Summer 2019

VO L . 7 0 N O. 3 Summer 2019

CAFP Foundation's Susan Hogeland, CAE Health Policy Fellows Drs. Jessica Farmer and Adia Scrubb Take On Washington DC.

in this issue: FAMILY MEDICINE TACKLES SEXUALLY TRANSMITTED INFECTIONS

ϭϱϮϬ WĂĐŝĮĐ ǀĞŶƵĞ • San Francisco, California 94109 • www.familydocs.org Phone (415) 345-8667 • Fax (415) 345-8668 • E-mail: cafp@familydocs.org

Officers and Board President Walter Mills, MD, MMM Immediate Past President Lisa M. Ward, MD, MScPH, MS President-elect ĂǀŝĚ ĂnjnjŽ͕ D Speaker Shannon Connolly, MD Vice-Speaker Lauren Simon, MD, MPH Secretary/Treasurer ZĂƵů LJĂůĂ͕ D Chief Executive Officer Lisa Folberg, MPP Foundation President Marianne McKennett, MD AAFP Delegates Jeff Luther, MD ĂƌŽů ,ĂǀĞŶƐ͕ D AAFP Alternates Jay W. Lee, MD, MPH Lee Ralph, MD CMA Delegation ƐŚďLJ tŽůĨĞ͕ D ͕ DW ͕ DW, ; ŚĂŝƌͿ Mark Dressner, MD Sumana Reddy, MD <ĞǀŝŶ ZŽƐƐŝ͕ D Lauren Simon, MD, MPH &Ğůŝdž EƵŶĞnj͕ D ͕ DW,

Staff Lisa Folberg, MPP

Chief Executive Officer lfolberg@familydocs.org

ŽŶƌĂĚ ŵĞŶƚĂ

Director, Health Policy and Strategic Engagement camenta@familydocs.org

DŽƌŐĂŶ ůĞǀĞůĂŶĚ

Manager, Operations|Governance and FP-PAC mcleveland@familydocs.org

:Ğƌƌŝ ĂǀŝƐ͕ , W

Director, CME/CPD jdavis@familydocs.org

ĚĂŵ &ƌĂŶĐŝƐ

Director, Government Affairs afrancis@familydocs.org

Josh Lunsford

Director, Membership and Marketing jlunsford@familydocs.org

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

Jonathan Rudolph

Manager, Finance jrudolph@familydocs.org

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4

California Family Physician Summer 2019

California

Summer 2019

FAMILY PHYSICIAN s t ro n g

m e d i c i n e

f o r

C a l i f o r n ia

KƵƌ ,ĞĂůƚŚ WŽůŝĐLJ &ĞůůŽǁƐ ǀŝƐŝƚĞĚ ƚŚĞ ^ƉĞĂŬĞƌ͛Ɛ ďĂůĐŽŶLJ͘

features 14 2019 Family Medicine Advocacy Summit Brings the FMRevolution to Congress 16 STIs in California: We Are Not Winning the Battle 20 Answering Questions about HIV Pre-Exposure Prophylaxis

Adam Francis Shelly B. Rodrigues, CAE, FACEHP Scott Nass, MD, MPA, FAAFP, AAHIVS

22 Strange Bedfellows: Adventures in sex and its least intended consequences

Ina Park, MD

24 To Be Syphilis Free, It’s Best to Do Three

Robert Assibey, MD

28 CME info & Quiz

departments 6

Editorial

Catching STIs is a Good Thing

8

President’s Message

Sex and STIs Never Get Old: Unveiling Unconscious Bias-Sexuality, STIs and Aging

10 Political Pulse

Brent Sugimoto, MD Walt Mills, MD

Ooooh We’re Halfway There!

Carla Kakutani, MD

Stand Up and Be Counted!

Lisa Folberg, MPP

12 In The News 30 CEO Message

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

5

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Catching STIs is a Good Thing dŚĞ ǁĂƌŶŝŶŐ ƐŝŐŶƐ ǁĞƌĞ ĂůǁĂLJƐ ƚŚĞƌĞ͘ Ɛ / ĐůŝĐŬĞĚ ƚŚƌŽƵŐŚ ŵLJ ƉĂƚŝĞŶƚ͛Ɛ ĐŚĂƌƚ͕ / ƐĂǁ ƚŚĞŵ͕ ůŽƚƐ ŽĨ ƚŚĞŵ͗ ŐŽŶŽƌƌŚĞĂ Ăƚ ĂŐĞ ϭϮ͕ ĐŚůĂŵLJĚŝĂ ŵƵůƚŝƉůĞ ƚŝŵĞƐ ƚŚƌŽƵŐŚ ĂĚŽůĞƐĐĞŶĐĞ͕ gonorrhea again and again, sometimes alongside chlamydia. / ƌĞǀŝĞǁĞĚ ŶŽƚĞƐ ĚŽĐƵŵĞŶƚŝŶŐ ĂĚŵŽŶŝƚŝŽŶƐ ŐŝǀĞŶ ƚŽ ƵƐĞ ĐŽŶĚŽŵƐ͘ / ƉŽƌĞĚ ƚŚƌŽƵŐŚ ŚŝƐ ĐŚĂƌƚ͕ LJĞƚ ŶĞǀĞƌ ĨŽƵŶĚ ƚŚĞ ŽŶĞ ƐŝŐŶ / ǁĂƐ ůŽŽŬŝŶŐ ĨŽƌ ƚŽ ĐŽŵƉůĞƚĞ ƚŚĞ ƐƚŽƌLJ͘ / ŵĞƚ ŵLJ ƉĂƚŝĞŶƚ LJĞĂƌƐ ůĂƚĞƌ ǁŚĞŶ ŚĞ ƚŚŽƵŐŚƚ ŚĞ ŚĂĚ ƐƚƌĞƉ ƚŚƌŽĂƚ͘ dŚĞ ƐŽƌĞ ƚŚƌŽĂƚ ĂŶĚ ƐǁŽůůĞŶ ůLJŵƉŚ ŶŽĚĞƐ Ĩŝƚ ƚŚĂƚ ƉŝĐƚƵƌĞ͕ ďƵƚ ŽƚŚĞƌ ƉƵnjnjůĞ ƉŝĞĐĞƐ Ͷ ůŝŬĞ ƚŚĞ ŚŝŐŚ ĨĞǀĞƌ͕ ĂŶĚ ŵŽƌĞ ŽŵŝŶŽƵƐůLJ͕ ƚŚĞ ĐŚĞƐƚ ƉĂŝŶ Ͷ ĚŝĚ ŶŽƚ͘ ƉŽƐŝƚŝǀĞ ,/s ƚĞƐƚ ǁĂƐ ƚŚĞ ŵŝƐƐŝŶŐ ƉŝĞĐĞ͕ ĂŶĚ ĂŶ ƵƉƉĞƌ ĞŶĚŽƐĐŽƉLJ ĨŽƌ his chest pain finding candida esophagitis completed the ƉŝĐƚƵƌĞ͘ DLJ ƉĂƚŝĞŶƚ ŚĂĚ ĂŶ / ^ͲĚĞĨŝŶŝŶŐ ŝůůŶĞƐƐ͘ /Ŷ ƚŚĞ ĞƌĂ ŽĨ ĐĂŵƉĂŝŐŶƐ ƉƌŽŵŝƐŝŶŐ njĞƌŽ ŶĞǁ ,/s ŝŶĨĞĐƚŝŽŶƐ͕ ŵLJ ƉĂƚŝĞŶƚ ŚĂĚ Ă ĚŝĂŐŶŽƐŝƐ ŽĨ / ^ ǁŝƚŚ ŚŝƐ ǀĞƌLJ ĨŝƌƐƚ ,/s ƚĞƐƚ͘ ,Ğ ǁĂƐ only 17-years-old.

California is the first amongst all states for chlamydia, ŐŽŶŽƌƌŚĞĂ ĂŶĚ ƐLJƉŚŝůŝƐ ; ͕ ϮϬϭϲͿ͘ KƵƌ ƐƚĂƚĞ ĂůƐŽ ŚĂƐ ƚŚĞ ƐĞĐŽŶĚ ŚŝŐŚĞƐƚ ŶƵŵďĞƌ ŽĨ ŶĞǁ ,/s ĚŝĂŐŶŽƐĞƐ͕ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϱ͕ϬϬϬ ƉĞŽƉůĞ ƚĞƐƚŝŶŐ ƉŽƐŝƚŝǀĞ ĂŶŶƵĂůůLJ ; ͕ ϮϬϭϳͿ͘ dŚĞƐĞ ƚǁŽ ƐƚĂƚŝƐƚŝĐƐ ĂƌĞ ŶŽƚ ƵŶƌĞůĂƚĞĚ͘ ^ĞdžƵĂůůLJ ƚƌĂŶƐŵŝƚƚĞĚ ŝŶĨĞĐƚŝŽŶƐ ;^d/ƐͿ ĂŶĚ ,/s ǁŽƌŬ ƐLJŶĚĞŵŝĐĂůůLJ ƚŽ ƉƌŽƉĞů ƚŚĞ ,/s ĞƉŝĚĞŵŝĐ ƚŚƌŽƵŐŚ ŝŶĐƌĞĂƐĞĚ ƐƵƐĐĞƉƚŝďŝůŝƚLJ ĨƌŽŵ ^d/ ĐŽͲ ŝŶĨĞĐƚŝŽŶ͘ ŽŶƐŝĚĞƌ ƚŚĂƚ ŽŶĞ ŝŶ ϭϱ ŵĞŶͲǁŚŽͲŚĂǀĞͲƐĞdžͲǁŝƚŚͲ ŵĞŶ ;D^DͿ ǁŝƚŚ ƌĞĐƚĂů ŐŽŶŽƌƌŚĞĂ Žƌ ĐŚůĂŵLJĚŝĂ ǁŝůů ďĞĐŽŵĞ ,/s ƉŽƐŝƚŝǀĞ ǁŝƚŚŝŶ ŽŶĞ LJĞĂƌ͕ ĂŶĚ ƚŚĂƚ ŽŶĞ ŝŶ ϭϯ D^D ǁŝƚŚ ƐLJƉŚŝůŝƐ ǁŝůů ƐŝŵŝůĂƌůLJ ƐĞƌŽĐŽŶǀĞƌƚ ǁŝƚŚ ,/s ;^ŽůŽŵŽŶ Ğƚ Ăů͕͘ ϮϬϭϰ͖ ĞƌŶƐƚĞŝŶ Ğƚ Ăů͕͘ ϮϬϬϵͿ͘ ĚĚ ƚŽ ƚŚŝƐ ƚŚĞ ƌĞĞŵĞƌŐĞŶĐĞ ŽĨ ĐŽŶŐĞŶŝƚĂů ƐLJƉŚŝůŝƐ͕ ĂŶĚ ŝƚ ŝƐ ƉůĂŝŶ ƚŽ ƐĞĞ ƚŚĂƚ ^d/Ɛ ĂƌĞ Ă ƉƵďůŝĐ ŚĞĂůƚŚ ĐƌŝƐŝƐ ǁŝƚŚ ƚŚĞ ƉŽƚĞŶƚŝĂů ƚŽ ĐĂƵƐĞ Ă ůŝĨĞƚŝŵĞ ŽĨ complications. >ŝŬĞ ŵŽƐƚ ŚĞĂůƚŚ ŝƐƐƵĞƐ ŝŶ ŽƵƌ ĐŽƵŶƚƌLJ͕ ^d/Ɛ ĂƌĞ ĂŶ ŝƐƐƵĞ ŽĨ ƐŽĐŝĂů ĂŶĚ ŚĞĂůƚŚ ĞƋƵŝƚLJ͘ ĨƌŝĐĂŶͲ ŵĞƌŝĐĂŶƐ ĞdžƉĞƌŝĞŶĐĞ ,/s͕ ƐLJƉŚŝůŝƐ ĂŶĚ ŐŽŶŽƌƌŚĞĂ Ăƚ ƌĂƚĞƐ ĨŽƵƌ͕ ĨŝǀĞ ĂŶĚ ϭϬ ƚŝŵĞƐ͕ ƌĞƐƉĞĐƚŝǀĞůLJ͕ ƚŚĞ ƌĂƚĞƐ ƐĞĞŶ ŝŶ ǁŚŝƚĞ ŵĞƌŝĐĂŶƐ͘ >ĂƚŝŶŽ D^D ŚĂǀĞ Ă ŽŶĞͲŝŶͲĨŽƵƌ ĐŚĂŶĐĞ ŽĨ ďĞĐŽŵŝŶŐ ,/s ƉŽƐŝƚŝǀĞ ŝŶ ƚŚĞŝƌ ůŝĨĞƚŝŵĞ͕ ǁŚŝůĞ ďůĂĐŬ D^D ŚĂǀĞ Ă ŽŶĞͲŝŶͲƚǁŽ ĐŚĂŶĐĞ͘ Family physicians have all the tools to help alter the course

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California Family Physician Summer 2019

ŽĨ ƚŚĞ ^d/ ĞƉŝĚĞŵŝĐ ŝŶ ŽƵƌ ƐƚĂƚĞ͘ / ŚŽƉĞ LJŽƵ ǁĂůŬ ĂǁĂLJ ĂƌŵĞĚ ǁŝƚŚ ƐŽŵĞ ŶĞǁ͕ ƵƐĞĨƵů ƚŽŽůƐ ƚŽ ƐĞƌǀĞ ŽƵƌ ƉĂƚŝĞŶƚƐ ŝŶ ƚŚĞŝƌ ƐĞdžƵĂů ŚĞĂůƚŚ ŶĞĞĚƐ͘ /Ŷ ƚŚŝƐ ŝƐƐƵĞ͕ LJŽƵ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ to earn CME while learning about it! &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ƌ͘ /ŶĂ WĂƌŬ͕ Ă ŶĂƚŝŽŶĂů ĞdžƉĞƌƚ ĂŶĚ ĞĚƵĐĂƚŽƌ ŽŶ ^d/Ɛ͕ ƚĂůŬƐ ĂďŽƵƚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ĐŽƵŶƚĞƌŝŶŐ ƚŚĞ ƐƚŝŐŵĂ ƐƵƌƌŽƵŶĚŝŶŐ ƚŚŝƐ ĂƐƉĞĐƚ ŽĨ ƐĞdžƵĂů ŚĞĂůƚŚ͘ &W WƌĞƐŝĚĞŶƚ ƌ͘ tĂůƚ DŝůůƐ ŐŝǀĞƐ ƵƐ ĂŶ ŝŵƉŽƌƚĂŶƚ ĞdžĂŵƉůĞ ĂďŽƵƚ ŶĞǀĞƌ ŵĂŬŝŶŐ ĂƐƐƵŵƉƚŝŽŶƐ ĂďŽƵƚ ŽƵƌ ƉĂƚŝĞŶƚƐ ĂŶĚ ƚŚĞŝƌ ƐĞdžƵĂů ŚĞĂůƚŚ͘ ƌ͘ ^ĐŽƚƚ EĂƐƐ ǁĂůŬƐ ƵƐ ƚŚƌŽƵŐŚ͕ ƐƚĞƉͲďLJͲƐƚĞƉ͕ ŚŽǁ ƚŽ ŽĨĨĞƌ Ă ƉŽƚĞŶƚŝĂůůLJ ůŝĨĞͲƐĂǀŝŶŐ ƚƌĞĂƚŵĞŶƚ͕ ,/s ƉƌĞͲĞdžƉŽƐƵƌĞ ƉƌŽƉŚLJůĂdžŝƐ ;Wƌ WͿ͕ ƚŽ ƉĂƚŝĞŶƚƐ ǁŚŽ ŵĂLJ ďĞ Ăƚ ƌŝƐŬ ĨŽƌ ,/s͘ CAFP Resident Council co-chair Rob Assibey describes his ŚŽƐƉŝƚĂů͛Ɛ ǁŽƌŬ ǁŝƚŚ ƉƌĞŶĂƚĂů ƐLJƉŚŝůŝƐ͘ ŶĚ͕ &W ĞƉƵƚLJ džĞĐƵƚŝǀĞ sŝĐĞ WƌĞƐŝĚĞŶƚ ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ ƐĞƚƐ ƚŚĞ ƐƚĂŐĞ ǁŝƚŚ the data and tools and resources for your practice.

DLJ ƉĂƚŝĞŶƚ͕ ĂŶ ĨƌŝĐĂŶͲ ŵĞƌŝĐĂŶ LJŽƵƚŚ͕ ĨŽůůŽǁĞĚ Ă ƐƚĂƚŝƐƚŝĐĂů destiny in a health system that should have offered him ƚŚĞ ƚŽŽůƐ ƚŽ ĨŽƌŐĞ Ă ĚŝĨĨĞƌĞŶƚ ƉĂƚŚ͗ ƌĞŐƵůĂƌ ĂŶĚ ƐŝƚĞͲ ĂƉƉƌŽƉƌŝĂƚĞ ;ƉŚĂƌLJŶŐĞĂů͕ ƌĞĐƚĂů͕ ĂŶĚ ƵƌĞƚŚƌĂůͿ ^d/ ƐĐƌĞĞŶŝŶŐ͕ ƌŝƐŬ ƌĞĚƵĐƚŝŽŶ ƐƚƌĂƚĞŐŝĞƐ͕ ƚŚĞ ŽƉƚŝŽŶ ŽĨ ,/s Wƌ W͕ ĂŶĚ ŵŽƐƚ ĐƌŝƚŝĐĂůůLJ͕ ĂŶ ,/s ƚĞƐƚ͘ /ŶƐƚĞĂĚ͕ ŚĞ ǁŝůů ŶŽǁ ůŝǀĞ ŚŝƐ ĞŶƚŝƌĞ ĂĚƵůƚŚŽŽĚ ǁŝƚŚ ƚŚĞ ĚŝĂŐŶŽƐŝƐ ŽĨ / ^͘ dŚĞ ŵĞĚŝĐĂů ƐLJƐƚĞŵ ĐĂŶ ƐĞƌǀĞ ŽƵƌ ƉĂƚŝĞŶƚƐ ďĞƚƚĞƌ͘ >Ğƚ͛Ɛ ƐŚŽǁ ƚŚĞŵ ŚŽǁ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĐĂŶ ůĞĂĚ ƚŚĞ ǁĂLJ͘ References 1.

Bernstein, KT. JL Marcus et al. Rectal Gonorrhea and ŚůĂŵLJĚŝĂ ZĞŝŶĨĞĐƚŝŽŶ /Ɛ ƐƐŽĐŝĂƚĞĚ tŝƚŚ /ŶĐƌĞĂƐĞĚ ZŝƐŬ ŽĨ ,/s ^ĞƌŽĐŽŶǀĞƌƐŝŽŶ͘ : / ^͘ ϮϬϬϵ͗ ϭͲϳ͘ Ϯ͘ ,ĞĂůƚŚ ŝƐƉĂƌŝƚŝĞƐ ŝŶ ,/sͬ / ^͕ sŝƌĂů ,ĞƉĂƚŝƚŝƐ͕ ^d Ɛ͕ ĂŶĚ d ͘ ͘ ϮϬϭϲ͘ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŶĐŚŚƐƚƉͬŚĞĂůƚŚĚŝƐƉĂƌŝƚŝĞƐͬ ĂĨƌŝĐĂŶĂŵĞƌŝĐĂŶƐ͘Śƚŵů͘ ĐĐĞƐƐĞĚ :ƵŶĞ ϭ͕ ϮϬϭϵ͘ 3. ,/s ŝĂŐŶŽƐĞƐ͕ ďLJ dŽƉ ϭϬ ^ƚĂƚĞƐ͘ ͘ ϮϬϭϳ͘ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ ŐŽǀͬŚŝǀͬƐƚĂƚŝƐƚŝĐƐͬŽǀĞƌǀŝĞǁͬŝŶĚĞdž͘Śƚŵů͘ ĐĐĞƐƐĞĚ :ƵŶĞ ϭ͕ ϮϬϭϵ͘ ϰ͘ ^ĞdžƵĂůůLJ dƌĂŶƐŵŝƚƚĞĚ ŝƐĞĂƐĞ ^ƵƌǀĞŝůůĂŶĐĞ͘ ͘ ϮϬϭϲ͘ ŚƚƚƉ͗ͬ​ͬ ǁǁǁ͘ĐĚĐ͘ŐŽǀͬƐƚĚͬƐƚĂƚƐ͘ ĐĐĞƐƐĞĚ :ƵŶĞ Ϯ͕ ϮϬϭϵ͘ 5. ^ŽůŽŵŽŶ͕ DD͘ <, DĂLJĞƌ Ğƚ Ăů͘ ^LJƉŚŝůŝƐ WƌĞĚŝĐƚƐ ,/s /ŶĐŝĚĞŶĐĞ ŵŽŶŐ DĞŶ ĂŶĚ dƌĂŶƐŐĞŶĚĞƌ tŽŵĞŶ tŚŽ ,ĂǀĞ ^Ğdž tŝƚŚ DĞŶ ŝŶ Ă WƌĞĞdžƉŽƐƵƌĞ WƌŽƉŚLJůĂdžŝƐ dƌŝĂů͘ / ͘ ϮϬϭϰ;ϱϵͿ͗ ϭϬϮϬ Ͳ ϭϬϮϲ͘

p r e s i d e n t ’s m e s s a g e

Walt Mills, MD

Sex and STIs Never Get Old: Unveiling Unconscious Bias-Sexuality, STIs and Aging :ŽŚŶ͕ Ă ϳϰͲLJĞĂƌͲŽůĚ >ĂƚŝŶŽ ŵĂŶ͕ ƐĞĞƐ LJŽƵ͕ ŚŝƐ ͞ŶĞǁ͟ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͕ ĨŽƌ ŚŝƐ DĞĚŝĐĂƌĞ ŶŶƵĂů tĞůůŶĞƐƐ džĂŵ͘ ,ŝƐ ƐĐƌĞĞŶŝŶŐ W,YϮ ŝƐ ϮͬϮ͘ ,ŝƐ 'ĞƌŝĂƚƌŝĐ ĞƉƌĞƐƐŝŽŶ ^ĐĂůĞ ƐĐŽƌĞ ŽĨ ϳͬϭϱ ƐƵŐŐĞƐƚƐ ĚĞƉƌĞƐƐŝŽŶ͘ ,Ğ ƚĞůůƐ LJŽƵ ŚĞ ŝƐ ŚĂǀŝŶŐ ƚƌŽƵďůĞ ƐůĞĞƉŝŶŐ͕ ŚĂƐ ŵŝůĚ ĂŶdžŝĞƚLJ ĂŶĚ ŚĂƐ ƐƚŽƉƉĞĚ seeing friends for lunch recently. He’s lost 15 pounds unintentionally since his last visit. He has diabetes, ŚLJƉĞƌƚĞŶƐŝŽŶ ĂŶĚ ůŽŽŬƐ ͞ŽůĚ͟ ƚŽĚĂLJ͘ “My wife and I divorced 25 years ago, when my children were young. I have a roommate and am in a relationship.” dŚĞ ,ĞĂůƚŚ ZŝƐŬ ƉƉƌĂŝƐĂů LJŽƵ ƵƐĞ ĨŽƌ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ DĞĚŝĐĂƌĞ ĂŶĚ DĞĚŝĐĂŝĚ ; D^Ϳ DĞĚŝĐĂƌĞ ŶŶƵĂů tĞůůŶĞƐƐ sŝƐŝƚ ŚĂƐ ŶŽ ŵĞŶƚŝŽŶ ŽĨ ƐĞdžƵĂů ŚŝƐƚŽƌLJ͘ ,ŽǁĞǀĞƌ͕ LJŽƵ ũƵƐƚ ƌĞĂĚ ĂŶ ĂƌƚŝĐůĞ ƐĂLJŝŶŐ͕ ŽŶůLJ ϯϴ ƉĞƌĐĞŶƚ ŽĨ ŵĞŶ ĂŶĚ ϮϮ ƉĞƌĐĞŶƚ ŽĨ ǁŽŵĞŶ ƌĞƉŽƌƚĞĚ ŚĂǀŝŶŐ ĚŝƐĐƵƐƐĞĚ ƐĞdž ǁŝƚŚ ƚŚĞŝƌ ƉŚLJƐŝĐŝĂŶ ƐŝŶĐĞ ƚŚĞ ĂŐĞ ŽĨ ϱϬ LJĞĂƌƐ͕͟ ƐŽ LJŽƵ ĂƐŬ͕ “are you sexually active?” John replies “yes.͟ zŽƵ ĂƐŬ ƚŚĞ ƐĂŵĞ ĨŝǀĞ ͞WƐ͟ LJŽƵ ĂƐŬ LJŽƵƌ LJŽƵŶŐĞƌ ƉĂƚŝĞŶƚƐ ǁŚĞŶ ĚŽŝŶŐ Ă ƐĞdžƵĂů ŚŝƐƚŽƌLJ ;ƉĂƌƚŶĞƌƐ͕ ƉƌĂĐƚŝĐĞƐ͕ ƉƌŽƚĞĐƚŝŽŶ ĨƌŽŵ ^ĞdžƵĂůůLJ dƌĂŶƐŵŝƚƚĞĚ /ŶĨĞĐƚŝŽŶƐ ;^d/ƐͿ͕ ƉĂƐƚ ŚŝƐƚŽƌLJ ŽĨ ^ĞdžƵĂůůLJ dƌĂŶƐŵŝƚƚĞĚ ŝƐĞĂƐĞƐ ;^d ƐͿ͕ ƉƌĞǀĞŶƚŝŽŶ ŽĨ ƉƌĞŐŶĂŶĐLJͿ ͙ ƐƚĂƌƚŝŶŐ ǁŝƚŚ ͞ƉĂƌƚŶĞƌƐ͘͟ “Have your sexual partners been men, women or both?” (You are surprised you ĂƌĞ ĂƐŬŝŶŐ Ă ƐĞƉƚƵĂŐĞŶĂƌŝĂŶ ƚŚŝƐ͕ ďƵƚ LJŽƵ ĚŝĚ ŚĞĂƌ Ăƚ LJŽƵƌ ůĂƐƚ &W D ƚŚŝƐ ǁĂƐ ŐŽŽĚ ƉƌĂĐƚŝĐĞͿ͘ :ŽŚŶ ĂŶƐǁĞƌƐ͕ “Both.”

