Fall 2018

VO L . 69 N O. 4 Fa l l 201 8

THE ACADEMY IS CHANGING HANDS Retiring EVP Susan Hogeland hands over her keys to CAFP’s new CEO Lisa Folberg

Also in this issue HEALTH POLICY AND YOU

ϭϱϮϬ WĂĐŝĮĐ ǀĞŶƵĞ • San Francisco, California 94109 • www.familydocs.org Phone (415) 345-8667 • Fax (415) 345-8668 • E-mail: cafp@familydocs.org

Officers and Board President Lisa M. Ward, MD, MScPH, MS Immediate Past President Michelle Quiogue, MD President-elect Walter Mills, MD

Staff Lisa Folberg, MPP

Chief Executive Officer lfolberg@familydocs.org

Conrad Amenta

Director, Health Policy camenta@familydocs.org

DŽƌŐĂŶ ůĞǀĞůĂŶĚ

Speaker ĂǀŝĚ ĂnjnjŽ͕ D

Manager, FP-PAC and Membership mcleveland@familydocs.org

Vice-Speaker Shannon Connolly, MD

:Ğƌƌŝ ĂǀŝƐ͕ , W

Secretary/Treasurer Lauren Simon, MD, MPH Executive Vice President Lisa Folberg, MPP Foundation President Marianne McKennett, MD AAFP Delegates Jeff Luther, MD ĂƌŽů ,ĂǀĞŶƐ͕ D

Director, CME/CPD jdavis@familydocs.org

Jonathan Rudolph

Manager, Finance jrudolph@familydocs.org

Adam Francis

Director, Government Affairs afrancis@familydocs.org

Pamela Mann, MPH

Program Manager pmann@familydocs.org

ůŝnjĂďĞƚŚ >ƵŬƌŝĐŚ

AAFP Alternates Jay W. Lee, MD, MPH Lee Ralph, MD

Manager, Communications and Social Media elukrich@familydocs.org

CMA Delegation Ashby Wolfe, MD, MPA, MPH (Chair) Mark Dressner, MD Sumana Reddy, MD <ĞǀŝŶ ZŽƐƐŝ͕ D Lauren Simon, MD, MPH &Ğůŝdž EƵŶĞnj͕ D ͕ DW,

Shelly Rodrigues, CAE, FACEHP Deputy Executive Vice President srodrigues@familydocs.org

Looking for a job?

Go to www.fpjobsonline.com YƵĞƐƟŽŶƐ͍ Ăůů ϴϴϴͲϴϴϰͲϴϮϰϮ ĂŶĚ a HEALTHeCAREERS ƌĞƉƌĞƐĞŶƚĂƟǀĞ ǁŝůů ŚĞůƉ LJŽƵ͘

Brent Sugimoto, MD, Editor Shelly Rodrigues, CAE, Managing Editor The California Family Physician is published quarterly by the California Academy of Family Physicians. Opinions are those of the authors and not necessarily those of the members and staff of the CAFP. Non-member subscriptions are $35 per year.

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California Family Physician Fall 2018

California

Fall 2018

FAMILY PHYSICIAN s t ro n g

me d i c i ne

f o r

C al i f o r n ia

features 12 Looming Legislative Battles Lead to FP-PAC Change

Jay W. Lee, MD, MPH

14 November Election Could Mean Major Changes in Health Care

Adam Francis

18 CAFP Leaders Explore the Heart of the FMRevolution 20 CAFP Foundation Talking about Immigration Policy Issues

Shelly B. Rodrigues, CAE, FACEHP

22 Welcome Lisa Folberg … We’re Excited to Have You Join Us! 26 I Spent My Summer Spent with Health Care Heroes

Marci Miller

departments 6

Editorial

Why are YOU a Family Physician?

8

President’s Message

Opioid Issues are Complex, and Policy Decisions are Adding to the Complexity

10 Political Pulse

CAFP Budget Advocacy Literally Paying Off

30 EVP Forum

This Really Is Good-Bye, with a Huge Side of Appreciation

Brent Sugimoto, MD Lisa M. Ward, MD, MScPH, MS Carla Kakutani, MD Susan Hogeland, CAE

&Žƌ ƵƉĐŽŵŝŶŐ D ĂĐƟǀŝƟĞƐ ǀŝƐŝƚ ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬĐŵĞ California Family Family Physician Physician Fall Fall 2018 ϮϬϭϴ California

5

Brent K. Sugimoto, MD, MPH, FAAFP

editorial

Why are YOU a Family Physician? ͞&ĂŵŝůLJ DĞĚŝĐŝŶĞ EŝĐĞ͟ ŝƐ Ă ƚĞƌŵ ŽŌĞŶ ŚĞĂƌĚ ĂƉƉůŝĞĚ ƚŽ ƉƌĂĐƟƟŽŶĞƌƐ ŽĨ ŽƵƌ ƐƉĞĐŝĂůƚLJ͕ ĂŶĚ Ă ĚŝĐŚŽƚŽŵLJ ŝŶ ŚŽǁ ŝƚ ŝƐ ŚĞĂƌĚ ĞdžŝƐƚƐ͕ ĚĞƉĞŶĚŝŶŐ ŽŶ ƚŚĞ ĐŽŶƚĞdžƚ ƚŚƌŽƵŐŚ ǁŚŝĐŚ ŝƚ ŝƐ ĮůƚĞƌĞĚ͘ DŽƐƚ ŽŌĞŶ ǁĞ ŚĞĂƌ ŝƚ ƉƌŽƵĚůLJ͕ ĂŶĚ ŝƚ ŵĞĂŶƐ ƚŚĞ ŚƵŵĂŶŝƐƟĐ ǁŽƌůĚǀŝĞǁ ƚŚĂƚ ŝƐ ƚŚĞ ĐŽƌĞ ŽĨ ƉĂƟĞŶƚ ĐĂƌĞ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ ^ŽŵĞƟŵĞƐ͕ ŝƚ ƐƟƌƐ ĂŶ ƵŶĞĂƐLJ ƐĞůĨͲ ĂǁĂƌĞŶĞƐƐ ƚŚĂƚ ŽƵƌ ŚƵŵĂŶŝƐƟĐ ǁŽƌůĚǀŝĞǁ ĂŶĚ ĐŽŶĐĞƌŶ ĨŽƌ Ăůů ŵĂLJ ďĞ ƉĞƌĐĞŝǀĞĚ ĂƐ ŶĂŢǀĞ͕ ƵŶĂƐƐĞƌƟǀĞ ĂŶĚ ĞĂƐŝůLJ ƚĂŬĞŶ ĂĚǀĂŶƚĂŐĞ ŽĨ͘ Family medicine physician Dr. G. Gayle Stephens, founder of one ŽĨ ƚŚĞ ĮƌƐƚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐŝĞƐ ĂŶĚ Ă ůŝĨĞƟŵĞ ĂĚǀŽĐĂƚĞ ĨŽƌ ƚŚĞ ƐƉĞĐŝĂůƚLJ͕ ǁƌŽƚĞ ƚŚŝƐ ĂďŽƵƚ ŽƵƌ ŝŶƚĞƌŶĂů ĐŽŶƚƌĂĚŝĐƟŽŶ͗ Some of us recoil at the use of the language of “reform” and ͞ƌĞǀŽůƵƟŽŶ͟ ƚŽ ĚĞƐĐƌŝďĞ ŽƵƌ ĚŝƐĐŝƉůŝŶĞ͘ dŚĞƐĞ ĂƌĞ ƚŚĞ ƐĞŵĂŶƟĐƐ ŽĨ ǀŝŽůĞŶĐĞ͕ ĂŶĚ ƚŚĞLJ ƉƌŽũĞĐƚ ĂŶ ŝŵĂŐĞ ƚŚĂƚ ǁĞ ĚŽ ŶŽƚ ĨĞĞů͘ tĞ ĂƌĞ ďĞŶĞǀŽůĞŶƚ͕ ǁĞůůͲŝŶƚĞŶƟŽŶĞĚ͕ ͞ŚƵŵďůĞ ĐŽƵŶƚƌLJ ĚŽĐƚŽƌƐ͟ ǁŚŽ ŽŶůLJ ǁĂŶƚ ƚŽ ƌĞƐƚŽƌĞ ƐŽŵĞ ďĂůĂŶĐĞ ƚŽ ŵĞĚŝĐŝŶĞ͘ tĞ ĚŽ ŶŽƚ ǁĂŶƚ ƚŽ ĚĞƐƚƌŽLJ ĂŶLJƚŚŝŶŐ͕ Žƌ ƚĂŬĞ ĂŶLJƚŚŝŶŐ ĂǁĂLJ ĨƌŽŵ ĂŶLJďŽĚLJ ΀͙΁ tĞ ĂƌĞ ŶŽƚ ƌĂĚŝĐĂůƐ ǁŚŽ ǁŝƐŚ ƚŽ ƚƵƌŶ ƚŚĞ ǁŽƌůĚ ƵƉƐŝĚĞ ĚŽǁŶ͘ ;^ƚĞƉŚĞŶƐ͕ ϭϵϴϵͿ Simon Sinek delivered one of the most popular TED talks about inspiring leadership ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ƚĞĚ͘ĐŽŵͬƚĂůŬƐͬƐŝŵŽŶͺƐŝŶĞŬͺ ŚŽǁͺŐƌĞĂƚͺůĞĂĚĞƌƐͺŝŶƐƉŝƌĞͺĂĐƟŽŶ͍ůĂŶŐƵĂŐĞсĞŶ. He argues that ŝƚ ŝƐ ŶŽƚ ŽƵƌ ŶĞŽĐŽƌƚĞdž͕ Žƌ ƌĂƟŽŶĂů ďƌĂŝŶ͕ ƚŚĂƚ ĚƌŝǀĞƐ ďĞŚĂǀŝŽƌ͕ ďƵƚ ŽƵƌ ĞŵŽƟŽŶĂů ďƌĂŝŶ͕ ƚŚĞ ůŝŵďŝĐ ƐLJƐƚĞŵ͘ Dƌ͘ ^ŝŶĞŬ ƉŽƐŝƚƐ ƚŚĂƚ ǁĞ ƐƵƉƉŽƌƚ ;Žƌ ŽƉƉŽƐĞͿ Ă ĐĂƵƐĞ͕ ŶŽƚ ĨŽƌ ƚŚĞ t, d͕ Žƌ ĨĂĐƚƐ͕ ďƵƚ ĨŽƌ ƚŚĞ t,z͕ Žƌ ǁŚĂƚ ƐŽŵĞŽŶĞ ďĞůŝĞǀĞƐ͘ dŚĞ t,z͕ ĐŽŵŵƵŶŝĐĂƚĞƐ ǁŝƚŚ ŽƵƌ ůŝŵďŝĐ ƐLJƐƚĞŵ ŝŶ Ă ǁĂLJ ƚŚĂƚ ĨĂĐƚƐ ĐĂŶŶŽƚ͕ ĂŶĚ ŵĂŬĞƐ ƵƐ ƵŶĚĞƌƐƚĂŶĚ ŚŽǁ ǁĞ ƐŚŽƵůĚ ĨĞĞů ĂďŽƵƚ Ă ƉĞƌƐŽŶ Žƌ ĐĂƵƐĞ͘ ŶLJŽŶĞ ǁŚŽ ŚĂƐ ƚƌŝĞĚ ƚŽ ƌĞƐŝƐƚ ƚŚĞŝƌ ĐƌĂǀŝŶŐ ĨŽƌ ĐŚŽĐŽůĂƚĞ͕ ŝĐĞ ĐƌĞĂŵ͕ Žƌ ;ŝŶƐĞƌƚ ƉĞƌƐŽŶĂů ǀŝĐĞͿ͕ ŬŶŽǁƐ ƚŚĞ ƉŽǁĞƌ ŽĨ ĨĞĞůŝŶŐƐ ŽǀĞƌ ĨĂĐƚƐ Ͷ ĞǀĞŶ ĨŽƌ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ƐŚŽƵůĚ ŬŶŽǁ ďĞƩĞƌ͊ tŚLJ ĂƌĞ LJŽƵ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͍ tĞ ŚĂǀĞ ŶŽ ƐŝŶŐůĞ ƌĞĂƐŽŶ͖ ǁĞ ĂƌĞ a diverse bunch. Nevertheless, talk to enough family physicians ĂŶĚ ŽŶĞ ŵĂLJ ƐĞŶƐĞ ǁŚĂƚ ƌ͘ ^ƚĞƉŚĞŶƐ ƌĞĨĞƌƌĞĚ ƚŽ ĂƐ ƚŚĞ ͞ƐŽĐŝĂů ƌĞĨŽƌŵ ĞƚŚŽƐ͟ ŽĨ ŽƵƌ ƐƉĞĐŝĂůƚLJ͗ ĂĐŚ ŽĨ ƵƐ ŵŝŐŚƚ ƐĞĞ ƚŚŝƐ ŝŶ Ă ƐŽŵĞǁŚĂƚ ĚŝīĞƌĞŶƚ ůŝŐŚƚ͕ ďƵƚ ǁĞ ǁŽƵůĚ ĂŐƌĞĞ͕ / ƚŚŝŶŬ͕ ƚŚĂƚ ƵŶŝŶŚŝďŝƚĞĚ ĂĐĐĞƐƐ ƚŽ ŵĞĚŝĐĂů ĐĂƌĞ ĨŽƌ everybody, especially the medically underserved, personal and ĨĂŵŝůLJ ŽƌŝĞŶƚĞĚ ĐĂƌĞ ŽŶ Ă ĐŽŶƟŶƵŝŶŐ ďĂƐŝƐ͕ ĂŶĚ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ĐĂƌĞ Ăƚ Ă ƌĞĂƐŽŶĂďůĞ ĐŽƐƚ ǁĞƌĞ ĐƌƵĐŝĂů ŝŶ ƚŚĞ ŵŽĚĞƌŶ ƌŝƐĞ ŽĨ ĨĂŵŝůLJ ƉƌĂĐƟĐĞ͘ ;^ƚĞƉŚĞŶƐ͕ ϭϵϴϵͿ 6

California Family Physician Fall 2018

dŚĞ ĐƵƌƌĞŶƚ ƉŽůŝƟĐĂů ĞŶǀŝƌŽŶŵĞŶƚ͕ ƚŚĞŶ͕ ƐŚŽƵůĚ ƐƚŽŬĞ ĐŽŶĐĞƌŶ ĂŶĚ ĂĐƟŽŶ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ dŚŽƐĞ ŝŶ ƉŽǁĞƌ ŚĂǀĞ ĂƌƟĐƵůĂƚĞĚ Ă ǀŝƐŝŽŶ ĨĂƌ ĨƌŽŵ ŽƵƌ ŽǁŶ ǁŽƌůĚǀŝĞǁ͕ ĂŶĚ ŝƚ ŝƐ Ă ǀŝƐŝŽŶ ĂŝŵĞĚ ĚŝƌĞĐƚůLJ Ăƚ ŽƵƌ ůŝŵďŝĐ ƐLJƐƚĞŵ͕ Ăƚ ŽƵƌ t,zƐ͘ dŚŝƐ ǀŝƐŝŽŶ ƚŚƌĞĂƚĞŶƐ ƚŽ ĚŝƐƌƵƉƚ ŽƵƌ ŽǁŶ t,zƐ ŽĨ ƉƌĂĐƟĐŝŶŐ ŵĞĚŝĐŝŶĞ͕ ǁŚĞƚŚĞƌ ŝƚ ďĞ ŽƵƌ ƌŝŐŚƚ ƚŽ Ă ůŝǀĞůŝŚŽŽĚ͕ ƚŚĞ ƌŝŐŚƚ ĨŽƌ ƉŚLJƐŝĐŝĂŶ ĂŶĚ ƉĂƟĞŶƚ ƚŽ ŵĂŬĞ their medical decisions ƵŶĞŶĐƵŵďĞƌĞĚ͕ ƚŚĞ ŚĞĂůƚŚ ĂŶĚ ǁĞůĨĂƌĞ ŽĨ ŽƵƌ ƉĂƟĞŶƚƐ͕ Žƌ ƚŚĞ ďĞůŝĞĨ ƚŚĂƚ ĞƋƵĂů ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƵůĚ ŵĂŬĞ ŽƵƌƐ Ă ďĞƩĞƌ ƐŽĐŝĞƚLJ͘ /Ĩ ƚŚĞƌĞ ŚĂƐ ďĞĞŶ Ă ďĞŶĞĮƚ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŝŶ ƚŚŝƐ ĞŶǀŝƌŽŶŵĞŶƚ͕ ǁĞ͕ ĂƐ Ă ŐƌŽƵƉ͕ ŚĂǀĞ ŚĞůĚ ŽƵƌƐĞůǀĞƐ ƵƉ ƚŽ ƚŚŝƐ ĐŽŶƚƌĂƐƟŶŐ ǀŝƐŝŽŶ͕ ĂŶĚ ƚŚƌŽƵŐŚ ƚŚŝƐ ĞdžĞƌĐŝƐĞ ŚĂǀĞ ůĞĂƌŶĞĚ ƚŽ ĂƌƟĐƵůĂƚĞ ŽƵƌ t,z͘ tĞ ĂƌĞ ŶŽƚ ũƵƐƚ ͞&ĂŵŝůLJ DĞĚŝĐŝŶĞ EŝĐĞ͟ͶǁĞ ƐƉĞĂŬ ŝŶ ƚŚĞ ůĂŶŐƵĂŐĞ ŽĨ ƌĞĨŽƌŵ ƌ͘ ^ƚĞƉŚĞŶƐ ƐĂŝĚ ǁĞ ŽŶĐĞ ƐŚŝĞĚ ĂǁĂLJ ĨƌŽŵ͘ &W WĂƐƚͲWƌĞƐŝĚĞŶƚ ƌ͘ :ĂLJ >ĞĞ͛Ɛ η&DZĞǀŽůƵƟŽŶ ŝƐ Ă ƉŽǁĞƌĨƵů ĞdžĂŵƉůĞ͕ ŽŶĞ ƚŚĂƚ ĂůůŽǁƐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂĚǀŽĐĂƚĞƐ ƚŽ ƐƵĐĐŝŶĐƚůLJ ĞdžƉƌĞƐƐ ƚŚĞŝƌ t,z ;ĞǀĞŶ ŵLJ ŽǁŶ ŝŶĨĂŶƚ ĚĂƵŐŚƚĞƌ ŝŶ ŚĞƌ η&DZĞǀŽůƵƟŽŶ ŽŶĞƐŝĞͿ͘ dŚŝƐ ŝƐƐƵĞ ŝƐ ĂďŽƵƚ ŚŽǁ ǁĞ ĂƐ ĂŶ ĐĂĚĞŵLJ ĂŶĚ ŝŶĚŝǀŝĚƵĂůƐ ĞŶŐĂŐĞ ĂŶĚ ĐĂŶ ĞŶŐĂŐĞ ŝŶ ǁŚĂƚ ǁĞ ďĞůŝĞǀĞ ŝŶ͘ ŝƌĞĐƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚĂů ZĞůĂƟŽŶƐ͕ ĚĂŵ &ƌĂŶĐŝƐ͕ ŽīĞƌƐ Ă ďƌŝĞĨ ŽŶ ƚŚĞ ƵƉĐŽŵŝŶŐ ĞůĞĐƟŽŶ ĂŶĚ ǁŚĂƚ ŝƚ ŵĞĂŶƐ ƚŽ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ŝŶ ĂůŝĨŽƌŶŝĂ͘ WƌĞƐŝĚĞŶƚ ƌ͘ >ŝƐĂ tĂƌĚ ŽƵƚůŝŶĞƐ ƚŚĞ ƉŽůŝĐLJ ƋƵĂŐŵŝƌĞ ŽŶ ŽƉŝŽŝĚ ƉƌĞƐĐƌŝďŝŶŐ͘ &W ŝŶƚĞƌŶ DĂƌĐŝ DŝůůĞƌ ŐŝǀĞƐ ƵƐ ĂŶ ŝŶƐŝĚĞƌ͛Ɛ ǀŝĞǁ ŽŶ ƚŚĞ ǁŽƌŬ ƚŚĞ ĐĂĚĞŵLJ ĚŽĞƐ ƚŽ ƐƵƉƉŽƌƚ ŽƵƌ ĂĚǀŽĐĂĐLJ ĞīŽƌƚƐ͘ ƌ͘ ĂƌůĂ <ĂŬƵƚĂŶŝ ŚŝŐŚůŝŐŚƚƐ ƚŚĞ ƐƚĂƚĞ ůĞŐŝƐůĂƟǀĞ ƐƵĐĐĞƐƐĞƐ ƚŚĂƚ ƌĞƐƵůƚ ĨƌŽŵ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƐƚĂLJŝŶŐ ĞŶŐĂŐĞĚ͕ ĂŶĚ ƌ͘ :ĂLJ >ĞĞ ĂƌŐƵĞƐ ƚŚĂƚ LJŽƵƌ ŝŶǀŽůǀĞŵĞŶƚ ŝŶ ŽƵƌ W ŝƐ ĐƌŝƟĐĂů ĂŶĚ ĞīĞĐƟǀĞ͘ ĞƉƵƚLJ sW ^ŚĞůůLJ Rodrigues and Health Policy Director Conrad Amenta discuss health ŝƐƐƵĞƐ ƌĞůĂƚĞĚ ƚŽ ŝŵŵŝŐƌĂƟŽŶ ƉŽůŝĐLJ͘ &ŝŶĂůůLJ͕ ŽƵƚŐŽŝŶŐ sW ^ƵƐĂŶ ,ŽŐĞůĂŶĚ ƌĞŇĞĐƚƐ ŽŶ Ă ĐĂƌĞĞƌ ŽĨ ŵĂŬŝŶŐ Ă ĚŝīĞƌĞŶĐĞ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ǁŚŝůĞ ǁĞ ŐĞƚ ƚŽ ŬŶŽǁ ŽƵƌ ŝŶĐŽŵŝŶŐ K >ŝƐĂ &ŽůďĞƌŐ͘ zŽƵ͛ůů ĂůƐŽ ŐĞƚ Ă ƉĞĞŬ Ăƚ LJŽƵƌ ůĞĂĚĞƌƐŚŝƉ ĞdžƉůŽƌŝŶŐ &W͛Ɛ t,z ĂŶĚ ,KtƐ͘ / ŚŽƉĞ LJŽƵ ĞŶũŽLJ ƚŚŝƐ ŝƐƐƵĞ ĂŶĚ ĐůŽƐĞ ƚŚĞ ĐŽǀĞƌ ǁŝƚŚ ƐŽŵĞ ŝŶƐƉŝƌĂƟŽŶ ƚŽ ĂĐƚ͗ ǀŽƚĞ͕ ĐŽŶƚƌŝďƵƚĞ ƚŽ ƚŚĞ W ͕ ŵĞĞƚ ǁŝƚŚ LJŽƵƌ ĐŽůůĞĂŐƵĞƐ͕ ůŽďďLJ͕ ůĞĂĚ͘ zŽƵƌ ĐŽůůĞĂŐƵĞƐ ŶĞĞĚ LJŽƵ͕ LJŽƵƌ ĂĐĂĚĞŵLJ ŶĞĞĚƐ LJŽƵ ĂŶĚ LJŽƵƌ ƐƉĞĐŝĂůƚLJ ŶĞĞĚƐ LJŽƵ ďĞĐĂƵƐĞ ƚŚĞ ǁŽƌůĚ ŶĞĞĚƐ &ĂŵŝůLJ DĞĚŝĐŝŶĞ EŝĐĞ͊ References ϭ͘ ^ŝŶĞŬ͕ ^ŝŵŽŶ͘ ^ƚĂƌƚ ǁŝƚŚ tŚLJ͗ ,Žǁ 'ƌĞĂƚ >ĞĂĚĞƌƐ /ŶƐƉŝƌĞ ǀĞƌLJŽŶĞ ƚŽ dĂŬĞ ĐƟŽŶ͘ EĞǁ zŽƌŬ͕ E͘z͗͘ WŽƌƞŽůŝŽ͕ ϮϬϬϵ͘ Ϯ͘ Stephens, G.Gayle. “Family Medicine as Counterculture.” &Ăŵ DĞĚ ϭϵϴϵ͖ Ϯϭ͗ϭϬϯͲϵ

