Winter 2020

VO L . 71 N O. 1 Wi n t er 2020

in this issue: WHAT’S NEW FOR 2020 NEW LAWS NEW POLICIES NEW OPPORTUNITIES

California Family Physician Winter 2020

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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 ZĂƵů LJĂůĂ͕ D <ŝŵďĞƌůLJ ƵƐƐ͕ D ͕ DW, Jay W. Lee, MD, MPH &Ğůŝdž EƵŶĞnj͕ D ͕ DW, <ĞǀŝŶ ZŽƐƐŝ͕ D

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

Melissa Grindstaff

Manager, Member Engagement mgrindstaff@familydocs.org

ƌůĂŶŶĂ ,ĞŶƌLJ

Looking for a job?

Josh Lunsford

Go to www.fpjobsonline.com

Manager, Educational Programs ahenry@familydocs.org Director, Membership and Marketing jlunsford@familydocs.org

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

YƵĞƐƟŽŶƐ͍ Ăůů ϴϴϴͲϴϴϰͲϴϮϰϮ ĂŶĚ a HEALTHeCAREERS ƌĞƉƌĞƐĞŶƚĂƟǀĞ ǁŝůů ŚĞůƉ LJŽƵ͘

Jonathan Rudolph

Manager, Finance jrudolph@familydocs.org

Brent Sugimoto, MD, Editor Shelly Rodrigues, CAE, Managing Editor

The California Family Physician is published quarterly by the California Academy of Family Physicians. Opinions are those of the authors and not necessarily those of the members and staff of the CAFP. Non-member subscriptions are $35 per year.

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California Family Physician Winter 2020

pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • dbrown@pcipublishing.com 800.561.4686 ext 103 For Advertising info contact Michelle Gilbert • 800.561.4686 ext 120 mgilbert@pcipublishing.com EDITION 33

Winter 2020

features 14 You Do Not Want to Miss the Family Medicine Clinical Forum! We Promise!

20 2020-2021 Strategic Plan 22 Get Ready for 2020: Changes are in Store

Adam Francis

24 CAFP Foundation … Investing in the Future of Family Medicine

Marianne McKennett, MD

26 Your Values, Beliefs, and Priorities are our Foundation: New CAFP Policies and Principles 28 CAFP Principles on the Independent Practice of Medicine by Nurse Practitioners 30 CAFP Principles for the Protection and Care of Transgender and Gender-Expansive Patients

Conrad Amenta

CAFP Scope of Practice Work Group

CAFP Committee on Health of the Public

32 Three Pathways Move Toward Achieving Value-Based Payment

Conrad Amenta

34 CAFP’s Nominating Committee Presents Its 2020 Slate

departments 6

Editorial

Are You Ready for Leap Year?

8

President’s Message

2020: We Need a Vision Forward

10 Political Pulse

Brent Sugimoto, MD, MPH Walt Mills, MD

CAFP Ends 2019 with a Bang!

Carla Kakutani, MD

Our Diversity is Our Strength

Lisa Folberg, MPP

12 In The News 38 CEO Message

&Žƌ ƵƉĐŽŵŝŶŐ D ĂĐƟǀŝƟĞƐ ǀŝƐŝƚ ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬĐŵĞ California Family Physician Winter 2020

editorial

Brent K. Sugimoto, MD, MPH, FAAFP

Are You Ready for Leap Year? / ŚŽƉĞ Ăůů ŽĨ LJŽƵ ĂƌĞ ƐƚĂƌƟŶŐ ƚŚŝƐ ŶĞǁ LJĞĂƌ ĨƌĞƐŚ͘ ϮϬϭϵ ǁĂƐ Ă ĐŚĂƌŐĞĚ LJĞĂƌ ĨŽƌ ĂůŝĨŽƌŶŝĂŶƐ͕ ǁŝƚŚ ĂŶŽƚŚĞƌ ĐĂƚĂƐƚƌŽƉŚŝĐ ĮƌĞ ƐĞĂƐŽŶ͕ ŵĂƐƐ ƐŚŽŽƟŶŐƐ ƚŚĂƚ ĐĂŶ ďĂƌĞůLJ ŚŽůĚ ĂŶ ĞŶƟƌĞ ŶĞǁƐ ĐLJĐůĞ ĂŶĚ ĐŽŶƟŶƵŝŶŐ ƚƵŵƵůƚ ŝŶ ŽƵƌ ŶĂƟŽŶĂů ƉŽůŝƟĐƐ͘ dŚĂŶŬĨƵůůLJ ǁĞ ŚĂǀĞ ƚŚĞ ŚŽůŝĚĂLJƐ ĂƐ Ă ĐŽĚĂ ƚŽ ŽƵƌ LJĞĂƌ ƚŽ ƌĞůĂdž͕ ƌĞŇĞĐƚ ĂŶĚ ƌĞĐŚĂƌŐĞ ĂŶĚ ƚŽ ďĞ ƌĞĂĚLJ ĨŽƌ ϮϬϮϬ͕ ǁŚŝĐŚ incidentally is a leap year. >ĞĂƉ LJĞĂƌƐ ǁĞƌĞ ŝŶǀĞŶƚĞĚ ďĞĐĂƵƐĞ ƚŚĞ ƟŵĞ ŝƚ ƚĂŬĞƐ ŽƵƌ ƉůĂŶĞƚ ƚŽ ƐƉŝŶ ĂƌŽƵŶĚ ŝƚƐ ĂdžŝƐ ŝƐ ŝŶ ŶŽ ǁĂLJ ƌĞůĂƚĞĚ ƚŽ ƚŚĞ ĂŵŽƵŶƚ ŽĨ ƟŵĞ ŝƚ ƚĂŬĞƐ ŽƵƌ ĂƌƚŚ ƚŽ ƌĞǀŽůǀĞ ĂƌŽƵŶĚ ƚŚĞ ƐƵŶ͘ dŚƵƐ͕ ƚŚĞƌĞ ŝƐ ŶŽ ǁĂLJ ƚŽ ŚĂǀĞ Ă LJĞĂƌ ĐŽŵƉŽƐĞĚ ŽĨ ŽŶůLJ ǁŚŽůĞͲŶƵŵďĞƌĞĚ ĚĂLJƐ͕ ŐŝǀŝŶŐ ƵƐ Ă ƐŽůĂƌ LJĞĂƌ ƚŚĂƚ ŝƐ Ϭ͘ϮϰϮϮ ĚĂLJƐ ůŽŶŐĞƌ ƚŚĂŶ ƚŚĞ tĞƐƚĞƌŶ ĐĂůĞŶĚĂƌ LJĞĂƌ͘ hŶĂĚũƵƐƚĞĚ͕ ǁĞ ǁŽƵůĚ ƋƵŝĐŬůLJ ŚĂǀĞ Ă ĐĂůĞŶĚĂƌ ǁŝƚŚ ůŝƩůĞ ƌĞůĂƟŽŶ ƚŽ ƚŚĞ ƐĞĂƐŽŶƐ͘ EŽƚ Ăůů ƐŽĐŝĞƟĞƐ ĐŚŽŽƐĞ ƚŽ ƌĞĐŽŐŶŝnjĞ ƚŚŝƐ ĚŝƐĐƌĞƉĂŶĐLJ ĂƐ Ă ƉƌŽďůĞŵ͕ ǁŚŝĐŚ ƐŚŽǁƐ ƚŚĂƚ ƚŚĞ ůĞĂƉ LJĞĂƌ ŝƐ Ă ĐƵůƚƵƌĂů ŝŶǀĞŶƟŽŶ͘ ŶĐŝĞŶƚ ŐLJƉƟĂŶƐ͕ ǁŚŽ ĂĚŽƉƚĞĚ ƚŚĞ ^ƵŵĞƌŝĂŶ ϯϲϬͲĚĂLJ ĐĂůĞŶĚĂƌ͕ ĐŚŽƐĞ ŝŶƐƚĞĂĚ ƚŽ ĂĚĚ ĮǀĞ Žƌ ƐŽ ĚĂLJƐ ŽĨ ƉĂƌƚLJŝŶŐ ƚŽ ƚŚĞ ĞŶĚ ŽĨ ĞĂĐŚ LJĞĂƌ ƚŽ ŬĞĞƉ ƚŚĞŝƌ ĐĂůĞŶĚĂƌ ŝŶ ƐLJŶĐ ǁŝƚŚ ƚŚĞ seasons. This, to me, highlights a strong expression of values— ůŝƩůĞ ĞůƐĞ ŝƐ ŵŽƌĞ ƉƌĞĐŝŽƵƐ ƚŚĂŶ ŚŽǁ ǁĞ ĚĞĐŝĚĞ ƚŽ ĂůůŽĐĂƚĞ ŽƵƌ ƟŵĞ͘ zĞƚ͕ ŽŶĞ ƐŽĐŝĞƚLJ ƐĂǁ ƚŚŝƐ ƐŝƚƵĂƟŽŶ ĂƐ Ă ƉƌŽďůĞŵ ƚŽ ďĞ ƐŽůǀĞĚ͕ ǁŚŝůĞ ƚŚĞ ŽƚŚĞƌ ƐĂǁ ŝƚ ĂƐ ĂŶ ŽƉƉŽƌƚƵŶŝƚLJ ĨŽƌ ĨƵŶ ĂŶĚ ĐŽŶŶĞĐƟŽŶ͘ / ǁŝůů ůĞĂǀĞ ŝƚ ƚŽ LJŽƵ͕ ƌĞĂĚĞƌ͕ ƚŽ ĚĞĐŝĚĞ ǁŚŝĐŚ ƉĞƌƐƉĞĐƟǀĞ ŵĂŬĞƐ ŵŽƌĞ ƐĞŶƐĞ͘ /ƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ŶŽƚĞ ƚŚĂƚ ŶĞǁ ƉĞƌƐƉĞĐƟǀĞƐ ŽŌĞŶ LJŝĞůĚ ĚŝīĞƌĞŶƚ ƌĞƐƵůƚƐ͘ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŽŌĞŶ ĚŽ ŚĂǀĞ Ă ĚŝīĞƌĞŶƚ ǀŝĞǁƉŽŝŶƚ from our colleagues throughout the country, and that is leading ƚŽ ƉƌŽŐƌĞƐƐ ĂŶĚ ƵŶŝƋƵĞ ƐŽůƵƟŽŶƐ ŝŶ ŽƵƌ ƐƚĂƚĞ͘ ĚĂŵ &ƌĂŶĐŝƐ͕ &W ŝƌĞĐƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƟŽŶƐ͕ ĂŶĚ ƌ͘ ĂƌůĂ <ĂŬƵƚĂŶŝ͕ >ĞŐŝƐůĂƟǀĞ īĂŝƌƐ ŽŵŵŝƩĞĞ ŚĂŝƌ͕ ǁŝůů ŚŝŐŚůŝŐŚƚ ƉƌŽŐƌĞƐƐ ƚŚĂƚ ŚĂƐ ďĞĞŶ ŵĂĚĞ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƉƌŝŽƌŝƟĞƐ ŝŶ ƚŚĞ ůĞŐŝƐůĂƚƵƌĞ͘ zŽƵ ǁŝůů ŚĞĂƌ ĂďŽƵƚ ƚŚĞ ƉŝŽŶĞĞƌŝŶŐ ǁŽƌŬ ƚŚĞ ŽŵŵŝƩĞĞ ŽŶ ƚŚĞ ,ĞĂůƚŚ ŽĨ ƚŚĞ WƵďůŝĐ ; ,KW͕ Ă͘Ŭ͘Ă͘ ƚŚĞ :ƵƐƟĐĞ >ĞĂŐƵĞͿ ŚĂƐ ĂĚǀĂŶĐĞĚ ƚŽ ŝŵƉƌŽǀĞ ĐĂƌĞ ĨŽƌ ŐĞŶĚĞƌͲĞdžƉĂŶƐŝǀĞ ƉĂƟĞŶƚƐ͘

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California Family Physician Winter 2020

Finally, of particular note is the CAFP Principles on the Independent Practice of Medicine by Nurse Practitioners, explained by CAFP Director of Policy and Strategic Initiatives ŽŶƌĂĚ ŵĞŶƚĂ͘ ƵƌƌĞŶƚ &W ƉŽůŝĐLJ ŚĂƐ ŶŽƚ ĂůůŽǁĞĚ family physicians nationally to engage on the topic of ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ ŽĨ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ;EWƐͿ͕ ĞdžĐĞƉƚ ŝŶ ƐƚƌŝĐƚ ŽƉƉŽƐŝƚŝŽŶ͘ dŚŝƐ ŽƉƉŽƐŝƚŝŽŶ ŶŽƚǁŝƚŚƐƚĂŶĚŝŶŐ͕ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ ĨŽƌ EWƐ ŚĂƐ ďĞĞŶ ƉĂƐƐĞĚ ŝŶ ϮϮ ƐƚĂƚĞƐ ĂŶĚ ƚŚĞ ŝƐƚƌŝĐƚ ŽĨ ŽůƵŵďŝĂ ĂŶĚ ŝƐ ŶŽǁ ĂůůŽǁĞĚ ŝŶ the Veterans’ Administration. Furthermore, on October 3, President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors ŝŶĐůƵĚĞƐ ^ĞĐƚŝŽŶ ϱ͕ ǁŚŝĐŚ ĚŝƌĞĐƚƐ ƚŚĞ ,ĞĂůƚŚ Θ ,ƵŵĂŶ Services Secretary to “[e]liminate excessive supervision requirements that prevent APRNs and physicians’ ĂƐƐŝƐƚĂŶƚƐ ;W ƐͿ ĨƌŽŵ ĚĞůŝǀĞƌŝŶŐ ĂƉƉƌŽƉƌŝĂƚĞ ĚŝĂŐŶŽƐŝƐ ĂŶĚ quality care.” /Ŷ ƚŚĞ ϮϬϭϵ ƐĞƐƐŝŽŶ ŽĨ ƚŚĞ ĂůŝĨŽƌŶŝĂ >ĞŐŝƐůĂƚƵƌĞ͕ ƐƐĞŵďůLJ ŝůů ϴϵϬ ;tŽŽĚͿ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ďƵƚ ĚŝĚ ŶŽƚ ĂĚǀĂŶĐĞ͘ /ƚ ŵĂLJ ďĞ ƌĞŝŶƚƌŽĚƵĐĞĚ ŝŶ ƚŚĞ ϮϬϮϬ ƐĞƐƐŝŽŶ͘ &ĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŶŽǁ ŚĂǀĞ Ă ƉŽůŝĐLJ ĂŶĚ ƐĞƚ ŽĨ ƉƌŝŶĐŝƉůĞƐ ŐƵŝĚŝŶŐ ƵƐ ĂƐ ǁĞ ĂƌŐƵĞ that patients are best cared for in a team led by physicians, ďƵƚ ǁĞ ĐĂŶ ĂůƐŽ ĞŶŐĂŐĞ ŽŶ ϴϵϬ ƚŽ ƐĞĐƵƌĞ ƉĂƚŝĞŶƚ ƐĂĨĞƚLJ through adequate NP training and oversight. In the current policy environment, this flexibility is extremely important. / ďĞůŝĞǀĞ ƚŚĂƚ ǁŚĂƚ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂƌĞ ĚŽŝŶŐ ŝƐ ƐŚŽǁŝŶŐ ƚŚĞ ŶĂƚŝŽŶ Ă ŶĞǁ ǁĂLJ ƚŽ ĂƉƉƌŽĂĐŚ ƚŚŝƐ ŝƐƐƵĞ͘ &Žƌ ŵĂŶLJ ƌĞĂƐŽŶƐ͕ ϮϬϮϬ ǁŝůů ďĞ Ă ƚƵŵƵůƚƵŽƵƐ LJĞĂƌ ŝŶ ƉŽůŝƚŝĐƐ͘ dŚĂŶŬƐ ƚŽ ƚŚĞ ĨƌĞƐŚ ƉĞƌƐƉĞĐƚŝǀĞ ŽĨ ŽƵƌ ĐŽůůĞĂŐƵĞƐ͕ ǁĞ ĂƌĞ ƉƌĞƉĂƌĞĚ ǁŝƚŚ ƚŚĞ ƌŝŐŚƚ ƚŽŽůƐ ƚŽ ŚĞůƉ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚĂŬĞ the leap to the next step in advancing health care for our patients, their families and communities.

References ϭ͘ ,ĂŶĚǁĞƌŬ͕ ƌŝĂŶ͘ dŚĞ ^ƵƌƉƌŝƐŝŶŐ ,ŝƐƚŽƌLJ ĞŚŝŶĚ >ĞĂƉ zĞĂƌ͘ EĂƚŝŽŶĂů 'ĞŽŐƌĂƉŚŝĐ͘ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ŶĂƚŝŽŶĂůŐĞŽŐƌĂƉŚŝĐ͘ĐŽŵͬ ŶĞǁƐͬϮϬϭϲͬϬϮͬϭϲϬϮϮϲͲůĞĂƉͲLJĞĂƌͲƐĐŝĞŶĐĞͲƚŝŵĞͲǁŽƌůĚͲĐƵůƚƵƌĞƐͲ ĨĞďƌƵĂƌLJͬ͘ &ĞďƌƵĂƌLJ Ϯϲ͕ ϮϬϭϲ͘ ĐĐĐĞƐƐĞĚ ĞĐĞŵďĞƌ ϭϲ͕ ϮϬϭϵ͘

California Family Physician Winter 2020

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p r e s i d e n t ’s m e s s a g e

Walt Mills, MD

2020: We Need a Vision Forward / ǁƌŽƚĞ ƚŚŝƐ ŵĞƐƐĂŐĞ Ăƚ ƚŚĞ ĞŶĚ ŽĨ Ă ǀĞƌLJ ƐŝŐŶŝĨŝĐĂŶƚ ǁĞĞŬ ŝŶ ŽƵƌ ŶĂƚŝŽŶ͛Ɛ ŚŝƐƚŽƌLJ͘ dŚĞ WƌĞƐŝĚĞŶƚ ŽĨ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ ǁĂƐ impeached by the House of Representatives. Regardless of ŽŶĞ͛Ɛ ƉŽůŝƚŝĐĂů ǀŝĞǁƐ ĂŶĚ ƉĞƌƐŽŶĂů ŽƉŝŶŝŽŶƐ͕ ƚŚĞ ǀŽƚĞ ƐŚŽǁĞĚ ŚŽǁ ĚĞĞƉůLJ ĚŝǀŝĚĞĚ ǁĞ ĂƌĞ ĂƐ Ă ĐŽƵŶƚƌLJ͘ ^ŽĐŝĂů ĚĞƚĞƌŵŝŶĂŶƚƐ ŽĨ ŚĞĂůƚŚ ƐƵĐŚ ĂƐ ŚŽŵĞůĞƐƐŶĞƐƐ ĂŶĚ ĨŽŽĚ ŝŶƐĞĐƵƌŝƚLJ ŐƌŽǁ ĚĞƐƉŝƚĞ Ă ͞ƚŚƌŝǀŝŶŐ ĞĐŽŶŽŵLJ͘͟ dŚĞ ŽƉŝŽŝĚ ĞƉŝĚĞŵŝĐ ƐŚĂĚŽǁ ĚĂƌŬĞŶƐ͘ dŚĞ ŶƵŵďĞƌ ŽĨ ƵŶŝŶƐƵƌĞĚ ĞdžƉĂŶĚƐ ǁŚŝůĞ ƚŚĞ ͞DĞĚŝĐĂƌĞ ĨŽƌ Ăůů͟ ĚĞďĂƚĞ ĨůĂƌĞƐ͘ /Ĩ ĞǀĞƌ ǁĞ ŶĞĞĚĞĚ ϮϬϮϬ ǀŝƐŝŽŶ ƚŽ ƐĞĞ ŽƵƌ ǁĂLJ ĨŽƌǁĂƌĚ͕ ŝƚ͛Ɛ ŶŽǁ͘ ϮϬϮϬ ǀŝƐŝŽŶ ĂůƐŽ ŝŵƉůŝĞƐ ƉĞƌƐƉĞĐƚŝǀĞ͘ ƵƌŝŶŐ ƚŚĞ ĨŝƌƐƚ ŚĂůĨ of my year as CAFP President I’ve been struck by the ĚŝǀĞƌƐĞ ĂŶĚ ƌŝĐŚ ƉĞƌƐƉĞĐƚŝǀĞƐ ŽĨ ŽƵƌ ϭϭ͕ϬϬϬ ŵĞŵďĞƌƐ͘ tŝƚŚ California’s Family Medicine Revolution in its third decade, ǁĞ ŶĞĞĚ ŶŽǁ ŵŽƌĞ ƚŚĂŶ ĞǀĞƌ ƚŽ ĞŶŐĂŐĞ ĂŶĚ ůĞǀĞƌĂŐĞ our membership’s diverse perspectives to ensure “strong medicine for California” prevails.

