California Family Physician - Spring 2024, Vol 75, No 1

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

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 oncall hours. We are a NHSC loan repayment eligible organization.

Salary (full-time): $250,000 - $265,000/year

For more information visit www.vcc.org or email hr@vcc.org

EEO/ AA/M/F/Vet/Disabled

Clinic

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

Located amid the peaks and pines of the Sierra Nevada in beautiful Truckee, California, Tahoe Forest Health System offers an ideal work-life balance. Just 15 minutes from Lake Tahoe and surrounded by world-class skiing, hiking, mountain biking, golf, boating, and fishing, Truckee is an outdoor enthusiast's dream.

Our friendly mountain town is the ideal place to raise a family, with a supportive, engaged community, high-quality educational opportunities, and all of the conveniences of modern living.

OPPORTUNITY AWAITS.

We are actively recruiting Primary Care physicians. To view current physician opportunities, visit tfhd.com/careers or contact Richard Shoff at rshoff@tfhd.com or (530) 606-0701.

Vista Community -�-rwo-

816 21st Street, Sacramento, California 95811

www.familydocs.org

(415) 345-8667

cafp@familydocs.org

Officers and Board Staff

President

Raul Ayala, MD, MHCM

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

Lisa Ward, MD, MPH, FAAFP

AAFP Alternates

Shannon Connolly, MD, FAAFP

Michelle Quiogue, MD

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

Brent Sugimoto, MD, Editor

Scott Nass, MD, Associate Editor

Josh Lunsford, Managing Editor

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

Karen Alvarado Advocacy Assistant kalvarado@familydocs.org

Anita Charles Manager, Educational Programs acharles@familydocs.org

Morgan Cleveland Manager, Operations & Governance mcleveland@familydocs.org

Jerri Davis, CHCP Vice President, Professional Development, CME/CPD jdavis@familydocs.org

Laurie Isenberg, MILS, CHCP Director, 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

Marissa Montano, PhD Vice President, Advocacy & Policy mmontano@familydocs.org

Jonathan Rudolph Manager, Finance jrudolph@familydocs.org

Tiyesha Watts Legislative & Policy Advocate trwatts@familydocs.org

Innovating Complex Care

Raul Ayala, MD, MHCM CAFP President

Innovation plays a crucial role in shaping the world we live in and drives progress forward. It also improves existing ideas that stem from societal needs.

About seven years ago, I was at a hospital lunchroom and heard, “Dr. Ayala, I need your help. My name is Martha, I am a new nurse navigator who has joined the hospital team and at times have difficulty getting an urgent appointment for follow up at the rural health clinics.”

She continued explaining that she cared for patients with both behavioral and medical problems, without a primary care doctor and who had transportation/communication barriers that left them at a higher disadvantage.

The power of “Yes, I can help” transformed our clinic into a fast pathway to care in the clinic. We devised a system to allow patients same-day medical visits and urgent follow-up visits by allotting protected time slots on my schedule and this allowed me to understand social drivers of health firsthand. The goal at that time was to establish patients with medical care and provide a medical home model for the patient and their family or caregivers. The practice grew to this high-risk cohort adding patients with multiple medical problems and behavioral, social, and demographic complexities.

Fast forward, a couple of years later, after numerous business meetings, and telling our story as often as needed, we grew to two key outpatient locations that were adjacent to our local hospitals in Hanford and Selma.

Our team experienced growth as well. We hired two great nurse practitioners who understood the role of patientcentered care. One of them was my sister Priscilla, who stayed with the team after her training. We also grew the whole person care team with a pharmacist, social worker, psychologist, a nurse manager, and medical assistants who are all serving to enhance the care of these patients. We then incorporated spiritual care into our clinic visits, adding two chaplains to our clinic team, Stan and Chuck, who are a joy to work alongside and have added to our patient experience.

An important milestone in our journey was establishing transitional patients from our local Children’s Hospital in

Madera. Their medical director heard me speak about our complex care clinic services and mentioned they had a pediatric version of complex care services they provided called Charlie Mitchell Children’s Center, where a full healthcare team cares for children with complex medical, behavioral, and developmental disabilities. Their largest barrier was transitioning patients into adult medicine care after the age of twenty.

This instantly became an opportunity to improve access yet again. We agreed on an experimental trial to fill that gap in care and began with a couple of patients and families, working through the transition of care, virtual care pathway meetings, and streamlining our process and services.

This quickly became a well-defined collaboration, and currently, we have quarterly clinical and operational meetings to discuss care and modes of improvement that have allowed us to enhance the whole person care and continue to grow every year. We have also incorporated our residency programs in family and internal medicine to have their curriculum include this learning experience through our complex care clinic.

The model of care has continued to evolve; we continued top decile performance in quality and patient experience and our team has prioritized increased training in behavioral health integration, substance use disorders, and social drivers of health. We now have enhanced our access for patients and families by providing a direct cell phone line, texting, and virtual care that allows us to keep our care day to day. This year we have standardized our screenings for social drivers of health and as a result have made some incredible partnerships within our community that have helped our patients with shelter, food, and transportation. The comprehensive training we receive as family physicians prepare us to address the changing health care landscape, lead teams, and with confidence believe that the family physician will pave the way for creativity, problem-solving, and will continue to improve upon existing ideas and processes in order to provide the care that we need for tomorrow.

Talk to Your Patients With HIV About the Benefits of Becoming Undetectable.

Getting your patients with HIV on treatment and helping them achieve and maintain an undetectable viral load are critical steps toward ending the HIV epidemic. People with HIV who take antiretroviral therapy as prescribed and become undetectable:

• Can live longer, healthier lives.

• Have no risk of transmitting HIV through sex.

Talk to your patients with HIV about the benefits of becoming undetectable to keep themselves and their partners healthy.

To access resources from the Centers for Disease Control and Prevention on HIV treatment as prevention, visit:

cdc.gov/HIVCareIsPrevention.

