Winter 2019

VO L . 70 N O. 1 Wi n t er 201 9

in this issue: ADDRESSING THE FAMILY MEDICINE WORKFORCE FOR THE FUTURE

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

ŽŶƌĂĚ ŵĞŶƚĂ

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 Chief Executive Officer Lisa Folberg, MPP Foundation President Marianne McKennett, MD AAFP Delegates Jeff Luther, MD ĂƌŽů ,ĂǀĞŶƐ͕ D

Director, CME/CPD jdavis@familydocs.org

ĚĂŵ &ƌĂŶĐŝƐ

Director, Government Affairs afrancis@familydocs.org

ůŝnjĂďĞƚŚ >ƵŬƌŝĐŚ

Manager, Communications and Social Media elukrich@familydocs.org

^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ͕ ͕ & ,W Deputy Executive Vice President srodrigues@familydocs.org

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

Jonathan Rudolph

Manager, Finance jrudolph@familydocs.org

CMA Delegation ƐŚďLJ tŽůĨĞ͕ D ͕ DW ͕ DW, ; ŚĂŝƌͿ Mark Dressner, MD Sumana Reddy, MD <ĞǀŝŶ ZŽƐƐŝ͕ D Lauren Simon, MD, MPH &Ğůŝdž EƵŶĞnj͕ D ͕ DW,

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 Cover art by Elizabeth Lukrich 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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4

California Family Physician Winter 2019

California

Winter 2019

FAMILY PHYSICIAN st ron g

me d i ci ne

f o r

C al i f o r nia

The cover poem was created by 25+ attendees at the July 2018 Strategic Planning meeting in a one-word-at-a-time exercise.

features 14 Healthy Harbors: Addressing Health Consequences of Immigration Policies 16 ABFM Offering a Longitudinal Pilot and Coming to CAFP to Answer Your Questions 18 25 x 2030: New Workforce Efforts Launched 20 I Believe We Must Come Out of the Shadows

Robert Assibey, MD

21 Family Medicine Must Create a New Environment of Inclusivity 22 Future of Family Medicine is a Calling

Zachary Nicholas Cynthia Chen-Joea, DO, MPH, CPH

24 I’m Inspired by Family Physicians, and the Way They Fought California Wildfires

Andrea Banuelos Mota

26 California’s Projected Primary Care Physician Needs Outstrip Supply

Conrad Amenta

28 PhD instead of MD: Why Mentorship Matters in Diversifying the Medical Workforce

Danielle Jones, MPH

departments 6

Editorial

Workforce Pipeline – The Public Has Other Options for the Drought

Brent Sugimoto, MD

8

President’s Message

Can Expansion of Scope Address Workforce Shortfalls in California?

Lisa M. Ward, MD, MScPH, MS

10 Political Pulse

CAFP Logs Another Victorious Year in Sacramento

Carla Kakutani, MD

12 In The News 30 CEO Message

CAFP empowers, educates and connects current and future family physicians to improve the health of all Californians

Lisa Folberg, MPP

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

5

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Workforce Pipeline – The Public Has Other Options for the Drought

dŚĂƚ ƚƌƵƐƚ ǁŽƵůĚ ĞƌŽĚĞ ƐŚŽƵůĚ ǁĞ ďĞĐŽŵĞ ƵŶĂďůĞ ƚŽ ĚĞůŝǀĞƌ ǁŚĂƚ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ ŶĞĞĚ͘ dŚĂƚ ƚƌƵƐƚ ǁŽƵůĚ ĨƌĂLJ ƐŚŽƵůĚ ǁĞ ďĞ ƐĞĞŶ ĂƐ ĂĐƟŶŐ ŝŶ Ă ƐĞůĨͲŝŶƚĞƌĞƐƚĞĚ ŵĂŶŶĞƌ͘ dŚĞ ŝƐƐƵĞ ƚŚĂƚ ƵƌŐĞŶƚůLJ ƚŚƌĞĂƚĞŶƐ ŽƵƌ ƐƉĞĐŝĂůƚLJ ŽŶ ƚŚĞƐĞ ƚǁŽ ĨƌŽŶƚƐ ŝƐ ƚŚŝƐ͗ ǁŽƌŬĨŽƌĐĞ ƉŝƉĞůŝŶĞ͘ /ƚ ŝƐ ĞƐƟŵĂƚĞĚ ƚŚĂƚ ƚŚĞ ŶĂƟŽŶ ǁŝůů ůĂĐŬ ƵƉ ƚŽ ϱϬ͕ϬϬϬ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ďLJ ϮϬϯϬ͘ /Ŷ ŚŝƐ ĂƌƟĐůĞ͕ ŽŶƌĂĚ ŵĞŶƚĂ ĚŝƐĐƵƐƐĞƐ ƚŚĞ ĐŚĂůůĞŶŐĞƐ ŝŶ ŵĞĞƟŶŐ ŽƵƌ ƐƚĂƚĞ͛Ɛ ŶĞĞĚƐ ĨŽƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ĂŶĚ ŚŽǁ ĞǀĞŶ increased residency slots are unlikely to close the gap. The fact ŝƐ ƚŚĂƚ͕ ĞǀĞŶ ǁŝƚŚ ŵŽƌĞ ĂŶĚ ŵŽƌĞ ŵĞĚŝĐĂů ŐƌĂĚƵĂƚĞƐ ĐŚŽŽƐŝŶŐ family medicine as their specialty, medical schools produce too ĨĞǁ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ŵĞĞƚ ƚŚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ŶĞĞĚƐ ŽĨ ŽƵƌ ƐƚĂƚĞ ĂŶĚ ŶĂƟŽŶ͘1 dŚĞ &ĞĚĞƌĂů dƌĂĚĞ ŽŵŵŝƐƐŝŽŶ ;&d Ϳ ƐĞĞƐ ƚŚĞ ŝŶƐƵĸĐŝĞŶƚ number of primary providers as a serious issue because it denies consumers access to the health care market. Furthermore, the &d ŝĚĞŶƟĮĞƐ ŵŝĚͲůĞǀĞů ƐĐŽƉĞͲŽĨͲƉƌĂĐƟĐĞ ůĂǁƐ ĂƐ ůŝŵŝƟŶŐ ͞ƚŚĞ supply of primary care services and giv[ing] one group of health care professionals [physicians] the ability to restrict access to ƚŚĞ ŵĂƌŬĞƚ ďLJ ĂŶŽƚŚĞƌ͕͟ ǁŚĞƌĞ ͞ŶĞǁ Žƌ ĞdžƚĞŶĚĞĚ ůĂLJĞƌƐ ŽĨ ŵĂŶĚĂƚŽƌLJ ƉŚLJƐŝĐŝĂŶ ƐƵƉĞƌǀŝƐŝŽŶ ŵĂLJ ŶŽƚ ďĞ ũƵƐƟĮĞĚ͘͟Ϯ It is disturbing that one group perceives physicians as denying ĐĂƌĞ ƚŽ ƉĂƟĞŶƚƐ͕ ďƵƚ ŝƚ ŝƐ ĐĂƵƐĞ ĨŽƌ ƐĞůĨͲƌĞŇĞĐƟŽŶ͘ ,Žǁ ŵƵĐŚ ĚŽ ƉŚLJƐŝĐŝĂŶƐ ĐŽŶƚƌŝďƵƚĞ ƚŽ ƚŚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐŚŽƌƚĂŐĞ͍ dǁĞŶƚLJͲƚǁŽ ƐƚĂƚĞƐ͕ ƚŚĞ ŝƐƚƌŝĐƚ ŽĨ ŽůƵŵďŝĂ͕ ĂŶĚ sĞƚĞƌĂŶƐ īĂŝƌƐ ĂůƌĞĂĚLJ ĂůůŽǁ ĚǀĂŶĐĞĚ WƌĂĐƟĐĞ ZĞŐŝƐƚĞƌĞĚ EƵƌƐĞƐ ; WZEƐͿ ƚŽ ƉƌĂĐƟĐĞ ŝŶĚĞƉĞŶĚĞŶƚůLJ ǁŝƚŚŽƵƚ ƉŚLJƐŝĐŝĂŶ ƐƵƉĞƌǀŝƐŝŽŶ͘3 The &d ŝƚƐĞůĨ ŝƐ ƉƌŽŵŽƟŶŐ ƌĞĨŽƌŵ ŽĨ ƐƚĂƚĞƐ͛ ƐĐŽƉĞͲŽĨͲƉƌĂĐƟĐĞ ůĂǁƐ ďLJ ƐŚĂƌŝŶŐ ĂŶĚ ƉƌŽǀŝĚŝŶŐ ŝŶĐĞŶƟǀĞƐ ĨŽƌ ƚŚĞ ĂĚŽƉƟŽŶ ŽĨ ďĞƐƚ ƉƌĂĐƟĐĞƐ͕ ͞ŝŶĐůƵĚŝŶŐ ƌĞƐƚƌŝĐƟŽŶƐ ŽŶ ƚŚĞ ďƵƐŝŶĞƐƐ ƉƌĂĐƟĐĞƐ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ͕ ĂƐ ǁĞůů ĂƐ ƉŽůŝĐŝĞƐ ƚŚĂƚ ĐŽƵůĚ ĂĐƚ ĂƐ Ă ďĂƌƌŝĞƌ ƚŽ ĞŶƚƌLJ ĨŽƌ ŶĞǁ ĐŽŵƉĞƟƚŽƌƐ ŝŶ ƚŚĞ ŵĂƌŬĞƚ͘͟Ϯ 6

California Family Physician Winter 2019

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Let California be the national model for how mid-level providers can fit to support a complex system.

“

Family physicians have helped the public understand — through ĚŝƐĐŝƉůŝŶĞĚ ŵĞƐƐĂŐŝŶŐ Ͷ ƚŚĂƚ Ă ƐƚƌŽŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐLJƐƚĞŵ ǁŝƚŚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶ ƚŚĞ ǀĂŶŐƵĂƌĚ ĐĂŶ ůĞĂĚ Ă ĐŽŵŵƵŶŝƚLJ ƚŽ ďĞƩĞƌ health. The public trusts that family physicians represent its interests in advancing American health care.

/ŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ŽĨ ŵŝĚͲůĞǀĞů ƉƌŽǀŝĚĞƌƐ ŝƐ ĞdžƉĂŶĚŝŶŐ ǁŝƚŚŽƵƚ ŽƵƌ ŝŶƉƵƚ ďĞĐĂƵƐĞ ůĂƌŐĞůLJ͕ ŵŽƐƚ ƉŚLJƐŝĐŝĂŶƐ ŽƉƉŽƐĞ ŝƚ ĐĂƚĞŐŽƌŝĐĂůůLJ͕ ĂŶĚ ǁĞ ƌĞĨƵƐĞ ƚŽ Ɛŝƚ Ăƚ ƚŚĞ ƚĂďůĞ͘ zĞƚ͕ ůĞŐŝƐůĂƚŽƌƐ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ĂůůŽǁ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ ŵŝĚͲůĞǀĞů ƉƌŽǀŝĚĞƌƐ͕ ƐƚĂƚĞ ďLJ ƐƚĂƚĞ͕ ďĞĐĂƵƐĞ ǁĞ ĐĂŶŶŽƚ ĚĞůŝǀĞƌ ƚŚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ ŶĞĞĚ͕ ŶŽƌ ĂƌĞ ǁĞ ůŝŬĞůLJ ƚŽ ĚŽ ƐŽ ǁŝƚŚŝŶ ƚŚĞ ŶĞdžƚ ĚĞĐĂĚĞ ǁŝƚŚ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƉŚLJƐŝĐŝĂŶƐ ĂǀĂŝůĂďůĞ͘ tĞ ƐŚŽƵůĚ ďĞ Ăƚ ƚŚŝƐ ƚĂďůĞ ďĞĐĂƵƐĞ ǁĞ ŬŶŽǁ ďĞƩĞƌ ƚŚĂŶ ĂŶLJŽŶĞ ǁŚĂƚ ŝƐ ŶĞĞĚĞĚ ƚŽ ĚĞůŝǀĞƌ ŶŽƚ ũƵƐƚ ƉƌŝŵĂƌLJ ĐĂƌĞ͕ ďƵƚ ƋƵĂůŝƚLJ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ tŚŝůĞ WZEƐ͛ ŐƌŽǁŝŶŐ ŶƵŵďĞƌƐ ŝŶ ƉƌŝŵĂƌLJ ĐĂƌĞ may help bridge the gap, they are arguably doing so at the cost ŽĨ ƋƵĂůŝƚLJ ŽĨ ƚƌĂŝŶŝŶŐ͘ WZE ĐŽƵƌƐĞǁŽƌŬ ŵĂLJ ďĞ ϭϬϬ ƉĞƌĐĞŶƚ online.Т ůŝŶŝĐĂů ĞdžƉĞƌŝĞŶĐĞ ŚŽƵƌƐ ĂƌĞ ŽŌĞŶ ŽŶ ƚŚĞ ŚŽŶŽƌ ƐLJƐƚĞŵ ĂŶĚ ŵĂLJ ŝŶǀŽůǀĞ ƐŝŵƉůLJ ƐŚĂĚŽǁŝŶŐ Ă ĚŽĐƚŽƌ Žƌ ŶƵƌƐĞ͕ ŵĂŶLJ ŽĨ ǁŚŽŵ ƚŚĞ ƐƚƵĚĞŶƚƐ ŚĂǀĞ ƚŽ ĮŶĚ ƚŚĞŵƐĞůǀĞƐ͘ /ŶĚĞĞĚ͕ ƚŚĞ /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ ;ŶŽǁ ƚŚĞ /ŶƐƟƚƵƚĞ ŽĨ ,ĞĂůƚŚĐĂƌĞ /ŵƉƌŽǀĞŵĞŶƚͿ ŝĚĞŶƟĮĞĚ ͞ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƚƌĂŶƐŝƟŽŶͲƚŽͲ ƉƌĂĐƟĐĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ͕ ǁŚŝĐŚ ŚĞůƉ ŵĂŶĂŐĞ ƚŚĞ ƚƌĂŶƐŝƟŽŶ ĨƌŽŵ ŶƵƌƐŝŶŐ ƐĐŚŽŽů ƚŽ ƉƌĂĐƟĐĞ ĂŶĚ ŚĞůƉ ŶĞǁ ŐƌĂĚƵĂƚĞƐ ĨƵƌƚŚĞƌ develop the skills needed to deliver safe, quality care.”У &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŝůů ƌĞŵĂŝŶ ƚŚĞ ĐŽƌĞ ŽĨ ƚŚĞ ƉƌŝŵĂƌLJ ƐLJƐƚĞŵ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ďƵƚ ǁĞ ĐĂŶŶŽƚ ĚŽ ŝƚ ĂůŽŶĞ͘ tĞ ǁŝůů ŶĞĞĚ ƋƵĂůŝĮĞĚ ƉĂƌƚŶĞƌƐ ǁŚŽ ĐĂŶ ŚĞůƉ ƵƐ ŵĂŶĂŐĞ Ă ĐŽŵƉůĞdž ƐƉĞĐŝĂůƚLJ ŝŶ Ă ƐƚĂƚĞ ǁŝƚŚ ĚĂƵŶƟŶŐ ĚĞŵŽŐƌĂƉŚŝĐ ŐƌŽǁƚŚ͘ >ŝŵŝƟŶŐ ĐŽŵƉĞƟƟŽŶ ĨƌŽŵ ŵŝĚͲůĞǀĞů ƉƌŽǀŝĚĞƌƐ ŝƐ Ă ĨĂůƐĞ ĞƋƵŝǀĂůĞŶĐLJ͘ &Žƌ ĞdžĂŵƉůĞ͕ ŝƚ ŝƐ ĞƐƟŵĂƚĞĚ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ĐŽŵƉůĞƚĞƐ ϭϲ͕ϬϬϬ ŚŽƵƌƐ ŽĨ ƚƌĂŝŶŝŶŐ͕ ǁŚŝůĞ ĂŶ WZE ƵŶĚĞƌŐŽĞƐ Ă ŵĞƌĞ ϭ͕ϱϬϬ ŚŽƵƌƐ͘ϲ The skills of midůĞǀĞů ƉƌŽǀŝĚĞƌƐ ĂƌĞ ĨĞǁĞƌ ƚŚĂŶ ƚŚŽƐĞ ŽĨ ƉŚLJƐŝĐŝĂŶƐ Ͷ ƚŚĞLJ ĂƌĞ ŶŽƚ ĐŽŵƉĞƟŶŐ ǁŝƚŚ ƵƐ ƵŶůĞƐƐ ǁĞ ĂůůŽǁ ƚŚĞŵ ƚŽ ƌĞĚĞĮŶĞ primary care ĂƐ Ă ůŝŵŝƚĞĚ ƐƉĞĐŝĂůƚLJ ŶĂƌƌŽǁ ŝŶ ƐĐŽƉĞ͘

California family physicians should ĞŵďƌĂĐĞ ƚŚĞƐĞ ĐŽůůĞĂŐƵĞƐ͕ ĂŶĚ ǁŽƌŬ to ensure they can provide the safe ĂŶĚ ƋƵĂůŝƚLJ ĐĂƌĞ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ need. We need to convince our legislators and policy makers that a safe primary care system for our ĐŝƟnjĞŶƐ ĚĞƉĞŶĚƐ ŽŶ ĞŶƐƵƌŝŶŐ ƚŚĂƚ Ăůů providers are adequately trained. Let ĂůŝĨŽƌŶŝĂ ďĞ ƚŚĞ ŶĂƟŽŶĂů ŵŽĚĞů ĨŽƌ ŚŽǁ ŵŝĚͲůĞǀĞů ƉƌŽǀŝĚĞƌƐ ĐĂŶ Įƚ ƚŽ ƐƵƉƉŽƌƚ Ă ĐŽŵƉůĞdž ƐLJƐƚĞŵ͘ DĂŬĞ ŶŽ ŵŝƐƚĂŬĞ͗ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ďĞ ůĞĂĚĞƌƐ ŝŶ ƐƚĞĞƌŝŶŐ ŚĞĂůƚŚ ĐĂƌĞ ƚŽǁĂƌĚ Ă ďĞƩĞƌ ƚŽŵŽƌƌŽǁ͘ Ƶƚ ŚĞĂůƚŚ ĐĂƌĞ ŝƐ Ă ďŝŐ ƐŚŝƉ͕ ĂŶĚ ǁĞ cannot change course alone.

References 1.

ϮϬϭϴ EZDW DĂŝŶ ZĞƐŝĚĞŶĐLJ DĂƚĐŚΠ͗ Match Rates by Specialty and State. ŚƩƉƐ͗ͬ​ͬŵŬϬŶƌŵƉĐŝŬŐďϴũdžLJĚϭϵŚ͘ ŬŝŶƐƚĂĐĚŶ͘ĐŽŵͬǁƉͲĐŽŶƚĞŶƚͬ ƵƉůŽĂĚƐͬϮϬϭϴͬϬϰͬDĂŝŶͲDĂƚĐŚͲZĞƐƵůƚͲ ďLJͲ^ƚĂƚĞͲĂŶĚͲ^ƉĞĐŝĂůƚLJͲϮϬϭϴ͘ƉĚĨ͘ ĐĐĞƐƐĞĚ ĞĐĞŵďĞƌ ϭϱ͕ ϮϬϭϴ͘ Ϯ͘ &ĞĚĞƌĂů dƌĂĚĞ ŽŵŵŝƐƐŝŽŶ ;ϮϬϭϰͿ͘ ŽŵƉĞƟƟŽŶ ĂŶĚ ƚŚĞ ZĞŐƵůĂƟŽŶ ŽĨ ĚǀĂŶĐĞĚ WƌĂĐƟĐĞ EƵƌƐĞƐ͘ 3. ͞^ƚĂƚĞ WƌĂĐƟĐĞ ŶǀŝƌŽŶŵĞŶƚ͘͟ ŵĞƌŝĐĂŶ ƐƐŽĐŝĂƟŽŶ ŽĨ EƵƌƐĞ WƌĂĐƟƟŽŶĞƌƐ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĂĂŶƉ͘ ŽƌŐͬĂĚǀŽĐĂĐLJͬƐƚĂƚĞͬƐƚĂƚĞͲƉƌĂĐƟĐĞͲ environment. Accessed December 15, ϮϬϭϴ͘ ϰ͘ RN to DNP Programs Online. Nurse :ŽƵƌŶĂů͘ ŚƩƉƐ͗ͬ​ͬŶƵƌƐĞũŽƵƌŶĂů͘ŽƌŐͬ ĚŶƉͲƉƌŽŐƌĂŵƐͬƌŶͲƚŽͲĚŶƉͲƉƌŽŐƌĂŵƐͲ ŽŶůŝŶĞͬ͘ ĐĐĞƐƐĞĚ ĞĐĞŵďĞƌ ϭϱ͕ ϮϬϭϴ͘ 5. /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ͘ ;ϮϬϭϬͿ͘ dŚĞ ĨƵƚƵƌĞ ŽĨ ŶƵƌƐŝŶŐ͗ >ĞĂĚŝŶŐ ĐŚĂŶŐĞ͕ advancing health. ϲ͘ ĚƵĐĂƟŽŶ ĂŶĚ dƌĂŝŶŝŶŐ͗ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ǀĞƌƐƵƐ EƵƌƐĞ WƌĂĐƟƟŽŶĞƌƐ͘ &W͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬ ĚĂŵͬ &WͬĚŽĐƵŵĞŶƚƐͬĂĚǀŽĐĂĐLJͬ ǁŽƌŬĨŽƌĐĞͬƐĐŽƉĞͬ&WǀƐEW͘ƉĚĨ͘ ĐĐĞƐƐĞĚ ĞĐĞŵďĞƌ ϭϲ͕ ϮϬϭϴ͘

California Family Physician Winter 2019

7

p r e s i d e n t ’s m e s s a g e

Lisa M. Ward, MD, MScPH, MS

Can Expansion of Scope Address Workforce Shortfalls in California? ^ŝƐLJƉŚƵƐ ĐŽŵĞƐ ƚŽ ŵŝŶĚ ĂƐ / ĐŽŶƚĞŵƉůĂƚĞ ƚŚĞ ŐĂƉ ďĞƚǁĞĞŶ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ǁĞ ŚĂǀĞ ĂŶĚ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ need. Like Sisyphus, unending task of rolling a boulder up a hill, ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉŽůŝĐLJ ĂŶĚ ĂĚǀŽĐĂĐLJ ŚĂǀĞ ďĞĞŶ ƌĞƉĞƟƟǀĞ ĞǀĞŶ ďĞĨŽƌĞ &W͛Ɛ ϭϵϰϴ ĨŽƵŶĚŝŶŐ ŽŶ ŬĞLJ ǁŽƌŬĨŽƌĐĞ ƋƵĞƐƟŽŶƐ͕ ƐƉĞĐŝĮĐĂůůLJ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ƋƵĞƐƟŽŶƐ͘ &W ŚĂƐ ĂĚǀŽĐĂƚĞĚ ǀŝŐŽƌŽƵƐůLJ ĂŶĚ ƐƵĐĐĞƐƐĨƵůůLJ ĂŐĂŝŶƐƚ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ĂŶĚ ŽƚŚĞƌ ƉƌŽǀŝĚĞƌƐ͘ zĞƚ͕ ƉŚĂƌŵĂĐŝƐƚƐ͕ ŶĂƚƵƌŽƉĂƚŚƐ͕ ŽƉƚŽŵĞƚƌŝƐƚƐ ĂŶĚ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ŚĂǀĞ Ăůů ƉƌŽƉŽƐĞĚ ĞdžƉĂŶƐŝŽŶƐ ŝŶ ƐĐŽƉĞ ŝŶ ƌĞĐĞŶƚ LJĞĂƌƐ͘ Ɛ ĐƵƌƌĞŶƚ ŚĞĂůƚŚ ƉŽůŝĐLJ ĞǀŽůǀĞƐ͕ ǁĞ ŵĂLJ ƐĞĞ ŐƌŽǁŝŶŐ ƐƵƉƉŽƌƚ ĨŽƌ ƚŚĞ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ŽĨ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ͕ ĨŽƌ ĞdžĂŵƉůĞ͕ ĂƐ ŽŶĞ ƐƚƌĂƚĞŐLJ ƚŽ ŐƌŽǁ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ŶĞĞĚĞĚ ƚŽ ĐĂƌĞ ĨŽƌ ĂůŝĨŽƌŶŝĂŶƐ /Ĩ ǁĞ ĐĂŶ͛ƚ ĮŐƵƌĞ ŽƵƚ Ă ǁĂLJ ƚŽ ǁŽƌŬ ƚŽŐĞƚŚĞƌ ƚŽ ŐĞƚ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ďŽƵůĚĞƌ ƵƉ ƚŚĞ Śŝůů͕ ǁĞ ŵĂLJ ůŽƐĞ ŽƵƌ ĨŽŽƟŶŐ ĂŶĚ ďĞ crushed by it. &W ŚĂƐ ƐŝŐŶŝĮĐĂŶƚ ƉŽůŝĐLJ ƚŽ ƐƵƉƉŽƌƚ ŝƚƐ ŽƉƉŽƐŝƟŽŶ ƚŽ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ĂƐƐŝƐƚĂŶƚƐ͕ ĂůƐŽ ŬŶŽǁŶ ĂƐ ĂĚǀĂŶĐĞĚ ƉƌĂĐƟĐĞ ĐůŝŶŝĐŝĂŶƐ ; W ƐͿ͘ dŚĞ ƵŶĚĞƌƉŝŶŶŝŶŐ ŽĨ &W͛Ɛ ƉŽƐŝƟŽŶ ŝƐ ĞƋƵŝƚLJ͗ ĞƋƵŝƚLJ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ƋƵĂůŝƚLJ͕ ĞƋƵŝƚLJ in oversight and equity for family physicians in the market place ŽĨ ŵĞĚŝĐŝŶĞ͘ &W ƉŽůŝĐLJ ŽŶ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ĂŝŵƐ ƚŽ ƉƌŽƚĞĐƚ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ͕ ǁŚŝůĞ ƌĞĐŽŐŶŝnjŝŶŐ ƚŚĞ ŝŵƉŽƌƚĂŶƚ ƌŽůĞ W Ɛ ŚĂǀĞ ŝŶ ƉĂƟĞŶƚ ĐĂƌĞ͘ &W ŚĂƐ ĂĚǀŽĐĂƚĞĚ ĨŽƌ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ƚŚĂƚ ŝŶĐůƵĚĞƐ ĞdžƉĂŶĚĞĚ ƚƌĂŝŶŝŶŐ͕ ĨŽƌŵĂƟǀĞ ůŝĐĞŶƐŝŶŐ ĂŶĚ ďŽĂƌĚ ĐĞƌƟĮĐĂƟŽŶ͕ ĞƋƵĂů ŵĞĚŝĐĂů ůŝĂďŝůŝƚLJ ŝŶƐƵƌĂŶĐĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ĂŶĚ ĞƋƵĂů ŝŵƉůĞŵĞŶƚĂƟŽŶ ŽĨ ƚŚĞ ĐŽƌƉŽƌĂƚĞ ďĂƌ ůŝŵŝƟŶŐ ĚŝƌĞĐƚ ĞŵƉůŽLJŵĞŶƚ ďLJ ŚŽƐƉŝƚĂůƐ ĂŶĚ ŽƚŚĞƌ ĐŽƌƉŽƌĂƟŽŶƐ͘ YƵĞƐƟŽŶƐ ĂďŽƵƚ ŚŽǁ ůŝĐĞŶƐŝŶŐ͕ ůŝĂďŝůŝƚLJ͕ ƉƌĞƐĐƌŝďŝŶŐ ĂŶĚ ĐŽƌƉŽƌĂƚĞ ďĂƌ ŚĂǀĞ ƐƚLJŵŝĞĚ &W͛Ɛ ĂďŝůŝƚLJ ƚŽ ƐƵƉƉŽƌƚ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ƉƌŽƉŽƐĂůƐ͘ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂůƐŽ ŚĂǀĞ ĐŽŶĐĞƌŶƐ ĂďŽƵƚ ŚŽǁ ƚŚĞ ĞŶƚƌĂŶĐĞ ŽĨ ŝŶĚĞƉĞŶĚĞŶƚ W Ɛ ŝŶƚŽ ƚŚĞ ŵĂƌŬĞƚ ƉůĂĐĞ ǁŽƵůĚ ŝŵƉĂĐƚ ŝŶƚĞƌĞƐƚ ŝŶ ƚŚĞ ƐƉĞĐŝĂůƚLJ͕ ƉĂLJ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ĞdžƉĞƌŝĞŶĐĞ͘ ,Žǁ ǁŽƵůĚ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ W Ɛ ĐŚĂŶŐĞ ƚŚĞ ƉĞƌĐĞŝǀĞĚ ǀĂůƵĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͍ tŽƵůĚ Ă ŐƌŽǁŝŶŐ W ǁŽƌŬĨŽƌĐĞ ĚƌŝǀĞ ĚŽǁŶ ƉĂLJ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͍ tŽƵůĚ ƚŚĞ ƉŝƉĞůŝŶĞ ŽĨ ƐƚƵĚĞŶƚƐ ĐŚŽŽƐĞ ƚƌĂŝŶŝŶŐ ƉƌŽŐƌĂŵƐ such as APCs because they are shorter and less costly than medical ƚƌĂŝŶŝŶŐ͍ tŚĂƚ ĚŽĞƐ ƚŚĞ ŝŶĚĞƉĞŶĚĞŶĐĞ ŽĨ W Ɛ ĚŽ ƚŽ ƚŚĞ ƌŽůĞ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͛ ĚĂLJͲƚŽͲĚĂLJ ƉƌĂĐƟĐĞ͍ Ž Ăůů ƚŚĞ ďƌŝĞĨ͕ ďƵƚ ƐĂƟƐĨLJŝŶŐ ǀŝƐŝƚƐ ƚŽ ƚƌĞĂƚ Ă hd/ ĂŶĚ ƚŚĞ ĚĞůŝŐŚƞƵů ǁĞůůͲďĂďLJ ĞdžĂŵƐ ŐŽ ƚŽ ĂŶ W ǁŚŝůĞ / ƉƌĂĐƟĐĞ Ă ĚĂƵŶƟŶŐ ĚĂLJ ŽĨ ŵĂŶĂŐŝŶŐ ƚŚĞ ĐŽŵƉůĞdžŝƚLJ ŽĨ ĨĂŝůŝŶŐ 8

