Spring 2019

VO L . 70 N O. 2 S p r i n g 201 9

A FAMILY PHYSICIAN FOR ALL SEASONS An Interview With Your New President Walt Mills, MD, MBA

in this issue: THE INTERSECTION OF HOUSING AND HEALTH

NOT ALL HEROES WEAR CAPES… SOME WEAR DOCTORS’ COATS Your priority is protecting your patients.

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4

California Family Physician Spring 2019

California

Spring 2019

FAMILY PHYSICIAN st ron g

me d i ci ne

f o r

C al i f o r nia

zŽƵƌ ϮϬϭϵͲϮϬϮϬ ŽĸĐĞƌƐ͘

features 14 An Interview With Your New President, Walt Mills, MD, MBA 17 Making a Difference for Patients and Family Physicians at AMAM!

Adam Francis

19 CAFP Honors Five Outstanding Members 22 Five Years and Counting: A Look at CAFP’s Landmark PCMH Pilot 26 CAFP Foundation Talking about Immigration Policy Issues: What Is “ICE”?

Conrad Amenta Shelly B. Rodrigues, CAE

28 Exploring the Intersection of Health Care and Housing

Sheryl Recinos, MD

departments 6

Editorial

Making Government See The Big Picture in Health

8

President’s Message

Homelessness is a First Step to Health

10 Political Pulse

Brent Sugimoto, MD Lisa M. Ward, MD, MScPH, MS

Retaking the “Family” In Family Medicine

Carla Kakutani, MD

12 In The News 30 CEO Message

Make It Work

Lisa Folberg, MPP

&Žƌ ƵƉĐŽŵŝŶŐ D ĂĐƟǀŝƟĞƐ ǀŝƐŝƚ ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬĐŵĞ California Family Physician Spring 2019

5

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Making Government See The Big Picture in Health You have probably seen them on your commute: the tents. ^ŽŵĞƟŵĞƐ ŽŶĞ Žƌ ƚǁŽ ƉŽƉƐ ŽĨ ĐŚĞĞƌLJ LJĞůůŽǁ Žƌ ŽƌĂŶŐĞ ƐƉƌŝŶŐ ƵƉ ŽŶ ƚŚĞ ƌŽĂĚƐŝĚĞ͕ ƐŝĚĞǁĂůŬƐ Žƌ ƉƵďůŝĐ ŐƌĞĞŶ ƐƉĂĐĞ ŝŶ LJŽƵƌ ƚŽǁŶ͘ Where I live, villages of tents pack the underpasses, and since even this prime real estate is in short supply, I see tents planted in the ůĂŶĚƐĐĂƉĞĚ ŐŽƌĞƐ ďĞƚǁĞĞŶ ƐĞǀĞƌĂů ůĂŶĞƐ ŽĨ ŚŝŐŚͲƐƉĞĞĚ ĨƌĞĞǁĂLJ ŽŶ either side, islands of humanity in the most precarious places. It is Ă ŵĂŶŝĨĞƐƚĂƟŽŶ ŽĨ Ă ŐƌĞĂƚ ƉƵďůŝĐ ƉŽůŝĐLJ ĨĂŝůƵƌĞ ƌĞŶĚĞƌĞĚ ŝŶ ďƌŝŐŚƚůLJ ĐŽůŽƌĞĚ ŶLJůŽŶ ƚŚĂƚ ƐŚŽƵůĚ ďĞ ƐŚŽĐŬŝŶŐ͕ LJĞƚ ƐŽŵĞŚŽǁ ŚĂƐ ƐƚĂƌƚĞĚ ƚŽ feel like one of the symbols of Californian life.

Most visibly urban, but increasingly rural, homelessness is a profound public health issue in our state. Consider this: Californians ĂĐĐŽƵŶƚ ĨŽƌ ĂďŽƵƚ ŽŶĞͲĞŝŐŚƚŚ ŽĨ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ͛ ƉŽƉƵůĂƟŽŶ͕ BUT, one in four homeless individuals come from our state — ŚŽŵĞůĞƐƐŶĞƐƐ ǁĂůŬƐ ŝŶƚŽ ŽƵƌ ĐůŝŶŝĐƐ ĞĂĐŚ ĂŶĚ ĞǀĞƌLJ ĚĂLJ͘ Homelessness comes in many forms. I once cared for a pregnant, single mother and her young daughter. The daughter, giggly and ĂůǁĂLJƐ ŶĞĂƚůLJ ĚƌĞƐƐĞĚ ĂŶĚ ŝŶ ƉŝŐƚĂŝůƐ͕ ǁĂƐ ŚĞĂůƚŚLJ͘ dŚĞ ŵŽƚŚĞƌ ŚĂĚ ƐĞǀĞƌĞ ŝƌŽŶ ĚĞĮĐŝĞŶĐLJ ĂŶĞŵŝĂ͘ &ŽŽĚ ĨŽƌ ŚĞƌ ĚĂƵŐŚƚĞƌ ǁĂƐ ŶŽŶͲ ŶĞŐŽƟĂďůĞ͕ ƐŽ ƐŚĞ ǁĂƐ ůĞŌ ƚŽ ĐŚŽŽƐĞ ĂŵŽŶŐ ŶŽƵƌŝƐŚŝŶŐ ŚĞƌ ƉƌĞŐŶĂŶƚ ƐĞůĨ͕ ŬĞĞƉŝŶŐ ƵƉ ŽŶ ƌĞŶƚ Ăƚ ŚĞƌ ƌĞƐŝĚĞŶƟĂů ŵŽƚĞů Žƌ ĐŽƵĐŚͲƐƵƌĮŶŐ ǁŝƚŚ ƌĞůĂƟǀĞƐ͘ Considering that inadequate health care contributes only 10 percent to the risk of premature death and genes only 30 percent, our ďŝŐŐĞƐƚ ŝŵƉĂĐƚ ĐŽŵĞƐ ĨƌŽŵ ĂĚĚƌĞƐƐŝŶŐ ƚŚĞ ƌĞƐƚ ;^ĐŚƌŽĞĚĞƌ͕ ϮϬϬϳͿ͘ Indeed, the American Academy of Family Physicians considers understanding the social determinants of health a core competency ďĞĐĂƵƐĞ ǁŝƚŚŽƵƚ ŝƚ͕ ͞ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƉĂƟĞŶƚƐ ĂůŝŬĞ ǁŝůů ďĞ ŝŵƉĞĚĞĚ ďLJ ƐƵďŽƉƟŵĂů ŽƵƚĐŽŵĞƐ͘͟ DLJ ƉĂƟĞŶƚ ƚŽŽŬ Ă ŚĞĂůƚŚLJ ďĂďLJ ďŽLJ from the hospital to her own ŚŽŵĞ ƚŚĂŶŬƐ ƚŽ ĐůŝŶŝĐ ƐƚĂī ǁŚŽ ŐŽƚ her referred to resources in our county. Her pregnancy had a good outcome because my health system could address an issue ͞ƵŶƌĞůĂƚĞĚ͟ ƚŽ ŚĞĂůƚŚ͘ ůƐŽ ͞ƵŶƌĞůĂƚĞĚ͟ ƚŽ ŵLJ ƉĂƟĞŶƚ͛Ɛ ŚĞĂůƚŚ ǁĞƌĞ ƉŽůŝĐŝĞƐ ƚŚĂƚ ůĞĚ ƚŽ Ă ĐŽŶƐƚƌĂŝŶĞĚ ŚŽƵƐŝŶŐ ƐƵƉƉůLJ ĂŶĚ Ă ůĂĐŬ ŽĨ ĂīŽƌĚĂďůĞ ĚĂLJĐĂƌĞ ƚŚĂƚ ůŝŵŝƚĞĚ ŚĞƌ ŝŶĐŽŵĞ ƉŽƚĞŶƟĂů ĂƐ Ă ƐŝŶŐůĞ ƉĂƌĞŶƚ͘ KƵƌ ƉĂƟĞŶƚƐ͛ ŚĞĂůƚŚ ŝƐ ƌĞŐƵůĂƌůLJ ĚŝĐƚĂƚĞĚ ďLJ ƉŽůŝĐŝĞƐ ƐĞĞŵŝŶŐůLJ ƵŶƌĞůĂƚĞĚ ƚŽ ǁĞůůͲďĞŝŶŐ͕ ǁŚĞƚŚĞƌ ŝƚ ďĞ ŚŽƵƐŝŶŐ ƐƵƉƉůLJ͕ ĞĚƵĐĂƟŽŶ ƌĞƐŽƵƌĐĞ ĚĞĐŝƐŝŽŶƐ͕ ĚĞƚĞƌŵŝŶŝŶŐ ǁŚĞƌĞ Ă ďƵƐ ůŝŶĞ ƐŚŽƵůĚ ƌƵŶ Žƌ 6

California Family Physician Spring 2019

njŽŶŝŶŐ ŶĞŝŐŚďŽƌŚŽŽĚƐ ƚŽ ĞŶĐŽƵƌĂŐĞ Ă ƉŚLJƐŝĐĂůůLJ ĂĐƟǀĞ ĐŽŵŵƵŶŝƚLJ͘ ,ĞĂůƚŚ ŝŶƚĞƌĂĐƚƐ ǁŝƚŚ ĞǀĞƌLJ ĨĂĐĞƚ ŽĨ ŚƵŵĂŶ ůŝĨĞ͕ ĂŶĚ ƚŚƵƐ ŚĞĂůƚŚLJ ƉŽůŝĐLJ ƌĞƋƵŝƌĞƐ ĂŶ ŝŶƚĞƌĚŝƐĐŝƉůŝŶĂƌLJ ĂƉƉƌŽĂĐŚ ŬŶŽǁŶ ĂƐ ŚĞĂůƚŚ ŝŶ Ăůů ƉŽůŝĐŝĞƐ ;,ŝ WͿ͘ ,ŝ W ŝƐ Ă ƐƚƌĂƚĞŐLJ ƚŽ ŝŶƚĞŐƌĂƚĞ ĐŽŶƐŝĚĞƌĂƟŽŶ ŽĨ ŚŽǁ ĂŶLJ ƉŽůŝĐLJ ǁŽƵůĚ ĂīĞĐƚ ŚĞĂůƚŚ ĞƋƵŝƚLJ ĂŶĚ ƚŚĞ ƐŽĐŝĂů ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ͕ ĞŵďĞĚĚŝŶŐ ƐƵĐŚ ĐŽŶƐŝĚĞƌĂƟŽŶƐ ŝŶƚŽ ƚŚĞ ĚĞĐŝƐŝŽŶͲŵĂŬŝŶŐ processes in every area of policy making. /Ŷ ĂůŝĨŽƌŶŝĂ͕ ,ŝ W ǁĂƐ ŝŶƐƟƚƵƚĞĚ ǁŚĞŶ džĞĐƵƟǀĞ KƌĚĞƌ ^ͲϬϰͲϭϬ ŝŶ ϮϬϭϬ ĨŽƵŶĚĞĚ ƚŚĞ ,ĞĂůƚŚ ŝŶ ůů WŽůŝĐŝĞƐ dĂƐŬĨŽƌĐĞ͕ Ă ƉĂƌƚŶĞƌƐŚŝƉ of the California Department of Public Health, the Public Health /ŶƐƟƚƵƚĞ ĂŶĚ ƚŚĞ ^ƚƌĂƚĞŐŝĐ 'ƌŽǁƚŚ ŽƵŶĐŝů͘ dŚŝƐ ƚĂƐŬĨŽƌĐĞ ďƌŽƵŐŚƚ ƚŽŐĞƚŚĞƌ ϮϮ ĚĞƉĂƌƚŵĞŶƚƐ͕ ĂŐĞŶĐŝĞƐ͕ ĂŶĚ ŽĸĐĞƐ ĨƌŽŵ ĂĐƌŽƐƐ ^ƚĂƚĞ 'ŽǀĞƌŶŵĞŶƚ ƚŽ ŝŶĐŽƌƉŽƌĂƚĞ ŚĞĂůƚŚ͕ ĞƋƵŝƚLJ ĂŶĚ ƐƵƐƚĂŝŶĂďŝůŝƚLJ ĐŽŶƐŝĚĞƌĂƟŽŶƐ ŝŶƚŽ ĚĞĐŝƐŝŽŶͲŵĂŬŝŶŐ ĂĐƌŽƐƐ ƐĞĐƚŽƌƐ ĂŶĚ ƉŽůŝĐLJ ĂƌĞĂƐ͘ ,ŽǁĞǀĞƌ͕ ĂƐ ƚŚŝƐ ƉƌŽŐƌĞƐƐŝǀĞ ĂƉƉƌŽĂĐŚ ƚŽ ƉŽůŝĐLJŵĂŬŝŶŐ ŝƐ ŶŽƚ ĐŽĚŝĮĞĚ ŝŶ ůĂǁ͕ ƚŚĞ ƉĞƌŵĂŶĞŶĐĞ ŽĨ ƚŚŝƐ ƐƚƌĂƚĞŐLJ ŝŶ ŽƵƌ ƐƚĂƚĞ ŝƐ not assured. Assemblymember Richard Bloom* sought to make ƚŚŝƐ ƚĂƐŬĨŽƌĐĞ ƉĞƌŵĂŶĞŶƚ ŝŶ ƚŚĞ ϮϬϭϴ ƐĞƐƐŝŽŶ ƚŚƌŽƵŐŚ Ϯϰϯϰ͘ hŶĨŽƌƚƵŶĂƚĞůLJ͕ ƚŚŝƐ ďŝůů ĚŝĞĚ ŝŶ ĐŽŵŵŝƩĞĞ ŝŶ ƚŚĞ ^ĞŶĂƚĞ͘ dŽ ƐĞĞ ƚŚĞ ƌĞǀŝǀĂů ŽĨ ƚŚŝƐ ďŝůů ǁŽƵůĚ ĨĂĐŝůŝƚĂƚĞ ƚŚĞ ǁŽƌŬ ǁĞ ĚŽ ĂƐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ / ŚŽƉĞ ƚŽ ƐĞĞ ŝƚ ĂƐ Ă ůĞŐŝƐůĂƟǀĞ ƉƌŝŽƌŝƚLJ ŝŶ ƚŚŝƐ Žƌ ĨƵƚƵƌĞ sessions of our Legislature. Imagine government being required ƚŽ ƚŚŝŶŬ ĂďŽƵƚ ƚŚĞ ŚĞĂůƚŚ ŝŵƉůŝĐĂƟŽŶƐ ĨŽƌ ĞǀĞƌLJ ƉŽůŝĐLJ ŝƚ ŵĂŬĞƐ͘ /ŵĂŐŝŶĞ ŐŽǀĞƌŶŵĞŶƚ ĐŽŵƉƌĞŚĞŶĚŝŶŐ ƚŚĂƚ ĂŶLJ ƉŽůŝĐLJ ŝŵƉĂĐƟŶŐ ƚŚĞ ĚĞĐŝƐŝŽŶƐ͕ ƐĂĨĞƚLJ͕ ĞŶǀŝƌŽŶŵĞŶƚ͕ ĞĚƵĐĂƟŽŶĂů ŽƉƉŽƌƚƵŶŝƟĞƐ ĂŶĚ ĮŶĂŶĐŝĂů ƐĞĐƵƌŝƚLJ ŽĨ ŝƚƐ ĐŽŶƐƟƚƵĞŶƚƐ ĂīĞĐƚƐ ƚŚĞŝƌ ǀĞƌLJ ŚĞĂůƚŚ͘ /ŵĂŐŝŶĞ ŐŽǀĞƌŶŵĞŶƚ ĂĐƟŶŐ Ă ůŝƩůĞ ŵŽƌĞ ůŝŬĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ References 1.

Ϯ͘

3.

Social Determinants of Health Policy. American Academy of &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂďŽƵƚͬƉŽůŝĐŝĞƐͬĂůůͬƐŽĐŝĂůͲ ĚĞƚĞƌŵŝŶĂŶƚƐ͘Śƚŵů͘ ĐĐĞƐƐĞĚ DĂƌĐŚ ϭϰ͕ ϮϬϭϵ͘ ^ĐŚƌŽĞĚĞƌ͕ ^ ͘ tĞ ĂŶ Ž ĞƩĞƌ Ͷ /ŵƉƌŽǀŝŶŐ ƚŚĞ ,ĞĂůƚŚ ŽĨ ƚŚĞ ŵĞƌŝĐĂŶ WĞŽƉůĞ͘ E ŶŐů : DĞĚ ϮϬϬϳ͖ ϯϱϳ͗ϭϮϮϭͲϭϮϮϴ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ ŶĞũŵ͘ŽƌŐͬĚŽŝͬĨƵůůͬϭϬ͘ϭϬϱϲͬE :DƐĂϬϳϯϯϱϬ͘ ĐĐĞƐƐĞĚ DĂƌĐŚ ϭϰ͕ ϮϬϭϵ͘ ϮϬϭϴ , Z͗ WĂƌƚ ϭ Ͳ W/d ƐƟŵĂƚĞƐ ŽĨ ,ŽŵĞůĞƐƐŶĞƐƐ ŝŶ ƚŚĞ h͘^͘ DĂƌĐŚ ϮϬϭϴ͘ ĞƉĂƌƚŵĞŶƚ ŽĨ ,ŽƵƐŝŶŐ Θ hƌďĂŶ ĞǀĞůŽƉŵĞŶƚ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ ŚƵĚĞdžĐŚĂŶŐĞ͘ŝŶĨŽͬƌĞƐŽƵƌĐĞͬϱϳϴϯͬϮϬϭϴͲĂŚĂƌͲƉĂƌƚͲϭͲƉŝƚͲĞƐƟŵĂƚĞƐͲŽĨͲ ŚŽŵĞůĞƐƐŶĞƐƐͲŝŶͲƚŚĞͲƵƐͬ͘ ĐĐĞƐƐĞĚ DĂƌĐŚ ϭϰ͕ ϮϬϭϵ͘

* Assemblymember Bloom is the brother of CAFP member Stuart Bloom.

p r e s i d e n t ’s m e s s a g e

Lisa Ward, MD, MsPH, MS, FAAFP Chief Medical Officer Santa Rosa Community Health

Homefulness is a First Step to Health When a firestorm burned through Santa Rosa in Sonoma County in October 2017, more than 5,000 homes were destroyed – about 10 percent of its housing stock. At the time of the fires, the vacancy rate stood at 1 percent for homes and at 3.5 percent for rentals.1 By all measures, the pre-fire housing market was already tight. The fires made a bad situation nearly impossible. So, where would our community members go?

“

health and housing needs. While the results have not been formally released, public health staff have conceded that this household, in-person survey represents a skewed sample.

The survey likely missed homeless people who don’t have houses to survey and underrepresents people working and not at home during the day. Nonetheless, the results are startling. The rate of depression and anxiety among those surveyed doubled to 37 percent; one in four with a preexisting respiratory illness reported their chronic respiratory conditions had worsened; 44 percent reported trauma related to disruption in their household, separation from family, destruction of their home, or firerelated injury. Yet more than 50 percent of those surveyed reported periods of time without access to their primary care provider and to their regular pharmacy.

Whether one is homeless because of a fire, the result of poverty, the chaos of living with severe mental illness or due to limitations from chronic medical disease, being homeless makes matters worse.

A year after the fires, the Sonoma County Department of Health completed a needs assessment of health, mental

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California Family Physician Spring 2019

“

A different kind of homelessness struck Santa Rosa that fall.

When our Vista Family Health Center burned, about 25,000 patients found themselves medically homeless.

They lost their primary care medical home and their known family physician. Since the fires, our Federally Qualified Health Center has lost about 6 percent – more than 4,500 – of its patients. Most patients who left are among the uninsured and those insured with Medi-Cal. They represent those least able to afford rising rents and mortgages, and least likely to have the savings needed to move to a new home in the aftermath of the fires. We have had too many good-bye visits with longtime patients who have found homes in nearby towns and far-away towns where housing is more affordable. Other patients have simply disappeared.

Now this may be stating the obvious, but I will do it anyway: “Studies have shown that being homeless is detrimental to one’s health.”2 What may be less obvious is that “selected housing interventions for low-income people have been found to improve health care outcomes and to reduce health care costs.”2 This is evidence-based medicine. Of all the social determinants of health, the reduction in homelessness is the most powerful influence on improved health outcomes and reduced health costs.