Elevating Family Medicine: The 2024 Advocacy Team Meet and Greet Tour

Empowering Family Physicians for a Healthier California

Tiyesha Watts CAFP, Legislative and Policy Advocate

In a dynamic political landscape where decisions shape the future of healthcare, the California Academy of Family Physicians (CAFP) is on a mission to advocate tirelessly for family medicine, family physicians, and the communities they serve. The 2024 Advocacy Team conducted meet and greets with the newly appointed leadership and committee chairs to forge collaborative partnerships and elevate the profile of family medicine across the Golden State.

Fostering Collaborative Relationships

With newly appointed leaders in both the Assembly and Senate, the Advocacy Team seized the opportunity to engage with key decision-makers, Speaker Robert Rivas (D-Salinas) and President pro-Tempore Mike McGuire(D-NorthCoast). Both legislators' staff welcomed the CAFP Advocacy Team, providing a platform to champion CAFP priorities and explore avenues for collaboration. Through open dialogue and mutual understanding, the Advocacy Team laid

the groundwork for collective action in pursuit of a healthier, more equitable future for all Californians and shared CAFP legislative priorities for the year, which include,

• AB 2250(Weber)-Social determinants of health: Screening and outreach

• AB 2250 budget request

• Family Physician Week resolution

• Investing in primary care and increasing health care access

• Preserving funding for the Song Brown Program

Of note, the Speaker and Senate Pro Tempore are high-ranking titles in their respective chambers. The Speaker is the highest-ranking officer of the Assembly, usually elected by Assembly members at the beginning of each twoyear legislative Session. The Speaker designee presides over Floor Sessions, and the Assembly Rules establish the Speaker's powers and duties. The President pro-Tempore is the leader of the State Senate and serves as the Chair of the Rules Committee. The Senators elect this individual at the beginning of each Session. The "Pro Tem" is the presiding officer on the Floor, overseeing the appointment of committee members, assignment of bills, progress of legislation through the house, confirmation of gubernatorial appointees, and overall direction

Pictured: Tiyesha Watts, CAFP Legislative and Policy Advocate, Marissa Montano, PhD, CAFP Vice President of Advocacy and Policy, and Karen Alvarado, CAFP Advocacy Assistant

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

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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

Special CME Programs ( 21.75)

of policy. The "Pro Tem" is also the political leader of the majority party.

Shaping Legislative Priorities

The CAFP Advocacy Team engagement extended to influential committee chairs who wield substantial influence in shaping health legislation. The advocacy team met with the legislative directors of both Assemblymember Buffy Wicks(D-Oakland), chair of the appropriations committee, and Senator Menjivar (D-San Fernando Valley), chair of the Senate Subcommittee on Health and Human Services, who welcomed discussions on crucial healthcare issues, and CAFP priorities. These trailblazing legislators chair important committees that shape health legislation and address issues vital to family physicians. The appropriations committee holds importance as it evaluates bills with fiscal impacts, playing a crucial role in deciding whether a bill advances to the next stage of the legislative process. The Senate Subcommittee No. 3 on Health and Human Services focuses on health and plays a crucial role, especially during committee hearings where budget requests accompanying bills are evaluated, such as CAFP’s Sponsored bill AB 2250, which has a fiscal cost

associated with it necessitating a budget request, and likely to be deliberated on in Senate Subcommittee No. 1 on Health.

Meeting with legislators who chair relevant committees is crucial for effective advocacy negotiation on important health topics. These meetings provide insights into legislative dynamics, build relationships, and empower us to present compelling arguments influencing decisionmaking. By fostering collaboration with committee chairs, CAFP can drive meaningful change and prioritize the health and well-being of the community’s family physicians serve.

continued on page 10

San Diego: Medical Corporation looking for a Full/Part time PCP (FP/IM or NP). Salary negotiable, future partnership and profit-sharing option. Benefit package negotiable. Please send your CV and intro letter to: NICE87@YAHOO.COM

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

Pictured: Zack Castillo-Krings, Legislative Director for Assemblymember Buffy Wicks, Tiyesha Watts, CAFP legislative and policy advocate, and Karen Alvarado, CAFP Advocacy Assistant

Photo by Dennis Ludlow (Sharkshock)

continued from page 9

Commitment to Health Equity

Despite the challenges, CAFP's commitment to advancing health equity remains unwavering. Assemblymember Weber, chair of the Assembly Subcommittee No. 1 on health and author of the CAFP sponsored bill

on Social Determinants of Health, embodies this commitment. Despite setbacks, including the veto of AB 85(Weber)- Social determinants of health: screening and outreach, CAFP's collaboration with Assemblymember Weber underscores our determination

to improve patient access to care and advance health equity. We are excited to reintroduce the social determinants of health bill with a new number, AB 2250(Weber), and mobilize grassroots efforts to drive positive change. Be on the lookout for advocacy opportunities to engage on AB 2250(Weber), including Lobby Day on April 15, a part of the 2024 All Member Advocacy Meeting (AMAM), where CAFP members can actively engage and make their voices heard. Don't forget to bring your white coats and comfortable walking shoes so we can get AB 2250 to the finish line!

Looking Ahead: Advocacy in Action

As the 2024 Legislative session progresses, the CAFP Advocacy Team remains vigilant. With the 2024 legislative session adjourning on August 31 and the Governor's deadline to sign, approve without signing, or veto all bills on September 30, CAFP's advocacy efforts are more critical than ever. The CAFP advocacy team is committed to getting AB 2250 across the finish line and engaging on legislation that aligns with CAFP strategic goals—advancing payment reform and system transformation, promoting the growth of the primary care physician workforce, defining and

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Pictured: Tiyesha Watts, CAFP Legislative and Policy Advocate, and Karen Alvarado, CAFP Advocacy Assistant

Pictured Left to Right: Lisa Folberg, CAFP CEO, Karen Alvarado, CAFP Advocacy Assistant, Tiyesha Watts, CAFP legislative and po licy advocate, Assemblymember Akilah Weber, MD, and Taylor Jackson, CPCA Deputy Director of Government Affairs.

