Fall 2023

Celebrating Independent Physicians

More than 13,000 California physicians rely on CAP to protect their practices every day.

At the Cooperative of American Physicians (CAP), we celebrate you—the independent and solo practitioner who keeps healthcare personal. We are here to support you with exceptional medical malpractice coverage supplemented by a host of outstanding risk management and practice management services, so you can stay focused on what’s important—patient care.

For over 40 years, CAP has delivered financially secure medical malpractice coverage options and practice solutions to help California physicians realize professional and personal success.

Find out what makes CAP different.

Scan the QR code to see how much you can save on your medical malpractice coverage

CAPphysicians.com 800-356-5672 MD@CAPphysicians.com

Medical professional liability coverage is provided to CAP members through the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.

Join America’s leader in occupational health

Take your career where you want it to go.

540 medical centers and 140+ onsite clinics nationwide.

Unlimited opportunity.

• Choose where to take your career, from patient care to medical leadership • Work normal business hours with no on-call • Focus on patient care - we’ll handle the paperwork • Contribute to the future of workplace health & safety

Email Concentra_Careers@Concentra.com for more information. ©2023 Concentra, Inc. All rights reserved.

072023

ADPHYSDINCAQ3

816 21st Street • Sacramento, California 95811 www.familydocs.org Phone (415) 345-8667 • Fax (415) 345-8668 E-mail: cafp@familydocs.org

Officers and Board

Staff

President Raul Ayala, MD, MHCM

Lisa Folberg, MPP Chief Executive Officer lfolberg@familydocs.org

Immediate Past President Lauren Simon, MD, MPH, FAAFP President-elect Alex McDonald, MD, FAAFP Speaker Anthony "Fatch" Chong, MD Vice-Speaker Kim Yu, MD, FAAFP Secretary/Treasurer Brent Sugimoto, MD, MPH, FAAFP Chief Executive Officer Lisa Folberg, MPP Foundation President Ron Labuguen, MD, FAAFP AAFP Delegates Lee Ralph, MD Michelle Quiogue, MD AAFP Alternates Lisa Ward, MD, MPH, FAAFP Shannon Connolly, MD, FAAFP CMA Delegates Kimberly Buss, MD Felix Nunez, MD Sumana Reddy, MD, FAAFP Kevin Rossi, MD, FAAFP CMA Alternate Delegates Raul Ayala, MD, MCMH Noemi Doohan, MD, PhD Adia Scrubb, MD, MPP David Tran, MD

Karen Alvarado Advocacy Assistant kalvarado@familydocs.org Anita Charles Program Assistant acharles@familydocs.org Morgan Cleveland Manager of Operations & Governance mcleveland@familydocs.org Jerri Davis, CHCP Vice President, Professional Development, CME/CPD jdavis@familydocs.org Laurie Isenberg, MA, MLS Director of Education and Professional Development lisenberg@familydocs.org Christine Lauryn Manager, Member Communications clauryn@familydocs.org Josh Lunsford Vice President, Membership & Communications jlunsford@familydocs.org Pamela Mann, MPH Executive Director, CAFP Foundation pmann@familydocs.org Jonathan Rudolph Manager, Finance jrudolph@familydocs.org Tiyesha Watts Legislative & Policy Advocate trwatts@familydocs.org

Brent Sugimoto, MD, Editor Scott Nass, MD, Associate Editor Josh Lunsford, Managing Editor The California Family Physician is published quarterly by the California Academy of Family Physicians. Opinions are those of the authors and not necessarily those of the members and staff of the CAFP. Non-member subscriptions are $35 per year. Call 415-345-8667 to subscribe.

4

California Family Physician Fall 2023

pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • dbrown@pcipublishing.com 800.561.4686 ext 103 For Advertising info contact Michelle Gilbert • 800.561.4686 ext 120 mgilbert@pcipublishing.com

EDITION 47

FEATURES

8

18

16 Navigating Complexity in Primary Care

Jeremy Fish, MD and Bill Bergquist, PhD

FOCUS ON: RURAL FAMILY MEDICINE 8 Power of Community & Mobile Clinics 18 Rural Family Medicine: What It Looks Like Today

Raul Ayala, MD, MHCM Sara Martin, MD

20 An Amazing Journey: Drs. Adnaan Edun & Shruti Javali 21 The Questions for Rural OB Deserts

Amanda Mooneyham, MD

DEPARTMENTS 14 Advocacy Update

What It Means to Be an Advocate

Tiyesha Watts

23 Members in the News 24 CAFP Foundation

Family Medicine, CAFP and Me. And You Too!

26 CAFP Foundation

2023 Outstanding Achievement Awards

29 Political Pulse

The Final Stride to the End of Session

Bright Zhou, MD

Jeff Luther, MD, FAAFP

Your Online Resource for Continuing Medical Education. Visit education.familydocs.org

Charles R. Drew University of Medicine and Science

invites applications for the position of: Senior Director, Behavioral Health and Assistant/Associate Professor The Senior Director of Behavioral Health is responsible for the development and delivery of the residency behavioral science curriculum in alignment with ACGME Requirements for the Family Medicine Residency Program. This individual works under the direction of the Residency Program Director, and collaborates with physician faculty, Family Medicine Practice (FMP) behavioral health team, and other team members to achieve patient care and academic goals. The Senior Director of Behavioral Health also works collaboratively with the Medical Director and Chief Medical Officer of the Martin Luther King Jr, Outpatient Center, the residency’s clinical home, to ensure a sound, accessible, culturally responsive, and impactful Behavioral Health program.

Essential Job Functions:

• Coordinate and evaluate Behavioral Health curriculum development and teaching for the FM residency program including, but not limited to, conducting support groups (e.g. Balint), completing resident training evaluations, and providing timely and constructive feedback to residents about patient-provider style and interactions.

• Collaborate with the development of a Residency Wellness Program.

• Act as a key member of the Recruitment and Promotion Committee.

• Evaluate Family Medicine residents, using competency based/milestone evaluations.

• Inform and advise the Program Director of individual residents’ and residents’ progress and/or challenges.

• Coordinate relevant behavioral health curricula, didactics, seminars, and workshops.

• Assume a major role in the preparation of grants, accreditation and research documents.

• Attend faculty meetings, serve on relevant committees, and participate in administrative decision making.

• Take responsibility for resident successful performance on the behavioral health sections of the in-training exams.

Applicant Requirements:

• Doctoral degree (PhD or PsyD) in clinical or counseling psychology, family therapy, or social work from an accredited program required.

• 5 or more years of experience in providing integrated behavioral health services in a Family Medicine Residency.

For more information contact:

Stephanie Brown, GME Program Administrator, stephaniebrown@cdrewu.edu Applications must be filed online at the cdrewu.edu employment site or click: https:// recruiting2.ultipro.com/CHA1037CHRS/JobBoard/7fb6ae1ee3f6-44ac-8694-2577af27ab6b/OpportunityDetail?opportunityId=264e3841-26a5-4f38b184-7710c5d1c968

NOW HIRING:

Medical Director

Love what you do & where you work!

We’re looking for: A dynamic, mission-driven physician who thrives in a team-based environment—where social justice and trauma-informed care are embodied—and is passionate about serving the needs of marginalized communities.

We offer competitive salary & exceptional benefits including: Medical, dental & vision plans Generous PTO & 10+ paid holidays per year

403(b) retirement plans, plus employer contribution Opportunity for loan repayment

Join our team!

Innovate and shape health care at an FQHC and engage with residents in our nationally accredited FNP residency program.