California Family Physician Fall 2018

7

p r e s i d e n t ’s m e s s a g e

Lisa M. Ward, MD, MScPH, MS

Opioid Issues are Complex, and Policy Decisions are Adding to the Complexity :ĂĐŬ ŝƐ ŝŶ ŚŝƐ ͚ϯϬƐ͕ ŵŽƌďŝĚůLJ ŽďĞƐĞ ĂŶĚ ǁŝƚŚ ĞĂƌůLJ ŽƐƚĞŽĂƌƚŚƌŝƟƐ͘ >ĞŐŝƐůĂƟŽŶ ŝŶƚƌŽĚƵĐĞĚ ƚŚŝƐ ƐĞƐƐŝŽŶ ĐĂůůƐ ĨŽƌ ůŝŵŝƚƐ ŽŶ ŽƉŝŽŝĚ ,Ğ ǁĂƐ ƉŚLJƐŝĐĂůůLJ ĂďƵƐĞĚ ĂƐ Ă ĐŚŝůĚ͕ ŽŶ ŽdžLJĐŽĚŽŶĞ ƚŽ ƚƌĞĂƚ ƉƌĞƐĐƌŝƉƟŽŶƐ͗ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƉŝůůƐ͕ ƉƌĞƐĐƌŝƉƟŽŶ ĚƵƌĂƟŽŶ͕ ƉĂƐƚ ĨŽŽƚďĂůů ŝŶũƵƌŝĞƐ ĂŶĚ ǁĂƐ ĐŽǀĞƌĞĚ ďLJ DĞĚŝͲ Ăů ƵŶƟů ŚŝƐ ĂŶĚ D Ɛ ƉĞƌ ƉƌĞƐĐƌŝƉƟŽŶ͘ dŚĞLJ ĐĂůů ĨŽƌ ŵĂŶĚĂƚŽƌLJ ƵƐĞ ŽĨ ǁŝĨĞ ƌĞĐĞŶƚůLJ ƐĞĐƵƌĞĚ Ă ͞ďĞƩĞƌ ũŽď͕͟ ŵŽǀŝŶŐ ƚŚĞŵ ƚŽ Ă ƉƌŝǀĂƚĞ͕ screening tools to assess risk for opioid use at all medical ŚŝŐŚͲĚĞĚƵĐƟďůĞ ŝŶƐƵƌĂŶĐĞ ƉůĂŶ͘ dŚŝƐ ŝŶĐƌĞĂƐĞĚ ƚŚĞ ĐŽƐƚ ŽĨ ŚŝƐ ǀŝƐŝƚƐ Ăƚ ǁŚŝĐŚ ŽƉŝŽŝĚ ƉƌĞƐĐƌŝƉƟŽŶƐ ĂƌĞ ĐŽŶƐŝĚĞƌĞĚ͘ dŚĞLJ ŽdžLJĐŽĚŽŶĞ͕ ƐŽ ŚĞ ƐƚĂƌƚĞĚ ďƵƉƌĞŶŽƌƉŚŝŶĞ ďƵƚ ĨĞůƚ ƚŚĞ ŵĞĚŝĐŝŶĞ ǁŽƵůĚ ŵĂŶĚĂƚĞ D ŚŽƵƌƐ ĂŶĚ ƚŽƉŝĐƐ ƌĞůĂƚĞĚ ƚŽ ƚƌĂŝŶŝŶŐ ŐĂǀĞ Śŝŵ ŝŶƚŽůĞƌĂďůĞ ƐŝĚĞ ĞīĞĐƚƐ ĂŶĚ ĚŝĚ ŶŽƚ ĂĚĚƌĞƐƐ ŚŝƐ ƉĂŝŶ ŽŶ ŽƉŝŽŝĚ ƉƌĞƐĐƌŝďŝŶŐ͘ ůŵŽƐƚ Ăůů ǁŽƵůĚ ƉƵŶŝƐŚ ƉŚLJƐŝĐŝĂŶƐ ĂƐ ǁĞůů͘ dŚĞ ďƵƉƌĞŶŽƌƉŚŝŶĞ ŝƐ ŶŽƚ ĐŽǀĞƌĞĚ ŝŶ ƐŵĂůů ĚŽƐŝŶŐ ĨŽƌ ŶŽƚ ĂĚŚĞƌŝŶŐ ƚŽ ƚŚĞƐĞ ƉƌĂĐƟĐĞƐ͘ tŚŝůĞ ǁĞůůͲŝŶƚĞŶƟŽŶĞĚ͕ ŝŶĐƌĞŵĞŶƚƐ͕ ƐŽ ĂĚũƵƐƟŶŐ the vast majority of these his dose at a price he ƉƌŽƉŽƐĂůƐ ǁŽƵůĚ ĚŽ ůŝƩůĞ ƚŽ ĐĂŶ ĂīŽƌĚ ŝƐ Ă ĐŚĂůůĞŶŐĞ͘ reduce inappropriate opioid 'ŽŝŶŐ ďĂĐŬ ƚŽ ŽdžLJĐŽĚŽŶĞ prescribing. Unfortunately, is not approved by his ǁŚĂƚ would result is massive As an organization representing health insurance as it is ĂŵŽƵŶƚƐ ŽĨ ĂĚŵŝŶŝƐƚƌĂƟǀĞ Ă ͞ŶĞǁ ƉƌĞƐĐƌŝƉƟŽŶ͘͟ ,Ğ ǁŽƌŬ ĂŶĚ ĐůŝŶŝĐĂů ŽďƐƚĂĐůĞƐ ƚŽ family physicians, CAFP seeks could acquire methadone appropriate care. to ensure that all proposed cheaply, but it is high risk for him due to his Physicians on the ground legislation adheres to evidence ǁĞŝŐŚƚ͕ ŵĞŶƚĂů ŝůůŶĞƐƐ ŬŶŽǁ ƚŚŝƐ ŝƐ ĨĂƌ ŵŽƌĞ ƚŚĂŶ ĂŶ and includes ample time ĂŶĚ ŽƚŚĞƌ ĐŽŶĚŝƟŽŶƐ͘ ŽƉŝŽŝĚ ŝƐƐƵĞ͘ /ƚ ŝƐ ĂŶ ĂĚĚŝĐƟŽŶ tŚĂƚ ŝƐ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ŝƐƐƵĞ͘ tĞ ĂůƌĞĂĚLJ ŚĂǀĞ ƚŚĞ and investment for provider ƐƵƉƉŽƐĞĚ ƚŽ ĚŽ͍ tools to prescribe safely and education and training. /ŶƐƵƌĂŶĐĞ ƌĞĮůů ŐƵŝĚĞůŝŶĞƐ appropriately in primary care. and formularies are tĞ ĚŽŶ͛ƚ ŶĞĞĚ ŵŽƌĞ ŵĂŶĚĂƚĞƐ ŶŽƚ ĂůŝŐŶĞĚ ǁŝƚŚ ďĞƐƚ ĂŶĚ ĞīŽƌƚƐ ƚŽ ůĞŐŝƐůĂƚĞ ƚŚĞ ƉƌĞƐĐƌŝďŝŶŐ ƉƌĂĐƟĐĞƐ Žƌ ƉƌĂĐƟĐĞ ŽĨ ŵĞĚŝĐŝŶĞ͘ tĞ ŶĞĞĚ ǁŝƚŚ ŚŝŐŚͲĚĞĚƵĐƟďůĞ ƉĂƟĞŶƚƐ ƚŽ ŚĂǀĞ ĞdžƉĂŶĚĞĚ ŝŶƐƵƌĂŶĐĞ ƉůĂŶƐ͘ ŽĞƐ ƚŚŝƐ ƐŽƵŶĚ ĨĂŵŝůŝĂƌ͍ ĂĐĐĞƐƐ ƚŽ ƚƌĞĂƚŵĞŶƚ ƉƌŽŐƌĂŵƐ͕ ŇĞdžŝďůĞ ĨŽƌŵƵůĂƌŝĞƐ ǁŝƚŚ small dose increments useful in tapering, adequate mental &Žƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚƌĞĂƟŶŐ ƉĂƟĞŶƚƐ ǁŝƚŚ ĐŚƌŽŶŝĐ ƉĂŝŶ͕ ƚŚĞ health and trauma care and resources to support training ŚĞĂůƚŚ ƉŽůŝĐLJ ĂƌĞŶĂ ŝƐ ĐŽŶŐĞƐƚĞĚ ǁŝƚŚ ĂĐƟǀŝƚLJ͘ KƵƌ ůĞŐŝƐůĂƚŽƌƐ ŽƵƌ ƉƌŽǀŝĚĞƌƐ ƚŽ ƉƌĞƐĐƌŝďĞ ;Žƌ ŶŽƚ ƉƌĞƐĐƌŝďĞͿ Ăƚ ƚŚĞ ŚŝŐŚĞƐƚ ĂƌĞ ŬĞĞŶ ƚŽ ƐƵƉƉŽƌƚ ĂůŵŽƐƚ ĂŶLJ ůĞŐŝƐůĂƟŽŶ ŝŶƚĞŶĚĞĚ ƚŽ ĐƵƌď ƐƚĂŶĚĂƌĚƐ͘ tŚŝůĞ ŝƚ ŝƐ ƉŽƐƐŝďůĞ ƚŚĂƚ ƚŚĞ ƌŝŐŚƚ ůĞŐŝƐůĂƟŽŶ ĐŽƵůĚ the opioid epidemic, insurance companies and pharmacies are ŝŵƉƌŽǀĞ ƉƌĞƐĐƌŝďŝŶŐ ƉƌĂĐƟĐĞƐ͕ ŝƚ ŵƵƐƚ ĂůůŽǁ ĨŽƌ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ŝŵƉůĞŵĞŶƟŶŐ ƌĞŐƵůĂƟŽŶƐ ŝŶƚĞŶĚĞĚ ƚŽ ůŝŵŝƚ ƌŝƐŬ͕ ŶĞǁ ŐƵŝĚĞůŝŶĞƐ ĚĞĐŝƐŝŽŶͲŵĂŬŝŶŐ͕ ŝŶǀĞƐƚŵĞŶƚƐ ŝŶ ĞĚƵĐĂƟŽŶ ĂŶĚ ƚƌĂŝŶŝŶŐ ĂŶĚ ĂŶ ƐĞĞŬ ƚŽ ƐŚĂƉĞ ŽƉŝŽŝĚ ƉƌĞƐĐƌŝďŝŶŐ ƉƌĂĐƟĐĞƐ ĂŶĚ ŽǀĞƌƐŝŐŚƚ ďŽĚŝĞƐ ĞŵƉŚĂƐŝƐ ŽŶ ĐŽŵƉƌŽŵŝƐĞ ĂŶĚ ĐŽŵŵƵŶŝĐĂƟŽŶ͘ ůŝŬĞ ƚŚĞ DĞĚŝĐĂů ŽĂƌĚ ŽĨ ĂůŝĨŽƌŶŝĂ ;D Ϳ ĂƌĞ ĚĞƉůŽLJŝŶŐ measures to punish past prescribing related to opioids. Some /͛ǀĞ ƐĞĞŶ ƐƵĐŚ ĞīŽƌƚƐ ǁŽƌŬ ŝŶ ŵLJ ĐŽŵŵƵŶŝƚLJ͘ KƵƌ ůŽĐĂů DĞĚŝͲ ĞīŽƌƚƐ ĂƌĞ ĐŽŶƐƚƌƵĐƟǀĞ͕ ƐŽŵĞ ĂƌĞ ĚŝƐƚƌĂĐƟŶŐ ĂŶĚ ƐŽŵĞ ĂƌĞ ũƵƐƚ Ăů ŵĂŶĂŐĞĚ ĐĂƌĞ ƉůĂŶ ǁŽƌŬĞĚ ǁŝƚŚ ƚŚĞ ƉƌŽǀŝĚĞƌ ĐŽŵŵƵŶŝƚLJ plain misguided. Our health policy and advocacy team at CAFP, ƚŽ ĚĞǀĞůŽƉ Ă ƐLJƐƚĞŵ ŽĨ ĐŚĞĐŬƐ ŽŶ ŽƉŝŽŝĚ ƉƌĞƐĐƌŝƉƟŽŶƐ͘ dŚĞ ĂƐ ǁĞůů ĂƐ ƚŚĞ ƌĞƐƚ ŽĨ ƵƐ͕ ŚĂǀĞ ŽƵƌ ŚĂŶĚƐ ĨƵůů͘ ŐƵŝĚĞůŝŶĞƐ ĂŶĚ ŶĞǁ ƉƌŽĐĞƐƐĞƐ ĂƌŽƐĞ ĨƌŽŵ Ă ĨĂŝƌ ĂŵŽƵŶƚ ŽĨ

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8

California Family Physician Fall 2018

ŶĞŐŽƟĂƟŽŶ ĂŶĚ ĐŽŵŵƵŶŝĐĂƟŽŶ ŽŶ ƉƌĞƐĐƌŝďŝŶŐ ĐƌŝƚĞƌŝĂ ĂŶĚ ǁĞƌĞ ĐŽƵƉůĞĚ ǁŝƚŚ Ă ůĂƌŐĞ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ĞĚƵĐĂƟŽŶ ĂŶĚ ƚƌĂŝŶŝŶŐ ďĞĨŽƌĞ ƚŚĞ ĐŚĂŶŐĞƐ ƚŽŽŬ ƉůĂĐĞ͘ ŽŵƉĂƌĞ ƚŚŝƐ ƚŽ DĞĚŝĐĂƌĞ͕ ǁŚĞƌĞ Ă ŶĞǁ d Z ƉƌŽĐĞƐƐ ŝƐ Ă ǀĞƌŝƚĂďůĞ ďůĂĐŬ ďŽdž ǁŝƚŚ ŶŽ ĐůĞĂƌ ŝŶĚŝĐĂƟŽŶ ĂƐ ƚŽ ǁŚĂƚ ƚƌŝŐŐĞƌƐ ƚŚĞ d Z͕ ǁŚĂƚ ƚŚĞ D Žƌ ƉƌĞƐĐƌŝƉƟŽŶ ŐŽĂůƐ ĂƌĞ Žƌ ǁŚĂƚ ĂĐĐŽŵŵŽĚĂƟŽŶ ĞdžŝƐƚƐ ĨŽƌ ƉĂƟĞŶƚƐ ǁŚŽ ĂƌĞ ƚĂƉĞƌŝŶŐ͘ /Ĩ ƚŚĂƚ ǁĞƌĞŶ͛ƚ ĞŶŽƵŐŚ͕ ŶĞǁ ŐƵŝĚĂŶĐĞ ĨƌŽŵ ƚŚĞ ŽĂƌĚ ŽĨ WŚĂƌŵĂĐLJ͕ ĚŝīĞƌĞŶƚ ƉŽůŝĐŝĞƐ ĨƌŽŵ ŶĂƟŽŶĂů ĂŶĚ ƌĞŐŝŽŶĂů ĐŽŵŵĞƌĐŝĂů pharmacies and the judgement of individual pharmacists ǁŽƌŬŝŶŐ Ăƚ ĚŝīĞƌĞŶƚ ƟŵĞƐ ǁŝƚŚŝŶ ĚŝīĞƌĞŶƚ ƉŚĂƌŵĂĐŝĞƐ ĐƌĞĂƚĞ ĂŶ ƵŶƉƌĞĚŝĐƚĂďůĞ ůĂŶĚƐĐĂƉĞ͘ ŽƚŚ ƚŚĞ ƉƌĞƐĐƌŝƉƟŽŶ ĂƉƉƌŽǀĂů ƉƌŽĐĞƐƐ ĂŶĚ ƚŚĞ ƉƌĞƐĐƌŝƉƟŽŶ ĚŝƐƚƌŝďƵƟŽŶ ƉƌŽĐĞƐƐ ŶŽǁ ƉŽƐĞ ďĂƌƌŝĞƌƐ ƚŽ ƟŵĞůLJ ŵĞĚŝĐĂƟŽŶ ƌĞĮůůƐ ĂŶĚ ǁŽƌŬ Ăƚ ĐƌŽƐƐͲƉƵƌƉŽƐĞƐ ƚŽ ƐĂĨĞ ƉƌĞƐĐƌŝďŝŶŐ ƉƌĂĐƟĐĞƐ͘ dŚĞ ĐůŝŶŝĐĂů ĐŚĂŽƐ ƚŚŝƐ ĐƌĞĂƚĞƐ ĨŽƌ ƉƌŽǀŝĚĞƌƐ ĂŶĚ ƉĂƟĞŶƚƐ ůĞĂĚƐ ƚŽ ďĂĚ ĐĂƌĞ ĂŶĚ ƉŽŽƌ ŽƵƚĐŽŵĞƐ͘ D ŽǀĞƌƐŝŐŚƚ ŝŶƚĞŶƐŝĮĞĚ ƚŚŝƐ LJĞĂƌ͘ dŚĞ ŽĂƌĚ ďĞŐĂŶ Ă ƌĞǀŝĞǁ ƉƌŽĐĞƐƐ ƚĂƌŐĞƟŶŐ ƉƌĞƐĐƌŝƉƟŽŶ ƉƌĂĐƟĐĞƐ ĚĂƟŶŐ ďĂĐŬ ƚŽ ϮϬϭϬ ĂŶĚ ŝƐƐƵĞĚ ůĞƩĞƌƐ ŽĨ ŝŶƋƵŝƌLJ ƚŽ ŚƵŶĚƌĞĚƐ ŽĨ ƉŚLJƐŝĐŝĂŶƐ͘ ĚĚ ƚŽ ƚŚŝƐ ƚŚĞ ƌĞƋƵŝƌĞŵĞŶƚ ƚŽ ĐŚĞĐŬ ƚŚĞ ŽŶƚƌŽůůĞĚ ^ƵďƐƚĂŶĐĞ hƟůŝnjĂƟŽŶ ZĞǀŝĞǁ ĂŶĚ ǀĂůƵĂƟŽŶ ^LJƐƚĞŵ ; hZ ^Ϳ ĚĂƚĂďĂƐĞ ǁŚŝĐŚ ǁĞŶƚ ŝŶƚŽ ĞīĞĐƚ ŽŶ KĐƚŽďĞƌ Ϯ ʹ Ăůů ͲƌĞŐŝƐƚĞƌĞĚ ƉŚLJƐŝĐŝĂŶƐ ŵƵƐƚ ƌĞŐŝƐƚĞƌ ǁŝƚŚ ĂŶĚ ĐŽŶƐƵůƚ hZ ^ ƉƌŝŽƌ ƚŽ ƉƌĞƐĐƌŝďŝŶŐ ^ĐŚĞĚƵůĞ //͕ /// Žƌ /s

ĐŽŶƚƌŽůůĞĚ ƐƵďƐƚĂŶĐĞƐ ƚŽ Ă ƉĂƟĞŶƚ ĨŽƌ ƚŚĞ ĮƌƐƚ ƟŵĞ ĂŶĚ Ăƚ ůĞĂƐƚ ŽŶĐĞ ĞǀĞƌLJ ĨŽƵƌ ŵŽŶƚŚƐ ƚŚĞƌĞĂŌĞƌ ŝĨ ƚŚĂƚ ƐƵďƐƚĂŶĐĞ ƌĞŵĂŝŶƐ ƉĂƌƚ ŽĨ ƚŚĞ ƉĂƟĞŶƚ͛Ɛ ƚƌĞĂƚŵĞŶƚ͘ ;zŽƵ ĐĂŶ ƌĞĂĚ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ D ͛Ɛ ƌĞǀŝĞǁ ŽĨ ƉƌĞƐĐƌŝďŝŶŐ ƉƌĂĐƟĐĞƐ ĂŶĚ hZ ^ ƌĞƋƵŝƌĞŵĞŶƚƐ ŽŶ ƚŚĞ &W ǁĞďƐŝƚĞ Ăƚ ŚƩƉ͗ͬ​ͬǁǁǁ͘ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬ hZ ^ƵƉĚĂƚĞͿ͘ Ɛ ĂŶ ŽƌŐĂŶŝnjĂƟŽŶ ƌĞƉƌĞƐĞŶƟŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ &W ƐĞĞŬƐ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ Ăůů ƉƌŽƉŽƐĞĚ ůĞŐŝƐůĂƟŽŶ ĂĚŚĞƌĞƐ ƚŽ ĞǀŝĚĞŶĐĞ ĂŶĚ ŝŶĐůƵĚĞƐ ĂŵƉůĞ ƟŵĞ ĂŶĚ ŝŶǀĞƐƚŵĞŶƚ ĨŽƌ ƉƌŽǀŝĚĞƌ ĞĚƵĐĂƟŽŶ ĂŶĚ ƚƌĂŝŶŝŶŐ͘ dŚĂŶŬĨƵůůLJ͕ &W ǁĂƐ ĂďůĞ ƚŽ ƐƚŽƉ Žƌ ĂŵĞŶĚ ϭϮ ďŝůůƐ ŽĨ ƚŚĞ ƚLJƉĞ ĚĞƐĐƌŝďĞĚ ĂďŽǀĞ͕ ĞŶƐƵƌŝŶŐ ƚŚĂƚ ǁŚĂƚ ŵŽǀĞĚ ĨŽƌǁĂƌĚ ǁĂƐ ŝŶ ƉĂƟĞŶƚƐ͛ ĂŶĚ ƉŚLJƐŝĐŝĂŶƐ͛ ďĞƐƚ ŝŶƚĞƌĞƐƚ͘ Ɛ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ŵƵƐƚ ƐƚĂLJ ŽŶ ƚŽƉ ŽĨ ŶĞǁ ŐƵŝĚĞůŝŶĞƐ ĨŽƌ ƉƌĞƐĐƌŝďŝŶŐ ŽƉŝŽŝĚƐ ĨƌŽŵ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ ; Ϳϭ and from the MBCϮ, and ensure they are informed by clinical evidence ĂŝŵĞĚ Ăƚ ƐĂĨĞƌ͕ ŝŵƉƌŽǀĞĚ ƉƌĞƐĐƌŝďŝŶŐ ƉƌĂĐƟĐĞƐ͘ /Ĩ ǁĞ ĚŽŶ͛ƚ ŐĞƚ ƚŚŝƐ ƌŝŐŚƚ͕ ŶŽ ŽŶĞ ǁŝŶƐ͕ ůĞĂƐƚ ŽĨ Ăůů :ĂĐŬ͘ References ϭ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬĚƌƵŐŽǀĞƌĚŽƐĞͬƉƌĞƐĐƌŝďŝŶŐͬ guideline.html Ϯ͘ ŚƩƉ͗ͬ​ͬǁǁǁ͘ŵďĐ͘ĐĂ͘ŐŽǀͬůŝĐĞŶƐĞĞƐͬƉƌĞƐĐƌŝďŝŶŐͬƉĂŝŶͺ guidelines.pdf