OPPORTUNITIES

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 80 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 24 hospitals, 400 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

continued from page 10

raising the profile of family medicine, supporting physician wellness, and promoting Justice, Equity, Diversity, and Inclusion (JEDI). Additionally, June 15 marks the deadline for the enacted budget, presenting another opportunity for CAFP to advocate to preserve

Song Brown funding greater investments in primary care and elevating family medicine.

Empowering Change

At its core, advocacy lies at the heart of CAFP's mission. The CAFP Advocacy Team tirelessly champions the interests

of family physicians, ensuring your collective voices resonate in the hallowed halls of the Capitol. Together, we can elevate family medicine and create a healthier future for our communities.

Join Us in Advocating for a Healthier California!

Bill introduction deadline

Last day for policy committees to hear and report to the floor nonfiscal bills introduced in their house (J.R. 61(b)(6)).

Last day for each house to pass bills introduced in that house (J.R. 61(b)(11)).

Enacted Budget must be passed

Last day for policy committees to hear and report to fiscal committees fiscal bills introduced in their house

Last day for fiscal committees to hear and report to Floor bills introduced in their house.(J.R. 61(b)(8)).

Summer Recess

Last day for policy committees to meet and report bills(J.R. 61(b)(13)).

Last day for fiscal committees to meet and report bills (J.R. 61(b)(14)).

Last day for Governor to sign or veto bills

Last day for each house to pass bills. (Art. IV, Sec. 10(c). (J.R. 61(b)(17)).

SATURDAY, APRIL 13

TIME SESSION

12:00 - 1:00 pm

1:00

AMAM Registration & Lunch

Delegates are invited to a Meet & Greet with the New Physician Director candidates

Opening Session of the AMAM – Welcome

Lisa Folberg, MPP, CAFP CEO

What Is the AMAM and What Will We Do During This Meeting

Anthony Chong, MD, FAAFP, CAFP Speaker

Certification of Delegates

Presentation of Election Slate and vote on uncontested positions

President’s Address

Raul Ayala, MD, MHCM

Resolutions Hearing – CAFP Board of Directors

Anthony Chong, MD, FAAFP, CAFP Speaker and Kim Yu, MD, FAAFP, CAFP Vice Speaker

Candidate Speeches and Delegate Voting for New Physician Director

Anthony Chong, MD, FAAFP, CAFP Speaker

Resolutions Hearing – CAFP Board of Directors

Anthony Chong, MD, FAAFP, CAFP Speaker and Kim Yu, MD, FAAFP, CAFP Vice Speaker

All Member Reception & Open House at CAFP Headquarters

816 21st Street, Sacramento, CA 95811

SUNDAY, APRIL 14

Registration & Continental Breakfast

All Member Advocacy Meeting Reconvenes – Welcome Back and Preview of the Day

Anthony Chong, MD, FAAFP, CAFP Speaker

Social Needs Screening: It Takes a Team

Margot Savoy, MD, FAAFP, Senior Vice President, Education, Inclusiveness and Physician Well-Being, AAFP

FP-PAC Weekend Update

Shannon Connolly, MD, FAAFP, FP-PAC Chair

Keynote Speaker

Elizabeth A. Landsberg, Director, Health Care Access and Information (HCAI)

Break

Resolutions Hearing – CAFP Board of Directors

Anthony Chong, MD, FAAFP, CAFP Speaker and Kim Yu, MD, FAAFP, CAFP Vice Speaker

CAFP Foundation Update & AMAM Scholarship Winners

Ronald Labuguen, MD, FAAFP, CAFP Foundation President

Celebration Lunch

Tochi Iroku-Malize, MD, FAAFP – AAFP Board Chair

Alex McDonald, MD, FAAFP – CAFP President

Convocation of Fellows

Installation of Officers

• President’s Address

Hero of Family Medicine Award Announcement

Resolutions Hearing – CAFP Board of Directors

MONDAY, APRIL 15

Anthony Chong, MD, FAAFP, CAFP Speaker and Kim Yu, MD, FAAFP, CAFP Vice Speaker

Training Tracks

Track One: How to Talk with your Legislator

Marissa Montano, PhD – CAFP Vice President of Advocacy and Policy Vanessa Cajina –CAFP Legislative Advocate

Track Two: The Sausage Making of Elections and Campaigns: An Insider’s View

Jasmeet Bains, MD – 35th District Assemblymember, California State Assembly

Alex McDonald, MD, FAAFP – Trustee Area No. 4, Claremont Unified School District

Daniel C. Weitzman – Client Relations Director, Daniel C. Weitzman Consulting Communications and Public Affairs Strategist

Legislative Briefing on CAFP Priorities

Jeff Luther, MD, FAAFP, CAFP Legislative Affairs Committee Chair

Tiyesha Watts, CAFP Legislative and Policy Advocate

Vanessa Cajina, CAFP Legislative Advocate

Family Medicine Revolution (of Peace)

Jay W. Lee, MD, MPH, FAAFP

“Rev·o·lu·tion (noun): a forcible overthrow of a government or social order, in favor of a new system”

So, you’ve been using the #FMRevolution hashtag since 2011, now what? Lest you envisioned a bloody, violent affair back then, the Family Medicine Revolution has neither been bloody nor violent. Rather, it’s been a steady, deliberate force that has bent the arc of the healthcare landscape towards a foundation of family medicine.

Here are several important accomplishments of note over the past 13 years:

• 5000+ available family medicine residency positionsi in 2023 (compared with 3000+ in 2013)

• Advancement of prospective, value-based primary care payments models

 Including G2211 add-on codeii which adds $16.05/visit in 2024 rewarding continuous care of complex patients

• Ongoing advocacy focus on reducing administrative burdeniii

• In California, we are approaching nearly universal health care with continued expansion of full-scope Medi-Caliv for all ages with the recent addition of those who are 26-49 years old

• Thousands of social media posts using the #FMRevolution hashtag to tell the story of family medicine, inspiring hundreds of residency applicantsv, many of whom proudly post their headshots emblazoned with #FMRevolution “Peace (noun): an equilibrium; the absence of conflict or strife”

Alas, Family Medicine Revolution is one aimed at achieving peace. In my mind’s eye, it’s the kind of peace that allows us to become the physicians we wrote about in our personal statements, unencumbered by the tyranny of urgency infusing the modern medical-industrial complex, where we can focus on doing our best to do what is right for our patients. It may be the kind of peace we will never know in our careers but that doesn’t mean we shouldn’t resist or continue to struggle to achieve it. After all, as George Bernard Shaw once wrote: “Revolutions have never lightened the burden of tyranny, they have only shifted it to another shoulder.”