Malina Cole, Clinician Recruiter

malinac@srhealth.org | srhealth.info/director

president 's message

Power of Community & Mobile Clinics

Raul Ayala, MD, MHCM CAFP President

The pandemic has surely taught us of how brief and precious life can be, and through these uncertain times, we learned the essential act of caring and lending a hand to one another in any way possible. By the same token, we can agree that the delivery of care must evolve, and this means meeting our patients where they are and properly address the various needs of their individual communities. Caring for patients in a rural health clinic setting for the last decade has taught me that our patients at times are traveling fifty to one hundred miles in distance to receive medical care and as a result, patients may delay vital care or skip it altogether.

A model in healthcare that has emerged and is growing in its use in many of our communities is the mobile clinic. Mobile health clinics can play a crucial part in public health and reduce health disparities, especially among vulnerable populations, those with chronic illness, and rural communities without access to healthcare facilities. Many of our patients have various social determinants of health such as transportation insecurity, low health literacy, food insecurity, and many are medically uninsured.

Some patients are afraid to walk into a clinic due to their documentation status and the mobile clinic may be the only safety net available.

During the pandemic, mobile clinics were an essential tool to delivering care in my organization, managing chronic diseases, COVID19 vaccinations,

8

California Family Physician Fall 2023

testing and treatment, and were able to address preventive care when needed. The mobile units are a traditional clinic on wheels.

Many are equipped with point of care testing, vaccines, and an interdisciplinary team including clinical social work, community health workers, nursing staff and medical assistants working as a team capable of managing the most common ailments and diagnoses. The goal of these mobile clinics is to create a medical home and bridge every patient to whole person care. The mobile clinic is the gateway to other services such as behavioral health, dental care, and specialty care. We were also able to integrate the mobile clinic into our residency programs where our faculty and residents have embraced caring for patients outside the traditional four walls.

I had a personal experience recently where a family medicine resident and I saw a patient during a mobile clinic outreach event who was consulting due to a six month history of dizziness.

During the history and physical examination, findings showed a heart murmur, and after further history he referred having a heart condition as a child and had not followed up in years. We learned that he had lost his health insurance, was worried about the cost for a doctor’s visit and had heard our mobile care clinic was free of charge and thought we may be able to help. We were to coordinate and establish care with our closest clinic to his home, assist him with social worker services for health insurance and referred him to a cardiology consultation at one of our clinics.

There are numerous patients with similar scenarios in vulnerable populations, those undiagnosed, and unmanaged, with uncontrolled chronic diseases, those battling through mental health disorders, substance use disorders, and these same individuals are not able to manage transportation to the nearest clinic. The mobile care clinic allows us to be a part of the community. We are able to initiate care in a school parking lot, the local church, sporting events, or unhoused encampments and meet their health care needs. The mobile clinic is a symbol of grace for our fellow human being, it allows the community to come together as an entity where clinicians and citizens are striving to provide the most basic human right, health care.

FREE TO FOCUS ON KARLY.

With healthcare’s constant complexities and distractions, it can be difficult to focus on patients.

We can help, with proven medical professional liability insurance and so much more. So you are free to focus on delivering superior patient care.

• Medical Professional Liability Insurance • Claims Analytics • Risk Mitigation • And more

Insurance products issued by Preferred Professional Insurance Company® (NAIC# 36234) and Coverys Insurance Company (CA# 6122-6), 11605 Miracle Hills Dr., Suite 200, Omaha, NE 68154-4467.

California Family Physician Fall 2023

9

Join a team that’s been helping to redefine what it means to be a community clinic for 50 years.

The Core Content Review of Family Medicine

Vista Community Clinic has outstanding opportunities for Full-Time and Part-Time Family Physicians. Join a 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. We provide healthcare throughout the Southern California regions of North San Diego, Orange and Riverside Counties.

Our compensation and benefits program includes: Competitive compensation, sign-on bonus, relocation bonus, health, dental, vision, company-paid life, longterm disability, flexible spending accounts , 403(b) retirement plan, malpractice coverage, CME allowance and no on call hours. We are a NHSC loan repayment eligible organization.

Salary (full-time): $255,000 – $270,000/year For more information visit www.vcc.org or email hr@vcc.org EEO/AA/M/F/Vet/Disabled

50 years

1972-2022

Why Choose Core Content Review?

• Online and Print Editions Available • Cost Effective CME with No Travel

• Stay Medically Relevant - Make sure you are ready for the new FMCLA (Family Medicine Certification Longitudinal Assessment) Exam alternative • 98% Board Exam Pass Rate Pass or get your Money Back • For Family Physicians by Family Physicians • Core is produced by the CT Academy of Family Physicians North America’s most widely recognized program for: • Family Medicine CME • ABFM Board Preparation Ordering is Easy • Visit www.CoreContent.com • Call 888-343-CORE (2673)

Help Your Patients Make Better Informed Decisions About Their Care The California Prostate Cancer Coalition, founded in 1997 as a 501(c)(3) not-for-profit organization, is dedicated to saving men’s lives!!! www.prostatecalif.org https://naspcc.org/docs/informed-decision-making-laminate2023.pdf

www.naspcc.org 10

California Family Physician Fall 2023

The Core Content Review of Family Medicine Follow us on Facebook:

Core Content Review of Family Medicine

Poor documentation during intake resulted in a

wrong-site surgery causing permanent damage to a good knee.

The Joint Commission data reveals that wrong-site incidents are the fourth most frequently reported sentinel event.

To minimize surgical errors, practices insured by ProAssurance can access annual risk assessments to learn how well their surgical teams and protocols are working. Risk consultants gather and review the data, note potential weak spots, and deliver recommendations based on former claims.

Helping our insureds assess their patient safety procedures and sharing strategies learned from our closed claims history helps them mitigate risk and be prepared if they ever need to face a malpractice claim.

* The Joint Commission, Sentinel Event data released for 2022. Visit: bit.ly/43TXUGi.

ProAssurance.com • 800-282-6242

12

California Family Physician Fall 2023

guest article guest article

Take your your career career Take where you you want want toto go go where Have you reached the point in your career where you’ve Have youit’s reached point your career where you’ve thought time tothe pivot or in look toward the next level or thought it’s time to pivot or look toward the next level or challenge? Sometimes, that involves stepping out of your challenge?

Sometimes, involvesout stepping of your comfort zone.

But whatthat if stepping of yourout comfort comfort zone.stepping But whatinto if stepping out ofand yourpurpose? comfort At zone means your passion zone means stepping into your passion and purpose?

Concentra®, the nation’s leader in occupational health,Atour Concentra®, the nation’s leader in occupational health, physicians have the chance every day to escape manyour of physicians have the chance every day to escape many of a the stressors that create job dissatisfaction and work for the stressors thatredefining create jobwhat dissatisfaction work for like. a company that’s workforce and health looks company that’s redefining what workforce health looks like.

Focus on patient care Focus on patient care A focus on patient care is at the core of Concentra’s mission Atofocus on patient careofisAmerica’s at the coreworkforce, of Concentra’s mission improve the health one patient at a totime. improve the health of America’s workforce, one patient at a Concentra physicians don’t have to worry about getting time.

Concentra physicians don’t have to worry about getting buried under mountains of paperwork or stuck with hours of buried under mountains of paperwork or stuck withprocesses hours of to administrative tasks. Concentra uses streamlined administrative tasks.

Concentra uses streamlined processes to eliminate headaches on the backend, and our support staff is eliminate headaches on the backend, and our support staff is there when issues arise. there when issues arise.

Additionally, Concentra works with you to create a tight-knit Additionally, Concentra works withthe younation to create a tight-knit team. We have recruiters around working to find the team.