California Family Physician Winter 2019

ŽƌŐĂŶ ƐLJƐƚĞŵƐ ŝŶ ĂĚƵůƚƐ͍ dŚĞƐĞ ƋƵĞƐƟŽŶƐ ƐƉĞĂŬ ƚŽ ƚŚĞ ŶĞĞĚ ƚŽ ƐƵƉƉŽƌƚ ŽƵƌ ĐƵƌƌĞŶƚ ǁŽƌŬĨŽƌĐĞ ǁŝƚŚ ũŽLJĨƵů͕ ƐƵƐƚĂŝŶĂďůĞ ƉƌĂĐƟĐĞƐ ǁŝƚŚ ƚŚĞ ǀĂƌŝĞƚLJ ŽĨ ƉĂƟĞŶƚ ĐĂƌĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂƌĞ ƐŽ ĂďůĞ ƚŽ ĚĞůŝǀĞƌ͘ tŝƚŚ ƐƟůů ŵŽƌĞ ƋƵĞƐƟŽŶƐ ƚŚĂŶ ĂŶƐǁĞƌƐ͕ ǁĞ ŵĂLJ ǁĂŶƚ ƚŽ ůŽŽŬ ƚŽ ƚŚĞ ĞdžƉĞƌŝĞŶĐĞƐ ŽĨ ƚŚĞ ϮϬ Žƌ ŵŽƌĞ ƐƚĂƚĞƐ ǁŚĞƌĞ W Ɛ ĐƵƌƌĞŶƚůLJ ƉƌŽǀŝĚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ŝŶĚĞƉĞŶĚĞŶƚůLJ͘ tĞ ŵĂLJ ĂůƐŽ ǁĂŶƚ ƚŽ ůŽŽŬ ƚŽ ĞdžƉĞƌƚƐ ůŝŬĞ ĚǁĂƌĚ K͛EĞŝů͕ WŚ ͘ ƌ͘ K͛EĞŝů͕ ƉĂƐƚ ĚŝƌĞĐƚŽƌ ŽĨ ƚŚĞ hŶŝǀĞƌƐŝƚLJ of California, San Francisco Center for the Health Professions and an ĞdžƉĞƌƚ ŽŶ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ƉŽůŝĐLJ͘ / ŝŶƚĞƌǀŝĞǁĞĚ ƌ͘ K͛EĞŝů ƚŽ ůĞĂƌŶ ĂďŽƵƚ ŚŝƐ ǀŝƐŝŽŶ ĨŽƌ ĐƵůƟǀĂƟŶŐ ƚŚĞ ĨƵƚƵƌĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ needed in California. Dr. O’Neil dismissed current approaches to ĐůŽƐĞ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ŐĂƉ ƐĂLJŝŶŐ ƚŚĂƚ ƐŝŵƉůLJ ĞdžƉĂŶĚŝŶŐ ƚŚĞ ŵŽĚĞů ĨŽƵŶĚĞĚ ŝŶ ƚŚĞ ϭϵϱϬƐ ͞ŝƐ ŶŽƚ ŐŽŝŶŐ ƚŽ ĞŶůĂƌŐĞ Žƌ ĚŝǀĞƌƐŝĨLJ ƉƌŝŵĂƌLJ ĐĂƌĞ ĂŶĚ ŶŽƚ ŐŽŝŶŐ ƚŽ ŵĂƚĐŚ ǁŚĂƚ ƉĂƟĞŶƚƐ ĂƌĞ ĚĞŵĂŶĚŝŶŐ͟ ƚŽ ŵĞĞƚ ƚŚĞŝƌ ŶĞĞĚƐ͘ /ŶƐƚĞĂĚ͕ ŚĞ ĞŶĐŽƵƌĂŐĞĚ ƵƐ ƚŽ ĐŽŶƐŝĚĞƌ ĨŽƵŶĚĂƟŽŶĂů changes in the model of health care delivery including the use of global payment models for reimbursement so that health care ƐLJƐƚĞŵƐ ĐĂŶ ďƌĞĂŬ ĂǁĂLJ ĨƌŽŵ ŶĂƌƌŽǁ ƉŚLJƐŝĐŝĂŶ ƌŽůĞƐ ƚŽ ĂĐŚŝĞǀĞ ƋƵĂůŝƚLJ ĨŽƌ ǀĂůƵĞ͘ ƌ͘ K͛EĞŝů ƐƚƌŽŶŐůLJ ĞŶĚŽƌƐĞĚ ĞīŽƌƚƐ ďLJ ƉƌŝŵĂƌLJ ĐĂƌĞ ůĞĂĚĞƌƐ ƚŽ ĐƌĞĂƚĞ ƚŚĞ ŝŶƚĞŐƌĂƚĞĚ ŽƌŐĂŶŝnjĂƟŽŶƐ ŽĨ ƚŚĞ ĨƵƚƵƌĞ ƚŽ ĂǀŽŝĚ ĨƵƌƚŚĞƌ ĨƌĂŐŵĞŶƚĂƟŽŶ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ĂŶĚ ƚŽ ƚĞƐƚ ƚŚĞ ŶĞǁ ŵŽĚĞůƐ ƚŽ ŵĞĞƚ ĂĐĐĞƐƐ ĂŶĚ ƋƵĂůŝƚLJ ƉĂƟĞŶƚƐ ŶĞĞĚ͘ &ŝŶĂůůLJ͕ ŚĞ ĞŶĐŽƵƌĂŐĞĚ ƵƐ ƚŽ ĐŽŶƐŝĚĞƌ ŶĞǁ ŬŝŶĚƐ ŽĨ ƉĂƌƚŶĞƌƐŚŝƉƐ ƚŚĂƚ ĂĚĚ ǀĂůƵĞ ƚŽ ŚĞĂůƚŚ ŝŶ ĨƵƚƵƌĞ ďƵƐŝŶĞƐƐ ŵŽĚĞůƐ ŽĨ ŚĞĂůƚŚ ƐĞƌǀŝĐĞƐ͘ &Žƌ ĞdžĂŵƉůĞ͕ ŐŝǀĞŶ ƚŚĞ prevalence of cardiovascular disease, a future health care enterprise ŵĂLJ ĞŵƉůŽLJ ĚŝĞƟƟĂŶƐ ƚŽ ĂƐƐŝƐƚ ǁŝƚŚ ŚĞĂůƚŚLJ ĞĂƟŶŐ ĂŶĚ ƉĂƌƚŶĞƌ ǁŝƚŚ ŐLJŵƐ ƚŽ ĐƌĞĂƚĞ Ă ŵŽĚĞů ƚŚĂƚ LJŝĞůĚƐ ŝŵƉƌŽǀĞĚ ŽƵƚĐŽŵĞƐ͕ ƉĂƟĞŶƚ ƐĂƟƐĨĂĐƟŽŶ ĂŶĚ ŵŽƌĞ ĞǀŽůǀĞĚ ƌŽůĞƐ ĨŽƌ ƚŚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ŽĨ ƚŽŵŽƌƌŽǁ͘ Ɛ Ă ƚŚŽƵŐŚƚ ůĞĂĚĞƌ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ƉŽůŝĐLJ͕ he advocates for bigger, bolder change to meet the needs of the ǁŽƌŬĨŽƌĐĞ ŽĨ ƚŚĞ ĨƵƚƵƌĞ͘ We are being asked to do more of the same or to re-design and ƌĞͲƚŚŝŶŬ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ŵŽĚĞůƐ ŽĨ ƚŚĞ ĨƵƚƵƌĞ͘ ^ŚŽƵůĚ ǁĞ ƌŽůů ƚŚĞ ƉƌŽǀĞƌďŝĂů ƌŽĐŬ ƵƉ ƚŚĞ Śŝůů ĂŐĂŝŶ Žƌ ƚĂŬĞ Ă ĚŝīĞƌĞŶƚ ĂƉƉƌŽĂĐŚ͍ /ŵƉƌŽǀŝŶŐ ŽƵƌ ƉŽůŝĐŝĞƐ ƚŽ ŚĞůƉ W Ɛ ƉƌĂĐƟĐĞ ŝŶĚĞƉĞŶĚĞŶƚůLJ ĂŶĚ ĐŚĂŶŐŝŶŐ ŽƵƌ ƐŝůŽĞĚ ŚĞĂůƚŚ ĐĂƌĞ ƐƚƌƵĐƚƵƌĞƐ ŵĂLJ ďĞ ƚǁŽ ǁĂLJƐ ƚŽ ƐƚĂƌƚ͘ ŝƚŚĞƌ ƉĂƚŚ ǁŝůů ďĞ ůĂďŽƌŝŽƵƐ͕ ďƵƚ ĐĞƌƚĂŝŶůLJ ŶŽƚ ĨƵƟůĞ͘ dŚĞ ŐĂƉ ďĞƚǁĞĞŶ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ŶĞĞĚĞĚ ĂŶĚ ŽƵƌ ĐƵƌƌĞŶƚ ǁŽƌŬĨŽƌĐĞ ŝƐ ďƌŽĂĚ͘ ŶĚ ĐůŽƐŝŶŐ ƚŚĂƚ ŐĂƉ ǁŝůů ŵĂŬĞ ƚŚĞ ĚŝīĞƌĞŶĐĞ ďĞƚǁĞĞŶ ǁĞůůŶĞƐƐ ĂŶĚ illness for millions of Californians.

political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

CAFP Logs Another Victorious Year in Sacramento dŚĞ ϮϬϭϳͲϭϴ >ĞŐŝƐůĂƟǀĞ ^ĞƐƐŝŽŶ ǁĂƐ͕ ĨŽƌ ƚŚĞ ŵŽƐƚ ƉĂƌƚ͕ Ă ƌĞƐŽƵŶĚŝŶŐ ǀŝĐƚŽƌLJ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ &W ĂĚǀĂŶĐĞĚ ƐĞǀĞƌĂů ŵĂũŽƌ ƉƌŝŽƌŝƟĞƐ͕ ƉĂƌƟĐƵůĂƌůLJ ŝŶ ƚĞƌŵƐ ŽĨ ƉĂƟĞŶƚ ĂĐĐĞƐƐ ƚŽ ƉƌŝŵĂƌLJ ĐĂƌĞ͕ ŐĞŶĞƌĂƟŶŐ ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ƚŽ ƉƵƌƐƵĞ ĐĂƌĞĞƌƐ ŝŶ family medicine and increasing access to care for the underserved.

DĂũŽƌ &ĞĚĞƌĂů ,ĞĂůƚŚ WƌŽŐƌĂŵƐ ZĞŶĞǁĞĚ ĂŌĞƌ &W ĚǀŽĐĂĐLJ Ɛ ƉĂƌƚ ŽĨ ƚŚĞ ĨĞĚĞƌĂů ďƵĚŐĞƚ ĮŐŚƚ͕ &W͕ &W ĂŶĚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĨƌŽŵ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌLJ ĐĂůůĞĚ ŽŶ ŽŶŐƌĞƐƐ ƚŽ ĞŶƐƵƌĞ ƚŚĞ ĐŽŶƟŶƵĂƟŽŶ of several crucially important health programs, and that advocacy has ƉĂŝĚ Žī ŝŶ Ă ƌĞŵĂƌŬĂďůĞ ǁĂLJ͘ dŚĞ WƌĞƐŝĚĞŶƚ ƐŝŐŶĞĚ Ă ƐƉĞŶĚŝŶŐ ŵĞĂƐƵƌĞ ƚŚĂƚ ĞdžƚĞŶĚƐ ĨƵŶĚŝŶŐ ĨŽƌ ƚŚĞ ŚŝůĚƌĞŶ͛Ɛ ,ĞĂůƚŚ /ŶƐƵƌĂŶĐĞ WƌŽŐƌĂŵ ĨŽƌ ĨŽƵƌ ĂĚĚŝƟŽŶĂů LJĞĂƌƐ ;ŽŶ ƚŽƉ ŽĨ ƚŚĞ ƉƌĞǀŝŽƵƐ ƐŝdžͲLJĞĂƌ ĞdžƚĞŶƐŝŽŶͿ ĂŶĚ ŝŶĐůƵĚĞƐ ƚŚĞ ĞdžƚĞŶƐŝŽŶ ŽĨ ƐĞǀĞƌĂů ŽƚŚĞƌ ŚŝŐŚͲƉƌŝŽƌŝƚLJ ŚĞĂůƚŚ ƉƌŽŐƌĂŵƐ͕ ŝŶĐůƵĚŝŶŐ͗ • ŽŵŵƵŶŝƚLJ ,ĞĂůƚŚ ĞŶƚĞƌƐ ; , ƐͿ͗ , Ɛ ƐĞƌǀĞ ŵŽƌĞ ƚŚĂŶ Ϯϰ ŵŝůůŝŽŶ ƉĞŽƉůĞ͕ ŵŽƐƚ ŽĨ ƚŚĞŵ ůŽǁͲŝŶĐŽŵĞ͕ ĂŶĚ ĂďŽƵƚ ŚĂůĨ ŽĨ ƚŚĞŵ ŝŶ ƌƵƌĂů ĂƌĞĂƐ ǁŚĞƌĞ ŽƉƟŽŶƐ ĨŽƌ ĐĂƌĞ ĂƌĞ ůŝŵŝƚĞĚ͘ dŽĚĂLJ͕ ŵŽƌĞ ƚŚĂŶ ϭ͕ϯϬϬ , Ɛ ƉƌŽǀŝĚĞ ĐŽŵƉƌĞŚĞŶƐŝǀĞ͕ ŚŝŐŚͲ ƋƵĂůŝƚLJ ĐĂƌĞ ƚŽ ϲ͘ϱ ŵŝůůŝŽŶ ƉĞŽƉůĞ ŝŶ ĂůŝĨŽƌŶŝĂ͘ /Ŷ ŵĂŶLJ ƌƵƌĂů ĐŽŵŵƵŶŝƟĞƐ͕ , Ɛ ƐĞƌǀĞ ĂƐ ƚŚĞ ŽŶůLJ ƐŽƵƌĐĞ ŽĨ ŵĞĚŝĐĂů ĂŶĚ ǁĞůůŶĞƐƐ ĐĂƌĞ ĨŽƌ ŵŝĚĚůĞͲ ĂŶĚ ǁŽƌŬŝŶŐͲĐůĂƐƐ ĨĂŵŝůŝĞƐ͘ dŚĞ ŶĞǁ ƐƉĞŶĚŝŶŐ ĂŐƌĞĞŵĞŶƚ ĞdžƚĞŶĚƐ ĂŶĚ ŝŶĐƌĞĂƐĞƐ ĨƵŶĚŝŶŐ ĨŽƌ , Ɛ ĨƌŽŵ Ψϯ͘ϲ ďŝůůŝŽŶ ƉĞƌ LJĞĂƌ ƚŽ Ψϯ͘ϴ ďŝůůŝŽŶ ĨŽƌ ϮϬϭϴ ĂŶĚ Ψϰ ďŝůůŝŽŶ ĨŽƌ ϮϬϭϵ͘ • dĞĂĐŚŝŶŐ ,ĞĂůƚŚ ĞŶƚĞƌƐ ;d, ƐͿ͗ d, Ɛ ĂƌĞ ƉƌŝŵĂƌLJ ĐĂƌĞ residency programs located in community clinics in underserved areas. Created and funded through the īŽƌĚĂďůĞ ĂƌĞ Đƚ͕ ƚŚĞLJ ŚĂǀĞ ƐŚŽǁŶ ƚƌĞŵĞŶĚŽƵƐ ƉƌŽŵŝƐĞ ŝŶ ŝŵƉƌŽǀŝŶŐ ĐĂƌĞ ŝŶ ƵŶĚĞƌƐĞƌǀĞĚ ƌĞŐŝŽŶƐ ǁŚŝůĞ ŐƌŽǁŝŶŐ ƚŚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶ ǁŽƌŬĨŽƌĐĞ͘ dŚĞ ŶĞǁ ƐƉĞŶĚŝŶŐ ĂŐƌĞĞŵĞŶƚ ĞdžƚĞŶĚƐ ĂŶĚ ŝŶĐƌĞĂƐĞƐ ĨƵŶĚŝŶŐ ĨŽƌ ƚŚĞ d, ƉƌŽŐƌĂŵ ĨƌŽŵ ΨϲϬ ŵŝůůŝŽŶ ƚŽ ΨϭϮϲ͘ϱ ŵŝůůŝŽŶ ƉĞƌ LJĞĂƌ ĨŽƌ ƚǁŽ LJĞĂƌƐ͘ dŚŝƐ ĚĞƐƉĞƌĂƚĞůLJ ŶĞĞĚĞĚ ŵŽŶĞLJ ǁŝůů ĞŶƐƵƌĞ ƚŚĂƚ d, Ɛ ŝŶ ĂůŝĨŽƌŶŝĂ ĂŶĚ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌLJ ǁŝůů ŶŽƚ ĐůŽƐĞ͘ • EĂƟŽŶĂů ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ŽƌƉƐ ;E,^ Ϳ͗ dŚĞ E,^ ƐĞŶĚƐ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂƐ ŝŶ ĞdžĐŚĂŶŐĞ for medical school debt repayment. The program places ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ŽƚŚĞƌ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ŝŶ ĂƌĞĂƐ ŝŶ ǁŚŝĐŚ ƚŚĞLJ ĂƌĞ ŽƚŚĞƌǁŝƐĞ ƵŶůŝŬĞůLJ ƚŽ ǁŽƌŬ͘ DŽƌĞ ƚŚĂŶ ϱϬ͕ϬϬϬ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ŚĂǀĞ ƐĞƌǀĞĚ ŝŶ ƚŚĞ E,^ ƐŝŶĐĞ ŝƚƐ ŝŶĐĞƉƟŽŶ ŝŶ ϭϵϳϮ͕ ĂŶĚ ƚŽĚĂLJ ϭϬ͕ϬϬϬ E,^ ŵĞŵďĞƌƐ ƉƌŽǀŝĚĞ ĐĂƌĞ ƚŽ ŵŽƌĞ ƚŚĂŶ ϭϭ ŵŝůůŝŽŶ ƉĂƟĞŶƚƐ Ăƚ ŵŽƌĞ ƚŚĂŶ ϱ͕ϬϬϬ ůŽĐĂƟŽŶƐ͘ dŚĞ ŶĞǁ ƐƉĞŶĚŝŶŐ ĂŐƌĞĞŵĞŶƚ ĞdžƚĞŶĚƐ E,^ ͛Ɛ ĐƵƌƌĞŶƚ ĨƵŶĚŝŶŐ ůĞǀĞů ŽĨ ΨϯϭϬ ŵŝůůŝŽŶ ĂŶŶƵĂůůLJ ĨŽƌ ϮϬϭϴ ĂŶĚ ϮϬϭϵ͘ 10

California Family Physician Winter 2019

dŚĞ ϮϬϭϴͲϭϵ ^ƚĂƚĞ ƵĚŐĞƚ /ŶĐůƵĚĞƐ DĂũŽƌ ,ĞĂůƚŚ ĂƌĞ tŝŶƐ CAFP secured major victories and investments in this year’s State Budget, including medical student loan repayment, a major increase ŝŶ DĞĚŝͲ Ăů ƉĂLJŵĞŶƚ ƌĂƚĞƐ ĂŶĚ Ă ƐƚĞƉ ƚŽǁĂƌĚ ĞƐƚĂďůŝƐŚŝŶŐ ƚŚĞ ŝŶĨƌĂƐƚƌƵĐƚƵƌĞ ŶĞĞĚĞĚ ƚŽ ŵĞĂƐƵƌĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐƉĞŶĚŝŶŐ͘ dŚĞ ϮϬϭϴͲϭϵ ^ƚĂƚĞ ƵĚŐĞƚ ŝŶĐůƵĚĞĚ͗ • ΨϮϯϯ ŵŝůůŝŽŶ ;ŽŶ ƚŽƉ ŽĨ ƚŚĞ ŵŽƌĞ ƚŚĂŶ ΨϯϱϬ ŵŝůůŝŽŶ ŝŶĐƌĞĂƐĞ ŝŶ ϮϬϭϳͿ ĨŽƌ ŝŶĐƌĞĂƐĞĚ ƉĂLJŵĞŶƚƐ ƚŽ DĞĚŝͲ Ăů ƉƌŽǀŝĚĞƌƐ͘ • ΨϭϵϬ ŵŝůůŝŽŶ ŝŶ ůŽĂŶ ƌĞƉĂLJŵĞŶƚ ĨƵŶĚƐ ĨŽƌ ƌĞĐĞŶƚůLJ ŐƌĂĚƵĂƚĞĚ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ƐĞƌǀĞ DĞĚŝͲ Ăů ďĞŶĞĮĐŝĂƌŝĞƐ͘ • dŚĞ ĐŽŶƟŶƵĂƟŽŶ ŽĨ ƚŚĞ ƚŚƌĞĞͲLJĞĂƌ ΨϭϬϬ ŵŝůůŝŽŶ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WƌŝŵĂƌLJ ĂƌĞ WŚLJƐŝĐŝĂŶ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ͕ ǁŝƚŚ ŝƚƐ ƐĞĐŽŶĚ ŝŶƐƚĂůůŵĞŶƚ ŽĨ Ψϯϯ ŵŝůůŝŽŶ ŝŶ ϮϬϭϴ͘ • ΨϲϬ ŵŝůůŝŽŶ ƚŽ ĐƌĞĂƚĞ ƚŚĞ ͞,ĞĂůƚŚ ĂƌĞ WĂLJŵĞŶƚƐ ĂƚĂďĂƐĞ͟ ʹ an All Payer Claims Database.

• dŚĞ ƌĞůĞĂƐĞ ŽĨ ΨϰϬ ŵŝůůŝŽŶͬLJĞĂƌ ŝŶ WƌŽƉŽƐŝƟŽŶ ϱϲ ĨƵŶĚƐ ƚŽ support primary care and emergency medicine residency programs in underserved areas. CAFP sit on the program’s ĚǀŝƐŽƌLJ ŽƵŶĐŝů ĂŶĚ ŝƐ ǁŽƌŬŝŶŐ ƚŽ ĞŶƐƵƌĞ ƚŚŽƐĞ ĨƵŶĚƐ ĂƌĞ ƵƐĞĚ for their intended purpose.

• ΨϱϬϬ ŵŝůůŝŽŶ ƚŽ ŚĞůƉ ĐŽŵŵƵŶŝƟĞƐ ĂĐƌŽƐƐ ĂůŝĨŽƌŶŝĂ ĂĚĚƌĞƐƐ homelessness.

• ΨϱϬ ŵŝůůŝŽŶ ƚŽ ĞdžƉĂŶĚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ĞdžĐŚĂŶŐĞƐ ƚŽ ŶĞǁ health care providers. 'ŽǀĞƌŶŽƌ ^ŝŐŶƐ &WͲ^ƉŽŶƐŽƌĞĚ ŝůů ƚŽ ZĞŐƵůĂƚĞ WŚĂƌŵĂĐLJ ĞŶĞĮƚ Managers dŚĞ 'ŽǀĞƌŶŽƌ ƐŝŐŶĞĚ &W͛Ɛ ĐŽͲƐƉŽŶƐŽƌĞĚ ůĞŐŝƐůĂƟŽŶ͕ ϯϭϱ ;tŽŽĚ͕ ĂŚůĞ͕ EĂnjĂƌŝĂŶ ĂŶĚ ^ƚŽŶĞͿ͕ ǁŚŝĐŚ ǁŝůů ƌĞŐƵůĂƚĞ ƉŚĂƌŵĂĐLJ ďĞŶĞĮƚ ŵĂŶĂŐĞƌƐ ;W DƐͿ ĂŶĚ ƉƌŽƚĞĐƚ ƉĂƟĞŶƚƐ ĨƌŽŵ ƵŶĨĂŝƌ ĚƌƵŐ ƉƌŝĐŝŶŐ͘ dŚĞ ŶĞǁ ůĂǁ ƌĞƋƵŝƌĞƐ W DƐ ƚŽ ƌĞŐŝƐƚĞƌ ǁŝƚŚ ƚŚĞ ƐƚĂƚĞ ĂŶĚ ŶŽƟĨLJ Ă ƉƵƌĐŚĂƐĞƌ ŽĨ ĂŶLJ ĂĐƟǀŝƚLJ͕ ƉŽůŝĐLJ Žƌ ƉƌĂĐƟĐĞ ƚŚĂƚ ƉƌĞƐĞŶƚƐ Ă ĐŽŶŇŝĐƚ ŽĨ ŝŶƚĞƌĞƐƚ͘ /Ŷ ĂĚĚŝƟŽŶ ƚŽ ƌĞŐƵůĂƟŶŐ W DƐ͕ ƚŚĞ ŶĞǁ ůĂǁ ƐĞĞŬƐ ƚŽ ŐƵŝĚĞ ƉĂƟĞŶƚƐ ƚŽ ƚŚĞ ůŽǁĞƐƚ ĐŽƐƚ ĨŽƌ ƚŚĞŝƌ ŵĞĚŝĐĂƟŽŶ ďLJ ďĂƌƌŝŶŐ W DƐ ĂŶĚ ŚĞĂůƚŚ ƉůĂŶƐ ĨƌŽŵ ƉƌŽŚŝďŝƟŶŐ ƉƌŽǀŝĚĞƌƐ ĨƌŽŵ ŝŶĨŽƌŵŝŶŐ ƉĂƟĞŶƚƐ ŽĨ Ă ůĞƐƐ ĐŽƐƚůLJ ĂůƚĞƌŶĂƟǀĞ ƚŽ Ă ƉƌĞƐĐƌŝďĞĚ ŵĞĚŝĐĂƟŽŶ͘ /ƚ ĂůƐŽ ƌĞƋƵŝƌĞƐ ƉŚĂƌŵĂĐŝĞƐ ƚŽ ŝŶĨŽƌŵ ĐƵƐƚŽŵĞƌƐ ǁŚĞƚŚĞƌ ƚŚĞ ƌĞƚĂŝů ƉƌŝĐĞ ŽĨ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ŝƐ ůŽǁĞƌ ƚŚĂŶ the applicable cost-sharing amount for that drug.

