Michigan Acedemy of Family Physicians Fall 2020 Issue

IMPLICIT BIAS Developing Awareness and Minimizing Impact

Plus New MAFP President Brings Diverse Perspectives

Influenza and COVID-19 MAFP Honors FALL 2020 | MAFP.COM 1 ‘Academy’ Awardees

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TABLE OF CONTENTS Chair Keerthy Krishnamani, MD, MBA President Mustafa “Mark” Hamed, MD, MBA, MPH, FAAFP President-elect Srikar Reddy, MD, FAAFP Vice President Glenn Dregansky, DO, FAAFP Speaker Beena Nagappala, MD, MPH Treasurer Rachel Klamo, DO AAFP Delegates Robert Jackson, MD, MMM, FAAFP Loretta Leja, MD AAFP Alternate Delegates Tina Tanner, MD, FAAFP Mary Marshall, MD, RN, FAAFP Members-at-Large Harshini Jayasuriya, MD, FAAFP Brandon Karmo, DO Amy Keenum, DO, PharmD, FAAFP Holli Neiman-Hart, MD, FAAFP Sadeer Peter, MD Pamela Rockwell, DO, FAAFP Kristi VanDerKolk, MD, FAAFP Bashar Yalldo, MD Resident Member Linda Stanek, MD Student Member Jaclyn Israel Ex Officio, Chief Executive Officer Karlene Ketola, MSA, CAE

FMFM BOARD OF TRUSTEES President Mary Marshall, MD, RN, FAAFP Vice President Keerthy Krishnamani, MD, MBA Secretary/Treasurer Robert Jackson, MD, MMM, FAAFP Executive Vice President Karlene Ketola, MSA, CAE Trustees-at-Large Jennifer Aloff, MD, FAAFP Christal Clemens Adam Jablonowoski, MPA David Kazanowski, MD

Amy McKenzie, MD, MBA Elizabeth Pionk, DO, FAAFP Jeanette Wilson, MD Bradford Woelke, MD

Michigan Family Physician is published quarterly by Michigan Academy of Family Physicians and provided to MAFP members.

Statements of fact and opinion are the responsibility of the authors and do not imply an opinion on the part of the Board of Directors or members of MAFP. Materials may not be reproduced without written permission. For subscription information, reprints, and back issues, email info@mafp.com. ©2020 MAFP. All rights reserved.

Editor: Dana Lawrence

Academy of Family Physicians FALL 2020 | MAFP.COM 4 Michigan

2164 Commons Parkway, Okemos, MI 48864 517.347.0098 | mafp.com

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Implicit Bias Cover Story

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During Times of Crisis, We Must Build Bridges of Strength and Optimism

Building Member Community in Challenging Times

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President’s Message

CEO Insight

MIDOCS, IVaccinate Face Cuts in State Budget Deal

Clinical Corner

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Advocacy Update

MAFP Honors ‘Academy’ Awardees Members in the News

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Meet the Legislators

Influenza and COVID-19

New MAFP President Brings Diverse Perspectives

Academy News

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Professional Development, CME & Networking

Events

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FALL 2020 | MAFP.COM

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During Times of Crisis, We Must Build Bridges of Strength and Optimism

by Mark Hamed, MD, MBA, MPH, FAAFP

I would like to thank the membership for electing me to serve as your 2020-2021 MAFP president. I am honored to take the reins from my good friend and Henry Ford Health System colleague, outgoing MAFP President Keerthy Krishnamani, MD, MBA. Dr. Krishnamani set a high bar, and rightfully so—our Academy members deserve and expect a leader who will work to meet their needs.

You Are Valued

As I take this leadership position, the world is experiencing a COVID-19 pandemic that is impacting every sector of our lives, including our practice of medicine. Family physicians are serving in many different roles during this public health crisis—wisely, safely, and bravely.

Some are on the frontline, caring for patients’ acute and chronic needs through reduced in-person office hours and/or telehealth visits. Emergency departments and inpatient wards staffed by family 6

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medicine physicians are dealing with limited personal protective equipment (PPE), increased risk of exposure, and delays in COVID-19 testing. Some of our physician members are practicing obstetrics and providing emergency deliveries in PPE-scarce settings. Family medicine physicians who manage medication-assisted therapy practices are working to keep their patients’ opioid addictions in check to prevent a resurgence of the opioid crisis. Many of our state’s local public health medical directors are MAFP members, and they are working hard to limit COVID-19’s spread and keep communities safe, while educating the public and combating misinformation.

You Are Supported

During this unprecedented time, we have to address the stressors facing a large number of family medicine office-based practices. Many of our colleagues are experiencing financial pressures from

being furloughed or having reduced patient volume and income. Many are struggling with the desire to maintain their sense of self and purpose during these trying times. The economic and mental health toll is affecting everyone, including family physicians, and it is important for our Academy to be a resource for our members.

In addition to advocating for and assisting our members whose practices have been affected by the COVID-19 pandemic, MAFP continues to champion a care coordination team approach with legitimate partners to increase access to care. This is especially important in underserved areas of Michigan with limited healthcare resources.

Our Academy’s advocacy work also continues to protect patients from harmful legislation that disregards safe public health initiatives, and we remain on the forefront of educating lawmakers about the dangers

PRESIDENT’S MESSAGE

If you have opted out of receiving Academy e-communications in the past, this is a very critical time to opt back in. I also encourage you to subscribe to MAFP’s text messaging service­—text FMCONNECT to 52886.

- Mark Hamed, MD, MBA, MPH, FAAFP

of the push by unlicensed professions, such as naturopathic providers, seeking authority to practice medicine. Protecting family medicine’s scope of practice protects patients and our communities.

MAFP is also a key player in the fight against healthcare inequities and for the removal of wasteful, inefficient barriers to delivering safe, high-quality, value-driven care for our patients.

Stay Connected to Stay Informed

MAFP is committed to providing resources and support to Michigan’s family medicine physicians, from COVID-19 updates and analysis of related executive orders, to chronic care best practices, coding and billing changes, and legislative alerts.

To ensure you receive this valuable information when and where you need it, I encourage you to update your preferred

email address to a personal address within your Academy account at aafp.org/ account/profile/home. I, like many of my colleagues affiliated with academic and health systems, have had firewalls at my work email address block MAFP electronic communications from reaching me.

Family medicine physicians are indispensable, and the specialty is more relevant now than ever before. MAFP has a busy and important agenda ahead of us in 2020-2021, and we will get through this together and be a much stronger specialty on the other side.

I find MAFP’s e-newsletter, Family Medicine Update, and other electronic updates vital to staying informed and on top of need-to-know family medicine information. There have been instances when time-sensitive MAFP notifications required member feedback to influence legislative efforts that had the potential to impact our practices, and this is likely to be the case again. If you have opted out of receiving Academy e-communications in the past, this is a critical time to opt back in. I also encourage you to subscribe to MAFP’s text messaging service—text FMCONNECT to 52886.

Mark Hamed, MD, MBA, MPH, FAAFP is the president of Michigan Academy of Family Physicians. He is also medical director of the Departments of Emergency Medicine and Hospital Medicine at McKenzie Health System in Sandusky, medical director at health departments in eight rural Michigan communities, a senior staff physician and faculty at Henry Ford Health System/ Wayne State University’s residency program, and associate clinical instructor at Michigan State University College of Human Medicine and Central Michigan University College of Medicine.

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CEO INSIGHT

Building Member Community in Challenging Times

by Karlene Ketola, MSA, CAE A noted philosopher once shared, “One of the marvelous things about community is that it enables us to welcome and help people in a way we couldn’t as individuals.” This is applicable today, as the past six months have taught us valuable lessons about the necessity of community. As COVID-19 required us to Stay Home, Stay Safe and now Mask Up Michigan (page 7), we’ve come to appreciate the importance of being together—even if it needs to be by phone or video—to maintain social distance.