Your conversation deepens and you learn John has been in Ă ŵŽŶŽŐĂŵŽƵƐ ƌĞůĂƚŝŽŶƐŚŝƉ ĨŽƌ ϮϬ LJĞĂƌƐ ǁŝƚŚ Ă ŵĂŶ͘ “No physician has had this conversation with me. My family doesn’t know, I’m still in ’the closet’.” Trusting you, he goes on. “You know, none of my other doctors have ever asked me about who I’m dating or if I’m having sex. I’ve never had a chance to tell them I was with another guy. I think they assume because I’m older, Latino and not married any longer, I must be straight, single and not sexually active.”

Fact: ϱϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƚŝĞŶƚƐ ƐĞĞŶ ŝŶ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͛ ŽĨĨŝĐĞƐ ĂƌĞ ŽǀĞƌ ĂŐĞ ϲϱ͘ ^ĞdžƵĂů ŚĞĂůƚŚ ŝƐ ůŝŶŬĞĚ ƚŽ ŵĂŶLJ

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California Family Physician Summer 2019

important health outcomes. Yet, it is not a standard ƋƵĞƐƚŝŽŶ ŝŶ ƚŚĞ DĞĚŝĐĂƌĞ ŶŶƵĂů tĞůůŶĞƐƐ sŝƐŝƚ͘ tĞ ĚŽ ĂƐŬ ĂďŽƵƚ ŝŶĐŽŶƚŝŶĞŶĐĞ͕ ĨĂůůƐ͕ ĐŽŐŶŝƚŝŽŶ ĂŶĚ ŽƚŚĞƌ ƌĞƋƵŝƌĞĚ ŐĞƌŝĂƚƌŝĐ ƐLJŶĚƌŽŵĞƐ ǁŚŝĐŚ Ăƚ ƚŚŝƐ ƉŽŝŶƚ ĂƌĞ ŶŽƚ ƌĞůĞǀĂŶƚ ƚŽ :ŽŚŶ͛Ɛ ŚĞĂůƚŚ ĐŽŶĐĞƌŶƐ͘ Fact: tŚŝůĞ ůĞǀĞůƐ ŽĨ ƐĞdžƵĂů ĂĐƚŝǀŝƚLJ ĚĞĐůŝŶĞ ǁŝƚŚ ĂŐĞ͕ ŵĂŶLJ ŵĞŶ ĂŶĚ ǁŽŵĞŶ ƌĞŵĂŝŶ ƐĞdžƵĂůůLJ ĂĐƚŝǀĞ ƵŶƚŝů ƚŚĞ ĞŝŐŚƚŚ ĂŶĚ ŶŝŶƚŚ ĚĞĐĂĚĞƐ ŽĨ ůŝĨĞ͘ ^ĞdžƵĂů ƉƌŽďůĞŵƐ ĂƌĞ ĨƌĞƋƵĞŶƚ ĂŵŽŶŐ older adults, but these problems are infrequently discussed ǁŝƚŚ ƉŚLJƐŝĐŝĂŶƐ͘ DŽƌĞ ƚŚĂŶ ϱϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƚŝĞŶƚƐ ďĞƚǁĞĞŶ ĂŐĞ ϲϱͲϳϰ ĂŶĚ Ϯϲ ƉĞƌĐĞŶƚ ďĞƚǁĞĞŶ ĂŐĞ ϳϱͲϴϰ ƌĞƉŽƌƚ ďĞŝŶŐ ƐĞdžƵĂůůLJ ĂĐƚŝǀĞ͘ :ŽŚŶ ŝƐ ŽŶĞ ĂŶĚ LJĞƚ ŶĞǀĞƌ ŚĂĚ Ă ƉŚLJƐŝĐŝĂŶ ƉƌŽǀŝĚĞ ƚŚĞ ĞĚƵĐĂƚŝŽŶ͕ ĐŽƵŶƐĞůŝŶŐ Žƌ ƐĐƌĞĞŶŝŶŐ ǁĞ ǁŽƵůĚ Ăůů ƉƌŽǀŝĚĞ ĨŽƌ LJŽƵŶŐĞƌ ƉĂƚŝĞŶƚƐ͘ Fact: WŚLJƐŝĐŝĂŶƐ ŵĂLJ ŵŝƐƚĂŬĞŶůLJ ĂƐƐƵŵĞ ĂŶ ŽůĚĞƌ ƉĂƚŝĞŶƚ ŝƐ ŚĞƚĞƌŽƐĞdžƵĂů͘ KůĚĞƌ >ĞƐďŝĂŶ͕ 'ĂLJ dƌĂŶƐŐĞŶĚĞƌ ĂŶĚ ŝƐĞdžƵĂů ;>'d Ϳ ƉĂƚŝĞŶƚƐ ĂƌĞ ŬŶŽǁŶ ĂƐ ƚŚĞ ͞ŝŶǀŝƐŝďůĞ ŐĞŶĞƌĂƚŝŽŶ͟ ďĞĐĂƵƐĞ ƚŚĞLJ ĂƌĞ ŵƵĐŚ ůĞƐƐ ůŝŬĞůLJ ƚŽ ĚŝƐĐůŽƐĞ ƚŚĞŝƌ ŽƌŝĞŶƚĂƚŝŽŶ ƚŽ ƉŚLJƐŝĐŝĂŶƐ͕ ĨĂŵŝůLJ Žƌ ŽƚŚĞƌƐ ǁŚŽ ĐŽƵůĚ support them better. >' d ŽůĚĞƌ ƉĞŽƉůĞ ǁŚŽ ĨŽƵŐŚƚ ƚŚĞ ĨŝƌƐƚ ďĂƚƚůĞƐ ĨŽƌ ĞƋƵĂůŝƚLJ ŶŽǁ ĨĂĐĞ ƐƵĐŚ ĨĞĂƌ ŽĨ ƌĞůŝŐŝŽƵƐ ŽďũĞĐƚŝŽŶ͕ bullying and abuse ƚŚĂƚ ŵĂŶLJ ĂƌĞ ŚŝĚŝŶŐ ƚŚĞŝƌ ŝĚĞŶƚŝƚŝĞƐ͘ / ƌĞĐŽŵŵĞŶĚ Gen Silent, a critically acclaimed documentary about >' d ƐĞŶŝŽƌƐ ŐŽŝŶŐ ďĂĐŬ ŝŶƚŽ ƚŚĞ ĐůŽƐĞƚ ƚŽ ƐƵƌǀŝǀĞ͕ ƐƚƵŵĂĚĚƵdž͘ĐŽŵͬ&/>D^͘Śƚŵů KƚŚĞƌ ĚĂƚĂ ĂďŽƵƚ ^d/Ɛ ŝŶ ŽƵƌ ƐĞŶŝŽƌ ƉĂƚŝĞŶƚƐ ĂŶĚ ƚŚĞ increases in cases in all patient categories are included ǁŝƚŚ ^ŚĞůůLJ ZŽĚƌŝŐƵĞƐ͛ ĂƌƚŝĐůĞ ŽŶ ƉĂŐĞ ϭϲ͘ WůĞĂƐĞ ƌĞĨĞƌ ƚŽ it for details.

My Reflection: / ŚĂǀĞ ďĞĞŶ Ă ĐĞƌƚŝĨŝĞĚ ŐĞƌŝĂƚƌŝĐŝĂŶ ĨŽƌ ŵŽƌĞ ƚŚĂŶ ϯϬ LJĞĂƌƐ͕ ĂŶĚ / ŬŶŽǁ / ŚĂǀĞ ĚŽŶĞ ƉŽŽƌůLJ ŝŶ ĂƐŬŝŶŐ ĂďŽƵƚ ƐĞdž͘ Ɛ ĚŝƌĞĐƚŽƌ ŽĨ ŽƵƌ ŐĞƌŝĂƚƌŝĐƐ ĐƵƌƌŝĐƵůƵŵ Ăƚ EĂƚŝǀŝĚĂĚ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐLJ͕ / ďĞůŝĞǀĞ ƌĞƐŝĚĞŶĐŝĞƐ ĂƌĞ ŶŽƚ ĚŽŝŶŐ ĂƐ ŐŽŽĚ Ă ũŽď ĂƐ ǁĞ ŵƵƐƚ ŝŶ ĞĚƵĐĂƚŝŶŐ ŽƵƌ ĨƵƚƵƌĞ family physicians in this regard.

tŚLJ͍ ^ŽŵĞ ƐĂLJ͕ ǁĞ ĚŽŶ͛ƚ ŚĂǀĞ ƚŝŵĞ͘ WĞƌŚĂƉƐ ǁĞ ĚŽ ƐƵĐŚ Ă ƉŽŽƌ ũŽď ďĞĐĂƵƐĞ ŽĨ ŽƵƌ ůĂĐŬ ŽĨ ĞĚƵĐĂƚŝŽŶ ĂďŽƵƚ ƐĞdžƵĂů ŚŝƐƚŽƌLJ ƚĂŬŝŶŐ͕ ĚŝƐĐŽŵĨŽƌƚ ƚĂůŬŝŶŐ ĂďŽƵƚ ƐĞdž Žƌ ŽƵƌ ŝŶĐŽƌƌĞĐƚ ĂƐƐƵŵƉƚŝŽŶƐ ĂŶĚ ďŝĂƐ ƚŚĂƚ ŽůĚĞƌ ĂĚƵůƚƐ ĂƌĞ ŶŽƚ ƐĞdžƵĂůůLJ ĂĐƚŝǀĞ͘ tĞ ƚŚŝŶŬ ŽůĚĞƌ ĂĚƵůƚƐ ĚŽ ŶŽƚ ǁĂŶƚ ƵƐ ƚŽ ƚĂůŬ ĂďŽƵƚ ƐĞdž͘ ĐƚƵĂůůLJ͕ ŵĂŶLJ ĂƌĞ ƐĞdžƵĂůůLJ ĂĐƚŝǀĞ ĂŶĚ wish that their family physician talked with them about sex. ĐƚŝŽŶ͗ / ĂƐŬ ƵƐ ƚŽ ĐŽŶƐŝĚĞƌ͗ • /ŶĐůƵĚŝŶŐ ĐŽŶǀĞƌƐĂƚŝŽŶƐ ĂďŽƵƚ ƐĞdžƵĂů ďĞŚĂǀŝŽƌ ǁŝƚŚ ŽůĚĞƌ ĂĚƵůƚ ƉĂƚŝĞŶƚƐ ŝŶ ƚŚĞ ƐĂŵĞ ǁĂLJ LJŽƵ ĚŽ ǁŝƚŚ LJŽƵŶŐĞƌ ƉĂƚŝĞŶƚƐ͕ ŝŶĐůƵĚŝŶŐ ĞĚƵĐĂƚŝŶŐ ƚŚĞŵ ĂƉƉƌŽƉƌŝĂƚĞůLJ ĂďŽƵƚ ƚŚĞ ǁŽƌƌŝƐŽŵĞ ƵƉǁĂƌĚ ƚƌĞŶĚ ŝŶ ^d/Ɛ͘ zŽƵ ĚŽŶ͛ƚ ǁĂŶƚ LJŽƵƌ ƉĂƚŝĞŶƚƐ ƚŽ ďĞ ƉĂƌƚ ŽĨ ƚŚŽƐĞ statistics.

• /ŶĐůƵĚŝŶŐ ĚŽŝŶŐ ĐĞƌǀŝĐĂů ĐLJƚŽůŽŐLJ ;ƉĂƉͲŶŽƚ ƌĞĐŽŵŵĞŶĚĞĚ ĂĨƚĞƌ ĂŐĞ ϲϱ ŽƚŚĞƌǁŝƐĞͿ͕ ,Ws ƐĐƌĞĞŶŝŶŐ͕ ŚůĂŵLJĚŝĂͬ' ͕ ,/s͕ ZWZ ĂŶĚ ŽƚŚĞƌ ^d/ ƐĐƌĞĞŶŝŶŐ ĂƐ ƉĂƌƚ ŽĨ ƚŚĞ DĞĚŝĐĂƌĞ ŶŶƵĂů tĞůůŶĞƐƐ sŝƐŝƚ ŝĨ ƚŚĞ ŚŝƐƚŽƌLJ ƌĞǀĞĂůƐ ͞ƌŝƐŬƐ͟ ;ũƵƐƚ ĂƐ ǁĞ ǁŽƵůĚ ƉƌŽǀŝĚĞ ĨŽƌ LJŽƵŶŐĞƌ

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ĂƚͲƌŝƐŬ ƉĂƚŝĞŶƚƐͿ͘ DĞĚŝĐĂƌĞ ƉĂLJƐ ĨŽƌ ƐƵĐŚ ƚĞƐƚŝŶŐ ĂŶĚ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞ WƌĞǀĞŶƚŝǀĞ ^ĞƌǀŝĐĞƐ ;h^W^d&Ϳ ƌĞĐŽŵŵĞŶĚƐ ŝŶƚĞŶƐŝǀĞ ďĞŚĂǀŝŽƌĂů ĐŽƵŶƐĞůŝŶŐ ĨŽƌ Ăůů ƐĞdžƵĂůůLJ ĂĐƚŝǀĞ ĂĚƵůƚƐ ǁŚŽ ĂƌĞ Ăƚ ŝŶĐƌĞĂƐĞĚ ƌŝƐŬ ĨŽƌ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƚƚĞĚ ŝŶĨĞĐƚŝŽŶƐ͘ ; ZĞĐŽŵŵĞŶĚĂƚŝŽŶͿ As a family physician, you are critically important in ƐƚŽƉƉŝŶŐ ƚŚĞ ƐƉƌĞĂĚ ŽĨ ,/s ;ŝƚ ŝƐ ŐƌŽǁŝŶŐ ĨĂƐƚĞƐƚ ŝŶ ŽůĚĞƌ ĂĚƵůƚ ƉŽƉƵůĂƚŝŽŶƐͿ ďLJ ĚŝƐĐƵƐƐŝŶŐ ƉƌĞͲĞdžƉŽƐƵƌĞ ƉƌŽƉŚLJůĂdžŝƐ ǁŝƚŚ LJŽƵƌ ƉĂƚŝĞŶƚƐ͕ ǁŚŝĐŚ ŵĂLJ ŝŶĐůƵĚĞ ƐŽŵĞ of your geriatric patients. ŽŶƚŝŶƵĂůůLJ ƌĞĨůĞĐƚŝŶŐ ŽŶ ƚŚĞ ƵŶĐŽŶƐĐŝŽƵƐ ďŝĂƐĞƐ͕ ǁĞ all may have that affect our ability to effectively care for our older patients, given the many biopsychosocial ŚĞĂůƚŚ ŝƐƐƵĞƐ ƌĞůĂƚĞĚ ƚŽ ƐĞdžƵĂůŝƚLJ ĂŶĚ ƐĞdžƵĂů ďĞŚĂǀŝŽƌ͘

&ŝŶĂůůLJ͕ ůĞƚ͛Ɛ ƌĂŝƐĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ĂǁĂƌĞŶĞƐƐ ĂďŽƵƚ ŝŵƉƌŽǀŝŶŐ ĐĂƌĞ ĨŽƌ ŽƵƌ ŽůĚĞƌ ƉĂƚŝĞŶƚƐ͘ ŝƐĐƵƐƐ ƚŚŝƐ ǁŝƚŚ LJŽƵƌ ĐŽůůĞĂŐƵĞƐ͖ ƐŚŽǁ ƚŚĞŵ ƚŚŝƐ ĂƌƚŝĐůĞ ĂŶĚ ƚŚĞ ĂƚƚĂĐŚĞĚ ǀŝĚĞŽƐ͘ >Ğƚ͛Ɛ ĚŽ ŽƵƌ ƉĂƌƚ ŝŶ ĚĞĐƌĞĂƐŝŶŐ ^d/ ƌĂƚĞƐ ĂŶĚ ŝŵƉƌŽǀŝŶŐ ƉĂƚŝĞŶƚ ĐĂƌĞ in California!

California Family Physician Summer 2019

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political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

Ooooh We’re Halfway There!

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&ƵŶĚŝŶŐ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WƌŝŵĂƌLJ ĂƌĞ WŚLJƐŝĐŝĂŶ Workforce Program at $33 Million a Year in Perpetuity. dŚŝƐ ŝƐ Ă D :KZ ǁŝŶ ĨŽƌ &W͘ &ŽƵƌ LJĞĂƌƐ ĂŐŽ͕ &W ŚĞůƉĞĚ ƐĞĐƵƌĞ ΨϭϬϬ ŵŝůůŝŽŶ ŝŶ 'ĞŶĞƌĂů &ƵŶĚ ŵŽŶŝĞƐ ƚŽ ďĞ ƐƉĞŶƚ ŽǀĞƌ ĨŝǀĞ LJĞĂƌƐ ŝŶ ƐƵƉƉŽƌƚ ŽĨ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WƌŽŐƌĂŵ͕ ǁŚŝĐŚ ĨƵŶĚƐ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ ƚƌĂŝŶŝŶŐ primary care physicians in underserved areas treating underserved populations. With that time-limited ŝŶǀĞƐƚŵĞŶƚ ƐŽŽŶ ƚŽ ĞdžƉŝƌĞ͕ ĂůŝĨŽƌŶŝĂ ŝƐ ƉŽŝƐĞĚ ƚŽ ŵĂŬĞ ĂŶ ŝŶĐƌĞĚŝďůĞ ŽŶŐŽŝŶŐ ĐŽŵŵŝƚŵĞŶƚ ƚŽ ŐƌŽǁ ŽƵƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶ ǁŽƌŬĨŽƌĐĞ ŝŶ ƚŚĞ ƌĞŐŝŽŶƐ ǁŚĞƌĞ they are needed most. &ƵůůLJ &ƵŶĚŝŶŐ ƚŚĞ WƌŽƉ ϱϲ DĞĚŝͲ Ăů WƌŽǀŝĚĞƌ WĂLJŵĞŶƚ /ŶĐƌĞĂƐĞ͕ EŽǁ ZĞĂĐŚŝŶŐ ΨϮ͘Ϯ ŝůůŝŽŶ͘ After several LJĞĂƌƐ ŽĨ ŽŶůLJ ƉĂƌƚŝĂů ĨƵŶĚŝŶŐ͕ ƚŚĞ ŶĞǁ EĞǁƐŽŵ Administration has called for full and complete use of ƚŚĞ WƌŽƉŽƐŝƚŝŽŶ ϱϲ ĨƵŶĚƐ ƐĞƚ ĂƐŝĚĞ ĨŽƌ ŝŶĐƌĞĂƐŝŶŐ DĞĚŝͲ Cal provider payment. ΨϱϬϬ DŝůůŝŽŶ ƚŽ ƌĞĂƚĞ Ă sĂůƵĞͲ ĂƐĞ WĂLJŵĞŶƚ WƌŽŐƌĂŵ ŝŶ DĞĚŝͲ Ăů DĂŶĂŐĞĚ ĂƌĞ͘ dŚŝƐ ŶĞǁ ƉƌŽŐƌĂŵ ƉƌŽǀŝĚĞƐ ŝŶĐĞŶƚŝǀĞ ƉĂLJŵĞŶƚƐ ƚŽ ŵĂŶĂŐĞĚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ǁŚŽ meet specific achievement on metrics targeting such areas as behavioral health integration, pediatric preventive care, prenatal and postpartum care and chronic disease management. džƉĂŶĚŝŶŐ &Ƶůů ^ĐŽƉĞ DĞĚŝͲ Ăů ŽǀĞƌĂŐĞ ƚŽ ůů ůŝŐŝďůĞ WĞŽƉůĞ hŶĚĞƌ ŐĞ Ϯϲ͘ dŚŝƐ ĞdžƉĂŶƐŝŽŶ ƐƉĞĐŝĨŝĐĂůůLJ covers individuals regardless of immigration status.

Transitioning Medi-Cal Pharmacy Services Out of DĂŶĂŐĞĚ ĂƌĞ ĂŶĚ /ŶƚŽ Ă &ĞĞͲ&ŽƌͲ^ĞƌǀŝĐĞ ĞŶĞĨŝƚ͘ dŚĞ ĚŵŝŶŝƐƚƌĂƚŝŽŶ ďĞůŝĞǀĞƐ ƚŚŝƐ ǁŝůů ƐĂǀĞ ŶĞĂƌůLJ ΨϰϬϬ million a year on pharmaceutical costs.

^ƉĞĂŬŝŶŐ ŽĨ ŚĂůĨǁĂLJ ƚŚĞƌĞ͕ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů͕ ϭϲϮϮ ; ĂƌƌŝůůŽͿ ƌĞĐĞŶƚůLJ ƉĂƐƐĞĚ ŽƵƚ ŽĨ ƚŚĞ ƐƐĞŵďůLJ ĂŶĚ ŝƐ ŚĞĂĚĞĚ 10

California Family Physician Summer 2019

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With the skills and training to care for the whole family, family medicine encourages continuity of care, which reduces health care costs and improves outcomes.

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tĞůů͕ ŵLJ ĨĞůůŽǁ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ĂƌĞ ŚĂůĨǁĂLJ ƚŚƌŽƵŐŚ ƚŚĞ ůĞŐŝƐůĂƚŝǀĞ LJĞĂƌ ĂŶĚ ǁĞ͛ƌĞ ĚŽŝŶŐ ĨĂƌ ďĞƚƚĞƌ ƚŚĂŶ ůŝǀŝŶŐ ŽŶ Ă ƉƌĂLJĞƌ͘ dŚĞ ĐŚĂŶŐĞ ŝŶ ŐŽǀĞƌŶŽƌ ĨƌŽŵ :ĞƌƌLJ ƌŽǁŶ ƚŽ 'ĂǀŝŶ EĞǁƐŽŵ ŚĂƐ ůĞĚ ƚŽ Ă ƐŝŐŶŝĨŝĐĂŶƚ ŝŶĐƌĞĂƐĞ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ƉŽůŝĐLJ activity. This has translated into major budget proposals to ƐƵƉƉŽƌƚ ĂŶĚ ƌĞĨŽƌŵ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ͘ Ɛ / ǁƌŝƚĞ ƚŚŝƐ͕ the governor and legislative leaders are putting the final ƚŽƵĐŚĞƐ ŽŶ ĂŶ ĞdžƚĞŶƐŝǀĞůLJ ŶĞŐŽƚŝĂƚĞĚ ďƵĚŐĞƚ ƚŚĂƚ ŝŶĐůƵĚĞƐ͗

ƚŽ ƚŚĞ ^ĞŶĂƚĞ͘ ϭϲϮϮ ƐĞĞŬƐ ƚŽ ƌĞŵŽǀĞ ŝŶĂƉƉƌŽƉƌŝĂƚĞ ĂŶĚ misinformed restrictions on family physicians, no longer ƉƌĞǀĞŶƚŝŶŐ ƵƐ ĨƌŽŵ ĨƵůůͲƐƉĞĐƚƌƵŵ ƉƌĂĐƚŝĐĞ͕ ǁŚŝĐŚ ǁĞ ǁĞƌĞ Ăůů ƚƌĂŝŶĞĚ ƚŽ ƉƌŽǀŝĚĞ͘ Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ǁĞ ŚĂǀĞ ĞdžƚĞŶƐŝǀĞ and comprehensive training that enables us to provide high quality primary care to EVERY member of the family regardless of a patient’s gender, age or affected organ system, from birth to end-of-life. Over time, regulators, legislators, health systems and others have restricted and underutilized family physicians. This has limited access to care, restricted patient choice and disrupted continuity for individuals and ĨĂŵŝůŝĞƐ͘ dŚĞ ďƌĞĂĚƚŚ ĂŶĚ ĚĞƉƚŚ ŽĨ ŽƵƌ ƚƌĂŝŶŝŶŐ ĂůůŽǁƐ ƵƐ ƚŽ adapt our practices to meet the specific medical needs of our ĐŽŵŵƵŶŝƚLJ͘ tŝƚŚ ƚŚĞ ƐŬŝůůƐ ĂŶĚ ƚƌĂŝŶŝŶŐ ƚŽ ĐĂƌĞ ĨŽƌ ƚŚĞ ǁŚŽůĞ ĨĂŵŝůLJ͕ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĞŶĐŽƵƌĂŐĞƐ ĐŽŶƚŝŶƵŝƚLJ ŽĨ ĐĂƌĞ͕ ǁŚŝĐŚ reduces health care costs and improves outcomes.

tĂŶƚ ƚŽ ŚĞůƉ ŝŶ ŽƵƌ ĞĨĨŽƌƚƐ ƚŽ ƉĂƐƐ ϭϲϮϮ͍ dĂŬĞ ŵLJ ŚĂŶĚ͖ ǁĞ͛ůů ŵĂŬĞ ŝƚ / ƐǁĞĂƌ͊ ^ŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞLJ ŽŶƚĂĐƚ ďLJ emailing our Director of Government Relations, Adam Francis, afrancis@familydocs.org.

