Fall 2014

California

FAMILY PHYSICIAN VOL. 65 NO.4 Fall 2014

10 EASY WAYS TO FIT IN FIVE MINUTES OF ADVOCACY

12

EVERY FAMILY PHYSICIAN NEEDS TO TAKE ACTION ON PROP 46

16

COVERED CALIFORNIA: PUTTING THE PUZZLE TOGETHER FOR 2015

` 18

PROTECTING WOMEN’S RIGHTS TO BASIC REPRODUCTIVE HEALTH CARE

19

FAMILY PHYSICIAN ADVOCACY: BE A VOICE FOR YOU AND YOUR PATIENTS

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California Family Physician Fall 2014

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A CONTINUING MEDICAL EDUCATION CONFERENCE

APPROVED FOR AMA PRA CATEGORY 1 CREDIT(S)™, NURSING AND PHARMACY CREDITS CONFERENCE CHAIRS: MEDICAL DERMATOLOGY Joseph F. Fowler, Jr, MD, University of Louisville AESTHETIC AND PROCEDURAL DERMATOLOGY Christopher B. Zachary, FRCP, UC Irvine SESSION CHAIRS: AESTHETIC MEDICINE Michael S. Kaminer, MD, Yale Medical School PEDIATRIC DERMATOLOGY Lawrence F. Eichenfield, MD, UC San Diego PSORIASIS Craig L. Leonardi, MD, Saint Louis University Medical School Linda F. Stein Gold, MD, Henry Ford Hospital MELANOMA/CUTANEOUS ONCOLOGY Allan C. Halpern, MD, Memorial Sloan-Kettering Cancer Center MOC-D Erik J. Stratman, MD, University of Wisconsin – Marshfield

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WWW.GLOBALACADEMYCME.COM/DERMATOLOGY California Family Physician Fall 2014

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ƒЬ¬М¬О¬Ы¬Ь»±¬К¬Ч¬Н»± ¬Ш¬К¬Ы¬Н

¬Э¬КƒЫ

President ƒЮ≈ѓ D≈љ∆М∆М≈Э∆РЌХ D

≈ѓ≈ѓ≈Э∆Р≈љ≈ґ ƒВ∆µƒЮ∆М

President-Elect :ƒВ«З >ƒЮƒЮЌХ D ЌХ DW,

^≈љ∆Й≈Ъ≈ЭƒВ ,ƒЮ≈ґ∆М«З

Speaker >ƒЮƒЮ ZƒВ≈ѓ∆Й≈ЪЌХ D

≈©ƒР≈Ъ≈љќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

:ƒЮ∆М∆М≈Э ƒВ«А≈Э∆РЌХ D W

ƒЪƒВ≈µ &∆МƒВ≈ґƒР≈Э∆Р

AAFP Delegates :ƒЮƒ®ƒ® >∆µ∆Ъ≈ЪƒЮ∆МЌХ D ƒВ∆М≈ѓƒВ <ƒВ≈ђ∆µ∆ЪƒВ≈ґ≈ЭЌХ D AAFP Alternates ƒВ∆М≈љ≈ѓ ,ƒВ«АƒЮ≈ґ∆Р D :ƒВ«З >ƒЮƒЮЌХ D ЌХ DW, CMA Delegation ∆Р≈ЪƒП«З t≈љ≈ѓƒ®ƒЮЌХ D ЌХ DWWЌХ DW, EƒВ∆Ъ≈ЪƒВ≈ґ ,≈Э∆Ъ«МƒЮ≈µƒВ≈ґЌХ D D≈ЭƒР≈ЪƒЮ≈ѓ≈ѓƒЮ Y∆µ≈Э≈љ≈Р∆µƒЮЌХ D ^∆µ≈µƒВ≈ґ ZƒЮƒЪƒЪ«ЗЌХ D <ƒЮ«А≈Э≈ґ Z≈љ∆Р∆Р≈ЭЌХ D WƒВ∆Ъ∆М≈ЭƒР≈ЭƒВ ^ƒВ≈µ∆µ≈ѓƒЮ∆Р≈љ≈ґЌХ D

Student, Resident and Social Media Manager

Executive Vice President

∆Р≈Ъ≈љ≈РƒЮ≈ѓƒВ≈ґƒЪќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

Manager, Medical Practice Affairs

Deputy Director, Government Affairs

ƒР≈µ≈Э∆ЪƒР≈ЪƒЮ≈ѓ∆Ъ∆МƒЮƒЮќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

Director, CME/CPD

≈©ƒЪƒВ«А≈Э∆РќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

>ƒЮƒВ≈Ъ EƒЮ«Б≈ђ≈Э∆М≈ђ Vice PresidentЌХ Health Policy ≈ѓ≈ґƒЮ«Б≈ђ≈Э∆М≈ђќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

«З≈ґ∆Ъ≈Ъ≈ЭƒВ <ƒЮƒВ∆МЌХ D ≈Э«АЌХ D W

^≈ЪƒЮ≈ѓ≈ѓ«З Z≈љƒЪ∆М≈Э≈Р∆µƒЮ∆РЌХ ЌХ & ,W

ƒР≈ђƒЮƒВ∆МќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

∆Р∆М≈љƒЪ∆М≈Э≈Р∆µƒЮ∆РќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

Senior Vice President

ƒВƒ®∆МƒВ≈ґƒР≈Э∆РќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

Deputy Executive Vice President

≈µ≈µƒВ >∆µ≈ґƒЪƒПƒЮ∆М≈Р

<ƒЮ≈ѓ≈ѓ«З '≈љ≈љƒЪ∆ЙƒВ∆Р∆ЪƒЮ∆М

Membership Coordinatorr elundberg@familydocs.org

Executive Vice President ^∆µ∆РƒВ≈ґ ,≈љ≈РƒЮ≈ѓƒВ≈ґƒЪЌХ Foundation President D≈ЭƒР≈ЪƒВƒЮ≈ѓ Z≈љƒЪ∆М≈Э≈Р∆µƒЮ«МЌХ D ЌХ DW,

≈љƒЪ«З D≈Э∆ЪƒР≈ЪƒЮ≈ѓ∆Ъ∆МƒЮƒЮ

^∆µ∆РƒВ≈ґ ,≈љ≈РƒЮ≈ѓƒВ≈ґƒЪЌХ

:ƒВ≈ґƒЮ ≈Ъ≈љ

Secretary/Treasurer >≈Э∆РƒВ tƒВ∆МƒЪЌХ D

Workforce Development Manager anarayanan@familydocs.org

∆Р≈ЪƒЮ≈ґ∆М«ЗќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

ƒВƒПƒВ∆µƒЮ∆МќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

Immediate Past President DƒВ∆М≈ђ ∆МƒЮ∆Р∆Р≈ґƒЮ∆МЌХ D

Vice-Speaker D≈ЭƒР≈ЪƒЮ≈ѓ≈ѓƒЮ Y∆µ≈Э≈љ≈Р∆µƒЮЌХ D

ƒП≈Ъ≈Э≈ґƒВ«ЗƒВ EƒВ∆МƒВ«ЗƒВ≈ґƒВ≈ґ

Associate Director, Membership and Marketing

Associate Director, Communications and Publications

California FAMILY PHYSICIAN

Manager, Financial Services

≈ђ≈Р≈љ≈љƒЪ∆ЙƒВ∆Р∆ЪƒЮ∆МќЫƒ®ƒВ≈µ≈Э≈ѓ«ЗƒЪ≈љƒР∆РЌШ≈љ∆М≈Р

EƒВ∆Ъ≈ЪƒВ≈ґ ,≈Э∆Ъ«МƒЮ≈µƒВ≈ґЌХ D ЌХ Editor ≈ѓ≈ѓ≈Э∆Р≈љ≈ґ ƒВ∆µƒЮ∆МЌХ Managing Editor

Quarterly publication of the California Academy of Family Physicians

≈љ≈µ≈µ∆µ≈ґ≈ЭƒРƒВ∆Ъ≈Э≈љ≈ґ∆Р ≈љ≈µ≈µ≈Э∆Ъ∆ЪƒЮƒЮЌЧ EƒВ∆Ъ≈ЪƒВ≈ґ ,≈Э∆Ъ«МƒЮ≈µƒВ≈ґЌХ D ЌХ Chair Ќї :∆µ≈ѓ≈ЭƒВ ≈ѓƒВ≈ґ≈ђЌХ D Ќї EƒВ∆Ъ≈ЪƒВ≈ґ ,≈Э∆Ъ«МƒЮ≈µƒВ≈ґЌХ D Ќї :ƒЮƒ®ƒ®∆МƒЮ«З >∆µ∆Ъ≈ЪƒЮ∆МЌХ D

Ќї :ƒВ«З D≈љ≈ґ≈Р≈ЭƒВ∆МƒЪ≈љЌХ D Ќї D≈ЭƒР≈ЪƒЮ≈ѓ≈ѓƒЮ Y∆µ≈Э≈љ≈Р∆µƒЮЌХ D Ќї ≈ѓƒПƒЮ∆М∆Ъ ZƒВ«ЗЌХ D

d≈ЪƒЮ California Family Physician (CFP) ≈Э∆Р ∆Й∆µƒП≈ѓ≈Э∆Р≈ЪƒЮƒЪ ∆Л∆µƒВ∆М∆ЪƒЮ∆М≈ѓ«З ƒП«З ∆Ъ≈ЪƒЮ ƒВ≈ѓ≈Эƒ®≈љ∆М≈ґ≈ЭƒВ ƒРƒВƒЪƒЮ≈µ«З ≈љƒ® &ƒВ≈µ≈Э≈ѓ«З W≈Ъ«З∆Р≈ЭЌ≤ ƒР≈ЭƒВ≈ґ∆РаіѓЌЊ &WЌњЌШ K∆Й≈Э≈ґ≈Э≈љ≈ґ∆Р ƒВ∆МƒЮ ∆Ъ≈Ъ≈љ∆РƒЮ ≈љƒ® ∆Ъ≈ЪƒЮ ƒВ∆µ∆Ъ≈Ъ≈љ∆М∆Р ƒВ≈ґƒЪ ≈ґ≈љ∆Ъ ≈ґƒЮƒРƒЮ∆Р∆РƒВ∆М≈Э≈ѓ«З ∆Ъ≈Ъ≈љ∆РƒЮ ≈љƒ® ∆Ъ≈ЪƒЮ ≈µƒЮ≈µƒПƒЮ∆М∆Р ƒВ≈ґƒЪ ∆Р∆ЪƒВƒЂ ≈љƒ® ∆Ъ≈ЪƒЮ &WЌШ E≈љ≈ґЌ≤≈µƒЮ≈µƒПƒЮ∆М ∆Р∆µƒП∆РƒР∆М≈Э∆Й∆Я≈љ≈ґ∆Р ƒВ∆МƒЮ ќ®ѕѓѕ± ∆ЙƒЮ∆М «ЗƒЮƒВ∆МЌШ ƒВ≈ѓ≈ѓ ѕ∞ѕ≠ѕ±Ќ≤ѕѓѕ∞ѕ±Ќ≤ѕіѕ≤ѕ≤ѕ≥ ∆Ъ≈љ ∆Р∆µƒП∆РƒР∆М≈ЭƒПƒЮЌШ

pcipublishing.com Created by Publishing Concepts, Inc. $AVID "ROWN 0RESIDENT s DBROWN PCIPUBLISHING COM For Advertising info contact -ICHELE 'ILBERT s EXT MGILBERT PCIPUBLISHING COM EDITION 12

>≈љ≈љ≈ђ≈Э≈ґ≈Р ƒ®≈љ∆М ƒВ ≈©≈љƒПЌН '≈љ ∆Ъ≈љ «Б«Б«БЌШƒ®∆Й≈©≈љƒП∆Р≈љ≈ґ≈ѓ≈Э≈ґƒЮЌШƒР≈љ≈µ «Б≈ЪƒЮ∆МƒЮ «З≈љ∆µ ƒРƒВ≈ґЌЧ Ќї ∆РƒЮƒВ∆МƒР≈Ъ ≈©≈љƒП∆Р ƒ®≈љ∆М ƒ®∆МƒЮƒЮ Ќї ∆Й≈љ∆Р∆Ъ ƒВ ∆Мƒ†∆Р∆µ≈µƒ† Ќї ƒПƒЮ «А≈Э∆Р≈ЭƒП≈ѓƒЮ ∆Ъ≈љ ƒЮ≈µ∆Й≈ѓ≈љ«ЗƒЮ∆М∆Р Ќї ∆МƒЮƒРƒЮ≈Э«АƒЮ ƒЮЌ≤≈µƒВ≈Э≈ѓ ƒВ≈ѓƒЮ∆М∆Ъ∆Р ≈љƒ® ≈ґƒЮ«Б ≈©≈љƒП ∆Й≈љ∆Р∆Я≈ґ≈Р∆Р Y∆µƒЮ∆Р∆Я≈љ≈ґ∆РЌН ƒВ≈ѓ≈ѓ ѕіѕіѕіЌ≤ѕіѕіѕ∞Ќ≤ѕіѕЃѕ∞ѕЃƒВ≈ґƒЪ ƒВ , >d,ƒЮ Z Z^ ∆МƒЮ∆Й∆МƒЮ∆РƒЮ≈ґ∆ЪƒВ∆Я«АƒЮ «Б≈Э≈ѓ≈ѓ ≈ЪƒЮ≈ѓ∆Й «З≈љ∆µЌШ

4

California Family Physician Fall 2014

16 Every Family Physician Needs to Take Action on Prop 46

Adam Francis

18 Covered California: Putting the Puzzle Together for 2015

Catherine Direen

19 Protecting Women’s Rights to Basic Reproductive Health Care

Lealah Pollock, MD, Erica Brode, MD, Sarah McNeil, MD and Suzan Goodman, MD, MPH, TEACH Program

20 Reawakening the Counterculture: #FMRevolution

David Tran

21 California Legislature Declares 2014 the Year of the Family Physician 26 Introducing Medical Students to Family Medicine Advocacy

6

Editorial

Time to Address the Big “D”

8

President’s Message

Does Tort Law Improve the Quality of Health Care?

9

PCMH Corner

Residency Transformation and Harbor–UCLA

10 Political Pulse

What Will 2015-16 Look Like?

12 Membership

10 Easy Ways to Fit in Five Minutes of Advocacy

14 Students & Residents

Record-Breaking Number of Students and Residents Gather at 2014 AAFP National Conference

30 Executive Vice

DHHS Secretary Diana Dooley Tours Fresno PCMH

Aaron Edelstein

Nathan Hitzeman, MD Del Morris, MD Leah Newkirk Ashby Wolfe, MD, MPP, MPH Emma Lundberg Abhinaya Narayanan Susan Hogeland, CAE

For the upcoming CME calendar go to www.familydocs.org California Family Physician Fall ϮϬϭϰ

5

EDITORIAL

ȱ ȱ ĵ ǰȱ ȱ

Time to Address the Big “D” ^ŽŵĞ ŽĨ ŵLJ ĞĂƌůŝĞƐƚ ĂŶĚ ĨŽŶĚĞƐƚ ŵĞŵŽƌŝĞƐ ǁĞƌĞ ǁĂƚĐŚŝŶŐ ds ǁŝƚŚ ŵLJ ĚĂĚ͘ ^ŽŵĞ ŽĨ ƚŚĞ ƐŚŽǁƐ ǁĞƌĞ ƵŶǁĂƚĐŚĂďůĞ ďLJ ƚŽĚĂLJ͛Ɛ ƐƚĂŶĚĂƌĚƐ͗ 'ƌĞĂƚĞƐƚ ŵĞƌŝĐĂŶ ,ĞƌŽ͕ ƵŬĞƐ ŽĨ ,ĂnjĂƌĚ ĂŶĚ ͲdĞĂŵ͘ ^ŽŵĞ ƐŚŽǁƐ ǁĞƌĞ ƚƌĂŝůďůĂnjŝŶŐ͕ ƐƵĐŚ ĂƐ :ŽŚŶŶŝĞ ĂƌƐŽŶ͛Ɛ dŽŶŝŐŚƚ ƐŚŽǁ͕ ^ƚĂƌ dƌĞŬ͕ ĂŶĚ͕ LJĞƐ͕ DŽƌŬ Θ DŝŶĚLJ͘ ,ĞƌĞ ǁĂƐ ĂŶ ĂůŝĞŶ ĨƌŽŵ ŽƵƚĞƌ ƐƉĂĐĞ ŝŶ ƚŚĞ ĨŽƌŵ ŽĨ Ă ŐŽŽĨLJͲ ůŽŽŬŝŶŐ ŐƵLJ ǁŝƚŚ ƐƵƐƉĞŶĚĞƌƐ͕ Ă ǀĞƌLJ ŚĂŝƌLJ ĐŚĞƐƚ ĂŶĚ ƐŽŵĞ ŬŝŶĚ ŽĨ ĞŐŐ ĐŚĂŵďĞƌ͘ dŚĞ ƐŚŽǁ ŵĂĚĞ ŶŽ ƐĞŶƐĞ ƚŽ ŵĞ͕ ďƵƚ ƚŚĞ ŵĂŝŶ ĂĐƚŽƌ͕ ZŽďŝŶ tŝůůŝĂŵƐ͕ ǁĂƐ ůĂƌŐĞƌ ƚŚĂŶ ůŝĨĞ͕ ĂŶĚ ǁĞ ůĂƵŐŚĞĚ Ă ůŽƚ͘

ĂǀĂŝůĂďůĞ ŽŶ ŵĂnjŽŶ͘ĐŽŵ͕ ďƵƚ ůĞƚ͛Ɛ ĮŶĚ ŽƵƚ ŵŽƌĞ ĂďŽƵƚ ƚŚŽƐĞ ĐĂƌĞ ƐƵƉƉŽƌƚƐ ĂŶĚ ƚƌLJ ƚŽ ŐĞƚ ƚŚĞŵ ĨƵŶĚĞĚ͘

DLJ ĚĂĚ ůĂƚĞƌ ƐƵīĞƌĞĚ Ă ďŽƵƚ ŽĨ ĚĞƉƌĞƐƐŝŽŶ ǁŚŝĐŚ͕ ĨŽƌƚƵŶĂƚĞůLJ͕ ƉĂƐƐĞĚ͘ KŶĞ ŽĨ ŵLJ ĨĂǀŽƌŝƚĞ ĨĂĐƵůƚLJ ĚƵƌŝŶŐ ƌĞƐŝĚĞŶĐLJ ĐŽŵŵŝƩĞĚ ƐƵŝĐŝĚĞ͘ ^ĞǀĞƌĂů LJĞĂƌƐ ŝŶƚŽ ƉƌĂĐƟĐĞ͕ Ă ĐŚĞƌŝƐŚĞĚ ŵĞĚŝĐĂů ĂƐƐŝƐƚĂŶƚ ŬŝůůĞĚ ŚĞƌƐĞůĨ͘ ^ĞǀĞƌĂů ƉĂƟĞŶƚƐ ŽǀĞƌ ƚŚĞ LJĞĂƌƐ ŚĂǀĞ ƐƵĐĐƵŵďĞĚ ƚŽ ƐĞůĨ ŚĂƌŵ͕ ĂŶĚ ƐĞǀĞƌĂů ŵŽƌĞ ƐƵīĞƌĞĚ ŵLJƐƚĞƌŝŽƵƐ ĚĞĂƚŚƐ͕ ƐŽŵĞƟŵĞƐ ĂĐĐŽŵƉĂŶŝĞĚ ďLJ Ă ĐĂůů ĨƌŽŵ Ă ĨĂŵŝůLJ ŵĞŵďĞƌ Žƌ ĨƌŝĞŶĚ ƚĞůůŝŶŐ ŵĞ ƚŚĂƚ ƚŚĞLJ ĚŝĚŶ͛ƚ ƚŚŝŶŬ ŝƚ ǁĂƐ ĂŶ ĂĐĐŝĚĞŶƚ͘

dŚĞ ŝŐ ŝƐ ĞĂƐLJ ƚŽ ŵŝƐƐ͘ dŚĞƌĞ ĂƌĞ ƐŽŵĞ ƉĂƟĞŶƚƐ / ǁŽƵůĚŶ͛ƚ ŚĂǀĞ ƐƵƐƉĞĐƚĞĚ ĂŶĚ ǁŚŽ ŶĞǀĞƌ ǁŽƵůĚ ŚĂǀĞ ǀŽůƵŶƚĞĞƌĞĚ ƚŚĞ ŝŶĨŽƌŵĂƟŽŶ ǀĞƌďĂůůLJ ŚĂĚ ŽƵƌ ŝŶƚĂŬĞ ĨŽƌŵ ŶŽƚ ŚĂĚ ƚŚĞ ĚĞƉƌĞƐƐŝŽŶ ƐĐƌĞĞŶŝŶŐ ƋƵĞƐƟŽŶ͘ / ůĞĂƌŶĞĚ ƚŚĂƚ ŝƚ͛Ɛ Ă ŐŽŽĚ ŝĚĞĂ ƚŽ ƌĞĂĚ ƚŚĞ ǁŚŽůĞ ŝŶƚĂŬĞ ĨŽƌŵ ďĞĨŽƌĞ ƚŚĞ ƉĂƟĞŶƚ ůĞĂǀĞƐ͘

,Žǁ ƐŚŽƵůĚ ǁĞ ƐĐƌĞĞŶ ĨŽƌ ĚĞƉƌĞƐƐŝŽŶ͍ ŽƚŚ ǁƌŝƩĞŶ ĂŶĚ ǀĞƌďĂů ƋƵĞƐƟŽŶƐ ĐĂŶ ŚĞůƉ͘ /ŶƚĞƌĞƐƟŶŐůLJ͕ / ŽŌĞŶ ĮŶĚ ƉĂƟĞŶƚƐ ǁŚŽ ĂƌĞ Ă ůŝƩůĞ ŽǀĞƌ ƚŚĞ ƚŽƉ͕ ŚƵŵŽƌŽƵƐ ĂŶĚ ĂŶŝŵĂƚĞĚ ƚŽ ďĞ ƐŽŵĞ ŽĨ ƚŚĞ ŵŽƐƚ ůŝŬĞůLJ ƚŽ ůĂƚĞƌ ĂĚŵŝƚ ƚŽ ďŽƵƚƐ ŽĨ ĚĞƉƌĞƐƐŝŽŶ͘ ƌŝŶŬŝŶŐ Ă ďŝƚ ƚŽŽ ŵƵĐŚ ŝƐ ĂůƐŽ Ă ƚĞůů ƚĂůĞ ƐŝŐŶ͘ &ĂŵŝůLJ ŚŝƐƚŽƌLJ ĐĂŶ ďĞ ǀĞƌLJ ƌĞǀĞĂůŝŶŐ͘ >Ğƚ͛Ɛ ĨĂĐĞ ŝƚ͕ ǁĞ Ăůů ŚĂǀĞ Ă ĐƌĂnjLJ ƵŶĐůĞ Žƌ ƚŚƌĞĞ͕ ďƵƚ ƉĂLJ ĂƩĞŶƟŽŶ ǁŚĞŶ ŝƚ͛Ɛ Ă ƉĂƌĞŶƚ Žƌ ƐŝďůŝŶŐ͘

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱŗŖ ȱ ȱ ȱ ȱ ȱ ȱ ȱŚŖǰŖŖŖȱ ȱ Ĵ ȱ ȱ ȱŘŖŗŖǯ

ĐĐŽƌĚŝŶŐ ƚŽ Ă ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ; Ϳ ƌĞƉŽƌƚ ƚŚŝƐ ƉĂƐƚ ƐƵŵŵĞƌ͕ ƐƵŝĐŝĚĞ ŝƐ ĂŐĂŝŶ ƚŚĞ ϭϬƚŚ ůĞĂĚŝŶŐ ĐĂƵƐĞ ŽĨ ĚĞĂƚŚ ǁŝƚŚ ĂůŵŽƐƚ ϰϬ͕ϬϬϬ ƉĞŽƉůĞ ĐŽŵŵŝƫŶŐ ƐƵŝĐŝĚĞ ŝŶ ϮϬϭϬ ʹ ũƵƐƚ Ă ĨĞǁ ƚŚŽƵƐĂŶĚ ƐŚLJ ŽĨ ƚŚĂƚ ĨƌŽŵ ŬŝĚŶĞLJ ĚŝƐĞĂƐĞ͘ ŝĂůLJƐŝƐ ŝƐ ǀĞƌLJ ǁĞůůͲĨƵŶĚĞĚ ŝŶ ƚŚŝƐ ĐŽƵŶƚƌLJ͘ DĞŶƚĂů ŚĞĂůƚŚ ĐŽǀĞƌĂŐĞ ŝƐ ĂƚƌŽĐŝŽƵƐ ʹ ƵŶůĞƐƐ LJŽƵ ĐŽƵŶƚ ũĂŝůƐ ĂŶĚ ĞŵĞƌŐĞŶĐLJ ƌŽŽŵƐ͕ ǁŚŝĐŚ ŚĂǀĞ ďĞĐŽŵĞ ƚŚĞ ĞdžƉĞŶƐŝǀĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ĨŽƌ ƚŚĞ ŵĞŶƚĂůůLJ ŝůů͘ ŶĚ ƚŚĂŶŬƐ ƚŽ ŝŶĂŶĞ ŝŶƐƵƌĂŶĐĞ ĐĂƌǀĞͲŽƵƚƐ͕ ƐŝůŽƐ ŽĨ ĐĂƌĞ͕ ĂŶĚ ĞǀĞƌ ŚĞůƉĨƵů ,ĞĂůƚŚ /ŶƐƵƌĂŶĐĞ WŽƌƚĂďŝůŝƚLJ ĂŶĚ ĐĐŽƵŶƚĂďŝůŝƚLJ Đƚ͕ ŝŶƚĞŐƌĂƟŶŐ ƚŚĞ ŚĞĂůƚŚ ŽĨ ƚŚĞ ŵŝŶĚ ǁŝƚŚ ƚŚĂƚ ŽĨ ƚŚĞ ďŽĚLJ ƐƟůů ƐĞĞŵƐ ĚĞĐĂĚĞƐ ĂǁĂLJ͘

6

KƵƌ ƌĞƐŽƵƌĐĞƐ ĂƌĞ ůŝŵŝƚĞĚ͘ &W ŚĂƐ Ă ĚĞƉƌĞƐƐŝŽŶ ƐĐƌĞĞŶŝŶŐ ƚŽŽů ĂǀĂŝůĂďůĞ ŽŶ ƚŚĞŝƌ ǁĞďƐŝƚĞ ƚŚĂƚ ŝƐ Ă ĚŽǁŶůŽĂĚĂďůĞ ƋƵĞƐƟŽŶŶĂŝƌĞ͘ WƌŽŵŽƚĞ ƚŚĞ ƐƵŝĐŝĚĞ ŚŽƚůŝŶĞ͘ ŽŶƐŝĚĞƌ ƚŚĞ ͞ŶŽ ƐƵŝĐŝĚĞ ĐŽŶƚƌĂĐƚ͟ ǁŝƚŚ LJŽƵƌ ƉĂƟĞŶƚ͕ ƚŽŽ͘ ŽƚŚ ĂƌĞ ĂǀĂŝůĂďůĞ ŽŶ ƐƵŝĐŝĚĞ͘ŽƌŐ͘ ,ĂǀĞ Ă ƉĂƟĞŶƚ ĂĚŵŝƩĞĚ Žƌ ƚƌĂŶƐƉŽƌƚĞĚ ŝĨ ŚĞ Žƌ ƐŚĞ ŝƐ ĂĐƟǀĞůLJ ƐƵŝĐŝĚĂů͘ /Ĩ LJŽƵ ŚĂǀĞ ĂŶLJŽŶĞ ƌĞƐĞŵďůŝŶŐ Ă ĐĂƐĞ ŵĂŶĂŐĞƌ Žƌ ƐŽĐŝĂů ǁŽƌŬĞƌ͕ ďƵLJ ƚŚĂƚ ŝŶĚŝǀŝĚƵĂů ĨƌĞƋƵĞŶƚ ĐƵƉƐ ŽĨ ĐŽīĞĞ͘ ŶĚ͕ LJĞƐ͕ ŝĨ LJŽƵ ĐĂŶ ŐĞƚ ƉĂƟĞŶƚƐ ŝŶƚŽ Ă ƉƐLJĐŚŽůŽŐŝƐƚͬ ƉƐLJĐŚŝĂƚƌŝƐƚ͕ ďLJ Ăůů ŵĞĂŶƐ͕ ƉƌŽĐĞĞĚ͘ /Ĩ ƚŚĞ ƉƐLJĐŚ ƉĞƌƐŽŶ ŝƐ ĂƐ ĞůƵƐŝǀĞ ĂƐ ƚŚĞ DĞĚŝͲ Ăů ƉŽĚŝĂƚƌŝƐƚ͕ ĨĂůů ďĂĐŬ ƚŽ ƚŚĞ ďĂƐŝĐƐ͘

/ ĚŽŶ͛ƚ ŚĂǀĞ ƚŚĞ ĂŶƐǁĞƌƐ ĂŶLJŵŽƌĞ ƚŚĂŶ LJŽƵ ĚŽ͘ Ƶƚ ǁŝƚŚ ĞǀĞƌLJ ŵĂƐƐ ŵƵƌĚĞƌ ĨƌŽŵ ĂŶ ŝƐŽůĂƚĞĚ ŐƵLJ ǁŚŽ ĞǀĞƌLJŽŶĞ ďƵƚ ŚŝƐ ŵŽŵ ƚŚŽƵŐŚƚ ǁĂƐ ǁĞŝƌĚ͕ ĂŶĚ ĞǀĞƌLJ ĚĞƉƌĞƐƐĞĚ ĐĞůĞďƌŝƚLJ ǁŝƚŚ ŽƐƚĞŶƐŝďůLJ ĞǀĞƌLJƚŚŝŶŐ ŐŽŝŶŐ ŚŝƐ Žƌ ŚĞƌ ǁĂLJ͕ / ǁŽŶĚĞƌ ǁŚĂƚ ǁĞ ĐĂŶ ĚŽ ďĞƩĞƌ͍

ŶĚ͕ ŽĨ ĐŽƵƌƐĞ͕ ƚŚĞƌĞ ĂƌĞ ƚŚĞ ŵĞĚƐ ƚŚĂƚ ǁĞ ŚĞĂƌ ĂďŽƵƚ ŽŶ ƚŚĞ ŵŝĚŶŝŐŚƚ ĐŽŵŵĞƌĐŝĂůƐ ǁŚĞŶ ĚĞƉƌĞƐƐĞĚ ƉĞŽƉůĞ ĂŶĚ ƚŚŽƐĞ ŽĨ ƵƐ ǁŝƚŚ LJŽƵŶŐ ĐŚŝůĚƌĞŶ ĂƌĞ ŶŽƚ ƐůĞĞƉŝŶŐ LJĞƚ͘ zĞƐ͕ ƚŚŽƐĞ ŵĞĚŝĐŝŶĞƐ ǁŽƌŬ͘ ŽŶ͛ƚ ďĞ ĂĨƌĂŝĚ ƚŽ ƵƐĞ ƚŚĞŵ͕ ƉƌĞĨĞƌĂďůLJ ƚŚĞŝƌ ĐŚĞĂƉĞƌ ŝƐŽŵĞƌ ŐĞŶĞƌŝĐ ĐŽƵƐŝŶƐ͕ ĂŶĚ Ăƚ ŵŽƌĞ ƚŚĂŶ Ă ŚŽŵĞŽƉĂƚŚŝĐ ĚŽƐĞ͘ >ĂƐƚůLJ͕ / ĐĂŶŶŽƚ ĞŵƉŚĂƐŝnjĞ ŚŽǁ ŵƵĐŚ ŝƚ ŵĞĂŶƐ ƚŽ ƉĂƟĞŶƚƐ ƚŽ ŐĞƚ ĂŶ ƵŶƐŽůŝĐŝƚĞĚ ĐĂůů ĨƌŽŵ ƚŚĞŝƌ ĨĂŵŝůLJ ĚŽĐƚŽƌ ƚŽ ĐŚĞĐŬ ŝŶ ŽŶ ƚŚĞŵ͘ / ƐŚŽƵůĚ ĚŽ ŝƚ ŵŽƌĞ ƚŚĂŶ / ĚŽ͕ ďƵƚ ǁŚĞŶ / ĚŽ͕ ŝƚ ŐŽĞƐ Ă ůŽŶŐ ǁĂLJ͘

dŚĞ h͘^͘ WƌĞǀĞŶƟǀĞ ^ĞƌǀŝĐĞƐ dĂƐŬ &ŽƌĐĞ ƌĞĐŽŵŵĞŶĚƐ ƐĐƌĞĞŶŝŶŐ ĂĚƵůƚƐ ĨŽƌ ĚĞƉƌĞƐƐŝŽŶ ǁŚĞŶ ͞ƐƚĂīͲĂƐƐŝƐƚĞĚ ĚĞƉƌĞƐƐŝŽŶ ĐĂƌĞ ƐƵƉƉŽƌƚƐ͟ ĂƌĞ ŝŶ ƉůĂĐĞ ƚŽ ĂƐƐƵƌĞ ĂĐĐƵƌĂƚĞ ĚŝĂŐŶŽƐŝƐ͕ ĞīĞĐƟǀĞ ƚƌĞĂƚŵĞŶƚ ĂŶĚ ĨŽůůŽǁ ƵƉ͘ hŶĨŽƌƚƵŶĂƚĞůLJ͕ / ĐŽƵůĚ ŶŽƚ ĮŶĚ ͞ƐƚĂīͲĂƐƐŝƐƚĞĚ ĚĞƉƌĞƐƐŝŽŶ ĐĂƌĞ ƐƵƉƉŽƌƚƐ͟