Many promising interventions include public-private partnerships, bond measures, increased investment in shelters and transitional housing, and even direct ĞdžƉĞŶĚŝƚƵƌĞƐ ďLJ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ĞŶƚŝƚŝĞƐ͘ Non-profit organizations and philanthropic groups have funded Housing First initiatives or permanent transitional housing for the chronically homeless. Many Housing First initiatives connect individuals and families to permanent ŚŽƵƐŝŶŐ ƌĞŐĂƌĚůĞƐƐ ŽĨ ŽƚŚĞƌǁŝƐĞ ĞdžĐůƵĚŝŶŐ ĐŽŶĚŝƚŝŽŶƐ ƐƵĐŚ ĂƐ substance use, mental illness or service requirements. ^ŽŵĞ ŚŽƉĞĨƵů ĞdžĂŵƉůĞƐ ŝŶĐůƵĚĞ Ă ^ĂŶ &ƌĂŶĐŝƐĐŽ ďƵƐŝŶĞƐƐ ƚĂdž ŵĞĂƐƵƌĞ ƚŚĂƚ ƉĂƐƐĞĚ ŝŶ EŽǀĞŵďĞƌ ϮϬϭϴ͘ dŚĞ ŵĞĂƐƵƌĞ is estimated to raise $300 million for increased shelter beds and mental health services for homeless people. In Oregon, ǁŚĞŶ ƚŚĞ ŚĞĂůƚŚ ƐLJƐƚĞŵ ŝŶǀĞƐƚĞĚ ŝŶ ŚŽƵƐŝŶŐ ƐƵƉƉŽƌƚ ĨŽƌ ŶĞĂƌůLJ ϭϬ͕ϬϬϬ ƉĞŽƉůĞ ǁŝƚŚ ƵŶƐƚĂďůĞ ŚŽƵƐŝŶŐ͕ ƚŚĞ ƉƌŽǀŝƐŝŽŶ ŽĨ ĂĨĨŽƌĚĂďůĞ ŚŽƵƐŝŶŐ ĚĞĐƌĞĂƐĞĚ DĞĚŝĐĂŝĚ ĞdžƉĞŶĚŝƚƵƌĞƐ ďLJ ϭϮ ƉĞƌĐĞŶƚ͘ ƚ ƚŚĞ ƐĂŵĞ ƚŝŵĞ͕ ŽƵƚƉĂƚŝĞŶƚ ƉƌŝŵĂƌLJ ĐĂƌĞ ƵƐĞ ŝŶĐƌĞĂƐĞĚ ďLJ ϮϬ ƉĞƌĐĞŶƚ ĂŶĚ ĞŵĞƌŐĞŶĐLJ ĚĞƉĂƌƚŵĞŶƚ ƵƐĞ ĚĞĐůŝŶĞĚ ďLJ ϭϴй ĨŽƌ ƚŚĞ ŶĞǁůLJ ŚŽƵƐĞĚ͘3 DLJ ŽǁŶ ƌĞŐŝŽŶĂů DĞĚŝͲ Ăů ŝŶƐƵƌĞƌ ŝŶǀĞƐƚĞĚ ŵŽƌĞ ƚŚĂŶ Ψϰ ŵŝůůŝŽŶ ĚŝƌĞĐƚůLJ ŝŶ

ŚŽƵƐŝŶŐ ĂƐ Ă ƉŝůŽƚ ƉƌŽũĞĐƚ ŝŶ ϮϬϭϴ ƚŽ ƉƌŽǀŝĚĞ ŚŽƵƐŝŶŐ ĨŽƌ fragile patients after hospitalization.

Whether one is homeless because of a fire, the result of ƉŽǀĞƌƚLJ͕ ƚŚĞ ĐŚĂŽƐ ŽĨ ůŝǀŝŶŐ ǁŝƚŚ ƐĞǀĞƌĞ ŵĞŶƚĂů ŝůůŶĞƐƐ or due to limitations from chronic medical disease, ďĞŝŶŐ ŚŽŵĞůĞƐƐ ŵĂŬĞƐ ŵĂƚƚĞƌƐ ǁŽƌƐĞ͘ /Ŷ ƉĂƌƚ͕ ŵĞĚŝĐĂů homelessness disrupts access to a trusted primary care physician, access to medications and use of mental health services accessed through one’s primary care medical home. HomeFULness is the path to health for the 130,000 ĂůŝĨŽƌŶŝĂŶƐ ǁŚŽ ůŝǀĞ ŽŶ ƚŚĞ ƐƚƌĞĞƚƐ ĞĂĐŚ ĚĂLJ͘ dŚĞ ĐŽƐƚƐ ŽĨ ĨƵŶĚŝŶŐ ŝŶƚĞƌǀĞŶƚŝŽŶƐ ĨŽƌ ŚŽƵƐŝŶŐ ĂƌĞ ƐƵďƐƚĂŶƚŝĂů͖ ƚŚĞ payoffs are priceless.

References: 1.

ĐĐĞƐƐĞĚ ϯͬϭϱͬϮϬϭϵ͘ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ŚƵĚƵƐĞƌ͘ŐŽǀͬƉŽƌƚĂůͬ ƉƵďůŝĐĂƚŝŽŶƐͬƉĚĨͬ ^ĂŶƚĂZŽƐĂ ͲĐŽŵƉͲϭϳ͘ƉĚĨ͘ Ϯ͘ ͞,ŽŵĞůĞƐƐŶĞƐƐ ĂŶĚ ,ĞĂůƚŚ ĂƌĞ͗ tŚĂƚ ŝƐ ďĞŝŶŐ ĨƵŶĚĞĚ͍͟ ,ĞĂůƚŚ ĨĨĂŝƌƐ͘ &ĞďƌƵĂƌLJ ϮϬϭϵ ;ϯϴ͗ϮͿ ƉĂŐĞ ϯϮϰ͘ 3. ͞,ŽƵƐŝŶŐ ĂŶĚ ,ĞĂůƚŚ͗ Ŷ KǀĞƌǀŝĞǁ ŽĨ dŚĞ >ŝƚĞƌĂƚƵƌĞ͕ ͞ ,ĞĂůƚŚ ĨĨĂŝƌƐ ,ĞĂůƚŚ WŽůŝĐLJ ƌŝĞĨ͕ :ƵŶĞ ϳ͕ ϮϬϭϴ͘

California Family Physician Spring 2019

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Carla Kakutani, MD

political pulse

Chair, CAFP Legislative Affairs Committee

Retaking the “Family” In Family Medicine LJ ŶŽǁ / ŚŽƉĞ ŵĂŶLJ ŽĨ LJŽƵ ŚĂǀĞ ŚĞĂƌĚ ĂďŽƵƚ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů ĨŽƌ ƚŚŝƐ ůĞŐŝƐůĂƟǀĞ ƐĞƐƐŝŽŶ͕ ϭϲϮϮ ; ĂƌƌŝůůŽͿ͕ ǁŚŝĐŚ ƐĞĞŬƐ ƚŽ ƌĞŵŽǀĞ ŝŶĂƉƉƌŽƉƌŝĂƚĞ ĂŶĚ ŵŝƐŝŶĨŽƌŵĞĚ ƌĞƐƚƌŝĐƟŽŶƐ ŽŶ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ƐƵƉƉŽƌƟŶŐ ƵƐ ŝŶ ƉƌĂĐƟĐŝŶŐ ƚŚĞ ĨƵůů ƐƉĞĐƚƌƵŵ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ĂƐ ǁĞ ǁĞƌĞ Ăůů ƚƌĂŝŶĞĚ ƚŽ ƉƌŽǀŝĚĞ͘ Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ŽƵƌ ĞdžƚĞŶƐŝǀĞ ĂŶĚ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ƚƌĂŝŶŝŶŐ enables us to provide high quality primary care to EVERY member ŽĨ ƚŚĞ ĨĂŵŝůLJ ƌĞŐĂƌĚůĞƐƐ ŽĨ ŐĞŶĚĞƌ͕ ĂŐĞ Žƌ ĂīĞĐƚĞĚ ŽƌŐĂŶ ƐLJƐƚĞŵ͕ ĨƌŽŵ ďŝƌƚŚ ƚŽ ĞŶĚͲŽĨͲůŝĨĞ͘ KǀĞƌ ƟŵĞ͕ ƌĞŐƵůĂƚŽƌƐ͕ ůĞŐŝƐůĂƚŽƌƐ͕ ŚĞĂůƚŚ ƐLJƐƚĞŵƐ ĂŶĚ ŽƚŚĞƌƐ ŚĂǀĞ ƌĞƐƚƌŝĐƚĞĚ ĂŶĚ ƵŶĚĞƌƵƐĞĚ ;ƵŶĚĞƌǀĂůƵĞĚͿ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ dŚŝƐ ůŝŵŝƚƐ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ͕ ƌĞƐƚƌŝĐƚƐ ƉĂƟĞŶƚ ĐŚŽŝĐĞ ĂŶĚ ĚŝƐƌƵƉƚƐ ĐŽŶƟŶƵŝƚLJ ĨŽƌ ŝŶĚŝǀŝĚƵĂůƐ ĂŶĚ ĨĂŵŝůŝĞƐ͘ ϭϲϮϮ ĂŵĞŶĚƐ ƐƚĂƚƵƚŽƌLJ ůĂŶŐƵĂŐĞ ƚŽ ŵŽƌĞ ĂĐĐƵƌĂƚĞůLJ ƌĞŇĞĐƚ ƚŚĞ ƚƌĂŝŶŝŶŐ ĂŶĚ ĞdžƉĞƌƟƐĞ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ (see infographic below)

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California Family Physician Spring 2019

Family physicians are more likely to be located in communitybased practices, including rural and underserved areas, compared to all other specialties. The breadth and depth ŽĨ ŽƵƌ ƚƌĂŝŶŝŶŐ ĂůůŽǁƐ ƵƐ ƚŽ ĂĚĂƉƚ ŽƵƌ ƉƌĂĐƚŝĐĞƐ ƚŽ ŵĞĞƚ ƚŚĞ specific medical needs of our community. With the skills ĂŶĚ ƚƌĂŝŶŝŶŐ ƚŽ ĐĂƌĞ ĨŽƌ ƚŚĞ ǁŚŽůĞ ĨĂŵŝůLJ͕ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ encourages continuity of care, reducing health care costs and improves outcomes.

Our advocacy docket for this year also includes: • Making PERMANENT the $33 million investment in the ^ŽŶŐͲ ƌŽǁŶ WƌŝŵĂƌLJ ĂƌĞ WŚLJƐŝĐŝĂŶ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ ;ǁŝƚŚŽƵƚ ĂĐƚŝŽŶ͕ ƚŚĞ ĨƵŶĚŝŶŐ ǁŝůů ĞŶĚ ŝŶ ϮϬϮϬͿ͘ • ŶƐƵƌŝŶŐ ƚŚĞ ŵŽƌĞ ƚŚĂŶ Ψϭ ďŝůůŝŽŶ ŝŶ WƌŽƉŽƐŝƚŝŽŶ ϱϲ ;ƚŽďĂĐĐŽ ƚĂdžͿ ĂŶĚ ĨĞĚĞƌĂů ŵĂƚĐŚŝŶŐ ĨƵŶĚƐ ŐŽĞƐ ƚŽǁĂƌĚ improving access to care for vulnerable populations

• • • •

through Medi-Cal provider payment increases.

Improving private payer financial support for primary care.

Stabilizing and improving California’s health insurance coverage.

Banning flavored tobacco so cigarette companies no longer target children.

Reducing the consumption of ƐƵŐĂƌͲƐǁĞĞƚĞŶĞĚ ďĞǀĞƌĂŐĞƐ͕ ǁŚŝĐŚ ŚĂǀĞ ďĞĞŶ ƐƚƌŽŶŐůLJ ůŝŶŬĞĚ to an increase in obesity.

/Ĩ LJŽƵ ǁŽƵůĚ ůŝŬĞ ƚŽ ũŽŝŶ ƵƐ ŝŶ ĂŶLJ ŽĨ ƚŚĞƐĞ efforts, please consider signing up to be a CAFP Key Contact or email CAFP’s ŝƌĞĐƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƚŝŽŶƐ͕ ĚĂŵ &ƌĂŶĐŝƐ ;ĂĨƌĂŶĐŝƐΛĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͿ͘

California Family Physician Spring 2019

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IN THE NEWS Spring 2019 &W ǁĂƐ ŵĞŶƚŝŽŶĞĚ ŝŶ Ă March 6, 2019 New Yorker article

by Sue Halpren for its role as a co-plaintiff in a case against the Food and Drug Administration led by the American Civil Liberties Union. The CAFP Board of Directors approved ƚŚĞ &W ƌŽůĞ͕ ĂŶĚ ƚǁŽ &W ŵĞŵďĞƌƐ ŚĂǀĞ ĂĚĚĞĚ ƚŚĞŝƌ ŶĂŵĞƐ ƚŽ ƚŚĞ ĐĂƐĞ͘ /Ŷ ϮϬϭϳ͕ ƚŚĞ ŵĞƌŝĐĂŶ ŝǀŝů >ŝďĞƌƚŝĞƐ hŶŝŽŶ ƐƵĞĚ ƚŚĞ &ŽŽĚ ĂŶĚ ƌƵŐ ĚŵŝŶŝƐƚƌĂƚŝŽŶ ;& Ϳ ŽǀĞƌ the Mifepristone REMS on behalf of the California Academy ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ͖ ƚŚĞ ^ŽĐŝĞƚLJ ŽĨ &ĂŵŝůLJ WůĂŶŶŝŶŐ͖ WŚĂƌŵĂĐŝƐƚƐ͛ WůĂŶŶŝŶŐ ^ĞƌǀŝĐĞƐ͕ /ŶĐ͘ ĂŶĚ ƌ͘ 'ƌĂŚĂŵ ŚĞůŝƵƐ͕ ƚŚĞ ĐŚŝĞĨ ŽĨ ƐƚĂĨĨ Ăƚ <ĂƵĂŝ sĞƚĞƌĂŶƐ DĞŵŽƌŝĂů ,ŽƐƉŝƚĂů͕ ǁŚŽ ŝƐ ƚŚĞ ŶĂŵĞĚ ƉůĂŝŶƚŝĨĨ͘ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ŶĞǁLJŽƌŬĞƌ͘ĐŽŵͬƐĐŝĞŶĐĞͬ ĞůĞŵĞŶƚƐͬƚŚĞͲĐŚĂůůĞŶŐĞƐͲŽĨͲŝŶŶŽǀĂƚŝŶŐͲĂĐĐĞƐƐͲƚŽͲĂďŽƌƚŝŽŶ͘

Welcome to Josh Lunsford, CAFP’s New Director of Membership and Marketing Josh comes to us from the Oklahoma Center for Non-Profits ĂŶĚ ŚĂƐ ŐƌĞĂƚ ĞdžƉĞƌŝĞŶĐĞ ŝŶ membership marketing, recruitment and retention strategies and communications. He jumped right into the fire, attending the Family Medicine Clinical Forum in March, a ŵĞƌĞ ǁĞĞŬ ŝŶƚŽ ŚŝƐ ƌŽůĞ͘

CAFP is Sending a Full Delegation to the AAFP’s National Conference for Constituent Leaders Ɖƌŝů ϮϰͲϮϳ͘ >ĞĚ ďLJ ƐĞŶŝŽƌ ŵĞŵďĞƌ͕ >' d ĞůĞŐĂƚĞ ƌĞŶƚ ^ƵŐŝŵŽƚŽ͕ ŽƵƌ ĐƌĞǁ ǁŝůů ďĞ ĚĞĂůŝŶŐ ǁŝƚŚ Ă ŵLJƌŝĂĚ ŽĨ ŝƐƐƵĞƐ͕ from reproductive rights and education to addressing ŝŵŵŝŐƌĂƚŝŽŶ ŝƐƐƵĞƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ǁĞůůŶĞƐƐ͘ KƵƌ ĚĞůĞŐĂƚŝŽŶ includes: Shani Muhammad, MD and Laura Murphy, DO, tŽŵĞŶ͛Ɛ ĐĂƵĐƵƐ͕ ƌĞŶƚ ĂŶĚ DŝĐŚĞůůĞ YƵŝŽŐƵĞ͕ D ͕ >' d ĐĂƵĐƵƐ͖ WŽͲzŝŶ ^ĂŵƵĞů ,ƵĂŶŐ ĂŶĚ :ŽƌŐĞ 'ĂůĚĂŵĞnj͕ DŝŶŽƌŝƚLJ ĐĂƵĐƵƐ͖ DĂƌŐĂƌĞƚĞ njŝŶǁĂ͕ D ĂŶĚ ƌŝŬĂ ZŽƐŚĂŶƌĂǀĂŶ͕ /D' ĐĂƵĐƵƐ͖ ĂŶĚ ůĞdž DĐ ŽŶĂůĚ ĂŶĚ ^ƵŵĞĚŚ DĂŶŬĂƌ͕ EĞǁ WŚLJƐŝĐŝĂŶƐ͘ ƌƐ͘ YƵŝŽŐƵĞ ĂŶĚ :ĂLJ >ĞĞ ǁŝůů ĂůƐŽ ďĞ ƐƉĞĂŬŝŶŐ Ăƚ the meeting. Shelly Rodrigues, CAE, staffs the delegation.

CAFP’s president Walt Mills, President-elect David

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California Family Physician Spring 2019

ĂnjnjŽ ĂŶĚ K >ŝƐĂ &ŽůďĞƌŐ͕ DWW͕ ǁŝůů ĂƚƚĞŶĚ ƚŚĞ ŶŶƵĂů Chapter Leaders Forum at the same time. Thanks to each for their service.

CAFP Heads to Kyoto, Japan &W ŚĂƐ ďĞĞŶ ǁŽƌŬŝŶŐ ǁŝƚŚ ƚŚĞ tŽƌůĚ KƌŐĂŶŝnjĂƚŝŽŶ ŽĨ &ĂŵŝůLJ ŽĐƚŽƌƐ ;tKE Ϳ ĨŽƌ ƚŚĞ ƉĂƐƚ ĨŝǀĞ LJĞĂƌƐ ŽŶ Ă ǀĂƌŝĞƚLJ of educational needs assessments and activities. The latest, ͞/ŵƉƌŽǀŝŶŐ KƵƌ ĂƌĞ ŽĨ WĂƚŝĞŶƚƐ ǁŝƚŚ ĞƉƌĞƐƐŝŽŶ ĂŶĚ ŶdžŝĞƚLJ͕͟ ŚŝŐŚůŝŐŚƚƐ ƚŚĞ ŝƐƐƵĞƐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŝŶ ƚŚĞ ƐŝĂ WĂĐŝĨŝĐ ƌĞŐŝŽŶ ĂŶĚ :ĂƉĂŶ ĨĂĐĞ ǁŝƚŚ ƚŚĞŝƌ ƉĂƚŝĞŶƚƐ͘ :ĂLJ >ĞĞ͕ MD, MPH, CAFP past president is a member of the master faculty for this initiative and chairs the train-the-trainer ǁŽƌŬƐŚŽƉƐ ĨŽƌ ŽƵƌ ĐŽŵŵƵŶŝƚLJ ĨĂĐƵůƚLJ͘ dŚĞ ĨŝƌƐƚ ǁŽƌŬƐŚŽƉ͕ Ă ƉŝůŽƚ ǁŝƚŚ ĞŝŐŚƚ W ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĂƐ ŚĞůĚ ůĂƐƚ KĐƚŽďĞƌ ŝŶ ĐŽŶũƵŶĐƚŝŽŶ ǁŝƚŚ ƚŚĞ tKE ^ĞŽƵů ŵĞĞƚŝŶŐ͘ dŚĞ ŶĞdžƚ ƐĞƚ ŽĨ ǁŽƌŬƐŚŽƉƐ͕ ŝŶ DĂLJ͕ ŝŶ ĐŽŶũƵŶĐƚŝŽŶ ǁŝƚŚ ƚŚĞ tKE ͕ <LJŽƚŽ ŵĞĞƚŝŶŐ͕ ŝŶĐůƵĚĞƐ ƚǁŽ ŚĂůĨͲĚĂLJ ǁŽƌŬƐŚŽƉƐ ĨŽƌ ϭϰ W ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ Ă ŵŝƌƌŽƌĞĚ ƚǁŽ ĨŽƌ Japanese physicians. Other members of the master faculty ŝŶĐůƵĚĞ ŚƌŝƐ ŽǁƌŝĐŬ͕ >ŝǀĞƌƉŽŽů͕ h<͖ ZLJƵŬŝ <ĂƐƐĂŝ͕ :ĂƉĂŶ͖ :ŝůůŝĂŶ ĞŶƐŽŶ͕ ƵƐƚƌĂůŝĂ͖ ŝŶĚLJ >Ăŵ͕ ,ŽŶŐ <ŽŶŐ͖ ĂŶĚ ^ŚĞůůLJ Rodrigues, CAAFP staff. The community faculty members ǁŝůů ƚŚĞŶ ƚĂŬĞ ƚŚĞŝƌ ůĞĂƌŶŝŶŐƐ ƚŽ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ caregivers in their region.