California Family Physician Fall 2018

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political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

CAFP Budget Advocacy Literally Paying Off

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ΨϮϯϯ ŵŝůůŝŽŶ ;ŽŶ ƚŽƉ ŽĨ ƚŚĞ ŵŽƌĞ ƚŚĂŶ ΨϯϱϬ ŵŝůůŝŽŶ ŝŶĐƌĞĂƐĞ ŝŶ ϮϬϭϳͿ ĨŽƌ ŝŶĐƌĞĂƐĞĚ ƉĂLJŵĞŶƚƐ ƚŽ DĞĚŝͲ Ăů ƉƌŽǀŝĚĞƌƐ͘ &W ǁŝůů ǁŽƌŬ ƚŽ ĞŶƐƵƌĞ ƚŚĞ ĞŶƚŝƌĞƚLJ of this money goes to health providers, even if ƉĂƐƐĞĚ ƚŚƌŽƵŐŚ DĂŶĂŐĞĚ ĂƌĞ WůĂŶƐ ;D WƐͿ͘ dŽ ŽƵƌ ŬŶŽǁůĞĚŐĞ͕ ǁŚĞŶ ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂƌĞ ^ĞƌǀŝĐĞƐ ; , ^Ϳ ŝŵƉůĞŵĞŶƚĞĚ ƚŚĞ ĨĨŽƌĚĂďůĞ ĂƌĞ Đƚ͛Ɛ ; Ϳ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉĂLJŵĞŶƚ ďƵŵƉ ŝŶ ϮϬϭϰ͕ ŶŽ ĂƵĚŝƚ Žƌ ƚƌĂĐŬŝŶŐ ŽĨ ƚŚĞ ĨƵŶĚƐ ƚŽŽŬ ƉůĂĐĞ͘ Transparency is required to make sure MCPs aren’t getting rich off the backs of Medi-Cal providers. ΨϭϵϬ ŵŝůůŝŽŶ ŽĨ ůŽĂŶ ƌĞƉĂLJŵĞŶƚ ĨƵŶĚƐ ĨŽƌ ƌĞĐĞŶƚůLJͲ ŐƌĂĚƵĂƚĞĚ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ƐĞƌǀĞ DĞĚŝͲ Ăů ďĞŶĞĨŝĐŝĂƌŝĞƐ ;ƚŽ ďĞ ƐƉĞŶƚ ďĞĨŽƌĞ :ƵůLJ ϭ͕ ϮϬϮϱͿ͘ ΨϲϬ ŵŝůůŝŽŶ ƚŽ ŝŵƉůĞŵĞŶƚ ĂŶ ůů WĂLJĞƌƐ ůĂŝŵƐ ĂƚĂďĂƐĞ ʹ Ă ŵĂũŽƌ ƐƚĞƉ ƚŽǁĂƌĚ &W͛Ɛ ŐŽĂů ŽĨ requiring health plans to report on the percentage they spend on primary care. ΨϰϬ ŵŝůůŝŽŶͬLJĞĂƌ ƚŽ ƐƵƉƉŽƌƚ ƉƌŝŵĂƌLJ ĐĂƌĞ ĂŶĚ emergency medicine residency programs in ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂƐ͘ &W ǁŝůů Ɛŝƚ ŽŶ ƚŚĞ ƉƌŽŐƌĂŵ͛Ɛ ĚǀŝƐŽƌLJ ŽŵŵŝƚƚĞĞ ĂŶĚ ǁŝůů ǁŽƌŬ ƚŽ ĞŶƐƵƌĞ ƚŚŽƐĞ

California Family Physician Fall 2018

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funds are used to support programs that truly need them. ŽŶƚŝŶƵĂƚŝŽŶ ŽĨ ƚŚĞ ΨϭϬϬ ŵŝůůŝŽŶ ƚŚƌĞĞͲLJĞĂƌ ^ŽŶŐ ƌŽǁŶ WŚLJƐŝĐŝĂŶ dƌĂŝŶŝŶŐ Đƚ ĂƉƉƌŽƉƌŝĂƚŝŽŶ͘ /Ŷ ϮϬϮϬ͕ Ăůů ŽƵƌ ŵĞŵďĞƌƐ ǁŝůů ďĞ ĂƐŬĞĚ ƚŽ ƌĞĂĐŚ ŽƵƚ ƚŽ ƚŚĞŝƌ legislators and urge them to continue funding this vital program.

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CAFP’s aggressive efforts to promote primary care and family medicine have helped legislative leaders truly understand the importance of a wellfunded and functioning primary care system.

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CAFP has significantly reallocated resources to fight for family medicine’s priorities through the California State ƵĚŐĞƚ ŽǀĞƌ ƚŚĞ ƉĂƐƚ ĨĞǁ LJĞĂƌƐ͕ ĂƐ LJŽƵ ŵĂLJ ŚĂǀĞ ŶŽƚŝĐĞĚ͘ CAFP remains deeply involved in legislation, but the opportunity to FUND primary care-focused programs, not ũƵƐƚ ĐƌĞĂƚĞ ƚŚĞŵ͕ ŝƐ ǁŚĞƌĞ ƚŚĞ ĂĚǀŽĐĂĐLJ ƌƵďďĞƌ ƌĞĂůůLJ ŵĞĞƚƐ the road. CAFP’s aggressive efforts to promote primary care and family medicine have helped legislative leaders ƚƌƵůLJ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ Ă ǁĞůůͲĨƵŶĚĞĚ ĂŶĚ ĨƵŶĐƚŝŽŶŝŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐLJƐƚĞŵ͘ Ɛ ŽĨ ƚŚŝƐ ǁƌŝƚŝŶŐ͕ &W has advocated for and secured more than $1 billion for our top priorities, including increased Medi-Cal payments, primary care residency funding stability, primary care medical student loan repayment and measurement of health plan primary care spending. Some of the recent ŵĂũŽƌ ƐƵĐĐĞƐƐĞƐ &W ǁŝůů ĨŽĐƵƐ ŽŶ ŝŵƉůĞŵĞŶƚŝŶŐ ŽǀĞƌ ƚŚĞ ŶĞdžƚ LJĞĂƌ ŝŶĐůƵĚĞ͗

CAFP member advocacy on the state budget is just as ŝŵƉŽƌƚĂŶƚ ĂƐ ĂĚǀŽĐĂĐLJ ŽŶ ůĞŐŝƐůĂƚŝŽŶ͘ tŚĞŶ LJŽƵ ŵĞĞƚ ǁŝƚŚ LJŽƵ ůĞŐŝƐůĂƚŽƌƐ͕ ďĞ ƐƵƌĞ ƚŚĞLJ ŬŶŽǁ ƚŚĂƚ ĞŶĂĐƚŝŶŐ ƉƌŽŐƌĂŵƐ ƚŽ help primary care mean nothing if those programs are not ĨƵŶĚĞĚ͘ tĂŶƚ ƚŽ ŐĞƚ ŵŽƌĞ ŝŶǀŽůǀĞĚ ŝŶ ŽƵƌ ĂĚǀŽĐĂĐLJ ĞĨĨŽƌƚƐ͍ WůĞĂƐĞ ƐŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞLJ ŽŶƚĂĐƚ ĂŶĚ ůĞĂƌŶ Ăůů ĂďŽƵƚ ŐĞƚƚŝŶŐ ŝŶǀŽůǀĞĚ ŝŶ ĨŝŐŚƚŝŶŐ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ƉĂƚŝĞŶƚƐ͗ ŚƚƚƉ͗ͬ​ͬǁǁǁ͘ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬĂĚǀŽĐĂĐLJͬŬĞLJͲĐŽŶƚĂĐƚ͘

Jay W. Lee, MD, MPH President, Family Physicians Political Action Committee (FP-PAC)

H e a l t h y P o l i c y a n d Yo u

Looming Legislative Battles Lead to FP-PAC Change dŚĞ ĐŚĂůůĞŶŐĞƐ ĨĂĐŝŶŐ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ ƐŽŵĞƟŵĞƐ ĨĞĞů ŽǀĞƌǁŚĞůŵŝŶŐ͘ ^Ž ŵƵĐŚ ĐĂŶ ďĞ ŝŵƉƌŽǀĞĚ ĂŶĚ ƐŽ ŵĂŶLJ ĐŽŵƉĞƟŶŐ ŝŶƚĞƌĞƐƚƐ ƐĞĞŬ ƚŽ ĚƌŽǁŶ ŽƵƚ ƚŚĞ ǀŽŝĐĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ &W ďĂƩůĞĚ nearly ϮϬ ƉŝĞĐĞƐ ŽĨ ůĞŐŝƐůĂƟŽŶ ĂŝŵĞĚ Ăƚ ƌĞŐƵůĂƟŶŐ ŚŽǁ ǁĞ ƉƌĂĐƟĐĞ ŵĞĚŝĐŝŶĞ ŝŶ ũƵƐƚ ƚŚŝƐ ůĞŐŝƐůĂƟǀĞ ƐĞƐƐŝŽŶ ĂůŽŶĞ͘ /Ĩ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŚĂĚ ƚŚĞ ƉŽǁĞƌ ƚŽ ^, W ƚŚĞ >ĞŐŝƐůĂƚƵƌĞ͕ ďLJ ĨĞƌǀĞŶƚůLJ ƐƵƉƉŽƌƟŶŐ ĂŶĚ ĞůĞĐƟŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĐŚĂŵƉŝŽŶƐ ƚŽ ŽĸĐĞ͕ ůĞŐŝƐůĂƚŽƌƐ ǁŽƵůĚ ALREADY know exactly which bills are the most harmful and those that ǁŝůů ŵĂŬĞ Ă ƉŽƐŝƟǀĞ ĚŝīĞƌĞŶĐĞ ƚŽ LJŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ƉƌĂĐƟĐĞ͊ >ŽŽŬ ŶŽ ĨƵƌƚŚĞƌ ƚŚĂŶ ƚŚĞ ĞůĞĐƟŽŶ ŽĨ ZŝĐŚĂƌĚ WĂŶ͕ D ƚŽ ƐĞĞ ƚŚĞ ĚŝīĞƌĞŶĐĞ ŵĂĚĞ ďLJ ĞůĞĐƟŶŐ Ă ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĐŚĂŵƉŝŽŶ ƚŽ ƚŚĞ >ĞŐŝƐůĂƚƵƌĞ͘ dŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ WŽůŝƟĐĂů ĐƟŽŶ ŽŵŵŝƩĞĞ ;&WͲ W Ϳ ǁĂƐ Ă ŵĂũŽƌ ƐƵƉƉŽƌƚĞƌ ŽĨ ŶŽǁͲ^ĞŶĂƚŽƌ WĂŶ͛Ɛ ĐĂŵƉĂŝŐŶ͘ &WͲW ŝƐ Ă ďŝƉĂƌƟƐĂŶ ƉŽůŝƟĐĂů ŽƌŐĂŶŝnjĂƟŽŶ ǁŝƚŚ ƚŚĞ ƐŽůĞ ŵŝƐƐŝŽŶ ŽĨ ŚĞůƉŝŶŐ ĞůĞĐƚ ƉƌŽͲĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĐĂŶĚŝĚĂƚĞƐ ƚŽ ƉƵďůŝĐ ŽĸĐĞ ĂŶĚ ĞĚƵĐĂƟŶŐ ĐƵƌƌĞŶƚ ůĞŐŝƐůĂƚŽƌƐ ŽŶ ƚŚĞ ǀĂůƵĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ ^ŝŶĐĞ ƚĂŬŝŶŐ ŽĸĐĞ͕ ^ĞŶĂƚŽƌ WĂŶ ŚĂƐ ĨŽƵŐŚƚ ƟƌĞůĞƐƐůLJ ĨŽƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ĂŶĚ ƉĂƟĞŶƚƐ͕ ƉĂƐƐŝŶŐ ůĂǁƐ ƚŽ ŝŵƉƌŽǀĞ ĐŚŝůĚŚŽŽĚ ŝŵŵƵŶŝnjĂƟŽŶƐ ĂŶĚ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉĂLJŵĞŶƚ͕ ƐƵƉƉŽƌƟŶŐ ƚŚĞ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ĂŶĚ ĮŐŚƟŶŐ ůĞŐŝƐůĂƟŽŶ ŚĂƌŵĨƵů ƚŽ ƉĂƟĞŶƚƐ ĂŶĚ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ͘ EŽƚ ŽŶůLJ ŚĂƐ ŚĞ ĞŶĂĐƚĞĚ ůĞŐŝƐůĂƟŽŶ͕ ŚĞ ŚĂƐ ĂĚǀŝƐĞĚ ŚŝƐ ŶŽŶͲƉŚLJƐŝĐŝĂŶ ĐŽůůĞĂŐƵĞƐ ĂďŽƵƚ ŚŽǁ ƚŚĞŝƌ ǀŽƚĞƐ ǁŝůů ĂīĞĐƚ ŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ƵƐ͘ KĨ ϭϮϬ ůĞŐŝƐůĂƚŽƌƐ͕ ŽŶůLJ dtK ĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ʹ ďƵƚ LJŽƵ ĚŽŶ͛ƚ ŚĂǀĞ ƚŽ ďĞ

Ă ƉŚLJƐŝĐŝĂŶ ƚŽ ďĞ Ă ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĐŚĂŵƉŝŽŶ͘ /Ĩ ǁĞ ŚĂĚ ƚŚĞ ƌĞƐŽƵƌĐĞƐ͕ we could help elect legislators who know what it is like to be a primary care physician – legislators who know family physicians should have ĐŽŶƚƌŽů ŽǀĞƌ ŽƵƌ ůŝǀĞƐ ĂŶĚ ƚŚĞ ǁĂLJ ǁĞ ƉƌĂĐƟĐĞ ŵĞĚŝĐŝŶĞ͕ ĨŽůůŽǁŝŶŐ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ŐƵŝĚĞůŝŶĞƐ͕ ŶŽƚ ƐĂĚĚůĞĚ ǁŝƚŚ ŵĂŶĚĂƚĞƐ ĨŽƌĐĞĚ ƵƉŽŶ ƵƐ by bureaucrats, health plans and regulators who have no idea what it is ůŝŬĞ ƚŽ ƉƌĂĐƟĐĞ ŵĞĚŝĐŝŶĞ͘ Family medicine needs a strong and robust grassroots advocacy ƉƌŽŐƌĂŵ ĂŶĚ Ă ǁĞůůͲĨƵŶĚĞĚ WŽůŝƟĐĂů ĐƟŽŶ ŽŵŵŝƩĞĞ͘ ZŝŐŚƚ ŶŽǁ͕ ůĞƐƐ ƚŚĂŶ ĮǀĞ ƉĞƌĐĞŶƚ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŚĞůƉ ŝŶ ŽƵƌ ĞīŽƌƚƐ͘ dŚĞ ƐĂĚ ĨĂĐƚ ŝƐ͕ &WͲW ůĂĐŬƐ ƚŚĞ ƌĞƐŽƵƌĐĞƐ ƚŽ ďĞ Ă ŵĂũŽƌ ƉůĂLJĞƌ ŝŶ ƚŚĞ ƉŽůŝƟĐĂů ĂƌĞŶĂ Ăƚ ƚŚŝƐ ƟŵĞ͘ tĞ ĐĂŶ ĚŽ ďĞƩĞƌ ĨŽƌ ŽƵƌ ƐƉĞĐŝĂůƚLJ ĂŶĚ ƉĂƟĞŶƚƐ͘ dŚĂƚ ŝƐ ǁŚLJ &W ĂŶĚ &WͲW ĂƌĞ ůĂƵŶĐŚŝŶŐ Ă ďŽůĚ ŝŶŝƟĂƟǀĞ ƚŽ ƚĂŬĞ ďĂĐŬ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͛Ɛ ƌŝŐŚƞƵů ƉůĂĐĞ ĂƐ ƚŚĞ ůĞĂĚĞƌ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ͘ s Zz ĂůŝĨŽƌŶŝĂ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͛Ɛ ŝŶǀŽůǀĞŵĞŶƚ ĂŶĚ ƐƵƉƉŽƌƚ ǁŝůů ďĞ ƌĞƋƵŝƌĞĚ͘ &W ŝƐ ĂƐŬŝŶŐ ĨŽƌ ůĞƐƐ ƚŚĂŶ ΨϬ͘Ϭϳ Ă ĚĂLJ ĨƌŽŵ ĞĂĐŚ ŵĞŵďĞƌ͕ ĂŶ ŝŶƐŝŐŶŝĮĐĂŶƚ ĂŵŽƵŶƚ ĨŽƌ ĞĂĐŚ ŽĨ ƵƐ͘ ŽůůĞĐƟǀĞůLJ͕ ƚŚĂƚ ΨϬ͘ϬϳͬĚĂLJ ĨƌŽŵ ŽƵƌ ϲ͕ϬϬϬн ĐƟǀĞ ŵĞŵďĞƌƐ ŵĞĂŶƐ &WͲW ǁŝůů ďĞĐŽŵĞ ŽŶĞ ŽĨ ƚŚĞ ŵŽƐƚ ƉŽǁĞƌĨƵů ŚĞĂůƚŚ ĐĂƌĞ W Ɛ ŝŶ ƚŚĞ ƐƚĂƚĞ͘ zŽƵ ĐĂŶ ƌĞĂĚ ŵŽƌĞ ĂďŽƵƚ ŝƚ ŽŶ &W͛Ɛ ǁĞďƐŝƚĞ͘ / ĂƐŬ LJŽƵ ƚŽ stand with us͘ &W ďĂƩůĞƐ ƐƚƌŽŶŐ ŽƉƉŽŶĞŶƚƐ ƚŚĂƚ ŚĂǀĞ Ă ƐŝŐŶŝĮĐĂŶƚ ĮŶĂŶĐŝĂů ĂĚǀĂŶƚĂŐĞ ŽǀĞƌ ƵƐ ŝŶ ĞǀĞƌLJ ůĞŐŝƐůĂƟǀĞ ƐĞƐƐŝŽŶ͘ tĞ

TRIAL LAWYERS

TEACHERS

UNIONS

PSYCHOLOGISTS NURSE PRACTITIONERS HOSPITALS UNIONS

FAMILY DOC

NATUROPATHS CORPORATIONS

RADIOLOGISTS

12

California Family Physician Fall 2018

BANKS OIL COMPANIES

H e a l t h y P o l i c y a n d Yo u

ĮŐŚƚ ŚĞĂůƚŚ ƉůĂŶƐ͕ ƚƌŝĂů ůĂǁLJĞƌƐ ĂŶĚ ƚŚŽƐĞ ǁŚŽ ƐĞĞŬ ƚŽ ƉƌŽĮƚ Ăƚ ƚŚĞ ĞdžƉĞŶƐĞ ŽĨ ƚŚĞ ƉƵďůŝĐ͛Ɛ ŚĞĂůƚŚ͕ ůŝŬĞ ŝŐ dŽďĂĐĐŽ͘ /ƚ ŵĂLJ take years for us to accomplish our goals, but we cannot waver or back down from ƚŚĞ ĮŐŚƚ͘ /ƚ ŵĞĂŶƐ ŵŽƌĞ ƚŚĂŶ ũƵƐƚ ƚŚĞ ΨϮϰ ŽŶ LJŽƵƌ ĚƵĞƐ͘ /ƚ ŵĞĂŶƐ ďĞŝŶŐ ĞŶŐĂŐĞĚ with your legislators and your colleagues. /ƚ ŵĞĂŶƐ ũŽŝŶŝŶŐ &W͛Ɛ <ĞLJ ŽŶƚĂĐƚ Program to stay up to date on decisions being made in Sacramento and swinging ŝŶƚŽ ĂĐƟŽŶ ǁŚĞŶ LJŽƵ ƌĞĐĞŝǀĞ ĂŶ ĐƟŽŶ Alert from CAFP. tŚĞƚŚĞƌ LJŽƵ ĂƌĞ ŝŶ Ă ůĂƌŐĞ ŵƵůƟͲƐƉĞĐŝĂůƚLJ ƉƌĂĐƟĐĞ Žƌ ŝŶ ƚŚĞ ƚƌĞŶĐŚĞƐ ĂƐ Ă ƐŽůŽ ƌƵƌĂů FP, we are ALL family physicians and we are the largest primary care specialty ƐŽĐŝĞƚLJ ŝŶ ĂůŝĨŽƌŶŝĂ͘ DŽƌĞ ƚŚĂŶ 10,000 members strong, if we act ƚŽŐĞƚŚĞƌ ǁĞ ĐĂŶŶŽƚ ĂŶĚ t/>> EKd ďĞ ignored.

CA POLITICAL SPENDING

Chiropractors spend more than $200,000.

Blue Cross spends more than $1.3 million a year.

FP-PAC ($50,000) Must Grow and Complete!

The Consumer Attorneys of California (trial lawyers) spend more than $1.6 million.

