter Chat: AAP CATCH Grants Info Session

Join us for a FREE interactive webinar and Q&A to learn about the CATCH (Community Access to Child Health) Grant Program on Monday, November 17 from 6PM to 7PM! The session will highlight how CATCH Planning, Implementation, and Resident Grants help pediatricians and trainees bring innovative child health ideas to life, especially projects that build community partnerships, address health disparities, and improve access to care.

Date: Monday, Nov. 17

Time: 06:00 p.m. – 07:00 p.m. PDT

Location: via Zoom

Events Page

Amplify Your Advocacy Op-Ed Writing for Pediatricians

AAP-CA1 invites you to join the joint committee meeting with the Committee on Developmental & Behavioral Pediatrics and the School Health Committee, held virtually on Tuesday, October 28, from 7:00 p.m. to 8:30 p.m. Don’t miss this important discussion on developmental, behavioral, and school health topics!

Date: Wednesday, December 10

Time: 06:30 p.m. – 08:00 p.m. PDT

Location: via Zoom

Events Page

CME Lecture - Artificial Intelligence in Pediatric Mental Health

Join us for this collaborative continuing education event, presented by the AAP-CA3, Smart Care BHCS, SD County HHSA, and SDACAP. Dr. Niranjan Karnik, MD, Ph.D will present on AI in Child & Adolescent Psychiatry. He is the Director, Institute for Juvenile Research, Department of Psychiatry, and Interim Director, AI.Health4All Center for Health Equity using ML/AI, at the University of Illinois Chicago, College of Medicine.

Date: Monday, Nov. 3

Time: 6:30 p.m. - 8:00 p.m. PT

Location: via Zoom

AAP-CA's 46th Annual Las Vegas Seminars

We personally invite you to attend this year’s Annual Las Vegas Seminars at the beautiful Caesars Palace Las Vegas! This meeting is the largest regional Pediatric Conference in the country, thanks to the continued support and participation of individuals like you.

Date: November 14-16

Location: Caesars Palace, Las Vegas

Up to 16 AMA PRA Category 1 Credit(s)™ available

Chapter Members receive a $75 discount!

ACES Health Champions Gathering

Immigrant children and families face growing levels of stress often missed by traditional systems. This gathering explores how collaboration across mental health, education, media/TV, and community organizing can create exponential impact.

Date: Monday, November 17, 2025

Location: via Zoom

Cal-MAP Presents Primary Care Project ECHO Series & School-Based Project ECHO Series!

The California Child and Adolescent Mental Health Access Portal (Cal-MAP) offers live interprofessional tele-mentoring and consultation with school-based teachers, administrators & staff and school-based health center staff focuses on on topics including bullying, disruptive behaviors, anxiety, autism and suicidality and mental and behavioral health presentations common in school-based settings.

Upcoming Primary Care Project ECHO Series:

All events in this series are from 12:00 pm – 01:00 pm PDT

November 14 –Diagnosing and Treating Depression in Children and Youth

Upcoming School-Based Project ECHO Series:

All events in this series are from 09:00 am – 10:00 am PDT

November 17 – Grief in School Communities
December 12 – Using SSRI's in Children and Youth
December 15 – Identifying and Promoting Success for Neurodiverse Students

Monthly Cal-MAP Webinar Series: Oct. 3, Nov. 7, Dec. 5 – Register Here!

CME, APA, ACE, and ASWB credits available

Some sessions may also qualify for MOC Part 2 and AAFP CME credits.

📌 Visit Cal-MAP to access program details and session recordings.

Visit Cal-MAP for More Information

KP Webinar Series on Firearm Violence Research

The Kaiser Permanente Center is launching a bimonthly webinar series designed to build the capacity, confidence, and visibility of those navigating the complexities of firearm violence research and prevention.

Each webinar will offer an opportunity to learn from a community of leading researchers and practitioners, receive expert guidance, and engage with peers in the field.

December 2025 | Navigating IRBs in Firearm Violence Research: What You Need to Know
February 2026 | Built on Trust: Community Partnerships for Firearm Violence Prevention Research
April 2026 | It’s Not Just What You Do – It’s How You Do It: Implementation Science for Firearm Violence Prevention
June 2026 | Not Just a Report: Disseminating Firearm Violence Research for Impact

Pediatric Careers in California!

Explore our job board for exciting career opportunities or share one of your own. Visit aapca1.org/jobs/.

Chapter Members: Enjoy a discounted rate of $50 for a 90-day job posting and promotion.
Non-Members/Corporate Entities: Post for 30 days at $100.

Take the next step in your pediatric career today!

Pediatric Jobs Available!

UCSF School of Medicine and UCSF Benioff Children’s Hospitals Division of General Pediatrics, Department of Pediatrics - San Francisco, CA

Pediatrician – Tamalpais Pediatrics - Marin County, CA

Job Board

Resources

SIDS Awareness Toolkit

Most children with ADHD have their first encounter for care within their primary clinician’s practice, their “medical home.”

These tools help you prepare for that encounter and beyond: readying your staff, screening, diagnosis, treatment, ongoing follow-up, and negotiating insurance payments for every step your patients need...

Recommended by AAP

Learn More

Reach Out & Read: Reading Recs

Books:

A Box Can Be Many Things

What Will We Build Today?

The Big Umbrella