California Family Physician - Fall 2024, Vol 75, No 3
Consider joining our team of dedicated, motivated and enthusiastic team players who make a difference in the community. Vista Community Clinic is a federally qualified, not-for-profit healthcare clinic with state-of-the-art clinics throughout the Southern California regions of North San Diego, Orange and Riverside Counties.
Our compensation and benefit program includes: Competitive compensation, sign-on bonus, relocation allowance, health, dental, vision, company-paid life, long-term disability, flexible spending accounts, retirement plan, malpractice coverage, CME allowance and no on-call hours. We are a NHSC loan repayment eligible organization.
Family Medicine Physician
Full Time and Part Time Opportunities in the cities of Vista, Oceanside and La Habra Compensation range is $280,000 - $300,000+
For more information visit www.vcc.org or email hr@vcc.org
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president's message
Vote! It's Good for Your Health
Alex McDonald, MD, CAQSM, FAAFP CAFP President
Unfortunately in this day and age, information, disinformation, and politics have crept into the exam room, hospital, operating room, and public health spheres. While we all want to be healthy and improve the health of our community, how we go about doing that has unfortunately fallen victim to the political division in this nation. This makes the work of physicians harder and the work to improve the health of our community harder. There is most certainly not one solution to the health challenges in our nation, nor a single solution that will meet everyone’s needs, but there is one thing that we all agree can help…VOTE!
Voting is not only a fundamental right and civic duty but can also have positive impacts on mental health, well-being, community engagement, and health. It goes without saying, but we must all vote in order to ensure we elect individuals who best represent our views and desires to impact health and health policy. Based on several studies, states with more inclusive voting policies and greater levels of civic engagement have improved health measures. There are no doubt several confounding factors in this association, but the implication remains that voting and civic engagement impacts community health. By participating in the democratic process, individuals contribute to shaping policies and priorities that sustainability affect public health, social welfare, and the environment. Voting empowers individuals to have a voice in the decisions that impact their lives and communities, fostering a sense of agency, belonging, and civic engagement. So, let's encourage everyone to exercise their right to vote—it's good for democracy, and it's good for our health!
This being said, voter registration in many parts of the country has declined and it’s hard to know if this is the cause or the result of political dysfunction, feeling like an individual voice does not matter, or disengagement in the democratic process. However large, some of these problems may be lack of voter registration or simply not voting are tangible and fixable problems to boost civic engagement and improve the health of our communities.
When it comes to voting and civic engagement, physicians, heal thyself! Healthcare professionals are one of the largest workforce sectors in the US, yet are 12-23% less likely to vote than the general population. However, perhaps in part due to the COVID-19 pandemic and the politicization of public health therein, physicians voted at a higher rate than the national average in the 2020 midterms. Common barriers to voting cited by physicians were not being registered to vote
and being too busy or having a conflicting work schedule. The most common reasons for not registering were not meeting the registration deadline and not being interested in politics.
In general, voting participation has been declining for decades, especially in midterms, and small or local elections. However, about two-thirds of eligible voters turned out in the 2020 presidential election, the highest rate for any national election since 1900 and the 2022 midterm turnout was just over 50% of eligible voters. Many voters are inconsistent and, despite the fact that US voter registration is very high, voter turnout lags behind most of the rest of the world. Furthermore, local election turnout is often very low, and the local city council or school boards likely have the most impact on our daily lives and no one is paying attention. Lack of media coverage, poor understanding of local government, distrust, and lack of local connection all influence low turnout rates of small or local elections.
Physicians play a unique role in our communities and are uniquely positioned to engage individuals with the importance of civic engagement, elections, and how voting can improve their health. There are many ways and varying degrees of energy and time investment in which physicians can support voting. Doctors can educate their patients about the importance of voting and provide information about voter registration deadlines, polling locations, and voting procedures. This could be as simple as having materials in the waiting room regarding voter registration information, posting on social media, writing Op-eds, blog posts, etc. Physicians may also raise awareness about key issues or ballot initiatives that impact public health and may educate patients or encourage patients to learn more or research candidates' positions on certain health issues.
Physicians often connect patients to social services that impact and improve health and connecting patients with community resources and support services to overcome voting barriers and ensure that everyone has equal access to the voting process is squarely within the purview of our work. Physicians and physician groups may engage in advocacy efforts to support policies that make voting more accessible and equitable, such as advocating for expanded early voting options, mail-in voting, and automatic voter registration.
continued on page 8
Lastly, doctors need to lead by example. As mentioned above, physicians have historically voted at lower rates than that of the general population. But this is changing as many more physicians seem to understand the growing importance of voting and civic engagement. As part of this, physicians must demonstrate their own commitment to civic engagement by not only participating in elections themselves but also sharing their experiences with patients and encouraging them to engage as well. Leading by example is one of the most powerful tools we hold as doctors whether it be by diet, exercise, or voting, we can inspire patients to follow suit and we can all take an active role in shaping our communities through voting. By actively supporting voting and civic engagement, physicians can help empower their patients to have a voice in decisions that impact their health and well-being, ultimately contributing to stronger, healthier communities.
While encouraging people to vote can have numerous benefits, there are potential downsides to consider. Patients may perceive a physician's encouragement to vote as a form of coercion or as a display of political bias. This could erode trust in the doctorpatient relationship and potentially lead to discomfort or reluctance to engage with the individual physician or the health care system, particularly for patients who already or historically may distrust the health care system. Discussions about voting and political issues have the potential to polarize the individual patient-physician relationship or colleague relationship and create tension or disagreement and damage therapeutic or professional relationships. Some patients may feel that any discussions of politics or voting are irrelevant or distracting in a medical setting.
Political activities or advocacy within the context of a physician’s professional roles may lead to ethics or professional concerns with individual patients or
employers. It must be clear how and when a physician represents their own views or views of their employer or organization. Lastly, physicians are exceptionally busy and in the midst of a clinical encounter there is never enough time to address all the medical concerns that a patient may have, and adding one more task may not be realistic.
Politics itself should never have a place in the exam room or when deciding clinical care, which is best left to physicians and scientists as well as evidence-based medicine and most importantly, what is best for the patient. However, understanding how politics and health policy impact clinical decisions and patient care does have a place in the exam room. While many physicians may disagree on how we improve our healthcare system, we can all agree that voting and civic engagement for both ourselves and for our patients is a critical first step. There are various ways physicians can support voting, activity, or in more nuanced ways and be adapted and applied to the individual patient or situation.
Come Join Us!