Division of General Internal Medicine University of California San Francisco School of Medicine

2019 Essentials CME Summer Courses Essentials of Womenâ&#x20AC;&#x2122;s Health

An Integrated Approach to Primary Care and Office Gynecology

June 30 - July 5, 2019 Westin Hapuna Beach Resort Mauna Kea, Big Island, Hawaii

Essentials of Primary Care A Core Curriculum for Ambulatory Practice

August 4 - 9, 2019 Resort at Squaw Creek North Lake Tahoe, California

For more information, visit: www.cme.ucsf.edu

A Family Physician for All Seasons An Interview with Your New President,

Walt Mills, MD, MBA Why family medicine for you? / ĚŝŝƐĐ ƐĐŽǀ ŽǀĞƌ ǀĞƌƌĞĚ ĨĂŵ ŵŝůůLJ ŵĞĚŝĐŝŶĞ ŝŶ ϭϵϳϱ ĂƐ ĂĂ ĨŝƌƐƚͲLJĞ LJĞĂƌ Ă ŵĞĚ ĞĚŝĐ ŝĐĂů Ă ƐƚƵĚ ƵĚ ĚĞŶ ĞŶƚƚ Ăƚ Ăƚ h ^ĂŶ Ŷ ŝĞŐŽ͘ / ƌĞĐĂůů ŵLJ ĞdžĐŝƚƚĞŵĞŶƚ ƚŚĂ ŚĂƚƚ ƚŚ ƚŚĞƌĞ ǁĂƐƐ ĂĐ Ɛ ĂĐƚƵ ƚƚƵ ƵĂĂůůůLJLJ ĂŶ ĂůůŽƉĂƚŚŝĐ ƐƉĞĐŝĂůƚLJ ƚŚĂƚ ǁ ǁĂƐ ͞ŚŽůŝƐƚŝĐ͕͟ ŽŶĞ ƚŚĂƚƚ ĂƉƉ ƉƉƌĞĐŝ ĞĐŝĂƚ ĂĂƚƚĞĚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ĐĂƌŝŶŐ ĨŽƌ ƚŚĞ ǁŚŽůĞ ƉĞƌƌƐŽ ƌƐŽŶ͕ ŵŝŶĚ ŵŝŶĚ ŵŝ ŶĚͲď ŶĚͲď ďŽĚLJ ĂŶĚ ƐƉŝƌŝƚ͘ dŚŝƐ ǁĂƐ ƚŚĞ ŶĂ Ŷ ƚƵƌĂů ŽƵƚĨůŽǁ ĨƌƌŽŵ Žŵ ŵLJ ƉƌĞŵ ĞŵĞĚ ĞĚ ĞdžƉ ƉĞƌ Ğ ŝĞŶĐĞƐ Ăƚ EŽƚƌĞ ĂŵĞ͕​͕ ǁŚ ǁŚĞƌ ĞƌĞ / ďĞŐĂŶ ƚƌĂŶ ƚƌ ĂŶ ŶƐĐ ƐĐĞŶ Ğ ĚĞŶƚĂů ŵĞĞĚŝƚĂƚŝŽ ŝŽŶ͕ Ŷ ǁŚŝĐŚ ůĞĚ ŵĞ ƚŽ ƐƚƵĚLJ ĚLJ ƚŚĞ ŚĞ ƐĐŝĞŶĐĞ of the min i d-body dy-s -spi p rit con nnection. While I loved bio iolo logy and science, I elected to mi sc mino nor in n theology. So, family med dic i ine has ĂůǁĂLJƐ ďĞĞŶ ĨƵŶĚĂŵĞŶ ŶƚĂ ƚ ů ďĞĐĐĂƵƐĞ ǁĞ ĂƌĞ ƚŚĞ ŵŽƐƚ ŐƌƌŽƵ ŽƵŶ ŶĚĞĚ Ě ƐƉĞĐŝĂůƚLJ ŝŶ ƚŚĞ ͞ďŝŽƉƐLJĐŚ ŚŽƐ ŽƐŽĐŝĂů ŵŽĚĞů͘͟ Who were the role models who inspired you to go into family medicine?

DLJ ĨĂĂƚŚĞƌ ǁĂƐ ŵLJ ĞĂƌůŝĞƐƚ ƌŽůĞ ŵŽĚĞů͘ ,Ğ ǁĂƐ Ă ŐĞŶĞƌĂů ŝŶƚĞƌƌŶŝƐƚ ŝŶ ^ƵŶŶLJǀĂůĞ͘ / ƌĞĐĂůů ŵĂŬŝŶŐ ŚŽƐƉŝƚĂů ƌŽƵŶĚƐ ǁŝ ǁŝƚŚ ƚŚ Śŝŵ and d being struck by the sense that being a personal ph physician ǁĂƐƐ ƐƵĐŚ Ă ŶŽďůĞ ǁĂLJ ƚŽ ƐĞƌǀĞ ŽƚŚĞƌƐ͘ tŚŝůĞ / ͞ŬŶ ŬŶĞĞǁ͟ ďLJ ĞůĞŵ ŵĞŶƚĂƌLJ ƐĐŚŽŽů / ǁĂŶƚĞĚ ƚŽ ďĞ Ă ƉŚLJƐŝĐŝ Đ ĂŶ ĂŶ͕​͕ Ăƚ ƚŝŵ ŝŵĞƐ ĞƐ ŝŶ ĞĂƌůLJ adolles e cence I thought I should become a prrie iest. Ironicalllly,, it ǁĂƐ &Ă &ĂƚŚĞƌ 'ůĂƐƐ͕ Ă ŵĞŶƚŽƌ ǁŚĞ ŚĞŶ Ŷ / ǁĂ ǁĂƐ Ă ƚĞĞĞŶ ĞŶĂŐĞƌ͕ ǁŚŽ ƚŽ ƚŽůĚ ŵĞ ŚĞ ƚŚ ƚ ŽƵŐŚƚ ŵLJ ĐĂůůŝŶŐ ŶŐ ǁĂƐ ĂĐƚƵĂůůLJ ŵĞĞĚŝ ĚŝĐŝ Đ ŶĞ͘ / ƐĞĞ ƚŚŽ ŚŽƐƐĞ elem emen ents t of sacred calling ng at times as a fam amiily physiciaan st stilll. tŚĂƚ ƉŝƋƵĞĚ LJŽƵƌ ŝŶƚĞƌĞƐƚ ŝŶ ďĞĐŽŵŝŶŐ ĂĐƚŝǀĞ ǁŝƚŚ LJŽƵƌ ĐŽƵŶƚLJ ĂŶĚ ƐƚĂƚĞ &W ĐŚĂƉƚĞƌƐ͍ / ĐŽŶŶĞĐƚĞĚ Ě ǁŝ ǁŝƚŚ ƚŚ ƚŚĞ ^ĂŶ ŝĞĞŐŽ ŐŽ ŚĂƉƚĞƌ ǁŚĞ ŚĞŶ Ŷ / ǁĂƐ ŝŶ ŵĞĚŝĐĂů school at UCSD SD. They hosted a dinner for med dic ical students … ǁŝƚŚ ĚĂŶĐŝŶŐ͘ // ǁĂƐ ƐŽ ŚĂƉƉLJ ƉLJ ƚŽ Ž ďĞ ď ĂŵŽŶŐƐƚ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ƐĞĞŵĞĚ ƚŽ ͞ŐĞƚƚ ŝƚ͕͟ / ŬŶĞǁ ƚŚĞ Ś Ŷ ƚŚ ƚŚĂƚ ƚŚŝƐ ǁĂƐ ͞ŵLJ ƚƌŝďĞ͕͟ ͞ŵLJ ĨĂŵŝůLJ͘͟ >ĂƚĞƌ Ğƌ͕ ŝŶ ŝŶ ^ĂŶƚĂ ZŽƐƐĂ ǁŚĞŶ / ǁĂƐ K ŽĨ WƌŝŵĂƌLJ ĂƌĞ ƐƐŽĐŝĂƚĞƐ ŽĨ ƚŚ ƚŚĞĞ ZĞĚǁŽŽ ŽĚ ŵƉŝƌĞ͕ Ă ŵƵ ŵƵůƚ ůƚŝƐƉĞĐŝĂůƚLJ ƚLJ ŐƌŽ ƌŽƵƉ Ƶ Ž Ĩ ŵŽƐƚůLJ ŐƌĞĂƚ &WƐ WƐ ;ĂďŽƵƚ ϯ ϯϬ ŽĨ ƵƐ ƵƐ ŽƵƚ Ƶ ŽĨ ϳϬͿ͕ / ǁĂƐ ďůĞĞƐƐ ƐƐĞĚ Ğ ƚŽ ƉƌĂĐƚŝĐĞ ǁŝƚŚ Ž Ž 'ƌĞĂǀĞƐ ; &W &W W WƌĞ ƌĞƐŝ ƐŝĚĞ ĚĞŶƚ Ŷ ŝŶ ϮϬϬϲͿ ĂŶĚ DĂƌLJ Ŷƚ ƌ &ƌĂŶŬ ; &W W Wƌ WƌĞƐ Ğ ŝĚĞŶƚ ŝŶ ϭϵϵϮ Ϯ ĂŶ Ă Ě &W & WƌĞ ƌĞƐŝ Ɛ ĚĞ Ě Ŷƚ ŝŶ ϮϬϬϮ ϬϮͿ͕ Ϳ͕ ǁŚŽ Ž ďŽƚŚ Ś ĞŶĐ ŶĐŽƵƌĂŐĞĚ ŵLJ ŵLJ ĐĂĂĚĞ ĚĞŵ ŵLJ ĞŶŐ ŵLJ ŶŐĂŐ ĂŐĞŵ ĂŐ ĞŵĞŶ Ğŵ ĞŶƚ͘ Ŷƚ͘ / ŚĂ ŚĂǀǀĞ ĞŶũŽLJĞĚ Ă ƉƌŽ ƌŽŐƌĞƐƐŝǀĞĞ ŝŶǀŽůǀĞ ŽůǀĞŵĞ ŵĞŶƚ Ŷƚ ǁŝƚƚŚ &W &W ƚŚĞ Ś ƉĂƐ ĂƐƚ ƚ 15 years as my oth ther profess sssio ionaal re resp spon onsi sibi bililiiti ties es per ermitt t ed ed.

DLJ ƚĞƌŵ ĂƐ ĂƐ ^ŽŶŽŵĂĂ ĐŚĂƉ ƉƚĞĞƌ ƌ Ɖƌ Ɖ ĞƐ ĞƐŝĚ ŝ ĞŶ ŝĚ ĞŶƚ͕ ƚ͕ ϮϬϬ ϬϬϲͲ ϲͲϮϬ ϮϬ ϬϭϮ ϭϮ ƚĂƵŐ ϭϮ͕ ƚĂ Ƶ Śƚ ŵĞ Ă ůŽƚ Žƚ͘ ƵƌƌŝŶ ŝŶŐŐ ƚŚ ƚŚĂƚ Ăƚ ƚŝŵ ŝŵĞ͕ Ğ͕ ǁĞ Őƌ ŐƌƌĞǁ ŽƵƌ ƌĞů Ğ Ăƚ ĂƚŝŽ ŝŽŶƐ ŶƐŚ ŶƐ ŚŝƉ ǁŝ Śŝ ǁŝƚŚ thee Santaa Ro Rosa s Faam mililyy Me Medi d ci cine nee Res esid iden ency cy,, es esta taabl blis ishe hed da ĐŚĂƉƚĞ ĐŚ ƚĞĞƌ ďŽ ďŽĂƌ ĂƌĚ Ě ŽĨ ŽĨ Ěŝƌ ŝƌĞĐ ĞĐƚŽ ĞĐ ƚŽƌƐ ƚŽ ƌƐ͕​͕ Ă ĨŽ ĨŽƌŵ ƌŵĂů Ăů ďƵĚ ƵĚŐĞ ŐĞƚ ƚ ǁŝ ƚ ǁŝƚŚ ƚŚ ĚƵĞ ƵĞƐ͕ Ɛ͕ ĂŶĚ en nha hanc han nced our u mem embe ber ed educ ucat atio ion n an and d ad advo voca caacy pro rogr g am gr ms. s. I 14

California Family Physician Spring 2019

ůĞĂƌŶĞĚ Ă ůŽƚ Ăď ĂďŽƵƚ ŽƚŚĞƌ ĐŚĂƉƚĞƌƐ͕ ŵĞ ŵĞƌŐ ƌŐŝŶŐŐ ŝŶ ϮϬϭϭ ǁŝƚŚ ƚŚĞ Marin chapter to become the North h Ba Bayy Ch C apter, thanks in part to the lead adership of the then CAFP P Di Dist s rict Director, Iriinaa ĚĞ&ŝƐĐŚĞƌ ĂŶ ŶĚ WĂ WĂŶŶĂ >ŽƐƐLJ ǁŚŽ ƌĞŵĂŝŶƐ ƚŚ ƚŚĞ Ğ EŽ E ƌƚŚ ĂLJ Ś ŚĂƉ ĂƉƚĞ ƚ ƌ president, (my bias, but I believe … onee of our most dyn nam a ic ƐƚĂƚĞ ĐŚĂƉƚĞƌƐ͘Ϳ /Ɛ ŶŽǁ ƚŚĞ ďĞƐƚ ƚŝŵĞ ĞǀĞƌ ƚŽ ďĞ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͕ ŝŶ LJŽƵƌ estimation? 'ƌĞĂƚ ƋƵĞƐƚŝŽŶ ŽŶ͘​͘ /ƚ /ƚ͛Ɛ ͛ Ă ŚĂƌĚ ƚŝŝŵĞĞ ĨŽƌ Žƌ ŵĂŶLJ͕ ǁŝƚŚ ŚŝŝŐŚ ŐŚĞƌ ƌĂƚĞƐ ŽĨ ďƵƌŶŽƵƚ ĂŶĚ ŚƵ ŚƵŐĞ ŐĞ ŵĞĚ ĞĚŝĐĂůů ƐĐŚ ĐŚŽŽů ĚĞďƚ͘ / ƚŚŝŶŬ ŝĨ ǁĞ ŐĞƚ ƚŽ ƚŚĞ system issues th that at obs bstr truc uctt many FPs from haaving sustainable jo oy in practice, truly this could be the best ti tim me to be a family

physiciaan. p n I do bel eliieve ve that for some, it is a good tiime, and tha h t th t e future could be evven betttteer. Fami mily ly physicians continue ƚŽ ďĞ ƚŚĞĞ ŵŽ ŵŽƐƚƚ ƐŽƵ ŽƵŐŚ Ő ƚͲ ƚͲĂĨƚĞƌ ƐƉĞĐŝĂůƚLJ͖ comp mpenssati tion o and ben e ef efits continue to ƌŝƐĞ ĨĂƐ Ă ƚĞĞƌ ƚŚ ƚŚĂŶ ĂŶ ŵŽƐ ŽƐƚƚ Žƚ Ž ŚĞ ŚĞƌ ƌ ƐƉĞĐŝĂůƚŝĞƐ͖ ƚĞĐŚŶŽ Ŷ ůŽŐLJ ŐLJ͕ ǁŚ ǁ ŝůŝůĞ ŽĨ ǁŚ ŽĨƚƚĞŶ Ŷ ĐŽŵƉůĂŝŶĞĚ abou ut, t actua uallllyy pr prom omis ises to make family mediccine more effective and interesting than eve v r.

As an AA AFP Ressid iden ency Consultant, I also o get to vissit man any programs around th thee ĐŽƵŶƚƌLJ͘ ^Ğ ^ĞĞŝ ĞŝŶŐ ŶŐ ƚŚĞ ƚƌĞŵĞŶĚŽƵƐ Őƌ ŐƌŽǁ ŽǁƚŚ ƚŚ ŽĨ ƌĞƐŝĚĞŶ Ğ Đŝ ĐŝĞƐ Ğ ͕ ǁŚŝĐŚ ŚĂƐ ŐŽŶĞ ĨƌŽŵ ŵ ϰϬ ϰϬϬ Ϭ ƚŽ ϲϮϬ ŝŶ ƚŚ ƚŚĞĞ ƉĂ ƉĂƐƚƚ ĚĞĐĂĚĞ ŐŝǀĞƐ ŵĞ ŵĞ ŐƌĞĂƚ o timism op m.

What are the most important challenges ĐŽŶĨƌŽŶƚŝŶŐ &W͍ Stayin ing relevant. Adapting to the changes in meembers’ diverse needs. What rural physic icians need in their first years of practicee is differ erent from a UC faculty, a senior med edic ical al director, large medical group or one in di dire rect patient care practice.

What has been the best part of being an ŽĨĨŝĐĞƌ ŝŶ &W ƐŽ ĨĂƌ͍ Comradery, co ontinuous education in the dialogu uess our board has about the ƐƚĂƚĞ ŽĨ ĂĨĨ ĨĨĂŝƌƐ ĂŶĚ ůĞĂƌŶŝŶŐ ŚŽǁ ƚŽ ŵŽƌĞ Ğ skillfful ully ly advocate for health equityy an and d tĂůƚ͕ ĂŶĚ ŚŝƐ ǁŝĨĞ ůŝnjĂďĞƚŚ͕ ĂƌĞ ƐŶŽǁƐŚŽĞŝŶŐ ĨĂŶƐ͘ ƐŽĐŝ ƐŽ ĐŝĂĂů ũƵƐƚŝĐĞ͘ dŚĞ ůĂƚƚĞƌ ŚĂƐ ƐŚ ƐŚŽǁ ŽǁŶ Ŷ ŵĞĞ ƚŚĂƚ ƚŚĞ ƉŽǁĞƌ ĂŶĚ ƉƌŝǀŝůĞŐĞ ǁĞ ŚĂ ŚĂǀĞ as physicians can be uniquelly ef e fective infl f uenc ncingg health How do you maintain what former President Jay Lee calls care policy that directly affe fect cts the qualit i y of the care our “the joy” of family medicine? patients receive.

Th hat at’s eassy. I ra rarrely do anything that I don’t love doingg. t ĞŶ tŚ ĞŶ LJŽƵ Ƶ ĨŝŶ ŝŶĚ Ě ͞ǁ ǁŽƌ ŽƌŬ͟ LJŽƵ ůŽǀĞ LJŽƵ ŶĞǀĞƌ ͞ǁŽƌŬ͟ ĂŶŽ ŽƚŚĞƌ How do you balance your family life … two grown kids, and da dayy of you ourr life fee — I’m m there. I get to teach residents and a new grandbaby on the way, a full-time practice, teaching me medi dica call st studen ents ts eve very ry day, see patients, do geriatric ic ĂŶĚ LJŽƵƌ ǀŽůƵŶƚĞĞƌ ǁŽƌŬ ǁŝƚŚ &W͍ cons co nsul u ta tati tion o s, and mor ore. e. I’m trulyy bl bles e sed. In ad addi d ti tion on,, I ,ŽŶĞƐƚůLJ͕ /͛ŵ ŶŽƚ Ă Ă ŐŽ ŐŽŽĚ ŽĚ ĞdžĂŵƉůĞ͙ ďƵƚ / ĐŽŶƐƚĂŶƚůLJ ƐƚƌŝǀĞ Ğ ŵ Ěŝ ŵĞ ĚŝƚĂ ƚĂƚĞ ƚĞ ĨŽƌ ŽŶĞ ƚŽ ƚǁŽ ŚŽ Ś ƵƌƐ ĞĂĐŚ ĚĂLJLJ ĂŶĚ ĞdžĞ dž ƌĐĐŝƐ ŝƐĞ ŵŽ ŵŽƐƚƚ ĨŽƌ ŝƚ͘ / ŚĂǀĞ ƚĂƵŐŐŚƚ Ă ĨĂĐƵůƚLJ ĚĞǀĞůŽƉŵĞŶƚ ǁŽƌ ŽƌŬƐŚŽ ŽƉ͕ Ě LJƐ ĚĂ LJƐ͕ Ɖƌ ƉƌĂĐĐƚŝ ƚŝĐŝ ĐŝŶŐ ŶŐ Ă ƉƌĞƚƚLJ ŚĞ ŚĞĂůƚŚLJ ůŝĨĞƐƚLJůĞ ĂƐƐ ǁĞů Ğůůů ĂƐ ďĞŝŶŐ ͞&ŝŶĚŝŶŐŐ ĂůĂŶĐĞĞ ŝŶ Ă DĞĚŝĐĂů >ŝĨĞ͕͟ ͕͟ ŝŶƐ ŶƐƉŝ ƉŝƌĞ Ɖŝ ƌĞĚ Ě ďLJ Ă ŶŽǁ Žǁ mind mi ndfful of the afo forrement re tio ioned ball juggl g in ng pr prioriti t es. deceased e dea ear friend, Lee Lipsen e thal en thal (high ghly ly recom omme mend nd >ĞĞ͛Ɛ ŬƐ ͞& ͞&ŝŶ ŝŶĚŝŶŐ ĂůĂŶĐĞĞ ŝŶ Ă DĞ DĞĚŝ Ě ĐĂů >ŝ >ŝĨĞ Ĩ ͟ ĂŶĚ ͞ ŶũŽLJ tŚĂƚ ĚŽ LJŽƵ ƐĞĞ ĂƐ ƚŚĞ ďĞƐƚ ǁĂLJƐ &W ĐĂŶ ŚĞůƉ ŝƚƐ ǀĞƌLJ ^Ă ^ĂŶĚ ŶĚǁŝ ǁŝĐŚ͟Ϳ͘ tĞ ŵĞŶ ĞŶƚŝ ƚŝŝŽŶ Ž Ă ĨĂŵŽƵƐ ƋƵŽƚĞ͕ Ğ͕ ͞zŽ zŽƵ zŽ Ƶ ǁŝ ǁŝůů members maintain the joy? ƐŽŽŶ ƵŶĚ ŶĚĞƌ Ğ ƐƚĂŶĚ ƚŚĂƚƚ ǁŽƌ ŽƌŬŬ ŝƐ ŝƐ Ă ƌƵďďĞĞƌ ďĂ ďĂůůůůůů͘ /Ĩ LJŽƵ LJŽƵ Ěƌ ĚƌŽƉ ŽƉ Ɖ ŝƚ͕ ŝƚ ƚ CAFP is alreadyy do doin i g a lot. The March Cllin nic i al For o um had ǁŝůů ďŽƵ ŽƵŶĐĞ ďĂĐŬ͘ Ƶƚƚ ƚŚĞ Ś ŽƚŚĞƌ ĨŽƵƌ ďĂ ďĂůůůůƐƐ ʹ ĨĂ ďĂ Ĩ ŵŝ ŵŝůLJ ůLJ͕​͕ ŚĞ ŚĞĂů ĂůƚŚ͕ ů ƐĞǀĞƌĂů ƐĞƐƐƐŝŽ ŝŽŶƐ ĂĚĚƌĞƐƐŝŶŐ ǁĞůůŶĞƐƐ ĂŶĚ ǁĞ͛ Ğ͛ůůů ĐŽŶƚŝŶƵĞ ƚŽ friend nds and spirit – aree mad de of glass. Iff you u dro rop p on onee of of ǁŽƌŬ ǁŝƚŚ ƚŚ ƚŚĞĞ &W ;ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬŵ ͬŵĞŵ ĞŵďĞƌƐŚŝƉͬ ƚŚĞƐĞ͕ ƚŚĞ ŚĞLJ LJ ǁŝůů ďĞ ŝƌƌĞǀŽĐĂ ĐĂďů ďůLJLJ ƐĐƵĨĨĨĞ ďů Ĩ Ě͕ Ě ŵĂĂƌƌŬĞ ŬĞĚ͕ Ě͕ ŶŝĐ ŝĐŬĞ ŬĞĚ͕ Ě͕​͕ ďĞŶĞĨŝƚƐͬƉ ͬƉŚLJ Ś ƐŝĐŝĂŶͲŚĞĂůƚŚͲĨŝƌƐƚ͘ŚƚŵůͿ ƚŽ ĞŶŚ ŚĂŶĐĞ ĐĞ ƐƵƉƉŽƌƚ ĚĂŵĂŐĞĚ Ě Žƌ Žƌ ĞǀĞŶ ƐŚĂƚƚĞĞƌĞ ƌĞĚ͘ Ě͘ dŚ dŚĞLJ ǁŝůůů ŶĞĞǀĞ ǀĞƌƌ ďĞ ƚŚĞ ƐĂŵ ŵĞ͘ of our mem embe bers. Myy in inco comi ming president add d ress in You must st und nderstand that and strivee fo for ba bala lanc ncee in you o r M rch focused Ma d on our three-yyea earr st s rategic pl plan an – practice ůŝĨĞ͘͟ tran tr a sformation, payment reform an an nd pipelinee as they relate

California Family Physician Spring 2019

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to addressing the need to improv ove jo joyy in practice. In the h end, this fourth aim of the Quadru uple Aim mayy be the he most important purpose for our Academy.