We have recruiters around the nation working to find the best physician assistants, nurse practitioners, patient service best physician assistants, nurse practitioners, patient service specialists, radiation techs, physical therapists, and more. We specialists, techs, therapists, We make sure radiation our clinical staffphysical members succeed and frommore. the very make sure our clinical staff members succeed from the very start by conducting a comprehensive orientation program start by patient conducting comprehensive orientation program before care abegins. before patient care begins.

Opportunities abound Opportunities abound With more than 540 medical centers and 140-plus onsite With more than 540you’ll medical centers and 140-plus clinics nationwide, have unparalleled accessonsite to clinics nationwide, you’ll have unparalleled access opportunities for advancement. If you want to staytoon the opportunities advancement. you pursue want towork stay on the clinical side offorthe business, youIf can that’s clinical side of the business, you can pursue work that’s focused strictly on patients. If you want to make a bigger focused strictly on patients.

If you want to make bigger pivot, you can pursue advancement through oura corporate pivot, you can pursue advancement through our corporate leadership structure and focus on advancing medicine from a leadership structure and focus on would advancing medicine a business perspective.

And if you like to relocatefrom without business perspective.

And if you would like to relocate without losing momentum in your career, Concentra will work with you losing in your career, Concentra to findmomentum a position near your desired location.will work with you to find a position near your desired location.

Work-life balance Work-life balance Physician burnout is an ongoing concern in the medical Physician burnout is an concern in the medical community.

Working asongoing a physician will always be hard work, community.

Working as a physician will always hard work, but the demands put on physicians often reachbeunreasonable but the demands put on physicians often reach unreasonable

levels. Most Concentra medical centers run on an 8-to-5 levels.

MostThat Concentra medicalwork-life centers run on anis8-to-5 schedule. means finding balance more schedule.

That means finding work-life balance is more conceivable when compared to medical specialties such as conceivable compared to medical specialties such as emergency when medicine. emergency medicine.

Targeted patient panel Targeted patient panel Concentra physicians have the opportunity to hone their skills Concentra physicians have medicine the opportunity to Our honetargeted their skills and become occupational experts. and become occupational medicine experts.

Our targeted patient panel adds stability while ensuring a constant stream patient addswhich stability constant stream of newpanel patients, are while mostlyensuring workingaadults.

And ofbecause new patients, which are mostly working adults.

And Concentra uses an evidence-based practice model because Concentra uses health an evidence-based practice model that integrates different care professionals in our clinics that integrates different health care professionals in our clinics or at worksites, our physicians can treat patients from injury oronset at worksites, our physicians can treat patients from injury to full recovery for end-to-end care. onset to full recovery for end-to-end care.

Patient care with a passion Patient care with a passion If you’re searching for a place to put your passion to work, Ifwe you’re searching forexplore a placeopportunities to put your passion to work,Here, welcome you to at Concentra. we welcome you to explore opportunities at Concentra.

Here,and patient care is delivered by physicians with a selfless heart patient care is delivered by physicians with a selfless heart and tireless resolve. And in return, an improved work-life balance tireless resolve.

And in return, an improved work-life balance and opportunities for personal and professional growth and opportunities for personal and professional growth abound. abound.

At Concentra, occupational health means helping people work At Concentra, occupational health means helping peopletowork smarter and safer so they can enjoy life. We’re working smarter soofthey canworkforce, enjoy life. including We’re working to That improveand thesafer health every our own. improve the health of every workforce, including our own. is part of our mission; it’s what we’re passionate about. That is part of our mission; it’s what we’re passionate about.

Ready to put your passion to work? Join us at Concentra, Ready to put your passion to work?

Join us athealth Concentra, America’s largest and leading occupational provider.

America’s largest and leading occupational health provider.

Email Concentra_Careers@Concentra.com for more Email Concentra_Careers@Concentra.com for more information. information.

California Family Physician Spring 2023 California Family Physician Spring 2023 California Family Physician Fall 2023

23 23 13

advocacy update

What It Means to Be an Advocate Tiyesha Watts

CAFP, Legislative and Policy Advocate

Advocacy is embedded in the core of CAFP. Through advocacy, family physicians can help change public policy to protect the health and well-being of their patients. Engaging in advocacy gives family physicians an opportunity to join a driven group of family physicians, residents, and medical students to help improve the health and well-being of their patients beyond the clinic walls.

The term advocacy can seem scary or convoluted at first; however, you participate in various forms of advocacy just by being family physicians. The most familiar forms of advocacy are often state and federal legislative advocacy intended to change public policies, rules, and laws that impact patient health. However, advocacy also happens through individual and community action. Individual advocacy includes the direct patient care and resources you provide your patients. It also includes your individual efforts to provide education through social media and sharing concerns with CAFP about system inefficiencies in healthcare and how it is impacting your ability to provide adequate access to care for your patients. You also participate in individual advocacy by serving on committees and advisory boards.

the profile of family medicine, justice through equity, diversity, and inclusion (JEDI), burnout and wellness, CAFP has advocated on behalf of members through legislation, budget, regulation, legal, administrative action, and initiatives/ballot measures.

CAFP works with legislators to pass state laws that advance the practice of family medicine, such as laws that help to grow the physician workforce, alleviate administrative burdens such as reforming prior authorizations, provide health care coverage, and, most recently, ensure important health care services are prioritized. This is exemplified by this year’s CAFP-sponsored bill AB 85, which seeks to address health-related social needs to improve health outcomes and equity by requiring health plans and insurers to provide coverage for social determinants of health screenings (SDOH). CAFP members and coalition partners amplifying the bill through various advocacy initiatives, such as writing letters of support to legislators, posting on social media, and educating legislative members on the importance of the bill during the 2023 All Member Advocacy Meeting(AMAM), led to AB 85 progressing out of every policy and fiscal committee to which the bill was referred to and is one step closer to becoming State law.

Community advocacy is when a group or organization, or in this case, a group of family physicians or an organization that represents family physicians, CAFP, comes together to amplify issues impacting the various practice settings and patients you serve. In other words, working together to systemically raise awareness, educate, and create policies to improve patient care access. By being a member of CAFP, you are part of an organization with collective voices of over 10,000 members ready to amplify issues important to family medicine and primary care.

CAFP participates in various forms of advocacy, and there are different ways for CAFP members to participate. Driven to our strategic goals: payment reform, raising 14

California Family Physician Fall 2023

CAFP is always looking for ways to engage members in advocacy. CAFP engages members in legislative advocacy through our key contacts program, the CAFP All Member Advocacy Meeting (AMAM) and by asking members to testify or provide clinical perspective. Lastly, we may ask members

to participate in grassroots efforts such as writing letters to legislators or amplifying legislation on social media.

The California State budget is also passed through legislation and CAFP advocates for essential healthcare issues in the state budget. CAFP has submitted budget requests to increase funding for the Song Brown Program and even had members during our All Member Advocacy Meeting, Lobby Day, meet with legislators on the importance of funding for the program and its impact on patient care and building the physician workforce. Additionally, in the 2023-2024 budget process, CAFP advocated to increase investments in Medi-Cal and primary care rates through the budget. This helped lead to the Governor passing the 2023 budget, which renewed the Managed Care Tax (MCO Tax), which increases primary care rates and allocates funding to expand GME programs.

An example is CAFP's ongoing engagement with the Medical Board to address post graduate training license (PTL) concerns.

Moreover, In the legal space, CAFP participates in advocacy by working with coalition partners to petition the court to submit amicus briefs to influence the court's decision on specific social issues. For example, CAFP signed an amicus brief opposing tobacco companies’ effort to prevent legislation prohibiting flavored tobacco product sales in California.