Working for You

With sincere appreciation, I thank our Michigan Academy of Family Physicians (MAFP) board members and Family Medicine Foundation of Michigan trustees for their steadfast leadership in governance, policy, and finances, especially during this new world shaped by the COVID-19 pandemic. Thank you, also, to our committees for continuing their work to support our family medicine community. And, I must say, the MAFP staff team has handled the virtual office transition exceedingly well. I commend them for being nimble and creative as we work through these unprecedented times.

As you know, MAFP is the state’s largest specialty physician association. With more than 4,200 members, MAFP is dedicated to assisting family physicians and their practices as they work to ensure highquality, cost-effective healthcare for patients of all ages. Our mission is to support family physicians in the state through leadership, collaboration, and innovation to achieve the best patient outcomes. Whether you’re a life member, practicing physician, 8

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resident, or student, I hope you consider MAFP as your profession’s community.

Here are just six ways that exemplify how MAFP supports you, a valued member of our family medicine community: • Advocates to protect family physicians’ scope of practice—in the recent past, MAFP successfully prevented efforts of advanced practice registered nurses and naturopathic providers to increase their autonomy • Advocates for a positive practice environment, which includes investing in primary care and reducing administrative burden that detracts from patient care • Works to preserve the physician-patient relationship by opposing legislative interference in the practice of medicine • Provides opportunities for relationship-building and mentorship among family physicians and physicians-intraining across the state • Hosts virtual professional development events for earning continuing medical education necessary for state licensure, board certification, and Academy membership • Increases awareness of the role, expertise, and value of family physicians among legislators, payers, partnering organizations, and families across the state

Working for You

On Aug. 8, MAFP held its Annual Meeting, where members elected the 2020-2021 MAFP Board of Directors and discussed and voted on 12 resolutions (mafp.com/

get-involved/annual-meeting). They also heard the vision of the future of family medicine from Board Chair Dr. Keerthy Krishnamani, President Dr. Mark Hamed, and AAFP President-elect Dr. Ada Stewart, who conferred MAFP’s newest Fellows of the American Academy of Family Physicians (bit.ly/AAFPfellows).

We also recognized our 2020 “Academy” Award honorees (page 19), whose accomplishments and dedication to family medicine were celebrated via live-stream.

Now our sights are focused on the year ahead and the robust agenda before us. I encourage you to mark your calendar to join your colleagues at the 2021 Michigan Family Medicine Conference & Expo, Aug. 5-8, where we hope to once again convene in person at the Detroit Marriott Troy.

As always, I encourage you to reach out and share your point of view. We are stronger together and learning lessons each day as we continue evolving and innovating through this public health crisis, connecting members, and furthering the mission of your Academy.

Karlene Ketola, MSA, CAE is Michigan Academy of Family Physicians’ chief executive officer and Family Medicine Foundation of Michigan’s executive vice president. She joined the MAFP/FMFM team in spring 2019 after serving as executive director of the Lansing-based Michigan Oral Health Coalition for 10 years.

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FALL 2020 | MAFP.COM

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MIDOCS, IVaccinate Face Cuts in State Budget Deal

by Matt Black

During the summer and leading into the fall, the state budget was and continues to be a major focus of the Michigan Legislature. Due to the COVID-19 pandemic, the state of Michigan is facing significant financial shortfalls. In late July, Gov. Gretchen Whitmer signed bipartisan, bicameral legislation that reduces spending for the current fiscal year, ending Sept.

30, by $2.2 billion ($629 billion General Fund). The legislation, combined with an executive order previously issued by the governor, also transfers money from the state’s Rainy Day Fund and restricted funds, reduces revenue sharing, allows for the lapse of work projects, and secures savings by furloughing state employees.

To fill remaining holes, the state will use federal funds available through the coronavirus relief bill. Among the programs facing funding cuts in this budget deal are two MAFP priorities— MIDOCS and IVaccinate.

MIDOCS

MIDOCS was authorized by Michigan legislation in 2017 to attract and retain primary care physicians in underserved communities. It increases the number of medical residency positions in primary care physician training programs at Central Michigan University, Michigan State University, Wayne State University, and 10 FALL 2020 | MAFP.COM

Western Michigan University in partnership with Michigan Department of Health and Human Services. In return for practicing in a rural or urban underserved community for a minimum of two years post-residency, MIDOCS-sponsored residents in the specialties of family medicine, internal medicine, pediatrics, obstetrics/gynecology, psychiatry, and general surgery are eligible for $75,000 in education loan repayment.

“MIDOCS is an important program designed to help solve an ongoing problem in Michigan—an insufficient number of medical residency positions for meeting the state’s primary care needs,” said Matt Black, MAFP’s director of government relations. “While MAFP understands the dire budget situation created by the COVID-19 pandemic, we are urging Gov. Whitmer and legislative leaders to restore this $2.5 million cut when it finalizes the Fiscal Year 2020-2021 budget. Investing in Michigan’s primary care workforce is investing in the health of our residents and communities.”

IVaccinate

MAFP also advocates that the $600,000 cut from the IVaccinate campaign be restored in the new budget that takes effect Oct. 1. Conversations among key legislators have been ongoing for how

to address the $3 billion deficit facing the state in Fiscal Year 2020-2021. At the time this article was published, negotiations have not been finalized.

IVaccinate is a public education campaign funded by Michigan Department of Health and Human Services and the Franny Strong Foundation, with support from numerous state and national organizations, including MAFP. It provides vaccine information and tools based on medical science and research to help Michigan parents protect their children from vaccine-preventable diseases.

Now more than ever, arming Michiganders with evidence-based information on the importance of immunizing against contagious illnesses, including influenza, is critical (page 16).

Telemedicine

In early June, the House and Senate passed a five-bill package expanding telehealth by making telemedicine and remote patient monitoring fully available to Medicaid beneficiaries.

These bills allow for coverage of remote patient monitoring in homes, schools, or other sites deemed appropriate by clinicians for delivering both behavioral and physical healthcare.

ADVOCACY UPDATE

Michigan Academy of Family Physicians urges Gov. Whitmer and legislative leaders to restore funding for MIDOCS and IVaccinate in the Fiscal Year 20202021 state budget.

- Matt Black

e-Prescribing

Legislation mandating the electronic transmission of prescriptions was also approved by the Michigan Legislature this summer. Senate Bills 248 and 254 and House Bill 4217 require all prescriptions be sent to pharmacies electronically. Centers for Medicare and Medicaid Services is in the process of finalizing a similar requirement for prescribing controlled substances for Medicare and Medicaid beneficiaries. These federal regulations are on track for implementation beginning Jan. 1. Michigan’s e-prescribing mandate will take effect Oct. 1, 2021, or on the federal implementation date if it is later than Oct. 1, 2021.

It is important to note there are several exemptions to the state’s new e-prescribing requirement and allowances for temporary technology outages. Any prescriber who obtains a waiver from CMS will be allowed to provide documentation of the exemption to the Michigan Department of Licensing and Regulatory Affairs (LARA) to secure

an exemption from the state requirement.

Per House Bill 4217, LARA must promulgate additional rules regarding electronic prescribing and waivers.

Throughout the process, MAFP will continue to advocate for additional hardship exemptions like those offered by CMS to protect practices that do not currently have the systems necessary to transmit prescriptions electronically, as well as their patients.

Implicit Bias Training

Finally, in early July, Gov. Whitmer issued a directive that all healthcare professionals take implicit bias training to obtain or renew a medical license in Michigan, with the goal of improving equity in the delivery of healthcare.

Under the directive, LARA is tasked with establishing rules for the training requirement. This is expected to take six to 12 months. In promulgating the rules, LARA must gather input regarding proposed training standards by consulting

with licensed healthcare professionals and other stakeholders. MAFP has been invited to participate in the inputgathering process to share the family medicine perspective. As with all rule making, a public comment period will be open following LARA’s issuance of the recommended training standards. This will offer additional opportunities for MAFP to weigh in on the requirement before it is finalized. Watch for updates in MAFP’s e-newsletter, Family Medicine Update.