EĞǁ WĂƌŬŝŶƐŽŶ͛Ɛ ŝƐĞĂƐĞ ZĞƉŽƌƟŶŐ ZĞƋƵŝƌĞŵĞŶƚ ZĞĚƵĐĞĚ &W ǁŽƌŬĞĚ ǁŝƚŚ Ă ŶƵŵďĞƌ ŽĨ ƐƚĂŬĞŚŽůĚĞƌƐ ƚŽ ƉƌĞƐƐƵƌĞ ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ ; W,Ϳ ĂŶĚ ƚŚĞ 'ŽǀĞƌŶŽƌ͛Ɛ ŽĸĐĞ ƚŽ ƌĞĚƵĐĞ ŽǀĞƌůLJ ďƵƌĚĞŶƐŽŵĞ ĂŶĚ ƵŶŶĞĐĞƐƐĂƌLJ ƌĞƉŽƌƟŶŐ ƌĞƋƵŝƌĞŵĞŶƚƐ ƌĞůĂƚĞĚ ƚŽ ƚŚĞ ĐŽůůĞĐƟŽŶ ŽĨ ĚĂƚĂ ĨŽƌ ƚŚĞ ĂůŝĨŽƌŶŝĂ WĂƌŬŝŶƐŽŶ͛Ɛ ŝƐĞĂƐĞ ZĞŐŝƐƚƌLJ͘ dŚĞ ZĞŐŝƐƚƌLJ͕ ǁŚŝĐŚ ŽƉĞŶĞĚ :ƵůLJ ϭ͕ ϮϬϭϴ͕ ƌĞƋƵŝƌĞƐ ƉŚLJƐŝĐŝĂŶƐ͕ ƉŚLJƐŝĐŝĂŶ

ĂƐƐŝƐƚĂŶƚ ĂŶĚ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ǁŚŽ ĚŝĂŐŶŽƐĞ Žƌ ƚƌĞĂƚ WĂƌŬŝŶƐŽŶ͛Ɛ ĚŝƐĞĂƐĞ ƉĂƟĞŶƚƐ ƚŽ ƌĞŐŝƐƚĞƌ ǁŝƚŚ W, ĂŶĚ ƌĞƉŽƌƚ ĐĂƐĞƐ ŽĨ WĂƌŬŝŶƐŽŶ͛Ɛ ĚŝƐĞĂƐĞ͘ dŚĞ ŽƌŝŐŝŶĂů ϲϮ ƌĞƋƵŝƌĞĚ ĚĂƚĂ ĮĞůĚƐ ŚĂǀĞ ďĞĞŶ ŶĂƌƌŽǁĞĚ ƚŽ ϭϰ ƌĞƋƵŝƌĞĚ ĮĞůĚƐ ĂŶĚ ƚŚƌĞĞ ŽƉƟŽŶĂů ĮĞůĚƐ ĂŶĚ Ă ŶĞǁ /ŵƉůĞŵĞŶƚĂƟŽŶ 'ƵŝĚĞ ŚĂƐ ďĞĞŶ ƌĞůĞĂƐĞĚ͘ /Ĩ LJŽƵ ƚƌĞĂƚ ƚŚŝƐ ƉŽƉƵůĂƟŽŶ͕ ƉůĞĂƐĞ ĨĂŵŝůŝĂƌŝnjĞ LJŽƵƌƐĞůĨ ǁŝƚŚ ƚŚĞ ŶĞǁ ŝŵƉůĞŵĞŶƚĂƟŽŶ ŐƵŝĚĞ ĂŶĚ ƐĞĞ W,͛Ɛ ͞ ƚ Ă 'ůĂŶĐĞ͟ ĚŽĐƵŵĞŶƚ͘ CDPH has also created an email list serve that clinicians can sign up for to receive updates on the registry. dŚĞƐĞ ǀŝĐƚŽƌŝĞƐ ǁŽƵůĚ ŶŽƚ ŚĂǀĞ ďĞĞŶ ƉŽƐƐŝďůĞ ǁŝƚŚŽƵƚ &W ŵĞŵďĞƌƐ ůŝŬĞ LJŽƵ͘ / ĞŶĐŽƵƌĂŐĞ LJŽƵ to reach out to your colleagues and ask if they are CAFP members. If they are, please thank them for their support of our specialty. If they are not, ƉůĞĂƐĞ ĞŶĐŽƵƌĂŐĞ ƚŚĞŵ ƚŽ ũŽŝŶ ƵƐ ŝŶ ŽƵƌ ĞīŽƌƚƐ ƚŽ ŵĂŬĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚŚĞ ĨŽƵŶĚĂƟŽŶ ŽĨ ŽƵƌ health care system.

California Family Physician Winter 2019

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IN THE NEWS Winter 2019

We’re excited to launch this new column … and to share news ŝƚĞŵƐ ĂďŽƵƚ &W ŵĞŵďĞƌƐ͘ ,ĂǀĞ ĂŶ ŝƚĞŵ ƚŽ ƐŚĂƌĞ͍ ^ĞŶĚ ŝƚ ƚŽ &W͕ ƩŶ͗ ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ͕ ͕ DĂŶĂŐŝŶŐ ĚŝƚŽƌ͕ ĂŶĚ ǁĞ͛ůů do our best to spread your news!

ůĞĂĚĞƌ͕ ĂŶĚ ŶŽǁ Ă ƌĞƐŝĚĞŶƚ ŝŶ tĂƐŚŝŶŐƚŽŶ͕ ŚĂƐ ďĞĞŶ ĂƉƉŽŝŶƚĞĚ ƚŽ ƚŚĞ ŽŵŵŝƐƐŝŽŶ ŽŶ YƵĂůŝƚLJ ĂŶĚ WƌĂĐƟĐĞ͘ dŚĞ ĮƌƐƚ &W ůƵƐƚĞƌ ŝƐ :ĂŶƵĂƌLJ ϮϱͲϮϳ͕ ŝŶ <ĂŶƐĂƐ ŝƚLJ͘ ŶĚ͕ Žď ŝĚƵƐ ŚĂƐ ďĞĞŶ ĂƉƉŽŝŶƚĞĚ to the American Board of Family Medicine Board of Directors.

ŽŶŐƌĂƚƵůĂƟŽŶƐ ĂƌĞ ŝŶ ŽƌĚĞƌ ĨŽƌ &W ŝƌĞĐƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚĂů īĂŝƌƐ ĂŶĚ ŚŝƐ ǁŝĨĞ ŵŝůŝĂ Ğ >Ƶnj͕ ŽŶ ƚŚĞ ďŝƌƚŚ ŽĨ ƚŚĞ ŶĞǁĞƐƚ &DZĞǀŽůƵŝŽŶĂƌLJ͕ ǁĞŝŐŚŝŶŐ ŝŶ Ăƚ ŶĞĂƌůLJ ϭϬ ƉŽƵŶĚƐ ŽŶ :ĂŶƵĂƌLJ ϭϲ͘ tĞůĐŽŵĞ ƚŽ ƚŚĞ ǁŽƌůĚ KǁĞŶ ĚĂŵ Joaquin Francis!

CAFP Nominating Committee Proposes its Slate of Officers for 2019-2020

CAFP Immediate Past President Michelle Quoigue has been selected as an American Academy of Family Physicians Health ƋƵŝƚLJ &ĞůůŽǁ͘ ^ŚĞ ƐƚĂƌƚĞĚ ŚĞƌ ǁŽƌŬ ŝŶ Kansas City at AAFP headquarters last fall!

David Bazzo, CAFP’s Speaker, is also the President of the San Diego County Medical Society.

The members of District IX have elected Ron Labuguen, MD to represent them on CAFP’s Board of Directors. Ron is professor of family and community medicine at the University of California, San Francisco (UCSF) and the medical director of the Adult Urgent Care Center at Zuckerberg San Francisco General Hospital and Trauma ĞŶƚĞƌ ; ^&'Ϳ͘ ZŽŶ ƌĞƉůĂĐĞƐ ƐŚďLJ tŽůĨĞ͕ ǁŚŽ ŚĂƐ ůĞŌ ĂůŝĨŽƌŶŝĂ ĨŽƌ tĂƐŚŝŶŐƚŽŶ ^ƚĂƚĞ͘ ƐŚďLJ ǁŝůů ƌĞŵĂŝŶ ĞŶŐĂŐĞĚ ǁŝƚŚ &W ŝŶ ŚĞƌ role for the Centers for Medicare and Medicaid (CMS). ůĞdž DĐ ŽŶĂůĚ ũŽŝŶƐ ƚŚĞ ƌĂŶŬƐ ŽĨ &W ŵĞŵďĞƌƐ ĂŶĚ ƐƚĂī ƐĞƌǀŝŶŐ ŽŶ &W ŽŵŵŝƐƐŝŽŶƐ ǁŝƚŚ ŚŝƐ ĂƉƉŽŝŶƚŵĞŶƚ ƚŽ the Commission on Membership and DĞŵďĞƌ ^ĞƌǀŝĐĞƐ͘ Ğǀ sĂƐŚŝƐŚƚŚĂ͕ a CAFP medical student leader, and ŶŽǁ Ă ƌĞƐŝĚĞŶƚ ŝŶ tĂƐŚŝŶŐƚŽŶ͕ ŚĂƐ been appointed to the Commission on YƵĂůŝƚLJ ĂŶĚ WƌĂĐƟĐĞ͘ ƌĞŶƚ ^ƵŐŝŵŽƚŽ͕ MD, MPH and Shelly Rodrigues, CAE also serve on CMMS. Art Ohannessian, D ĂŶĚ ŶŶĂ ƐŬĂƌŝ ; ĚƵĐĂƟŽŶͿ͕ Resha Ramachandran, MD, MPP and ^ĐŽƩ EĂƐƐ͕ D ͕ DW ; ĚǀŽĐĂĐLJͿ͕ ĂŶĚ Shani Muhammad, MD and Shannon Connolly, MD (Health of the Public) are also serving on commissions. Dev sĂƐŚŝƐŚƚŚĂ͕ Ă &W ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ 12

California Family Physician Winter 2019

&W͛Ɛ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ ĂĐĐĞƉƚĞĚ ƚŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ͛Ɛ ƐůĂƚĞ Ăƚ ŝƚƐ EŽǀĞŵďĞƌ ϯ͕ ϮϬϭϴ ŵĞĞƟŶŐ͘ dŚĞƐĞ ŝŶĚŝǀŝĚƵĂůƐ ǁŝůů ďĞ ĞůĞĐƚĞĚ ďLJ ƚŚĞ ĚĞůĞŐĂƚĞƐ Ăƚ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ͕ DĂƌĐŚ ϭϬ͕ ϮϬϭϵ͘ WƌĞƐŝĚĞŶƚͲĞůĞĐƚ͗ ĂǀŝĚ ĂnjnjŽ͕ D ^ƉĞĂŬĞƌ͗ Shannon Connolly, MD sŝĐĞͲ^ƉĞĂŬĞƌ͗ Lauren Simon, MD &W ĞůĞŐĂƚĞ ;ϮϬϭϵͲϮϬͿ͗ :ĞīƌĞLJ >ƵƚŚĞƌ͕ D &W ůƚ͘ ĞůĞŐĂƚĞ ;ϮϬϭϵͲϮϬͿ͗ Jay Lee, MD EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ;ϮϬϭϵͲϮϬͿΎ͗ dŽŶĂƚnjŝŶ ZŽĚƌŝŐƵĞnj͕ D Elected by and from the Board ^ĞĐƌĞƚĂƌLJͲdƌĞĂƐƵƌĞƌ ;ϮϬϭϵͲϮϬͿ͗ ZĂƵů LJĂůĂ͕ D ΎdŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ ; D DͿ ŶŽǁ ŶŽŵŝŶĂƚĞƐ ĂŶĚ ĞůĞĐƚƐ Ă ƚŽƚĂů ŽĨ ƚŚƌĞĞ ŵĞŵďĞƌƐ ŽĨ ƚŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ĨƌŽŵ ƚŚĞ D D ĞůĞŐĂƚĞƐ ;ĂĚĚŝƟŽŶĂů ŵĞŵďĞƌ ĂĚĚĞĚ Ăƚ ϭϵϵϲ ŽŶŐƌĞƐƐ ŽĨ ĞůĞŐĂƚĞƐ ĂŶĚ ďLJůĂǁƐ ĐŚĂŶŐĞ ĂƉƉƌŽǀĞĚ Ăƚ ϭϵϵϳ ŽŶŐƌĞƐƐͿ͖ ƚǁŽ ĂƌĞ ĞůĞĐƚĞĚ ĨŽƌ ƚǁŽͲ LJĞĂƌ ƚĞƌŵƐ ŝŶ ŽŶĞ LJĞĂƌ͕ ĂŶĚ ŽŶĞ ŝƐ ĞůĞĐƚĞĚ ĨŽƌ Ă ƚǁŽͲLJĞĂƌ ƚĞƌŵ ƚŚĞ ŶĞdžƚ͘ EŽŵŝŶĂƟŽŶƐ ŵĂLJ ďĞ ŵĂĚĞ ĨƌŽŵ ƚŚĞ ŇŽŽƌ͕ ĂůƚŚŽƵŐŚ ƚŚĞƌĞ ŝƐ ŶŽ ǁƌŝƩĞŶ ƉƌŽŚŝďŝƟŽŶ ŽŶ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ ĨƌŽŵ ƚŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ͕ ĂŶĚ ƚƌĂĚŝƟŽŶĂůůLJ͕ ƐƵĐŚ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ ŚĂǀĞ ďĞĞŶ ŵĂĚĞ͘

Healthy Harbors: Addressing Health Consequences of Immigration Policies /Ŷ ŽƵƌ &Ăůů ϮϬϭϴ ŝƐƐƵĞ ǁĞ ŝŶƚƌŽĚƵĐĞĚ &W &ŽƵŶĚĂƟŽŶ͛Ɛ ,ĞĂůƚŚLJ ,ĂƌďŽƌƐ ƉƌŽũĞĐƚ ʹ Ă ƉƌŽũĞĐƚ ƚŽ ŬĞĞƉ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƚŚĞŝƌ ƉƌĂĐƟĐĞ ƚĞĂŵƐ ƵƉͲƚŽͲĚĂƚĞ ŽŶ ƚŚĞ ŝŵŵŝŐƌĂƟŽŶ ŝƐƐƵĞƐ ǁŚŝĐŚ ŵĂLJ ĂīĞĐƚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͘ tŚŝůĞ ƚŚĞ ĚĞƉƚŚ ŽĨ ƉƌŽďůĞŵƐ ƚŚĂƚ ŵĂLJ ďĞ ĐƌĞĂƚĞĚ ďLJ ƐĞƉĂƌĂƟŽŶ ŽĨ ĨĂŵŝůŝĞƐ͕ / ĂĐƟǀŝƟĞƐ͕ ĐŚĂŶŐĞƐ ƚŽ ƚŚĞ WƵďůŝĐ ŚĂƌŐĞ ƉŽůŝĐŝĞƐ ĨŽƌ DĞĚŝĐĂŝĚ ĂŶĚ ,/W͕ Ăƚ ƚŚĞ &ĞĚĞƌĂů ůĞǀĞů ƌĞŵĂŝŶƐ ƵŶĐůĞĂƌ ƚŽĚĂLJ͕ ŝŶĐƌĞĂƐŝŶŐ ƉŚLJƐŝĐŝĂŶ ĂǁĂƌĞŶĞƐƐ ĂďŽƵƚ ƐƵĐŚ ŝƐƐƵĞƐ ǁŝůů ďĞƩĞƌ ƉƌĞƉĂƌĞ LJŽƵ ĂŶĚ ŽƚŚĞƌ ĐůŝŶŝĐŝĂŶƐ ŝĨ ĂŶĚ ǁŚĞŶ ƚŚĞ ĂĐƟŽŶƐ ĂƌĞ ŝŵƉůĞŵĞŶƚĞĚ͘ tŽƌŬŝŶŐ ŝŶ ĐŽůůĂďŽƌĂƟŽŶ ǁŝƚŚ ƚŚĞ ůĂŵĞĚĂ ŽŶƚƌĂ ŽƐƚĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ͕ ^ĂŶ &ƌĂŶĐŝƐĐŽ DĂƌŝŶ DĞĚŝĐĂů ^ŽĐŝĞƚLJ͕ ŵĞƌŝĐĂŶ ĐĂĚĞŵLJ ŽĨ Pediatrics-California, Osteopathic Physicians and Surgeons of California and Sonoma County Medical Society, 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 of California’s most vulnerable ƉŽƉƵůĂƟŽŶƐ͕ ĞƐƉĞĐŝĂůůLJ ĐŚŝůĚƌĞŶ͘

ŝŶ ĞĂƟŶŐ ĂŶĚ ƐůĞĞƉŝŶŐ͕ ĨƌĞƋƵĞŶƚ ĐƌLJŝŶŐ͕ ŝŶĐƌĞĂƐĞĚ ĨĞĂƌ ĂŶĚ ĂŶdžŝĞƚLJ͕ ĂŶĚͬŽƌ ǁŝƚŚĚƌĂǁĂů Žƌ ĂŶŐĞƌ͘͟Ϯ ^ŽŵĞ ĐŚŝůĚƌĞŶ ĞdžƉĞƌŝĞŶĐĞ ͞ƐƉĞĞĐŚ ĂŶĚ ĚĞǀĞůŽƉŵĞŶƚĂů ĚŝĸĐƵůƟĞƐ͕ ŝŶĐůƵĚŝŶŐ ƌĞŐƌĞƐƐŝŽŶ ĂŶĚ ƌĞǀĞƌƐĂů ŽĨ developmental milestones.” 3 ^ƚƵĚŝĞƐ ƐŚŽǁ ŚŝŐŚ ůĞǀĞůƐ ŽĨ ƉƐLJĐŚŝĂƚƌŝĐ ĚŝƐƚƌĞƐƐ͕ ŝŶĐůƵĚŝŶŐ ĚĞƉƌĞƐƐŝŽŶ ĂŶĚ ƉŽƐƚͲƚƌĂƵŵĂƟĐ ƐƚƌĞƐƐ͕ ĂŵŽŶŐ ĚĞƚĂŝŶĞĚ ĂƐLJůƵŵ ƐĞĞŬĞƌƐ͕ ĞǀĞŶ ĂŌĞƌ ƐŚŽƌƚ ĚĞƚĞŶƟŽŶ ƉĞƌŝŽĚƐ͕ ĂŶĚ ƚŚĂƚ ƐLJŵƉƚŽŵƐ ǁŽƌƐĞŶ ŽǀĞƌ ƟŵĞ͘ ϰ 'ůŽďĂů ƐƚƵĚŝĞƐ ĂůƐŽ ƐŚŽǁ ƐŝŐŶŝĮĐĂŶƚ ĞīĞĐƚƐ ĨŽƌ ĐŚŝůĚƌĞŶ ŚĞůĚ ŝŶ ĚĞƚĞŶƟŽŶ͕ ŝŶĐůƵĚŝŶŐ ĚĞƉƌĞƐƐŝŽŶ͕ ƉŽƐƚͲƚƌĂƵŵĂƟĐ stress, suicidal thoughts and behaviors, developmental delays, and behavioral issues.5 W ĂůƐŽ ŶŽƚĞƐ ŶĞŐĂƟǀĞ ŝŵƉĂĐƚƐ ŽŶ ƚŚĞ ƉĂƌĞŶƚͲĐŚŝůĚ ƌĞůĂƟŽŶƐŚŝƉ͘ϲ

What can family physicians do to ƌĞƐƉŽŶĚ ƚŽ ĨĂŵŝůLJ ƐĞƉĂƌĂƟŽŶ͍ The American Academy of Family Physicians (AAFP) opposes the forced ƐĞƉĂƌĂƟŽŶ ŽĨ ĐŚŝůĚƌĞŶ ĨƌŽŵ ĨĂŵŝůLJ members or caregivers crossing the United States border unless the child’s ŝŵŵĞĚŝĂƚĞ ƉŚLJƐŝĐĂů Žƌ ĞŵŽƟŽŶĂů ŚĞĂůƚŚ Žƌ ƐĂĨĞƚLJ ŝƐ Ăƚ ƌŝƐŬ͕ ĂƐ ƐƵĐŚ ƐĞƉĂƌĂƟŽŶ poses great physical and mental health tŚĂƚ ĂƌĞ ƚŚĞ ŬĞLJ ŚĞĂůƚŚ ŝŵƉůŝĐĂƟŽŶƐ ƌŝƐŬƐ ŝŶ ƚĞƌŵƐ ŽĨ ĞŵŽƟŽŶĂů ƚƌĂƵŵĂ͕ ŽĨ ĨĂŵŝůLJ ƐĞƉĂƌĂƟŽŶ ĂŶĚ ĚĞƚĞŶƟŽŶ͍ ƐĂĨĞƚLJ͕ ĂŶĚ ĚŝŵŝŶŝƐŚĞĚ ŽǀĞƌĂůů ǁĞůůͲ &ĂŵŝůLJ ƐĞƉĂƌĂƟŽŶ ĂŶĚ ĚĞƚĞŶƟŽŶ being.ϳ FP and their team members ĐĂŶ ĐŽŵƉůŝĐĂƚĞ ĂŶĚ ĞdžĂĐĞƌďĂƚĞ ĂƌĞ ĞŶĐŽƵƌĂŐĞĚ ƚŽ ĞŶŐĂŐĞ ǁŝƚŚ ĞdžŝƐƟŶŐ ƚƌĂƵŵĂ ĂŵŽŶŐ ǀƵůŶĞƌĂďůĞ either the AAFP or the CAFP to join in ƉŽƉƵůĂƟŽŶƐ͘ Ɛ ŶŽƚĞĚ ďLJ ƚŚĞ ĞdžŝƐƟŶŐ ĞīŽƌƚƐ ƚŽ ŽƉƉŽƐĞ ƉŽůŝĐŝĞƐ ĂŶĚ American Academy of Pediatrics ƌĞŐƵůĂƟŽŶƐ ƚŚĂƚ ĞŶĂďůĞ ƐĞƉĂƌĂƟŽŶ ŽĨ ; WͿ͕ ƐĞƉĂƌĂƟŶŐ ĐŚŝůĚƌĞŶ ĨƌŽŵ families at the US border. Furthermore, ƚŚĞŝƌ ƉĂƌĞŶƚƐ ĞdžƉŽƐĞƐ ƚŚĞŵ ƚŽ ͞ƚŽdžŝĐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ĐŽŵĞ ŝŶƚŽ ĐŽŶƚĂĐƚ stress” that can disrupt healthy ǁŝƚŚ ƚŚŽƐĞ ǁŚŽ ŚĂǀĞ ĐƌŽƐƐĞĚ ƚŚĞ h^ development and lead to lifelong border to reside in the US should inquire ŶĞŐĂƟǀĞ ŝŵƉĂĐƚƐ ŽŶ ƚŚĞŝƌ ŵĞŶƚĂů ŝŶƚŽ ǁŚĞƚŚĞƌ ƚŚĞLJ ŚĂǀĞ ĞdžƉĞƌŝĞŶĐĞĚ ĂŶĚ ƉŚLJƐŝĐĂů ǁĞůůďĞŝŶŐ͘ /Ŷ ƚŚĞ ƐŚŽƌƚ ĨĂŵŝůLJ ƐĞƉĂƌĂƟŽŶ ŝŶ ƚŚĞ ĐŽƵƌƐĞ ŽĨ ŚĞĂůƚŚ ƚĞƌŵ͕ ƚŽdžŝĐ ƐƚƌĞƐƐ ĐĂŶ ŝŶĐƌĞĂƐĞ ƚŚĞ ĂƐƐĞƐƐŵĞŶƚ͘ dŚĞ ĐŚŝůĚƌĞŶ ŽĨ ƚŚŽƐĞ ǁŚŽ ƌŝƐŬ ĂŶĚ ĨƌĞƋƵĞŶĐLJ ŽĨ ŝŶĨĞĐƟŽŶƐ ŝŶ ŚĂǀĞ ĞdžƉĞƌŝĞŶĐĞĚ ĨĂŵŝůLJ ƐĞƉĂƌĂƟŽŶ children as high levels of stress hormones suppress the body’s immune should be screened for signs of childhood trauma using tools associated system. It can also result in developmental issues due to reduced neural ǁŝƚŚ ĚǀĞƌƐĞ ŚŝůĚŚŽŽĚ džƉĞƌŝĞŶĐĞƐ ; ƐͿ͘ ĐŽŶŶĞĐƟŽŶƐ ƚŽ ŝŵƉŽƌƚĂŶƚ ĂƌĞĂƐ ŽĨ ƚŚĞ ďƌĂŝŶ͘ dŽdžŝĐ ƐƚƌĞƐƐ ŝƐ ĂƐƐŽĐŝĂƚĞĚ • ͞^ĐƌĞĞŶŝŶŐ ĂŶĚ ƐƐĞƐƐŵĞŶƚ͟ ʹ dŚĞ EĂƟŽŶĂů ŚŝůĚ dƌĂƵŵĂƟĐ ǁŝƚŚ ĚĂŵĂŐĞ ƚŽ ĂƌĞĂƐ ŽĨ ƚŚĞ ďƌĂŝŶ ƌĞƐƉŽŶƐŝďůĞ ĨŽƌ ůĞĂƌŶŝŶŐ ĂŶĚ ŵĞŵŽƌLJ͘ ^ƚƌĞƐƐ EĞƚǁŽƌŬ ;ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ŶĐƚƐŶ͘ŽƌŐͬƚƌĞĂƚŵĞŶƚƐͲĂŶĚͲ KǀĞƌ ƚŚĞ ůŽŶŐ ƚĞƌŵ͕ ƚŽdžŝĐ ƐƚƌĞƐƐ ŵĂLJ ŵĂŶŝĨĞƐƚ ĂƐ ƉŽŽƌ ĐŽƉŝŶŐ ƐŬŝůůƐ ƉƌĂĐƟĐĞƐͬƐĐƌĞĞŶŝŶŐͲĂŶĚͲĂƐƐĞƐƐŵĞŶƚͿ ĂŶĚ ƐƚƌĞƐƐ ŵĂŶĂŐĞŵĞŶƚ͕ ƵŶŚĞĂůƚŚLJ ůŝĨĞƐƚLJůĞƐ͕ ĂĚŽƉƟŽŶ ŽĨ ƌŝƐŬLJ ŚĞĂůƚŚ • ͞^ĐƌĞĞŶŝŶŐ ĂŶĚ ƐƐĞƐƐŵĞŶƚ ŽĨ ŚŝůĚ dƌĂƵŵĂ͟ ʹ ŚŝůĚ tĞůĨĂƌĞ ďĞŚĂǀŝŽƌƐ͕ ĂŶĚ ŵĞŶƚĂů ŚĞĂůƚŚ ŝƐƐƵĞƐ͕ ƐƵĐŚ ĂƐ ĚĞƉƌĞƐƐŝŽŶ͘ dŽdžŝĐ ƐƚƌĞƐƐ ŝƐ /ŶĨŽƌŵĂƟŽŶ 'ĂƚĞǁĂLJ ;ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĐŚŝůĚǁĞůĨĂƌĞ͘ŐŽǀͬƚŽƉŝĐƐͬ ĂůƐŽ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ŝŶĐƌĞĂƐĞĚ ƌĂƚĞƐ ŽĨ ƉŚLJƐŝĐĂů ĐŽŶĚŝƟŽŶƐ ŝŶƚŽ ĂĚƵůƚŚŽŽĚ͕ ƐLJƐƚĞŵǁŝĚĞͬĂƐƐĞƐƐŵĞŶƚͬĨĂŵŝůLJͲĂƐƐĞƐƐͬĐŚŝůĚŶĞĞĚƐͬƚƌĂƵŵĂͬͿ ŝŶĐůƵĚŝŶŐ ĐŚƌŽŶŝĐ ŽďƐƚƌƵĐƟǀĞ ƉƵůŵŽŶĂƌLJ ĚŝƐĞĂƐĞ͕ ŽďĞƐŝƚLJ͕ ŝƐĐŚĞŵŝĐ ŚĞĂƌƚ • DĞŶƚĂů ,ĞĂůƚŚ ĂƌĞ ^ĞƌǀŝĐĞƐ ďLJ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ;ƉŽƐŝƟŽŶ ĚŝƐĞĂƐĞ͕ ĚŝĂďĞƚĞƐ͕ ĂƐƚŚŵĂ͕ ĐĂŶĐĞƌ͕ ĂŶĚ ƉŽƐƚͲƚƌĂƵŵĂƟĐ ƐƚƌĞƐƐ ĚŝƐŽƌĚĞƌ͘1 ƉĂƉĞƌͿ ʹ &W ;ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂďŽƵƚͬƉŽůŝĐŝĞƐͬĂůůͬ mental-services.html) • ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů͕ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬ ŚŝůĚƌĞŶ ŝŶ ĨĂŵŝůŝĞƐ ǁŚĞƌĞ Ă ƉĂƌĞŶƚ ŚĂƐ ďĞĞŶ ĚĞƚĂŝŶĞĚ ĂŶĚ ĚĞƉŽƌƚĞĚ ǀŝŽůĞŶĐĞƉƌĞǀĞŶƟŽŶͬĂĐĞƐƚƵĚLJͬ ĞdžŚŝďŝƚ ƐŝŐŶŝĮĐĂŶƚ ĐŚĂŶŐĞƐ ŝŶ ďĞŚĂǀŝŽƌ ƚŚĂƚ ĐĂŶ ŝŶĐůƵĚĞ ͞ĐŚĂŶŐĞƐ 14