Ɛ ǁĞ ĨĂŵŝůLJ ĚŽĐƐ ĐŽŶƟŶƵĞ ŽƵƌ ƋƵĞƐƚ ĨŽƌ ƚŚĞ ƉĞƌĨĞĐƚ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ͕ ůĞƚ͛Ɛ ŬĞĞƉ ĂŶ ŽƉĞŶ ĐŽŶĐĞƉƚ ƉůĂŶ ŝŶ ŵŝŶĚ ĨŽƌ ŵĞŶƚĂů ŚĞĂůƚŚ͘ ŶĚ ůĞƚ͛Ɛ ŚŽƉĞ ƚŚĂƚ ŽƵƌ ƉĂƌĞŶƚ ŽƌŐĂŶŝnjĂƟŽŶƐ͕ ŝŶƐƵƌĂŶĐĞ ƉĂLJĞƌƐ͕ ĂŶĚ ŐŽǀĞƌŶŵĞŶƚ ŚĞůƉ ƐƵƉƉŽƌƚ ƚŚĞ ƌĞŵŽĚĞů͘

California Family Physician Fall 2014

California Family Physician Fall 2014

7

PRESIDENT’S MESSAGE

ȱ ǰȱ

Does Tort Law Improve the Quality of Health Care? dŚŝƐ ŝƐƐƵĞ ĚŝƐĐƵƐƐĞƐ WƌŽƉ ϰϲ ĂŶĚ ŝƚƐ ĂƚƚĂĐŬ ŽŶ ƚŚĞ DĞĚŝĐĂů /ŶũƵƌLJ ŽŵƉĞŶƐĂƚŝŽŶ ZĞĨŽƌŵ Đƚ ;D/ Z Ϳ ĂŶĚ ŽŶ ĂůŝĨŽƌŶŝĂ ƉŚLJƐŝĐŝĂŶƐ͘ ůŵŽƐƚ ŚŝĚĚĞŶ ŝŶ WƌŽƉ ϰϲ ŝƐ ƚŚĞ ŐŝǀĞŶ ĂƐƐƵŵƉƟŽŶ ƚŚĂƚ ůĂǁƐƵŝƚƐ ĂƌĞ ŶĞĞĚĞĚ ƚŽ ŝŵƉƌŽǀĞ ŵĞĚŝĐĂů ƋƵĂůŝƚLJ ŽĨ ĐĂƌĞ͘ &ĂŵŽƵƐ ĐŚĂŵƉŝŽŶƐ ŽĨ ƚŚĞ ƚŽƌƚ ůĂǁ ƐLJƐƚĞŵ ŝŶĐůƵĚĞ ZĂůƉŚ EĂĚĞƌ ĂŶĚ DŝůƚŽŶ &ƌŝĞĚŵĂŶ͘ ZĂůƉŚ EĂĚĞƌ ŐĂŝŶĞĚ ĨĂŵĞ ǁŚĞŶ ŚĞ ƉƵďůŝƐŚĞĚ hŶƐĂĨĞ Ăƚ ŶLJLJ ^ƉĞĞĚ Ɖ ŝŶ ϭϵϲϱ͕ ĞdžƉŽƐŝŶŐ ƚŚĞ ƌĞƐŝƐƚĂŶĐĞ ŝŶƚƌŽĚƵĐŝŶŐ ŵĂŶƵĨĂĐƚƵƌĞƌƐ ƚŽ ĐĂƌ ŽĨ ƐĂĨĞƚLJ ĨĞĂƚƵƌĞƐ͘ ,Ğ ƵƐĞĚ ŵŽŶĞLJ ĨƌŽŵ Ă ůĂǁƐƵŝƚ ĂŐĂŝŶƐƚ 'ĞŶĞƌĂů DŽƚŽƌƐ ƚŽ ůŽďďLJ ĨŽƌ ƚŚĞ ĐƌĞĂƟŽŶ ŽĨ ƚŚĞ h͘^͘ ŶǀŝƌŽŶŵĞŶƚĂů WƌŽƚĞĐƟŽŶ ŐĞŶĐLJ ĂŶĚ ƚŚĞ ůĞĂŶ ŝƌ Đƚ͘ dŚĞ EŽďĞů WƌŝnjĞͲǁŝŶŶŝŶŐ ĞĐŽŶŽŵŝƐƚ DŝůƚŽŶ &ƌŝĞĚŵĂŶ ŝŶ &ĞďƌƵĂƌLJ ϭϵϵϵ͕ ĐĂůůĞĚ ĨŽƌ ƚŚĞ ĞůŝŵŝŶĂƟŽŶ ŽĨ ƚŚĞ &ŽŽĚ ĂŶĚ ƌƵŐ ĚŵŝŶŝƐƚƌĂƟŽŶ͕ ĂƌŐƵŝŶŐ ƚŚĂƚ ĐŽƌƉŽƌĂƟŽŶƐ ǁŽƵůĚ ŚĂǀĞ ƚŚĞ ŝŶĐĞŶƟǀĞ ŶŽƚ ƚŽ ƉŽŝƐŽŶ ƉĞŽƉůĞ ďĞĐĂƵƐĞ ŽĨ ƚŚĞ ƚŚƌĞĂƚ ŽĨ ůĂǁƐƵŝƚƐ͘

tŝůůŝĂŵ ,͘ ^ĂŐĞ ǁƌŽƚĞ ŝŶ ͞>Ğƚ͛Ɛ ŵĂŬĞ Ă ĚĞĂů͗ ƚƌĂĚŝŶŐ ŵĂůƉƌĂĐƟĐĞ ƌĞĨŽƌŵ ĨŽƌ ŚĞĂůƚŚ ƌĞĨŽƌŵ͕͟ ,ĞĂůƚŚ īĂŝƌƐ͕ :ĂŶƵĂƌLJ ϮϬϭϰ͕ ƚŚĂƚ ͞΀ƚ΁ŚĞ ŵĂůƉƌĂĐƟĐĞ ƐLJƐƚĞŵ ŚĂƐ ďĞĞŶ ƐƚƵĚŝĞĚ ĞdžƚĞŶƐŝǀĞůLJ ĂŶĚ ŝƚƐ ŐĞŶĞƌĂů ƉĞƌĨŽƌŵĂŶĐĞ ŝƐ ǁĞůů ĞƐƚĂďůŝƐŚĞĚ͘ KǀĞƌĂůů͕ ŵĂůƉƌĂĐƟĐĞ ůŝƟŐĂƟŽŶ ĚŽĞƐ ŶŽƚ ƉƌŽǀŝĚĞ ĂŶ ĂĐĐĞƐƐŝďůĞ͕ ƌĞƐƉĞĐƞƵů͕ Žƌ ĞĸĐŝĞŶƚ ƐŽƵƌĐĞ ŽĨ ƉŚLJƐŝĐŝĂŶ ĂĐĐŽƵŶƚĂďŝůŝƚLJ͕ ĂŶĚ ŝƚ ŝƐ ƵŶůŝŬĞůLJ ƚŽ ĚŽ ƐŽ ŝŶ ƚŚĞ ĨƵƚƵƌĞ͘͟

/ ŵĞƚ ZĂůƉŚ EĂĚĞƌ Ăƚ Ă ůĞŐŝƐůĂƟǀĞ ŚĞĂƌŝŶŐ ŝŶ tĂƐŚŝŶŐƚŽŶ ƐƚĂƚĞ ĂďŽƵƚ ŵĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ƚŽƌƚ ƌĞĨŽƌŵ ŝŶ :ĂŶƵĂƌLJ ϭϵϴϲ ;/ ƌĞŵĞŵďĞƌ ƚŚĞ ĚĂƚĞ ďĞĐĂƵƐĞ ŝƚ ǁĂƐ ƚŚĞ ĚĂLJ ŽĨ ƚŚĞ ŚĂůůĞŶŐĞƌ ĚŝƐĂƐƚĞƌͿ͘ ,Ğ ǁĂƐ ĐŚĂƌŝƐŵĂƟĐ ĂŶĚ ƐƚƌŝĚĞŶƚ ƚŚĞŶ ĂŶĚ ŚĞ ƌĞŵĂŝŶƐ ƐŽ ŶŽǁ͘ ,Ğ ĂƌŐƵĞĚ ƚŚĂƚ ǁŝƚŚŽƵƚ ƚŚĞ ĨĞĂƌ ŽĨ ůĂǁƐƵŝƚƐ͕ ĚŽĐƚŽƌƐ ǁŽƵůĚ ďĞ ĐĂƌĞůĞƐƐ ĂŶĚ ũĞŽƉĂƌĚŝnjĞ ƉĂƟĞŶƚƐ͛ ůŝǀĞƐ͕ ũƵƐƚ ůŝŬĞ ďŝŐ ĐŽƌƉŽƌĂƟŽŶƐ ĚŽ͘

Oppose Prop 46͘ ŚĂŶŐŝŶŐ ƚŚĞ ŶŽŶͲĞĐŽŶŽŵŝĐ ĐĂƉ ŝŶ D/ Z ǁŝůů ŝŶĐƌĞĂƐĞ ƚŚĞ ĐŽƐƚ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ͘ /Ŷ ĨĂĐƚ͕ ĂůŝĨŽƌŶŝĂ D/ Z ŚĂƐ ďĞĞŶ Ă ͞'ŽůĚ ^ƚĂŶĚĂƌĚ͟ ĨŽƌ ƉƌŽƉŽƐĞĚ ŶĂƟŽŶĂů ƚŽƌƚ ƌĞĨŽƌŵ͘ /Ŷ ϮϬϬϭ ƚŚĞ ŽŶŐƌĞƐƐŝŽŶĂů ƵĚŐĞƚ KĸĐĞ ĞƐƟŵĂƚĞĚ ƚŚĂƚ Ă ďŝůů ĐĂƉƉŝŶŐ ŶŽŶͲĞĐŽŶŽŵŝĐ ĚĂŵĂŐĞƐ Ăƚ ΨϮϱϬ͕ϬϬϬ ĂĐƌŽƐƐ ƚŚĞ ŶĂƟŽŶ ǁŽƵůĚ ƌĞĚƵĐĞ ŶĂƟŽŶĂů ŚĞĂůƚŚ ƐƉĞŶĚŝŶŐ ďLJ Ϭ͘ϱ ƉĞƌĐĞŶƚ ;ŵŽƌĞ ƚŚĂŶ ΨϭϬ ďŝůůŝŽŶ ĂŶŶƵĂůůLJͿ͘

DĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ůĂǁ ŝƐ Ă ƐƵďƐĞƚ ŽĨ ƚŽƌƚ ůĂǁ͘ DĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ůĂǁ ŝŶǀŽůǀĞƐ͗ ϭͿ ƉƌŽĨĞƐƐŝŽŶĂůƐ ĂŶĚ ŝŶƐƟƚƵƟŽŶƐ ĚĞůŝǀĞƌŝŶŐ ŚĞĂůƚŚ ĐĂƌĞ ƐĞƌǀŝĐĞƐ͖ ϮͿ ƚŚĞ ůĞŐĂů ƉƌŽĐĞƐƐĞƐ ƚŚĂƚ ƌĞƐŽůǀĞ ĚŝƐƉƵƚĞƐ͖ ĂŶĚ ϯͿ ƚŚĞ ůŝĂďŝůŝƚLJ ŝŶƐƵƌĞƌƐ ;ŝŶĚŝƌĞĐƚůLJ͕ ŚĞĂůƚŚ ŝŶƐƵƌĞƌƐͿ͘

WƌĂĐƟĐĞ ŐŽŽĚ ŵĞĚŝĐŝŶĞ͘ EĞŝů Ğ'ƌĂƐƐĞ dLJƐŽŶ ŚĂƐ ƉƌŽƉŽƐĞĚ &ŝǀĞ WƌŝŶĐŝƉůĞƐ ŽĨ ^ĐŝĞŶĐĞ ƚŚĂƚ ǁĞ ĐĂŶ ŵŽĚŝĨLJ ĨŽƌ ƚŚĞ ƉƌĂĐƟĐĞ ŽĨ ŵĞĚŝĐŝŶĞ͘

dŚĞ ŽďũĞĐƟǀĞƐ ŽĨ ƚŽƌƚ ůĂǁ ĂŶĚ ŵĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ůĂǁ ĂƌĞ͗ ϭͿ ĐŽŵƉĞŶƐĂƟŽŶ ƚŽ ŵĂŬĞ ǀŝĐƟŵƐ ǁŚŽůĞ͖ ϮͿ ĐŽƌƌĞĐƟǀĞ ũƵƐƟĐĞ ƚŽ ƐŝŐŶĂů ƚŽ ƉĂƌƟĞƐ ƚŚĂƚ ƐŽĐŝĞƚLJ ĚŝƐƟŶŐƵŝƐŚĞƐ ďůĂŵĞůĞƐƐ ĨƌŽŵ ďůĂŵĞǁŽƌƚŚLJ ĞǀĞŶƚƐ ĂŶĚ ƚŚĞ ĂďŽǀĞͲŵĞŶƟŽŶĞĚ͖ ĂŶĚ ϯͿ ĚĞƚĞƌƌĞŶĐĞ ƚŽ ŐŝǀĞ ŝŶĐĞŶƟǀĞ ƚŽ ďĞŚĂǀĞ ŶŽŶͲŶĞŐůŝŐĞŶƚůLJ͘ Does Tort Law Decrease Medical Malpractice? dŚĞ ĐŽƐƚƐ ŽĨ ƚŽƌƚ ůĂǁ ŐŽ ďĞLJŽŶĚ ƚŚĞ ϭϱ͕ϬϬϬͲϭϵ͕ϬϬϬ ŵĂůƉƌĂĐƟĐĞ ƐƵŝƚƐ ƉĞƌ LJĞĂƌ ĂŐĂŝŶƐƚ ĚŽĐƚŽƌƐ ĨŽƌ ĐůĂŝŵƐ ŽĨ ĞƌƌŽƌ͕ ǁŝƚŚ Ă ŵĞĂŶ ƉĂLJŵĞŶƚ ŽĨ ΨϮϯϰ͕ϲϯϱ ŝŶ ϮϬϬϲ ;EĂƟŽŶĂů WƌĂĐƟƟŽŶĞƌ ĂƚĂ ĂŶŬ ŶŶƵĂů ZĞƉŽƌƚͿ͘ &ĞĂƌ ŽĨ ůŝƟŐĂƟŽŶ ŝƐ Ă ƉŽǁĞƌĨƵů ƐƟŵƵůƵƐ ůĞĂĚŝŶŐ ƚŽ ŽǀĞƌͲŝŶǀĞƐƟŐĂƟŽŶ ĂŶĚ ŽǀĞƌͲƚƌĞĂƚŵĞŶƚ͘ /Ŷ ĂŶ ĂƚŵŽƐƉŚĞƌĞ ŽĨ ůŝƟŐĂƟŽŶ ƉŚŽďŝĂ͕ ƚŚĞ ŽŶůLJ ďĂĚ ƚĞƐƚ ŝƐ ƚŚĞ ƚĞƐƚ LJŽƵ ĚŝĚŶ͛ƚ ƚŚŝŶŬ ŽĨ ŽƌĚĞƌŝŶŐ͘

8

California Family Physician Fall 2014

DĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ƉŽůŝĐLJ ŚĂƐ ďĞĞŶ ĐĂƵŐŚƚ ƵƉ ĨŽƌ ĚĞĐĂĚĞƐ ŝŶ Ă ůĂǁLJĞƌ ǀƐ͘ ĚŽĐƚŽƌ ƉŽůŝƟĐĂů ĚĞďĂƚĞ ŽǀĞƌ ǁŚĞƚŚĞƌ ƉĞƌƐŽŶĂů ŝŶũƵƌLJ ůĂǁƐƵŝƚƐ ĂƌĞ ŐŽŽĚ Žƌ ďĂĚ ĨŽƌ ƐŽĐŝĞƚLJ͘ ^ĂŐĞ ƐƵŐŐĞƐƚƐ ƚŚĞ ĚĞďĂƚĞ ƐŚŽƵůĚ ďĞ ŚĞĂůƚŚ ĐĂƌĞͲĐĞŶƚƌŝĐ͕ ŶŽƚ ůĂǁLJĞƌͲĐĞŶƚƌŝĐ͘ What should we do for our patients to improve medical quality of care?

ϭ͘ YƵĞƐƟŽŶ ĂƵƚŚŽƌŝƚLJ͘ Ϯ͘ ŽŶ͛ƚ ďĞůŝĞǀĞ ƐŽŵĞƚŚŝŶŐ ũƵƐƚ ďĞĐĂƵƐĞ LJŽƵ ǁĂŶƚ ƚŽ͘ ϯ͘ dĞƐƚ ŝĚĞĂƐ ďLJ ĞǀŝĚĞŶĐĞ ŐĂŝŶĞĚ ĨƌŽŵ ŽďƐĞƌǀĂƟŽŶ ʹ ƵƐĞ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ŬŶŽǁůĞĚŐĞ͘ ϰ͘ &ŽůůŽǁ ƚŚĞ ĞǀŝĚĞŶĐĞ ǁŚĞƌĞǀĞƌ ŝƚ ůĞĂĚƐ ʹĚŽŶ͛ƚ ƐƚŽƉ ĚĞǀĞůŽƉŝŶŐ LJŽƵƌ ĂƐƐƵŵƉƟŽŶƐ ƚŽŽ ƐŽŽŶ͘ ϱ͘ /Ĩ LJŽƵ ŚĂǀĞ ŶŽ ĞǀŝĚĞŶĐĞ͕ ƌĞƐĞƌǀĞ ũƵĚŐŵĞŶƚ͘ ,ĂǀĞ ĚŽĐƚŽƌƐ ŬŶŽǁŶ ƐŝŶ͍ zĞƐ͘ Ƶƚ Ă ƉƌŽĨĞƐƐŝŽŶ ůŝŬĞ ŽƵƌƐ ĐĂŶ͛ƚ ďĞ ůĞŌ ŝŶ ƚŚĞ ŚĂŶĚƐ ŽĨ ĂŶ ŝŶŇƵĞŶƟĂů ĂŶĚ ůŽƵĚ ĨĞǁ͘ KƵƌ ƐƉĞĐŝĂůƚLJ ǁĂƐ ŽŶĞ ŽĨ ƚŚĞ ĞĂƌůŝĞƐƚ ƚŽ ĂĚŽƉƚ ĐŽŶƟŶƵŽƵƐ ůŝĨĞƟŵĞ ƉƌŽĨĞƐƐŝŽŶĂů ůĞĂƌŶŝŶŐ ĂƐ Ă ƌĞƋƵŝƌĞŵĞŶƚ ĨŽƌ ŵĂŝŶƚĂŝŶŝŶŐ ŽƵƌ ŽĂƌĚ ƐƚĂƚƵƐ͘ dŚĞ ŵĞƌŝĐĂŶ ŽĂƌĚ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ͛Ɛ DĂŝŶƚĞŶĂŶĐĞ ŽĨ ĞƌƟĮĐĂƟŽŶ ĂŶĚ ƚŚĞ ŵĂŶLJ ƌĞƐŽƵƌĐĞƐ ĨŽƌ ŽŶƟŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ ŽĨ ƚŚĞ &W ƉƌŽŵŽƚĞ ƚŚĞ ƐĐŝĞŶĐĞ ĂŶĚ ƚŚĞ ƉƌŽĨĞƐƐŝŽŶĂůŝƐŵ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ dŚŝƐ ŝƐ ƚŚĞ ƚƌƵĞ ƉĂƚŚ ĨŽƌ ŵĂŝŶƚĂŝŶŝŶŐ ĂŶĚ ŝŵƉƌŽǀŝŶŐ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ͘

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ȱȱȱȱȱȱȱ

PCMH CORNER

Residency Transformation and Harbor–UCLA ƵŝůĚŝŶŐ ŽŶ LJĞĂƌƐ ŽĨ ĞdžƉĞƌŝĞŶĐĞ ŝŶ ĨĂĐƵůƚLJ ĚĞǀĞůŽƉŵĞŶƚ͕ ^ƵƐĂŶ ^ŶLJĚĞƌ͕ D ͕ ŝƌĞĐƚŽƌ ŽĨ ƚŚĞ ,ĂƌďŽƌͲh > WƌŝŵĂƌLJ ĂƌĞ &ĂĐƵůƚLJ ĞǀĞůŽƉŵĞŶƚ &ĞůůŽǁƐŚŝƉ͕ ŚĂƐ ĚĞǀĞůŽƉĞĚ ĂŶ ĞŶŚĂŶĐĞĚ͕ ŝŶŶŽǀĂƟǀĞ ƉƌŽŐƌĂŵ ƚŽ ƉƌĞƉĂƌĞ ƌĞĐĞŶƚ ƌĞƐŝĚĞŶĐLJ ŐƌĂĚƵĂƚĞƐ ƚŽ ůĞĂĚ͕ ƚĞĂĐŚ ĂŶĚ ŝŵƉůĞŵĞŶƚ ƚŚĞ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ŵŽĚĞů ŽĨ ĐĂƌĞ ǁŝƚŚ Ă ƐƉĞĐŝĂů ĨŽĐƵƐ ŽŶ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶƐ͘

Luz Felix-Marquez, MD, MSPH

Joanne Suh, MD

^ƵĐĐĞƐƐĨƵů ƉƌŝŵĂƌLJ ĐĂƌĞ ƚƌĂŶƐĨŽƌŵĂƟŽŶ ŝƐ ĚĞƉĞŶĚĞŶƚ ŽŶ ŝŶĨŽƌŵĞĚ ĂŶĚ ĞŶŐĂŐĞĚ ůĞĂĚĞƌƐŚŝƉ͕ LJĞƚ ĨĞǁ ƉƌŽŐƌĂŵƐ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌLJ ƉƌĞƉĂƌĞ ĞĂƌůLJ ĐĂƌĞĞƌ ƉŚLJƐŝĐŝĂŶƐ ĨŽƌ ƚŚŝƐ ƌŽůĞ͘ dŚĞ ƉƌŽŐƌĂŵ͛Ɛ ŝŶƐƉŝƌŝŶŐ ĨĞůůŽǁƐ͕ >Ƶnj &ĞůŝdžͲDĂƌƋƵĞnj͕ D ͕ D^W, ĂŶĚ :ŽĂŶŶĞ ^ƵŚ͕ D ͕ ůĞĂĚ ŵƵůƟͲĚŝƐĐŝƉůŝŶĂƌLJ ƉƌĂĐƟĐĞ ĂŶĚ ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ ƚĞĂŵƐ ŝŶ Ă ƐĂĨĞƚLJ ŶĞƚ ĐůŝŶŝĐ ƚƌĂŶƐŝƟŽŶŝŶŐ ƚŽ ƚŚĞ W D, ŵŽĚĞů͘ dŚĞ ĨĞůůŽǁƐ ĂůƐŽ ƚĞĂĐŚ ,ĂƌďŽƌͲh > ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĨƌŽŵ h > ĂďŽƵƚ ƚŚĞ W D, ŵŽĚĞů͘ &ŝŶĂůůLJ͕ ƚŚĞ ĨĞůůŽǁƐ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ǁĞĞŬůLJ ƐĞŵŝŶĂƌƐ ƚŚĂƚ ĐŽǀĞƌ ƚĞĂĐŚŝŶŐ ƐŬŝůůƐ͕ ůĞĂĚĞƌƐŚŝƉ͕ ƚĞĂŵ ĚLJŶĂŵŝĐƐ͕ ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ͕ ŶĞǁ ŵŽĚĞůƐ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ĂŶĚ ŽƌŐĂŶŝnjĂƟŽŶĂů ƚƌĂŶƐĨŽƌŵĂƟŽŶ͘ ĂĐŚ ĨĞůůŽǁ ĐŽŶĚƵĐƚƐ ĂŶ ŝŶĚŝǀŝĚƵĂů ƉƌŽũĞĐƚ ĂŶĚ ƌĞĐĞŝǀĞƐ ĞdžƚĞŶƐŝǀĞ ĐŽĂĐŚŝŶŐ ĂŶĚ ŵĞŶƚŽƌŝŶŐ ŝŶ ůĞĂĚĞƌƐŚŝƉ ƐŬŝůůƐ ĨƌŽŵ ĨĞůůŽǁƐŚŝƉ ĨĂĐƵůƚLJ͘ dŽŐĞƚŚĞƌ ƌƐ͘ ^ŶLJĚĞƌ͕ DĂƌƋƵĞnj ĂŶĚ ^ƵŚ͕ ĂůŽŶŐ ǁŝƚŚ ĨĞůůŽǁƐŚŝƉ ĨĂĐƵůƚLJ ŵĞŵďĞƌƐ͕ ƌƐ͘ :ĞƐƵƐ 'ƵƟĞƌƌĞnj ĂŶĚ &Ğůŝdž ĂƌƉŝŽ͕ ĞŶŐĂŐĞ ŝŶ ƉƌŝŵĂƌLJ ĐĂƌĞ ƚƌĂŶƐĨŽƌŵĂƟŽŶ ďLJ ƚƌĂŶƐĨŽƌŵŝŶŐ ĐĂƌĞ ĚĞůŝǀĞƌLJ ŝŶ ĐůŝŶŝĐ ĂŶĚ ƚƌĂŶƐĨŽƌŵŝŶŐ ƌĞƐŝĚĞŶĐLJ ƚƌĂŝŶŝŶŐ ƚŽ ĚĞǀĞůŽƉ ĨƵƚƵƌĞ W D, ůĞĂĚĞƌƐ͘ ƌ͘ ^ŶLJĚĞƌ ĂŶƐǁĞƌƐ ŽƵƌ ƋƵĞƐƟŽŶƐ͗

What moƟvated you to start a fellowship focused on pracƟce transformaƟon? dŚĞ ŶĞĞĚ ǁĂƐ ĐƌLJƐƚĂů ĐůĞĂƌ ƚŽ ŵĞ ĞǀĞŶ ďĞĨŽƌĞ ŽƵƌ ĐůŝŶŝĐ ƚŽŽŬ ŝƚƐ ĮƌƐƚ ďĂďLJ ƐƚĞƉƐ ƚŽǁĂƌĚ W D, ƚƌĂŶƐĨŽƌŵĂƟŽŶ͘ dŚĞ ŽůĚ ŵŽĚĞů ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ŝƐ ŶŽƚ ƐƵƐƚĂŝŶĂďůĞ͕ ĂŶĚ ƚŚĞ ŶĞǁ ŵŽĚĞů͕ W D,͕ ŝƐ ƐƉƌĞĂĚŝŶŐ Susan Snyder, MD ƌĂƉŝĚůLJ͘ &Ğǁ ƌĞƐŝĚĞŶƚƐ ǁĞƌĞ ďĞŝŶŐ ĞdžƉŽƐĞĚ ƚŽ ƚŚĞ ŶĞǁ ŵŽĚĞů͕ ƐŽ ǁŚĞƌĞ ǁŽƵůĚ ƚŚĞ ŶĞdžƚ ŐĞŶĞƌĂƟŽŶ ŽĨ ůĞĂĚĞƌƐ ĐŽŵĞ ĨƌŽŵ͍ tĞ ŚĂĚ ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ ĞdžƉĞƌŝĞŶĐĞ ĂŶĚ Ă ŚŝŐŚůLJ ŵŽƟǀĂƚĞĚ ĚĞƉĂƌƚŵĞŶƚ͕ ƐŽ ǁŚLJ ŶŽƚ ƵƐ͍

What has the residency program gained from having a fellowship focus on transforming primary care? / ƚŚŝŶŬ ŽĨ ƚŚĞ ĨĞůůŽǁƐŚŝƉ ĂƐ ƚŚĞ ƚŚŝŶŬ ƚĂŶŬ ĨŽƌ ƚƌĂŶƐĨŽƌŵĂƟŽŶ͕ ƉƌŽǀŝĚŝŶŐ ĞŶĞƌŐLJ ĂŶĚ ůĞĂĚĞƌƐŚŝƉ ƚŽ ƚŚĞ ƚĞĂŵƐ͘ dŚĞ ĨĞůůŽǁƐ ƋƵŝĐŬůLJ ĂƉƉůLJ ǁŚĂƚ ƚŚĞLJ ůĞĂƌŶ ŝŶ ŽƵƌ ƐĞŵŝŶĂƌƐ ƚŽ ƚŚĞŝƌ ĚĂŝůLJ ǁŽƌŬ ŽĨ ůĞĂĚŝŶŐ ƚŚĞ ƚĞĂŵƐ͘ ZĞƐŝĚĞŶƚ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ ƚĞĂŵƐ ĞŶƌŝĐŚĞƐ ƚŚĞŝƌ ůĞĂƌŶŝŶŐ ŝŶ Ă ŶƵŵďĞƌ ŽĨ ƚŚĞ ĐĐƌĞĚŝƚĂƟŽŶ ŽƵŶĐŝů ĨŽƌ 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ĐŽŵƉĞƚĞŶĐŝĞƐ͘ What are the special challenges for turning a residency program into a medical home and how have you met those challenges? dŚĞƌĞ ĂƌĞ ŵĂŶLJ ĐŚĂůůĞŶŐĞƐ͕ ďƵƚ ǁĞ ĨĞĞů ŝƚ ŝƐ ǁŽƌƚŚ ƚŚĞ ĞīŽƌƚ͘ Ɛ Ă ŽŶĞͲLJĞĂƌ ĨĞůůŽǁƐŚŝƉ͕ ǁĞ ŚĂǀĞ ƚƵƌŶŽǀĞƌ ŽĨ ĨĞůůŽǁƐ ǁŚŽ ůĞĂĚ ƚŚĞ ƚĞĂŵƐ͘ tĞ ĂƌĞ ĚĞǀĞůŽƉŝŶŐ ƐƚĂī ĂŶĚ ĨĂĐƵůƚLJ ĂƐ ĐŽͲůĞĂĚĞƌƐ ŽĨ ƚĞĂŵƐ ƚŽ ƉƌŽǀŝĚĞ ĐŽŶƐŝƐƚĞŶƚ ƚĞĂŵ ůĞĂĚĞƌƐŚŝƉ͘ ZĞƐŝĚĞŶƚ ƚƵƌŶŽǀĞƌ ŝƐ ĂůƐŽ ĂŶ ŽŶŐŽŝŶŐ ĐŚĂůůĞŶŐĞ͘ What recommendaƟons do you have for other residency programs interested in starƟng similar training programs? ŽŶƚĂĐƚ ƵƐ͊ tĞ ĂƌĞ ĚĞůŝŐŚƚĞĚ ƚŽ ƐŚĂƌĞ ŽƵƌ ĐƵƌƌŝĐƵůƵŵ ĂŶĚ ĞdžƉĞƌŝĞŶĐĞ͘ dŚĞ ŬĞLJ ŝƐ ƚŽ ƉƌŽǀŝĚĞ ůŽƚƐ ŽĨ ŵĞŶƚŽƌŝŶŐ ĂŶĚ ĐŽĂĐŚŝŶŐ ƚŽ ĨĞůůŽǁƐ ƚŽ ŚĞůƉ ƚŚĞŵ ĚĞǀĞůŽƉ ĂƐ ůĞĂĚĞƌƐ͘ tŽƌŬŝŶŐ ǁŝƚŚ ĞdžƉĞƌŝĞŶĐĞĚ ĐůŝŶŝĐŝĂŶ ůĞĂĚĞƌƐ ŽƵƚƐŝĚĞ ƚŚĞ ĂĐĂĚĞŵŝĐ ƐĞƫŶŐ ĂĚĚĞĚ ĞŶƌŝĐŚŵĞŶƚ͘ ƌ͘ :ĞŚŶŝ ZŽďŝŶƐŽŶ͕ ĨŽƌŵĞƌ ŵĞĚŝĐĂů ĚŝƌĞĐƚŽƌ ŽĨ ƚŚĞ ^ĂďĂŶ &ƌĞĞ ůŝŶŝĐ ĂŶĚ ŝŶĐŽŵŝŶŐ ǀŝĐĞ ĐŚĂŝƌ ŽĨ ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ Ăƚ ƚŚĞ hŶŝǀĞƌƐŝƚLJ ŽĨ ^ŽƵƚŚĞƌŶ ĂůŝĨŽƌŶŝĂ͕ ǁŽƌŬĞĚ ǁŝƚŚ ƵƐ ĨŽƌ ƚŚĞ ƉĂƐƚ LJĞĂƌ ĂŶĚ ŐƌĞĂƚůLJ ĞŶŚĂŶĐĞĚ ŽƵƌ ůĞĂĚĞƌƐŚŝƉ ĐƵƌƌŝĐƵůƵŵ͘ What kind of curriculum do you use for the fellowship? Are there resources that you have relied on to train your fellows? ůŽƚ ŽĨ ĞdžĐĞůůĞŶƚ ŵĂƚĞƌŝĂů ŝƐ ĂǀĂŝůĂďůĞ ƚŚĂƚ ǁĞ ŚĂǀĞ ŝŶĐŽƌƉŽƌĂƚĞĚ ŝŶƚŽ ŽƵƌ ĐƵƌƌŝĐƵůƵŵ͘ ŚĞĐŬ ŽƵƚ ŽƵƌ ǁĞďƐŝƚĞ͕ ǁǁǁ͘ ƚƌĂŶƐĨŽƌŵŝŶŐƉƌŝŵĂƌLJĐĂƌĞĨĞůůŽǁƐ͘ŽƌŐ͕ ĨŽƌ ĚĞƚĂŝůƐ ŽŶ ŽƵƌ ĐƵƌƌŝĐƵůƵŵ ĂŶĚ ŽƚŚĞƌ ƌĞƐŽƵƌĐĞƐ͘ dŚĞ ,ĂƌďŽƌͲh > dƌĂŶƐĨŽƌŵŝŶŐ WƌŝŵĂƌLJ ĂƌĞ &ĞůůŽǁƐŚŝƉ ŝƐ ƚƌĂŝŶŝŶŐ LJŽƵŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ďĞ ƚŚĞ ĨƵƚƵƌĞ ůĞĂĚĞƌƐ ŽĨ ƚŚĞ W D, ŵŽǀĞŵĞŶƚ͕ ũŽŝŶŝŶŐ Ă ŶĂƟŽŶĂů ŵŽǀĞŵĞŶƚ ƚŽ ƚƌĂŶƐĨŽƌŵ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ƚŚĂƚ ŝŶĐůƵĚĞƐ ƉƌŽũĞĐƚƐ ŝŶ ŽůŽƌĂĚŽ͕ WĞŶŶƐLJůǀĂŶŝĂ͕ EŽƌƚŚ ĂŶĚ ^ŽƵƚŚ ĂƌŽůŝŶĂ ĂŶĚ DĂƐƐĂĐŚƵƐĞƩƐ͘ tĞ ŚŽƉĞ ƚŚĂƚ ƚŚĞ ,ĂƌďŽƌͲ h > ŵŽĚĞů ǁŝůů ŝŶƐƉŝƌĞ ĐŚĂŶŐĞ͘ sŝƐŝƚ ƚŚĞ dƌĂŶƐĨŽƌŵŝŶŐ WƌŝŵĂƌLJ ĂƌĞ &ĞůůŽǁƐŚŝƉ ǁĞďƐŝƚĞ Žƌ ĐŽŶƚĂĐƚ ^ƵƐĂŶ ^ŶLJĚĞƌ͕ D ƚŽ ůĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ,ĂƌďŽƌͲh > &ĞůůŽǁƐŚŝƉ ĂŶĚ ƚŚĞ ƐƚĞƉƐ LJŽƵ ĐĂŶ ƚĂŬĞ ƚŽ ƚƌĂŶƐĨŽƌŵ LJŽƵƌ ƉƌŽŐƌĂŵ͘ Leah Newkirk is CAFP’s Vice President of Health Policy.