IN THE NEWS Summer 2019 Ăƌƌ &ŝƌĞ͕ ĂŶĚ ǁŚĂƚ ǁĂƐ ĞdžĐŝƟŶŐ ŝƐ ŝĨ LJŽƵ͛ƌĞ Ă ĨĂŵŝůLJ ƉƌĂĐƟĐĞ doctor, you can see everybody. You can see babies to adults, ĞǀĞƌLJƚŚŝŶŐ͘ ŶĚ ŝƚ͛​͛ ũƵƐƚ ƐŽ ĞdžĐŝƟŶŐ ƚŽ ƐĞĞ ƚŚĞŵ ůŝŬĞ ĐůŝĐŬ ŝŶ ƚŚĞŝƌ ŚĞĂĚ͕ ǁŽǁ͕ ůŽŽŬ Ăƚ Ăůů ƚŚĞ ƚŚŝŶŐƐ / ĐĂŶ ĚŽ͕ ĂŶĚ ůŽŽŬ Ăƚ Ăůů ƚŚĞ ƉŽƉƵůĂƟŽŶ / ĐĂŶ ƐĞƌǀĞ͕ ƐŽ ƚŚĂƚ͛Ɛ ƚŚĞ ďĞƐƚ ƉĂƌƚ ŽĨ ŵLJ ũŽď͕͟ ƐĂŝĚ ƌ͘ >ƵƉĞŝŬĂ ŝŶ ƚŚĞ ƐĂŵĞ ŶĞǁƐĐĂƐƚ͘ >ĂƵƌĞŶ ^ŝŵŽŶ͕ D ͕ DW,͕ &W͛Ɛ sŝĐĞ ^ƉĞĂŬĞƌ͕ ǁŝůů ƐĞƌǀĞ ĂƐ Ă ŵĞĚŝĐĂů ƚĞĂŵ ŵĞŵďĞƌ ŽĨ ƚŚĞ /ŶƚĞƌŶĂƟŽŶĂů ^ĞƌǀŝĐĞ dĞĂŵ ;/^dͿ ĨŽƌ ƚŚĞ tŽƌůĚ ^ĐŽƵƚ :ĂŵďŽƌĞĞ ǁŚŝĐŚ ŝƐ ďĞŝŶŐ ŚŽƐƚĞĚ ďLJ EŽƌƚŚ ŵĞƌŝĐĂ Ăƚ ƚŚĞ EĂƟŽŶĂů ^ĐŽƵƚ 'ƌŽƵŶĚƐ Ăƚ ĞĐŚƚĞů ^Ƶŵŵŝƚ ZĞƐĞƌǀĞ ŝŶ :ƵůLJ͘ DŽƌĞ ƚŚĂŶ ϰϬ͕ϬϬϬ ^ĐŽƵƚƐ ĨƌŽŵ ϭϲϵ ĐŽƵŶƚƌŝĞƐ ĂƌĞ ĞdžƉĞĐƚĞĚ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ũĂŵďŽƌĞĞ͕ ĂŶĚ ƚŚĞ ŵĞĚŝĐĂů ƚĞĂŵ ;ƉŚLJƐŝĐŝĂŶƐ͕ ŶƵƌƐĞƐ ĂŶĚ DdƐͿ ǁŝůů ďĞ ĚŝǀŝĚĞĚ ŝŶƚŽ ďĂƐĞ ĐĂŵƉƐ ʹ >ĂƵƌĞŶ ǁŝůů ďĞ Ăƚ ĂƐĞ ĂŵƉ ůƉŚĂ ĐĂƌŝŶŐ ĨŽƌ ϳ͕ϬϬϬ ƐĐŽƵƚƐ ĂŶĚ /^d ŵĞŵďĞƌƐ͘ ͞dŚŝƐ ŝƐ Ă ŐƌĞĂƚ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ƵƐĞ ŵLJ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĚŝĂŐŶŽƐƟĐ ĂŶĚ ƚŚĞƌĂƉĞƵƟĐ ƐŬŝůůƐ͕ ůŝƚĞƌĂůůLJ ͛ŽƵƚ ŝŶ ƚŚĞ ĮĞůĚ͛͘ tĞ͛ůů ǁŽƌŬ ŝŶ ĮĞůĚ ƚĞŶƚƐ͕ ĂƌŵĞĚ ǁŝƚŚ ƐƚĞƚŚŽƐĐŽƉĞƐ͕ ŽƚŽƐĐŽƉĞƐ͕ W ĐƵīƐ͕ ĮƌƐƚ ĂŝĚ ƐƵƉƉůŝĞƐ ĂŶĚ /sƐ ĂƐ ǁĞ ǁŝůů ĐĂƌĞ ĨŽƌ Ăůů ƚŚĞ ŵĞĚŝĐĂů ĂŶĚ ŵĞŶƚĂů ŚĞĂůƚŚ ŶĞĞĚƐ ƚŚĂƚ ĂƌŝƐĞ ĂƐ ƚŚĞ ^ĐŽƵƚƐ ƉĂƌƟĐŝƉĂƚĞ ŝŶ Ă ƉůĞƚŚŽƌĂ ŽĨ ǁŝůĚĞƌŶĞƐƐ͕ ƐƉŽƌƟŶŐ ĂŶĚ ŝŶƚĞƌŶĂƟŽŶĂů ĐŽůůĂďŽƌĂƟǀĞ ĂĐƟǀŝƟĞƐ͘ / Ăŵ ƐƵƉĞƌ ĞdžĐŝƚĞĚ ƚŽ ƌĞƉƌĞƐĞŶƚ ƚŚĞ h^ ͕ ǁŽƌŬŝŶŐ ĐŽůůĂďŽƌĂƟǀĞůLJ ĂŶĚ ĞdžĐŚĂŶŐŝŶŐ ŝĚĞĂƐ ǁŝƚŚ ŵĞĚŝĐĂů ĐŽůůĞĂŐƵĞƐ ĨƌŽŵ EŽƌƚŚ ŵĞƌŝĐĂ ĂŶĚ ŽƚŚĞƌ ƌĞŐŝŽŶƐ ǁŚŝůĞ ĐĂƌŝŶŐ ĨŽƌ ^ĐŽƵƚƐ ĂŶĚ ƐƵƉƉŽƌƚ ƐƚĂī ĨƌŽŵ ĂƌŽƵŶĚ ƚŚĞ ǁŽƌůĚ͊͟ W^͗ ŝĚ ǁĞ ŵĞŶƟŽŶ ƚŚĞ ŵĞĚŝĐĂů ƚĞĂŵ ĂůƐŽ ƐůĞĞƉƐ ŝŶ ƚĞŶƚƐ ĨŽƌ ƚŚĞ ƚǁŽͲǁĞĞŬ :ĂŵďŽƌĞĞ͍ dŚĞ ƐƐŽĐŝĂƟŽŶ ŽĨ ůŝŶŝĐŝĂŶƐ ĨŽƌ the Underserved named &W Member Debbie Lupeika ǁŝƚŚ ŝƚƐ ϮϬϭϵ ůŝŶŝĐŝĂŶ ŽĨ ƚŚĞ zĞĂƌ ĂǁĂƌĚ͘ ƌ͘ >ƵƉĞŝŬĂ ǁŽƌŬƐ ǁŝƚŚ residents at Mercy Medical Center in Redding and at Shasta Community College Health ĞŶƚĞƌ ǁŚŝĐŚ ƐĞƌǀĞƐ ƉƌŝŵĂƌŝůLJ uninsured or underinsured ƉĂƟĞŶƚƐ͘ ͞^ŚĞ ůŝǀĞƐ ĂŶĚ breathes this teaching program, teaching residents, teaching young people, and passing on ƚŚĞ ŬŶŽǁůĞĚŐĞ͕ ƚŚĞ ůĞĂƌŶŝŶŐ ĂŶĚ ƚŚĞ ĐƌĞĂƟŽŶ ŽĨ ƚŚĞ ŶĞdžƚ ŐĞŶĞƌĂƟŽŶ ŽĨ ĐůŝŶŝĐŝĂŶƐ ƚŽ ƚĂŬĞ ĐĂƌĞ ŽĨ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ͕͟ ƐĂŝĚ Dean Germano, the CEO of Shasta Community Health Center ŝŶ Ă ƌĞĐĞŶƚ ŝŶƚĞƌǀŝĞǁ ŽŶ <Z Z EĞǁƐ͘ ƌ͘ >ƵƉĞŝŬĂ ŝƐ ĂůƐŽ ďĞŝŶŐ honored for her advocacy for residency programs in rural ĂƌĞĂƐ ůŝŬĞ ƚŚĞ EŽƌƚŚ ^ƚĂƚĞ͘ ͞tĞ ǁĞƌĞ ƐĞĞŝŶŐ ƉĂƟĞŶƚƐ Ăƚ ƚŚĞ ƐŚĞůƚĞƌ ǁŚŽ͛Ě ďĞĞŶ ĚŝƐƉůĂĐĞĚ ĨƌŽŵ ƚŚĞŝƌ ŚŽƵƐĞƐ ĚƵƌŝŶŐ ƚŚĞ 12

California Family Physician Summer 2019

:ĂĐŬ ŚŽƵ͕ D ͕ &W ƉĂƐƚ ƉƌĞƐŝĚĞŶƚ ŝƐ ŶŽǁ ƚĂŬŝŶŐ ŽŶ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ͘ :ĂĐŬ ŝƐ ƌƵŶŶŝŶŐ ĨŽƌ sŝĐĞ ^ƉĞĂŬĞƌ ŽĨ ƚŚĞ D ,ŽƵƐĞ ŽĨ ĞůĞŐĂƚĞƐ͘ dŚĞ ĞůĞĐƟŽŶ ǁŝůů ďĞ ŚĞůĚ ĚƵƌŝŶŐ ƚŚĞ D ,ŽƵƐĞ͕ KĐƚŽďĞƌ ϮϲͲϮϳ͕ ŝŶ ŶĂŚĞŝŵ͘ :ĂĐŬ ŝƐ ĐƵƌƌĞŶƚůLJ a member of the CMA Board of Trustees and has served as a member of the AAFP Board of Directors. He believes the ƐƚƌĞŶŐƚŚ ŽĨ ƚŚĞ ŽƌŐĂŶŝnjĂƟŽŶ ŝƐ ƚŚĞ ǀŽŝĐĞ ŽĨ ŝƚƐ ŵĞŵďĞƌƐ͘ ͞/ƚ ŝƐ ĐƌŝƟĐĂů ƚŚĂƚ ƚŚĞ sŝĐĞ ^ƉĞĂŬĞƌ ŚĂƌŶĞƐƐ ĂŶĚ ƐƵƐƚĂŝŶ ƚŚĞ ĐŽůůĞĐƟǀĞ voice of the House of Delegates and be that voice of our ŵĞŵďĞƌƐŚŝƉ ŽŶ ƚŚĞ džĞĐƵƟǀĞ ŽŵŵŝƩĞĞ͘ tŝƚŚ Ă ƐƚƌŽŶŐ͕ ƵŶŝƚĞĚ͕ ĂŶĚ ĨŽĐƵƐĞĚ ǀŽŝĐĞ͕ ǁĞ ĐĂŶ ƐƚƌŝǀĞ ƚŽŐĞƚŚĞƌ ƚŽ ĞŶŚĂŶĐĞ ƚŚĞ ůŝǀĞƐ ŽĨ Ăůů ƚŚĞ ƉŚLJƐŝĐŝĂŶƐ͕ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ ŽĨ ĂůŝĨŽƌŶŝĂ͘͟ :ĂĐŬ ŝƐ ĨĂĐŝŶŐ ĐŽŵƉĞƟƟŽŶ ĨƌŽŵ ƚǁŽ ŽƚŚĞƌ ĐĂŶĚŝĚĂƚĞƐ͕ ďƵƚ ŽƵƌ ǀŽƚĞƐ ĂƌĞ ǁŝƚŚ Śŝŵ ĂƐ ĂŶ ƵƉĐŽŵŝŶŐ ůĞĂĚĞƌ Ăƚ ƚŚĞ D ůĞǀĞů͘ dŽ ůĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ŚŽǁ LJŽƵ ĐĂŶ ĂƐƐŝƐƚ :ĂĐŬ͕ contact Adam Francis.

Adam Francis CAFP Director of Government Relations

2019 Family Medicine Advocacy Summit Brings the FMRevolution to Congress /Ŷ ůĂƚĞ DĂLJ͕ ŶĞĂƌůLJ ϯϬϬ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĨƌŽŵ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌLJ ĐŽŶǀĞƌŐĞĚ ŽŶ ŽƵƌ ŶĂƟŽŶ͛Ɛ ĂƉŝƚĂů ĨŽƌ ƚŚĞ &W &ĂŵŝůLJ DĞĚŝĐŝŶĞ ĚǀŽĐĂĐLJ ^Ƶŵŵŝƚ ;&D ^Ϳ͘ dŚĞ ŐŽĂů͗ ĂĚǀŽĐĂƚĞ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ƉĂƟĞŶƚƐ ŝŶ ŵĞĞƟŶŐƐ ǁŝƚŚ ŽƵƌ ƌĞƉƌĞƐĞŶƚĂƟǀĞƐ ĂŶĚ ƐĞŶĂƚŽƌƐ͘ &W͛Ɛ &D ^ ŝƐ ǀĞƌLJ ƐŝŵŝůĂƌ ƚŽ &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ ĂŶĚ >ŽďďLJ ĂLJ͕ ďƵƚ ŝƐ ĚĞƐŝŐŶĞĚ ƚŽ ďƌŝŶŐ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͛Ɛ ŵĞƐƐĂŐĞ ƚŽ ĨĞĚĞƌĂů ůĂǁŵĂŬĞƌƐ͘ &W ĮĞůĚĞĚ ŝƚƐ ďŝŐŐĞƐƚ ĚĞůĞŐĂƟŽŶ ĞǀĞƌ ǁŝƚŚ ŶĞĂƌůLJ ϮϬ ĂĚǀŽĐĂƚĞƐ ŝŶ ŽƵƌ ƌĂŶŬƐ͊ DŽƌĞ ƚŚĂŶ ϮϴϬ ŵĞĞƟŶŐƐ ǁĞƌĞ ƐĐŚĞĚƵůĞĚ͕ ĂŶĚ η&D ^ϭϵ ƚƌĞŶĚĞĚ ŝŶ ͕ ĂŶĚ ǁĞ ŚĂĚ ŶĞĂƌůLJ ĨŽƵƌ ŵŝůůŝŽŶ ƉŽƚĞŶƟĂů ŝŵƉƌĞƐƐŝŽŶƐ͘ dŚŝƐ LJĞĂƌ͕ ŽƵƌ ĂĚǀŽĐĂƚĞƐ ĨŽĐƵƐĞĚ ŽŶ ĮǀĞ ŬĞLJ ŝƐƐƵĞƐ͗ • Teaching Health Centers ʹ &W ƵƌŐĞƐ ƉŽůŝĐLJ ŵĂŬĞƌƐ ƚŽ reauthorize and fully fund the Teaching Health Center 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ;d, 'D Ϳ ƉƌŽŐƌĂŵ͘ ^ĞŶƐ͘ ^ƵƐĂŶ ŽůůŝŶƐ ;ZͲD Ϳ ĂŶĚ :ŽŶ dĞƐƚĞƌ ; ͲDdͿ͕ ĂŶĚ ZĞƉƐ͘ ZĂƵů

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ZƵŝnj ; Ͳ Ϳ ĂŶĚ ĂƚŚLJ DĐDŽƌƌŝƐ ZŽĚŐĞƌƐ ;ZͲt Ϳ ŝŶƚƌŽĚƵĐĞĚ ƚŚĞ dƌĂŝŶŝŶŐ ƚŚĞ EĞdžƚ 'ĞŶĞƌĂƟŽŶ ŽĨ WƌŝŵĂƌLJ ĂƌĞ ŽĐƚŽƌƐ Đƚ ŽĨ ϮϬϭϵ ;^͘ ϭϭϵϭͬ ,Z ϮϴϭϱͿ͘ dŚĞ ůĞŐŝƐůĂƟŽŶ ĂƵƚŚŽƌŝnjĞƐ ƚŚĞ d, 'D ƉƌŽŐƌĂŵ ŽǀĞƌ ĮǀĞ LJĞĂƌƐ ĂŶĚ ƐƵƉƉŽƌƚƐ ƚŚĞ ĐƌĞĂƟŽŶ ŽĨ ŶĞǁ ƉƌŽŐƌĂŵƐ ǁŝƚŚ Ă ƉƌŝŽƌŝƚLJ ĨŽƌ ƚŚŽƐĞ ŝŶ ƌƵƌĂů ĂŶĚ ƵŶĚĞƌƐĞƌǀĞĚ ĐŽŵŵƵŶŝƟĞƐ͘ dŚĞ ďŝůůƐ ǁŽƵůĚ ĂůƐŽ ŝŶĐƌĞĂƐĞ ĨƵŶĚŝŶŐ ĨƌŽŵ ΨϭϮϲ͘ϱ ŵŝůůŝŽŶ ƉĞƌ LJĞĂƌ ;ĐƵƌƌĞŶƚ ůĂǁͿ ƚŽ Ψϭϰϭ͘ϱ ŵŝůůŝŽŶͬLJĞĂƌ ;^͘ϭϭϵϭͿ ĂŶĚ Ψϭϱϭ ŵŝůůŝŽŶͬLJĞĂƌ ;,Z ϮϴϭϱͿ͘ 'D >ĞŐŝƐůĂƟŽŶ ŝŶ ƚŚĞ ϭϭϲƚŚ ŽŶŐƌĞƐƐ ʹ &W ƌĞĐŽŵŵĞŶĚƐ ŽŶŐƌĞƐƐ ƌĞĨŽƌŵ DĞĚŝĐĂƌĞ 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ĮŶĂŶĐŝŶŐ ƚŽ ĂĚĚƌĞƐƐ ŝŶĞƋƵŝƟĞƐ͕ ŝŵƉƌŽǀĞ ĂĐĐŽƵŶƚĂďŝůŝƚLJ ĂŶĚ train more family physicians. The AAFP urges legislators to cosponsor the Advancing Medical Resident Training in ŽŵŵƵŶŝƚLJ ,ŽƐƉŝƚĂůƐ Đƚ ;,Z ϭϯϱϴͿ ĂŶĚ ƚŚĞ ZƵƌĂů WŚLJƐŝĐŝĂŶ tŽƌŬĨŽƌĐĞ WƌŽĚƵĐƟŽŶ Đƚ ;^ ϮϴϵͿ͘

&WĞƌƐ ǀŝƐŝƚ ƚŚĞ ŽĸĐĞƐ ŽĨ h^ ŽŶŐƌĞƐƐŵĂŶ ZĂƵů ZƵŝnj͕ D ͕ DW, ;ĐĞŶƚĞƌͿ ǁŚŝůĞ ĂƩĞŶĚŝŶŐ ƚŚĞ &W͛Ɛ &ĂŵŝůLJ DĞĚŝĐŝŶĞ ĚǀŽĐĂĐLJ ^Ƶŵŵŝƚ͘ 14

California Family Physician Summer 2019

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'ƵŶ sŝŽůĞŶĐĞ WƌĞǀĞŶƟŽŶ ZĞƐĞĂƌĐŚ ʹ &W ƌĞĐŽŵŵĞŶĚƐ ŽŶŐƌĞƐƐ ĂĚĚƌĞƐƐ ŐƵŶ ǀŝŽůĞŶĐĞ ĂƐ Ă ŶĂƟŽŶĂů ƉƵďůŝĐ ŚĞĂůƚŚ ĞƉŝĚĞŵŝĐ ĂŶĚ ĂƉƉƌŽƉƌŝĂƚĞ ΨϱϬ ŵŝůůŝŽŶ ŝŶ ĮƐĐĂů LJĞĂƌ ϮϬϮϬ ƚŽ ĐŽŶĚƵĐƚ ƉƵďůŝĐ ŚĞĂůƚŚ ƌĞƐĞĂƌĐŚ ŝŶƚŽ ĮƌĞĂƌŵ ŵŽƌďŝĚŝƚLJ ĂŶĚ ŵŽƌƚĂůŝƚLJ ƉƌĞǀĞŶƟŽŶ͘ Congressional Primary Care Caucus ʹ &W ďĞůŝĞǀĞƐ ƚŚŝƐ ďŝƉĂƌƟƐĂŶ ĐĂƵĐƵƐ ǁŝůů ŵĂŬĞ ŐƌĞĂƚ ƐƚƌŝĚĞƐ ŝŶ ĞĚƵĐĂƟŶŐ ůĞŐŝƐůĂƚŽƌƐ͕ ƐƚĂī͕ ĂŶĚ ƚŚĞ ƉƵďůŝĐ ŽŶ ƉƌŝŵĂƌLJ ĐĂƌĞ ŝƐƐƵĞƐ͕ ĞdžƉĞƌŝĞŶĐĞƐ͕ ĂŶĚ ĐŽŶĐĞƌŶƐ͘ &W ĞŶĐŽƵƌĂŐĞƐ Ăůů ,ŽƵƐĞ ŽĨ ZĞƉƌĞƐĞŶƚĂƟǀĞ ŵĞŵďĞƌƐ ƚŽ ũŽŝŶ ŝƚ͘ WƌŝŵĂƌLJ ĂƌĞ WĂƟĞŶƚ WƌŽƚĞĐƟŽŶ Đƚ ŽĨ ϮϬϭϵ ʹ &W ƵƌŐĞƐ ,ŽƵƐĞ ŵĞŵďĞƌƐ ƚŽ ĐŽƐƉŽŶƐŽƌ ƚŚĞ WƌŝŵĂƌLJ ĂƌĞ WĂƟĞŶƚ WƌŽƚĞĐƟŽŶ Đƚ ŽĨ ϮϬϭϵ ;,Z ϮϳϳϰͿ͕ Ă ďŝůů ƐƉŽŶƐŽƌĞĚ ďLJ ZĞƉƐ͘ ƌĂĚ ^ĐŚŶĞŝĚĞƌ ; Ͳ/>Ϳ ĂŶĚ ůŝƐĞ ^ƚĞĨĂŶŝŬ ;ZͲEzͿ͘ dŚĞ ďŝůů ǁŽƵůĚ ŵĂŬĞ ŝƚ ŵŽƌĞ ĂīŽƌĚĂďůĞ ĨŽƌ ƉĂƟĞŶƚƐ ǁŝƚŚ ŚŝŐŚ ĚĞĚƵĐƟďůĞ ŚĞĂůƚŚ ƉůĂŶƐ ƚŽ ĂĐĐĞƐƐ ƉƌŝŵĂƌLJ ĐĂƌĞ͘

&W ŚĂĚ ŝƚƐ ůĂƌŐĞƐƚ ĞǀĞƌ ĐŽŶƟŶŐĞŶĐLJ Ăƚ ƚŚŝƐ LJĞĂƌ͛Ɛ &D ^͘

zŽƵ ĐĂŶ ŚĞůƉ ƚŚĞ ĮŐŚƚ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ďLJ ƵƐŝŶŐ &W͛Ɛ ^W < Khd ǁĞďƐŝƚĞ ĂŶĚ ƵƌŐŝŶŐ ŽŶŐƌĞƐƐ ƚŽ ƌĞĂƵƚŚŽƌŝnjĞ ĂŶĚ ĨƵůůLJ ĨƵŶĚ ƚŚĞ dĞĂĐŚŝŶŐ ,ĞĂůƚŚ ĞŶƚĞƌ 'ƌĂĚƵĂƚĞ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ƉƌŽŐƌĂŵ͘ dĞůů LJŽƵƌ ƉŽůŝĐLJ ŵĂŬĞƌƐ ƚŽ ^ƵƉƉŽƌƚ dƌĂŝŶŝŶŐ ĨŽƌ ƚŚĞ EĞdžƚ 'ĞŶĞƌĂƟŽŶ ŽĨ Family Physicians!

California Family Physician Summer 2019

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Ta c k l i n g S T I s

Shelly B. Rodrigues, CAE, FACEHP CAFP Deputy Executive Vice President

STIs in California: We Are Not Winning the Battle In its 2019-2021 Strategic Plan, CAFP’s Board of Directors emphasized the need for CAFP to reengage in public health dialogues, from ĂǁĂƌĞŶĞƐƐ ƚŽ ĞĚƵĐĂƟŽŶ͕ ĂĚǀŽĐĂĐLJ ƚŽ ƉŽůŝĐLJ͘ dŚĞ ŽŵŵŝƩĞĞ ŽŶ ,ĞĂůƚŚ ŽĨ ƚŚĞ WƵďůŝĐ ; ,KWͿ ŝĚĞŶƟĮĞĚ ^ĞdžƵĂůůLJ dƌĂŶƐŵŝƩĞĚ /ŶĨĞĐƟŽŶƐ ;^d/ƐͿ ĂƐ Ă ƚĂƌŐĞƚ ĨŽƌ ǁŽƌŬ ŝŶ ϮϬϭϵ͘ dŚĞ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ Professional Development (CCPD) included a session at the 2019 Family Medicine Clinical Forum on STIs and has taken the lead in adding AAFP Prescribed CME credit to this issue of California Family Physician. To earn credit, please complete and return the form on page 28.

dŚĞ ŝŐ dŚƌĞĞ ^d/Ɛ Chlamydia ŝƐ ĐƵƌƌĞŶƚůLJ ƚŚĞ ŵŽƐƚ ĐŽŵŵŽŶůLJ ƌĞƉŽƌƚĞĚ ^d/ ŝŶ ǁŝƚŚ ϮϬϭϳ͛Ɛ ϱϱϮ͘ϭ ĐĂƐĞƐͬϭϬϬ͕ϬϬϬ ĂůŝĨŽƌŶŝĂŶƐ ďĞŝŶŐ Ă ϵ͘ϲ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ ŽǀĞƌ ϮϬϭϲ ;ƚŚĞ ŚŝŐŚĞƐƚ ƌĂƚĞ ƐŝŶĐĞ ϭϵϵϬͿ͘ ŚůĂŵLJĚŝĂ ƌĂƚĞƐ ĂŵŽŶŐ ĨĞŵĂůĞƐ ǁĞƌĞ ϲϬ ƉĞƌĐĞŶƚ ŚŝŐŚĞƌ ƚŚĂŶ ƚŚŽƐĞ ĂŵŽŶŐ ŵĂůĞ ĐŽƵŶƚĞƌƉĂƌƚƐ ǁŝƚŚ ƚŚĞ ŚŝŐŚĞƐƚ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ĨĞŵĂůĞ ĐĂƐĞƐ ŝŶ ǁŽŵĞŶ ĂŐĞƐ ϮϬͲϮϰ͘ ZĞƉŽƌƚĞĚ ĐĂƐĞƐ ĂŵŽŶŐ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶ LJŽƵƚŚ ĂƌĞ ĨŽƵƌ ƟŵĞƐ ŚŝŐŚĞƌ ƚŚĂŶ ƌĂƚĞƐ ŝŶ ĂƵĐĂƐŝĂŶ LJŽƵƚŚ͕ ǁŝƚŚ ŚŝŐŚĞƌ ƌĂƚĞƐ ŝŶ ƚŚĞ &ŝƌƐƚ ŵĞƌŝĐĂŶ ĂŶĚ >ĂƟŶŽ ƉŽƉƵůĂƟŽŶƐ ĂƐ ǁĞůů͘

tĞ ĂƌĞ ŶŽƚ ǁŝŶŶŝŶŐ ƚŚĞ ďĂƩůĞ ƚŽ ĚĞĐƌĞĂƐĞ ĐĂƐĞƐ ŽĨ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶƐ ;^d/ƐͿ ŝŶ ĂůŝĨŽƌŶŝĂ Žƌ ŶĂƟŽŶĂůůLJ͘ /Ŷ ĨĂĐƚ͕ ŶĞĂƌůLJ ϮϬ ŵŝůůŝŽŶ ŶĞǁ ^d/Ɛ ŽĐĐƵƌ ĞǀĞƌLJ LJĞĂƌ͕ ĂŶĚ ŝŶ ϮϬϭϲ ŵŽƌĞ ƚŚĂŶ Ϯ ŵŝůůŝŽŶ ĐĂƐĞƐ ŽĨ ƚŚƌĞĞ ŶĂƟŽŶĂůůLJͲƌĞƉŽƌƚĞĚ ^d/Ɛ ;ĐŚůĂŵLJĚŝĂ͕ ŐŽŶŽƌƌŚĞĂ͕ ĂŶĚ ƐLJƉŚŝůŝƐͿ ǁĞƌĞ ƌĞƉŽƌƚĞĚ͘ dŚŝƐ ŝƐ ƚŚĞ ŚŝŐŚĞƐƚ ŶƵŵďĞƌ ŽŶ ƌĞĐŽƌĚ͕ ĂŶĚ ƵŶĨŽƌƚƵŶĂƚĞůLJ ŝƚ ŵĂLJ ŶŽƚ ďĞ ĐŽŵƉůĞƚĞ ĂƐ ŵĂŶLJ ĐĂƐĞƐ ĐŽŶƟŶƵĞ ƚŽ ŐŽ undiagnosed and unreported. Sadly, young adolescents account for ŵŽƌĞ ƚŚĂŶ ŚĂůĨ ŽĨ ŶĞǁ ŝŶĨĞĐƟŽŶƐ͕ ǁŝƚŚ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶƐ ĂŶĚ ŐĂLJ ĂŶĚͬ Žƌ ďŝƐĞdžƵĂů ŵĞŶ ĚŝƐƉƌŽƉŽƌƟŽŶĂƚĞůLJ ĂīĞĐƚĞĚ͘ ĂƚĂ ĂůƐŽ ƐŚŽǁƐ ƚŚĂƚ ŽƵƌ ƐĞŶŝŽƌ ĐŽŵŵƵŶŝƚLJ ŝƐ ƐŝŵŝůĂƌůLJ ĂīĞĐƚĞĚ ďLJ ƚŚĞ ŝŶĐƌĞĂƐĞƐ ŝŶ ^d/ ĐĂƐĞƐ͘