Where will family medicine be in 10 years and what role will &W ŚĂǀĞ ƉůĂLJĞĚ ŝŶ ŝƚ͍ /Ĩ ŵLJ ĐĂƌ ĐĂŶ ŶŽǁ ĚƌŝǀĞ ŝƚ ŝƚƐƐĞůĨ͕ ĞǀĞŶ ďĞ ƐƵŵŵŽŶĞĚ ŽŶ ŵLJ ŝWŚŽŶĞ ĂƉƉ͕ ƚŚĞŶ / ĐĂŶ͛ƚ ͛ƚ ŝŵĂŐŝŶĞ ŚŽǁ ĨƵŶ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůLJ medici c ne leveraged by the augmentation age could be! I imag im agin inee handheld po oint of care ultrasound at the bedside, ǀŝĚĞŽͬĨĂĐĞĞƚŝŵĞ ƚŝŵĞ ǀŝƐŝƚƐ ǀŝƐŝƚƐƐ ƚŽ ƚŽ ƉĂƚŝĞŶƚƐ ƉĂƚŝĞŶƚƐ͛ ŚŽŵ ŚŽŵĞƐ ŽŵĞƐ ĞƐ͕​͕ ŝŶƚĞ ĞƐ ŝ ƚĞ ŝŶ ƚĞƌĂ ĞƌĂĐƚŝǀĞ ƌ ĐƚŝǀĞ ƐĞƐƐŝŽŶƐ ƐĞƐƐŝŽŶƐ ǁŝƚŚ ƉĂƚŝĞŶƚƚƐ ƵƐŝŶŐ ĂĂƌƚŝĨŝĐŝĂů ŝŶƚĞůůŝŝŐĞ ŐĞŶ ŶĐĞ͕ ĂĚǀ Ě ĂŶ Ă ĐĞĚ Ě ŐĞ ŐĞŶŽ Ŷ ŵŝĐƐ͘ Ɛ ŝŶĨŽƌŵĂƚŝŽŶ ŽŶ ŝŶƚĞŐŐƌĂ ƌ ƚŝŽŶ ŵĂƚƵƌĞƐ ĞƐ ŝƚ ǁŝůů ďĞ ĂŵĂnjŝŶŐŐ ǁŚ ǁ Ăƚ FPs have at theeir fingger ertips, like ke point of care evidencee-ba b sed guidelines at th he bedssid idee orr ele lect c ronic records that aree as ƐĞĂŵůĞƐƐ ĂŶĚ ĞĨĨ Ĩ ŽƌƚůĞƐƐƐ Ğdž ĞdžƚĞ ƚĞŶƐ Ŷ ŝŽŶƐ ŽĨ ŽƵƌƐĞůǀĞƐ ĂƐ ŵĂŶ ŶLJ ŽĨ ƚŚĞ ƐŵĂƌƚƉŚŽŶĞ ĂƉƉ ƉƐ ƚŚĂƚ ǁĞ ŶŽǁ ƚĂŬĞ ĨŽƌ ŐƌĂŶƚĞĚ͘

^ŽŶͲŝŶͲůĂǁ DĂdž͕ ĚĂƵŐŚƚĞƌ sŝĐƚŽƌŝĂ͕ ůŝnjĂďĞƚŚ͕ ƐŽŶ ŚƌŝƐ ĂŶĚ tĂůƚ͕ ŽŶ Ă ŚŝŬĞ ďƌĞĂŬ͘

/ ƐĞĞ &W ƉůĂLJŝŶŐŐ ƚŚĞ ƌŽůĞ ŝƚ ĂůǁĂLJƐ ŚĂƐ͕ ƉƌŽǀŝĚŝŶŐ ŵĞŵďĞ ďĞƌƐ ƌƐ ǁŝƚŚ ƐƚĂƚĞͲŽĨͲƚŚĞͲĂƌ Ă ƚ Ɖƌ ƉƌŽĨ ŽĨĞƐ Ğ ƐŝŽŶĂů ĚĞǀĞůŽƉŵĞŶƚ ƚŽ ďĞƚƚĞƌƌ Ğ ďƌĂĐĞ ƚŚĞ ĨƵƚƵƌĞ͕ ĂĚǀŽĐĂ Ğŵ ĐĂƚŝŶŐ ǁŝƚŚ ŽƵƌ ůĂǁŵĂŬĞƌƐ ƚŽ ĞŶƐ ŶƐƵƌĞ th hat technology and innovati tions affecting FPs supports ts our u ŵĞĞŵď ŵ ĞƌƐ ĂŶĚ ĐůŽƐĞůLJ ĞŶŐĂŐŝ Ő ŶŐ ŶŐ ǁŝƚŚ ŵĞ ŵĞŵďĞƌƐ ƚŽ ŝŶǀĞŶ Ŷƚ ƚŚ ƚŚĞ best st possible future of family ly mediccin i e imaginable.

I want members to know I would treasure them reaching out to me and telling me how I can serve them, personally, as president.

&W ŽĂƌĚ ŚĂŝƌ DŝŬĞ DƵŶŐĞƌ͕ D ͕ ƐǁŽƌĞ tĂůƚ ŝŶƚŽ ŽĸĐĞ͘

What’s your message to the next generation of FPs – what will sustain them? /Ĩ LJŽƵƌ ĐĂůůŝŶŐ ŝƐ ŝ ƚŽ ďĞ Ă ĨĂŵ Ă ŝůLJ ƉŚLJƐŝĐŝĂŶ͕ ƚŚĞ ĨƵƚƵƌĞ ǁŝůů ďĞ bright. Learn and nd practic icee resiliency, learn and use performance i provementt sc im s ieence to ree engineer the systems that impair LJŽ ŽƵƌ Ăďŝ ď ůŝŝƚLJ ƚŽ ƐƵƐƚĂŝŶ ũŽLJ LJ ŝŶ ƉƌĂĐƚŝĐĞ ĂŶĚ ƌĞĂĚ ƚŚĞ Ŭ ͞'ƌŝƚ͟ ďLJ ŶŐĞůĂ ƵĐŬǁŽƌƚŚ͊ &ŝŶĂůůLJ͕ ǁŚĂƚ ŽŶĞ ƚŚŝŶŐ ƐŚŽƵůĚ &W ŵĞŵďĞƌƐ ŬŶŽǁ ĂďŽƵƚ LJŽƵ͍ / ǁĂŶƚ ŵĞŵ ŵďĞ ďĞƌƐ ƌƐ ƚŽ ŬŶ ŬŶŽǁ Ž / ǁŽƵ Ž ůĚ ƚƌĞĂƐƵƌĞ ƚŚĞŵ ƌĞĂĐŚŝŶŐ ŽƵ Ƶƚ ƚ ƚŽ ŵĞĞ ĂŶĚ ƚĞ ƚĞůůůůŝŶ ŝŶŐŐ ŵĞ ŚŽǁ ǁ / ĐĂŶ ƐĞƌǀĞ ƚŚĞŵ͕ ƉĞƌƐŽŶĂĂůůůůLJ͕ LJ͕ ĂĂƐƐ ƉƌĞĞƐŝ ƐŝĚ ĚĞŶƚƚ͘ ƉŚŽ ŚŽŶĞ ŶĞ ĐĂů Ă ů ;ĐĞĞůů ϳϬϳͲϰϵϰͲϬϬϳϬͿ͕ ƚĞdžƚ͕ ĞŵĂ ŵĂŝůŝů ;ŵ ŵŝůŝůůƐ ůƐǁΛ ǁΛŶĂĂƚŝ ƚŝǀŝ ǀŝĚĂ Ě Ě͘ĐŽ ŽŵͿ ĂŶLJƚŝ ƚŝŵĞ ŵ ŽĨ ƚŚĞ ĚĂLJͬŶŝŐŚƚͬǁĞĞŬ ĞŬĞŶĚ ŝƐ ǁĞůĐĐŽŵ ŵĞĚ ĞĚ͕ Ăď ĂďŽƵ Ž ƚ E Ezz ĐŽŶĐĞƌƌŶ Ŷ ƚŚĂƚ / ĐĂŶ ŚĞůƉ ƚĂĐŬůĞ͘

tĂůƚ͕ ďŽƚŚĞƌͲŝŶͲůĂǁ ^ƚĞǀĞ ĂŶĚ ƐŽŶ ŚƌŝƐ ƚĂĐŬůĞ ƚŚĞ ǁĂǀĞƐ͘ 16

California Family Physician Spring 2019

/ ŐĞƚ ĞŶĞƌŐŐŝnjnjĞĚ Ě ǁŽƌŬŬŝŶ ŝŶŐŐ ǁŝ ǁ ƚŚ ŽƚŚ ƚŚĞƌ Ğ &WƐ͘ /͛Ě ůŝŬĞ ƚŽ ďĞ Ăƚ ŵĞŵ ĞŵďĞƌ ĐŚĂƉƚĞƌ ŵĞ ŵ Ğƚ ŵĞ Ğ ŝŶ ŶŐƐ ŐƐ͕ ǀŝƐŝŝƚ ŽĨ ŽĨĨŝ Ĩ ĐĞƐ͕ Žƌ ƌ ĐŽŵĞ ǁŚĞƌĞǀĞƌ ŝƚ͛Ɛ ƵƐĞĨƵ ĨƵů͘ ů͘ /͛Ě ůŝŬĞĞ ƚŽ ƉĞ ƉĞƌƐŽŶ ŽŶĂĂůůLJ ŬŶŽǁ ǁ ŚŽǁ ƚŽ Ž ƐƵƉƉŽƌƚ ŽƵƌ ĞŶƚŝƌĞ ĂůŝĨŽ ŽƌŶ ƌŶŝĂ ŝĂ ĨĂŵŝůLJ ŽĨ ĨĂ ĨĂĂŵŝ ŵ ůLJ ƉŚLJLJƐŝ Ɛ Đŝ ĐŝĂŶ ĂŶ ƉƌĂĐƚŝĐĞĞƐ ʹ ƌƵƌĂů͕ ƐƵďƵƌďĂŶͬƵƌďĂŶ͕ safety nett, acad adem e ic,, di direect patien nt care or solo to large group p.

Adam Francis CAFP Director of Government Relations

Making a Difference for Patients and Family Physicians at AMAM! /Ŷ ĞĂƌůLJ DĂƌĐŚ͕ ŶĞĂƌůLJ ϮϬϬ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ŵĞĚŝĐĂů students from across the state converged on the State Capitol for &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ ; D DͿ ĂŶĚ &ĂŵŝůLJ DĞĚŝĐŝŶĞ Lobby Day. Our goal: to discuss important topics in health care ĂŶĚ ĂĚǀŽĐĂƚĞ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ƉĂƟĞŶƚƐ͘ dŚĞ D D ŐŝǀĞƐ ĂƩĞŶĚĞĞƐ ƚŚĞ ƚŽŽůƐ ƚŚĞLJ ŶĞĞĚ ƚŽ ďĞĐŽŵĞ ƚŚĞ ůĞĂĚĞƌƐ ŽĨ ƚŚĞ ĨƵƚƵƌĞ ĂŶĚ ĞīĞĐƟǀĞ ĂĚǀŽĐĂƚĞƐ ĨŽƌ ƚŚĞŵƐĞůǀĞƐ ĂŶĚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͘ dŚĞ &W ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ ĂůƐŽ ŚĞĂƌĚ ƚĞƐƟŵŽŶLJ ĨŽƌ ĂŶĚ ĂŐĂŝŶƐƚ ƐĞǀĞƌĂů ƌĞƐŽůƵƟŽŶƐ ŽŶ ǁŚŝĐŚ ƚŚĞ ŽĂƌĚ ǁŝůů ĐŽŶƐŝĚĞƌ ĂĐƟŽŶ͘ dŚŝƐ LJĞĂƌ͕ ĂƩĞŶĚĞĞƐ ĚƵŐ ŝŶƚŽ ŵĞĂƚLJ ƉŽůŝĐLJ ŝƐƐƵĞƐ͕ ƐƵĐŚ ĂƐ ŝŵŵŝŐƌĂƟŽŶ ĂŶĚ ĂĚǀŽĐĂĐLJ ĨŽƌ ǀƵůŶĞƌĂďůĞ ƉŽƉƵůĂƟŽŶƐ͖ ƌĞůĂƟŽŶƐ ǁŝƚŚ ŚĞĂůƚŚ ƉůĂŶƐ͕ ƉŚĂƌŵĂĐĞƵƟĐĂů ĐŽŵƉĂŶŝĞƐ ĂŶĚ ŚŽƐƉŝƚĂůƐ͖ ĂŶĚ ƚŚĞ ďĞƐƚ ǁĂLJƐ ƚŽ ĂĚǀŽĐĂƚĞ ĨŽƌ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů͕ ϭϲϮϮ ; ĂƌƌŝůůŽͿ͕ ǁŚŝĐŚ ƐĞĞŬƐ ƚŽ ƌĞŵŽǀĞ ŵŝƐŝŶĨŽƌŵĞĚ ĂŶĚ ŽƵƚĚĂƚĞĚ ƐĞĐƟŽŶƐ ŽĨ ůĂǁ ƚŚĂƚ ŝŵƉƌŽƉĞƌůLJ ĐŽŶƐƚƌĂŝŶ ƚŚĞ ƉƌĂĐƟĐĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ ƩĞŶĚĞĞƐ ĂůƐŽ ƌĞĐĞŝǀĞĚ ƚƌĂŝŶŝŶŐƐ ŝŶ ĐƌĂŌŝŶŐ Ă ŵĞƐƐĂŐĞ ĨƌŽŵ Ă ƉŚLJƐŝĐŝĂŶ͛Ɛ ƉŽŝŶƚ ŽĨ ǀŝĞǁ͕ ŚŽǁ ƚŽ ŵĞĞƚ ǁŝƚŚ Ă ůĞŐŝƐůĂƚŽƌ ĂŶĚ ŚŽǁ ƚŽ ŝŶƚĞƌĂĐƚ ĂŶĚ ĂĚǀŽĐĂƚĞ ǁŝƚŚ ŵĞŵďĞƌƐ ŽĨ ĚŝīĞƌĞŶƚ ŐĞŶĞƌĂƟŽŶƐ͘ dŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ ǁĂƐ ĂůƐŽ Ă ĐŚĂŶĐĞ ƚŽ ĂĐŬŶŽǁůĞĚŐĞ ƚŚĞ ĞīŽƌƚƐ ĂŶĚ ĂĐŚŝĞǀĞŵĞŶƚƐ ŽĨ ƚŚŽƐĞ ǁŚŽ ŵĂĚĞ Ă ƚƌĞŵĞŶĚŽƵƐ ĚŝīĞƌĞŶĐĞ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŽǀĞƌ ƚŚĞ ƉĂƐƚ LJĞĂƌ͘ :ĂƐŵĞĞƚ ĂŝŶƐ͕ D ;ůĞŌͿ ǁŽŶ ƚŚĞ ,ĞƌŽ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ĂǁĂƌĚ ĨŽƌ ŚĞƌ ŽƵƚƐƚĂŶĚŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂĚǀŽĐĂĐLJ ĞīŽƌƚƐ Ăƚ ƚŚĞ ůŽĐĂů͕ ƐƚĂƚĞ͕ ŶĂƟŽŶĂů ĂŶĚ ŝŶƚĞƌŶĂƟŽŶĂů ůĞǀĞů͘ ;^ĞĞ ƚŚĞ ĂƌƟĐůĞ ŽŶ ŽƵƌ ĂǁĂƌĚƐ ǁŝŶŶĞƌƐ ŽŶ ƉĂŐĞ ϮϬ͘Ϳ ƐƐĞŵďůLJŵĞŵďĞƌ WŚŝů dŝŶŐ ; ʹ ^ĂŶ &ƌĂŶĐŝƐĐŽͿ ƌĞĐĞŝǀĞĚ ƚŚĞ ŚĂŵƉŝŽŶ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ǁĂƌĚ ĨŽƌ ƚŚĞ ǁŽƌŬ ŚĞ ŚĂƐ ĚŽŶĞ ŽŶ ƚŚĞ ƐƐĞŵďůLJ ƵĚŐĞƚ ŽŵŵŝƩĞĞ͕ ƐƉĞĐŝĮĐĂůůLJ ŝŶ ƐƵƉƉŽƌƚ ŽĨ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WƌŝŵĂƌLJ ĂƌĞ WŚLJƐŝĐŝĂŶƐ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ͘

dŚĞ ǁĞĞŬĞŶĚ ǁĂƐ ĂďŽƵƚ ŵŽƌĞ ƚŚĂŶ ũƵƐƚ ůĞĂƌŶŝŶŐ͘ ƩĞŶĚĞĞƐ ƌĂǀĞĚ ĂďŽƵƚ ƚŚĞ ǁŽƌŬ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ WŽůŝƟĐĂů ĐƟŽŶ ŽŵŵŝƩĞĞ ;&WͲW Ϳ ǁĂƐ ĚŽŝŶŐ ƚŽ ŚĞůƉ ĞůĞĐƚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ĐŚĂŵƉŝŽŶ ůĞŐŝƐůĂƚŽƌƐ ŝŶ ĂůŝĨŽƌŶŝĂ ĂŶĚ ĞŶƐƵƌĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ĂĐĐĞƐƐ ƚŽ ůĞŐŝƐůĂƟǀĞ ůĞĂĚĞƌƐ͘ &WͲW ŝƐ ƚŚĞ ŽŶůLJ ƉŽůŝƟĐĂů ĂĐƟŽŶ ĐŽŵŵŝƩĞĞ ŝŶ ĂůŝĨŽƌŶŝĂ ƚŚĂƚ ŵĂŬĞƐ ĚŝƌĞĐƚ ĐŽŶƚƌŝďƵƟŽŶƐ ƚŽ ƉƌŽͲĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ƉƌŽͲƉĂƟĞŶƚ ƐƚĂƚĞ ůĞŐŝƐůĂƟǀĞ ĐĂŶĚŝĚĂƚĞƐ ĂŶĚ ƐĞůĞĐƚ ƐƚĂƚĞǁŝĚĞ ŽĸĐĞƐ͘ D D ĂƩĞŶĚĞĞƐ ƌĂŝƐĞĚ ŵŽƌĞ ŵŽŶĞLJ ĨŽƌ &WͲW ƚŚŝƐ LJĞĂƌ ƚŚĂŶ Ăƚ ĂŶLJ ŽƚŚĞƌ ƉƌĞǀŝŽƵƐ &W ŵĞĞƟŶŐ ŝŶ ŝƚƐ ĞdžŝƐƚĞŶĐĞ͊ &WͲW ĐŽŶƚƌŝďƵƚŽƌƐ ĂůƐŽ ĂƩĞŶĚĞĚ Ă ƐƉĞĐŝĂů ŽŶŽƌ ZĞĐŽŐŶŝƟŽŶ ^ŽĐŝĂů ǀĞŶƚ ǁŝƚŚ ŶĞǁ ĂůŝĨŽƌŶŝĂ /ŶƐƵƌĂŶĐĞ Commissioner Ricardo Lara. If you have not yet contributed to FP-PAC ŝŶ ϮϬϭϵ͕ ƉůĞĂƐĞ ŐŽ ƚŽ ŽƵƌ ĚŽŶĂƟŽŶ ƉĂŐĞ ;ŚƩƉƐ͗ͬ​ͬĨĂŵŝůLJĚŽĐƐ͘ƐĞĐƵƌĞ͘ ĨŽƌĐĞ͘ĐŽŵͬƉĂĐͬ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĐĂŶ ĐŽŶƟŶƵĞ ŽƵƌ important electoral advocacy.