California Family Physician Fall 2014

9

¢ȱ ǰȱ ǰȱ ǰȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ

POLITICAL PULSE

What Will 2015-16 Look Like?

As we come to the end of the 201ϯ-14 legislaƟve session, it is astonishing to look back at the groundbreaking changes that have occurred in California’s health care system over the past two years. With the Legislature naming 2014 the “Year of the Family Physician,” it is no wonder that CAFP has been very acƟve in advocaƟng for you and your paƟents in 2014. Four trends have emerged that will likely shape the 201ϱ-16 legislaƟve session.

Health Care Zeform /mplementaƟon egins in Earnest /Ŷ ϮϬϭϯͲϭϰ ǁĞ ƐĂǁ ƚŚĞ ƉůĂŶŶŝŶŐ ĂŶĚ ŝŵƉůĞŵĞŶƚĂƟŽŶ ŽĨ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͕ ŽƵƌ ƐƚĂƚĞ͛Ɛ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ďĞŶĞĮƚ ĞdžĐŚĂŶŐĞ ƉƌŽŐƌĂŵ͘ tŚŝůĞ ƚŚĞ ĨĞĚĞƌĂů ĞdžĐŚĂŶŐĞ ƐƚƌƵŐŐůĞĚ͕ ĂůŝĨŽƌŶŝĂ ǁĂƐ ŽŶĞ ŽĨ ƚŚĞ ĮƌƐƚ ƐƚĂƚĞƐ ƚŽ ĚĞǀĞůŽƉ ŝƚƐ ŽǁŶ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ĞdžĐŚĂŶŐĞ͕ ǁŚĞƌĞ ŝŶĚŝǀŝĚƵĂůƐ͕ ĨĂŵŝůŝĞƐ ĂŶĚ ƐŵĂůů ďƵƐŝŶĞƐƐĞƐ ƐŚŽƉ ĨŽƌ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ƵƐŝŶŐ ĂƉƉůĞƐͲƚŽͲĂƉƉůĞƐ ĐŽŵƉĂƌŝƐŽŶƐ͘ EŽƚ ŽŶůLJ ǁĂƐ &W ĂĐƟǀĞ ŽŶ ƚŚĞ ůĞŐŝƐůĂƟŽŶ ƚŚĂƚ ĐƌĞĂƚĞĚ ƚŚĞ ĞdžĐŚĂŶŐĞ͕ &W ĂůƐŽ ǁĂƐ ĂǁĂƌĚĞĚ Ă ŐƌĂŶƚ ĨƌŽŵ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ƚŽ ŚĞůƉ ŝŶĨŽƌŵ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƚŚĞŝƌ ƐƚĂīƐ ĂďŽƵƚ ŚĞĂůƚŚ ĐĂƌĞ ĐŽǀĞƌĂŐĞ ĂǀĂŝůĂďůĞ ƚŽ ƚŚĞŝƌ ƉĂƟĞŶƚƐ ĂƐ ƉĂƌƚ ŽĨ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ͘ tŚŝůĞ ƐƵƉƉŽƌƟǀĞ ŽĨ ƚŚĞ ĐƌĞĂƟŽŶ ŽĨ ƚŚĞ ĞdžĐŚĂŶŐĞ͕ &W ŚĂƐ ďĞĞŶ Ă ĐƌŝƟĐ ŽĨ ĐŚĂŶŐĞƐ ŝŶ ƉĂLJŵĞŶƚ ƌĂƚĞƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ƉĂŶĞůƐ ŵĂĚĞ ďLJ ŚĞĂůƚŚ ƉůĂŶƐ ƐĞůůŝŶŐ ƉƌŽĚƵĐƚƐ ƚŚĞƌĞ͘ &W ŚĂƐ ďĞĞŶ ŝŶ ĐŽŶƚĂĐƚ ǁŝƚŚ ƚŚĞ ĞdžĞĐƵƟǀĞ ĚŝƌĞĐƚŽƌ ĂŶĚ ďŽĂƌĚ ŽĨ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ƌĞŐĂƌĚŝŶŐ ŚĞĂůƚŚ ƉůĂŶ ĐŽŶƚƌĂĐƟŶŐ ƐƚƌĂƚĞŐŝĞƐ͘ tĞ ĂƌĞ ŐůĂĚ ƚŽ ƐĞĞ ƚŚĂƚ ƚŚĞ ƟĚĞ ŝƐ ďĞŐŝŶŶŝŶŐ ƚŽ ƚƵƌŶ ĂƐ ŚĞĂůƚŚ ƉůĂŶƐ ĂƌĞ ďƌŝŶŐŝŶŐ ŵŽƌĞ ƉŚLJƐŝĐŝĂŶƐ ŝŶƚŽ ƚŚĞŝƌ ƉůĂŶ ŶĞƚǁŽƌŬƐ͘

Ɖ ŽŐƌĂ Ɖƌ ŽŐƌĂ ƌĂŵ͖ ŵ͖​͖ ϯϱϬ ϱϬ͕Ϭ ͕ϬϬϬ ϬϬ ƐĞŶ ĞŶŝŽ ŝŽƌƌƐ ŝŽ ƌƐ ĂŶĚ ŶĚ ƉĞƌ ĞƌƐŽŶƐ ƐŽ ŽŶƐ ǁŝƚŚ ŝƚƚŚ Ěŝ ĚŝƐĂ ƐĂďŝ ƐĂ ďŝůŝůŝƟĞ ďŝ ƟĞĞƐ͖ ŵŽ ŽƌĞ ƚŚĂĂŶ ϰϬ ϬϬ͕ Ϭ͕Ϭ ϬϬϬ ͞Ě ϬϬ ͞ĚƵĂ Ƶ ů ĞůůŝŐ ƵĂ ŝŐŝď ŝďůĞ ŝď ůĞƐ͟ ůĞ Ɛ ;Ɖ Ɛ͟ ƉĂĂƟĞ ĂƟĞ Ɵ Ŷƚ ŶƚƐƐ ǁŚ ǁŚŽ Ž ƋƵ Ƌ ĂůŝĨLJ ĨŽ Žƌ ďŽƚŚ ďŽƚŚ Ś DĞĚ ĞĚŝĐ ŝĐĂƌ ĂƌĞĞ ĂŶ ŶĚ DĞ DĞĚŝ ĚŝͲ Ěŝ Ͳ Ăů Ͳ ĂůͿͿ ďĞ Ăů ďĞŐĂ ŐĂŶ Ŷ ƚƌ ƚƌĂŶ ĂŶƐŝƟŽŶŝŶŐ ŽŶ Ɖ Ɖƌŝ Ɖƌŝůŝů ϭ͕ ϮϬϭ Ϭϭϰ͘ ϰ͘ ĞƉ ĞƉĂƌ Ăƌƌƚŵ ƚŵĞŶ ĞŶƚƚ ŽĨ ,ĞĂůƚŚ ĂƌĞ ^ĞƌǀŝĐĞ ĐĞƐƐ ; ; , , ^Ϳ ^Ϳ ĞƐƚĂ ĞƐ ƚĂďů ďůŝƐ ŝƐŚĞ ŚĞĚ Ě ĐŽ ĐŽŶƚ ŶƚƌƌĂĐƚƐ ǁŝƚŚ ŵĂŶĂŐĞĚ ĐĂƌĞ ŽƌŐĂŶŝnjĂƟŽŶƐ ƚŽ ƐĞƌǀĞ DĞĚŝͲ Ăů ďĞŶĞĮĐŝĂƌŝĞƐ ŝŶ ƌƵƌĂů ĐŽƵŶƟĞƐ ǁŚĞƌĞ ŵĂŶĂŐĞĚ ĐĂƌĞ ƉƌĞǀŝŽƵƐůLJ ĚŝĚ ŶŽƚ ĞdžŝƐƚ͘ tŚĂƚ ƚŚĞ ƌŽǁŶ ĚŵŝŶŝƐƚƌĂƟŽŶ ĚŽĞƐ ŶŽƚ ƵŶĚĞƌƐƚĂŶĚ ŝƐ ƚŚĂƚ͕ ǁŚŝůĞ Ă ĨĞǁ ŽĨ ƚŚĞƐĞ ƉƌŽŐƌĂŵƐ Ɖ Ő ĂƌĞ ĨŽĐƵƐĞĚ ŽŶ ƉƌŽǀŝĚŝŶŐ Ɖ ŐƉ ƉĂƟĞŶƚƐ ǁŝƚŚ ŵĂŶLJ ĂƌĞ ŵŽƌĞ ĂŶĚ ĐĂƌĞ͕ ŵĞĚŝĐĂů ŚŽŵĞƐ ƉĂƟĞŶƚͲĐĞŶƚĞƌĞĚ ͞ŵĂŶĂŐĞĚ ĐŽƐƚ͟ ƚŚĂŶ ͞ŵĂŶĂŐĞĚ ĐĂƌĞ͘͟ &W ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ĂĚǀŽĐĂƚĞ ƚŚĂƚ ƚƌƵĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ĐŽŽƌĚŝŶĂƟŽŶ ďĞ ƐƵƉƉŽƌƚĞĚ ĂŶĚ ƌĞǁĂƌĚĞĚ ŝŶ ŵĂŶĂŐĞĚ ĐĂƌĞ ƉůĂŶƐ ƚŽ ĞŶƐƵƌĞ ƚŚĞƐĞ ǀƵůŶĞƌĂďůĞ ƉĂƟĞŶƚƐ ĚŽ ŶŽƚ ƐůŝƉ ƚŚƌŽƵŐŚ ƚŚĞ ĐƌĂĐŬƐ͘ Medi-Cal Payment’s Ups and Downs &W͕ ĂƐ ƉĂƌƚ ŽĨ Ă ĐŽĂůŝƟŽŶ ůĞĚ ďLJ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ͕ ǁĂƐ ĂďůĞ ƚŽ ĚĞůĂLJ Ă ϭϬ ƉĞƌĐĞŶƚ DĞĚŝͲ Ăů ƉƌŽǀŝĚĞƌ ƉĂLJŵĞŶƚ ĐƵƚ ĨŽƌ ƐĞǀĞƌĂů LJĞĂƌƐ͕ ŝƚƐ ŝŵƉůĞŵĞŶƚĂƟŽŶ ŚĂƐ ĮŶĂůůLJ ďĞŐƵŶ͘ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ƚŚŽƵŐŚ͕ ƐŚŽƵůĚ ŶŽƚ LJĞƚ ďĞ ĨĞĞůŝŶŐ ŝƚƐ ĞīĞĐƚƐ͕ ĂƐ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶ DĞĚŝͲ Ăů ƉĂLJŵĞŶƚ ǁĂƐ ƐŝŐŶŝĮĐĂŶƚůLJ ŝŶĐƌĞĂƐĞĚ ƚŽ DĞĚŝĐĂƌĞ ůĞǀĞůƐ ƚŚĂŶŬƐ ƚŽ Ă ƉƌŽǀŝƐŝŽŶ ŝŶ ƚŚĞ ͘ dŚŝƐ ƉĂLJŵĞŶƚ ŝŶĐƌĞĂƐĞ ;ŝŶ ďŽƚŚ ĨĞĞͲĨŽƌͲƐĞƌǀŝĐĞ ĂŶĚ ŵĂŶĂŐĞĚ ĐĂƌĞͿ ƌƵŶƐ ĨƌŽŵ :ĂŶƵĂƌLJ ϮϬϭϯ ƚŽ ĞĐĞŵďĞƌ ϮϬϭϰ͘ &W ĂŶĚ &W ĂƌĞ ĂĚǀŽĐĂƟŶŐ ƚŚĂƚ ƚŚŝƐ ŝŵƉŽƌƚĂŶƚ ƉƌŽǀŝƐŝŽŶ ƐƵƉƉŽƌƟŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ ďĞ ĞdžƚĞŶĚĞĚ ŝŶĚĞĮŶŝƚĞůLJ͘

ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱŘŖŗśȬŗŜȱ ȱ ǯ

AdministraƟon All /n on Managed Care dŚĞ ƌŽǁŶ ĚŵŝŶŝƐƚƌĂƟŽŶ ĐůĞĂƌůLJ ƐĞĞƐ ŵĂŶĂŐĞĚ ĐĂƌĞ ĂƐ ƚŚĞ ƉĂŶĂĐĞĂ ƚŽ Ăůů ŽĨ ƚŚĞ ŝůůƐ ŽĨ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͘ Ɛ ƐƵĐŚ͕ ŚƵŐĞ ƉĂƟĞŶƚ ƉŽƉƵůĂƟŽŶƐ ;ƉĂƌƟĐƵůĂƌůLJ ǀƵůŶĞƌĂďůĞ ƉŽƉƵůĂƟŽŶƐͿ ǁĞƌĞ ƚƌĂŶƐĨĞƌƌĞĚ ĚƵƌŝŶŐ ƚŚŝƐ ůĞŐŝƐůĂƟǀĞ ƐĞƐƐŝŽŶ ŝŶƚŽ DĞĚŝͲ Ăů DĂŶĂŐĞĚ ĂƌĞ ĨƌŽŵ ĨĞĞͲĨŽƌͲƐĞƌǀŝĐĞƐ ƐĞƫŶŐƐ͕ ŝŶĐůƵĚŝŶŐ ŶĞĂƌůLJ ϴϬϬ͕ϬϬϬ ĐŚŝůĚƌĞŶ ĨƌŽŵ ƚŚĞ ,ĞĂůƚŚLJ &ĂŵŝůŝĞƐ

10

California Family Physician Fall 2014

ConsolidaƟon /s not ũust Happening in the Private Market tŚĞƚŚĞƌ ƚŚƌŽƵŐŚ ĐĐŽƵŶƚĂďůĞ ĂƌĞ ŽƌŐĂŶŝnjĂƟŽŶƐ͕ ŵĞƌŐĞƌƐ Žƌ ƐŵĂůů ƉƌĂĐƟĐĞƐ ũŽŝŶŝŶŐ ůĂƌŐĞ ƉŚLJƐŝĐŝĂŶ ŐƌŽƵƉƐ͕ ƚŚĞ ƉƌŝǀĂƚĞ ŵĂƌŬĞƚ ŚĂƐ ƐĞĞŶ ƐŝŐŶŝĮĐĂŶƚ ĐŽŶƐŽůŝĚĂƟŽŶ ƚŚĞ ƉĂƐƚ ƚǁŽ LJĞĂƌƐ͘ dŚŝƐ ŚĂƐ ĂůƐŽ ŽĐĐƵƌƌĞĚ ŝŶ ƚŚĞ ƉƵďůŝĐ ƐĞĐƚŽƌ ĂƐ ŶƵŵĞƌŽƵƐ ĚĞƉĂƌƚŵĞŶƚƐ ĂŶĚ ƉƌŽŐƌĂŵƐ ŚĂǀĞ ůŽƐƚ ƚŚĞŝƌ ĂƵƚŽŶŽŵLJ ĂŶĚ ďĞĞŶ ƚƌĂŶƐĨĞƌƌĞĚ ƚŽ ƚŚĞ ŽǀĞƌǁŚĞůŵĞĚ ĂŶĚ ƵŶĚĞƌƐƚĂīĞĚ , ^͘ tŚŝůĞ ƚŚĞƌĞ ŝƐ ŚŽƉĞ ƚŚĂƚ ƚŚŝƐ ŵĂLJ ůĞĂĚ ƚŽ ŶĞǁ ĞĸĐŝĞŶĐŝĞƐ͕ ĨƌŽŵ ƚŚĞ ŽƵƚƐŝĚĞ ůŽŽŬŝŶŐ ŝŶ͕ ŝƚ ĂƉƉĞĂƌƐ ƚŽ ďĞ Ă ďƵƌĞĂƵĐƌĂƟĐ ŚŽƵƐĞ ŽĨ ĐĂƌĚƐ ŽŶ ƚŚĞ ǀĞƌŐĞ ŽĨ ĐŽůůĂƉƐŝŶŐ͘

CAFP WINS

CAFP Instrumental in Securing Millions in New GME Primary Care Funding dŚƌƌŽ dŚ ŽƵŐ ƵŐŚ ŐŚ ƚŚ ŚĞ ŚĂ ŚĂĂƌĚ ƌƌĚ Ě ǁŽƌŬ ŽƌŬ ŽĨ Žƌ ŽĨ ŽƵƌ ĂĚǀŽĐĂĐLJ ƚĞĂŵ ŝŶ ^ Đƌ ^Ă ĐƌĂŵ ĐƌĂŵ ŵĞŶƚŽ ƚŽ͕ ƚŽ͕ &&W W <ĞLJ ŽŶ ŽŶƚĂĐƚƐ ĂŶĚ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐ Ɖƌ ŽŐƌĂ ƌĂŵƐ ŵƐ ƚŚƌƌŽƵ ŽƵŐŚŽƵ Ƶƚ ƚŚ ƚŚĞĞ ƐƚĂƚ ĂƚĞ͕ Ğ͕ & &W W ĂŶĚ ĂŶĚ ŽƵ ĂŶ ŽƵƌƌ ĂĂůůůŝůŝĞĞƐ ĞƐ ƐƵĐ ƵĐĐĞ ĐĞƐƐ ĐĞ ƐƐĨƵ ƐƐ ƐĨƵ ĨƵůůůLJ ůůŽ Žďď ď ŝĞ ŝ Ě ƚƚŽ Ž ŝŶĐ ŶĐůƵ ůƵĚĞ Ě ŵŽƌ ĚĞ Ž Ğ ƚŚ ƚŚĂŶ Ψϰ ŵŝůůůůŝŽŶ ŵŝ ŝŽŶ ŝŶ ŝŽ ŝŶ ƚŚĞ ƐƚĂĂƚĞ ďƵĚ ƵĚŐĞ ŐĞƚƚ ƚƚŽ ŐĞ Ž ĞdžƉĂŶĚ ƉƌŝŵĂƌLJ ĐĂƌĞ ƌĞƐŝĚĞŶĐLJ ƐůŽƚƐ Ăƚƚ ƉƌŽ ƌ Őƌ ŐƌĂŵ ĂŵƐƐ ŝŶ Ăŵ ŝŶ ƵŶĚ ŶĚĞƌ ĞƌƐĞ ƐĞƌǀ ƌǀĞĚ ĞĚ ĂƌĞ ƌĞĂƐ ĐĂƌŝŶŐŐ ĨŽƌƌ ƵŶĚ ŶĚĞƌ ĞƌƐĞĞƌǀ ƌ ĞĚ ƉŽƉƵů ƵůĂƟŽŶƐ͘

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Michelle Gilbert

mgilbert@pcipublishing.com

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Optometrist ill Heavily Amended aŌer CAFP Advocacy dŚĂŶ dŚ ĂŶŬƐ ŬƐ ƚŽ ǀŝ ǀŝŐŽ ŐŽƌŽ ƌŽƵƐ ƵƐ ůŽď Ž ďLJ ď ŝŶŐ ďLJ &W ĂŶĚ ŽƵƌ ƚĂƌŐĞƚĞĚ ŐƌĂƐƐƌŽŽƚƐ ĞīŽƌƚ ŝŶĐůƵĚŝŶŐ Ă ĂůůŝĞƐ͕ ŵĞŵďĞƌƐ ĞĚƵĐĂƚĞ ƚŽ ŽŶƚĂĐƚƐ <ĞLJ &W ďLJ ŽĨ ƚŚĞ ƐƐĞŵďůLJ ƉƉƌŽƉƌŝĂƟŽŶƐ ŽŵŵŝƩĞĞ͕ ^ ϰϵϮ ;,ĞƌŶĂŶĚĞnjͿ ; Ϳ ǁĂƐ ĂŵĞŶĚĞĚ ƚŽ ƌĞŵŽǀĞ ƉƌŽǀŝƐŝŽŶƐ ƚŚĂƚ ŝŶĂƉƉƌŽƉƌŝĂƚĞůLJ ǁŽƵůĚ ŚĂǀĞ ĞŶĐŽƵƌĂŐĞĚ Ă ƉŝůŽƚ ƉƌŽũĞĐƚ ĂůůŽǁŝŶŐ ŽƉƚŽŵĞƚƌŝƐƚƐ ƚŽ ŵĂŶĂŐĞ ĂŶĚ ƚƌĞĂƚ ĚŝĂďĞƚĞƐ͕ ŚLJƉĞƌƚĞŶƐŝŽŶ ĂŶĚ ŚLJƉĞƌĐŚŽůĞƐƚĞƌŽůĞŵŝĂ͘ Good CUZES eat the ad CUZES dŚĞ ϮϬϭϯͲϭϰ ůĞŐŝƐůĂƟǀĞ ƐĞƐƐŝŽŶ ƐĂǁ ƚǁŽ ďŝůůƐ ƚŚĂƚ ǁŽƵůĚ ĚƌĂƐƟĐĂůůLJ ĐŚĂŶŐĞ ĂŶĚ ƐƵƉƉŽƌƚ ƚŚĞ ŽŶƚƌŽůůĞĚ ^ƵďƐƚĂŶĐĞ hƟůŝnjĂƟŽŶ ZĞǀŝĞǁ ĂŶĚ ǀĂůƵĂƟŽŶ ^LJƐƚĞŵ ; hZ ^Ϳ͕ ǁŚŝĐŚ ŝƐ ƵƐĞĚ ƚŽ ŵŽŶŝƚŽƌ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ƵƐĞ͘ dŚĞ ĮƌƐƚ ďŝůů͕ ƐƵƉƉŽƌƚĞĚ ďLJ &W ĂŶĚ ŽƚŚĞƌ ƉŚLJƐŝĐŝĂŶ ŽƌŐĂŶŝnjĂƟŽŶƐ͕ ƐŽƵŐŚƚ ƚŽ ƌĂŝƐĞ ŵŽŶĞLJ ĨŽƌ ƚŚŝƐ ŝŵƉŽƌƚĂŶƚ ďƵƚ ƵŶĚĞƌĨƵŶĚĞĚ ĂŶĚ ƵŶĚĞƌƐƚĂīĞĚ ƐLJƐƚĞŵ͘ dŚĞ ŽƚŚĞƌ ďŝůů͕ ŽƉƉŽƐĞĚ ďLJ &W͕ ƐŽƵŐŚƚ ƚŽ ŵĂŶĚĂƚĞ ĞůĞĐƚƌŽŶŝĐ ƉƌĞƐĐƌŝďŝŶŐ͖ ĂĚĚ ^ĐŚĞĚƵůĞ s ĚƌƵŐƐ ƚŽ hZ ^͖ ĂůůŽǁ ŝŶǀĞƐƟŐĂƚŽƌƐ ƚŽ ĨƌĞĞůLJ ĐŽŵď ĂŶĚ ĂĐĐĞƐƐ hZ ^ ĚĂƚĂ͖ ĂŶĚ ůŝŵŝƚ Ăůů ĐŽŶƚƌŽůůĞĚ ƐƵďƐƚĂŶĐĞ ƉƌĞƐĐƌŝƉƟŽŶƐ ƚŽ ϯϬͲĚĂLJ ƐƵƉƉůŝĞƐ͘ dŚĞ ĮƌƐƚ ďŝůů͕ ^ ϴϬϵ͕ ƉĂƐƐĞĚ͘ dŚĞ ƐĞĐŽŶĚ ďŝůů͕ ^ ϭϮϱϴ͕ ĚŝĞĚ ŝŶ ĐŽŵŵŝƩĞĞ͘ Legislature Supports PCMH DeĮniƟon &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ƌĞƐŽůƵƟŽŶ ǁĂƐ ŽǀĞƌǁŚĞůŵŝŶŐůLJ ƐƵƉƉŽƌƚĞĚ ŝŶ ƚŚĞ >ĞŐŝƐůĂƚƵƌĞ ƚŚŝƐ LJĞĂƌ͘ dŚĞ ƌĞƐŽůƵƟŽŶ͕ Z ϭϱϮ͕ ĚĞĮŶĞƐ ƚŚĞ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ĂƐ ͞Ă ŚĞĂůƚŚ ĐĂƌĞ ĚĞůŝǀĞƌLJ ŵŽĚĞů ŝŶ ǁŚŝĐŚ Ă ƉĂƟĞŶƚ ĞƐƚĂďůŝƐŚĞƐ ĂŶ ŽŶŐŽŝŶŐ ƌĞůĂƟŽŶƐŚŝƉ ǁŝƚŚ Ă ƉĞƌƐŽŶĂů ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶ Žƌ ŽƚŚĞƌ ƉĞƌƐŽŶĂů ůŝĐĞŶƐĞĚ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌ ǁŽƌŬŝŶŐ ŝŶ Ă ƉŚLJƐŝĐŝĂŶͲůĞĚ ƉƌĂĐƟĐĞ ƚĞĂŵ ƚŽ ƉƌŽǀŝĚĞ ĐŽŵƉƌĞŚĞŶƐŝǀĞ͕ ĂĐĐĞƐƐŝďůĞ ĂŶĚ ĐŽŶƟŶƵŽƵƐ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ƉƌŝŵĂƌLJ ĂŶĚ ƉƌĞǀĞŶƚĂƟǀĞ ĐĂƌĞ͕ ĂŶĚ ƚŽ ĐŽŽƌĚŝŶĂƚĞ ƚŚĞ ƉĂƟĞŶƚ͛Ɛ ŚĞĂůƚŚ ĐĂƌĞ ŶĞĞĚƐ ĂĐƌŽƐƐ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ ŝŶ ŽƌĚĞƌ ƚŽ ŝŵƉƌŽǀĞ ƋƵĂůŝƚLJ ĂŶĚ ŚĞĂůƚŚ ŽƵƚĐŽŵĞƐ ŝŶ Ă ĐŽƐƚͲĞīĞĐƟǀĞ ŵĂŶŶĞƌ͘͟ Dr. Wolfe is Chair, CAFP LegislaƟve Aīairs CommiƩee.