So we need to find ways to accelerate the changes:

• We celebrate the 5000+ available family medicine residency positions but we are not satisfied because it’s still not enough to bridge the widening primary care workforce gapvi

• Even with the advancement of prospective, value-based primary care payment models, our nation spends less than $0.05 of each healthcare dollar on primary carevii

• While there is promise in emerging technologies like AI+machine learning, family physicians still experience high amounts of administrative burden due to prior authorizations, quality and performance management, medical supply coverage requirements, and medical record documentation viii

• Although uninsurance rates are historically low ix in California, lack of insurance disproportionately impacts people of color and those who are poor and/or live in rural areas

• In spite of the enthusiasm (and wisdom) of those who choose family medicine as their medical specialty, there are real microeconomic and systems-based reasons why more students are not choosing family medicinex

Suffice it to say, we have deep, existential challenges ahead for family medicine, especially as we struggle to escape the gravitational pull of the pandemic. Let’s take whatever tailwind comes. Now is the time to revisit our spirit of resistance so that we may better achieve the peace to make health primary for the patients and communities we serve. As Lewis Lapham wrote: “No country can preserve its political liberties unless its rulers know that their people preserve the spirit of resistance.”xi And let’s endeavor to take on the headwinds together with the long term goal in mind: everyone deserves a family physician who practices medicine that is first-contact, continuous, comprehensive, and coordinated. ¡Viva the Family Medicine Revolution!

i https://www.aafp.org/students-residents/residency-program-directors/ national-resident-matching-program-results.html

ii https://www.aafp.org/family-physician/practice-and-career/getting-paid/ coding/evaluation-management/G2211-what-it-is-and-how-to-use-it. html#:~:text=G2211%20is%20an%20add%2Don,care%20services%20 the%20patient%20needs.

iii https://www.aafp.org/news/blogs/inthetrenches/entry/2024-wins-in-effect. html

iv https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/32424

v https://www.aafp.org/news/blogs/freshperspectives/entry/20220121fpacgme.html

vi https://kffhealthnews.org/news/article/lack-of-primary-care-tipping-point/

vii https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/primary-carescorecard.html

viii https://www.aafp.org/about/policies/all/principles-administrativesimplification.html

ix https://healthpolicy.ucla.edu/our-work/publications/california-achieveslowest-uninsured-rate-ever-2022#:~:text=Summary%3A%20Based%20 on%202022%20California,a%20historic%20low%20in%202022.

x https://www.aafp.org/about/policies/all/studentchoice-familymedicine.html

xi https://www.laphamsquarterly.org/revolutions/crowd-control

Local Chapters Leaders Transition in 2024

Local chapters value the volunteer leadership of members in their area. Four of our largest southern California chapters are welcoming new incoming presidents this year. Sarah Merrill, MD will lead our San Diego Chapter. Emma Hiscocks, MD is the new President in Los Angeles. Shayne Poulin, MD joins us as President of the Riverside-San Bernardino Chapter. And Jaesu Han, MD begins a one-year term as President in the Orange County Chapter.

Jaesu Han, MD is a Clinical Professor in the UC Irvine Departments of Psychiatry and Family Medicine. He completed combined family medicine and psychiatry residency training at UC Davis in 2002 and stayed on at UC Davis to practice and teach in several psychiatric and primary care settings. In 2017, Dr. Han transferred to UC Irvine where he is full-time faculty in the Department of Psychiatry and Family Medicine. His current activities include providing primary care, medication-assisted treatment for substance use disorders and psychiatric consultation in the primary care setting. He directs the behavioral health curriculum in the family medicine residency program and is core clinical faculty in the UCI TNT Primary Care Psychiatry Fellowship Program. His interests include medical education, motivational interviewing and integrating behavioral health into primary care.

Emma Hiscocks, MD has served on the Los Angeles Academy of Family Physicians Executive Board for six years after starting to attend LAAFP events, which inspired her interest in advocating for family medicine. In her current role providing primary care at Tia Clinic in Los Angeles, she enjoys practicing high-quality, compassionate, evidencebased medical care with patients who have felt unheard during their past medical experiences. Dr. Hiscocks is honored to serve as 2024 LAAFP President.

Sarah Merrill, MD , is a boardcertified family medicine doctor who specializes in sports medicine. As an assistant professor in the Department of Family Medicine and Public Health, Dr. Merrill instructs students, residents and fellows at UC San Diego School of Medicine. Dr. Merrill has provided care throughout the San Diego community and for many sporting events. She is an associate team physician for the San Diego Seals professional indoor lacrosse team, a team physician for the UC San Diego Tritons, and has also served as team physician for University City High School's and Scripps Ranch High School's football teams, medical director for California State Games, medical team captain for San Diego Rock and Roll Marathon, and event physician for BMX World Championships.

Shayne Poulin, MD completed medical school at the University of Arizona and went on to Family Medicine residency at Boston University/ Boston Medical Center. In 2016 her passion for integrating full-scope reproductive health into primary care led her to Planned Parenthood of Orange and San Bernardino, where she is currently the manager of clinical services for San Bernardino County. She is also the co-founder of the Reproductive Health within Primary Care Conference and serves as District V Director on the board of the California Academy of Family Physicians.

Many thanks to outgoing Presidents Julie Celebi, MD (San Diego), Greg Lewis, MD (Los Angeles), Mai Linh-Tran, MD (Riverside-San Bernardino) and Stephanie Chu, MD (Orange).