ZĞƉƌŽĚƵĐƟǀĞ ƋƵŝƚLJ I recently signed a letter representing you, CAFP members, protesting the potential merger of UCSF and a health system operating under the directives of the Roman Catholic ŚƵƌĐŚ͘ dŚĞ ĂƚŚŽůŝĐ ĚŝƌĞĐƚŝǀĞƐ ǁŽƵůĚ ŚĂǀĞ ůŝŵŝƚĞĚ ǁŽŵĞŶ͛Ɛ access to comprehensive reproductive health care, affecting ƐŽŵĞ ŽĨ ƚŚĞ ŵŽƐƚ ǀƵůŶĞƌĂďůĞ͕ ƵŶĚĞƌƐĞƌǀĞĚ ǁŽŵĞŶ ŝŶ ĂůŝĨŽƌŶŝĂ͘ tŝƚŚ &W ůĞĂĚĞƌƐŚŝƉ͕ ŝŶ ĐŽůůĂďŽƌĂƚŝŽŶ ǁŝƚŚ ŽƚŚĞƌ ŽƌŐĂŶŝnjĂƚŝŽŶƐ ĐŽŵŵŝƚƚĞĚ ƚŽ ƌĞƉƌŽĚƵĐƚŝǀĞ ũƵƐƚŝĐĞ͕ ƚŚĞ ŵĞƌŐĞƌ ǁĂƐ ĐŚĞĐŬĞĚ͘ / ĐŽŶƐƵůƚĞĚ Ă ĨĞůůŽǁ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͕ ƚŚĞ ĐŚŝĞĨ ĞdžĞĐƵƚŝǀĞ ƉŚLJƐŝĐŝĂŶ ŽĨ ƚŚĞ ŽƚŚĞƌ ƐLJƐƚĞŵ͕ ĚƵƌŝŶŐ ƚŚĞ ƉƌŽĐĞƐƐ͘ /ƚ ǁĂƐ affirming that such a conversation could happen coming from different perspectives. Affirming, but not surprising ŐŝǀĞŶ ǁĞ ǁĞƌĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ĞdžƉĞƌƚƐ Ăƚ ĚŝĂůŽŐ ĂŶĚ ƐĞĞŬŝŶŐ ĐŽůůĂďŽƌĂƚŝǀĞ ƐŽůƵƚŝŽŶƐ ;ŝƚ͛Ɛ ǁŚĂƚ ǁĞ ĚŽ ĞǀĞƌLJ ĚĂLJ ǁŝƚŚ ŽƵƌ ƉĂƚŝĞŶƚƐ ĂĨƚĞƌ ĂůůͿ͘ tĞ ůĞĂƌŶĞĚ ĨƌŽŵ ĞĂĐŚ ŽƚŚĞƌ ŚŽǁ ƚŽ ďĞƐƚ ƉƌŽĐĞĞĚ͘ Gun Safety I signed another letter declaring the need for stronger gun

8

California Family Physician Winter 2020

regulation and more research to inform evidence-based ŵĞĂŶƐ ƚŽ ĂĚĚƌĞƐƐ ƚŚŝƐ ƚĞƌƌŝďůĞ ŚĞĂůƚŚ ŚĂnjĂƌĚ ƚŚĂƚ ŚĂƐ devastated many of our patients. ĞĨŽƌĞ ƚŚĞ ůĞƚƚĞƌ ǁĞŶƚ ŽƵƚ͕ / ĐĂůůĞĚ ƐĞǀĞƌĂů ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ůĞĂĚĞƌƐ ǁŚŽ / ŬŶŽǁ ŚĂǀĞ ĚŝĨĨĞƌĞŶƚ ǀŝĞǁƐ ĂďŽƵƚ ƚŚĞ ůĞƚƚĞƌ͛Ɛ ŵĞƐƐĂŐĞ͘ dŚĞ ŝŶĐůƵƐŝŽŶ ŽĨ ƚŚĞŝƌ ǁŝƐĞ ƉĞƌƐƉĞĐƚŝǀĞ ĂŶĚ ĚĞĞƉĞƌ ŬŶŽǁůĞĚŐĞ ŽĨ ƚŚĞ ƐƵďũĞĐƚ ŵĂĚĞ ƚŚĞ ůĞƚƚĞƌ ƐƚƌŽŶŐĞƌ͘ tŝƚŚŽƵƚ ƐƵĐŚ ŝŶĐůƵƐŝŽŶ ĂŶĚ ƌĞƐƉĞĐƚ͕ ŶŽƚ ŽŶůLJ ǁŽƵůĚ ǁĞ ŚĂǀĞ ŵŝƐƐĞĚ ǀĂůƵĂďůĞ ŝŵƉƌŽǀĞŵĞŶƚƐ ŝŶ ŽƵƌ ŵĞƐƐĂŐĞ͕ ďƵƚ / ǁŽƵůĚŶ͛ƚ ŚĂǀĞ been surprised to hear of their resignation from an Academy that did not respect its members’ perspectives. /ŶƚĞƌƉƌŽĨĞƐƐŝŽŶĂů dĞĂŵͲ ĂƐĞĚ ĂƌĞ /Ŷ ϭϵϴϬ Ă ĨƌŝĞŶĚ ĂƚƚĞŵƉƚĞĚ ƚŽ ĂƌƌĂŶŐĞ Ă ďůŝŶĚ ĚĂƚĞ ĨŽƌ ŵĞ ǁŝƚŚ Ă ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌ ǁŚŽ ŚĂĚ ũƵƐƚ ŵŽǀĞĚ ƚŽ ĂůŝĨŽƌŶŝĂ͘ / ǁĂƐ Ă ƐĞŶŝŽƌ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ Ăƚ h ^ ͘ / ǁĂƐ ƚŽůĚ ƚŚĞ FNP had no interest in dating me. Her experiences in her professional role as an RN/NP had been too negative in relation to physician colleagues to begin dating a medical student. Sad testament to the culture, then prevalent, of ƉŚLJƐŝĐŝĂŶ ƐƵƉĞƌŝŽƌŝƚLJ͘ ǀĞŶƚƵĂůůLJ / ǁĂƐ ĂďůĞ ƚŽ ƉƌŽǀĞ ŵLJƐĞůĨ ǁŽƌƚŚLJ͘ tĞ ŚĂǀĞ ŚĂƉƉŝůLJ ďĞĞŶ ƚŽŐĞƚŚĞƌ ϰϬ LJĞĂƌƐ ĂŶĚ ƐŚĞ ŚĂƐ ƐŝŶĐĞ ĚĞǀĞůŽƉĞĚ ǁŽŶĚĞƌĨƵů ƌĞůĂƚŝŽŶƐŚŝƉƐ ǁŝƚŚ ŵĂŶLJ ŬŝŶĚ ĂŶĚ thoughtful physicians. ŶĞǁ &W ^ĐŽƉĞ ŽĨ WƌĂĐƚŝĐĞ ŽŵŵŝƚƚĞĞ ǁĂƐ ĐŽŶǀĞŶĞĚ ƚŽ ĚĞǀĞůŽƉ ƉŽůŝĐLJ ĞdžƉůŽƌŝŶŐ ĐŽůůĂďŽƌĂƚŝŽŶ ǁŝƚŚ ŽƚŚĞƌ ĂůůŝĞĚ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂůƐ ;EWƐ ĂŶĚ W ƐͿ ƚŽ ŵĞĞƚ ĂůŝĨŽƌŶŝĂ͛Ɛ primary care needs. Longstanding AAFP policy declares allied health professionals should never be permitted to have independent practice. In unprecedented fashion, CAFP is ĂƚƚĞŵƉƚŝŶŐ ƚŽ ďĞ ŝŶĐůƵƐŝǀĞ ǁŝƚŚ EWƐ ĂŶĚ W Ɛ͘ dĂŬĞ Ă ůŽŽŬ Ăƚ ŽƵƌ ŶĞǁ ƉƌŝŶĐŝƉůĞƐ ŽŶ ƉĂŐĞƐ ϮϮͲϮϱ͘ DLJ ͞ĚĂƚŝŶŐ͟ ŵĞƚĂƉŚŽƌ ǁŝƚŚ ŵLJ ǁŝĨĞ ŝƐ ĂďŽƵƚ ŚŽǁ ƉĂƐƚ ĞdžƉĞƌŝĞŶĐĞƐ ďŝĂƐ ƵƐ ĂŶĚ ƉŽƚĞŶƚŝĂůůLJ ĐůŽƐĞ ƵƐ ƚŽ ĂŵĂnjŝŶŐ possibilities. Similarly, I am open and hopeful that our courageous leadership’s convening the Scope Committee, is Ă ďƌĂǀĞ ƐƚĂƌƚ ƚŽ ŵŽǀŝŶŐ ƚŽǁĂƌĚ ƚŚĞ ƚLJƉĞ ŽĨ ĐŽůůĂďŽƌĂƚŝŽŶ ĂŶĚ ƚĞĂŵǁŽƌŬ ŶĞĞĚĞĚ ƚŽ ŵĞĞƚ ƚŚĞ ŶĞĞĚƐ ŽĨ ŽƵƌ ŵĞŵďĞƌƐ ĂŶĚ

ƚŚĞ ƉĂƚŝĞŶƚƐ ŽĨ ĂůŝĨŽƌŶŝĂ͘ tĞ ǁŝůů ŶĞǀĞƌ ƐŽůǀĞ ŽƵƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ĐƌŝƐŝƐ ǁŝƚŚŽƵƚ ƐƵĐŚ inclusion strategies. ŝǀĞƌƐŝƚLJ͕ /ŶĐůƵƐŝŽŶ͕ ƋƵŝƚLJ͗ DLJ ϮϬϮϬ Commitment h ^& ƉůĂŶƐ ƚŽ ƚƌĂŝŶ ϭ͕ϮϬϬ ĨĂĐƵůƚLJ ƚŽ be “diversity, equity and inclusion champions” over the next several LJĞĂƌƐ͘ / ĐŽŵƉůĞƚĞĚ ƚŚĞ ƚƌĂŝŶŝŶŐ ǁŝƚŚ many other FM faculty from multiple California programs. I learned I need to become a more inclusive leader. I ĐŽŵŵŝƚƚĞĚ ƚŽ ůĞĂƌŶ ƚŽ ƵƐĞ ŵLJ ƉŽǁĞƌ and privilege in “allyship.” Allyship is ƌĞĐŽŐŶŝnjŝŶŐ ƉƌŝǀŝůĞŐĞ ĂŶĚ ƵƐŝŶŐ ŝƚ ƚŽ amplify underrepresented voices. I have been striving to understand the ƐLJƐƚĞŵĂƚŝĐ ĂŶĚ ƐŽĐŝĞƚĂů ŝƐƐƵĞƐ ǁŚŝĐŚ ŚĂǀĞ played in my favor since before I met that ĂǁĞƐŽŵĞ &EW ůŽŶŐ ĂŐŽ͘

tŚĞƚŚĞƌ / Ăŵ ǁŝƚŚ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ struggling to survive a surgery clerkship, a teen patient “coming out,” ĐŽŵƉĂƐƐŝŽŶĂƚĞůLJ ĐŽŶŶĞĐƚŝŶŐ ǁŝƚŚ Ă ϲϬͲLJĞĂƌͲŽůĚ ŽƉŝŽŝĚ ĂĚĚŝĐƚ ŝŶ ŚŽƉĞƐ Ă ďƵƉƌĞŶŽƌƉŚŝŶĞ ƉƌĞƐĐƌŝƉƚŝŽŶ ǁŽƌŬƐ ƚŽ save a life, or a colleague struggling to make sense of the “Me Too” movement ĂƐ Ă ǁŽŵĂŶ ůĞĂĚĞƌ͕ / ƌĞĐŽŐŶŝnjĞ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ĂŶĚ ƉŽǁĞƌ ƚŚĞ ĚŝǀĞƌƐŝƚLJ ƚƌĂŝŶŝŶŐ ďĞƐƚŽǁƐ͘ dĂŬĞ Ă ůŽŽŬ Ăƚ ŚƚƚƉƐ͗ͬ​ͬ differencesmatter.ucsf.edu/diversityequity-and-inclusion-champion-training for more on this. We must all be Diversity Champions to be real healers.

to discover “shared decision making” as Ă ďĞƚƚĞƌ ǁĂLJ ƚŽ ĚĞĂů ǁŝƚŚ ƵŶĐĞƌƚĂŝŶƚLJ ĂŶĚ ƉŽƐƐŝďŝůŝƚŝĞƐ ǁŝƚŚ ŵLJ ƉĂƚŝĞŶƚƐ͖ ůŝŬĞǁŝƐĞ͕ CAFP and you can create the best ĚĞĐŝƐŝŽŶƐ ĂŶĚ ĨƵƚƵƌĞ ďLJ ǁŽƌŬŝŶŐ ƚŽŐĞƚŚĞƌ͘ zĞƐ͕ / ƵŶĚĞƌƐƚĂŶĚ ďĞƚƚĞƌ͕ ǁĞ ĂƌĞ ƉĂƌƚ ŽĨ ĂŶ ŝŶĐƌĞĂƐŝŶŐůLJ ĐŽŵƉůĞdž ǁŽƌůĚ ǁŝƚŚ ƵŶƉƌĞĚŝĐƚĂďůĞ ĨŽƌĐĞƐ Ăƚ ǁŽƌŬ͘ ,ŽǁĞǀĞƌ͕ / ĚŽ ŬŶŽǁ ƚŚĂƚ ǁŚĂƚĞǀĞƌ &W ĐƌĞĂƚĞƐ ĨŽƌ ĂŶĚ ǁŝƚŚ LJŽƵ͕ ŽƵƌ ŵĞŵďĞƌƐ͕ ŝŶ ϮϬϮϬ͕ ƚŚĞ ŐŽĂů ǁŝůů ďĞ ƚŽ ďĞĐŽŵĞ ŝŶĐƌĞĂƐŝŶŐůLJ ŝŶĐůƵƐŝǀĞ ŽĨ Ăůů͘ &W ŝƐ ŐƌŽǁŝŶŐ ŝŶ ƐŝnjĞ and influence as the voice for primary care in California. Our mission is to ĞŶŐĂŐĞ͕ ĞĚƵĐĂƚĞ͕ ĂŶĚ ĞŵƉŽǁĞƌ Ăůů ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ͕ ƐŽ ƚŚĂƚ ǁĞ ŵĂLJ ƉƌŽǀŝĚĞ ƚŚĞ absolute best care for all Californians.

ϮϬϮϬ WƌĞĚŝĐƟŽŶƐ /͛ǀĞ ďĞĐŽŵĞ ŚƵŵďůĞ ŽǀĞƌ ƚŚĞ LJĞĂƌƐ ǁŝƚŚ making predictions for my patients; EŽǁ͕ ůĞƚ͛Ɛ ŐŽ ŵĂŬĞ ϮϬϮϬ ĂŵĂnjŝŶŐ ůŝŬĞǁŝƐĞ͕ ǁŝƚŚ ƉƌĞĚŝĐƚŝŶŐ ƚŚĞ ĨƵƚƵƌĞ ĨŽƌ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ŽƌŐĂŶŝnjĂƚŝŽŶƐ͘ / ǁĂƐ ŚĂƉƉLJ together!

California Family Physician Winter 2020

9

political pulse

Carla Kakutani, MD Chair, CAFP Legislative Affairs Committee

CAFP Ends 2019 with a Bang! / ŚĂǀĞ ƚŽ ƐƚĂƌƚ ŽƵƚ ǁŝƚŚ Ă ,h' ƚŚĂŶŬƐ ƚŽ ĞǀĞƌLJŽŶĞ ǁŚŽ called, emailed and texted their legislators and the governor ŝŶ ϮϬϭϵ͘ zŽƵƌ ĂĚǀŽĐĂĐLJ ŚĞůƉĞĚ ƉƵƐŚ ŵĂŶLJ &W ƉƌŝŽƌŝƚLJ ŝƐƐƵĞƐ ƚŽ ĂůŝĨŽƌŶŝĂ͛Ɛ ůĞŐŝƐůĂƚŝǀĞ ĨŽƌĞĨƌŽŶƚ ĂŶĚ ůĞĚ ƚŽ ϮϬ &WͲ ƐƵƉƉŽƌƚĞĚ ďŝůůƐ ďĞĐŽŵŝŶŐ ůĂǁ͕ ŝŶĐůƵĚŝŶŐ &W͛Ɛ ƐƉŽŶƐŽƌĞĚ ďŝůů͕ ϭϲϮϮ ; ĂƌƌŝůůŽͿ͘ ϭϲϮϮ ŝƐ Ă ďŝŐ ĚĞĂů͘ /ƚ ĨŝdžĞƐ ŽƵƚĚĂƚĞĚ ůĂǁƐ ƚŚĂƚ ƉƌĞǀĞŶƚĞĚ family physicians from receiving recognition for the true value and diversity of care they can provide. The bill adds family ƉŚLJƐŝĐŝĂŶƐ ƚŽ ǀĂƌŝŽƵƐ ĞdžŝƐƚŝŶŐ ƉƌŽǀŝƐŝŽŶƐ ŝŶ ůĂǁ͕ ŝŶĐůƵĚŝŶŐ͗ • dŚĞ EƵƌƐĞ WƌĂĐƚŝĐĞ Đƚ ƚŽ ĂůůŽǁ &WƐ ƚŽ ďĞ ŵĞŵďĞƌƐ of an existing committee to develop educational standards and associated matters relating to the ƉƌĂĐƚŝĐĞ ŽĨ ŶƵƌƐĞͲŵŝĚǁŝĨĞƌLJ͖ • The Sexual Health Education Accountability Act to modify the definition of “medically accurate” to ŝŶĐůƵĚĞ ƌĞƐĞĂƌĐŚ ƌĞĐŽŐŶŝnjĞĚ ĂƐ ĂĐĐƵƌĂƚĞ ĂŶĚ ŽďũĞĐƚŝǀĞ by the American Academy of Family Physicians; • The list of practitioners that a parent/guardian of a minor could consult regarding options available for a minor’s dental treatment; • The list of subject matter experts for purposes of the ZĞƉƌŽĚƵĐƚŝǀĞ ZŝŐŚƚƐ >Ăǁ ŶĨŽƌĐĞŵĞŶƚ ŝŶŝƚŝĂƚŝǀĞ͖ • Health promotion education programs for allied health professionals.

The bill also permits a board-certified family medicine ƉŚLJƐŝĐŝĂŶ ƚŽ ƉƌŽǀŝĚĞ ǁƌŝƚƚĞŶ ĐĞƌƚŝĨŝĐĂƚŝŽŶ ĨŽƌ ĂŶ ŝŶĨĂŶƚ ƵŶĚĞƌ the age of one month to participate in the entertainment ŝŶĚƵƐƚƌLJ͘ dŚĂŶŬ LJŽƵ ƚŽ Ăůů ƚŚĞ &W ŵĞŵďĞƌƐ ǁŚŽ ŚĞůƉĞĚ pass this bill! Today, legislators and the public have a clearer understanding of the value of family medicine because of our ǁŽƌŬ ƚŽŐĞƚŚĞƌ͘ ,ĞƌĞ ĂƌĞ ũƵƐƚ Ă ĨĞǁ ŽĨ ƚŚĞ ŽƚŚĞƌ ďŝŐ ǁŝŶƐ ǁĞ ŚĂĚ ŝŶ ϮϬϭϵ͗ ϳϰϰ ; ŐƵŝĂƌͲ ƵƌƌLJͿ ʹ ZĞƋƵŝƌĞƐ Ă ŚĞĂůƚŚ ƉůĂŶ ƚŽ ƉĂLJ ĨŽƌ a diagnosis, consultation or treatment delivered through telehealth services on the same basis as in-person diagnosis, consultation or treatment. ^ ϭϱϵ ;tŝĞŶĞƌͿ ʹ ƵƚŚŽƌŝnjĞƐ Ă ƉŚĂƌŵĂĐŝƐƚ͕ ĂĨƚĞƌ ĐŽŵƉůĞƚŝŶŐ

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California Family Physician Winter 2020

a training program and HIV status has been determined, to furnish preexposure and postexposure prophylaxis to a ƉĂƚŝĞŶƚ ǁŝƚŚ Žƌ Ăƚ ƌŝƐŬ ĨŽƌ ,/s͘ ^ Ϯϳϲ ;WĂŶͿ ʹ ĨƚĞƌ Ă ĚŝƐƌƵƉƚŝǀĞ ƉƵďůŝĐ ďĂƚƚůĞ ďĞƚǁĞĞŶ legislators, the Governor and pro- and anti-vaccination ŐƌŽƵƉƐ͕ ^ Ϯϳϲ ďŝůů ǁĂƐ ƐŝŐŶĞĚ ŝŶƚŽ ůĂǁ͕ ƌĞƐŚĂƉŝŶŐ ƚŚĞ procurement and monitoring of medical exceptions to ĐŚŝůĚŚŽŽĚ ǀĂĐĐŝŶĞƐ͘ /Ŷ ƌĞĂĐƚŝŽŶ ƚŽ &WͲƐƵƉƉŽƌƚĞĚ ^ Ϯϳϳ ;ϮϬϭϱͿ͕ ǁŚŝĐŚ ƌĞŵŽǀĞĚ ƚŚĞ ͞ZĞůŝŐŝŽƵƐ ĂŶĚ WĞƌƐŽŶĂů ĞůŝĞĨ͟ exemption to vaccines, some physicians began issuing inappropriate medical exemptions, dropping the vaccination ƌĂƚĞ Ăƚ ƐŽŵĞ ƐĐŚŽŽůƐ ďĞůŽǁ ƚŚĞ ϵϱ ƉĞƌĐĞŶƚ ŚĞƌĚ ŝŵŵƵŶŝƚLJ ƌĂƚĞ͘ hŶĚĞƌ ƚŚĞ ŶĞǁ ůĂǁ͕ ƚŚĞ ƐƚĂƚĞ ǁŝůů ĐŽůůĞĐƚ ŵĞĚŝĐĂů ĞdžĞŵƉƚŝŽŶƐ ĞůĞĐƚƌŽŶŝĐĂůůLJ ďLJ :ĂŶƵĂƌLJ ϭ͕ ϮϬϮϭ͘ DĞĚŝĐĂů ĞdžĞŵƉƚŝŽŶƐ ǁŝůů ďĞ ƌĞǀŝĞǁĞĚ ǁŚĞŶ͗ • ƐĐŚŽŽů͛Ɛ ŝŵŵƵŶŝnjĂƚŝŽŶ ƌĂƚĞ ĨĂůůƐ ďĞůŽǁ ϵϱ ƉĞƌĐĞŶƚ͖ Žƌ • ĚŽĐƚŽƌ ǁƌŝƚĞƐ ŵŽƌĞ ƚŚĂŶ ĨŝǀĞ ŵĞĚŝĐĂů ĞdžĞŵƉƚŝŽŶƐ ƉĞƌ LJĞĂƌ ďĞŐŝŶŶŝŶŐ :ĂŶƵĂƌLJ ϭ͕ ϮϬϮϬ͖ Žƌ • A school fails to provide reports of vaccination rates to ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ WƵďůŝĐ ,ĞĂůƚŚ ; W,Ϳ͘ >ŽĂĚƐ ŽĨ ǁŝŶƐ ƐŚŽǁ ƵƉ ŝŶ 'ŽǀĞƌŶŽƌ 'ĂǀŝŶ EĞǁƐŽŵ͛Ɛ ďƵĚŐĞƚ ĐŽůƵŵŶ ĂƐ ǁĞůů͕ ŝŶĐůƵĚŝŶŐ͗ • $33 million in annual ongoing funding for the Song ƌŽǁŶ WƌŝŵĂƌLJ ĂƌĞ WŚLJƐŝĐŝĂŶ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ͕ ǁŚŝĐŚ disburses grants to primary care residency programs ǁŚŽƐĞ ŐƌĂĚƵĂƚĞƐ ƚƌĂŝŶ ĂŶĚ ĐŽŶƚŝŶƵĞ ƚŽ ƉƌĂĐƚŝĐĞ ŝŶ underserved areas treating underserved populations.

• ĐŽŶƚŝŶƵĂƚŝŽŶ ŽĨ ŶĞĂƌůLJ ΨϰϬ ŵŝůůŝŽŶ WƌŽƉŽƐŝƚŝŽŶ ϱϲ ĨƵŶĚƐ ƚŽ ƐƵƉƉŽƌƚ ƉƌŝŵĂƌLJ ĐĂƌĞ ĂŶĚ ĞŵĞƌŐĞŶĐLJ medicine residency programs as administered by the hŶŝǀĞƌƐŝƚLJ ŽĨ ĂůŝĨŽƌŶŝĂ ŝŶ ƉĂƌƚŶĞƌƐŚŝƉ ǁŝƚŚ WŚLJƐŝĐŝĂŶƐ for a Healthy California.