Lastly, CAFP takes positions on initiatives and ballot measures that pertain to health. Last year, CAFP Supported the 2022 initiative, Proposition 1, to enshrine the right to safe and legal abortions in the State Constitution and Proposition 31, a referendum challenging a 2020 law prohibiting the retail sale of flavored tobacco products. CAFP has also engaged in Administrative Actions such as supporting executive orders to address the rising cost of prescription drugs and to address the impacts of the COVID-19 pandemic on healthcare providers and healthcare services plans.

As family physicians, you are advocates. As members of CAFP, you have the support of staff and over 10,000 collective voices to help you raise awareness, educate, and create policies that can improve patient access to care and raise the profile of family medicine.

CAFP participates in regulatory advocacy by engaging in the rulemaking process with State Agencies, such as the Department of Health Care Services, The Department of Health Care Access and Information (HCAI), and many others. CAFP engages with Agencies by participating in stakeholder meetings and may even bring family physicians to speak on specific topics. CAFP also provides written comments to try and shape regulations.

California Family Physician Fall 2023

15

feature ar ticle

Navigating Complexity in Primary Care Jeremy Fish, MD and Bill Bergquist, PhD

Daniel Pink teaches us that we humans are motivated internally by four great callings: a search for personal mastery, the freedom of autonomy, a deep sense of purpose, and a keen curiosity.

Wherever we find these four intrinsic motivators alive and well, the people, communities and organizations exhibiting them are flourishing. As a specialty, Family Medicine has long lived in a world between flourishing and floundering—caught in a sustained identify crisis as a force of integration and wholistic values in the midst of often reductionistic and fragmented health systems. Our recovery from our prolonged identity crisis requires we focus on our strengths and personal mastery.

Bazemore et al. (https://journals.stfm.org/media/4120/ bazemore-2020-0569.pdf ) have expanded the Starfield 4 C’s to now include three vitally important new C’s—Complexity, Pt. Centeredness, and Community-engaged care. Most of us intuitively get the importance of patient centeredness and communityengaged care (even as we struggle to manifest them). Yet, despite navigating complexity every day with our patients, few Family Physician seem inclined to fully understand and appreciate our mastery in family medicine around complexity. Many confuse complexity with complicated, which are two very different things.

Complicated is the domain of the specialists—developing stepby-step approaches to address the many complicated illnesses and organ-system diseases a patient might have. Complexity, on the other hand, is about multiple interacting and inter-dependent agents (diseases, social determinants, people and processes, etc.) that move about in patterned-yet hard-to-predict ways. A key example of complexity is the weather and meteorology—a field that embraced complexity science decades ago and now has far more sophisticated weather predictions than we had just 20 years ago.

Just as the weather is a dance between atmospheric pressure, cloud formation, wind conditions, and seasons—family medicine is a dance between human blood pressure, social-drivers of health, complex health conditions and health systems, physical, behavioral, and spiritual health.

In family medicine we often see ourselves as a collection of lessthans. We are almost as good at cardiology as cardiologists, same for nephrologists, hospitals, ED docs, you name it. Yet, complexity science tells us you can not understand and appreciate complexity by breaking it down into individual parts (that is reductionistic). And so, we often don’t appreciate our Family Medicine Super-Power— our ability to navigate and guide patients, families and communities through complexity. We likely get this important navigational and guiding skill through our intense focus on relationships—the bonds between agents, not the separate agents themselves. Our focus on relationships amplifies our complexity navigation super-power into enormous value for our patients and communities. No other area of 16

California Family Physician Fall 2023

medicine can claim a proven reduction in mortality rates, improved health outcomes across a broad sphere of conditions, while reducing costs and improving our patients experience of healthcare all together. That enormous value is slowly being recognized by the public and just as slowly by ourselves. One of the great thinkers of our age is Dave Snowden, who has developed a simple cynefin framework to help us gain insights and abilities in the realm of complexity:

While all of us wish we could exist in continuous Clear realm, where life is predictable, choices are constrained, and all we have to do is categorize everyone and everything and copy best practices—most of us in Family Medicine are continuously experiencing complicated, complex and chaotic existence depending on the day. Embracing that our lives and careers are complex can help us navigate in that realm in a more satisfying and effective way. In the complex realm, the outcomes are not highly predictable, they are emergent. We know that when we find out four years into caring for that “brittle diabetic” that actually he eats candy bars when his sugar drops below 300 and he feels “hypo”—something he was too afraid to tell us until we made ourselves vulnerable and admitted we didn’t know how to help him control his diabetes after four years of trying, sending him to multiple specialists, multiple hospital stays, endless medication changes, etc. We spent that four years thinking his case was complicated and treated it as such—just have to find the right medicine or specialists to help out and all will be well. No, actually, by focusing on relationship, we finally found out what was really

going on and now must address the complex reality that the patient had re-set his glucose sensitivity to 300 and has a deep fear of being hypoglycemic. Maybe some CBT and slower reductions in sugars to give him time to adapt his glycemic thermostat. Maybe bring in his family members to help them understand anxiety and depression about having diabetes was impacting his health more than any individual sugar level so we can begin to focus on what really matters--his development of healthy self-care and well-being over time. We move from trying to “control” (a complicated domain behavior) his diabetes with tightly coupled Medications proven to reduce sugar levels to trying to “navigate and guide” his emergent complex reality of diabetes, depression, loneliness, isolation, anxiety, and fear.

Navigating complexity also requires teams of people (NASEM Report High-Quality Primary Care)—self-organized teams that adapt and support our patient’s complex needs across many domains, not just medication management (which is more like moving the medication deck-chairs on the Titanic).

We need behavioralists, social workers, patient navigators to help our patients through complexity—yet Family Medicine under-resourcing likely means most of us practice in environments with little to no interprofessional teamwork we so desperately need to care for our patients, communities and surrounding populations.

Special CME Program (21.75)

Medical Review Officer Training Medical Review Officer Training and Certification Exam On-Site and Online Las Vegas, NV December 8-10, 2023 Approved for 21.75 AAFP prescribed credits For more information:

800-489-1839 www.aamro.com

All AAMRO training programs include the latest information on hair, sweat, oral fluids, and interpretation of opiates in the field of drug and alcohol testing

Embracing our complex navigation super-powers is just the beginning of the recognition of how much value we bring to the health of our communities. We must embrace it and then fund it fully by engaging in broad and impactful advocacy—assuring more resources are spent on team-based Advanced Primary Care each year for the next decade until we begin to have enough resources to hire inter-professional teams to help us with our noble and highly valuable service to our communities. If not for ourselves, then we must for our medical students, residents, and our patients. We must inspire the next generation of Family Physicians to embrace our complexity superpower and fulfill our noble mission to provide the best care to the most people in the most affordable way.

NASEM High-Quality Primary Care: https:// www.nationalacademies.org/our-work/ implementing-high-quality-primary-care

California Family Physician Fall 2023

17

feature article

Rural Family Medicine: What It Looks Like Today Sara Martin, MD

drive through a wiggly bit and then the valley opens out in front of you with vineyards running between mountains on either side.”

It’s beautiful here, and the setting is matched by a deep and vibrant community.

And yet, despite its stunning scenery and welcoming people, it has struggled to recruit enough physicians to provide healthcare for the community. I came to work in Ukiah post-residency because I understood there was a need: I had patients that were driving more than 2 hours south to come see me in Santa Rosa.