Overall, U.S. politics, dysfunctional as it may be a times, has a profound influence on the direction and priorities of the healthcare system, shaping access to care, healthcare delivery models, public health initiatives, and the availability of resources to impact the health of our communities. As a result, if physicians truly want to improve the health of their patients and their communities, we must think upstream and focus our efforts on system transformation and not just on individual patients. To quote Dr. Don Berwick, “The work of a physician as healer cannot stop at the door of an office, the threshold of an operating room, or the front gate of a hospital … Professional silence in the face of social injustice is wrong. Either engage or assist the harm. There is no third choice."
Vote! It’s good for your health.
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FM Revolution on Capitol Hill: Member Experiences at FMAS
Tiyesha Watts , MPA CAFP, Legislative and Policy Advocate
Nearly 300 family physicians, residents, and medical students, including 11 CAFP members, attended the American Academy of Family Physicians (AAFP) Family Medicine Advocacy Summit (FMAS) in Washington, D.C. Meeting with policymakers, physicians spent an entire day advocating for issues such as the Resident Education Deferred Interest (REDI) Act, Medicare coverage for vaccines, and on the Primary and Virtual Care Affordability Act.
The FMAS is a vital platform for family physicians to share ideas and amplify the collective voice of family medicine at the nation’s capital– activating family physicians as champions for the specialty and their patients. Regardless of whether it is their first time to advocate, or they have been advocates for decades, family physicians come together for the collective good of advocating for family medicine and primary care.
Don’t just take CAFP’s word for it, learn from the experiences of Drs. Huang and Lee, two 2024 FMAS Champions:
Samuel Huang, MD, FAAFP, a faculty physician at Kaiser Permanente's family residency program in Southern California, has been attending FMAS for seven years. He highlights the enriching experience of
FMAS, noting its impact on his practice and approach to patient care by bringing his on-the-ground experiences to the national stage. Dr. Huang shares that FMAS is effective in influencing policymakers due to the significant platform of AAFP and the collective efforts of the attending physicians.
Cecilia Lee, MD, a recent family medicine resident graduate from Kaiser Permanente, Woodland Hills family medicine residency program, shared her perspective as a firsttime attendee, emphasizing the significance of participating in advocacy efforts, given her residency program did not afford this opportunity in her training.
What has your overall experience been like at FMAS?
Dr. Huang: Attending FMAS has been incredibly enriching. This year, the focus on primary care advocacy at the national level was more pronounced than ever. It’s always inspiring to see so many dedicated professionals coming together for a common cause.
Dr. Lee: Attending FMAS has been wonderful and well-organized, especially as someone with no prior advocacy experience on such a large scale. While I had a general
sense of advocacy at the local level, I had never had the opportunity to go to the Nation’s Capital and speak with legislators on issues that impact family medicine. I was particularly impressed by the collaboration between family physicians across the country.
During FMAS, what policy changes have you advocated for?
Dr. Huang: Over the years, we’ve tackled various issues. A notable success was advocating for a prescription drug database across state lines. We worked with Congressman Adam Schiff’s office to amend a bill, a direct outcome of our efforts at FMAS.
Dr. Lee: After returning from FMAS, I shared with colleagues and faculty the issues I advocated for on the Hill. Everyone was surprised because they assumed certain things existed, such as patients being able to access preventive care not realizing barriers posed by high-deductible health plans. However, after sharing the data and stories with my colleagues, they became more interested in advocacy, some even committing to attend FMAS next year.
How effective do you think the FMAS is in influencing policymakers and legislators?
Dr. Huang: Extremely effective because the AAFP, the largest family medicine organization, has a significant platform. Our presence on Capitol Hill, with hundreds of physicians advocating, amplifies our voices and facilitates real change.
Dr. Lee: FMAS is very powerful in influencing policymakers and legislators because physicians from all over the country share their personal experiences and explain why the issues being advocated for are important. Family physicians are often the first point of contact in the healthcare
system, so being able to provide that perspective to legislators is very impactful. How valuable is the networking aspect of FMAS for you personally and professionally?
Dr. Huang: FMAS provides a unique, invaluable opportunity to interact with leaders and peers from across the country. It has led to collaborations and new ideas that I’ve implemented in my practice.
Dr. Lee: Networking at FMAS was incredibly valuable both personally and professionally. Some of the physicians I met at FMAS have worked with or know my faculty and colleagues. The ambiance of FMAS is uplifting. There is a sense of camaraderie among the physicians attending – all sharing challenges experienced in our designated states and celebrating wins.
What advice would you give to a family physician, resident, or medical student considering attending the summit for the first time?
Dr. Huang: Get involved at whatever level is comfortable for you. The most important part is showing up. It’s a significant commitment, but your presence makes a difference. Even if you can’t attend FMAS, advocate locally and stay engaged.
Dr. Lee: I was a third-year resident when I first attended FMAS and wished I had signed up earlier. Initially, I was nervous about Hill Day and wasn't sure if I could effectively express the issues we were advocating for to lawmakers since this wasn't a part of the training in my residency program. However, the conference includes specific sessions for communicating with lawmakers and what Hill Day will entail. I felt very comfortable and even practiced for our lobby day meetings with Dr. Huang, getting feedback ahead of time.
Take it from your peers, FMAS ensures that family physicians have a seat at the table, protecting them from being overlooked in critical policy decisions that impact medicine and patient care. The long-term impact family medicine champions have is profound in shaping the future of equitably, high quality, affordable primary care.
Dr. Huang’s and Dr. Lee’s experiences underscore the power of physician-led advocacy at FMAS, highlighting the importance of connecting, learning, and growing as a community dedicated to improving healthcare. As Dr. Huang aptly puts it, "If you are not at the table, you are on the menu," so advocate at the level most comfortable for you. See you there next year!
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The latest research and the 2020 Dietary Guidelines for Americans indicate that eggs can be included in a healthy diet.
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Building a Trauma-Informed Culture:
Practical Tips for Moving From Principles to Practice
Lori Chelius, MBA, MPH Co-Founder, Origins Training & Consulting
Trauma Informed Practices for Your Workplace CAFP has assembled practical resources for family docs, including Trauma Informed Tips for Workplace Training from Origins Training, at https://familydocs.org/aces
Image used with permission from NVRnorthampton. See https://tinyurl.com/yc7y4b78 for a description of Dr. Siegel’s flipped lid model.
As healthcare professionals, you all came to this work to support healing. It’s hard work, and sometimes the reason you started this work – your why – can get pushed aside. Overloaded schedules, frustrated patients, and strained resources can all contribute to stress and burnout. Within that context, trauma-informed care (TIC) can sometimes seem like one more thing to do. But what if TIC is less about one more thing to do and more about HOW we are doing
WHAT we are already doing? And how can TIC help us reconnect with that purpose?