Matt Black serves as Michigan Academy of Family Physicians’ director of government relations. He is responsible for directing the organization’s state public policy agenda, analyzing legislation and regulatory changes for potential impact on patients and the practice of medicine in Michigan, and bridging the gap between members and elected officials.

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COVER STORY

Developing Awareness of Implicit Bias and Minimizing Its Impact on Care Delivery

by Danielle D. Jones, MPH Implicit bias is the unconscious association individuals form in response to social conditioning and audiovisual cues. In primitive persons, implicit bias was a useful tool for quickly triggering the fightor-flight reaction in response to danger.

Today the reaction is often elicited in response to race and/or ethnicity.

In the delivery of healthcare, implicit bias has shown to directly drive disparities in a number of diagnostic and treatment recommendations, including pain, coronary artery disease,

kidney dialysis, contraception, and prenatal care.1-3 More recently, it has been suggested that implicit bias may influence clinicians’ decisionmaking with regards to testing for and treating COVID-19.4 It is important for family physicians to understand that despite their best intentions, not even they are immune to the neurological phenomenon of implicit bias. By raising their own awareness, family physicians can learn skills to minimize the influence of implicit bias on their clinical decisionmaking process.

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The American Academy of Family Physicians (AAFP) recommends educating physicians about implicit bias and strategies to address it to support culturally appropriate, patient-centered care, and reduce health disparities. AAFP’s Board of Directors also recently adopted a racebased medicine policy opposing the use of race as a proxy for biology or genetics in clinical evaluation and management and in research. AAFP encourages clinicians and researchers to investigate alternative indicators to race to stratify medical risk factors for disease states.

Training Pilot

AAFP has developed training resources to assist family physicians, family medicine residents, and medical students in recognizing and overcoming implicit bias and combating racism. These resources cover the neurobiological process that leads to the formation of unconscious associations in the context of current medical education and training, making implicit bias easier to understand. AAFP’s training also includes the perspectives of patients who share their experiences with bias in the clinical setting. This helps physicians relate the concept to patientcentered care. Lastly, the training provides a set of skills physicians can practice in and out of the clinical setting to further reduce their reliance on unconscious associations.

While designed primarily to address unconscious associations that arise during physician-patient encounters, the same skills can be used in relationships between physician peers, especially in

the context of employee relations such as hiring and promotion. The training was developed using resources cited in medical literature as effective for training in the healthcare setting. It includes self-assessments and case study examples similar to those used in medical education and training.

AAFP began piloting this training with members of its board of directors and commissions, as well as executive leadership and staff. It is now in the second phase of the pilot, working with a select group of chapters to measure the effectiveness of the learning outcomes and engagement as part of AAFP’s compliance as a continuing medical education provider. AAFP plans to share what it learns through this pilot to inform future education on implicit bias.

Training Guide

Through The EveryOne Project, AAFP developed an implicit bias training guide (bit.ly/implicit-bias-training-tools) to promote awareness of unconscious associations among primary care physicians and their practice teams.

Included are faciliator and participant guides, a video series, and customizable PowerPoint presentations that can help structure practice teams’ inservice or lunch-and-learn sessions.

Health Equity Fellowship

Another training opportunity is the Health Equity Fellowship, a collaboration between AAFP and the Association of Family Medicine Residency Directors.

Cultural Intelligence CME Virtual Course Sept. 30, 12-5 pm ET In partnership with the Ohio chapter, MAFP is co-hosting this CME program that tackles the difficult topic of racism and its impact on healthcare. Learn how to be more culturally intelligent by developing awareness of people of other races and ethnic backgrounds and understanding your own biases. Approved for 4.5 AAFP Prescribed credits. Family physicians may also apply their knowledge toward the American Board of Family Medicine’s Health Equity Performance Improvement activity. Register at mafp.com/events.

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It was established to cultivate a cohort of family physicians as subject matter experts capable of driving policy and system changes that produce equitable health outcomes in their local communities and across primary care.

Applications are being accepted until Oct. 1 for the 2020-2021 Fellowship (bit.ly/health-equity-fellowship).

Interested members can apply to one of three tracks: rural health, academic medicine, or traditional family medicine.

Health Equity PI Activity

The American Board of Family Medicine is also committed to assisting family physicians in turning the tide on implicit bias. Its new Health Disparities/Equity Self-Directed Performance Improvement Clinical Activity (theabfm.org/continue-certification/ performance-improvement) addresses many different dimensions of care—such as assessing race/ethnicity, socioeconomic status, sexual orientation/ gender identity, disability, rural, and the underserved—and provides an opportunity for delegates to develop a plan for closing gaps in care, such as disparate outcomes of common screening activities (e.g., cancer, HIV) and/or conditions (e.g., quality measures for hypertension, diabetes).

Beyond Training

While training may be an effective intervention for targeting healthcare inequities that result from physicians’ unconscious associations, additional upstream interventions are needed that target the use of race as a proxy in medical decision-making and the

Implicit Bias On-demand Webinar Included in MAFP’s e-learning library is a 22-minute on-demand webinar on implicit bias. Danielle Jones, MPH, director of AAFP’s Center for Diversity and Health Equity, discusses how implicit bias operates in the healthcare setting and guides members in developing awareness of their own implicit bias and building skills for identifying and reducing its negative effects on patients. This MAFP member-exclusive training webinar is available at mafp.com/elearning-library.

COVER STORY

healthcare system more broadly. The way race is currently used as a proxy in medical decision-making allows for differential diagnosis and treatment recommendations for which there is no biological or genetic justification. AAFP opposes the use of race-based medicine and encourages family physicians and other clinicians to investigate alternative indicators. In addition, interventions that aim to implement more equitable policies, procedures, and processes in the delivery of care must also be considered. Addressing the root cause of health iniquities will require structural change on multiple levels.

It is important for family physicians to understand that despite their best intentions, not even they are immune to the neurological phenomenon of implicit bias. By raising their awareness, family physicians can learn skills to minimize the influence of implicit bias on their clinical decision-making process.

- Danielle D. Jones, MPH

AAFP hopes that members see implicit bias training as an opportunity to be part of the solution. By acknowledging and actively working to become aware of and address one’s own personal biases, family physicians can collectively begin to engage and dismantle the systems which impact both them and their patients.

1. Hoffman, K.M., et al., Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A, 2016. 113(16): p. 4296-301.

2. Daugherty, S.L., et al., Implicit Gender Bias and the Use of Cardiovascular Tests Among Cardiologists. J Am Heart Assoc, 2017. 6(12).

3. Kogan, M.D., et al., Racial disparities in reported prenatal care advice from health care providers.

Am J Public Health, 1994. 84(1): p. 82-8.

4. Milam, A.J., et al., Are Clinicians Contributing to Excess African American COVID-19 Deaths? Unbeknownst to Them, They May Be. Health Equity, 2020. 4(1): p. 139-141.

Danielle D. Jones, MPH is director of the Center for Diversity and Health Equity at American Academy of Family Physicians. She guides the strategic priority of AAFP’s Board of Directors towards a leadership role in addressing diversity and social determinants of health as they impact individuals, families, and communities across the lifespan and strive for health equity.

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Influenza and COVID-19

by Pamela G. Rockwell, DO, FAAFP

Research shows that healthcare professionals are the most trusted source of vaccine information for parents and patients..

- Pamela G. Rockwell, DO, FAAFP

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Expert opinion warns that co-infection with influenza and COVID-19 has the potential to be devastating to patients and our healthcare system during the upcoming flu season, stretching the healthcare infrastructure to its capacity and possibly beyond. This makes getting vaccinated against influenza especially critical this year.

Aside from COVID-19, influenza illness already places a substantial burden on health annually. Based on preliminary data from the 2019-2020 U.S. influenza season (Oct. 1, 2019, through Apr. 4, 2020), the Centers for Disease Control and Prevention (CDC) estimates there were 39 million-56 million flu illnesses, 18 million-26 million flu-related medical visits, 410,000-740,000 flu hospitalizations, and 24,000-62,000 flu deaths.