California Family Physician Winter 2019

dŚĞ Ɛŝdž ,ĞĂůƚŚLJ ,ĂƌďŽƌƐ ƉĂƌƚŶĞƌƐ ŝŶ ƚŚŝƐ ƉƌŽũĞĐƚ ĂƌĞ ŝŵƉůĞŵĞŶƟŶŐ Ă ŵƵůƟͲƉƌŽŶŐĞĚ ŝŶĨŽƌŵĂƟŽŶ ƐƚƌĂƚĞŐLJ͕ ŝŶĐůƵĚŝŶŐ ŝĚĞŶƟĨLJŝŶŐ ĐŚĂŵƉŝŽŶƐ ƚŽ speak at live events and to the media; a series ŽĨ ƉŽƐŝƟŽŶ ƉĂƉĞƌƐ ĂŶĚ ƉĂƟĞŶƚ ĞĚƵĐĂƟŽŶ ƉŝĞĐĞƐ͖ ǁĞďŝŶĂƌƐ Žƌ ƉŽĚĐĂƐƚƐ 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 Care &ŽƵŶĚĂƟŽŶ ĨŽƌ ŝƚƐ ƐƵƉƉŽƌƚ ŽĨ ƚŚŝƐ ŝŵƉŽƌƚĂŶƚ project.

References 1.

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<ĂŝƐĞƌ &ĂŵŝůLJ &ŽƵŶĚĂƟŽŶ͘ ͞<ĞLJ ,ĞĂůƚŚ /ŵƉůŝĐĂƟŽŶƐ ŽĨ ^ĞƉĂƌĂƟŽŶ ŽĨ &ĂŵŝůŝĞƐ Ăƚ ƚŚĞ ŽƌĚĞƌ͟ ; ĐĐĞƐƐĞĚ EŽǀĞŵďĞƌ ϮϬϭϴͿ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘Ŭī͘ŽƌŐͬĚŝƐƉĂƌŝƟĞƐͲƉŽůŝĐLJͬ ĨĂĐƚͲƐŚĞĞƚͬŬĞLJͲŚĞĂůƚŚͲŝŵƉůŝĐĂƟŽŶƐͲŽĨͲ ƐĞƉĂƌĂƟŽŶͲŽĨͲĨĂŵŝůŝĞƐͲĂƚͲƚŚĞͲďŽƌĚĞƌͬ Ajay Chaudry, et al., Facing Our Future ŚŝůĚƌĞŶ ŝŶ ƚŚĞ ŌĞƌŵĂƚŚ ŽĨ /ŵŵŝŐƌĂƟŽŶ Enforcement, ;tĂƐŚŝŶŐƚŽŶ͕ ͗ dŚĞ hƌďĂŶ /ŶƐƟƚƵƚĞ͕ &ĞďƌƵĂƌLJ ϮϬϭϬͿ͕ ŚƩƉƐ͗ͬ​ͬ ǁǁǁ͘ƵƌďĂŶ͘ŽƌŐͬƐŝƚĞƐͬĚĞĨĂƵůƚͬĮůĞƐͬ ƉƵďůŝĐĂƟŽŶͬϮϴϯϯϭͬϰϭϮϬϮϬͲ&ĂĐŝŶŐͲKƵƌͲ Future.PDF Ibid Janet Cleveland, Cecile Rousseau, and Rachel Kronick, dŚĞ ŚĂƌŵĨƵů ĞīĞĐƚƐ ŽĨ ĚĞƚĞŶƟŽŶ ĂŶĚ ĨĂŵŝůLJ ƐĞƉĂƌĂƟŽŶ ŽŶ ĂƐLJůƵŵ seekers’ mental health in the context of Bill C-31, Ɖƌŝů ϮϬϭϮ͕ ŚƩƉƐ͗ͬ​ͬĐƐƐƐĚĞůĂŵŽŶƚĂŐŶĞ͘ ƋĐ͘ĐĂͬĮůĞĂĚŵŝŶͬĐƐƐƐͺĚůŵͬWƵďůŝĐĂƟŽŶƐͬ WƵďůŝĐĂƟŽŶƐͺ Z&ͬďƌŝĞĨͺĐϯϭͺĮŶĂů͘ƉĚĨ͖ :ƵůŝĞ D͘ >ŝŶƚŽŶ͕ DĂƌƐŚĂ 'ƌŝĸŶ͕ ůĂŶ :͘ ^ŚĂƉŝƌŽ͕ and Council on Community Pediatrics, ͞ ĞƚĞŶƟŽŶ ŽĨ /ŵŵŝŐƌĂŶƚ ŚŝůĚƌĞŶ͕͟ WĞĚŝĂƚƌŝĐƐ͕ DĂƌĐŚ ϭϯ͕ ϮϬϭϳ͕͖ ŚƩƉ͗ͬ​ͬ ƉĞĚŝĂƚƌŝĐƐ͘ĂĂƉƉƵďůŝĐĂƟŽŶƐ͘ŽƌŐͬĐŽŶƚĞŶƚͬ ĞĂƌůLJͬϮϬϭϳͬϬϯͬϬϵͬƉĞĚƐ͘ϮϬϭϳͲϬϰϴϯ͕ tĞŶĚLJ Cervantes, &ĂŵŝůLJ ĞƚĞŶƟŽŶ͗ dŚĞ ,ĂƌŵĨƵů Impact on Children, ;tĂƐŚŝŶŐƚŽŶ͕ ͗ &ŝƌƐƚ &ŽĐƵƐ͕ ĞĐĞŵďĞƌ ϴ͕ ϮϬϭϱͿ͕ ŚƩƉƐ͗ͬ​ͬ ĮƌƐƞŽĐƵƐ͘ŽƌŐͬƌĞƐŽƵƌĐĞƐͬĨĂĐƚͲƐŚĞĞƚͬĨĂŵŝůLJͲ ĚĞƚĞŶƟŽŶͲƚŚĞͲŚĂƌŵĨƵůͲŝŵƉĂĐƚͲŽŶͲĐŚŝůĚƌĞŶ͘ Ibid :ƵůŝĞ D͘ >ŝŶƚŽŶ͕ DĂƌƐŚĂ 'ƌŝĸŶ͕ ůĂŶ :͘ Shapiro, and Council on Community WĞĚŝĂƚƌŝĐƐ͕ ͞ ĞƚĞŶƟŽŶ ŽĨ /ŵŵŝŐƌĂŶƚ Children,” Pediatrics, DĂƌĐŚ ϭϯ͕ ϮϬϭϳ͕ ŚƩƉ͗ͬ​ͬƉĞĚŝĂƚƌŝĐƐ͘ĂĂƉƉƵďůŝĐĂƟŽŶƐ͘ŽƌŐͬ ĐŽŶƚĞŶƚͬĞĂƌůLJͬϮϬϭϳͬϬϯͬϬϵͬƉĞĚƐ͘ϮϬϭϳͲ Ϭϰϴϯ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂďŽƵƚͬƉŽůŝĐŝĞƐͬĂůůͬ ƐĞƉĂƌĂƟŽŶŽĨͲĨĂŵŝůŝĞƐ͘Śƚŵů California Family Physician Winter 2019

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ABFM Offering a Longitudinal Pilot and Coming to CAFP to Answer Your Questions The American Board of Family Medicine (ABFM) has announced a ŶĞǁ ƉŝůŽƚ ƉƌŽŐƌĂŵ ĚĞƐŝŐŶĞĚ ƚŽ ĂƐƐĞƐƐ ƚŚĞ ǀĂůƵĞ ĂŶĚ ĨĞĂƐŝďŝůŝƚLJ ŽĨ Ă ůŽŶŐŝƚƵĚŝŶĂů ĂƐƐĞƐƐŵĞŶƚ ŽƉƟŽŶ ƚŽ ƚŚĞ ϭϬͲLJĞĂƌ ĞdžĂŵŝŶĂƟŽŶ͘ WŚLJƐŝĐŝĂŶƐ ǁŚŽ ĂƌĞ ĐƵƌƌĞŶƚ ǁŝƚŚ ĐŽŶƟŶƵŽƵƐ ĐĞƌƟĮĐĂƟŽŶ ĂŶĚ ĚƵĞ ƚŽ ƚĂŬĞ ƚŚĞ ĞdžĂŵŝŶĂƟŽŶ ŝŶ ϮϬϭϵ ĂƌĞ ĞůŝŐŝďůĞ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ŶĞǁ ƉŝůŽƚ͘ dŚŝƐ ŶĞǁ ůŽŶŐŝƚƵĚŝŶĂů ƉĂƚŚǁĂLJ ŝƐ ďĂƐĞĚ ŽŶ ƚŚĞ ƉŽƉƵůĂƌ ŽŶƟŶƵŽƵƐ <ŶŽǁůĞĚŐĞ ^ĞůĨͲ ƐƐĞƐƐŵĞŶƚ ; <^ Ϳ ƉůĂƞŽƌŵ ĂŶĚ ĚĞůŝǀĞƌƐ Ϯϱ ŽŶůŝŶĞ ƋƵĞƐƟŽŶƐ ĞĂĐŚ ƋƵĂƌƚĞƌ͘ /ŶĐŽŵŝŶŐ &D WƌĞƐŝĚĞŶƚ ĂŶĚ K tĂƌƌĞŶ EĞǁƚŽŶ͕ D ŶŽƚĞĚ ƚŚĂƚ ƚŚĞ ƉŝůŽƚ ͙͞ ǁŝůů ƉƌŽǀŝĚĞ ƋƵĞƐƟŽŶƐ ŽŶ Ă ƌĞŐƵůĂƌ͕ ůŽŶŐŝƚƵĚŝŶĂů ďĂƐŝƐ͕ ŝŶ Ă ĨŽƌŵĂƚ ƚŚĂƚ ŝƐ ŵƵĐŚ ŵŽƌĞ ĐŽŶǀĞŶŝĞŶƚ͕ ͲͲ Ă ĨĞǁ ƋƵĞƐƟŽŶƐ Ăƚ Ă ƟŵĞ͕ ŝŶ ƚŚĞ ƉůĂĐĞ ĂŶĚ ƟŵĞ ŽĨ LJŽƵƌ ĐŚŽŝĐĞ͘ zŽƵ ŵĂLJ ƵƐĞ ĐůŝŶŝĐĂů ƌĞĨĞƌĞŶĐĞƐ ĚƵƌŝŶŐ ƚŚĞ ĂƐƐĞƐƐŵĞŶƚ͕ ŵƵĐŚ ůŝŬĞ LJŽƵ ĚŽ ŝŶ ƉƌĂĐƟĐĞ͘ zŽƵ ǁŝůů ŶŽƚ ŶĞĞĚ ƚŽ ƚƌĂǀĞů ƚŽ Ă ƚĞƐƚ ĐĞŶƚĞƌ͕ ŶŽƌ ƐƉĞŶĚ ĂĚĚŝƟŽŶĂů ƟŵĞ ĂŶĚ ŵŽŶĞLJ ŽŶ preparatory courses.” dŚĞ &W ŚĂƐ ďĞĞŶ ǁŽƌŬŝŶŐ ĐůŽƐĞůLJ ǁŝƚŚ ƚŚĞ &D ĂĚǀŽĐĂƟŶŐ ĨŽƌ DĂŝŶƚĞŶĞŶĐĞ ŽĨ ĞƌƟĮĐĂƟŽŶ ;DK Ϳ ŝŵƉƌŽǀĞŵĞŶƚƐ ƐŽƵŐŚƚ ďLJ ŝƚƐ member diplomates. Last year the AAFP assembled a task force to ƐƚƵĚLJ ƐĞǀĞƌĂů ŝƐƐƵĞƐ ĂŶĚ ƚŽ ĨŽƌŵƵůĂƚĞ ĂĐƟŽŶ ƉůĂŶƐ͘ &W͛Ɛ ŝŵŵĞĚŝĂƚĞ

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California Family Physician Winter 2019

past president Michelle Quiogue served on the task force. Dr. Quiogue ĂŶĚ &W ƉĂƐƚ ƉƌĞƐŝĚĞŶƚ ^ƚĞǀĞ 'ƌĞĞŶ ĂůƐŽ ƉĂƌƟĐŝƉĂƚĞĚ ŝŶ ƚŚĞ &D͛Ɛ ƐƚƌĂƚĞŐŝĐ ƉůĂŶŶŝŶŐ ƐĞƐƐŝŽŶ ůĂƐƚ ƐƵŵŵĞƌ͘ &W ĞƉƵƚLJ sW ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ ĂůƐŽ ƐĞƌǀĞƐ ŽŶ Ă ĐŚĂƉƚĞƌ ĂĚǀŝƐŽƌLJ ĐŽŵŵŝƩĞĞ ƚŽ ƚŚĞ &D͘ ƌ͘ EĞǁƚŽŶ ŚĂƐ ĂĐĐĞƉƚĞĚ ŽƵƌ ŝŶǀŝƚĂƟŽŶ ƚŽ ĂƩĞŶĚ &W͛Ɛ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ůŝŶŝĐĂů &ŽƌƵŵ͕ DĂƌĐŚ ϮϵͲϯϭ͕ ŝŶ DŽŶƚĞƌĞLJ͘ /Ŷ ĂĚĚŝƟŽŶ ƚŽ ĂƩĞŶĚŝŶŐ ƚŚĞ ŵĞĞƟŶŐ ĂŶĚ ŵĞĞƟŶŐ ǁŝƚŚ ŵĞŵďĞƌƐ͕ ŚĞ ǁŝůů ŚŽƐƚ ŽŶĞ ŽĨ ƚŚĞ ^ƵŶĚĂLJ ŵŽƌŶŝŶŐ ƚĂďůĞ ƚĂůŬƐ ŽŶ ƚŚĞ ŶĞǁ ůŽŶŐŝƚƵĚŝŶĂů ƉƌŽŐƌĂŵ ĂŶĚ ĂŶƐǁĞƌŝŶŐ LJŽƵƌ DK ƋƵĞƐƟŽŶƐ͘ WŚLJƐŝĐŝĂŶƐ ŵĂLJ ŽƉƚ ŝŶ ƚŽ ƚŚĞ &D &ĂŵŝůLJ DĞĚŝĐŝŶĞ ĞƌƟĮĐĂƟŽŶ >ŽŶŐŝƚƵĚŝŶĂů ƐƐĞƐƐŵĞŶƚ ;&D > Ϳ ƉŝůŽƚ ƐƚĂƌƟŶŐ ĞĐĞŵďĞƌ ϳ͕ ϮϬϭϴ͘ ƉƉůŝĐĂƟŽŶƐ ŵƵƐƚ ďĞ ĐŽŵƉůĞƚĞĚ ďLJ :ĂŶƵĂƌLJ ϯ͕ ϮϬϭϵ͕ ƚŽ ŚĂǀĞ ƚŚĞ ŵĂdžŝŵƵŵ ĂŵŽƵŶƚ ŽĨ ƟŵĞ ƚŽ ĂŶƐǁĞƌ ĮƌƐƚ ƋƵĂƌƚĞƌ ƋƵĞƐƟŽŶƐ͘ dŚĞ ůĂƐƚ ĚĂLJ ƚŽ ĂƉƉůLJ ĨŽƌ ƚŚĞ ƉŝůŽƚ ŝƐ DĂƌĐŚ ϭ͕ ϮϬϭϵ͘ ŚĞĐŬ LJŽƵƌ ĞůŝŐŝďŝůŝƚLJ͘ &Žƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ƚŚĞ ƉŝůŽƚ ƉƌŽŐƌĂŵ͕ ĐŚĞĐŬ ƚŚĞƐĞ ƚǁŽ ƌĞƐŽƵƌĐĞƐ͗ &W͗ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĐŵĞͬĨŵĐůĂ͘Śƚŵů &D͗ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ƚŚĞĂďĨŵ͘ŽƌŐͬŵŽĐͬĨŵĐůĂ͘ĂƐƉdž &Žƌ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ƚŚĞ &ŽƌƵŵ͗ ŚƩƉ͗ͬ​ͬǁǁǁ͘ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬ&D&ŽƌƵŵ

F M Wo r k f o rc e

25 x 2030: New Workforce Efforts Launched Late last summer, the American Academy of Family Physicians ĂŶĚ ƐĞǀĞŶ ŽƚŚĞƌ ŶĂƟŽŶĂů ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŽƌŐĂŶŝnjĂƟŽŶƐ ŬŝĐŬĞĚ Žī Ă ĐŽůůĂďŽƌĂƟǀĞ ƚŽ ƚĂŬĞ ďŽůĚ ƐƚĞƉƐ ƚŽ ŝŶĐƌĞĂƐĞ ƐƚƵĚĞŶƚ ĐŚŽŝĐĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ dŚĞ ŐŽĂů͗ Ϯϱ ƉĞƌĐĞŶƚ ŽĨ h^ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ŵĂƚĐŚ ŝŶƚŽ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ďLJ ƚŚĞ LJĞĂƌ ϮϬϯϬ ;͞Ϯϱ dž ϮϬϯϬ͟Ϳ͕ ĞƐƐĞŶƟĂůůLJ ĚŽƵďůŝŶŐ ƚŚĞ ƌĂƚĞ ŽĨ h^ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĞŶƚĞƌŝŶŐ family medicine from the current rate. &ĂŵŝůLJ ŵĞĚŝĐŝŶĞ ďĞŐĂŶ ĂƐ Ă ƌĞǀŽůƵƟŽŶĂƌLJ ŵŽǀĞŵĞŶƚ ŝŶ ƚŚĞ ϭϵϲϬƐ ĂŶĚ ƉƌĞĐĞĚĞĚ Ă ƉĞƌŝŽĚ ŽĨ ƌĂƉŝĚ ŐƌŽǁƚŚ ĂŶĚ ĞdžƉĂŶƐŝŽŶ for the specialty. ŌĞƌ Ă ĚŽǁŶƚƵƌŶ beginning in the ϭϵϵϬƐ ǁŝƚŚ ĨĞǁĞƌ US medical students pursuing family medicine careers and, residency ƉŽƐŝƟŽŶƐ͕ ĚǁŝŶĚůŝŶŐ family medicine has regained ƚƌĂĐƟŽŶ ǁŝƚŚ Ă decade of steady Ͷ ďƵƚ ŝŶƐƵĸĐŝĞŶƚ Ͷ ŐƌŽǁƚŚ͘

WƌŽĐĞƐƐ ŽĨ DĞĚŝĐĂů ĚƵĐĂƟŽŶ͕ WƌĂĐƟĐĞ dƌĂŶƐĨŽƌŵĂƟŽŶ͕ WĂLJŵĞŶƚ ZĞĨŽƌŵ ĂŶĚ ƚŚĞ ƌĂŶĚ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ͘ KŶĞ ŽĨ ƚŚĞ ĮƌƐƚ ƉƌŽũĞĐƚƐ ŽĨ ƚŚĞ ĐŽůůĂďŽƌĂƟǀĞ ǁŝůů ďĞ ƚŽ ĐƌĞĂƚĞ ƚŚĞ ŝŶĨƌĂƐƚƌƵĐƚƵƌĞ ƚŽ ƐƵƉƉŽƌƚ Ă ƐƚƵĚĞŶƚ ĐŚŽŝĐĞ ůĞĂƌŶŝŶŐ ĂŶĚ ĂĐƟŽŶ ŶĞƚǁŽƌŬ ĨŽƌ departments of family medicine to leverage the concepts of ƉŽƐŝƟǀĞ ĚĞǀŝĂŶĐĞ͕ ĚĂƚĂ ƚŽ ŝŶĨŽƌŵ ĂŶĚ ŐƵŝĚĞ ŝŵƉƌŽǀĞŵĞŶƚ͕ ĂŶĚ ĐƌĞĂƚĞ Ă ďŝĂƐ ƚŽǁĂƌĚ ĂĐƟŽŶ͘ Ŷ ĂĚĚŝƟŽŶĂů ĞĂƌůLJ ƉƌŽũĞĐƚ ǁŝůů ďĞ ĚĞǀĞůŽƉŝŶŐ ĂŶĚ ƉƌŽŵŽƟŶŐ ƚŚĞ ďƌĂŶĚ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚŽ ĐŽŵŵƵŶŝĐĂƚĞ ƚŽ ƉŽƚĞŶƟĂů ͞ƉŝƉĞůŝŶĞ͟ ƐƚƵĚĞŶƚƐ͘ ZŝŐŚƚ ŶŽǁ͕ ƚŚĞ ǁŽƌŬĨŽƌĐĞ ŵĂƚĐŚ ĮŐƵƌĞ ƐƚĂŶĚƐ Ăƚ ĂďŽƵƚ ϭϮ ƉĞƌĐĞŶƚ͕ said Clif Knight, MD, the AAFP’s senior vice president for ĞĚƵĐĂƟŽŶ͘ ͞tĞ ǁĂŶƚ ƚŽ ŵŽƌĞ ƚŚĂŶ double that,” he ƐĂŝĚ Ăƚ ƚŚĞ ŬŝĐŬͲŽī ƚŚŝƐ ƐƵŵŵĞƌ͘ ͞dŚŝƐ is an opportunity to ƉĂƌƚŶĞƌ ǁŝƚŚ ŽƚŚĞƌ family medicine ŽƌŐĂŶŝnjĂƟŽŶƐ ƚŽ tackle a goal set together during the Family Medicine for America’s Health (FMAHealth) project,” said Dr. Knight.

The eight family medicine ŽƌŐĂŶŝnjĂƟŽŶƐ͕ though they have unique missions, all share the vision ůŝĨ <ŶŝŐŚƚ͕ DW͕ &W ^ĞŶŝŽƌ sW ĨŽƌ ĚƵĐĂƚŝŽŶ͕ ŬŝĐŬƐ ŽĨĨ ƚŚĞ Ϯϱ dž ϮϬϯϬ /ŶŝƚŝĂƚŝǀĞ͘ ŽĨ Ă ĐŽƵŶƚƌLJ ǁŝƚŚ the robust family ŵĞĚŝĐŝŶĞ ǁŽƌŬĨŽƌĐĞ ŶĞĞĚĞĚ ƚŽ ƉƌŽǀŝĚĞ ĂĐĐĞƐƐŝďůĞ͕ ƋƵĂůŝƚLJ͕ dŚĞ &W ǁŝůů ƐĞƌǀĞ ĂƐ ƚŚĞ ďĂĐŬďŽŶĞ ŽƌŐĂŶŝnjĂƟŽŶ ĨŽƌ ƚŚĞ ĂīŽƌĚĂďůĞ͕ ĂŶĚ ŝŶĐůƵƐŝǀĞ ĐĂƌĞ ĨŽƌ Ăůů͘ tŝƚŚ Ă ƉƌŽũĞĐƚĞĚ ƉƌŝŵĂƌLJ ĐŽůůĂďŽƌĂƟǀĞ ĂŶĚ ŚĂƐ ĨŽƌŵĞĚ Ă ƐƚĞĞƌŝŶŐ ĐŽŵŵŝƩĞĞ ǁŝƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ ƐŚŽƌƚĂŐĞ ŽĨ ϱϮ͕ϬϬϬ ďLJ ϮϬϮϱ ĂŶĚ ĚĞĐĂĚĞƐ ŽĨ ŵĞŵďĞƌƐ ŝŶǀŝƚĞĚ ĨƌŽŵ ƚŚĞ &W &ŽƵŶĚĂƟŽŶ͕ ŵĞƌŝĐĂŶ ŽĂƌĚ ƉƌŽŵŝƐŝŶŐ͕ LJĞƚ ŽŌĞŶ ƵŶĐŽŽƌĚŝŶĂƚĞĚ͕ ĞīŽƌƚƐ ƚŽ ŝŶĐƌĞĂƐĞ ƐƚƵĚĞŶƚ of Family Medicine, American College of Osteopathic Family ĐŚŽŝĐĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ďLJ ĞĂĐŚ ŽĨ ƚŚĞ ŽƌŐĂŶŝnjĂƟŽŶƐ͕ ƚŚĞ ƟŵĞ WŚLJƐŝĐŝĂŶƐ͕ ƐƐŽĐŝĂƟŽŶ ŽĨ ĞƉĂƌƚŵĞŶƚƐ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ͕ ŝƐ ŶŽǁ ƚŽ ƚĂŬĞ Ă ƌĂĚŝĐĂůůLJ ŶĞǁ͕ ƚƌƵůLJ ĐŽůůĞĐƟǀĞ ĂƉƉƌŽĂĐŚ ƚŽ ƚŚŝƐ ƐƐŽĐŝĂƟŽŶ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐLJ ŝƌĞĐƚŽƌƐ͕ EŽƌƚŚ ůĂƐƟŶŐ ĐŚĂůůĞŶŐĞ͘ American Primary Care Research Group and Society of Teachers ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ͘ &W ŝƐ ůŽŽŬŝŶŐ ĨŽƌǁĂƌĚ ƚŽ ǁŽƌŬŝŶŐ dŚĞ ĞŝŐŚƚͲŵĞŵďĞƌ ĐŽůůĂďŽƌĂƟǀĞ ŬŝĐŬŽī ŐĞŶĞƌĂƚĞĚ ŝĚĞĂƐ ĨŽƌ ǁŝƚŚ ƚŚĞ ĐŽůůĂďŽƌĂƟǀĞ ŽŶ ƚŚŝƐ ŶĞǁ ŝŶŝƟĂƟǀĞ ʹ ǁĂƚĐŚ ŚĞƌĞ ĨŽƌ ĞīŽƌƚƐ ƚŽ ĂĚĚƌĞƐƐ ƚŚĞ ŬĞLJ ĚƌŝǀĞƌƐ ŽĨ ƐƚƵĚĞŶƚ ĐŚŽŝĐĞ͗ WŝƉĞůŝŶĞ͕ more details.