TIC is a strengths-based approach to building an organizational culture that recognizes how stress affects people, promotes tools and practices to increase resilience, and encourages opportunities for safety and connection. But culture can sometimes feel daunting and nebulous so let’s take a look at this in practice. We hope you
are inspired by how TIC has been brought to life.
Erika Roshanravan, MD FAAFP, is a family physician and the Medical Director at Davis Community Clinic at CommuniCare+OLE, a federally qualified health center (FQHC) in Northern California. She is also a champion of TIC within her clinic and within CAFP.
Establishing a Shared Language
Davis Community Clinic has initiated teambuilding activities during staff meetings, incorporating the “flipped lid” hand model developed by Dr. Dan Siegel. Activities encourage staff to recognize signs of stress, identify coping strategies, and offer support to one another. Establishing this shared language fosters communication during times of stress, promoting a culture of connection among teammates.
Assuming Best Intent
Another example involves adopting a mindset of assuming best intent, especially in stressful situations where conflicts may arise, whether with patients or among staff. This approach embodies a key principle of trauma-informed care: shifting from asking “What’s wrong with you?” to “What happened to you?” This shift creates room for a healing-centered approach, fostering understanding and empathy.
Bringing the Team Together for “Cuddles”
A third example, still in the process of being implemented, involves introducing team huddles (they’ve coined them “cuddles”) at the close of clinic hours, complementing morning “huddles” that prepare for the day ahead. Coined to highlight their nurturing nature, these cuddles offer a supportive space where providers and staff can tie up loose ends for patients, share feedback on clinic processes and debrief with fellow team members. Additionally, bi-weekly team meetings are held to enhance coordination and discuss improvements. These initiatives underscore the importance of staff empowerment, emphasizing that each team member’s input is valued–one of the key principles of a trauma-informed approach. At the core of this approach is identifying concrete ways to operationalize the traumainformed principles of safety, trustworthiness and transparency, peer support and mutual self-help, collaboration and mutuality, empowerment, voice, and choice, strengthsbased, and cultural, historical, and gender humility. While these concepts may appear
straightforward, implementing them can be challenging. However, their impact on patient care and staff well-being is profound and transformative.
Says Dr. Roshanravan, “This is a culture change, not a specific thing we do.” And while culture change can take time, there are simple and concrete practices that can be sprinkled in right away to support that culture of safety and connection.
CommuniCare+OLE’s approach highlights that while TIC supports patient care, the approach starts internally. By incorporating TIC practices within their organization, they have observed improvements in staff wellbeing and resilience, which in turn positively impacts patient care. As echoed by a team member at Eisner Health, an FQHC in Southern California, “When we take care of ourselves, that’s when we can provide the best care for others.”
The Direct Primary Care Model: A
Path to Better Care for Patients and Physicians
Maryal Concepcion, MD, FAAFP
Jeannine Rodems, MD, FAAFP
In recent years, the healthcare landscape has been increasingly complex, with rising administrative burdens and fluctuating patient satisfaction. One promising solution that has emerged is the Direct Primary Care (DPC) model. This innovative approach promises not only to improve patient care but also to rejuvenate the practice of medicine for family physicians. Let’s explore how DPC is reshaping the future of healthcare and why it may well become the preferred model of care.
What is Direct Primary Care?
Direct Primary Care is a healthcare model where patients pay a fixed, monthly fee directly to their physician, bypassing traditional insurance-based billing. This fee covers a range of services, from routine check-ups to urgent care visits, and often includes additional perks like 24/7 access to the physician and longer appointment times. By eliminating the need for insurance claims and reducing administrative overhead, DPC allows physicians to focus on delivering high-quality care without the constraints imposed by thirdparty payers.
Benefits to Patients
For patients, the DPC model offers several compelling advantages:
1. Enhanced Access and Convenience: With DPC, patients typically enjoy more flexible appointment scheduling, including same-day or next-day visits. This direct access reduces wait times and ensures timely intervention, which is crucial for managing chronic conditions and preventing acute issues.
2. Personalized Care: The DPC model supports longer, more comprehensive appointments. Physicians can spend more time understanding their patient’s needs and developing tailored treatment plans, leading to a more personalized and effective approach to care.
3. Predictable Costs: The fixed monthly fee means patients are not surprised by unexpected bills or co-pays. This transparency fosters trust and allows patients to budget their healthcare expenses more effectively.
4. Improved Patient-Physician Relationship: The model encourages a closer, more collaborative relationship between
patients and their physicians. With fewer constraints from insurance companies, patients and doctors can focus on what truly matters: the patient's health and well-being.
Benefits to Physicians
Family physicians, too, stand to gain significantly from adopting the DPC model:
1. Reduced Administrative Burden: By eliminating the need for insurance billing and claims processing, physicians can streamline their administrative tasks. This reduction in paperwork allows them to spend more time on patient care rather than dealing with bureaucracy.
2. Increased Job Satisfaction: Physicians in DPC practices often report higher job satisfaction due to greater autonomy and the ability to build deeper, more meaningful relationships with their patients. This renewed focus on patient care, rather than insurance restrictions, can lead to a more fulfilling professional experience.
3. Financial Stability: The predictable monthly fees provide a steady income stream, which can improve financial stability and allow physicians to invest in their practice. This stability also supports better work-life balance by reducing the pressure to see a high volume of patients.
4. Opportunity for Innovation: DPC practices often have the flexibility to innovate and adopt new technologies or approaches to care without needing to navigate complex insurance requirements. This freedom can lead to more creative and effective healthcare solutions.
The Future of Healthcare
As the traditional fee-for-service model faces increasing scrutiny for its inefficiencies and high costs, DPC offers a viable alternative. By prioritizing the doctor-patient relationship and reducing administrative burdens, the DPC model aligns more closely with the principles of patient-centered care. It holds promise not only for improving the quality of care but also for making the practice of medicine more rewarding and sustainable for physicians.
In conclusion, Direct Primary Care represents a transformative shift in how we approach primary care. Its benefits for both patients and physicians suggest that it is not merely a passing trend but a viable and potentially superior model of care. As more healthcare professionals and patients experience the advantages of DPC, its adoption is likely to grow, making it a central feature of the future healthcare landscape.
Jeannine Rodems, MD, FAAFP, is a board-certified family medicine physician at Santa Cruz Direct Primary Care. She has been an active member of the local physician community in Santa Cruz County for several years. She is a past president of the Santa Cruz County Medical Society. She has been very active with CAFP, having been a previous member of the board of directors, and served as a past president of the Santa Cruz-Monterey-San Benito Chapter. When she is not working with patients, she enjoys theater, gardening, and walking her dog, Shadow. She is married and has one daughter.