DŽŶĚĂLJ ǁĂƐ &ĂŵŝůLJ DĞĚŝĐŝŶĞ >ŽďďLJ ĂLJ͘ EĞĂƌůLJ ϭϬϬ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ŵĞƚ ŝŶ ŵŽƌĞ ƚŚĂŶ dtKͲd,/Z ^ ŽĨ Ăůů ůĞŐŝƐůĂƚŽƌƐ͛ ŽĸĐĞƐ ƚŽ ƐƵƉƉŽƌƚ ϭϲϮϮ ; ĂƌƌŝůůŽͿ͕ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ůĞŐŝƐůĂƟŽŶ ƚŽ ƌĞŵŽǀĞ ŝŶĂƉƉƌŽƉƌŝĂƚĞ ĐŽŶƐƚƌĂŝŶƚƐ ŽŶ ƚŚĞ ƉƌĂĐƟĐĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ zŽƵ ĐĂŶ ƌĞĂĚ ŵƵĐŚ ŵŽƌĞ ĂďŽƵƚ ϭϲϮϮ ŝŶ ĂƌůĂ <ĂŬƵƚĂŶŝ͛Ɛ WŽůŝƟĐĂů WƵůƐĞ ŽŶ ƉĂŐĞ ϭϬ͘ /ƚ ǁĂƐ ĂŶ ŝŶƐƉŝƌŝŶŐ ĂŶĚ ĞdžĐŝƟŶŐ ǁĞĞŬĞŶĚ͊ tĞ ŝŶǀŝƚĞ ĂŶLJ ĂŶĚ Ăůů &W ŵĞŵďĞƌƐ ŝŶƚĞƌĞƐƚĞĚ ŝŶ ĂĚǀĂŶĐŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ƉĂƟĞŶƚ ƉƌŽƚĞĐƟŽŶƐ ƚŽ ũŽŝŶ ƵƐ Ăƚ ŶĞdžƚ LJĞĂƌ͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ ĂŶĚ &ĂŵŝůLJ DĞĚŝĐŝŶĞ >ŽďďLJ ĂLJ͕ ƚĂŬŝŶŐ ƉůĂĐĞ DĂƌĐŚ ϭϯͲϭϱ͕ ϮϬϮϬ Ăƚ ƚŚĞ ^ŚĞƌĂƚŽŶ 'ƌĂŶĚ Hotel in Sacramento.

WŚŽƚŽ ĐĂƉƟŽŶƐ WƌĞǀŝŽƵƐ ƉĂŐĞ͗ &W ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ůĞĂĚĞƌƐ ŐĂƚŚĞƌ ŝŶ ^ĂĐƌĂŵĞŶƚŽ͖͘ DŽƌĞ ƚŚĂŶ ϵϬ &WĞƌƐ ƉĂƌƟĐŝƉĂƚĞĚ ŝŶ >ŽďďLJ ĂLJ͖͘ ƐƐĞŵďůLJ ŵĞŵďĞƌ WŚŝů dŝŶŐ ǁĂƐ ŶĂŵĞĚ ƚŚĞ ϮϬϭϵ ŚĂŵƉŝŽŶ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ͖͘ &WĞƌƐ ǀŝƐŝƚĞĚ ůĞŐŝƐůĂƟǀĞ ŽĸĐĞƐ͕ ŚĞĂƌĚ ĨƌŽŵ /ŶƐƵƌĂŶĐĞ ŽŵŵŝƐƐŝŽŶƐ ZŝĐĂƌĚŽ >ĂƌĂ ĂŶĚ ŐĂƚŚĞƌĞĚ ĨŽƌ ƚŚĞ ƚƌĂĚŝƟŽŶĂů ĂůŝĨŽƌŶŝĂ ďĞĂƌ ƉŚŽƚŽ͖͘ &W /ŵŵĞĚŝĂƚĞ WĂƐƚ WƌĞƐŝĚĞŶƚ >ŝƐĂ tĂƌĚ͕ ƐƐĞŵďůLJ ŵĞŵďĞƌ :ŝŵ tŽŽĚ͕ ĂŶĚ K >ŝƐĂ &ŽůďĞŐ ŵĞƚ in Sacramento.

18

California Family Physician Spring 2019

CAFP Honors Five Outstanding Members

Lee Ralph, MD

2019 Family Physician of the Year The California Academy of Family Physicians proudly ƉƌĞƐĞŶƚƐ ƚŚĞ ϮϬϭϵ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ ŽĨ ƚŚĞ zĞĂƌ ǁĂƌĚ ƚŽ >ĞĞ ZĂůƉŚ͕ D ͘ dŚŝƐ ƉƌĞƐƚŝŐŝŽƵƐ ĂǁĂƌĚ ŐŽĞƐ ƚŽ ĂŶ ŝŶĚŝǀŝĚƵĂů ǁŚŽ ĞdžŚŝďŝƚƐ ƚŚĞ ĨŝŶĞƐƚ ƋƵĂůŝƚŝĞƐ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ǁŚŽ ŐŽĞƐ ĂďŽǀĞ ĂŶĚ ďĞLJŽŶĚ ŝŶ ƐĞƌǀŝĐĞ ƚŽ ƉĂƚŝĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƚLJ͘ DŽƐƚ ŽĨ LJŽƵ ŬŶŽǁ >ĞĞ ĂƐ Ă ƉĂƐƚ ƉƌĞƐŝĚĞŶƚ ŽĨ ƚŚŝƐ ĐĂĚĞŵLJ͘ WĞƌŚĂƉƐ LJŽƵ ŬŶŽǁ Śŝŵ ĂƐ Ă ĨĂĐƵůƚLJ ŵĞŵďĞƌ ĨŽƌ CAFP educational events and a member of CAFP’s Committee ŽŶ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ͘ DĂLJďĞ LJŽƵ͛ǀĞ ǁŽƌŬĞĚ ǁŝƚŚ him in San Diego at the local chapter level, or in practice at UCSF and San Diego Sports Medicine. All those interactions ǁŝƚŚ >ĞĞ ĂƌĞ ƋƵŝƚĞ ǁŽŶĚĞƌĨƵů͕ ĂŶĚ ƚŚĞLJ ĂƌĞ ƉĂƌƚ ŽĨ ƚŚĞ ƌĞĂƐŽŶ ǁĞ ƐĞůĞĐƚĞĚ Śŝŵ ƚŚŝƐ LJĞĂƌ͘ Ƶƚ͕ >ĞĞ ǁĂƐ ĂůƐŽ ƐĞůĞĐƚĞĚ because he possesses all of the qualities of an incredible family physician … He is bright, kind, compassionate, an ĞdžĐĞůůĞŶƚ ƚĞĂĐŚĞƌ ĂŶĚ ĂďůĞ ƚŽ ĂƚƚĞŶĚ͕ ǁŝƚŚ ŐƌĞĂƚ ĚŝůŝŐĞŶĐĞ͕ ƚŽ ŚŝƐ ƉĂƚŝĞŶƚƐ͛ ĂŶĚ ĐŽůůĞĂŐƵĞƐ͛ ŶĞĞĚƐ͘ ,Ğ ŝƐ ĂůƐŽ Ă ǁŽŶĚĞƌĨƵů father, husband and philanthropist. From a business ƐƚĂŶĚƉŽŝŶƚ͕ >ĞĞ ŚĂƐ ďĞĞŶ Ă ƉŚLJƐŝĐŝĂŶ ĂŶĚ ƉĂƌƚŶĞƌ ǁŝƚŚ ^ĂŶ ŝĞŐŽ ^ƉŽƌƚƐ DĞĚŝĐŝŶĞ ƐŝŶĐĞ ϭϵϵϳ͕ Ă ƚŚƌŝǀŝŶŐ ƉƌĂĐƚŝĐĞ and one of the first of its kind in our community. He has engendered the confidence and admiration of many in his profession and in doing so has been designated a leader at

Ăůů ůĞǀĞůƐ͘ >ĞĞ ŚĂƐ ĚŽŶĞ Ăůů ŽĨ ƚŚŝƐ ǁŚŝůĞ ŵĂŝŶƚĂŝŶŝŶŐ Ă ŚĞĂůƚŚLJ ůŝĨĞ ǁŽƌŬ ďĂůĂŶĐĞ͘ ,Ğ ĐŽŶƐŝƐƚĞŶƚůLJ ƐŚŽǁƐ Ă ǁŝůůŝŶŐŶĞƐƐ ƚŽ volunteer at every opportunity that presents itself in order ƚŽ ĨƵƌƚŚĞƌ ƚŚĞ ƉƌŽĨĞƐƐŝŽŶ ĂŶĚ ĞŶŚĂŶĐĞ ƚŚĞ ǁĞůĨĂƌĞ ŽĨ ŚŝƐ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ƉĂƚŝĞŶƚƐ͘ ,Ğ ƌĞƉƌĞƐĞŶƚƐ Ăůů ƚŚŝƐ ŝƐ ƌŝŐŚƚ ǁŝƚŚ our specialty.

ZŽď ƐƐŝďĞLJ͕ D ĂŶĚ Romero Santiago, MD, MPH

2019 Family Medicine Residents of the Year Robert Assibey, MD, second-year resident at San Joaquin 'ĞŶĞƌĂů ,ŽƐƉŝƚĂů͕ ŝƐ ĂŶ ĞŶƚŚƵƐŝĂƐƚŝĐ ůĞĂĚĞƌ ŝŶ ďŽƚŚ ŚŝƐ residency program and in the Academy. He currently serves as Co-chair of CAFP’s Resident Council, and as Co-chair leader, Rob represents California as a delegate to local and ŶĂƚŝŽŶǁŝĚĞ ĐŽŶĨĞƌĞŶĐĞƐ ĂŶĚ ĞǀĞŶƚƐ͘ ,Ğ ŝƐ Ă ǀŽƚŝŶŐ ŵĞŵďĞƌ on the Academy Board of Directors and Foundation Board of dƌƵƐƚĞĞƐ͘ ZŽď ƚŽŽŬ ĨŝƌƐƚ ƉůĂĐĞ ŝŶ ƚŚĞ ϮϬϭϴ &W &ŽƵŶĚĂƚŝŽŶ ZĞƐŝĚĞŶƚ WŽƐƚ ŽŵƉĞƚŝƚŝŽŶ ĂŶĚ LJŽƵ ƐĂǁ Śŝŵ ůĂƐƚ ĞǀĞŶŝŶŐ ƉƌĞƐĞŶƚ ŚŝƐ ϮϬϭϵ ƉŽƐƚĞƌ͊ KŶ Ă ƉĞƌƐŽŶĂů ůĞǀĞů͕ ZŽď ŝƐ ĐƵƌŝŽƵƐ and full of personality. He is quick to volunteer his time ĂŶĚ ƚŽ ŚĞůƉ ǁŚĞŶ ĞdžƚƌĂ ŚĂŶĚƐ ĂƌĞ ŶĞĞĚĞĚ͘ tŚĞŶ ZŽď ŝƐ ŶŽƚ encouraging his peers to get involved in CAFP, he is teaching &W ŽĂƌĚ ŵĞŵďĞƌƐ ŚŽǁ ƚŽ ĚŽ ƚŚĞ ͞ĨůŽƐƐ͟ ĂŶĚ ƉƌĞƉĂƌŝŶŐ his haiku presentations.

California Family Physician Spring 2019

19

Romero Santiago, MD, a second-year resident at the University of California Davis Family and Community Medicine Program, ĐƵƌƌĞŶƚůLJ ƐĞƌǀĞƐ ŽŶ ƚŚĞ &W ZĞƐŝĚĞŶƚ ŽƵŶĐŝů͕ Ă ƐƚĂƚĞǁŝĚĞ ƌĞƐŝĚĞŶƚ ŵĞŵďĞƌ ŐƌŽƵƉ ƚŚĂƚ ǁŽƌŬƐ ƚŽ ƉƌŽŵŽƚĞ ĂŶĚ ĂĚǀŽĐĂƚĞ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶƚĞƌĞƐƚƐ͘ ƵƌŝŶŐ ŚŝƐ ƚǁŽͲLJĞĂƌ ƚĞŶƵƌĞ ŽŶ ƚŚĞ ĐŽƵŶĐŝů͕ ŚĞ ŚĂƐ ĐŽͲĂƵƚŚŽƌĞĚ ƚǁŽ ƌĞƐŽůƵƚŝŽŶƐ ƚŚĂƚ ŚĂǀĞ ďĞĞŶ presented at the All Member Advocacy Meeting and passed by the CAFP Board of Directors. He is also a member of CAFP’s ŽŵŵŝƚƚĞĞ ŽŶ ,ĞĂůƚŚ ŽĨ ƚŚĞ WƵďůŝĐ͕ ǁŚŝĐŚ ĂĚĚƌĞƐƐĞƐ ƚŚĞ ůĂƚĞƐƚ and most pressing public health concerns. As a leader, Romero ǁŽƌŬƐ ǁŝƚŚ ĐŽŵŵŝƚƚĞĞ ĂŶĚ ĐŽƵŶĐŝů ŵĞŵďĞƌƐ ƚŽ ŚĞůƉ &W address resolutions and develop Academy policy statements or position papers. Romero is committed to staying abreast of issues affecting family medicine and his patients, honing his advocacy and clinical skills, and posting positive messages about family medicine and CAFP on social media.

Kristine Brownell, MD

2019 Barbara Harris Award for Educational Excellence /ƚ ŝƐ ŽƵƌ ŚŽŶŽƌ ƚŽ ƉƌĞƐĞŶƚ ƚŚŝƐ ĂǁĂƌĚ ƚŽ <ƌƐŝƚŝŶĞ͕ ĂŶĚ ĨĞůůŽǁƐ ^ĂŶ ŝĞŐŽ ƌĞƐŝĚĞŶĐLJ faculty member. Kristine has all of the qualities of a great educator. She is an ŽƵƚƐƚĂŶĚŝŶŐ ĐůŝŶŝĐĂů ƚĞĂĐŚĞƌ͘ ^ŚĞ ǁŽƌŬƐ ǁŝƚŚ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƐƚƵĚĞŶƚƐ ŝŶ ŶƵŵĞƌŽƵƐ settings. She does scholarly projects and teaches her physician colleagues. She is a community leader, social justice zealot, ĂŶĚ ĂĐƚŝǀŝƐƚ͘ <ƌŝƐƚŝŶĞ͛Ɛ ǁŽƌŬ ƚŽ ƚĂĐŬůĞ ŽŶ social justice and health inequities and her program to assist patients in a very busy, diverse setting raise the bar for us all. Her specialized training including Masters of Public Health, Underserved DĞĚŝĐŝŶĞ &ĞůůŽǁƐŚŝƉ͕ ĂŶĚ ƐĞƌǀŝĐĞ ŝŶ ƚŚĞ WĞĂĐĞ ŽƌƉƐ͕ ŚĂƐ ŐŝǀĞŶ ŚĞƌ ĞdžƉĞƌƚŝƐĞ ŝŶ treating the very diverse San Diego patient population. On a typical clinic day she ĐĂŶ ďĞ ƐĞĞŶ ĨůŝƚƚŝŶŐ ŝŶƚŽ ŽŶĞ ƌŽŽŵ ǁŝƚŚ Ă ^ŽŵĂůŝ ƐƉĞĂŬŝŶŐ ƉƌĞŶĂƚĂů ƉĂƚŝĞŶƚ ǁŚŽ ŚĂƐ ƵŶĚĞƌŐŽŶĞ &' ;ĨĞŵĂůĞ ŐĞŶŝƚĂů ĐƵƚƚŝŶŐͿ͕ ŝŶƚŽ ƚŚĞ ŶĞdžƚ ǁŚĞƌĞ ƐŚĞ ŝƐ ƚƌĞĂƚŝŶŐ ƚŚĞ children and parents in a recently arrived ƵƌŵĞƐĞ ƌĞĨƵŐĞĞ ĨĂŵŝůLJ͕ ĂŶĚ ŝŶƚŽ ƚŚĞ ŶĞdžƚ ǁŚĞƌĞ Ă ǁĞůů ĞƐƚĂďůŝƐŚĞĚ ƵŶĚŽĐƵŵĞŶƚĞĚ ƉĂƚŝĞŶƚ ĨƌŽŵ DĞdžŝĐŽ ŚĂƐ ďƌŽƵŐŚƚ ŚĞƌ ŚŽŵĞ made caramels as a token of appreciation. ƌ͘ ƌŽǁŶĞůů ŝŶĨĞĐƚŝŽƵƐůLJ ƐŚĂƌĞƐ ŚĞƌ 20

California Family Physician Spring 2019

ũŽLJ ĨŽƌ ƵŶĚĞƌƐĞƌǀĞĚ ŵĞĚŝĐŝŶĞ ǁŝƚŚ ŚĞƌ ƌĞƐŝĚĞŶƚƐ͘ ^ŚĞ ŝƐ ǁŝĚĞůLJ ƌĞĐŽŐŶŝnjĞĚ Ă ƉƌĞŵŝĞƌ ƉƌĞĐĞƉƚŽƌ ŝŶ ĂĚĚƌĞƐƐŝŶŐ ƐŽĐŝĂů determinants of health, accessing community resources, and ŬĞĞƉŝŶŐ ĚŝĨĨĞƌĞŶƚŝĂůƐ ďƌŽĂĚ ƐŽ ǁĞ ĚŽŶ͛ƚ ŵŝƐƐ ƌĂƌĞ ĚŝĂŐŶŽƐĞƐ such as malaria. <ƌŝƐƚŝŶĞ ŚĂƐ Ă ůŽŶŐ ůŝƐƚ ŽĨ ĂĐĐŽŵƉůŝƐŚŵĞŶƚƐ͕ ďƵƚ ǁŚĂƚ ƐĞƚƐ ŚĞƌ apart is her amazing skill, passion and enthusiasm as a teacher.

Jasmeet Bains, MD

CAFP Hero of Family Medicine Dr. Jasmeet Bains has taken family medicine advocacy ƚŽ Ă ǁŚŽůĞ ŶĞǁ ůĞǀĞů͘ tŚĞƚŚĞƌ ŝƚ ďĞ ǁŝƚŚ ĞŵŽĐƌĂƚƐ Žƌ Republicans, in Washington DC or the State Capitol, Dr. Bains ƐƉĞĂŬƐ ƚƌƵƚŚ ƚŽ ƉŽǁĞƌ͘ /Ŷ ƚŚĞ ůĂƐƚ LJĞĂƌ ĂůŽŶĞ͕ ƐŚĞ ŚĂƐ ďƌŽƵŐŚƚ ƚŚĞ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞǀŽůƵƚŝŽŶ ƚŽ ŵĞĞƚŝŶŐƐ ǁŝƚŚ ƚŚĞŶͲ 'ŽǀĞƌŶŽƌ ƌŽǁŶ͕ ŶŽǁͲ'ŽǀĞƌŶŽƌ EĞǁƐŽŵ͕ ĂŶĚ ƚŚĞŶͲDĂũŽƌŝƚLJ >ĞĂĚĞƌ <ĞǀŝŶ DĐ ĂƌƚŚLJ͘ /Ŷ ĂĚĚŝƚŝŽŶ ƚŽ ŚĞƌ ŵĞĞƚŝŶŐƐ ǁŝƚŚ ŚŝŐŚͲ ƉŽǁĞƌĞĚ ŽĨĨŝĐŝĂůƐ͕ ƌ͘ ĂŝŶƐ ƐŝƚƐ ŽŶ ƚŚĞ ĂůŝĨŽƌŶŝĂ ,ĞĂůƚŚĐĂƌĞ tŽƌŬĨŽƌĐĞ WŽůŝĐLJ ŽŵŵŝƐƐŝŽŶ͕ ǁŚŝĐŚ ŽǀĞƌƐĞĞƐ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ Healthcare Workforce Training Program that disburses grants

to primary care residency programs.

In that role, Dr. Bains helps to direct funding to residency programs that recruit underrepresented minorities, ƚƌĂŝŶ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ƌĞŵĂŝŶ ŝŶ ƉƌŝŵĂƌLJ ĐĂƌĞ͕ ĂŶĚ ǁŚŽ ƐĞƌǀĞ ƵŶĚĞƌƐĞƌǀĞĚ populations and regions. Her advocacy for the underserved does not stop Ăƚ ŚĞƌ ƉŽůŝƚŝĐĂů ǁŽƌŬ͕ ƐŚĞ ůŝǀĞƐ ŝƚ every day delivering care at the Omni Family Health Clinic in Taft, a severely underserved area of the San Joaquin Valley. Dr. Bains has consistently ĚĞŵŽŶƐƚƌĂƚĞĚ ŚŽǁ ƉŽǁĞƌĨƵů ĂŶĚ influential an engaged family physician can be at the local, state, national, and even international level, embarking on medical missions to India and Honduras. She is member of the CAFP ϮϬϭϵͲϮϬϮϬ ZĞĂĚLJ ƚŽ >ĞĂĚ͗ ƵŝůĚŝŶŐ Women Family Physician Leaders class, ĂŶĚ ǁĞ ŚĂǀĞ ŶŽ ĚŽƵďƚ ƐŚĞ ǁŝůů ůĞĂĚ family medicine to great things.

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California Family Physician Spring 2019

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Conrad Amenta CAFP Director of Health Policy

Five Years and Counting: A Look at CAFP’s Landmark PCMH Pilot Ă ϮϬϭϰ ƌĞƉŽƌƚ ƚŝƚůĞĚ ͞WĂƚŝĞŶƚͲ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ͗ >ŽŽŬŝŶŐ ĨŽƌ ǁĂLJƐ ƚŽ ŝŵƉƌŽǀĞ ƚŚĞ ŚĞĂůƚŚ ŽĨ ďĞŶĞĨŝĐŝĂƌŝĞƐ ŽŵŵƵŶŝƚLJ DĞĚŝĐĂů WƌŽǀŝĚĞƌƐ͛ ^ƵĐĐĞƐƐ͘͟ ĂŶĚ ĂĚĚƌĞƐƐ ƚŚĞ ĞƐĐĂůĂƚŝŶŐ ĐŽƐƚƐ ŽĨ ĐĂƌĞ͕ ŝŶ ůĂƚĞ ϮϬϭϬ ƚŚĞ • dŚĞ ŶƵŵďĞƌ ŽĨ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ĚŝĂďĞƚĞƐ ǁŚŽƐĞ ďůŽŽĚ ƐĞůĨͲŝŶƐƵƌĞĚ &ƌĞƐŶŽ hŶŝĨŝĞĚ ^ĐŚŽŽů ŝƐƚƌŝĐƚͬ:ŽŝŶƚ ,ĞĂůƚŚ ƐƵŐĂƌ ůĞǀĞůƐ ǁĞƌĞ ĐŽŶĨŝƌŵĞĚ ĂƐ ĐŽŶƚƌŽůůĞĚ ŝŶĐƌĞĂƐĞĚ Management Board joined the California Academy of by 50 percent.