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California Family Physician Fall 2014

11

ȱ ȱȱȱȱȱ

ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ

MEMBERSHIP

10 Easy Ways to Fit in Five Minutes of Advocacy ĞĐŽŵŝŶŐ Ă ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĐŚĂŵƉŝŽŶ Žƌ ƉĂƟĞŶƚ ĂĚǀŽĐĂƚĞ ŝƐŶ͛ƚ Ăůů ƚŚĂƚ ĚŝīĞƌĞŶƚ ĨƌŽŵ ǁŚĂƚ LJŽƵ ĂƌĞ ĚŽŝŶŐ ŽŶ Ă ĚĂŝůLJ ďĂƐŝƐ͘ zŽƵ ĂƌĞ ĂůƌĞĂĚLJ Ă ǀĂůƵĞĚ ƉĂƌƚ ŽĨ Ă ĐŽŵŵƵŶŝƚLJ͕ ĂŶĚ LJŽƵƌ ŽƉŝŶŝŽŶ ŝƐ ƌĞƐƉĞĐƚĞĚ ďLJ LJŽƵƌ ƉĂƟĞŶƚƐ͕ ƉĞĞƌƐ ĂŶĚ ůŽĐĂů ůĞŐŝƐůĂƚŽƌƐ͕ ŐŝǀĞŶ LJŽƵƌ ĞdžƚĞŶƐŝǀĞ LJĞĂƌƐ ŽĨ ƚƌĂŝŶŝŶŐ ĂŶĚ ĞĚƵĐĂƟŽŶ͘ ĞĐŝĚŝŶŐ ǁŚĞƌĞ ĂŶĚ ŚŽǁ ƚŽ ŝŶǀĞƐƚ LJŽƵƌ ƟŵĞ ĂŶĚ ĞŶĞƌŐLJ ĐĂŶ ƐĞĞŵ ĚĂƵŶƟŶŐ͘ Ƶƚ͕ ƌĞĂůůLJ ŝƚ͛Ɛ ũƵƐƚ Ă ŵĂƩĞƌ ŽĨ ƐƉĞĂŬŝŶŐ ƵƉ ĂŶĚ ŵĂŬŝŶŐ LJŽƵƌ ƉƌĞƐĞŶĐĞ ŬŶŽǁŶ͊ ŽŶƐŝĚĞƌ ƚŚĞƐĞ ϭϬ ƋƵŝĐŬ ĂŶĚ ĞĂƐLJ ǁĂLJƐ LJŽƵ ĐĂŶ ĂĚǀŽĐĂƚĞ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶ ũƵƐƚ ƵŶĚĞƌ ĮǀĞ ŵŝŶƵƚĞƐ ĂƉŝĞĐĞ͘ ϭ͘ e posiƟve͗ tŚĞŶ ďƌĞĂŬŝŶŐ ƚŚĞ ŝĐĞ ǁŝƚŚ Ă ŶĞǁ ƉĂƟĞŶƚ͕ ƚĞůů Śŝŵ Žƌ ŚĞƌ ĂďŽƵƚ ƚŚĞ ĨƵůů ƐĐŽƉĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ /Ĩ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ĂƐŬƐ ǁŚLJ LJŽƵ ĐŚŽƐĞ ƚŚĞ ƐƉĞĐŝĂůƚLJ͕ ƐŚĂƌĞ Ă ŵĞĂŶŝŶŐĨƵů͕ ƉŽƐŝƟǀĞ ƐƚŽƌLJ ƚŚĂƚ ŵŽƟǀĂƚĞƐ ƚŚĂƚ ƐƚƵĚĞŶƚ ƚŽ ĐŽŶƐŝĚĞƌ ĐŚŽŽƐŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ zŽƵƌ ƐƚŽƌŝĞƐ ĐĂŶ ƌĂŝƐĞ ĂǁĂƌĞŶĞƐƐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͛Ɛ ƉŽǁĞƌĨƵů ŝŵƉĂĐƚ ŽŶ LJŽƵƌ ĐŽŵŵƵŶŝƚLJ͘ Ϯ͘ Understand͗ <ŶŽǁ ƚŚĞ ĨĂĐƚƐ ƚŚĂƚ ƐƵƉƉŽƌƚ LJŽƵƌ ƉĞƌƐƉĞĐƟǀĞ ŽŶ ƉŽůŝĐŝĞƐ ƚŚĂƚ ĂīĞĐƚ LJŽƵƌ ƉƌĂĐƟĐĞ͘ ZĞĂĚ &W͛Ɛ ǁĞĞŬůLJ >ĞŐŝƐůĂƟǀĞ hƉĚĂƚĞ ĂŶĚ &W͛Ɛ ĚĂŝůLJ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ^ŵĂƌƚ ƌŝĞĨ ƚŽ ƐƚĂLJ ƵƉͲƚŽͲĚĂƚĞ ŽŶ ĞŵĞƌŐŝŶŐ ŝƐƐƵĞƐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘

ϰ͘ Share͗ ŵĂŝů ĂŶĚ ƐŽĐŝĂů ŵĞĚŝĂ ĂƌĞ ĞīĞĐƟǀĞ ƚŽŽůƐ ĨŽƌ ƌĂŝƐŝŶŐ ĂǁĂƌĞŶĞƐƐͶŝŶ ũƵƐƚ Ă ĨĞǁ ĐůŝĐŬƐ LJŽƵ ĐĂŶ ŵĂŬĞ Ă ĚŝīĞƌĞŶĐĞ͘ ^ŚĂƌĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĨĂĐƚƐ͕ ĂƌƟĐůĞƐ ĂŶĚ ŵŽƌĞ ŽŶ &ĂĐĞŬ͕ dǁŝƩĞƌ͕ Žƌ LJŽƵƌ ƉĞƌƐŽŶĂů ďůŽŐ͘ Kƌ ĞŵĂŝů ĂƌƟĐůĞƐ ŽĨ ŝŶƚĞƌĞƐƚ ƚŽ ƚŚŽƐĞ ǁŚŽ ŚĂǀĞ ĂƐŬĞĚ ƋƵĞƐƟŽŶƐ Žƌ ĂƉƉĞĂƌ ƚŽ ǁĂŶƚ ƚŽ ůĞĂƌŶ ŵŽƌĞ͘ ϱ͘ Promote͗ ZĂŝƐĞ ĂǁĂƌĞŶĞƐƐ ĂďŽƵƚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ǁŝƚŚŽƵƚ ƐĂLJŝŶŐ Ă ǁŽƌĚ͘ ŽǁŶůŽĂĚ Ă ĨƌĞĞ ϮϬϭϰ zĞĂƌ ŽĨ ƚŚĞ &ĂŵŝůLJ ƐŝŐŶďŽĂƌĚ Ăƚ ǁǁǁ͘ ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬϮϬϭϰzĞĂƌ&W ĂŶĚ ƉŽƐƚ ŝƚ ŝŶ LJŽƵƌ ŽĸĐĞ͕ ĐůŝŶŝĐ Žƌ ďƌĞĂŬ ƌŽŽŵ͘ /ƚ͛Ɛ Ă ŐƌĞĂƚ ǁĂLJ ƚŽ ƐƚĂƌƚ Ă ĐŽŶǀĞƌƐĂƟŽŶ ĂďŽƵƚ ǁŚLJ ĨĂŵŝůLJ

California Family Physician Fall 2014

ϲ͘ sote͗ ůĞĐƟŽŶ ĂLJ ŝƐ ƋƵŝĐŬůLJ ĂƉƉƌŽĂĐŚŝŶŐ͕ ĂŶĚ ƚŚĞ ďĞƐƚ ǁĂLJ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ LJŽƵƌ ŝŶƚĞƌĞƐƚƐ ĂƌĞ ƌĞƉƌĞƐĞŶƚĞĚ ŝƐ ďLJ ĞdžĞƌĐŝƐŝŶŐ LJŽƵƌ ƌŝŐŚƚ ƚŽ ǀŽƚĞ͊ ZĞŐŝƐƚĞƌ Ăƚ ǁǁǁ͘ǀŽƚĞϰϭϭ͘ŽƌŐ͘ dŚŝƐ EŽǀĞŵďĞƌ͕ WƌŽƉŽƐŝƟŽŶ ϰϲ ŚĂƐ ƚŚĞ ƉŽƚĞŶƟĂů ƚŽ ĐŚĂŶŐĞ ƚŚĞ ǁĂLJ LJŽƵ ƉƌĂĐƟĐĞ ŵĞĚŝĐŝŶĞ͕ ƐŽ ŵĂŬĞ ƐƵƌĞ ƚŽ ŐĞƚ ƚŚĞ ĨĂĐƚƐ ĨƌŽŵ ΀ƉĂŐĞ ηϭϲ΁ ďĞĨŽƌĞ LJŽƵ Śŝƚ ƚŚĞ ƉŽůůƐ͘ ϳ͘ Write͗ &W͛Ɛ ͞^ƉĞĂŬ KƵƚ͟ ŵĂŬĞƐ ǁƌŝƟŶŐ Ă ůĞƩĞƌ Žƌ ĞŵĂŝů ƚŽ LJŽƵƌ ĞůĞĐƚĞĚ ƌĞƉƌĞƐĞŶƚĂƟǀĞ ƋƵŝĐŬ ĂŶĚ ĞĂƐLJ͘ dŽ ďĞŐŝŶ͕ ŐŽ ƚŽ ŐƌĂƐƐƌŽŽƚƐ͘ ĂĂĨƉ͘ŽƌŐͬĂĂĨƉͬƐƉĞĂŬŽƵƚ͘ &W ŚĂƐ ƉƌŽǀŝĚĞĚ ƉƌĞͲǁƌŝƩĞŶ ůĞƩĞƌƐ ĨŽƌ Ă ǀĂƌŝĞƚLJ ŽĨ ŝƐƐƵĞƐ͘ zŽƵ ĐĂŶ ƉĞƌƐŽŶĂůŝnjĞ ƚŚĞ ŵĞƐƐĂŐĞ ĂŶĚ ƐĞŶĚ ŝƚ ƚŽ LJŽƵƌ ĞůĞĐƚĞĚ ŽĸĐŝĂůƐ͘

ȱ ȱŗŖȱ ȱ ȱ ¢ȱ ¢ ȱ¢ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱę ȱ ȱ ǯȱ

ϯ͘ Connect͗ džƉĂŶĚ LJŽƵƌ ĐŝƌĐůĞƐ ďLJ ƚĂƉƉŝŶŐ ŝŶƚŽ LJŽƵƌ &W ŶĞƚǁŽƌŬ ŽŶ >ŝŶŬĞĚ/Ŷ͘ 'ĂŝŶ ǁŝĚĞƌ ĂĐĐĞƐƐ ƚŽ LJŽƵƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉĞĞƌƐ ĂŶĚ ŵĂŬĞ LJŽƵƌƐĞůĨ Ă ƉĂƌƚ ŽĨ ƚŚĞ ƐƚĂƚĞǁŝĚĞ ĐŽŵŵƵŶŝƚLJ͘

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ŵĞĚŝĐŝŶĞ ŝƐ Ă ŐƌĞĂƚ ĮĞůĚ ĂŶĚ ŚŽǁ ĨĂŵŝůLJ ĚŽĐƐ ƉůĂLJ ĂŶ ŝŵƉŽƌƚĂŶƚ ƌŽůĞ ŝŶ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͘

ϴ͘ Call͗ ĮǀĞͲŵŝŶƵƚĞ ƉŚŽŶĞ ĐĂůů ƚŽ LJŽƵƌ ŐŽǀĞƌŶŵĞŶƚ ƌĞƉƌĞƐĞŶƚĂƟǀĞ͛Ɛ ŽĸĐĞ ĐĂŶ ŵĂŬĞ Ă ďŝŐ ŝŵƉĂĐƚ͘ dŚĂŶŬ ƚŚĞŵ ĨŽƌ ƚŚĞŝƌ ƉĂƐƚ ƐƵƉƉŽƌƚ͕ Žƌ ĂƐŬ ĨŽƌ ƐƵƉƉŽƌƚ ŽŶ Ă ƉĂƌƟĐƵůĂƌ ŝƐƐƵĞ͘ ŚĞĐŬ ŽƵƚ ΀ƉĂŐĞ ηϭϬ΁͕ ŝŶ ǁŚŝĐŚ ƐŚďLJ tŽůĨĞ͕ D ͕ DWW͕ DW, ŐŝǀĞƐ ĂŶ ƵƉĚĂƚĞ ŽŶ ƵƌŐĞŶƚ ůĞŐŝƐůĂƟǀĞ ŵĂƩĞƌƐ ĂŶĚ ǁŚĂƚ WƌŽƉŽƐŝƟŽŶ ϰϲ ŵĞĂŶƐ ĨŽƌ LJŽƵ ĂŶĚ LJŽƵƌ ƉƌĂĐƟĐĞ͘

ϵ͘ Support͗ ŽŶĂƚĞ ƚŽ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ WŽůŝƟĐĂů ĐƟŽŶ ŽŵŵŝƩĞĞ͕ Ă ďŝƉĂƌƟƐĂŶ ŐƌŽƵƉ ƚŚƌŽƵŐŚ ǁŚŝĐŚ LJŽƵ ĐĂŶ ƐƵƉƉŽƌƚ ƚŚĞ ĞůĞĐƟŽŶ Žƌ ƌĞĞůĞĐƟŽŶ ŽĨ ĐĂŶĚŝĚĂƚĞƐ ǁŚŽ ƐŚĂƌĞ LJŽƵƌ ĐŽŵŵŝƚŵĞŶƚ ƚŽ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ ϭϬ͘ Get Involved͗ Ăůů ƵƐ ĨŽƌ ŵŽƌĞ ǁĂLJƐ ƚŽ ŐĞƚ ŝŶǀŽůǀĞĚ ŝŶ ĐĂĚĞŵLJ ĂĚǀŽĐĂĐLJ ĞīŽƌƚƐ͘ ƐƚĂī ŵĞŵďĞƌ ǁŽƵůĚ ďĞ ŚĂƉƉLJ ƚŽ ƐƉĞĂŬ ǁŝƚŚ LJŽƵ ĂďŽƵƚ ƵƉĐŽŵŝŶŐ ĂĚǀŽĐĂĐLJ ƚƌĂŝŶŝŶŐ ĞǀĞŶƚƐ ĂŶĚ ůĞĂĚĞƌƐŚŝƉ ĐŽŶĨĞƌĞŶĐĞƐ͕ ƐƵĐŚ ĂƐ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ Žƌ ƚŚĞ EĂƟŽŶĂů ŽŶĨĞƌĞŶĐĞ ŽĨ ŽŶƐƟƚƵĞŶĐLJ >ĞĂĚĞƌƐ͘ /Ĩ LJŽƵ ǁĂŶƚ ƚŽ ƐŚĂƌĞ ĂĚǀŽĐĂĐLJ ƟƉƐ ŽĨ LJŽƵƌ ŽǁŶ͕ ŐŝǀĞ ƵƐ Ă ƐŚŽƵƚͲŽƵƚ͊ dǁŝƩĞƌ͗ ΛĐĂĨƉͺĨĂŵŝůLJĚŽĐƐ &ĂĐĞŬ͗ ĂůŝĨŽƌŶŝĂ ĐĂĚĞŵLJ ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ηϮϬϭϰzĞĂƌ&W η&DZĞǀŽůƵƟŽŶ͘ Emma Lundberg is CAFP’s Membership Coordinator.

California Family Physician Fall 2014

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STUDENTS AND RESIDENTS

Record-Breaking Number of Students and Residents Gather at 2014 AAFP National Conference ZŽƵƐŝŶŐ ĂƉƉůĂƵƐĞ ĨŝůůĞĚ ƚŚĞ <ĂŶƐĂƐ ŝƚLJ ŽŶǀĞŶƚŝŽŶ ĞŶƚĞƌ ĂƐ ƌ͘ ZĞŝĚ ůĂĐŬǁĞůĚĞƌ͕ ƉƌĞƐŝĚĞŶƚ ŽĨ ƚŚĞ ŵĞƌŝĐĂŶ ĐĂĚĞŵLJ ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ͕ ŝŶƐƉŝƌĞĚ ƚŚĞ ŶĞdžƚ ŐĞŶĞƌĂƚŝŽŶ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ďĞĐŽŵĞ ƉĂƚŝĞŶƚͲĐĞŶƚĞƌĞĚ͕ ĐŽŵƉĂƐƐŝŽŶĂƚĞ ŚĞĂůĞƌƐ͘ /ƚ ǁĂƐ Ă ĨŝƚƚŝŶŐ ĐŽŶĐůƵƐŝŽŶ ĨŽƌ ƚŚŝƐ LJĞĂƌ͛Ɛ EĂƚŝŽŶĂů ŽŶĨĞƌĞŶĐĞ ŽĨ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶƚƐ ĂŶĚ DĞĚŝĐĂů ^ƚƵĚĞŶƚƐ͘ DŽƌĞ ƚŚĂŶ Ϯ͕ϬϬϬ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ŐĂƚŚĞƌĞĚ ŝŶ <ĂŶƐĂƐ ŝƚLJ ŽŶ ƵŐƵƐƚ ϳͲϵ ƚŽ ůĞĂƌŶ ĨƌŽŵ ůĞĂĚĞƌƐ ŝŶ ƚŚĞ ĨŝĞůĚ͕ ĞŶŐĂŐĞ ǁŝƚŚ ƚŚĞŝƌ ƉĞĞƌƐ͕ ĐŽŶŶĞĐƚ ǁŝƚŚ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ĂŶĚ ƉƌŽƉŽƐĞ ƚŚĞŝƌ ǀŝƐŝŽŶ ĨŽƌ &W ƉŽůŝĐLJ͘ dŚĞ ƚŚƌĞĞͲĚĂLJ ĐŽŶĨĞƌĞŶĐĞ ǁĂƐ ĨŝůůĞĚ ǁŝƚŚ ŝŶƚĞƌĞƐƚŝŶŐ ĂŶĚ ĞdžĐŝƚŝŶŐ ƐĞƐƐŝŽŶƐ͘ ,ŝŐŚůŝŐŚƚƐ ŝŶĐůƵĚĞĚ Ă ƉƌŽĐĞĚƵƌĂů ǁŽƌŬƐŚŽƉ ŽŶ ǁŝůĚĞƌŶĞƐƐ ŵĞĚŝĐŝŶĞ ŝŶ ǁŚŝĐŚ ƉĂƌƚŝĐŝƉĂŶƚƐ ůĞĂƌŶĞĚ ŚŽǁ ƚŽ ďƵŝůĚ ƐƚƌĞƚĐŚĞƌƐ ĨƌŽŵ ŶĂƚƵƌĂů ŵĂƚĞƌŝĂůƐ͕ Ă ƉĂĐŬĞĚ ƐĞƐƐŝŽŶ ŽŶ ĨŝŶĂŶĐŝĂů ŵĂŶĂŐĞŵĞŶƚ ůĞĚ ďLJ ƌ͘ dĂŵ EŐƵLJĞŶ͕ ƉƌŽŐƌĂŵ ĚŝƌĞĐƚŽƌ Ăƚ ^ĂŶ :ŽĂƋƵŝŶ ŽƵŶƚLJ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐLJ ĂŶĚ ĂŶ ŝŶƐŝŐŚƚĨƵů ŵŝŶŽƌŝƚLJ ƐƉĞĐŝĂů ŝŶƚĞƌĞƐƚ ĚŝƐĐƵƐƐŝŽŶ͘ ƌ͘ WĂƵů 'ƌƵŶĚLJ͛Ɛ ŽƉĞŶŝŶŐ ƐĞƐƐŝŽŶ ŽŶ ĚĞůŝǀĞƌLJ ƐLJƐƚĞŵ ƌĞĨŽƌŵ ĂŶĚ ƚŚĞ ŝŶƚĞŐƌĂƚŝŽŶ ŽĨ ĚĂƚĂ ŝŶ ŵŽĚĞƌŶ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉĂƌƚŝĐƵůĂƌůLJ ƌĞƐŽŶĂƚĞĚ ǁŝƚŚ ĂƚƚĞŶĚĞĞƐ͘ ƌ͘ 'ƌƵŶĚLJ ĂƉƚůLJ ŶŽƚĞĚ ƚŚĂƚ ŝĨ ŚŝƐ ǀĞƚĞƌŝŶĂƌŝĂŶ ĐĂŶ ƐĞŶĚ Śŝŵ Ă ŶŽƚŝĨŝĐĂƚŝŽŶ ǁŚĞŶ ŚŝƐ ĐĂƚ ŶĞĞĚƐ Ă ǀĂĐĐŝŶĂƚŝŽŶ͕ ǁĞ ƐŚŽƵůĚ ďĞ ĂďůĞ ƚŽ ĚŽ ƚŚĞ ƐĂŵĞ ǁŝƚŚ Ă ǁŽŵĂŶ ǁŚŽ ŝƐ ĚƵĞ ĨŽƌ Ă ŵĂŵŵŽŐƌĂŵ͘ ,Ğ ǁĞŶƚ ŽŶ ƚŽ ĐŚĂůůĞŶŐĞ ƚŚĞ ĂƵĚŝĞŶĐĞ ŽĨ ƌŝƐŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ŝŶŶŽǀĂƚĞ ĂŶĚ ůĞĂĚ ƚŚŝƐ ŵĞĚŝĐĂů ĚĂƚĂ ƌĞǀŽůƵƚŝŽŶ͘ dŚĞ ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ĐŽŶŐƌĞƐƐĞƐ ĂƌĞ ĐŽŶƐŝƐƚĞŶƚůLJ ŚŝŐŚůLJ ĂŶƚŝĐŝƉĂƚĞĚ ƐĞƐƐŝŽŶƐ͕ ĂƐ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ƌƵŶ ĨŽƌ ůĞĂĚĞƌƐŚŝƉ ƉŽƐŝƚŝŽŶƐ ĂƐ ǁĞůů ĂƐ ƉƌŽƉŽƐĞ

ƌĞƐŽůƵƚŝŽŶƐ ƚŽ ĂŵĞŶĚ Žƌ ĐƌĞĂƚĞ ŶĞǁ &W ƉŽůŝĐLJ͘ dŚŝƐ LJĞĂƌ͕ ƚŚĞ ĐŽŶŐƌĞƐƐĞƐ ĂĚŽƉƚĞĚ ƌĞƐŽůƵƚŝŽŶƐ ƚŽ ĐƌĞĂƚĞ Ă ĚŝƌĞĐƚ ƉƌŝŵĂƌLJ ĐĂƌĞ ƚŽŽůŬŝƚ͕ ĂĚĚƌĞƐƐ ĐŽŶƚƌĂĐĞƉƚŝǀĞ ĂĐĐĞƐƐ ŝŶ ƚŚĞ ǁĂŬĞ ŽĨ ƚŚĞ ,ŽďďLJ >ŽďďLJ ^ƵƉƌĞŵĞ ŽƵƌƚ ĐĂƐĞ ƌƵůŝŶŐ͕ ĂŶĚ ŽƉƉŽƐĞ ĐĂƉƐ ŽŶ ůŽĂŶ ďĂůĂŶĐĞƐ ƚŚĂƚ ĂƌĞ ƉĂƌƚ ŽĨ ƚŚĞ WƵďůŝĐ ^ĞƌǀŝĐĞ >ŽĂŶ &ŽƌŐŝǀĞŶĞƐƐ WƌŽŐƌĂŵ ĨŽƌ ƉƌŝŵĂƌLJ ĐĂƌĞ͕ ĂůŽŶŐ ǁŝƚŚ ŵĂŶLJ ŽƚŚĞƌ ŝŶŶŽǀĂƚŝǀĞ ƉƌŽƉŽƐĂůƐ͘ ĂůŝĨŽƌŶŝĂ ŚĂĚ Ă ƐƚƌŽŶŐ ƉƌĞƐĞŶĐĞ Ăƚ ƚŚĞ džƉŽ ,Ăůů͕ ǁŝƚŚ ϯϵ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉƌŽŐƌĂŵƐ͕ ŵŽƌĞ ƚŚĂŶ ĂŶLJ ŽƚŚĞƌ ƐƚĂƚĞ Ăƚ ƚŚĞ ĐŽŶĨĞƌĞŶĐĞ͕ ĞdžŚŝďŝƚŝŶŐ ƚŽ ŝŶƚĞƌĞƐƚĞĚ ƐƚƵĚĞŶƚƐ ĨƌŽŵ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌLJ͘ &ĂŵŝůLJ DĞĚŝĐŝŶĞ /ŶƚĞƌĞƐƚ 'ƌŽƵƉƐ ;&D/'ƐͿ ďĂƐĞĚ Ăƚ ƚǁŽ ĂůŝĨŽƌŶŝĂ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ ǁĞƌĞ ĂǁĂƌĚĞĚ ͞WƌŽŐƌĂŵ ŽĨ džĐĞůůĞŶĐĞ͟ ĂǁĂƌĚƐ͘ dŚĞ &D/' Ăƚ hŶŝǀĞƌƐŝƚLJ ŽĨ ^ŽƵƚŚĞƌŶ ĂůŝĨŽƌŶŝĂ͛Ɛ <ĞĐŬ ^ĐŚŽŽů ŽĨ DĞĚŝĐŝŶĞ ǁĂƐ ƌĞĐŽŐŶŝnjĞĚ ĂƐ ĂŶ ŽǀĞƌĂůů ĂǁĂƌĚ ǁŝŶŶĞƌ ĂŶĚ ƚŚĞ &D/' Ăƚ hŶŝǀĞƌƐŝƚLJ ŽĨ ĂůŝĨŽƌŶŝĂ͕ >ŽƐ ŶŐĞůĞƐ͛ ĂǀŝĚ 'ĞĨĨĞŶ ^ĐŚŽŽů ŽĨ DĞĚŝĐŝŶĞ ǁĂƐ ƌĞĐŽŐŶŝnjĞĚ ĨŽƌ ͞ džĐĞůůĞŶĐĞ ŝŶ džƉŽƐƵƌĞ ƚŽ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ĂŶĚ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ͘͟ DŽƌĞ ƚŚĂŶ ϭϬϬ ƐƚƵĚĞŶƚƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ĨĂĐƵůƚLJ ĨƌŽŵ ĂĐƌŽƐƐ ƚŚĞ ƐƚĂƚĞ ĂůƐŽ ŚĂĚ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ŐĂƚŚĞƌ Ăƚ ƚŚĞ ĂůŝĨŽƌŶŝĂ ƌĞĐĞƉƚŝŽŶ͘ ^ƚƵĚĞŶƚ ĐŽƵŶĐŝů ĐŽͲĐŚĂŝƌƐ͕ ƌƐ͘ <ĂƌŝŶĂ 'ŽŽŬŝŶ ĂŶĚ >ĂƵƌĂ DƵƌƉŚLJ͕ ĂŶĚ ƌĞƐŝĚĞŶƚ ĐŽƵŶĐŝů ĐŽͲ ĐŚĂŝƌƐ ƌƐ͘ ĂƌŽŶ ĚĞůƐƚĞŝŶ ĂŶĚ ĂŶŝĞů WŝŽ ƐƉŽŬĞ ĂďŽƵƚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ďƌŝŶŐŝŶŐ ƚŚĞ ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ǀŽŝĐĞ ƚŽ ƐƚĂƚĞ ĂĚǀŽĐĂĐLJ ĞĨĨŽƌƚƐ ƚŚƌŽƵŐŚ ĞŶŐĂŐĞŵĞŶƚ ǁŝƚŚ &W͘ dŚĞ ƵŝůĚŝŶŐ ƌŝĚŐĞƐ ƉƌŽũĞĐƚ ŝƐ &W͛Ɛ ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚͲ ůĞĚ ĞĨĨŽƌƚ ƚŽ ĐŽŶŶĞĐƚ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ͕ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ĂŶĚ ůŽĐĂů ĐŚĂƉƚĞƌƐ ŝŶ Ɛŝdž ƌĞŐŝŽŶƐ ĂĐƌŽƐƐ ƚŚĞ ƐƚĂƚĞ͘ dŚĞ ŐŽĂů ŽĨ ƚŚĞ ƉƌŽũĞĐƚ ŝƐ ŶŽƚ ŽŶůLJ ƚŽ ĨĂĐŝůŝƚĂƚĞ ƌĞŐŝŽŶĂů ĞǀĞŶƚƐ ĂŶĚ ĐŽůůĂďŽƌĂƚŝŽŶ͕ ďƵƚ ĂůƐŽ ƚŽ ĞŶĐŽƵƌĂŐĞ ŵĞŶƚŽƌƐŚŝƉ ĂŶĚ ĐŽŵŵƵŶŝƚLJ ĂŵŽŶŐ ĐŽŵŵƵŶŝƚLJ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƌŝƐŝŶŐ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ͘ ƚ ƚŚŝƐ LJĞĂƌ͛Ɛ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ^Ƶŵŵŝƚ ŽŶ EŽǀĞŵďĞƌ ϭ ŝŶ >ŽƐ ŶŐĞůĞƐ͕ ĂƉƉƌŽƉƌŝĂƚĞůLJ ƚŚĞŵĞĚ ͞ ƌŽƐƐŝŶŐ ƌŝĚŐĞƐ͕͟ ƵŝůĚŝŶŐ ƌŝĚŐĞƐ ůĞĂĚĞƌƐ ǁŝůů ƌĞĨůĞĐƚ ŽŶ ƚŚĞ ĨŝƌƐƚ LJĞĂƌ ŽĨ ƚŚĞ ƉƌŽũĞĐƚ ĂŶĚ ƐƚƌĂƚĞŐŝnjĞ ŽŶ ŚŽǁ ƚŽ ƌĞƉůŝĐĂƚĞ ƐƵĐĐĞƐƐĨƵů ĞǀĞŶƚƐ ĂĐƌŽƐƐ ƚŚĞ ƐƚĂƚĞ͘ dŚŝƐ LJĞĂƌ͛Ɛ EĂƚŝŽŶĂů ŽŶĨĞƌĞŶĐĞ ƐƉĂŶŶĞĚ ƚŚĞ ǁŝĚĞ ƌĂŶŐĞ ŽĨ ŝƐƐƵĞƐ ƚŚĂƚ ƌĞůĂƚĞ ƚŽ ƚŚĞ ƉƌĂĐƚŝĐĞ ĂŶĚ ĐƵůƚƵƌĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ tŝƚŚ ŽƉƉŽƌƚƵŶŝƚŝĞƐ ƚŽ ŚŽŶĞ ƚŚĞŝƌ ĐůŝŶŝĐĂů ƐŬŝůůƐ͕ ĞŶŐĂŐĞ ǁŝƚŚ ĞŵĞƌŐŝŶŐ ĐĂƌĞ ŵŽĚĞůƐ ĂŶĚ ĂĚǀŽĐĂĐLJ ŝƐƐƵĞƐ ĂŶĚ ƐŽĐŝĂůŝnjĞ ǁŝƚŚ ĞŶĞƌŐŝnjĞĚ ƉĞĞƌƐ ĂŶĚ ůĞĂĚĞƌƐ͕ ƐƚƵĚĞŶƚƐ ƌĞĂĨĨŝƌŵĞĚ ƚŚĞŝƌ ĐŽŵŵŝƚŵĞŶƚ ƚŽ ƉƵƌƐƵŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ĨĂĐƵůƚLJ ǁĂůŬĞĚ ĂǁĂLJ ǁŝƚŚ Ă ƌĞŶĞǁĞĚ ƉĂƐƐŝŽŶ ĨŽƌ ƚŚĞ ĨŝĞůĚ͘

Students and residents aƩend CAFP’s California recepƟon at this year’s conference.

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California Family Physician Fall 2014

Abhinaya Narayanan is CAFP’s Manager of Workforce Development.