Maryal Concepcion, MD, FAAFP practices at Big Trees MD, a rural DPC she owns and operates with her husband and fellow family doc, Jeremiah Fillo, MD, FAAFP. As a national advocate and speaker on Direct Primary Care, she hosts the top podcast in the US about DPC, My DPC Story, and is a mom of two boys.
PRIMARY CARE PHYSICIANS
San Francisco Bay Area
$239,000 - $273,000 with a 5% increase on 11/1/24
Contra Costa Health is seeking full-time and part-time BC/BE Family Medicine, Pediatric or Internal Medicine Primary Care Physicians. Our health centers across Contra Costa County are integrated with specialty care services and the public hospital.
We are looking for providers from diverse backgrounds and lived experiences who share our vision of providing equitable and quality health care to all members of our Contra Costa community. Desired applicants would work with a motivated practitioner group to provide innovative community medicine that empowers patients by fostering an environment of belonging and well-being.
To learn more, please contact: Recruit@cchealth.org
We offer:
• Flexible full- and part-time scheduling; no required weekends and no call!
• Modern facilities serving the needs of ethnically and culturally diverse populations
• Opportunity to be involved in resident teaching with our nationally recognized Family Medicine Residency Program
• Comprehensive compensation package
• 4 hours of paid administrative time a week, with opportunity for more paid time
• Favorable HPSA score for national and state loan repayment programs
• EPIC medical record system
CONTINUING MEDICAL EDUCATION
PRIMARY CARE UPDATE
Monday, November 4, 2024, 8:00 am - Wednesday, December 4, 2024, 11:59 pm. Earn 20.00 hours, AOA Category 1-A credits.
The goal of the 2024 Virtual Primary Care Update is to provide primary care providers with the latest in practice guidelines over a wide variety of frequently encountered topics and disease processes. Program participants will then apply the knowledge gained back to their existing rural, suburban or urban practice allowing them to bridge the gap between previous therapies and the current best practices.
ENDURING CREDITS & PACKAGES
Specialty Credits: Over 20 specialty credits available including internal medicine, preventative medicine, OMM/NMM, and more! Visit okla.st/cme-credits to see Enduring Credits and Package options.
Vote!
Voting is Good for your Patients' Health
Important Dates: November 5, General Election Day
• October 7 - Your county elections office will begin mailing ballots (All California active registered voters will receive a vote-by-mail ballot for the November 5, 2024, General Election.)
• October 8 - Ballot drop-off locations open
• October 21 - The last day to register to vote for the November 5, 2024 General Election
Voting is a powerful tool for improving the health of all Californians. With major upcoming elections at the national, state, and local levels, voting is a way that people can use their voice to advance policy that shapes their overall well-being, from health care access to environmental sustainability, and everything in between. Engaging in the voting process builds a strong sense of community and responsibility, boosting both mental and physical health. Family physicians, as trusted community leaders, are perfectly positioned to lead this charge. By helping patients register to vote, family physicians are not just promoting civic engagement—they are actively strengthening the health and unity of their communities.
Recognizing the pivotal role of our family physicians in building momentum for civic engagement, the California Academy of Family Physicians (CAFP) is supporting our members with an easy way to engage with patients and get them registered to vote ASAP. CAFP is providing easy-to-use, downloadable resources and information to help physicians educate their patients about the voting process.
CAFP is also hosting a virtual webinar on September 4th to highlight how family physicians can promote voter registration, fostering a sense of community and connectedness that positively impacts patient health.
What is Vot-ER and why is it important?
Vot-ER is a nonpartisan platform designed to empower physicians and other health care providers in getting their patients registered to vote during medical visits. Because medical offices are crucial community hubs for patients across the diverse communities in California, they serve as an excellent location, paired with the trusted relationships fostered by family physicians, to help patients take the crucial first step in civic engagement- registering to vote.
Vot-ER seamlessly integrates voter registration into the health care setting, making it easy and accessible. For family physicians, Vot-ER is an invaluable tool to promote civic engagement, strengthen the doctor-patient relationship, and contribute to the overall health of their communities by ensuring patients have a voice in shaping the policies that affect their lives. Visit https://vot-er.org for resources.
• November 12 - Vote-by-mail ballots can be returned by mail, at a drop-off location, or your county elections office
Prop 35 would secure dedicated funding to help hospitals, clinics and doctors’ offices stay open and support care for 15 million Californians on Medi-Cal. That’s why we encourage you to vote #YESon35 to protect Medi-Cal and access to health care for all Californians. @YesOnProp35. Visit VoteYes35.com to learn more.
Cut out this page, hang in your office, and encourage your patients and colleagues to vote!
California Residency Program Collaboration for Real Change:
Learning, Sharing and Serving Patients Together
"This grant has truly been successful in changing the culture of substance use treatment." ~ CRPC-2 grantee
“The educational resources, connections, reflections, and inspirational stories from other participants was ultimately as valuable as the monetary funding that accompanied this collaboration.” ~ CRPC-3 grantee
“A year and a half ago I didn’t know what Buprenorphine was, much less how to use it in OUD/SUD Treatment and now all our residents know about it and I’m teaching those rotating in about OUD/SUD treatment too!” ~ CRPC-2 grantee
“It is possible to move an entire residency group in the same direction when time is provided, and incentives are included.” ~ CRPC-1 grantee
Since 2019, and with the support from California Department of Health Care Services (DHCS) Opioid Response, CAFP and CAFPFoundation have led three separate multi-specialty California Residency Program Collaboratives (CRPC) aimed at improving care for patients with Opioid Use Disorder (OUD). The collaborative has awarded 68 grants to family medicine, emergency medicine, internal medicine, pediatrics, obstetrics and psychiatry residency programs based on their proposed initiatives to reach the goals identified by DHCS and SAMHSA for the use of State Opioid Response (SOR) funds each funding cycle.
CRPC Goals -
1. Advance the training of primary care residents and physicians in the field of substance use disorder disease screening, diagnosis and treatment;
2. Improve the patient experience of care (including quality and satisfaction);
3. Promote care that is patient-centric and evidence-based, engaging the community in the overall management of substance use disorder.
These residency programs developed and implemented initiatives that have not only succeeded at meeting their goals to improve care; but their efforts have spawned a sea change in the way residents, residency programs and health systems now view and offer services for their patients experiencing pain and OUD/SUD. They broke down long held institutional silos between departments and specialties, established new addiction care rotations and curricula, included nurses and the entire care team in educational sessions, and better coordinated care for patients.