• ΨϭϮϬ ŵŝůůŝŽŶ ĂĚĚŝƚŝŽŶĂů ŽŶĞͲƚŝŵĞ ĨƵŶĚŝŶŐ ĨŽƌ ƚŚĞ physician and dentist loan repayment program. This ŵĂŬĞƐ ΨϯϰϬ ŵŝůůŝŽŶ ĂǀĂŝůĂďůĞ ĨŽƌ ƚŚĞ ƉƌŽŐƌĂŵ ŽǀĞƌ ƚŚĞ next several years.

• ΨϮϱϬ ŵŝůůŝŽŶ ŝŶ ŽŶĞͲƚŝŵĞ ĨƵŶĚŝŶŐ ĨŽƌ ǀĂƌŝŽƵƐ DĞĚŝͲ Ăů Value-Based Payments programs.

• Restoration of optical, audiology, incontinence ĐƌĞĂŵƐͬǁĂƐŚĞƐ͕ ƉŽĚŝĂƚƌLJ ĂŶĚ ƐƉĞĞĐŚ ƚŚĞƌĂƉLJ ďĞŶĞĨŝƚƐ in Medi-Cal.

• •

džƚĞŶƐŝŽŶ ŽĨ DĞĚŝͲ Ăů ĞůŝŐŝďŝůŝƚLJ ĨƌŽŵ ϲϬ ĚĂLJƐ ƚŽ ŽŶĞ LJĞĂƌ ĨŽƌ ƉŽƐƚͲƉĂƌƚƵŵ ǁŽŵĞŶ ĚŝĂŐŶŽƐĞĚ ǁŝƚŚ Ă ŵĞŶƚĂů health disorder.

Funding for prevention and linkage to care programs ĨŽƌ ƉĂƚŝĞŶƚƐ ǁŝƚŚ ,/s͕ ,ĞƉĂƚŝƚŝƐ ͕ ĂŶĚ ^d Ɛ͘

We cannot rest on our laurels, though. Major opportunities ͙ ůŝĞ ŝŶ ĨƌŽŶƚ ŽĨ ƵƐ͘ ^Ž ĚŽ ƚŚƌĞĂƚƐ ͙ ƚŚĞ ůĞĂƐƚ ŽĨ ǁŚŝĐŚ ŝƐ Ă ϮϬϮϬ ƐƚĂƚĞǁŝĚĞ ďĂůůŽƚ ŝŶŝƚŝĂƚŝǀĞ ŚĂƐ ũƵƐƚ ŝŶƚƌŽĚƵĐĞĚ ƚŚĂƚ ǁŽƵůĚ ĐŚĂůůĞŶŐĞ ƚŚĞ DĞĚŝĐĂů /ŶũƵƌLJ ŽŵƉĞŶƐĂƚŝŽŶ ZĞĨŽƌŵ Đƚ ;D/ Z Ϳ͘ &Žƌ ŵŽƌĞ ƚŚĂŶ ϯϱ LJĞĂƌƐ͕ D/ Z ŚĂƐ ĞŶƐƵƌĞĚ ƉĂƚŝĞŶƚ

ĂĐĐĞƐƐ ƚŽ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ďLJ ƌĞĚƵĐŝŶŐ ĨƌŝǀŽůŽƵƐ ůĂǁƐƵŝƚƐ ĂŶĚ ůŝŵŝƚŝŶŐ ŐƌŽǁƚŚ ŝŶ ŵĞĚŝĐĂů ŵĂůƉƌĂĐƚŝĐĞ ƉƌĞŵŝƵŵƐ͘ ZĞƐƚ ĂƐƐƵƌĞĚ͕ &W ŝƐ ƉƌĞƉĂƌŝŶŐ ƚŽ ĨŝŐŚƚ ƚŚŝƐ ŝŶŝƚŝĂƚŝǀĞ ƚŚĂƚ ǁŝůů ultimately increase costs and decrease access to health care.

If you’d like to support our efforts on this and other political matters, please consider contributing to the Family Physicians WŽůŝƚŝĐĂů ĐƚŝŽŶ ŽŵŵŝƚƚĞĞ ;&WͲW Ϳ͘ tĂŶƚ ƚŽ ŐĞƚ ĞǀĞŶ ŵŽƌĞ ŝŶǀŽůǀĞĚ͍ ^ŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞLJ Contact by emailing our Director of Government Relations, Adam Francis, at afrancis@familydocs.org.

Want to take your advocacy to the next level or just learn the basics, and have a chance to meet with your legislator?

ZĞŐŝƐƚƌĂƟŽŶ ŝƐ ŶŽǁ ŽƉĞŶ ĨŽƌ &W͛Ɛ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ ; D DͿ͘ dŚĞ D D ǁŝůů ďĞ Ăƚ ƚŚĞ ^ŚĞƌĂƚŽŶ 'ƌĂŶĚ ^ĂĐƌĂŵĞŶƚŽ͕ Saturday and Sunday, March 14-15, 2020 followed by Family Medicine Lobby Day on Monday, March 16͕ ĚƵƌŝŶŐ ǁŚŝĐŚ LJŽƵ͛ůů ŚĂǀĞ ĂŶ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ŵĞĞƚ ǁŝƚŚ LJŽƵƌ ůĞŐŝƐůĂƚŽƌƐ ĂŶĚ ƚŚĞŝƌ ƐƚĂī͘ dŚŝƐ ŵĞĞƟŶŐ ŝƐ ŽƉĞŶ ƚŽ Ăůů &W ŵĞŵďĞƌƐ͕ ƌĞŐĂƌĚůĞƐƐ ŽĨ ǁŚĞƚŚĞƌ LJŽƵ ĂƌĞ Ă ĚĞůĞŐĂƚĞ Žƌ ĂůƚĞƌŶĂƚĞ ĨƌŽŵ LJŽƵƌ ĐŽƵŶƚLJ ĐŚĂƉƚĞƌ Žƌ Ă ŐĞŶĞƌĂů ĂƩĞŶĚĞĞ͘ ƚ ƚŚĞ D D͕ LJŽƵ͛ůů ŚĞĂƌ ĨƌŽŵ ƉŽůŝĐLJ ĂŶĚ ƉŽůŝƟĐĂů ĞdžƉĞƌƚƐ͕ ŐĞƚ ŚĂŶĚƐͲŽŶ ĞdžƉĞƌŝĞŶĐĞ ĂĚǀŽĐĂƟŶŐ ĨŽƌ ŝƐƐƵĞƐ ŝŵƉŽƌƚĂŶƚ ƚŽ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ŶĞƚǁŽƌŬ ǁŝƚŚ ĂĚǀŽĐĂĐLJͲŽƌŝĞŶƚĞĚ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ŵĞĞƚ ǁŝƚŚ LJŽƵƌ ůĞŐŝƐůĂƚŽƌƐ͊ &ƌŽŵ ŝŵƉƌŽǀŝŶŐ ƉƵďůŝĐ ŚĞĂůƚŚ ƚŽ ŝŶĐƌĞĂƐŝŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉĂLJŵĞŶƚ͕ ůĞĂƌŶ ŚŽǁ zKh ĐĂŶ ďĞ ƚŚĞ ĐŚĂŶŐĞ LJŽƵ ǁĂŶƚ ƚŽ ƐĞĞ ŝŶ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƉŽůŝĐLJ ǁŽƌůĚ͘ /Ŷ ĂĚĚŝƟŽŶ͕ ƚŚĞ D D ǁŝůů ďĞ ĂĐĐƌĞĚŝƚĞĚ ĨŽƌ &W ƉƌĞƐĐƌŝďĞĚ D ĐƌĞĚŝƚ͘ ůů ƚŚŝƐ ĨŽƌ ůĞƐƐ ƚŚĂŶ ΨϱϬ ƌĞŐŝƐƚƌĂƟŽŶ ; &W ĐŽǀĞƌƐ ƌĞŐŝƐƚƌĂƟŽŶ ĨŽƌ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐͿ͊

California Family Physician Winter 2020

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IN THE NEWS Winter 2020

:ĂƐŵĞĞƚ ĂŝŶƐ͕ D ͕ ;ƐĞĐŽŶĚ ĨƌŽŵ ůĞŌ ŝŶ ƚŚĞ ƉŚŽƚŽͿ ŚĂƐ ƌĞĐĞŝǀĞĚ ŽĸĐŝĂů ǁŽƌĚ ĂŶĚ ǁĞ͛ƌĞ ƉůĞĂƐĞĚ ƚŽ ƐŚĂƌĞ ƚŚĂƚ ƐŚĞ ŚĂƐ ďĞĞŶ ŽĸĐŝĂůůLJ ĂƉƉŽŝŶƚĞĚ ƚŽ ƚŚĞ ĂůŝĨŽƌŶŝĂ ĞǀĞůŽƉŵĞŶƚĂů ^ĞƌǀŝĐĞƐ ; ^Ϳ dĂƐŬĨŽƌĐĞ͘ ^ŚĞ ǁŝůů ďĞ ǁŽƌŬŝŶŐ ƚŽ ŝŶĐƌĞĂƐĞ ƋƵĂůŝƚLJ ĐŽŶƟŶƵŝƚLJ ŚĞĂůƚŚ ĐĂƌĞ ƐĞƌǀŝĐĞƐ ĂŶĚ ĂĐĐĞƐƐ ƚŽ ƌĞƐŽƵƌĐĞƐ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ǁŝƚŚ ĚĞǀĞůŽƉŵĞŶƚĂů ĚŝƐĂďŝůŝƟĞƐ͘ dŚŝƐ ŝƐ Ă ĚŝƌĞĐƚ ŽƵƚŐƌŽǁƚŚ ŽĨ ŚĞƌ ǁŽƌŬ ŝŶ <ĞƌŶ ĐŽƵŶƚLJ ĂƐ Ă ƉƌĂĐƟĐŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ĂŶĚ ďŽĂƌĚ ŵĞŵďĞƌ Ăƚ ƚŚĞ <ĞƌŶ ZĞŐŝŽŶĂů ĞŶƚĞƌ͘ ^ŚĞ͛Ɛ ĂůƌĞĂĚLJ ĂƩĞŶĚĞĚ ŚĞƌ ĮƌƐƚ ŵĞĞƟŶŐ ĂŶĚ ƌĞƉŽƌƚƐ͕ ͞'ƌĞĂƚ ŵĞĞƟŶŐ ĂŶĚ ĚŝƐĐƵƐƐŝŽŶ ƚŽĚĂLJ ǁŝƚŚ ^ĞĐƌĞƚĂƌLJ 'ŚĂůLJ͕ ŝƌĞĐƚŽƌ ĂƌŐŵĂŶŶ ĂŶĚ ĨĞůůŽǁ ŵĞŵďĞƌƐ ŽĨ ƚŚĞ ŶĞǁ ^ dĂƐŬĨŽƌĐĞ͘ tŽŶĚĞƌĨƵů ƚŽ ŚĞůƉ ůĞĂĚ ƋƵĂůŝƚLJ ŝŵƉůĞŵĞŶƚĂƟŽŶ ĂŶĚ ƐLJƐƚĞŵ ƌĞĨŽƌŵ ŽĨ ŽƵƌ ƐĞƌǀŝĐĞƐ ĨŽƌ ƉĞŽƉůĞ ǁŝƚŚ ĚĞǀĞůŽƉŵĞŶƚĂů ĂŶĚ ŝŶƚĞůůĞĐƚƵĂů ĚŝƐĂďŝůŝƟĞƐ ŝŶ ĂůŝĨŽƌŶŝĂ͘ tŽƌŬŝŶŐ ŽŶ ƐŽŵĞ ŐƌĞĂƚ ƉƌŽũĞĐƚƐ ĂŶĚ ŚĞůƉŝŶŐ ǁŝƚŚ ƚŚĞ ƚƌĂŶƐŝƟŽŶ ĨƌŽŵ ƚŚĞ ĐůŽƐƵƌĞ ŽĨ ĚĞǀĞůŽƉŵĞŶƚĂů ĐĞŶƚĞƌƐ͘ /Ĩ ǁĞ ǁĂŶƚ ƚŽ ŚĞůƉ ƚƌĂŶƐĨŽƌŵ ŚĞĂůƚŚ ĐĂƌĞ͕ ǁĞ ŵƵƐƚ ĮƌƐƚ ƐƚĂƌƚ ǁŝƚŚ ƚŚĞ ǀƵůŶĞƌĂďůĞ ƉŽƉƵůĂƟŽŶƐ ƚŚĂƚ ŶĞĞĚ ĂƩĞŶƟŽŶ ƌŝŐŚƚ ĂǁĂLJ͘͟ ηƋƵĂůŝƚLJŚĞĂůƚŚϰĂůů͘ ŽŶŐƌĂƚƵůĂƟŽŶƐ :ĂƐŵĞĞƚ͊

>ĂƵƌĂ DĂƌƟŶ͕ ŝĂŶĂ DŽŬĂLJĂ͕ ƌŝŬĂ ZŽƐŚĂŶƌĂǀĂŶ͕ dŽŶĂ ZŽĚƌŝŐƵĞnj͕ DĂƌŐĂƵdž >ĂnjĂƌŝŶ͕ /ƐĂďĞů ŚĞŶ ĂŶĚ <ĂƌĞĞŶ ƐƉŝŶŽ͘ KƵƌ ĐŽĂĐŚĞƐ ĂƌĞ ƌƐ͘ ĂƌŽů ,ĂǀĞŶƐ͕ ĂƌůĂ <ĂŬƵƚĂŶŝ͕ ^ŚĂŶŶŽŶ ŽŶŶŽůůLJ͕ ŶŶĞ DŽŶƚŐŽŵĞƌLJ͕ ŵŝůLJ ďĞƌƚ͕ <ŝŵ Ƶŝƌ͕ ĂƚŚĞƌŝŶĞ ^ŽŶƋƵŝƐƚ &ŽƌĞƐƚ͕ >ĂƵƌĞŶ ^ŝŵŽŶ͕ ĂŶĚ >ŝƐĂ tĂƌĚ͘ tŚĂƚ ĂŶ ĂŵĂnjŝŶŐ ŐƌŽƵƉ͊ The second cohort of the Ready to Lead class of leaders and coaches ŵĞƚ ŝŶ KĐƚŽďĞƌ͘ dŚĞLJ ŚĂĚ Ă ĨƵůů ĂŐĞŶĚĂ ǁŝƚŚ ƐĞƐƐŝŽŶƐ ŽŶ ǁŽƌŬŝŶŐ ǁŝƚŚ ǀŝƐŝŽŶ͕ ůĞĂĚŝŶŐ ĐŚĂŶŐĞ͕ ĐŽŵŵƵŶŝĐĂƟŽŶ ĂŶĚ ŝŶŇƵĞŶĐĞ͘ dŚĞLJ ĚŝƐĐƵƐƐĞĚ ĞŶǀŝƌŽŶŵĞŶƚĂů ŝƐƐƵĞƐ ĂŶĚ ƚŚĞŝƌ ŝŶŇƵĞŶĐĞ ŽŶ ĐŚĂŶŐĞ͕ ŚŽǁ ƚŽ ĚƌŝǀĞ ĐŚĂŶŐĞ͕ ŝĚĞŶƟĨLJŝŶŐ ĂŶĚ ŽǀĞƌĐŽŵŝŶŐ ďĂƌƌŝĞƌƐ ĨŽƌ ĐŚĂŶŐĞ͘ Mary Ales, MBA, FACEHP also led a special breakout core value ĞdžƉůŽƌĂƟŽŶ ͙ ƚŚĞ ǀĂůƵĞƐ ƚŚĂƚ ƉƌŽǀŝĚĞ ŽƵƌ ƉĞƌƐŽŶĂů ĨŽƵŶĚĂƟŽŶ ĂŶĚ ŽŶ ǁŚŝĐŚ ǁĞ ĐŽŶƐƚƌƵĐƚ ƚŚĞ ƐĐĂīŽůĚŝŶŐ ƚŽ ŚŽůĚ ŽƵƌ ŚŽƵƐĞƐ ŝŶ ƉůĂĐĞ͘ dŚĞ ŐƌŽƵƉ ĞdžĂŵŝŶĞĚ ƚŚĞ ǀĂůƵĞƐ ǁŝƚŚŝŶ ƚŚĞ ĐůŝŶŝĐ Žƌ ƉƌĂĐƟĐĞ ƐĞƫŶŐ ĂŶĚ ĐƌĂŌĞĚ Ă ƌĞĂůŝƐƟĐ ĂŶĚ ƐƵƐƚĂŝŶĂďůĞ ƉůĂŶ ƚŽ ŬĞĞƉ ƚŚĞŝƌ ŚŽƵƐĞƐ ƐƚĂŶĚŝŶŐ ĞǀĞŶ ĂƐ ƚŚĞ ǁŝŶĚƐ ŽĨ ĐŚĂŶŐĞ Ɛǁŝƌů ĂƌŽƵŶĚ ƵƐ͘ &Žƌ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ZĞĂĚLJ ƚŽ >ĞĂĚ ƉƌŽũĞĐƚ͗ ǁǁǁ͘ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐ͘ >ĞĂĚĞƌƐ ŝŶĐůƵĚĞ ƌƐ͘ ŶũĂŶĂ ^ŚĂƌŵĂ͕ :ĂƐŵĞĞƚ ĂŝŶƐ͕ ^ŚĞƌLJů ZĞĐŝŶŽƐ͕ EnjŝŶŐĂ 'ƌĂŚĂŵ͕ ^ƚĂĐĞLJ >ƵĚǁŝŐ͕ ŚƌŝƐƟŶĞ ŚĂǀĞnj :ŽŚŶƐŽŶ͕ ZĞďĞĐĐĂ ĞƌƟŶ͕ 12

California Family Physician Winter 2020

We’re excited to announce that Kimberly Yu, MD been appointed ƚŽ ƚŚĞ &W ĚĞůĞŐĂƟŽŶ ƚŽ ƚŚĞ D ͊ She’s joining a tremendous team ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ĂĚǀŽĐĂƚĞ ĨŽƌ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͕ ĐŽŵŵƵŶŝƟĞƐ ĂŶĚ family medicine every day. As an AAFP ĚĞůĞŐĂƚĞ ƚŽ ƚŚĞ D ͕ ƌ͘ zƵ ǁŝůů ƐĞƌǀĞ ĂƐ ĂŶ ŝŵƉŽƌƚĂŶƚ ĐŽŵŵƵŶŝĐĂƟŽŶ͕ ƉŽůŝĐLJ ĂŶĚ ŵĞŵďĞƌƐŚŝƉ ůŝŶŬ ďĞƚǁĞĞŶ ƚŚĞ D and grassroots physicians. They are Ă ŬĞLJ ƐŽƵƌĐĞ ŽĨ ŝŶĨŽƌŵĂƟŽŶ ĨŽƌ &W ŵĞŵďĞƌƐ ŽŶ ĂĐƟǀŝƟĞƐ͕ ƉƌŽŐƌĂŵƐ ĂŶĚ ƉŽůŝĐŝĞƐ ŽĨ ƚŚĞ D ͘͟ ηŝŶƐƉŝƌĞĐƌĞĂƚĞůĞĂĚ η&ĂŵŝůLJDĞĚŝĐŝŶĞ^ƚƌŽŶŐ η&DƌĞǀŽůƵƟŽŶ

H e r e ’s W h a t ’s N e w i n 2 0 2 0

You Do Not Want to Miss the Family Medicine Clinical Forum! We Promise!

This May, the CAFP’s Family Medicine Clinical Forum comes to >ŽŶŐ ĞĂĐŚ͕ ĂŶĚ ĨŽƌ ƚŚŽƐĞ ŽĨ LJŽƵ ǁŚŽ ŚĂǀĞ ŶĞǀĞƌ ĂƩĞŶĚĞĚ͕ Žƌ ŚĂǀĞŶ͛ƚ ďĞĞŶ ŝŶ Ă ǁŚŝůĞ͕ ǁĞ ŚŽƉĞ LJŽƵ ƌĞĂĚ ŽŶ ĂŶĚ ŐĞƚ ŝŶƐƉŝƌĞĚ ƚŽ ũŽŝŶ ƵƐ͘ &Žƌ ƚŚŽƐĞ ŽĨ LJŽƵ ǁŚŽ ĂƌĞ ĨƌĞƋƵĞŶƚ ĂƩĞŶĚĞĞƐ͕ ǁĞ ŬŶŽǁ ƚŚŝƐ LJĞĂƌ ǁŝůů ďĞ ŽŶĞ ŽĨ LJŽƵƌ ďĞƐƚ ĞǀĞƌ͊ tĞ ƉůĂŶ ƚŽ ƚĂŬĞ ŽƵƌ ƚŚĞŵĞ ʹ >ĞĂƌŶ͕ ŽŶŶĞĐƚ͕ ĞůĞďƌĂƚĞ͕ ƚŽ ĞŶƟƌĞůLJ ŶĞǁ ůĞǀĞůƐ ĂŶĚ ǁŽƵůĚ ůŽǀĞ for you to join us!