Family Physicians in supporting a local Patient Centered ŵŽŶŐ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ĚŝĂďĞƚĞƐ ĂŶĚ ǁŝƚŚ ĐŽƌŽŶĂƌLJ • DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ŝŶŝƚŝĂƚŝǀĞ͘ dŚĞ ďĞŶĞĨŝƚƐ ŽĨ ƚŚĞ W D,͕ artery disease, blood pressure control and LDL as described by accrediting bodies such as the National control increased significantly.

Committee for Quality Assurance, include increasing • ƌĞĂƐƚ ĐĂŶĐĞƌ ƐĐƌĞĞŶŝŶŐ ĂŶĚ ďŽĚLJ ŵĂƐƐ ŝŶĚĞdž patient and staff satisfaction, better management of counseling increased across the entire patient ĐŚƌŽŶŝĐ ĐŽŶĚŝƚŝŽŶƐ͕ ƌĞĚƵĐŝŶŐ ĨƌĂŐŵĞŶƚĂƚŝŽŶ͕ ĂůŝŐŶŵĞŶƚ ǁŝƚŚ population. ƉĂLJĞƌƐ ĂŶĚ ƐƚĂƚĞͬĨĞĚĞƌĂů ŝŶŝƚŝĂƚŝǀĞƐ ĂŶĚ ůŽǁĞƌŝŶŐ ŚĞĂůƚŚ • Medication adherence increased. care costs.

• Patient satisfaction increased.

• Emergency department visits and inpatient /Ŷ :ƵůLJ ϮϬϭϮ͕ ĂĨƚĞƌ ϭϴ ŵŽŶƚŚƐ ŽĨ ƉƌĞƉĂƌĂƚŝŽŶ ĂŶĚ ƚƌĂŝŶŝŶŐ͕ admissions decreased. a primary care medical group – Community Medical WƌŽǀŝĚĞƌƐ ; DWͿ ʹ ůĂƵŶĐŚĞĚ ƚŚĞ ŝŶŝƚŝĂƚŝǀĞ͘ dŚĞ ƉƌŽũĞĐƚ DĞĂŶǁŚŝůĞ͕ ƚŽƚĂů ŚĞĂůƚŚ ĐĂƌĞ ĐŽƐƚƐ ĚĞĐƌĞĂƐĞĚ ďLJ ŶŝŶĞ ĐŽǀĞƌĞĚ ĂƉƉƌŽdžŝŵĂƚĞůLJ Ϯ͕ϱϬϬ ƉĂƚŝĞŶƚƐ ĐŽŵƉƌŝƐŝŶŐ ϭϬ percent, or almost a million dollars. Costs among high-risk ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ŝƐƚƌŝĐƚ͛Ɛ Ϯϱ͕ϬϬϬ ďĞŶĞĨŝĐŝĂƌŝĞƐ͘ dŚĞ ƌĞƐƵůƚƐ ŵĞŵďĞƌƐ ĚĞĐƌĞĂƐĞĚ ďLJ ĂůŵŽƐƚ ϭϲ ƉĞƌĐĞŶƚ͘ ŽŶĞ LJĞĂƌ ůĂƚĞƌ ǁĞƌĞ ƌĞŵĂƌŬĂďůĞ͘ dŚĞLJ ǁĞƌĞ ĐĂƉƚƵƌĞĚ ŝŶ

Quality and Patient Satisfaction Outcomes/All Cohorts This information is a sample of the 19 metrics captured during Periods 12 nad 13 of the project.

Metric

P 12: 7/1/17-12/31/17

P13: 1/1/18-6/0/18

Goal

P4P%

Patients at Goal

Patients in Group

& at Goal

Patients at Goal

Patients in Group

% at Goal

P13-P12

Diabetes: HBA1c Poor Control (>9%)

59

644

9%

64

636

10%

1%

<25%

0%

100%

Diabetes: LDL. Control (LDL <100)

431

644

67%

422

636

66%

-1%

50%

61%

100%

IVD: LDL Control (LDL <100)

247

376

66%

247

368

67%

1%

88%

-24%

6%

Population: BMI Counseling

2097

2265

93%

2029

2103

96%

4%

60%

38%

100%

22

California Family Physician Spring 2019

The Fresno pilot has formed the backbone of CAFP’s The PCMH has evolved from an evidence-based concept advocacy for PCMH, providing tangible evidence of the to a tried-and-true, accredited method to improve benefits of investing in PCMH-accredited practices. quality and contain costs. That the CMP PCMH continues Five years after the release of its final report, the CMP to thrive, to the benefit of patients in Fresno, is a PCMH is still going strong. An update on the project testament to that fact. ĨƌŽŵ ĞĐĞŵďĞƌ ϮϬϭϴ ŝŶĚŝĐĂƚĞƐ ƚŚĂƚ the pilot is still performing across ϭϵ ƋƵĂůŝƚLJ ĂŶĚ ƉĂƚŝĞŶƚ ƐĂƚŝƐĨĂĐƚŝŽŶ indicators, including screening targets, documentation and control of the diabetes patient populations’ ƐLJŵƉƚŽŵƐ͕ ĂĐŚŝĞǀŝŶŐ ϴϱ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞƐĞ ƚĂƌŐĞƚƐ͘ dŚĞƌĞ ǁĂƐ ĂůƐŽ ĂŶ increase in the number of physicians using secure electronic patient messaging systems to communicate ǁŝƚŚ ƚŚĞŝƌ ƉĂƚŝĞŶƚƐ ĂŶĚ ĂŶ ŝŶĐƌĞĂƐĞ in the number of ‘E-Visits’ conducted via a secure patient portal. The PCMH continues to represent a proactive method for furthering high-value, team-based care for AVAILABLE PROVIDER ƉĂƚŝĞŶƚ ƉŽƉƵůĂƚŝŽŶƐ ƚŚĂƚ ƉƌĞƐĞŶƚ ǁŝƚŚ OPPORTUNITIES IN FAMILY MEDICINE ŵƵůƚŝƉůĞ͕ ĐŽŵƉůĞdž ĐŽŵŽƌďŝĚŝƚŝĞƐ͘

JOIN OUR TEAM • Salary based on experience

dŚĞ ĨƵůůͲƚŚƌŽĂƚĞĚ ƐƵƉƉŽƌƚ ǁĞ ŚĂǀĞ ŚŽƉĞĚ ǁŽƵůĚ ĞŵĞƌŐĞ ĨŽƌ W D,͕ including true, risk-adjusted, valuebased payment, has not emerged as of ϮϬϭϵ͘ WĂƌƚ ŽĨ ƚŚŝƐ ŝƐ ĚƵĞ ƚŽ ĂŶ ĞƌŽƐŝŽŶ of support for implementation of the Affordable Care Act by the federal government and, in part, is due to a lack of understanding among health plans of the value of the PCMH. Undaunted, CAFP continues to share ƚŚĞ ŽǀĞƌǁŚĞůŵŝŶŐ ĂŶĚ ĐŽŵƉĞůůŝŶŐ evidence of the effectiveness of the PCMH. Numerous research reports have emerged detailing the unprecedented shortage of primary care physicians California is facing. As a result, health plans and legislators ĂƌĞ ŝŶĐƌĞĂƐŝŶŐůLJ ǁŝůůŝŶŐ ƚŽ ĐŽŶƐŝĚĞƌ increased investments in primary ĐĂƌĞ͕ ŝŶĐůƵĚŝŶŐ ƚŚĞ W D,͕ ƚŚĂƚ ǁŽƵůĚ ĂůůŽǁ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ƉƌĂĐƚŝĐĞ Ăƚ the top of their license and emphasize high-value care.

• Sign on bonus and relocation assistance • 5 days of CME, $3,000 CME reimbursement and 10 paid holidays • Bonuses based on quality and productivity • Cap Exempt and Offering Visa Sponsorship • National Health Service Corps Scholar and Loan Repayment eligible • Many sites close to Yosemite National Park, San Francsico Bay Area and Monterey • 37 sites located throughout California’s Central Valley and growing each year

TO DISCUSS CURRENT OPPORTUNITIES, CONTACT: Joshua Skunca Director of Medical Staff Services jskunca@gvhc.org Office: 209.384.6489 | Cell: 209.291.9750

WWW.GVHC.ORG California Family Physician Spring 2019

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Leading the future of health care.

WE OFFER The Permanente Medical Group, Inc. (TPMG) is one of the largest medical groups in the nation with over 9,000 physicians, 22 medical centers, numerous clinics throughout Northern and Central California and a 70 year tradition of providing quality medical care.

• FAMILY MEDICINE RESIDENCY Faculty Inpatient Service Lead - Sacramento, California This is an exciting opportunity for a Family Medicine Physician to be the Faculty Lead for the Family Medicine Inpatient Service for the new Kaiser Permanente Sacramento Valley Family Medicine Residency Program. We invite you to join a forward-thinking educational team, develop a patientcentered curriculum, and work in the country's most collaborative and innovative medical group.

• ADULT & FAMILY MEDICINE PHYSICIAN OPPORTUNITIES Openings available throughout Northern & Central California

FORGIVABLE LOAN PROGRAM $150,000-$300,000 (based on location) FAMILY MEDICINE OPPORTUNITIES: Contact Aileen Ludlow at: Aileen.M.Ludlow@kp.org | (510) 625-5934 INTERNAL MEDICINE OPPORTUNITIES: Contact Bianca Davis at: Bianca.X.Davis@kp.org | (510) 625-5935

• Physician-led organization–career growth and leadership opportunities • Multi-specialty collaboration and integration • Technology driven innovation • Mission-driven, patient-centered care and one of the largest progressive medical groups in the nation!

EXTRAORDINARY BENEFITS • Shareholder track • Three retirement plans, including pension • Moving allowance • Comprehensive medical and dental • Home loan assistance - up to $200,000 • Malpractice and tail insurance (approval required)

• Reimbursement of new CA medical license fees • Paid holidays, sick leave, education leave (with generous stipend)

CONNECT WITH US:

http://physiciancareers-ncal.kp.org We are an EOE/AA/M/F/D/V Employer. VEVRAA Federal Contractor.

CAFP Foundation Talking about Immigration Policy Issues: What Is “ICE”? /Ŷ ƚŚŝƐ͕ ƚŚĞ ƚŚŝƌĚ ŝŶ ƚŚĞ ,ĞĂůƚŚLJ ,ĂƌďŽƌƐ ƐĞƌŝĞƐ͕ ǁĞ ĚŝƐĐƵƐƐ / ĂŶĚ LJŽƵƌ ƌŽůĞƐ͕ ƌĞƐƉŽŶƐŝďŝůŝƚŝĞƐ ĂŶĚ ƌŝŐŚƚƐ ǁŚĞŶ / ĐŽŵĞƐ ƚŽ LJŽƵƌ ŽĨĨŝĐĞ͕ ĐůŝŶŝĐ Žƌ ŚŽƐƉŝƚĂů͘ tŽƌŬŝŶŐ ŝŶ ĐŽůůĂďŽƌĂƚŝŽŶ ǁŝƚŚ the Alameda Contra Costa Medical Association, San Francisco Marin Medical Society, American Academy of PediatricsCalifornia, Osteopathic Physicians and Surgeons of California and Sonoma County Medical Society, your Foundation offers ĂŶ ŽƉĞŶŝŶŐ ƐĂůǀŽ͕ ƐŽ ƚŽ ƐƉĞĂŬ͕ ĂŶ ŝŶĨŽƌŵĂƚŝŽŶ ĂŶĚ ĂǁĂƌĞŶĞƐƐ ĐĂŵƉĂŝŐŶ ƚŽ ůĂLJ ƚŚĞ ŐƌŽƵŶĚǁŽƌŬ ĨŽƌ ĨƵƚƵƌĞ ƉŽůŝƚŝĐĂů͕ ĂĚǀŽĐĂĐLJ and educational efforts aimed at protecting the health of California’s most vulnerable populations, especially children.

Our thanks to the California Healthcare Foundation for a grant to support the Healthy Harbors project.

ICE stands for Immigration and Customs Enforcement. ICE is Ă ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ĂŐĞŶĐLJ ŽĨ ƚŚĞ ĨĞĚĞƌĂů ŐŽǀĞƌŶŵĞŶƚ ƚĂƐŬĞĚ ǁŝƚŚ ĞŶĨŽƌĐŝŶŐ ŝŵŵŝŐƌĂƚŝŽŶ ůĂǁƐ ĂŶĚ ŝŶǀĞƐƚŝŐĂƚŝŶŐ ĐƌŝŵŝŶĂů ĂŶĚ terrorist activities of foreign nationals residing in the United ^ƚĂƚĞƐ͘ / ŚĂƐ ƚǁŽ ƉƌŝŵĂƌLJ ĐŽŵƉŽŶĞŶƚƐ͗ ,ŽŵĞůĂŶĚ ^ĞĐƵƌŝƚLJ /ŶǀĞƐƚŝŐĂƚŝŽŶƐ ;,^/Ϳ ĂŶĚ ŶĨŽƌĐĞŵĞŶƚ ĂŶĚ ZĞŵŽǀĂů KƉĞƌĂƚŝŽŶƐ ; ZKͿ͘ What are “ICE raids”?

A raid is an enforcement tactic ICE uses to confront immigrants ǁŚŽ ŚĂǀĞ ĂŶ ŽƵƚƐƚĂŶĚŝŶŐ ĚĞƉŽƌƚĂƚŝŽŶ ŽƌĚĞƌ͘ ĚĚŝƚŝŽŶĂůůLJ͕ ŝƚ ŝƐ ƵƐĞĚ ƚŽ ĨŝŶĚ ŽƚŚĞƌ ŝŵŵŝŐƌĂŶƚƐ ǁŚŽ ŵĂLJ ďĞ ŝŶ ƚŚĞ ĐŽƵŶƚƌLJ illegally.

What are ICE officials empowered to do during a raid? / ĂŐĞŶƚƐ ĚŽ ŶŽƚ ŚĂǀĞ ƚŚĞ ƌĂŶŬ ŽĨ ͞ƐƉĞĐŝĂů ĂŐĞŶƚ͟Ͷ ǁŚĂƚ͛Ɛ ŬŶŽǁŶ ŝŶ ĨĞĚĞƌĂů ŐƵŝĚĞůŝŶĞƐ ĂƐ ϭϴϭϭ ƐƚĂƚƵƐ ͶǁŚŝĐŚ ƐĞƚƐ ŽĨĨŝĐĞƌƐ ŽŶ ƚŚĞ ƐĂŵĞ ůĞǀĞů ĂƐ & / ĂŐĞŶƚƐ ĂŶĚ ĂůůŽǁƐ ƚŚĞŵ ƚŽ ĞdžĞĐƵƚĞ Ă ƐĞĂƌĐŚ ǁĂƌƌĂŶƚ͘ dŚĞLJ ƉŽƐƐĞƐƐ ĂŶ ϭϴϬϭ ĐůĂƐƐŝĨŝĐĂƚŝŽŶ͕ Ă ƉŽƐŝƚŝŽŶ ƚLJƉŝĐĂůůLJ ŚĂǀŝŶŐ ůŝŵŝƚĞĚ ƉŽǁĞƌƐ͘ / ĂŐĞŶƚƐ ŵĂLJ ďĞ ŝŶ ƉŽƐƐĞƐƐŝŽŶ ŽĨ Ă ǁĂƌƌĂŶƚ ƚŚĂƚ ƉĞƌŵŝƚƐ ƚŚĞŵ ƚŽ ĞŶƚĞƌ Ă ŚŽŵĞ Žƌ ĨĂĐŝůŝƚLJ͘ /Ĩ ƚŚĞLJ ĚŽ ŶŽƚ ŚĂǀĞ Ă ǁĂƌƌĂŶƚ͕ ƚŚĞLJ ŵƵƐƚ ŽďƚĂŝŶ ĐŽŶƐĞŶƚ ƚŽ ĞŶƚĞƌ͘ / ĂŐĞŶƚƐ ŚĂǀĞ ďĞĞŶ ŬŶŽǁŶ to resort to intimidation tactics – the element of surprise, ĚĞŵĂŶĚŝŶŐ ĞŶƚƌLJ ĂŶĚ ƉŽƐƐŝďůLJ ĚƌĂǁŝŶŐ ƚŚĞŝƌ ǁĞĂƉŽŶƐ ʹ ŝŶ ŽƌĚĞƌ ƚŽ ŝŵƉůLJ ƚŚĂƚ ĐŽŶƐĞŶƚ ŵƵƐƚ ďĞ ŐŝǀĞŶ͕ ďƵƚ ƚŚĞLJ ĂƌĞ ŶŽƚ ĂůůŽǁĞĚ ƚŽ ĞŶƚĞƌ ǁŝƚŚŽƵƚ ĐŽŶƐĞŶƚ͘ Agents aren’t limited to arresting their initial targets. Based on information provided by people in the raided homes or ĨĂĐŝůŝƚŝĞƐ͕ ĂŐĞŶƚƐ ĐĂŶ ŵĂŬĞ ĂĚĚŝƚŝŽŶĂů ĂƌƌĞƐƚƐ͘ WĞŽƉůĞ ǁŚŽ admit to being in the country illegally are taken into custody ĂůŽŶŐ ǁŝƚŚ ŽƚŚĞƌƐ͘

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California Family Physician Spring 2019

,Žǁ ŚĂǀĞ / ƌĂŝĚƐ ĐŚĂŶŐĞĚ͍ Until recently, ICE has abided by a policy intended to give ƵŶĚŽĐƵŵĞŶƚĞĚ ŝŵŵŝŐƌĂŶƚƐ Ă ƐĞŶƐĞ ŽĨ ƐĂĨĞƚLJ ŝŶ ͞ƐĞŶƐŝƚŝǀĞ ůŽĐĂƚŝŽŶƐ͕͟ ŝŶĐůƵĚŝŶŐ ƐĐŚŽŽůƐ͕ ƉůĂĐĞƐ ŽĨ ǁŽƌƐŚŝƉ ĂŶĚ ŚŽƐƉŝƚĂůƐ͘ Anecdotal evidence suggests that ICE has been operating more often in the vicinity of sensitive locations to conduct raids. ,Žǁ ĚŽĞƐ ƚŚĞ ƉŽƚĞŶƚŝĂů ĨŽƌ ĂŶ / ƌĂŝĚ ĂĨĨĞĐƚ LJŽƵƌ ƉĂƚŝĞŶƚƐ͍ The primary effect of the threat of an ICE raid on a health care facility is a reticence among patients to seek medical care.