Sources: http://powersearch.sos.ca.gov/advanced.php http://maplight.org/

California Family Physician Fall 2018

13

H e a l t h y P o l i c y a n d Yo u

Adam Francis D i r e c t o r, G o v e r n m e n t A f f a i r s

November Election Could Mean Major Changes in Health Care From State Assembly, State Senate, US House ŽĨ ZĞƉƌĞƐĞŶƚĂƟǀĞƐ͕ h^ ^ĞŶĂƚĞ ƚŽ ƐƚĂƚĞǁŝĚĞ ĐŽŶƐƟƚƵƟŽŶĂů ŽĸĐĞƐ͕ ĂůŝĨŽƌŶŝĂŶƐ ǁŝůů ŐŽ ƚŽ the polls this November and set our state on Ă ŶĞǁ ƉŽůŝĐLJ ƉĂƚŚ͘ dŚŝƐ ŝŶĐůƵĚĞƐ ϭϮ ďĂůůŽƚ ŝŶŝƟĂƟǀĞƐ ;ƉůĞĂƐĞ ƐĞĞ ƚŚĞ ƐĞĐŽŶĚ ŚĂůĨ ŽĨ ƚŚŝƐ ĂƌƟĐůĞͿ ĂŶĚ ǁŚĂƚ ƐĞĞŵƐ ůŝŬĞ ĐŽƵŶƚůĞƐƐ ƐƚĂƚĞ ĂŶĚ ůŽĐĂů ŽĸĐĞƐ ƵƉ ĨŽƌ ŐƌĂďƐ͘ tŚŝůĞ ǁĞ ĐŽƵůĚ Įůů ƚŚŝƐ ĞŶƟƌĞ ŵĂŐĂnjŝŶĞ ǁŝƚŚ ĂŶĂůLJƐŝƐ ŽĨ ĞĂĐŚ ƌĂĐĞ͕ ƚŚĞ ĐŽŵƉĞƟƟŽŶ ƚŚĂƚ ǁŝůů ŚĂǀĞ ƚŚĞ ŵŽƐƚ ŝŶŇƵĞŶĐĞ ŽŶ ŚĞĂůƚŚ ĐĂƌĞ ǁŝůů ďĞ ĨŽƌ ĂůŝĨŽƌŶŝĂ ŐŽǀĞƌŶŽƌ͘ ŌĞƌ ŵŽƌĞ ƚŚĂŶ ϰϬ LJĞĂƌƐ ŝŶ ƉƵďůŝĐ ůŝĨĞ͕ ŝŶĐůƵĚŝŶŐ ϭϱ LJĞĂƌƐ ĂƐ ŐŽǀĞƌŶŽƌ ŽĨ ĂůŝĨŽƌŶŝĂ͕ :ĞƌƌLJ ƌŽǁŶ ŚĂƐ ďĞĞŶ ƐƚĞĂĚĨĂƐƚ ŝŶ ŚŝƐ ƉƌŝŽƌŝƟĞƐ͗ Ă ďĂůĂŶĐĞĚ ĂŶĚ ƌĞƐƚƌĂŝŶĞĚ ďƵĚŐĞƚ ǁŝƚŚ ƌĞƐĞƌǀĞƐ ĂŶĚ Ă ƐƚƌŽŶŐ ƌĂŝŶLJͲĚĂLJ ĨƵŶĚ͖ ůŝŵŝƟŶŐ ĂŶLJ ŝŶĐƌĞĂƐĞ ŝŶ ĞdžƉĞŶĚŝƚƵƌĞƐ ƚŽ ŽŶĞͲƟŵĞ ƐƉĞŶĚŝŶŐ͕ ŶŽƚ ŽŶŐŽŝŶŐ ƉƌŽŐƌĂŵƐ͖ ĞŶǀŝƌŽŶŵĞŶƚĂů ƉƌŽƚĞĐƟŽŶ ĂŶĚ ĂĚǀĂŶĐĞŵĞŶƚƐ ŝŶ ĞŶǀŝƌŽŶŵĞŶƚĂů ƚĞĐŚŶŽůŽŐLJ͖ ĂŶĚ ĂŶ ĂƐͲLJĞƚ ƵŶĨƵůĮůůĞĚ ƉƌŽŵŝƐĞ ƚŽ ďƌŝŶŐ ŚŝŐŚͲƐƉĞĞĚ ƌĂŝů ƚŽ ƚŚĞ ƐƚĂƚĞ͘ EĞŝƚŚĞƌ ĐĂŶĚŝĚĂƚĞ ǁŝůů ďĞ ƚŚĞ ŶĞdžƚ ͞:ĞƌƌLJ ƌŽǁŶ͕͟ ĂŶĚ ƚŚĂƚ ƵŶĐĞƌƚĂŝŶƚLJ ůĞĂĚƐ ƚŽ ďŽƚŚ ŚŽƉĞ ĂŶĚ ĐŽŶĐĞƌŶ ĨŽƌ ǁŚĂƚ ĂůŝĨŽƌŶŝĂ͛Ɛ ĨƵƚƵƌĞ ǁŝůů ůŽŽŬ ůŝŬĞ ŝŶ ƚŚĞ ŶĞdžƚ ĨŽƵƌ ƚŽ ĞŝŐŚƚ LJĞĂƌƐ͘ dŚĞ ďƵĚŐĞƚ ǁŝůů ƌĞŵĂŝŶ Ă ƉĞƌĞŶŶŝĂů ŝƐƐƵĞ͕ ĂƐ ƚŚĞ ŶĞdžƚ ŐŽǀĞƌŶŽƌ ŝƐ ůŝŬĞůLJ ƚŽ ĐŽŶĨƌŽŶƚ ĂůŝĨŽƌŶŝĂ͛Ɛ ŵ ĂŶĚ ďƵƐƚ ĮŶĂŶĐŝĂů ĐLJĐůĞƐ ƚŚĂƚ ŚĂǀĞ ĐŚĂůůĞŶŐĞĚ ƵƐ ĨŽƌ ĚĞĐĂĚĞƐ͘ tŚŝůĞ ůĞĂĚŝŶŐ ĂůŝĨŽƌŶŝĂ ƚŽ ŵƵůƟƉůĞ ďƵĚŐĞƚ ƐƵƌƉůƵƐĞƐ͕ 'ŽǀĞƌŶŽƌ ƌŽǁŶ ŽŌĞŶ ŝŐŶŽƌĞĚ ŚĞĂůƚŚ ĐĂƌĞͲƌĞůĂƚĞĚ ŝƐƐƵĞƐ͘ /Ŷ ĨĂĐƚ͕ ŚĞ ŚĂƐ ďĞĞŶ ŵŽƐƚůLJ ĂďƐĞŶƚ ĨƌŽŵ ƚŚĞ ĐŽŶǀĞƌƐĂƟŽŶ͘ &W ĂŶĚ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ĐŽŵŵƵŶŝƚLJ Ăƚ ůĂƌŐĞ ŽŌĞŶ ĐŚŝĚĞ ŚŝƐ ĨƌĞƋƵĞŶƚ ǀĞƚŽĞƐ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ƌĞĨŽƌŵ ůĞŐŝƐůĂƟŽŶ ĂŶĚ his resistances to spending any General Fund monies on needed health care coverage and ĂĚǀĂŶĐĞŵĞŶƚƐ͘ dŚĞ ŶĞdžƚ ŐŽǀĞƌŶŽƌ ǁŝůů ĨĂĐĞ ŵĂũŽƌ ŝƐƐƵĞƐ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ͕ ĂůŽŶŐ ǁŝƚŚ ŚŽŵĞůĞƐƐŶĞƐƐͬ ŚŽƵƐŝŶŐ͕ ĐŽŶŇŝĐƚƐ ǁŝƚŚ ƚŚĞ ĨĞĚĞƌĂů ŐŽǀĞƌŶŵĞŶƚ ĂŶĚ ĞĚƵĐĂƟŽŶ ƌĞĨŽƌŵ͘ &W ĚŽĞƐ ŶŽƚ ĞŶĚŽƌƐĞ ĐĂŶĚŝĚĂƚĞƐ ĨŽƌ ŐŽǀĞƌŶŽƌ͕ ďƵƚ ǁĞ ƚŚŝŶŬ ŝƚ ĂƉƉƌŽƉƌŝĂƚĞ ƚŽ ƉƌŽǀŝĚĞ Ă ďƌŝĞĨ ŽǀĞƌǀŝĞǁ ŽĨ ĞĂĐŚ ĐĂŶĚŝĚĂƚĞƐ͛ ďĂĐŬŐƌŽƵŶĚ ĂŶĚ ǁŚĞƌĞ ƚŚĞLJ ƐƚĂŶĚ on the prominent issues of the day, including health care.

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California Family Physician Fall 2018

H e a l t h y P o l i c y a n d Yo u

Candidates for Governor

ĞŵŽĐƌĂƚ 'ĂǀŝŶ EĞǁƐŽŵ

ZĞƉƵďůŝĐĂŶ :ŽŚŶ Ždž

WƌŽĨĞƐƐŝŽŶ͗ >ŝĞƵƚĞŶĂŶƚ 'ŽǀĞƌŶŽƌ

WƌŽĨĞƐƐŝŽŶ͗ ƌĞĂů ĞƐƚĂƚĞ ŝŶǀĞƐƚŽƌ ĂŶĚ ǀĞŶƚƵƌĞ ĐĂƉŝƚĂůŝƐƚ

WŽůŝƟĐĂů džƉĞƌŝĞŶĐĞ͗ ƵƌƌĞŶƚ >ŝĞƵƚĞŶĂŶƚ 'ŽǀĞƌŶŽƌ ĂŶĚ ĨŽƌŵĞƌ ^ĂŶ &ƌĂŶĐŝƐĐŽ DĂLJŽƌ ;ϮϬϬϰͲϮϬϭϭͿ͖ ƵŶƐƵĐĐĞƐƐĨƵů ƌƵŶ ĨŽƌ 'ŽǀĞƌŶŽƌ ŝŶ ϮϬϭϬ͘

WŽůŝƟĐĂů džƉĞƌŝĞŶĐĞ͗ hŶƐƵĐĐĞƐƐĨƵů ƌƵŶƐ ĨŽƌ h^ ,ŽƵƐĞ ŽĨ ZĞƉƌĞƐĞŶƚĂƟǀĞƐ͕ ^ĞŶĂƚĞ ĂŶĚ WƌĞƐŝĚĞŶƚ ŵƵůƟƉůĞ ƟŵĞƐ ŝŶ ƚŚĞ ϮϬϬϬƐ͘

DĂŝŶ WůĂƞŽƌŵ͗ ^ƵƉƉŽƌƚƐ ŝŶĨƌĂƐƚƌƵĐƚƵƌĞ ŝŶǀĞƐƚŵĞŶƚ͕ ĨŽĐƵƐŝŶŐ ŽŶ ŵĂŶƵĨĂĐƚƵƌŝŶŐ ĂŶĚ ĞdžƉŽƌƚƐ͕ ŐƵŶ ƐĂĨĞƚLJ͕ ĐƌŝŵŝŶĂů ũƵƐƟĐĞ ƌĞĨŽƌŵ͕ ƉĂŝĚ ĨĂŵŝůLJ ůĞĂǀĞ͕ ŵŝŶŝŵƵŵ ǁĂŐĞ͕ ƵŶŝǀĞƌƐĂů ƉƌĞͲ< ĂŶĚ marriage rights for all.

DĂŝŶ WůĂƞŽƌŵ͗ 'Ğƚ ƚŚĞ ƐƉĞĐŝĂů ŝŶƚĞƌĞƐƚƐ ŽƵƚ ŽĨ ŐŽǀĞƌŶŵĞŶƚ͕ ƐƵƉƉŽƌƚ ĨƌĞĞ ŵĂƌŬĞƚƐ͕ ĨĞǁĞƌ ƌĞŐƵůĂƟŽŶƐ ĂŶĚ ůŽǁĞƌ ƚĂdžĞƐ͘

,ĞĂůƚŚ ĂƌĞ͗ ĞůŝĞǀĞƐ ĐŽŵƉĞƟƟŽŶ ĂŶĚ ƚŚĞ ĨƌĞĞ ŵĂƌŬĞƚ ǁŽƵůĚ ƉƌŽĚƵĐĞ ďĞƩĞƌ ƌĞƐƵůƚƐ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ͘ ƵŶŝǀĞƌƐĂů ŚĞĂůƚŚ ĐĂƌĞ ,ĞĂůƚŚ ĂƌĞ͗ ^ƵƉƉŽƌƚƐ ƵŶŝǀĞƌƐĂů ŚĞĂůƚŚ ĐĂƌĞ ĂŶĚ Ă ƐŝŶŐůĞ ƉĂLJĞƌ ƐLJƐƚĞŵ ǁŽƵůĚ ĂĚĚ Ă ďƵƌĚĞŶ ƚŽ ƚĂdžƉĂLJĞƌƐ͕ ĂīĞĐƚ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ ďƵƚ ĂĐŬŶŽǁůĞĚŐĞƐ ƉŽůŝƟĐĂů ĂŶĚ ůĞŐĂů ŚƵƌĚůĞƐ ĐĂƌĞ ĂŶĚ ĂƩƌĂĐƚ ĂŶ ŝŶŇƵdž ŽĨ ƉĞŽƉůĞ ƐĞĞŬŝŶŐ ĨƌĞĞ ŚĞĂůƚŚ ƐĞƌǀŝĐĞƐ to that system in California. Helped implement Healthy San ŝŶƚŽ ĂůŝĨŽƌŶŝĂ͘ tĂŶƚƐ ƚŽ ƉƌĞǀĞŶƚ ƌĂƟŽŶŝŶŐ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ǁŚŝůĞ &ƌĂŶĐŝƐĐŽ ʹ Ă ƉƌŽŐƌĂŵ ƚŽ ŝŶƐƵƌĞ ůŽǁͲŝŶĐŽŵĞ ĐŝƚLJ ĂĚƵůƚ ƌĞƐŝĚĞŶƚƐ bending the cost curve. ǁŚŽ ŽƚŚĞƌǁŝƐĞ ǁŽƵůĚ ŶŽƚ ƋƵĂůŝĨLJ ĨŽƌ ŽƚŚĞƌ ƉƵďůŝĐ ĐŽǀĞƌĂŐĞ͘ KƚŚĞƌ ŝƚĞŵƐ͗ ^ƵƉƉŽƌƚƐ ƚŚĞ ĐƌĞĂƟŽŶ ŽĨ ĨƵƌƚŚĞƌ ůŝŵŝƚƐ ƚŽ KƚŚĞƌ /ƚĞŵƐ͗ ĂƌůLJ ƐƵƉƉŽƌƚĞƌ ŽĨ ŐƌĂŶƟŶŐ ŵĂƌƌŝĂŐĞ ůŝĐĞŶƐĞƐ ƚŽ ŝŵŵŝŐƌĂƟŽŶ ŝŶƚŽ ƚŚĞ h^ ĂŶĚ ĂůŝĨŽƌŶŝĂ͘ ŶĚŽƌƐĞĚ ďLJ WƌĞƐŝĚĞŶƚ ƐĂŵĞͲƐĞdž ĐŽƵƉůĞƐ ĂŶĚ ƌĞĐƌĞĂƟŽŶĂů ŵĂƌŝũƵĂŶĂ͘ ŶĚŽƌƐĞĚ ďLJ ƚŚĞ Donald Trump. ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ͘ ĐŽŶƟŶƵĞĚ ŽŶ ŶĞdžƚ ƉĂŐĞ х

California Family Physician Fall 2018

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H e a l t h y P o l i c y a n d Yo u

November Ballot Initiatives dŚĞ &W >ĞŐŝƐůĂƟǀĞ īĂŝƌƐ ŽŵŵŝƩĞĞ ƌĞĐŽŵŵĞŶĚĞĚ͕ ĂŶĚ ƚŚĞ &W ŽĂƌĚ ĂŐƌĞĞĚ͕ ƚŚĂƚ &W ƚĂŬĞ ŶŽ ƉŽƐŝƟŽŶƐ ŽŶ ƚŚĞ EŽǀĞŵďĞƌ ϮϬϭϴ ballot measures. CAFP has some related policy in each area covered ďLJ ƚŚĞƐĞ ŝŶŝƟĂƟǀĞƐ ;Ğ͘Ő͕͘ ŚŽƵƐŝŶŐ͕ ƐĂĨĞ ĚƌŝŶŬŝŶŐ ǁĂƚĞƌ͕ ĞŵĞƌŐĞŶĐLJ ĐĂƌĞͿ͕ ďƵƚ ƚŚĞ ƐĐŽƉĞ ŽĨ ƚŚĞŵ ŐŽ ďĞLJŽŶĚ ĐƵƌƌĞŶƚ ƉŽůŝĐLJ͘ tĞ ƐƚƌŽŶŐůLJ ĞŶĐŽƵƌĂŐĞ Ăůů ŵĞŵďĞƌƐ ƚŽ ůĞĂƌŶ ĂďŽƵƚ ĞĂĐŚ ŝŶŝƟĂƟǀĞ ĂŶĚ ďĞ ŝŶĨŽƌŵĞĚ ǀŽƚĞƌƐ͘ ĚĞƐĐƌŝƉƟŽŶ ŽĨ ƚŚĞ ďĂůůŽƚ ŵĞĂƐƵƌĞƐ ĨŽůůŽǁƐ͕ ǁŝƚŚ ůŝŶŬƐ ĨŽƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ĞĂĐŚ͗ WƌŽƉŽƐŝƟŽŶ ϭ ʹ sĞƚĞƌĂŶƐ ĂŶĚ īŽƌĚĂďůĞ ,ŽƵƐŝŶŐ ŽŶĚ Đƚ ŽĨ ϮϬϭϴ dŚŝƐ ŝŶŝƟĂƟǀĞ ĂƵƚŚŽƌŝnjĞƐ Ψϰ ďŝůůŝŽŶ ŝŶ ďŽŶĚƐ ĨŽƌ ĂīŽƌĚĂďůĞ ŚŽƵƐŝŶŐ ƉƵƌƉŽƐĞƐ ŝŶĐůƵĚŝŶŐ ĨŽƌ ĨĂŵŝůŝĞƐ͕ ǀĞƚĞƌĂŶƐ͕ ĨĂƌŵǁŽƌŬĞƌƐ ĂŶĚ ƌĞŶƚĞƌƐ͘ ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϭ͕ͺ,ŽƵƐŝŶŐͺWƌŽŐƌĂŵƐͺ ĂŶĚͺsĞƚĞƌĂŶƐйϮϳͺ>ŽĂŶƐͺ ŽŶĚͺ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ Ϯ ʹ EŽ WůĂĐĞ >ŝŬĞ ,ŽŵĞ Đƚ ŽĨ ϮϬϭϴ dŚŝƐ ŝŶŝƟĂƟǀĞ ĂƵƚŚŽƌŝnjĞƐ ƚŚĞ ƐƚĂƚĞ ƚŽ ƵƐĞ ƌĞǀĞŶƵĞ ĨƌŽŵ WƌŽƉŽƐŝƟŽŶ ϲϯ ;ϮϬϬϰͿ ĨŽƌ ΨϮ ďŝůůŝŽŶ ŝŶ ƌĞǀĞŶƵĞ ďŽŶĚƐ ĨŽƌ ŚŽŵĞůĞƐƐŶĞƐƐ ƉƌĞǀĞŶƟŽŶ housing for persons in need of mental health services. Prop 63 created a ŽŶĞ ƉĞƌĐĞŶƚ ƚĂdž ŽŶ ŝŶĚŝǀŝĚƵĂůƐ ǁŝƚŚ ŝŶĐŽŵĞƐ ĂďŽǀĞ Ψϭ ŵŝůůŝŽŶ ĂŶĚ ƵƐĞƐ the funds to support mental health services. ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϮ͕ͺhƐĞͺDŝůůŝŽŶĂŝƌĞйϮϳƐͺdĂdžͺZĞǀĞŶƵĞͺĨŽƌͺ ,ŽŵĞůĞƐƐŶĞƐƐͺWƌĞǀĞŶƟŽŶͺ,ŽƵƐŝŶŐͺ ŽŶĚƐͺDĞĂƐƵƌĞͺ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ ϯ ʹ ĂůŝĨŽƌŶŝĂ tĂƚĞƌ /ŶĨƌĂƐƚƌƵĐƚƵƌĞ ĂŶĚ tĂƚĞƌƐŚĞĚ ŽŶƐĞƌǀĂƟŽŶ ŽŶĚ /ŶŝƟĂƟǀĞ dŚŝƐ ŝŶŝƟĂƟǀĞ ĂƵƚŚŽƌŝnjĞƐ ŶĞĂƌůLJ Ψϵ ďŝůůŝŽŶ ŝŶ ƐƚĂƚĞ ŐĞŶĞƌĂů ŽďůŝŐĂƟŽŶ ďŽŶĚƐ ĨŽƌ ǀĂƌŝŽƵƐ ŝŶĨƌĂƐƚƌƵĐƚƵƌĞ ƉƌŽũĞĐƚƐ͕ Ψϯ ďŝůůŝŽŶ ĨŽƌ ƐĂĨĞ ĚƌŝŶŬŝŶŐ ǁĂƚĞƌ ĂŶĚ ǁĂƚĞƌ ƋƵĂůŝƚLJ͕ Ψϯ ďŝůůŝŽŶ ĨŽƌ ǁĂƚĞƌƐŚĞĚ ĂŶĚ ĮƐŚĞƌŝĞƐ ŝŵƉƌŽǀĞŵĞŶƚƐ͕ ΨϵϰϬ ŵŝůůŝŽŶ ĨŽƌ ŚĂďŝƚĂƚ ƉƌŽƚĞĐƟŽŶ͕ Ψϴϱϱ ŵŝůůŝŽŶ ĨŽƌ ŝŵƉƌŽǀĞĚ ǁĂƚĞƌ ĐŽŶǀĞLJĂŶĐĞ͕ Ψϲϴϱ ŵŝůůŝŽŶ ĨŽƌ ŐƌŽƵŶĚǁĂƚĞƌ ƐƵƐƚĂŝŶĂďŝůŝƚLJͬƐƚŽƌĂŐĞ ĂŶĚ ΨϰϳϮ ŵŝůůŝŽŶ ĨŽƌ ƐƵƌĨĂĐĞ ǁĂƚĞƌ ƐƚŽƌĂŐĞͬĚĂŵ ƌĞƉĂŝƌƐ͘ ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϯ͕ͺtĂƚĞƌͺ/ŶĨƌĂƐƚƌƵĐƚƵƌĞͺĂŶĚͺtĂƚĞƌƐŚĞĚͺ ŽŶƐĞƌǀĂƟŽŶͺ ŽŶĚͺ/ŶŝƟĂƟǀĞͺ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ ϰ ʹ ŚŝůĚƌĞŶ͛Ɛ ,ŽƐƉŝƚĂů ŽŶĚƐ /ŶŝƟĂƟǀĞ dŚŝƐ ŝŶŝƟĂƟǀĞ ĂƵƚŚŽƌŝnjĞƐ Ψϭ͘ϱ ďŝůůŝŽŶ ŝŶ ďŽŶĚƐ͕ ƚŽ ďĞ ƌĞƉĂŝĚ ĨƌŽŵ ƐƚĂƚĞ͛Ɛ 'ĞŶĞƌĂů &ƵŶĚ͕ ƚŽ ĨƵŶĚ ŐƌĂŶƚƐ ĨŽƌ ĐŽŶƐƚƌƵĐƟŽŶ͕ ĞdžƉĂŶƐŝŽŶ͕ ƌĞŶŽǀĂƟŽŶ and equipping qualifying children’s hospitals. ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϰ͕ͺ ŚŝůĚƌĞŶйϮϳƐͺ,ŽƐƉŝƚĂůͺ ŽŶĚƐͺ/ŶŝƟĂƟǀĞͺ ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ ϱ ʹ WƌŽƉĞƌƚLJ dĂdž dƌĂŶƐĨĞƌ /ŶŝƟĂƟǀĞ dŚŝƐ ŝŶŝƟĂƟǀĞ ĂůůŽǁƐ ŝŶĚŝǀŝĚƵĂůƐ ϱϱ LJĞĂƌƐ ŽĨ ĂŐĞ ĂŶĚ ŽůĚĞƌ Žƌ ƐĞǀĞƌĞůLJ ĚŝƐĂďůĞĚ ƚŽ ƚƌĂŶƐĨĞƌ ƚŚĞŝƌ ƉƌŽƉĞƌƚLJ ƚĂdž ďĂƐŝƐ ƚŽ ĂŶLJ ŚŽŵĞ ŝŶ ƚŚĞ ƐƚĂƚĞ͕ ƚŽ ƉƵƌĐŚĂƐĞ ĂŶLJ ƉƌŝĐĞ ŚŽŵĞ͕ ĂŶĚ ƚŽ ƚƌĂŶƐĨĞƌ ƚŚĞŝƌ ďĂƐŝƐ ĂƐ ŵĂŶLJ ƟŵĞƐ ĂƐ ƚŚĞLJ ǁŝƐŚ͘ /ƚ ĂŵĞŶĚƐ WƌŽƉŽƐŝƟŽŶ ϭϯ ;ϭϵϳϴͿ ƚŽ ĂůůŽǁ ƚŚĞ ƚƌĂŶƐĨĞƌ͕ ǁŝƚŚ Ă ƉŽƐƐŝďůĞ ĂĚũƵƐƚŵĞŶƚ͕ ŶŽ ŵĂƩĞƌ ƚŚĞ ŶĞǁ ŚŽŵĞ͛Ɛ ŵĂƌŬĞƚ ǀĂůƵĞ͕ ƚŚĞ ŶĞǁ ŚŽŵĞ͛Ɛ ůŽĐĂƟŽŶ ŝŶ ƚŚĞ ƐƚĂƚĞ Žƌ ƚŚĞ ďƵLJĞƌ͛Ɛ ŶƵŵďĞƌ ŽĨ ŵŽǀĞƐ͘ ŚƩƉƐ͗ͬ​ͬ ďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϱ͕ͺWƌŽƉĞƌƚLJͺdĂdžͺdƌĂŶƐĨĞƌͺ /ŶŝƟĂƟǀĞͺ;ϮϬϭϴͿ 16