Learn tĞ ƉƌŽŵŝƐĞ LJŽƵ ǁŝůů ƌĞĐĞŝǀĞ ƋƵĂůŝƚLJ͕ ĞǀŝĚĞŶĐĞ ĂŶĚ ĐĂƐĞͲďĂƐĞĚ ĞĚƵĐĂƟŽŶ ƚŚĂƚ ƌĞƐƉĞĐƚƐ LJŽƵƌ ƟŵĞ ĂŶĚ ŝŶĐůƵĚĞƐ ĐůĞĂƌ ŬĞLJ ůĞĂƌŶŝŶŐ ƉŽŝŶƚƐ͕ ƉƌĂĐƟĐĂů ƟƉƐ ƚŽ ŝŵďĞĚ ŶĞǁ ŝŶĨŽƌŵĂƟŽŶ ŝŶ ƉƌĂĐƟĐĞ ĂŶĚ ĞĂƐLJ ĂĐĐĞƐƐ ƚŽ ĂĚĚŝƟŽŶĂů ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ƌĞƐŽƵƌĐĞƐ ƉƌŽǀŝĚĞĚ͘ KŶ ƚĂƉ ĨŽƌ ƚŚŝƐ LJĞĂƌ͗ ǀĂƉŝŶŐ ĂŶĚ ĞͲĐŝŐĂƌĞƩĞƐ͕ ŵĞŶŽƉĂƵƐĞ͕ ƌĞĚƵĐŝŶŐ ǁŽƌŬ ĂŌĞƌ ĐůŝŶŝĐ ;t Ϳ͕ ĚĞŵĞŶƟĂ ĐĂƌĞ͕ ĂĚǀĞƌƐĞ ĐŚŝůĚŚŽŽĚ ĞdžƉĞƌŝĞŶĐĞƐͬƚƌĂƵŵĂ ĐĂƌĞ͕ ŵĂdžŝŵŝnjŝŶŐ ƐĞdžƵĂůůLJ ƚƌĂŶƐŵŝƩĞĚ ŝŶĨĞĐƟŽŶ ;^d/Ϳ ƐĐƌĞĞŶŝŶŐ ĂŶĚ Wƌ W ƚŚĞƌĂƉLJ ĂŶĚ ŵŽƌĞ͊ zŽƵ ĐĂŶ ĂůƐŽ ƚĂŬĞ ĂĚǀĂŶƚĂŐĞ ŽĨ ƚŚĞ WĂůůŝĂƟǀĞ ĂƌĞ ĂŶĚ DĂƚĞƌŶŝƚLJ ĂƌĞ <^ Ɛ ĨŽƌ DK ĐƌĞĚŝƚ ĂŶĚ ŚĂŶĚƐͲŽŶ ǁŽƌŬƐŚŽƉƐ ŝŶ ƉŽŝŶƚ ŽĨ ĐĂƌĞ ƵůƚƌĂƐŽƵŶĚ ;WK h^Ϳ ĂŶĚ ĚĞƌŵŽƐĐŽƉLJͬďŝŽƉƐLJ͘

Connect tĞ ƉƌŽŵŝƐĞ ĂŵƉůĞ ŽƉƉŽƌƚƵŶŝƟĞƐ ƚŽ ŵĂŬĞ ŶĞǁ ƉĞƌƐŽŶĂů ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂů ĐŽŶŶĞĐƟŽŶƐ͘ zŽƵ ĐĂŶ ũŽŝŶ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ǁŝƚŚ ƐŝŵŝůĂƌ ŝŶƚĞƌĞƐƚƐ Ăƚ ^ƵŶĚĂLJ ŵŽƌŶŝŶŐ͛Ɛ dĂďůĞ dĂůŬƐ͕ ƚĂĐŬůĞ ĚŝĸĐƵůƚ ƉƌĂĐƟĐĞ ŝƐƐƵĞƐ Ăƚ ^ĂƚƵƌĚĂLJ ĂŌĞƌŶŽŽŶ͛Ɛ ŽƉƟŽŶĂů WƌĂĐƟĐĞ /ŶƋƵŝƌLJ ƐĞƐƐŝŽŶ͕ ǁĂůŬ Žƌ ƌƵŶ ĂůŽŶŐƐŝĚĞ ĐŽůůĞĂŐƵĞƐ Ăƚ ^ƵŶĚĂLJ͛Ɛ &ŽƵŶĚĂƟŽŶ FundRun, join in the community service project, compete for the most social media posts and more. Everyone has something ƚŽ ƐŚĂƌĞ͕ ĂŶĚ ǁĞ ŚŽƉĞ ƚŽ ĐŽŶƟŶƵĞ ƚŽ ĨĂĐŝůŝƚĂƚĞ ŵĂŶLJ ŶĞǁ ƌĞůĂƟŽŶƐŚŝƉƐ Ăƚ ƚŚĞ &ŽƌƵŵ͘

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Excellent, engaging speakers, well organized, succinct, excellent slides. Very efficient learning in just a few days instead of over an entire week.

– 2016 Forum Attendee

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California Ca C alilif lif ifo orrn orn rnia ia Fa Fam Fam Family mily ily ly P Ph Physician hysi yssiicia cia i n Win Winter Wi W iin ntter te err 20 e 2 2020 020 20

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The Forum is an event I look forward to attending ever y year! I always meet amazing people and come away with valuable information and inspiration I put to use right away.

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Celebrate

– 2019 Forum Attendee

We promise you’ll be inspired by family physician leaders and colleagues as you experience the joy and “family” of family ŵĞĚŝĐŝŶĞ ĮƌƐƚŚĂŶĚ͘ /ƚ͛Ɛ Ă ƌĂƌĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ďĞ ƐƵƌƌŽƵŶĚĞĚ ďLJ ƐŽ ŵĂŶLJ ƉĞŽƉůĞ ǁŚŽ ƐŚĂƌĞ ŵĂŶLJ ŽĨ LJŽƵƌ ǀĂůƵĞƐ ĂŶĚ ĐŚŽŽƐĞ ƚŽ ƐĞƌǀĞ ŽƚŚĞƌƐ ƚŚƌŽƵŐŚ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ zŽƵ͛ůů ĂůƐŽ ŚĂǀĞ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĐĞůĞďƌĂƚĞ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ƚŚĞ ƉƌŽĨĞƐƐŝŽŶ ďLJ ǀŝƐŝƟŶŐ ǁŝƚŚ ƚŚĞ ďĞƐƚ ĂŶĚ ďƌŝŐŚƚĞƐƚ ZĞƐŝĚĞŶƚ WŽƐƚĞƌ ŽŶƚĞƐƚ ǁŝŶŶĞƌƐ͘

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I wondered in reading the comments from past attendees how a conference could leave you energized, but the sense of community was palpable.

Thank you.

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The Keynotes

– 2017 Forum Attendee

tĞ ĂƌĞ ǀĞƌLJ ĞdžĐŝƚĞĚ ƚŚŝƐ LJĞĂƌ ƚŽ ŽīĞƌ ƚǁŽ ŬĞLJŶŽƚĞ ƐĞƐƐŝŽŶƐ Ăƚ ƚŚĞ &ŽƌƵŵ͘ ƌ͘ WĂƵů 'ƌƵŶĚLJ͕ ŬŶŽǁŶ ĂƐ ƚŚĞ ŐŽĚĨĂƚŚĞƌ ŽĨ ƚŚĞ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ĂŶĚ ƚŚĞ ƐƵďũĞĐƚ ŽĨ Ă ŶĞǁ Ŭ͕ Trusted Healer͕ ǁŝůů ŬŝĐŬ Žī ƚŚĞ ĐŽŶĨĞƌĞŶĐĞ ŽŶ &ƌŝĚĂLJ ĂŌĞƌŶŽŽŶ͘ r ,Ğ ǁŝůů ƐŚĂƌĞ ŚŽǁ ƚŚĞ ĐŽŶĐĞƉƚ ŽĨ ͞dƌƵƐƚĞĚ ,ĞĂůĞƌ͟ ďƌŝŶŐƐ together leadership, an understanding of societal change and culture and a hopeful vision of the future.

T.R. Reid, bestselling author of the book, The Healing of America: 'ůŽďĂů YƵĞƐƚ ĨŽƌ ĞƩĞƌ͕ ŚĞĂƉĞƌ ĂŶĚ &ĂŝƌĞƌ ,ĞĂůƚŚ ĂƌĞ, ŬŝĐŬƐ Žī ^ĂƚƵƌĚĂLJ ŵŽƌŶŝŶŐ͛Ɛ ƐĞƐƐŝŽŶƐ ďLJ ĚĞƐĐƌŝďŝŶŐ ƚŚĞ ƐƚĂƚĞ ŽĨ ŚĞĂůƚŚĐĂƌĞ ŝŶ ŵĞƌŝĐĂ ĂŶĚ ĂƌŽƵŶĚ ƚŚĞ ǁŽƌůĚ͘ ,Ğ ǁŝůů ŚŝŐŚůŝŐŚƚ ƚŚĞ ďĞŶĞĮƚƐ ŽĨ Ă ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ ƚŚĂƚ ĐŽǀĞƌƐ ĞǀĞƌLJďŽĚLJ͘ So don’t miss out . . .

Check out the complete conference schedule, “Top Ten Lists” ;ĨĂŵŝůLJ ĂĐƟǀŝƟĞƐ͕ ƌĞƐƚĂƵƌĂŶƚƐ͕ ĐŽīĞĞŚŽƵƐĞƐ͕ ĞƚĐ͘Ϳ ĨŽƌ >ŽŶŐ ĞĂĐŚ ĂŶĚ ƌĞŐŝƐƚĞƌ ƚŽĚĂLJ Ăƚ ǁǁǁ͘ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬ&D&ŽƌƵŵ͘ ^ĞĞ LJŽƵ DĂLJ ϭϱͲϭϳ Ăƚ ƚŚĞ >ŽŶŐ ĞĂĐŚ ,ŝůƚŽŶ͊ η&D&ŽƌƵŵϮϬ California Family Physician Winter 2020

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California Family Physician Winter 2020

2020 CAFP Family Medicine Clinical Forum â&#x20AC;&#x201C; Learn | Connect | Celebrate Long Beach Hilton, May 15-17, 2020 All Plenary CME Sessions to be held in International Ballroom

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ф ĐŽŶƟŶƵĞĚ ĨƌŽŵ ƉƌĞǀŝŽƵƐ ƉĂŐĞ

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California Family Physician Winter 2020

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California Family Physician Summer 2019

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Adam Francis CAFP Director of Government Relations

H e r e ’s W h a t ’s N e w i n 2 0 2 0

Get Ready for 2020: Changes are in Store ZĞŐĂƌĚůĞƐƐ ŽĨ ŽƵƌ ƐƵƉƉŽƌƚ Žƌ ŽƉƉŽƐĞ ƉŽƐŝƟŽŶƐ ŽŶ ďŝůůƐ͕ ĞǀĞƌLJ :ĂŶƵĂƌLJ ďƌŝŶŐƐ Ă ŶĞǁ ƐůŽƵŐŚ ŽĨ ƌĞƋƵŝƌĞŵĞŶƚƐ ĂŶĚ ŝŵƉƌŽǀĞŵĞŶƚƐ ŝŶ ůĂǁ ĂīĞĐƟŶŐ LJŽƵ͕ LJŽƵƌ ƉƌĂĐƟĐĞ͕ ĂŶĚ LJŽƵƌ ƉĂƟĞŶƚƐ͘ dŚŝƐ ŵŽŶƚŚ ŶŽ ĞdžĐĞƉƟŽŶ͘ ĞůŽǁ ĂƌĞ ŶĞǁ ůĂǁƐ ƚŚĂƚ ŵĂLJ ĐŚĂŶŐĞ ƚŚĞ ǁĂLJ LJŽƵ ƉƌĂĐƟĐĞ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶ ƚŚĞ ŶĞǁ LJĞĂƌ͘ hZ ^ ZĞĨŽƌŵĂƟŽŶ͗ ϱϮϴ ;>ŽǁͿ ƌĞĨŽƌŵƐ ĂŶĚ ŝŵƉƌŽǀĞƐ ƚŚĞ ŽƉĞƌĂƟŽŶ ŽĨ ƚŚĞ ŽŶƚƌŽůůĞĚ hƟůŝnjĂƟŽŶ ZĞǀŝĞǁ ĂŶĚ ǀĂůƵĂƟŽŶ ^LJƐƚĞŵ ; hZ ^Ϳ ĚĂƚĂďĂƐĞ ŝŶ ƚŚƌĞĞ ǁĂLJƐ͗ • ZĞĂůͲdŝŵĞ ĂƚĂ͗ WŚĂƌŵĂĐLJ ƌĞƉŽƌƚ ƟŵĞůŝŶĞƐ ĂƌĞ ƐŚŽƌƚĞŶĞĚ ĨƌŽŵ ƐĞǀĞŶ ĚĂLJƐ ƚŽ ƚŚĞ ĨŽůůŽǁŝŶŐ ǁŽƌŬŝŶŐ ĚĂLJ͕ ƌĞĚƵĐŝŶŐ ƚŚĞ ĂďŝůŝƚLJ ĨŽƌ ƉĂƟĞŶƚƐ ƚŽ ͞ĚŽĐƚŽƌ ƐŚŽƉ͟ ĂŶĚ ŐŝǀŝŶŐ ƚŚĞ ƉŚLJƐŝĐŝĂŶ ŶĞĂƌͲƌĞĂůͲƟŵĞ ĚĂƚĂ͘ • džƉĂŶĚĞĚ ĂƚĂďĂƐĞ͗ WŚĂƌŵĂĐŝĞƐ ĂƌĞ ŶŽǁ ƌĞƋƵŝƌĞĚ ƚŽ ƌĞƉŽƌƚ Schedule V drugs to the database, helping to regulate some commonly misused drugs, such as cough syrups. As many ĂƐ ƚŚƌĞĞ ŵŝůůŝŽŶ ĂĚŽůĞƐĐĞŶƚƐ ĂŶĚ LJŽƵŶŐ ĂĚƵůƚƐ ďĞƚǁĞĞŶ ƚŚĞ ĂŐĞƐ ŽĨ ϭϮ ĂŶĚ Ϯϱ ĂďƵƐĞ ĐŽƵŐŚ Žƌ ĐŽůĚ ŵĞĚŝĐŝŶĞƐ͘ • ZĞĚƵĐĞĚ ĚŵŝŶŝƐƚƌĂƟǀĞ ƵƌĚĞŶ͗ >ŝĐĞŶƐĞĚ ĚĞůĞŐĂƚĞƐ͕ ŝŶƐƚĞĂĚ ŽĨ ũƵƐƚ ƉŚLJƐŝĐŝĂŶƐ͕ ĐĂŶ ŶŽǁ ŵĂŬĞ ƉĂƟĞŶƚ ĂĐƟǀŝƚLJ ƌĞƉŽƌƚ ƌĞƋƵĞƐƚƐ ǀŝĂ hZ ^͘ dŚŝƐ ŵĞĂŶƐ ƚŚĞ ĞŶƟƌĞ ŚĞĂůƚŚ ĐĂƌĞ ƚĞĂŵ ĐĂŶ ƚŽ ďĞ ŝŶǀŽůǀĞĚ ŝŶ ŝŵƉƌŽǀŝŶŐ ƉĂƟĞŶƚ ĐĂƌĞ͕ ǁŚŝůĞ ĂůƐŽ ƌĞĚƵĐŝŶŐ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ ŽŶ ƉŚLJƐŝĐŝĂŶƐ͘ ĞůĂLJ ŽŶ WƌĞƐĐƌŝƉƟŽŶ WĂĚ ZĞƉůĂĐĞŵĞŶƚƐ͗ ŌĞƌ ƐŝŐŶŝĮĐĂŶƚ pushback by the physician community, including family physicians ǁŚŽ ŽƌŐĂŶŝnjĞĚ ĂĐƟŽŶ ƵƐŝŶŐ &W͛Ɛ ŵĞŵďĞƌƐͲŽŶůLJ ŵĞƐƐĂŐĞ ďŽĂƌĚ ;^W Z<Ϳ͕ ϭϰϵ ; ŽŽƉĞƌͿ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ƚŽ ĚĞůĂLJ Ă ƌĞƋƵŝƌĞŵĞŶƚ ƚŚĂƚ ƉŚLJƐŝĐŝĂŶƐ ƌĞƉůĂĐĞ ƚŚĞŝƌ ƉƌĞƐĐƌŝƉƟŽŶ ƉĂĚƐ ǁŝƚŚ ŶĞǁ ĨŽƌŵƐ ǁŝƚŚ Ă ƵŶŝƋƵĞůLJ ƐĞƌŝĂůŝnjĞĚ ŶƵŵďĞƌ ďLJ :ĂŶƵĂƌLJ ϭ ϮϬϭϵ͘ dŚĂƚ ůĂǁ ĐŚĂŶŐĞ ĚŝĚ ŶŽƚ ŝŶĐůƵĚĞ Ă ƚƌĂŶƐŝƟŽŶ ƉĞƌŝŽĚ͘ Ɛ Ă ƌĞƐƵůƚ͕ ƉƌĞƐĐƌŝďĞƌƐ ĚŝĚ ŶŽƚ ŚĂǀĞ ƟŵĞ ƚŽ ŽƌĚĞƌ ŶĞǁ ƉƌĞƐĐƌŝƉƟŽŶ ƉĂĚƐ ďLJ ƚŚĞ :ĂŶƵĂƌLJ ϭ͕ ϮϬϭϵ ĚĞĂĚůŝŶĞ ƌĞƐƵůƟŶŐ ŝŶ ĚŝĸĐƵůƟĞƐ ĨŽƌ ƉĂƟĞŶƚƐ ƚƌLJŝŶŐ ƚŽ ŐĞƚ ƉƌĞƐĐƌŝƉƟŽŶƐ ĮůůĞĚ ĨŽƌ ĐŽŶƚƌŽůůĞĚ ƐƵďƐƚĂŶĐĞƐ͘ ϭϰϵ ĂůůŽǁƐ ĨŽƌ Ă ƚƌĂŶƐŝƟŽŶ ƉĞƌŝŽĚ͕ ƵŶƟů :ĂŶƵĂƌLJ ϭ͕ ϮϬϮϭ͕ ŵĂŬŝŶŐ ĐƵƌƌĞŶƚ ƉĂĚƐ ǀĂůŝĚ ƵŶƟů ƚŚĂƚ ƟŵĞ͘ EĂůŽdžŽŶĞ ZĞƋƵŝƌĞŵĞŶƚƐ ůĂƌŝĮĞĚ͗ ϳϭϰ ;tŽŽĚͿ ĐůĂƌŝĮĞƐ ǁŚĞŶ ŽīĞƌŝŶŐ ŶĂůŽdžŽŶĞ ŝƐ ƌĞƋƵŝƌĞĚ ŽĨ ƉƌĞƐĐƌŝďĞƌƐ͘ dŚĞ ďŝůů ǁĂƐ ĂƵƚŚŽƌĞĚ in response to concerns raised by CAFP and others regarding ƉƌŽǀŝƐŝŽŶƐ ĐŽŶƚĂŝŶĞĚ ŝŶ ϮϳϲϬ ;ƐŝŐŶĞĚ ďLJ 'ŽǀĞƌŶŽƌ ƌŽǁŶ ŝŶ ϮϬϭϴ͕ ƌĞƋƵŝƌŝŶŐ ƉƌĞƐĐƌŝďĞƌƐ ƚŽ ŽīĞƌ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ ŶĂůŽdžŽŶĞ Žƌ ŝƚƐ ĞƋƵŝǀĂůĞŶƚ ǁŚĞŶ ĐĞƌƚĂŝŶ ĐŽŶĚŝƟŽŶƐ ĂƌĞ ƉƌĞƐĞŶƚ͕ ĂŶĚ ƉƌŽǀŝĚĞ 22

California Family Physician Winter 2020

ĞĚƵĐĂƟŽŶ ƚŽ ƚŚĞ ƉĂƟĞŶƚ ǁŝƚŚ ĞǀĞƌLJ ƉƌĞƐĐƌŝƉƟŽŶ͕ ĞǀĞŶ ƌĞŶĞǁĂůƐ͘Ϳ ϳϭϰ ĐůĂƌŝĮĞƐ ǁŚĞŶ Ă ƉƌĞƐĐƌŝďĞƌ ǁŚŽ ŝƐ ƉƌĞƐĐƌŝďŝŶŐ ĂŶ ŽƉŝŽŝĚ Žƌ ďĞŶnjŽĚŝĂnjĞƉŝŶĞ ŵĞĚŝĐĂƟŽŶ ŵƵƐƚ ŽīĞƌ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ EĂůŽdžŽŶĞ ;Žƌ ĂŶŽƚŚĞƌ ĚƌƵŐ ĂƉƉƌŽǀĞĚ ďLJ ƚŚĞ & ĨŽƌ ƚŚĞ ĐŽŵƉůĞƚĞ Žƌ ƉĂƌƟĂů ƌĞǀĞƌƐĂů ŽĨ ŽƉŝŽŝĚͲŝŶĚƵĐĞĚ ƌĞƐƉŝƌĂƚŽƌLJ ĚĞƉƌĞƐƐŝŽŶͿ͘ dŚĞ ŶĞǁ ůĂǁ ƐƟƉƵůĂƚĞƐ ƚŚĂƚ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĚŽƐĂŐĞ ŽĨ ϵϬ Žƌ ŵŽƌĞ ŵŽƌƉŚŝŶĞ ŵŝůůŝŐƌĂŵ ĞƋƵŝǀĂůĞŶƚƐ ƉĞƌ ĚĂLJ͕ ŽƉŝŽŝĚ ŵĞĚŝĐĂƟŽŶ ŝƐ ƉƌĞƐĐƌŝďĞĚ ǁŝƚŚŝŶ Ă LJĞĂƌ ĨƌŽŵ ƚŚĞ ĚĂƚĞ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĨŽƌ ďĞŶnjŽĚŝĂnjĞƉŝŶĞ ŚĂƐ ďĞĞŶ ĚŝƐƉĞŶƐĞĚ ƚŽ ƚŚĞ ƉĂƟĞŶƚ͕ ĂŶĚͬŽƌ ƚŚĞ ƉĂƟĞŶƚ ƉƌĞƐĞŶƚƐ ǁŝƚŚ an increased risk for opioid overdose require an accompanying EĂůŽdžŽŶĞ ƉƌĞƐĐƌŝƉƟŽŶ͘ dŚĞ ŶĞǁ ůĂǁ ĂůƐŽ ĞdžĞŵƉƚƐ ƚŚĞ ĐŽŶĐƵƌƌĞŶƚ ƉĂƟĞŶƚ ĞĚƵĐĂƟŽŶ ƌĞƋƵŝƌĞŵĞŶƚ ŝĨ ƚŚĞ ƉĂƟĞŶƚ ƌĞĐĞŝǀŝŶŐ ƚŚĞ ƉƌĞƐĐƌŝƉƟŽŶ ĚĞĐůŝŶĞƐ ƚŚĞ ĞĚƵĐĂƟŽŶ Žƌ ŚĂƐ ƌĞĐĞŝǀĞĚ ƚŚĞ ĞĚƵĐĂƟŽŶ ǁŝƚŚŝŶ ƚŚĞ ƉĂƐƚ Ϯϰ ŵŽŶƚŚƐ͘ ĚĚŝƟŽŶĂůůLJ͕ ƚŚĞ ďŝůů ĞdžĞŵƉƚƐ ŽīĞƌŝŶŐ ŶĂůŽdžŽŶĞ ĂŶĚ ƉƌŽǀŝĚŝŶŐ ĞĚƵĐĂƟŽŶ ǁŚĞŶ ƚŚĞ ŵĞĚŝĐĂƟŽŶ ŝƐ ƚŽ ďĞ ĂĚŵŝŶŝƐƚĞƌĞĚ ƚŽ Ă ƉĂƟĞŶƚ ǁŚŝůĞ ƚŚĞ ƉĂƟĞŶƚ ŝƐ ŝŶ ĞŝƚŚĞƌ ĂŶ ŝŶƉĂƟĞŶƚ Žƌ ŽƵƚƉĂƟĞŶƚ ƐĞƫŶŐ͕ Žƌ ŝƐ ĨŽƌ Ă ƚĞƌŵŝŶĂůůLJ ŝůů ƉĂƟĞŶƚ͘ EŽ /ŶĚĞƉĞŶĚĞŶƚ WƌĂĐƟĐĞ ĨŽƌ W Ɛ͗ dŚŝƐ ďŝůů ŽƌŝŐŝŶĂůůLJ ǁŽƵůĚ ŚĂǀĞ ĂůůŽǁĞĚ ĨŽƌ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƟĐĞ ĨŽƌ WŚLJƐŝĐŝĂŶ ƐƐŝƐƚĂŶƚƐ ;W ƐͿ͘ &W ĂŶĚ ŽƚŚĞƌƐ ŝŶ ŽƉƉŽƐŝƟŽŶ ǁŽƌŬĞĚ ǁŝƚŚ ƚŚĞ ĂƵƚŚŽƌ ĂŶĚ ƐƉŽŶƐŽƌƐ ŽĨ ƚŚĞ ^ ϲϵϳ (Caballero) ƚŽ ĂŵĞŶĚ ŝƚ ƚŽ ĂůůŽǁ W Ɛ ƚŽ ŚĂǀĞ ĞƋƵŝǀĂůĞŶĐLJ ǁŝƚŚ EƵƌƐĞ WƌĂĐƟƟŽŶĞƌƐ ǁŚĞŶ ŝƚ ĐŽŵĞƐ ƚŽ ƐƵƉĞƌǀŝƐŝŽŶ ǁŝƚŚŽƵƚ ĐŚĂŶŐŝŶŐ ƚŚĞ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ŽĨ W Ɛ͘ dŚĞ ŶĞǁ ůĂǁ ĚŽĞƐ ƚŚŝƐ ďLJ͗ • Removing the requirement that the supervising physician be ƉŚLJƐŝĐĂůůLJ ƉƌĞƐĞŶƚ ĂŶĚ ŝŶƐƚĞĂĚ ĂůůŽǁƐ ƚŚĞ ƉŚLJƐŝĐŝĂŶ ƚŽ ĚĞĐŝĚĞ ǁŚĞƚŚĞƌ ƚŚĂƚ ŝƐ ŶĞĐĞƐƐĂƌLJ Žƌ ǁŚĞƚŚĞƌ ƚŚĞ ƉŚLJƐŝĐŝĂŶ ďĞŝŶŐ ĂǀĂŝůĂďůĞ ďLJ ƚĞůĞƉŚŽŶĞ Žƌ ŽƚŚĞƌ ĞůĞĐƚƌŽŶŝĐ ĐŽŵŵƵŶŝĐĂƟŽŶ ŵĞƚŚŽĚ ŝƐ ƐƵĸĐŝĞŶƚ Ăƚ ƚŚĞ ƟŵĞ ƚŚĞ W ĞdžĂŵŝŶĞƐ ƚŚĞ ƉĂƟĞŶƚ͘ /ƚ ĂůƐŽ ƐƉĞĐŝĮĞƐ ƚŚĂƚ ƚŚĞ WŚLJƐŝĐŝĂŶ ƐƐŝƐƚĂŶƚ ŽĂƌĚ ;W Ϳ ĐĂŶ require the physical presence of a physician as a term or ĐŽŶĚŝƟŽŶ ŽĨ Ă W ͛Ɛ ƌĞŝŶƐƚĂƚĞŵĞŶƚ͕ ƉƌŽďĂƟŽŶ͕ Žƌ ŝŵƉŽƐŝŶŐ discipline.