Thanks to our partner, the Interstate Postgraduate Medical Association (IPMA), grantees were provided with an opportunity to support practice transformation through completing a quality improvement (QI) project. The online QI module was developed for the multispecialty programs to help assess program readiness for change, introduce and guide them through the Quality Improvement Framework for improvement, and to increase the likelihood of making sustainable changes in practice. With the help of this QI project, coaching, education, tools and resources shared among grantees, programs not only reached their goals, but laid a foundation for change that will serve them well beyond this initiative.
Grantees now understand the importance of addressing concepts like stigma, harm reduction, motivational interviewing, and treating OUD/ SUD patients as if they have a chronic medical condition deserving of respectful, non-judgmental care. Oh wait - many DO have a chronic medical condition, and the sooner we start accepting this, the sooner more lives will be saved.
Bringing together these grantees that were working above and beyond their “normal duties” to improve care to some of our most vulnerable underserved patients was truly awe-inspiring. Over and above the funds, education and training CAFP provided was the gift of time - time away from their busy day-to-day world to let their
passion for public service shine. They made the most of their time spent with us, but more importantly, with fellow grantees who shared their passion and desire to make a difference in the lives of their patients.
These programs have improved their institutions and communities through initiatives like MOUD training for all levels of clinicians, launching buprenorphine induction order sets in EHRs, improving workflow and formulary alignment, launching addiction consult services, initiating FM MAT consult services, increasing Medication for Opioid Use Disorder (MOUD) initiation in the emergency room and arranging continuing care through primary care providers, increasing street medicine outreach, launching a bridge clinic, creating new inpatient consult service that specifically addresses OUD/SUD and Stimulant Use Disorder, implementing standardized screening, and developing critical community partnerships. In fact, one of our grantees was inspired enough to work toward creation of a countywide addiction medicine fellowship!
We asked our CRPC-3 grantees to complete this statement, “Without this Collaborative and CRPC resources, we would not have been able to…” and their replies speak volumes about the impact CRPC has had:
• Change a hospital and community culture surrounding substance use disorder and its associated conditions
• Inspire the next generation of family physicians to view substance use disorder as a chronic, treatable disease which they can address
• Initiate adolescent addiction services that provide immediate harm reduction, evidenced based SUD care and longitudinal follow up.
• Transform addiction education and care in our region
• Remove institutional barriers for primary care physicians to prescribe Suboxone for OUD or Chronic Pain.
• Design, deliver and sustain a culture of low threshold MAT for Alcohol Use Disorder (AUD)
• Seriously affect the policies of the hospital to become MAT friendly and OUD understanding.
• Realize a large [unmet] diagnostic and treatment need for our clinic patients and bring new processes and resources to bear in helping meet and sustain their treatment needs.
• Build an energetic community of health care providers with the expertise to care for marginalized individuals while simultaneously challenging and improving the system of care.
Many of the CRPC education modules are publicly available online 24/7 on Homeroom (CAFP’s Learning Management System) at https://education.familydocs.org/. Additional OUD/SUD resources, including podcasts, MOUD Champions Program, and more are available at https://www.familydocs.org/sud/. For more information, contact Jerri Davis at JDavis@familydocs.org.
Join the MAT/MOUD Discussion on CAFP’s 365 App for ongoing support and community, visit https://www.familydocs.org/app
■ 284 Physicians Receiving X-Waiver (not including those awaiting an application response)
■ 88 Staff Physicians Receiving X-Waiver
■ 196 Residents Receiving X-Waiver
■ 6 Guidelines and Protocols Implemented (multiple built into medical records)
Cohort 2 outcomes data
■ 411 more X-Waivered physicians in California
■ 10,025 patients screened for SUD
■ 7,300 patients referred to recovery services
■ 7,000 Fentanyl test strips distributed
■ 6,525 patients received Narcan
■ 1,800 patients served Fentanyl test strips
■ 6,527 units of Narcan distributed
Cohort 3 outcomes data
■ 333 physicians newly prescribing MAT
■ 3,779 more physicians trained in MAT
■ 2,939 patients referred for SUD treatment
■ 1,494 patients referred for housing support
■ 5,253 patients referred to SUD recovery services
■ 1,750+ Fentanyl test strips distributed*
■ 6,100+ xylazine test strips distributed*
■ 933 safer consumption kits distributed
■ 13,442 units of Narcan distributed
*data only collected for part of the collaborate term
California Residency Programs that participated in CRPC:
2019-2021 CRPC 1 grantees:
• Kaiser Permanente Orange FMRP
• Loma Linda FMRP
• PIH Health FMRP
• San Joaquin-SJGH FMRP
• Ventura FMRP
• Kaiser Permanente Napa Solano FMRP
• John Muir Health FMRP
• Family Health Center FMRP
• Kaiser Permanente Santa Rosa FMRP
• UC Davis FMRP
• UC Davis OBRP
• Adventist Health FMRP
• Emanate Health FMRP
• UC Davis IMRP
• Natividad FMRP
• Valley-Stanislaus FMRP
• Scripps Chula Vista FMRP
• Sutter-Santa Rosa FMRP
• Kaiser Permanente San Diego FMRP
• UC San Diego IMRP
• Contra Costa FMRP+OBRP
• Olive View-UCLA IMRP
• USC-Keck IMRP
• Stanford-O'Connor FMRP
• Kaiser Permanente San Jose FMRP
• UC San Diego FMRP
• UCSF-Fresno FMRP
2021-2022 CRPC 2 grantees:
• Adventist Health Hanford FMRP
• Adventist Health Tulare FMRP
• Adventist Health Ukiah Valley FMRP
• Eisenhower Health GME EMRP
• Eisenhower Health GME FMRP
• Harbor-UCLA EMRP
• Harbor-UCLA FMRP
• Kaiser Central Valley EMRP
• LAC+USC EMRP
• LAC+USC Psychiatry Residency Program
• Olive View-UCLA Medical Center EMRP, OB-GynRP, Psychiatry RP, Pediatrics RP
• Pomona Valley Hospital Medical Center’s (PVHMC) FMRP
• Shasta Community Health Center FMRP
• Stanford Pediatrics RP
• Sutter Health FMRP
• Sutter Health FMRP, Davis Track
2023-2024 CRPC 3 grantees:
• Adventist Health Hanford FMRP
• Adventist Health Tulare FMRP
• Alameda Health System/ Highland Hospital EMRP
• California Hospital Medical Center FMRP
• Contra Costa Regional Medical Center FMRP
• County of San Mateo/San Mateo Psych RP
• Kaiser Permanente Vallejo FMRP (Fourth Second: One Love Vallejo Mobile Health)
• Harbor UCLA FMRP + PEDs RP
• Harbor UCLA IMRP + FMRP
• Kaiser Permanente Santa Rosa FMRP
• Kaiser San Diego FMRP
• Kern Medical Center IMRP
• Olive View-UCLA Medical Center EMRP
• Pomona Valley Hospital Medical Center FMRP
• Rio Bravo FMRP
• San Joaquin General Hospital FMRP
• Shasta Community Health Center FMRP
• Sierra Nevada Memorial Hospital FMRP
• St Joseph's Stockton EMRP
• UC Davis EMRP
• UC Davis FMRP
• UC San Diego FMRP
• UC San Diego IMRP
• UCSF Fresno FMRP
• Ventura County Medical Center FMRP
Learn more about a primary care career at Adventist Health
At Adventist Health, we are dedicated to transforming the health experience of the more than 100 communities we serve. Our focus is the whole person — mind, body and spirit. As a faith-based health system founded on Seventh-day Adventist heritage and values, we know you want more purpose in your work. We will ensure you find it.