California Family Physician Fall 2018

WƌŽƉŽƐŝƟŽŶ ϲ ʹ sŽƚĞƌ ƉƉƌŽǀĂů ĨŽƌ &ƵƚƵƌĞ 'ĂƐ ĂŶĚ sĞŚŝĐůĞ dĂdžĞƐ ĂŶĚ ϮϬϭϳ dĂdž ZĞƉĞĂů /ŶŝƟĂƟǀĞ dŚŝƐ ŝŶŝƟĂƟǀĞ ƌĞƉĞĂůƐ Ă ϮϬϭϳ ƚƌĂŶƐƉŽƌƚĂƟŽŶ ůĂǁ͛Ɛ ƚĂdž ĂŶĚ ĨĞĞ ƉƌŽǀŝƐŝŽŶƐ ƚŚĂƚ ƉĂLJ ĨŽƌ ƌĞƉĂŝƌƐ ĂŶĚ ŝŵƉƌŽǀĞŵĞŶƚƐ ƚŽ ůŽĐĂů ƌŽĂĚƐ͕ ƐƚĂƚĞ ŚŝŐŚǁĂLJ ĂŶĚ ƉƵďůŝĐ ƚƌĂŶƐƉŽƌƚĂƟŽŶ͘ /ƚ ĂůƐŽ ƌĞƋƵŝƌĞƐ ƚŚĞ >ĞŐŝƐůĂƚƵƌĞ ƚŽ ƐƵďŵŝƚ ĂŶLJ ŵĞĂƐƵƌĞ ĞŶĂĐƟŶŐ ƐƉĞĐŝĮĞĚ ƚĂdžĞƐ Žƌ ĨĞĞƐ ŽŶ ŐĂƐ Žƌ ĚŝĞƐĞů ĨƵĞů͕ Žƌ ŽŶ ƚŚĞ ƉƌŝǀŝůĞŐĞ ƚŽ ŽƉĞƌĂƚĞ Ă ǀĞŚŝĐůĞ ŽŶ ƉƵďůŝĐ ŚŝŐŚǁĂLJƐ͕ ƚŽ ƚŚĞ ĞůĞĐƚŽƌĂƚĞ ĨŽƌ approval. ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϲ͕ͺsŽƚĞƌͺ ƉƉƌŽǀĂůͺĨŽƌͺ&ƵƚƵƌĞͺ'ĂƐͺĂŶĚͺsĞŚŝĐůĞͺdĂdžĞƐͺĂŶĚͺϮϬϭϳͺdĂdžͺZĞƉĞĂůͺ /ŶŝƟĂƟǀĞͺ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ ϳ ʹ WĞƌŵĂŶĞŶƚ ĂLJůŝŐŚƚ ^ĂǀŝŶŐ dŝŵĞ DĞĂƐƵƌĞ dŚŝƐ ŝŶŝƟĂƟǀĞ ƌĞƉĞĂůƐ ĂLJůŝŐŚƚ ^ĂǀŝŶŐƐ dŝŵĞ ŝŶ ĂůŝĨŽƌŶŝĂ͘ /Ĩ ĂƉƉƌŽǀĞĚ ďLJ ƚŚĞ ǀŽƚĞƌƐ͕ ŝƚ ĂůƐŽ ǁŽƵůĚ ŚĂǀĞ ƚŽ ďĞ ĂƉƉƌŽǀĞĚ ďLJ ƚŚĞ ĨĞĚĞƌĂů ŐŽǀĞƌŶŵĞŶƚ͘ ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϳ͕ͺWĞƌŵĂŶĞŶƚͺ ĂLJůŝŐŚƚͺ ^ĂǀŝŶŐͺdŝŵĞͺDĞĂƐƵƌĞͺ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ ϴ ʹ >ŝŵŝƚƐ ŽŶ ŝĂůLJƐŝƐ ůŝŶŝĐƐ͛ ZĞǀĞŶƵĞ ĂŶĚ ZĞƋƵŝƌĞĚ ZĞĨƵŶĚƐ /ŶŝƟĂƟǀĞ dŚŝƐ ŝŶŝƟĂƟǀĞ͕ ƐƉŽŶƐŽƌĞĚ ďLJ ƚŚĞ ^ĞƌǀŝĐĞ ŵƉůŽLJĞĞƐ /ŶƚĞƌŶĂƟŽŶĂů hŶŝŽŶͲ hŶŝƚĞĚ ,ĞĂůƚŚĐĂƌĞ tŽƌŬĞƌƐ͕ ĐĂƉƐ ƌĞǀĞŶƵĞ ĨŽƌ ĚŝĂůLJƐŝƐ ĐŽŵƉĂŶŝĞƐ Ăƚ ϭϭϱ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ĐŽƐƚ ŽĨ ĚŝƌĞĐƚ ƉĂƟĞŶƚ ĐĂƌĞ ĂŶĚ ƚƌĞĂƚŵĞŶƚ ƋƵĂůŝƚLJ ĞīŽƌƚƐ͘ /Ĩ Ă ĐŽŵƉĂŶLJ͛Ɛ ƌĞǀĞŶƵĞ ĞdžĐĞĞĚƐ ƚŚĂƚ ƚŚƌĞƐŚŽůĚ͕ ŝƚ ǁŽƵůĚ ŚĂǀĞ ƚŽ ŝƐƐƵĞ rebates, primarily to commercial health insurers. ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϴ͕ͺ>ŝŵŝƚƐͺŽŶͺ ŝĂůLJƐŝƐͺ ůŝŶŝĐƐйϮϳͺZĞǀĞŶƵĞͺĂŶĚͺ ZĞƋƵŝƌĞĚͺZĞĨƵŶĚƐͺ/ŶŝƟĂƟǀĞͺ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ ϵ ǁĂƐ ƌĞŵŽǀĞĚ ĨƌŽŵ ƚŚĞ ďĂůůŽƚ͘ WƌŽƉŽƐŝƟŽŶ ϭϬ ʹ >ŽĐĂů ZĞŶƚ ŽŶƚƌŽů /ŶŝƟĂƟǀĞ dŚŝƐ ŝŶŝƟĂƟǀĞ ƌĞƉĞĂůƐ ƐƚĂƚĞ ůĂǁ ƚŚĂƚ ƌĞƐƚƌŝĐƚƐ ƚŚĞ ƐĐŽƉĞ ŽĨ ƌĞƐŝĚĞŶƟĂů ƌĞŶƚͲĐŽŶƚƌŽů ƉŽůŝĐŝĞƐ ƚŚĂƚ ĐŝƟĞƐ ĂŶĚ ŽƚŚĞƌ ůŽĐĂů ũƵƌŝƐĚŝĐƟŽŶƐ ŵĂLJ ŝŵƉŽƐĞ͕ ƚŚƵƐ ĂůůŽǁŝŶŐ ůŽĐĂů ŐŽǀĞƌŶŵĞŶƚƐ ƚŽ ĂĚŽƉƚ ƌĞŶƚ ĐŽŶƚƌŽů ŽƌĚŝŶĂŶĐĞƐ͘ ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϭϬ͕ͺ>ŽĐĂůͺZĞŶƚͺ ŽŶƚƌŽůͺ /ŶŝƟĂƟǀĞͺ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ ϭϭ ʹ ŵďƵůĂŶĐĞ ŵƉůŽLJĞĞƐ WĂŝĚ KŶͲ Ăůů ƌĞĂŬƐ͕ dƌĂŝŶŝŶŐ ĂŶĚ DĞŶƚĂů ,ĞĂůƚŚ ^ĞƌǀŝĐĞƐ /ŶŝƟĂƟǀĞ dŚŝƐ ŝŶŝƟĂƟǀĞ ĂůůŽǁƐ ƉƌŝǀĂƚĞͲƐĞĐƚŽƌ ĞŵĞƌŐĞŶĐLJ ĂŵďƵůĂŶĐĞ ĐŽŵƉĂŶŝĞƐ ƚŽ ƌĞƋƵŝƌĞ DdƐ ƚŽ ƌĞŵĂŝŶ ŽŶ ĐĂůů ǁŚĞŶ ƚĂŬŝŶŐ Ă ǁŽƌŬ ďƌĞĂŬ ;ŵĞĂů ĂŶĚ ƌĞƐƚͿ͘ ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϭϭ͕ͺ ŵďƵůĂŶĐĞͺ ŵƉůŽLJĞĞƐͺWĂŝĚͺKŶͲ Ăůůͺ ƌĞĂŬƐ͕ͺdƌĂŝŶŝŶŐ͕ͺĂŶĚͺDĞŶƚĂůͺ,ĞĂůƚŚͺ ^ĞƌǀŝĐĞƐͺ/ŶŝƟĂƟǀĞͺ;ϮϬϭϴͿ WƌŽƉŽƐŝƟŽŶ ϭϮ ʹ &Ăƌŵ ŶŝŵĂů ŽŶĮŶĞŵĞŶƚ /ŶŝƟĂƟǀĞ dŚŝƐ ŝŶŝƟĂƟǀĞ ĞƐƚĂďůŝƐŚĞƐ ŶĞǁ ŵŝŶŝŵƵŵ ƐƉĂĐĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ĨŽƌ ĐŽŶĮŶŝŶŐ veal calves, breeding pigs and egg-laying hens, and requires egg-laying ŚĞŶƐ ďĞ ƌĂŝƐĞĚ ŝŶ Ă ĐĂŐĞͲĨƌĞĞ ĞŶǀŝƌŽŶŵĞŶƚ ĂŌĞƌ ĞĐĞŵďĞƌ ϯϭ͕ ϮϬϮϭ͘ /ƚ ĂůƐŽ ƉƌŽŚŝďŝƚƐ ĐŽŵŵĞƌĐŝĂů ƐĂůĞƐ ŽĨ ƐƉĞĐŝĮĞĚ ŵĞĂƚ ĂŶĚ ĞŐŐ ƉƌŽĚƵĐƚƐ ĨƌŽŵ ĂŶŝŵĂůƐ ĐŽŶĮŶĞĚ ŝŶ Ă ŶŽŶͲĐŽŵƉůLJŝŶŐ ŵĂŶŶĞƌ͘ ŚƩƉƐ͗ͬ​ͬďĂůůŽƚƉĞĚŝĂ͘ŽƌŐͬ ĂůŝĨŽƌŶŝĂͺWƌŽƉŽƐŝƟŽŶͺϭϮ͕ͺ&Ăƌŵͺ ŶŝŵĂůͺ ŽŶĮŶĞŵĞŶƚͺ/ŶŝƟĂƟǀĞͺ;ϮϬϭϴͿ

H e a l t h y P o l i c y a n d Yo u

CAFP Leaders Explore the Heart of the FMRevolution zŽƵƌ &W ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ ŵĞŵďĞƌƐ͕ ĐŽŵŵŝƩĞĞ ĐŚĂŝƌƐ ĂŶĚ ƐƚĂī ƐƉĞŶƚ ƚǁŽ ĚĂLJƐ ŝŶ :ƵůLJ ĞdžƉůŽƌŝŶŐ ƚŚĞ ŵĂŶLJ ĨĂĐĞƚƐ ŽĨ ŵĞŵďĞƌ ĞŶŐĂŐĞŵĞŶƚ ĚƵƌŝŶŐ ƚŚĞ ƐƚƌĂƚĞŐŝĐ ƉůĂŶŶŝŶŐ ŵĞĞƟŶŐ͘ >ĞĚ ďLJ ƌƐ YƵĞĞŶ ŽĨ ,ĞĂƌƚƐ tĂƌĚ͕ :ŶĂǀĞ >ĞĞ͕ dǁŝĚĚůĞ ĞĞƐ ŽŶŶŽůůLJ ĂŶĚ YƵŝŽŐƵĞ͕ ĂŶĚ DƐ ,ĂƩĞƌ ZŽĚƌŝŐƵĞƐ͕ ƚŚĞ ĂƐƐĞŵďůĞĚ ŐƌŽƵƉ ƉĂƌƟĐŝƉĂƚĞĚ ŝŶ Ă ƐĞƌŝĞƐ ŽĨ ĞdžĞƌĐŝƐĞƐ ƚŽ ƉƌŽǀŝĚĞ ƐƚĂī ǁŝƚŚ ƚŚĞ ŶĞĐĞƐƐĂƌLJ ŝŶĨŽƌŵĂƟŽŶ ƚŽ ĐƌĞĂƚĞ ƚŚƌĞĞ ŽĨ &W͛Ɛ Ɛŝdž ƐƚƌĂƚĞŐŝĐ ƉůĂŶƐ ƉŝůůĂƌƐ͘ dŚĞ ŽĂƌĚ ĂƉƉƌŽǀĞĚ ƚŚƌĞĞ ƉŝůůĂƌƐ ʹ ƉĂLJŵĞŶƚ ƌĞĨŽƌŵ͕ ƉŝƉĞůŝŶĞ ŐƌŽǁƚŚ ĂŶĚ ƉƌĂĐƟĐĞ ƚƌĂŶƐĨŽƌŵĂƟŽŶ ʹ Ăƚ ŝƚƐ Ɖƌŝů ϮϬϭϴ ŵĞĞƟŶŐ ŝŶ DŽŶƚĞƌĞLJ͘ dŚĞ :ƵůLJ ŵĞĞƟŶŐ ĨŽĐƵƐĞĚ ŽŶ ŵĞŵďĞƌ ĞŶŐĂŐĞŵĞŶƚ͕ ĐůŝŶŝĐĂů ƐƵƉƉŽƌƚ ĂŶĚ ŵŝƐƐŝŽŶ ƌĞĮŶĞŵĞŶƚ͘ dŚĞ ŵĞĞƟŶŐ ďĞŐĂŶ ǁŝƚŚ a session on physician ŝĚĞŶƟĨLJ͗ ŚŽǁ ŽƵƌ ŝĚĞŶƟƟĞƐ ĂƌĞ ĐƌĞĂƚĞĚ͕ ŚŽǁ ƚŚĞLJ ĐŚĂŶŐĞ͕ ĂŶĚ ŚŽǁ ǁĞ ƐĞĞ ŽƵƌƐĞůǀĞƐ and believe others see us.

A series of data reports ĂŶĚ Ă ƉĞƌƐŽŶĂ ƌĞǀŝĞǁ set the stage for the ĂŌĞƌŶŽŽŶ͛Ɛ ƐĞƐƐŝŽŶ ŽŶ t,z ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ students and resident join the Academy, retain their membership and ĞŶŐĂŐĞ ŝŶ &W ĂĐƟǀŝƟĞƐ͘ dŚĞ t,z ƐƚĂƚĞŵĞŶƚƐ ǁĞƌĞ ŵŽůĚĞĚ ŝŶƚŽ ĚƌĂŌ mission statements and the group voted on the statement that best represents the heart and head of CAFP. Saturday ǁĂƐ ĐĂƉƉĞĚ Žī ǁŝƚŚ ĂŶ evening of fun, including a Susan Hogeland haiku ƐůĂŵ ĂŶĚ ďŽǁůŝŶŐ͘

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Sunday morning brought the group together to recommend strategies to help CAFP meet members’ needs and to more fully ĞŶŐĂŐĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŝŶ ĐĂĚĞŵLJ ǁŽƌŬ͘ ͞ƐƉĞĞĚ ĚĂƟŶŐ͟ ĞdžĞƌĐŝƐĞ ĞŶƐƵĞĚ ĂŶĚ ƐƚĂī ůĞŌ ƚŚĞ ŵĞĞƟŶŐ ǁŝƚŚ ƉĂŐĞƐ ĂŶĚ ƉĂŐĞƐ ŽĨ ŝĚĞĂƐ ƚŽ ƚƵƌŶ ŝŶƚŽ ƚŚĞ ĮŶĂů ƚŚƌĞĞ ƉŝůůĂƌƐ͘ dŚĞ ŚĞĂƌƚ ŽĨ ƚŚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞǀŽůƵƟŽŶ ǁĂƐ ŝŶ ĨƵůů ďĞĂƚ ǁŝƚŚ ƚŚĞ ĮŶĂů ĞdžĞƌĐŝƐĞ ŽĨ ƚŚĞ ŵĞĞƟŶŐ ʹ ƚŚĞ ŽŶĞͲǁŽƌĚͲĂƚͲĂͲƟŵĞ ĐƌĞĂƟŽŶ ŽĨ Ă ƉŽĞŵ ƚŽ &W͘ ĂĐŚ ŝŶĚŝǀŝĚƵĂů ŽīĞƌĞĚ ŽŶĞ ǁŽƌĚ ;ĂŶ ĞdžƚƌĂ ĂƌƟĐůĞ Žƌ ƉƌĞƉŽƐŝƟŽŶ ǁĂƐ ĂůůŽǁĞĚͿ ĂŶĚ ƚŚĞ ĐŚĂŝŶ ŽĨ ǁŽƌĚƐ ďƵŝůĚ ƚŚŝƐ ƉŽĞŵ͕ ǁŚŝĐŚ ĞŶĐĂƉƐƵůĂƚĞƐ Ăůů ƚŚĂƚ &W ŝƐ ĂŶĚ ĐĂŶ ďĞ ƚŽ ŵĞŵďĞƌƐ͕ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ ƉĂƟĞŶƚƐ͘ Love teaches us grounding and inspires ƵƐ ƚŽ ĞdžƉĂŶĚ ŽƵƌ understanding and ŝŶŇƵĞŶĐĞ ƚŽ ĐĂƌĞ͖ And our connectedness and hearts unite To provide a valuable ĞdžƉĞƌŝĞŶĐĞ ĂŶĚ ĞŶĞƌŐLJ͘ ĐƟŽŶ ĂŶĚ ĐŽŵŵƵŶŝƚLJ ŵŽďŝůŝnjĞ ĂŶĚ ƉƌŽƉĞů ƚŚĞ ƌĞǀŽůƵƟŽŶ ƚŽ ƐĞƌǀĞ ƚŚĞ hearts of our members. ,ŽƉĞ ĂŶĚ ƚĞĂŵǁŽƌŬ encourage and transform, ůŽƐƐŽŵŝŶŐ Ă ŐĞŶĞƌĂƟŽŶ ƚŽ ůĞĂĚ ĂŶĚ ŝŶƐƉŝƌĞ͕ ǁŝƚŚ ƐƚƌĞŶŐƚŚ ƵŶŝƟŶŐ ƵƐ Ăůů͘

&W ďŽǁůĞƌƐ ůĞdž DĐ ŽŶĂůĚ͕ <ĞǀŝŶ ZŽƐƐ͕ ZĂƵů LJĂůĂ͕ :Ğƌƌŝ ĂǀŝĚ͕ ĂƌŽů ,ĂǀĞŶƐ͕ >ĂƵƌĞŶ ^ŝŵŽŶ͕ :ĂLJ >ĞĞ͕ DŝĐŚĞůůĞ YƵŝŽŐƵĞ ĂŶĚ ĂǀĞ ĂnjnjŽ ůŝƚ ƵƉ ƚŚĞ ůĂŶĞƐ͘

California Family Physician Fall 2018

Our thanks to everyone ǁŚŽ ƉĂƌƟĐŝƉĂƚĞĚ ĂŶĚ ǁĂƚĐŚ ŚĞƌĞ ĨŽƌ ƚŚĞ results as our strategic ƉůĂŶ ĨŽƌ ϮϬϭϵͲϮϬϮϭ ŝƐ revealed.