18

California Family Physician Winter 2019

Robert Assibey, MD Co-Chair, CAFP President Council

F M Wo r k f o rc e

I Believe We Must Come Out of the Shadows / ǁĂƐ Ă ďŝƚ ůĂƚĞ ƚƵƌŶŝŶŐ ŵLJ ĂƌƟĐůĞ ŝŶ ƚŽ ƚŚĞ ĞĚŝƚŽƌƐ͘ ŶĚ / ƐĞŶƚ ŝƚ ŝŶ ĂŌĞƌ ƐĞǀĞƌĂů ƐŚŝŌƐ ǁŽƌŬŝŶŐ ŝŶ ƚŚĞ / h ͘​͘​͘ Ă ƚƌƵĞ ƌĞŇĞĐƟŽŶ ŽĨ ƚŚĞ ďƌĞĂĚƚŚ ŽĨ ŽƵƌ ƐƉĞĐŝĂůƚLJ͘ I chose family medicine because it closely aligns ǁŝƚŚ ŵLJ ĚĞƐŝƌĞƐ ĂŶĚ ƉĂƐƐŝŽŶ͘ ĞƐŝƌĞƐ ĂŶĚ ƉĂƐƐŝŽŶƐ ŶŽƚ ŽŶůLJ ƚŽ ƚƌĞĂƚ ƉĂƟĞŶƚƐ͕ ďƵƚ ƚŽ ĂůƐŽ ĐŽŶŶĞĐƚ ǁŝƚŚ ƚŚĞŵ͘ / ŚĂĚ ƚŚĂƚ ĐůŝĐŚĠ ŵĞŶƚĂůŝƚLJ ŽĨ ǁĂŶƟŶŐ ƚŽ ŵĂŬĞ Ă ĚŝīĞƌĞŶĐĞ͘ /ƚ ǁĂƐŶ͛ƚ ƵŶƟů / ũŽŝŶĞĚ &W ƚŚĂƚ / ƌĞĂůŝnjĞĚ ŚŽǁ / ĐŽƵůĚ ƚƌƵůLJ ŵĂŬĞ ƚŚĂƚ ĚŝīĞƌĞŶĐĞ͘ EŽƚ ũƵƐƚ ŝŶ ŵLJ ŽǁŶ ĐůŝŶŝĐ͕ ďƵƚ ŵŽƌĞ ŐůŽďĂůůLJ͕ ĨŽƌ the specialty of family medicine. Being involved ŝŶ ǀĂƌŝŽƵƐ ƌĞƐŽůƵƟŽŶƐ ƚŚĂƚ ĐŽŵĞ ďĞĨŽƌĞ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ͕ ƌĞƐŽůƵƟŽŶƐ ĨŽƌ ƉŽůŝĐŝĞƐ that are changing the shape of health care in California and America, has been enlightening. /Ŷ ƚŚŝƐ ĐŚĂŶŐŝŶŐ ƉŽůŝƟĐĂů ĐůŝŵĂƚĞ͕ / ŚĂǀĞ ĂůƐŽ ƐĞĞŶ LJŽƵŶŐ ŝŶĚŝǀŝĚƵĂůƐ ƌĂůůLJ ƚŽŐĞƚŚĞƌ ƚŽǁĂƌĚ Ă ƵŶŝĮĞĚ ĐĂƵƐĞ͘ dŚĞ ƌĂůůLJŝŶŐ ůĞĂǀĞƐ ŵĞ ǁŝƚŚ ŚŽƉĞ ĨŽƌ ĨƵƚƵƌĞ ŐĞŶĞƌĂƟŽŶ ŽĨ LJŽƵŶŐ ƉŚLJƐŝĐŝĂŶƐ͘ / ďĞůŝĞǀĞ ƚŚĞLJ ǁŝůů ŶŽƚ ďĞ ĐŽŶƚĞŶƚ ƚŽ ũƵƐƚ Ɛŝƚ ďĂĐŬ ŝŶ ƚŚĞ ƐŚĂĚŽǁƐ ĂŶĚ ĂĐĐĞƉƚ ƚŚĞ ǁĂLJƐ ƚŚŝŶŐƐ ŚĂǀĞ ĂůǁĂLJƐ ďĞĞŶ ĚŽŶĞ Žƌ ŶŽƚ ĂĚǀŽĐĂƚĞ ĨŽƌ ƚŚĞŝƌ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽůůĞĂŐƵĞƐ͘ tĞ ŚĂǀĞ ƚŚĞ ĂďŝůŝƚLJ ƚŽ ĂīĞĐƚ ŵĂŶLJ ůŝǀĞƐ ĂƐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ďƵƚ ŵĂŶLJ ƉĞŽƉůĞ ĂƌĞ ƵŶĂǁĂƌĞ ŽĨ ŽƵƌ ŝŶŇƵĞŶĐĞ͘ /Ŷ ƚŚĞ ĞƌĂ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ͕ ǁĞ ŚĂǀĞ ƚŚĞ resources to bring to light the various things that ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƵŶĚĞƌƚĂŬĞ͘ ŶĚ / ƐĞĞ Ă ŐƌŽǁŝŶŐ ŝŶƚĞƌĞƐƚ ŝŶ ƚŚĞ ĮĞůĚ͘ KƵƌ ƐƚĂƚĞ ĐŽŶƟŶƵĞƐ ƚŽ ŚĂǀĞ Ă ŐƌĞĂƚ ŶĞĞĚ ĨŽƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ͕ ĂŶĚ ǁĞ͕ ĂƐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŶŽƚ ŽŶůLJ Įůů ƚŚĞ ŶĞĞĚ͕ ďƵƚ ĂƌĞ ĂůƐŽ Ăƚ ƚŚĞ ĨŽƌĞĨƌŽŶƚ ŽĨ ŵĞĚŝĐŝŶĞ͘ / Ăŵ ĂƉƉƌĞĐŝĂƟǀĞ ŽĨ the opportunity I had to become a family physician.

Being a family physician has given me the venue to ŚĂǀĞ Ă ůĞŐŝƐůĂƟǀĞ ǀŽŝĐĞ ŝŶ ƚŚĞ ƌĞĂůŵ ŽĨ ĂĚǀŽĐĂĐLJ͘ dŚƌŽƵŐŚ ŽƵƌ ǀĂƌŝŽƵƐ ǁŽƌŬ ĂŶĚ ƉƌŽũĞĐƚƐ͕ / ĨŽƌĞƐĞĞ ƚŚĞ ƐŚŝŌ ƚŽǁĂƌĚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶĐƌĞĂƐŝŶŐ͕ ĂŶĚ / ůŽŽŬ ĨŽƌǁĂƌĚ ƚŽ ƐĞĞŝŶŐ ƚŚĞ ŐƌĞĂƚ ƚŚŝŶŐƐ ǁĞ ǁŝůů accomplish. ƌ͘ ƐƐŝďĞLJ ŝƐ Ă ƌĞƐŝĚĞŶƚ Ăƚ ^ĂŶ :ŽĂƋƵŝŶ &DZW͘ 20

California Family Physician Winter 2019

Robert Assibey, MD Co-Chair, CAFP President Council

F M Wo r k f o rc e

Zachary Nicholas Co-chair CAFP Student Committee

Family Medicine Must Create a New Environment of Inclusivity &ĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŚĂƐ ƉůĂLJĞĚ Ă ǀŝƚĂů ƌŽůĞ ŝŶ ƚŚĞ ƚƌĂŶƐĨŽƌŵĂƟŽŶ ŽĨ ŵĞĚŝĐŝŶĞ ŝŶƚŽ Ă ĮĞůĚ ƚŚĂƚ ƉƌŝŽƌŝƟnjĞƐ ĂŶĚ ƚƌƵůLJ ǀĂůƵĞƐ ĚŝǀĞƌƐŝƚLJ ĂŶĚ ƌĞƉƌĞƐĞŶƚĂƟŽŶ͘ / Ăŵ ƉƌŽƵĚ ƚŽ ƐƚĂŶĚ ǁŝƚŚ ŽƚŚĞƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ĂƌĞ ĚĞĚŝĐĂƚĞĚ ƚŽ ƐĞƌǀŝŶŐ ƉĂƟĞŶƚƐ ĂŶĚ ĞĚƵĐĂƟŶŐ ƚŚĞ ŶĞdžƚ ŐĞŶĞƌĂƟŽŶ ŽĨ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ŚĂŝů ĨƌŽŵ ĂŶĚ ƐĞƌǀĞ ƚŚĞ ŐƌĞĂƚĞƐƚ ŶĞĞĚ ĐŽŵŵƵŶŝƟĞƐ͘ ŽůůĞĐƟǀĞůLJ͕ ǁĞ ĂƌĞ ǁŽƌŬŝŶŐ ƚŽ ĚŝƐŵĂŶƚůĞ ƚŚĞ ƵŶƐĂǀŽƌLJ ĂƐƉĞĐƚƐ ŽĨ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ͛Ɛ ŚŝƐƚŽƌLJ ĂŶĚ ĐƌĞĂƚĞ Ă ŶĞǁ ĞŶǀŝƌŽŶŵĞŶƚ ďƵŝůƚ ŽŶ ŵƵƚƵĂů ƌĞƐƉĞĐƚ ĂŶĚ ŝŶĐůƵƐŝǀŝƚLJ͘ dŽ ĂĐĐŽŵƉůŝƐŚ ƚŚŝƐ͕ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŵƵƐƚ ƌĞǀŽůƵƟŽŶŝnjĞ ĞĂƌůLJ ĂĐĐĞƐƐ ƚŽ ĐůŝŶŝĐĂů ĞdžƉŽƐƵƌĞ ĂŶĚ ŽƚŚĞƌ ĞdžƉĞƌŝĞŶĐĞƐ ǁŚŝůĞ ĞdžƉĂŶĚŝŶŐ ĚŝǀĞƌƐŝƚLJ ŝŶŝƟĂƟǀĞƐ ĂŶĚ ƉĂƚŚǁĂLJƐ ĨŽƌ ƉŽƚĞŶƟĂů ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͘ dŚŽƵŐŚ ƚŚĞ h^ ƉŽƉƵůĂƟŽŶ ĐŽŶƟŶƵĞƐ ƚŽ ƚƌĂŶƐĨŽƌŵ ĂŶĚ ĂŐĞ͕ ŵĞĚŝĐĂů professions have remained historically inept at recognizing and addressing professional, socioeconomic and racial-ethnic diversity. Family ŵĞĚŝĐŝŶĞ ŵƵƐƚ ĐŽŶƟŶƵĞ ĂƐ ƚŚĞ ǀŽŝĐĞ ŽĨ ƚŚŝƐ ĨƵƚƵƌĞ ĂŶĚ ǁŽƌŬ ƟƌĞůĞƐƐůLJ ƚŽ ƌĞĂůŝnjĞ ŝƚ ŝŶ ŵLJ ůŝĨĞƟŵĞ Žƌ͕ ŝĚĞĂůůLJ͕ ƐŽŽŶĞƌ͘

ĮǀĞ ƉŚLJƐŝĐŝĂŶƐ͘ Ɛ ŽĨ ϮϬϬϴ͕ ϳϱ ƉĞƌĐĞŶƚ ŽĨ ƉŚLJƐŝĐŝĂŶƐ ǁĞƌĞ ǁŚŝƚĞ͘ KŶůLJ ŝŶ ϭϵϳϯ ĚŝĚ ƚŚĞ ŵĞƌŝĐĂŶ WƐLJĐŚŝĂƚƌŝĐ ƐƐŽĐŝĂƟŽŶ ƌĞŵŽǀĞ ŚŽŵŽƐĞdžƵĂůŝƚLJ ĂƐ a mental disorder, having had a horrendous impact on LGBTQ physicians ĂŶĚ ƚŚĞŝƌ ƋƵĂůŝƚLJ ŽĨ ůŝĨĞ Žƌ ƉƌĂĐƟĐĞ ŽƉƟŽŶƐ ƚŚĂƚ ƉĞƌƐŝƐƚƐ ƚŽ ƚŚŝƐ ĚĂLJ͘ ZĞĐĞŶƚůLJ͕ ŵĂŶLJ ŝŶŝƟĂƟǀĞƐ ǁĞƌĞ ŝŵƉůĞŵĞŶƚĞĚ ƚŽ ĂĚĚƌĞƐƐ ƚŚĞ ŚŝƐƚŽƌŝĐ ůĂĐŬ ŽĨ ĚŝǀĞƌƐŝƚLJ ŝŶ ŵĞĚŝĐŝŶĞ ǁŝƚŚ ŵŽĚĞƌĂƚĞ ƐƵĐĐĞƐƐ͘ ^ƵĐŚ ƐƵĐĐĞƐƐ ŝƌŽŶŝĐĂůůLJ ŚŝŐŚůŝŐŚƚƐ ƚŚĞ ĂďƐƵƌĚ ůĞǀĞůƐ ŽĨ ŵŝƐƌĞƉƌĞƐĞŶƚĂƟŽŶ ĂŶĚ ƚŚĞ ĚŝƌĞ ŶĞĞĚ ĨŽƌ ŐƌĞĂƚĞƌ ĂĐƟŽŶ͘ Ɛ ĂĸƌŵĂƟǀĞ ĂĐƟŽŶ ĂŶĚ ƌĞůĂƚĞĚ ƉŽůŝĐŝĞƐ ĐŽŶƟŶƵĞ ƚŽ ďĞ ĐŚŝƉƉĞĚ ĂǁĂLJ͕ ŝƚ ŝƐ ǀŝƚĂů ƚŚĂƚ ƉŚLJƐŝĐŝĂŶƐ ůŝƐƚĞŶ ƚŽ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ ƚŚĂƚ ƌĞĐŽŐŶŝnjĞ ƚŚĞ ƉŽǁĞƌ ĂŶĚ ǀĂůƵĞ ŽĨ ƐĞĞŝŶŐ ƚŚĞŵƐĞůǀĞƐ ŝŶ ƚŚĞŝƌ ŚĞĂůƚŚ ĐĂƌĞ ĞdžƉĞƌŝĞŶĐĞ͘ ^ƵĐŚ ĐŚĂŶŐĞ ŶĞĐĞƐƐŝƚĂƚĞƐ ƉĞƌƐŽŶĂů ĂŶĚ ĐŽŵŵƵŶĂů ƐĂĐƌŝĮĐĞ ƚŚĂƚ ǁŝůů ƵůƟŵĂƚĞůLJ ďĞ ƌĞǁĂƌĚĞĚ ǁŝƚŚ Ă ŵŽƌĞ ũƵƐƚ ĂŶĚ ĞīĞĐƟǀĞ ƉŚLJƐŝĐŝĂŶ ǁŽƌŬĨŽƌĐĞ͕ ůĞĚ ďLJ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ Dƌ͘ EŝĐŚŽůĂƐ ŝƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ Ăƚ ĂůŝĨŽƌŶŝĂ EŽƌƚŚ ^ƚĂƚĞ hŶŝǀĞƌƐŝƚLJ͘

tŝƚŚŽƵƚ ĨĂŵŝůŝĂů Žƌ ŝŶƚĞƌƉĞƌƐŽŶĂů ĐŽŶŶĞĐƟŽŶƐ ƚŽ clinicians, students from non-physician families ĂŶĚ ƵŶĚĞƌͲƌĞƐŽƵƌĐĞĚ ĐŽŵŵƵŶŝƟĞƐ ƐƚƌƵŐŐůĞ ƚŽ ĮŶĚ physicians and health systems that encourage, let alone permit, the presence of aspiring medical students. As a result, students may be discouraged from pursuing medicine or have their ĚĞĚŝĐĂƟŽŶ ĂŶĚ ŝŶƚĞƌĞƐƚƐ ƋƵĞƐƟŽŶĞĚ ĚƵƌŝŶŐ ƚŚĞ ĂƉƉůŝĐĂƟŽŶ ƉƌŽĐĞƐƐ͘ LJ ƌĞĐŽŐŶŝnjŝŶŐ ƚŚĞ ĞŶƟƌĞƚLJ of the individual and the role of environmental ĨĂĐƚŽƌƐ͕ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉŚLJƐŝĐŝĂŶƐ ŬŶŽǁ ƚŚĞ ǀĂůƵĞ ŽĨ ƉƌŽǀŝĚŝŶŐ ƚŚĞƐĞ ĚĞĚŝĐĂƚĞĚ ƐƚƵĚĞŶƚƐ ǁŝƚŚ ŽƉƉŽƌƚƵŶŝƟĞƐ ĂŶĚ ŝŶƐŝŐŚƚ ŶŽƚ ĂīŽƌĚĞĚ ďLJ ĨĂŵŝůLJ Žƌ ƉƌŽĨĞƐƐŝŽŶĂů ďŽŶĚƐ͘ LJ ƐĞĞŬŝŶŐ ŝŶƐƟƚƵƟŽŶĂů ĐŚĂŶŐĞƐ ƚŽ ĂīŽƌĚ ƉƌŽƚĞĐƟŽŶ ƚŽ ƉƌĞͲŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ǁŚŝůĞ ƐŚĂĚŽǁŝŶŐ Žƌ ǀŽůƵŶƚĞĞƌŝŶŐ͕ ĞĚƵĐĂƟŶŐ ƉĂƟĞŶƚƐ ŽŶ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƉŚLJƐŝĐŝĂŶ ƚƌĂŝŶŝŶŐ ǁŚĞŶ ǁŽƌŬŝŶŐ ǁŝƚŚ ƐƚƵĚĞŶƚƐ͕ ĂŶĚ ƐĞƌǀŝŶŐ ĂƐ ĂŶ ĂĚǀŽĐĂƚĞ ƚŽ ŽƚŚĞƌ ƉŚLJƐŝĐŝĂŶƐ͕ ƐƉĞĐŝĂůƟĞƐ͕ Žƌ ŝŶƐƟƚƵƟŽŶƐ͕ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉŚLJƐŝĐŝĂŶƐ ƉůĂLJ ĂŶ ĂĐƟǀĞ ƌŽůĞ ŝŶ ƐƵƉƉŽƌƟŶŐ ƐƚƵĚĞŶƚƐ ǁŚŽ ůĂĐŬ ƚŚĞ ŵĞŶƚŽƌƐŚŝƉ͕ ƌĞƐŽƵƌĐĞƐ Žƌ ƟŵĞ ƚŽ ďĞ ĐŽŵƉĞƟƟǀĞ applicants. dŚŝƐ ŝƐƐƵĞ ĞdžƚĞŶĚƐ ŝŶƚŽ ŽƚŚĞƌ ĂƐƉĞĐƚƐ ŽĨ ƐŽĐŝĞƚĂů inequality that discriminate, overtly or subtly, on racial, ethnic and socioeconomic bases. Thirty LJĞĂƌƐ ĂŐŽ͕ ǁŽŵĞŶ ĐŽŵƉƌŝƐĞĚ ĨĞǁĞƌ ƚŚĂŶ ŽŶĞͲŝŶͲ California Family Physician Winter 2019

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Cynthia Chen-Joea, DO, MPH, CPH Co-chair, CAFP Resident Council

F M Wo r k f o rc e

“There is no medicine ůŝŬĞ ŚŽƉĞ͕ ŶŽ ŝŶĐĞŶƟǀĞ so great, and no tonic so ƉŽǁĞƌĨƵů ĂƐ ĞdžƉĞĐƚĂƟŽŶ of something tomorrow.” ʹ KƌŝƐŽŶ ^ǁĞƩ DĂƌĚĞŶ

Future of Family Medicine is a Calling

Throughout the years, family medicine has evolved into something ŵŽƌĞ ƚŚĂŶ ũƵƐƚ ƐĐŝĞŶĐĞ ĂŶĚ ŵĞĚŝĐŝŶĞ͘ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ Įůů ĞǀĞƌLJ ŶŝĐŚĞ ĨƌŽŵ ƐŵĂůů ƚŽǁŶƐ͕ ƚŽ ƌƵƌĂů ƐĞƫŶŐƐ͕ ƚŽ ůĂƌŐĞ ƵƌďĂŶ ĐŝƟĞƐ͘ tĞ ĂƌĞ ĂďůĞ ƚŽ ƐĞĞ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞ ĐůŝŶŝĐ Žƌ ŚŽƐƉŝƚĂů͕ ƌĞŵŽǀĞ Ă ůĂƌŐĞ ƐĞďĂĐĞŽƵƐ ĐLJƐƚ ŽŶ ƚŚĞ ďĂĐŬ ƌŝŐŚƚ ĂŌĞƌ ĚĞůŝǀĞƌŝŶŐ ďƌĂŶĚ ŶĞǁ ůŝĨĞ ŝŶƚŽ ƚŚĞ ǁŽƌůĚ͘ tŝƚŚ ƐƵĐŚ Ă ďƌŽĂĚ ƐƉĞĐƚƌƵŵ ŽĨ ƉŽƐƐŝďŝůŝƟĞƐ͕ ĨĞǁ ƉĞŽƉůĞ ƌĞĂůŝnjĞ ƚŚĞ ĚĞƉƚŚ ŽĨ ǁŚĂƚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂƌĞ ĂďůĞ ƚŽ ĂĐĐŽŵƉůŝƐŚ ĂŶĚ ƉƌŽǀŝĚĞ͘ dŽ ĨƵƌƚŚĞƌ ƚŚĞ ĐŽŶĨƵƐŝŽŶ͕ ĨĂŵŝůLJ ĚŽĐƚŽƌƐ ŽŌĞŶ ƚĂŬĞ ŽŶ ŵƵůƟƉůĞ ƌŽůĞƐ ŽĨ ƉŽůŝĐLJ advocate, public health professional and community leader. Without ĐůĞĂƌ ŐƵŝĚĞůŝŶĞƐ ĂŶĚ ĚĞĮŶŝƟŽŶƐ͕ ĨĞǁ ƉĞŽƉůĞ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞ ǀĂůƵĞ ĂŶĚ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƚŚŝƐ ƉƌŽĨĞƐƐŝŽŶ͘ ŽŶƐĞƋƵĞŶƚůLJ͕ ĨĞǁĞƌ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂƌĞ ĐŚŽŽƐŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂƐ Ă ĐĂƌĞĞƌ͕ ƚŚƵƐ ůĞĂĚŝŶŐ ƚŽ ŽƵƌ ĐƵƌƌĞŶƚ ĚĞĮĐŝƚ of primary care providers in the United States.

