Foothill ENT Care Specialists

09/08/2026

Costco does not manufacture hearing aids; instead, it rebrands or contracts hardware from the world’s "Big 5" hearing aid conglomerates.

1. Stripped Firmware Features: While the internal silicon chips are often identical to $4,000–$7,000 flagship clinic models, the firmware loaded onto Costco-exclusive models typically disables specific high-end clinical features:Tinnitus masking: Tinnitus sound-generator algorithms are universally disabled in Costco models to avoid complex clinical liability.Proprietary remote mic protocols: For example, Sonova-built devices at Costco frequently lack native compatibility with high-end Phonak Roger accessories. Real-time remote audiologist telemetry: Certain advanced tele-audiology adjustments available in standard clinic software are locked or simplified.

2. The Kirkland Signature HiatusFor years, Costco’s in-house Kirkland Signature (KS) line was its top seller (KS9 and KS10 were built by Sonova). However, Costco discontinued the KS10 after widespread battery/recharging issues. Rather than releasing a KS11, Costco shifted entirely to selling name-brand lines (Philips, Jabra, Rexton, and Sennheiser) at ~$1,500–$1,700 a pair.

3. Software "Locking" and Portability: Costco hearing aids are technically unbundled prescription devices, but the programming software is locked to Costco’s system in practice. If a patient moves or wants their hearing aids serviced at a private clinic, independent audiologists often cannot reprogram or adjust them because Costco uses customized software keys for their specific sub-models.

4. Provider Credentials Vary by State: Costco’s Hearing Aid Centers are staffed by a mix of licensed Doctors of Audiology (Au.D.) and state-licensed Hearing Instrument Specialists (HIS). An HIS is trained specifically to test for basic presbycusis/sensorineural loss and program hearing aids, but they do not possess the clinical training to identify underlying medical pathologies (e.g., cholesteatomas, otosclerosis, acoustic neuromas).

5. Verification Best Practices: Costco corporate mandates Real Ear Measurement (REM)—using probe microphones in the ear canal to verify acoustic output against target prescriptive curves (such as NAL-NL2). Many independent clinics charge extra for this or skip it entirely, making Costco’s technical verification protocol surprisingly rigorous despite the discount price point.

09/08/2026

09/06/2026

What type of yogurt is good for oral candida?

Plain, unsweetened yogurt containing live and active cultures is the most effective choice for managing oral Candida (oral thrush).

Key Criteria to Look For

Live and Active Cultures: The label should explicitly state "live and active cultures." Specifically, look for species from the Lactobacillus and Bifidobacterium genera—such as Lactobacillus acidophilus, L. rhamnosus, L. casei, and L. reuteri. These bacteria compete with Candida albicans for mucosal binding sites, produce lactic acid and hydrogen peroxide, and lower the local pH to inhibit fungal adherence.

Zero Added Sugars: Unsweetened, plain varieties are essential. Simple sugars feed Candida yeast and promote fungal proliferation, which counteracts the probiotic benefits.

Plain Greek Yogurt: A practical option because the straining process removes much of the liquid whey, resulting in lower naturally occurring lactose (sugar) and higher protein density than standard yogurt.

Traditional Unsweetened Kefir: While technically a fermented drink rather than a spoonable yogurt, plain kefir typically contains a broader diversity of probiotic strains (often 10–12 or more) and yeast-antagonizing lactic acid bacteria.

Application Tip
Swishing a spoonful of plain, cold yogurt around the mouth and letting it coat the mucosal surfaces and tongue for 30–60 seconds before swallowing can maximize direct contact with the oral tissues.

09/01/2026

Most urgent care centers in Southern California operate under a bifurcated structure that separates clinical oversight from business operations to comply with California’s Corporate Practice of Medicine (CPOM) doctrine. Under this model, clinical authority sits under a physician-owned Professional Corporation (PC), while day-to-day administrative functions are often managed by an associated Management Services Organization (MSO) or private equity-backed operator.Hierarchical Structure Medical Director (MD/DO)
│
┌──────────────────┴──────────────────┐
▼ ▼
Clinical Operations Business Operations
(Supervising Physician) (Practice Administrator / Clinic Mgr)
│ │
┌────────┴────────┐ ┌────────┴────────┐
▼ ▼ ▼ ▼
Staff Physician PAs / NPs Front Desk / Intake Billing / MSO Support
│ │
└────────┬────────┘
▼
Clinical Support (MAs, Phlebotomists, X-Ray Techs / RTs)
Medical Director / Supervising Physician (MD/DO): Holds clinical responsibility, establishes clinical standard operating procedures (SOPs), signs the required PA Practice Agreements, and provides clinical escalations.Practice Administrator / Clinic Manager: Oversees front-office operations, staffing schedules, supply chain, patient throughput metrics, billing coordination, and customer service.Advanced Practice Providers (PAs & NPs): Serve as the primary front-line diagnosticians and prescribers for walk-in acuity.Clinical Support Staff: Medical Assistants (MAs) and Limited/Full Radiologic Technologists (RTs) cross-trained to handle rooming, vitals, POC testing, basic splinting, and X-rays.Staffing & Physician Supervision ModelsYour second scenario—a solo PA on-site with a supervising physician available remotely via telephone or electronic communication—is the standard operational model for most independent, PE-backed, and retail urgent care chains in Southern California. Legal Supervision Requirements (California SB 697 & AB 1501): California law does not require supervising physicians to be physically present on-site during routine patient encounters. The supervising physician must simply be available for consultation via telephone or electronic means at the time of the exam. California permits one physician to supervise up to 8 PAs concurrently. Private/MSO Chains: Typically staff 1 PA (or NP), 1–2 MAs, 1 RT, and 1 front-desk receptionist per shift. The Medical Director or designated supervising physician covers multiple clinics remotely by phone. Hospital/Academic Health Systems: Centers affiliated with major regional systems (e.g., Kaiser Permanente, UCLA Health, Cedars-Sinai, Providence) are far more likely to maintain an MD/DO on-site alongside PAs, or run physician-led shifts.Quotas and Productivity MetricsWhile urgent cares rarely use the word "quota" in employment contracts to avoid regulatory scrutiny, PAs are held to strict throughput and efficiency benchmarks:Patients Per Hour (PPH): The baseline target in high-volume Southern California centers is 3.5 to 4.5+ patients per hour, which translates to 35 to 50+ patients during a standard 10- to 12-hour shift.Door-to-Door / Cycle Time: Clinics track the total elapsed time from patient check-in to discharge, targeting under 45 to 60 minutes for low-to-moderate complexity visits.Compensation & RVUs: Many urgent care groups offer base hourly rates paired with volume-based incentive structures (e.g., bonuses for exceeding target patient thresholds per shift or work RVU targets).Utilization & Scorecards: Providers are tracked on key performance indicators including Net Promoter Scores (NPS), antibiotic prescribing rates for viral diagnoses, and appropriate utilization of point-of-care diagnostics and imaging.

08/22/2026

Another day in the operating room. Today's pt had a extremely large goiter. It was so large that I could not take it out on one piece.

08/17/2026

08/14/2026

Today was a day for jokes. Our pts gave several today

08/12/2026

to our Samantha