As high and devastating as these statics are, these numbers reflect a flu season less severe than 60% of flu seasons of the past decade. We do not know how severe the upcoming flu season will be, nor can we predict the efficacy of the 20202021 vaccine. What we do know is the benefit of receiving an influenza vaccine

outweighs the extremely low risk of side effects. Although the influenza vaccine has been available in the U.S. for the past 74 years, less than half of the population was vaccinated during the 2018-2019 flu season. We must do better this year.

A Perfect Storm

We are currently experiencing a historic pandemic unlike one seen since the 1918-1919 H1N1 influenza pandemic, estimated to have infected about 500 million people (one-third of the world’s population) and responsible for at least 50 million deaths worldwide, with about 675,00 deaths in the U.S. The current SARS-CoV-2 (COVID-19) pandemic began in December 2019 in China. By January 2020, it had spread to other parts of the world, including the U.S. At this writing, COVID-19 outbreaks are increasing in many regions across the country.

The CDC reports a wide range of death rates due to COVID-19 per 100,000 population throughout the United States, with New York City having the

CLINICAL CORNER highest death rate at 281 per 100,000 population and Michigan with 66 deaths per 100,000 population. As of August 26, there are more than 5.7 million confirmed cases of COVID-19 in the nation, with over 177,000 deaths.

Most likely, both statistics reflect low estimates by expert scientific accounts.

A preliminary analysis led by Ian Brown, MD at Stanford School of Medicine shows that about one in five people with COVID-19 are also infected with other respiratory viruses, and about one in 10 people diagnosed with common, routinely tested-for respiratory viruses are coinfected with COVID-19. It is important to underscore that patients diagnosed with influenza, respiratory syncytial virus, and other common viruses this fall and winter may also be co-infected with COVID-19.

Sound familiar? The description of the flu virus’s mode of transmission and the symptoms it produces are almost identical to what is known about the novel coronavirus we are just beginning to understand. Outcomes of COVID-19 infection can result in mild symptoms to hospitalization, with serious complications involving multi-organ system morbidity and failure, and death.

Commonalities

Like the flu virus, COVID-19 spreads mainly via droplets and close contact with infected persons when they cough, sneeze, or talk. A person may contract COVID-19 through close contact with others who have the virus and also by touching a surface or object with the virus on it and then self-inoculating by touching his/ her own mouth, nose, or eyes.

Current data regarding COVID-19 infection show that persons infected with the virus may infect others if they are asymptomatic, pre-symptomatic, or symptomatic. The CDC warns that older adults, persons who are immunocompromised, and those with underlying medical conditions such as cancer, Type 2 diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, sickle cell disease, heart disease, and obesity (defined as having a BMI greater than 30), for example, may develop serious complications if infected with COVID-19.

Most adults may be infectious one day before symptoms develop and up to seven days after becoming sick. Common symptoms of the flu include fever/chills, cough, fatigue, muscle/body aches, headache, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.

Common symptoms of early COVID-19 infection include fever/chills, cough, fatigue, muscle/body aches, headache, sore throat, congestion or runny nose, nausea or vomiting, as well as anosmia and ageusia. The loss of one’s sense of taste and/or smell are two symptoms that appear unique to COVID-19 infection compared to the flu. The best recommendations for preventing COVID-19 include frequent handwashing, social distancing, and wearing masks in public and around others.

Compounding the public health threat is that a safe and effective COVID-19 vaccine will not be readily available before the 2020-2021 influenza season begins. Without a national or federally implemented plan to mitigate the SARS-CoV-2 pandemic, it is possible the U.S. population will not see a significant reduction in COVID-19 rates before the start of the flu season.

Therefore, it is imperative that we vaccinate against influenza and other vaccine-preventable diseases to prevent catastrophic public health outcomes.

Flu viruses spread mainly via droplets through close contact with infected persons when they cough, sneeze, or talk, and also by touching a surface or object that has flu virus on it and then self-inoculating by touching one’s own mouth, nose, or eyes.

Resources: Fostering a Culture of Immunization • The CDC’s vaccine-provider and patient education resources (cdc. gov/vaccines) as well as the #HowIRecommend video series (cdc. gov/vaccines/howirecommend/ index.html) provide simple and practical guidance for having successful vaccine conversations.

• CDC guidance videos (cdc gov/ vaccines/ed/vaccine-communication/

foster-culture-of-immunization.html) on how nurses and medical assistants can help foster a culture of immunization in your practice offer continuing education through Dec. 4, 2021.

• Michigan’s IVaccinate campaign (ivaccinate.org) is a resource of immunization information and tools to help Michigan parents protect their children.

The 2020-2021 influenza vaccine recommendation of the CDC’s Advisory Committee on Immunization Practices is the same as last year—an annual influenza vaccine for all individuals aged 6 months and older is recommended.

Across the country, the CDC is reporting a drop in vaccination rates as many patients and families are declining or delaying trips to medical facilities due to the COVID-19 pandemic. Let’s make sure children and adults continue to stay up-to-date on recommended vaccines to prevent additional infectious disease outbreaks caused by measles, mumps, and pertussis; receive recommended pneumococcal vaccines to prevent pneumonia; and that all persons over 6 months of age get their annual influenza vaccination.

Strong Recommendation

Research shows that healthcare professionals are the most trusted source of vaccine information for parents and patients. A strong recommendation to vaccinate is effective. As a family physician who has built strong, longterm relationships with your patients, you are uniquely positioned to help them, including those who are vaccinehesitant, understand the importance of flu vaccination this year above all other years.

In addition to the need for accurate testing and diagnosis of COVID-19 and other common viral illnesses, we must do our best as family physicians to prevent influenza through vaccination.

It is possible that this upcoming fall and winter may prove to be the most devastating health-related months we’ve experienced since the early 20th century.

It is imperative that all healthcare professionals are vaccinated against influenza and we do our best to increase uptake in influenza vaccination to reduce morbidity and mortality in our country, which is predicted to be unprecedented.

Pamela G. Rockwell, DO, FAAFP serves as the American Academy of Family Physicians’ liaison to the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. She is an associate professor in the Department of Family Medicine at University of Michigan in Ann Arbor.

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MEMBERS IN THE NEWS

MAFP Honors ‘Academy’ Awardees

by Dana Lawrence The ‘Archie’ Award of Excellence: Dr. Kenneth Bollin

Although this year’s “Academy” Awards celebration held Aug. 8 via live-stream looked different than those of years past, it was just as exciting to honor such dedicated, accomplished, and trend-setting members who exemplify the mission and vision of the statewide organization of family physicians.

Kenneth Bollin, MD began his career at Harvard Medical School when family medicine was in its infancy. He graduated in 1976 and bucked the trend of specialization, choosing to join a groundbreaking family medicine residency program at the University of Iowa.

As a National Health Service Corps scholar, he landed in Algonac, a rural community north of Detroit. There he provided full-spectrum family medicine as a solo physician and worked in the small rural River District Hospital, which eventually became part of the St. John Hospital system.

After more than 10 years practicing in Algonac, Dr. Bollin was recruited to serve as chief of the department of family medicine at St. John Hospital. He was later appointed program director of the hospital’s family medicine residency program, nurturing it from a little-known entity to the successful program that it is today.

When he retired in 2018, Dr. Bollin had served in family medicine leadership positions at the hospital for more than 25 years, mentoring and training hundreds of family medicine physicians, many of whom are still practicing in Michigan today. He was also directly involved in and oversaw managed care in the St. John Hospital system, bringing cost-efficient healthcare to southeast Michigan.

In his retirement, he maintains clinical faculty appointments at Wayne State University School of Medicine, Central Michigan University College of Medicine, and St. George’s School of Medicine.

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The ‘Archie’ Award of Excellence: Dr. Robert Toteff

know them today.

Robert Toteff, MD, FAAFP paved the way for the family medicine specialty and residency as we

As a family physician practicing in Saginaw in the late 1950s, he established one of the first private family medicine group practices—a model for many modern primary care practices, even today.

Then, in the early 1970s, he advocated for the formal recognition of “general practice” as a specialty and was a charter diplomate of the American Board of Family Practice.