During my short three years of residency, I have come to love the diverse ƉĂƟĞŶƚ ƉŽƉƵůĂƟŽŶ ĂŶĚ ĂƐƐŽƌƚŵĞŶƚ ŽĨ ƉƌŽĐĞĚƵƌĞƐ ĂŶĚ ĐŚĂůůĞŶŐĞƐ ƚŚĂƚ ĂƌĞ ĨĂĐĞĚ ĚĂŝůLJ ǁŝƚŚŽƵƚ ĞǀĞƌ Ă ĚƵůů ŵŽŵĞŶƚ͘ DŽƌĞ ƚŚĂŶ ƚŚĂƚ͕ ƌĞƐŝĚĞŶĐLJ ƌĞǀĞĂůĞĚ ŵLJ ƚƌƵĞ ĐĂůůŝŶŐ ǁŝƚŚŝŶ ŵĞĚŝĐŝŶĞ ʹ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŶĚ ŝŶƐƉŝƌŝŶŐ Ă ŶĞǁ ŐĞŶĞƌĂƟŽŶ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƐƚƵĚĞŶƚƐ͘ dŚŝƐ ĐŽŵĞƐ ĚƵƌŝŶŐ Ă ƉĞƌŝůŽƵƐ ƟŵĞ ǁŚĞŶ ŵĞĚŝĐŝŶĞ ĂŶĚ ƚŚĞ ƌŽůĞ ŽĨ Ă ĨĂŵŝůLJ ĚŽĐƚŽƌ ĂƌĞ ƋƵŝĐŬůLJ ĐŚĂŶŐŝŶŐ͘ / Ăŵ ƉĂƌƚ ŽĨ Ă ŐĞŶĞƌĂƟŽŶ ŽĨ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ďƌŝĚŐĞĚ ƉĂƉĞƌ ƌĞĐŽƌĚƐ ĂƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ǁŝƚŚ ,Z ĂƐ Ă ƌĞƐŝĚĞŶƚ͘ >ĂƌŐĞ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵƐ ŶŽǁ ŵŽŶŝƚŽƌ ŚŽǁ ƉŚLJƐŝĐŝĂŶƐ ƉƌĂĐƟĐĞ ǁŝƚŚ ƉĂƟĞŶƚ ƐĂƟƐĨĂĐƟŽŶ ĂŶĚ ZĞůĂƟǀĞ sĂůƵĞ hŶŝƚƐ ;ZshͿ͕ ǁŝƚŚ ƚŚĞ ƵůƟŵĂƚĞ ŐŽĂů ŽĨ ƉƌŽǀŝĚŝŶŐ ƚŚĞ ŵŽƐƚ ĞĸĐŝĞŶƚ ĂŶĚ ĐŽƐƚ ĞīĞĐƟǀĞ ŵĞĚŝĐĂů ĐĂƌĞ͘ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŝƚŚŝŶ Ă ϭϱͲŵŝŶƵƚĞ ǀŝƐŝƚ͕ ŵƵƐƚ ĞůŝĐŝƚ Ă ĐŚŝĞĨ ĐŽŵƉůĂŝŶƚ͕ ŐĂƚŚĞƌ ĚĂƚĂ ŽŶ ƉĂƟĞŶƚ ƐLJŵƉƚŽŵƐ͕ ĐƌĞĂƚĞ Ă ĚŝīĞƌĞŶƟĂů ůŝƐƚ͕ ƵƉĚĂƚĞ ŵĞĚŝĐĂƟŽŶƐ͕ ĚŽ Ă ĨŽĐƵƐĞĚ ƉŚLJƐŝĐĂů͕ ĐŽŵƉůĞƚĞ Ă ^K W ŶŽƚĞ ĂŶĚ ĐƌĞĂƚĞ Ă ƉůĂŶ ƚŽ ŝŵƉƌŽǀĞ ƉĂƟĞŶƚ ŚĞĂůƚŚ ŵŽǀŝŶŐ ĨŽƌǁĂƌĚ͘ tŚĞŶ ŽƉĞƌĂƟŶŐ ǁŝƚŚŝŶ ƚŚĞƐĞ ĐŽŶƐƚƌĂŝŶƚƐ͕ ŽƵƌ ĐĂůůŝŶŐ ĐĂŶ ďĞ ĐŚĂůůĞŶŐŝŶŐ͖ ŽƚŚ ƉŚLJƐŝĐŝĂŶ ĂŶĚ ƉĂƟĞŶƚ ŚĂǀĞ Ă ƐŚĂƌĞĚ ƐĞŶƐĂƟŽŶ ŽĨ ĨƌƵƐƚƌĂƟŽŶ ĂŶĚ ǀŽŝĚ͘ ĂĐŚ ŚĂƐ ĂŶ ŽǁŶ ĂŐĞŶĚĂ ǁŚĞŶ ĐŽŵŝŶŐ ƚŽ ĂŶ ĂƉƉŽŝŶƚŵĞŶƚ͕ ĂŶĚ ĞĂĐŚ ůĞĂǀĞƐ ǁŝƚŚŽƵƚ ĂĐŚŝĞǀŝŶŐ ǁŚĂƚ ƚŚĞLJ ŚĂĚ ŚŽƉĞĚ͘ dŚĞ ƉĂƟĞŶƚ ŚĂĚ ŚŽƉĞĚ ĨŽƌ ŝŵƉƌŽǀĞĚ ŚĞĂůƚŚ ƚƌĞĂƚĞĚ ďLJ Ă ĚŽĐƚŽƌ ǁŚŽ ƚƌƵůLJ ĐĂƌĞĚ ĂďŽƵƚ ŚŝƐͬŚĞƌ ǁĞůů ďĞŝŶŐ͘ Ƶƚ ĚŽĐƚŽƌ͛Ɛ ĂƩĞŶƟŽŶ ŝƐ ďĞŝŶŐ ƉƵůůĞĚ ŝŶ ĚŝīĞƌĞŶƚ ĚŝƌĞĐƟŽŶƐ ĚƵĞ ƚŽ ŚŽǁ ŵŽĚĞƌŶ ŵĞĚŝĐŝŶĞ ŝƐ ďĞŝŶŐ ƉƌĂĐƟĐĞĚ͘ DĞĚŝĐŝŶĞ ŚĂƐ ƋƵŝĐŬůLJ ĞǀŽůǀĞĚ ŝŶƚŽ ŶĞǁ ƵŶĐŚĂƌƚĞĚ ƚĞƌƌŝƚŽƌLJ ƚŽ ĐŽŶƋƵĞƌ͘ tŚŽ ǁŝůů Įůů ŝŶ ƚŚĞ ƌŽůĞ ĂƐ ƚŚĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ŝŶ ƐŽ ŵĂŶLJ ƵŶĚĞƌƐĞƌǀĞĚ ĂŶĚ ƌƵƌĂů ĐŽŵŵƵŶŝƟĞƐ ǁŚŝůĞ ĂƩĞŵƉƟŶŐ ƚŽ ŵĂŶĞƵǀĞƌ ƚŚƌŽƵŐŚ ƚŚĞ ŵƵůƟƚƵĚĞ ŽĨ ŽďƐƚĂĐůĞƐ ƚŚĂƚ ĨĂĐĞ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ͍ /ƚ ŝƐ ƚŚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚ ŽĨ ƚŽĚĂLJ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ǁŚŽ ŝƐ ĚƌĞĂŵŝŶŐ ƚŽ ďĞ Ă ĨƵƚƵƌĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͘ tĞ ŶĞĞĚ ƚŽ ŝŶƐƉŝƌĞ ƚŚĞ ĨƵƚƵƌĞ ŐĞŶĞƌĂƟŽŶƐ ŽĨ ĨĂŵŝůLJ 22

California Family Physician Winter 2019

ƉŚLJƐŝĐŝĂŶƐ ƚŚŽƵŐŚ ŽƵƌ ƉĂƐƐŝŽŶƐ͕ ĐŽŵŵƵŶŝƚLJ ǁŽƌŬ ĂŶĚ ĞdžĂŵƉůĞ͘ DŽĚĞůŝŶŐ ŝƐ ŝŶŇƵĞŶĐŝŶŐ ŽƚŚĞƌƐ ƚŽ ĨĞĞů ŽƵƌ ŽǁŶ ƐĞŶƐĞ ŽĨ ĞŶƚŚƵƐŝĂƐŵ͕ ƉƌŝĚĞ ĂŶĚ ũŽLJ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ǁŚĞŶ ƚŚĞŝƌ ŚĞĂůƚŚ ŝƐ ƉƌĞƐĞƌǀĞĚ ĂŶĚ ŝŵƉƌŽǀĞĚ͘ tŝƚŚ ƚŚĞ ŶĞǁ LJĞĂƌ͕ / ĞŶĐŽƵƌĂŐĞ LJŽƵ ƚŽ ŵĂŬĞ Ă ƌĞƐŽůƵƟŽŶ ƚŽ ďĞ Ă ŵŽĚĞů ĂŶĚ ĮŐŚƚ ĨŽƌ ǁŚĂƚ LJŽƵ ĨĞĞů ŝƐ ƌŝŐŚƚ͕ ǁŚĞƚŚĞƌ ŝƚ ŝƐ ƚŽ ƉƌŽǀŝĚĞ ĞŵƉĂƚŚĞƟĐ ĂŶĚ ĞǀŝĚĞŶĐĞ ĚƌŝǀĞŶ ŵĞĚŝĐĂů ĐĂƌĞ͕ Žƌ ƚŽ ĞŶŐĂŐĞ ǁŝƚŚ LJŽƵƌ ůŽĐĂů ŚŝŐŚ ƐĐŚŽŽů ƚŽ ƉƌŽǀŝĚĞ ůĞĐƚƵƌĞƐ ŽŶ ƉƌĞǀĞŶƚĂƟǀĞ ŚĞĂůƚŚ͘ WĞƌŚĂƉƐ being a mentor in family medicine is important to you, and you’d like to ƉĂƌƟĐŝƉĂƚĞ ŝŶ Ă ůŽĐĂů ƉŝƉĞůŝŶĞ ƉƌŽŐƌĂŵ ǁŝƚŚ ĐŽůůĞŐĞ ƐƚƵĚĞŶƚƐ ŝŶƚĞƌĞƐƚĞĚ ŝŶ ŵĞĚŝĐŝŶĞ͘ /Ĩ ƉƵďůŝĐ ŚĞĂůƚŚ Žƌ ĂĚǀŽĐĂĐLJ ŝƐ ŝŶƚĞƌĞƐƟŶŐ͕ LJŽƵ ŵŝŐŚƚ ĐŽŶƐŝĚĞƌ ƉƌŽǀŝĚŝŶŐ ŽŶůŝŶĞ ƚĞƐƟŵŽŶLJ ĨŽƌ Ă ƌĞƐŽůƵƟŽŶ LJŽƵ ĨĞĞů ƐƚƌŽŶŐůLJ ĂďŽƵƚ͕ Žƌ ŝŶŝƟĂƚĞ Ă ƐĐƌĞĞŶŝŶŐ ƉƌŽŐƌĂŵ ŽŶ ĨŽŽĚ ŝŶƐĞĐƵƌŝƚLJ ŝŶ LJŽƵƌ ĐůŝŶŝĐ ƚŽ ĂĚĚƌĞƐƐ social determinants of health. When students and residents observe ŵŽƟǀĂƟŽŶĂů ĞŶŐĂŐĞŵĞŶƚ͕ ŝƚ ŝŶƐƉŝƌĞƐ ƉĂƐƐŝŽŶ ĂŶĚ ĐƌĞĂƟǀĞ ƚŚŝŶŬŝŶŐ ŝŶ ƚŚĞ ĮĞůĚ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ ƚŚĞ ůŝŵŝƚůĞƐƐ ďŽƵŶĚĂƌŝĞƐ ŝƚ ĐĂŶ ĞŶƚĂŝů͘ &ĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝƐ ŽŶĞ ŽĨ ƚŚĞ ĨĞǁ ĮĞůĚƐ ŽĨ ŵĞĚŝĐŝŶĞ ƚŚĂƚ ŽīĞƌƐ ƐƵĐŚ Ă ďƌŽĂĚ ƐƉĞĐƚƌƵŵ ŽĨ ƉƌĂĐƟĐĞ ƐƵĐŚ ƚŚĂƚ ŽƵƌ ƐĐŽƉĞ ŝƐ ŶĞĂƌůLJ ĞŶĚůĞƐƐ͘ &ĞůůŽǁƐŚŝƉƐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŵĂLJ ŝŶĐůƵĚĞ͕ ďƵƚ ĂƌĞ ŶŽƚ ůŝŵŝƚĞĚ ƚŽ obstetrics, adolescent medicine, emergency medicine, geriatrics, ƉĂůůŝĂƟǀĞͬŚŽƐƉŝĐĞ ĐĂƌĞ͕ ŚŽƐƉŝƚĂůŝƐƚ ŵĞĚŝĐŝŶĞ͕ ŝŶƚĞŐƌĂƟǀĞ ŵĞĚŝĐŝŶĞ͕ ŐůŽďĂů ŚĞĂůƚŚ͕ ƉƌĞǀĞŶƚĂƟǀĞ ŵĞĚŝĐŝŶĞ͕ ƌƵƌĂů ŵĞĚŝĐŝŶĞ͕ ƐƉŽƌƚƐ ŵĞĚŝĐŝŶĞ͕ ƐƵďƐƚĂŶĐĞ ĂďƵƐĞ ĂŶĚ ǁŽŵĞŶ͛Ɛ ŚĞĂůƚŚ͘ ĚƵĐĂƟŶŐ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂďŽƵƚ family medicine and inspiring them to undertake family medicine as a ĮĞůĚ ŵĂLJ ŚĞůƉ ƐƉƌĞĂĚ ƚŚĞ ǁŽƌĚ ĂďŽƵƚ ǁŚĂƚ ĨĂŵŝůLJ ĚŽĐƚŽƌƐ ĂƌĞ ĐĂƉĂďůĞ ŽĨ ĂĐĐŽŵƉůŝƐŚŝŶŐ͘ tĞ ĂƌĞ ƚŚĞ ĮƌƐƚ ůŝŶĞ ŽĨ ĚĞĨĞŶƐĞ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ĂƌĞ ƉƌŝǀŝůĞŐĞĚ ƚŽ ďĞ ŽŶĞ ŽĨ ƚŚĞ ĨĞǁ ƉƌŽĨĞƐƐŝŽŶƐ ĂďůĞ ƚŽ ƉƌŽǀŝĚĞ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ĐĂƌĞ ĨŽƌ ƚŚĞ ǁŚŽůĞ ƉĂƟĞŶƚ͕ ǁŚĞƚŚĞƌ ƉŚLJƐŝĐĂů͕ ŵĞŶƚĂů or socioeconomical. With such an important undertaking, our focus ƐŚŽƵůĚ ďĞ ŽŶ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŶĚ ĐƵůƟǀĂƟŶŐ Ă ŶĞǁ ŐĞŶĞƌĂƟŽŶ ŽĨ ĚŽĐƚŽƌƐ ĨŽĐƵƐĞĚ ŽŶ ƚƌĞĂƚŵĞŶƚ ǁŝƚŚ ĞŵƉĂƚŚLJ ĂŶĚ ĐŽŵƉĂƐƐŝŽŶ ĚƵƌŝŶŐ ƚŚŝƐ contemporary age of technology. The intrinsic calling of helping others in need is not a quality that can be taught, but one that is nurtured and ĞŶĐŽƵƌĂŐĞĚ ĚƵƌŝŶŐ ŵĞĚŝĐĂů ƐĐŚŽŽů ĂŶĚ ƌĞƐŝĚĞŶĐLJ͘ dƌĂŝŶŝŶŐ ǁĞůůͲƌŽƵŶĚĞĚ͕ ŝŶƋƵŝƐŝƟǀĞ͕ ƉĂƐƐŝŽŶĂƚĞ ƉŚLJƐŝĐŝĂŶƐ ŚĞůƉƐ ƚŽ ƉĂǀĞ ƚŚĞ ǁĂLJ ĨŽƌ ƌĞƐŽƵƌĐĞĨƵů ŵĞƚŚŽĚƐ ŽĨ ƉƌĞƐĞƌǀŝŶŐ ƉĂƟĞŶƚ ŚĞĂůƚŚ ĂŶĚ ǁĞůůͲďĞŝŶŐ͘ dƌƵƚŚĨƵůůLJ͕ / ĚŽ ŶŽƚ ŬŶŽǁ ǁŝƚŚ ĐĞƌƚĂŝŶƚLJ ǁŚĞƌĞ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ƚŚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ǁŝůů ůĞĂĚ͘ ,ŽǁĞǀĞƌ͕ / ŚŽƉĞ ƚŚĂƚ ǁŝƚŚ ĐŽŶƟŶƵĞĚ ƐƚƌŽŶŐ͕ ƐƵƉƉŽƌƟǀĞ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŶĚ ƌĞƐŝĚĞŶĐLJ ƚƌĂŝŶŝŶŐ͕ ƚŚĞ ĮĞůĚ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŵĂLJ ďĞ ƐƚĞĞƌĞĚ ƚŽǁĂƌĚ Ă ƉŽƐŝƟǀĞ ĚŝƌĞĐƟŽŶ ʹ Ă ǁŽƌůĚ ǁŝƚŚ Ă ďĞƩĞƌ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ǁŚĂƚ ǁĞ ĂƌĞ ĂďůĞ ƚŽ ĂĐĐŽŵƉůŝƐŚ͘ ƌ͘ ŚĞŶ ŝƐ Ă ƌĞƐŝĚĞŶƚ Ăƚ ƚŚĞ >ŽŶŐ ĞĂĐŚ DĞŵŽƌŝĂů DĞĚŝĐĂů ĞŶƚĞƌ͘

California Family Physician Winter 2019

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F M Wo r k f o rc e

Andrea Banuelos Mota Co-chair, CAFP Student Council

I’m Inspired by Family Physicians, and the Way They Fought California Wildfires /Ŷ DĂƌĐŚ ϮϬϭϴ͕ / ŚĂĚ ƚŚĞ ƉƌŝǀŝůĞŐĞ ƚŽ ĂƩĞŶĚ ƚŚĞ &W ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ ; D DͿ͘ /ƚ ǁĂƐ Ă ĚĂLJ ǁŚĞŶ / ůĞĂƌŶĞĚ Ă ŐƌĞĂƚ ĚĞĂů ĂďŽƵƚ ƵƐŝŶŐ ŵLJ ǀŽŝĐĞ ƚŽ ŝŶƚĞƌĂĐƚ ǁŝƚŚ ŵLJ ůĞŐŝƐůĂƚŽƌƐ͘ /ƚ ǁĂƐ ĂůƐŽ Ă ĚĂLJ ǁŚĞŶ / ŚĞĂƌĚ ƐƚŽƌŝĞƐ ĨƌŽŵ ŵĂŶLJ ŝŶƐƉŝƌŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ĂƌĞ ƌŽůĞ ŵŽĚĞůƐ ƚŽ ŵĞ͘ dǁŽ ŽĨ ƚŚĞ ƌŽůĞ ŵŽĚĞůƐ ĂƌĞ ƌ͘ >ŝƐĂ tĂƌĚ͕ ĐƵƌƌĞŶƚ &W WƌĞƐŝĚĞŶƚ ĂŶĚ ƌ͘ dĂƌĂ ^ĐŽƩ͕ ZĞƐŝĚĞŶĐLJ ŝƌĞĐƚŽƌ ŽĨ ^ĂŶƚĂ ZŽƐĂ ^ƵƩĞƌ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐLJ͘ dŚĞLJ ƐƉŽŬĞ ĂďŽƵƚ ƚŚĞ ƵŶĨŽƌƚƵŶĂƚĞ ĞǀĞŶƚƐ ŝŶ ƚŚĞŝƌ ĐŽŵŵƵŶŝƟĞƐ ĂƐ ƚŚĞ ƌĞƐƵůƚ ŽĨ ƚŚĞ dƵďďƐ &ŝƌĞ ŝŶ ϮϬϭϳ͘ dŚĞLJ ƐŚĂƌĞĚ ƚŚĞŝƌ ƐƚŽƌŝĞƐ ͙ ƐƚŽƌŝĞƐ ŽĨ ŚŽǁ ƚŚĞLJ ŵŽďŝůŝnjĞĚ ƚŚĞŝƌ ĞŶƟƌĞ ŶĞƚǁŽƌŬ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ƉƌŽǀŝĚĞ ĐĂƌĞ ĨŽƌ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞ most unpredictable of circumstances — such as opening up a school gym ƚŽ ƉƌŽǀŝĚĞ ĐĂƌĞ ĂŶĚ ƚƌĂŶƐĨĞƌƌŝŶŐ ĐĂƌĞ ĨƌŽŵ ŽŶĞ ŚŽƐƉŝƚĂů ƚŽ ƚŚĞ ŶĞdžƚ ďĞĐĂƵƐĞ ƚŚĞŝƌ ŚŽƐƉŝƚĂů ǁĂƐ ďĂĚůLJ ĚĂŵĂŐĞĚ ĨƌŽŵ ƚŚĞ ĮƌĞ͘ dŚĞŝƌ Őƌŝƚ ĂŶĚ ƌĞƐŝůŝĞŶĐĞ͕ ŝůůƵƐƚƌĂƚĞ ŚŽǁ ďŽůĚůLJ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƐŚŝŶĞƐ ŝŶ ƚŚĞ ĐŽŵŵƵŶŝƚLJ͕ ĞƐƉĞĐŝĂůůLJ ŝŶ ƚŚĞƐĞ ĐŝƌĐƵŵƐƚĂŶĐĞƐ͘ dŚĞLJ ŝŶƐƉŝƌĞĚ ŵĞ ƚŽ ƐƉƌĞĂĚ ƚŚĞ ǁŽƌĚ ĂďŽƵƚ ǁŚĂƚ ŚĂĚ ďĞĞŶ ĂĐĐŽŵƉůŝƐŚĞĚ ĂŶĚ ĂďŽƵƚ ŚŽǁ ǁŽŶĚĞƌĨƵů ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝƐ͘ Ɛ ϮϬϭϴ ĐůŽƐĞĚ͕ ĂůŝĨŽƌŶŝĂ ĐŽŶƟŶƵĞƐ ƚŽ ƐƵīĞƌ ƚŚĞ ǁƌĂƚŚ ŽĨ ǁŝůĚĮƌĞƐ͕ ŵŽƐƚ recently the Woolsey Fire, Camp Fire and Paradise Fire. These tragic events

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California Family Physician Winter 2019

ĂƌĞ ƐŽ ĚĞǀĂƐƚĂƟŶŐ ĨŽƌ ŝŶĚŝǀŝĚƵĂůƐ͕ ĨŽƌ ĞŶƟƌĞ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ ĨŽƌ ĂůŝĨŽƌŶŝĂ͘ dŚĞ ĞīĞĐƚƐ ŽĨ ƚŚĞŝƌ ĚĂŵĂŐĞ ĂƌĞ ůŽŶŐͲůĂƐƟŶŐ͘ ZĞĐĞŶƚůLJ͕ ŝƚ ƐĞĞŵƐ ƚŚĂƚ ũƵƐƚ ĂƐ ǁĞ ďĞŐŝŶ ƚŽ ƉŝĞĐĞ ŽƵƌƐĞůǀĞƐ ďĂĐŬ ƚŽŐĞƚŚĞƌ͕ ĂŶŽƚŚĞƌ ƐǁĞĞƉ ŽĨ ǁŝůĚĮƌĞƐ ĞŶŐƵůĨƐ ĂƌĞĂƐ ŽĨ ŽƵƌ ƐƚĂƚĞ͘ dŚŝƐ ǀŽůĂƟůŝƚLJ ƌĞŵŝŶĚƐ ƵƐ ƚŚĂƚ ŶŽ ŽŶĞ ŝƐ ŝŵŵƵŶĞ from facing such disasters. I think that it is even more important for family ƉŚLJƐŝĐŝĂŶƐ ƚŽ ďĞ ŽŵŶŝƉƌĞƐĞŶƚ ŝŶ ĞǀĞƌLJ ĂƌĞĂ ŽĨ ŽƵƌ ƐƚĂƚĞ͘ Ɛ Ă ŐƌŽƵƉ͕ ǁĞ ĐĂŶ unite and prepare to support each other if tragedy knocks at our door. Ɛ Ă ŶĂƟǀĞ ĂůŝĨŽƌŶŝĂŶ͕ / ƚĂŬĞ ŐƌĞĂƚ ƉƌŝĚĞ ŝŶ ŚŽǁ ǁĞ ƵŶŝĨLJ ŝŶ ƟŵĞƐ ŽĨ ƚƌĂŐĞĚLJ͘ tĞ ĐĂŶ ĐŽŶƟŶƵĞ ĚŽŝŶŐ ƚŚĂƚ͕ ŝƐ ďLJ ƐƚƌĞŶŐƚŚĞŶŝŶŐ ŽƵƌ ƟĞƐ͕ ƌĞĐƌƵŝƟŶŐ ŵŽƌĞ ƉƌŽŵŝƐŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ũŽŝŶ ŽƵƌ ĨĂŵŝůLJ ĂŶĚ ĐŽŶƟŶƵĞ ƵƐŝŶŐ ŽƵƌ ǀĞƌƐĂƟůĞ ƐŬŝůůƐ ĚƵƌŝŶŐ ŐƌĞĂƚ ƟŵĞƐ ĂŶĚ ĚƵƌŝŶŐ ĚŝĸĐƵůƚ ƟŵĞƐ͘ Ɛ ĚŝĸĐƵůƚ ĂƐ ŝƚ ŝƐ ĨŽƌ ŵĞ ƚŽ ǁƌŝƚĞ ƚŚŝƐ ŚĞĂǀLJ ƉŝĞĐĞ͕ / ǁƌŝƚĞ ŝƚ ǁŝƚŚ ƚŚĞ ŐƌĞĂƚĞƐƚ ĂĚŵŝƌĂƟŽŶ ĨŽƌ ƚŚĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ƉƌŽĨĞƐƐŝŽŶ ĂŶĚ ǁŝƚŚ ƚŚĞ ƐŝŶĐĞƌĞƐƚ ŚŽƉĞ ƚŚĂƚ ƌĞŐĂƌĚůĞƐƐ ŽĨ ǁŚĂƚ ǁĞ ĂƐ Ă ƐŽĐŝĞƚLJ ĨĂĐĞ ŝŶ ƚŚĞ ĨƵƚƵƌĞ͕ ǁĞ ĐĂŶ ƉĞƌƐĞǀĞƌĞ ĂŶĚ ƚĂŬĞ ŐƌĞĂƚ ĐĂƌĞ ŽĨ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ ʹ ĂŶĚ ŽĨ ĞĂĐŚ ŽƚŚĞƌ͘ DƐ͘ ĂŶƵĞůŽƐ DŽƚĂ ŝƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ Ăƚ <ĞĐŬ ^ĐŚŽŽů ŽĨ DĞĚŝĐŝŶĞ ŽĨ h^ ͘

Conrad Amenta CAFP Director of Health Policy

F M Wo r k f o rc e

California’s Projected Primary Care Physician Needs Outstrip Supply dŚĞ ŶƵŵďĞƌƐ ĂƌĞ ƐƚĂƌŬ͗ ĂůŝĨŽƌŶŝĂ ĐŽƵůĚ ĨĂĐĞ Ă ƐŚŽƌƚĂŐĞ ŽĨ ϱϮ͕ϬϬϬ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ďLJ ϮϬϯϬ͘ dŽ ƉƵƚ ƚŚĂƚ ŝŶƚŽ ĐŽŶƚĞdžƚ͕ according to a recent University of California, San Francisco report ƟƚůĞĚ ͞ ĂůŝĨŽƌŶŝĂ͛Ɛ WƌŝŵĂƌLJ ĂƌĞ tŽƌŬĨŽƌĐĞ͗ &ŽƌĞĐĂƐƚĞĚ ^ƵƉƉůLJ͕ ĞŵĂŶĚ ĂŶĚ WŝƉĞůŝŶĞ ŽĨ dƌĂŝŶĞĞƐ͕ ϮϬϭϲͲϮϬϯϬ͟ ŝƚ͛Ɛ Ă ƐŚŽƌƚĂŐĞ ŽĨ ĂƉƉƌŽdžŝŵĂƚĞůLJ ƚǁŝĐĞ ƚŚĞ ƚŽƚĂů ƐŝnjĞ ŽĨ ƚŚĞ ƚŽĚĂLJ͛Ɛ ǁŽƌŬĨŽƌĐĞ ŽĨ ĂďŽƵƚ Ϯϲ͕ϬϬϬ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ͘1

residency slots in the state. If medical students interested in ďĞĐŽŵŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ĐĂŶŶŽƚ ŵĂƚĐŚ ŝŶƚŽ Ă ƌĞƐŝĚĞŶĐLJ program usually leave for another state. The number and size ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ŝƐ ŝŶĐƌĞĂƐŝŶŐ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϲϬ 'D ͲĂĐĐƌĞĚŝƚĞĚ ƉƌŽŐƌĂŵƐ ŝŶ ĂůŝĨŽƌŶŝĂ ƚŽĚĂLJ ͙ ďƵƚ ƚŚĞ ŐƌŽǁƚŚ ŝƐ ŶŽƚ ŶĞĂƌůLJ ĨĂƐƚ ĞŶŽƵŐŚ ƚŽ ŵĞĞƚ ƚŚĞ ĚĞŵĂŶĚ ĞdžƉĞĐƚĞĚ ďLJ ϮϬϯϬ͘

tŚŝůĞ ƚŚŝƐ ŝƐ Ă ǁŽƌƐƚ ĐĂƐĞ ƐĐĞŶĂƌŝŽ͕ ĞǀĞŶ ŝŶ ƚŚĞ ďĞƐƚ ĐĂƐĞ ƐĐĞŶĂƌŝŽƐ ʹ ƚŚŽƐĞ ŝŶ ǁŚŝĐŚ ƚŚĞ ƉŽƉƵůĂƟŽŶ ĚŽĞƐ ŶŽƚ ŐƌŽǁ ƋƵŝƚĞ ĂƐ ĨĂƐƚ͕ Žƌ ƚŚĞ ĨƌĞƋƵĞŶĐLJ ŽĨ ƌĞƟƌĞŵĞŶƚƐ ĂŵŽŶŐ ƉƌĂĐƟĐŝŶŐ ƉŚLJƐŝĐŝĂŶƐ ĚĞĐƌĞĂƐĞƐ͕ Žƌ ĂůŝĨŽƌŶŝĂ ĞŶũŽLJƐ Ă ŚŝŐŚĞƌ ŝŶŇƵdž ŽĨ ŐƌŽǁƚŚ ĚƵĞ ƚŽ ŝŵŵŝŐƌĂƟŽŶ ĨƌŽŵ ŽƚŚĞƌ ƐƚĂƚĞƐ ĂŶĚ ĐŽƵŶƚƌŝĞƐ͕ Žƌ ǁĞ ƐĞĞ ŝŶĐƌĞĂƐĞĚ training capacity at medical schools and residency programs in ůŝŶĞ ǁŝƚŚ ƚŚĞŝƌ ƚƌĂĚŝƟŽŶĂů ŐƌŽǁƚŚ ʹ ƚŚĞ ƐŚŽƌƚĂŐĞ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ŝƐ ĞdžƉĞĐƚĞĚ ƚŽ ƌĞĂĐŚ ϭϳ͕ϱϬϬ͕ Žƌ ĂƉƉƌŽdžŝŵĂƚĞůLJ ƚǁŽͲ ƚŚŝƌĚƐ ƚŚĞ ƐŝnjĞ ŽĨ ƚŚĞ ĐƵƌƌĞŶƚ ǁŽƌŬĨŽƌĐĞ͘ dŚĞ ƐŚŽƌƚĂŐĞ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ǁŝůů ďĞ ĨĞůƚ ŵŽƐƚ ĂĐƵƚĞůLJ ŝŶ ĂƌĞĂƐ ŽĨ ƚŚĞ ƐƚĂƚĞ ǁŝƚŚ ƚŚĞ ǁŽƌƐƚ ƌĂƟŽƐ ŽĨ ĂĐƟǀĞ ƉĂƟĞŶƚ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ƉĞƌ ϭϬϬ͕ϬϬϬ ƉŽƉƵůĂƟŽŶ ʹ /ŶůĂŶĚ ŵƉŝƌĞ͕ ^ĂŶ :ŽĂƋƵŝŶ sĂůůĞLJ͕ EŽƌƚŚĞƌŶ ĂŶĚ Sierra and Central Coast. With about one-third of the state’s ƉŽƉƵůĂƟŽŶ ĞŶƌŽůůĞĚ ŝŶ DĞĚŝͲ Ăů͕ ĂůŝĨŽƌŶŝĂ ŚĂƐ Ă ƌĞƐƉŽŶƐŝďŝůŝƚLJ ƚŽ guarantee a level of access lest its residents rely increasingly on ĞŵĞƌŐĞŶĐLJ ĚĞƉĂƌƚŵĞŶƚƐ ĨŽƌ ƌŽƵƟŶĞ ĐĂƌĞ Žƌ forgo care altogether.