Gonorrhea ŝƐ ƚŚĞ ƐĞĐŽŶĚ ŵŽƌĞ ĐŽŵŵŽŶůLJ ƌĞƉŽƌƚĞĚ ^d/ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ǁŝƚŚ Ă ϮϬϭϳ ƌĂƚĞ ŽĨ ϭϵϬ͘ϱͬϭϬϬ͕ϬϬϬ ĂŶŶƵĂůůLJ ĂŵŽŶŐ ĂůŝĨŽƌŶŝĂŶƐ ĂŶĚ Ă ϭϲ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ ŽǀĞƌ ϮϬϭϲ ƌĂƚĞƐ ;ƚŚĞ ŚŝŐŚĞƐƚ ƌĂƚĞ ƐŝŶĐĞ ϭϵϴϴͿ͘ 'ŽŶŽƌƌŚĞĂ ĐĂƐĞƐ ĂŵŽŶŐ ŵĂůĞƐ ĂƌĞ ƚǁŽͲĨŽůĚ ŚŝŐŚĞƌ ƚŚĂŶ ĂŵŽŶŐ ĨĞŵĂůĞƐ͕ ǁŝƚŚ ŝŶĐƌĞĂƐĞƐ ƌĞƉŽƌƚĞĚ ŝŶ ŵĞŶͲǁŚŽͲŚĂǀĞͲƐĞdž ǁŝƚŚ ŵĞŶ ;D^DͿ͕ ǁŚĞƌĞ ƚŚĞ ĞƐƟŵĂƚĞĚ ƌĂƚĞ ŝƐ Ϯ͕ϴϴϰͬϭϬϬ͕ϬϬϬ ƉĞƌ LJĞĂƌ͘ /ŶĐƌĞĂƐĞƐ ŝŶ ƌĂƚĞƐ ĂƌĞ ĂůƐŽ ƐĞĞŶ ŝŶ ƉĂƟĞŶƚƐ ĂŐĞƐ ϭϱͲϮϰ͕ ďƵƚ ƚŚĞ ůĂƌŐĞƐƚ ŝŶĐŝĚĞŶĐĞ ƌĞŵĂŝŶƐ ĨŽƌ ŵĂůĞƐ ĂŐĞƐ ϮϱͲϮϵ LJĞĂƌƐ͘ ŐĂŝŶ͕ ǁĞ ƐĞĞ Ă ƐŝŐŶŝĮĐĂŶƚ ĚŝīĞƌĞŶĐĞ ďĞƚǁĞĞŶ ĐĂƐĞƐ ŝŶ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶ ǀƐ͘ ĂƵĐĂƐŝĂŶ LJŽƵƚŚ͖ ǁŝƚŚ ŶƵŵďĞƌƐ ƐĞǀĞŶ ƟŵĞƐ ŚŝŐŚĞƌ ŝŶ ƚŚĞ ĨƌŝĐĂŶ American community.

ƵƌƌĞŶƚůLJ͕ ϯϬϬ͕ϬϬϬ ĐĂƐĞƐ ŽĨ ĐŚůĂŵLJĚŝĂ͕ ŐŽŶŽƌƌŚĞĂ ĂŶĚ ĞĂƌůLJ ƐLJƉŚŝůŝƐ ŚĂǀĞ ďĞĞŶ ƌĞƉŽƌƚĞĚ ŝŶ ĂůŝĨŽƌŶŝĂ ʹ ƚŚŝƐ ŝƐ Ă ϰϱ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ ŝŶ ƚŚĞ ůĂƐƚ ĮǀĞ LJĞĂƌƐ͊ zĞƐ͕ Ă ϰϱ ƉĞƌĐĞŶƚ ŝŶĐƌĞĂƐĞ͘ ĂƚĂ ĨƌŽŵ ϮϬϭϳ ƐŚŽǁƐ ϳϱ͕ϰϱϬ ŐŽŶŽƌƌŚĞĂ ĐĂƐĞƐ͖ ϭϯ͕ϲϬϱ ƐLJƉŚŝůŝƐ ĐĂƐĞƐ͖ Ϯϭϴ͕ϳϭϬ ĐŚůĂŵLJĚŝĂ ĐĂƐĞƐ ĂŶĚ Ϯϳϴ ĐĂƐĞƐ ŽĨ ĐŽŶŐĞŶŝƚĂů ƐLJƉŚŝůŝƐ͘ ĐůŽƐĞƌ ůŽŽŬ Ăƚ ƚŚĞ data reveals much to be done, but tools and resources, including ĞĚƵĐĂƟŽŶ͕ ƉƵďůŝĐ ĂǁĂƌĞŶĞƐƐ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ĐŽǀĞƌĂŐĞ͕ ĂƌĞ ĂǀĂŝůĂďůĞ ĂƐ ǁĞ ƚĂĐŬůĞ ƚŚŝƐ ŝŵƉŽƌƚĂŶƚ ƉƵďůŝĐ ŚĞĂůƚŚ ŝƐƐƵĞ͘

Syphilis ŝƐ ĚŝǀŝĚĞĚ ŝŶƚŽ ƐƚĂŐĞƐ ǁŝƚŚ ĚŝīĞƌĞŶƚ ƐŝŐŶƐ ĂŶĚ ƐLJŵƉƚŽŵƐ͖ early syphilis refers to primary, secondary and early latent stages of ƚŚĞ ĚŝƐĞĂƐĞ͘ /Ŷ ϮϬϭϳ ƚŚĞ ƌĂƚĞ ŽĨ ĞĂƌůLJ ƐLJƉŚŝůŝƐ ǁĂƐ ϮϬ ƉĞƌĐĞŶƚ ŚŝŐŚĞƌ ƚŚĂŶ ŝŶ ϮϬϭϲ͕ ǁŝƚŚ ϯϰ͘ϱ ĐĂƐĞƐͬϭϬϬ͕ϬϬϬ ĂŵŽŶŐ ĂůŝĨŽƌŶŝĂŶƐ ;ƚŚĞ ŚŝŐŚĞƐƚ ƌĂƚĞ ƐŝŶĐĞ ϭϵϴϳͿ͘ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶ ƌĂƚĞƐ ĨŽƌ ĞĂƌůLJ ƐLJƉŚŝůŝƐ ĂƌĞ ƚǁŽ ƟŵĞƐ ŚŝŐŚĞƌ ƚŚĂŶ ĂƵĐĂƐŝĂŶ ƌĂƚĞƐ͘ tŚŝůĞ ŵŽƌĞ ƚŚĂŶ ƐĞǀĞŶͲŝŶͲϭϬ ĐĂƐĞƐ ĂƌĞ ĂŵŽŶŐ ŐĂLJ ĂŶĚ ďŝͲƐĞdžƵĂů ŵĞŶ͕ ĂŶ ĂůĂƌŵŝŶŐ ƐĞǀĞŶͲĨŽůĚ ŝŶĐƌĞĂƐĞ ŚĂƐ ďĞĞŶ ƌĞĐŽƌĚĞĚ ĨŽƌ ĨĞŵĂůĞƐ ƐŝŶĐĞ ϮϬϭϮ͘ dŚŝƐ ŝŶĐƌĞĂƐĞ in female rates is important as 3,315 females of childbearing age ǁĞƌĞ ĚŝĂŐŶŽƐĞĚ ǁŝƚŚ ƐLJƉŚŝůŝƐ ŝŶ ϮϬϭϳ͕ ĂŶĚ ŶĞĂƌůLJ ŚĂůĨ ƚŚŽƐĞ ĐĂƐĞƐ ǁĞƌĞ ĞĂƌůLJ ƐLJƉŚŝůŝƐ͘ KĨ ƚŚŽƐĞ ƌĞƉŽƌƚĞĚ͕ ϭϱͲϮϬ ƉĞƌĐĞŶƚ ǁĞƌĞ ĂŵŽŶŐ ƉƌĞŐŶĂŶƚ ǁŽŵĞŶ͘ Congenital syphilis ŝƐ ĂŶ ŝŶĨĞĐƟŽŶ ƚƌĂŶƐŵŝƩĞĚ ĨƌŽŵ ŵŽƚŚĞƌ ƚŽ ĐŚŝůĚ ĚƵƌŝŶŐ ƉƌĞŐŶĂŶĐLJ Žƌ ĚĞůŝǀĞƌLJ͘ /ƚ ĐĂŶ ĐĂƵƐĞ ƐĞǀĞƌĞ ŝůůŶĞƐƐ ŝŶ ďĂďŝĞƐ ŝŶĐůƵĚŝŶŐ ƉƌĞŵĂƚƵƌĞ ďŝƌƚŚ͕ ůŽǁ ďŝƌƚŚ ǁĞŝŐŚƚ͕ ďŝƌƚŚ ĚĞĨĞĐƚƐ͕ ďůŝŶĚŶĞƐƐ ĂŶĚ ŚĞĂƌŝŶŐ ůŽƐƐ Žƌ ůĞĂĚ ƚŽ ƐƟůůďŝƌƚŚ Žƌ ŝŶĨĂŶƚ ĚĞĂƚŚ͘ &ŝŐƵƌĞƐ ĨŽƌ ϮϬϭϳ ƐŚŽǁ Ă ĮŌŚ LJĞĂƌ ŽĨ ĐŽŶƐĞĐƵƟǀĞ ŝŶĐƌĞĂƐĞƐ ŝŶ ƚŚĞ ŶƵŵďĞƌ ŽĨ ŝŶĨĂŶƚƐ ďŽƌŶ ǁŝƚŚ ĐŽŶŐĞŶŝƚĂů ƐLJƉŚŝůŝƐ͘ ^ƉĞĐŝĮĐ WĂƟĞŶƚ WŽƉƵůĂƟŽŶƐ WƌĞǀĞŶƟŽŶ ĐŚĂůůĞŶŐĞƐ ƌĞŵĂŝŶ ĂƐ ǁĞ ĚĞĂů ǁŝƚŚ Ă ůĂĐŬ ŽĨ ĂǁĂƌĞŶĞƐƐ ŽĨ ^d/ ƐƚĂƚƵƐ ĂŶĚ ƐƟŐŵĂ ĂŶĚ ƉŽƚĞŶƟĂů ĚŝƐĐƌŝŵŝŶĂƟŽŶ ĂƩĂĐŚĞĚ ƚŽ

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California Family Physician Summer 2019

ĚŝƐĐƵƐƐŝŶŐ ƐĞdžƵĂů ŚŝƐƚŽƌLJ ĂŶĚ ^d/ ƐĐƌĞĞŶŝŶŐ͘ ŶĚ͕ ŚĞƌĞ ŝƐ ǁŚĞƌĞ ƐŽĐŝĂů ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ ŵĂLJ ĐŽŵĞ ŝŶƚŽ ƉůĂLJ͘ ,ŝŐŚĞƌ ƌĂƚĞƐ ŽĨ ,/sͬ^d/Ɛ ĂŵŽŶŐ ĨƌŝĐĂŶ ŵĞƌŝĐĂŶ ĂŶĚ >ĂƟŶŽ ƉŽƉƵůĂƟŽŶƐ ŵĂLJ ĐŽƌƌĞůĂƚĞ ƚŽ ŚŝŐŚĞƌ ƉŽǀĞƌƚLJ ƌĂƚĞƐ͕ ůŽǁĞƌ ƐŽĐŝŽĞĐŽŶŽŵŝĐ ƐƚĂƚƵƐ ;^ ^Ϳ͕ ůŝŵŝƚĞĚ ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ ĂŶĚ ^d/ ĞĚƵĐĂƟŽŶ͘ >ŝǀŝŶŐ ŝŶ ĐŽŵŵƵŶŝƟĞƐ ǁŝƚŚ ŚŝŐŚĞƌ ŝŶĨĞĐƟŽŶ ƌĂƚĞƐ ĂŶĚ ƚŚĞ ƚĞŶĚĞŶĐLJ ƚŽ ŚĂǀĞ ƐĞdž ǁŝƚŚ ƉĂƌƚŶĞƌƐ ŽĨ ƚŚĞ ƐĂŵĞ ƌĂĐĞͬĞƚŚŶŝĐŝƚLJ ŵĂLJ ĂůƐŽ ďĞ ĚĞƚĞƌŵŝŶĂŶƚ ĨĂĐƚŽƌƐ͘ dŚĞ ĞŶƚĞƌ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů͛Ɛ ; ͛ƐͿ ϮϬϭϳ EĂƟŽŶĂů zŽƵƚŚ ZŝƐŬ Behavior Survey provides the most recent surveillance data on health ďĞŚĂǀŝŽƌƐ ĂŶĚ ĞdžƉĞƌŝĞŶĐĞƐ ĂŵŽŶŐ ŚŝŐŚ ƐĐŚŽŽů ƐƚƵĚĞŶƚƐ ĂĐƌŽƐƐ ƚŚĞ ĐŽƵŶƚƌLJ͘ /ƚ ƌĞƉŽƌƚƐ ƚŚĞ ƉƌŽƉŽƌƟŽŶ ŽĨ ŚŝŐŚ ƐĐŚŽŽů ƐƚƵĚĞŶƚƐ ǁŚŽ ĂƌĞ ƐĞdžƵĂůůLJ ĂĐƟǀĞ ŚĂƐ ƐƚĞĂĚŝůLJ ĚĞĐůŝŶĞĚ͕ LJĞƚ ŚĂůĨ ŽĨ ƚŚĞ ϮϬ ŵŝůůŝŽŶ ŶĞǁ ^d/Ɛ ƌĞƉŽƌƚĞĚ ĞĂĐŚ LJĞĂƌ ǁĞƌĞ ĂŵŽŶŐ LJŽƵŶŐ ƉĞŽƉůĞ͘ dŚĞ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ƐƚƵĚĞŶƚƐ ĐƵƌƌĞŶƚůLJ ƐĞdžƵĂůůLJ ĂĐƟǀĞ ĚĞĐƌĞĂƐĞĚ ĨƌŽŵ ϯϱ ƉĞƌĐĞŶƚ ŝŶ ϮϬϬϳ ƚŽ Ϯϴ͘ϳ ƉĞƌĐĞŶƚ ŝŶ ϮϬϭϳ͕ ďƵƚ Ă ƐŝŐŶŝĮĐĂŶƚ ĚĞĐƌĞĂƐĞ ŝŶ ĐŽŶĚŽŵ ƵƐĂŐĞ ďLJ ŚŝŐŚ ƐĐŚŽŽů ƚĞĞŶƐ ǁĂƐ ĂůƐŽ ŶŽƚĞĚ͘ ŵŽŶŐ ƐĞdžƵĂůůLJ ĂĐƟǀĞ ĂůŝĨŽƌŶŝĂ ŚŝŐŚ ƐĐŚŽŽůĞƌƐ͕ ŽŶůLJ ŽŶĞͲŝŶͲƚǁŽ ƵƐĞĚ Ă ĐŽŶĚŽŵ ƚŚĞ ůĂƐƚ ƟŵĞ ƚŚĞLJ ŚĂĚ ƐĞdž͕ ĂŶĚ ŽŶĞ ŽŶĞͲŝŶͲƚŚƌĞĞ ƵƐĞĚ Ă ĐŽŶĚŽŵ ĞǀĞƌLJ ƟŵĞ ƚŚĞLJ ŚĂǀĞ ƐĞdž͘ dŚĞ ĂůŝĨŽƌŶŝĂ ,ĞĂůƚŚLJ zŽƵƚŚ Đƚ ;ϮϬϭϲͿ ƌĞƋƵŝƌĞƐ ƚŚĂƚ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ƐĞdžƵĂů ŚĞĂůƚŚ ĞĚƵĐĂƟŽŶ ĂŶĚ ,/s ƉƌĞǀĞŶƟŽŶ ĞĚƵĐĂƟŽŶ ďĞ ƚĂƵŐŚƚ ŽŶĐĞ in middle school and once in high school. The goal is to provide young ƐƚƵĚĞŶƚƐ ǁŝƚŚ ƚŚĞ ŬŶŽǁůĞĚŐĞ ĂŶĚ ƐŬŝůůƐ ŶĞĞĚĞĚ ƚŽ ƉƌŽƚĞĐƚ ƚŚĞŝƌ ƐĞdžƵĂů ĂŶĚ ƌĞƉƌŽĚƵĐƟǀĞ ŚĞĂůƚŚ ĨƌŽŵ ,/s ĂŶĚ ŽƚŚĞƌ ^d/Ɛ͘ ďƐƟŶĞŶĐĞ ŽŶůLJ ŝŶƐƚƌƵĐƟŽŶ ŝƐ ŶŽƚ ƉĞƌŵŝƩĞĚ͖ Ăůů ŝŶƐƚƌƵĐƟŽŶ ŵƵƐƚ ďĞ ŵĞĚŝĐĂůůLJ ĂĐĐƵƌĂƚĞ͕ and the curriculum must address the needs of students of all genders ĂŶĚ ƐĞdžƵĂů ŽƌŝĞŶƚĂƟŽŶ͘ KĨ ŶŽƚĞ͕ ǁŝƚŚ ƉĂƌĞŶƚĂů ƉĞƌŵŝƐƐŝŽŶ͕ ƐƚƵĚĞŶƚƐ ĐĂŶ ŽƉƚ ŽƵƚ ŽĨ ƐĞdžƵĂů ĞĚƵĐĂƟŽŶ ůĞƐƐŽŶƐ͘ tŚŝůĞ ŵĂŶLJ ŽĨ ƚŚĞ ŝŶĐƌĞĂƐĞƐ ŝŶ ^d/Ɛ ĂƌĞ ĂŵŽŶŐ LJŽƵƚŚ͕ ^d/ ƌĂƚĞƐ ŝŶ ŽůĚĞƌ ĂĚƵůƚƐ ĂƌĞ ƌŝƐŝŶŐ ƌĂƉŝĚůLJ͕ ĐŽůůĞĐƟǀĞůLJ ďLJ ϱϬ ƉĞƌĐĞŶƚ ŝŶ ƚŚĞ ƉĂƐƚ ĨĞǁ ĚĞĐĂĚĞƐ͘ /Ŷ ϮϬϭϳ͕ ϱϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ǁŝƚŚ ,/s ǁĞƌĞ ŽǀĞƌ ĂŐĞ ϱϬ͕ ĂŶĚ ϳϳ ƉĞƌĐĞŶƚ ŽĨ ŶĞǁ ,/s ĐĂƐĞƐ ĂƌĞ ŝŶ ƉĂƟĞŶƚƐ ŽǀĞƌ ĂŐĞ ϱϬ͘ dŚĞ ƌĞƉŽƌƚƐ ƚŚĂƚ ďĞƚǁĞĞŶ ϮϬϭϮ ĂŶĚ ϮϬϭϲ ĨŽƌ ŵĞŶ ĂŶĚ ǁŽŵĞŶ ŽǀĞƌ ĂŐĞ ϲϱ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ ŚůĂŵLJĚŝĂ ŚĂƐ ƌŝƐĞŶ ďLJ ϱϲ ƉĞƌĐĞŶƚ ;ϭ͕ϭϯϰ ƚŽ ϭ͕ϳϳϮ ĐĂƐĞƐ ĂŶŶƵĂůůLJͿ͘ EĞǁ ĐĂƐĞƐ ŽĨ ƐLJƉŚŝůŝƐ ĚŽƵďůĞĚ ;ϭϮϯ ƚŽ Ϯϳϵ ĐĂƐĞƐ ĂŶŶƵĂůůLJͿ͘ 'ŽŶŽƌƌŚĞĂ ŚĂƐ ƌŝƐĞŶ ďLJ ϭϱϬ ƉĞƌĐĞŶƚ ;ϲϰϰ ƚŽ ϭ͕ϱϵϵ ĐĂƐĞƐ ĂŶŶƵĂůůLJͿ͘ dŚĞ ĚƌĂŵĂƟĐ ƌŝƐĞ ŝŶ ^d/Ɛ ŝŶ ƚŚĞ ĞůĚĞƌůLJ ŵĂLJ ďĞ ĐĂƵƐĞĚ ďLJ ŶƵŵĞƌŽƵƐ ĨĂĐƚŽƌƐ͕ ŝŶĐůƵĚŝŶŐ ƌĞůƵĐƚĂŶĐĞ ƚŽ ďƌŝŶŐ ƵƉ ƐĞdž ;ŽŶ ďŽƚŚ ƉĂƟĞŶƚ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ƐŝĚĞƐͿ ůĞĂĚŝŶŐ ƚŽ ůŽǁ ƐĐƌĞĞŶŝŶŐ ƌĂƚĞƐ͖ ĐŚĂŶŐĞƐ ŝŶ ŝŵŵƵŶŽƐĞŶĞƐĐĞŶĐĞ ĂŶĚ ǁĞĂŬĞŶĞĚ ŵƵĐŽƐĂů ƟƐƐƵĞ ƚŚĂƚ ŵĂLJ ŵĂŬĞ ŝƚ ŚĂƌĚĞƌ ĨŽƌ ƐĞŶŝŽƌƐ ƚŽ ĮŐŚƚ ŝŶĨĞĐƟŽŶ͖ ĚĂƟŶŐ ŵŽƌĞ ƚŚĂŶ ŽŶĞ ƉĂƌƚŶĞƌ ĂŌĞƌ ĚŝǀŽƌĐĞ Žƌ ƚŚĞ ĚĞĂƚŚ ŽĨ Ă ƉĂƌƚŶĞƌ͕ ƌĂŝƐŝŶŐ ƚŚĞŝƌ ƌŝƐŬ ĨŽƌ ŝŶĨĞĐƟŽŶ ĂŌĞƌ Ă ůŽŶŐ ƉĞƌŝŽĚ ŽĨ ŵŽŶŽŐĂŵLJ ĂŶĚͬŽƌ ĂĐĐĞƐƐŝďŝůŝƚLJ ƚŽ ŵŽƌĞ ƉŽƚĞŶƟĂů ƉĂƌƚŶĞƌƐ ŝŶ ĐŽŵŵƵŶŝƚLJ ůŝǀŝŶŐ ƐĞƫŶŐƐ͖ ĂŶĚ ƚŚĞ ĂďŝůŝƚLJ ƚŽ ŵĂŝŶƚĂŝŶ ƐĞdžƵĂů ĨƵŶĐƟŽŶ ůŽŶŐĞƌ Ăƚ ĂŶ ŽůĚĞƌ ĂŐĞ ǁŝƚŚ ƉŚĂƌŵĂĐĞƵƟĐĂů assistance, e.g., phosphodiesterase inhibitors.