He also fought for family practice residency programs in Michigan to receive federal funding at a time when very few had such funding.

Dr. Toteff helped found Saginaw Cooperative Hospitals in 1974, serving as its first family medicine residency program director. This was the first family practice residency program in Saginaw and one of just a few programs across the country that trained medical residents outside a university or single hospital affiliation.

Saginaw Cooperative Hospitals later became the modern Synergy Medical Education Alliance, known today as CMU Healthcare.

Dr. Toteff went on to serve as director of the family medicine residency program at Wayne State University School of Medicine, his alma mater (class of 1955), and at Beaumont Health-Troy—a position he held until his retirement in 1991.

Do you know an exemplary individual deserving of an MAFP “Academy” Award? Nominations for the 2021 awards are due March 1 at mafp.com/getinvolved/awards.

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Michigan Family Physician of the Year: Dr. Lynn Gray

Lynn Gray, MD, MPH, FAAFP was a steadfast advocate for his patients, practiced family medicine and emergency medicine for more than 40 years in southwest Michigan. He was affiliated with Lakeland Regional Health System, where he served as medical director for diversity and health equity.

Since first joining the Academy in 1978, he served in many leadership positions to advance his specialty and support his peers across the state, including 2005-2006 MAFP president, MAFP board member, and Family Medicine Foundation of Michigan trustee.

With expertise in diversity and health equity, Dr. Gray was especially dedicated to promoting the value of and need for family medicine in underserved communities and advocating for increased diversity among family physicians. On his application to serve on the MAFP board, Dr. Gray shared that he chose family medicine as his specialty because primary care specialties are most needed in the African American community.

A life-long learner, Dr. Gray received his medical degree in 1975 from University of Michigan Medical School, completed residency in 1978 at Grand Rapids Family Medicine Residency, achieved the AAFP Degree of Fellow in 1986, and earned his master’s in public health in 1994 from Loma Linda University School of Public Health.

“Lynn was an amazing mentor to so many. He was kind and caring. He served on the Committee for Membership and was passionate about recruiting members.

And he challenged and encouraged me to build a MAFP that looks like the physicians in Michigan. Lynn, we did it!

Thank you for your support. I will always honor your memory,” said Tina Tanner, MD, FAAFP.

Michigan Family Medicine Educator of the Year: Dr. Christine Medaugh

Christine Medaugh, MD is described as one who puts learners at all levels at ease while still expecting high standards. As a preceptor on the faculty inpatient family medicine obstetrics service at University of Michigan Family Medicine Residency, residents have praised her passion for teaching while still respecting their autonomy, challenging them to think critically, and maintaining approachability and a supportive environment. She is also a favorite of medical students.

“She is kind, compassionate, and intelligent. She made me feel included and, when she was giving me feedback, she did so in a way that was respectful and professional. I admired how she interacted with patients, and I loved working with her every single time. She has undoubtedly made me a better doctor,” said one of her University of Michigan clerkship students.

Dr. Medaugh is medical director at the large, rapidly growing, multispecialty Livonia Health Center, where she precepts as she maintains a busy clinical practice that includes full-spectrum outpatient care, prenatal care, and procedures. She also practices at the Luke Clinic, a source of free care for pregnant women and their children in Detroit.

Kelly Hill, MD, director of MidMichigan Medical Center Family Medicine Residency in Midland, where Dr. Medaugh completed her residency training in 2015, said, “It is amazing that she has continued to provide this care for her patients, support her colleagues both in family medicine and in OBGYN, and role model to all residents that these two specialties can work together to provide obstetrical care to broad patient populations.”

MEMBERS IN THE NEWS

Michigan Family Medicine Resident of the Year: Dr. Jawan Gorgis

Michigan Family Medicine Resident of the Year: Dr. Julie Thai

Jawan Gorgis, MD completed family medicine residency in June at Beaumont Health-Troy, where her passion for teaching, endless patience, natural leadership and mentorship, genuine support for her colleagues and their wellness, and gentle way of setting high expectations for performance earned her the role of chief of the 24-resident program.

Julie Thai, MD, MPH, a thirdyear resident at the McLaren Flint Family Medicine Residency program, is considered an “all-arounder” by her program director, Prabhat Pokhrel, MD, PhD, FAAFP. He identifies one of Dr. Thai’s greatest strengths as her ability to form strong interpersonal relationships with every person she encounters.

A first-generation immigrant, her story is one of overcoming obstacles, and she often acts as a translator and medical advocate for her own family. This makes her an incredible asset to the resident clinic, which serves a large population of Middle Eastern immigrant families.

Dr. Thai was elected by her fellow residents and faculty to serve as assistant chief resident for the 2019-2020 academic year, which she did with distinction. She now serves as academic chief resident for the last year of her residency training, organizing lectures and academic activities that are helping shape her fellow residents’ educational experience.

From the perspective of her program director, David Lick, MD, MPH, MBA, FAAFP, Dr. Gorgis is a “dynamo” and a “true ambassador and future leader for family medicine with unlimited potential.”

“I have been blessed with many outstanding residents in my time as program director and few have been able to match her level of commitment,” he said, noting Dr. Gorgis’ superb patient care skills, excellent medical knowledge, diagnostic and procedural skills, and initiative as an active and self-directed learner.

Dr. Gorgis now practices at the Beaumont Rochester Hills Family Physicians Clinic and serves as a community preceptor, teaching inpatient medicine to residents at the Beaumont-Troy Family Medicine Residency program.

Moreover, Dr. Thai is a catalyst for family medicine advocacy. After completing MAFP’s Advocacy and Leadership Development Program in 2018, she coauthored an advocacy and health policy curriculum. Various components of the four-week elective are being incorporated into McLaren Flint Family Medicine Residency program’s required Health System Sciences rotation. The curriculum (mafp.com/advocacy), is getting state and national attention as a model to replicate.

Dr. Thai plans to pursue a fellowship in geriatrics after she completes residency in June 2021.

Outstanding Medical Student in Michigan: Jaclyn Israel

Jaclyn Israel has been a steadfast family medicine candidate since entering Michigan State University College of Osteopathic Medicine in 2016.

She is a committed volunteer leader at Tumaini Center in Detroit, partnering with a team of dedicated physician preceptors to provide primary healthcare at no cost to uninsured and underinsured patients.

She also serves on the senior advisory board of Detroit Street Care, a student-led volunteer organization that provides nocost care to unhoused Detroit citizens in their environment. At Detroit Street Care, Jaclyn was instrumental in developing a program for disseminating Narcan kits and training community members on how to use them.

“For a medical student to take the initiative on a project that so directly impacts our patients is incredible,” said her Detroit Street Care faculty advisor, Richard Bryce, DO. Jaclyn was elected during the MAFP Annual Meeting on Aug. 8 to serve as student member on the Board of Directors.

She was also appointed by the Family Medicine Foundation of Michigan Board of Trustees to represent Michigan as student delegate at AAFP’s National Conference of Family Medicine Residents and Medical Students, July 30-Aug. 1.

“Jaclyn is a true family physician and will give everything she has to give the best care to her patients and the communities she serves,” said Dr. Bryce.

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New MAFP President Brings Diverse Perspectives Mark Hamed, MD, MBA, MPH, FAAFP brings a wealth of experience to his role as 2020-2021 MAFP president.

Through his current professional positions, which are many, he combines family medicine, emergency medicine, academic medicine, and public health.

For the past nine years, Dr. Hamed has served as medical director of the Departments of Emergency and Hospital Medicine at McKenzie Health System in Sandusky—a rural community located in Michigan’s Thumb. He is also medical director of health departments in eight rural northeast Michigan communities— Huron, Lapeer, Sanilac, Tuscola, and District Health Department #2 (Alcona, Iosco, Ogemaw, and Oscoda counties)—a senior staff physician and faculty at Henry Ford Health System/Wayne State University’s residency program, and associate clinical instructor at Michigan State University College of Human Medicine and Central Michigan College of Medicine.