Three steps should be taken by family physicians: ϭ͘ WƌĞƉĂƌĞ LJŽƵƌ ƚĞĂŵ͕ ƉƌĂĐƚŝĐĞ ĂŶĚͬŽƌ ĨĂĐŝůŝƚLJ ƚŽ ƌĞƐƉŽŶĚ ƚŽ Ă ƌĂŝĚͬ/ ŝŶƚĞƌǀĞŶƚŝŽŶ Ϯ͘ /ŶĨŽƌŵ LJŽƵƌ ƉĂƚŝĞŶƚƐ ĂďŽƵƚ ƚŚĞŝƌ ƌŝŐŚƚƐ ϯ͘ 'ĂƚŚĞƌ ŝŶĨŽƌŵĂƚŝŽŶ ĂďŽƵƚ ĂŶ / ƌĂŝĚ ƚŚĂƚ ŚĂƐ ĂůƌĞĂĚLJ occurred

How family physicians should prepare for or respond to an ICE raid ƐƚĂďůŝƐŚ Ă ǁƌŝƩĞŶ ƉŽůŝĐLJ ŝĚĞŶƟĨLJŝŶŐ ĂƌĞĂƐ ŽĨ ƚŚĞ ĐůŝŶŝĐ ĂƐ ƉƌŝǀĂƚĞ ĂŶĚ ŶŽƚ ŽƉĞŶ ƚŽ ƚŚĞ ŐĞŶĞƌĂů ƉƵďůŝĐ͘ &Žƌ ĞdžĂŵƉůĞ͕ ĞdžĂŵŝŶŝŶŐ ƌŽŽŵƐ͕ ŽĸĐĞƐ ĂŶĚ ƌĞĐŽƌĚƐ ĂƌĞĂƐ͘ ůƚĞƌŶĂƟǀĞůLJ͕ ƚŚĞ ǁĂŝƟŶŐ ƌŽŽŵ ŵĂLJ ďĞ ŽƉĞŶ ŽŶůLJ ƚŽ ƉĂƟĞŶƚƐ ĂŶĚ ƉĞƌƐŽŶƐ ĂĐĐŽŵƉĂŶLJŝŶŐ ƚŚĞŵ͕ ǁŚŝůĞ ƚŚĞ ƉƵďůŝĐ ŵƵƐƚ ƌĞŵĂŝŶ ŝŶ ĂƌĞĂƐ ŽƵƚƐŝĚĞ ƚŚĞ building. ĞƐŝŐŶĂƚĞ Ă ƐƉĞĐŝĮĐ ƉĞƌƐŽŶ Žƌ ƉĞƌƐŽŶƐ ƌĞƐƉŽŶƐŝďůĞ ĨŽƌ ŚĂŶĚůŝŶŐ ĐŽŶƚĂĐƚƐ ǁŝƚŚ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ŽĸĐŝĂůƐ͘ dƌĂŝŶ Ăůů ŽƚŚĞƌ ƐƚĂī ƚŽ ŝŶĨŽƌŵ ŝŵŵŝŐƌĂƟŽŶ Žƌ ŽƚŚĞƌ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ŽĸĐŝĂůƐ ƚŚĂƚ ŽŶůLJ ƚŚĞ ĚĞƐŝŐŶĂƚĞĚ ŝŶĚŝǀŝĚƵĂůƐ ĂƌĞ ĂƵƚŚŽƌŝnjĞĚ ƚŽ ƌĞǀŝĞǁ Ă ǁĂƌƌĂŶƚ Žƌ ƚŽ ĐŽŶƐĞŶƚ ƚŽ ƚŚĞŝƌ ĞŶƚƌLJ ŝŶƚŽ ƉƌŝǀĂƚĞ ĂƌĞĂƐ͘ /Ĩ ŝŵŵŝŐƌĂƟŽŶ ĂŐĞŶƚƐ ĂƐŬ ƉĞƌŵŝƐƐŝŽŶ Žƌ ĂƩĞŵƉƚ ƚŽ ĞŶƚĞƌ Ă ƉƌŝǀĂƚĞ ĂƌĞĂ͕ ƚŚĞ ĚĞƐŝŐŶĂƚĞĚ ƉĞƌƐŽŶ ƐŚŽƵůĚ ƐƚĂƚĞ ĞdžƉůŝĐŝƚůLJ ƚŚĂƚ ŚĞͬƐŚĞ ĚŽĞƐ ŶŽƚ ĐŽŶƐĞŶƚ ƚŽ entry without a warrant. /Ĩ ƚŚĞ ĂŐĞŶƚƐ ŝŶĚŝĐĂƚĞ ƚŚĂƚ ƚŚĞLJ ǁŝůů ŐĞƚ Ă ǁĂƌƌĂŶƚ͕ ĐŽŶƚĂĐƚ Ă ůĂǁLJĞƌ ĂŶĚ ƚƌLJ ƚŽ ŚĂǀĞ ƚŚĂƚ ƉĞƌƐŽŶ ƉƌĞƐĞŶƚ ĨŽƌ ƚŚĞ ƐĞĂƌĐŚ͘ tŚĞŶ ƉƌĞƐĞŶƚĞĚ ǁŝƚŚ Ă ǁĂƌƌĂŶƚ͕ ƚŚĞ ĚĞƐŝŐŶĂƚĞĚ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ĐŽŶƚĂĐƚ;ƐͿ ƐŚŽƵůĚ ƌĞǀŝĞǁ ƚŚĞ ǁĂƌƌĂŶƚ ĨŽƌ ǀĂůŝĚŝƚLJ͘ ǁĂƌƌĂŶƚ ŝƐ ŶŽƚ ǀĂůŝĚ ƵŶůĞƐƐ ŝƚ ŝƐ ƐŝŐŶĞĚ ďLJ Ă ũƵĚŐĞ ĂŶĚ ƐƚĂƚĞƐ ƚŚĞ ĂĚĚƌĞƐƐ ŽĨ ƚŚĞ ƐƉĞĐŝĮĐ ƉƌĞŵŝƐŝƐ ƚŽ ďĞ ƐĞĂƌĐŚĞĚ͘ /Ĩ ƚŚĞ ŝŵŵŝŐƌĂƟŽŶ ĂŐĞŶƚƐ ŚĂǀĞ Ă ǀĂůŝĚ ǁĂƌƌĂŶƚ͕ ƚŚĞLJ ĐĂŶ ĞŶƚĞƌ ƚŚĞ ƉƌŝǀĂƚĞ ĂƌĞĂƐ ĂŶĚ ƋƵĞƐƟŽŶ ĂŶLJŽŶĞ ƉƌĞƐĞŶƚ͘ ZĞŵŝŶĚ Ăůů ƉĂƟĞŶƚƐ ĂŶĚ ŽƚŚĞƌ ƉĞƌƐŽŶƐ ƉƌĞƐĞŶƚ ƚŚĂƚ ƚŚĞLJ ŚĂǀĞ ƚŚĞ ƌŝŐŚƚ ŶŽƚ ƚŽ ĂŶƐǁĞƌ ĂŶLJ ƋƵĞƐƟŽŶƐ͘ WƌŽǀŝĚĞ ƉŽƐƚĞƌƐ͕ ͞<ŶŽǁ zŽƵƌ ZŝŐŚƚƐ͟ ĐĂƌĚƐ ĂŶĚ ĞĚƵĐĂƟŽŶĂů ŵĂƚĞƌŝĂůƐ ĂĚǀŝƐŝŶŐ ƉĂƟĞŶƚƐ ƚŚĂƚ ƚŚĞLJ ŚĂǀĞ ƚŚĞ ƌŝŐŚƚ ƚŽ ƌĞĨƵƐĞ ƚŽ ĂŶƐǁĞƌ ƋƵĞƐƟŽŶƐ ĨƌŽŵ ŝŵŵŝŐƌĂƟŽŶ ĂŐĞŶƚƐ ĂŶĚ ƚŽ ĂƐŬ ƚŚĂƚ Ă ůĂǁLJĞƌ ďĞ ƉƌĞƐĞŶƚ ŝĨ ƚŚĞLJ ĂƌĞ ƋƵĞƐƟŽŶĞĚ͘ ĚǀŝƐĞ ƉĂƟĞŶƚƐ ŶĞǀĞƌ ƚŽ ƌƵŶ ĨƌŽŵ ŝŵŵŝŐƌĂƟŽŶ ŽĸĐŝĂůƐ͕ ĂƐ ƚŚŝƐ ĐĂŶ ĐĂƵƐĞ ƚŚĞŵ ƚŽ ďĞ ĂƌƌĞƐƚĞĚ͘ ,ĂǀĞ ƉĂƟĞŶƚƐ Įůů ŽƵƚ Ă ĐĂƌĞŐŝǀĞƌ ĂƵƚŚŽƌŝnjĂƟŽŶ ĂĸĚĂǀŝƚ ĨŽƌ ŵŝŶŽƌ ĐŚŝůĚƌĞŶ͘ dŚŝƐ ǁŝůů ĂůůŽǁ ĂŶŽƚŚĞƌ ƌĞůĂƟǀĞ ƚŽ ƚĂŬĞ Ă ĐŚŝůĚ ƚŽ ĂŶ ĂƉƉŽŝŶƚŵĞŶƚ ŝĨ ƚŚĞ ƉĂƌĞŶƚƐ ĂƌĞ ƵŶĂǀĂŝůĂďůĞ ƚŽ ĚŽ ƐŽ ƚŚĞŵƐĞůǀĞƐ͘ ZĞĂĐŚ ŽƵƚ ƚŽ ŝŵŵŝŐƌĂŶƚ ƌŝŐŚƚƐ ŐƌŽƵƉƐ͕ ůŝŬĞ ƚŚĞ ĂůŝĨŽƌŶŝĂ /ŵŵŝŐƌĂŶƚ WŽůŝĐLJ ĞŶƚĞƌ͕ ƚŽ ŚĞůƉ ĐƌĞĂƚĞ ƚƌĂŝŶŝŶŐƐ ĨŽƌ LJŽƵƌ ƐƚĂī ĂŶĚ ƉĂƟĞŶƚƐ͘ ,ĂǀĞ ƐƚĂī ƌŽůĞͲƉůĂLJ ƚŚĞŝƌ ƌĞƐƉŽŶƐĞƐ ƚŽ ĂŶ ŝŵŵŝŐƌĂƟŽŶ ƌĂŝĚ ŽŶ ƚŚĞ ĐůŝŶŝĐ͕ ƐŽ ƚŚĞLJ ĂƌĞ ƉƌĞƉĂƌĞĚ ƚŽ ƌĞƐƉŽŶĚ ĐŽŶĮĚĞŶƚůLJ ŝŶ Ă ƐƚƌĞƐƐĨƵů ƐŝƚƵĂƟŽŶ͘ ƐƚĂďůŝƐŚ Ă ƌĞůĂƟŽŶƐŚŝƉ ǁŝƚŚ ĂŶ ŝŵŵŝŐƌĂƟŽŶ ĂƩŽƌŶĞLJ ǁŚĞŶ ƉŽƐƐŝďůĞ Žƌ Ă ůĂǁLJĞƌ͕ ƐƵĐŚ ĂƐ Ă ďŽĂƌĚ ŵĞŵďĞƌ ǁŚŽ ŝƐ ĂŶ ĂƩŽƌŶĞLJ͕ ǁŚŽ ĐĂŶ ďĞ ĂǀĂŝůĂďůĞ ŝĨ an agent comes into the clinic.

KďƚĂŝŶ ĐŽŶƚĂĐƚ ŝŶĨŽƌŵĂƟŽŶ ;Ğ͘Ő͕͘ ƉŚŽŶĞ ŶƵŵďĞƌƐͿ ĨŽƌ ĨŽƌĞŝŐŶ ĐŽŶƐƵůĂƚĞƐ ŝŶ LJŽƵƌ ĂƌĞĂ ĂŶĚ ƚŚĞ ƉŚŽŶĞ ŶƵŵďĞƌ ŽĨ ƚŚĞ ůŽĐĂů / ĚĞƚĞŶƟŽŶ ĐĞŶƚĞƌ ƚŽ ŚĞůƉ ƚŚĞ ĨĂŵŝůŝĞƐ ŽĨ ƉĂƟĞŶƚƐ ǁŚŽ ŵĂLJ ďĞ ĚĞƚĂŝŶĞĚ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ŝĐĞ͘ŐŽǀͬĚĞƚĞŶƟŽŶͲĨĂĐŝůŝƟĞƐ͘

/ŶĨŽƌŵ ƉĂƟĞŶƚƐ ŽĨ ƚŚĞŝƌ ƌŝŐŚƚƐ ƐŽ ƚŚĞLJ ŬŶŽǁ ƚŚĞLJ ƐŚŽƵůĚ͗ ZĞŵĂŝŶ ƐŝůĞŶƚ Žƌ ƚĞůů ƚŚĞ / ĂŐĞŶƚ ƚŚĂƚ ƚŚĞLJ ǁĂŶƚ ƚŽ ƌĞŵĂŝŶ ƐŝůĞŶƚ͘ ƐŬ ƚŽ ƐƉĞĂŬ ǁŝƚŚ Ă ůĂǁLJĞƌ͘ NOT carry false documents. ĂƌƌLJ Ă ͞ŬŶŽǁ LJŽƵƌ ƌŝŐŚƚƐ ĐĂƌĚ͟ &ŝŶĚ ŽƵƚ ƚŚĞ ŶĂŵĞ ĂŶĚ ƉŚŽŶĞ ŶƵŵďĞƌ ŽĨ Ă ƌĞůŝĂďůĞ ŝŵŵŝŐƌĂƟŽŶ ĂƩŽƌŶĞLJ ĂŶĚ ŬĞĞƉ ƚŚĂƚ ŝŶĨŽƌŵĂƟŽŶ ǁŝƚŚ ƚŚĞŵ Ăƚ Ăůů ƟŵĞƐ͘ <ŶŽǁ ƚŚĞŝƌ ͞ĂůŝĞŶ ƌĞŐŝƐƚƌĂƟŽŶ ŶƵŵďĞƌ͟ ;͞ ͟ ŶƵŵďĞƌͿ ŝĨ ƚŚĞLJ ŚĂǀĞ ŽŶĞ ĂŶĚ ǁƌŝƚĞ ŝƚ ĚŽǁŶ ƐŽŵĞ ƉůĂĐĞ Ăƚ ŚŽŵĞ ǁŚĞƌĞ ƚŚĞŝƌ ĨĂŵŝůLJ ŵĞŵďĞƌƐ ŬŶŽǁ ǁŚĞƌĞ ƚŽ ĮŶĚ ŝƚ͘

/Ĩ ĂŶ / ƌĂŝĚ ŚĂƐ ŽĐĐƵƌƌĞĚ͕ ŐĂƚŚĞƌ ŝŶĨŽƌŵĂƟŽŶ ĂďŽƵƚ ƚŚĞ ƌĂŝĚ͕ ŝŶĐůƵĚŝŶŐ͗ ŽŶĮƌŵŝŶŐ ǁŚĞƚŚĞƌ ƚŚĞ ƌĂŝĚ;ƐͿ ŽĐĐƵƌƌĞĚ͗ Ă͘ tŚĞƚŚĞƌ ƚŚĞ ƌĂŝĚ ǁĂƐ ĐĞŶƚĞƌĞĚ ŽŶ Ă ǁŽƌŬƉůĂĐĞ;ƐͿ ĂŶĚ ǁŚŝĐŚ ůŽĐĂƟŽŶƐ͖ ď͘ ƉƉƌŽdžŝŵĂƚĞ ŶƵŵďĞƌ ŽĨ ƉĞƌƐŽŶƐ ĂƉƉƌĞŚĞŶĚĞĚ͖ Đ͘ /ĚĞŶƟƟĞƐ ŽĨ ƉĞƌƐŽŶƐ ĂƉƉƌĞŚĞŶĚĞĚ͖ Ě͘ >ŽĐĂƟŽŶ ŽĨ ƚŚĞ ŝŶŝƟĂů ĚĞƚĞŶƟŽŶ ;ĨƌĞƋƵĞŶƚůLJ Ă ůŽĐĂů ĨĂĐŝůŝƚLJ ŝƐ ƵƐĞĚ ĨŽƌ ƚĞŵƉŽƌĂƌLJ ŚŽůĚŝŶŐ ĂŶĚ ƉƌŽĐĞƐƐŝŶŐͿ͘ dŚĞ ŶĂŵĞƐ ĂŶĚ ďĂĚŐĞ ŶƵŵďĞƌƐ ŽĨ / ĂŐĞŶƚƐ͖ ŶLJ ĂŶĚ Ăůů ĂĐƟŽŶƐ ƚĂŬĞŶ ďLJ / ĂŐĞŶƚƐ ƚŚĂƚ ŵĂLJ ďĞ ƵŶůĂǁĨƵů͖ tŚĞƚŚĞƌ / ŝƐ ƐĐƌĞĞŶŝŶŐ ƉĞƌƐŽŶƐ ĨŽƌ ŚƵŵĂŶŝƚĂƌŝĂŶ ƌĞůĞĂƐĞƐ ;ƐŝŶŐůĞ ƉĂƌĞŶƚƐͬĐĂƌĞŐŝǀĞƌƐ͕ ƉĞŽƉůĞ ǁŝƚŚ ŚĞĂůƚŚ ŝƐƐƵĞƐ͕ ĞƚĐ͘Ϳ͖ tŚĞƚŚĞƌ / ŚĂƐ ĐƌĞĂƚĞĚ ĂŶ ϴϬϬη ĨŽƌ ĨĂŵŝůLJ ŵĞŵďĞƌƐ ƚŽ ůĞĂƌŶ ŝĨ ƚŚĞŝƌ ƌĞůĂƟǀĞƐ ŚĂǀĞ ďĞĞŶ ĂƉƉƌĞŚĞŶĚĞĚ ĂŶĚ ǁŚĞƌĞ ƚŚĞLJ ĂƌĞ ĚĞƚĂŝŶĞĚ͖ ĂŶĚ What arrangements are being made for minor children and other involvement by state social services agencies.

Ŷ ĞdžƚĞŶƐŝǀĞ ůŝƐƚ ŽĨ ƌĞƐŽƵƌĐĞƐ ŽŶ / ĂŶĚ ŽƚŚĞƌ ŝŵŵŝŐƌĂƟŽŶ ŝƐƐƵĞƐ ĐĂŶ ďĞ ĨŽƵŶĚ ŽŶ ƚŚĞ ,ĞĂůƚŚLJ ,ĂƌďŽƌƐ page on www.familydocs.org.

California Family Physician Spring 2019

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Sheryl Recinos, MD

Exploring the Intersection of Health Care and Housing We have not seen a better time to discuss the social ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ ĂŶĚ ŚŽǁ ƚŚĞLJ ĂĨĨĞĐƚ ŚĞĂůƚŚ ŝŶ ŽƵƌ ĐŽŵŵƵŶŝƚLJ͘ WĂƚŝĞŶƚƐ ǁŝƚŚ ŝŶĂĚĞƋƵĂƚĞ Žƌ ŝŶƐĞĐƵƌĞ ŚŽƵƐŝŶŐ ĞdžƉĞƌŝĞŶĐĞ ŚŝŐŚĞƌ ůĞǀĞůƐ ŽĨ ƐƚƌĞƐƐ ĂŶĚ ŝŶĐƌĞĂƐĞĚ ŝŶĐŝĚĞŶĐĞ ŽĨ pulmonary and cardiovascular diseases. Additionally, patients ǁŚŽ ůŝǀĞ ŝŶ ĐƌŽǁĚĞĚ ŚŽƵƐŝŶŐ Žƌ ůĂĐŬ ŚŽƵƐŝŶŐ ĂƌĞ Ăƚ ŚŝŐŚĞƌ ƌŝƐŬ of infectious diseases. Homelessness is a serious concern as it greatly impacts patients’ morbidity and mortality. In California, ƉĂƚŝĞŶƚƐ ǁŚŽ ĂƌĞ ĐŚƌŽŶŝĐĂůůLJ ŚŽŵĞůĞƐƐ ŚĂǀĞ Ă ƐŝŐŶŝĨŝĐĂŶƚůLJ ƌĞĚƵĐĞĚ ůŝĨĞ ĞdžƉĞĐƚĂŶĐLJ ĐŽŵƉĂƌĞĚ ƚŽ ƚŚĞ ŵĂŝŶƐƚƌĞĂŵ ƉŽƉƵůĂƚŝŽŶ͘ tŚĞƌĞĂƐ ƚŚĞ h^ ůŝĨĞ ĞdžƉĞĐƚĂŶĐLJ ƌĂŶŐĞƐ ĨƌŽŵ ϳϲ ƚŽ ϴϭ LJĞĂƌƐ ŽĨ ĂŐĞ͕ ŚŽŵĞůĞƐƐ ƉĂƚŝĞŶƚƐ ĐĂŶ ĞdžƉĞĐƚ ŽŶůLJ ƚŽ ƐƵƌǀŝǀĞ ĂŶLJǁŚĞƌĞ ďĞƚǁĞĞŶ ϰϮ ƚŽ ϱϮͲLJĞĂƌƐͲŽůĚ͘ As housing costs rise and previously housed people are ƉƵƐŚĞĚ ŽŶƚŽ ƚŚĞ ƐƚƌĞĞƚƐ͕ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƉĞŽƉůĞ ĞdžƉĞƌŝĞŶĐŝŶŐ homelessness continues to climb in California and across the ŶĂƚŝŽŶ͘ dŚĞ ŐƌŽǁƚŚ ŽĨ ƚĞŶƚ ĐŝƚŝĞƐ ĂĐƌŽƐƐ ĂůŝĨŽƌŶŝĂ ŵĂLJ ƉƌŽǀĞ ƚŽ ďĞ ĂŶ ĞLJĞƐŽƌĞ ĨŽƌ ŵĂŶLJ͕ ďƵƚ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ƐŚŽƵůĚ see this as an opportunity. Our communities are greatly affected, and our impoverished populations are at risk. Many ĨĂŵŝůŝĞƐ ĂƌĞ ǁŝƚŚŝŶ ŽŶĞ ƉĂLJĐŚĞĐŬ ŽĨ ůŽƐŝŶŐ ƚŚĞŝƌ ŚŽƵƐŝŶŐ͘ dŚĞƐĞ ĂƌĞ ƚŚĞ ƐĂŵĞ ĨĂŵŝůŝĞƐ ǁŚŽ ƐƚƌƵŐŐůĞ ƚŽ ƉƵƌĐŚĂƐĞ ŶƵƚƌŝƚŝŽƵƐ ĨŽŽĚ ĂŶĚ ƉĂLJ ƚŚĞŝƌ ƉƌĞƐĐƌŝƉƚŝŽŶ ĐŽͲƉĂLJƐ͘ ͞,ƵŵĂŶ ĚŝŐŶŝƚLJ ŝƐ ŶŽƚ ƵŶŝƋƵĞ ƚŽ ƚŚŽƐĞ ǁŝƚŚ ƌŽŽĨƐ ŽǀĞƌ ƚŚĞŝƌ ŚĞĂĚƐ͕͟ ƐƚĂƚĞƐ ƉƵůŵŽŶĂƌLJ and critical care specialist Tabassum Nafsi, MD. Unfortunately, medical conditions can be both a cause of ŚŽŵĞůĞƐƐŶĞƐƐ͕ ĂƐ ǁĞůů ĂƐ ĂŶ ŽƵƚĐŽŵĞ ŽĨ ůŝǀŝŶŐ ŽŶ ƚŚĞ ƐƚƌĞĞƚƐ͘ In fact, 50 percent of all bankruptcies are caused by health care ĞdžƉĞŶƐĞƐ͘ /Ĩ ƚŚŽƐĞ ƉĂƚŝĞŶƚƐ ŚĂǀĞ ŶŽ ƐĂĨĞƚLJ ŶĞƚ͕ ƚŚĞLJ ĂƌĞ Ăƚ ƌŝƐŬ of losing their housing and finding themselves alongside many of our chronically homeless patients.