DĂŶLJ ŽƚŚĞƌ ƐƚĂƚĞƐ ĨƵŶĚ 'D ďLJ ĚƌĂǁŝŶŐ ĚŽǁŶ ĨĞĚĞƌĂů ĨƵŶĚƐ ǀŝĂ ƚŚĞ DĞĚŝĐĂƌĞ ĂŶĚͬŽƌ DĞĚŝĐĂŝĚ ƉƌŽŐƌĂŵƐ͘ ĂůŝĨŽƌŶŝĂ ŚĂƐ ŐŽŶĞ ŝƚƐ ŽǁŶ ǁĂLJ͕ ĚƌĂǁŝŶŐ ĚŽǁŶ ůŝŵŝƚĞĚ ĨĞĚĞƌĂů ĨƵŶĚƐ ĨŽƌ ǁŽƌŬĨŽƌĐĞ ƚƌĂŝŶŝŶŐ͘ dŚŝƐ ŝƐ ŝŶ ƉĂƌƚ ďĞĐĂƵƐĞ ƚŚĞ ĨĞĚĞƌĂů ĨŽƌŵƵůĂƐ ĚĞƚĞƌŵŝŶŝŶŐ ŚŽǁ ŵƵĐŚ ĞĂĐŚ ƐƚĂƚĞ ƌĞĐĞŝǀĞƐ ĂƌĞ ŽƵƚĚĂƚĞĚ ĂŶĚ ĚŝƐĂĚǀĂŶƚĂŐĞ ǁĞƐƚĞƌŶ ƐƚĂƚĞƐ͘ /ŶƐƚĞĂĚ͕ ĨƵŶĚŝŶŐ ĨŽƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƌĞƐŝĚĞŶĐLJ ƚƌĂŝŶŝŶŐ ŝŶ ĂůŝĨŽƌŶŝĂ ŚĂƐ ƚƌĂĚŝƟŽŶĂůůLJ ďĞĞŶ ŐƌĂŶƚĞĚ ǀŝĂ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ ,ĞĂůƚŚĐĂƌĞ tŽƌŬĨŽƌĐĞ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ͕ ǁŚŝĐŚ ĂǁĂƌĚƐ ŐƌĂŶƚƐ ƚŽ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ŽŶ ƚŚĞ ďĂƐŝƐ ŽĨ ƐĞƌǀŝĐĞ ƚŽ ƵŶĚĞƌƐĞƌǀĞĚ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ ƌĞĐƌƵŝƚŵĞŶƚ ŽĨ ƵŶĚĞƌƌĞƉƌĞƐĞŶƚĞĚ ŵŝŶŽƌŝƟĞƐ͘ &W ŝƐ Ă ůŽŶŐƟŵĞ ĐŚĂŵƉŝŽŶ ĂŶĚ ƐƵƉƉŽƌƚĞƌ ŽĨ ^ŽŶŐͲ ƌŽǁŶ͕ ŚĂǀŝŶŐ ŚĞůƉĞĚ ƚŽ ĞƐƚĂďůŝƐŚ ƚŚĞ ƉƌŽŐƌĂŵ ŝŶ ϭϵϳϯ͘ /Ŷ ϮϬϭϲ͕ &W ŚĞůƉĞĚ ƚŽ ƐĞĐƵƌĞ ΨϭϬϬ ŵŝůůŝŽŶ ĨŽƌ ĚŝƐďƵƌƐĂů ƚŚƌŽƵŐŚ ^ŽŶŐͲ ƌŽǁŶ͘ dŚĞ ƐĂŵĞ LJĞĂƌ͕ ĂůŝĨŽƌŶŝĂŶƐ ĂůƐŽ ǀŽƚĞĚ ƚŽ ƉĂƐƐ WƌŽƉŽƐŝƟŽŶ ϱϲ͕ ǁŚŝĐŚ ŝŶĐƌĞĂƐĞĚ ƚĂdžĞƐ ŽŶ ƚŽďĂĐĐŽ ƉƌŽĚƵĐƚƐ͘ dŚĞ ƌĞǀĞŶƵĞ

Research indicates that physicians are most ůŝŬĞůLJ ƚŽ ůŽĐĂƚĞ ƚŚĞŝƌ ƉƌĂĐƟĐĞƐ ǁŝƚŚŝŶ ϱϬ ŵŝůĞƐ ŽĨ ǁŚĞƌĞ ƚŚĞLJ ĚŝĚ ƚŚĞŝƌ ƌĞƐŝĚĞŶĐLJ͕ ŵĂŬŝŶŐ ƚŚĞ ůŽĐĂƟŽŶ ŽĨ Ă ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵ ŝŶ ĂŶ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂ ĂŶ ĞīĞĐƟǀĞ ǁĂLJ to increase the physician supply in that ĂƌĞĂ͘ dŚĞ ŬĞLJ ďŽƩůĞŶĞĐŬ ŝŶ ƚŚĞ ƉƌŽĚƵĐƟŽŶ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ͕ ŚŽǁĞǀĞƌ͕ ŝƐ establishing appropriate funding to sustain ĂŶĚ ĞdžƉĂŶĚ ŐƌĂĚƵĂƚĞ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ;'D Ϳ ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ train and remain in primary care. According ƚŽ ƚŚĞ <ĂŝƐĞƌ &ĂŵŝůLJ &ŽƵŶĚĂƟŽŶ͕ ϭ͕ϭϯϯ medical school students graduated in ĂůŝĨŽƌŶŝĂ ŝŶ ϮϬϭϳ͘ ƚ ƚŚĞ ƐĂŵĞ ƟŵĞ͕ ƚŚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŵĂƚĐŚ ǁĂƐ ůŝŵŝƚĞĚ ƚŽ ƐůŝŐŚƚůLJ ŵŽƌĞ ƚŚĂŶ ϰϬϬ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ 26

California Family Physician Winter 2019

/Ŷ ϭϵϳϯ͕ ƚŚĞŶ 'ŽǀĞƌŶŽƌ ZŽŶĂůĚ ZĞĂŐĂŶ ƐŝŐŶĞĚ ƚŚĞ ŚŝƐƚŽƌŝĐ ^ŽŶŐͲ ƌŽǁŶ >ĞŐŝƐůĂƚŝŽŶ͘

ĨƌŽŵ ƚŚŝƐ ŝŶĐƌĞĂƐĞĚ ƚĂdž ŚĂƐ ďĞĞŶ ĚŝƌĞĐƚĞĚ ƚŽ a number of health care-related programs ĂŶĚ ƉĂLJŵĞŶƚƐ͕ ŝŶĐůƵĚŝŶŐ ΨϰϬ ŵŝůůŝŽŶ annually for primary care GME. Together, ^ŽŶŐͲ ƌŽǁŶ ĂŶĚ WƌŽƉŽƐŝƟŽŶ ϱϲ ƌĞƉƌĞƐĞŶƚ Ă ƐŝŐŶŝĮĐĂŶƚ ĂŶĚ ǀŝƚĂů ĨƵŶĚŝŶŐ ƐƚƌĞĂŵ ĨŽƌ primary care GME. We face numerous policy challenges, to ĞŶƐƵƌĞ ƚŚĞ ĨƵŶĚƐ ĂƌĞ ĚŝƐďƵƌƐĞĚ ĂƐ ĞĸĐŝĞŶƚůLJ ĂƐ ƉŽƐƐŝďůĞ͘ &Žƌ ĞdžĂŵƉůĞ͕ ƚŚĞ ůĞŐŝƐůĂƚƵƌĞ ŽƉĞŶĞĚ ĞůŝŐŝďŝůŝƚLJ ĨŽƌ ďŽƚŚ ^ŽŶŐͲ ƌŽǁŶ ĂŶĚ WƌŽƉŽƐŝƟŽŶ ϱϲ ŐƌĂŶƚƐ ƚŽ ŝŶƚĞƌŶĂů ŵĞĚŝĐŝŶĞ͕ ƉĞĚŝĂƚƌŝĐƐ ĂŶĚ ŽďƐƚĞƚƌŝĐƐͬŐLJŶĞĐŽůŽŐLJ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ͘ hƉ ƚŽ ϴϬ ƉĞƌĐĞŶƚ ŽĨ ŝŶƚĞƌŶĂů ŵĞĚŝĐŝŶĞ ŐƌĂĚƵĂƚĞƐ ĂŶĚ ϱϬ ƉĞƌĐĞŶƚ of pediatrics graduates subspecialize ŽƵƚƐŝĚĞ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ ,Žǁ͕ ƚŚĞŶ͕ ĐĂŶ ƚŚĞ state direct funding to programs that train ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ƌĞŵĂŝŶ ŝŶ ƉƌŝŵĂƌLJ ĐĂƌĞ͍ ĚĚŝƟŽŶĂůůLJ͕ ŶŽƚ Ăůů ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ĂƌĞ located in underserved areas, and those that ĂƌĞ ŵĂLJ ŶŽƚ ƐĞƌǀĞ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶƐ͘ &ŝŶĂůůLJ͕ ƚŚĞ ƟŵĞůŝŶĞ ĨŽƌ ĞƐƚĂďůŝƐŚŝŶŐ Ă ŶĞǁ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵ ŝƐ ŽŌĞŶ ůŽŶŐĞƌ ƚŚĂŶ ƚŚĞ ƟŵĞůŝŶĞƐ ĨŽƌ ĚŝƐďƵƌƐŝŶŐ ĨƵŶĚŝŶŐ͘ &W ŝƐ deeply involved in advising decision-makers as they develop assessment criteria and ĚŝƐďƵƌƐĞ ĨƵŶĚƐ͕ ĂƩĞŶĚŝŶŐ Ăůů ƉƵďůŝĐ ŵĞĞƟŶŐƐ of the California Healthcare Workforce WŽůŝĐLJ ŽŵŵŝƐƐŝŽŶ ĂŶĚ ĂĚǀŽĐĂƟŶŐ ĨŽƌ ƚŚĞ ĂƉƉƌŽƉƌŝĂƚĞ ĚŝƐďƵƌƐĂů ŽĨ WƌŽƉŽƐŝƟŽŶ ϱϲ funds. dŚĞ ĨĂĐƚ ƌĞŵĂŝŶƐ ƚŚĂƚ ƚŚĞ ŵŽƐƚ ĞĸĐŝĞŶƚ ǁĂLJ ƚŽ ŝŶĐƌĞĂƐĞ ƚŚĞ ƌĂǁ ŶƵŵďĞƌ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ʹ ĨŽĐƵƐŝŶŐ ŽŶ ďŽƩůĞŶĞĐŬƐ ĂŶĚ ensuring funds are used to train physicians serve the underserved and remain in ƉƌŝŵĂƌLJ ĐĂƌĞ ƌĂƚŚĞƌ ƚŚĂŶ ƐƵďƐƉĞĐŝĂůŝnjĞ ʹ ŝƐ ƚŽ ŵĂŬĞ ĨƵŶĚƐ ĂǀĂŝůĂďůĞ ĨŽƌ ŶĞǁ ĂŶĚ ĞdžŝƐƟŶŐ family medicine residency programs located in the highest need areas. Workforce remains a strategic priority area for CAFP ĂŶĚ ǁĞ ĂƌĞ ĐŽŵŵŝƩĞĚ ƚŽ ŵĂŬŝŶŐ ƚŚŝƐ ƉŽůŝĐLJ goal a reality.

References 1.

ŚƩƉƐ͗ͬ​ͬŚĞĂůƚŚĨŽƌĐĞ͘ƵĐƐĨ͘ĞĚƵͬ ƉƵďůŝĐĂƟŽŶƐͬĐĂůŝĨŽƌŶŝĂƐͲƉƌŝŵĂƌLJͲĐĂƌĞͲ ǁŽƌŬĨŽƌĐĞͲĨŽƌĞĐĂƐƚĞĚͲƐƵƉƉůLJͲĚĞŵĂŶĚͲ ĂŶĚͲƉŝƉĞůŝŶĞͲƚƌĂŝŶĞĞƐͲϮϬϭϲ California Family Physician Winter 2019

27

F M Wo r k f o rc e

Danielle Jones, MPH M a n a g e r, A m e r i c a n A c a d e m y o f F a m i l y P h y s i c i a n s Center for Diversity and Health Equity

PhD instead of MD: Why Mentorship Matters in Diversifying the Medical Workforce

dŚĞ ŐŽŽĚ ŶĞǁƐ ŝƐ͕ ŵLJ ƐƚŽƌLJ ĚŝĚŶ͛ƚ ĞŶĚ ƚŚĞƌĞ͘ / ǁĞŶƚ ŽŶ ƚŽ ŶŽƚ ŽŶůLJ complete that degree but also earn a Master’s in Public Health and ĐŽŵĞ ϮϬϮϬ ;ĮŶŐĞƌƐ ĐƌŽƐƐĞĚͿ ǁŝůů ŚĂǀĞ ĞĂƌŶĞĚ Ă WŚ ŝŶ ,ĞĂůƚŚ WŽůŝĐLJ ;ƚĂŬĞ ƚŚĂƚ WƌŽĨĞƐƐŽƌ͊Ϳ͘ zĞƚ͕ / ĐĂŶ͛ƚ ŚĞůƉ ďƵƚ ŽĐĐĂƐŝŽŶĂůůLJ ƌĞŇĞĐƚ ŽŶ ŚŽǁ Ă ĂŶŝĞůůĞ :ŽŶĞƐ͕ D ĐŽƵůĚ ŚĂǀĞ ďĞƩĞƌ ƐĞƌǀĞĚ ƚŚĞ ŶĞĞĚƐ ŽĨ her community than a Danielle Jones, PhD, especially considering ƚŚĂƚ ŵLJ ĐŽŵŵƵŶŝƚLJ ŽĨ tLJĂŶĚŽƩĞ ŽƵŶƚLJ ĐŽŶƐŝƐƚĞŶƚůLJ ƌĂŶŬƐ ŝŶ ƚŚĞ ďŽƩŽŵ ϱ ƉĞƌĐĞŶƚ ŽĨ <ĂŶƐĂƐ͛ ϭϬϭ ĐŽƵŶƟĞƐ ŝŶ ƐĞǀĞƌĂů ŚĞĂůƚŚ outcome areas.1 /Ŷ ϮϬϭϳ͕ tLJĂŶĚŽƩĞ ŽƵŶƚLJ <^ ǁĂƐ ŝĚĞŶƟĮĞĚ ĂƐ ͞ƚŚĞ ƐĞĐŽŶĚ ŵŽƐƚ ĚŝǀĞƌƐĞ ĐŽŵŵƵŶŝƚLJ ŝŶ ƚŚĞ ŶĂƟŽŶ͕͟ ďĞŚŝŶĚ ƌŽǁĂƌĚ County, FL, and lacks an ethnic majority.Ϯ EŽŶͲ,ŝƐƉĂŶŝĐ ǁŚŝƚĞƐ ĂĐĐŽƵŶƚ ĨŽƌ ĂƉƉƌŽdžŝŵĂƚĞůLJ ϰϬ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ƉŽƉƵůĂƟŽŶ ĂŶĚ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶƐ ĂŶĚ >ĂƟŶŽƐ ĂƌĞ ĞƋƵĂůůLJ ƌĞƉƌĞƐĞŶƚĞĚ Ăƚ ĂďŽƵƚ Ϯϱ ƉĞƌĐĞŶƚ͕ ƌĞƐƉĞĐƟǀĞůLJ͘3 zĞƚ͕ ƚŚŝƐ ĚŝǀĞƌƐŝƚLJ ŝƐ ŶŽƚ ƌĞŇĞĐƚĞĚ ŝŶ ƚŚĞ ůŽĐĂů ŚĞĂůƚŚ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ͕ ĚĞƐƉŝƚĞ ŚĂǀŝŶŐ ƚŚƌĞĞ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ͘ /Ŷ ϮϬϬϮ͕ ƚŚĞ /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ͕ ŝŶ ŝƚƐ ƌĞƉŽƌƚ hŶĞƋƵĂů dƌĞĂƚŵĞŶƚ͗ ŽŶĨƌŽŶƟŶŐ ZĂĐŝĂů ĂŶĚ ƚŚŶŝĐ ŝƐƉĂƌŝƟĞƐ ŝŶ ,ĞĂůƚŚ ĂƌĞ͕ concluded ƚŚĂƚ ŐƌŽǁŝŶŐ Ă ĚŝǀĞƌƐĞ ĂŶĚ ĂĚĞƋƵĂƚĞ ƐƵƉƉůLJ ŽĨ ƉŚLJƐŝĐŝĂŶƐ ǁĂƐ 28

California Family Physician Winter 2019

ĞƐƐĞŶƟĂů ƚŽ ƐŽůǀŝŶŐ ŝƐƐƵĞƐ ŽĨ ŚĞĂůƚŚ ĚŝƐƉĂƌŝƟĞƐ ŝŶ ƚŚĞ h͘^͘ϰ 'ƌĞĂƚĞƌ ƉŚLJƐŝĐŝĂŶ ĚŝǀĞƌƐŝƚLJ ŚĂƐ ďĞĞŶ ŝŶĚŝĐĂƚĞĚ ŝŶ ƚŚĞ ƌĞĚƵĐƟŽŶ ŽĨ ŚŽƐƉŝƚĂůŝnjĂƟŽŶ ĨŽƌ ĂŵďƵůĂƚŽƌLJ ĐĂƌĞ ƐĞŶƐŝƟǀĞ ĐŽŶĚŝƟŽŶƐ͕ ŝŵƉƌŽǀĞĚ ĂĐĐĞƐƐ ĨŽƌ ƵŶĚĞƌƐĞƌǀĞĚ ƉĂƟĞŶƚƐ ĂŶĚ ƉĂƟĞŶƚ ƐĂƟƐĨĂĐƟŽŶ͘ϱͲϳ While ƚŚĞƐĞ ƌĞƐƵůƚƐ ƌĞŇĞĐƚ ĚŝǀĞƌƐŝƚLJ ĂĐƌŽƐƐ Ăůů ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ͕ family physicians have a greater propensity to care for underserved ƉŽƉƵůĂƟŽŶƐ ƚŚĂŶ ĚŽ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ŝŶ ŽƚŚĞƌ ƐƉĞĐŝĂůƟĞƐ͘ϴ It is for this reason, the American Academy of Family Physicians ůĂƵŶĐŚĞĚ ƚŚĞ ĞŶƚĞƌ ĨŽƌ ŝǀĞƌƐŝƚLJ ŝŶ ,ĞĂůƚŚ ƋƵŝƚLJ ; , Ϳ ŝŶ ϮϬϭϳ͕ ǁŝƚŚ ƚŚĞ ƐƚƌĂƚĞŐŝĐ ƉƌŝŽƌŝƚLJ ŽĨ ĂĚĚƌĞƐƐŝŶŐ ĚŝǀĞƌƐŝƚLJ ĂŶĚ ŝŶĐůƵƐŝŽŶ ŝŶ ƚŚĞ ŵĞĚŝĐĂů ǁŽƌŬĨŽƌĐĞ͘ /Ŷ ĂĚĚŝƟŽŶ͕ ĞĂĐŚ ŽĨ ƚŚĞ ĞŝŐŚƚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŽƌŐĂŶŝnjĂƟŽŶƐ ƐĞƚ Ă ŐŽĂů ƚŽ ŚĂǀĞ Ϯϱ ƉĞƌĐĞŶƚ ŽĨ ĂůůŽƉĂƚŚŝĐ ĂŶĚ osteopathic medical school seniors select family medicine as their ƐƉĞĐŝĂůƚLJ ďLJ ϮϬϯϬ͘ dŚŝƐ ŐŽĂů ǁŽƵůĚ ĚŽƵďůĞ ƚŚĞ ĐƵƌƌĞŶƚ ǁŽƌŬĨŽƌĐĞ ĂŶĚ ƚŚĞ , ǁŝůů ďĞ ĐůŽƐĞůLJ ŝŶǀŽůǀĞĚ ƚŽ ĞŶƐƵƌĞ ŝƚ ŝƐ Ă ĚŝǀĞƌƐĞ ŽŶĞ͘

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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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I can remember the moment I chose to forgo applying to medical ƐĐŚŽŽů ƋƵŝƚĞ ĐůĞĂƌůLJ͘ /ƚ ǁĂƐ ƚŚĞ ĨĂůů ŽĨ ŵLJ ƐĞŶŝŽƌ LJĞĂƌ ŝŶ ƵŶĚĞƌŐƌĂĚ͕ ĂŶĚ / ŚĂĚ ũƵƐƚ ĨĂŝůĞĚ Ă ŚŝƐƚŽůŽŐLJ ůĂď ĮŶĂů͘ / ƌƵƐŚĞĚ ƚŚĂƚ ƐĂŵĞ ĚĂLJ ŝŶƚŽ ƚŚĞ ƉƌŽĨĞƐƐŽƌ͛Ɛ ŽĸĐĞ ƌĞĂĚLJ ƚŽ ĂƌŐƵĞ ĨŽƌ ĞǀĞƌLJ ďŝƚ ŽĨ ƉĂƌƟĂů ĐƌĞĚŝƚ / ĐŽƵůĚ ŐĞƚ ƚŽ ƌĂŝƐĞ ŵLJ ŐƌĂĚĞ ĞŶŽƵŐŚ ƚŽ ƉĂƐƐ ƚŚĞ ĐůĂƐƐ͘ ŌĞƌ ĂďŽƵƚ ĂŶ ŚŽƵƌ ĂŶĚ ŵĂŶĂŐŝŶŐ ƚŽ ƐŬŝƌƚ ďLJ ƚŚĞ ƐĞŵĞƐƚĞƌ ǁŝƚŚ Ă ďĂƌĞůLJ ƉĂƐƐŝŶŐ ͕ ŵLJ ƉƌŽĨĞƐƐŽƌ ĂƐŬĞĚ ĂďŽƵƚ ŵLJ ƉůĂŶƐ ĂŌĞƌ ŐƌĂĚƵĂƟŽŶ ĂŶĚ / ĞŶƚŚƵƐŝĂƐƟĐĂůůLJ ĚŝƐĐƵƐƐĞĚ ŵLJ ĐŚŝůĚŚŽŽĚ ĚƌĞĂŵƐ ŽĨ ďĞŝŶŐ Ă ĚŽĐƚŽƌ ĂŶĚ ƚƌĂǀĞůŝŶŐ ƚŚĞ ǁŽƌůĚ ƚŽ ĐĂƌĞ ĨŽƌ ƚŚĞ ƵŶĚĞƌƐĞƌǀĞĚ͘ /Ŷ ůĞƐƐ ƚŚĂŶ Ă ŵŝŶƵƚĞ͕ ƚŚĂƚ ĮƌĞ ǁĂƐ ĞdžƟŶŐƵŝƐŚĞĚ ǁŝƚŚ ƚŚĞ ƐƚĂƚĞŵĞŶƚ͕ ͞/ ĚŽŶ͛ƚ ƚŚŝŶŬ LJŽƵ ŚĂǀĞ ǁŚĂƚ ŝƚ ƚĂŬĞƐ͕ ŚĂǀĞ LJŽƵ ĐŽŶƐŝĚĞƌĞĚ Ă WůĂŶ ͍͟ dƌƵƚŚ ŝƐ / hadn’t. I had been fortunate to have parents, teachers and school ĐŽƵŶƐĞůŽƌƐ ǁŚŽ ƌĞĐŽŐŶŝnjĞĚ ŝŶ ŵĞ Ăƚ ĂŶ ĞĂƌůLJ ĂŐĞ ĂŶ ŝŶƚĞƌĞƐƚ ĂŶĚ ƉƌŽƉĞŶƐŝƚLJ ĨŽƌ ƚŚĞ ^ĐŝĞŶĐĞ͕ dĞĐŚŶŽůŽŐLJ͕ ŶŐŝŶĞĞƌŝŶŐ ĂŶĚ DĂƚŚŵĂƟĐƐ ;^d DͿ ĮĞůĚ͘ Ɛ Ă ƌĞƐƵůƚ͕ / ǁĂƐ ŽīĞƌĞĚ ŽƉƉŽƌƚƵŶŝƟĞƐ ƚŽ ƉĂƌƟĐŝƉĂƚĞ in just about every kind of pipeline program you could imagine; ĂŌĞƌͲƐĐŚŽŽů ƉƌŽŐƌĂŵƐ͕ ǁĞĞŬĞŶĚ ǀŝƐŝƚƐ ƚŽ ŚŽƐƉŝƚĂůƐ͕ ƐƵŵŵĞƌ ĐĂŵƉƐ Ăƚ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ͕ ĞƚĐ͘ / ĐĂŶ ƐƟůů ƌĞŵĞŵďĞƌ ͞ĞdžƉĞƌŝŵĞŶƟŶŐ͟ ǁŝƚŚ ŵLJ ĮƌƐƚ ĐĂĚĂǀĞƌ͊ ,ŽǁĞǀĞƌ͕ ďLJ ƚŚĞ ƟŵĞ / ŐŽƚ ƚŽ ĐŽůůĞŐĞ͕ ŝƚ ǁĂƐ Ă ĚĂŝůLJ struggle to earn that Bachelor of Science degree in biology, and unfortunately, the support, encouragement and mentorship I had ĨŽƵŶĚ ĂƐ ĂŶ ĂĚŽůĞƐĐĞŶƚ ǁĂƐ ŶŽǁŚĞƌĞ ƚŽ ďĞ ĨŽƵŶĚ ĂƐ Ă LJŽƵŶŐ ĐŽůůĞŐĞ student.