H e a l t h y P o l i c y a n d Yo u

Chris Flores, Larry Shore, Fatch Chong and Shannon Connolly work on engagement messages.

dŚĞ ŐƌŽƵƉ ĞdžƉůŽƌĞĚ &W͛Ɛ t,z͘

ĂƌŽů ,ĂǀĞŶƐ͕ LJŶƚŚŝĂ ŚĞŶ͕ ^ƵƐĂŶ ,ŽŐĞůĂŶĚ ĂŶĚ :ĞƌĞŵLJ &ŝƐŚ ĂƚƚĞŵƉƚĞĚ ƚŽ ƚĞĂĐŚ ͞ĨůŽƐƐŝŶŐ͟ ŝŶ ^ĂƚƵƌĚĂLJ ĞǀĞŶŝŶŐ͛Ɛ ŝŵƉƌŽǀ ĞdžĞƌĐŝƐĞ ;ƚŚĞLJ ĚŝĚŶ͛ƚ ŬŶŽǁ ĂďŽƵƚ ƚŚĞ ĚĂŶĐĞ͊Ϳ

YƵĞĞŶ >ŝƐĂ tĂƌĚ ŝƐ ŇĂŶŬĞĚ ďLJ ,ĂƩĞƌ ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ ĂŶĚ :ŶĂǀĞ :ĂLJ >ĞĞ ŽŶ ƚŚĞ ůĞŌ ĂŶĚ ƚŚĞ dǁĞĞĚůĞƐ DŝĐŚĞůůĞ YƵŝŽŐƵĞ ĂŶĚ ^ŚĂŶŶŽŶ ŽŶŶŽůůLJ ŽŶ ƚŚĞ ƌŝŐŚƚ͘

&ĂŵŝůLJ DĞĚŝĐŝŶĞ͗ tĞ ƌĞ &ĂŵŝůLJ͊ California Family Physician Fall 2018

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H e a l t h y P o l i c y a n d Yo u

S h e l l y B . R o d r i g u e s , C A E , FA C E H P Deputy Executive Vice President

CAFP Foundation Talking about Immigration Policy Issues

tŽƌŬŝŶŐ ŝŶ ĐŽůůĂďŽƌĂƟŽŶ ǁŝƚŚ ƚŚĞ Alameda Contra Costa Medical ƐƐŽĐŝĂƟŽŶ͕ ^ĂŶ &ƌĂŶĐŝƐĐŽ DĂƌŝŶ DĞĚŝĐĂů Society, American Academy of PediatricsCalifornia, Osteopathic Physicians and Surgeons of California and Sonoma ŽƵŶƚLJ DĞĚŝĐĂů ^ŽĐŝĞƚLJ͕ LJŽƵƌ &ŽƵŶĚĂƟŽŶ ŽīĞƌƐ ĂŶ ŽƉĞŶŝŶŐ ƐĂůǀŽ͕ ƐŽ ƚŽ ƐƉĞĂŬ͕ ĂŶ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ĂǁĂƌĞŶĞƐƐ ĐĂŵƉĂŝŐŶ ƚŽ ůĂLJ ƚŚĞ ŐƌŽƵŶĚǁŽƌŬ ĨŽƌ ĨƵƚƵƌĞ ƉŽůŝƟĐĂů͕ ĂĚǀŽĐĂĐLJ ĂŶĚ ĞĚƵĐĂƟŽŶĂů ĞīŽƌƚƐ ĂŝŵĞĚ Ăƚ ƉƌŽƚĞĐƟŶŐ ƚŚĞ ŚĞĂůƚŚ ŽĨ ĂůŝĨŽƌŶŝĂ͛Ɛ ŵŽƐƚ ǀƵůŶĞƌĂďůĞ ƉŽƉƵůĂƟŽŶƐ͕ ĞƐƉĞĐŝĂůůLJ children. dŚĞ Ɛŝdž ƉĂƌƚŶĞƌƐ ŝŶ ƚŚŝƐ ƉƌŽũĞĐƚ ŚĂǀĞ ƉůĂŶŶĞĚ Ă ŵƵůƟͲƉƌŽŶŐĞĚ ŝŶĨŽƌŵĂƟŽŶ ƐƚƌĂƚĞŐLJ͕ ŝŶĐůƵĚŝŶŐ ŝĚĞŶƟĨLJŝŶŐ ĐŚĂŵƉŝŽŶƐ ƚŽ ƐƉĞĂŬ Ăƚ ůŝǀĞ ĞǀĞŶƚƐ ĂŶĚ ƚŽ ƚŚĞ ŵĞĚŝĂ͖ Ă ƐĞƌŝĞƐ ŽĨ ƉŽƐŝƟŽŶ ƉĂƉĞƌƐ ĂŶĚ ƉĂƟĞŶƚ ĞĚƵĐĂƟŽŶ ƉŝĞĐĞƐ͖ ǁĞďŝŶĂƌƐ ŽŶ Ă ǀĂƌŝĞƚLJ ŽĨ ƚŽƉŝĐƐ ĂŶĚ Ă ǁĞď ƌĞƐŽƵƌĐĞ ĐĞŶƚĞƌ ĨŽƌ ĂůŝĨŽƌŶŝĂ ƉŚLJƐŝĐŝĂŶƐ͕ ĐƵůŵŝŶĂƟŶŐ ǁŝƚŚ Ă ůŝǀĞ ƉĂŶĞů ƉƌĞƐĞŶƚĂƟŽŶ Ăƚ &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ͕ DĂƌĐŚ ϮϬϭϵ͘ tĂƚĐŚ LJŽƵƌ ŝŶďŽdž ĨŽƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ͘ And our thanks to the California Health ĂƌĞ &ŽƵŶĚĂƟŽŶ ĨŽƌ ŝƚƐ ƐƵƉƉŽƌƚ ŽĨ ƚŚŝƐ important project.

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California Family Physician Fall 2018

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Moving beyond textbooks and theories in school, I’ve gained firsthand experience learning about the complexities of health care.

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/ƐƐƵĞƐ ďĞŝŶŐ ƌĂŝƐĞĚ ďLJ ŝŵŵŝŐƌĂƟŽŶ ĂĐƟŽŶƐ͕ ƐƵĐŚ ĂƐ ƐĞƉĂƌĂƟŽŶ ŽĨ ĨĂŵŝůŝĞƐ͕ / ĂĐƟǀŝƟĞƐ͕ ĐŚĂŶŐĞƐ ƚŽ ƚŚĞ WƵďůŝĐ ŚĂƌŐĞ ƉŽůŝĐŝĞƐ ĨŽƌ DĞĚŝĐĂŝĚ ĂŶĚ ,/W͕ Ăƚ ƚŚĞ &ĞĚĞƌĂů ůĞǀĞů ǁŝůů ŚĂǀĞ ƌĞƉĞƌĐƵƐƐŝŽŶƐ ĨŽƌ all Californians, including physicians, ƚŚĞŝƌ ƉƌĂĐƟĐĞ ƚĞĂŵƐ ĂŶĚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͘ tŚŝůĞ ƚŚĞ ĚĞƉƚŚ ŽĨ ƉƌŽďůĞŵƐ ƚŚĂƚ ŵĂLJ ďĞ created remains unclear today, increasing ƉŚLJƐŝĐŝĂŶ ĂǁĂƌĞŶĞƐƐ ĂďŽƵƚ ƐƵĐŚ ŝƐƐƵĞƐ ǁŝůů ďĞƩĞƌ ƉƌĞƉĂƌĞ ƚŚĞŵ ĂŶĚ ŽƚŚĞƌ ĐůŝŶŝĐŝĂŶƐ ŝĨ ĂŶĚ ǁŚĞŶ ƚŚĞ ĂĐƟŽŶƐ ĂƌĞ ŝŵƉůĞŵĞŶƚĞĚ͘

Special CME Programs

Medical Review Officer Training Comprehensive MRO Training including Hair, Sweat, Oral Fluid, Interpretation of Optiates, Alcohol Testing, and AAMRO Certification Exam (Friday–Sunday) Las Vegas, NV December 7–9, 2018 21.75 CME Credits by AAFP

800-489-1839 www.aamro.com

Four topic areas are top of the list, but given the rapidly changing policy ůĂŶĚƐĐĂƉĞ ǁĞ ǁŝůů ĂĚĂƉƚ͕ ĂĐĐĞůĞƌĂƚĞ ĂŶĚ ƐĞƋƵĞŶĐĞ ŽƵƌ ĂĐƟǀŝƟĞƐ ƚŽ ĂĚĚƌĞƐƐ ƟŵĞ ƐĞŶƐŝƟǀĞ ŝƐƐƵĞƐ͘ Public Charge: According to a policy ďƌŝĞĮŶŐ ƉƵďůŝƐŚĞĚ ďLJ ƚŚĞ ,ĞŶƌLJ :͘ <ĂŝƐĞƌ &ĂŵŝůLJ &ŽƵŶĚĂƟŽŶ͕ ƚŚĞ dƌƵŵƉ ĚŵŝŶŝƐƚƌĂƟŽŶ ŝƐ ƉƵƌƐƵŝŶŐ ĐŚĂŶŐĞƐ ƚŚĂƚ͕ ĨŽƌ ƚŚĞ ĮƌƐƚ ƟŵĞ͕ ǁŽƵůĚ ĂůůŽǁ the federal government to consider ƚŚĞ ƵƐĞ ŽĨ ŚĞĂůƚŚ͕ ŶƵƚƌŝƟŽŶ ĂŶĚ ŽƚŚĞƌ ŶŽŶͲĐĂƐŚ ƉƌŽŐƌĂŵƐ ǁŚĞŶ ŵĂŬŝŶŐ ƉƵďůŝĐ ĐŚĂƌŐĞ ĚĞƚĞƌŵŝŶĂƟŽŶƐ͘ hŶĚĞƌ these changes, use of these programs, ŝŶĐůƵĚŝŶŐ DĞĚŝĐĂŝĚ͕ ,/W͕ ƐƵďƐŝĚŝĞƐ ĨŽƌ Marketplace coverage, by an individual or ĨĂŵŝůLJ ŵĞŵďĞƌ͕ ŝŶĐůƵĚŝŶŐ Ă ĐŝƟnjĞŶ ĐŚŝůĚ͕ could result in the federal government denying an individual a “green card” or ĂĚũƵƐƚŵĞŶƚ ƚŽ ůĂǁĨƵů ƉĞƌŵĂŶĞŶƚ ƐƚĂƚƵƐ Žƌ ĞŶƚƌLJ ŝŶƚŽ ƚŚĞ h^͘ dŚĞƐĞ ĐŚĂŶŐĞƐ ǁŽƵůĚ ůŝŬĞůLJ ƌĞƐƵůƚ ŝŶ ƌĞĚƵĐĞĚ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ DĞĚŝĐĂŝĚ͕ ,/W͕ DĂƌŬĞƚƉůĂĐĞ ĐŽǀĞƌĂŐĞ͕ and other programs by immigrant ĨĂŵŝůŝĞƐ͕ ŝŶĐůƵĚŝŶŐ ĐŝƟnjĞŶ ĐŚŝůĚƌĞŶ͕ ĞǀĞŶ ƚŚŽƵŐŚ ƚŚĞLJ ǁŽƵůĚ ƌĞŵĂŝŶ ĞůŝŐŝďůĞ͘ ĞĐƌĞĂƐĞƐ ŝŶ DĞĚŝĐĂŝĚ ĂŶĚ ,/W ĞŶƌŽůůŵĞŶƚ ǁŽƵůĚ ŝŶĐƌĞĂƐĞ ƚŚĞ ŶƵŵďĞƌ of uninsured and reduce access to care, ŝŶĐƌĞĂƐĞ ĮŶĂŶĐŝĂů ƐƚƌĂŝŶƐ ŽŶ ĨĂŵŝůŝĞƐ͕ ĂŶĚ ǁŝĚĞŶ ĚŝƐƉĂƌŝƟĞƐ ŝŶ ĐŽǀĞƌĂŐĞ͘

ŽƵƚ ŽĨ ĨĞĂƌ ƚŚĂƚ ŽŶĞ͛Ɛ ŝŵŵŝŐƌĂƟŽŶ ƐƚĂƚƵƐ Žƌ ĂƉƉůŝĐĂƟŽŶ ĨŽƌ ĐŝƟnjĞŶƐŚŝƉ ĐŽƵůĚ ďĞ ĂĚǀĞƌƐĞůLJ ĂīĞĐƚĞĚ ďLJ ƵƐĞ ŽĨ ƐƵĐŚ ƐĞƌǀŝĐĞƐ͘ /ŵŵŝŐƌĂƟŽŶ WŽůŝĐLJ /ƐƐƵĞƐ͗ 'ĞŽƌŐĞƚŽǁŶ hŶŝǀĞƌƐŝƚLJ͛Ɛ ,ĞĂůƚŚ WŽůŝĐLJ /ŶƐƟƚƵƚĞ ŝƐƐƵĞĚ

Ă ƐƚƵĚLJ ŝŶ :ƵŶĞ ϮϬϭϴ ƚŚĂƚ ĚĞůǀĞƐ ŝŶƚŽ the issues surrounding undocumented ŝŵŵŝŐƌĂŶƚƐ ŝŶ ƚŚĞ h^ ĂŶĚ ƚŚĞ ĐŝƟnjĞŶ children of these immigrants. Currently, ϭϭ͘ϭ ŵŝůůŝŽŶ ƵŶĚŽĐƵŵĞŶƚĞĚ ŝŵŵŝŐƌĂŶƚƐ reside in the US and debates have focused ĐŽŶƟŶƵĞĚ ŽŶ ŶĞdžƚ ƉĂŐĞ х

/Ŷ ϮϬϭϲ͕ ƚŚĞƌĞ ǁĞƌĞ ϭϬ͘ϰ ŵŝůůŝŽŶ ĐŝƟnjĞŶ ĐŚŝůĚƌĞŶ ǁŝƚŚ Ăƚ ůĞĂƐƚ ŽŶĞ ŶŽŶͲĐŝƟnjĞŶ ƉĂƌĞŶƚ͘ EĞĂƌůLJ ŶŝŶĞ ŝŶ ϭϬ ŽĨ ƚŚĞƐĞ ĐŚŝůĚƌĞŶ ůŝǀĞ ŝŶ ĨĂŵŝůŝĞƐ ǁŝƚŚ ĨƵůůͲƟŵĞ ǁŽƌŬĞƌƐ͕ ďƵƚ ƚŚĞƐĞ ǁŽƌŬĞƌƐ ŽŌĞŶ ĂƌĞ ŝŶ ůŽǁͲǁĂŐĞ ũŽďƐ͕ ůĞĂĚŝŶŐ ƚŽ ůŽǁĞƌ ĨĂŵŝůLJ ŝŶĐŽŵĞƐ ĂŶĚ more limited access to health coverage. Ɛ ƐƵĐŚ͕ ŵŽƌĞ ƚŚĂŶ ŚĂůĨ ;ϱϲ ƉĞƌĐĞŶƚͿ Žƌ ϱ͘ϴ ŵŝůůŝŽŶ͕ ĐŝƟnjĞŶ ĐŚŝůĚƌĞŶ ǁŝƚŚ Ă ŶŽŶͲĐŝƟnjĞŶ ƉĂƌĞŶƚ ŚĂĚ DĞĚŝĐĂŝĚ Žƌ ,/W ĐŽǀĞƌĂŐĞ ŝŶ ϮϬϭϲ͘ /Ŷ ĂůŝĨŽƌŶŝĂ͕ ϭ͘ϱ ŵŝůůŝŽŶ ĐŝƟnjĞŶ ĐŚŝůĚƌĞŶ ǁŝƚŚ Ă ŶŽŶͲĐŝƟnjĞŶ ƉĂƌĞŶƚ currently receive care via the Medi-Cal Žƌ ,/W ƉƌŽŐƌĂŵƐ ʹ ƚŚĞƐĞ ĐŚŝůĚƌĞŶ ĐŽƵůĚ leave the ranks of covered Californians, decreasing their access to care and ŝŶĐƌĞĂƐŝŶŐ ŶĞŐĂƟǀĞ ŚĞĂůƚŚ ŽƵƚĐŽŵĞƐ ʹ California Family Physician Fall 2018

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ůŝƩůĞ ŽŶ ƚŚĞ ϰ͘ϱ ŵŝůůŝŽŶ ĐŝƟnjĞŶ ĐŚŝůĚƌĞŶ ŽĨ ƵŶĚŽĐƵŵĞŶƚĞĚ ƉĂƌĞŶƚƐ͘ ŶĞǁ ƌĞƉŽƌƚ ŚŝŐŚůŝŐŚƚƐ ƚŚĞ ĚĂŵĂŐŝŶŐ ĞīĞĐƚƐ ŽŶ ƚŚĞ ŚĞĂůƚŚ ŽĨ ƚŚĞƐĞ ĐŚŝůĚƌĞŶ ƌĞƐƵůƟŶŐ ĨƌŽŵ ƚŚĞ precarious legal status of one or more of ƚŚĞŝƌ ƉĂƌĞŶƚƐ͘ ŚŝůĚƌĞŶ ǁŝƚŚ ƵŶĚŽĐƵŵĞŶƚĞĚ ƉĂƌĞŶƚƐ ůŝǀĞ ǁŝƚŚ ĂŶdžŝĞƚLJ ĂďŽƵƚ ǁŚĞƚŚĞƌ their families can stay together in the ĨƵƚƵƌĞ͘ DĂŶLJ ǁŚŽ ĞdžƉĞƌŝĞŶĐĞ ƚŚĞ ůŽƐƐ ŽĨ Ă ƉĂƌĞŶƚ ĂůƐŽ ƐƵīĞƌ ĨƌŽŵ ƉŽǀĞƌƚLJ͕ ƌĞĚƵĐĞĚ access to food and health care and limited ĞĚƵĐĂƟŽŶĂů ŽƉƉŽƌƚƵŶŝƟĞƐ͘ dŚĞ ƌĞƉŽƌƚ describes the behavioral and mental health ƉƌŽďůĞŵƐ ƚŚĂƚ ĂƌŝƐĞ ǁŚĞŶ Ă ƉĂƌĞŶƚ ŝƐ actually arrested, detained or deported. dŚĞ ĂƵƚŚŽƌƐ ƉƌĞĚŝĐƚ ƚŚĂƚ ŝĨ ƉŽůŝĐŝĞƐ ƌĞƐƵůƟŶŐ ŝŶ ĂƌƌĞƐƚ͕ ĚĞƚĞŶƟŽŶ ĂŶĚ ĚĞƉŽƌƚĂƟŽŶ ĚŽ ŶŽƚ ĐŚĂŶŐĞ͕ ŵŽƌĞ ƚŚĂŶ ϭϱϯ͕ϬϬϬ h^ ĐŝƟnjĞŶ ĐŚŝůĚƌĞŶ ĐŽƵůĚ ŚĂǀĞ Ă ƉĂƌĞŶƚ ƚĂŬĞŶ ĂǁĂLJ ĨƌŽŵ ƚŚĞŵ ĞĂĐŚ LJĞĂƌ͘ dŚĞ ƉƌŽũĞĐƚĞĚ ĞīĞĐƚƐ ŽŶ ŚĞĂůƚŚ ŝŶĐůƵĚĞ͗ ϭ͘ ϰϯ͕ϬϬϬ h^ ĐŝƟnjĞŶ ĐŚŝůĚƌĞŶ ǁŝůů ĞdžƉĞƌŝĞŶĐĞ Ă ĚĞĐůŝŶĞ ŝŶ ƚŚĞŝƌ ŚĞĂůƚŚ ƐƚĂƚƵƐ ĂŌĞƌ Ă ĐŚĂŶŐĞ ŝŶ ŚŽƵƐĞŚŽůĚ ŝŶĐŽŵĞ ƌĞƐƵůƟŶŐ ĨƌŽŵ ĚĞƚĞŶƟŽŶͬ ĚĞƉŽƌƚĂƟŽŶ͖ Ϯ͘ poorer health and shorter lifespans ĨŽƌ ƌĞŵĂŝŶŝŶŐ ĂĚƵůƚ ƉĂƌƚŶĞƌƐ͖ ĂŶĚ 3. absence of the primary household earner could result in more than ϭϮϱ͕ϬϬϬ ĐŚŝůĚƌĞŶ ůŝǀŝŶŐ ŝŶ ĨŽŽĚͲ ŝŶƐƵĸĐŝĞŶƚ ŚŽƵƐĞŚŽůĚƐ͘ &ĂŵŝůLJ ^ĞƉĂƌĂƟŽŶ͗ /ƚ ŐŽĞƐ ǁŝƚŚŽƵƚ ƐĂLJŝŶŐ that children need caretakers. As the ƐĐŝĞŶƟƐƚƐ ĚĞƐĐƌŝďĞ ŝƚ͕ ƚŚĞ ůŽŶŐ ŵĂƚƵƌĂƟŽŶ ƌĂƚĞ ĨŽƌ ŚƵŵĂŶƐ ĂůůŽǁƐ ŽƵƌ ďƌĂŝŶƐ ƚŽ ĚĞǀĞůŽƉ ĂŶĚ ĚŽ ŵƵĐŚ ŵŽƌĞ ĐŽŵƉůĞdž ƚŚŝŶŬŝŶŐ͘ tŚĂƚ ŚĂƉƉĞŶƐ ǁŚĞŶ ĐŚŝůĚƌĞŶ ĚŽŶ͛ƚ ŚĂǀĞ Ă ĐĂƌĞƚĂŬĞƌ͍ dŚĞ ƌĞƐĞĂƌĐŚ ŝƐ ƉƌĞƩLJ ĐůĞĂƌ͕ ĂŶĚ h > WƌŽĨĞƐƐŽƌƐ :ƵǀŽŶĞŶ ĂŶĚ ^ŝůǀĞƌƐ ƐƵŵŵĂƌŝnjĞ ŝƚ ǁĞůů ŝŶ ƚŚŝƐ Washington Post ƉŝĞĐĞ ŽĨ DĂLJ ϭϱ͕ ϮϬϭϴ͗ “The strongest evidence for the importance of close caregivers comes from children who ŚĂǀĞ ĞdžƉĞƌŝĞŶĐĞĚ ĐĂƌĞŐŝǀĞƌ ĚĞƉƌŝǀĂƟŽŶ͘ Even when their physical needs are met, ĐŚŝůĚƌĞŶ ƌĂŝƐĞĚ ŝŶ ŝŶƐƟƚƵƟŽŶĂů ŽƌƉŚĂŶĂŐĞƐ ĐŽŵŵŽŶůLJ ĞdžŚŝďŝƚ ƐƚƵŶƚĞĚ ŐƌŽǁƚŚ͕ ĐŽŐŶŝƟǀĞ impairments, heightened anxiety and ƐƚƌĞƐƐͲƌĞůĂƚĞĚ ŚĞĂůƚŚ ƉƌŽďůĞŵƐ ƚŚĂƚ ŽŌĞŶ ƉĞƌƐŝƐƚ ĞǀĞŶ ĂŌĞƌ ďĞŝŶŐ ĂĚŽƉƚĞĚ ŝŶƚŽ ŚŝŐŚůLJ nurturing homes. Even mere instability ŽĨ ĐĂƌĞŐŝǀĞƌƐ ĞĂƌůLJ ŝŶ ůŝĨĞ ŝƐ ĚŝƐƌƵƉƟǀĞ ƚŽ children’s development. For example, youth 22