California Family Physician Fall 2014

15

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Every Family Physician Needs to Take Action on Prop 46 /ƚ ǁŽƵůĚ ďĞ ĚŝĸĐƵůƚ ƚŽ ĮŶĚ ĂŶLJŽŶĞ ǁŚŽ ďĞůŝĞǀĞƐ ǁĞ ŚĂǀĞ Ă ŐƌĞĂƚ ƐLJƐƚĞŵ ŽĨ ŵĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ƌĞƐŽůƵƟŽŶ ŝŶ ƚŚŝƐ ĐŽƵŶƚƌLJ͘ /ƚ ŝƐ Ă ĐŽŵƉůŝĐĂƚĞĚ ĂŶĚ ŽŌĞŶ ĞŵŽƟŽŶĂů ƉƌŽĐĞƐƐ ƚŚĂƚ ĂīĞĐƚƐ ƉĂƟĞŶƚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ĂŶĚ ƚŚĞ ůŝǀĞůŝŚŽŽĚ ŽĨ ĞǀĞƌLJ ƉƌĂĐƟĐŝŶŐ ƉŚLJƐŝĐŝĂŶ͘ dŚĂƚ ƐĂŝĚ͕ ĂůŝĨŽƌŶŝĂ ŚĂƐ ŽŶĞ ŽĨ ƚŚĞ ŵŽƐƚ ƐƚĂďůĞ ĂŶĚ ƐƚƌŽŶŐĞƐƚ ŵĂůƉƌĂĐƟĐĞ ůĂǁƐ ŝŶ ƚŚĞ ĐŽƵŶƚƌLJ͘ dŚŝƐ ǁĂƐ ŶŽƚ ĂůǁĂLJƐ ƚŚĞ ĐĂƐĞ͘ ^ŽŵĞ ƟŵĞ ĂŐŽ͕ ŽƵƌ ŵĂůƉƌĂĐƟĐĞ ƌĞƐŽůƵƟŽŶ ƐLJƐƚĞŵ ǁĂƐ ƵŶƐƵƐƚĂŝŶĂďůĞ͘ ĂůŝĨŽƌŶŝĂ͛Ɛ DĞĚŝĐĂů /ŶũƵƌLJ ŽŵƉĞŶƐĂƟŽŶ ZĞĨŽƌŵ Đƚ ǁĂƐ ĂĚŽƉƚĞĚ ŝŶ ƌĞƐƉŽŶƐĞ ƚŽ ƚŚĂƚ ĐƌŝƐŝƐ͘ dŚŝƐ ůĞŐŝƐůĂƟŽŶ͕ ŬŶŽǁŶ ĂƐ D/ Z ͕ ŚĂƐ ƉƌŽǀĞĚ ƚŽ ďĞ ĂŶ ŝŵƉŽƌƚĂŶƚ ĂŶĚ ĞīĞĐƟǀĞ ŵĞĂƐƵƌĞ ƚŽ ƉƌĞƐĞƌǀĞ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ĨŽƌ ƉĂƟĞŶƚƐ͘ hŶĨŽƌƚƵŶĂƚĞůLJ͕ ƚƌŝĂů ůĂǁLJĞƌƐ ĂƌĞ ƐĞĞŬŝŶŐ ƚŽ ĚŝƐŵĂŶƚůĞ D/ Z ƚŚŝƐ EŽǀĞŵďĞƌ͘ dŚĞŝƌ ƉŽŽƌůLJͲǁŽƌĚĞĚ ĂŶĚ ŵŝƐŐƵŝĚĞĚ ŝŶŝƟĂƟǀĞ͕ WƌŽƉŽƐŝƟŽŶ ϰϲ͕ ǁŝůů ƋƵĂĚƌƵƉůĞ D/ Z ͛Ɛ ŶŽŶͲĞĐŽŶŽŵŝĐ ĚĂŵĂŐĞƐ ĐĂƉ ʹ ĨƌŽŵ ΨϮϱϬ͕ϬϬϬ ƚŽ ŶĞĂƌůLJ Ψϭ͘ϭ ŵŝůůŝŽŶ͘ dŚŝƐ ƐŝŶŐůĞ ĐŚĂŶŐĞ ĐŽƵůĚ ƚƌŝƉůĞ ůĂǁLJĞƌƐ͛ ĞĂƌŶŝŶŐƐ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ůĂǁƐƵŝƚƐ͘ dŚĞ ŵĞĂƐƵƌĞ ĂůƐŽ ĐŽŶƚĂŝŶƐ ƉƌŽǀŝƐŝŽŶƐ ƌĞƋƵŝƌŝŶŐ ĚƌƵŐ ƚĞƐƟŶŐ ŽĨ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƵƐĞ ŽĨ ĂůŝĨŽƌŶŝĂ͛Ɛ ƵŶĚĞƌĨƵŶĚĞĚ ĂŶĚ ŵĂůĨƵŶĐƟŽŶŝŶŐ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ĚĂƚĂďĂƐĞ ŝŶ ĂŶ ĂƩĞŵƉƚ ƚŽ ĚŝƐŐƵŝƐĞ ƚŚĞ ƌĞĂů ŐŽĂů ŽĨ ƚŚĞ ŝŶŝƟĂƟǀĞ͗ ƚŽ ŝŶĐƌĞĂƐĞ ƚƌŝĂů ůĂǁLJĞƌ ƉĂLJŵĞŶƚ͘ KŶĞ ƐƵƉƉŽƌƚĞƌ ŽĨ WƌŽƉŽƐŝƟŽŶ ϰϲ ĞǀĞŶ ĂĚŵŝƩĞĚ ƚŚŝƐ ŝŶ Ă >ŽƐ ŶŐĞůĞƐ dŝŵĞƐ ĂƌƟĐůĞ ĂŶĚ ǁĂƐ ƋƵŽƚĞĚ ĂƐ ƐĂLJŝŶŐ ƚŚŽƐĞ ƉƌŽǀŝƐŝŽŶƐ ĂƌĞ ͞ŝŶ ƚŚĞ ŝŶŝƟĂƟǀĞ ďĞĐĂƵƐĞ ƚŚĞLJ ƉŽůů ǁĞůů͕ ĂŶĚ ƚŚĞ ďĂĐŬĞƌƐ ĮŐƵƌĞ ƚŚĂƚ͛Ɛ ƚŚĞ ǁĂLJ ƚŽ ŐĞƚ ƚŚĞ ƉƵďůŝĐ ƚŽ ƐƵƉƉŽƌƚ ƚŚĞ ŵĞĂƐƵƌĞ͘ ͚/ƚ͛Ɛ ƚŚĞ ƵůƟŵĂƚĞ ƐǁĞĞƚĞŶĞƌ͕͛ ƐĂLJƐ :ĂŵŝĞ ŽƵƌƚ͕ ƚŚĞ ŚĞĂĚ ŽĨ ŽŶƐƵŵĞƌ tĂƚĐŚĚŽŐ͘͟ dŽ ƵŶĚĞƌƐƚĂŶĚ ǁŚLJ ŝƚ ŝƐ ƐŽ ŝŵƉŽƌƚĂŶƚ ƚŚĂƚ WƌŽƉŽƐŝƟŽŶ ϰϲ ďĞ

16

California Family Physician Fall 2014

ĚĞĨĞĂƚĞĚ͕ ŽŶĞ ŵƵƐƚ ŬŶŽǁ D/ Z ͛Ɛ ŚŝƐƚŽƌLJ͘ ĞĨŽƌĞ D/ Z ǁĂƐ ĞŶĂĐƚĞĚ ŝŶƚŽ ůĂǁ͕ ǁĞ ŚĂĚ Ă ŵĂũŽƌ ŵĂůƉƌĂĐƟĐĞ ŝŶƐƵƌĂŶĐĞ ĐƌŝƐŝƐ͕ ǁŝƚŚ ƉƌĞŵŝƵŵƐ ƌŝƐŝŶŐ ďLJ ŶĞĂƌůLJ ϰϬϬ ƉĞƌĐĞŶƚ ĂŶŶƵĂůůLJ͘ dŚĞ ŶƵŵďĞƌ ŽĨ ŵĂůƉƌĂĐƟĐĞ ŝŶƐƵƌĂŶĐĞ ĐĂƌƌŝĞƌƐ ĚƌŽƉƉĞĚ ĨƌŽŵ ϯϬ ƚŽ ũƵƐƚ ƚŚƌĞĞ͕ ĂŶĚ ŶĂƟŽŶĂůůLJ ĨƌŽŵ ϱϬ ƚŽ ϭϬ͘ ĂƐƵĂůƚLJ ŝŶƐƵƌĞƌƐ ůŽƐƚ ĂƐ ŵƵĐŚ ĂƐ ϴϬ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞŝƌ ƐƵƌƉůƵƐ ĂŶĚ ǁĞƌĞ ĐŽŶƐŝĚĞƌĞĚ ƚŽ ďĞ ĮŶĂŶĐŝĂůůLJ ŝŶƐŽůǀĞŶƚ͘ hŶĂďůĞ ƚŽ ƐƵƌǀŝǀĞ͕ ŝŶƐƵƌĂŶĐĞ ĐĂƌƌŝĞƌƐ ůĞŌ ƚŚĞ ŵĂƌŬĞƚ͕ ůĞĂǀŝŶŐ ƉŚLJƐŝĐŝĂŶƐ ǁŝƚŚ ŶŽ ŵĞĚŝĐĂů ŵĂůƉƌĂĐƟĐĞ ŝŶƐƵƌĂŶĐĞ ĐŽǀĞƌĂŐĞ͕ ĞīĞĐƟǀĞůLJ ĨŽƌĐŝŶŐ ƚŚĞŵ ƚŽ ĐůŽƐĞ ƚŚĞŝƌ ŽĸĐĞƐ Žƌ ƉƌĂĐƟĐĞ ǁŝƚŚ ŶŽ ŝŶƐƵƌĂŶĐĞ ĐŽǀĞƌĂŐĞ͘ WŚLJƐŝĐŝĂŶƐ͕ ĂůůŝĞĚ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ͕ ŝŶƐƵƌĞƌƐ ĂŶĚ ƉĂƟĞŶƚ ŐƌŽƵƉƐ ŬŶĞǁ ƐŽŵĞƚŚŝŶŐ ŚĂĚ ƚŽ ďĞ ĚŽŶĞ ƚŽ ƐƚŽƉ ƚŚĞ ĐƌŝƐŝƐ ƚŚĂƚ ǁĂƐ ĚĞƐƚƌŽLJŝŶŐ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ͘ dƌŝĂů ůĂǁLJĞƌƐ͕ ƉůĞĂƐĞĚ ǁŝƚŚ ƚŚĞ ŝŶĐƌĞĂƐĞĚ ŝŶĐŽŵĞ͕ ĨŽƵŐŚƚ ƚŚĞ ƚŽƌƚ ƌĞĨŽƌŵ ĞīŽƌƚƐ ƚŚĂƚ ĞŶƐƵĞĚ͘ dŚĞLJ ƉĂƌƟĐƵůĂƌůLJ ŽƉƉŽƐĞĚ ƚŚĞ ĞīŽƌƚ ƚŽ ůŝŵŝƚ ƚŚĞŝƌ ĐŽŶƟŶŐĞŶĐLJ ĨĞĞƐ ĂŶĚ ĐƌĞĂƚĞ Ă ΨϮϱϬ͕ϬϬϬ ĐĂƉ ŽŶ ƚŚĞ ĂŵŽƵŶƚ Ă ũƵƌLJ ĐŽƵůĚ ĂǁĂƌĚ ĨŽƌ ŐĞŶĞƌĂů͕ ŶŽŶͲĞĐŽŶŽŵŝĐ ĚĂŵĂŐĞƐ͕ ŵŽƌĞ ĐŽŵŵŽŶůLJ ŬŶŽǁŶ ĂƐ ͞ƉĂŝŶ ĂŶĚ ƐƵīĞƌŝŶŐ͘͟ &ŽƌƚƵŶĂƚĞůLJ ĨŽƌ ƉĂƟĞŶƚƐ ĂŶĚ ĂůŝĨŽƌŶŝĂ͛Ɛ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͕ ƚŚĞ ƚƌŝĂů ůĂǁLJĞƌƐ ůŽƐƚ ƚŚĞ ďĂƩůĞ ĂŶĚ D/ Z ƉĂƐƐĞĚ͘ ^ŝŶĐĞ ƚŚĂƚ ƟŵĞ͕ ƉůĂŝŶƟī ĂƩŽƌŶĞLJƐ ŚĂǀĞ ǁĂŐĞĚ ƵŶƐƵĐĐĞƐƐĨƵů ůĞŐŝƐůĂƟǀĞ ĂŶĚ ůĞŐĂů ďĂƩůĞƐ ƚŽ ŽǀĞƌƚƵƌŶ Žƌ ĂŵĞŶĚ D/ Z ͕ ƉƌŝŵĂƌŝůLJ ĨŽĐƵƐĞĚ ŽŶ ŝŶĐƌĞĂƐŝŶŐ ƚŚĞŝƌ ĨĞĞƐ ĂŶĚ ƚŚĞ ĐĂƉ͘ dŚĞŝƌ ůĂƚĞƐƚ ĂƩĞŵƉƚ ŝƐ WƌŽƉŽƐŝƟŽŶ ϰϲ͘ /Ĩ ƉĂƐƐĞĚ͕ ŝƚ ǁŝůů ƚŚƌĞĂƚĞŶ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ĨŽƌ ƚŚĞ ŵŽƐƚ ǀƵůŶĞƌĂďůĞ ƉĂƟĞŶƚƐ͘ /Ĩ ŵĞĚŝĐĂů ůĂǁƐƵŝƚ ĂǁĂƌĚƐ ĂƌĞ ŝŶĐƌĞĂƐĞĚ͕ ĐŽŶƐƵŵĞƌƐ ǁŝůů ƐĞĞ ŚŝŐŚĞƌ ŚĞĂůƚŚ ĐĂƌĞ ƉƌĞŵŝƵŵƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶƐ ǁŝůů ƉĂLJ ŚŝŐŚĞƌ ůŝĂďŝůŝƚLJ ƌĂƚĞƐ͘ ĐĐŽƌĚŝŶŐ ƚŽ Ă ƐƚƵĚLJ ďLJ ĂůŝĨŽƌŶŝĂ͛Ɛ ĨŽƌŵĞƌ >ĞŐŝƐůĂƟǀĞ ŶĂůLJƐƚ͕ ƚŚŝƐ ƉƌŽƉŽƐŝƟŽŶ ǁŝůů ŝŶĐƌĞĂƐĞ ŚĞĂůƚŚ ĐĂƌĞ ĐŽƐƚƐ ĂĐƌŽƐƐ Ăůů ƐĞĐƚŽƌƐ ďLJ Ψϵ͘ϵ ďŝůůŝŽŶ ĂŶŶƵĂůůLJ͘ &ƵƌƚŚĞƌŵŽƌĞ͕ ĂůŝĨŽƌŶŝĂ͛Ɛ ĐƵƌƌĞŶƚ >ĞŐŝƐůĂƟǀĞ ŶĂůLJƐƚ͛Ɛ KĸĐĞ ǁĂƌŶƐ WƌŽƉŽƐŝƟŽŶ ϰϲ ĐŽƵůĚ ŝŶĐƌĞĂƐĞ ƐƚĂƚĞ ĂŶĚ ůŽĐĂů ŐŽǀĞƌŶŵĞŶƚ ŵĞĚŝĐĂů ůŝĂďŝůŝƚLJ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ĐŽƐƚƐ ďLJ ͞ŚƵŶĚƌĞĚƐ ŽĨ ŵŝůůŝŽŶƐ ŽĨ ĚŽůůĂƌƐ ĂŶŶƵĂůůLJ͕͟ ƉůĂĐŝŶŐ ƚŚĞ ďƵƌĚĞŶ ŽĨ ƚŚŝƐ ĂĚĚŝƟŽŶĂů ĐŽƐƚ ŽŶ ƚĂdžƉĂLJĞƌƐ͘ ŚĂŶŐĞƐ ƚŽ D/ Z ĐŽƵůĚ ĐĂƵƐĞ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ůĞĂǀĞ ŽƵƌ ƐƚĂƚĞ ĂƐ ƚŚĞLJ ŚĂǀĞ ĚŽŶĞ ŝŶ ŽƚŚĞƌ ƐƚĂƚĞƐ ĂīĞĐƚĞĚ ďLJ ƐŝŵŝůĂƌ ŵĂůƉƌĂĐƟĐĞ ĐƌŝƐĞƐ ĂŶĚ ĞůŝŵŝŶĂƟŽŶ ŽĨ ĐŽŵŵƵŶŝƚLJ ƐĞƌǀŝĐĞƐ͘ dŚĞ ŵĞĚŝĐĂů ĐŽŵŵƵŶŝƚLJ ŵƵƐƚ ũŽŝŶ ƚŽŐĞƚŚĞƌ ƚŽ ƉƌĞǀĞŶƚ ƚŚĞ ƚƌŝĂů ĂƩŽƌŶĞLJƐ ĨƌŽŵ ĐƌĞĂƟŶŐ ĂŶŽƚŚĞƌ ĐƌŝƐŝƐ ƚŚĂƚ ƚŚƌĞĂƚĞŶƐ ƉĂƟĞŶƚ ĂĐĐĞƐƐ ƚŽ ŵĞĚŝĐĂů ƐĞƌǀŝĐĞƐ͘ WůĞĂƐĞ ƌĞŐŝƐƚĞƌ ƚŽ ǀŽƚĞ ĂŶĚ ǀŽƚĞ ͚EŽ͛ ŽŶ WƌŽƉŽƐŝƟŽŶ ϰϲ͘ zŽƵ ĐĂŶ ůĞĂƌŶ ŵŽƌĞ Ăƚ ǁǁǁ͘ EŽKŶϰϲ͘ĐŽŵ

MICRA 101

D/ Z ŐŽǀĞƌŶƐ ǁŚĂƚ ŚĂƉƉĞŶƐ ǁŚĞŶ ƐŽŵĞŽŶĞ ĮůĞƐ Ă ůĂǁƐƵŝƚ ĂůůĞŐŝŶŐ ŚĞ Žƌ ƐŚĞ ǁĂƐ ŝŶũƵƌĞĚ ǁŚŝůĞ ƌĞĐĞŝǀŝŶŐ ŵĞĚŝĐĂů ƚƌĞĂƚŵĞŶƚ͘ dŚĞ ůĂǁ ĞŶƐƵƌĞƐ ŝŶũƵƌĞĚ ƉĂƟĞŶƚƐ ƌĞĐĞŝǀĞ ĨĂŝƌ ĐŽŵƉĞŶƐĂƟŽŶ͕ ǁŚŝůĞ ĂůƐŽ ƉƌĞƐĞƌǀŝŶŐ ƉĂƟĞŶƚƐ͛ ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ ďLJ ŝŶĐůƵĚŝŶŐ ĚŝƐŝŶĐĞŶƟǀĞƐ ĨŽƌ ůĂǁLJĞƌƐ ƚŽ ĮůĞ ŵĞƌŝƚůĞƐƐ ůĂǁƐƵŝƚƐ ĂŐĂŝŶƐƚ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ƚŚĂƚ ŝŶĐƌĞĂƐĞ ŚĞĂůƚŚ ĐĂƌĞ ĐŽƐƚƐ͘ /Ŷ ƚƵƌŶ͕ ƚŚŝƐ ŬĞĞƉƐ ŵĞĚŝĐĂů ůŝĂďŝůŝƚLJ ƌĂƚĞƐ ƐƚĂďůĞ ĨŽƌ ĚŽĐƚŽƌƐ͕ ŶƵƌƐĞƐ ĂŶĚ ŽƚŚĞƌ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽĨĞƐƐŝŽŶĂůƐ ƐŽ ƚŚĞLJ ĐĂŶ ƐƚĂLJ ŝŶ ƉƌĂĐƟĐĞ͕ ƚƌĞĂƟŶŐ ƉĂƟĞŶƚƐ͘ WƌŝŽƌ ƚŽ D/ Z ͕ ĂůŝĨŽƌŶŝĂ ŵĞĚŝĐĂů ůŝĂďŝůŝƚLJ ƌĂƚĞƐ ǁĞƌĞ ƐƉŝƌĂůŝŶŐ ŽƵƚ ŽĨ ĐŽŶƚƌŽů͘ tŝƚŚ D/ Z ͕ ŵĞĚŝĐĂů ůŝĂďŝůŝƚLJ ƌĂƚĞƐ ŚĂǀĞ ƐƚĂďŝůŝnjĞĚ͘ ^ƚĂƚĞƐ ǁŝƚŚŽƵƚ ŵĞĚŝĐĂů ůŝĂďŝůŝƚLJ ƌĞĨŽƌŵ ƐƵīĞƌ ĨƌŽŵ ƐŚŽƌƚĂŐĞƐ ŽĨ ƉŚLJƐŝĐŝĂŶƐ͕ ůĞĂĚŝŶŐ ƚŽ ƚŚĞ ĐůŽƐŝŶŐ ŽĨ ŚŽƐƉŝƚĂůƐ͕ ĐůŝŶŝĐƐ ĂŶĚ ƚƌĂƵŵĂ ĐĞŶƚĞƌƐ ĂŶĚ ůĞĂǀŝŶŐ ƉĂƟĞŶƚƐ ǁŝƚŚŽƵƚ ĐŽŵŵƵŶŝƚLJ ƉŚLJƐŝĐŝĂŶƐ͘ dŚŝƐ ϮϬϭϯ ĚĂƚĂ ĨƌŽŵ ƚŚĞ ͞DĞĚŝĐĂů >ŝĂďŝůŝƚLJ DŽŶŝƚŽƌ͟ ĐŽŵƉĂƌĞƐ ĂŶŶƵĂů ƉƌŽĨĞƐƐŝŽŶĂů ůŝĂďŝůŝƚLJ ĐŽƐƚƐ ŝŶ ƚŚƌĞĞ ƐƚĂƚĞƐ͘

California

New York

Florida

O -GYN

$ 71,248

$ 184,802

$ 190,829

General Surgery

$54,400

$ 133,593

$ 190,829

Internal Medicine/ Family Medicine

$15,415

$ 35,733

$ 47,707

*Internal Medicine and Family Medicine rates are similar. Rates maybe slightly higher for family physicians who include K in their pracƟces.

Provisions of MICRA͗

D/ Z ƉƌĞƐĞƌǀĞƐ ƉĂƟĞŶƚƐ͛ ĂĐĐĞƐƐ ƚŽ ĨĂŝƌ ĐŽŵƉĞŶƐĂƟŽŶ ǁŚĞŶ ƚŚĞLJ ŚĂǀĞ ũƵƐƟĮĂďůĞ ĐůĂŝŵƐ͕ ŝŶĐůƵĚŝŶŐ͗ ͻ hE>/D/d ĐŽŵƉĞŶƐĂƟŽŶ ĨŽƌ Ăůů ĞĐŽŶŽŵŝĐ Žƌ ŽƵƚͲŽĨͲƉŽĐŬĞƚ ĐŽƐƚƐ ĨŽƌ ƉĂƐƚ ĂŶĚ ĨƵƚƵƌĞ ŵĞĚŝĐĂů ĐĂƌĞ͖ ͻ hE>/D/d ĐŽŵƉĞŶƐĂƟŽŶ ĨŽƌ ĂŶLJ ƉĂƐƚ ĂŶĚ ĨƵƚƵƌĞ ůŽƐƚ ǁĂŐĞƐ Žƌ ůŽƐƚ ĞĂƌŶŝŶŐ ƉŽƚĞŶƟĂů͖ ͻ hE>/D/d ĐŽŵƉĞŶƐĂƟŽŶ ĨŽƌ ƉƵŶŝƟǀĞ ĚĂŵĂŐĞƐ͖ ĂŶĚ ͻ hƉ ƚŽ ΨϮϱϬ͕ϬϬϬ ĨŽƌ ŶŽŶͲĞĐŽŶŽŵŝĐ ĚĂŵĂŐĞƐ͘ Ž dŚĞ ΨϮϱϬ͕ϬϬϬ ĐĂƉ ƌĞĚƵĐĞƐ ŝŶĐĞŶƟǀĞƐ ƚŽ ĮůĞ ŵĞƌŝƚůĞƐƐ ůĂǁƐƵŝƚƐ͕ ǁŚŝůĞ ĞŶƐƵƌŝŶŐ ƚŚĂƚ ůĞŐŝƟŵĂƚĞ ĐůĂŝŵƐ ĐĂŶ ŵŽǀĞ ĨŽƌǁĂƌĚ͘ ͻ ƐƐƵƌŝŶŐ ƚŚĂƚ ƚŚĞ ŝŶũƵƌĞĚ ƉĞƌƐŽŶ͕ ŶŽƚ ƚŚĞ ůĂǁLJĞƌ͕ ŐĞƚƐ ŵŽƌĞ ŽĨ ƚŚĞ ŵŽŶĞLJ ĂǁĂƌĚĞĚ ďLJ ƚŚĞ ĐŽƵƌƚ͘ ͻ ƐƐƵƌŝŶŐ ƚŚĂƚ ĨƵŶĚƐ ǁŝůů ďĞ ĂǀĂŝůĂďůĞ ƚŽ ƉĂLJ ĚĂŵĂŐĞƐ ƚŽ ƉĂƟĞŶƚƐ ǁŚŽ ĂƌĞ ŝŶũƵƌĞĚ ŶĞŐůŝŐĞŶƚůLJ͘ ͻ WƌŽƚĞĐƟŶŐ ƐƉĞĐŝĂůƚLJ ĂŶĚ ŚŝŐŚͲƌŝƐŬ ƐĞƌǀŝĐĞƐ͕ ŝŶĐůƵĚŝŶŐ ǁŽŵĞŶ͛Ɛ ŚĞĂůƚŚ ĐĂƌĞ͕ ĐŽŵŵƵŶŝƚLJ ĐůŝŶŝĐƐ͕ ŚĞĂůƚŚ ĐĞŶƚĞƌƐ ĂŶĚ ƌƵƌĂů ƉƌŽǀŝĚĞƌƐ ƚŚĂƚ ĐĂŶ ůĞĂƐƚ ĂīŽƌĚ ƐŬLJƌŽĐŬĞƟŶŐ ĐŽƐƚƐ͘ Adam Francis is CAFP’s Deputy Director of Government Relations.

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Opportunities in Northern California Ş &uaranteeC 'ours , % 2BheCule Ş 6orJ +ife !alanBe Vith No NiFhts or 6eeJenCs Ş No !illinF 'assles Ş 1easonaAle /atient +oaC Ş ,alpraBtiBe /aiC Ş /atient %oBuseC $nUironLent Ş nX 2tate +iBense Ş !C !$ in %aLilX /raBtiBe Nationwide Opportunities Available!

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Covered California: Putting the Puzzle Together for 2015 dŚĞ ŶƵŵďĞƌ ŽĨ ƵŶŝŶƐƵƌĞĚ ŝŶ ĂůŝĨŽƌŶŝĂ ĚĞĐůŝŶĞĚ ĚƌĂŵĂƟĐĂůůLJ ĚƵƌŝŶŐ ƚŚĞ ĮƌƐƚ ŽƉĞŶ ĞŶƌŽůůŵĞŶƚ ƉĞƌŝŽĚ ŚĞůĚ ŝŶ ůĂƚĞ ϮϬϭϯ ĂŶĚ ĞĂƌůLJ ϮϬϭϰ ďLJ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͕ ƚŚĞ ƐƚĂƚĞ͛Ɛ ŚĞĂůƚŚ ďĞŶĞĮƚ ĞdžĐŚĂŶŐĞ͘ EĞĂƌůLJ ϲϬ ƉĞƌĐĞŶƚ ŽĨ ƉƌĞǀŝŽƵƐůLJ ƵŶŝŶƐƵƌĞĚ ĂůŝĨŽƌŶŝĂŶƐ ŶŽǁ ŚĂǀĞ ĐŽǀĞƌĂŐĞ ƚŚĂŶŬƐ ƚŽ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ͕ ďƵƚ ǁĞ ƐƟůů ŚĂǀĞ Ă ůŽŶŐ ǁĂLJ ƚŽ ŐŽ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ ŚĞĂůƚŚ ĐĂƌĞ ŝƐ ĂīŽƌĚĂďůĞ ĂŶĚ ĂĐĐĞƐƐŝďůĞ ƚŽ Ăůů͘ KƉĞŶ ĞŶƌŽůůŵĞŶƚ ĨŽƌ ϮϬϭϱ ŽƉĞŶƐ EŽǀĞŵďĞƌ ϭϱ͕ ϮϬϭϰ͘ ,ĞƌĞ ŝƐ ŝŶĨŽƌŵĂƟŽŶ ƚŽ ŚĞůƉ LJŽƵ ŚĞůƉ LJŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ƐƚĂī ŶĂǀŝŐĂƚĞ ƚŚĞ ŶĞdžƚ ƐƚĞƉƐ͘ 2015 Open Enrollment͗ November 15, 2014 ʹ February 15, 2015 Enrollment dŚĞ ŵŽƐƚ ŝŵƉŽƌƚĂŶƚ ƌŽůĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĐĂŶ ƉůĂLJ ŝŶ ŚĞůƉŝŶŐ ŵŽƌĞ ƉĞŽƉůĞ ŐĂŝŶ ĐŽǀĞƌĂŐĞ ŝƐ ƚŽ ůĞƚ ƉĂƟĞŶƚƐ ŬŶŽǁ ƚŚĞLJ ĐĂŶ ĮŶĚ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ĂůƐŽ ĞŶƌŽůů Ăƚ ƚŚĞ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ǁĞďƐŝƚĞ͕ ŽǀĞƌĞĚ ͘ĐŽŵ͕ Žƌ ďLJ ĐĂůůŝŶŐ ϭͲϴϬϬͲϯϬϬͲϭϱϬϲ͘ ŽƚŚ ƉƌŝŶƚ ĂŶĚ ǀŽŝĐĞ ŝŶĨŽƌŵĂƟŽŶ ĂƌĞ ƉƌŽǀŝĚĞĚ ŝŶ ƐĞǀĞƌĂů ůĂŶŐƵĂŐĞƐ͕ ĂŶĚ ƚŚĞ ĨƵůů ǁĞďƐŝƚĞ ŝƐ ŝŶ ^ƉĂŶŝƐŚ ĂŶĚ ŶŐůŝƐŚ͘ WůĞĂƐĞ ůĞƚ LJŽƵƌ ŽĸĐĞ ƐƚĂī ŬŶŽǁ ĂƐ ƚŚĞLJ͕ ƚŽŽ͕ ŚĂǀĞ ĐŽŶƚĂĐƚ ǁŝƚŚ LJŽƵƌ ƉĂƟĞŶƚƐ ǁŚŽ ŶĞĞĚ ĐŽǀĞƌĂŐĞ͘ ^ŽŵĞ ŽĨ LJŽƵƌ ƉĂƟĞŶƚƐ ŵĂLJ ĂůƐŽ ďĞ ĂďůĞ ƚŽ ĞŶƌŽůů ƚŚƌŽƵŐŚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ŽƵƚƐŝĚĞ ƚŚĞ ŐĞŶĞƌĂů ŽƉĞŶ ĞŶƌŽůůŵĞŶƚ ƉĞƌŝŽĚ ŝĨ ƚŚĞLJ ŚĂǀĞ Ă ͞ƋƵĂůŝĨLJŝŶŐ ůŝĨĞ ĞǀĞŶƚ͟ ƚŚĂƚ ŽƉĞŶƐ Ă ͞ƐƉĞĐŝĂů ĞŶƌŽůůŵĞŶƚ͟ ŽƉƉŽƌƚƵŶŝƚLJ͘ YƵĂůŝĨLJŝŶŐ ůŝĨĞ ĞǀĞŶƚƐ ŝŶĐůƵĚĞ ŐĞƫŶŐ ŵĂƌƌŝĞĚ͕ ŚĂǀŝŶŐ Ă ĐŚŝůĚ͕ ůŽƐŝŶŐ DĞĚŝͲ Ăů Žƌ ĞŵƉůŽLJĞƌͲƉƌŽǀŝĚĞĚ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ͕ ďĞĐŽŵŝŶŐ Ă ĐŝƟnjĞŶ ĂŶĚ ŵŽƌĞ͘ WĂƟĞŶƚƐ ŝŶ ƐƵĐŚ ĐŝƌĐƵŵƐƚĂŶĐĞƐ ƐŚŽƵůĚ ĐŽŶƚĂĐƚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ƚŽ ĚĞƚĞƌŵŝŶĞ ǁŚĞƚŚĞƌ ƚŚĞLJ ƋƵĂůŝĨLJ͘ ŶƌŽůůŵĞŶƚ ŝŶ DĞĚŝͲ Ăů ĐĂŶ ĂůƐŽ ďĞ ĚŽŶĞ ƚŚƌŽƵŐŚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ĂŶĚ ŝƐ ŽƉĞŶ Ăůů LJĞĂƌ ůŽŶŐ͘ Consumer Rates and Subsidies /Ŷ ƚŚĞ EŽǀĞŵďĞƌ ϮϬϭϰ ĞůĞĐƟŽŶ͕ ĂůŝĨŽƌŶŝĂ ǀŽƚĞƌƐ ǁŝůů ĚĞĐŝĚĞ ǁŚĞƚŚĞƌ ĨƵƚƵƌĞ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ƌĂƚĞ ŚŝŬĞƐ ƐŚŽƵůĚ ďĞ ƐƵďũĞĐƚ ƚŽ ƚŚĞ ƐƚĂƚĞ ŝŶƐƵƌĂŶĐĞ ĐŽŵŵŝƐƐŝŽŶĞƌ͛Ɛ ĂƉƉƌŽǀĂů͕ Ă ƌĞŐƵůĂƚŽƌLJ ƌĞƋƵŝƌĞŵĞŶƚ ŝŶ Ă ŵĂũŽƌŝƚLJ ŽĨ ŽƚŚĞƌ ƐƚĂƚĞƐ͘ &Žƌ ϮϬϭϱ͕ <ĂŝƐĞƌ WĞƌŵĂŶĞŶƚĞ͕ ĂŵŽŶŐ ƚŚĞ ŵŽƐƚ ĞdžƉĞŶƐŝǀĞ ŚĞĂůƚŚ ƉůĂŶƐ ŽīĞƌĞĚ ƚŚƌŽƵŐŚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ŝŶ ϮϬϭϰ͕ ŝƐ ĞdžƉĞĐƚĞĚ ƚŽ ĚĞĐƌĞĂƐĞ ŝƚƐ ƌĂƚĞƐ ŝŶ ƚŚĞ ĞdžĐŚĂŶŐĞ ďLJ ϭ͘ϰ ƉĞƌĐĞŶƚ͘ ŶƚŚĞŵ ůƵĞ ƌŽƐƐ͕ ůƵĞ ^ŚŝĞůĚ ŽĨ ĂůŝĨŽƌŶŝĂ ĂŶĚ ,ĞĂůƚŚ EĞƚ /ŶĐ͕͘ ǁŚŝĐŚ Ăůů ŚĂĚ ŚŝŐŚĞƌ ĞŶƌŽůůŵĞŶƚƐ ĨŽƌ ϮϬϭϰ ƚŚĂŶ ĚŝĚ <ĂŝƐĞƌ͕ ĂƌĞ ĞdžƉĞĐƚĞĚ ƚŽ ƌĂŝƐĞ ƌĂƚĞƐ ďLJ ϰ͘ϲ ƉĞƌĐĞŶƚ͕ ϲ ƉĞƌĐĞŶƚ ĂŶĚ ϰ͘ϵ ƉĞƌĐĞŶƚ ƌĞƐƉĞĐƟǀĞůLJ͘

18

California Family Physician Fall 2014

KǀĞƌĂůů͕ ĂǀĞƌĂŐĞ ƉƌĞŵŝƵŵ ƌĂƚĞƐ ĨŽƌ ŚĞĂůƚŚ ƉůĂŶƐ ŽīĞƌĞĚ ƚŚƌŽƵŐŚ ƚŚĞ ƐƚĂƚĞ ŚĞĂůƚŚ ďĞŶĞĮƚ ĞdžĐŚĂŶŐĞ ǁŝůů ŝŶĐƌĞĂƐĞ ďLJ ĂŶ ĂǀĞƌĂŐĞ ŽĨ ϰ͘Ϯ ƉĞƌĐĞŶƚ ĨŽƌ ϮϬϭϱ͕ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ŽĸĐŝĂůƐ ĂŶŶŽƵŶĐĞĚ ŝŶ ůĂƚĞ :ƵůLJ͘ ^ƵďƐŝĚŝĞƐ ĨŽƌ ϮϬϭϱ ĂƌĞ ůŝŬĞůLJ ƚŽ ƌĞŵĂŝŶ ƚŚĞ ƐĂŵĞ Žƌ ďĞ ƐůŝŐŚƚůLJ ŚŝŐŚĞƌ ƚŚĂŶ ŝŶ ϮϬϭϰ͕ ƚŚĞLJ ƐĂŝĚ͕ ĂŶĚ ŵĂLJ ŽīƐĞƚ ƉƌĞŵŝƵŵ ŝŶĐƌĞĂƐĞƐ ĨŽƌ ƐŽŵĞ ĐŽŶƐƵŵĞƌƐ͘ Health Plans ůů ϭϬ ŝŶƐƵƌĞƌƐ ƉĂƌƟĐŝƉĂƟŶŐ ŝŶ ƚŚĞ ĞdžĐŚĂŶŐĞ ŝŶ ϮϬϭϰ ŚĂǀĞ ďĞĞŶ ĂƉƉƌŽǀĞĚ ƚŽ ƌĞƚƵƌŶ ŝŶ ϮϬϭϱ͗ ͻ ŶƚŚĞŵ ůƵĞ ƌŽƐƐ ŽĨ ĂůŝĨŽƌŶŝĂ ͻ ůƵĞ ^ŚŝĞůĚ ŽĨ ĂůŝĨŽƌŶŝĂ ͻ ŚŝŶĞƐĞ ŽŵŵƵŶŝƚLJ ,ĞĂůƚŚ WůĂŶ ͻ ,ĞĂůƚŚ EĞƚ ͻ <ĂŝƐĞƌ WĞƌŵĂŶĞŶƚĞ ͻ >͘ ͘ ĂƌĞ ,ĞĂůƚŚ WůĂŶ ͻ DŽůŝŶĂ ,ĞĂůƚŚĐĂƌĞ ͻ ^ŚĂƌƉ ,ĞĂůƚŚ WůĂŶ ͻ sĂůůĞLJ ,ĞĂůƚŚ WůĂŶ ͻ tĞƐƚĞƌŶ ,ĞĂůƚŚ ĚǀĂŶƚĂŐĞ dŚĞ ƐƚĂƚĞ͛Ɛ ĞƉĂƌƚŵĞŶƚ ŽĨ DĂŶĂŐĞĚ ,ĞĂůƚŚ ĂƌĞ ; D, Ϳ ŝƐ ĐŽŶĚƵĐƟŶŐ ĂŶ ŝŶǀĞƐƟŐĂƟŽŶ ŝŶƚŽ ƚŚĞ ĂĐĐƵƌĂĐLJ ŽĨ ƉƌŽǀŝĚĞƌ ĚŝƌĞĐƚŽƌŝĞƐ ƉƌŽǀŝĚĞĚ ďLJ ŶƚŚĞŵ ůƵĞ ƌŽƐƐ ĂŶĚ ůƵĞ ^ŚŝĞůĚ ŽĨ ĂůŝĨŽƌŶŝĂ ƚŽ ĐŽŶƐƵŵĞƌƐ ǁŚŽ ĞŶƌŽůůĞĚ ƚŚƌŽƵŐŚ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ ĨŽƌ ϮϬϭϰ͘ &W ŝƐ ƐƵƉƉŽƌƟŶŐ ƚŚĞ ŝŶǀĞƐƟŐĂƟŽŶ ĂŶĚ ĞŶĐŽƵƌĂŐĞƐ ŵĞŵďĞƌƐ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ďLJ ƌĞƐƉŽŶĚŝŶŐ ŝĨ ĐŽŶƚĂĐƚĞĚ ďLJ ƉŵƉŵ ŽŶƐƵůƟŶŐ /ŶĐ͕͘ ƚŚĞ Įƌŵ D, ŚĂƐ ŚŝƌĞĚ ƚŽ ĐĂƌƌLJ ŽƵƚ ƉĂƌƚƐ ŽĨ ƚŚĞ ŝŶǀĞƐƟŐĂƟŽŶ͘ ĂůůŝŶŐ ƉŚLJƐŝĐŝĂŶƐ͛ ŽĸĐĞƐ ŝƐ ŽŶĞ ǁĂLJ ƚŚĞ Įƌŵ ŝƐ ĂƐƐĞƐƐŝŶŐ ƚŚĞ ĚŝƌĞĐƚŽƌŝĞƐ͛ ĂĐĐƵƌĂĐLJ͘ Catherine Direen is CAFP’s media consultant.