ĂƌĞ ŶŽƚ Ăƚ ƌŝƐŬ ĨŽƌ ^d/Ɛ ĂŶĚ ƚŚĞLJ ŵĂLJ ŶŽƚ ĐŽŶƐŝĚĞƌ ŽƌĂů Žƌ ĂŶĂů ƐĞdž ĂƐ Ă ǁĂLJ ŽĨ ĐŽŶƚƌĂĐƟŶŐ Žƌ ƚƌĂŶƐŵŝƫŶŐ ^d/Ɛ͘ ŚĂůůĞŶŐĞƐ ĂŶĚ ^ŽůƵƟŽŶƐ Clinical measures ŚĂǀĞ ďĞĞŶ ĚĞǀĞůŽƉĞĚ ƚŽ ůŽŽŬ Ăƚ ŝŵƉƌŽǀĞŵĞŶƚ ŝŶ ƐĐƌĞĞŶŝŶŐ͕ ĚŝĂŐŶŽƐŝƐ ĂŶĚ ƚƌĞĂƚŵĞŶƚ ŽĨ ^d/Ɛ͘ dŚĞ ƌĞĐŽŵŵĞŶĚƐ ƌŽƵƟŶĞ ,/s ƐĐƌĞĞŶŝŶŐ Ăƚ ůĞĂƐƚ ŽŶĐĞ ĨŽƌ ƚŚŽƐĞ ĂŐĞƐ ϭϯͲϲϰ ĂŶĚ ĂŶŶƵĂů ƐĐƌĞĞŶŝŶŐ ĨŽƌ ƚŚŽƐĞ Ăƚ ŚŝŐŚĞƌ ƌŝƐŬ ŽĨ ĐŽŶƚƌĂĐƟŶŐ ƚŚĞ ǀŝƌƵƐ͘ ĚĂƚĂ ĨƌŽŵ ƐƵƌǀĞLJƐ ĨƌŽŵ ϮϬϬϲ ƚŽ ϮϬϭϲ͕ ƐŚŽǁ ƚŚĂƚ ŽĨ ϭϭ͕ϲϴϴ ƌĞƐƉŽŶĚĞŶƚƐ ŽŶůLJ ϰϵ͘ϲ ƉĞƌĐĞŶƚ ŚĂĚ ĞǀĞƌ ďĞĞŶ ƚĞƐƚĞĚ͕ ĂŶĚ ŽŶůLJ ϲϮ͘Ϯ ƉĞƌĐĞŶƚ ŽĨ ƚŚŽƐĞ ǁŝƚŚ ,/sͲƌĞůĂƚĞĚ ƌŝƐŬ ďĞŚĂǀŝŽƌƐ ǁĞƌĞ ƚĞƐƚĞĚ͘ PubMed: ĚŽůĞƐĐĞŶƚ džƉĞƌŝĞŶĐĞƐ ŽĨ ^d/ ŽŵŵƵŶŝĐĂƟŽŶ ŝŶ WƌŝŵĂƌLJ ĂƌĞ ƌĞƉŽƌƚ ƐĂŝĚ ƚŚĂƚ ĞīĞĐƟǀĞ ĐůŝŶŝĐŝĂŶͲƉĂƟĞŶƚ ĐŽŵŵƵŶŝĐĂƟŽŶ ŝƐ ůŝŶŬĞĚ ǁŝƚŚ ƉŽƐŝƟǀĞ ƉĂƟĞŶƚ ŚĞĂůƚŚ ŽƵƚĐŽŵĞƐ ŝŶ ĂĚƵůƚƐ ĂŶĚ ĂĚŽůĞƐĐĞŶƚƐ͘ ĚŽůĞƐĐĞŶƚƐ ĞdžƉƌĞƐƐĞĚ ƚŚĞ ŶĞĞĚ ĨŽƌ ĐůŝŶŝĐŝĂŶƐ ƚŽ ĞŶŐĂŐĞ LJŽƵƚŚ ŝŶ ĐŚĂůůĞŶŐŝŶŐ ĐŽŶǀĞƌƐĂƟŽŶƐ ĂďŽƵƚ ƐĞdž ĂŶĚ ^d/Ɛ͕ ďƵƚ ĂůƐŽ ĚĞƐĐƌŝďĞĚ perceived judgment from clinicians.

Treatment guidelines ŚĂǀĞ ďĞĞŶ ŝƐƐƵĞĚ ďLJ ƚŚĞ ĂŶĚ h^ WƌĞǀĞŶƟǀĞ ^ĞƌǀŝĐĞƐ dĂƐŬ &ŽƌĐĞ ;h^W^d&Ϳ͘ dŚĞ ŐƵŝĚĞůŝŶĞƐ ĂƌĞ ĂǀĂŝůĂďůĞ ŝŶ ƉŽĐŬĞƚ ŐƵŝĚĞ͕ ǁĂůů ĐŚĂƌƚƐ ĂŶĚ WW ĨŽƌŵĂƚ͘ dŚĞ ŵĞƌŝĐĂŶ ĐĂĚĞŵLJ ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ŚĂƐ ĂůƐŽ ŝƐƐƵĞĚ ƚƌĞĂƚŵĞŶƚ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ͗ /ŶƚĞŶƐŝǀĞ ĞŚĂǀŝŽƌĂů ŽƵŶƐĞůŝŶŐ ĂƐ ƌĞĐŽŵŵĞŶĚĞĚ ďLJ ƚŚĞ h^W^d& ĨŽƌ ƐĞdžƵĂůůLJ ĂĐƟǀĞ ŝŶĚŝǀŝĚƵĂůƐ Ăƚ ŝŶĐƌĞĂƐĞĚ ƌŝƐŬ͘ dŚĞ h^W^d& ĨŽƵŶĚ ĞǀŝĚĞŶĐĞ ƚŚĂƚ ŝŶƚĞŶƐŝǀĞ ŝŶƚĞƌǀĞŶƟŽŶƐ ƌĞĚƵĐĞ ƌŝƐŬLJ ƐĞdžƵĂů ďĞŚĂǀŝŽƌƐ ĂŶĚ ŝŶĐƌĞĂƐĞ ƚŚĞ ůŝŬĞůŝŚŽŽĚ ŽĨ ĐŽŶĚŽŵ ƵƐĞ ĂŶĚ ŽƚŚĞƌ ƉƌŽƚĞĐƟǀĞ ƐĞdžƵĂů ƉƌĂĐƟĐĞƐ͘ • /ŶƚĞƌǀĞŶƟŽŶƐ ƌĂŶŐĞ ŝŶ ŝŶƚĞŶƐŝƚLJ ĨƌŽŵ ϯϬ ŵŝŶ ƚŽ Ϯ ŚŽƵƌƐ ĂŶĚ can be delivered through a primary care clinician or through ƌĞĨĞƌƌĂů ƚŽ Ă ƚƌĂŝŶĞĚ ďĞŚĂǀŝŽƌĂů ĐŽƵŶƐĞůŽƌ͘ dŚĞ ŝŶƚĞƌǀĞŶƟŽŶƐ ŝŶĐůƵĚĞ ƚĞĂĐŚŝŶŐ ƚŚĞ ďĂƐŝĐƐ ŽĨ ^d/Ɛ ĂŶĚ ƚƌĂŶƐŵŝƐƐŝŽŶ͕ ĂƐ ǁĞůů ĂƐ ƐŬŝůůƐ ŝŶ ĐŽŶĚŽŵ ƵƐĞ ĂŶĚ ĐŽŵŵƵŶŝĐĂƟŽŶ ǁŝƚŚ ƉĂƌƚŶĞƌƐ ĂŶĚ ĂƐƐĞƐƐŝŶŐ ŝŶĚŝǀŝĚƵĂůƐ͛ ƌŝƐŬƐ ŽĨ ƚƌĂŶƐŵŝƐƐŝŽŶ͘ džƉĞĚŝƚĞĚ WĂƌƚŶĞƌ dŚĞƌĂƉLJ ; WdͿ ŝƐ Ă ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ŽĨ ƚƌĞĂƟŶŐ ƐĞdž ƉĂƌƚŶĞƌƐ ŽĨ ƉĂƟĞŶƚƐ ǁŝƚŚ Ă ĚŝĂŐŶŽƐĞĚ ^d ǁŝƚŚŽƵƚ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌ ĮƌƐƚ ĞdžĂŵŝŶŝŶŐ ƚŚĞ ƉĂƌƚŶĞƌ͘ dŚĞ STD Treatment Guidelines ƌĞĐŽŵŵĞŶĚƐ ŽīĞƌŝŶŐ Wd ƚŽ ƉĂƟĞŶƚƐ ǁŝƚŚ ƉĂƌƚŶĞƌƐ ǁŚŽ ĂƌĞ ƵŶĂďůĞ Žƌ ƵŶůŝŬĞůLJ ƚŽ ĂĐĐĞƐƐ ƚƌĞĂƚŵĞŶƚ ŽŶ ƚŚĞŝƌ ŽǁŶ͘ • tŚŝůĞ Wd ŚĂƐ ďĞĞŶ ĂůůŽǁĂďůĞ ŝŶ ĂůŝĨŽƌŶŝĂ ƐŝŶĐĞ ϮϬϬϭ͕ ŝƚ ŝƐ ŶŽƚ Ă ĐŽǀĞƌĞĚ ďĞŶĞĮƚ ŽĨ &ĂŵŝůLJ WĂĐƚ ŽĨ DĞĚŝͲ Ăů ƉƌŽŐƌĂŵƐ͘ • WƌŽǀŝĚĞƌƐ ĐĂŶ ŐŝǀĞ ƉĂƟĞŶƚƐ Ă ǁƌŝƩĞŶ ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ Wd ƚŽ ďĞ ĮůůĞĚ Ăƚ ƚŚĞŝƌ ůŽĐĂů ƉŚĂƌŵĂĐLJ͘

Funding ŝƐ ĂůƐŽ ĂŶ ŝƐƐƵĞ ƚŽ ďĞ ĂĚĚƌĞƐƐĞĚ͘ dŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; ͕ ĂƐ ŝƚ ƐƚŽŽĚ ŝŶ ŵŝĚͲϮϬϭϴͿ ƌĞƋƵŝƌĞƐ ŵŽƐƚ ƉƌŝǀĂƚĞ ŚĞĂůƚŚ ŝŶƐƵƌĂŶĐĞ ƉůĂŶƐ ƚŽ ĐŽǀĞƌ ƌĞĐŽŵŵĞŶĚĞĚ ƉƌĞǀĞŶƟǀĞ ƐĞƌǀŝĐĞƐ ǁŝƚŚŽƵƚ ƉĂƟĞŶƚ ĐŽƐƚ ƐŚĂƌŝŶŐ͕ ŝŶĐůƵĚŝŶŐ ,/s ĂŶĚ ^d/ ĐŽƵŶƐĞůŝŶŐ ĂŶĚ ƐĐƌĞĞŶŝŶŐ͕ ǀĂĐĐŝŶĞƐ ĨŽƌ ,Ws ĂŶĚ ,ĞƉĂƟƟƐ ͘ DĞĚŝĐĂŝĚ ŝƐ ƚŚĞ ůĂƌŐĞƐƚ ƉƌŽǀŝĚĞƌ ŽĨ ,/s ƚƌĞĂƚŵĞŶƚ ĂŶĚ ĐĂƌĞ͕ ŝŶĐůƵĚŝŶŐ ĐŽǀĞƌĂŐĞ ĨŽƌ ^d/ ĐŽƵŶƐĞůŝŶŐ͕ ƐĐƌĞĞŶŝŶŐƐ >ŝŬĞ ŽƵƌ LJŽƵƚŚĨƵů ƉĂƟĞŶƚƐ͕ ŽƵƌ ƐĞŶŝŽƌƐ ŵĂLJ ŶŽƚ ďĞ ĂĐĐƵƐƚŽŵĞĚ ƚŽ ƵƐŝŶŐ ĂŶĚ ƉƌĞǀĞŶƟǀĞ ǀĂĐĐŝŶĂƟŽŶƐ͘ WƌĞƐŝĚĞŶƚ dƌƵŵƉ͛Ɛ &ŝƐĐĂů zĞĂƌ ϮϬϭϴ Ă ĐŽŶĚŽŵ Žƌ ĚŽŶ͛ƚ ƵƐĞ ŽŶĞ ďĞĐĂƵƐĞ ƚŚĞLJ ƚŚŝŶŬ ƚŚĞLJ Žƌ ƚŚĞŝƌ ƉĂƌƚŶĞƌƐ ƵĚŐĞƚ ĐƵƚ ĞƐƐĞŶƟĂů ĨƵŶĚŝŶŐ ĨŽƌ ƚŚĞ ƚƌĞĂƚŵĞŶƚ ĂŶĚ ƉƌĞǀĞŶƟŽŶ ŽĨ California Family Physician Summer 2019 ĐŽŶƟŶƵƚĞĚ ŽŶ ƉĂŐĞ ϭϴхх

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ĐŽŶƟŶƵƚĞĚ ĨƌŽŵ ƉĂŐĞ ϭϳ

,/sͬ / Ɛ ĂŶĚ ^d/Ɛ͕ ǁŝƚŚ ƐŝŐŶŝĮĐĂŶƚ ĐƵƚƐ ƚŽ ƚŚĞ ͛Ɛ ,/s ĂŶĚ ^d/ ƉƌĞǀĞŶƟŽŶ ƉƌŽŐƌĂŵƐ ĂŶĚ ŐƌĂŶƚƐ ƚŽ ĂůŝĨŽƌŶŝĂ ĞŶƟƟĞƐ͘ dŚĞ dƌƵŵƉ ĂĚŵŝŶŝƐƚƌĂƟŽŶ͛Ɛ ƌĞĐĞŶƚ ƉƌŽƉŽƐĞĚ ĐŚĂŶŐĞƐ ƚŽ dŝƚůĞ y ƐĞƌǀŝĐĞƐ ǁŝůů ĂůƐŽ ƵŶĚĞƌŵŝŶĞ ƚŚĞ ĐĂƌĞ ŽĨ ƉĂƟĞŶƚƐ Ăƚ ƌŝƐŬ Žƌ ǁŝƚŚ ^d/Ɛ͘

Ăůů ƚŽ ĐƟŽŶ CAFP’s CHOP and CCPD are calling on family ƉŚLJƐŝĐŝĂŶƐƚŽ ƚĂĐŬůĞ ƚŚŝƐ ƉƵďůŝĐ ŚĞĂůƚŚ ĐƌŝƐŝƐ͘ ^d/Ɛ ĂƌĞ ŵĂŶĂŐĞĂďůĞ ǁŝƚŚŝŶ ƚŚĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ƌĞĂůŵ͘ tŚŽ ďĞƩĞƌ ƚŽ ŝŶƚĞŐƌĂƚĞ ƚŚŝƐ ĐĂƌĞ ǁŝƚŚŝŶ ƚŚĞ ĨƵůů ƐƉĞĐƚƌƵŵ ŽĨ ĐĂƌĞ ƚŚĂŶ ĨĂŵŝůLJ

ƉŚLJƐŝĐŝĂŶƐ͍ dŚĞ ŐŽŽĚ ŶĞǁƐ ŝƐ ƚŚĂƚ &W ŝƐ ŚĞƌĞ ƚŽ ŚĞůƉ͘ tĞ͛ǀĞ ŝŶĐůƵĚĞĚ Ă ƐĞƌŝĞƐ ŽĨ ƉƌĂĐƟĐĞ ƚŽŽůƐ ŝŶĐůƵĚŝŶŐ ǀŝĚĞŽƐ͕ ůŝŶŬƐ ƚŽ ŐƵŝĚĞŬƐ͕ payment and coverage tables, resources and ƟƉƐ ƐŚĞĞƚƐ ŽŶ ŽƵƌ ǁĞďƐŝƚĞ͕ ŚƩƉ͗ͬ​ͬĨĂŵŝůLJĚŽĐƐ͘ ŽƌŐͬŵĞŵďĞƌƐͬƉƌĂĐƟĐĞͲƚŽŽůƐͬ͘ W^͗ ZĞĂĚ ƚŚĞ ƌĞƐƚ ŽĨ ƚŚĞ ĂƌƟĐůĞƐ ŝŶ ƚŚŝƐ ŝƐƐƵĞ͖ ŐŽ ƚŽ ƉĂŐĞ Ϯϴ͖ ĐŽŵƉůĞƚĞ ĂŶĚ ƌĞƚƵƌŶ ƚŚĞ D card to earn 3 AAFP Prescribed credits.

JOIN OUR TEAM AVAILABLE PROVIDER OPPORTUNITIES IN FAMILY MEDICINE • Salary based on experience • Sign on bonus and relocation assistance • 5 days of CME, $3,000 CME reimbursement and 10 paid holidays • Bonuses based on quality and productivity • Cap Exempt and Offering Visa Sponsorship • National Health Service Corps Scholar and Loan Repayment eligible • Many sites close to Yosemite National Park, San FrancǠsico Bay Area and Monterey • 37 sites located throughout California’s Central Valley and growing each year

TO DISCUSS CURRENT OPPORTUNITIES, CONTACT: Joshua Skunca Director of Medical Staff Services jskunca@gvhc.org Office: 209.384.6489 | Cell: 209.291.9750

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California Family Physician Summer 2019

Reference 1. Centers for Disease Control and WƌĞǀĞŶƚŝŽŶ͗ Ϯ͘ ^ĞdžƵĂůůLJ dƌĂŶƐŵŝƚƚĞĚ ŝƐĞĂƐĞ /ŶĨŽƌŵĂƚŝŽŶ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬ ƐƚĚͬĚƐƚĚƉͬ 3. ,ƵŵĂŶ /ŵŵƵŶŽĚĞĨŝĐŝĞŶĐLJ sŝƌƵƐ /ŶĨŽƌŵĂƚŝŽŶ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚŝǀͬ ϰ͘ ^ĞdžƵĂůůLJ dƌĂŶƐŵŝƚƚĞĚ ŝƐĞĂƐĞ &ĂĐƚ ^ŚĞĞƚƐ ĨŽƌ zŽƵƚŚ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ ŐŽǀͬƐƚĚͬ,ĞĂůƚŚ ŽŵŵͬĨĂĐƚͺƐŚĞĞƚƐ͘ htm 5. Reported STDs in the United States ϮϬϭϲ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŶĐŚŚƐƚƉͬ ŶĞǁƐƌŽŽŵͬĚŽĐƐͬĨĂĐƚƐŚĞĞƚƐͬ^d Ͳ dƌĞŶĚƐͲϱϬϴ͘ƉĚĨ ϲ͘ zŽƵƚŚ ZŝƐŬ ĞŚĂǀŝŽƌ ^ƵƌǀĞLJ ĂƚĂ ^ƵŵŵĂƌLJ ϮϬϬϳͲϮϬϭϳ ŚƚƚƉƐ͗ͬ​ͬ ǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚĞĂůƚŚLJLJŽƵƚŚͬĚĂƚĂͬ LJƌďƐͬƉĚĨͬƚƌĞŶĚƐƌĞƉŽƌƚ͘ƉĚĨ͍Ƶƚŵͺ ƐŽƵƌĐĞс^d dнEĞǁƐůĞƚƚĞƌƐΘƵƚŵͺ ĐĂŵƉĂŝŐŶсϱϵĞĂĂϯϭϮϳϵͲDZͺ KWzͺϬϭΘƵƚŵͺŵĞĚŝƵŵсĞŵĂŝůΘƵƚŵͺ ƚĞƌŵсϬͺϴĐĂďϭĚϳϵϲϭͲ ϱϵĞĂĂϯϭϮϳϵͲϭϱϬϳϬϵϲϳϳ 7. U.S. Department of Health and ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ͗ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ŚŚƐ͘ŐŽǀ ϴ͘ ŝdžďLJ ĞŶƚĞƌ ĨŽƌ 'ůŽďĂů ZĞƉƌŽĚƵĐƚŝǀĞ ,ĞĂůƚŚ͗ ŚƚƚƉƐ͗ͬ​ͬďŝdžďLJĐĞŶƚĞƌ͘ƵĐƐĨ͘ĞĚƵ ϵ͘ ,ĞĂůƚŚ ĂƌĞ͘'Žǀ͗ WƌĞǀĞŶƚŝǀĞ ĂƌĞ ďĞŶĞĨŝƚƐ ĨŽƌ ĚƵůƚƐ͗ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ ŚĞĂůƚŚĐĂƌĞ͘ŐŽǀͬƉƌĞǀĞŶƚŝǀĞͲĐĂƌĞͲ ĂĚƵůƚƐͬ ϭϬ͘ U.S. Preventive Services dĂƐŬ &ŽƌĐĞ͗ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ ƵƐƉƌĞǀĞŶƚŝǀĞƐĞƌǀŝĐĞƐƚĂƐŬĨŽƌĐĞ͘ŽƌŐ 11. American Academy of Family WŚLJƐŝĐŝĂŶƐ ; &WͿ͗ ^ĞdžƵĂůůLJ dƌĂŶƐŵŝƚƚĞĚ /ŶĨĞĐƚŝŽŶƐ ŽůůĞĐƚŝŽŶ͗ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĂĨƉͬ ƚŽƉŝĐDŽĚƵůĞƐͬǀŝĞǁdŽƉŝĐDŽĚƵůĞ͘ Śƚŵ͍ƚŽƉŝĐDŽĚƵůĞ/ĚсϮϯ

California Family Physician Summer 2019

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Ta c k l i n g S T I s

Scott Nass, MD, MPA, FAAFP, AAHIVS

Answering Questions about HIV Pre-Exposure Prophylaxis zŽƵƌ ƉĂƟĞŶƚ :ĂŵĞƐ ŝƐ Ă ϮϳͲLJĞĂƌͲŽůĚ ĐŝƐŐĞŶĚĞƌ ŵĂůĞ ǁŚŽ ƉƌĞƐĞŶƚƐ ĨŽƌ ŚŝƐ ĂŶŶƵĂů ǁĞůůŶĞƐƐ ǀŝƐŝƚ ĚƵƌŝŶŐ Ă ĚĂLJ Žī ĨƌŽŵ ŚŝƐ ũŽď ĂƐ Ă ĐŽŵƉƵƚĞƌ ƉƌŽŐƌĂŵŵĞƌ͘ tŚŝůĞ ƵƉĚĂƟŶŐ ŚŝƐ ƐŽĐŝĂů ŚŝƐƚŽƌLJ͕ LJŽƵ ůĞĂƌŶ ŚĞ ƌĞĐĞŶƚůLJ ŚĂƐ ĞŶĚĞĚ ŚŝƐ ƌĞůĂƟŽŶƐŚŝƉ ǁŝƚŚ ŚŝƐ ŵĂůĞ ƉĂƌƚŶĞƌ ŽĨ ĮǀĞ LJĞĂƌƐ͘ ͞ ŽĐƚŽƌ͕͟ ŚĞ ĂƐŬƐ͕ ͞ĚŽ LJŽƵ ƚŚŝŶŬ / ƐŚŽƵůĚ ŐŽ ŽŶ Wƌ W͍͟ :ĂŵĞƐ ŝƐ ĂƐŬŝŶŐ͕ ŽĨ ĐŽƵƌƐĞ͕ ĨŽƌ LJŽƵƌ ŐƵŝĚĂŶĐĞ ŽŶ ƚŚĞ ůĂƚĞƐƚ ,/s ƉƌĞǀĞŶƟŽŶ ƐƚƌĂƚĞŐLJ͕ ƚĞƌŵĞĚ WƌĞͲ džƉŽƐƵƌĞ WƌŽƉŚLJůĂdžŝƐ͕ Žƌ Wƌ W͘ Ɛ Ă ĐŽŶĐĞƉƚ͕ Wƌ W ŐĂŝŶĞĚ ŵŽŵĞŶƚƵŵ ŝŶ ϮϬϭϮ ǁŚĞŶ ƚŚĞ h^ &ŽŽĚ ĂŶĚ ƌƵŐ ĚŵŝŶŝƐƚƌĂƟŽŶ ĂƉƉƌŽǀĞĚ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů ĨƵŵĂƌĂƚĞ ;dƌƵǀĂĚĂͿ ĨƌŽŵ 'ŝůĞĂĚ ĂƐ ƚŚĞ ĮƌƐƚ ŵĞĚŝĐĂƟŽŶ ŝŶĚŝĐĂƚĞĚ ƚŽ ƌĞĚƵĐĞ ƚŚĞ ƌŝƐŬ ŽĨ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ,/sͲϭ ŝŶĨĞĐƟŽŶ ŝŶ ĂĚƵůƚƐ Ăƚ ŚŝŐŚ ƌŝƐŬ͕ ǁŚĞŶ ƵƐĞĚ ŝŶ ĐŽŵďŝŶĂƟŽŶ ǁŝƚŚ ƐĂĨĞƌ ƐĞdž ƉƌĂĐƟĐĞƐ͘ /Ŷ ƚŚĞ ĞĂƌůŝĞƐƚ ƐƚƵĚŝĞƐ ƌĞǀŝĞǁĞĚ ĨŽƌ ƚŚŝƐ ĚĞĐŝƐŝŽŶ͕ ĞŵƚƌŝĐŝƚĂďŝŶĞͬ ƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů ĨƵŵĂƌĂƚĞ ĚĞŵŽŶƐƚƌĂƚĞĚ ƐŝŐŶŝĮĐĂŶƚ ƌĞĚƵĐƟŽŶ ŝŶ ƌĂƚĞƐ ŽĨ ,/sͲϭ ĂĐƋƵŝƐŝƟŽŶ ĂŵŽŶŐ ŵĞŶ ǁŚŽ ŚĂǀĞ ƐĞdž ǁŝƚŚ ŵĞŶ͘ &ƵƌƚŚĞƌ ƐƚƵĚŝĞƐ ƐŚŽǁĞĚ ƐŝŵŝůĂƌ ƌĞĚƵĐƟŽŶƐ ĨŽƌ ,/sͲĚŝƐĐŽƌĚĂŶƚ ŽƉƉŽƐŝƚĞͲƐĞdž ƉĂƌƚŶĞƌƐ ĂƐ ǁĞůů ĂƐ ĨŽƌ ŝŶũĞĐƟŽŶ ĚƌƵŐ ƵƐĞƌƐ͘ ĂƌůLJ ƚƌŝĂůƐ ĨŽĐƵƐĞĚ ŽŶ ĞŶĐŽƵƌĂŐŝŶŐ ;ĂŶĚ ŵĞĂƐƵƌŝŶŐͿ ĂĚŚĞƌĞŶĐĞ ƚŽ ƚŚĞ ƵƐĞ ŽĨ ƚŚĞ ŽŶĐĞͲĚĂŝůLJ Ɖŝůů͘ WĂƟĞŶƚƐ ǁĞƌĞ ƐĞĞŶ Ăƚ ĨƌĞƋƵĞŶƚ ŝŶƚĞƌǀĂůƐ ĚƵƌŝŶŐ ĐůŝŶŝĐĂů ƚƌŝĂůƐ͕ Ăƚ ǁŚŝĐŚ ƟŵĞ ƚŚĞLJ ƌĞĐĞŝǀĞĚ ,/s ƉƌĞǀĞŶƟŽŶ ĐŽƵŶƐĞůŝŶŐ ĂŶĚ ǁĞƌĞ ƚĞƐƚĞĚ ;ĂŶĚ ƚƌĞĂƚĞĚ ǁŚĞŶ ŝŶĚŝĐĂƚĞĚͿ ĨŽƌ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶƐ͘ ŽŶƐŝƐƚĞŶƚůLJ͕ ĚĂƚĂ ĂŶĂůLJƐŝƐ ƌĞǀĞĂůĞĚ ƚŚĂƚ ƌĂƚĞƐ ŽĨ ,/s ƚƌĂŶƐŵŝƐƐŝŽŶ ǁĞƌĞ ůŽǁĞƌ ĨŽƌ ƉĂƌƟĐŝƉĂŶƚƐ ǁŝƚŚ ĚĞƚĞĐƚĂďůĞ ůĞǀĞůƐ ŽĨ ƚĞŶŽĨŽǀŝƌ ŝŶ ƚŚĞŝƌ ďůŽŽĚƐƚƌĞĂŵ͘ This consistency of outcomes led the US Public Health Service ŝŶ ϮϬϭϰ ƚŽ ŝƐƐƵĞ ŝƚƐ ĮƌƐƚ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ ĨŽƌ Wƌ W͘ϭ /ĚĞŶƟĨLJŝŶŐ ƉĂƟĞŶƚƐ Ăƚ ŚŝŐŚ ƌŝƐŬ ĨŽƌ ,/s ĂĐƋƵŝƐŝƟŽŶ ĂŶĚ ƉƌŽŵŽƟŶŐ ĂĚŚĞƌĞŶĐĞ ǁĞƌĞ ďŽƚŚ ŚŝŐŚůŝŐŚƚĞĚ ĂƐ ŬĞLJ ƚŽ ƌĞĚƵĐŝŶŐ ,/s ƚƌĂŶƐŵŝƐƐŝŽŶ ƌŝƐŬ͘ DŽƐƚ ƌĞĐĞŶƚůLJ ƌĞǀŝƐĞĚ ŝŶ DĂƌĐŚ ϮϬϭϴ͕ ƚŚĞ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ ŝƐ ĂǀĂŝůĂďůĞ ĨƌŽŵ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ ǁĞďƐŝƚĞ͘ /ƚ ŶŽƚĂďůLJ ŝŶĐůƵĚĞƐ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ among those in the intended audience.