Fresh from my urban/suburban training, I didn’t know what a rural health center was, how to define a critical access hospital, or how different—and fulfilling—it could be to practice clinical medicine in a rural community. Now I wish everyone could know how amazing it is to practice rural medicine!

Placer-Sierra-Nevada Chapter hosts their inaugural member social event.

Statistically, most of us reading this article went to medical schools and residencies in urban or suburban areas. I did, having trained first in Boston and later in Santa Rosa, CA. Now, I practice in a wonderful town called Ukiah (yoo-KY-ə). I describe it to people as “two hours north of San Francisco on the 101, you

The fulfillment is grounded in relationships: I see a patient, then her husband, then her best friend, and the best friend mentions that she thinks her daughter needs to bring in her grandson to come see me (I also take care of the grandfather). I go to lunch in the cafeteria, passing an emergency room nurse (who is also my patient) who stops me in the hallway so we can celebrate that he has quit smoking; he offers me one of the beaded bracelets he has started making instead of smoking. After work, I stop to chat with my neighbor (also my patient) about her garden and she mentions that her sleep apnea is much better with the device I recommended.

CAFP President Raul Ayala, MD begins his local chapter visit road trip with the Stanislaus Chapter.

18

California Family Physician Fall 2023

Please reach out to Dr. Martin if you are in a rural chapter, county or community.

Your voice is important to the work she does on the board.

Email her at ruraldirector@familydocs.org.

Shasta-Trinity Chapter launches with a food truck gathering.

These moments, these unique relationships where my patients have welcomed me to the community by letting me bear witness to their most intimate sufferings and allow me to care for their loved ones—these are what makes rural medicine so fulfilling. My privacy is respected, but my caring is both celebrated and reciprocated.

Just as the rewards of rural medicine are deep, so too are the challenges. Lack of specialists has been somewhat mitigated by telemedicine, but the fact remains that my county (which is nearly 4,000 square miles) has no endocrinologist, psychiatrist, rheumatologist, neurologist, or otolaryngologist. In my hospital—the largest in the county—there is no capacity for cardiac catheterization, CRRT, or most interventional radiology procedures. Most nights at dinner with my family, I can tell how busy my hospital is by how often I hear the helicopters airlifting patients to urban hospitals with more resources.

help that to happen. If you would like to send me a message, please email ruraldirector@familydocs.org.

Dr. Sara Martin is currently associate program director at the Adventist Health Ukiah Valley Family Medicine Residency in rural Mendocino County. She was recently elected rural director for the CAFP and in this role hopes to support the needs of rural physicians across California.

PRIMARY CARE PHYSICIANS San Francisco Bay Area

Some of our challenges overlap with that of our urban counterparts; for example, we also struggle with substance use disorder and rising rates of homelessness. But some of our challenges are unique, such as the rise of “OB deserts.” A push for rural graduate medical education is helping to turn the tide, but state and national advocacy is needed to both promote and sustain careers in rural medicine.

In January, I was elected as the Rural Director of the CAFP Board of Directors, a position that I view with tremendous hope that it will provide an organizing nexus for the rural chapters. If this has reached your mailbox in a rural community in California and you have read this far, please consider reaching out.

Twenty percent of Americans are considered rural, but only ten percent of physicians are—which means each rural physician has an important voice on behalf of rural communities. The CAFP needs to hear from you, and I am hopeful that we can begin to

Contra Costa Health Services is seeking full-time BC/BE FM, Peds or IM 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 schedules available • 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 for full-time providers and No Call • Favorable HPSA score for national and state loan repayment programs • EPIC medical record system

California Family Physician Fall 2023

19

feature article

An Amazing Journey:

Drs. Adnaan Edun & Shruti Javali Drs. Adnaan Edun and Shruti Javali, two remarkable individuals with a shared commitment to improving the lives of underserved populations, invite us into their inspiring world of medicine, adventure, and love. Born and raised in diverse corners of the world, their paths converged in medical school, leading to a shared mission of making a positive impact on global healthcare.

Their journey began when they met at the Saba University School of Medicine on the island of Saba. This serendipitous encounter marked the beginning of a profound partnership in both life and medicine. As they pursued their medical degrees, they felt a deep sense of responsibility and a calling to serve those who lacked access to proper healthcare.

Both had already been exposed to the concept of giving back from a young age. Dr. Edun’s mother, a nurse, always dreamed of working in Africa, instilling in him a sense of social responsibility.

He had also seen his mother’s focus on sponsoring children through various organizations long before his medical career began.

Before medical school, Dr. Edun ventured to Peru, where he worked in an orphanage, addressing basic hygiene needs and witnessing firsthand the stark disparities in health care between North America and developing nations. This experience ignited his passion for global health and community service.

Dr. Javali spent her childhood in India and Dubai, before moving to Toronto in middle school. She understood the significance of culturally sensitive care and global health from an early age, and her experiences shaped her determination to bridge gaps in health care access.

Their mutual desire to make a difference in the world led to a series of remarkable mission trips. A pivotal moment in their journey was their recent trip to Turkey to 20

California Family Physician Fall 2023

aid earthquake survivors. Facing burnout from their demanding medical careers, they found solace in this humanitarian mission.

Volunteering with International Medical Relief (IMR), a U.S.-based organization, they brought much-needed supplies, tents, and medical expertise to a region devastated by natural disasters.

Their journey to the epicenter was marked by challenging conditions, but their unwavering dedication to helping those in need kept them going. The makeshift clinic they established became a beacon of hope for the local community, treating dozens of patients daily. The resilience and gratitude of the people they encountered reminded them of their own patients in California's Central Valley, where they currently reside and practice medicine.

Their first overseas mission together took them to Guatemala, followed by a month-long trip to Kenya in early 2020. These journeys further solidified their commitment to international medical relief and reinforced their sense of purpose.

Upon returning from each of these missions, they have a feeling of rejuvenation and refocus. Their experiences abroad enrich their medical knowledge and deepen their understanding of diverse approaches to health care.

Today, Drs. Edun and Javali call Visalia, California, home. They work tirelessly in rural health care settings, serving migrant farming communities and advocating for better health care access in the Central Valley. Their collaborative efforts have made a significant impact, with Dr. Edun’s work in teaching and Dr. Javali’s dedication to obstetrics exemplifying their commitment to their community.

Amid their busy careers, they have not only found love but have also forged a partnership dedicated to improving the lives of others. Their story serves as a testament to the power of love, shared purpose, and the incredible impact that two individuals can make when they work together toward a common goal.

Their journey is a reminder that compassion knows no borders, and with determination and empathy, we can all make the world a better place, one patient at a time. You can follow along on their upcoming journeys through their Instagram— @wanderingphysicians.

Dr. Edun is currently the chapter president for the renewed Tulare Chapter. Dr. Javali is the incoming president for the Fresno-KingsMadera Chapter.

feature article

The Questions for Rural OB Deserts Amanda Mooneyham, MD

When I travel, I like to play a game of “what if?” What if I were pregnant and I went into labor here? Where would I deliver? When traveling to different parts of California, it’s a fun, though sobering exercise in finding where obstetrical deserts exist. On a recent personal trip to Mammoth Lakes, I posed this question to a friend living there—where do women in this town deliver? Her answer—not at Mammoth Hospital. They closed their birthing center in January 2022, and rumor is that the nearest hospital may also be shutting down their labor and delivery unit. Pregnant patients will be faced with the choice of traveling more than two hours for prenatal care, forgoing prenatal care, or simply moving away to safely be cared for in their pregnancy. This situation deeply affects me as I’ve attended to the long-lasting effects of obstetrical deserts over the course of my lifetime, starting in the town in which I was born.