If you are interested in serving in a local chapter leadership position, get in contact with your local chapter or contact CAFP. Visit www.familydocs.org/chapters.

New Physician Director Candidates

The New Physician Director brings the interest and perspective of new or early career physicians on the CAFP Board of Directors. They also sit on the Membership Engagement Committee and are involved in various aspects of membership outreach and retention for new physicians. The New Physician Director will be elected at the 2024 All Member Advocacy Meeting.

Cynthia Chen-Joea, DO, MPH, CPH, FAAFP

Being a Family Physician is an honor for which I am incredibly proud and grateful. We are privileged to serve our patients, and uniquely positioned to help optimize their well-being within our health care system. I am honored to be considered a candidate for CAFP New Physician Director, where I may work collaboratively with others to represent the best interests of Family Physicians everywhere. My journey with CAFP started with the ResidentStudent Council, where I was incredibly inspired and motivated by the advocacy work Family Physicians do across our communities. I am passionate about engaging medical students, residents, and new physicians with CAFP so they may be aware of the resources CAFP has to offer, and become more actively involved with the health care issues that may be important to them. My background in medicine and public health has afforded me a unique insight into how the pandemic has affected physicians working in diverse settings, and the natural aftermath of what medicine has become post-COVID. As Associate Program Director and Inpatient Director of the Emanate Health Family Medicine Residency Program, I work with medical students and residents closely introducing them to advocacy within our specialty. As Secretary-Treasurer and past Department Chair at Emanate Health, I promote the best interests of our medical staff and am highly involved in quality improvement projects in our hospitals. I also serve on the board of our local LA-AFP chapter, am involved in the CAFP Committee of Public Health and Equity and will serve as Co-Chair of the Member Engagement Committee this upcoming year. I look forward to my own growth and learning as Co-Convener of the Women’s Constituency at NCCL and as NCCL Delegate to AAFP Congress of Delegates this year. I believe our specialty is the backbone of our healthcare system, and we have the

power to affect legislation that may improve the health of the population. With my experience, I hope to continue engaging CAFP members across our state to motivate them to fight for the change that they hope to see and inspire a new generation of leaders who may continue leading change for the better in California. Thank you for your time, consideration, and opportunity to share my ideas. I hope to help make our specialty and your healthcare goals for our state a reality as CAFP's New Physician Director.

C. Emily Lu, MD

I am running for the New Physician Director position because I represent the large proportion of new family physicians who are relatively new to organized medicine, but have nevertheless been working hard to try different ways to care for our patients and change the healthcare system. I want to reach those CAFP members no matter where they practice so that we can elevate their diverse voices and build a family medicine community that doesn’t just care for our patients but also for each other as we grow our careers. Though I haven’t held leadership positions in CAFP until recently, I have sought career experiences that have allowed me to lead primary care innovation in different settings: from academic safety-net care to private practice tech-enabled care, from fully-capitated risk contracts to feefor-service volume management, from building tech products to leading multidisciplinary care coordination teams, from coordinating FQHC quality care collaboratives to speaking at health tech conferences, from caring for the sickest of the sick Medicaid/Medicare patients to caring for CEOs and other female professionals hitting the burnout ceiling. I believe my diversity of experience helps me understand some of the diversity of practice that new physicians face today. I have already had the opportunity to bring that experience to the CAFP as an AMAM delegate, a member of CAFP’s medical practice committee, and very recently this year as Vice President of the newly reconstituted CAFP East Bay chapter. I hope as the New Physician Director to build other ways for new physicians to engage with CAFP leadership and receive CAFP support. Being a family physician in our fragmented system is hard enough – we should not have to do it alone.

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I am very excited to announce my candidacy to serve as the New Physician board member. The CAFP became my community when I was a medical student after I noticed a pattern: every time I would tell my peers that I was going into Family Medicine, they would question my choice. It was as if they did not know that primary care is the only field in medicine that increases lifespan and health equity. Or worse, if they did know, that medicine was no longer about the patients, but about the physician. The #FMRevolution embodied by the CAFP was a counterforce to that, aiming to shift the focus back to the patients, and so began my advocacy journey on the board of directors

as a medical student. I organized workshops for medical students introducing them to the breadth of family medicine. I later became the resident member of the Committee on Continuing Professional Development, which I continue to serve on today, listening to our members' needs to help strengthen our ability to care for our patients effectively, and our profession unapologetically.

As core faculty at Ventura County Medicine Center Family Medicine Residency, I have begun an advocacy curriculum to empower residents to break down the barriers to health equity that our patients face outside of the clinic walls every day. Of course, our hard work does not stop when we graduate. As the New Physician representative on the board, this work to increase, mobilize, and revolutionize the family medicine workforce is what I aim to carry forward so that when future medical students decide to enter family medicine, rather than question the choice, others will join the cause. Thank you for considering me as your New Physician board member.

Laura Murphy, DO, CAQSM

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New Leadership, Budget Deficits, and Advocacy, Oh My!

Jeff Luther, MD, FAAFP Chair, Legislative Affairs Committee

California Legislators returned to Sacramento on January 3, 2024, kicking off year two of the two-year legislative session. This new year in the California Legislature comes with fresh new leadership in key positions of power—ushering in a wave of optimism, promising collaboration and progress in the months ahead. In the Assembly, Speaker Robert Rivas will serve his first full year in this role. In the Senate, Senate President Pro Tempore changed hands from Senator Toni G. Atkins (D-San Diego), who announced her run for Governor, to Senator Mike McGuire (D-North Coast) on February 5, 2024. As expected, new committee chairs assumed their roles, influencing committees that shape health legislation on issues vital to family physicians. Furthermore, Governor Newsom released his fiscal year (FY) 2024-2025 budget proposal that is central to the legislative agenda—setting the stage for policy priorities for the coming year.