• ůůŽǁŝŶŐ ƚŚĞ ƉƌĂĐƟĐĞ ĂŐƌĞĞŵĞŶƚ ƚŽ ďĞ ũŽŝŶĞĚ ďĞƚǁĞĞŶ the PA and one or more physicians, detailing the medical ƐĞƌǀŝĐĞƐ ƚŚĞ W ŝƐ ĂƵƚŚŽƌŝnjĞĚ ƚŽ ƉĞƌĨŽƌŵ ŝŶ ƚŚĞ ĐůŝŶŝĐ Žƌ health system.

• /ŶƐƚĞĂĚ ŽĨ ƌĞƋƵŝƌŝŶŐ Ă ŵŝŶŝŵƵŵ ƉĞƌĐĞŶƚĂŐĞ ŽĨ ĐŚĂƌƚ ƌĞǀŝĞǁƐ ĂŶĚ ĐŽƵŶƚĞƌƐŝŐŶĂƚƵƌĞƐ͕ ŝƚ ĂůůŽǁƐ ƚŚĞ ƐƵƉĞƌǀŝƐŝŶŐ ƉŚLJƐŝĐŝĂŶ ƚŽ ĚĞƚĞƌŵŝŶĞ ŚŽǁ ŵƵĐŚ ƐŚŽƵůĚ ĞdžŝƐƚ͕ ŝĨ ĂŶLJ͕ ĚĞƉĞŶĚŝŶŐ ŽŶ the skills of the PA (though, again, the PAB could require it as ĚŝƐĐŝƉůŝŶĂƌLJ ĂĐƟŽŶͿ͘

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ZĞƋƵŝƌŝŶŐ ƚŚĞ ƉƌĂĐƟĐĞ ĂŐƌĞĞŵĞŶƚ ;ƐĞĞ ƐŝĚĞďĂƌ ďĞůŽǁͿ ƚŽ ƐƉĞĐŝĨLJ ǁŚŝĐŚ PAs may furnish or order a drug or ĚĞǀŝĐĞ͕ ǁŚŝĐŚ ĚƌƵŐƐ Žƌ ĚĞǀŝĐĞƐ ŵĂLJ ďĞ ĨƵƌŶŝƐŚĞĚ Žƌ ŽƌĚĞƌĞĚ͕ ƵŶĚĞƌ ǁŚĂƚ circumstances, the extent of physician supervision, the method of periodic ƌĞǀŝĞǁ ŽĨ ƚŚĞ W ͛Ɛ ĐŽŵƉĞƚĞŶĐĞ͕ ŝŶĐůƵĚŝŶŐ ƉĞĞƌ ƌĞǀŝĞǁ͕ ĂŶĚ ƌĞǀŝĞǁ ŽĨ ƚŚĞ ƉƌĂĐƟĐĞ ĂŐƌĞĞŵĞŶƚ͘ dŚĞ ƉƌĂĐƟĐĞ agreement must address the diagnosis ŽĨ ƚŚĞ ŝůůŶĞƐƐ͕ ŝŶũƵƌLJ͕ Žƌ ĐŽŶĚŝƟŽŶ ĨŽƌ ǁŚŝĐŚ ƚŚĞ W ŵĂLJ ĨƵƌŶŝƐŚ ƚŚĞ Schedule II controlled substance. The W ŵƵƐƚ ƐĂƟƐĨĂĐƚŽƌŝůLJ ĐŽŵƉůĞƚĞ Žƌ ŚĂǀĞ completed a course in pharmacology covering the drugs or devices to be ĨƵƌŶŝƐŚĞĚ Žƌ ŽƌĚĞƌĞĚ͘ dŚŝƐ ůĂǁ ƐƉĞĐŝĮĞƐ that the signature of a PA on a drug order issued pursuant to the Act is deemed to be the signature of a prescriber for purposes of the BPC and the Health and Safety Code.

WŚLJƐŝĐŝĂŶͲWŚLJƐŝĐŝĂŶ ƐƐŝƐƚĂŶƚ WƌĂĐƟĐĞ ŐƌĞĞŵĞŶƚ ^ƵŵŵĂƌLJ dŚĞ ƉƌĂĐƟĐĞ ĂŐƌĞĞŵĞŶƚ ƐƟƉƵůĂƚĞƐ͗ • The types of medical services a PA is ĂƵƚŚŽƌŝnjĞĚ ƚŽ ƉĞƌĨŽƌŵ͘ • Policies and procedures to ensure adequate supervision of the PA, including, but not limited to, ĂƉƉƌŽƉƌŝĂƚĞ ĐŽŵŵƵŶŝĐĂƟŽŶ͕ ĂǀĂŝůĂďŝůŝƚLJ͕ ĐŽŶƐƵůƚĂƟŽŶƐ͕ ĂŶĚ ƌĞĨĞƌƌĂůƐ ďĞƚǁĞĞŶ Ă ƉŚLJƐŝĐŝĂŶ ĂŶĚ the PA in the provision of medical services.

• dŚĞ ŵĞƚŚŽĚƐ ĨŽƌ ƚŚĞ ĐŽŶƟŶƵŝŶŐ ĞǀĂůƵĂƟŽŶ ŽĨ ƚŚĞ ĐŽŵƉĞƚĞŶĐLJ ĂŶĚ ƋƵĂůŝĮĐĂƟŽŶƐ ŽĨ ƚŚĞ W ͘ • The furnishing or ordering of drugs or devices by a PA. • ŶLJ ĂĚĚŝƟŽŶĂů ƉƌŽǀŝƐŝŽŶƐ ĂŐƌĞĞĚ ƚŽ by the PA and physician. &Žƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ͕ Žƌ ƚŽ ŐĞƚ ŝŶǀŽůǀĞĚ ǁŝƚŚ ůĞŐŝƐůĂƟŽŶ &KZ ŝƚ ďĞĐŽŵĞƐ ůĂǁ͕ ƉůĞĂƐĞ ƐŝŐŶ ƵƉ ƚŽ ďĞ Ă &W <ĞLJ ŽŶƚĂĐƚ Žƌ ĞŵĂŝů ŵĞ͕ Ăƚ afrancis@familydocs.org.

California Family Physician Winter 2020

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Marianne McKennett, MD President, CAFP Foundation

CAFP Foundation … Investing in the Future of Family Medicine /ƚ ŝƐ Ă ũŽLJ ƚŽ ƐŚĂƌĞ ƚŚĞ &W &ŽƵŶĚĂƟŽŶ͛Ɛ ϮϬϭϵ ĂĐĐŽŵƉůŝƐŚŵĞŶƚƐ͘ /Ŷ ŬĞĞƉŝŶŐ ǁŝƚŚ ŽƵƌ ŵŝƐƐŝŽŶ ƚŽ ƐƵƉƉŽƌƚ ĐŽŵƉĂƐƐŝŽŶĂƚĞ ĂŶĚ comprehensive primary health care for the people of California, ǁĞ ŚĂǀĞ ƵƐĞĚ LJŽƵƌ ĐŽŶƚƌŝďƵƟŽŶƐ ƚŽ ďƌŝŶŐ ĚLJŶĂŵŝĐ ƉƌŽŐƌĂŵƐ ƚŽ ůŝĨĞ͘ /ŶŝƟĂƟǀĞƐ ƚŽ ƉƌŽǀŝĚĞ ŵĞŶƚŽƌƐŚŝƉ ĂŶĚ ĞĚƵĐĂƟŽŶ ƚĂƌŐĞƚ ůŝĨĞůŽŶŐ ůĞĂƌŶĞƌƐ͕ ĨƌŽŵ ŚŝŐŚ ƐĐŚŽŽů ƐƚƵĚĞŶƚƐ ǁŝƚŚ Ă ĚƌĞĂŵ ŽĨ ďĞĐŽŵŝŶŐ Ă doctor toseasoned family physicians. &W &ŽƵŶĚĂƟŽŶ ƌĞƉƌĞƐĞŶƚƐ ŵŽƌĞ ƚŚĂŶ ϯ͕ϬϬϬ ƐƚƵĚĞŶƚ ĂŶĚ ƌĞƐŝĚĞŶƚ ŵĞŵďĞƌƐ ĂŶĚ ƐĞƌǀĞƐ ĂƐ Ă ƌĞƐŽƵƌĐĞ ŚƵď ĨŽƌ ϭϯ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ ĂŶĚ ϲϱ family medicine residency programs. We are excited to highlight our ϮϬϭϵ ŝŶŝƟĂƟǀĞƐ ƚŚĂƚ ŚĂǀĞ ƐƵƉƉŽƌƚĞĚ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ in their journey to become family physician leaders.

/ Ăŵ ƉƌŽƵĚ ŽĨ ƚŚĞ &W &ŽƵŶĚĂƟŽŶ͛Ɛ ǁŽƌŬ ƐƵƉƉŽƌƟŶŐ ŽƉƉŽƌƚƵŶŝƟĞƐ for medical students and residents as they develop leadership and ĂĚǀŽĐĂĐLJ ƐŬŝůůƐ ŝŶĐůƵĚŝŶŐ ŽƵƌ ZĞĂĚLJ ƚŽ >ĞĂĚ ƉƌŽŐƌĂŵ ƚĂƌŐĞƟŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƉƌĂĐƟĐŝŶŐ ŝŶ ůĂƌŐĞ ŵĞĚŝĐĂů ƐLJƐƚĞŵƐ͖ ƚŚĞ ^ƵƐĂŶ ,ŽŐĞůĂŶĚ ,ĞĂůƚŚ WŽůŝĐLJ &ĞůůŽǁƐŚŝƉ ƉƌŽǀŝĚŝŶŐ ƐƚƵĚĞŶƚƐ ĂŶĚ ƌĞƐŝĚĞŶƚƐ ǁŝƚŚ ĂĚǀĂŶĐĞĚ ůĞŐŝƐůĂƟǀĞ ĂĚǀŽĐĂĐLJ ĂŶĚ ŵĞŶƚŽƌƐŚŝƉ ĞdžƉĞƌŝĞŶĐĞƐ͖ ĂŶĚ ƚŚĞ &W WƌŝŵĂƌLJ ĂƌĞ ZĞƐŝĚĞŶĐLJ ŽůůĂďŽƌĂƟǀĞ ƉƌĞƉĂƌŝŶŐ ƌĞƐŝĚĞŶƚ physicians to address the opioid crisis. Ɛ ǁĞ ĨĂĐĞ Ă ĐƌŝƐŝƐ ŝŶ ŚĞĂůƚŚ ĐĂƌĞ ĂĐĐĞƐƐ͕ ŝƚ ŝƐ ƐŽ ŝŵƉŽƌƚĂŶƚ ƚŽ ĚĞǀĞůŽƉ our future health care leaders. Thank you for your support of the &W &ŽƵŶĚĂƟŽŶ ĂŶĚ ŽƵƌ ŵƵƚƵĂů ŐŽĂů ŽĨ ƉƌŽǀŝĚŝŶŐ ĂĐĐĞƐƐ ƚŽ ƋƵĂůŝƚLJ health care for all people of California.

Our Mission: dŚƌŽƵŐŚ ƉŚŝůĂŶƚŚƌŽƉLJ͕ ƚŚĞ ĂůŝĨŽƌŶŝĂ ĐĂĚĞŵLJ ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ &ŽƵŶĚĂƟŽŶ ŶƵƌƚƵƌĞƐ ĞĂĐŚ ŐĞŶĞƌĂƟŽŶ ŽĨ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ĞŶƐƵƌĞ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ĐĞůĞďƌĂƚĞ ƚŚĞ ũŽLJ ŽĨ ŽƵƌ ƐƉĞĐŝĂůƚLJ͘

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California Family Physician Winter 2020

The Work of the Foundation Scholarships Investing in family medicine’s future means providing opportunities for students and residents to attend seminal family medicine events including the CAFP All Members Advocacy Meeting and the AAFP National Conference.

Funding Building a strong primary care ǁŽƌŬĨŽƌĐĞ ŝƐ ƉŽƐƐŝďůĞ ǁŚĞŶ ǁĞ support leaders dedicated to transforming their communities through mentorship programs ĂŶĚ ŽƌŐĂŶŝnjĞĚ ŶĞƚǁŽƌŬƐ͕ ŝŶĐůƵĚŝŶŐ Future Faces of Family Medicine, Emerging Health Advocates and Family Medicine Interest Groups. ^ĐŚŽůĂƌůLJ ĐƚŝǀŝƚLJ ŵƉŽǁĞƌŝŶŐ students and residents to conduct and present clinical and educational ƌĞƐĞĂƌĐŚ ĂůůŽǁƐ ƚŚĞŵ ƚŽ ŵĞĞƚ critical academic requirements through the Student Research Grant Program and the Resident Poster Contest.

Education Training the next generation of healthcare leaders ensures a ĐĂƉĂďůĞ ĂŶĚ ĚŝǀĞƌƐĞ ǁŽƌŬĨŽƌĐĞ ĂŶĚ is accomplished through activities including Procedures Workshops, the Family Medicine Summit and the Primary Care Residency Collaborative.

WůĞĂƐĞ ĐŚĞĐŬ ǁǁǁ͘ĐĂĨƉĨŽƵŶĚĂƚŝŽŶ͘ ŽƌŐ ƚŽ ƌĞĂĚ ŽƵƌ ϮϬϭϵ ŶŶƵĂů ZĞƉŽƌƚ ĂŶĚ ŵĂŬĞ LJŽƵƌ ϮϬϮϬ ŝŶǀĞƐƚŵĞŶƚ in family medicine by contributing to the CAFP-F today, https:// familydocs.secure.force.com/ foundation/.

California Family Physician Winter 2020

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Conrad Amenta CAFP Director of Policy and Strategic Initiatives

Your Values, Beliefs, and Priorities Are our Foundation: New CAFP Policies and Principles

&W WƌŝŶĐŝƉůĞƐ ŽŶ ƚŚĞ /ŶĚĞƉĞŶĚĞŶƚ WƌĂĐƚŝĐĞ ŽĨ DĞĚŝĐŝŶĞ ďLJ Nurse Practitioners /Ŷ ϮϬϭϵ͕ ƐƐĞŵďůLJ ŝůů ϴϵϬ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ͘ dŚĞ ďŝůů ;ǁŚŝĐŚ is currently held in committee and may be re-introduced ŝŶ ϮϬϮϬͿ ǁŽƵůĚ ĞdžƉĂŶĚ ƚŚĞ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ ĨŽƌ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ƚŽ ĂůůŽǁ ƚŚĞŵ ƚŽ ƉƌĂĐƚŝĐĞ ŵĞĚŝĐŝŶĞ ǁŝƚŚŽƵƚ physician supervision. Existing AAFP and CAFP policy is clear in its opposition to this outcome, but does not expand upon that opposition to clarify issues related to educational standards, regulation and oversight, liability, California’s bar on the corporate practice of medicine, or accountability to provide primary care to underserved populations. /Ŷ ƌĞƐƉŽŶƐĞ ƚŽ ϴϵϬ͕ Ă ŵĞŵďĞƌ ƐƵďŵŝƚƚĞĚ Ă ƌĞƐŽůƵƚŝŽŶ to the CAFP Board asking that CAFP policy be assessed and expanded as required. The CAFP Board heard testimony from ŵĞŵďĞƌƐ ĚƵƌŝŶŐ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƚŝŶŐ ; D DͿ ŝŶ ^ĂĐƌĂŵĞŶƚŽ ŝŶ DĂƌĐŚ ϮϬϭϵ͕ ŝŶ ŽƉƉŽƐŝƚŝŽŶ ĂŶĚ ƐƵƉƉŽƌƚ ŽĨ the resolution. In response to the resolution and testimony, ƚŚĞ &W ŽĂƌĚ ĞƐƚĂďůŝƐŚĞĚ Ă ƚŝŵĞͲůŝŵŝƚĞĚ ǁŽƌŬŝŶŐ ŐƌŽƵƉ of members representing policy expertise and a diversity of practice environments and care models to make a ƌĞĐŽŵŵĞŶĚĂƚŝŽŶ ƚŽ ƚŚĞ ŽĂƌĚ͘ dŚĞ ŽƵƚĐŽŵĞ ŽĨ ƚŚĞ ǁŽƌŬŝŶŐ ŐƌŽƵƉ͛Ɛ ĚŝƐĐƵƐƐŝŽŶ ǁĂƐ CAFP Principles on the Independent Practice of Medicine by Nurse Practitioners. <ĞLJ ƚŽ ƚŚŝƐ ƉŽůŝĐLJ ĂƌĞ ƚŚĞ ĨŽůůŽǁŝŶŐ͗ CAFP considers ordering and interpreting diagnostic procedures, certifying disability, and prescribing, dispensing, and administering controlled substances 26

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to be the practice of medicine. CAFP believes that it is of utmost importance that consistency of standards and regulations be maintained in the regulation of the practice of medicine in California.

CAFP’s position on any proposed legislation and/or regulation that seeks to expand the ability of NPs to practice medicine independently of physician supervision ǁŝůů ďĞ ŐƵŝĚĞĚ ďLJ ĐŽƌĞ ƉƌŝŶĐŝƉůĞƐ ƌĞůĂƚĞĚ ƚŽ ĞƐƚĂďůŝƐŚŝŶŐ ĐŽŶƐŝƐƚĞŶĐLJ ŽĨ ƐƚĂŶĚĂƌĚƐ ĂŶĚ ƌĞŐƵůĂƚŝŽŶ͕ ĂƐ ǁĞůů ĂƐ the ability of the proposal to address the problems it purports to resolve, including but not limited to: access to primary care, cost of care, quality of care, and the ŽǀĞƌĂůů ƐƵƐƚĂŝŶĂďŝůŝƚLJ ŽĨ ƚŚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ͘

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By developing and adopting this new set of principles, CAFP now has guidance directs its involvement in both state and federal policy that has the potential to affect the health and wellbeing of transgender and genderexpansive patients.