California Family Physician Fall 2018

ŝŶ ĨŽƐƚĞƌ ĐĂƌĞ ǁŚŽ ĞdžƉĞƌŝĞŶĐĞ ŵƵůƟƉůĞ ƚƌĂŶƐŝĞŶƚ ƉůĂĐĞŵĞŶƚƐ ĂƌĞ ƐŝŐŶŝĮĐĂŶƚůLJ more likely to drop out of high school, be unemployed as adults and develop mental and physical illnesses.” / ĐƟŽŶƐ͗ CAFP members have ĞdžƉƌĞƐƐĞĚ ĚĞĞƉ ĐŽŶĐĞƌŶ ĂďŽƵƚ ƚŚĞŝƌ ƌŽůĞƐ ĂŶĚ ƌĞƐƉŽŶƐŝďŝůŝƟĞƐ ƚŽ ƉƌŽƚĞĐƚ ƚŚĞŝƌ ƉƌĂĐƟĐĞƐ͕ ƐƚĂī ĂŶĚ ƉĂƟĞŶƚƐ ƐŚŽƵůĚ h^ /ŵŵŝŐƌĂƟŽŶ ĂŶĚ ƵƐƚŽŵƐ ŶĨŽƌĐĞŵĞŶƚ ;/ Ϳ ĂŐĞŶƚƐ ǀŝƐŝƚ ƚŚĞŝƌ ŽĸĐĞƐ Žƌ ĐůŝŶŝĐƐ͘ DĞĚŝĐĂů ƐŽĐŝĞƟĞƐ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ŽƌŐĂŶŝnjĂƟŽŶƐ ĐĂŶ ƉƌŽǀŝĚĞ ŝŶĨŽƌŵĂƟŽŶ ƚŽ ƉĂƟĞŶƚƐ ĂďŽƵƚ ƚŚĞ ĂǀĂŝůĂďŝůŝƚLJ ŽĨ ůĞŐĂů ĂŶĚ ƉƌĂĐƟĐĞ ĂĚǀŝĐĞ ŽŶ ƚŚĞŝƌ ƌŝŐŚƚƐ͘ tŽƌŬ ŚĂƐ ĂůƌĞĂĚLJ been completed by groups including ƚŚĞ EĂƟŽŶĂů /ŵŵŝŐƌĂƟŽŶ >Ăǁ ĞŶƚĞƌ͕ ĂůŝĨŽƌŶŝĂ WƌŝŵĂƌLJ ĂƌĞ ƐƐŽĐŝĂƟŽŶ ĂŶĚ California Health+advocates. Physicians ĂŶĚ ƚŚĞŝƌ ƉƌĂĐƟĐĞ ƚĞĂŵƐ ŵƵƐƚ ďĞ ĂǁĂƌĞ of their rights and have a plan in place ƚŽ ƌĞƐƉŽŶĚ ƚŽ / ĂŐĞŶƚƐ ďƵƚ ĂůƐŽ ŵƵƐƚ ďĞ ƉƌĞƉĂƌĞĚ ƚŽ ƉƌŽƚĞĐƚ ƚŚĞŝƌ ƐƚĂīƐ͛ ĂŶĚ ƉĂƟĞŶƚƐ͛ ƌŝŐŚƚƐ ŝŶ ƚŚĞ ƉƌŽĐĞƐƐ͘

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MICHELLE GILBERT 501-221-9986, ext.120 mgilbert@pcipublishing.com

California Family Physician Fall 2018

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Welcome Lisa Folberg …

We’re Excited to Have You Join Us! tĞůĐŽŵĞ ƚŽ ŽƵƌ ŶĞǁ K >ŝƐĂ &ŽůďĞƌŐ͕ MPP. Lisa came on board September ϭϳ ĂŶĚ Śŝƚ ƚŚĞ ŐƌŽƵŶĚ ƌƵŶŶŝŶŐ͘ ^ŚĞ ŚĂƐ ϭϴ LJĞĂƌƐ ŽĨ ĞdžƉĞƌŝĞŶĐĞ ŝŶ ŐŽǀĞƌŶŵĞŶƚ ƌĞůĂƟŽŶƐ͕ ŵĂŶĂŐĞŵĞŶƚ͕ ŚĞĂůƚŚ ƉŽůŝĐLJ ĂŶĚ program development and most recently served for three years as President and K ŽĨ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ &ŽƵŶĚĂƟŽŶ ; D &Ϳ͕ ŶŽǁ ŬŶŽǁŶ ĂƐ Physicians for a Healthy California. She ŚĞůƉĞĚ ďƵŝůĚ ƚŚĞ EĞƚǁŽƌŬ ŽĨ ƚŚŶŝĐ WŚLJƐŝĐŝĂŶ KƌŐĂŶŝnjĂƟŽŶƐ ;E WKͿ Ăƚ D &͘ WƌĞǀŝŽƵƐůLJ͕ >ŝƐĂ ƐĞƌǀĞĚ ĂƐ sŝĐĞ WƌĞƐŝĚĞŶƚ͕ Medical and Regulatory Policy and as ƐƐŽĐŝĂƚĞ ŝƌĞĐƚŽƌ͕ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƟŽŶƐ ĨŽƌ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ ĂŶĚ ĂƐ ^ĞŶŝŽƌ &ŝƐĐĂů ĂŶĚ WŽůŝĐLJ ŶĂůLJƐƚ ĨŽƌ ƚŚĞ ĂůŝĨŽƌŶŝĂ >ĞŐŝƐůĂƟǀĞ ŶĂůLJƐƚ͛Ɛ KĸĐĞ͘ ^ŚĞ ƌĞĐĞŝǀĞĚ ŚĞƌ ƵŶĚĞƌŐƌĂĚƵĂƚĞ ĚĞŐƌĞĞ Ăƚ ^ĂŶ Francisco State University and her Masters of Public Policy from 'ĞŽƌŐĞƚŽǁŶ hŶŝǀĞƌƐŝƚLJ͘ /Ŷ ĂŶ ĞīŽƌƚ ƚŽ ŐĞƚ ƚŽ ŬŶŽǁ ŚĞƌ Ă ďŝƚ ďĞƩĞƌ͕ CFP asked her a series ŽĨ ƋƵĞƐƟŽŶƐ͘ WůĞĂƐĞ ũŽŝŶ ƵƐ ŝŶ ǁĞůĐŽŵŝŶŐ >ŝƐĂ &ŽůďĞƌŐ ƚŽ ƚŚĞ family medicine family. ,Žǁ ĚŝĚ LJŽƵ ŐĞƚ LJŽƵƌ ƐƚĂƌƚ ŝŶ ŵĞĚŝĐĂů ĂƐƐŽĐŝĂƟŽŶ ǁŽƌŬ͍ / ǁĂƐ ǁŽƌŬŝŶŐ ŽŶ ŚĞĂůƚŚ ĂŶĚ ƐŽĐŝĂů ƐĞƌǀŝĐĞƐ ŝƐƐƵĞƐ ĂƐ Ă ƐĞŶŝŽƌ

/ƚ͛Ɛ ŽĸĐŝĂů͕ &W WƌĞƐŝĚĞŶƚ >ŝƐĂ tĂƌĚ ǁŝƚŶĞƐƐĞĚ >ŝƐĂ͛Ɛ ƐŝŐŶĂƚƵƌĞ ŽŶ her contract.

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California Family Physician Fall 2018

ƐƚĂī ŵĞŵďĞƌ ǁŝƚŚ ƚŚĞ ĂůŝĨŽƌŶŝĂ >ĞŐŝƐůĂƟǀĞ ŶĂůLJƐƚ͛Ɛ KĸĐĞ͘ / ĐĂŵĞ ƚŽ ŬŶŽǁ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ ; D Ϳ ĨƌŽŵ ǁŽƌŬŝŶŐ ŽŶ ƐƚĂƚĞǁŝĚĞ ďĂůůŽƚ ŝŶŝƟĂƟǀĞƐ͘ D ƌĞĐƌƵŝƚĞĚ ŵĞ ƚŽ ďĞ Ă ůŽďďLJŝƐƚ ĨŽƌ ƚŚĞ ŽƌŐĂŶŝnjĂƟŽŶ͕ ĨŽĐƵƐŝŶŐ on state budget issues, Medi-Cal and health ƐLJƐƚĞŵ ĮŶĂŶĐŝŶŐ͘ How do your roles with the CMA and the CMA &ŽƵŶĚĂƟŽŶ ƉƌĞƉĂƌĞ LJŽƵ ĨŽƌ ƚŚĞ ƚƌĂŶƐŝƟŽŶ ƚŽ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ƚŚĞ ĐĂĚĞŵLJ͍ / ǁŝůů ĐĞƌƚĂŝŶůLJ ŚĂǀĞ Ă ůŽƚ ƚŽ ůĞĂƌŶ ĂďŽƵƚ ĨĂŵŝůLJ medicine and about CAFP, but my background ŝŶ ƉŽůŝĐLJ͕ ƉŽůŝƟĐƐ͕ ŽƌŐĂŶŝnjĞĚ ŵĞĚŝĐŝŶĞ ĂŶĚ ŶŽŶͲƉƌŽĮƚ ŵĂŶĂŐĞŵĞŶƚ ǁŝůů ŚĞůƉ ŵĞ Śŝƚ ƚŚĞ ŐƌŽƵŶĚ ƌƵŶŶŝŶŐ͘ DLJ ĞdžƉĞƌŝĞŶĐĞ ĂƐ Ă ůŽďďLJŝƐƚ for physicians and heading CMA’s policy and regulatory advocacy ƉƌŽǀŝĚĞĚ ŵĞ ǁŝƚŚ ĂŶ ŝŶͲĚĞƉƚŚ ŬŶŽǁůĞĚŐĞ ŽĨ ƚŚĞ ŝƐƐƵĞƐ ĨĂĐŝŶŐ ĂůŝĨŽƌŶŝĂ͛Ɛ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ĂŶ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ŚŽǁ ƚŽ ŶĂǀŝŐĂƚĞ ƚŚĞ ĐŚĂůůĞŶŐĞƐ ƵŶŝƋƵĞ ƚŽ ŵĞŵďĞƌ ŽƌŐĂŶŝnjĂƟŽŶƐ͘ DLJ ĞdžƉĞƌŝĞŶĐĞ ŝŶ ŐƌĂŶƚ ĚĞǀĞůŽƉŵĞŶƚ͕ ƉƌŽŐƌĂŵ ŝŵƉůĞŵĞŶƚĂƟŽŶ ĂŶĚ ĚĞǀĞůŽƉŝŶŐ ŽƌŐĂŶŝnjĂƟŽŶĂů ƉĂƌƚŶĞƌƐŚŝƉƐ ĂůƐŽ ǁŝůů ŚĞůƉ ƉƌĞƉĂƌĞ ŵĞ ĨŽƌ ƚŚĞ ĐŚĂůůĞŶŐĞƐ ŽĨ ƚŚĞ ĐĂĚĞŵLJ ĂŶĚ &ŽƵŶĚĂƟŽŶ͘ tŚĂƚ ĂďŽƵƚ ƚŚĞ &W ŵĂĚĞ LJŽƵ ŝŶƚĞƌĞƐƚĞĚ ŝŶ ƚŚĞ K ƌŽůĞ͍ &ĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ &W ŚĂǀĞ ĂůǁĂLJƐ ƐƚŽŽĚ ŽƵƚ ĨŽƌ ŵĞ ĨŽƌ ĐĂƌŝŶŐ ĂƐ ŵƵĐŚ ĂďŽƵƚ ƉƵďůŝĐ ŚĞĂůƚŚ ĂŶĚ ƉĂƟĞŶƚ ĐĂƌĞ ĂƐ ƉŽĐŬĞƚ

>ŝƐĂ &ŽůďĞƌŐ ĂŶĚ ŚĞƌ ĨĂŵŝůLJ ĂƌĞ ůŽŽŬŝŶŐ ĨŽƌǁĂƌĚ ƚŽ ŶĞǁ ĂĚǀĞŶƚƵƌĞƐ ŝŶ San Francisco.

Ŭ ŝƐƐƵĞƐ͘ DLJ ƐŬŝůůƐ ĂŶĚ ĞdžƉĞƌŝĞŶĐĞ ĂƌĞ Ă ŐƌĞĂƚ Įƚ ǁŝƚŚ &W͕ ďƵƚ ĂƐ ŝŵƉŽƌƚĂŶƚůLJ͕ / ŚĂǀĞ Ă ƉĂƐƐŝŽŶ ĨŽƌ ƚŚĞ ǁŽƌŬ ŽĨ ĨĂŵŝůLJ physicians and tremendous respect for the important role family physicians play ĂƐ ƚŚĞ ŐůƵĞ ŝŶ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͘ / Ăŵ ƐŽ ĞdžĐŝƚĞĚ ƚŽ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ďƌŝŶŐ ƚŽŐĞƚŚĞƌ ƐŽ ŵĂŶLJ ŽĨ ŵLJ ŝŶƚĞƌĞƐƚƐ͗ health policy, advocacy, management, team ďƵŝůĚŝŶŐ͕ ĨŽƵŶĚĂƟŽŶ ǁŽƌŬ ĂŶĚ ŵĞŵďĞƌ development.

Where do you think the CAFP goes ŶĞdžƚ͍ ŶĚ ŚŽǁ ĚŽ LJŽƵ ƉůĂŶ ƚŽ ŐƵŝĚĞ ƚŚĞ ĐĂĚĞŵLJ͍ dŚŝƐ ŝƐ Ă ƉŝǀŽƚĂů ƟŵĞ ĨŽƌ ŚĞĂůƚŚ ĐĂƌĞ ŝŶ ƚŚĞ ŶĂƟŽŶ ĂŶĚ ŝŶ ĂůŝĨŽƌŶŝĂ͘ WĂLJŵĞŶƚ ƌĞĨŽƌŵ͕ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ĂŶĚ ƐLJƐƚĞŵ ĐŚĂŶŐĞƐ present an opportunity for family physicians ƚŽ ďĞ ƌĞĐŽŐŶŝnjĞĚ ĂŶĚ ĐŽŵƉĞŶƐĂƚĞĚ ĨŽƌ their central place in the system. Family ƉŚLJƐŝĐŝĂŶƐ ĂƌĞ Ă ĐŽƌĞ ƉĂƌƚ ŽĨ ƚŚĞ ƐŽůƵƟŽŶ ƚŽ ĐƌĞĂƟŶŐ Ă ŵŽƌĞ ĞīĞĐƟǀĞ ĂŶĚ ĞĸĐŝĞŶƚ ƐLJƐƚĞŵ ĂŶĚ ƐŚŽƵůĚ ďĞ ƉŽƐŝƟŽŶĞĚ ĂƐ thought leaders on big issues. CAFP has a great opportunity to become even more ĞŶŐĂŐĞĚ ŝŶ ĐŽŵŵƵŶŝƚLJͲďĂƐĞĚ ĞīŽƌƚƐ ƚŚĂƚ highlight the role of family physicians as change agents. ŶƟĐŝƉĂƟŶŐ ĂŶĚ ĂĚũƵƐƟŶŐ ƚŽ ŶĞǁ ƉŚLJƐŝĐŝĂŶ ĚĞŵŽŐƌĂƉŚŝĐƐ ĂŶĚ ƉƌĂĐƟĐĞ ƚƌĞŶĚƐ ĂůƐŽ ǁŝůů ďĞ ĞƐƐĞŶƟĂů ƚŽ ƚŚĞ ŚĞĂůƚŚ ŽĨ ƚŚĞ ŽƌŐĂŶŝnjĂƟŽŶ ĂŶĚ ƚŽ ƉƌŽŵŽƟŶŐ ƚŚĞ ƐƉĞĐŝĂůƚLJ͘ What do you think your biggest challenge ŝŶ ƚŚĞ ŶĞdžƚ Ɛŝdž ŵŽŶƚŚƐ ǁŝůů ďĞ͍ Listening and learning. Also, developing ĂƐƉŝƌĂƟŽŶĂů ŐŽĂůƐ ŐƌŽƵŶĚĞĚ ŝŶ ƚŚĞ ŽƉĞƌĂƟŽŶĂů ƌĞĂůŝƚLJ ŽĨ ƌƵŶŶŝŶŐ ĂŶ ŽƌŐĂŶŝnjĂƟŽŶ͘ Can you tell us a bit about your family, work-life balance, and what “outside the ŽĸĐĞ͟ ůŽŽŬƐ ůŝŬĞ͍ / ƚŚŝŶŬ ŽĨ ŝƚ ŵŽƌĞ ĂƐ ǁŽƌŬͲůŝĨĞ ŝŶƚĞŐƌĂƟŽŶ ĂŶĚ ŚĂƌŵŽŶLJ͘ KŶĞ ǁĂLJ / ǁŝůů ŬĞĞƉ ŵLJ ƌŽůĞƐ as CEO of CAFP and being mom to three girls in harmony is to schedule “date nights” ǁŝƚŚ ŵLJ ŐŝƌůƐ ǁŚĞƌĞ ƚŚĞLJ ŐĞƚ ƚŽ ƉŝĐŬ Ă ^ĂŶ &ƌĂŶĐŝƐĐŽ ŽƵƟŶŐ͘ /ƚ ǁŝůů ďĞ Ă ŐƌĞĂƚ ǁĂLJ ƚŽ ŐĞƚ ƚŽ ŬŶŽǁ ŽƵƌ ŶĞǁ ĐŝƚLJ ĂŶĚ ĨŽƌ ŵĞ ƚŽ ŐŝǀĞ ŵLJ ĨĂŵŝůLJ ŵLJ ƟŵĞ ĂŶĚ ĂƩĞŶƟŽŶ͘ KƚŚĞƌ ǁĂLJƐ / ŬĞĞƉ ŵLJ ůŝĨĞ ŝŶ ŚĂƌŵŽŶLJ ŝƐ ďLJ ƉƌĂĐƟĐŝŶŐ LJŽŐĂ͕ ĚĂŶĐŝŶŐ ĂŶĚ ƐƉĞŶĚŝŶŐ ƟŵĞ ǁŝƚŚ ĨƌŝĞŶĚƐ͘

California Family Physician Fall 2018

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H e a l t h y P o l i c y a n d Yo u

Marci Miller U n d e r g r a d u a t e S o c i a l We l f a r e S t u d e n t , U C B e r k e l e y

I Spent My Summer Spent with Health Care Heroes

^ĞdžƵĂůůLJ dƌĂŶƐŵŝƩĞĚ ŝƐĞĂƐĞƐ ;^d Ϳ ZĞƐĞĂƌĐŚ WƌŽũĞĐƚ ^d ƌĂƚĞƐ ŚĂǀĞ ƐŬLJƌŽĐŬĞƚĞĚ ƚŽ ĂŶ ĂůůͲƟŵĞ ŚŝŐŚ ŝŶ ĂůŝĨŽƌŶŝĂ͘ According to the California Department of Public Health, more ƚŚĂŶ ϯϬϬ͕ϬϬϬ ĐĂƐĞƐ ŽĨ ĐŚůĂŵLJĚŝĂ͕ ŐŽŶŽƌƌŚĞĂ ĂŶĚ ĞĂƌůLJ ƐLJƉŚŝůŝƐ ǁĞƌĞ ĐŽƵŶƚĞĚ ŝŶ ϮϬϭϳ ʹ Ă ϰϱ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ ǁŝƚŚŝŶ ƚŚĞ ůĂƐƚ ĮǀĞ LJĞĂƌƐ͘ dŽ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞ ƐŝŐŶŝĮĐĂŶĐĞ ŽĨ ƚŚĞ ĞīĞĐƚƐ ŽĨ ^d Ɛ ŝŶ ĂůŝĨŽƌŶŝĂ͕ / ĐƌĞĂƚĞĚ Ă ƐůŝĚĞ ĚĞĐŬ ƐLJŶƚŚĞƐŝnjŝŶŐ ŵLJ ƌĞƐĞĂƌĐŚ͕ ǁŝƚŚ ƉĂƌƟĐƵůĂƌ ĂƩĞŶƟŽŶ ƚŽ ĚŝƐƉƌŽƉŽƌƟŽŶĂůŝƟĞƐ ĂŵŽŶŐ LJŽƵŶŐ ŝŶĚŝǀŝĚƵĂůƐ͕ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶƐ ĂŶĚ ŵĞŶ ǁŚŽ ŚĂǀĞ ƐĞdž ǁŝƚŚ ŵĞŶ͘ / ǁŝůů ƉƌĞƐĞŶƚ ƚŚŝƐ ƌĞƐĞĂƌĐŚ ĚĞĐŬ ƚŽ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ƚŚĞ ,ĞĂůƚŚ ŽĨ ƚŚĞ Public in order to advance CAFP’s policy and ĞĚƵĐĂƟŽŶ ŝŶŝƟĂƟǀĞƐ ŽŶ ^d ƉƌĞǀĞŶƟŽŶ ĂŶĚ management. ,ĞĂůƚŚ WƌĂĐƟƟŽŶĞƌ dƌĂŝŶŝŶŐ ZĞƋƵŝƌĞŵĞŶƚƐ Chart >ĞŐŝƐůĂƚŽƌƐ ŽŌĞŶ ŝŶƚƌŽĚƵĐĞ ďŝůůƐ ƚŽ ĞdžƉĂŶĚ ŚĞĂůƚŚ ƉƌĂĐƟƟŽŶĞƌƐ͛ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ŝŶ ĂŶ ĞīŽƌƚ ƚŽ ŝŶĐƌĞĂƐĞ ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ͘ tŝƚŚŽƵƚ ĐŽŵŵĞŶƐƵƌĂƚĞ ĞĚƵĐĂƟŽŶ ĂŶĚ ƚƌĂŝŶŝŶŐ͕ ƚŚŝƐ strategy for increased access to care could be ĐŽŵƉƌŽŵŝƐĞĚ ďLJ ŶĞŐĂƟǀĞ ŝŵƉĂĐƚƐ ŽŶ ƋƵĂůŝƚLJ͘ / ĐŽŶƐƚƌƵĐƚĞĚ ƐĞǀĞƌĂů ĐŚĂƌƚƐ ŽƵƚůŝŶŝŶŐ ƚŚĞ ĚŝīĞƌĞŶĐĞƐ ŝŶ ƚƌĂŝŶŝŶŐ ƌĞƋƵŝƌĞŵĞŶƚƐ ĂĐƌŽƐƐ ĂůůŝĞĚ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶƐ ƚŽ ĐƌŽƐƐͲĂŶĂůLJnjĞ ŵĞĚŝĐĂů ĐŽŵƉĞƚĞŶĐŝĞƐ ǁŝƚŚ ĞĚƵĐĂƟŽŶ ĂŶĚ ĐůŝŶŝĐĂů ĞdžƉĞƌŝĞŶĐĞ͘ WƌŝŵĂƌLJ ĂƌĞ ^ƉĞŶĚŝŶŐ ƌŝĞĨ dŽ ƵůƟŵĂƚĞůLJ ƌĞĚƵĐĞ ŚĞĂůƚŚ ĐĂƌĞ ĐŽƐƚƐ ĂŶĚ improve price transparency, California has ƉĂƐƐĞĚ ůĞŐŝƐůĂƟŽŶ ƚŽ ĞƐƚĂďůŝƐŚ ĂŶ ůůͲWĂLJĞƌ ůĂŝŵƐ ĂƚĂďĂƐĞ ; W Ϳ͘ Ŷ W ĐŽůůĞĐƚƐ ĐůĂŝŵƐ ĂŶĚ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ĚĂƚĂ ĨƌŽŵ ďŽƚŚ 26

California Family Physician Fall 2018

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Moving beyond textbooks and theories in school, I’ve gained firsthand experience learning about the complexities of health care.