Championing Equity: AB 2250 to Advance the Social Determinants of Health

Following the bill introduction deadline on February 16, the bill tally for 2024 is 2,124 bills. Among those bills is CAFP’s sponsored bill AB 2250 (Weber), which builds upon the momentum from last year’s bill to advance social determinants of health (SDOH) screening and outreach. The first legislative hurdle for AB 2250 will be policy committees in the Assembly. Assemblymember Mia Bonta, the new Chair of the Assembly Health Committee, champions SDOH as a key legislative priority, putting the passage of AB 2250 on a promising path forward this legislative session.

Key Legislative Leadership and Committee Changes

Senate Appropriations

• Senator Anna M. Caballero(D-Merced), Chair

• Senator Brian W. Jones (R-Santee), Vice-Chair

Assembly Appropriations

• Assemblymember Buffy Wicks (D-Alameda), Chair

• Assemblymember Kate Sanchez (Murrieta), Vice-Chair

Senate Budget and Fiscal Review

• Senator Scott Wiener(D-San Francisco), Chair

• Senator Roger W. Niello (R-Fair Oaks), Vice-Chair

Assembly Budget

• Jesse Gabriel (D-Encino), Chair

• Assemblymember Vince Fong (R-Kern County), Vice-Chair

Senate Budget Subcommittee #3 on Health and Human Services

• Senator Caroline Menjivar (D-San Fernando Valley), Chair

• Senator Susan Talamantes Eggman (D-Stockton)

Assembly Budget Subcommittee #1 on Health and Human Services

• Assemblymember Akilah Weber, MD (D-San Diego), Chair

Senate Business, Professions and Economic Development

• Angelique Ashby (D-Sacramento), Chair

• Senator Janet Nguyen (R-Huntington Beach), Vice-Chair

Assembly Business and Professions

• Assemblymember Marc Berman (D-San Mateo), Chair

• Assemblymember Heath Flora (R-Ripon), Vice-Chair

Senate Health

• Senator Richard Roth (D-Riverside), Chair

• Senator Janet Nguyen (R-Huntington Beach), Vice-Chair

Assembly Health

• Assemblymember Mia Bonta (D-Alameda), Chair

• Assemblymember Marie Waldron (R-Valley Center), Vice-Chair

Budget Shortfall

Governor Newsom released his FY 2024-2025 Budget Proposal on January 10, 2024. The budget proposes spending $291.5 billion ($208.7 General Funds (GF), $80.8 billion in special funds, and $2 billion from bond funds). Almost a quarter (24.5 percent) of state funds are dedicated to health-related expenditures. The proposal also projects a $37.9 billion shortfall reflecting lower-than-expected state revenue and a steep stock market decline in 2022 that negatively impacted the state income tax collections from corporations and high-income Californians.

The Newsom Administration proposes addressing the shortfall by:

• Drawing down $13.1 billion from reserves;

• Reducing programmatic funding by $8.5 billion;

• Generating $5.7 billion from revenue and internal borrowing;

• Implementing $10.6 billion in funding delays, shifts, and deferrals.

As budget deliberations continue, the Administration may propose additional measures, including program reductions, to maintain a balanced budget.

How is Healthcare Impacted by this Year’s ‘Bad Budget’?

The good news is that despite major deficits, the budget proposal preserves investments in healthcare including dedicated funding for Medi-Cal expansion, Medi-Cal primary care provider rate increases, and Song Brown funding, totaling $73.9 billion GF.

Budget proposals include:

• Provider Rate Increases—Amending the federally-approved MCO Tax is proposed to increase state revenue by $1.5 billion (for a total of $20.9 billion in funds) to support provider rate increases. Pending federal approvals, this proposal will leverage the MCO tax dollars to support the Medi-Cal program ($12.9 billion) and $8 billion for targeted rate increases and investments, inclusive of primary care providers.

• Medi-Cal Expansion—Keeping with Governor Newsom’s promise for universal coverage, the budget includes $1.4 billion ($1.2 billion GF) in FY 2023-24, $3.4 billion ($2.9 billion GF) in FY 2024-25, and approximately $3.7 billion ($3.2 billion GF) ongoing to expand full-scope Medi-Cal eligibility to income-eligible, undocumented adults aged 26 to 49. This Medi-Cal expansion effort began January 1, 2024.

• California Advancing and Innovating Medi-Cal (CalAIM)—Approximately $2.4 billion ($811.1 million GF) in FY 2024-25 is proposed for ongoing implementation of the CalAIM Initiative, a Medi-Cal transformation effort rooted in personcentered care.

• Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration—Effective January 1, 2025, the proposed budget includes $7.6 billion ($350.4 million GF, $87.5 million Mental Health Services Fund, $2.6 billion Medi-Cal County Behavioral Health Fund, and $4.6 billion federal funds) for the

2024-25

General Fund Expenditures (Dollars in Millions)

Department of Health Care Services (DHCS) and the Department of Social Services (DSS) to implement the BHCONNECT Demonstration.

• Reproductive Health Services— Access to reproductive healthcare remains a key priority where the proposed budget includes, no sooner than July 1, 2024, $200 million total funds (TF) ($100 million GF) in FY 2024-25 to provide funding for California's Reproductive Health Access Demonstration (CalRHAD).

• Vaccinations—The federal Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) approved two RSV vaccines (older adults and pregnant individuals) and one injectable drug (healthy

children) to protect against RSV. The RSV vaccines and injectable drugs were available starting in October 2023, and costs are estimated to be $138.7 million TF ($61.4 million GF) in FY 2023-24 and $215.8 million TF ($95.5 million GF) in FY 2024-25.

Next Steps

CAFP will work with the legislature and allies to advocate for proactive, equitable healthcare across California. Our ongoing dedication includes working with state government leaders to ensure continuous growth for the primary care physician workforce, fortify healthcare resources and access, and protect funding for a robust and resilient healthcare system.

An Interview with your new President, Alex McDonald, MD, CAQSM, FAAFP

Why family medicine for you? Who were the role models who inspired you to go into family medicine?