Adventist Health is 28 hospitals, 440 clinics and 4,500 providers throughout the West Coast and Hawaii.
Why Choose Adventist Health
• Opportunities in locations to suit any lifestyle
• Starting bonus up to $60,000
• Residency/Fellowship stipend
• Additional bonus and incentive structures Qualified Public Service Loan Forgiveness (PSLF) Employer
• Leadership and academic opportunities available
• Large network of primary care and specialty providers
Scan the QR code to learn more about opportunities at Adventist Health or visit PhysicianCareers.ah.org To speak to a recruiter directly, please email us at phyjobs@ah.org
CAFP Foundation
CAFP Foundation Celebrates 40 Years: Looking Back at the Past and Ahead to the Future
Ronald Labuguen, MD, FAAFP
Through philanthropy, the California Academy of Family Physicians Foundation nurtures each generation of family physicians to ensure the future of family medicine and celebrate the joy of our specialty!
As your CAFP Foundation President, I’m thrilled to share a few comments about the Foundation and what we’ve been working on during the first half of 2024.
ABOUT THE CAFP FOUNDATION:
The CAFP Foundation has a bold ambition of helping build and nurture the next generation of family physicians. Since 1984, we’ve served as the philanthropic arm of the CAFP; and over the years, we’ve had the honor of supporting thousands of medical students, residents, and early career physicians along their journey into family medicine. Now, in 2024 - that’s right, we’ve turned 40! - we’re at a natural inflection point for looking back at the past and ahead to the future.
Over the last four decades, the Foundation’s programs and initiatives have varied greatly. One thing has remained constant—our deep commitment to providing education, leadership, and connection for our beneficiaries.
We are widely known for signature activities, such as:
• Administering scholarships to national and state-wide events,
• Supporting pathways programs for middle and high school students,
• Funding Family Medicine Interest Groups at all 16 medical schools,
• Promoting scholarly projects like the Medical Student Research Grants and Resident Poster Competition,
• Offering educational experiences like our Clinical Procedures Workshops, Chief Resident Leadership Program, Family Medicine POP sessions, and the California Residency Program Collaborative, and
• Serving as the backbone entity of the CAFP Residency Network, which represents the interests of the nearly 80 family medicine residency programs in the state.
That’s a lot of activity! While the continuous implementation of these programs is important, we have also embarked on another adventure: a process of discovering and learning about the impact of all this work.
WHAT IMPACT MEANS TO US:
The Foundation believes in the power of philanthropy to create meaningful, transformative change in the lives of our beneficiaries and in our specialty. For the past year, we rigorously developed an evaluation framework for measuring change and understanding impact. We have now begun to collect data on some of our activities. By examining the breadth and depth of our work, we can be more truly aware of our successes, strengths, and limitations—and that empowers us to ask important questions, such as:
• How can we deepen and extend our work for greater success?
• How can we be good stewards of our resources in support of our mission?
• If our programs feel brittle or stale, how can we best respond?
• And ultimately, how can we best support students, residents, and early career family physicians when our field is constantly changing?
These are important questions we must ask, but here’s another one: what’s next?
WHAT’S NEXT?
The Foundation cares about long-term impact. We hope to see that our programs make a positive and significant contribution to the development of our upcoming generation of family physicians. If we can show that, we also hope to use this information to continue generating support from member donors and outside funders. We also hope to strengthen our work by forging partnerships in the community with others whose missions align with ours.
My greatest hope is that when our members come to the Foundation, they find overflowing encouragement, joy, support, and belonging.
I’d like to offer my thanks to all our supporters for their unwavering support of the Foundation. Please stay connected - we look forward to sharing with you what we learn along the way!
Where’s My Doctor?
Role Misidentification Against Female Physicians
Cynthia Chen-Joea, DO, MPH, CPH
(Article first appeared in the Los Angeles AFP Chapter Newsletter)
“I haven’t seen a doctor in 2 days. Where’s my doctor?” a patient asked me as I entered the room. As the Inpatient Director and attending for our residency program, I was taken aback for many reasons. I calmly said, “I’m Dr. Chen, I saw you yesterday and I came with my senior resident at that time.” In the back of my brain, I started triaging the possibilities of why my patient had made this comment, just like I do in medicine thinking about differentials. Did my residents wake the patient up this morning to examine him? Most likely yes, I trusted my group and felt they were responsible and reliable. Did my residents run out of time due to an emergency and weren’t able to see the patient this morning? Possibly, last minute admits and critical care patients do require a lot of time and effort. Maybe the patient was sleeping so soundly that he forgot he was examined. Maybe, but who knows?
I listened to his symptoms, and we chatted pleasantly about the plan of care for the day. I returned to the resident room to discuss the patient’s comments with my team. My highly trusted senior resident noted that she rounded on the patient with the junior resident in the early hours of the morning, spoke with the patient, and did a full physical exam. She noted that the patient had complained yesterday to her that he had not seen a doctor since admission. At that time, she kindly reminded him that she was Dr. X, one of the many doctors on his medical team taking care of him. It suddenly dawned on me that I was leading a team with all female physicians. Even though I did not want to believe the reality, I knew the little voice in the back of my brain triaging differentials whispering Maybe my patient didn’t think he saw a doctor for the last 2 days because I was female was true. Unfortunately, this experience is not a singular episode or even a unique one, but a widely shared encounter among my female physician colleagues.