Trinity General Hospital in small rural Weaverville, California served as a hub for very isolated and frontier pockets of small independent communities. Prenatal care was delivered primarily by family physicians with surgical obstetrical training. They closed their Labor and Delivery unit in 2002 and I feel sad that my youngest rural patients can’t experience the joy of being cared for and delivering within their own communities. I feel lucky that recently I was able to take care of a woman who was also born at the same hospital. She lived on a small rural mountain ranch with cattle, goats, chickens, and horses. She drove over an hour through tortuous mountain highways for prenatal care and as a result, eventually planned an elective induction because she was afraid to unintentionally deliver at home.

I have also experienced a labor floor closing during my residency training in 2016 at a hospital in Fall River Mills, at the northern end of the Sierra Nevadas. These patients now travel more than an hour on a winding two-lane road for prenatal care and safe, hospital-based deliveries. Road closures are common, especially during inclement weather, and I have seen how this affected their decision-making

processes about how to deliver their children safely.

But what about rural places that are successful in delivering care?

Tahoe Forest in Truckee still thrives. Adventist Health in Sonora has an obstetrical call group. Adventist Health in Ukiah has a robust FMOB group. Natividad in Salinas has enough volume to support an obstetrical fellowship. Look at Banner Health in Susanville or St. Elizabeth in Red Bluff. The hospital in Jackson, California, where I delivered my first baby as a medical student still offers deliveries.

What sets these places apart? Is it because they have trainees there?

Are there more family physicians with obstetrical privileges? Are there more spousal employment opportunities? What can we do to support or encourage trainees to consider not only full spectrum family medicine training, but to consider practice in rural or subrural areas? Can we offer more support to rural physicians? What if we could change the health and the lives of pregnant women in rural communities? What would that look like? Definitely an FM Revolution.

Dr. Amanda Mooneyham is currently an associate program director at Shasta Community Health Center Family Medicine Residency Program in Shasta County.

She is currently the Shasta-Trinity CAFP Chapter president and advocates for full spectrum family medicine training.

MEDICAL PRACTICE FOR SALE

Well-established and respected Family Medicine practice in Culver City/West LA for twenty years.

Serve a diverse patient population in a desirable location near technology and media businesses.

Organized, great staff, good systems in place.

Have you considered going into independent practice? Being your own boss? Running the show? It is doable and I’m ready to retire after I teach you how to do this!

Work with patients who make every day interesting and a learning experience for the physician—not just in medicine, but about the lives people lead and the struggles they face, the joys they experience.

Financing Options Available. More details if you contact me.

Contact: ccfamdoc@yahoo.com California Family Physician Fall 2023

21

Clinics don’t have to do it alone.

No matter where your clinic is on its ACE screening and response journey, ACEs Aware has resources available to help you.

 Clinical Implementation Pilot Program  Technical Assistance California Medi-Cal providers can apply for funding to overcome barriers to implementing and sustaining an ACE screening and response initiative in their clinic.

See reverse side for eligibility requirements.

California health care teams can contact our experts to get answers to their implementation questions.

 Implementation Resources ACE Screening Implementation How-To Guide: We have online trainings as well as a downloadable guide that provides clinical teams step-by-step guidance on how to introduce ACE screening and trauma-informed care into practice at the organizational level.

ACEsAware.org/Implement-Screening Frequently Asked Questions (FAQ): Check out our FAQs for answers to commonly asked questions about implementation and more.

ACEsAware.org/Resources/FAQ

Contact us to request technical assistance: ACEsAware.org/ ContactUs

The ACEs Aware initiative offers Medi-Cal providers training, screening tools, clinical protocols, and payment for screening children and adults for Adverse Childhood Experiences (ACEs). Screening for ACEs, assessing for risk of toxic stress, and responding with evidence-based interventions can significantly improve the health and well-being of individuals and families.

22

California Family Physician Fall 2023

members in the news Alex McDonald, MD, elected to the Claremont Unified School District’s Board of Education. Dr. McDonald will serve the current term through December 2026.

Neha D. Chande, MD, was recently selected as an AAFP 2023 Vaccine Science Fellow. Dr. Chande is a health sciences assistant clinical professor in the Department of Family Medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

Bright Zhou, MD, was elected as the Resident Chair for the 2024 AAFP National Conference of Family Medicine Residents and Medical Students. Dr. Zhou is in his last year of residency at the Stanford – O’Connor Family Medicine Residency in San Jose.

Paola Lepe, MD, was elected as Resident Member to the Society of Teachers of Family Medicine (STFM)Board of Directors. Dr. Lepe is currently a resident at Stanford – O’Connor Family Medicine Residency Program in San Jose.

Ernie Rodriguez, M.B.A., was elected as the AAFP National FMIG Coordinator. Mr. Rodriguez is attending the Universidad

Autónoma de Guadalajara School of Medicine, Los Angeles.

Silvia Diego, MD, was selected as California’s Immunization Champion Award winner by the California Department of Public Health. Dr. Diego is a family physician with Family First Medical Care of Stanislaus County, and was nominated and selected from a pool of health professionals, community advocates, and other immunization leaders for making a significant contribution of public health in California through her work in family medicine.

The 2023 Primary Care Initiative (The Keck School of Medicine of the University of Southern California), led by Jo Marie Reilly, MD, MPH, was awarded the STFM Innovative Program Award earlier this year. STFM stated, “PCI is effective in addressing the primary care workforce shortage as the number of students matching into primary care specialties, and most notably family medicine, which has increased consistently and significantly after the initiative's inception. This program is unique by combining early primary care clinical training, mentorship, community service, leadership, advocacy, and research training.”

FOR SALE Family Practice/Urgent Care

Family Medicine Come join Yampa Valley Medical Associates, a multispecialty primary care practice in beautiful Steamboat Springs, Colorado!

YVMA provides inpatient and outpatient care for newborns, children, adults and local skilled nursing facilities. Our clinic offers on-site ultrasound, point-of-care lab testing, an integrated behavioral health provider, a clinical pharmacist, and a diabetes care manager. We are part of the Primary Care First advance payment model, Signify Health Accountable Care Organization, and the Trinsic Clinically Integrated Network. A wonderful medical home close to world-class skiing, mountain biking, hiking, and more!

www.yvma.com

jobs@yvma.com

Selling a very comfortable but busy Family Practice/Urgent Care in the Sierra Foothills with nearby ski resorts and wine country.

A long-established practice with a large patient base is in an excellent location for Urgent Care. Situated in a new facility with seven patient care rooms and a new x-ray machine, this opportunity has a pharmacy in the building and is close to a very nice hospital with a friendly Emergency Room and hospital staff. A transition team will make assumption of the practice stress free. All equipment and staff make this a first day turnkey operation.

For more information call

209-418-9178

California Family Physician Fall 2023

23

CAFP Foundation

Family Medicine, CAFP and Me. And You Too!

Bright Zhou, MD Family Medicine Resident at Stanford Health Care, O’Connor Family Medicine Residency

In August, I started my last year of residency. I began reflecting on how CAFP has been my home base for mentorship and networking within Family Medicine. Starting with my first Resident and Student Council meeting, I was struck by CAFP’s “come as you are” ethos, a group of physicians and staff who were warm, accommodating, and overjoyed to have resident involvement within the organization.

Over the next few years, I’ve said yes to many opportunities*, each of which came about through a conversation, a seemingly random moment where a staff member or physician mentor would turn to me and say “You’d be great for this position!” I

Now Hiring Family Doctors Acacia Family Medical Group is hiring Family Doctors. Join an independent family practice on the Central Coast of California that has led for 25 years in providing comprehensive and relationship-oriented care.