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CAFP policies and principles articulate the positions, values, beliefs and priorities of CAFP members. Every year, the &W ŽĂƌĚ ĂĚŽƉƚƐ ŶĞǁ ƉŽůŝĐŝĞƐ ĂŶĚ ƉƌŝŶĐŝƉůĞƐ ƚŽ ĂĚĚƌĞƐƐ emerging issues affecting family physicians and their patients. These documents guide CAFP staff and the Board in the positions it takes on proposed legislation and regulation ĂŶĚ ƚŚĞ ƐƉĞĐŝĨŝĐ ǁŽƌŬ ǁĞ ƵŶĚĞƌƚĂŬĞ͘ &W ĂĚŽƉƚĞĚ Ă ŶƵŵďĞƌ ŽĨ ŶĞǁ ƉŽůŝĐŝĞƐ ĂŶĚ ƉƌŝŶĐŝƉůĞƐ ŝŶ ϮϬϭϵ͖ ǁĞ͛Ě ůŝŬĞ ƚŽ ŚŝŐŚůŝŐŚƚ ƚǁŽ ŐƌŽƵŶĚďƌĞĂŬŝŶŐ ŽŶĞƐ͘

dŚĞ ƉŽůŝĐLJ ŐŽĞƐ ŽŶ ƚŽ ĂƌƚŝĐƵůĂƚĞ ϭϭ ƉƌŽǀŝƐŝŽŶƐ ƚŚĂƚ ĂŶLJ legislative proposal must demonstrate it establishes or ĂĐĐŽƵŶƚƐ ĨŽƌ ďĞĨŽƌĞ &W ĐĂŶ ŵĞĂŶŝŶŐĨƵůůLJ ĞŶŐĂŐĞ ǁŝƚŚ ƚŚĞ ƉƌŽƉŽƐĂů͘ &W ƉŽůŝĐLJ ŶŽǁ ĂĚĚƌĞƐƐĞƐ ŵŽƌĞ ĨƵůůLJ ƚŚĞ concerns of family physicians, as it takes into account, for example: compensation for education, training and

practice supervision of NPs by family physicians; obtaining and maintaining sufficient liability insurance; and a uniform, consistent education program to attain independent practice ĨŽůůŽǁŝŶŐ EW ĐĞƌƚŝĨŝĐĂƚŝŽŶ͕ ƐƵĐŚ ĂƐ Žƌ ĞƋƵŝǀĂůĞŶƚ ƚŽ ĐŽŵƉůĞƚŝŽŶ ŽĨ ƚƌĂŝŶŝŶŐ ǁŝƚŚŝŶ ĂŶ ĂĐĐƌĞĚŝƚĞĚ ƌĞƐŝĚĞŶĐLJ ƚƌĂŝŶŝŶŐ ƉƌŽŐƌĂŵ and appropriate testing for the practice of medicine.

Principles for the Protection of Care for Transgender and 'ĞŶĚĞƌͲ džƉĂŶƐŝǀĞ WĂƚŝĞŶƚƐ CAFP has a long record of standing up for universal coverage and access to vital care. Transgender and gender-expansive ƉĂƚŝĞŶƚƐ ŚĂǀĞ ĐŽŵĞ ƵŶĚĞƌ ŝŶĐƌĞĂƐŝŶŐ ĂƚƚĂĐŬ͕ ŚŽǁĞǀĞƌ͕ ĂƐ federal policy and regulations take aim at their rights as ƉĂƚŝĞŶƚƐ ĂŶĚ ƉƌŽƚĞĐƚŝŽŶƐ ĂŐĂŝŶƐƚ ĚŝƐĐƌŝŵŝŶĂƚŝŽŶ͘ /Ŷ ϮϬϭϵ͕ &W͛Ɛ ŽŵŵŝƚƚĞĞ ŽŶ ƚŚĞ ,ĞĂůƚŚ ŽĨ ƚŚĞ WƵďůŝĐ ; ,KWͿ ƉƌŽƉŽƐĞĚ ƚŽ ƚŚĞ &W ŽĂƌĚ ϭϬ ƉƌŝŶĐŝƉůĞƐ ƚŽ ƉƌŽƚĞĐƚ ĐĂƌĞ for transgender and gender-expansive patients. These principles outline patient rights, physician responsibilities, and supports inclusion of transgender and gender-expansive people and consideration of their needs in the development of billing systems, the undertaking of research and policy,

and the design of medical school and residency curriculum.

This policy also supports safe and humane conditions for ƚƌĂŶƐŐĞŶĚĞƌ ƉĞŽƉůĞ ŝŶ ĂŶLJ ĨŽƌŵ ŽĨ ĚĞƚĞŶƚŝŽŶ͕ ĂŶĚ ƌĞĐŽŐŶŝnjĞƐ that biological sex, gender identity, and sexual orientation are separate facets of a patient’s intersectional identity. LJ ĚĞǀĞůŽƉŝŶŐ ĂŶĚ ĂĚŽƉƚŝŶŐ ƚŚŝƐ ŶĞǁ ƐĞƚ ŽĨ ƉƌŝŶĐŝƉůĞƐ͕ &W ŶŽǁ ŚĂƐ ŐƵŝĚĂŶĐĞ ĚŝƌĞĐƚƐ ŝƚƐ ŝŶǀŽůǀĞŵĞŶƚ ŝŶ ďŽƚŚ ƐƚĂƚĞ ĂŶĚ federal policy that has the potential to affect the health and ǁĞůůďĞŝŶŐ ŽĨ ƚƌĂŶƐŐĞŶĚĞƌ ĂŶĚ ŐĞŶĚĞƌͲĞdžƉĂŶƐŝǀĞ ƉĂƚŝĞŶƚƐ͘ It also declares CAFP’s intention to stand up for equality of ĐŽǀĞƌĂŐĞ ĂŶĚ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ƵŶĚĞƌ ƚŚĞ ůĂǁ͘ ZĞƐŽůƵƚŝŽŶƐ ƚŽ ƚŚĞ &W ŽĂƌĚ dŚĞ ĂďŽǀĞ ƉŽůŝĐŝĞƐ ĂŶĚ ƉƌŝŶĐŝƉůĞƐ ĂƌĞ ũƵƐƚ ƚǁŽ ĐŽŶƐŝĚĞƌĞĚ ĂŶĚ ĂĚŽƉƚĞĚ ďLJ ƚŚĞ &W ŽĂƌĚ ŝŶ ϮϬϭϵ͘ dŚĞ ŽĂƌĚ ĐŽŶƐŝĚĞƌĞĚ ϭϭ ŵĞŵďĞƌͲƐƵďŵŝƚƚĞĚ ƌĞƐŽůƵƚŝŽŶƐ ŝŶ Ăůů͘ ZĞƐŽůƵƚŝŽŶƐ ĐĂŶ ďĞ submitted by CAFP members to the CAFP Board of Directors at any time throughout the year by completing the Resolution Submission Form (https://cafponcloud.egnyte.com/dl/ ĨϱϯϭŽƌϱƋϴǀͬͿ ĂŶĚ ĞŵĂŝůŝŶŐ ŝƚ ƚŽ ĐĂĨƉΛĨĂŵŝůLJĚŽĐƐ͘ŽƌŐ͘

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CAFP Principles on the Independent Practice of Medicine by Nurse Practitioners California’s family physicians are on the frontline of health ĐĂƌĞ͕ ƉƌŽǀŝĚŝŶŐ ĐĂƌĞ ƚŽ ŵŝůůŝŽŶƐ ŽĨ ŵĞŶ͕ ǁŽŵĞŶ ĂŶĚ ĐŚŝůĚƌĞŶ ŝŶ ĐŽŵŵƵŶŝƚŝĞƐ ůĂƌŐĞ ĂŶĚ ƐŵĂůů͕ ƌƵƌĂů ĂŶĚ ƵƌďĂŶ͕ ǁĞĂůƚŚLJ and poor. One in five physician office visits takes place ǁŝƚŚ Ă ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͕ ĂŶĚ ĞdžƚĞŶƐŝǀĞ ĞǀŝĚĞŶĐĞ ƉƌŽǀĞƐ ƚŚĂƚ primary care provides exceptional value for health care dollars. Family physicians save lives and costs.

It is the policy of the California Academy of Family WŚLJƐŝĐŝĂŶƐ ; &WͿ ƚŚĂƚ ŶƵƌƐĞ ƉƌĂĐƚŝƚŝŽŶĞƌƐ ;EWƐͿ ĂƌĞ ǀĂůƵĂďůĞ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ǁŚŽƐĞ ƐĐŽƉĞ ŽĨ ƉƌĂĐƚŝĐĞ ƐŚŽƵůĚ ĐŽƌƌĞƐƉŽŶĚ ƚŽ͕ ďƵƚ ŶŽƚ ĞdžĐĞĞĚ͕ ƚŚĞŝƌ ůĞǀĞů ŽĨ ŬŶŽǁůĞĚŐĞ͕ skill, experience, licensure and training (using competency ƚƌĂŝŶŝŶŐ ŵĞĂƐƵƌĞƐͿ͕ ĂŶĚ ĂŶ EW ƐŚŽƵůĚ ŶĞǀĞƌ ŝŶĚĞƉĞŶĚĞŶƚůLJ ĚĞůŝǀĞƌ ĐĂƌĞ ǁŝƚŚŽƵƚ ŽďƚĂŝŶŝŶŐ ƚŚĞ ŚŝŐŚĞƌ ůĞǀĞů ŽĨ ĞĚƵĐĂƚŝŽŶ and clinical training of a physician.

CAFP considers ordering and interpreting diagnostic procedures, certifying disability, and prescribing, dispensing and administering controlled substances to be the practice of medicine. CAFP believes that it is of utmost importance that consistency of standards and regulations be maintained in the regulation of the practice of medicine in California.

CAFP’s position on any proposed legislation and/or regulation that seeks to expand the ability of NPs to practice ŵĞĚŝĐŝŶĞ ŝŶĚĞƉĞŶĚĞŶƚůLJ ŽĨ ƉŚLJƐŝĐŝĂŶ ƐƵƉĞƌǀŝƐŝŽŶ ǁŝůů ďĞ guided by core principles related to establishing consistency ŽĨ ƐƚĂŶĚĂƌĚƐ ĂŶĚ ƌĞŐƵůĂƚŝŽŶ͕ ĂƐ ǁĞůů ĂƐ ƚŚĞ ĂďŝůŝƚLJ ŽĨ ƚŚĞ proposal to address the problems it purports to resolve, including but not limited to: access to primary care, cost of care, quality of care and the overall sustainability of ƚŚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ǁŽƌŬĨŽƌĐĞ͘ ŶLJ ƐƵĐŚ ƉƌŽƉŽƐĂů ŵƵƐƚ ĚĞŵŽŶƐƚƌĂƚĞ ƚŚĂƚ ŝƚ ĞƐƚĂďůŝƐŚĞƐ Žƌ ĂĐĐŽƵŶƚƐ ĨŽƌ ƚŚĞ ĨŽůůŽǁŝŶŐ provisions: Educational Standards ϭ͘ ƵŶŝĨŽƌŵ͕ ĐŽŶƐŝƐƚĞŶƚ ĞĚƵĐĂƚŝŽŶ ƉƌŽŐƌĂŵ ƚŽ ĂƚƚĂŝŶ EW certification.

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Ϯ͘ ƵŶŝĨŽƌŵ͕ ĐŽŶƐŝƐƚĞŶƚ ĞĚƵĐĂƚŝŽŶ ƉƌŽŐƌĂŵ ƚŽ ĂƚƚĂŝŶ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ ĨŽůůŽǁŝŶŐ EW ĐĞƌƚŝĨŝĐĂƚŝŽŶ͕ ƐƵĐŚ ĂƐ Žƌ ĞƋƵŝǀĂůĞŶƚ ƚŽ ĐŽŵƉůĞƚŝŽŶ ŽĨ ƚƌĂŝŶŝŶŐ ǁŝƚŚŝŶ ĂŶ accredited residency training program and appropriate testing for the practice of medicine. Residency training, or its equivalent, must include sufficient primary care hours and patient visits in multiple settings of varying acuity to ensure direct observation of clinical proficiency.

3. Initial and ongoing maintenance of certification specific to primary care. ϰ͘ ŽŵƉĞŶƐĂƚŝŽŶ ĨŽƌ ĞĚƵĐĂƚŝŽŶ͕ ƚƌĂŝŶŝŶŐ ĂŶĚ ƉƌĂĐƚŝĐĞ supervision of NPs by family physicians.

ZĞŐƵůĂƚŝŽŶ ĂŶĚ KǀĞƌƐŝŐŚƚ 5. Regulation and oversight by the Medical Board of California.

Liability ϲ͘ KďƚĂŝŶŝŶŐ ĂŶĚ DĂŝŶƚĂŝŶŝŶŐ ^ƵĨĨŝĐŝĞŶƚ >ŝĂďŝůŝƚLJ /ŶƐƵƌĂŶĐĞ Ăƌ ŽŶ ƚŚĞ ŽƌƉŽƌĂƚĞ WƌĂĐƚŝĐĞ ŽĨ DĞĚŝĐŝŶĞ ϳ͘ ŽŵƉůŝĂŶĐĞ ǁŝƚŚ ĂůŝĨŽƌŶŝĂ͛Ɛ ďĂƌ ŽŶ ƚŚĞ ĐŽƌƉŽƌĂƚĞ practice of medicine.

WƌŽǀŝƐŝŽŶ ŽĨ WƌŝŵĂƌLJ ĂƌĞ ƚŽ hŶĚĞƌƐĞƌǀĞĚ WŽƉƵůĂƚŝŽŶƐ ϴ͘ ƌĞƋƵŝƌĞŵĞŶƚ ŽĨ ůŝĐĞŶƐƵƌĞ ƚŽ ƌĞŵĂŝŶ ŝŶ ƉƌŝŵĂƌLJ ĐĂƌĞ ĂƐ ŽƉƉŽƐĞĚ ƚŽ ƐƵďͲƐƉĞĐŝĂůŝnjĂƚŝŽŶ͘ ϵ͘ /ŶĐĞŶƚŝǀĞƐ ƚŽ ƉƌĂĐƚŝĐĞ ŝŶ ƵŶĚĞƌƐĞƌǀĞĚ ŐĞŽŐƌĂƉŚŝĐ ĂƌĞĂƐ and/or delivery of service to underserved populations. ϭϬ͘ WƌŽƐƉĞĐƚŝǀĞ ĂŶĚ ŽŶŐŽŝŶŐ ĂŶĂůLJƐĞƐ ŽĨ ƋƵĂůŝƚLJ ŽĨ ĐĂƌĞ͕ ĐŽƐƚ ŽĨ ĐĂƌĞ͕ ŚĞĂůƚŚ ĐĂƌĞ ƵƚŝůŝnjĂƚŝŽŶ ĂŶĚ ƉƌŽǀŝĚĞƌ and patient satisfaction, upon starting independent practice. hŶŝĨŽƌŵŝƚLJ ŽĨ ZĞƋƵŝƌĞŵĞŶƚƐ ϭϭ͘ ƉƉůŝĐĂƚŝŽŶ ŽĨ ƚŚĞ ĂďŽǀĞ ƉƌŽǀŝƐŝŽŶƐ ƚŽ EWƐ ƌĞůŽĐĂƚŝŶŐ ƚŽ ĂůŝĨŽƌŶŝĂ ĨƌŽŵ Ă ƐƚĂƚĞ ǁŝƚŚ ŝŶĚĞƉĞŶĚĞŶƚ ƉƌĂĐƚŝĐĞ authority.

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CAFP Principles for the Protection and Care of Transgender and Gender-Expansive Patients

Ϯ͘ KƉƉŽƐĞƐ Ăůů ƉƵďůŝĐ ĂŶĚ ƉƌŝǀĂƚĞ ĚŝƐĐƌŝŵŝŶĂƟŽŶ ĂŐĂŝŶƐƚ transgender and gender-expansive individuals in the areas, including but not exclusive of, health care, employment, ŚŽƵƐŝŶŐ͕ ƉƵďůŝĐ ĂĐĐŽŵŵŽĚĂƟŽŶ͕ ĞĚƵĐĂƟŽŶ ĂŶĚ ůŝĐĞŶƐŝŶŐ͘ ϯ͘ ^ƵƉƉŽƌƚƐ ĞdžŝƐƟŶŐ ƐƚĂƚĞ ĂŶĚ ĨĞĚĞƌĂů ůĂǁƐ ƚŚĂƚ ƉƌŽƚĞĐƚ ƉĞŽƉůĞ ĨƌŽŵ ĚŝƐĐƌŝŵŝŶĂƟŽŶ ďĂƐĞĚ ŽŶ ŐĞŶĚĞƌ ĞdžƉƌĞƐƐŝŽŶ ĂŶĚ ŝĚĞŶƟƚLJ ĂŶĚ ŽƉƉŽƐĞƐ ůĂǁƐ ƚŚĂƚ ĐŽŵƉƌŽŵŝƐĞ ƚŚĞ ƐĂĨĞƚLJ ĂŶĚ ŚĞĂůƚŚ of transgender and gender-expansive people by failing to ƉƌŽǀŝĚĞ ƚŚŝƐ ƉƌŽƚĞĐƟŽŶ͘ ϰ͘ ƐƐĞƌƚƐ ƚŚĂƚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƐŚŽƵůĚ ŶŽƚ ĚŝƐĐƌŝŵŝŶĂƚĞ ĂŐĂŝŶƐƚ ĐůĂƐƐĞƐ Žƌ ĐĂƚĞŐŽƌŝĞƐ ŽĨ ƉĂƟĞŶƚƐ ŝŶ ƚŚĞ ĚĞůŝǀĞƌLJ ŽĨ ŶĞĞĚĞĚ health care. Such classes and categories include gender ŝĚĞŶƟƚLJ ĂŶĚ ĞdžƉƌĞƐƐŝŽŶ͘ ϱ͘ ƐƐĞƌƚƐ ƚŚĂƚ ƚŚĞ ŵĞĚŝĐĂů ƉƌŽĐĞĚƵƌĞƐ ĂƩĞŶĚĂŶƚ ƚŽ ŐĞŶĚĞƌͲ ĂĸƌŵŝŶŐͬĐŽŶĮƌŵŝŶŐ ƐƵƌŐĞƌŝĞƐ ĂŶĚ ƚŚĞƌĂƉŝĞƐ ƐƵĐŚ ĂƐ ŚŽƌŵŽŶĞƐ Žƌ ŽƚŚĞƌ ŵĞĚŝĐĂƟŽŶƐ ƚŚĂƚ ĂĚŚĞƌĞ ƚŽ ƚŚĞ ƉƌĞǀĂŝůŝŶŐ ƐƚĂŶĚĂƌĚƐ ŽĨ ĐĂƌĞ ĂƌĞ ŶŽƚ ͞ĐŽƐŵĞƟĐ͟ Žƌ ͞ĞůĞĐƟǀĞ͕͟ ďƵƚ ĂƌĞ understood to be medically necessary. ϲ͘ ^ƵƉƉŽƌƚƐ ƐĂĨĞ ĂŶĚ ŚƵŵĂŶĞ ĐŽŶĚŝƟŽŶƐ ĨŽƌ ƚƌĂŶƐŐĞŶĚĞƌ ƉĞŽƉůĞ ŝŶ ĂŶLJ ĨŽƌŵ ŽĨ ĚĞƚĞŶƟŽŶ͕ ǁŝƚŚ ŝŶĚŝǀŝĚƵĂůƐ͛ ƌŝŐŚƚ ƚŽ ƐĞůĨͲŝĚĞŶƟĨLJ ƚŚĞŝƌ ŐĞŶĚĞƌ ƵŶĚĞƌ ƐƵĐŚ ĚĞƚĞŶƟŽŶ ĐŽŶĚŝƟŽŶƐ͕ and asserts that transgender and gender-expansive prisoners should have the same access to medically necessary care as non-incarcerated transgender and gender-expansive people ĂŶĚ ƚŚĂƚ ŵĞĚŝĐĂůůLJ ŶĞĐĞƐƐĂƌLJ ĐĂƌĞ ŝŶĐůƵĚĞƐ ŐĞŶĚĞƌͲĂĸƌŵŝŶŐ treatments and procedures.

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California Family Physician Winter 2020

ϳ͘ ZĞĐŽŐŶŝnjĞƐ ƚŚĂƚ ďŝŽůŽŐŝĐĂů ƐĞdž͕ ŐĞŶĚĞƌ ŝĚĞŶƟƚLJ ĂŶĚ ƐĞdžƵĂů ŽƌŝĞŶƚĂƟŽŶ ĂƌĞ ƐĞƉĂƌĂƚĞ ĨĂĐĞƚƐ ŽĨ Ă ƉĂƟĞŶƚ͛Ɛ ŝŶƚĞƌƐĞĐƟŽŶĂů ŝĚĞŶƟƚLJ͘ ϴ͘ ƐƐĞƌƚƐ ƚŚĂƚ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚƐ͕ ďŝůůŝŶŐ ƐLJƐƚĞŵƐ͕ and insurance be designed to respect the asserted ŐĞŶĚĞƌ ŝĚĞŶƟƚLJ ĂŶĚ ƉƌĞĨĞƌƌĞĚ ŶĂŵĞ ŽĨ ĞĂĐŚ ƉĂƟĞŶƚ ǁŚŝůĞ ŵĂŝŶƚĂŝŶŝŶŐ ĐŽŶĮĚĞŶƟĂůŝƚLJ ĂŶĚ ĂǀŽŝĚŝŶŐ ĚƵƉůŝĐĂƚĞ ĐŚĂƌƚƐ͘ dŚĞ ŝŶĐůƵƐŝŽŶ ŽĨ ƐĞdžƵĂů ŽƌŝĞŶƚĂƟŽŶͬŐĞŶĚĞƌ ŝĚĞŶƟƚLJ ĂůůŽǁƐ ĨŽƌ ŵŽƌĞ ĂĐĐƵƌĂƚĞ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ŵĞĂƐƵƌĞŵĞŶƚ ŽĨ ŚĞĂůƚŚ ĚŝƐƉĂƌŝƟĞƐ͘ ϵ͘ ^ƵƉƉŽƌƚƐ ƚŚĞ ŝŶĐůƵƐŝŽŶ ŽĨ ƚƌĂŶƐŐĞŶĚĞƌ ĂŶĚ ŐĞŶĚĞƌͲ expansive people in development of both health and social determinants of health research and policy, including ĐůŝŶŝĐĂů ƚƌŝĂůƐ ĂŶĚ ŽďƐĞƌǀĂƟŽŶĂů ƐƚƵĚŝĞƐ͕ ŝŶ ŽƌĚĞƌ ƚŽ ďĞƩĞƌ ƵŶĚĞƌƐƚĂŶĚ ŚĞĂůƚŚ ĚŝƐƉĂƌŝƟĞƐ ĂŶĚ ƚŽ ďƵŝůĚ Ă ƐƚƌŽŶŐĞƌ evidence base for transgender and gender minority health. ϭϬ͘ ŶĐŽƵƌĂŐĞƐ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ ĂŶĚ ŐƌĂĚƵĂƚĞ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ƉƌŽŐƌĂŵƐ ƚŽ ĚĞǀĞůŽƉ ĂŶĚ ŝŶĐŽƌƉŽƌĂƚĞ ĞĚƵĐĂƟŽŶĂů ŵĂƚĞƌŝĂů͕ ƚŽŽůƐ ĂŶĚ ƚƌĂŝŶŝŶŐ ƚŚĂƚ ǁŝůů ĂůůŽǁ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ƉƌŽǀŝĚĞ ŬŶŽǁůĞĚŐĞĂďůĞ ĂŶĚ ƌĞƐƉĞĐƞƵů ĐĂƌĞ ƚŽ ƚƌĂŶƐŐĞŶĚĞƌ ĂŶĚ ŐĞŶĚĞƌͲĞdžƉĂŶƐŝǀĞ ƉĂƟĞŶƚƐ͘

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The inclusion of sexual orientation/gender identity allows for more accurate information and measurement of health disparities.