:ĂŵĞƐ ůŝŬĞůLJ ŚĞĂƌĚ ŽĨ Wƌ W ĨƌŽŵ ĨƌŝĞŶĚƐ Žƌ ƐĞdžƵĂů ƉĂƌƚŶĞƌƐ͕ Žƌ ĨƌŽŵ ĐŽƵŶƚůĞƐƐ ŵĞŶƟŽŶƐ ŝŶ ŵĂƌŬĞƟŶŐ ĐĂŵƉĂŝŐŶƐ ƚĂƌŐĞƚĞĚ ƚŽǁĂƌĚ ƚŚĞ ŐĂLJ ĐŽŵŵƵŶŝƚLJ͘ DĂŶLJ ƉĂƟĞŶƚƐ ŝŶ ĨĂĐƚ ǁŝůů ĂƐŬ ĂďŽƵƚ ƚŚĞ ŵĞĚŝĐĂƟŽŶ ďLJ ďƌĂŶĚ ŶĂŵĞ͘ ZĞŐĂƌĚůĞƐƐ ŽĨ :ĂŵĞƐ͛Ɛ ƌĞůĂƟŽŶƐŚŝƉ ƐƚĂƚƵƐ͕ ƉĂƐƚ Žƌ ƉƌĞƐĞŶƚ͕ LJŽƵ ŶŽǁ ƐŚŽƵůĚ ĂƐƐĞƐƐ ŚŝƐ ƌŝƐŬƐ ĨŽƌ ,/s ĂĐƋƵŝƐŝƟŽŶ͘ ^ƉĞĐŝĮĐ ƚŽŽůƐ ĨŽƌ ĂƐƐĞƐƐŝŶŐ ŚŝƐ ƌŝƐŬ͕ ŝŶĐůƵĚŝŶŐ Ă ƐĐƌŝƉƚ ŽĨ ƋƵĞƐƟŽŶƐ ƚŽ ƵƐĞ͕ ĐĂŶ ďĞ ĨŽƵŶĚ ŝŶ ƚŚĞ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ͘ ^ĞůĞĐƚĞĚ ŵĂũŽƌ ƌŝƐŬ ĨĂĐƚŽƌƐ ĂƌĞ ƉƌĞƐĞŶƚĞĚ ŝŶ dĂďůĞ ϭ͖ ƚŚĞ ƉƌĞƐĞŶĐĞ ŽĨ ĂŶLJ ŽĨ ƚŚĞƐĞ 20

California Family Physician Summer 2019

ĨĂĐƚŽƌƐ ƐŚŽƵůĚ ƉƌŽŵƉƚ ĨƵƌƚŚĞƌ ƋƵĞƐƟŽŶŝŶŐ ĨŽƌ ƌŝƐŬ ƐƚƌĂƟĮĐĂƟŽŶ͘

/Ĩ :ĂŵĞƐ ŝƐ ŝĚĞŶƟĮĞĚ ĂƐ Ă ŐŽŽĚ ĐĂŶĚŝĚĂƚĞ ĨŽƌ Wƌ W͕ ŚĞ ŶĞdžƚ ƐŚŽƵůĚ ďĞ ƐĐƌĞĞŶĞĚ ĨŽƌ ,/s ŝŶĨĞĐƟŽŶ͘ dĂŬĞ ŶŽƚĞ͕ ĞǀĞŶ ŝĨ Ă ƉĂƟĞŶƚ ƌĞƉŽƌƚƐ Ă ƌĞĐĞŶƚ ŶĞŐĂƟǀĞ ,/s ƚĞƐƚ ƌĞƐƵůƚ ĂŶĚ ŶŽ ƌŝƐŬ ďĞŚĂǀŝŽƌƐ ŝŶ ƚŚĞ ŝŶƚĞƌŝŵ͕ Ă ŶĞŐĂƟǀĞ ,/s ƚĞƐƚ ŝƐ ƌĞƋƵŝƌĞĚ ǁŝƚŚŝŶ ϭϬ ĚĂLJƐ ƉƌŝŽƌ ƚŽ ŝŶŝƟĂƟŶŐ ƚŚĞƌĂƉLJ ŝŶ ŽƌĚĞƌ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ ĂŶ ,/s ŝŶĨĞĐƟŽŶ ŝƐ ŶŽƚ ƉĂƌƟĂůůLJ ƚƌĞĂƚĞĚ͘ ^ŝŶĐĞ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů ĂůƐŽ ŝƐ ƵƐĞĚ ŝŶ ĐŽŵďŝŶĂƟŽŶ ƚŚĞƌĂƉLJ ĨŽƌ ,ĞƉĂƟƟƐ ŝŶĨĞĐƟŽŶ͕ ŚŝƐ ŝŵŵƵŶĞ ƐƚĂƚƵƐ ŵƵƐƚ ďĞ ĞǀĂůƵĂƚĞĚ ĂƐ ǁĞůů͘ ĚĚŝƟŽŶĂůůLJ͕ ƐĞƌƵŵ ĐƌĞĂƟŶŝŶĞ ƐŚŽƵůĚ ďĞ ŵĞĂƐƵƌĞĚ ƚŽ ĂƐƐĞƐƐ ĨŽƌ ĚĞĐƌĞĂƐĞĚ ƌĞŶĂů ĨƵŶĐƟŽŶ ĚƵĞ ƚŽ ƚŚĞ ĂƐƐŽĐŝĂƟŽŶ ŽĨ ƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů ǁŝƚŚ ƌĞŶĂů ƚŽdžŝĐŝƚLJ͘ /ŶŝƟĂů ƐĐƌĞĞŶŝŶŐ ŐƵŝĚĞůŝŶĞƐ ĨŽƌ ŽƚŚĞƌ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶƐ ĂŶĚ ŚĞƉĂƟƟƐ ĂƌĞ ĂůƐŽ ŝŶĐůƵĚĞĚ ŝŶ ƚŚĞ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ͘ KŶĐĞ :ĂŵĞƐ ŝƐ ĐŽŶĮƌŵĞĚ ƚŽ ďĞ ,/s ŶĞŐĂƟǀĞ͕ ŚĞ ĐĂŶ ƌĞĐĞŝǀĞ ŚŝƐ ŝŶŝƟĂů ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ ϵϬ ĚĂLJƐ ŽĨ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů͘ EŽ ƌĞĮůůƐ ĂƌĞ ƉĞƌŵŝƩĞĚ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ :ĂŵĞƐ ƌĞƚƵƌŶƐ ǁŝƚŚŝŶ ϵϬ ĚĂLJƐ ĨŽƌ ƌĞƉĞĂƚ ƐĐƌĞĞŶŝŶŐ ĨŽƌ ,/s͖ ĂƐ ǁŝƚŚ ƚŚĞ ŝŶŝƟĂů ƉƌĞƐĐƌŝƉƟŽŶ͕ Ă ŶĞŐĂƟǀĞ ,/s ƚĞƐƚ ŝƐ ƌĞƋƵŝƌĞĚ ǁŝƚŚŝŶ ϭϬ ĚĂLJƐ ƉƌŝŽƌ ƚŽ Ă ƌĞŶĞǁĂů ƉƌĞƐĐƌŝƉƟŽŶ͘ ƚ ĞĂĐŚ ĨŽůůŽǁ ƵƉ͕ ĂƐƐĞƐƐ ƌŝƐŬ ĨĂĐƚŽƌƐ ĨŽƌ ,/s ĂĐƋƵŝƐŝƟŽŶ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ Wƌ W ƌĞŵĂŝŶƐ ĂƉƉƌŽƉƌŝĂƚĞ͕ ĐŽƵŶƐĞů ŽŶ ƐĂĨĞƌ ƐĞdž ƉƌĂĐƟĐĞƐ͕ ĂŶĚ ƐĐƌĞĞŶ ĨŽƌ ĂŶĚ ƚƌĞĂƚ ŽƚŚĞƌ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶƐ͘ DĞĂƐƵƌĞ ƐĞƌƵŵ ĐƌĞĂƟŶŝŶĞ ĞǀĞƌLJ Ɛŝdž ŵŽŶƚŚƐ ǁŚŝůĞ ŚĞ ƌĞŵĂŝŶƐ ŽŶ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů ĨŽƌ Wƌ W͘ /Ĩ ŝŶ ƚŚĞ ĨƵƚƵƌĞ :ĂŵĞƐ ŝƐ ŶŽ ůŽŶŐĞƌ Ă ĐĂŶĚŝĚĂƚĞ ĨŽƌ ŽŶŐŽŝŶŐ Wƌ W͕ ŵĞĚŝĐĂƟŽŶ ƐŝŵƉůLJ ĐĂŶ ďĞ ĚŝƐĐŽŶƟŶƵĞĚ͕ ĂŶĚ ĂŶLJ ƌĞŵĂŝŶŝŶŐ ƉŝůůƐ should be disposed of.

h^W^d&͛Ɛ :ƵŶĞ ϮϬϭϵ ƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐ ĨŽƌ ƉƌĞĞdžƉŽƐƵƌĞ ƉƌŽƉŚLJůĂdžŝƐ ;Wƌ WͿ ĨŽƌ ƚŚĞ ƉƌĞǀĞŶƚŝŽŶ ŽĨ ,/s ŝŶĨĞĐƚŝŽŶ ŶŽǁ >ĞǀĞů ĞǀŝĚĞŶĐĞ͘ ŚƚƚƉƐ͗ͬ​ͬũĂŵĂŶĞƚǁŽƌŬ͘ĐŽŵͬũŽƵƌŶĂůƐͬ ũĂŵĂͬĨƵůůĂƌƚŝĐůĞͬϮϳϯϱϱϬϵ

&Žƌ ŶŽǁ͕ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů ;dƌƵǀĂĚĂͿ ƌĞŵĂŝŶƐ ƚŚĞ ŽŶůLJ ŵĞĚŝĐĂƟŽŶ ŝŶĚŝĐĂƚĞĚ ĨŽƌ ƵƐĞ ǁŝƚŚ Ă Wƌ W ƌĞŐŝŵĞŶ͘ ,ŽǁĞǀĞƌ͕ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĂůĂĨĞŶĂŵŝĚĞ ; ĞƐĐŽǀLJͿ ŚĂƐ ďĞĞŶ ƐŚŽǁŶ ŝŶ ƌĞĐĞŶƚ ƚƌŝĂůƐ ƚŽ ďĞ ŶŽŶͲŝŶĨĞƌŝŽƌ ƚŽ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů͕ ĂŶĚ 'ŝůĞĂĚ ŚĂƐ ƐƵďŵŝƩĞĚ ĂŶ ĂƉƉůŝĐĂƟŽŶ ĨŽƌ Ă Wƌ W ŝŶĚŝĐĂƟŽŶ͘ KƚŚĞƌ ŝŶŶŽǀĂƟŽŶƐ ĂůƐŽ ĂƌĞ ŝŶ ƚŚĞ ƉŝƉĞůŝŶĞ͕ ŝŶĐůƵĚŝŶŐ ůŽŶŐͲĂĐƟŶŐ ŝŶũĞĐƚĂďůĞ ĂŶĚ ŝŵƉůĂŶƚĂďůĞ ĨŽƌŵƵůĂƟŽŶƐ͘

ZĞĂĚLJ ƚŽ ƉƌŽǀŝĚĞ Wƌ W ƚŽ LJŽƵƌ ƉĂƟĞŶƚƐ Ăƚ ŝŶĐƌĞĂƐĞĚ ƌŝƐŬ ĨŽƌ ĂĐƋƵŝƌŝŶŐ ,/s͍ EŽ ƐƉĞĐŝĂů ƚƌĂŝŶŝŶŐ ŝƐ ƌĞƋƵŝƌĞĚ͘ :ƵƐƚ ĨŽůůŽǁ ƚŚĞ ůĂƚĞƐƚ ůŝŶŝĐĂů WƌĂĐƟĐĞ 'ƵŝĚĞůŝŶĞ ĂŶĚ ŐĞƚ ƐƚĂƌƚĞĚ ƚŽĚĂLJ͘

ƌ͘ ^ĐŽƩ EĂƐƐ ŝƐ ƚŚĞ ƉƌŽŐƌĂŵ ĚŝƌĞĐƚŽƌ Ăƚ ƚŚĞ ŝƐĞŶŚŽǁĞƌ DĞĚŝĐĂů Center Family Medicine Residency Program.

Reference ϭ͘ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ͗ h^ WƵďůŝĐ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ͗ WƌĞĞdžƉŽƐƵƌĞ ƉƌŽƉŚLJůĂdžŝƐ ĨŽƌ ƚŚĞ ƉƌĞǀĞŶƟŽŶ ŽĨ ,/s ŝŶĨĞĐƟŽŶ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐͶϮϬϭϳ hƉĚĂƚĞ͗ Ă ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ŐƵŝĚĞůŝŶĞ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚŝǀͬƉĚĨͬƌŝƐŬͬƉƌĞƉͬĐĚĐͲŚŝǀͲƉƌĞƉͲ ŐƵŝĚĞůŝŶĞƐͲϮϬϭϳ͘ƉĚĨ͘ WƵďůŝƐŚĞĚ DĂƌĐŚ ϮϬϭϴ͘

Need a little more help to get started? Ăůů ƚŚĞ EĂƟŽŶĂů ůŝŶŝĐŝĂŶƐ ŽŶƐƵůƚĂƟŽŶ ĞŶƚĞƌ Wƌ WůŝŶĞ Ăƚ ϴϱϱͲϰϰϴͲϳϳϯϳ Žƌ ǀŝƐŝƚ ƚŚĞŝƌ ǁĞďƐŝƚĞ Ăƚ ŚƩƉ͗ͬ​ͬŶĐĐĐ͘ƵĐƐĨ͘ĞĚƵͬĐůŝŶŝĐŝĂŶͲĐŽŶƐƵůƚĂƟŽŶͬƉƌĞƉͲƉƌĞͲĞdžƉŽƐƵƌĞͲƉƌŽƉŚLJůĂdžŝƐͬ͘ >ĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ďĞŶĞĮƚƐ ĂŶĚ ƌŝƐŬƐ ŽĨ ĞŵƚƌŝĐŝƚĂďŝŶĞͬƚĞŶŽĨŽǀŝƌ ĚŝƐŽƉƌŽdžŝů Ăƚ ƚŚĞ ŵĂŶƵĨĂĐƚƵƌĞƌ͛Ɛ ZŝƐŬ ǀĂůƵĂƟŽŶ ĂŶĚ DŝƟŐĂƟŽŶ ^ƚƌĂƚĞŐLJ ;Z D^Ϳ ƐŝƚĞ Ăƚ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ŌĐͲƚĚĨͲƉƌĞƉƌĞŵƐ͘ĐŽŵͬ͘

California Family Physician Summer 2019

21

Ta c k l i n g S T I s

Ina Park, MD

Strange Bedfellows: Adventures in sex and its least intended consequences LJ ƚŚĞ ƟŵĞ LJŽƵ͛ǀĞ ĮŶŝƐŚĞĚ ƌĞĂĚŝŶŐ ƚŚŝƐ ƐĞŶƚĞŶĐĞ͕ ϭϬϬ ƉĞŽƉůĞ ǁŽƌůĚǁŝĚĞ ǁŝůů ďĞ ŝŶĨĞĐƚĞĚ ǁŝƚŚ Ă ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶ ;^d/Ϳ͘ LJ ƚŚŝƐ ƟŵĞ ƚŽŵŽƌƌŽǁ͕ ƚŚĞ tŽƌůĚ ,ĞĂůƚŚ KƌŐĂŶŝnjĂƟŽŶ ĞƐƟŵĂƚĞƐ ƚŚĂƚ ŽŶĞ ŵŝůůŝŽŶ ŽƚŚĞƌƐ ǁŝůů ĨŽůůŽǁ ƐƵŝƚ͘ ĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ ; Ϳ͕ ϮϬ ŵŝůůŝŽŶ ŶĞǁ ĐĂƐĞƐ ŽĨ ^d/Ɛ ĂŶĚ ,/s ĂƌĞ ŝĚĞŶƟĮĞĚ ƉĞƌ LJĞĂƌ ŝŶ ƚŚĞ h^͕ ĂŶĚ ŵŽƌĞ ƚŚĂŶ ŚĂůĨ ŽĨ ŵĞƌŝĐĂŶƐ ĐŽŶƚƌĂĐƚ Ă ^d/ ďLJ ĂŐĞ Ϯϱ͘ ůƚŚŽƵŐŚ ƚŚĞ ŶĞĂƌ ƵďŝƋƵŝƚLJ ŽĨ ^d/Ɛ ŝƐ ƐƵƌƉƌŝƐŝŶŐ͕ ĞǀĞŶ ŵŽƌĞ ƉƵnjnjůŝŶŐ ŝƐ ŽƵƌ ŝŶĂďŝůŝƚLJ ƚŽ ĚŝƐĐƵƐƐ ƚŚĞŵ ŽƉĞŶůLJ͘ ^ŽŵĞŚŽǁ ŚĂǀŝŶŐ ƐĞdž ŝƐ ŝŶĮŶŝƚĞůLJ ĞĂƐŝĞƌ ƚŚĂŶ ƚĂůŬŝŶŐ ĂďŽƵƚ ƐĞdž͕ ĞƐƉĞĐŝĂůůLJ ŝƚƐ ůĞĂƐƚ ƉůĞĂƐĂŶƚ ĐŽŶƐĞƋƵĞŶĐĞƐ͘

ƚŚĞ ĐŽŶƚĞdžƚ ŽĨ ƚŚĞ ƐŽĐŝĂů ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ ŝŶ ƚŚĞŝƌ ůŝǀĞƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ͘

With STD rates reaching historic highs in the United States, my ŝŶƚĞƌĞƐƚƐ ŚĂǀĞ ƌĞĐĞŶƚůLJ ƐŚŝŌĞĚ ƚŽǁĂƌĚ ĞĚƵĐĂƟŶŐ ƚŚĞ ƉƵďůŝĐ ĂďŽƵƚ ^d/Ɛ ĂŶĚ ƚŚĞŝƌ ƉůĂĐĞ ŝŶ ƐŽĐŝĞƚLJ͕ ŝŶ ƚŚĞ ĂƌĞĂƐ ŽĨ ƌĞƐĞĂƌĐŚ͕ ŚŝƐƚŽƌLJ͕ ƐŽĐŝĂů ƐĐŝĞŶĐĞ͕ ĞǀĞŶ ƉŽƉ ĐƵůƚƵƌĞ͘ dŽ ƚŚĂƚ ĞŶĚ /͛ǀĞ ǁƌŝƩĞŶ à Ŭ ĞŶƟƚůĞĚ STRANGE BEDFELLOWS͗ ĚǀĞŶƚƵƌĞƐ ŝŶ ƐĞdž ĂŶĚ ŝƚƐ ůĞĂƐƚ ŝŶƚĞŶĚĞĚ ĐŽŶƐĞƋƵĞŶĐĞƐ ;&ůĂƟƌŽŶ ŽŽŬƐ͕ ^ƉƌŝŶŐ ϮϬϮϬͿ͘ /Ŷ ŝƚ / ĞŵƉůŽLJ ƐƚŽƌLJƚĞůůŝŶŐ͕ ŚƵŵŽƌ ĂŶĚ ŝŶͲĚĞƉƚŚ ŝŶƚĞƌǀŝĞǁƐ ǁŝƚŚ ƐĐŝĞŶƟƐƚƐ ƚŽ ĞĚƵĐĂƚĞ ƚŚĞ public on the latest trends and ĚĞǀĞůŽƉŵĞŶƚƐ ŝŶ ƚŚĞ ĮĞůĚ ŽĨ ^d/ͬ,/s ƉƌĞǀĞŶƟŽŶ͘ DŽƐƚ ŽĨ Ăůů͕ / ŚŽƉĞ ƚŚĂƚ ďLJ ĞŶĐŽƵƌĂŐŝŶŐ Society has managed to defeat ĐŽŶǀĞƌƐĂƟŽŶ ĂďŽƵƚ ƚŚĞ ƚŽƉŝĐ͕ stigma surrounding other ǁĞ ĐĂŶ ǁŽƌŬ ŽŶ ƌĞĚƵĐŝŶŐ ƚŚĞ ĞŶŽƌŵŽƵƐ ƐƟŐŵĂ ƚŚĂƚ ƐƟůů previously taboo subjects such ĞdžŝƐƚƐ ĂƌŽƵŶĚ ƚŚĞƐĞ ŝŶĨĞĐƟŽŶƐ͘

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While dressed as a giant condom as a pre-med ƐƚƵĚĞŶƚ Ăƚ h ĞƌŬĞůĞLJ͕ / ƌĞĂůŝnjĞĚ ƚŚĂƚ / ǁĂƐ ǁŝůůŝŶŐ to push boundaries to ĞŵƉŽǁĞƌ ĂŶĚ ŝŶĨŽƌŵ ŽƚŚĞƌƐ ĂďŽƵƚ ƐĞdžƵĂů ŚĞĂůƚŚ ĂŶĚ ^d/Ɛͬ,/s͘ / as cancer, creating discourse and ƐƉĞŶƚ ƚǁŽ ǁŽŶĚĞƌĨƵů LJĞĂƌƐ ĂƐ Ă ƐĞdžƵĂů ŚĞĂůƚŚ Society has managed to defeat shifting public sentiment towards peer educator during ƐƟŐŵĂ ƐƵƌƌŽƵŶĚŝŶŐ ŽƚŚĞƌ support rather than shame. my undergraduate previously taboo subjects such ƚƌĂŝŶŝŶŐ͗ ĚŝƐƚƌŝďƵƟŶŐ ĂƐ ĐĂŶĐĞƌ͕ ĐƌĞĂƟŶŐ ĚŝƐĐŽƵƌƐĞ condoms, lecturing in ĂŶĚ ƐŚŝŌŝŶŐ ƉƵďůŝĐ ƐĞŶƟŵĞŶƚ the community and ƚŽǁĂƌĚ ƐƵƉƉŽƌƚ ƌĂƚŚĞƌ ƚŚĂŶ ĐŽƵŶƐĞůŝŶŐ ƐƚƵĚĞŶƚƐ ĂŌĞƌ Ă ^d/ ĚŝĂŐŶŽƐŝƐ͘ dŚĞƌĞ ǁĂƐ ƐŽŵĞƚŚŝŶŐ ƐŚĂŵĞ͘ tĞ ŶĞĞĚ Ă ƐŝŵŝůĂƌ ƐĞĂ ĐŚĂŶŐĞ ĂƌŽƵŶĚ ^d/Ɛͬ,/s ƚŽ ŚĂǀĞ ĂŶLJ ƉŽǁĞƌĨƵů ŝŶ ƐŝŵƉůLJ ƐŝƫŶŐ ĂŶĚ ƚĂůŬŝŶŐ ǁŝƚŚ ƐŽŵĞŽŶĞ ĚƵƌŝŶŐ Ă hope of curbing the current epidemic. As a family physician and ǀƵůŶĞƌĂďůĞ ŵŽŵĞŶƚ͕ ŬŶŽǁŝŶŐ ƚŚĂƚ / ŵŝŐŚƚ ďƌŝŶŐ ƚŚĞŵ ĐŽŵĨŽƌƚ ĂŶĚ ŵĞĚŝĐĂů ĞƉŝĚĞŵŝŽůŽŐŝƐƚ͕ /͛ŵ ĞdžĐŝƚĞĚ ĂŶĚ ƉƌŽƵĚ ƚŽ ďĞ Ă ĐĂƚĂůLJƐƚ ĨŽƌ ƌĞĚƵĐĞ ƚŚĞ ƐƟŐŵĂ ŽĨ ďĞŝŶŐ ĨĂĐĞĚ ǁŝƚŚ ĂŶ ^d/͘ / ŐƌĂĚƵĂƚĞĚ ŬŶŽǁŝŶŐ this change. ƚŚĂƚ ĞŵƉŽǁĞƌŝŶŐ ŽƚŚĞƌƐ ĂďŽƵƚ ^d/ ƉƌĞǀĞŶƟŽŶ ǁĂƐ Ă ƉĂƐƐŝŽŶ ƚŚĂƚ ǁŽƵůĚ ĞŶĚƵƌĞ ƚŚƌŽƵŐŚŽƵƚ ŵLJ ŵĞĚŝĐĂů ĐĂƌĞĞƌ͘ Dr. Ina Park is an Associate Professor in the Department of Family and Community Medicine at the University of California San EŽǁ ĂƐ Ă ƉƵďůŝĐ ŚĞĂůƚŚ ƉƌĂĐƟƟŽŶĞƌ ŝŶ ƚŚĞ ĮĞůĚ ŽĨ ^d/ͬ,/s Francisco School of Medicine. She also serves as the Medical ƉƌĞǀĞŶƟŽŶ͕ / ůŝǀĞ ŽƵƚ ŵLJ ƉĂƐƐŝŽŶ ĨŽƌ ƐĞdžƵĂů ŚĞĂůƚŚ ĚĂŝůLJ ŝƌĞĐƚŽƌ ŽĨ ƚŚĞ ĂůŝĨŽƌŶŝĂ WƌĞǀĞŶƟŽŶ dƌĂŝŶŝŶŐ ĞŶƚĞƌ ĂŶĚ Ă ƚŚƌŽƵŐŚ ŵLJ ƌĞƐĞĂƌĐŚ͕ ƚĞĂĐŚŝŶŐ ĂŶĚ ƉĂƟĞŶƚ ĐĂƌĞ͘ /Ŷ ĂŶLJ ŐŝǀĞŶ ǁĞĞŬ͕ Medical Consultant for the Centers for Disease Control, Division ŵLJ ũŽď ƌƵŶƐ ƚŚĞ ŐĂŵƵƚ ĨƌŽŵ ĐĂƌŝŶŐ ĨŽƌ ŝŶĚŝǀŝĚƵĂů ƉĂƟĞŶƚƐ͕ ƚƌĂŝŶŝŶŐ ŽĨ ^d WƌĞǀĞŶƟŽŶ͘ ,Ğƌ ƌĞƐĞĂƌĐŚ ŝŶƚĞƌĞƐƚƐ ŝŶĐůƵĚĞ ĞǀĂůƵĂƟŶŐ ƚŚĞ ŽƚŚĞƌ ĐůŝŶŝĐŝĂŶƐ͕ ǁŽƌŬŝŶŐ ŽŶ ƉƌĂĐƟĐĞͲůĞǀĞů ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ ƉŽƉƵůĂƟŽŶͲůĞǀĞů ŝŵƉĂĐƚ ŽĨ ,Ws ǀĂĐĐŝŶĂƟŽŶ ĂŶĚ ŶŽǀĞů ĚŝĂŐŶŽƐƟĐ ĂŶĚ ĚĞǀĞůŽƉŝŶŐ ƉŽƉƵůĂƟŽŶͲůĞǀĞů ŐƵŝĚĞůŝŶĞƐ͘ DLJ ƚƌĂŝŶŝŶŐ ŝŶ ĨĂŵŝůLJ ƚĞƐƚƐ ĨŽƌ ƐLJƉŚŝůŝƐ͘ tŚĞŶ ƐŚĞ ŝƐŶ͛ƚ ǁŽƌŬŝŶŐ͕ ƐŚĞ͛Ɛ ĐŚĂƐŝŶŐ ĂŌĞƌ ŵĞĚŝĐŝŶĞ ǁĂƐ ƚŚĞ ƉĞƌĨĞĐƚ ƐƉƌŝŶŐďŽĂƌĚ ŝŶƚŽ ŵLJ ĐƵƌƌĞŶƚ ĐĂƌĞĞƌ͖ ƚǁŽ ƌĂŵďƵŶĐƟŽƵƐ ďŽLJƐ͕ ƉƌĂĐƟĐŝŶŐ LJŽŐĂ͕ ĂŶĚ ŚƵŶƟŶŐ ĨŽƌ ŐŽŽĚ ŽƵƌ ƐƉĞĐŝĂůƚLJ ŝƐ ƵŶŝƋƵĞ ŝŶ ŝƚƐ ĨŽĐƵƐ ŽŶ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ƉĂƟĞŶƚ ŝŶ ethnic food.