OPINION

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Protecting Women’s Rights to Basic Reproductive Health Care tŽŵĞŶ͛Ɛ ƌŝŐŚƚƐ ĂƌĞ ƵŶĚĞƌ ĂƩĂĐŬ͘ Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ŬŶŽǁ ƚŚĂƚ ŝŶƐƵƌĂŶĐĞ ĐŽǀĞƌĂŐĞ ĨŽƌ ĐŽŶƚƌĂĐĞƉƟŽŶ ŝƐ ĞƐƐĞŶƟĂů ĨŽƌ Ăůů ŽĨ ŽƵƌ ƉĂƟĞŶƚƐ͘ zĞƚ͕ ůĂƐƚ :ƵŶĞ͕ ĮǀĞ ^ƵƉƌĞŵĞ ŽƵƌƚ ũƵƐƟĐĞƐ ĚŝƐƌĞŐĂƌĚĞĚ ƐĐŝĞŶĐĞ ĂŶĚ ƉƵďůŝĐ ŚĞĂůƚŚ ǁŚĞŶ ƚŚĞLJ ƐŝĚĞĚ ǁŝƚŚ ĐŽƌƉŽƌĂƟŽŶƐ ůŝŬĞ ,ŽďďLJ >ŽďďLJ ƚŽ ĚĞŶLJ ŝŵƉŽƌƚĂŶƚ ĞŵĞƌŐĞŶĐLJ ĂŶĚ ůŽŶŐͲĂĐƟŶŐ ĐŽŶƚƌĂĐĞƉƟǀĞƐ ƐƵĐŚ ĂƐ WůĂŶ ͕ ůůĂ͕ DŝƌĞŶĂ ĂŶĚ WĂƌĂŐĂƌĚ͘ /Ŷ ƵƌǁĞůů ǀƐ͘ ,ŽďďLJ >ŽďďLJ͕ ƚŚĞ ^ƵƉƌĞŵĞ ŽƵƌƚ ŚĞůĚ ƚŚĂƚ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ͛Ɛ ; Ϳ ƌĞƋƵŝƌĞŵĞŶƚ ƚŚĂƚ ĞŵƉůŽLJĞƌ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ŝŶĐůƵĚĞ ĐŽǀĞƌĂŐĞ ĨŽƌ ĐŽŶƚƌĂĐĞƉƟŽŶ ǀŝŽůĂƚĞƐ ƚŚĞ ĞŵƉůŽLJĞƌ͛Ɛ ƌĞůŝŐŝŽƵƐ ĨƌĞĞĚŽŵ͘ dŚŝƐ ƌƵůŝŶŐ ƐĞƚƐ Ă ĚŝƐƚƵƌďŝŶŐ ŶĞǁ ƉƌĞĐĞĚĞŶƚ ƚŚĂƚ ĂůůŽǁƐ ĐŽƌƉŽƌĂƟŽŶƐ ƚŽ ĚĞƚĞƌŵŝŶĞ ĞŵƉůŽLJĞĞƐ͛ ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ ƐĞƌǀŝĐĞƐ͘ /Ŷ ƚŚĞ ƐĂŵĞ ǁĂƌƉĞĚ ǀĞŝŶ ĂƐ Ă ƉƌĞǀŝŽƵƐ ƌƵůŝŶŐ ƚŽ ĂůůŽǁ ĐŽƌƉŽƌĂƟŽŶƐ ƚŽ ŵĂŬĞ ƉŽůŝƟĐĂů ĐŽŶƚƌŝďƵƟŽŶƐ͕ ŝƚ ƐƵŐŐĞƐƚƐ ĐŽƌƉŽƌĂƟŽŶƐ ĂƌĞ ƉĞŽƉůĞ͘ Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ Ăůů ƵŶĚĞƌƐƚĂŶĚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƉƌĞǀĞŶƟŽŶ ĂŶĚ ĨƵƚƵƌĞ ƉƌĞŐŶĂŶĐLJ ƉůĂŶŶŝŶŐ͘ Ɛ ƐƵĐŚ͕ ǁŚĞŶ ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂŶĚ ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ͕ ŐƵŝĚĞĚ ďLJ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ ĨƌŽŵ ƚŚĞ /ŶƐƟƚƵƚĞ ŽĨ DĞĚŝĐŝŶĞ͕ ĚĞĐŝĚĞĚ ǁŚĂƚ ƐĞƌǀŝĐĞƐ ƚŽ ĚĞĮŶĞ ĂƐ ͞ĞƐƐĞŶƟĂů͕͟ ƚŚĞLJ ŝŶĐůƵĚĞĚ ƚŚĞ ĨƵůů ƐƉĞĐƚƌƵŵ ŽĨ ĐŽŶƚƌĂĐĞƉƟŽŶ͘ ůĂƌŐĞ ǀŝĐƚŽƌLJ ŝŶ ƚŚĞ ǁĂƐ ƚŚĞ ĂĐŬŶŽǁůĞĚŐĞŵĞŶƚ ƚŚĂƚ Ăůů ŵĞƌŝĐĂŶƐ ĚĞƐĞƌǀĞ ĂĐĐĞƐƐ ƚŽ ďĂƐŝĐ ƉƌĞǀĞŶƟǀĞ ŚĞĂůƚŚ ĐĂƌĞ͕ ŝŶĐůƵĚŝŶŐ ǁĞůůͲǁŽŵĂŶ ǀŝƐŝƚƐ ĂŶĚ Ăůů &ŽŽĚ ĂŶĚ ƌƵŐ ĚŵŝŶŝƐƚƌĂƟŽŶ ;& ͿͲĂƉƉƌŽǀĞĚ ĐŽŶƚƌĂĐĞƉƟǀĞƐ͕ ǁŝƚŚŽƵƚ

ƉĂLJŝŶŐ ŽƵƚͲŽĨͲƉŽĐŬĞƚ͘ >Ğƚ͛Ɛ ŶŽƚ ůĞƚ ƚŚŝƐ ǀŝĐƚŽƌLJ ďĞ ƐǁĞƉƚ ĂǁĂLJ͘ tĞ ĐĂƌĞ ĨŽƌ ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶƐ͕ ĂŶĚ ǁĞ ƐĞĞ ƚŚĞ ŝŵƉĂĐƚ ŽĨ ƵŶŝŶƚĞŶĚĞĚ ƉƌĞŐŶĂŶĐŝĞƐ ŽŶ ĞĂĐŚ ǁŽŵĂŶ͛Ɛ ǁĞůůͲďĞŝŶŐ͘ >ĂƐƚ ǁĞĞŬ͕ ǁĞ ƐĂǁ Ă ϮϴͲLJĞĂƌͲŽůĚ ǁŽŵĂŶ ǁŚŽ ǁĂƐ ŝŶ Ă ŶĞǁ ƌĞůĂƟŽŶƐŚŝƉ ĂŶĚ ǁĂŶƚĞĚ ƚŽ ŬĞĞƉ ŚĞƌƐĞůĨ ĨƌŽŵ ŐĞƫŶŐ ƉƌĞŐŶĂŶƚ͘ ^ŚĞ ǁĂŶƚĞĚ Ă DŝƌĞŶĂ /h ͕ ďƵƚ ŚĂĚ ƌĞĐĞŶƚůLJ ůŽƐƚ ŚĞƌ ũŽď͕ ĚŝĚ ŶŽƚ LJĞƚ ŵĞĞƚ ƚŚĞ ŝŶĐŽŵĞ ƌĞƋƵŝƌĞŵĞŶƚ ĨŽƌ ƚŚĞ ƐƚĂƚĞ ƉƌŽŐƌĂŵ &ĂŵWĂĐƚ͕ ĂŶĚ ĐŽƵůĚ ŶŽƚ ĂīŽƌĚ ƚŚĞ ΨϳϬϬ ĨŽƌ Ă DŝƌĞŶĂ͘ 'ŝǀĞŶ ŚĞƌ ŚŝƐƚŽƌLJ ŽĨ ĐŽŵƉůŝĐĂƚĞĚ ŵŝŐƌĂŝŶĞƐ͕ ƐŚĞ ĞŶĚĞĚ ƵƉ ůĞĂǀŝŶŐ ǁŝƚŚ Ă ďĂŐ ŽĨ ĐŽŶĚŽŵƐ ĂŶĚ Ă ƉůĞĂ ƚŽ ĮŶĚ ĐŽǀĞƌĂŐĞ͘ 'ŝǀŝŶŐ ŽƵƌ ƉĂƟĞŶƚ ƚŚĞ ƉŽǁĞƌ ƚŽ ĐŽŶƚƌŽů ŚĞƌ ůŝĨĞ ƚƌĂũĞĐƚŽƌLJ ƐƚĂƌƚƐ ǁŝƚŚ ƚŚĞ ƉŽǁĞƌ ƚŽ ĐŽŶƚƌŽů ŚĞƌ ŽǁŶ ƌĞƉƌŽĚƵĐƟǀĞ ŚĞĂůƚŚ͘ dŚĞ ,ŽďďLJ >ŽďďLJ ĚĞĐŝƐŝŽŶ ĂůůŽǁƐ ĐŽƌƉŽƌĂƟŽŶƐ ĂŶĚ ĞdžĞĐƵƟǀĞ ŽĸĐĞƌƐ ƚŽ ĚŝĐƚĂƚĞ ƚŽ ĨĞŵĂůĞ ĞŵƉůŽLJĞĞƐ ůŝŵŝƚƐ ŽŶ ƚŚĞŝƌ ƌĞƉƌŽĚƵĐƟǀĞ ŚĞĂůƚŚ͘ tŽŵĞŶ ƉĂLJ ĨŽƌ ƚŚĞŝƌ ŝŶƐƵƌĂŶĐĞ ǁŝƚŚ ƚŚĞŝƌ ŚĂƌĚ ǁŽƌŬ͕ ĂŶĚ ƚŚĞƌĞ ŝƐ ŶŽƚŚŝŶŐ ͞ĨƌĞĞ͟ ĂďŽƵƚ ƚŚĞ ŝŶĐůƵƐŝŽŶ ŽĨ ĐŽǀĞƌĂŐĞ ĨŽƌ ĐŽŶƚƌĂĐĞƉƟŽŶ͕ ĂƐ ƐŽŵĞ ŵŝŐŚƚ ĐůĂŝŵ͘ /Ŷ ƚŚĞƐĞ ƐƟůů ĚŝĸĐƵůƚ ĞĐŽŶŽŵŝĐ ƟŵĞƐ͕ ƉĂƟĞŶƚƐ ƐŚŽƵůĚ ŶŽƚ ďĞ ƉůĂĐĞĚ ŝŶ ƚŚĞ ƉŽƐŝƟŽŶ ŽĨ ĐŚŽŽƐŝŶŐ ďĞƚǁĞĞŶ ĐŽŶƚƌĂĐĞƉƟŽŶ ĂŶĚ ƚŚĞŝƌ ŵŽŶƚŚůLJ ŚŽƵƐĞŚŽůĚ ďŝůůƐ͘ tĞ ĂƌĞ ĚĞĞƉůLJ ĚŝƐĂƉƉŽŝŶƚĞĚ ƚŚĂƚ ƚŚĞ ŽƵƌƚ ŚĂƐ ƉůĂĐĞĚ ƚŚĞ ƉĞƌƐŽŶĂů ďĞůŝĞĨƐ ŽĨ ƚŚĞ ĨĞǁ ĂŚĞĂĚ ŽĨ ƚŚĞ ƉƌĞǀĞŶƟǀĞ ŶĞĞĚƐ ŽĨ ƚŚĞ ŵĂŶLJ͘ ůĞĐƟŶŐ ƌĞƉƌĞƐĞŶƚĂƟǀĞƐ ŝŶ ŽŶŐƌĞƐƐ ƚŚŝƐ LJĞĂƌ ǁŚŽ ǀĂůƵĞ ǁŽŵĞŶ͛Ɛ ŚĞĂůƚŚ ĐĂƌĞ ƌŝŐŚƚƐ ŝƐ ŽƵƌ ŽŶůLJ ŚŽƉĞ ƚŽ ƌĞŵĞĚLJ ƚŚŝƐ ŝŶũƵƐƟĐĞ͘ /ƚ ǁĂƐ ŽŶŐƌĞƐƐ͛ ZĞůŝŐŝŽƵƐ &ƌĞĞĚŽŵ ZĞƐƚŽƌĂƟŽŶ Đƚ ŽĨ ϭϵϵϯ ƚŚĂƚ ŐĂǀĞ ƚŚĞ ĮǀĞ ^ƵƉƌĞŵĞ ŽƵƌƚ ũƵƐƟĐĞƐ ůĞŐĂů ƚƌĂĐƟŽŶ ŝŶ ƚŚĞ ,ŽďďLJ >ŽďďLJ ƌƵůŝŶŐ͘ tĞ ƵƌŐĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ĂĚǀŽĐĂƚĞ ĨŽƌ ǁŽŵĞŶ͛Ɛ ŚĞĂůƚŚ ĐĂƌĞ ƌŝŐŚƚƐ ĂŶĚ ĂƐŬ ƚŚĞŝƌ ƌĞƉƌĞƐĞŶƚĂƟǀĞƐ ƚŽ ƐƵƉƉŽƌƚ ůĞŐŝƐůĂƟŽŶ ůŝŬĞ ƚŚĞ WƌŽƚĞĐƚ tŽŵĞŶ͛Ɛ ,ĞĂůƚŚ ĨƌŽŵ ŽƌƉŽƌĂƚĞ /ŶƚĞƌĨĞƌĞŶĐĞ Đƚ ƚŚĂƚ ǁĂƐ ƌĞĐĞŶƚůLJ ďůŽĐŬĞĚ ďLJ ^ĞŶĂƚĞ ZĞƉƵďůŝĐĂŶƐ͘ dŽ ĮŶĚ ŽƵƚ ŚŽǁ LJŽƵ ĐĂŶ ďĞĐŽŵĞ ŝŶǀŽůǀĞĚ ǁŝƚŚ &W͛Ɛ ĂĚǀŽĐĂĐLJ ĞīŽƌƚƐ͕ ƉůĞĂƐĞ ǀŝƐŝƚ ƚŚĞ ͞ ĚǀŽĐĂĐLJ ĐƟŽŶ ĞŶƚĞƌ͟ ůŽĐĂƚĞĚ ŽŶ &W͛Ɛ ǁĞďƐŝƚĞ͘ dŚĞŝƌ ĐĞŶƚĞƌ ĐŽŶƚĂŝŶƐ ŝŶĨŽƌŵĂƟŽŶ ĂďŽƵƚ ĐŽŶƚĂĐƟŶŐ LJŽƵƌ ůĞŐŝƐůĂƚŽƌ͕ ũŽŝŶŝŶŐ ŽƵƌ ŬĞLJ ĐŽŶƚĂĐƚ ƉƌŽŐƌĂŵ͕ ŝŶĨŽƌŵĂƟŽŶ ŽŶ &W͛Ɛ ƉƌŝŽƌŝƚLJ ůĞŐŝƐůĂƟŽŶ ĂŶĚ ŵŽƌĞ͘ California Family Physician Fall 2014

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Reawakening the Counterculture: #FMRevolution /ƚ ǁĂƐ ůĂƚĞ Ăƚ ŶŝŐŚƚ ĂŶĚ / ǁĂƐ ƌĞƐĞĂƌĐŚŝŶŐ͕ ŽĨ Ăůů ƚŚŝŶŐƐ͕ ƚŚĞ ŽƌŝŐŝŶƐ ĂŶĚ ŵĞĂŶŝŶŐ ŽĨ η&DZĞǀŽůƵƟŽŶ͕ ƚŚĞ ƌŽůĞ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ ĂƐ Ă ŐĂůǀĂŶŝnjŝŶŐ ĨŽƌĐĞ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ ǁŚĂƚ ŝƚ ƌĞĂůůLJ ŵĞĂŶƐ ƚŽ ďĞ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ŝŶ ŽƵƌ ĐƵƌƌĞŶƚ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͘ / ŚĂǀĞ ŽŌĞŶ ŚĞĂƌĚ ĂďŽƵƚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͛Ɛ ŽƌŝŐŝŶ ĂƐ Ă ĐŽƵŶƚĞƌ ĐƵůƚƵƌĞ ŵŽǀĞŵĞŶƚ͕ ďƵƚ ĂƐ Ă ƚƌĂŝŶĞĞ ŚĂůĨͲĂͲĐĞŶƚƵƌLJ ƌĞŵŽǀĞĚ ĨƌŽŵ ƚŚĞ ƐŽĐŝĂů ƵƉŚĞĂǀĂů ŽĨ ƚŚĞ ϭϵϲϬƐ͕ ŝƚ ǁĂƐŶ͛ƚ ĐůĞĂƌ ƚŽ ŵĞ ǁŚĂƚ ƚŚĂƚ ƌĞĂůůLJ ŵĞĂŶƚ͘ ƌ͘ '͘ 'ĂLJůĞ ^ƚĞƉŚĞŶƐ͛ ƐĞŵŝŶĂů ǁŽƌŬ͕ ͞&ĂŵŝůLJ DĞĚŝĐŝŶĞ ĂƐ ŽƵŶƚĞƌĐƵůƚƵƌĞ͕͟ ŽƌŝŐŝŶĂůůLJ ƉƌĞƐĞŶƚĞĚ ŝŶ ϭϵϳϵ͕ ǁĂƐ ƚŚĞ ƌĞǀŽůƵƟŽŶĂƌLJ ƐƉĂƌŬ ƚŚĂƚ ŚƵŵďůLJ ĚĞĮŶĞĚ ŵĂŶLJ ŽĨ ŽƵƌ ǀĂůƵĞƐ ĂƐ Ă ƐƉĞĐŝĂůƚLJ͕ ŝĚĞŶƟĨLJŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ͞… with issues that have deep roots in American history͗ the preservaƟon of rural life, humane values, consumerism, and the rights of women.͟ dŚĞ ĐŽŶĐĞƉƚ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞǀŽůƵƟŽŶ͕ ƚŚĞ ŝĚĞĂůƐ ĂŶĚ ǀŝƌƚƵĞƐ ƚŚĂƚ ĚƌŝǀĞ ŽƵƌ ƉĂƐƐŝŽŶ͕ ďĞŐĂŶ ĚĞĐĂĚĞƐ ďĞĨŽƌĞ ƚŚĞ /ŶƚĞƌŶĞƚ͘ Ɛ ĂŶ ŝŶƚĞƌŶ͕ / ƌĞĂůŝnjĞ / Ăŵ ĮŶĂůůLJ ũŽŝŶŝŶŐ ƚŚĞ ƌĂŶŬƐ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ƚƌĂŝŶ ĂŶĚ ĨƵůĮůů ǁŚĂƚ / ďĞůŝĞǀĞ ƚŽ ďĞ ŵLJ ůŝĨĞ͛Ɛ ƉƵƌƉŽƐĞ͗ ƚŽ ďĞ Ă ƌĞƐŽƵƌĐĞ ĨŽƌ ƚŚĞ ŚĞĂůƚŚ ŽĨ ŵLJ ĐŽŵŵƵŶŝƚLJ͕ ƚŽ ďĞ ĂŶ ĂĚǀŽĐĂƚĞ͕ Ă ƐŽĐŝĂů ĂĐƟǀŝƐƚ ĂŶĚ Ă ŚĞĂůĞƌ͘ dŚĞƐĞ ĂƌĞ ŚĞĂǀLJ ǁŽƌĚƐ͕ ŽŶĞƐ / ŚĂǀĞ ƌĂƌĞůLJ ƐŚĂƌĞĚ ĚƵƌŝŶŐ ŵĞĚŝĐĂů ƐĐŚŽŽů͕ ƵŶƐƵƌĞ ŽĨ ŚŽǁ ƚŽ ƌĞƐƉŽŶĚ ƚŽ ƚŚĞ ĐLJŶŝĐŝƐŵ / ǁŽƵůĚ ŝŶĞǀŝƚĂďůLJ ĞŶĐŽƵŶƚĞƌ͘ tĞ ŚĂǀĞ ďĞĞŶ ƚŽŽ ĚĞĞƉůLJ ŝŵŵĞƌƐĞĚ ŝŶ ƚŚĞ ďĂƐŝĐ ƐĐŝĞŶĐĞƐ͕ ŝŶ ŝŶŶŽǀĂƟǀĞ ƌĞƐĞĂƌĐŚ ĂŶĚ ŶĞǁ ƚŚĞƌĂƉŝĞƐ͕ ĚŝƐĞĂƐĞ ŵĞĐŚĂŶŝƐŵƐ ĂŶĚ ƚŚĞŝƌ ƐĞƋƵĞůĂĞ͕ ƚŚĂƚ ƐƵĐŚ ǁŽƌĚƐ ŚĞůĚ ůŝƩůĞ ǀĂůƵĞ͘ ďŽǀĞ Ăůů͕ ǁĞ ĨĂĐĞ Ă ŚĞĂůƚŚĐĂƌĞ ƐLJƐƚĞŵ ŝŶ ƚƵƌŵŽŝů͕ ĂŶĚ ĞǀĞƌLJ ĚĂLJ / ƌĞĂĚ ŶĞǁƐ ĂƌƟĐůĞƐ ĂďŽƵƚ ǁŚLJ ŐŽŝŶŐ ŝŶƚŽ ŵĞĚŝĐŝŶĞ ǁĂƐ Ă ŵŝƐƚĂŬĞ͖ ĂďŽƵƚ ŚŽǁ ǁĞ ĂƌĞ ďƵƌŶĞĚ ŽƵƚ͕ ƵŶĚĞƌƉĂŝĚ ĂŶĚ ŝŶ ĚĞďƚ͘ Ɛ Ă ĐŽůůĞĂŐƵĞ ĂƐƚƵƚĞůLJ ƉŽŝŶƚĞĚ ŽƵƚ͕ ŝĚĞĂůŝƐŵ ĂůŽŶĞ ǁŝůů ŶŽƚ ďĞŶĚ ƚŚĞ ĐŽƐƚ ĐƵƌǀĞ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ŝŶ ƚŚŝƐ ĐŽƵŶƚƌLJ͕ ŶŽƌ ǁŝůů ŝƚ ĂĚĚƌĞƐƐ ƚŚĞ ƉƌĂĐƟĐĂů ŝƐƐƵĞƐ ƚŚĂƚ ƉůĂŐƵĞ ŽƵƌ ƐLJƐƚĞŵ ƐƵĐŚ ĂƐ ƚŚĞ ŶĞĞĚ ĨŽƌ ƐƵƐƚĂŝŶĂďůĞ ŐƌŽǁƚŚ ƌĂƚĞ ;^'ZͿ ƌĞƉĞĂů͘ / Ăŵ ĐĞƌƚĂŝŶ͕ ŚŽǁĞǀĞƌ͕ ƚŚĂƚ ƵŶďƌŝĚůĞĚ ĐLJŶŝĐŝƐŵ ǁŝůů ŶŽƚ ƐŽůǀĞ ŽƵƌ ƉƌŽďůĞŵƐ͘ KŶůLJ ĂŵŽŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŚĂǀĞ / ŚĞĂƌĚ ĐŽŶǀĞƌƐĂƟŽŶƐ ĂďŽƵƚ ŚĞĂůƚŚ ĐĂƌĞ ƌĞĨŽƌŵ͕ ƐŽĐŝĂů ũƵƐƟĐĞ͕ ĐĂƌĞ ĨŽƌ ƚŚĞ ƵŶĚĞƌƐĞƌǀĞĚ ĂŶĚ ƵŶĚŽĐƵŵĞŶƚĞĚ ĂŶĚ ƚŚĞ ŶĞĞĚ ĨŽƌ ƌĞǀŽůƵƟŽŶ͘ KŶůLJ ĂŵŽŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŚĂǀĞ / ďĞĞŶ ĞŶĐŽƵƌĂŐĞĚ ƚŽ ƉĂƌƟĐŝƉĂƚĞ͕ ƚŽ ďĞ Ă ƉĂƌƚ ŽĨ ŽƵƌ ĐƵƌƌĞŶƚ ĞƌĂ ŽĨ η&DZĞǀŽůƵƟŽŶ ĂŶĚ ŚĞůƉ ĚĞĮŶĞ ǁŚĂƚ ŝƚ ŵĞĂŶƐ ƚŽ ŽƵƌ ŐĞŶĞƌĂƟŽŶ͘ Ɛ ƌ͘ DĂƌĐŽ 20

California Family Physician Fall 2014

ŶŐƵůŽ͕ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ Ăƚ ƚŚĞ hŶŝǀĞƌƐŝƚLJ ŽĨ ĂůŝĨŽƌŶŝĂ͕ /ƌǀŝŶĞ͕ ŽŶĐĞ ƐĂŝĚ ƚŽ ŵĞ ŝŶ ƟŵĞƐ ŽĨ ŐƌĞĂƚ ƋƵĞƐƟŽŶŝŶŐ͕ ͞/Ĩ ŶŽƚ LJŽƵ͕ ƚŚĞŶ ǁŚŽ͍͟ / ǁŽƵůĚ ĂƌŐƵĞ ƚŚĂƚ ĞǀĞƌLJ ŽƵŶĐĞ ŽĨ ĐLJŶŝĐŝƐŵ / ŚĂǀĞ ƐĞĞŶ ŚĂƐ ďĞĞŶ ŵĞƚ ďLJ ƚŚĞ ƉĂƐƐŝŽŶ ĂŶĚ ĨƵƌLJ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŽŶ ĂƉŝƚŽů ,ŝůů͘ dŚŽƐĞ ƉŚLJƐŝĐŝĂŶƐ ƉƌŽƵĚůLJ ŚŽůĚ ďĂŶŶĞƌƐ ĂŶĚ ĂĚǀŽĐĂƚĞ͕ ŝŶ ĨƌŽŶƚ ŽĨ ŵŝĐƌŽƉŚŽŶĞƐ ĂŶĚ ŽŶ ƐŽĐŝĂů ŵĞĚŝĂ͕ ŶŽƚ ŽŶůLJ ĨŽƌ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ͕ ďƵƚ ĂůƐŽ ĨŽƌ ďŝůůƐ ƚŚĂƚ ĚŝƌĞĐƚůLJ ĂīĞĐƚ ƚŚĞ ŚĞĂůƚŚ ŽĨ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ ŽƵƌ ƉĂƟĞŶƚƐ͘ / Ăŵ ĐŽŶǀŝŶĐĞĚ ƚŚĂƚ Ă ƐƚƌĂƚĞŐŝĐ͕ ƉƌĂĐƟĐĂů ŝĚĞĂůŝƐŵ ĂŶĚ Ă ŐƌĞĂƚ ƐĞŶƐĞ ŽĨ ƉƵƌƉŽƐĞ ǁŝůů ďĞ ƚŚĞ ŬĞLJƐ ƚŽ ŵĂŬŝŶŐ ƉƌŽŐƌĞƐƐ͘ Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ŚĂǀĞ ŝŶŚĞƌŝƚĞĚ ƚŚĞ ĨŽƌŵŝĚĂďůĞ ƚĂƐŬ ŽĨ ŚĞůƉŝŶŐ ƌĞĨŽƌŵ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͕ ŽŶĞ ƚŚĂƚ ŝƐ ĞǀĞŶ ůĂƌŐĞƌ ĂŶĚ ŵŽƌĞ ĐŽŵƉůĞdž ƚŚĂŶ ŽƵƌ ƉƌĞĚĞĐĞƐƐŽƌƐ ĨĂĐĞĚ͘ ƌ͘ ^ƚĞƉŚĞŶƐ͕ ǁŚŽ ƉĂƐƐĞĚ ĂǁĂLJ ĞĂƌůŝĞƌ ƚŚŝƐ LJĞĂƌ͕ ůĞŌ ƵƐ ǁŝƚŚ Ă ůĞŐĂĐLJ ƌŽŽƚĞĚ ĮƌŵůLJ ŝŶ ĐŽƵŶƚĞƌĐƵůƚƵƌĞ͘ tĞ ŚĂǀĞ ďĞĐŽŵĞ ƚŚĞ ĂƌďŝƚĞƌƐ ŽĨ ƌĞǀŽůƵƟŽŶ͘ KƵƌ ƟŵĞ ŝƐ ŶŽǁ͘ David Tran is a medical resident at UCI and Co-Vice Chair of the CAFP Student Council.