For the last five years, women have comprised over half of medical school applicants and graduates, and are an increasingly larger percentage of physicians (AAMC 2023). Despite the greater prevalence female physicians have in medicine, role misidentification is one component of gender-based physician stereotypes that often occur. A study of emergency medicine patients in 2019 showed that patients recognized male attendings as physicians 75% of the time, but only female attendings as physicians 58% of the time (Boge et. al 2019). Another study of residents across multiple specialties found that 100% of women were misidentified as nonphysicians at least once during their professional career, compared to 49% of men
(Berwick et al. 2021). Xun et al. (2021) studied public perception of physician attire and found that male models were more likely to be perceived as physicians compared to female models when both were dressed in professional wear and white coats. The study also showed male models, regardless of what they were wearing underneath their white coats, were perceived as significantly more professional than the female models wearing similar attire (Xun et al. 2021). Females were more often thought to be technicians, physician assistants, or nurses. As a response to being misidentified, female physicians may feel reduced self-confidence and self-efficacy, as well as less job satisfaction, which may contribute to burnout (Berwick et al. 2021). This phenomenon may also affect patient-physician relationships and patient dissatisfaction if the patient mistakenly believes that they have not seen a physician. In literature, suggestions to address this issue often focus on female physicians dressing more professionally, wearing white coats and clearly identifying their role to their patients. Unsurprisingly, even with all these interventions, I continue to be misidentified as someone other than the doctor to this day.
In chatting with my colleagues, it is apparent that this issue is rooted in more than just the healthcare community. These gender-biased stereotypes and role misidentification likely resulted from historical trends seen in society and cultures that placed limitations on the female labor workforce to fill areas that males did not or were unable to occupy. Throughout the history of medicine, females were allowed in specialty areas that were considered lower status or areas that did not attract male physicians. Dr. Elizabeth Blackwell was the first female physician in the US who earned a medical degree. She graduated at the top of her class in 1849 despite facing discrimination and many obstacles in medical college. At the time, Dr. Blackwell was seen as a woman who did not conform to societal standards, and therefore was unpopular and discriminated against as a female physician. Consequently, she worked in the realm of midwifery or nursing, which ultimately led her to work in obstetrics and gynecology treating women and children. These trends may be why there is a greater percentage of female physicians compared to male physicians in Obstetrics and Gynecology and Pediatrics today. This may also be why female physicians are frequently thought to be nurses or other nonphysician hospital staff members.
Gender-based stereotypes and role misidentification against female physicians may be deeply rooted in our culture, society, and
continued on page 26
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continued from page 24
medicine. Rather than putting the onus on female physicians, all healthcare workers and our communities should share the responsibility of addressing this multifaceted issue. Changing the collective mindset and norms requires both men and women to be transparent and honest in their behaviors and actions, and actively participate in understanding components that contribute to conscious and unconscious biases. Leaders and executives should serve as strong advocates to help champion and support efforts around gender equality. This can help create a culture of inclusivity and set the standard for other organizations and medical institutions. Despite progress in promoting gender equality in medicine, there is still much to tackle. Biases will not change overnight, but we can start the conversations to increase advocacy and awareness of this issue. One might say What can I really do around this enormous problem? My answer is simple. I challenge you to ask your colleagues if they’ve ever
Health Sciences Clinical Professor Series - Family Medicine
JOB LOCATION: Santa Ana, CA and Anaheim, CA
2 POSITIONS AVAILABLE:
The UC Irvine Department of Family Medicine anticipates openings for a full-time faculty position in the Department of Family Medicine, School of Medicine, at the University of California, Irvine. We are seeking qualified individuals who are excellent clinicians with a strong commitment to medical education. The position will be offered in the Health Sciences Clinical Professor Series at the Assistant Professor, Associate Professor, or Professor level. This position would have a primary care practice at UCI's Federally Qualified Health Centers and serve as core faculty in the Family Medicine Residency Program. This on-going recruitment is for clinicians in an ambulatory practice with possible obstetric work if desired. The salary range for this position is $237,500-$256,500.
REQUIREMENTS:
Candidates must have MD or DO degrees and have current or applied for California Medical License. Candidates should be board-certified in Family Medicine.
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Please log onto UC Irvine’s RECRUIT located at https://recruit.ap.uci.edu/JPF09309
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been faced with gender biases in medicine. I guarantee that they have experienced some form of discrimination. These are tough conversations that we must have, but this small and concrete step may be the first of many that ultimately lead to lasting and effective change that transforms our society and medicine. We may be surprised by what our dialogues reveal and never know where the insight may take us.
References:
AAMC. New AAMC Data on Diversity In Medical School Enrollment in 2023. December 2023. Retrieved from https://www.aamc.org/news/pressreleases/new-aamc-data-diversity-medical-schoolenrollment-2023#:~:text=Women%20comprised%20 56.6%25%20of%20applicants,of%20these%20 three%20distinct%20groups.
Berwick, Shana MS, MD; Calev, Hila MD; Matthews, Andrew MD; Mukhopadhyay, Amrita MD; Poole, Brian MD; Talan, Jordan MD; Hayes, Margaret M. MD; Smith, C. Christopher MD. Mistaken Identity:
Frequency and Effects of Gender-Based Professional Misidentification of Resident Physicians. Academic Medicine 96(6):p 869-875, June 2021. | DOI: 10.1097/ ACM.0000000000004060
Boge, LA, Santos, CD, Moreno-Walton, LA, Cubeddu, LX and Farcy, DA. Health Care Professional Roles in the Emergency Department. Journal of Women’s Health 28(7). https://www.liebertpub.com/doi/ epub/10.1089/jwh.2018.7571
Laurie A. Boge, Carlos Dos Santos, Lisa A. MorenoWalton, Luigi X. Cubeddu, and David A. Farcy.The Relationship Between Physician/Nurse Gender and Patients’ Correct Identification of Health Care Professional Roles in the Emergency Department. Journal of Women’s Health.Jul 2019.961-964.http://doi. org/10.1089/jwh.2018.7571
Xun H, Chen J, Sun AH, Jenny HE, Liang F, Steinberg JP. Public Perceptions of Physician Attire and Professionalism in the US. JAMA Netw Open. 2021;4(7):e2117779. doi:10.1001/ jamanetworkopen.2021.17779
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Remember That Your Vote Counts
Scott Nass, MD, MPA, FAAFP, AAHIVS
The first time I voted for President of the United States, I was ten years old. I am sure it was a crisp November morning in Eastern Kentucky among the foothills of the Appalachian Mountains, when I proudly jumped off the school bus and rushed to my classroom, ready to vote armed with critical knowledge that I had gained from my parents the night before: Ronald Reagan HAD to be our next President.
Obviously, this wasn’t the REAL presidential election, but rather an exercise in civics for the fourth and fifth graders at my elementary school. In the moment, however, I assure you it felt very real. The hallway was abuzz with hushed excitement as we dutifully walked single file to the cafegymatorium to exercise our right to vote. (Or was it a responsibility? That debate was part of another lesson.)