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California Family Physician Summer 2019

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Call us at 781-829-9696 California Family Physician Summer 2019

23

Ta c k l i n g S T I s

Robert Assibey, MD

To Be Syphilis Free, It’s Best to Do Three ƌŝƐĞ ŝŶ ƉƌĞŶĂƚĂů ĂŶĚ ĐŽŶŐĞŶŝƚĂů ƐLJƉŚŝůŝƐ ͙ ^LJƉŚŝůŝƐ ŝƐ Ă ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƚƚĞĚ ŝŶĨĞĐƚŝŽŶ ;^d/Ϳ ĐĂƵƐĞĚ ďLJ ƚŚĞ spirochete Treponema pallidum͖ ĚƵƌŝŶŐ ƉƌĞŐŶĂŶĐLJ ŝƚ ĐĂƵƐĞƐ significant concern because infection can be transferred to the fetus via the placenta. Congenital syphilis can cause ŵŝƐĐĂƌƌŝĂŐĞ͕ ƉƌĞŵĂƚƵƌĞ ďŝƌƚŚ͕ ůŽǁ ďŝƌƚŚǁĞŝŐŚƚ͕ ďŝƌƚŚ ĚĞĨĞĐƚƐ͕ blindness, hearing loss, lifelong physical and mental health problems, and even death.

WĞƌ ƚŚĞ ĞŶƚĞƌ ŽĨ ŝƐĞĂƐĞ ŽŶƚƌŽů ; Ϳ͕ ƌĞƉŽƌƚĞĚ ĐĂƐĞƐ ŽĨ syphilis have more than doubled during the four-year period ďĞƚǁĞĞŶ ϮϬϭϯ ĂŶĚ ϮϬϭϳ͕ ƌĞĂĐŚŝŶŐ Ă ϮϬͲLJĞĂƌ ŚŝŐŚ͘ dŚĞ majority of the cases have been reported in the Western and ^ŽƵƚŚĞƌŶ ƐƚĂƚĞƐ͕ ĂŶĚ / ŚĂǀĞ ǁŝƚŶĞƐƐĞĚ Ă ůĂƌŐĞ ŝŶĐƌĞĂƐĞ ŝŶ ŵLJ ŽǁŶ ĐŽŵŵƵŶŝƚLJ ŝŶ ƚŚĞ ^ĂŶ :ŽĂƋƵŝŶ ŽƵŶƚLJ͘ ^LJƉŚŝůŝƐ ƌĂƚĞƐ ŚĂǀĞ ŽƵƚƉĂĐĞĚ ƚŚĞ ŶĂƚŝŽŶĂů ŝŶĐƌĞĂƐĞƐ ŝŶ ^d/Ɛ ŽǀĞƌĂůů͘ dŚĞ ĐƵƌƌĞŶƚůLJ ƌĞĐŽŵŵĞŶĚƐ Ăůů ƉƌĞŐŶĂŶƚ ǁŽŵĞŶ ďĞ ƚĞƐƚĞĚ for syphilis at the first prenatal appointment. Due to the labile nature of prenatal syphilis, CDC has various state-based ƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐ ĂƐ ǁĞůů͘ dŚŽƐĞ ǁŽŵĞŶ ǁŚŽ ĂƌĞ ĞƐƉĞĐŝĂůůLJ ŚŝŐŚ ƌŝƐŬ ĂŶĚ ůŝǀĞ ŝŶ ŚŝŐŚ ƉƌĞǀĂůĞŶĐĞ ĂƌĞĂƐ͕ ƐŚŽƵůĚ ďĞ ƚĞƐƚĞĚ Ă second time during the early third trimester, and some even Ăƚ ĚĞůŝǀĞƌLJ͘ /Ŷ ĂůŝĨŽƌŶŝĂ͕ ƚŚĞ ĐƵƌƌĞŶƚ ƌĞƋƵŝƌĞŵĞŶƚ ŝƐ ƚŽ ƐĐƌĞĞŶ at the first prenatal visit only. The question becomes, is that ĞŶŽƵŐŚ ƚŽ ĂƉƉƌŽƉƌŝĂƚĞůLJ ƐĐƌĞĞŶ ĂŶĚ ƚƌĞĂƚ ŽƵƌ ƉĂƚŝĞŶƚƐ͍ ,ĞƌĞ ŝŶ ƚŚĞ ^ĂŶ :ŽĂƋƵŝŶ ŽƵŶƚLJ ǁĞ ůŝǀĞ ŝŶ Ă ǀĞƌLJ ŚŝŐŚ ƉƌĞǀĂůĞŶĐĞ ĂƌĞĂ͕ ĂŶĚ ďĞĐĂƵƐĞ ŽĨ ƚŚĂƚ ŽƵƌ ŽǁŶ ƉƌĞŶĂƚĂů ĐůŝŶŝĐ ƐĐƌĞĞŶƐ ĨŽƌ ƉƌĞŶĂƚĂů ƐLJƉŚŝůŝƐ ƚŚƌĞĞ ƚŝŵĞƐ ĚƵƌŝŶŐ ĞǀĞƌLJ ƉƌĞŐŶĂŶĐLJ͗ ŽŶĐĞ ŽŶ ŝŶŝƚŝĂů ǀŝƐŝƚ͕ ƐĞĐŽŶĚ ŝŶ ƚŚĞ ĞĂƌůLJ ƚŚŝƌĚ ƚƌŝŵĞƐƚĞƌ ĂŶĚ ƚŚŝƌĚ ǁŚĞŶ patient presents for delivery. We have seen a significant increase in the number of prenatal syphilis cases over the years and have treated multiple babies for congenital syphilis. tŚŝůĞ ǁĞ ƐĞĞ Ă ƐƵďƐƚĂŶƚŝĂů ŝŶĐƌĞĂƐĞ ƉƌĞŶĂƚĂů ƐLJƉŚŝůŝƐ ĐĂƐĞƐ ŶĂƚŝŽŶĂůůLJ͕ ǁĞ ƐĞĞ ŝƚ ĞǀĞŶ ŵŽƌĞ ƐŽ ŝŶ ĂůŝĨŽƌŶŝĂ͘ /Ŷ ϮϬϭϳ͕ Ϯϴϯ ĐĂƐĞƐ ŽĨ ĐŽŶŐĞŶŝƚĂů ƐLJƉŚŝůŝƐ ǁĞƌĞ ƌĞƉŽƌƚĞĚ͕ ŝŶĐůƵĚŝŶŐ ϯϬ ƐƚŝůůďŝƌƚŚƐ ŝŶ ĂůŝĨŽƌŶŝĂ ĂůŽŶĞ͘ &Žƌ ĐŽŵƉĂƌŝƐŽŶ͕ ŽŶůLJ ϯϯ ƌĞƉŽƌƚĞĚ ĐĂƐĞƐ ŝŶ ϮϬϭϮ͘ /ƚ ŚĂƐ ďĞĞŶ ŶŽƚĞĚ ƚŚĂƚ ƚŚĞ ĞŶƚƌĂů sĂůůĞLJ ŚĂƐ Ă ƐŝŐŶŝĨŝĐĂŶƚ ŶƵŵďĞƌ ŽĨ ƌĞƉŽƌƚĞĚ ĐŽŶŐĞŶŝƚĂů ƐLJƉŚŝůŝƐ ĐĂƐĞƐ ͙ ƚŚŽƐĞ ƐĂŵĞ ĞŶƚƌĂů sĂůůĞLJ ĐŽƵŶƚŝĞƐ ĂůƐŽ ĂƉƉĞĂƌ ƚŽ have high rates of homelessness, poverty and substance abuse. An active syphilis infection is easily screened and 24

California Family Physician Summer 2019

ƚƌĞĂƚĂďůĞ͕ ǁŚĞŶ ƉĂƚŝĞŶƚ ŝƐ ƚƌĞĂƚĞĚ ǁŝƚŚ ƚŚĞ ĐŽƌƌĞĐƚ ĂŶƚŝďŝŽƚŝĐƐ͕ and per the appropriate timeline.

A caution should be noted for false positive testing, as it is more common in pregnancy. A confirmatory test should be ƉĞƌĨŽƌŵĞĚ ĂĨƚĞƌ Ă ƉŽƐŝƚŝǀĞ ƐĐƌĞĞŶŝŶŐ ƚĞƐƚ͘ WƌĞŐŶĂŶƚ ǁŽŵĞŶ ŵĂLJ ďĞ ĂƐLJŵƉƚŽŵĂƚŝĐ ǁŚĞŶ ƚŚĞLJ ƉƌĞƐĞŶƚ ĨŽƌ ƉƌĞŶĂƚĂů appointments, but that should not deter from appropriate ƐĐƌĞĞŶŝŶŐ͘ /ƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ŶŽƚĞ ƚŚĂƚ ŽŶĐĞ Ă ƐĐƌĞĞŶŝŶŐ ƚĞƐƚ ŝƐ

appropriately positive, all future testing ǁŝůů ĂůƐŽ ďĞ ƉŽƐŝƚŝǀĞ͘ dŚŽƐĞ ƉĂƚŝĞŶƚƐ ǁŽƵůĚ ŶĞĞĚ ĐŽŶĨŝƌŵĂƚŽƌLJ ƚĞƐƚŝŶŐ ƚŽ evaluate for active infection and for titers. tŝƚŚ ƚŚĂƚ ďĞŝŶŐ ƐĂŝĚ͕ ǁŚĞƌĞ ĚŽ ǁĞ ŐŽ ĨƌŽŵ ŚĞƌĞ͍ ^d/Ɛ ŝŶ ŐĞŶĞƌĂů ŚĂǀĞ ďĞĐŽŵĞ a significant problem in the nation, and ŝŶ ĂůŝĨŽƌŶŝĂ͘ EŽƚ ŽŶůLJ ĚŽ ǁĞ ŚĂǀĞ Ă ŵĞĚŝĐĂů ƉƌŽďůĞŵ͕ ǁĞ ŚĂǀĞ Ă ůĂƌŐĞ ƉƵďůŝĐ health issue.

Syphilis is a treatable disease, and ǁŝƚŚ ƚŚĞ ĂƉƉƌŽƉƌŝĂƚĞ ƐƵƌǀĞŝůůĂŶĐĞ ĂŶĚ ƐĐƌĞĞŶŝŶŐ ǁĞ ĐĂŶ ƉƌĞǀĞŶƚ Ă ůĂƌŐĞ number of congenital syphilis case and concomitant complications. California may benefit from changing to the current CDC guidelines and possibly increasing ƚŚĞ ĂŵŽƵŶƚ ŽĨ ƚŝŵĞƐ ƉƌĞŐŶĂŶƚ ǁŽŵĞŶ ĂƌĞ ƐĐƌĞĞŶĞĚ͘ DLJ ŚŽƉĞ ŝƐ ƚŚĂƚ ǁŝƚŚ

Aspire • Achieve • Inspire

the current screening guidelines in San :ŽĂƋƵŝŶ 'ĞŶĞƌĂů ,ŽƐƉŝƚĂů͕ ǁĞ ĂƌĞ ĂďůĞ to reduce the transmission of congenital syphilis by capturing prenatal syphilis ĞĂƌůLJ ĂŶĚ ƉƌŽǀŝĚŝŶŐ ƋƵŝĐŬ ĂŶĚ ĂĚĞƋƵĂƚĞ treatment.

Dr. Assibey is a third-year resident at the San Joaquin General Hospital program resident and co-chair of the CAFP Resident Council.

BECOME AN INTEGRAL PART OF AN EXCITING YOUNG RESIDENCY PROGRAM! Become an integral part of an exciting young residency program that began in 2013. We have full 10 year ACGME accreditation. Eisenhower Health in Rancho Mirage, California seeks to hire a MD faculty member to serve as part of our residency program. You will have outpatient care responsibilities and may choose to have inpatient care responsibilities. You will precept FM residents in the Center for Family Medicine. Faculty have protected time for curriculum management, resident advising, and scholarly work.

Board certification in Family Medicine (ABMS or AOA) is required. Academic appointment will be confirmed from the USC Keck School of Medicine or Western University of Health Sciences. Rank will depend upon experience and qualifications.

Family Medicine Physicians

Eisenhower Health seeks candidates whose experience, teaching, research and community service have prepared them to contribute to our commitment to serving the Coachella Valley. Eisenhower is an EO/M employer.

(MD/DO/IM)

Qualified applicants, including recent residency graduates, are encouraged to apply. Candidates should submit a digital CV and statement of interest to Scott Nass, MD, MPA, Program Director at SNass@eisenhowerhealth.org with . cc: Tamara Dunn at TDunn@eisenhowerhealth.org.

• Board, DEA and License Reimbursement • Malpractice Insurance, including Tail Coverage • 2 Weeks Vacation, 2 Weeks Sick Pay, 11.5 Holidays • 5 Days CME + Allowance • 403b Retirement Plan, Discretionary Match up to 5% • Medical, Dental, Vision, Chiro and Life Insurance Contact Information: Website: www.achievable.org Forward CVs to employment@achievable.org

For questions, please contact Michelle Harding at mharding@eisenhowerhealth.org or 760-773-4504.

www.eisenhowerhealth.org California Family Physician Summer 2019

25

Join Our Team in the

Heart of Sonoma Wine Country Healdsburg District Hospital is seeking a full-time Primary Care Physician with a background in Family Practice or Internal Medicine.

This position would be located at our Healdsburg Physician Group Clinic on the hospitalâ&#x20AC;&#x2122;s campus located in the heart of Sonoma Wine Country. About an hour north of the Golden Gate Bridge, beautiful Healdsburg, California offers wonderful wineries, world-class dining, redwood forests and gorgeous countryside.

Healdsburg District Hospital connects and delivers personalized high quality, accessible local healthcare services, and advocates for the health and wellness of the communities in the District.

Healdsburg Physician Group is a distinctive primary care group delivering the highest-quality care and service available, and offers providers gratifying and sustainable careers. As an outpatient department of a Critical Access Hospital and independent of large healthcare institutions, our clinic is open Monday â&#x20AC;&#x201C; Friday, hours 9am â&#x20AC;&#x201C; 5pm.

In addition, we offer benefits designed to aid your health and wellness including: â&#x20AC;¢ Comprehensive Medical, Dental and Vision plans â&#x20AC;¢ Robust voluntary insurance plan options â&#x20AC;¢ Retirement Savings Program with Employer match â&#x20AC;¢ Paid Time Off (PTO) starting at over 30 days per year â&#x20AC;¢ Relocation assistance â&#x20AC;¢ Malpractice Insurance coverage â&#x20AC;¢ 5 days of Continuing Medical Education (CME) and $5,000 CME reimbursement; â&#x20AC;¢ Hospital sponsored loan repayment program and eligibility for additional loan programs Our ideal physician will have: â&#x20AC;¢ Excellent clinical and communication skills, bilingual ability a plus â&#x20AC;¢ An interest in using technology to deliver high quality, primary care â&#x20AC;¢ The desire to be an integral part of a rapidly growing team of clinicians dedicated to changing health care delivery â&#x20AC;¢ BC/BE in Family or Internal Medicine â&#x20AC;¢ California Medical license

Contact: Heather Balitzkat (707) 431-6492 Email: hbalitzkat@nschd.org www.healdsburgdistricthospital.org

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California Family Physician Summer 2019

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For Advertising CONTACT

Michelle Gilbert mgilbert@pcipublishing.com

1.800.561.4686 ext. 120

LAC Medical Inc. Family Medicine Physician Job inBakersfield, CA Located in beautiful Bakersfield, CA, LAC Medical Inc. is a private practice with 3 Primary Care Providers, in San Joaquin Valley. Bakersfield is a great location, with easy travel to the beach or the mountains. We also have very competitive schools and affordable housing.

Patient encounters average 25 – 35. 40 Patient contact hours per week. Call frequency: Approximately 1 in 10 – weekend call, weekdays shared amongst providers. This is for 1FTE. Fully Integrated Electronic Medical Record (eClinical).

Comprehensive benefits package: • 4 weeks off and CME allowance, • Malpractice Insurance, • Income details:$175,000 - $205,000 DOE.

MD/DO Please contact Dr. Cousins at Lcousin99@aol.com LAC Medical Inc.

9508 Stockdale Hwy., Suite 120 Bakersfield, CA 93311 (661) 735-1710 • Fax (661) 888-4841 Toll Free (661) 656-7245

California Family Physician Summer 2019

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&

Family Medicine Tackles STIs in California This issue of California Family Physician ŚĂƐ ďĞĞŶ ƌĞǀŝĞǁĞĚ ĂŶĚ accepted by the American Academy of Family Physicians for three Prescribed CME credits. Clinicians should claim only the credit ĐŽŵŵĞŶƐƵƌĂƚĞ ǁŝƚŚ ƚŚĞ ĞdžƚĞŶƚ ŽĨ ƚŚĞŝƌ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ ƚŚĞ ĂĐƟǀŝƚLJ͘ dŽ ĐůĂŝŵ LJŽƵƌ ĐƌĞĚŝƚƐ͕ ƉůĞĂƐĞ ĐŽŵƉůĞƚĞ ĂŶĚ ƌĞƚƵƌŶ ƚŚŝƐ ƋƵŝnj ĂŶĚ ĞǀĂůƵĂƟŽŶ ƚŽ &W͕ ĐĂĨƉΛĨĂŵŝůLJĚŽĐƐ͘ŽƌŐ Žƌ ĨĂdž ϰϭϱͲϯϰϱͲϴϲϲϴ͘ Ɛ ĂŶ ĐĐƌĞĚŝƚĂƟŽŶ ŽƵŶĐŝů ĨŽƌ ŽŶƟŶƵŝŶŐ DĞĚŝĐĂů ĚƵĐĂƟŽŶͲ accredited provider, CAFP is required by the ACCME Standards of ŽŵŵĞƌĐŝĂů ^ƵƉƉŽƌƚ͕ ƚŽ ŝĚĞŶƟĨLJ͕ ŵĂŶĂŐĞ Žƌ ƌĞƐŽůǀĞ ĂŶLJ ĐŽŶŇŝĐƚ ŽĨ ŝŶƚĞƌĞƐƚ ĨŽƌ ĂŶLJ ŝŶĚŝǀŝĚƵĂů ǁŚŽ ŵĂLJ ŚĂǀĞ ŝŶŇƵĞŶĐĞ ŽǀĞƌ ĞĚƵĐĂƟŽŶĂů ĐŽŶƚĞŶƚ ƉƌŽǀŝĚĞĚ ďLJ ƚŚĞ &W͘ KƵƌ ĐŽŶŇŝĐƚ ŽĨ ŝŶƚĞƌĞƐƚ ƉŽůŝĐLJ ŝƐ ŝŶĐůƵƐŝǀĞ ŽĨ Ăůů ƚŚĞ ĞůĞŵĞŶƚƐ ŽĨ ƚŚĞ D ĚĞĮŶŝƟŽŶ ŽĨ Ă ĐŽŵŵĞƌĐŝĂů

interest. Our policy requires us to collect disclosure forms from any ŝŶĚŝǀŝĚƵĂů ǁŚŽ ŵĂLJ ŚĂǀĞ ĂŶ ŝŶŇƵĞŶĐĞ ŽŶ ĂŶLJ ĞĚƵĐĂƟŽŶĂů ĐŽŶƚĞŶƚ͘ tĞ ĂůƐŽ ĐĂƉƚƵƌĞ ƚŚĞ ƐĂŵĞ ƌĞůĂƟŽŶƐŚŝƉƐ ĨƌŽŵ ŝŶĚŝǀŝĚƵĂů͛Ɛ ƐƉŽƵƐĞƐͬ ƉĂƌƚŶĞƌƐ͘ KƵƌ ŐŽĂů ŝŶ ŝĚĞŶƟĨLJŝŶŐ͕ ŵĂŶĂŐŝŶŐ ĂŶĚ ƌĞƐŽůǀŝŶŐ ŝŶƚĞƌĞƐƚ ŝƐ ƚŽ ĞŶƐƵƌĞ ƚŚĂƚ Ăůů ĞĚƵĐĂƟŽŶ ĐŽŶƚĞŶƚ ĂŶĚ ĐƵƌƌŝĐƵůƵŵ͕ ƉƌĞƐĞŶƚĂƟŽŶƐ ĂŶĚ ƉƌŽĚƵĐƚƐ ĂƌĞ ĨƌĞĞ ŽĨ ĐŽŵŵĞƌĐŝĂů ďŝĂƐ ĂŶĚ ƉƌŽŵŽƟŽŶ͘ dŚĞ W ƌĞǀŝĞǁƐ Ăůů K/ ĨŽƌŵƐ ĂŶĚ ĞŵƉůŽLJƐ Ă ƉƌŽĐĞƐƐ ƚŽ ĞŶƐƵƌĞ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ŽƵƌ ĞĚƵĐĂƟŽŶĂů ƉƌŽŐƌĂŵ͘ tĞ ĂůƐŽ ĞŶŐĂŐĞ ŽƵƌ ůĞĂƌŶĞƌƐ ƚŚƌŽƵŐŚ ƚŚĞ ĞǀĂůƵĂƟŽŶ ƉƌŽĐĞƐƐ ƚŽ ŵŽŶŝƚŽƌ ĨŽƌ ďŝĂƐͬƉƌŽŵŽƟŽŶ ĂŶĚ ĞīĞĐƟǀĞŶĞƐƐ ŽĨ ƚŚĞ ĂĐƟǀŝƟĞƐ͘

NAME

AFFILIATION

RESPONSIBILITY

DISCLOSURE

Brent Sugimoto, MD, MPH

DecodedHealth

Editor, Planner and Author

Nothing to Declare

Walter Mills, MD, MMM

Natividad FMRP

Author

Nothing to Declare

Scott Nass, MD, MPA

Eisenhower FMRP

Author

Nothing to Declare

Ina Park, MD

UCSF and SF VA

Author

Nothing to Declare

Robert Assibey, MD

San Joaquin FMRP

Author

Nothing to Declare

Shelly B. Rodrigues, CAE

CAFP

Managing Editor, Planner and Author

Nothing to Declare

>ĞĂƌŶŝŶŐ KďũĞĐƟǀĞƐ ŌĞƌ ƌĞĂĚŝŶŐ ƚŚĞ ĂƌƟĐůĞƐ ŝŶ ƚŚŝƐ ŝƐƐƵĞ͕ ůĞĂƌŶĞƌƐ ƐŚŽƵůĚ ďĞ ĂďůĞ ƚŽ͗ • /ŶĐƌĞĂƐĞ ĂǁĂƌĞŶĞƐƐ ĂŵŽŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂďŽƵƚ ƚŚĞ ŝŶĐƌĞĂƐŝŶŐ ƌĂƚĞƐ ŽĨ ^d/ ŝŶ ĂůŝĨŽƌŶŝĂ͖ • KƵƚůŝŶĞ ƚŚĞ ĐĂƵƐĞƐ ĨŽƌ ŝŶĐƌĞĂƐĞƐ ŝŶ ^d/ ƌĂƚĞƐ ĂŵŽŶŐ ƐĞŶŝŽƌ ƉĂƟĞŶƚƐ͖ YƵŝnj͗ WůĞĂƐĞ ĐŝƌĐůĞ ƚŚĞ ĐŽƌƌĞĐƚ ĂŶƐǁĞƌ͘ 1. California ranks _____ in new HIV diagnosis.