California Legislature Declares 2014 the Year of the Family Physician /ƚ͛Ɛ ŽĸĐŝĂů͗ ϮϬϭϰ ŝƐ ƚŚĞ zĞĂƌ ŽĨ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ ŝŶ ĂůŝĨŽƌŶŝĂ͊ dŚĞ ^ƚĂƚĞ ƐƐĞŵďůLJ ĂŶĚ ^ĞŶĂƚĞ ƉĂƐƐĞĚ Ă ƌĞƐŽůƵƟŽŶ ƌĞĐŽŐŶŝnjŝŶŐ ƚŚĞ ĞƐƐĞŶƟĂů ƌŽůĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƉůĂLJ ŝŶ ƚŚĞ ƐƚĂƚĞ͛Ɛ ĞdžƚĞŶƐŝǀĞ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͘ ͞tĞ ƌĞĐŽŐŶŝnjĞ ƚŚĞ ĐƌŝƟĐĂůůLJ ŝŵƉŽƌƚĂŶƚ ƐĞƌǀŝĐĞƐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂƌĞ ƉƌŽǀŝĚŝŶŐ ĨŽƌ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ ĂƐ ŶĂƟŽŶĂů ŚĞĂůƚŚ ĐĂƌĞ ƌĞĨŽƌŵ ƌŽůůƐ ŽƵƚ ŝŶ ŽƵƌ ƐƚĂƚĞ͕͟ ƐĂŝĚ ƐƐĞŵďůLJŵĞŵďĞƌ ZŝĐŚĂƌĚ ůŽŽŵ ; Ͳ^ĂŶƚĂ DŽŶŝĐĂͿ͕ ǁŚŽ ĂƵƚŚŽƌĞĚ ƐƐĞŵďůLJ ŽŶĐƵƌƌĞŶƚ ZĞƐŽůƵƟŽŶ ; ZͿ ϭϬϳ͘ dŚĞ ŝŵƉůĞŵĞŶƚĂƟŽŶ ŽĨ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ ŚĂƐ ůĞĚ ƚŽ Ă ƐŝŐŶŝĮĐĂŶƚ ĚĞŵĂŶĚ ĨŽƌ ĞdžƉĞƌŝĞŶĐĞĚ ĂŶĚ ǁĞůůͲƚƌĂŝŶĞĚ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽĨĞƐƐŝŽŶĂůƐ ǁŚŽ ĐĂŶ ƚƌĞĂƚ Ă ǁŝĚĞ ǀĂƌŝĞƚLJ ŽĨ ŚĞĂůƚŚ ĐŽŶĚŝƟŽŶƐ ĂŶĚ ĐŽŵƉĂƐƐŝŽŶĂƚĞůLJ ŐƵŝĚĞ ƉĂƟĞŶƚƐ ƚŚƌŽƵŐŚ ŽƵƌ ĐŽŵƉůĞdž ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͘ ZĞƐĞĂƌĐŚ ƐŚŽǁƐ ƚŚĂƚ ŝŶĚŝǀŝĚƵĂůƐ ǁŚŽ ƌĞŐƵůĂƌůLJ ǀŝƐŝƚ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ŝŶ Ă ƉĂƟĞŶƚͲĐĞŶƚĞƌĞĚ ŵĞĚŝĐĂů ŚŽŵĞ ŵŽĚĞů ŽĨ ƉƌĂĐƟĐĞ ĂƌĞ ŵŽƌĞ ůŝŬĞůLJ ƚŽ ƌĞĐĞŝǀĞ ƉƌĞǀĞŶƟǀĞ ƐĞƌǀŝĐĞƐ ĂŶĚ ďĞƩĞƌ ŵĂŶĂŐĞŵĞŶƚ ŽĨ ĐŚƌŽŶŝĐ ŝůůŶĞƐƐĞƐ͘ dŚĞLJ ƐƚĂLJ ŚĞĂůƚŚŝĞƌ ĂŶĚ ůŝǀĞ ůŽŶŐĞƌ͘ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂůƐŽ ŽŌĞŶ ǁŽƌŬ ǁŝƚŚ ƵŶĚĞƌƐĞƌǀĞĚ ƉĂƟĞŶƚƐ͕ ŚĞůƉŝŶŐ ƚŽ ƌĞĚƵĐĞ ŚĞĂůƚŚ ĐĂƌĞ ĚŝƐƉĂƌŝƟĞƐ͘

ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŚĂǀĞ ďĞĞŶ ƌĂůůLJŝŶŐ ĂƌŽƵŶĚ ƚŚĞ ƐůŽŐĂŶ ͞ϮϬϭϰ͗ dŚĞ zĞĂƌ ŽĨ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ͘͟ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŚĂǀĞ ƉƌŝŶƚĞĚ ŽƵƚ ϮϬϭϰ zĞĂƌ ŽĨ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ƉůĂĐĂƌĚƐ ĂŶĚ ƚĂŬĞŶ ƉŚŽƚŽƐ ǁŝƚŚ ƚŚĞŵ Ăůů ĂĐƌŽƐƐ ƚŚĞ ǁŽƌůĚ͕ ĨƌŽŵ DĞdžŝĐŽ ƚŽ dŚĂŝůĂŶĚ ƚŽ :ĂŵĂŝĐĂ͖ ǁŝƚŚ ůĞŐŝƐůĂƚŽƌƐ ĂŶĚ ĨĂŵŝůLJ͖ Ăƚ &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ ĂLJ ĂŶĚ &ĂŵŝůLJ DĞĚŝĐŝŶĞ >ŽďďLJ ĂLJ͖ ǁŝƚŚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ŽŶ DĂƚĐŚ ĂLJ ĂƐ ƚŚĞLJ ĨŽƵŶĚ ŽƵƚ ŝŶ ǁŚŝĐŚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵ ƚŚĞLJ ǁŝůů ƚƌĂŝŶ͖ ŽŶ ƌŽŽŌŽƉƐ ĂŶĚ ŚŝůůƚŽƉƐ Ăůů ŽǀĞƌ ƚŚĞ ĐŽƵŶƚƌLJ ƚŽ ŵĂŬĞ ƐƵƌĞ ĞǀĞƌLJŽŶĞ ŬŶŽǁƐ ƚŚĞ ǀĂůƵĞ ŽĨ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͘ /Ŷ ĂĚĚŝƟŽŶ ƚŽ ƚŚĞ ƐƚĂƚĞ͕ ƚŚƌĞĞ ĂůŝĨŽƌŶŝĂ ĐŝƟĞƐ ŚĂǀĞ ĂůƐŽ ŶĂŵĞĚ ϮϬϭϰ ĂƐ ƚŚĞ zĞĂƌ ŽĨ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ͘ ;dŚĞƌĞ͛Ɛ ƐƟůů ƟŵĞ ĨŽƌ zKh ƚŽ ĂƐŬ LJŽƵƌ ůŽĐĂů ƐƵƉĞƌǀŝƐŽƌ ƚŽ ŝŶƚƌŽĚƵĐĞ ĂŶĚ ƐĞĞŬ ĂĚŽƉƟŽŶ ŽĨ ƐƵĐŚ Ă ƌĞƐŽůƵƟŽŶ ʹ ĐŽŶƚĂĐƚ &W Ăƚ ĐĂĨƉΛĨĂŵŝůLJĚŽĐƐ͘ŽƌŐ ƚŽ ĂƐŬ ŚŽǁ͘Ϳ tŚŝůĞ ϮϬϭϰ ŝƐ ƚŚĞ zĞĂƌ ŽĨ ƚŚĞ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ͕ ĞǀĞƌLJ ĚĂLJ ŝƐ ƚŚĞ ĚĂLJ ŽĨ ƚŚĞ ƉĂƟĞŶƚ͘ īŽƌƚƐ ƚŽ ƉƌŽŵŽƚĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂƌĞ ƌĞĂůůLJ ĞīŽƌƚƐ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ ƉĂƟĞŶƚƐ ŚĂǀĞ ĂĐĐĞƐƐ ƚŽ ƚŚĞ ĐŽŵƉƌĞŚĞŶƐŝǀĞ͕ ĐŽŽƌĚŝŶĂƚĞĚ ƉƌŝŵĂƌLJ ĐĂƌĞ ƚŚĞLJ ŶĞĞĚ ĂŶĚ ĚĞƐĞƌǀĞ͘

dŚĞ &W ŝƐ ǁŽƌŬŝŶŐ ŽŶ Ă ŶƵŵďĞƌ ŽĨ ĨƌŽŶƚƐ ƚŽ ƌĂŝƐĞ ĂǁĂƌĞŶĞƐƐ ǁŝƚŚ ůĞŐŝƐůĂƚŽƌƐ͕ ŚĞĂůƚŚ ƐLJƐƚĞŵƐ ĂŶĚ ƚŚĞ ƉƵďůŝĐ Ăƚ ůĂƌŐĞ ƚŚĂƚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĚĞůŝǀĞƌ ƚŚŝƐ ŬŝŶĚ ŽĨ ĐĂƌĞ ĞǀĞƌLJ ĚĂLJ͘ dŚƌŽƵŐŚŽƵƚ ƚŚŝƐ LJĞĂƌ͕

&Žƌ ƚŚĞ ĨƵůů ƚĞdžƚ ŽĨ ƚŚĞ ƌĞƐŽůƵƟŽŶ ƉůĞĂƐĞ ǀŝƐŝƚ ƚŚĞ ůĞŐŝƐůĂƟŽŶ ƉĂŐĞ ŽŶ ĐĂ͘ŐŽǀ͗ ŚƩƉ͗ͬ​ͬůĞŐŝŶĨŽ͘ĐĂ͘ŐŽǀͬƉƵďͬϭϯͲϭϰͬďŝůůͬĂƐŵͬĂďͺϬϭϬϭͲ ϬϭϱϬͬĂĐƌͺϭϬϳͺďŝůůͺϮϬϭϰϬϮϮϭͺŝŶƚƌŽĚƵĐĞĚ͘Śƚŵ

More than four dozen CAFP members spent a day visiƟng legislators during CAFP’s Lobby Day in Sacramento.

California Family Physician Fall 2014

21

Because we can’t redesign thumbs

We designed FlexTouch® Introducing [NEW] Levemir ® FlexTouch® The only prefilled insulin pen with no push-button extension 2 Low injection force1 2 Dosing from 1 to 80 units - End-of-dose clicka - Available on more than 96% of managed care plans nationwide2,b

Text to Experience FlexTouch® Both pens are shown at maximum dose.

Text TOUCH to 51212 to discover the Levemir® FlexTouch® differencec

Get in touch with your Novo Nordisk representative or visit levemirpro.com today a

Patient may or may not hear an audible click at end of dose. Dose is delivered when dial resets to 0 and the needle is held under the skin for 6 seconds. Please see Instructions For Use for complete instructions.

Intended as a guide. Lower acquisition costs alone do not necessarily reflect a cost advantage in the outcome of the condition treated because there are other variables that affect relative costs. Formulary status is current as of March 2014 and is subject to change. c By texting TOUCH to 51212, you consent to receive a one-time text message containing a link to the requested information from Novo Nordisk. Your consent is voluntary and you are not required to consent to receive information or other benefits from Novo Nordisk. Standard text messaging rates will apply. b

Indications and Usage G Levemir ® (insulin detemir [rDNA origin] injection) is indicated to improve glycemic control in adults and children with diabetes mellitus.

Important Limitations of Use G Levemir ® is not recommended for the treatment of diabetic ketoacidosis.

Intravenous rapid-acting or short-acting insulin is the preferred treatment for this condition.

Important Safety Information Contraindications G Levemir ® is contraindicated in patients with hypersensitivity to Levemir ® or any of its excipients.

Warnings and Precautions G Dosage adjustment and monitoring: Monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified cautiously and only under medical supervision.

G Administration: Do not dilute or mix with any other insulin or solution.

Do not administer subcutaneously via an insulin pump, intramuscularly, or intravenously because severe hypoglycemia can occur.

G Hypoglycemia: Hypoglycemia is the most common adverse reaction of insulin therapy and may be life-threatening. When a GLP-1 receptor agonist is used in combination with Levemir ®, the Levemir ® dose may need to be lowered or more conservatively titrated to minimize the risk of hypoglycemia.

G Hypersensitivity and allergic reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulin products, including Levemir ®.

California Family Physician Fall 2014

G Renal and hepatic impairment: Careful glucose monitoring and dose adjustments of insulin, including Levemir ®, may be necessary in patients with renal or hepatic impairment.

G Fluid retention and heart failure with concomitant use of PPAR-gamma agonists: Fluid retention and heart failure can occur with concomitant use of thiazolidinediones (TZDs), which are PPAR-gamma agonists, and insulin, including Levemir ®.

Adverse Reactions G Adverse reactions associated with Levemir ® include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, rash, pruritus, and if taken with GLP-1 receptor agonist, diarrhea.

Needles and Levemir® FlexTouch® should never be shared.

Use in Specific Populations G Levemir® has not been studied in children with type 2 diabetes or in children with type 1 diabetes who are younger than 2 years of age.

G The background risk of birth defects, pregnancy loss, or other adverse events that exists for all pregnancies is increased in pregnancies complicated by hyperglycemia.

Please see Important Safety Information. Please see brief summary of Prescribing Information on adjacent pages.

Needles are sold separately and may require a prescription in some states.

References: 1. Wielandt JO, Niemeyer M, Hansen MR, Bucher D, Thomsen NB. An assessment of dose accuracy and injection force of a novel prefilled insulin pen: comparison with a widely used prefilled insulin pen. Expert Opin Drug Deliv. 2011;8(10):1271-1276. 2. Fingertip Formulary®, March 2014.

FlexTouch® and Levemir ® are registered trademarks of Novo Nordisk A/S. © 2014 Novo Nordisk Printed in the U.S.A. 0314-00020498-2 June 2014

LEVEMIR® (insulin detemir [rDNA origin] injection) Rx ONLY BRIEF SUMMARY: Please consult package insert for full prescribing information.

INDICATIONS AND USAGE: LEVEMIR® is indicated to improve glycemic control in adults and children with diabetes mellitus. Important Limitations of Use: LEVEMIR® is not recommended for the treatment of diabetic ketoacidosis. Intravenous rapid-acting or short-acting insulin is the preferred treatment for this condition.

CONTRAINDICATIONS: LEVEMIR® is contraindicated in patients with hypersensitivity to LEVEMIR® or any of its excipients. Reactions have included anaphylaxis.

WARNINGS AND PRECAUTIONS: Dosage adjustment and monitoring: Glucose monitoring is essential for all patients receiving insulin therapy. Changes to an insulin regimen should be made cautiously and only under medical supervision.

Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in the insulin dose or an adjustment of concomitant anti-diabetic treatment. As with all insulin preparations, the time course of action for LEVEMIR® may vary in different individuals or at different times in the same individual and is dependent on many conditions, including the local blood supply, local temperature, and physical activity. Administration: LEVEMIR® should only be administered subcutaneously. Do not administer LEVEMIR® intravenously or intramuscularly. The intended duration of activity of LEVEMIR® is dependent on injection into subcutaneous tissue. Intravenous or intramuscular administration of the usual subcutaneous dose could result in severe hypoglycemia. Do not use LEVEMIR® in insulin infusion pumps.

Do not dilute or mix LEVEMIR® with any other insulin or solution. If LEVEMIR® is diluted or mixed, the pharmacokinetic or pharmacodynamic profile (e.g., onset of action, time to peak effect) of LEVEMIR® and the mixed insulin may be altered in an unpredictable manner. Hypoglycemia: Hypoglycemia is the most common adverse reaction of insulin therapy, including LEVEMIR®. The risk of hypoglycemia increases with intensive glycemic control. When a GLP-1 receptor agonist is used in combination with LEVEMIR®, the LEVEMIR® dose may need to be lowered or more conservatively titrated to minimize the risk of hypoglycemia. All patients must be educated to recognize and manage hypoglycemia. Severe hypoglycemia can lead to unconsciousness or convulsions and may result in temporary or permanent impairment of brain function or death. Severe hypoglycemia requiring the assistance of another person or parenteral glucose infusion, or glucagon administration has been observed in clinical trials with insulin, including trials with LEVEMIR®. The timing of hypoglycemia usually reflects the time-action profile of the administered insulin formulations. Other factors such as changes in food intake (e.g., amount of food or timing of meals), exercise, and concomitant medications may also alter the risk of hypoglycemia. The prolonged effect of subcutaneous LEVEMIR® may delay recovery from hypoglycemia. As with all insulins, use caution in patients with hypoglycemia unawareness and in patients who may be predisposed to hypoglycemia (e.g., the pediatric population and patients who fast or have erratic food intake). The patient’s ability to concentrate and react may be impaired as a result of hypoglycemia. This may present a risk in situations where these abilities are especially important, such as driving or operating other machinery. Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions, such as longstanding diabetes, diabetic neuropathy, use of medications such as beta-blockers, or intensified glycemic control. These situations may result in severe hypoglycemia (and, possibly, loss of consciousness) prior to the patient’s awareness of hypoglycemia. Hypersensitivity and allergic reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulin products, including LEVEMIR®. Renal Impairment: No difference was observed in the pharmacokinetics of insulin detemir between non-diabetic individuals with renal impairment and healthy volunteers. However, some studies with human insulin have shown increased circulating insulin concentrations in patients with renal impairment.

Careful glucose monitoring and dose adjustments of insulin, including LEVEMIR®, may be necessary in patients with renal impairment. Hepatic Impairment: Nondiabetic individuals with severe hepatic impairment had lower systemic exposures to insulin detemir compared to healthy volunteers. However, some studies with human insulin have shown increased circulating insulin concentrations in patients with liver impairment. Careful glucose monitoring and dose adjustments of insulin, including LEVEMIR®, may be necessary in patients with hepatic impairment. Drug interactions: Some medications may alter insulin requirements and subsequently increase the risk for hypoglycemia or hyperglycemia. Fluid retention and heart failure with concomitant use of PPAR-gamma agonists: Thiazolidinediones (TZDs), which are peroxisome proliferator-activated receptor (PPAR)-gamma agonists, can cause dose-related fluid retention, particularly when used in combination with insulin.

Fluid retention may lead to or exacerbate heart failure. Patients treated with insulin, including LEVEMIR®, and a PPAR-gamma agonist should be observed for signs and symptoms of heart failure. If heart failure develops, it should be managed according to current standards of care, and discontinuation or dose reduction of the PPAR-gamma agonist must be considered.

ADVERSE REACTIONS: The following adverse reactions are discussed elsewhere: Hypoglycemia; Hypersensitivity and allergic reactions. Clinical trial experience: Because clinical trials are conducted under widely varying designs, the adverse reaction rates reported in one clinical trial may not be easily compared to those rates reported in another clinical trial, and may not reflect the rates actually observed in clinical practice. The frequencies of adverse reactions (excluding hypoglycemia)

reported during LEVEMIR® clinical trials in patients with type 1 diabetes mellitus and type 2 diabetes mellitus are listed in Tables 1-4 below. See Tables 5 and 6 for the hypoglycemia findings. In the LEVEMIR® add-on to liraglutide+metformin trial, all patients received liraglutide 1.8 mg + metformin during a 12-week run-in period. During the run-in period, 167 patients (17% of enrolled total) withdrew from the trial: 76 (46% of withdrawals) of these patients doing so because of gastrointestinal adverse reactions and 15 (9% of withdrawals) doing so due to other adverse events. Only those patients who completed the run-in period with inadequate glycemic control were randomized to 26 weeks of add-on therapy with LEVEMIR® or continued, unchanged treatment with liraglutide 1.8 mg + metformin. During this randomized 26-week period, diarrhea was the only adverse reaction reported in ≥5% of patients treated with liraglutide 1.8 mg + metformin (11.7%) and greater than in patients treated with liraglutide 1.8 mg and metformin alone (6.9%). In two pooled trials, a total of 1155 adults with type 1 diabetes were exposed to individualized doses of LEVEMIR® (n=767) or NPH (n=388).

The mean duration of exposure to LEVEMIR® was 153 days, and the total exposure to LEVEMIR® was 321 patient-years. The most common adverse reactions are summarized in Table 1.

Table 1: Adverse reactions (excluding hypoglycemia) in two pooled clinical trials of 16 weeks and 24 weeks duration in adults with type 1 diabetes (adverse reactions with incidence ≥ 5%) LEVEMIR®, % (n = 767) NPH, % (n = 388) Upper respiratory tract infection 26.1 21.4 Headache 22.6 22.7 Pharyngitis 9.5 8.0 Influenza-like illness 7.8 7.0 Abdominal Pain 6.0 2.6 A total of 320 adults with type 1 diabetes were exposed to individualized doses of LEVEMIR® (n=161) or insulin glargine (n=159). The mean duration of exposure to LEVEMIR® was 176 days, and the total exposure to LEVEMIR® was 78 patient-years.

The most common adverse reactions are summarized in Table 2.

Table 2: Adverse reactions (excluding hypoglycemia) in a 26-week trial comparing insulin aspart + LEVEMIR® to insulin aspart + insulin glargine in adults with type 1 diabetes (adverse reactions with incidence ≥ 5%) LEVEMIR®, % (n = 161) Glargine, % (n = 159) Upper respiratory tract infection 26.7 32.1 Headache 14.3 19.5 Back pain 8.1 6.3 Influenza-like illness 6.2 8.2 Gastroenteritis 5.6 4.4 Bronchitis 5.0 1.9 In two pooled trials, a total of 869 adults with type 2 diabetes were exposed to individualized doses of LEVEMIR® (n=432) or NPH (n=437). The mean duration of exposure to LEVEMIR® was 157 days, and the total exposure to LEVEMIR® was 186 patient-years.

The most common adverse reactions are summarized in Table 3.

Table 3: Adverse reactions (excluding hypoglycemia) in two pooled clinical trials of 22 weeks and 24 weeks duration in adults with type 2 diabetes (adverse reactions with incidence ≥ 5%) LEVEMIR®, % (n = 432) NPH, % (n = 437) Upper respiratory tract infection 12.5 11.2 Headache 6.5 5.3 A total of 347 children and adolescents (6-17 years) with type 1 diabetes were exposed to individualized doses of LEVEMIR® (n=232) or NPH (n=115). The mean duration of exposure to LEVEMIR® was 180 days, and the total exposure to LEVEMIR® was 114 patient-years. The most common adverse reactions are summarized in Table 4.

Table 4: Adverse reactions (excluding hypoglycemia) in one 26-week clinical trial of children and adolescents with type 1 diabetes (adverse reactions with incidence ≥ 5%) LEVEMIR®, % (n ( = 232)) NPH, % (n ( = 115)) Upper pp respiratory p y tract infection 35.8 42.6 Headache 31.0 32.2 Pharyngitis yg 17.2 20.9 Gastroenteritis 16.8 11.3 Influenza-like illness 13.8 20.9 Abdominal pain p 13.4 13.0 Pyrexia y 10.3 6.1 Cough g 8.2 4.3 Viral infection 7.3 7.8 Nausea 6.5 7.0 Rhinitis 6.5 3.5 Vomitingg 6.5 10.4

California Family Physician Fall 2014

Pregnancy: A randomized, open-label, controlled clinical trial has been conducted in pregnant women with type 1 diabetes. Hypoglycemia: Hypoglycemia is the most commonly observed adverse reaction in patients using insulin, including LEVEMIR®. Tables 5 and 6 summarize the incidence of severe and non-severe hypoglycemia in the LEVEMIR® clinical trials. For the adult trials and one of the pediatric trials (Study D), severe hypoglycemia was defined as an event with symptoms consistent with hypoglycemia requiring assistance of another person and associated with either a plasma glucose value below 56 mg/dL (blood glucose below 50 mg/dL) or prompt recovery after oral carbohydrate, intravenous glucose or glucagon administration. For the other pediatric trial (Study I), severe hypoglycemia was defined as an event with semi-consciousness, unconsciousness, coma and/or convulsions in a patient who could not assist in the treatment and who may have required glucagon or intravenous glucose. For the adult trials and pediatric Study D, non-severe hypoglycemia was defined as an asymptomatic or symptomatic plasma glucose < 56 mg/dL (or equivalently blood glucose <50 mg/dL as used in Study A and C) that was self-treated by the patient. For pediatric Study I, non-severe hypoglycemia included asymptomatic events with plasma glucose <65 mg/dL as well as symptomatic events that the patient could self-treat or treat by taking oral therapy provided by the caregiver. The rates of hypoglycemia in the LEVEMIR® clinical trials (see Section 14 for a description of the study designs) were comparable between LEVEMIR®-treated patients and non-LEVEMIR®-treated patients (see Tables 5 and 6).

Table 5: Hypoglycemia in Patients with Type 1 Diabetes Severe Hypoglycemia Non-Severe Hypoglycemia Percent of patients with at Percent of patients Event/patient/year Event/patient/year least 1 event (n/total N) (n/total N) ® 8.7 (24/276) 0.52 88.0 (243/276) 26.4 Twice-Daily LEVEMIR Study A, Type 1 Diabetes, Adults, 16 weeks In combination with insulin aspart Twice-Daily NPH 10.6 (14/132) 0.43 89.4 (118/132) 37.5 5.0 (8/161) 0.13 82.0 (132/161) 20.2 Twice-Daily LEVEMIR® Study B, Type 1 Diabetes, Adults, 26 weeks In combination with insulin aspart Once-Daily Glargine 10.1 (16/159) 0.31 77.4 (123/159) 21.8 7.5 (37/491) 0.35 88.4 (434/491) 31.1 Once-Daily LEVEMIR® Study C, Type 1 Diabetes, Adults, 24 weeks In combination with regular insulin Once-Daily NPH 10.2 (26/256) 0.32 87.9 (225/256) 33.4 ® 15.9 (37/232) 0.91 93.1 (216/232) 31.6 Study D, Type 1 Diabetes, Pediatrics, 26 weeks Once- or Twice Daily LEVEMIR In combination with insulin aspart Once- or Twice Daily NPH 20.0 (23/115) 0.99 95.7 (110/115) 37.0 ® 1.7 (3/177) 0.02 94.9 (168/177) 56.1 Study I, Type 1 Diabetes, Pediatrics, 52 weeks Once- or Twice Daily LEVEMIR In combination with insulin aspart Once- or Twice Daily NPH 7.1 (12/170) 0.09 97.6 (166/170) 70.7 Table 6: Hypoglycemia in Patients with Type 2 Diabetes Study E, Type 2 Diabetes, Adults, 24 weeks Study F, Type 2 Diabetes, Adults, 22 weeks Study H, Type 2 Diabetes, Adults, 26 weeks In combination with oral agents In combination with insulin aspart in combination with Liraglutide and Metformin Twice-Daily Onceor Twice Daily Once Daily LEVEMIR® + Liraglutide + Onceor Twice Daily Twice-Daily NPH LEVEMIR® NPH Liraglutide + Metformin Metformin LEVEMIR® Severe hypoglycemia Percent of patients with at 0.4 2.5 1.5 4.0 0 0 least 1 event (n/total N) (1/237) (6/238) (3/195) (8/199) Event/patient/year 0.01 0.08 0.04 0.13 0 0 Non-severe Percent of patients 40.5 64.3 32.3 32.2 9.2 1.3 hypoglycemia (n/total N) (96/237) (153/238) (63/195) (64/199) (15/163) (2/158*) Event/patient/year 3.5 6.9 1.6 2.0 0.29 0.03 *One subject is an outlier and was excluded due to 25 hypoglycemic episodes that the patient was able to self-treat. This patient had a history of frequent hypoglycemia prior to the study Insulin Initiation and Intensification of Glucose Control: Intensification or rapid other insulins, particularly rapid-acting or short-acting insulins, have been accidentally improvement in glucose control has been associated with a transitory, reversible administered instead of LEVEMIR®. To avoid medication errors between LEVEMIR® ophthalmologic refraction disorder, worsening of diabetic retinopathy, and acute and other insulins, patients should be instructed always to verify the insulin label painful peripheral neuropathy. However, long-term glycemic control decreases the before each injection. risk of diabetic retinopathy and neuropathy. Lipodystrophy: Long-term use of insulin, OVERDOSAGE: An excess of insulin relative to food intake, energy expenditure, or including LEVEMIR®, can cause lipodystrophy at the site of repeated insulin injections. both may lead to severe and sometimes prolonged and life-threatening hypoglycemia.

Lipodystrophy includes lipohypertrophy (thickening of adipose tissue) and lipoatrophy Mild episodes of hypoglycemia usually can be treated with oral glucose. Adjustments (thinning of adipose tissue), and may affect insulin absorption. Rotate insulin injection in drug dosage, meal patterns, or exercise may be needed. More severe episodes with sites within the same region to reduce the risk of lipodystrophy. Weight Gain: Weight coma, seizure, or neurologic impairment may be treated with intramuscular/subcutagain can occur with insulin therapy, including LEVEMIR®, and has been attributed neous glucagon or concentrated intravenous glucose. After apparent clinical recovery to the anabolic effects of insulin and the decrease in glucosuria. Peripheral Edema: from hypoglycemia, continued observation and additional carbohydrate intake may be Insulin, including LEVEMIR®, may cause sodium retention and edema, particularly if necessary to avoid recurrence of hypoglycemia. previously poor metabolic control is improved by intensified insulin therapy. Allergic Reactions: Local Allergy: As with any insulin therapy, patients taking LEVEMIR® More detailed information is available upon request. may experience injection site reactions, including localized erythema, pain, pruritus, For information about LEVEMIR® contact: urticaria, edema, and inflammation. In clinical studies in adults, three patients treated Novo Nordisk Inc. with LEVEMIR® reported injection site pain (0.25%) compared to one patient treated 800 Scudders Mill Road with NPH insulin (0.12%). The reports of pain at the injection site did not result in Plainsboro, New Jersey 08536 discontinuation of therapy. Rotation of the injection site within a given area from one 1-800-727-6500 injection to the next may help to reduce or prevent these reactions. In some instances, www.novonordisk-us.com these reactions may be related to factors other than insulin, such as irritants in a skin Manufactured by: cleansing agent or poor injection technique. Most minor reactions to insulin usually Novo Nordisk A/S resolve in a few days to a few weeks. Systemic Allergy: Severe, life-threatening, gener- DK-2880 Bagsvaerd, Denmark alized allergy, including anaphylaxis, generalized skin reactions, angioedema, bron- Novo Nordisk®, Levemir®, NovoLog®, FlexPen®, FlexTouch®, NovoFine®, and chospasm, hypotension, and shock may occur with any insulin, including LEVEMIR®, NovoTwist® are registered trademarks of Novo Nordisk A/S. and may be life-threatening. Antibody Production: All insulin products can elicit the LEVEMIR® is covered by US Patent Nos. 5,750,497, 5,866,538, 6,011,007, 6,869,930 formation of insulin antibodies. These insulin antibodies may increase or decrease the and other patents pending. efficacy of insulin and may require adjustment of the insulin dose. In phase 3 clinical ® trials of LEVEMIR®, antibody development has been observed with no apparent impact FlexPen is covered by US Patent Nos. RE 41,956, 6,004,297, RE 43,834 and other patents pending. on glycemic control. Postmarketing experience: The following adverse reactions ® have been identified during post approval use of LEVEMIR®. Because these reactions FlexTouch is covered by US patent Nos. 7,686,786, 6,899,699, and other patents are reported voluntarily from a population of uncertain size, it is not always possible pending. to reliably estimate their frequency or establish a causal relationship to drug exposure. © 2005-2014 Novo Nordisk Medication errors have been reported during post-approval use of LEVEMIR® in which 0314-00020331-1 3/2014

24

California Family Physician Fall 2014

PHYSICIAN â&#x20AC;&#x201C; FAMILY MEDICINE Vista Community Clinic located in North San Diego County Seeking: Full-time, part-time and per diem Family Medicine Physicians.

Requirements: California license, DEA license, CPR certiďŹ cation and board certiďŹ ed in family medicine.

Bilingual English/Spanish preferred.

Contact Us: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760-414-3702

FAMILY PRACTICE MD/DO

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Open Door Community Health Centers in coastal Northern California is seeking 3 full-time Family Practice MD/DOâ&#x20AC;&#x2122;s for our clinics in Crescent City, Eureka and McKinleyville. We offer competitive salary and benefits, including health insurance, malpractice insurance, pension plan, vacation/holiday pay, CEU time/stipend, and loan repayment options.

Requires CA license, Board Certification, DEA, EMR experience.

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Vista Community Clinic located in North San Diego County Seeking: Part-Time and per diem OB/GYN Physicians.

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Requirements: California license, DEA license, CPR certiďŹ cation and board certiďŹ ed in obstetrics and gynecological medicine.

Bilingual English/Spanish preferred. Bilingual English/Spanish

ACHIEVE

extraordinary outcomes When you're part of Dignity Health Medical Foundation you'll be able to do more than just care for your patients.

Youâ&#x20AC;&#x2122;ll have the opportunity to develop and participate in health, education and wellness programs that will help improve the lives of people throughout your communityâ&#x20AC;Śand beyond. If you want to achieve extraordinary outcomes, join us today.