KƵƌ ƚĂĐƟĐƐ ĂƌĞ ĞŵĞƌŐŝŶŐ ŝŶ ƚŚŝƐ ĂƌĞĂ ĂŶĚ ǁŝůů ƌĞƋƵŝƌĞ ůŽĐĂů͕ ƌĞŐŝŽŶĂů ĂŶĚ ŶĂƟŽŶĂů ŝŶŝƟĂƟǀĞƐ ĚƌŝǀĞŶ ďLJ ƚŚĞ &W͕ ĐŚĂƉƚĞƌƐ ĂŶĚ ŵĞŵďĞƌƐ͘ But if my story communicates anything, it is that mentorship ŵĂƩĞƌƐ͊ &Žƌ ŵĞ͕ ŚĂǀŝŶŐ ŚĂĚ Ă ŵĞŶƚŽƌ ƚŽ ƚƵƌŶ ƚŽ ĨŽůůŽǁŝŶŐ Ă ďĂĚ grade, discouraging comments from a professor or struggling to ƵŶĚĞƌƐƚĂŶĚ DĞŶĚĞůŝĂŶ ŐĞŶĞƟĐƐ ǁŽƵůĚ ŚĂǀĞ ŵĂĚĞ ƚŚĞ ĚŝīĞƌĞŶĐĞ ďĞƚǁĞĞŶ ĂŶŝĞůůĞ :ŽŶĞƐ͕ D Žƌ ĂŶŝĞůůĞ :ŽŶĞƐ͕ WŚ ͘ ŶĚ ǁŚŝůĞ mentorship can occur on a grand scale, like The Ladder in Minnesota Žƌ dŽƵƌ ĨŽƌ ŝǀĞƌƐŝƚLJ ŝŶ DĞĚŝĐŝŶĞ͕ ƚǁŽ ĂŵĂnjŝŶŐ ƉƌŽŐƌĂŵƐ ĨŽƵŶĚĞĚ ďLJ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ƐŽŵĞƟŵĞƐ ƚŚĞ ŵŽƐƚ ƐŝŐŶŝĮĐĂŶƚ ůĂƐƟŶŐ ŝŵƉĂĐƚ ĐĂŶ ďĞ ũƵƐƚ ďĞƚǁĞĞŶ ŝŶĚŝǀŝĚƵĂůƐ͘ / ĂƐŬ LJŽƵ ƚŽ ĐŽŶƐŝĚĞƌ LJŽƵƌ ĐĂƉĂĐŝƚLJ ĂŶĚ ŽƉƉŽƌƚƵŶŝƟĞƐ ŝŶ LJŽƵƌ ĐŽŵŵƵŶŝƚLJ ƚŽ ŵĞŶƚŽƌ ƚŚĂƚ ŶĞdžƚ ŐĞŶĞƌĂƟŽŶ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ǁŝůů ďĞĐŽŵĞ ƚŚĞ Ϯϱ ƉĞƌĐĞŶƚ ďLJ ϮϬϯϬ͘ ǀĞŶ ŝŶ LJŽƵƌ ƉĂƟĞŶƚ ĞŶĐŽƵŶƚĞƌƐ͕ LJŽƵ ŚĂǀĞ ĂŶ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĐƵůƟǀĂƚĞ Ă ĨƵƚƵƌĞ ƉŚLJƐŝĐŝĂŶ ǁŝƚŚ ƐĞǀĞŶ ǁŽƌĚƐ͕ ͞,ĂǀĞ LJŽƵ ĞǀĞƌ ĐŽŶƐŝĚĞƌĞĚ ďĞŝŶŐ Ă ĚŽĐƚŽƌ͍͟

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County Health Rankings and ZŽĂĚŵĂƉƐ ;ϮϬϭϴͿ <ĂŶƐĂƐ͗ tLJĂŶĚŽƩĞ ŽƵŶƚLJ ŚƩƉ͗ͬ​ͬǁǁǁ͘ ĐŽƵŶƚLJŚĞĂůƚŚƌĂŶŬŝŶŐƐ͘ŽƌŐͬĂƉƉͬ ŬĂŶƐĂƐͬϮϬϭϴͬŽǀĞƌǀŝĞǁ Montgomery, Rick. This Kansas County has no ethnic majority, but ŝƐ ŝƚ ŽŶĞ ŽĨ ƚŚĞ ŵŽƐƚ ĚŝǀĞƌƐĞ ŝŶ h͘^͍͘ dŚĞ <ĂŶƐĂƐ ŝƚLJ ^ƚĂƌ͕ EŽǀ͘ ϲ͕ ϮϬϭϳ ĐĐĞƐƐĞĚ EŽǀĞŵďĞƌ ϳ͕ ϮϬϭϴ ĨƌŽŵ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ŬĂŶƐĂƐĐŝƚLJ͘ĐŽŵͬŶĞǁƐͬ ůŽĐĂůͬĂƌƟĐůĞϭϴϯϬϲϬϰϵϭ͘Śƚŵů U.S. Census Bureau Quick Facts tLJĂŶĚŽƩĞ ŽƵŶƚLJ <ĂŶƐĂƐ ;ϮϬϭϳͿ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĐĞŶƐƵƐ͘ŐŽǀͬƋƵŝĐŬĨĂĐƚƐͬ ĨĂĐƚͬƚĂďůĞͬǁLJĂŶĚŽƩĞĐŽƵŶƚLJŬĂŶƐĂƐͬ W^dϬϰϱϮϭϳ hŶĞƋƵĂů dƌĞĂƚŵĞŶƚ͗ ŽŶĨƌŽŶƟŶŐ ZĂĐŝĂů ĂŶĚ ƚŚŶŝĐ ŝƐƉĂƌŝƟĞƐ ŝŶ ,ĞĂůƚŚ ĂƌĞ͘ tĂƐŚŝŶŐƚŽŶ͕ ͗ EĂƟŽŶĂů ĐĂĚĞŵLJ WƌĞƐƐ͖ /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ͖ ϮϬϬϮ͘ Laditka J. Physician Supply, physician diversity, and outcomes of primary healthcare for older persons in the United States. Health Place. ϮϬϬϰ͖ϭϬ;ϯͿ͗ϮϯϭʹϮϰϰ͘ Kington R, Tisnado D, Carlisle DM. Increasing racial and ethnic diversity ĂŵŽŶŐ ƉŚLJƐŝĐŝĂŶƐ͗ ĂŶ ŝŶƚĞƌǀĞŶƟŽŶ ƚŽ ĂĚĚƌĞƐƐ ŚĞĂůƚŚ ĚŝƐƉĂƌŝƟĞƐ͍ /Ŷ ^ŵĞĚůĞLJ ͕ ^ƟƚŚ z͕ ŽůďƵƌŶ >͕ Evans CH, (eds.). The Right Thing ƚŽ Ž͕ dŚĞ ^ŵĂƌƚ dŚŝŶŐ ƚŽ Ž͗ Enhancing Diversity in the Health WƌŽĨĞƐƐŝŽŶƐ͘ tĂƐŚŝŶŐƚŽŶ͕ ͗ EĂƟŽŶĂů ĐĂĚĞŵLJ WƌĞƐƐ͕ ϮϬϬϭ͘ ŽŽƉĞƌ > ͕ WŽǁĞ EZ͘ ŝƐƉĂƌŝƟĞƐ ŝŶ ƉĂƟĞŶƚ ĞdžƉĞƌŝĞŶĐĞƐ͕ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽĐĞƐƐĞƐ͕ ĂŶĚ ŽƵƚĐŽŵĞƐ͗ ƚŚĞ ƌŽůĞ ŽĨ ƉĂƟĞŶƚͲƉƌŽǀŝĚĞƌ ƌĂĐŝĂů͕ ĞƚŚŶŝĐ͕ ĂŶĚ language concordance. Washington ͗ dŚĞ ŽŵŵŽŶǁĞĂůƚŚ &ƵŶĚ͕ ϮϬϬϰ͘ Grumbach K, Hart LG, Mertz E, ŽīŵĂŶ :͕ WĂůĂnjnjŽ >͘ tŚŽ ŝƐ ĐĂƌŝŶŐ ĨŽƌ ƚŚĞ ƵŶĚĞƌƐĞƌǀĞĚ͍ ĐŽŵƉĂƌŝƐŽŶ of primary care physicians and non-physician clinicians in California and Washington. Ann Fam Med. ϮϬϬϯ͖ϭ;ϮͿ͗ϵϳͲϭϬϰ͘ ĚŽŝ͗ϭϬ͘ϭϯϳϬͬ ĂĨŵ͘ϰϵ California Family Physician Winter 2019

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ceo message

Lisa Folberg, MPP

CAFP empowers, educates and connects current and future family physicians to improve the health of all Californians ƚ ŵLJ ĮƌƐƚ ŽĂƌĚ ŵĞĞƟŶŐ ĂƐ ŚŝĞĨ džĞĐƵƟǀĞ KĸĐĞƌ͕ ƚŚĞ &W ŽĂƌĚ ƌĞǀŝĞǁĞĚ͕ ĚĞďĂƚĞĚ ĂŶĚ ĂĚŽƉƚĞĚ Ă ŶĞǁ ŵŝƐƐŝŽŶ ƐƚĂƚĞŵĞŶƚ ĨŽƌ ƚŚĞ ĐĂĚĞŵLJ͘ KƵƌ ŽďũĞĐƟǀĞ ǁĂƐ ƚŽ ŬĞĞƉ ŝƚ ƐŝŵƉůĞ͕ ǁŚŝůĞ ĐĂƉƚƵƌŝŶŐ ƚŚĞ ĞƐƐĞŶĐĞ ŽĨ ǁŚĂƚ &W ĚŽĞƐ͘ dŚŝƐ ǁĂƐ ŶŽ ĞĂƐLJ ĨĞĂƚ͘ dŚĞ ďƌĞĂĚƚŚ ĂŶĚ ĚĞƉƚŚ ŽĨ &W ĂĐƟǀŝƟĞƐ ĂĚĚƌĞƐƐŝŶŐ ĂĚǀŽĐĂĐLJ͕ ĞĚƵĐĂƟŽŶ͕ ƉƌĂĐƟĐĞ support, and nurturing future family physicians is astounding.

CAFP empowers ŵĞŵďĞƌƐ ƚŚƌŽƵŐŚ ĂĚǀŽĐĂĐLJ ĂŶĚ ĞĚƵĐĂƟŽŶ͘ &W ŚĂƐ ďĞĞŶ ƉŚĞŶŽŵĞŶĂůůLJ ƐƵĐĐĞƐƐĨƵů ŝŶ ůĞŐŝƐůĂƟǀĞ ĂĚǀŽĐĂĐLJ͕ ŝŶĐůƵĚŝŶŐ ƐĞĐƵƌŝŶŐ ŵŝůůŝŽŶƐ ŽĨ ĚŽůůĂƌƐ ŝŶ ĂĚĚŝƟŽŶĂů ĨƵŶĚŝŶŐ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ programs, lobbying to increase Medi-Cal rates and taking a lead role in ĞůŝŵŝŶĂƟŶŐ ǀĂĐĐŝŶĞ ƉĞƌƐŽŶĂů ďĞůŝĞĨ ĞdžĞŵƉƟŽŶƐ͘ /ƚ ŝƐ ŶŽ ǁŽŶĚĞƌ &W ŚĂƐ ƌĞĐĞŝǀĞĚ ƚŚĞ &W͛Ɛ ůĞĂĚĞƌƐŚŝƉ ŝŶ ƐƚĂƚĞ ŐŽǀĞƌŶŵĞŶƚ ĚǀŽĐĂĐLJ ǁĂƌĚ ĨŽƌ ƚŚĞ ĨŽƵƌƚŚ ƟŵĞ ŝŶ ĮǀĞ LJĞĂƌƐ͘ /Ŷ ϮϬϭϵ͕ ǁĞ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĞŶŐĂŐĞ ŝŶ ƚŚĞ ƉŽůŝƟĐĂů ůĂŶĚƐĐĂƉĞ ůŝŬĞ ŶĞǀĞƌ ďĞĨŽƌĞ͘ tŝƚŚ Ă ŶĞǁ 'ŽǀĞƌŶŽƌ ǁŚŽ ŚĂƐ ĚĞŵŽŶƐƚƌĂƚĞĚ Ă ĐŽŵŵŝƚŵĞŶƚ ƚŽ ĂĚĚƌĞƐƐŝŶŐ ŚĞĂůƚŚ ĐĂƌĞ ĐŚĂůůĞŶŐĞƐ͕ Ă W ƚŚĂƚ ǁŝůů ĂůŵŽƐƚ ƚƌŝƉůĞ ŝƚƐ ƉƌĞǀŝŽƵƐ ƐŝnjĞ͕ ĂŶĚ ĞŶĞƌŐŝnjĞĚ ƐƚĂī ĂŶĚ ƉŚLJƐŝĐŝĂŶ ůĞĂĚĞƌƐŚŝƉ͕ ƚŚŝƐ ŝƐ Ă ƟŵĞ ǁŚĞŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĐŽƵůĚ ĂŶĚ ƐŚŽƵůĚ ďĞ ƉŽƐŝƟŽŶĞĚ ĂƐ Ă ƚŚŽƵŐŚƚ ůĞĂĚĞƌ ŽŶ ŚĞĂůƚŚ ĐĂƌĞ ŝƐƐƵĞƐ͘ Ɛ ƚŚĞ ƐƚĂƚĞ ĂŶĚ ŶĂƟŽŶ ƐƚƌƵŐŐůĞ ǁŝƚŚ ĨƵŶĚĂŵĞŶƚĂů ƋƵĞƐƟŽŶƐ ĂƌŽƵŶĚ ƚŚĞ ĐŽƐƚ ĂŶĚ ĚĞůŝǀĞƌLJ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ services, family medicine has an opportunity through advocacy and ĞĚƵĐĂƟŽŶ ƚŽ ďĞ ƌĞĐŽŐŶŝnjĞĚ ĨŽƌ ŝƚƐ ĐĞŶƚƌĂů ƉůĂĐĞ ŝŶ ďƵŝůĚŝŶŐ Ă ďĞƩĞƌ ŚĞĂůƚŚ care system. ƉĂƌƚ ĨƌŽŵ ĞĚƵĐĂƟŶŐ ĞdžƚĞƌŶĂů ĂƵĚŝĞŶĐĞƐ ĂďŽƵƚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ &W ƉƌŽǀŝĚĞƐ Ă ŚƵŐĞ ĂƌƌĂLJ ŽĨ ĞĚƵĐĂƟŽŶĂů ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƚŚĞŝƌ ƉƌĂĐƟĐĞ ƚĞĂŵƐ͕ ƐƚĂƚĞǁŝĚĞ ĂŶĚ ŶĂƟŽŶĂůůLJ͕ ĂŶĚ ĞǀĞŶ ŝŶƚĞƌŶĂƟŽŶĂůůLJ͘ &W͛Ɛ ĐŽŵŵŝƚŵĞŶƚ ƚŽ educate includes accredited CME ĂĐƟǀŝƟĞƐ͕ ƉĞƌĨŽƌŵĂŶĐĞ ŝŵƉƌŽǀĞŵĞŶƚ ŵŽĚƵůĞƐ ĂŶĚ ĞŶĚƵƌŝŶŐ ƚŽŽůƐ ĂŶĚ ƌĞƐŽƵƌĐĞƐ͘ Ɛ Ă ƚĞƐƚĂŵĞŶƚ ƚŽ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ &W͛Ɛ ĐůŝŶŝĐĂů ĞĚƵĐĂƟŽŶ͕ ǁĞ ŚĂǀĞ ďĞĞŶ ĂƐŬĞĚ ƚŽ ůĞĂĚ ĞĚƵĐĂƟŽŶĂů ƉƌŽŐƌĂŵŵŝŶŐ ŶĂƟŽŶĂůůLJ ĂŶĚ ŝŶƚĞƌŶĂƟŽŶĂůůLJ ŽŶ ƚŽƉŝĐƐ ĂƐ ĚŝǀĞƌƐĞ ĂƐ ƌĞƉƌŽĚƵĐƟǀĞ ŚĞĂůƚŚ ĐĂƌĞ ƚŽ ŚĞƉĂƟƟƐ ͕ ƐĐŽƌĞƐ ƚŽ ƉĂŝŶ ŵĂŶĂŐĞŵĞŶƚ͘ ůŝŶŝĐĂů ŬŶŽǁůĞĚŐĞ ŝƐ Ă ŚƵŐĞůLJ ŝŵƉŽƌƚĂŶƚ ƉĂƌƚ ŽĨ ƉƌŽǀŝĚŝŶŐ ƋƵĂůŝƚLJ ĐĂƌĞ͕ ďƵƚ ďĞŝŶŐ ǁĞůů ŝŶĨŽƌŵĞĚ ŽŶ ŶŽŶͲĐůŝŶŝĐĂů ŝƐƐƵĞƐ ĐĂŶ ďĞ ĂƐ ŝŵƉŽƌƚĂŶƚ ŝŶ ŶĂǀŝŐĂƟŶŐ LJŽƵƌ ƌĞƐƉŽŶƐŝďŝůŝƟĞƐ ĂƐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ Ɛ ƐƵĐŚ͕ &W ƉƌŽǀŝĚĞƐ ĞĚƵĐĂƟŽŶ ŽŶ Ă ŚŽƐƚ ŽĨ ŝƐƐƵĞƐ ƚŚĂƚ ĂīĞĐƚ LJŽƵƌ ƉƌĂĐƟĐĞ ŝŶĐůƵĚŝŶŐ ůĞĂĚĞƌƐŚŝƉ ĚĞǀĞůŽƉŵĞŶƚ͕ ƉŚLJƐŝĐŝĂŶ ǁĞůůŶĞƐƐ ĂŶĚ ǁĞĞŬůLJ ƵƉĚĂƚĞƐ ŽŶ ŶĞǁ ůĂǁƐ ĂŶĚ ƌĞŐƵůĂƟŽŶƐ͘ 30

California Family Physician Winter 2019

&W ƐƚĂī ĂŶĚ ƉŚLJƐŝĐŝĂŶ ůĞĂĚĞƌƐŚŝƉ ĚŽ ĂŶ ĞdžĐĞůůĞŶƚ ũŽď ĂĚǀŽĐĂƟŶŐ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ĚĞǀĞůŽƉŝŶŐ ƉŽůŝĐLJ͕ ƉƌŽǀŝĚŝŶŐ ĐůŝŶŝĐĂů ĂŶĚ ƉƌĂĐƟĐĞ ƐƵƉƉŽƌƚ to members, and keeping family physicians informed. But CAFP is so ŵƵĐŚ ŵŽƌĞ ƚŚĂŶ ĂŶ ĂĚǀŽĐĂĐLJ ŽƌŐĂŶŝnjĂƟŽŶ͕ ƉŽůŝĐLJ ĂĐĂĚĞŵLJ Žƌ ƉƵƌǀĞLJŽƌ ŽĨ ƉŚLJƐŝĐŝĂŶ ĞĚƵĐĂƟŽŶ͘ tŚĂƚ ďĞĐĂŵĞ ŽďǀŝŽƵƐ ŝŶ ƚŚĞ ĐƌĂŌŝŶŐ ŽĨ ƚŚĞ ŶĞǁ ŵŝƐƐŝŽŶ ƐƚĂƚĞŵĞŶƚ ŝƐ ƚŚĂƚ ǁŚĂƚ &W ŵĞĂŶƐ ƚŽ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶ ĂůŝĨŽƌŶŝĂ ŝƐ ĂƐ ŝŵƉŽƌƚĂŶƚ ĂƐ ƚŚĞ ĂĐƟǀŝƟĞƐ ŝŶ ǁŚŝĐŚ &W ĞŶŐĂŐĞƐ͘ &W ŚĞůƉƐ ŵĞŵďĞƌƐ ĐŽŶŶĞĐƚ ƚŽ ĞĂĐŚ ŽƚŚĞƌ ĂŶĚ ƌĞͲĐŽŶŶĞĐƚ ǁŝƚŚ ƚŚĞ ƉĂƐƐŝŽŶ ĂŶĚ ǀĂůƵĞƐ ƚŚĂƚ ŝŶƐƉŝƌĞĚ ƚŚĞŵ ƚŽ ďĞĐŽŵĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŝŶ ƚŚĞ ĮƌƐƚ place. tŚĞŶ ƐƚĂī ŶĞĞĚƐ ƚŽ ƌĞͲĐŽŶŶĞĐƚ ĂŶĚ ĞŶĞƌŐŝnjĞ͕ ƚŚĞLJ ƐƉĞŶĚ Ă ůŝƩůĞ ƟŵĞ ǁŝƚŚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚƐ͘ dŚĞ ĞŶĞƌŐLJ ĂŶĚ ĐŽŵŵŝƚŵĞŶƚ ŽĨ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ŝƐ ŝŶĨĞĐƟŽƵƐ͘ &W ŝƐ ŚĞĂǀŝůLJ ŝŶǀĞƐƚĞĚ ŝŶ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚŚƌŽƵŐŚ Ă ǁŝĚĞ ĂƌƌĂLJ ŽĨ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ĂĐƟǀŝƟĞƐ͕ ĨƌŽŵ ƚŚĞ ĂŶŶƵĂů &ĂŵŝůLJ DĞĚŝĐŝŶĞ ^Ƶŵŵŝƚ ƚŽ ƉƌŽǀŝĚŝŶŐ ƐĐŚŽůĂƌƐŚŝƉƐ ĂŶĚ ƚŚĞ ŶĞǁ ^ƵƐĂŶ ,ŽŐĞůĂŶĚ͕ ,ĞĂůƚŚ WŽůŝĐLJ &ĞůůŽǁƐŚŝƉ͘ Ɛ Ă ƌĞĐĞŶƚ ƚƌĂŶƐƉůĂŶƚ ƚŽ ^ĂŶ &ƌĂŶĐŝƐĐŽ͕ / Ăŵ ƐƟůů ůŝŬĞ Ă ƚŽƵƌŝƐƚ͕ ƐƚŽƉƉŝŶŐ ƚŽ ƚĂŬĞ ŝŶ ƚŚĞ ďƌĞĂƚŚƚĂŬŝŶŐ ůĂŶĚƐĐĂƉĞ ĂƐ ŶĂƟǀĞƐ ĂƌĞ ǁŚŝnjnjŝŶŐ ďLJ ŵĞ ŶŽƚ ŶŽƟĐŝŶŐ ƚŚĞ ƐƵŶ ƐŚŝŶŝŶŐ ŽŶ ƚŚĞ ĂLJ͘ / Ăŵ ĂůƐŽ ůŝŬĞ ƚŚĂƚ ƚŽƵƌŝƐƚ ǁĂŶĚĞƌŝŶŐ through the impressive landscape of family medicine and CAFP. With ĨƌĞƐŚ ĞLJĞƐ / ŵĂƌǀĞů Ăƚ Ăůů ƚŚĂƚ LJŽƵ ĚŽ ĨŽƌ LJŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ Ăůů ƚŚĂƚ &W does for you. /Ŷ ŵLJ ĮƌƐƚ ƚŚƌĞĞ ŵŽŶƚŚƐ ǁŝƚŚ &W͕ / ŚĂǀĞ ŚĂĚ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ŵĞĞƚ ŵĂŶLJ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƉƌĂĐƟĐŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͘ zŽƵ ĂƌĞ ĂŶ ŝŵƉƌĞƐƐŝǀĞ ďƵŶĐŚ͕ ďĂůĂŶĐŝŶŐ ƉĞƌƐŽŶĂů ůŝǀĞƐ ĂŶĚ ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞƐ ƐĞĞŵ challenging enough, but the family physicians I have met do even more. zŽƵ ĂƌĞ ĞŶŐĂŐĞĚ ŝŶ ƌĞƐĞĂƌĐŚ͕ ĐŽŵŵƵŶŝƚLJͲďĂƐĞĚ ƉƌŽũĞĐƚƐ ĂŶĚ ĞĚƵĐĂƟŽŶ͘ zŽƵ ĂƌĞ current and future family physicians, mentors and innovators.

KƵƌ ŶĞǁ ŵŝƐƐŝŽŶ ƐƚĂƚĞŵĞŶƚ ŝƐ ƐŝŵƉůĞ͕ ďƵƚ ŝƚ ĐĂƉƚƵƌĞƐ ƐŽ ŵƵĐŚ ĂďŽƵƚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ /ƚ ƌĞŇĞĐƚƐ ƚŚĞ ŚƵŵŝůŝƚLJ ĂŶĚ ƉĂƐƐŝŽŶ ƚŚĂƚ ŝƐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ ƉĂƐƐŝŽŶ ŶŽƚ ďĂƐĞĚ ŽŶ ĞŐŽ͕ ďƵƚ ŽŶ Ă ĚƌŝǀĞ ƚŽ ĚŽ ƚŚĞ ƌŝŐŚƚ ƚŚŝŶŐ ĨŽƌ ƉĂƟĞŶƚƐ͘ tŚŝůĞ ǁĞ ĚĞďĂƚĞĚ ĂďŽƵƚ ƚŚĞ ǁŽƌĚƐ ƚŽ ĐĂƉƚƵƌĞ ƚŚĞ ǁŽƌŬ ĂŶĚ ƉĂƐƐŝŽŶ ŽĨ &W ŝŶ Ă ƐŝŶŐůĞ ƐĞŶƚĞŶĐĞ͕ ǁĞ ŚĂĚ ŝŵŵĞĚŝĂƚĞ ĐŽŶƐĞŶƐƵƐ ƚŚĂƚ ƚŚĞ ĞŶĚ ŐŽĂů ŽĨ LJŽƵƌ ĐĂĚĞŵLJ͛Ɛ ǁŽƌŬ ŝƐ ŶŽƚ ƉƌĂĐƟĐĞ ŵĂŶĂŐĞŵĞŶƚ Žƌ ĞǀĞŶ ƉĂLJŵĞŶƚ͕ it is giving family physicians the support and tools they need to help their ƉĂƟĞŶƚƐ ůŝǀĞ ŚĞĂůƚŚŝĞƌ ůŝǀĞƐ ĂŶĚ ƚŽ ŝŵƉƌŽǀĞ ƚŚĞ ŚĞĂůƚŚ ŽĨ Ăůů ĂůŝĨŽƌŶŝĂŶƐ. Ƶƚ ƚŚĂƚ ŝƐ ŽďǀŝŽƵƐ ƚŽ LJŽƵ͕ LJŽƵ ĚŝĚ ĂŌĞƌ Ăůů ĐŚŽŽƐĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘

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