Chronic health conditions such as substance abuse, mental health disorders, pulmonary disorders, infectious diseases such ĂƐ ƚƵďĞƌĐƵůŽƐŝƐ͕ ŚĞƉĂƚŝƚŝƐ͕ ,/sͬ / ^ ĂŶĚ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƚƚĞĚ infections are found in homeless youth. Homeless adults ƐƵĨĨĞƌ ĨƌŽŵ Ăůů ŽĨ ƚŚĞƐĞ ŝůůŶĞƐƐĞƐ͕ ĂƐ ǁĞůů ĂƐ ƚŚĞ ůŽŶŐ ƚĞƌŵ effects of poorly treated heart disease, liver disease, kidney disease and lung disease. 'ĂƐƚƌŽĞŶƚĞƌŽůŽŐŝƐƚ ƌŝƐƚŝŶĂ DĂƌŝŶ͕ D ͕ ƌĞůĂƚĞƐ Ă ƐƚŽƌLJ ŽĨ ƚĂĐŬůŝŶŐ ďĂƌƌŝĞƌƐ ƚŽ ĐĂƌĞ ĨŽƌ Ă ƉĂƚŝĞŶƚ ƐƚƌƵŐŐůŝŶŐ ǁŝƚŚ ďŽƚŚ schizophrenia and homelessness. While undergoing treatment 28

California Family Physician Spring 2019

^ŚĞƌLJů ĂŶĚ ŚĞƌ ŚƵƐďĂŶĚ LJƌŽŶ ZĞĐŝŶŽƐ͕ ƐĞƌǀŝŶŐ Ă ŵĞĂů ƚŚĞLJ ƉƌĞƉĂƌĞĚ ĨŽƌ homeless youth at My Friend’s Place in Hollywood.

ĨŽƌ ,ĞƉĂƚŝƚŝƐ ͕ ŚĞƌ ƉĂƚŝĞŶƚ ƐƚƌƵŐŐůĞĚ ǁŝƚŚ ƉĂLJŝŶŐ ĨŽƌ ŚŝƐ ŵĞĚŝĐŝŶĞ ĂŶĚ ŬĞĞƉŝŶŐ ƚƌĂĐŬ ŽĨ ǁŚĞƌĞ ƚŚĞ ŵĞĚŝĐŝŶĞƐ ǁĞƌĞ ůŽĐĂƚĞĚ͘ ƌ͘ DĂƌŝŶ ĂŶĚ ŚĞƌ ƐƚĂĨĨ ƐĞƚ ƵƉ ǁĞĞŬůLJ ŵĞĞƚŝŶŐƐ ǁŝƚŚ him so he could take his treatment at her clinic. He received Ă ŵĞĂů Ăƚ ĞĂĐŚ ŵĞĞƚŝŶŐ͕ ǁŚŝĐŚ ŚĞůƉĞĚ ŐĞƚ Śŝŵ ŝŶƚŽ ƚŚĞ ĐůŝŶŝĐ͘ Ɛ Ă ƌĞƐƵůƚ͕ ŚŝƐ ,ĞƉĂƚŝƚŝƐ ǁĂƐ ĐƵƌĞĚ͘ ƌ͘ DĂƌŝŶ ƌĞƉŽƌƚƐ ƚŚĂƚ͕ ͞/ĚĞŶƚŝĨLJŝŶŐ ŝƐƐƵĞƐ ƚŽ ŚĞůƉ ŚŽŵĞůĞƐƐ ƉĂƚŝĞŶƚƐ ŚĂǀĞ ŝŵƉƌŽǀĞĚ ĂĐĐĞƐƐ ŝƐ ǀŝƚĂů͘͟

Homeless patients encounter health care in a variety of ƐĞƚƚŝŶŐƐ͖ ŽĨƚĞŶ ŝŶ ƚŚĞ ĞŵĞƌŐĞŶĐLJ ƌŽŽŵ͕ ĂůƚŚŽƵŐŚ ŽƚŚĞƌƐ ƐĞĞŬ ĐĂƌĞ ŝŶ ĐŽŵŵƵŶŝƚLJ ĐůŝŶŝĐƐ ĂŶĚ ĨƌŽŵ ƉƌŽŐƌĂŵƐ ŐĞĂƌĞĚ ƚŽǁĂƌĚƐ ƚƌĞĂƚŝŶŐ ƉĂƚŝĞŶƚƐ ǁŚĞƌĞ ƚŚĞLJ ůŝǀĞ͘ EƵŵĞƌŽƵƐ ĨƌĞĞ ĐůŝŶŝĐƐ ĂŶĚ ŵŽďŝůĞ ŚĞĂůƚŚ ĐůŝŶŝĐƐ ƌĞĂĐŚ ŽƵƚ ƚŽ ƉĞŽƉůĞ ǁŚŽ ĂƌĞ ƐĐĂƚƚĞƌĞĚ amongst the city’s streets and offer specialized care for this disadvantaged population.

On the frontlines of the crisis are primary ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ƐƵĐŚ ĂƐ &W ϮϬϭϵ ,ĞƌŽ of Family Medicine, Jasmeet Bains, MD. tŚĞŶ ƐŚĞ ďĞŐĂŶ ǁŽƌŬŝŶŐ ŝŶ Ă &ĞĚĞƌĂůůLJͲ YƵĂůŝĨŝĞĚ ,ĞĂůƚŚ ĞŶƚĞƌ ;&Y, Ϳ ĐůŝŶŝĐ ŝŶ dĂĨƚ͕ ĂůŝĨŽƌŶŝĂ͕ ƐŚĞ ǁĂƐ ĂƐƚŽƵŶĚĞĚ ďLJ the lack of support services for her local homeless population. As a result, she began volunteering at a local homeless ƐŚĞůƚĞƌ͕ ͞ ĞĐĂƵƐĞ ŝƚ ŚĞůƉĞĚ ŵĞ ĐŚĞĐŬ up on my patients and at the same time understand my patients by observing their ďĞŚĂǀŝŽƌƐ ŽƵƚƐŝĚĞ ŽĨ ĐůŝŶŝĐ͘͟ While a smaller percentage of homeless individuals die as a direct result of ůŝǀŝŶŐ ŝŶ ĞdžƚƌĞŵĞ ĐŽŶĚŝƚŝŽŶƐ ;ĨƌŽƐƚďŝƚĞ͕ ŚLJƉŽƚŚĞƌŵŝĂ͕ ŝŵŵĞƌƐŝŽŶ ĨŽŽƚͿ͕ ƉĂƚŝĞŶƚƐ ǁŚŽ ŚĂǀĞ ĞdžƉĞƌŝĞŶĐĞĚ ĂŶĚ ƐƵƌǀŝǀĞĚ ĨƌŽŵ ĂŶLJ ŽĨ ƚŚĞƐĞ ĞdžƉŽƐƵƌĞƐ ĂƌĞ ĞŝŐŚƚ ƚŝŵĞƐ more likely to die from any cause. These patients could be easily identified and ƉƌŽǀŝĚĞĚ ǁŝƚŚ ŝŶĐƌĞĂƐĞĚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ĂƐ Ă preventative measure.

The numbers are staggering. As family ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ĂƌĞ ƚŚĞ ůĞĂĚĞƌƐ ǁŚŽ ĂƌĞ uniquely suited to step up and take a stand for housing and health care. We can reach out to local government officials, develop patient care plans for our homeless ƉŽƉƵůĂƚŝŽŶƐ ĂŶĚ ǀŽůƵŶƚĞĞƌ ǁŝƚŚŝŶ ƚŚĞ community. We can participate in clothing and food drives, community health fairs, ĂŶĚ ǁŽƌŬ ĂůŽŶŐƐŝĚĞ ůŽĐĂů ŽƌŐĂŶŝnjĂƚŝŽŶƐ ƚŚĂƚ ĂƌĞ ĞdžƉĞƌƚƐ ŝŶ ŵĞĞƚŝŶŐ ƚŚĞ ŶĞĞĚƐ ŽĨ ƚŚŝƐ ĞdžƉĂŶĚŝŶŐ ƉŽƉƵůĂƚŝŽŶ͘ tĞ ĂƌĞ ƵŶŝƋƵĞůLJ suited to identify needs and find remedies at the local, state and federal level. These are our patients, this is our community, ĂŶĚ ǁĞ ĐĂŶ ĚŽ ŵƵĐŚ ďĞƚƚĞƌ ƚŚĂŶ Ă ůŝĨĞ ĞdžƉĞĐƚĂŶĐLJ ŽĨ ϰϮ ƚŽ ϱϮͲLJĞĂƌƐͲŽůĚ͘

^ŚĞƌLJů ZĞĐŝŶŽƐ͕ D ͕ ŝƐ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ǁŽƌŬŝŶŐ ĂƐ Ă Hospitalist in Los Angeles County. She recently released her memoir entitled Hindsight: Coming of Age on the Streets of Hollywood͕ ŝŶ ǁŚŝĐŚ ƐŚĞ ƐŚĂƌĞƐ ŚĞƌ ĞdžƉĞƌŝĞŶĐĞƐ ĂƐ Ă formerly homeless teenager.

BECOME AN INTEGRAL PART OF AN EXCITING YOUNG RESIDENCY PROGRAM! Become an integral part of an exciting young residency program that began in 2013. We have full 10 year ACGME accreditation. Eisenhower Health in Rancho Mirage, California seeks to hire a MD faculty member to serve as part of our residency program. You will have outpatient care responsibilities and may choose to have inpatient care responsibilities. You will precept FM residents in the Center for Family Medicine. Faculty have protected time for curriculum management, resident advising, and scholarly work.

Board certification in Family Medicine (ABMS or AOA) is required. Academic appointment will be confirmed from the USC Keck School of Medicine or Western University of Health Sciences. Rank will depend upon experience and qualifications.

Eisenhower Health seeks candidates whose experience, teaching, research and community service have prepared them to contribute to our commitment to serving the Coachella Valley. Eisenhower is an EO/M employer.

Qualified applicants, including recent residency graduates, are encouraged to apply. Candidates should submit a digital CV and statement of interest to Scott Nass, MD, MPA, Program Director at SNass@eisenhowerhealth.org with . cc: Tamara Dunn at TDunn@eisenhowerhealth.org.

For questions, please contact Michelle Harding at mharding@eisenhowerhealth.org or 760-773-4504.

www.eisenhowerhealth.org California Family Physician Spring 2019

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ceo message

Lisa Folberg, MPP

Make It Work I had the pleasure of helping plan, implement and then attend ŵLJ ĨŝƌƐƚ &W ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƚŝŶŐ ; D DͿ ŝŶ ^ĂĐƌĂŵĞŶƚŽ ŝŶ DĂƌĐŚ͘ / ǁŝůů ĂĚŵŝƚ ƚŚĂƚ Ă ĨĞǁ ĚĂLJƐ ďĞĨŽƌĞ ǁĞ ŚĞĂĚĞĚ ƚŽ ^ĂĐƌĂŵĞŶƚŽ͕ / ǁĂƐŶ͛ƚ ƐƵƌĞ ǁĞ ǁĞƌĞ ŐŽŝŶŐ ƚŽ ŵĂŬĞ ŝƚ Ăůů ŚĂƉƉĞŶ͘ dŚƌŽƵŐŚ ŝƚ Ăůů / ǁŽƌŬĞĚ ǁŝƚŚ ŽƵƌ ƉŚLJƐŝĐŝĂŶ ůĞĂĚĞƌƐ ǁŚŽ ŶĞǀĞƌ ƐĞĞŵĞĚ ŶĞƌǀŽƵƐ Žƌ ƉĂŶŝĐŬĞĚ ĂďŽƵƚ ĞǀĞƌLJƚŚŝŶŐ ĐŽŵŝŶŐ ƚŽŐĞƚŚĞƌ͘ KŶĞ ŽĨ LJŽƵƌ ŽĂƌĚ ŵĞŵďĞƌƐ ĞdžƉůĂŝŶĞĚ ƚŚĂƚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝƐ Ă ƐĞƌŝĞƐ ŽĨ ŵĂŬĞ ŝƚ ǁŽƌŬ ŵŽŵĞŶƚƐ͘ ,Ğ ĂĚĚĞĚ ƚŚĂƚ ĂƐ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͕ LJŽƵ ŽĨƚĞŶ ĚŽŶ͛ƚ ŬŶŽǁ ǁŚĂƚ ƚŽ ĞdžƉĞĐƚ ǁŚĞŶ Ă ƉĂƚŝĞŶƚ ǁĂůŬƐ ƚŚƌŽƵŐŚ ƚŚĞ ĚŽŽƌ͘ EŽƚ ŽŶůLJ ĚŝĚ ƚŚĞ D D ǁŽƌŬ͕ ŝƚ ǁĂƐ ĨĂŶƚĂƐƚŝĐ͘ /ƚ ǁĂƐ ǁŽŶĚĞƌĨƵů to see so many people attending AMAM for the first time, and a ĚĞůŝŐŚƚ ƚŽ ƚĂůŬ ƚŽ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ŚĂǀĞ ĂƚƚĞŶĚĞĚ D D ƐŝŶĐĞ ŝƚƐ inception seven years ago.

share the plans they have put in place to keep ICE out of clinics and a brave member in tears as she shared for the first time in public that she is an abortion provider. I heard moms and dads ƚĂůŬŝŶŐ ĂďŽƵƚ ƚŚĞ ƐƚƌƵŐŐůĞƐ ŽĨ ďĂůĂŶĐŝŶŐ ǁŽƌŬ ĂŶĚ ƉĂƌĞŶƚŚŽŽĚ ĂŶĚ ŚŽǁ ŵƵĐŚ ƚŚĞLJ ŵŝƐƐ ƚŚĞŝƌ ŬŝĚƐ ŽŶ ǁĞĞŬĞŶĚƐ ůŝŬĞ ƚŚŝƐ͘ ǀĞŶ ǁŝƚŚ ƚŚĞƐĞ ĐŚĂůůĞŶŐĞƐ͕ ƐŽŵĞŚŽǁ LJŽƵ ŵĂŬĞ ŝƚ ǁŽƌŬ͘ dŚĞ ĐŽŵŵŝƚŵĞŶƚ ƚŽ &W ĂŶĚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ǁĂƐ ĞǀŝĚĞŶƚ throughout the AMAM. The Family Physician Political Action ŽŵŵŝƚƚĞĞ ;&WͲW Ϳ ƌĂŝƐĞĚ ŵŽƌĞ ŵŽŶĞLJ ƚŚĂŶ ŝŶ ĂŶLJ ƉƌĞǀŝŽƵƐ LJĞĂƌ͘ dŚĂŶŬ LJŽƵ ƚŽ ĞĂĐŚ ŽĨ LJŽƵ ǁŚŽ ŚĂƐ ŵĂĚĞ Ă ĚŽŶĂƚŝŽŶ ƚŽ &WͲ W ͘ tŝƚŚ LJŽƵƌ ŚĞůƉ͕ ĂŶ ĞdžƉĂŶĚĞĚ &WͲW ǁŝůů ĂůůŽǁ ƵƐ ƚŽ ŚĂǀĞ an even bigger voice in State legislative issues.

/ƚ ǁĂƐ ƉŽǁĞƌĨƵů ƚŽ ƐĞĞ Ă ƐĞĂ ŽĨ ǁŚŝƚĞ ĐŽĂƚƐ Ăƚ ƚŚĞ ĂƉŝƚŽů ŽŶ Monday after AMAM for the CAFP Day at the Capitol. CAFP D D ǁĂƐ Ă ǁŽŶĚĞƌĨƵů ŽƉƉŽƌƚƵŶŝƚLJ ĨŽƌ ŵĞ ƚŽ ŐĞƚ ƚŽ ŬŶŽǁ ŵŽƌĞ ŵĞŵďĞƌƐ ƚĂůŬĞĚ ǁŝƚŚ ůĞŐŝƐůĂƚŽƌƐ ĂŶĚ ƚŚĞŝƌ ƐƚĂĨĨƐ ĂďŽƵƚ &W͛Ɛ CAFP members and learn more about your practices. I spoke ƐƉŽŶƐŽƌĞĚ ďŝůů ϭϲϮϮ͕ ĂƵƚŚŽƌĞĚ ďLJ ƐƐĞŵďůLJ DĞŵďĞƌ tĞŶĚLJ ǁŝƚŚ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶƐ ĐŽŶƚĞŵƉůĂƚŝŶŐ ƌĞƚŝƌĞŵĞŶƚ͘ / ŵĞƚ Carillo. Your CAFP staff and contractors do a fantastic job ǁŝƚŚ WĞƌŵĂŶĞŶƚĞ ĂŶĚ ĐůŝŶŝĐ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƚŚŽƐĞ ĚŽŝŶŐ ĚŝƌĞĐƚ advocating on your behalf, but no one can tell your stories primary care. ƚŚĞ ǁĂLJ LJŽƵ ĐĂŶ͘ EŽ ŽŶĞ ĐĂŶ ƚĂůŬ ǁŝƚŚ ƚŚĞ ƐĂŵĞ ĂƵƚŚŽƌŝƚLJ ĂŶĚ ƉĂƐƐŝŽŶ ĂƐ LJŽƵ ĂďŽƵƚ LJŽƵƌ ĞdžƉĞƌŝĞŶĐĞ ǁŝƚŚ ƉĂƚŝĞŶƚƐ͕ ǁŚLJ / ǁĂƐ ĂůƐŽ ĂŵĂnjĞĚ Ăƚ ƚŚĞ ĚŝǀĞƌƐŝƚLJ ŽĨ ƉĞƌƐŽŶĂů ŝŶƚĞƌĞƐƚ ĂŶĚ LJŽƵ ĐŚŽƐĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ǁŚLJ ŝƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ƉƌŽƚĞĐƚ ƚĂůĞŶƚƐ ŝŶ ƚŚĞ ƌŽŽŵ͘ / ŐŽƚ ƚŽ ŬŶŽǁ ƌ͘ ^ŚĞƌLJů ZĞĐŝŶŽƐ͕ ǁŚŽ a family physician’s ability to practice full spectrum family ǁƌŽƚĞ Ă ďŽŽŬ ĂďŽƵƚ ŚĞƌ ĞdžƉĞƌŝĞŶĐĞ ĂƐ Ă ŚŽŵĞůĞƐƐ LJŽƵƚŚ ĂŶĚ medicine. ƌ͘ DŽĂnjnjĂŵ ĂǁũĂ ǁŚŽ ĚŽĞƐ ͞ƐƉŽŬĞŶ ǁŽƌĚ͟ ĂƐ Ă ǁĂLJ ƚŽ ƐƚĂLJ connected to his roots.

California is facing a number of challenges, from natural disasters and the shortage of affordable housing to primary dŚĞ ĚŝǀĞƌƐŝƚLJ ŽĨ ƉƌŽĨĞƐƐŝŽŶĂů ĂŶĚ ƉĞƌƐŽŶĂů ĞdžƉĞƌŝĞŶĐĞ ĂŶĚ care physician shortages and rising health care costs. Family perspectives made for rich and interesting discussions. Part of physicians are continually challenged to meet mounting the focus of the AMAM is discussing and providing testimony administrative burdens. Many of you face student debt and on resolutions for CAFP action or policy change – these ƌĞƐƚƌŝĐƚŝŽŶƐ ŽŶ ŚŽǁ LJŽƵ ĂƌĞ ĂďůĞ ƚŽ ĐĂƌĞ ĨŽƌ LJŽƵƌ ƉĂƚŝĞŶƚƐ͘ resolutions have been submitted by CAFP members for Board ǀĞŶ ǁŝƚŚ ƚŚĞƐĞ ĐŚĂůůĞŶŐĞƐ͕ LJŽƵ ƉƌŽǀŝĚĞ ŚŝŐŚ ƋƵĂůŝƚLJ ĐĂƌĞ ƚŚĂƚ consideration. Eleven resolutions included challenging issues, benefits your patients and the health care system. Evidence ĨƌŽŵ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ ĂŶĚ ƌĞƐŝĚĞŶƚ ǁĞůůŶĞƐƐ ƐŚŽǁƐ ƚŚĂƚ ĂĐĐĞƐƐ ƚŽ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ŽƚŚĞƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƚŽ ƌĞƉƌŽĚƵĐƚŝǀĞ ŚĞĂůƚŚ ĂŶĚ ĂŝĚͲŝŶͲĚLJŝŶŐ͘ KƵƌ ŵĞŵďĞƌƐ ǁĞƌĞ providers helps people live longer, healthier lives. In fact, a respectful and thoughtful in their comments. Not afraid to &ĞďƌƵĂƌLJ ϮϬϭϵ ƐƚƵĚLJ ŝŶ ƚŚĞ EĞǁ ŶŐůĂŶĚ :ŽƵƌŶĂů ŽĨ DĞĚŝĐŝŶĞ speak their minds, but gentle in their delivery. ƐŚŽǁĞĚ ƚŚĂƚ ĂƌĞĂƐ ǁŝƚŚ ŵŽƌĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ŚĂǀĞ ůŽŶŐĞƌ ůŝĨĞ ĞdžƉĞĐƚĂŶĐLJ͘ ^Ž͕ ĂƐ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ĚĞĐŝƐŝŽŶ ŵĂŬĞƌƐ͕ ^ŝƚƚŝŶŐ ŽŶ ƚŚĞ ĚĂŝƐ / ŚĂĚ ƚŽ ĨŝŐŚƚ ďĂĐŬ ŵLJ ŽǁŶ ĞŵŽƚŝŽŶƐ ĂƐ / ǁĂƐ LJŽƵ ǁŝůů ĂƉƉƌĞĐŝĂƚĞ ƚŚĂƚ ƐĐŝĞŶƚŝĨŝĐ ƌĞƐĞĂƌĐŚ ƐƵƉƉŽƌƚƐ ǁŚĂƚ / ƐĂǁ ƌĞŵŝŶĚĞĚ ŽĨ ƚŚĞ ƉŽǁĞƌ ĂŶĚ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƚŚĞ ǁŽƌŬ ƚŚĂƚ LJŽƵ ĚŽ at AMAM and CAFP Lobby Day, family physicians’ amazing ability for your patients across California. Listening to CAFP members to Make It Work.

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California Family Physician Spring 2019

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