As Dr. Hamed prepared for his presidential induction at the virtual MAFP Annual Meeting on Aug. 8, Michigan Family Physician (MFP) had the opportunity to learn what inspires him, what he sees as the most pressing challenges facing the specialty, and his vision for the future of family medicine.

22 FALL 2020 | MAFP.COM

MFP: Why did you choose to become a family physician?

Dr. Hamed: I enjoy being able to develop a level of trust and continuity of care with patients of all ages. As a medical student, I quickly recognized the versatility of family medicine and the ability to tailor one’s practice to meet professional goals and lifestyle choices.

With that being said, I always knew I wanted to practice outpatient clinical medicine along with inpatient and emergency medicine. My medical student core clerkship family medicine rotation at Synergy Health in Saginaw, with Dr. Edward Jackson, really solidified my decision to pursue family medicine. My residency training at Henry Ford Health System in Detroit gave me excellent preparation for practicing medicine in all of those settings.

Here’s a pretty cool related fact. When I was growing up in Metro Detroit, my dad and uncle owned a supermarket on Fort Street in the mid-1980s that was next door to the Community Health and Social Services (CHASS) Center—a federally qualified health center. During summer vacation from school, I offered to “work” as a grocery bagger (I refused to take money from my dad and insisted on being paid in candy and chips). My

aunt would pick me up from work to take me home. On a few of those days, she took me with her to appointments at the CHASS Center. Dr. Susan Schooley was my aunt’s physician at the time, and I remember how grateful my aunt was to have such a skilled and caring physician.

Fast forward 15 years, when I was doing my residency at Henry Ford Health System, and the physician-in-charge of my continuity clinic at the Detroit East Clinic was the one and only Dr. Schooley!

I have been truly blessed to have such positive influences that helped me choose family medicine as my career.

MFP: What compelled you to join the Academy in 2011, and how have you benefited from your membership and being actively engaged?

Dr. Hamed: I was completing my family

medicine training in 2011 and enjoying what MAFP was doing for residents. So, I decided to join, after consulting with my senior family medicine staff at Henry Ford, including Dr. Jackson and the late Dr. Angelo Patsalis. Both were previous MAFP presidents.

MAFP is extremely valuable in ensuring that family physicians have the tools necessary to continue being family physicians. It has always advanced the goals of protecting the physician-

ACADEMY NEWS

MFP: What are the top challenges facing family physicians today and how can MAFP help address them?

Dr. Hamed: COVID-19 has dramatically changed the outpatient practice of family medicine. Practices have been forced to close or dramatically reduce hours, as fears of COVID-19 exposure has resulted in decreased volume. This has directly affected the management of acute and chronic illnesses.

MAFP President Dr. Mark Hamed and Chair Dr. Keerthy Krishnamani.

patient relationship, removing barriers to maintaining that relationship, and ensuring the efficiency and stability of family medicine practices. I have found the timely information in MAFP emails and publications absolutely critical to staying up-to-date on the latest news affecting my profession.

MFP: What do you say to students,

residents, and physicians of all practice types and years in the profession who want to get involved in the Academy?

Dr. Hamed: It is absolutely important,

probably more now than ever before, to get involved! Every voice counts and is appreciated. Your Academy is committed to understanding the needs of our members of all practice types in order to provide the tools and advocacy needed to practice medicine as efficiently as possible, and to enable family physicians to maximize their financial security as best as possible. The family medicine specialty is more relevant than ever, and we must work to collectively ensure its survival and give it the prominence it deserves. To learn about opportunities for getting involved, visit mafp.com/get-involved.

Meet the 2020-2021 MAFP Board of Directors at mafp.com/about-us/ mafp-board-of-directors.

Family medicine physicians who practice in emergency departments and inpatient and OB settings have especially faced periods of limited personal protective equipment and COVID-19 testing challenges. Family physicians who practice public health are dealing with COVID-19 testing limitations, business and school reopening guidance, and battling misinformation about the virus and pandemic.

MAFP will continue working to guide family physicians through this difficult time to ensure their practices remain open and their patients get the care they need.

Family physicians will continue being on the cutting edge, providing care when, where, and how patients need it. The swift transition to telemedicine is just one example of how family physicians answer the call for innovation.

Reimbursement is also critical. MAFP is a steadfast advocate for appropriate reimbursement for family medicine physicians that is based on the value and efficiency of the care they provide.

A third top challenge is ensuring patients have access to quality, equitable healthcare. There needs to remain coordination of care in a team-based approach, with legitimate members of the medical team, and at the same time safeguarding Michigan residents from harm from unlicensed groups such as naturopaths, as they attempt to get their foot in Michigan’s medical door under the guise of primary care.

MFP: As someone who is passionate

about growing the next generation of family physicians, how can we attract more students into family medicine?

Dr. Hamed: It is essential that students realize family medicine is an important and very relevant specialty. Medical students graduate with a high debt load, so they need to see their Academy will always advocate for the payment family medicine physicians deserve.

We must show that family medicine is a value-focused and efficient specialty that provides the opportunity to tailor a practice as one desires.

We need to increase students’ awareness that being a family physician allows them to practice outpatient medicine, emergency medicine, inpatient medicine, obstetrics, public health, addiction medicine, among other areas of focus that interest them. Did you know that almost half of Michigan’s public health medical directors are family physicians? How cool is that!

We need seasoned family physicians to continue paving the way for the next generation, seeking leadership positions on hospital credentialing boards and member associations to ensure that entrance barriers are removed for family medicinetrained physicians who have demonstrated competence and quality.

MFP: What do you most enjoy about being a family physician today?

Dr. Hamed: I enjoy the ability to make a positive change for patients in multiple areas of the healthcare environment. I enjoy the ability to manage acute and chronic conditions in an outpatient setting.

I enjoy practicing emergency medicine and inpatient medicine in rural Michigan, where I serve as medical director.

I feel proud to say that a family medicinetrained physician developed Michigan’s first oxy-free emergency department before the opioid crisis was even acknowledged as an “epidemic,” led the emergency department to be the first fully accredited Level IV Trauma ED in Michigan, the first rural Michigan ED to achieve Acute Stroke Ready accreditation, and the first to achieve Acute Heart Attack certification.

I am the associate medical director of a robust rural county EMS service and enjoy being able to develop protocols to ensure excellence in pre-hospital care.

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SPONSORED

“Diabetes Took My Eyesight!”

Patient “regains vision,” controls blood sugar with insulin management specialists and their AI-powered mobile app.

Nearly one million Michiganders struggle with Type 2 diabetes. For many, it is a daily battle fought and lost at the most granular of levels: their blood sugar numbers. To April, in her early 20s when she was diagnosed with gestational diabetes, it was nearly a death sentence.

Hygieia, led by Eran Bashan, Ph.D., and Israel Hodish, M.D., Ph.D., is a Livonia, Michigan-based specialty group that has developed the d-Nav® Insulin Management Program to provide real-time adjustments for insulin therapy as often as needed.

For 20 years the “slow poison,” as April called her Type 2 diabetes, hijacked her life. Diabetes stole her eyesight, her career, her independence and finally, her ability to care for her family.

“I felt like garbage,” April shared. “Like I couldn’t get out of bed. Like I was taking more medication than food. I didn’t feel like it was worth doing anymore.”

Despite medications and insulin adjustments every few months, her blood glucose levels remained out of control. In fact, April’s HbA1c was sometimes higher than 14 percent.

Finally, her doctor recommended the specialists at Hygieia, and their unique approach to safely and effectively regulating blood glucose levels for people with advanced Type 2 diabetes.

Now, patients can have automated insulin dose adjustments by way of an FDA-cleared mobile app. The app works by tracking and analyzing each patient’s blood glucose patterns and, based on those patterns, automatically determining how much insulin is needed at the time of each injection.

A New Standard

Sick for Decades

April’s complications were the shattering culmination of decades of uncontrolled blood sugar levels despite a regimen of medications, insulin therapy, regular physician visits and sticking to the rules that people with Type 2 diabetes are advised to follow.

match their fluctuating glucose levels.