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ϭ͘ ƐƐĞƌƚƐ ƚŚĂƚ ĞǀĞƌLJ ƉĂƟĞŶƚ Žƌ ůĞĂƌŶĞƌ ƉƌĞƐĞŶƟŶŐ ƚŽ Ă ĨĂŵŝůLJ physician, family medicine residency or other health care/ ƉƌĂĐƟĐĞ ĞŶǀŝƌŽŶŵĞŶƚ ŚĂƐ ƚŚĞ ƌŝŐŚƚ ƚŽ ďĞ ƉƌŽǀŝĚĞĚ ǁŝƚŚ Ă ƐĂĨĞ͕ ĞƋƵŝƚĂďůĞ͕ ŬŶŽǁůĞĚŐĞĂďůĞ͕ ĐƵůƚƵƌĂůůLJ ƐĞŶƐŝƟǀĞ ĂŶĚ ĂĐĐĞƉƟŶŐ ĞŶǀŝƌŽŶŵĞŶƚ ĨƌĞĞ ĨƌŽŵ ĚŝƐĐƌŝŵŝŶĂƟŽŶ ƌĞŐĂƌĚůĞƐƐ ŽĨ ŐĞŶĚĞƌ ŝĚĞŶƟƚLJ ƐƚĂƚƵƐ͘

California Family Physician Winter 2020

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H e r e ’s W h a t ’s N e w i n 2 0 2 0

Conrad Amenta CAFP Director of Policy and Strategic Initiatives

Three Pathways Move Toward Achieving Value-Based Payment the California Department of Health Care Services advising them that overreliance on pay-for-performance measures, ǁŚĞŶ ĐŽŵďŝŶĞĚ ǁŝƚŚ ŵLJƌŝĂĚ ŽƚŚĞƌ ƉĂLJŵĞŶƚ ƉůĂŶƐ͕ ĐĂŶ ĚŝƐƚŽƌƚ ĂƉƉƌŽƉƌŝĂƚĞ ďĞŚĂǀŝŽƌ ĂŶĚ ůĞĂĚ ƚŽ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ͘ /Ŷ ĂŶ ŝĚĞĂů ǁŽƌůĚ͕ ĂůŝĨŽƌŶŝĂ ǁŽƵůĚ ŝŶƚƌŽĚƵĐĞ s W ƚŚĂƚ ƌĞŇĞĐƚƐ ƚŚĞ dŚŽƵŐŚ ƚŚĞ ĚĞƚĂŝůƐ ŽĨ ǀĂƌŝŽƵƐ s W ƉƌŽƉŽƐĂůƐ ĚŝīĞƌ͕ &W ďĞůŝĞǀĞƐ ƚƌƵĞ W & ŝŶŝƟĂƟǀĞ͕ ĂƐ ƚŚĞ ĞŶƚĞƌ ĨŽƌ DĞĚŝĐĂƌĞ ĂŶĚ DĞĚŝĐĂŝĚ ^ĞƌǀŝĐĞƐ ; D^Ϳ ŝŶƚĞŶĚĞĚ ƚŚĞ ƉƌŽŐƌĂŵ ƚŽ ͞ĞŶĐŽƵƌĂŐĞ ŽƚŚĞƌ ƉĂLJĞƌƐ VBP must be: ʹ ŝŶĐůƵĚŝŶŐ DĞĚŝĐĂƌĞ ĚǀĂŶƚĂŐĞ WůĂŶƐ͕ ĐŽŵŵĞƌĐŝĂů ŚĞĂůƚŚ • WƌŽƐƉĞĐƟǀĞ͗ Up-front payment that covers investments in insurers, Medicaid managed care plans, and State Medicaid upstream primary care. ĂŐĞŶĐŝĞƐ ʹ ƚŽ ĂůŝŐŶ ƉĂLJŵĞŶƚ͕ ƋƵĂůŝƚLJ ŵĞĂƐƵƌĞŵĞŶƚ͕ ĂŶĚ ĚĂƚĂ • Risk-adjusted: WĂLJŵĞŶƚƐ ƌĞŇĞĐƚ ƚŚĞ ĐŽŵƉůĞdžŝƚLJ ŽĨ ƚŚĞ ƐŚĂƌŝŶŐ ǁŝƚŚ D^ ŝŶ ƐƵƉƉŽƌƚ ŽĨ WƌŝŵĂƌLJ ĂƌĞ &ŝƌƐƚ ƉƌĂĐƟĐĞƐ͘͟ ƉĂƟĞŶƚ ƉŽƉƵůĂƟŽŶ͘ • /ŶĐĞŶƟǀŝnjŝŶŐ͗ Bonus payments for performance measures that are evidence-based, clinically relevant, and aligned ĞŵŽŶƐƚƌĂƚĞ ƚŚĞ ǀĂůƵĞ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ across payers. &W ŝƐ Ă ůŽŶŐƟŵĞ ƐƵƉƉŽƌƚĞƌ ŽĨ ƚŚĞ WĂƟĞŶƚͲ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ͘ W D, ŝƐ Ă ĐĂƌĞ ŵŽĚĞů͕ ŶŽƚ Ă ƉĂLJŵĞŶƚ ŵŽĚĞů͕ Ɛ s W ŐƌŽǁƐ ŝŶ ƉŽƉƵůĂƌŝƚLJ͕ &W ŚĂƐ ĞŵƉůŽLJĞĚ ƚŚƌĞĞ ĚŝƐƟŶĐƚ but PCMH and VBP are co-dependent; each strengthens and ƐƚƌĂƚĞŐŝĞƐ ƚŽ ƐŚĂƉĞ ŚŽǁ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ŵĂLJ ƉĂƌƟĐŝƉĂƚĞ ŝŶ perpetuates the other. ĚŝīĞƌĞŶƚ ŵŽĚĞůƐ͗ tŚŝůĞ ƐƚĂƚĞǁŝĚĞ ƉĂLJĞƌƐ ŚĂǀĞ ƌĞŵĂŝŶĞĚ ŚĞƐŝƚĂŶƚ ƚŽ ĮŶĂŶĐŝĂůůLJ WƵƚ ĨŽƌǁĂƌĚ Ă ƐƉĞĐŝĮĐ ŵŽĚĞů ǁŝƚŚ ƚŚĞ ŐŽĂů ŽĨ ĐƌĞĂƟŶŐ ĂůŝŐŶŵĞŶƚ ƐƵƉƉŽƌƚ ƚŚĞ W D,͕ ƚŚŽƐĞ ǁŚŽ ŚĂǀĞ ƐĞĞŶ ƚŚĞ ǀĂůƵĞ ŽĨ ƚŚĞ between federal and state plans ŵŽĚĞů ĮƌƐƚͲŚĂŶĚ ŚĂǀĞ ŶŽƚ ŚĞƐŝƚĂƚĞĚ ƚŽ ƌĞͲŝŶǀĞƐƚ͘ /Ŷ ϮϬϭϭ͕ &W /Ŷ ƌĞĐĞŶƚ ŵŽŶƚŚƐ͕ ǁĞ͛ǀĞ ƐĞĞŶ ĞdžĐŝƟŶŐ ŵŽǀĞŵĞŶƚ ŝŶ ƚŚĞ s W ƐƉĂĐĞ͘ ƉĂƌƚŶĞƌĞĚ ǁŝƚŚ ƚŚĞ &ƌĞƐŶŽ hŶŝĮĞĚ ^ĐŚŽŽů ŝƐƚƌŝĐƚ ;&h^ Ϳ ĂŶĚ dŚĞ ĞŶƚĞƌ ĨŽƌ DĞĚŝĐĂƌĞ Θ DĞĚŝĐĂŝĚ /ŶŶŽǀĂƟŽŶ͛Ɛ ; DD/Ϳ WƌŝŵĂƌLJ Santé Community Physicians to create a PCMH pilot for FUSD’s ĂƌĞ &ŝƌƐƚ DŽĚĞů ;ϭͿ ;W &Ϳ ǁĂƐ ĚĞǀĞůŽƉĞĚ ƚŽ ƌĞŇĞĐƚ ĂŶĚ ĞdžƉĂŶĚ employees. Eight years later, the project has expanded and is ƵƉŽŶ ƚŚĞ ƉƌŝŶĐŝƉůĞƐ ŽĨ ŽŵƉƌĞŚĞŶƐŝǀĞ WƌŝŵĂƌLJ ĂƌĞ WůƵƐ ; W нͿ͘ W & ƐƟůů ŐŽŝŶŐ ƐƚƌŽŶŐ͘ dŚĞ ĞīŽƌƚ ŚĂƐ ƐĂǀĞĚ ƐĞǀĞƌĂů ŵŝůůŝŽŶ ĚŽůůĂƌƐ ŝŶ ǁĂƐ ĚĞǀĞůŽƉĞĚ ŝŶ ĐůŽƐĞ ĐŽůůĂďŽƌĂƟŽŶ ǁŝƚŚ ƚŚĞ ŵĞƌŝĐĂŶ ĐĂĚĞŵLJ ŚĞĂůƚŚ ĐĂƌĞ ĐŽƐƚƐ͕ ĚƌĂŵĂƟĐĂůůLJ ŝŵƉƌŽǀĞĚ ŚĞĂůƚŚ ĐĂƌĞ ŽƵƚĐŽŵĞƐ͕ ŽĨ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ; &WͿ ďĂƐĞĚ ŽŶ ŝƚƐ ĚǀĂŶĐĞĚ WƌŝŵĂƌLJ ĂƌĞ ĂŶĚ ƚŚĞ &h^ ƌĞĐĞŶƚůLJ ƌĞŶĞǁĞĚ ŝƚƐ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ƚŚĞ ƉƌŽũĞĐƚ͘ ůƚĞƌŶĂƟǀĞ WĂLJŵĞŶƚ DŽĚĞů ;ϮͿ͘ /Ŷ ďŽƚŚ ŵŽĚĞůƐ͕ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌĂĐƟĐĞƐ ǁŽƵůĚ ƌĞĐĞŝǀĞ ƚŚƌĞĞ ƚLJƉĞƐ ŽĨ ƉĂLJŵĞŶƚƐ͗ Ɛ ŽŶĞ ǁĂLJ ƚŽ ŐĞƚ ƵƐ ĐůŽƐĞƌ ƚŽ s W͕ ĂĚĚŝƟŽŶĂů ƉĂƌƚŶĞƌƐŚŝƉƐ ďĞƚǁĞĞŶ ƉĂLJĞƌƐ ĂŶĚ W D,ͲĂĐĐƌĞĚŝƚĞĚ • A monthly capitated payment ƉƌĂĐƟĐĞƐ ƐŚŽƵůĚ ďĞ ĨƵŶĚĞĚ͘ dŚĞ ƐƚĂƚĞ ŝŶƐƵƌĂŶĐĞ ĞdžĐŚĂŶŐĞ͕ • ƉŽƉƵůĂƟŽŶͲďĂƐĞĚ ƌŝƐŬͲĂĚũƵƐƚĞĚ ƉĂLJŵĞŶƚ Covered California, should also consider requiring that • A performance-based adjustment providing an upside of ƵƉ ƚŽ ϱϬ ƉĞƌĐĞŶƚ ŽĨ ƌĞǀĞŶƵĞ ĂƐ ǁĞůů ĂƐ Ă ƐŵĂůů ĚŽǁŶƐŝĚĞ ;ϭϬ ƉĂLJĞƌƐ ĐŽŶƚƌĂĐƚ ǁŝƚŚ Ă ĐĞƌƚĂŝŶ ŶƵŵďĞƌ ĂŶĚͬŽƌ ƉĞƌĐĞŶƚĂŐĞ ŽĨ W D,ͲĂĐĐƌĞĚŝƚĞĚ ƉƌĂĐƟĐĞƐ͘ &ŝŶĂůůLJ͕ ĂĐĐƌĞĚŝƚŽƌƐ ƐŚŽƵůĚ ůŽǁĞƌ ƉĞƌĐĞŶƚ ŽĨ ƌĞǀĞŶƵĞͿ ƚŽ ƌĞĚƵĐĞ ĐŽƐƚƐ ĂŶĚ ŝŵƉƌŽǀĞ ƋƵĂůŝƚLJ͘ ƚŚĞ ŚƵƌĚůĞƐ ƚŽ ĂƩĂŝŶŝŶŐ W D, ĂĐĐƌĞĚŝƚĂƟŽŶ͕ Žƌ ƌĞĐŽŐŶŝnjĞ dŚŝƐ ǁŽƵůĚ ďĞ ĂƐƐĞƐƐĞĚ ĂŶĚ ƉĂŝĚ ƋƵĂƌƚĞƌůLJ͘ PCMH-like outcomes. /Ŷ ƐŚŽƌƚ͕ ǁŚĞƌĞ ƉĂƐƚ ƉƌŽƉŽƐĂůƐ ŚĂǀĞ ŽǀĞƌͲƌĞůŝĞĚ ŽŶ ͞ƉĂLJ ĨŽƌ ƉĞƌĨŽƌŵĂŶĐĞ͟ ďŽŶƵƐĞƐ͕ ƉĞŶĂůƟĞƐ ƚŚĂƚ ůĞĂǀĞ ƵŶĚĞƌůLJŝŶŐ ŝŶĐĞŶƟǀĞƐ ZĞƋƵŝƌĞ ŚĞĂůƚŚ ƉůĂŶƐ ƐƉĞŶĚ Ă ŵŝŶŝŵƵŵ ƉĞƌĐĞŶƚĂŐĞ ŽŶ ƵŶĐŚĂŶŐĞĚ ĂŶĚ ŝŶĐƌĞĂƐĞ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ͕ W & ŝƐ ĂŶ ŝŵƉŽƌƚĂŶƚ primary care ƐƚĞƉ ƚŽ ĚŝƌĞĐƚůLJ ĂĚĚƌĞƐƐ ƚŚĞƐĞ ŇĂǁƐ͘ /Ŷ Ă ƐĐĞŶĂƌŝŽ ŝŶ ǁŚŝĐŚ ƉĂLJĞƌƐ ĐŚŽŽƐĞ ŶŽƚ ƚŽ ĐŽŶƐŝĚĞƌ ĞŝƚŚĞƌ ƚƌƵĞ s W Žƌ ƚŚĞ W D,͕ ĂůŝĨŽƌŶŝĂ ĐĂŶ ĚŽ ǁŚĂƚ ŽƚŚĞƌ ƐƚĂƚĞƐ ŚĂǀĞ /Ŷ ƚŚĞ ϮϬϭϵͲϮϬ ĂůŝĨŽƌŶŝĂ ^ƚĂƚĞ ƵĚŐĞƚ͕ DĞĚŝͲ Ăů DĂŶĂŐĞĚ ĂƌĞ done and require that payers report the percentage of their ǁŝůů ƉŝůŽƚ ŝƚƐ ŽǁŶ s W ƐLJƐƚĞŵ͘ &W ƐƵďŵŝƩĞĚ Ă ůĞƩĞƌ ;ϯͿ ƚŽ revenue dedicated to primary care. For those payers behind At the core of the California Academy of Family Physicians’ payment ƌĞĨŽƌŵ ĂĐƟǀŝƟĞƐ ŝƐ Ă ĚĞƐŝƌĞ ƚŽ ƐĞĞ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƉĂŝĚ ŝŶ Ă ǁĂLJ ƚŚĂƚ ƌĞŇĞĐƚƐ ƚŚĞ ǀĂůƵĞ ƚŚĞLJ ƉƌŽĚƵĐĞ ĨŽƌ ƉĂƟĞŶƚƐ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵƐ͘ dŚŝƐ ŝƐ ƌĞƉƌĞƐĞŶƚĞĚ ďLJ ƚƌƵĞ ǀĂůƵĞͲďĂƐĞĚ ƉĂLJŵĞŶƚ ;s WͿ͘

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in their support for primary care, many states have mandated that they spend at least a certain percentage to support such ĐĂƌĞ͘ dŚŝƐ ƉĂƚŚǁĂLJ ĐŽŵďŝŶĞƐ Ă ŵĂŶĚĂƚĞ ;Ğ͘Ő͕͘ ůĞŐŝƐůĂƟŽŶ ĂŶĚ ƌĞŐƵůĂƟŽŶͿ ǁŝƚŚ ŇĞdžŝďŝůŝƚLJ ;ŝ͘Ğ͕͘ ƉĂLJĞƌƐ ĐĂŶ ŐĞƚ ƚŽ ƚŚĞ ƚŚƌĞƐŚŽůĚ ŝŶ ŵĂŶLJ ĚŝīĞƌĞŶƚ ǁĂLJƐ ĂŶĚ ƚŚĞŝƌ ǁŽƌŬ ŝƐ ƐƵƉƉŽƌƚĞĚ ďLJ Ă ƉƌŝŵĂƌLJ ĐĂƌĞ ĐŽůůĂďŽƌĂƟǀĞ ƚŽ ƐŚĂƌĞ ďĞƐƚ ƉƌĂĐƟĐĞƐͿ͘

Conclusion Health care stakeholders from consumers to payers to employers are ƌĞĂůŝnjŝŶŐ ƚŚĂƚ ƉĂLJŝŶŐ ĨŽƌ ǀĂůƵĞ ŝƐ ƐLJŶŽŶLJŵŽƵƐ ǁŝƚŚ ƉĂLJŝŶŐ ĨŽƌ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ Ɛ ƐƵĐŚ͕ ŝƚ ŝƐ ĞƐƐĞŶƟĂů ƚŚĂƚ ǀĂůƵĞͲďĂƐĞ ƉĂLJŵĞŶƚ ďĞ ĚĞƐŝŐŶĞĚ ŝŶ Ă ǁĂLJ ƚŚĂƚ ƐƵƉƉŽƌƚƐ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ &W ǁŝůů ƚĂŬĞ ĞǀĞƌLJ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĮŐŚƚ ĨŽƌ s W ƚŚĂƚ ŝƐ ƉƌŽƐƉĞĐƟǀĞ͕ ƌŝƐŬͲĂĚũƵƐƚĞĚ ĂŶĚ ŝŶĐĞŶƟǀŝnjŝŶŐ͘

KƌĞŐŽŶ ŚĂƐ ƐƵĐŚ ůĞŐŝƐůĂƟŽŶ ŝŶ ƉůĂĐĞ ĂŶĚ ƉƌŽĚƵĐĞƐ ĂŶ ĂŶŶƵĂů ƌĞƉŽƌƚ ĚĞƐĐƌŝďŝŶŐ ƚŚĞŝƌ ƉƌŽŐƌĞƐƐ ;ϰͿ͘ &W ƐƉŽŶƐŽƌĞĚ Ă ďŝůů ŝŶ ϮϬϭϳ ; ϮϴϵϱͿ ;ϱͿ ŵŽĚĞůĞĚ ŽŶ KƌĞŐŽŶ͛Ɛ ůĞŐŝƐůĂƟŽŶ ǁŚŝĐŚ ƌĞƋƵŝƌĞƐ payers to report their primary care spend. While the bill stalled in ƚŚĞ ůĞŐŝƐůĂƟǀĞ ƉƌŽĐĞƐƐ͕ &W ƐƵĐĐĞƐƐĨƵůůLJ ĂĚǀŽĐĂƚĞĚ ĨŽƌ ƚŚĞ ƵƐĞ ŽĨ state funds to develop an all-payer claims database, a key piece ŽĨ ŝŶĨƌĂƐƚƌƵĐƚƵƌĞ ƚŽ ŵĞĂƐƵƌĞ ŚĞĂůƚŚ ƉůĂŶ ƐƉĞŶĚŝŶŐ͘ ĞůĂǁĂƌĞ ;ϲͿ ĂŶĚ ŽůŽƌĂĚŽ ;ϳͿ ŚĂǀĞ ĨŽůůŽǁĞĚ ƐƵŝƚ͘ ZŚŽĚĞ /ƐůĂŶĚ͛Ɛ /ŶƐƵƌĂŶĐĞ ŽŵŵŝƐƐŝŽŶĞƌ ŵĂŶĚĂƚĞĚ ƚŚĞ ƐĂŵĞ ƌĞƉŽƌƟŶŐ ĂŶĚ ƐƉĞŶĚŝŶŐ ǀŝĂ ƌĞŐƵůĂƟŽŶ ;ϴͿ͘ &ŝŶĂůůLJ͕ ƚŚĞ DŝůďĂŶŬ &ƵŶĚ ĂƵƚŚŽƌĞĚ Ă ƌĞƉŽƌƚ ŝŶ ϮϬϭϳ ĞdžƉůŽƌŝŶŐ ǀŽůƵŶƚĂƌLJ ĨƌĂŵĞǁŽƌŬƐ ĨŽƌ ƚŚĞ ƌĞƉŽƌƟŶŐ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐƉĞŶĚŝŶŐ ďLJ ƉƌŝǀĂƚĞ ƉĂLJĞƌƐ ;ϵͿ͘

Notes: ϭ͘ ŚƩƉƐ͗ͬ​ͬŝŶŶŽǀĂƟŽŶ͘ĐŵƐ͘ŐŽǀͬŝŶŝƟĂƟǀĞƐͬƉƌŝŵĂƌLJͲĐĂƌĞͲĮƌƐƚͲŵŽĚĞůͲ ŽƉƟŽŶƐͬ Ϯ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ĂĂĨƉ͘ŽƌŐͬĚĂŵͬ &WͬĚŽĐƵŵĞŶƚƐͬĂĚǀŽĐĂĐLJͬ ƉĂLJŵĞŶƚͬĂƉŵƐͬWZͲWd Ͳ W Ͳ WDͲϰϭϰϭϳ͘ƉĚĨ ϯ͘ ŚƩƉƐ͗ͬ​ͬĐĂĨƉŽŶĐůŽƵĚ͘ĞŐŶLJƚĞ͘ĐŽŵͬĚůͬϳdždž :tď'tƵ ϰ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ŽƌĞŐŽŶ͘ŐŽǀͬŽŚĂͬ,W ͬ E >zd/ ^ͬ ŽĐƵŵĞŶƚƐͬ^ Ͳ ϮϯϭͲZĞƉŽƌƚͲϮϬϭϵ͘ƉĚĨ ϱ͘ ŚƩƉƐ͗ͬ​ͬůĞŐŝŶĨŽ͘ůĞŐŝƐůĂƚƵƌĞ͘ĐĂ͘ŐŽǀͬĨĂĐĞƐͬďŝůůdĞdžƚ ůŝĞŶƚ͘džŚƚŵů͍ďŝůůͺ ŝĚсϮϬϭϳϮϬϭϴϬ Ϯϴϵϱ ϲ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ƉĐƉĐĐ͘ŽƌŐͬϮϬϭϵͬϬϭͬϭϭͬƉĐƉĐĐͲĂƉƉůĂƵĚƐͲĚĞůĂǁĂƌĞͲ report-recommending-increased-investment-primary-care ϳ͘ ŚƩƉ͗ͬ​ͬǁǁǁ͘ůĞŐ͘ĐŽůŽƌĂĚŽ͘ŐŽǀͬďŝůůƐͬŚďϭϵͲϭϮϯϯ ϴ͘ ŚƩƉ͗ͬ​ͬǁǁǁ͘ŽŚŝĐ͘ƌŝ͘ŐŽǀͬĚŽĐƵŵĞŶƚƐͬWƌŝŵĂƌLJͲ ĂƌĞͲ^ƉĞŶĚŝŶŐͲ ŐĞŶĞƌĂůƉƌŝŵĂƌLJͲĐĂƌĞͲ:ĂŶͲϮϬϭϰ͘ƉĚĨ ϵ͘ ŚƩƉƐ͗ͬ​ͬǁǁǁ͘ŵŝůďĂŶŬ͘ŽƌŐͬϮϬϭϳͬϬϳͬŐĞƫŶŐͲƉƌŝŵĂƌLJͲĐĂƌĞͲ oriented-measuring-primary-care-spending/