The recruited physician may choose to work as an employee or select a mentorship track with a path to co-ownership status. Our goal is to nurture the next generation of independent clinicians, providing relationship oriented, cost effective care to our community, with high personal satisfaction for you. Come join an organization with supportive staff and colleagues, effective workflows, and an environment that encourages professional and personal development. We are at the forefront of models to invest in primary care, providing our physicians with autonomy and practice stability.

For the interested physician, we will work to match any local salary offer.

Sign on and annual bonuses 401K plan with 100% first tier match Partnership with mentoring if desired

To apply and for more information, contact us at: hiring@acaciamed.org

24

California Family Physician Fall 2023

reflect on how Dr. Emmeline Ha (senior resident at the time) brought me into this organization with a similar comment, and thus I have also been committed to bringing other trainees into CAFP with similar warmth and zest.

While it is challenging to balance resident workload with active involvement in CAFP—holding calls on the drive home from inpatient service or discussing meeting agendas while cooking dinner - I’ve been continually drawn to this community that so openly embraces one another and highlights the families, significant others, and pets that center us in our work.

Part appreciation and part advertisement, I hope this reflection encourages other medical students and residents to become involved with CAFP, and encourages other FM docs to bring their students and residents into the organization. CAFP and the CAFP Foundation have jump started my Family Medicine career and I cannot wait to remain actively involved for years to come! *I am fortunate to represent the resident voice though CAFP: • Committee of Continuing Professional Development • Committee on Membership Engagement • Delegate to AAFP National Conference for Students and Residents • LGBTQ+ alternate delegate to the National Conference of Constituency Leaders • Resident chair of next year’s 50th National Conference.

Primary Care: FM Opportunities

Come for the Opportunities. Stay for the Lifestyle.

Join the Banner Health Team, in an outdoor paradise where the beautiful Sierra Nevada and Cascade mountains meet the desert of the Great Basin in Susanville, California — where you’ll have the time to connect with your patients, your practice, your family and the great outdoors! We offer dedication to work/life balance unmatched in our industry.

Meaning you get to spend more time doing what you love. That’s HEALTH CARE made easier, LIFE made better!

• $240K Salary Guarantee • $100K Sign-On Bonus • $100K Educational Loan Repayment • Eligible for $50K from California Health Planning • Eligible for Public Service Loan Forgiveness • Eligible for HRSA Educational Loan Repayment • Retention Bonus • Focus on Patient and Provider Well-Being • Top of Market Compensation and Benefits

Join our Provider Network! Register using our job portal: PracticeWithUs.BannerHealth.com Or, email CV: primarycaredocs@bannerhealth.com For information call Martha Gonzales 602.747.4328 Banner Health is an EEO/AA - M/W/D/V Employer.

HPSA score: 17

California Family Physician Fall 2023

25

CAFP Foundation Awards Outstanding Achievement in 2023

Lauren Simon, MD, MPH

Natalie Rodriguez, MD

2023 Preceptor of the Year - Lauren Simon, MD, MPH Congratulations to Lauren Simon, MD, MPH on being awarded 2023 Preceptor of the Year. The CAFP Foundation Preceptor of the Year award honors family physicians who precept and mentor our future generations. Dr. Simon is the immediate Past-President of CAFP. She is a prior recipient of the CAFP Barbara Harris award for educational excellence. She received her medical degree at Hahnemann University and completed her Family Medicine residency training at Loma Linda University and her Primary Care Sports Medicine fellowship at Kaiser Permanente. She is Board Certified in Family Medicine with Certificates of Added Qualification in Sports Medicine and Adolescent Medicine. She is a Professor of Family Medicine at Loma Linda University and Clinical Professor of Family Medicine at the University of California, Riverside. She teaches resident physicians and medical students full spectrum Family Medicine. Dr. Simon serves a diverse patient population and is actively involved in the community helping people of all ages and abilities to live healthier lives.

2023 Educator of the Year Natalie Rodriguez, MD Congratulations to Natalie Rodriguez, MD on being awarded 2023 Educator of the Year. This award recognizes educational excellence in the field of family medicine. Criteria for the award include advances in education in the field of family medicine; excellence in family medicine teaching in medical schools, residency programs or post‐graduate CME. Dr. Rodriguez is an Associate Clinical Professor at the UCSD 26

California Family Physician Fall 2023

Chelsey Song, MD

School of Medicine Department of Family Medicine and Public Health, and serves as the Associate Medical Director of the UCSD Student-Run Free Clinic Project. Since becoming a medical student at UCSD to then joining the faculty she has been fully committed to education across all settings from the individual level to instruction at seminars, courses, large classes, and medical clinics. She has been and continues to be a mentor to hundreds of learners. She is a tireless advocate for medical students and residents while consistently demonstrating strong commitment and determination to provide quality care to underserved communities.

2023 Resident of the Year - Chelsey Song, MD Congratulations to Chelsey Song, MD on being awarded 2023 Resident of the year. The California Family Medicine Resident of the Year award is given a resident who represents the finest characteristics of family medicine. Dr. Song is a recent graduate from the Sutter Family Medicine Residency Program in Sacramento.

During residency, she helped to re-launch the Future Faces of Family Medicine Program. This program hosts interactive workshops for high school students to learn about the various aspects of Family Medicine.

Dr. Song also participated in many scholarly activities and received the Outstanding Resident Leadership Award upon graduation from residency. Clinically, Dr. Song is a hospitalist fellow at Sutter Medical Center, Sacramento.

County of Santa Cruz

Invites You To Apply for the Position of:

TARGETED ADVERTISING

Clinic Physician Health Services Agency

FOR THE MEDICAL

PROFESSIONAL LIVE Here. WORK Here. PLAY Here.

• Bilingual (English/Spanish) Candidates Encouraged to Apply • Salary: $252,283 - 272,480 Annually • Sign-on incentive pay $30,000 • Comprehensive benefits to eligible employees and their dependents To apply and for more information, visit: www.santacruzcountyjobs.com You may contact us by phone at (831) 454-2600 or e-mail at personnel@Santacruzcountyca.gov

CREDITS WHILE YOU CRUISE

Earn Live, Accredited CME on your vacation

Advertise HERE Contact Michelle Gilbert at 501-725-3561

mgilbert@pcipublishing.com

Book Now (800) 422-0711 ContinuingEducation.NET California Family Physician Fall 2023

27

Eligibility for ACEs Aware Clinical Implementation Pilot Program To be eligible for funding, applicant organizations must meet the following requirements: Be a clinical service provider located in California.

At least 25 percent of patient/client population of the clinic must be enrolled in Medi-Cal. Is early in their ACE screening and response journey.

Organizations that receive an ACEs Aware Clinical Implementation Pilot Program award will commit to: | Ensuring all clinical staff complete the Becoming ACEs Aware in California core training and attest to completion (as appropriate). | Forming an ACE screening and response implementation team. | Attending three virtual meetings with the ACEs Aware technical assistance team (before, midway, and at the end of the grant period, which begins when the organization receives funds). | Launching an ACE screening and response pilot within three months of receiving the award. | Submitting a final report

28

California Family Physician Fall 2023

Apply Today!



political pulse

The Final Stride to the End of Session Jeff Luther, MD, FAAFP Chair, Legislative Affairs Committee

of health, the final step in this legislative session is for both houses to approve bills that will be sent to the Governor's Office. The Governor then has three choices—sign the bill into law, allow the bill to become law without his signature or veto the bill. Most bills go into effect on January 1 of the following year. Urgency measures take effect immediately after they are signed or allowed to become law without signature.