April contracted gestational diabetes that persisted after her baby was born. She lost her eyesight and independence. Hygieia’s d-Nav® Insulin Management Program gave April back her life, and her vision.

Under the care of physician specialists, and additional clinical support, the program takes advantage of Hygieia’s patented technology, and a hand-held device equipped with special software and a builtin glucose monitor.

Quick Results

Within 90 days of starting the d-Nav program, April began experiencing dramatic results. Her blood glucose levels improved and her HbA1c inched downward. Her eyesight returned and soon she was driving, working, taking care of herself and her family, and living as an independent adult.

This is a dramatic change from today’s standard of care in which a patient’s insulin dose is modified only when he or she can see a physician for evaluation every few months. The Hygieia program is completely virtual, so the patient can be treated at home. Also, all treatment information is available to the patient’s PCP at any time through a dedicated physician portal.

Interested in learning more about Hygieia’s d-Nav insulin management program? Visit hygieia.com/provider. Physicians can refer adult patients with Type 2 diabetes, using insulin, to Hygieia by faxing patient information to 734-469-5082, or by calling 734-743-2838.

Uncategorized References Hodish, I. Insulin therapy for type 2 diabetes – are we there yet? The d-Nav® story. Clin Diabetes Endocrinol 4, 8 (2018). https://doi.org/10.1186/s40842-0180056-5

“D-Nav became personal. Like I had a friend. Now, I have my life back. I walk to work, I drive, I feel 20 years younger. I’m ME again,” April said.

Controlling Blood Sugar

Hygieia’s d-Nav app tracks patients’ glucose and insulin dose history in a simple format. Primary care physicians can track this information on Hygieia’s dedicated physician portal.

24 FALL 2020 | MAFP.COM

Sadly, two out of three people who use insulin to treat diabetes do not have blood sugar levels under control – often because they are not taking the correct insulin dose.

Hygieia’s research proved that outcomes for these patients improved when their insulin doses were frequently adjusted to

Hygieia’s d-Nav app is available for download on Android and Apple platforms.

SPONSORED

Preparing Michigan for the Behavioral Health Impact of COVID-19 Report Predicts Up to 32% Increase in Statewide Suicide Rates Tied to Pandemic In April, Pine Rest Christian Mental Health Services released the report “Preparing Michigan for the Behavioral Health Impact of COVID-19” that predicts Michigan will experience a mental health crisis as a result of the aftershocks of COVID-19 and as well as a 15 to 32% increase in statewide suicide rates unless swift action is taken.

The paper offers a range of concrete solutions to address the risks and calls for immediate action.

Preparing Michigan for the Behavioral Health Impact of COVID-19

Report Contributors:

B

Mariah DeYoung, L.M.S.W., C.A.A.D.C.

Substance Use Director, Outpatient and Recovery Services

Mark Eastburg, Ph.D.

President and Chief Executive Officer

Evonne Edwards, Ph.D.

Clinical Director, Outpatient and Recovery Services

Scott Halstead, Ph.D.

Amy Mancuso, L.M.S.W.

Pine Rest Foundation Grants Manager

Their examination into research on previous epidemics including SARS— combined with data on the impact that factors such as isolation, unemployment and economic distress, increased substance use, physical health problems and increased access to guns have on suicide rates—point to the predicted increase. Certain groups are at especially high risk, including healthcare providers, children and adolescents, older adults, and people with pre-existing mental illness.

Fortunately, the SARS research also suggests strategies on how our state can effectively prepare for, and mitigate, the risks.

“We must take immediate steps to improve access to care through awareness, affordability, telehealth technology and workforce development,” said Eastburg.

“We also need to work with policy makers and the healthcare community to fix gaps in critical behavioral health infrastructure.”

including scaling up teletherapy and telepsychiatry, informing Michiganders and referral sources about the availability of these care options and how to find them, and maintaining financial incentives such as waivers for co-pays for these services.

In addition, the current healthcare service tracking infrastructure should be quickly retooled to serve as a statewide behavioral health clearinghouse for people seeking these services.

These calls to action are getting traction.

In June, Governor Whitmer signed a package of bills (HB 5412-16) that collectively increase Michigander’s access to health care by requiring health insurers to cover telemedicine without first requiring an in-person visit. In that package, HB 5414 adds a definition of telemedicine to the state’s Mental Health Code.

Some payers are extending $0 cost sharing telehealth services for behavioral health through December 31, 2020.

Heide Rollings, M.D.

Program Director, Child & Adolescent Psychiatry Fellowship; Child, Adolescent & Adult Psychiatrist, Board Certified; Assistant Clinical Professor of Psychiatry, Michigan State University

Amy VanDenToorn, L.M.S.W. Manager, Campus Clinic

Vice President, Outpatient and Recovery Services

The first call to action is to the public.

Read the full report at: pinerest.org/ COVID19-report.

People experiencing mental health issues or suicidal thoughts should not wait to seek help. They should contact their primary care physician or call the National Suicide Prevention Hotline (1-800-273-8255), Pine Rest or another behavioral health hospital.

Pine Rest Christian Mental Health Services is the 4th largest behavioral health provider in the nation and offers a full continuum of behavioral health care services and addiction treatment. In addition to inperson treatment, individual and group therapy, intensive outpatient therapy, and same-day psychiatric urgent care are available via telehealth. Call 1-800-6785500 for referrals or more information.

Presented COVID-19 data is current as of June 13, 2020 Contributors are listed alphabetically

A B

“Due to COVID-19’s sweeping impact on our lives and economy, we’re experiencing a rise in many of the stressors that are known to increase risk for suicide,” said Mark Eastburg, Ph.D., president and CEO of Pine Rest and one of the report authors.

Increasing access to care.

The report calls for a comprehensive approach to increase access to care,

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Making Government Work for All

by Matt Black

With backgrounds in science, Sen. Lana Theis and Rep. Laurie Pohutsky consider legislation from fact-based perspectives, relying on research and input from constituents to form their positions. Both are also committed to making government work for all, with the goal of ensuring every Michigander has access to the healthcare they need.

Sen. Lana Theis

Services Committee, Appropriations K-12 Subcommittee, Regulatory Reform Committee as vice chair, and Insurance and Banking Committee as chair, among other committee assignments.

Serving on numerous committees has given Sen. Theis a well-rounded view of a diverse array of topics. So has her education. With a degree in biology and a minor in chemistry, she approaches healthcare with a scientific mindset that, she said, has assisted her in developing a better understanding of the complexities within healthcare and how it intersects with public policy.

When it comes to healthcare, her overarching goal is to ensure that needed medical treatment is available and affordable to all citizens of Michigan.

“I see the proper role of government as one that creates the path rather than creating walls or mandating the solution,” she said.

Following two terms in the Michigan House of Representatives, Sen. Lana Theis (R-Brighton) was elected to the upper chamber in 2018. Today, she represents the 22nd Senate District and is a member of the Health Policy and Human 26 FALL 2020 | MAFP.COM

More specifically, Sen. Theis identifies her top legislative priorities as focusing on patient and physician protections.

Namely, she would like to see changes to the prior authorization process with passage of Senate Bill 612. Her support for change stems from personal experiences with prior authorization and her belief that it removes physicians from and delays patient care.

Preventing individuals from trying to use the guise of medicine to abuse children

is another priority of the senator. As the primary sponsor of Senate Bill 217, which awaits a hearing in the Judiciary and Public Safety Committee, Sen. Theis advocates that two individuals must be present when procedures are performed on minors, and that informed consent must be given for certain procedures.

In regards to Gov. Gretchen Whitmer’s executive order mandating implicit bias training for medical professionals, Sen. Theis said, “I believe such training should be offered by the employer if such a bias is evidenced, but to mandate it on all medical licensure is concerning.”

As a member of the Joint Committee on Administrative Rules, it is her goal to ensure a fair and balanced implicit bias rule is the final product.