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/ŶŇƵĞŶĐĞĚ ďLJ ŵLJ ƉĂƐƐŝŽŶ ĨŽƌ ŚĞĂůƚŚ ĞƋƵŝƚLJ͕ / ƉƵƌƐƵĞĚ Ă ƐƵŵŵĞƌ ŝŶƚĞƌŶƐŚŝƉ ǁŝƚŚ ,ĞĂůƚŚ ĂƌĞĞƌ ŽŶŶĞĐƟŽŶƐ͕ ĂŶĚ ǁĂƐ ƉůĂĐĞĚ ǁŝƚŚ ƚŚĞ ĂůŝĨŽƌŶŝĂ ĐĂĚĞŵLJ ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ͘ KǀĞƌ ϭϬ ǁĞĞŬƐ ƚŚŝƐ ƐƵŵŵĞƌ͕ / ǁĂƐ ŝŶƐƉŝƌĞĚ ďLJ &W͛Ɛ ĐŽŵŵŝƚŵĞŶƚ ƚŽ ŝŵƉƌŽǀŝŶŐ ĂĐĐĞƐƐ ƚŽ ĐŽƐƚͲ ĞīĞĐƟǀĞ ĂŶĚ ŚŝŐŚͲƋƵĂůŝƚLJ ŚĞĂůƚŚ ĐĂƌĞ ĨŽƌ Ăůů ĂůŝĨŽƌŶŝĂŶƐ͘ tŽƌŬŝŶŐ ǁŝƚŚ ŽŶƌĂĚ ŵĞŶƚĂ͕ &W͛Ɛ ŝƌĞĐƚŽƌ ŽĨ ,ĞĂůƚŚ WŽůŝĐLJ͕ / ƚĂĐŬůĞĚ ĮǀĞ ǀĞƌLJ ĚŝǀĞƌƐĞ ƉƌŽũĞĐƚƐ͗

private and public payers. An APCD gives California the opportunity to replicate Oregon’s success in tracking primary care spending. dŚƌŽƵŐŚ ĂŶĂůLJnjŝŶŐ KƌĞŐŽŶ͛Ɛ W ͕ / ĐƌĞĂƚĞĚ Ă ƉŽůŝĐLJ ďƌŝĞĨ ĂďŽƵƚ ŚŽǁ KƌĞŐŽŶ ŵĞĂƐƵƌĞƐ primary care spending in both fee-for-service ĂŶĚ ŵĂŶĂŐĞĚ ĐĂƌĞ ƐĞƫŶŐƐ͘ ^ĂĨĞ ƌƵŐ ŽŶƐƵŵƉƟŽŶ ^ĞƌǀŝĐĞƐ ;^ ^Ϳ ZĞƉŽƌƚ Amid the current opioid epidemic, public ĚƌƵŐ ƵƐĞ ŚĂƐ ŚĂĚ ƐĞƌŝŽƵƐ ŝŵƉůŝĐĂƟŽŶƐ ŽŶ ŝŶĚŝǀŝĚƵĂůƐ͛ ŚĞĂůƚŚ ĂŶĚ ƐĂĨĞƚLJ͘ WĞŽƉůĞ ǁŚŽ use drugs in public spaces remain at greater risk of overdose, disease transmission, emergency room admission and arrest. Safe ĚƌƵŐ ĐŽŶƐƵŵƉƟŽŶ ƐĞƌǀŝĐĞƐ ƉƌŽǀŝĚĞ Ă ƐĂĨĞ environment for individuals to consume pre-obtained drugs under the supervision of ƚƌĂŝŶĞĚ ƐƚĂī ŝŶ ĐŽŶƚƌŽůůĞĚ ŚĞĂůƚŚ ƐĞƫŶŐƐ͕ ǁŝƚŚ ĂĐĐĞƐƐ ƚŽ ƐƚĞƌŝůĞ ŝŶũĞĐƟŶŐ ĞƋƵŝƉŵĞŶƚ ĂŶĚ ƐŽĐŝĂů ƐĞƌǀŝĐĞƐ͘ / ĐƌĞĂƚĞĚ Ă ƌĞƉŽƌƚ ŽŶ ^ ^ ƚŽ ĂŶĂůLJnjĞ ƚŚŝƐ ĐƌŝƟĐĂů ƉƵďůŝĐ ŚĞĂůƚŚ ĂƉƉƌŽĂĐŚ ĂŶĚ ĚŝƐƉůĂLJ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ƉŽƐŝƟǀĞ ŽƵƚĐŽŵĞƐ͘ dŚŝƐ ƌĞƉŽƌƚ ŝĚĞŶƟĮĞƐ ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ &W ƚŽ ŝŵƉůĞŵĞŶƚ ƉŽůŝĐLJ ĂŶĚ ĞĚƵĐĂƟŽŶ ĂĐƟǀŝƟĞƐ͕ ĂŶĚ ĂƌƟĐƵůĂƚĞ support for SCS. ,ĞĂůƚŚ WŽůŝĐLJ >ĞŐŝƐůĂƟŽŶ ^ƉƌĞĂĚƐŚĞĞƚ &Žƌ ŵLJ ĮŶĂů ƉƌŽũĞĐƚ͕ / ƌĞǀŝĞǁĞĚ ƚŚĞ ůĞŐŝƐůĂƟǀĞ ůĞƩĞƌƐ ŽĨ ƐƵƉƉŽƌƚ ĂŶĚ ŽƉƉŽƐŝƟŽŶ &W ŚĂƐ ƐĞŶƚ ƚŽ ŐŽǀĞƌŶŵĞŶƚ ŽĸĐŝĂůƐ ŽǀĞƌ ƚŚĞ ůĂƐƚ ƐĞǀĞƌĂů LJĞĂƌƐ ĂŶĚ ĐƌĞĂƚĞĚ Ă ƐƉƌĞĂĚƐŚĞĞƚ ƚŚĂƚ ŽƌŐĂŶŝnjĞƐ ŝƚƐ ůĞŐŝƐůĂƟǀĞ ƉŽƐŝƟŽŶƐ ďLJ ƚŽƉŝĐ͘ / ĚĞǀĞůŽƉĞĚ overarching policy statements based on those ƉŽƐŝƟŽŶƐ͘ dŚŝƐ ƐƉƌĞĂĚƐŚĞĞƚ ǁŝůů ďĞ ƵƐĞĚ ƚŽ ĂŶĂůLJnjĞ ĂƌĞĂƐ ŝŶ ǁŚŝĐŚ &W ŵĂLJ ĐŚŽŽƐĞ ƚŽ ŝŵƉůĞŵĞŶƚ ĂĚĚŝƟŽŶĂů ŽƌŐĂŶŝnjĂƟŽŶĂů ƉŽůŝĐŝĞƐ͘ / Ăŵ ƚŚĂŶŬĨƵů ĨŽƌ ƐƵĐŚ Ă ŵĞĂŶŝŶŐĨƵů ĂŶĚ ǀĂůƵĂďůĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ǁŽƌŬ ǁŝƚŚ ƚŚĞ &W team this summer. Each team member dedicates his or her professional life to ŝŵƉƌŽǀŝŶŐ ƚŚĞ ĞǀĞƌLJĚĂLJ ƉƌĂĐƟĐĞ ŽĨ ĨĂŵŝůLJ physicians and strengthening the primary care ƉŝƉĞůŝŶĞ͘ tŚLJ ĚŽĞƐ &W ĚĞĚŝĐĂƚĞ ŝƚƐ ĞīŽƌƚƐ ƚŽ ƉĂƟĞŶƚ ĐĂƌĞ͍ ĞĐĂƵƐĞ ĞǀĞƌLJ ŝŶĚŝǀŝĚƵĂů ƐŚŽƵůĚ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ůŝǀĞ Ă ŚĞĂůƚŚŝĞƌ ůŝĨĞ͘ / ƉůĂŶ ƚŽ ĂƉƉůLJ ŵLJ ĞdžƉĞƌŝĞŶĐĞ ǁŝƚŚ &W ƚŽ Ă ĨƵƚƵƌĞ ĐĂƌĞĞƌ ŝŶ ƉƵďůŝĐ ŚĞĂůƚŚ͕ ĐŽŶƟŶƵŝŶŐ ƚŽ ĮŐŚƚ ƚŚĞ ĐŚĂůůĞŶŐĞƐ ŽĨ ŚĞĂůƚŚ ŝŶĞƋƵŝƚLJ͘ California Family Physician Fall 2018

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evp forum

Susan Hogeland, CAE

This Really Is Good-Bye, with a Huge Side of Appreciation dŚŝƐ ƌĞĂůůLJ ŝƐ ŐŽŽĚͲďLJĞ͘ ĨƚĞƌ ǁƌŝƚŝŶŐ ϭϬϲ ŽĨ ƚŚĞƐĞ ĂƌƚŝĐůĞƐ ŽǀĞƌ Ϯϳ LJĞĂƌƐ͕ ŝƚ ƐĞĞŵƐ ŝŵƉŽƐƐŝďůĞ ƚŚŝƐ ŝƐ ŵLJ ůĂƐƚ͕ ďƵƚ ƚŚĞƌĞ ŝƚ ŝƐ͘ /Ŷ ƚƌƵƚŚ͕ ŝƚ͛Ɛ ďĞĞŶ Ă ůŽŶŐ ĂŶĚ ůŽǀĞůLJ ŐŽŽĚͲďLJĞ ʹ ďĞŐŝŶŶŝŶŐ ǁŝƚŚ ĂŶ ĂďƐŽůƵƚĞůLJ ĨĂďƵůŽƵƐ celebration dinner at our Clinical Forum in Monterey ĨĞĂƚƵƌŝŶŐ ŶŽƚ ŽŶůLJ Ă ŐŽŽĚ ŶƵŵďĞƌ ŽĨ ŽƵƌ ǁŽŶĚĞƌĨƵů past present presidents, current officers and many friends and colleagues from California and around the country, but also my dear friend, Grammy-nominated ũĂnjnj ǀŽĐĂůŝƐƚ <ĂƌƌŝŶ ůůLJƐŽŶ ĂŶĚ ŚĞƌ ĂŵĂnjŝŶŐ ŵƵƐŝĐŝĂŶƐ͘ / ĞdžƚĞŶĚ ŵLJ ĚĞĞƉ ĂƉƉƌĞĐŝĂƚŝŽŶ ƚŽ ŽƵƌ ŽĨĨŝĐĞƌƐ ĂŶĚ Board for that incredible send-off and the beautiful ŝŶƐĐƌŝďĞĚ dŝĨĨĂŶLJ ďŽǁů͕ ƚŽ ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ ĂŶĚ :Ğƌƌŝ ĂǀŝƐ͕ ƉĂƌƚLJ ƉůĂŶŶĞƌƐ ĞdžƚƌĂŽƌĚŝŶĂŝƌĞ͕ ĂŶĚ ƚŚĞ ŽƚŚĞƌ &W ƐƚĂĨĨ ǁŚŽ ĐĂƌƌŝĞĚ ŽĨĨ ƚŚĞ ĞǀĞŶƚ ǁŝƚŚ ƐƵĐŚ ƐƚLJůĞ͘ Thank you, thank you. dŽ ƚŚĞ ǁŽŶĚĞƌĨƵů ĨŽůŬƐ Ăƚ ƚŚĞ &W͕ ĞƐƉĞĐŝĂůůLJ ŽƵŐ Henley, Nancy Laughlin and Marci McNeal, thank you ĨŽƌ ƚŚĞ ƌĞĐŽŐŶŝƚŝŽŶ ĂŶĚ ďĞĂƵƚŝĨƵů ĞŶŐƌĂǀĞĚ ďŽǁů Ăƚ ƚŚĞ Annual Chapter Leadership Forum in April. dŚĞ ůŽŶŐ ŐŽŽĚͲďLJĞ ĐŽŶƚŝŶƵĞĚ Ăƚ ŽƵƌ :ƵůLJ ŽĂƌĚ ĂŶĚ ƉůĂŶŶŝŶŐ ŵĞĞƚŝŶŐ ǁŝƚŚ Ă ŚĂŝŬƵ ƐůĂŵ ŝŶ ŵLJ ŚŽŶŽƌ ĂŶĚ ƉƌĞƐĞŶƚĂƚŝŽŶ ŽĨ Ă ǀĞƌLJ ŐĞŶĞƌŽƵƐ ŐŝĨƚ͘ DLJ tŽŵĞŶ ŽĨ ƚŚĞ tĞƐƚ ĨƌŝĞŶĚƐ ƐŚŽǁĞĚ ƚŚĞŝƌ ůŽǀĞ ĂƐ ǁĞůů Ăƚ ŽƵƌ ƌĞĐĞŶƚ ŵĞĞƚŝŶŐ ŝŶ KƌĞŐŽŶ͕ ŚŽƐƚĞĚ ďLJ ĂŶŽƚŚĞƌ ƌĞƚŝƌŝŶŐ tŽŵĂŶ ŽĨ ƚŚĞ tĞƐƚ͕ <ĞƌƌLJ 'ŽŶnjĂůĞnj͘ dŚĂŶŬ LJŽƵ͕ tKt ƐŝƐƚĞƌƐ͘ tŽƌĚƐ ĐĂŶ ŶĞǀĞƌ ĨƵůůLJ ĞdžƉƌĞƐƐ ƚŚĞ ĂƉƉƌĞĐŝĂƚŝŽŶ ĂŶĚ ůŽǀĞ / ŚĂǀĞ ĨŽƌ ŵLJ ĚĞĂƌ ĨƌŝĞŶĚ ĂŶĚ ĐŽůůĞĂŐƵĞ͕ ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ͕ ĨŽƌ ŚĞƌ ĂŵĂnjŝŶŐ ƚĂůĞŶƚ͕ ƐŬŝůůƐ͕ ǁŝĚĞͲƌĂŶŐŝŶŐ ŬŶŽǁůĞĚŐĞ͕ ƐƚĞĂĚĨĂƐƚŶĞƐƐ͕ ǁŽƌŬ ĞƚŚŶŝĐ ĂŶĚ ĚĞĚŝĐĂƚŝŽŶ to CAFP. Our partnership over the past almost 35 LJĞĂƌƐ ŚĂƐ ďĞĞŶ Ă ƚŚŝŶŐ ŽĨ ďĞĂƵƚLJ ĂŶĚ / ƚƌƵůLJ Ăŵ ŶŽƚ ƐƵƌĞ ǁŚĂƚ ůŝĨĞ ǁŝůů ďĞ ůŝŬĞ ǁŝƚŚŽƵƚ ŚĞƌ ŝŶ ŝƚ ĂůŵŽƐƚ ĞǀĞƌLJ day. CAFP is fortunate, indeed, to have her steady ŚĂŶĚ ŽĨ ƐƵƉƉŽƌƚ ĂƐ ƚŚĞ ƚƌĂŶƐŝƚŝŽŶ ƚŽ Ă ŶĞǁ ƐƚĂĨĨ ůĞĂĚĞƌ comes about.

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Thank you, too, to the many CAFP members, AAFP ůĞĂĚĞƌƐ ĂŶĚ ƐƚĂĨĨ ĂŶĚ ĨƌŝĞŶĚƐ ǁŚŽ ŚĂǀĞ ĞŵĂŝůĞĚ ĂŶĚ ǁƌŝƚƚĞŶ ƐƵĐŚ ƐǁĞĞƚ ŶŽƚĞƐ ŽĨ ĨĂƌĞǁĞůů ʹ ŝƚ ŝƐ ƐŽ ŐƌĂƚŝĨLJŝŶŐ ƚŽ ŬŶŽǁ LJŽƵ ďĞůŝĞǀĞ / ŚĂǀĞ ďĞĞŶ ŽĨ ŚĞůƉ ƚŽ LJŽƵ ĂŶĚ family medicine over the years.

EŽǁ͕ ƚŽ ƚŚĞ ĨƵƚƵƌĞ͘ /ƚ ŝƐ ĞĂƐŝĞƌ ƚŽ ůĞĂǀĞ &W ŬŶŽǁŝŶŐ LJŽƵƌ ŶĞǁ ĐŚŝĞĨ ĞdžĞĐƵƚŝǀĞ ŽĨĨŝĐĞƌ ; KͿ ǁŝůů ďĞ ĂŶ individual of great ability and leadership, Lisa Folberg, DWW͘ zŽƵƌ ^ĞĂƌĐŚ ŽŵŵŝƚƚĞĞ͕ ůĞĚ ďLJ /ŵŵĞĚŝĂƚĞ WĂƐƚ President Michelle Quiogue, did an incredible job ŽĨ ƐĞůĞĐƚŝŶŐ ĂŶ ŽƵƚƐƚĂŶĚŝŶŐ ĐĂŶĚŝĚĂƚĞ͕ ŽŶĞ ǁŚŽ ǁŝůů ĐŽŶƚŝŶƵĞ ƚŽ ŵŽǀĞ ƚŚĞ ĐĂĚĞŵLJ ĨŽƌǁĂƌĚ ĂŶĚ ƚĂŬĞ ŝƚ ƚŽ ŶĞǁ ŚĞŝŐŚƚƐ ŽĨ ƐƵĐĐĞƐƐ͘ >ŝƐĂ͛Ɛ ĞdžƚĞŶƐŝǀĞ ĞdžƉĞƌŝĞŶĐĞ ŽŶ nearly every front of CAFP’s strategic plan is a great ŵĂƚĐŚ͘ Ɛ ĚĞƚĂŝůĞĚ ŝŶ ĂŶ ŝŶƚĞƌǀŝĞǁ ǁŝƚŚ ŚĞƌ ŝŶ ĂŶ ĂƌƚŝĐůĞ ĞůƐĞǁŚĞƌĞ ŝŶ ƚŚŝƐ ĞĚŝƚŝŽŶ͕ ƐŚĞ ŚĂƐ ǁŽƌŬĞĚ ŝŶ ƚŚĞ ^ƚĂƚĞ Legislative Analyst’s Office, at the California Medical ƐƐŽĐŝĂƚŝŽŶ ĂƐ ďŽƚŚ Ă ůŽďďLJŝƐƚ ĂŶĚ sŝĐĞ WƌĞƐŝĚĞŶƚ ŽĨ Medical and Regulatory Policy and as President and CEO of the California Medical Association Foundation. Her ĞdžƉĞƌŝĞŶĐĞ ŝƐ ďƌŽĂĚ ĂŶĚ ĚĞĞƉ ĂŶĚ ƐŚĞ ǁŝůů ďƌŝŶŐ ďŽƚŚ ĞŶƚŚƵƐŝĂƐŵ ĂŶĚ ƉĂƐƐŝŽŶ ƚŽ ŚĞƌ ŶĞǁ ƌŽůĞ͘ / ŚĂĚ ƚŚĞ ƉůĞĂƐƵƌĞ ŽĨ ŝŶƚƌŽĚƵĐŝŶŐ >ŝƐĂ ƚŽ ŵLJ tŽŵĞŶ ŽĨ ƚŚĞ tĞƐƚ ƉĂůƐ ǁŚŝůĞ ǁĞ ǁĞƌĞ ŝŶ KƌĞŐŽŶ ƌĞĐĞŶƚůLJ͘ ^ŚĞ ǁĂƐ Ă ďŝŐ Śŝƚ ĂŶĚ / ŬŶŽǁ ƐŚĞ ǁŝůů ĨŝŶĚ ƚŚĞŝƌ ƐƵƉƉŽƌƚ ĂƐ ǁĞůů ĂƐ ƚŚĂƚ ŽĨ ŵLJ ŽƚŚĞƌ ĚĞĂƌ ĐŽůůĞĂŐƵĞƐ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌLJ ƚŽ ďĞ ŝŶǀĂůƵĂďůĞ͘ / Ăŵ ĐŽŶĨŝĚĞŶƚ͕ ƚŽŽ͕ ƚŚĂƚ &W ŵĞŵďĞƌƐ ǁŝůů ǁĞůĐŽŵĞ ŚĞƌ ǁŝƚŚ ŽƉĞŶ ĂƌŵƐ ĂŶĚ ĚŽ Ăůů ƚŚĞLJ ĐĂŶ ƚŽ ŵĂŬĞ ŚĞƌ ĨĞĞů ƐŚĞ ŚĂƐ ĨŽƵŶĚ ŚĞƌ ǁŽƌŬ ĨĂŵŝůLJ͘ tŝƚŚ >ŝƐĂ tĂƌĚ Ăƚ ƚŚĞ ŚĞůŵ ĂƐ LJŽƵƌ WƌĞƐŝĚĞŶƚ͕ ĂŶĚ >ŝƐĂ Folberg as CEO, the sky is the limit for family medicine in California, as it should be. dŚĂŶŬ LJŽƵ Ăůů ĨŽƌ LJŽƵƌ ƐƵƉƉŽƌƚ ŽǀĞƌ ƚŚĞ LJĞĂƌƐ ʹ LJŽƵ ĂƌĞ ƚŚĞ ďĞƐƚ ĂŶĚ / Ăŵ ĐŽŶǀŝŶĐĞĚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ǁŝůů ďĞ Ăƚ the heart of the future of health care in California.

CALIFORNIA ACADEMY OF FAMILY PHYSICIANS 1520 PACIFIC AVE SAN FRANCISCO, CA 94109 -2627

Presorted Standard U.S. POSTAGE PAID

Little Rock, AR Permit No. 2437