This legislative session, CAFP was proud to sponsor AB 85 (Weber), to address social determinants of health. AB 85 is critical to improving health outcomes for vulnerable communities and aids in California's efforts to achieve a whole-person health care system. AB 85 would improve access to social determinants of health (SDOH) screenings, referrals, and community navigation services by requiring health plans and insurers to pay for screening for SDOH and to provide adequate access to community health workers and social workers. CAFP members and coalition partners sent letters, walked the halls of the capitol, testified at hearings, met with legislators and made hundreds of phone calls to help push this bill through multiple policy committees and legislative votes.

The legislative process is touted in its design as being a transparent process that allows the voices of Californians to be heard. However, in the long journey of developing an idea into law, change can feel opaque. Luckily, family physicians are well represented by advocates who study, track, and help family physicians engage in the process to ensure that you, your patients, and the issues that are important to you are truly represented. That long journey concludes for the year as California state lawmakers wrap up their legislative session on September 14. After months of debating a range of health care issues from prior authorization to social determinants

At the time of writing, CAFP's sponsored bill, AB 85, authored by Assemblywoman Dr. Akilah Weber, passed out of the Senate with overwhelming support in a 30-7 vote during the Senate "floor session vote." After the "floor session vote," AB 85 returned to its house origin, the Assembly, to concur amendments made by the Senate. The Assembly concurred the amendments made in the Senate, and the bill was sent to the Governor to request his signature to sign into law. The Governor has until October 14 to sign, approve without signing, or veto the bill. CAFP submitted a letter on behalf of CAFP and coalition partners urging the Governor's signature and launched grassroots efforts for members and coalition partners to amplify the bill.

AB 85 was one of over 2,660 bills introduced during the 2023 legislative session. Almost half of the bills did not make it to the final steps of the process and were either continued on page 30 California Family Physician Fall 2023

29

continued from page 29

justice through diversity, equity, and inclusion; and alleviate burnout and support member wellness and joy in medicine.

turned into two-year bills (eligible to be acted on in the next legislative session), died in their respective policy committees or were held in the Appropriations Committee.

At the time of writing, Governor Newsom had already signed several CAFP-supported bills into law. (You can find more information on these bills on familydocs.org.) These include SCR 23 (Newman), establishing a 2023 Family Physician Week; AB 1166 (Bains), creating immunity for those administering emergency opioid antagonists; AB 1452 (Jackson), related to health insurance coverage for mental and health and substance use disorder without prior authorization; SB 282 (Eggman), allowing for Medi-Cal reimbursement for certain multiple same day FQHC/RHC visits; and SB 571 (PetrieNorris,) protecting medical malpractice coverage for physicians and other providers of abortion and gender affirming care.

All bills on which CAFP has taken a position fit under one of CAFP's strategic goals – advance payment reform and system transformation; raise the profile of family medicine; prioritize

Provided by:

Not all legislative action happens through bills that are introduced.

The budget process is an important part of policy change and implementation. Despite a gloomy state fiscal forecast, CAFP saw big wins for primary care in the 2023 budget. The 2023 budget renewed the State's Managed Care Organization (MCO) tax to provide California's most significant Medi-Cal rate increases. Starting in 2024 Medi-Cal will pay at least 87.5 percent of Medicare rates for primary care, maternity care and non-specialty mental health services. Starting in 2025 an additional annual appropriation of $1.38 billion will be directed to Medi-Cal rate increases. Additionally, the health budget trailer bill contains other investments in health care, including an additional $75 million starting in 2024 to be allocated annually to increase residency slots for primary and specialty care and expand the number of residency programs in California.

USF Health Divisions of Allergy and Immunology, Internal Medicine and Pediatrics

Symposium Update in

USF Health

Allergy and Immunology 2024

This activity is approved for AMA PRA Category 1 Credit™

Tampa, Florida Friday-Saturday • January 19-20, 2024 Topics Include:

• Rhinoscopy Skills Workshop • Food Allergy • Atopic Dermatitis and Other Dermatologic Conditions • Severe Asthma and Chronic Rhinosinusitis • Biologic Therapies for Allergic and Immunologic Diseases • Immunodeficiencies and Immune Dysregulation • Inhalant Allergens, Allergen Immunotherapy, and Chronic Cough

Featured Speakers: • Thomas Casale, MD • Thomas A. Fleisher, MD • Dennis Ledford, MD • Stephen Liggett, MD • Nina Ramirez, MD • Jolan Walter, MD

SCAN QR CODE

For more information and to register, visit: https://cmetracker.net/USF/Publisher?page=pubOpen#/EventID/355491/ 30

California Family Physician Fall 2023

A leader and innovator in the future of health care Adult and Family Medicine Physician Opportunities Northern & Central California - Ask us about our enhanced compensation!

The Permanente Medical Group, Inc. (TPMG) has a longstanding reputation for progress and quality service that not only offers you the stability you need for a fulfilling career, but also the freedom to explore innovative ideas.

We invite you to join our over 9,500 physicians at one of our 22 medical centers or numerous clinics throughout Northern and Central California and become part of our 75-year tradition.

Adult and Family Medicine Virtual Care Physician (aka Virtualogist) - Exciting openings for remote work!

Seeking physicians who are BC/BE by an American Specialty Board to provide virtual care in a variety of ways that may include, but not limited to, scheduled and unscheduled video visits, telephone visits, e-visits, chat, and secure messages. Positions can be fully virtual/remote. Applicants must reside in and be licensed to practice in California. Applicants may also be required to receive licenses in multiple other states.

Ideal candidates:

• Must be flexible with the duration of work shifts and 24/7 availability, including weekdays, weekends, and holidays.

• Must be willing to work shifts in flexible increments (i.e. 1-10 hour units).

A FEW REASONS TO PRACTICE WITH TPMG:

• Work-life balance focused practice, including flexible schedules and unmatched practice support.

• We can focus on providing excellent patient care without managing overhead and billing. No RVUs. • PSLF eligible employer • We demonstrate our commitment to a culture of equity, inclusion, and diversity by hiring physicians that reflect and celebrate the diversity of people and cultures.

• Amazing benefits package, including comprehensive medical and dental, moving allowance and home loan assistance (up to $250,000 - approval required), and more!

ASK US ABOUT OUR FORGIVABLE LOAN PROGRAM! For more information about our career opportunities and wage ranges, please visit: northerncalifornia.permanente.org FAMILY MEDICINE: Contact Bianca Canales at: Bianca.Canales@kp.org or 510-421-2183 INTERNAL MEDICINE: Contact Michael Truong at: Michael.V.Truong@kp.org or 510-625-5917 CONNECT WITH US: We are an EOE/AA/M/F/D/V Employer. VEVRAA Federal Contractor.

California Family Physician Fall 2023

31

CALIFORNIA ACADEMY OF FAMILY PHYSICIANS 816 21st Street Sacramento, California 95811

miec_2022_CAFP_bleed.pdf

1

4/15/22

10:52 AM

Every physician deserves to be insured by a company like MIEC. As a reciprocal exchange, MIEC is

entirely owned by the policyholders we protect. Our mission to protect physicians and the practice of

medicine has guided us over the past 47 years. Our Patient Safety and Risk Management team continues to

provide policyholders timely resources and expert advice to improve patient safety and reduce risk. To learn more about the benefits of being an MIEC policyholder, or to apply, visit miec.com or call 800.227.4527.

Get a quote today.

Medical Malpractice coverage for individuals, groups and facilities.

Acupuncture, Psychiatry, and other specialty coverages available.

miec.com | 800.227.4527

Insurance by physicians, for physicians.™