In each of these scenarios, requiring that payers report and spend more of their revenue on primary care has resulted in greater investment in VBP models. Should the evidence of VBP and ƉƌŝŵĂƌLJ ĐĂƌĞ ŶŽƚ ďĞ ƐƵĸĐŝĞŶƚ͕ ŵĂŶĚĂƚĞƐ ƐŚŽƵůĚ ĨŽůůŽǁ͘

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CAFP’s Nominating Committee Presents Its 2020 Slate dŚĞ ƌŽůĞ ŽĨ ƚŚĞ &W EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ŝƐ ƚŽ ŝĚĞŶƟĨLJ ĂŶĚ ŶŽŵŝŶĂƚĞ ŝŶĚŝǀŝĚƵĂůƐ ĨŽƌ ƚŚĞ ƉŽƐŝƟŽŶƐ ƐŚŽǁŶ ďĞůŽǁ͕ ƚŽ ďĞ ĞůĞĐƚĞĚ ďLJ ƚŚĞ ĞůĞŐĂƚĞƐ ĂŶĚ ƚŚĞ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ Ăƚ ƚŚĞ ϮϬϮϬ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ ; D DͿ ĂŶĚ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ ŵĞĞƟŶŐ͘ dŚĞ ϮϬϭϵ ĐŽŵŵŝƩĞĞ ŵĞŵďĞƌƐ ĂƌĞ ƌƐ͘ ŶƚŚŽŶLJ &ĂƚĐŚ ŚŽŶŐ͕ DŽŶŝƋƵĞ 'ĞŽƌŐĞ͕ ^ƚĞǀĞŶ ,ĂƌƌŝƐŽŶ͕ ƐŵĂ :ĂĨƌŝ ĂŶĚ dŽŶĂƚnjŝŶ ZŽĚƌŝŐƵĞnj͘ >ŝƐĂ tĂƌĚ͕ ŝŵŵĞĚŝĂƚĞ ƉĂƐƚ ƉƌĞƐŝĚĞŶƚ͕ ĐŚĂŝƌƐ ƚŚĞ ĐŽŵŵŝƩĞĞ͘ dŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ŵĞƚ ŝŶ ůĂƚĞ KĐƚŽďĞƌ ĂŶĚ ƉƌĞƐĞŶƚĞĚ ƚŚŝƐ ƐůĂƚĞ ŽĨ ŽĸĐĞƌƐ͕ ǁŚŝĐŚ ǁĂƐ ĂƉƉƌŽǀĞĚ ďLJ ƚŚĞ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ Ăƚ ŝƚƐ EŽǀĞŵďĞƌ ŵĞĞƟŶŐ͘ dŚĞ ƐůĂƚĞ ǁŝůů ďĞ ǀŽƚĞĚ ŽŶ Ăƚ ƚŚĞ D D ŵĞĞƟŶŐ͘

ůĞĐƚĞĚ ďLJ ĞůĞŐĂƚĞƐ Ăƚ ƚŚĞ ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƚŝŶŐ President-elect Speaker Vice Speaker &W ĞůĞŐĂƚĞ &W ůƚĞƌŶĂƚĞ ĞůĞŐĂƚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞΎ ;ĨƌŽŵ D DͿ Rural Director

^ŚĂŶŶŽŶ ŽŶŶŽůůLJ >ĂƵƌĞŶ ^ŝŵŽŶ ZĂƵů LJĂůĂ >ĞĞ ZĂůƉŚ DŝĐŚĞůůĞ YƵŝŽŐƵĞ DŽŶŝƋƵĞ 'ĞŽƌŐĞ ĂŶĚ ŶũĂŶĂ ^ŚĂƌŵĂ ^ƚĞǀĞŶ ,ĂƌƌŝƐŽŶ

ϮϬϮϬ ϮϬϮϬ ϮϬϮϬ ϮϬϮϬͲϮϮ ϮϬϮϬͲϮϮ ϮϬϮϬͲϮϭ ϮϬϮϬͲϮϭ

ůĞĐƚĞĚ ďLJ ĂŶĚ ĨƌŽŵ ƚŚĞ ŽĂƌĚ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞΎ ;ĨƌŽŵ ƚŚĞ K Ϳ ^ĞĐƌĞƚĂƌLJͬdƌĞĂƐƵƌĞƌ

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ƌƚŚƵƌ KŚĂŶŶĞƐƐŝĂŶ ĂŶĚ ^ƚĞǀĞŶ ,ĂƌƌŝƐŽŶ ůĞdž DƌŽƐnjĐnjLJŬͲDĐ ŽŶĂůĚ

ϮϬϮϬͲϮϭ ϮϬϮϬ

The All Member Advocacy DĞĞƟŶŐ ; D DͿ ŶŽŵŝŶĂƚĞƐ and elects a total of three ŵĞŵďĞƌƐ ŽĨ ƚŚĞ EŽŵŝŶĂƟŶŐ ŽŵŵŝƩĞĞ ĨƌŽŵ ƚŚĞ D D ĞůĞŐĂƚĞƐ͖ ƚǁŽ ĂƌĞ ĞůĞĐƚĞĚ ĨŽƌ ƚǁŽͲLJĞĂƌ ƚĞƌŵƐ ŝŶ ŽŶĞ year, and one is elected for a ƚǁŽͲLJĞĂƌ ƚĞƌŵ ƚŚĞ ŶĞdžƚ LJĞĂƌ͘ EŽŵŝŶĂƟŽŶƐ ŵĂLJ ďĞ ŵĂĚĞ ĨƌŽŵ ƚŚĞ ŇŽŽƌ ĂƐ ǁĞůů͘ The Secretary/Treasurer ƉŽƐŝƟŽŶ ŵƵƐƚ ďĞ ĞůĞĐƚĞĚ ĨƌŽŵ among eligible board members, Ğ͘Ő͕͘ ƚŚŽƐĞ ǁŚŽƐĞ ƚĞƌŵƐ ĂƌĞ ŶŽƚ expiring during the proposed ƚĞƌŵ ŽĨ ŽĸĐĞ ;ŽŶĞ LJĞĂƌͿ͘

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ceo message

Lisa Folberg, MPP

Our Diversity is Our Strength &W ŵĞŵďĞƌƐ ĂƌĞ ŝŶ ĞǀĞƌLJ ƉƌĂĐƟĐĞ ƚLJƉĞ ŝŶ ĞǀĞƌLJ ĐŽƌŶĞƌ ŽĨ ƚŚĞ ƐƚĂƚĞ͕ ĨƌŽŵ ƵƌĞŬĂ ƚŽ ^ĂŶ ŝĞŐŽ͘ zŽƵ ĂƌĞ ƌƵƌĂů ĂŶĚ ƵƌďĂŶ͖ ϮϬͲƐŽŵĞƚŚŝŶŐƐ ĂŶĚ ŽĐƚŽŐĞŶĂƌŝĂŶƐ͖ ŵĞŶ͕ ǁŽŵĞŶ ĂŶĚ ŐĞŶĚĞƌ ŇƵŝĚ͖ DƵƐůŝŵ͕ ŚƌŝƐƟĂŶ͕ :ĞǁŝƐŚ ĂŶĚ ŶŽŶͲĨĂŝƚŚͲďĂƐĞĚ͖ ŐĂLJ͕ ƐƚƌĂŝŐŚƚ ĂŶĚ ƋƵĞƐƟŽŶŝŶŐ͖ ZĞƉƵďůŝĐĂŶƐ͕ /ŶĚĞƉĞŶĚĞŶƚƐ͕ 'ƌĞĞŶƐ ĂŶĚ ĞŵŽĐƌĂƚƐ͘ tŝƚŚ ƐŽ ŵƵĐŚ ĚŝǀĞƌƐŝƚLJ͕ LJŽƵ ƐƟůů ŚĂǀĞ ƐŽ ŵƵĐŚ ŝŶ ĐŽŵŵŽŶ͘ zŽƵ ĂƌĞ family physicians or future family physicians, and family medicine is LJŽƵƌ ĐĂůůŝŶŐ͘ KŶ ƚŚĞ ǀĂƐƚ ŵĂũŽƌŝƚLJ ŽĨ ƉŽůŝĐLJ ŝƐƐƵĞƐ ŽŶ ǁŚŝĐŚ ǁĞ ǁŽƌŬ͕ you have some level of agreement. But family physicians also agree ƚŽ ĚŝƐĂŐƌĞĞ ŽŶ ƐŽŵĞ ŝƐƐƵĞƐ͘ zŽƵ ƐŚĂƌĞ Ă ƉĂƐƐŝŽŶ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ĂŶĚ ĨŽƌ LJŽƵƌ ƉĂƟĞŶƚƐ ďƵƚ ŵĂLJ ĚŝīĞƌ ŽŶ ŝƐƐƵĞƐ ůŝŬĞ ĂďŽƌƟŽŶ͕ gun control or even approach on clinical issues.

“

KŶĞ ŽĨ ƚŚĞ ƚŚŝŶŐƐ / ƚƌĞĂƐƵƌĞ ĂďŽƵƚ ǁŽƌŬŝŶŐ ĨŽƌ &W ŝƐ ŽƵƌ ǀĞƌLJ ĚĞůŝďĞƌĂƟǀĞ ƉƌŽĐĞƐƐ ĨŽƌ ŝŶƚƌŽĚƵĐŝŶŐ͕ ĚŝƐĐƵƐƐŝŶŐ͕ ĚĞďĂƟŶŐ ĂŶĚ ĚĞĐŝĚŝŶŐ ŽŶ ƚŚĞ ƉŽůŝĐLJ ŽĨ ƚŚĞ ŽƌŐĂŶŝnjĂƟŽŶ͘ tĞ ŚĂǀĞ Ă ƉŽůŝĐLJ ƉƌŽĐĞƐƐ ƚŚĂƚ ĞŶĐŽƵƌĂŐĞƐ ŶĞǁ ŝĚĞĂƐ ĂŶĚ ĚĞďĂƚĞ͘ DĞŵďĞƌƐ ĐĂŶ ĞŶƐƵƌĞ ƚŚĞŝƌ ǀŽŝĐĞƐ ĂƌĞ ŚĞĂƌĚ ƚŚƌŽƵŐŚ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ &W͛Ɛ ŽŶͲ ůŝŶĞ ƉůĂƞŽƌŵ ^W Z<͕ ďĞŝŶŐ Ă ƉĂƌƚ ŽĨ ƚŚĞ ƌĞƐŽůƵƟŽŶƐ ƉƌŽĐĞƐƐ ĂŶĚ ĂŶŶƵĂů ůů DĞŵďĞƌ ĚǀŽĐĂĐLJ DĞĞƟŶŐ͕ ůŽĐĂů ĐŚĂƉƚĞƌ ůĞĂĚĞƌƐŚŝƉ͕ ĐŽŵŵŝƩĞĞ ĂƉƉŽŝŶƚŵĞŶƚƐ͕ ĂŶĚ ďĞĐŽŵŝŶŐ Ă ůĞŐŝƐůĂƟǀĞ ŬĞLJ ĐŽŶƚĂĐƚ͘ ůů ƉŽůŝĐLJ ƌĞƐŽůƵƟŽŶ ŽƵƚĐŽŵĞƐ ĂƌĞ ƉŽƐƚĞĚ ŽŶ ŽƵƌ ǁĞďƐŝƚĞ ;ůŝŶŬͿ ĂŶĚ ŝŶ &W͛Ɛ ďŝͲǁĞĞŬůLJ ŽŶͲůŝŶĞ ƉƵďůŝĐĂƟŽŶ͕ ĐĂĚĞŵLJ /Ŷ ĐƟŽŶ͘

Diversity means diversity of minds,

dŚŝƐ LJĞĂƌ ǁĞ ĂƌĞ ĞdžĐŝƚĞĚ ƚŽ launch an all-member survey. dŚŝƐ ŝƐ Ă ďŝŐ ĞŶĚĞĂǀŽƌ ĂŶĚ ǁŝůů ƌĞƋƵŝƌĞ LJŽƵƌ ƉĂƌƟĐŝƉĂƟŽŶ͘ tĞ ĂƌĞ ŝŶǀĞƐƟŶŐ ŝŶ Ă ƐƚĂƚĞǁŝĚĞ ƐƵƌǀĞLJ ŽĨ ŵĞŵďĞƌƐ ƚŽ ďĞƩĞƌ ƵŶĚĞƌƐƚĂŶĚ ǁŚĂƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ƚŽ LJŽƵ͘ dŚĞ ƐƵƌǀĞLJ ǁŝůů ŚĞůƉ ŝŶĨŽƌŵ ƉŽůŝĐLJ͕ ĂĚǀŽĐĂĐLJ ĞīŽƌƚƐ ĂŶĚ ŽƌŐĂŶŝnjĂƟŽŶĂů ƉƌŝŽƌŝƟĞƐ͘ WůĞĂƐĞ ůŽŽŬ ĨŽƌ ĂĚĚŝƟŽŶĂů ŝŶĨŽƌŵĂƟŽŶ and please consider taking the ƟŵĞ ƚŽ ƌĞƐƉŽŶĚ͘

ŝǀĞƌƐŝƚLJ ĚŽĞƐŶ͛ƚ ĂůǁĂLJƐ ŵĂŬĞ ideas, and approaches – which allows things easier, but it makes us teams to find a solution that takes into stronger, smarter, more curious ĂŶĚ ďĞƩĞƌ ƉƌĞƉĂƌĞĚ ƚŽ ŚĂŶĚůĞ account multiple angles the problem, ĐŚĂůůĞŶŐĞƐ ƚŚĂƚ ĐŽŵĞ ŽƵƌ ǁĂLJ͘ thus making the solution stronger, A number of studies looking well rounded and optimized. Ăƚ ĚŝǀĞƌƐŝƚLJ ŝŶ ƚŚĞ ǁŽƌŬƉůĂĐĞ have found employee diversity – Anna Powers, Forbes magazine ŝŵƉƌŽǀĞƐ ƚŚĞ ďŽƩŽŵ ůŝŶĞ͘ ƐƚƵĚLJ ďLJ ƚŚĞ ŽƐƚŽŶ ŽŶƐƵůƟŶŐ 'ƌŽƵƉ ; 'Ϳ ĨŽƵŶĚ ƚŚĂƚ ĚŝǀĞƌƐŝƚLJ ŝŶĐƌĞĂƐĞƐ ƚŚĞ ďŽƩŽŵ ůŝŶĞ ĨŽƌ ǀĞŶ ǁŚĞŶ LJŽƵ ŵĂLJ ŶŽƚ ůŝŬĞ ĞǀĞƌLJ ƉŽůŝĐLJ ƚŚĂƚ ĐŽŵĞƐ ŽƵƚ ŽĨ &W͛Ɛ companies and is an important part of a successful business. ƉŽůŝĐLJ ƉƌŽĐĞƐƐ͕ / ŚŽƉĞ LJŽƵ ǁŝůů ĐŽŶƟŶƵĞ ƚŽ ƐƵƉƉŽƌƚ ŽƵƌ ĞīŽƌƚƐ ƚŽ advocate on your behalf around important issues like reducing 'ŝǀĞŶ ƚŚĞ ƉŽůŝƟĐĂů͕ ĞƚŚŶŝĐ͕ ŐĞŶĚĞƌ͕ ƌĞůŝŐŝŽƵƐ ĂŶĚ ŐĞŽŐƌĂƉŚŝĐ ĚŝǀĞƌƐŝƚLJ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ͕ ƉƌŽƚĞĐƟŶŐ LJŽƵƌ ĂďŝůŝƚLJ ƚŽ ƉƌĂĐƟĐĞ ĨƵůů ŽĨ ŽƵƌ ŶĞĂƌůLJ ϭϭ͕ϬϬϬ ŵĞŵďĞƌƐ͕ ĨƵŶĚĂŵĞŶƚĂů ĚŝƐĂŐƌĞĞŵĞŶƚ ŽĨ ƐŽŵĞ spectrum care if you chose to, public health, payment reform and issues is inevitable. This diversity of opinion is healthy. It is good for ŽƚŚĞƌ ŝƐƐƵĞƐ ƚŚĂƚ ĂƌĞ ĞƐƐĞŶƟĂů ƚŽ LJŽƵƌ ƉƌĂĐƟĐĞ ĂŶĚ LJŽƵƌ ƉĂƟĞŶƚƐ͘ ƚŚĞ ŽƌŐĂŶŝnjĂƟŽŶ͘ dŚŝƐ ĞůĞĐƟŽŶ LJĞĂƌ ǁŝůů ƚĞƐƚ ŽƵƌ ƚŽůĞƌĂŶĐĞ ĂŶĚ ĂĐĐĞƉƚĂŶĐĞ ŽĨ ƚŚŽƐĞ sĂůƵŝŶŐ ĂŶĚ ƌĞƐƉĞĐƟŶŐ ĚŝǀĞƌƐŝƚLJ ĚŽĞƐ ŶŽƚ ŵĞĂŶ ǁĞ ƐŚŽƵůĚŶ͛ƚ ǁŚŽ ĚŽ ŶŽƚ ƐŚĂƌĞ ŽƵƌ ƉĞƌƐƉĞĐƟǀĞ͘ /ƚ ŝƐ Ă ŐƌĞĂƚ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĂĐŬŶŽǁůĞĚŐĞ ĚŝīĞƌĞŶĐĞ Žƌ ƐƚĂŶĚ ƵƉ ĂŶĚ ĮŐŚƚ ĨŽƌ ǁŚĂƚ ǁĞ ďĞůŝĞǀĞ͘ ĐŚĂůůĞŶŐĞ ŽƵƌƐĞůǀĞƐ ƚŽ ǀĂůƵĞ ƚŚĞ ŚƵŵĂŶŝƚLJ ŽĨ ƚŚŽƐĞ ǁŚŽ ĂƌĞ Ɛ ĂŶ ŽƌŐĂŶŝnjĂƟŽŶ ŝƚ ŵĞĂŶƐ ƚŚĂƚ ǁĞ ǁŝůů ůŝƐƚĞŶ͕ ǀĂůƵĞ ĚŝīĞƌĞŶƚ ĚŝīĞƌĞŶƚ ƚŚĂŶ ƵƐ͘ Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ LJŽƵ ƉƌĂĐƟĐĞ ƚŚŝƐ ĞǀĞƌLJ ŽƉŝŶŝŽŶƐ ĂŶĚ ƉĞƌƐƉĞĐƟǀĞƐ͕ ĂŶĚ ƉƌŽǀŝĚĞ ŽƉƉŽƌƚƵŶŝƚLJ ĨŽƌ Ăůů ŽĨ ŽƵƌ ĚĂLJ͘ zŽƵƌ ƉĂƟĞŶƚƐ ĚŽŶ͛ƚ ĐŽŵĞ ƚŽ LJŽƵ ďĞĐĂƵƐĞ LJŽƵ ǀŽƚĞĚ ǁŝƚŚ ŵĞŵďĞƌƐ ƚŽ ďĞ ŚĞĂƌĚ͘ ƚ ŵLJ ĮƌƐƚ &W ŽŶŐƌĞƐƐ ŽĨ ĞůĞŐĂƚĞƐ ƚŚĞ ƚŚĞŵ ŝŶ ƚŚĞ ůĂƐƚ ĞůĞĐƟŽŶ͕ ƚŚĞLJ ĐŽŵĞ ƚŽ LJŽƵ ĨŽƌ LJŽƵƌ ŵĂƐƚĞƌLJ ŽĨ ŝƐƐƵĞ ŽĨ DĞĚŝĐĂůͲ ŝĚͲŝŶͲ LJŝŶŐ ;D / Ϳ ǁĂƐ ĚĞďĂƚĞĚ͘ / ďƌĂĐĞĚ ĨŽƌ Ă ƚŚĞ Ăƌƚ ĂŶĚ ƐĐŝĞŶĐĞ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ /Ŷ ƚŚĞƐĞ ĨƌĂĐƚƵƌĞĚ ƟŵĞƐ ƌĂƵĐŽƵƐ ĚĞďĂƚĞ ǁŝƚŚ ŶĂŵĞͲĐĂůůŝŶŐ ĂŶĚ ĂĐĐƵƐĂƟŽŶƐ͘ /ŶƐƚĞĂĚ / ŚĞĂƌĚ ǁŚĞŶ ǀŝƚƌŝŽů ĂŶĚ ĂĐĐƵƐĂƟŽŶ ƐĞĞŵ ƚŽ ďĞ ƚŚĞ ĚĞĨĂƵůƚ͕ LJŽƵƌ &W impassioned arguments that stayed focused on the issue, not the ĐŽŶƟŶƵĞƐ ƚŽ ůŝǀĞ ŽƵƌ ĐŽŵŵŝƚŵĞŶƚ ƚŽ ƚƌĞĂƐƵƌĞ ŽƵƌ ĚŝǀĞƌƐŝƚLJ ŽĨ ƉƌĞƐĞŶƚĞƌ͘ / ǁŝƚŶĞƐƐĞĚ Ă ŚĞĂůƚŚLJ ĚĞďĂƚĞ ŽŶ ĂŶ ŝŵƉŽƌƚĂŶƚ ŝƐƐƵĞ͘ ŽƉŝŶŝŽŶƐ ĂŶĚ ƉĞƌƐƉĞĐƟǀĞƐ͘

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California Family Physician Winter 2020

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