I always wanted to be able to care for all ages and stages of life and deal with 90% of common conditions that walk in the door. I didn't really have much of an exposure to family medicine until late in medical school. In fact, I was dangerously close to becoming a pediatrician for most of medical school, but fortunately, I had some early mentors who asked me some pointed questions about the type of career I wanted and communities I wanted to serve. After I shared my thoughts and vision for my career, they looked at me and said, “kind of sounds like you are describing family medicine.” In retrospect I always wanted to be a Family Physician, I just didn't know what that was and I think we need to do a much better job articulating who we are and what we do to patients and medical students far earlier in their training.

What piqued your interest in becoming active with your county and state AFP chapters?

I like to joke that I accidentally stumbled into the California Academy of Family Physicians. As a resident, I saw an email to join the newly formed resident and student council so I signed up and received emails that I passively read for a few months. Then one day I saw an email stating the resident delegate to the national conference could not attend and I responded that I was interested in serving in this role. Since I was the first one

to respond to the email I was selected and was on my way to Kansas City. At the national conference for the first time, I was blown away by the passionate, smart, and articulate family physicians and wanted to be part of this group and found many mentors and colleagues. It may be a bit tongue in cheek, but that e-mail and attending the national conference changed the trajectory of my career in ways I never imagined, and for which I am deeply grateful. Being involved in the academy both at the state and national level I remain connected to why I am a family physician, mitigate burnout, and take tremendous pride in learning how to and advocating for our specialty as well as our patients. There is nothing like being in a room full of smart, passionate, and dedicated family physicians.

Is now the best time ever to be a family physician, in your estimation?

Family medicine and primary care in general are at an inflection point and I believe the future is very bright. We have been battling for decades for the respect of our colleagues but also the ability to practice full spectrum family medicine knowing to serve our patients but also improve quality and reduce costs. With spiraling and unsustainable health care costs which are literally breaking the budget of many families and our nation, many people are looking for a solution, and I truly believe that solution is comprehensive family medicine.

What are the most important challenges confronting CAFP?

Nearly 90% of residency graduates are joining large group practice or being employed by health care systems and are becoming cogs in the healthcare wheel and no longer have the autonomy or ability to practice the way they were trained. As such, many are becoming burnt out with administration or losing connection with why they become family physicians. CAFP must support and collaborate with family physicians across the state to ensure that we are able to maintain the joy in medicine yet also not let others dictate who we are, the type of medicinal practice, or our value to the health care system. We must help support our members and give them the tools and the voice to define their own practice and their own spectrum of care regardless of practice setting.

What has been the best part of being an officer in CAFP so far?

Being able to help shape and steer the Academy is truly an honor and a responsibility that I do not take lightly. However, being able to serve with many other amazing family physicians who bring a tremendous amount of knowledge, experience, and breadth to the table has really helped us all collaborate to best serve our members in the Academy. Furthermore, serving as an officer has empowered me with tools and skills which I have been able to apply in multiple other domains within my personal and professional life and I'm deeply grateful for this experience.

How do you maintain what former President Jay Lee calls “the joy” of family medicine?

For me, the joy of family medicine is about practicing what I preach and serving patients and my health care system in a multitude of dimensions. I practice outpatient family medicine and truly get to practice comprehensive and longitudinal care with all of my patients, but that's not all. I also practice sports medicine and I practice hospital-based medicine. I teach medical students, residents, and fellows. I serve as a residency core faculty member, and I perform point-of-care ultrasounds and almost every office-based procedure you can think of. The joy of family medicine is different for every family physician, but for me, it's variety. No day is the same and that's what makes it sustainable and fulfilling for me. But each of our members needs to decide for themselves what brings them joy, and CAFP needs to help support them to do this.

How do you maintain work-life balance?

People ask me this all the time, however for me it's not about balance, it's about meeting my obligations and responsibilities within all domains. I focus on being present when I'm at work and being present when I'm at home. There are ebbs and flows where my attention is focused on one more than the other at times. Yet I have also realized that taking vacation regularly, spending quality time with my family, and completely disconnecting from work and professional responsibilities is absolutely vital. Also, just like medicine, raising a family is a team-based sport, and I have an amazing family and support team to ensure we are all meeting every one of my family member's needs, both personally and professionally. Lastly, I think it's critical to demonstrate the importance of leadership and extracurricular work for my children, and I involve them in my professional work whenever possible.

What do you see as the best ways CAFP can help its members maintain the joy?

As I mentioned above each family physician needs to indicate and dictate what joy is to them and our job as CAFP is to help support and advocate so that they may not only define joy, but define their practice to maintain that joy. Lastly, encourage all of our members to show up to a CAFP meeting and connect with the continued on page 24

continued from page 23

doctors there. Those are perhaps the happiest and most fulfilled family physicians that I know and there is a tremendous amount of knowledge to be gained from them.

Where will family medicine be in ten years and what role will CAFP have played in it?

In an ideal world, in ten years family medicine will be the foundation of the health care pyramid with the respect and admiration of not only the public and health policy experts but also the physician community in general. Family medicine physicians will be highly sought after and compensated for their comprehensive and longitudinal care of patients in all practice settings and in all communities throughout the US. Medical students will enter medical school seeking out experiences and rotations to improve their chances of becoming a family physician and no one will ever again dare tell a medical student ”you're too smart to be a family physician." Family physicians will also be sprinkled throughout health care policy organizations not only in organized medicine but also as elected officials who are truly making the decisions which impact our patients and our health care delivery systems. Family medicine will be ubiquitous and synonymous with the quadruple aim; higher quality care, lower cost, improved patient satisfaction, and improved physician joy in medicine.

What is your message to the next generation of family physicians—what will sustain them?

Don't let anyone define you or your practice. Only you can define who you are as a family physician. Take tremendous pride in the value and quality that you bring to the health care system, find your voice to speak up for yourself and those who may not be able to speak for themselves, and continue to advocate for yourself and your patients. Family physicians are the plenty potent stem cells of the healthcare system and can adapt, adjust, and meet the needs of any community, anywhere.

Finally, what is one fun thing that CAFP members should know about you?

I am an acapella dork and in college sang in an acapella group and honed my performance and vocal percussion skills.

Any parting thoughts you want to share with members?