The expansive cinder-block walled room had been partially staged for the actual election set to take place the next day. With few public spaces large enough in our small town, the handful of elementary schools throughout the rural county made for convenient polling stations. Along the back wall, away from the elevated stage, ran a bank of official voting booths, as tall as could be with actual curtains that closed behind, offering the utmost privacy for determining the future of our country.
In turn, we approached an open booth with a paper ballot in hand. This was a simple exercise, so we had only one choice to make once we entered the private sanctum: would it be Reagan/Bush or Mondale/Ferraro rising to become the most powerful leaders in the world?
At the end of the day, just as with the actual election, Reagan won by a landslide. I imagine we fourth and fifth graders relied
on much the same criteria for making our selection as did voters around the country. Name recognition and charisma (and probably a lot of parental influence) made the choice for most of us an easy one.
Over the years since, I have learned to make important decisions regarding the fate of our country (mostly) without the guidance of my parents. I was over the moon to be able to attend Bill Clinton’s inauguration as part of my high school’s youth in government club field trip. I nearly (or maybe more than nearly) cried when my environmental hero Al Gore conceded the race and broke my heart all in one halting moment. And I have lived the same emotional ups and downs, and around and arounds, as we all have these past few years while watching American politics become more and more polarizing.
Through it all, I have stayed true to myself and channeled my enthusiasm and frustrations into making a difference wherever I can, particularly in my own community and for our profession. Joining CAFP in Sacramento, and the AAFP in Washington, to speak to my local representatives has given me an informed perspective on the inner workings of government, while the privilege of being a family medicine physician has enabled my advocacy efforts, particularly around LGBTQ+ health, to have a platform for making a difference.
Politics today may not be as simple as that small square of paper where I once marked my “X” in the fifth grade, but our engagement is just as necessary as I felt it was then. As you reflect on the perspectives in this issue, consider the impact we all can have at every level of government. Go make the world one of which that ten-year-old you would be proud.
CAFP Sets the Table for Success in Sacramento
Lisa Folberg, MPP, CAFP CEO
CAFP has completed its move from San Francisco to Sacramento and opened its doors to the new headquarters in Spring 2024.
The essential work CAFP does in advocacy and policy largely happens in Sacramento. Many California regulatory agencies, the Legislature, foundations and other advocacy organizations are strategically located in the state capital. As part of CAFP’s strategic goal to raise the profile of family physicians and increase our influence in advocacy and policy, the CAFP Board of Directors unanimously decided to move the organization from San Francisco to Sacramento.
As the saying goes, if you are not at the table, you will be on the menu. By moving to Sacramento, CAFP has taken a seat at the table and helped set it for success. Our move is not just a physical one, it symbolizes a continued commitment to position CAFP as a thought leader in California. Being in Sacramento has helped us
raise the profile of family physicians and ensure that we are able to attend legislative hearings, stakeholder meetings and better develop Sacramento-based relationships.
Our new space is not only the headquarters for staff, but a meeting place for family physicians. In the months since moving into our new space we have hosted a general member reception as part of the All Member Advocacy Meeting, CAFP board meetings, CAFP committee meetings, and local chapter meetings. The space was designed to be available for community events and member meetings. There is always a place for our members at the CAFP table. The next time you are in Sacramento, please come by, say hello, and tour the new space at 816 21st Street!
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political pulse
Managed Care Organization (MCO) Tax Explained
Jeff Luther, MD, FAAFP Chair, Legislative Affairs Committee
For nearly two decades, California has been leveraging a federally-approved tax on managed care organizations (MCOs, or health plans) (known as the MCO Tax), as a funding mechanism to offset the nonfederal share of the Medi-Cal program and to draw down federal funds, enhancing the state’s budget. The structure of the MCO Tax has evolved since its inception, but it still generates substantial revenue for the state (currently $19.4 billion between April 2023 and December 2026) without compromising consumer health care coverage affordability. The MCO Tax revenue, generated by the health care industry and meant to bolster the Medi-Cal program, has also been used by the state as a fiscal mechanism to balance the budget in hard budget years, like this year. In response to the uncertainty in the way the state uses these funds, a coalition of health care leaders campaigned for a ballot measure to remove some of the decisionmaking power from the state government and let the voters decide. Below, see the dichotomy of the budget deal and the ballot measure on these funds.
MCO Tax Spending: California FY 20242025 Budget
In 2023, the MCO Tax was expanded, and the Legislature allocated a portion of the expanded tax funding to increase Medi-Cal rates for various types of services, including those rendered by primary care physicians. Fast forward to fiscal year (FY) 2024-2025 budget when the state must address a hefty budget deficit and faces the challenge of enacting a balanced budget that maintains the state programs and investments—putting the MCO-tax supported rate increases and other spending on the chopping
block. The budget agreement between the Legislature and the Governor reduces the original planned investments for provider rate increases, preserving some of the rate increases (including up to 87.5 percent of Medicare rates for primary care physicians), but not all of the promised rate increases-and some providers will not see rate increases until 2026, one year later than planned. The state budget leverages the MCO Tax to offset general fund costs outside of the 2023 deal, including, but not limited to, continuous coverage in Medi-Cal for children ages 0-5 and offsetting the general fund support for community health workers.
MCO Tax Spending: MCO Tax Ballot Initiative
Led by a coalition of doctors, community health centers, and other health care stakeholders, and endorsed by CAFP, Proposition 35, the Protect Our Health Care ballot initiative (Proposition 35) qualifies for the upcoming November election ballot. Proposition 35 would permanently specify allocations of federally approved MCO Tax revenue for Medi-Cal and other health carespecific spending, preventing the state from redirecting this funding stream to offset other costs. If passed, the initiative would override the enacted budget, allocating more funding for Medi-Cal--including resources for a larger, and different group of Medi-Cal providers and higher rate increases than what is included in the budget. Proposition 35 would also reinstate funding for GME programs, which was eliminated permanently in the FY 2024-2025 budget. The table shows the comparison of the services included in the FY 2024-2025 budget deal and the ballot initiative.
*Table citation: Hwang, Kristen. CalMatters, California Voters Will Decide Who Wins on Health Care Tax: Gavin Newsom or Doctors, July 1, 2024.
What Happens Next?
Voters will decide. This fall, if voters pass Proposition 35, then the measure will override the deal made in the budget. The state will have no choice but to allocate the MCO Tax revenue as specified in the ballot measure and make further budget decisions to maintain a balanced budget. Stay tuned for more updates!
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