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s 'ERIATRICIAN 3ACRAMENTO Our locations offer access to outstanding schools, exciting recreational opportunities and a wide variety of cultural events. Our physicians utilize leading edge technology, including EMR, and enjoy a collegial and supportive environment. We also offer a competitive compensation & benefits package which includes bonus potential and a very desirable retirement plan. health.org

&OR MORE INFORMATION PLEASE CONTACT 0HYSICIAN 2ECRUITMENT 0HONE %MAIL PROVIDERS DIGNITYHEALTH ORG WWW DIGNITYHEALTH ORG PHYSICIAN CAREERS

Contact Us: Visit our website at www.vistacommunityclinic.org Forward resume to hr@vistacommunityclinic.org or fax resume to 760-414-3702 California Family Physician Fall 2014

25

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Introducing Medical Students to Family Medicine Advocacy EŽŽŶ ůĞĐƚƵƌĞ ĚƵƌŝŶŐ ƚŚĞ ĚĞŵĂŶĚŝŶŐ ƌŽƚĂƟŽŶ ŽĨ ŝŶƚĞƌŶĂů ŵĞĚŝĐŝŶĞ ŝƐ Ă ĚĂŝůLJ ƌŝƚƵĂů ĨŽƌ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ĂƩĞŶĚŝŶŐƐ͘ ^ĞŶŝŽƌ ƌĞƐŝĚĞŶƚƐ͕ ůŝŬĞ ŵĞ͕ ƚLJƉŝĐĂůůLJ ůĞĂĚ ƚŚĞ ƚĂůŬƐ͘ dŽĚĂLJ͕ ŝŶƐƚĞĂĚ ŽĨ ĚŝƐĐƵƐƐŝŶŐ ƉŶĞƵŵŽŶŝĂ Žƌ ƚŚĞ ĚƌĞĂĚĞĚ ƚŽƉŝĐ ŽĨ ŚLJƉŽŶĂƚƌĞŵŝĂ͕ / ŝŶƚƌŽĚƵĐĞĚ ŽƵƌ ƌŽƵŶĚŝŶŐ ƚĞĂŵ ƚŽ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ĂĚǀŽĐĂĐLJ ĂŶĚ ŚŽǁ ĞĂƐLJ ŝƚ ǁĂƐ ƚŽ ŵĂŬĞ Ă ĚŝīĞƌĞŶĐĞ ĂƐ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͘ ŌĞƌ ƌĞĐĞŝǀŝŶŐ ĂŶ ĞŵĂŝů ĨƌŽŵ ĚĂŵ &ƌĂŶĐŝƐ͕ ĞƉƵƚLJ ŝƌĞĐƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƟŽŶƐ Ăƚ &W͕ ĂƐŬŝŶŐ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ƚĂŬĞ ĂĐƟŽŶ ŽŶ ^ ϰϵϮ ;Ă ďŝůů ƚŚĂƚ ǁŽƵůĚ ĂůůŽǁ ŽƉƚŽŵĞƚƌŝƐƚƐ ƚŽ ƚƌĞĂƚ ĐŚƌŽŶŝĐ ĐŽŶĚŝƟŽŶƐ ůŝŬĞ ĚŝĂďĞƚĞƐͿ͕ / ŬŶĞǁ ƚŚŝƐ ǁŽƵůĚ ďĞ Ă ŐƌĞĂƚ ƐƚĂƌƚ͘ dŚĞ ĞŵĂŝů ŝŶĐůƵĚĞĚ &W͛Ɛ ĐŽŶĐĞƌŶƐ ĂŶĚ ƚŚĞ ƚĞůĞƉŚŽŶĞ ŶƵŵďĞƌ ĨŽƌ ŽƵƌ ƐƉĞĐŝĮĐ ůĞŐŝƐůĂƚŽƌ͘ &ŝƌƐƚ͕ ǁĞ ĚŝƐĐƵƐƐĞĚ ƚŚĞ ƉƌŽƐ ĂŶĚ ĐŽŶƐ ŽĨ ƚŚŝƐ ďŝůů͘ / ĞdžƉůĂŝŶĞĚ ŵLJ ĐŽŶĐĞƌŶ ƚŚĂƚ ŵLJ ĚŝĂďĞƟĐ ƉĂƟĞŶƚƐ ĐŽƵůĚ ƉŽƚĞŶƟĂůůLJ ďĞ ƐƚĂƌƚĞĚ ŽŶ ĚĂŶŐĞƌŽƵƐ ŵĞĚŝĐĂƟŽŶƐ ďLJ ƉƌŽǀŝĚĞƌƐ ǁŚŽ ĚŝĚŶ͛ƚ ŬŶŽǁ ƚŚĞŝƌ ĨƵůů ŵĞĚŝĐĂů ŚŝƐƚŽƌLJ͘ tŽƵůĚ ƚŚĞLJ ƐƚĂƌƚ ĚŝĂďĞƟĐ ƉĂƟĞŶƚƐ ǁŝƚŚ ƉŽŽƌ ŬŝĚŶĞLJ ĨƵŶĐƟŽŶ ŽŶ ŵĞƞŽƌŵŝŶ͕ Ă ŵĞĚŝĐĂƟŽŶ ƚŚĂƚ ĐŽƵůĚ ĨƵƌƚŚĞƌ ŚĂƌŵ ƚŚĞŝƌ ŬŝĚŶĞLJƐ͍ tŚĂƚ ŬŝŶĚ ŽĨ ƚƌĂŝŶŝŶŐ ĚŝĚ ŽƉƚŽŵĞƚƌŝƐƚƐ ŚĂǀĞ ƚŽ ƉƌĞƉĂƌĞ ƚŚĞŵ ĨŽƌ ĂǀŽŝĚŝŶŐ ŵĞĚŝĐĂƟŽŶ ŝŶƚĞƌĂĐƟŽŶƐ͍ KƚŚĞƌƐ ďƌŽƵŐŚƚ ƵƉ ƐŝŵŝůĂƌ ĐŽŶĐĞƌŶƐ͘ ŌĞƌ Ă ĨĞǁ ŵŝŶƵƚĞƐ ŽĨ ĚŝƐĐƵƐƐŝŽŶ͕ / ƚŽŽŬ ŽƵƚ ŵLJ ĐĞůů ƉŚŽŶĞ͕ ƉůĂĐĞĚ ŝƚ ŝŶ ƚŚĞ ŵŝĚĚůĞ ŽĨ ŽƵƌ ƚĂďůĞ ĂŶĚ ƐĂŝĚ͕ ͞EŽǁ ůĞƚ͛Ɛ ƐĞĞ ǁŚĂƚ ǁĞ ĐĂŶ ĚŽ ĂďŽƵƚ ŝƚ͘͟

/ ĞdžƉůĂŝŶĞĚ ƚŚĂƚ ƚŚŝƐ ďŝůů ǁŽƵůĚ ďĞ ŚĞĂƌĚ ŝŶ ƐƐĞŵďůLJ ƉƉƌŽƉƌŝĂƟŽŶƐ ŽŵŵŝƩĞĞ ĂŶĚ ƚŚĂƚ ŽƵƌ ƐƐĞŵďůLJŵĞŵďĞƌ͕ ^ŚŝƌůĞLJ tĞďĞƌ͕ ƐŝƚƐ ŽŶ ƚŚĂƚ ĐŽŵŵŝƩĞĞ͘ tĞ ŚĂĚ ĂŶ ŝŵƉŽƌƚĂŶƚ ŽƉƉŽƌƚƵŶŝƚLJ ĂŶĚ ŽďůŝŐĂƟŽŶ ƚŽ ůĞƚ ŚĞƌ ŬŶŽǁ ŚŽǁ ƚŚŝƐ ďŝůů ǁŽƵůĚ ĂīĞĐƚ ƉĂƟĞŶƚƐ ŝŶ ŽƵƌ ƉƌĂĐƟĐĞƐ͕ ƚŚĞ ǀĞƌLJ ƐĂŵĞ ĐŽŶƐƟƚƵĞŶƚƐ ƚŚĂƚ ŵĂŬĞ ƵƉ ŚĞƌ ĚŝƐƚƌŝĐƚ͘ /ŶƚƌŝŐƵĞĚ ĨĂĐĞƐ ƌĞƚƵƌŶĞĚ ŵLJ ŐůĂŶĐĞ͘ DŽŵĞŶƚƐ ůĂƚĞƌ͕ ǁĞ ǁĞƌĞ ĐŽŶŶĞĐƚĞĚ ƚŽ ŚĞƌ ƐƚĂī ĂŶĚ ǁĞƌĞ ĞdžƉůĂŝŶŝŶŐ ŽƵƌ ĐŽŶĐĞƌŶƐ͘ dŚĞ ƉƌŽĐĞƐƐ ǁĂƐ ƐŝŵƉůĞ ĂŶĚ ƐƵƌƉƌŝƐŝŶŐůLJ ƐĂƟƐĨLJŝŶŐ͘ KƵƌ ƉůĞĂƐĂŶƚ͕ ƚŚƌĞĞͲŵŝŶƵƚĞ ƉŚŽŶĞ ĐŽŶǀĞƌƐĂƟŽŶ ĞŶĚĞĚ ǁŝƚŚ͕ ͞/͛ůů ůĞƚ ƚŚĞ ƐƐĞŵďůLJŵĞŵďĞƌ ŬŶŽǁ͕͟ ďƵƚ ŽƵƌ ƚĞĂŵ͛Ɛ ĐŽŶǀĞƌƐĂƟŽŶ ĂďŽƵƚ ĂĚǀŽĐĂĐLJ ǁĂƐ ũƵƐƚ ŐĞƫŶŐ ƐƚĂƌƚĞĚ͘ Aaron Edelstein, MD, MBA is resident co-chair of the CAFP and chief resident at the Kaiser Permanente Family Medicine Residency Program in San Diego.

Editor’s note: After efforts similar to this by family physicians throughout the state, the bill was amended, removing the provisions that would allow optometrists to manage and treat diabetes, hypertension and hypercholesterolemia.

During a lunch lecture, Aaron Edelstein, MD teaches students and residents about advocacy.

26

California Family Physician Fall 2014

and focus on what’s really important:

THE STRENGTH TO HEAL

my patient.

As a family practice physician on the U.S. Army Health Care Team, you don’t have to worry about operational burdens such as overhead costs, malpractice premiums or patient billing.

Instead, our physicians get to focus on what they were educated to do — treat patients to the very best of their abilities.

You’ll work with the most sophisticated modern technology, shoulder-to-shoulder with recognized experts in their fields. You may also earn many financial benefits, including student loan repayment and a $240,000 signing bonus.

To learn more, call us at 310-216-4433 or visit: healthcare.goarmy.com/info.

SCAN THIS CODE TO WATCH A VIDEO Meet some of the dedicated physicians and surgeons that are members of the Army health care team. ©2014. Paid for by the United States Army. All rights reserved.

California Family Physician Fall 2014

1 in 8 will become disabled for 5 years* or more...

Mortgage payments…college tuition…car loans…credit cards…taxes…and day-to-day items such as food, clothing, and utilities are just some of the expenses you could continue to face if you suffered a disability, injury or illness and you could not work. By protecting yourself with The AAFP Disability Income Insurance Plan, you can help guard your financial stability so you can hold on to what you’ve worked so hard to achieve.

For information including exclusions, limitations, rates, eligibility and renewal provisions of The AAFP Disability Income Insurance Plan call (800) 325-8166 or visit our new website at aafpins.com twitter.com/aafpinsurance facebook.com/aafpinsurance linkedin.com/company/aafp-insurance-services *Source: The Council for Disability Awareness July 3, 2013

MED7 has been providing urgent care services in the Greater Sacramento area since 1987 Urgent care clinics are located in Roseville, Carmichael, Folsom & North Sacramento. Board Certified or Board Eligible in family practice or emergency medicine.

All shifts 9am to 9pm. Full time is 13 shifts per month. We offer our full time physicians the following: full malpractice coverage, medical & dental coverage at no cost for the physician & any dependents, disability policy & we have a simple IRA you can contribute to with 3% matching. Part time is 6 to 8 shifts per month. There is no call. There is no tail coverage that needs to be purchased should you leave our employment. We have a single policy that continues on after you leave.

If something were to arise here after you left our employment, you would be covered.

For more information about MED7 and our clinics please visit our website: www.med7.com We offer an attractive compensation package.

Contact Merl O’Brien,MD, at: (916) 483-5400, ext.111; or email CV to: sherry@med7atwork.com.

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California Family Physician Fall 2014

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DHHS Secretary Diana Dooley Tours Fresno PCMH /Ŷ Ă ŵĂũŽƌ ĂĚǀŽĐĂĐLJ ǁŝŶ ƚŚŝƐ ƐƵŵŵĞƌ͕ &W ǁĂƐ ĂďůĞ ƚŽ ƐŚŽǁ Žī ŽƵƌ ƐƵĐĐĞƐƐĨƵů WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ƉŝůŽƚ ŝŶ &ƌĞƐŶŽ ƚŽ ƚǁŽ ŽĨ ƚŚĞ ƚŽƉ ŚĞĂůƚŚ ĐĂƌĞ ůĞĂĚĞƌƐ ŝŶ ŽƵƌ ƐƚĂƚĞ͗ ĂůŝĨŽƌŶŝĂ͛Ɛ ^ĞĐƌĞƚĂƌLJ ŽĨ ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂŶĚ ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ ; ,,^Ϳ ĂŶĚ ĐŚĂŝƌ ŽĨ ŽǀĞƌĞĚ ĂůŝĨŽƌŶŝĂ͛Ɛ ŐŽǀĞƌŶŝŶŐ ďŽĂƌĚ͕ ŝĂŶĂ ŽŽůĞLJ͕ ĂŶĚ ƐƐĞŵďůLJ ,ĞĂůƚŚ ŽŵŵŝƩĞĞ ŚĂŝƌŵĂŶ ZŝĐŚĂƌĚ WĂŶ͕ D ͘ ŌĞƌ ƚŚĞ ƉƌŽũĞĐƚ ƐĂǀĞĚ ŶĞĂƌůLJ Ψϭ ŵŝůůŝŽŶ ǁŚŝůĞ ƌĞĚƵĐŝŶŐ ŚŽƐƉŝƚĂůŝnjĂƟŽŶƐ ĂŶĚ ĞŵĞƌŐĞŶĐLJ ƌŽŽŵ ƵƐĞ ĂŶĚ ŝŵƉƌŽǀŝŶŐ ĐĂƌĞ ĨŽƌ ƉĂƟĞŶƚƐ ǁŝƚŚ ĚŝĂďĞƚĞƐ͕ ĐŽƌŽŶĂƌLJ ĂƌƚĞƌLJ ĚŝƐĞĂƐĞ ĂŶĚ ŚŝŐŚ ďůŽŽĚ ƉƌĞƐƐƵƌĞ͕ ƚŚĞ ŽĸĐŝĂůƐ ŚĂĚ ƚŽ ĐŽŵĞ ƐĞĞ ŝƚ ŝŶ ƉĞƌƐŽŶ͊

WĞƌĞĂ͕ ZĞŶĞ WůĂƚĂ͘ WĂƌƟĐŝƉĂŶƚƐ ǁĞƌĞ ŐƌĞĞƚĞĚ ĂŶĚ ƚƌĞĂƚĞĚ ďLJ ƌ͘ tŝŶŐĞƌƚ͛Ɛ ŚĞĂůƚŚ ƚĞĂŵ ĂƐ ŝĨ ƚŚĞLJ ǁĞƌĞ ƉĂƟĞŶƚƐ ʹ ĂŶĚ ƚŚĂƚ͛Ɛ ŚŽǁ ƚŚĞLJ ǁĞƌĞ ŵŽǀĞĚ ƚŚƌŽƵŐŚ ƚŚĞ ŽĸĐĞ͘ /ƚ ǁĂƐ ĐůĞĂƌ ĨƌŽŵ ƚŚĞ ŽƵƚƐĞƚ ƚŚĂƚ ĞĂĐŚ ŵĞŵďĞƌ ŽĨ ƚŚĞ ƐƚĂī ƚŽŽŬ ƉĞƌƐŽŶĂů ƌĞƐƉŽŶƐŝďŝůŝƚLJ ĨŽƌ ƉĂƟĞŶƚƐ͛ ĞdžƉĞƌŝĞŶĐĞƐ ĂŶĚ ŚĞĂůƚŚ͘ DƐ͘ &ƌLJĞ ůĂƚĞƌ ƚŽůĚ ƚǁŽ ƐƚŽƌŝĞƐ ŽĨ ŐƌĞĂƚ ƉĂƟĞŶƚ ͞ƐĂǀĞƐ͟ ďLJ ĐĂƌĞ ƚĞĂŵ ŵĞŵďĞƌƐ ĚŽŝŶŐ W D, ŽƵƚƌĞĂĐŚ͘ /Ŷ ŽŶĞ ĐĂƐĞ͕ Ă ƉĂƟĞŶƚ ƌĞĐĞŶƚůLJ ĚŝƐĐŚĂƌŐĞĚ ĨƌŽŵ ƚŚĞ ŚŽƐƉŝƚĂů ĂŶĚ ƌĞĐŽǀĞƌŝŶŐ ĨƌŽŵ ƐĞƉƐŝƐ ǁĂƐ ĨŽƵŶĚ ƚŽ ďĞ ƚĂŬŝŶŐ ŽŶůLJ ŚĂůĨ ŽĨ ƚŚĞ ƉƌĞƐĐƌŝďĞĚ ĂŶƟďŝŽƟĐ͖ ŝŶ ĂŶŽƚŚĞƌ͕ Ă ǁŽŵĂŶ ǁŚŽ ŚĂĚ ƉƵƚ Žī ŚĞƌ ŵĂŵŵŽŐƌĂŵ ǁĂƐ ĮŶĂůůLJ ĐŽŶǀŝŶĐĞĚ ƚŽ ŐĞƚ ŽŶĞ͕ ĂŶĚ ĂŶ ĞĂƌůLJ ĐĂŶĐĞƌ ǁĂƐ ĚŝƐĐŽǀĞƌĞĚ ĂŶĚ ƚƌĞĂƚĞĚ ƐƵĐĐĞƐƐĨƵůůLJ͘

dŚĞ ƚŽƵƌ ĨĞĂƚƵƌĞĚ ƚŚĞ ƉƌĂĐƟĐĞ ŽĨ &W ŵĞŵďĞƌ <ĞǀŝŶ tŝŶŐĞƌƚ͕ D ĂŶĚ ŚŝƐ ƚĞĂŵ ĂŶĚ /Ŷ ƚŚĞ ƐĞĐŽŶĚ ŚĂůĨ ŽĨ ƚŚĞ ĚĞŵŽŶƐƚƌĂƚĞĚ ƚŚĞ ĚŝīĞƌĞŶĐĞ ^ĞĐƌĞƚĂƌLJ͛Ɛ ǀŝƐŝƚ͕ ĞĂĐŚ ƉĂƌƚŶĞƌ ďĞƚǁĞĞŶ Ă ǀŝƐŝƚ ƚŽ Ă W D,Ͳ ŝŶ ƚŚĞ W D, ƉŝůŽƚ ƉƌŽũĞĐƚ ȱ ȱ ȱ ȱ ȱ Ă ĂŶĚ ƉƌĂĐƟĐĞ ƚƌĂŶƐĨŽƌŵĞĚ ŚĂĚ Ă ĐŚĂŶĐĞ ƚŽ ƐŚĂƌĞ ƚŚĞŝƌ ĐĂƌĞ ǀŝƐŝƚ͘ ƌ͘ ƌĞŐƵůĂƌ ƉƌŝŵĂƌLJ ĞdžƉĞƌŝĞŶĐĞƐ ĂŶĚ ƚŚĞŝƌ ŵŽƟǀĂƟŽŶƐ ȱ ¢ȱ ȱ ȱ ȱ ŽĨ ƉĂƌƚ ŝƐ ƉƌĂĐƟĐĞ tŝŶŐĞƌƚ͛Ɛ ĨŽƌ ƉĂƌƟĐŝƉĂƟŶŐ ŝŶ ƚŚĞ ƉƌŽũĞĐƚ͘ ȱ ȱ ȱ ȱ ŽŵŵƵŶŝƚLJ DĞĚŝĐĂů WƌŽǀŝĚĞƌƐ ŽƚŚ ƚŚĞ ^ĞĐƌĞƚĂƌLJ ĂŶĚ ; DWͿ ŵĞĚŝĐĂů ŐƌŽƵƉ ŝŶ ƚŚĞ ƐƐĞŵďůLJŵĞŵďĞƌ WĂŶ ĂƐŬĞĚ ȱ ȱ ȱ ȱ dŚĞ ĂƌĞĂ͘ ƉƌŽũĞĐƚ ǁĂƐ &ƌĞƐŶŽ ŝŶƐŝŐŚƞƵů ƋƵĞƐƟŽŶƐ ĂďŽƵƚ ƉƌŽũĞĐƚ ŽĨ ĐŽŶĐĞƉƚ ƵŶĚĞƌƚĂŬĞŶ ĂƐ ƉƌŽŽĨ ĐŽƐƚƐ͕ ĚĂƚĂ ĐĂƉƚƵƌĞ ĂŶĚ ŵŽƌĞ͘ ȱ ȱ ȱ ¢ȱ ƚŽ ƐƵƉƉŽƌƚ &W͛Ɛ ƐƚƌĂƚĞŐŝĐ ŐŽĂů >ŽĐĂů ^ƵƉĞƌǀŝƐŽƌ ,ĞŶƌLJ WĞƌĞĂ ŽĨ ĞŶĐŽƵƌĂŐŝŶŐ ƚƌĂŶƐĨŽƌŵĂƟŽŶ ;ĨĂƚŚĞƌ ŽĨ ƐƐĞŵďůLJŵĞŵďĞƌ ¢ ȱ ȱ ȱ ȱ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͛ ŵĞĚŝĐĂů ,ĞŶƌLJ d͘ WĞƌĞĂͿ͕ ũŽŝŶĞĚ ƚŚŝƐ ȱ ȱ ȱ ǯ ƚŚĞ ŵŽĚĞů ƉƌĂĐƟĐĞƐ ŝŶƚŽ W D, ƉŽƌƟŽŶ ŽĨ ƚŚĞ ǀŝƐŝƚ ĂŶĚ ŚĂĚ ŽĨ ĐĂƌĞ ĂŶĚ ĚĞŵŽŶƐƚƌĂƟŶŐ ƚŚĂƚ ƋƵĞƐƟŽŶƐ ĂďŽƵƚ ďĞŚĂǀŝŽƌĂů ŚĞĂůƚŚ ƚŚĞ ŵŽĚĞů ŝƐ ďŽƚŚ ƐƉƌĞĂĚĂďůĞ ĐĂƌĞ ŝŶƚĞŐƌĂƟŽŶ ƵŶĚĞƌ ƚŚĞ ŵŽĚĞů͘ &ƌĞƐŶŽ ĂŶĚ ƐƵƐƚĂŝŶĂďůĞ͘ hŶŝĮĞĚ ^ĐŚŽŽů ŝƐƚƌŝĐƚ͛Ɛ :ŽŝŶƚ ,ĞĂůƚŚ DĂŶĂŐĞŵĞŶƚ ŽĂƌĚ ;:,D Ϳ ƉĂŝĚ ΨϭϬ &W ŚĂĚ ƚŚƌĞĞ ƐƉĞĐŝĮĐ ͞ĂƐŬƐ͟ ŽĨ ^ĞĐƌĞƚĂƌLJ ŽŽůĞLJ͗ ϭ͘ KīĞƌ ƚŚĞ ƐƚĂƚĞ͛Ɛ ƐƵƉƉŽƌƚ ĨŽƌ ƚŚĞ ďƌŽĂĚ ĐŽŶĐĞƉƚ ŽĨ ƉƌĂĐƟĐĞ ƉĞƌͲŵĞŵďĞƌͲƉĞƌ ŵŽŶƚŚ ƚŽ ƐƵƉƉŽƌƚ ƚŚĞ W D, ƐĞƌǀŝĐĞƐ ŽĨ ƋƵĂůŝƚLJ ƚƌĂŶƐĨŽƌŵĂƟŽŶ ĂŶĚ ƚŚĞ W D, ŵŽĚĞů ŽĨ ĐĂƌĞ͖ ŝŵƉƌŽǀĞŵĞŶƚ͕ ĐĂƌĞ ĐŽŽƌĚŝŶĂƟŽŶ ĂŶĚ Ă ƉĂƟĞŶƚ ƌĞŐŝƐƚƌLJ ĂŶĚ Ă ƉĂLJͲ ŽŶǀĞŶĞ ŚĞĂůƚŚ ƉůĂŶƐ ĂŶĚ ŽƚŚĞƌ ƐƚĂŬĞŚŽůĚĞƌƐ ƚŽ ĚŝƐĐƵƐƐ ŵĞĞƟŶŐ Ϯ͘ ĨŽƌ ŵĞƚƌŝĐƐ͕ ĂůŽŶŐ ƚŚĞ ĨŽƌͲƉĞƌĨŽƌŵĂŶĐĞ ďŽŶƵƐ ƋƵĂůŝƚLJ ǁŝƚŚ W D, ƉƌŽũĞĐƚ ŝŶ ĂůŝĨŽƌŶŝĂ ƚŽ ŝŶƐƵůĂƚĞ Ă ŵƵůƟͲƉĂLJĞƌ ĐŽǀĞƌĞĚ ƉĂƌƟĐŝƉĂŶƚƐ͘ :,D ƉĂLJŵĞŶƚ ĨŽƌ ŝƚƐ ƵƐƵĂů ĨĞĞͲĨŽƌͲƐĞƌǀŝĐĞ ĂŐĂŝŶƐƚ ƌĞƐƚƌĂŝŶƚ ŽĨ ƚƌĂĚĞ ŝƐƐƵĞƐ͘ ƉĂƌƟĐŝƉĂŶƚƐ ŝƐ ƉƌŽũĞĐƚ ϭϴ ŵŽŶƚŚƐ ĂŶĚ ŚĂƐ ŶŽǁ ĞdžƚĞŶĚĞĚ ƚŚĞ ĨŽƌ ĂŶ ĂĚĚŝƟŽŶĂů ϯ͘ ŶĐŽƵƌĂŐĞ ŚĞƌ ƐƚĂī ƚŽ ƌĞĂĐŚ ŽƵƚ ƚŽ DW͕ ƚŚĞ :,D ĂŶĚ ĐŽŶƐŝĚĞƌŝŶŐ ŝŶĐůƵĚŝŶŐ ŵŽƌĞ ƉĂƌƟĐŝƉĂŶƚ ŚĞĂůƚŚ ƉůĂŶ ĞŶƌŽůůĞĞƐ ĂŶĚ &W ƚŽ ŐĞƚ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ ĂďŽƵƚ ƚŚĞ ƉƌŽũĞĐƚ ĂŶĚ ŝƚƐ DW ƉŚLJƐŝĐŝĂŶ ƉƌĂĐƟĐĞƐ͘ ƐƵĐĐĞƐƐ ĂŶĚ ƚŚĞ W D, ŵŽĚĞů͘ ůů ĂƌƌĂŶŐĞŵĞŶƚƐ ǁĞƌĞ ŚĂŶĚůĞĚ ďLJ DW͛Ɛ YƵĂůŝƚLJ /ŵƉƌŽǀĞŵĞŶƚ ŽĂĐŚ͕ >ĂƵƌŝĞ &ƌLJĞ͕ ƌ͘ tŝŶŐĞƌƚ ĂŶĚ ŚŝƐ ƐƚĂī͕ ŶĚLJ tŽŽĚ ŽĨ &W ǁŝůů ĨŽůůŽǁ ƵƉ ǁŝƚŚ ƚŚĞ ^ĞĐƌĞƚĂƌLJ ŽŶ ƚŚĞƐĞ ĂƐŬƐ ĂŶĚ ĐŽŶƟŶƵĞ DW͕ ^ĂŶƚğ DĞĚŝĐĂů ^ĞƌǀŝĐĞƐ KƌŐĂŶŝnjĂƟŽŶ ƐƚĂī ĂŶĚ ŚŽƐƉŝƚĂů ƚŽ ĞĚƵĐĂƚĞ ŽƵƌ ƐƚĂƚĞ ůĞĂĚĞƌƐ ƌĞŐĂƌĚŝŶŐ ƚŚĞ ŝŵƉŽƌƚĂŶƚ ǁŽƌŬ ĨĂŵŝůLJ ƌĞƉƌĞƐĞŶƚĂƟǀĞƐ ĨƌŽŵ ůŽǀŝƐ ŽŵŵƵŶŝƚLJ DĞĚŝĐĂů ĞŶƚĞƌ͘ dŚĞ ƚŽƵƌ ƉŚLJƐŝĐŝĂŶƐ ĂƌĞ ĚŽŝŶŐ ƚŽ ƚƌĂŶƐĨŽƌŵ ĂŶĚ ŝŵƉƌŽǀĞ ĐĂƌĞ͘ ŽĨ ƚŚĞ DW W D, ƉƌĂĐƟĐĞ ĂŶĚ Ă ƐŝƚͲĚŽǁŶ ǁĂƐ ĂŶ ĞīĞĐƟǀĞ ǁĂLJ ŽĨ ƚĞůůŝŶŐ ƚŚĞ ƐƚŽƌLJ ŽĨ ǁŚĂƚ ƚŚĞ W D, ĐĂŶ ĚĞůŝǀĞƌ ĨŽƌ ƉĂƟĞŶƚƐ͕ ŚĞĂůƚŚ tĞ ƐŝŶĐĞƌĞůLJ ƚŚĂŶŬ ^ĞĐƌĞƚĂƌLJ ŽŽůĞLJ ĂŶĚ ƐƐĞŵďůLJ ŵĞŵďĞƌ WĂŶ ƉůĂŶƐ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ƚĞĂŵƐ͘ ĨŽƌ ƚĂŬŝŶŐ ƟŵĞ ĨƌŽŵ ƚŚĞŝƌ ďƵƐLJ ƐĐŚĞĚƵůĞƐ ƚŽ ǀŝƐŝƚ ŽŵŵƵŶŝƚLJ DĞĚŝĐĂů WƌŽǀŝĚĞƌƐ ĂŶĚ ƐĞĞ ƚŚĞ W D, ŵŽĚĞů ŝŶ ĂĐƟŽŶ͘ ůŝƩůĞ ůƐŽ ũŽŝŶŝŶŐ ƚŚĞ ƚŽƵƌ ǁĞƌĞ ƐƐĞŵďůLJ ,ĞĂůƚŚ ŽŵŵŝƩĞĞ ĐŽŶƐƵůƚĂŶƚ ƐƚĂƚĞ ƐƵƉƉŽƌƚ ǁŝůů ŐŽ Ă ůŽŶŐ ǁĂLJ ƚŽǁĂƌĚ ĞŶĐŽƵƌĂŐŝŶŐ ĂĚŽƉƟŽŶ ŽĨ >ĂƌĂ &ůLJŶŶ ĂŶĚ ĚŝƐƚƌŝĐƚ ƐƚĂīĞƌ ĨŽƌ ƐƐĞŵďůLJŵĞŵďĞƌ ,ĞŶƌLJ d͘ ƚŚĞ ŵŽĚĞů ŝŶ ĂůŝĨŽƌŶŝĂ ʹ ǁĞ ŚŽƉĞ ŝƚ ŝƐ ĨŽƌƚŚĐŽŵŝŶŐ͘ 30

California Family Physician Fall 2014

Leading the future of health care.

FAMILY MEDICINE PHYSICIAN OPPORTUNITIES Northern & Central California Many organizations have a mission statement; we have a calling: to lead the way to a better future for health care. Through our leadership in the use of advanced technology, our creation of innovative solutions and our influence on health policy and reform efforts, we are shaping the future of health care in the nation. Currently, we have opportunities available for Family Medicine Physicians in Northern and Central California.

FORGIVABLE LOAN PROGRAM To demonstrate how much we value the role our Primary Care Physicians play, we’ve created a special incentive just for you. Available exclusively to Internal Medicine and Family Medicine Physicians, the Forgivable Loan Program is just one of many incentives we offer in exchange for your dedication and expertise.

LA SALUD PERMANENTE At The Permanente Medical Group, Inc. (TPMG), we practice a multi-lingual, culturally inclusive approach to care that celebrates the diversity of our patients and physicians.

By developing medical programs that are in tune with every aspect of our patients’ lives—from the language they speak to the heritage they embrace—we are actively investing in initiatives and services that reflect the diversity of our member community.

Here, our bilingual physicians can act as true advocates for their patients, delivering care that’s as medically advanced as it is culturally sensitive. Si su vocación y avocación son una y la misma, please join us today.

TPMG is the largest multi-specialty group practice in the nation with over 8,000 physicians and a 65-year tradition of providing quality medical care. We offer competitive salaries and a generous benefits package. For further details, please contact Gretchen Miles at Gretchen.H.Miles@kp.org or Aileen Ludlow at Aileen.M.Ludlow@kp.org. You may also call (800) 777-4912. Please visit our website at: http://physiciancareers-ncal.kp.org. We are an EOE/AA/M/F/D/V Employer.

VEVRAA Federal Contractor.

http://physiciancareers-ncal.kp.org California Family Physician Fall 2014

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Presorted Standard U.S. POSTAGE PAID

Little Rock, AR Permit No. 2437

“ As your MIEC Claims Representative, I will serve your professional liability needs with both steadfast advocacy and compassionate support.”

Senior Claims Representative Michael Anderson

Service and Value MIEC takes pride in both. For almost 40 years now, MIEC has been steadfast in our protection of California physicians. With conscientious Underwriting, excellent Claims management and hands-on Loss Prevention services, we’ve partnered with policyholders to keep premiums low.

Added value: Q No profit motive and low overhead Q $17.5 million in dividends* distributed in 2014 For more information or to apply: Q www.miec.com Q Call 800.227.4527 Q Email questions to underwriting@miec.com * (On premiums at $1/3 million limits. Future dividends cannot be guaranteed.)

Average Dividend as % of Premiums Past five Years

40% 35% 30% 25% 20% 15% 10% 5% 0%

MIEC 6250 Claremont Avenue, Oakland, California 94618 s 800-227-4527 s www.miec.com 32

California Family Physician Fall 2014

38.6%

6.66% MIEC

Med Mal Industry

MIEC Owned by the policyholders we protect.