I am excited and honored for the privilege to serve as the CAFP president this year. I hope to connect with as many members as possible and want all of you to reach out if there's anything the Academy can do for you. But I also encourage everyone to attend a meeting and bring a friend. I assure you, you will not be disappointed.

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Restore the Patient-Physician Relationship

Cameron MacInnis, MD Core Faculty Adventist Health Ukiah Valley FMR

“You aren’t going to fix me, no one has!”

My first establish-care visit of the day started. Ms. G explained that she had been throwing up for 8 years—but that no one had seen her more than twice. She felt that every doctor gave up because they couldn’t figure out what was causing the vomiting. Naturally, she was very upset, feeling that the previous doctors had let her down.

In moments like this, I often feel like patients are asking me to be like a vending machine: if they push the right buttons, they will get what they want. It feels like we are adversaries, rather than like we were on a team.

Many medical professionals feel less connected to their patients, just as patients feel disconnected from their doctors.

In my experience, some important steps to improving these patient-physician relationships are:

• Validate previous poor experiences: “I’m so sorry that you have had such a challenging time getting answers about this medical problem.”

• Reframe general frustration: “It sounds like previous doctors have not taken your symptoms seriously.”

• Reassure the patient that you are on their team: “We are going to work together to figure this out.”

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• Be honest when you don’t have answers: “We don’t have a diagnosis yet, but I am reassured that it does not sound like something scary, such as cancer.”

• Give them a plan moving forward: “We will continue working together to explore other ideas.”

The first time I met with Ms. G, I did just this: I asked if we could start at the beginning, so I could understand the history of what had happened. I explained the approach I wanted to take, and I promised her we would keep following up until we had a solution. We discussed her medical concerns, as well as her frustrations with the medical system. It took almost 3 years, but following her Nissen fundoplication, which successfully treated the vomiting, I got a giant hug. Joy can come from even the rockiest of starts.

Cameron MacInnis, MD is Core Faculty and practices Family Medicine with Adventist Health Ukiah Valley Family Medicine Residency in rural Northern California. He is passionate about improving access to care in rural communities, mental health and addiction, preventive care for patients of all ages, and global health. Before returning home to Northern California to practice, he completed his education and gained a passion for rural underserved communities, with time in New Mexico, North Dakota, and Idaho. Outside of medicine, he enjoys the outdoors (hiking and photography), sports (Go 49ers and Warriors!), and wine tasting.

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Reflections on the Past Six Years

Brent K. Sugimoto, MD, MPH, FAAFP

Six years ago, I packed plenty of diapers, enough adorable outfits for the anticipated blow-outs, and a Pack ‘N Play before strapping my two-week old daughter, Mari, into her car seat for our first father-daughter road trip. Our destination was the annual CAFP CME event in Monterey, California, then known as Clinical Forum, for my first CAFP board meeting as the incoming editor of this magazine, California Family Physician (CFP)

In the boardroom atop the Marriott, Mari and I were welcomed warmly to my daughter’s very first board meeting. I quickly learned that CAFP’s past CEO, Ms. Susan Hogeland, was an expert baby whisperer. Staff and colleagues helped to keep Mari entertained. And among the sweeping views of the azure Monterey Bay, Mari promptly spit up on Dr. Carol Havens (then AAFP alternate delegate). Thus began my tenure as editor of the publication you hold in your hands.

It is hard to believe that six years have already passed. Yet, I look at Mari, just shy of that milestone, and have incontrovertible proof that my two terms as Editor are coming to an end. Reflecting on those years, I see so much packed into our issues of the magazine, a reflection of all the work that California Family Physicians do.

Family doctors shared their work in the #MeToo movement, #BlackLivesMatter, and the birth of our own JEDI committee. We heard about members working to keep their health systems running while the wildfires burned around them. The COVID pandemic came, and amidst that crisis, we got to hear about amazing work of our members that got state and national attention.

Members shared their work in areas such as helping the unhoused, sexually transmitted infections, gender-affirming care, rural family medicine, and substance use. We started a new department in the magazine to highlight members’ work in trauma-informed Family Medicine. Our colleagues told us of their fight against the intensifying assault on reproductive rights. There was #FMRising and Dr. Jay Lee’s election as AAFP director. Dr. Jasmeet Bains was the very first SikhAmerican and Family Physician elected to the California Assembly. And that’s just a sample of what our members did! Our issues covered so much ground because you were Family Physicians on the move.

While I move on, the magazine will remain in good hands— as it always has been—under Mr. Josh Lunsford, Managing Editor. The gloss and pop you see throughout the issue are the talents of Josh. Even more important are his editorial instincts for keeping the magazine engaging and readable. Josh is a powerhouse, and I will miss working with him on the magazine, but Josh will have a new great team with Dr. Scott Nass.

I am delighted to introduce Associate Editor Dr. Scott Nass as the incoming editor of CFP. Many of you already know him. Scott showed me the ropes when I first started working at the national level in the AAFP and has much leadership experience at both the national and state level.

A regional medical director at Aledade, Scott is also a recognized leader in Family Medicine and LGBTQIA+ health, having led in many positions of influence, such as President of GLMA, advisory group member of InterACT (an advocacy group for intersex youth), and as a member of the Transgender, Gender Diverse, or Intersex Working Group at the California Department of Managed Health Care. Within the CAFP, Scott is also Vice-Chair of the Committee on Public Health & Equity.

I am excited that Scott will be serving in this role. He is an excellent writer with a perspective of someone with such broad scope within Family Medicine that includes advocacy, education, health equity, international health, the arts (interesting fact: Scott was a producer of “Medicine: The Musical,” a show off-Broadway), and much more.

In these last few lines of my tenure, I would like to express my appreciation for your readership. It has been a real privilege to highlight your work to make the world a better place. Certainly, there is so much you do in medicine that I hope we did an adequate job of representing the remarkable dynamism of California Family Physicians. Properly elevating important work and facilitating the exchange of innovative ideas can broaden their impact. If were able to achieve some of that, then I would be honored to think we did a good job.

Thank you for the past six years. It’s been a great ride!

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