First Second Third Fourth ͕ ϮϬϭϳ͕ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚŝǀͬƐƚĂƟƐƟĐƐͬ overview/index.html

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hƐĞ ĐĂƐĞͲďĂƐĞĚ ĂƉƉƌŽĂĐŚ ĨŽƌ Wƌ W ŝŶ ƉĂƟĞŶƚƐ Ăƚ ƌŝƐŬ ĨŽƌ ,/s ŝŶĨĞĐƟŽŶ͖ ĂŶĚ ,ŝŐŚůŝŐŚƚ ƉƌĞŶĂƚĂů ƐLJƉŚŝůŝƐ ĂƐ Ă ƚƌĞĂƚĂďůĞ ĐŽŶĚŝƟŽŶ͘

Ϯ͘ ůĂĐŬ ŵĞŶ ǁŚŽ ŚĂǀĞ ƐĞdž ǁŝƚŚ ŵĞŶ ;D^DͿ ƉĂƟĞŶƚƐ ŚĂǀĞ ǁŚĂƚ ĐŚĂŶĐĞ ŽĨ ƚĞƐƟŶŐ ƉŽƐŝƟǀĞ ŝŶ ƚŚĞŝƌ ůŝĨĞƟŵĞ͍ KŶĞ ŝŶ ƚǁŽ One in three One in four KŶĞ ŝŶ ĮǀĞ ͕ ϮϬϭϲ͕ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŶĐŚŚƐƚƉͬ newsroom/2016/croi-press-release-risk.html

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California Family Physician Summer 2019

3͘ tŚĂƚ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ďĞƚǁĞĞŶ ƚŚĞ age of 75-84 report being sexually ĂĐƟǀĞ͍ ϲ ƉĞƌĐĞŶƚ ϭϲ ƉĞƌĐĞŶƚ Ϯϲ ƉĞƌĐĞŶƚ ϯϲ ƉĞƌĐĞŶƚ Solway E, Clark S, Singer D, Kirch M, Malani P. Let’s dĂůŬ ĂďŽƵƚ ^Ğdž͘ hŶŝǀĞƌƐŝƚLJ ŽĨ DŝĐŚŝŐĂŶ EĂƟŽŶĂů WŽůů ŽŶ ,ĞĂůƚŚLJ ŐŝŶŐ͘ DĂLJ ϮϬϭϴ͘ ǀĂŝůĂďůĞ Ăƚ͗ ŚƩƉ͗ͬ​ͬŚĚů͘ handle.net/2027.42/143212

ϰ͘ tŚĂƚ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ƐĞdžƵĂůůLJ ĂĐƟǀĞ ŵĞƌŝĐĂŶƐ ǁŝůů ĐŽŶƚƌĂĐƚ Ă ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶ ;^d/Ϳ ďLJ ĂŐĞ Ϯϱ͍ ϯϬ ƉĞƌĐĞŶƚ ϰϬ ƉĞƌĐĞŶƚ ϱϬ ƉĞƌĐĞŶƚ ϲϬ ƉĞƌĐĞŶƚ

ϲ͘ ϯϬϬ͕ϬϬϬ ĐĂƐĞƐ ŽĨ ĐŚůĂŵLJĚŝĂ͕ ŐŽŶŽƌƌŚĞĂ͕ ĂŶĚ ĞĂƌůLJ ƐLJƉŚŝůŝƐ ŚĂǀĞ been reported in California. This represents ____percent increase ŝŶ ƚŚĞ ůĂƐƚ ĮǀĞ LJĞĂƌƐ͘ 15 Ϯϱ 35 ϰϱ

Cates JR, Herndon NL, Schulz S L, Darroch JE. (2004). Our voices, our lives, our futures: zŽƵƚŚ ĂŶĚ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ĚŝƐĞĂƐĞƐ͘ ŚĂƉĞů ,ŝůů͕ E ͗ hŶŝǀĞƌƐŝƚLJ ŽĨ EŽƌƚŚ ĂƌŽůŝŶĂ Ăƚ ŚĂƉĞů ,ŝůů ^ĐŚŽŽů ŽĨ :ŽƵƌŶĂůŝƐŵ ĂŶĚ DĂƐƐ ŽŵŵƵŶŝĐĂƟŽŶ͘ ĐĐĞƐƐĞĚ Ăƚ͗ ŚƩƉ͗ͬ​ͬǁǁǁ͘ĂƐŚĂƐĞdžƵĂůŚĞĂůƚŚ͘ŽƌŐͬƐƚĚƐƐƟƐͬƐƚĂƟƐƟĐƐͬ

ĞƉƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ͕ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ůĂƟŵĞƐ͘ĐŽŵͬůŽĐĂůͬĐĂůŝĨŽƌŶŝĂͬůĂͲŵĞͲůŶͲƐƚĚͲ rates-20180515-story.html

ϱ͘ ĐĐŽƌĚŝŶŐ ƚŽ ŐƵŝĚĞůŝŶĞƐ͕ ďĞĨŽƌĞ ŝŶŝƟĂƟŶŐ Wƌ W͕ Ă ŶĞŐĂƟǀĞ ,/s ƚĞƐƚ ŝƐ ƌĞƋƵŝƌĞĚ ǁŝƚŚŝŶ ŚŽǁ ŵĂŶLJ ĚĂLJƐ͍ 3 5 7 ϭϬ ĞŶƚĞƌƐ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ĂŶĚ WƌĞǀĞŶƟŽŶ͗ h^ WƵďůŝĐ ,ĞĂůƚŚ ^ĞƌǀŝĐĞ͗ WƌĞĞdžƉŽƐƵƌĞ ƉƌŽƉŚLJůĂdžŝƐ ĨŽƌ ƚŚĞ ƉƌĞǀĞŶƟŽŶ ŽĨ ,/s ŝŶĨĞĐƟŽŶ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐͶϮϬϭϳ hƉĚĂƚĞ͗ Ă ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ŐƵŝĚĞůŝŶĞ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬŚŝǀͬƉĚĨͬƌŝƐŬͬƉƌĞƉͬĐĚĐͲŚŝǀͲƉƌĞƉͲŐƵŝĚĞůŝŶĞƐͲϮϬϭϳ͘ƉĚĨ͘ WƵďůŝƐŚĞĚ March 2018.

7. The most commonly reported STI in California is: Chlamydia Syphilis Gonorrhea ĞƉƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ͕ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ůĂƟŵĞƐ͘ĐŽŵͬůŽĐĂůͬĐĂůŝĨŽƌŶŝĂͬůĂͲŵĞͲůŶͲƐƚĚͲ rates-20180515-story.html

ϴ͘ ^d dƌĞĂƚŵĞŶƚ 'ƵŝĚĞůŝŶĞƐ ƌĞĐŽŵŵĞŶĚ ŽīĞƌŝŶŐ ͺͺͺͺ ƚŽ ƉĂƟĞŶƚƐ ǁŝƚŚ ƉĂƌƚŶĞƌƐ ƚŚĂƚ ĂƌĞ ƵŶĂďůĞ Žƌ ƵŶůŝŬĞůLJ ƚŽ ĂĐĐĞƐƐ ƚƌĞĂƚŵĞŶƚ ŽŶ ƚŚĞŝƌ ŽǁŶ͍ /ŶƚĞŶƐŝǀĞ ĞŚĂǀŝŽƌĂů ŽƵŶƐĞůŝŶŐ džƉĞĚŝƚĞĚ WĂƌƚŶĞƌ dŚĞƌĂƉLJ Daily Suppressive Therapy

dŽ ĐůĂŝŵ LJŽƵƌ ĐƌĞĚŝƚƐ͕ ƉůĞĂƐĞ ĐŽŵƉůĞƚĞ ĂŶĚ ƌĞƚƵƌŶ ƚŚŝƐ ƋƵŝnj ĂŶĚ ĞǀĂůƵĂƟŽŶ ƚŽ &W͕ ĐĂĨƉΛĨĂŵŝůLJĚŽĐƐ͘ŽƌŐ Žƌ ĨĂdž ϰϭϱͲϯϰϱͲϴϲϲϴ͘​͘

California Family Physician Summer 2019

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ceo message

Lisa Folberg, MPP

Stand Up and Be Counted! dŚĞ h^ ŽŶƐƟƚƵƟŽŶ ƌĞƋƵŝƌĞƐ ƚŚĂƚ ĞǀĞƌLJ ϭϬ LJĞĂƌƐ͕ ƚŚĞ ĞŶƐƵƐ ƵƌĞĂƵ ĐŽƵŶƚ ĞǀĞƌLJ ƌĞƐŝĚĞŶƚ ŝŶ ƚŚĞ ŶĂƟŽŶ͘ ĐŽŵƉůĞƚĞ ĂŶĚ ĂĐĐƵƌĂƚĞ ĐĞŶƐƵƐ ŝƐ ǀŝƚĂů ƚŽ ĂůŝĨŽƌŶŝĂ͘ ĞŶƐƵƐ ĚĂƚĂ ŚĞůƉƐ ĚĞƚĞƌŵŝŶĞ ƚŚĞ ĂůůŽĐĂƟŽŶ ŽĨ ďŝůůŝŽŶƐ of dollars in federal funds for building schools, roads, businesses and ŚŽƐƉŝƚĂůƐ͘ /Ŷ ĨĂĐƚ͕ ĐĞŶƐƵƐ ĚĂƚĂ ŝƐ ƵƐĞĚ ĂƐ ƉĂƌƚ ŽĨ ƚŚĞ ĨƵŶĚŝŶŐ ĨŽƌŵƵůĂ ĨŽƌ ŵŽƌĞ ƚŚĂŶ ϳϬ ĨĞĚĞƌĂů ƉƌŽŐƌĂŵƐ ƚŚĂƚ ďĞŶĞĮƚ ĂůŝĨŽƌŶŝĂ ĂŶĚ ĚĞƚĞƌŵŝŶĞƐ ƚŚĞ ŶƵŵďĞƌ ŽĨ ƐĞĂƚƐ ĞĂĐŚ ƐƚĂƚĞ ŚĂƐ ŝŶ ƚŚĞ h^ ,ŽƵƐĞ ŽĨ ZĞƉƌĞƐĞŶƚĂƟǀĞƐ͘

ŚĂƌĚͲƚŽͲĐŽƵŶƚ ŝŶĐůƵĚĞ ŚŽŵĞůĞƐƐ͕ ƚŚŽƐĞ ŝŶ ƚŚĞ ůŽǁĞƌ ŝŶĐŽŵĞ ƐƚƌĂƚĂ͕ ŶŐůŝƐŚ ůĂŶŐƵĂŐĞ ůĞĂƌŶĞƌƐ͕ ƵŶĚŽĐƵŵĞŶƚĞĚ ŝŵŵŝŐƌĂŶƚƐ ĂŶĚ ƌĂĐŝĂůͬ ĞƚŚŶŝĐ ŵŝŶŽƌŝƟĞƐ͘ ĂůŝĨŽƌŶŝĂ ŝƐ ĂƌŐƵĂďůLJ ŚŽŵĞ ƚŽ ƚŚĞ ŵŽƐƚ ŚĂƌĚͲƚŽͲĐŽƵŶƚ people in the United States. /Ŷ DĂƌĐŚ ϮϬϮϬ͕ ƚŚĞ ĞŶƐƵƐ ƵƌĞĂƵ ǁŝůů ďĞŐŝŶ ƚŽ ŵĂŝů ŝŶĨŽƌŵĂƟŽŶ͕ ǁŚŝĐŚ ǁŝůů ŝŶĐůƵĚĞ Ă ƉĂƉĞƌ ƋƵĞƐƟŽŶŶĂŝƌĞ ĂŶĚ ĂŶ ŝŶǀŝƚĂƟŽŶ ƚŽ Įůů ŽƵƚ ƚŚĞ ƋƵĞƐƟŽŶŶĂŝƌĞ ŽŶůŝŶĞ ŝŶƐƚĞĂĚ͘ dŚŝƐ ǁŝůů ďĞ ƚŚĞ ĮƌƐƚ ƟŵĞ ŝŶ ĐĞŶƐƵƐ ŚŝƐƚŽƌLJ ƚŚĞ ƋƵĞƐƟŽŶŶĂŝƌĞƐ ĐĂŶ ďĞ ĐŽŵƉůĞƚĞĚ ŽŶůŝŶĞ͘

/ ƐƉŽŬĞ ǁŝƚŚ :ƵĚLJ ZŽďŝŶƐŽŶ͕ ϮϬϮϬ ĞŶƐƵƐ DĂŶĂŐĞƌ ĨŽƌ ^ĂĐƌĂŵĞŶƚŽ ŽƵŶƚLJ͕ ĂďŽƵƚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ƚŚĞ ĐĞŶƐƵƐ ĂŶĚ ƉƌŽďůĞŵƐ ǁŝƚŚ /Ŷ ĂůŝĨŽƌŶŝĂ͕ ĂĚǀŽĐĂƚĞƐ ĂŶĚ ŐŽǀĞƌŶŵĞŶƚ ĞŶƟƟĞƐ ĂƌĞ ŝŶǀĞƐƟŶŐ ŝŶ ĞīŽƌƚƐ ƵŶĚĞƌĐŽƵŶƟŶŐ͘ ^ŚĞ ŶŽƚĞĚ͕ ͞ ĂůŝĨŽƌŶŝĂ ƌĞĐĞŝǀĞƐ ĂƉƉƌŽdžŝŵĂƚĞůLJ Ψϭ͕ϵϱϮ ƉĞƌ ƚŽ ĞŶƐƵƌĞ ĂŶ ĂĐĐƵƌĂƚĞ ĐĞŶƐƵƐ͘ 'ŽǀĞƌŶŽƌ EĞǁƐŽŵ͛Ɛ ϮϬϭϵͲϮϬ ƉƌŽƉŽƐĞĚ person per year in federal funding. ďƵĚŐĞƚ ŝŶĐůƵĚĞƐ Ψϱϰ ŵŝůůŝŽŶ ŽŶ DƵůƟƉůŝĞĚ ŽǀĞƌ ϭϬ LJĞĂƌƐ ;ĚĞĐĞŶŶŝĂů ƚŽƉ ŽĨ ŵŽƌĞ ƚŚĂŶ ΨϭϬϬ ŵŝůůŝŽŶ ĐĞŶƐƵƐͿ ƚŚŝƐ ƌĞƉƌĞƐĞŶƚƐ ŚƵŶĚƌĞĚƐ ĂůƌĞĂĚLJ ĐŽŵŵŝƩĞĚ ƚŽ ĂƵŐŵĞŶƚ The US Census is vital to our ŽĨ ŵŝůůŝŽŶƐ ŽĨ ĚŽůůĂƌƐ ůŽƐƚ Žƌ ǁŝƚŚ Ă Ă ƐƚĂƚĞǁŝĚĞ ŽƵƚƌĞĂĐŚ ĂŶĚ democracy. It paints a picture of America successful count, dollars gained for ĐŽŵŵƵŶŝĐĂƟŽŶ ĐĂŵƉĂŝŐŶ͘ important programs and funding – who we are, what we look like, and ƚŽ ŬĞĞƉ ĐŽŵŵƵŶŝƟĞƐ ƐĂĨĞ͕ ŚĞĂůƚŚLJ What does the census have to do what our needs are – and that picture is a ǁŝƚŚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͍ 'ĞƫŶŐ ĂŶĚ ĞĚƵĐĂƚĞĚ͘ /Ŷ ϮϬϭϬ ĐŚŝůĚƌĞŶ ĂŐĞƐ ϬͲϱ LJĞĂƌƐ ǁĞƌĞ ƐŝŐŶŝĮĐĂŶƚůLJ ĂŶ ĂĐĐƵƌĂƚĞ ĐŽƵŶƚ ǁŝůů ƚĂŬĞ ĂŶ ĂůůͲ key factor in determining the distribution ƵŶĚĞƌĐŽƵŶƚĞĚ͘ ^ƉĞĐŝĂů ĞīŽƌƚƐ ŚĂŶĚƐͲŽŶͲĚĞĐŬ ĂƉƉƌŽĂĐŚ͘ &ĂŵŝůLJ of resources in our country.” ǁŝůů ŶĞĞĚ ƚŽ ďĞ ŵĂĚĞ ƚŽ ĞŶƐƵƌĞ physicians are respected members – Senate President these children and their families ŽĨ ƚŚĞŝƌ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ ƉĂƌƟĐŝƉĂƚĞ ĂŶĚ ĂƌĞ ĐŽƵŶƚĞĚ͘͟ ďĞĐŽŵĞ Ă ƉĂƌƚ ŽĨ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͛ pro Tempore Toni Atkins life landscape. Because of their ǀĞƌLJ ĚĞĐĂĚĞ ƚŚĞ ĐĞŶƐƵƐ ƐƟƌƐ ƐƉĞĐŝĂů ƉůĂĐĞ ŝŶ ƉĂƟĞŶƚƐ͛ ůŝǀĞƐ͕ Ă ĚĞďĂƚĞ ĂďŽƵƚ ŚŽǁ ƚŽ ĐĂƉƚƵƌĞ Ă ƚƌƵĞ ƉŝĐƚƵƌĞ ŽĨ ƉĞŽƉůĞ ůŝǀŝŶŐ ŝŶ ƚŚĞ family physicians add validity to an issue and are trusted messengers. hŶŝƚĞĚ ^ƚĂƚĞƐ͘ dŚĞ ϮϬϮϬ ĐĞŶƐƵƐ ŚĂƐ ƚƵƌŶĞĚ ƉĂƌƟĐƵůĂƌůLJ ƉŽůŝƟĐĂů͘ /ƚ ŚĂƐ ^ŝŶĐĞ ĂĚĞƋƵĂƚĞ ĨƵŶĚŝŶŐ ĨŽƌ ƐĐŚŽŽůƐ͕ ŶƵƚƌŝƟŽŶ ƉƌŽŐƌĂŵƐ͕ ĞĚƵĐĂƟŽŶ͕ ƌĞĐĞŶƚůLJ ďĞĞŶ ĚŝƐĐŽǀĞƌĞĚ ƚŚĂƚ Ă ZĞƉƵďůŝĐĂŶ ƉŽůŝƟĐĂů ĐŽŶƐƵůƚĂŶƚ ŬŶŽǁŶ housing and countless other services relies on its results, the census is, ĂƐ ƚŚĞ ͞DŝĐŚĞůĂŶŐĞůŽ ŽĨ ŐĞƌƌLJŵĂŶĚĞƌŝŶŐ͟ ƉůĂLJĞĚ Ă ĐƌƵĐŝĂů ƌŽůĞ ŝŶ ƚŚĞ indeed, a family physician issue. dƌƵŵƉ ĂĚŵŝŶŝƐƚƌĂƟŽŶ͛Ɛ ĚĞĐŝƐŝŽŶ ƚŽ ĂĚĚ Ă ĐŝƟnjĞŶƐŚŝƉ ƋƵĞƐƟŽŶ ƚŽ ƚŚĞ ϮϬϮϬ ĐĞŶƐƵƐ͘ ǀĞŶ ƚŚŽƵŐŚ ĨĞĚĞƌĂů ůĂǁ ƉƌŽƚĞĐƚƐ ƚŚĞ ĐŽŶĮĚĞŶƟĂůŝƚLJ ŽĨ Ăůů tŝƚŚ ďƵƐLJ ůŝǀĞƐ ŝƚ ŝƐ ŽŌĞŶ ŚĂƌĚ ĨŽƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ŬŶŽǁ ŚŽǁ ƚŽ individual responses the Census Bureau collects, advocates contend that ĞŶŐĂŐĞ ŝŶ ĂĚǀŽĐĂĐLJ Žƌ ŵŽƌĞ ůŝŬĞůLJ ŚŽǁ ƚŽ ĞĚŝƚ ƚŚĞŝƌ ĞŶŐĂŐĞŵĞŶƚ ŝŶ ƐƵĐŚ ĨĞĂƌ ƚŚĞ ŐŽǀĞƌŶŵĞŶƚ ǁŝůů ƵƐĞ ĐŝƟnjĞŶƐŚŝƉ ŝŶĨŽƌŵĂƟŽŶ ĂŐĂŝŶƐƚ ŝŵŵŝŐƌĂŶƚƐ Ă ǁĂLJ ƚŚĂƚ ůĞĂǀĞƐ ƟŵĞ ĨŽƌ ĨƌŝĞŶĚƐ ĂŶĚ ĨĂŵŝůLJ͘ ǁŽƵůĚ ĚĞƚĞƌ ŵĂŶLJ ŝŵŵŝŐƌĂŶƚƐ ĨƌŽŵ ƉĂƌƟĐŝƉĂƟŶŐ ŝŶ ƚŚĞ ϮϬϮϬ ĐĞŶƐƵƐ͘ dŚŝƐ͕ ƚŚĞLJ ƐĂLJ ǁŝůů ƌĞƐƵůƚ ŝŶ ƚŚĞ ƵŶĚĞƌĐŽƵŶƟŶŐ ŽĨ ŵŝůůŝŽŶƐ ŽĨ ĂůŝĨŽƌŶŝĂŶƐ͘ ŶĐŽƵƌĂŐŝŶŐ ƉĂƟĞŶƚƐ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ĐĞŶƐƵƐ ŝƐ ĂŶ ĞdžĂŵƉůĞ ŽĨ ŚŽǁ dŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ ^ƵƉƌĞŵĞ ŽƵƌƚ ŝƐ ĞdžƉĞĐƚĞĚ ƚŽ ƌƵůĞ ŽŶ ƚŚĞ ůĞŐĂůŝƚLJ ŽĨ LJŽƵ ĐĂŶ ŚĂǀĞ ĂŶ ŝŵƉŽƌƚĂŶƚ ŝŶŇƵĞŶĐĞ ŽŶ ĐŽŵŵƵŶŝƚLJ ŚĞĂůƚŚ ǁŝƚŚŽƵƚ ŝŶĐůƵĚŝŶŐ ƚŚĞ ĐŝƟnjĞŶƐŚŝƉ ƋƵĞƐƟŽŶ ďLJ ůĂƚĞ :ƵŶĞ ϮϬϭϵ͘ /ƚ ŵĂLJ ďĞ ƚŚĂƚ ďLJ Ă ŚƵŐĞ ƟŵĞ ĐŽŵŵŝƚŵĞŶƚ͘ zŽƵ ĐĂŶ ƚĂŬĞ ĂŶ ĂĐƟǀĞ ƌŽůĞ ŝŶ ŵĂŶLJ ǁĂLJƐ͗ ƚŚĞ ƟŵĞ LJŽƵ ƌĞĂĚ ƚŚŝƐ͕ Ă ĚĞĐŝƐŝŽŶ ǁŝůů ŚĂǀĞ ďĞĞŶ ŵĂĚĞ͘ ƚŚƌŽƵŐŚ ƚĂůŬŝŶŐ ǁŝƚŚ ƉĂƟĞŶƚƐ͕ ŚĂŶŐŝŶŐ ĂŶ ŽĸĐĞ ƉŽƐƚĞƌ͕ ŵĂŬŝŶŐ Ă ĨĂĐƚ ƐŚĞĞƚ ĂǀĂŝůĂďůĞ ƚŽ ƉĂƟĞŶƚƐ ŝŶ LJŽƵƌ ŽĸĐĞƐ Žƌ ďLJ ĞŶĐŽƵƌĂŐŝŶŐ LJŽƵƌ ĐůŝŶŝĐƐ͕ tŝƚŚ ĂŶ ĞƐƟŵĂƚĞĚ ϭϭ ŵŝůůŝŽŶ ŝŵŵŝŐƌĂŶƚƐ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ĂŶLJƚŚŝŶŐ ƚŚĂƚ ƵŶŝǀĞƌƐŝƟĞƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ŐƌŽƵƉƐ ƚŽ ĞŶŐĂŐĞ͘ /Ĩ ǁĞ ĚŽŶ͛ƚ ŐĞƚ ƚŚĞ ĐŽƵŶƚ ĚŝƐĐŽƵƌĂŐĞƐ ƚŚĞ ƉĂƌƟĐŝƉĂƟŽŶ ŽĨ ƚŚŝƐ ŐƌŽƵƉ ŽĨ ĂůŝĨŽƌŶŝĂŶƐ ŝŶ ƚŚĞ ĐĞŶƐƵƐ ƌŝŐŚƚ ŝŶ ϮϬϮϬ͕ ǁĞ ǁŝůů ďĞ ůŝǀŝŶŐ ǁŝƚŚ ƚŚĞ ƌĂŵŝĮĐĂƟŽŶƐ ƵŶƟů ϮϬϯϬ͘ ĐŽƵůĚ ďĞ ƐŝŐŶŝĮĐĂŶƚ ĨŽƌ ĞǀĞƌLJƚŚŝŶŐ ĨƌŽŵ DĞĚŝͲ Ăů ĂŶĚ ƚƌĂŶƐƉŽƌƚĂƟŽŶ ĨƵŶĚŝŶŐ ƚŽ ƐƚĂƚĞ ĂŶĚ ƌĞŐŝŽŶĂů ƉŽůŝƟĐĂů ƌĞƉƌĞƐĞŶƚĂƟŽŶ͘ &W ŝƐ ŚĞƌĞ ƚŽ ŚĞůƉ͊ >ŽŽŬ ĨŽƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ ĨƌŽŵ &W ŝŶ ƚŚĞ ĐŽŵŝŶŐ ŵŽŶƚŚƐ ĂďŽƵƚ ŚŽǁ LJŽƵ ĐĂŶ ŚĞůƉ ĞŶĐŽƵƌĂŐĞ LJŽƵƌ ƉĂƟĞŶƚƐ ƚŽ /ŵŵŝŐƌĂŶƚƐ ĂƌĞ ŶŽƚ ƚŚĞ ŽŶůLJ ŐƌŽƵƉ ĐŽŶƐŝĚĞƌĞĚ ͞ŚĂƌĚͲƚŽͲĐŽƵŶƚ͘͟ dŚĞ stand up and be counted!

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California Family Physician Summer 2019

CALIFORNIA ACADEMY OF FAMILY PHYSICIANS 1520 PACIFIC AVE SAN FRANCISCO, CA 94109 -2627

Presorted Standard U.S. POSTAGE PAID

Little Rock, AR Permit No. 2437