Sen. Theis would like to have greater communication with family physicians— communication that is grounded in scientific data, studies, and reports. With such a large number of bills introduced in the Legislature, Sen. Theis said that she, like all legislators, is unable to do all of the needed research. Thus, she relies on constituents to help her build an understanding of their concerns.

Sen. Theis has lived in Brighton with the love of her life, Sam, for over two decades. They are blessed to be the parents of a son and a daughter, and the grandparents of a granddaughter.

MEET THE LEGISLATORS

Healthcare, and access to it, is a large part of what drove me to run for office.

The inability of so many Michiganders to receive the care they need has farreaching consequences, and it’s my duty as a legislator to work toward solutions for the roadblocks the people of our state encounter.

- Rep. Laurie Pohutsky

Rep. Laurie Pohutsky While hosting coffee hours or attending other community events, Rep. Pohutsky said she often hears about the high costs associated with healthcare coverage and prescriptions from seniors on fixed incomes as well as young professionals who are establishing their lives and community roots. Reducing costs is one of her primary legislative focuses in the healthcare sector.

“I am, and always have been, committed to providing for affordable, complete health coverage for all Michiganders,” she said.

Rep. Laurie Pohutsky (D-Livonia) is nearing the end of her first term representing the 19th District in the Michigan House of Representatives. She currently serves on the House Health Policy Committee and Natural Resources and Outdoor Recreation Committee.

Prior to being elected to the House, Rep. Pohutsky was a microbiologist, working on projects related to food safety, toxicology, and healthcare research. She is one of only a few scientists in the Legislature and believes that perspective is especially important in not only making health policy decisions but in helping address the needs arising from COVID-19.

The current lack of access to behavioral healthcare in Michigan is one of Rep. Pohutsky’s top concerns. This topic comes before the House Health Policy Committee time and time again, she explained.

“I believe that mental healthcare is a core part of the well-being of Michigan residents, and I am committed to working across the aisle to develop policy initiatives to expand access to these critical services.”

During her time in the Michigan Legislature, Rep. Pohutsky has been most surprised by politics often prohibiting or altering good legislation—a practice, she said, that can frequently be witnessed during the committee process.

“The partisan divide should not have an effect on policies which are beneficial to Michigan,” she said.

When it comes to grassroots advocacy success, Rep. Pohutsky urges constituents to continually communicate with their legislators.

“Family physicians and legislators must work together to solve important health policy issues, including access to care” in both urban and rural communities of all sizes, she said. She feels this can be partially addressed by investing in and creating new incentives for medical students and residents who choose family medicine and other primary care specialties to remain in Michigan posttraining. She also believes in providing and expanding economic incentives for family physicians to open practices in areas lacking primary medical care.

“Healthcare, and access to it, is a large part of what drove me to run for office,” she said. “The inability of so many Michiganders to receive the care they need has far-reaching consequences, and it’s my duty as a legislator to work toward solutions for the roadblocks the people of our state encounter.

Rep. Pohutsky is a lifelong Michigan resident and resides in Livonia with her dog, Hank. When not working with constituents or meeting in Lansing, she enjoys baking. She is also a member of Michigan United and engaged in the community.

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EVENTS

Professional Development, CME & Networking Details and registration at mafp.com/events October 17

November 14

December 5

Virtual: Pallative Care Knowledge Self-Assessment

Virtual: Women in Family Medicine Conference

Virtual: Mental Health in the Community Knowledge Self-Assessment

Complete the 60-question KSA via a facilitated group discussion focused on important aspects of medical care; communication strategies; shared decision making; and ethical consideration in palliative care, including pain management, legal and regulatory issues, and cultural and psychological aspects of care. ǀ 8 am-12 pm

October 24 Virtual: Michigan Future of Family Medicine Student Conference

Explore the breadth and depth of the family medicine specialty through webinar sessions. ǀ 7:30 am-1:15 pm

28 FALL 2020 | MAFP.COM

Evidence-based strategies, education, and skill development to help women family physicians advance at various stages of their career. ǀ 8:45 am-2 pm

December 4 Virtual: Advocacy & Leadership Development Program

Leadership development, media relations, and grassroots advocacy sessions will help shape you into an advocacy leader in your clinic, institution, or community. | FREE to MAFP members; applications accepted until Oct. 9.

Complete the 60-question KSA via a facilitated group discussion focused on co-management, referral, models of care, and family and community resources pertinent to mental health issues, co-morbid disorders, epidemiology/risk factors, primary management, and screening and diagnosis. | 8 am-12 pm

CME Reporting Deadlines for AAFP Membership

AAFP/MAFP members whose CME reelection cycle ends Dec. 31, 2020, who have not met the requirement, will have an additional year to fulfill their CME requirement. Members whose CME reelection cycle ended Dec. 31, 2019, have until Dec. 31, 2020, to report their CME, which they earned prior to Dec. 31, 2019, to remain eligible for membership.

Saturday, October 24 7:30 am - 1 pm ET Live-streamed via Zoom Agenda & Registration at mafp.com/events Supported in part by grant funding from AAFP Foundation through the Family Medicine Philanthropic Consortium.

$25 for MAFP members

(Student membership is FREE! Join at aafp.org/membership/join.html)

$50 for non-members

CLINICAL WORKSHOPS

MICHIGAN

Future of Family Medicine VIRTUAL

PANEL DISCUSSIONS

STUDENT CONFERENCE Explore the breadth & depth of family medicine RESIDENCY PROGRAM CONNECTION

FALL 2020 | MAFP.COM

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Smart Start BEEF AS A FIRST FOOD FOR INFANTS The addition of solid foods to the diet of breastfed and formula-fed infants, referred to as complementary feeding, is recommended to begin around 6 months of age, when the child enters a period of rapid growth and development. Complementary foods are essential to promote a baby’s proper growth and development as well as to prevent vitamin and mineral deficiencies with potential longterm adverse consequences, even though breastfeeding may continue beyond 2 years.1 The World Health Organization guidelines for complementary feeding recommend daily intake of animal source foods to ensure nutrient needs are met.2 It is reported that 5 percent of infants consume baby-food meat and 12 percent of infants consume non-baby-food meat in their first nine months.3 More specifically, 1.3 percent of infants consume beef in this timeframe.3 The American Academy of Pediatrics advises that meat, including beef, be introduced as an early solid food in an infant’s diet, since proper nutrition during this critical time sets the stage for continued development and lifelong health.1

1

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STARTING STRONG FOR OPTIMAL GROWTH Beef contains essential nutrients to fuel a child’s early growth and development. With nutrients like zinc, iron and protein, along with vitamins B6 and B12, choline and selenium, beef as a complementary food is associated with normal physical growth in infants.4,5 Recent research has shown that high protein intake from meat as a complementary food favorably increases growth but not adiposity in breastfed infants.4

INTRODUCING VITAL NUTRIENTS FOR A BUDDING BRAIN Infants and toddlers need protein, iron and zinc to support brain health and optimal cognitive development.6 Iron deficiency can have longterm effects on learning, behavior and neurodevelopment.7 Research shows that the iron and zinc found in animal protein foods are more readily absorbed than the same nutrients from plant sources like rice and grains – an important consideration when selecting nutrient-rich complementary foods for infants.8

3

NURTURING IMMUNITY Zinc and iron play an important role in an infant’s developing immune system.8 Introduction of foods that are a good dietary source of iron and zinc, like beef, early in life supports the growth of healthful bacteria in an infant’s gastrointestinal tract, which plays an important role in enhancing immune function.9-11

If you have questions about starting solid foods, consult a physician or healthcare provider.

Visit www.BeefItsWhatsForDinner.com for more research on beef’s role as a complementary food.

1. American Academy of Pediatrics. Pediatric Nutrition Handbook. 7th ed. Elk Grove, IL: American Academy of Pediatrics; 2014.

2. Pan American Health Organization/World Health Organization. Guiding principles for complementary feeding of the breastfed child. Washington DC: Pan American Health Organization/World Health Organization; 2003.

3. Roess AA, Jacquier EF, Catellier DJ, Carvalho R, Lutes AC, Anater AS and Dietz WH. Food Consumption Patterns of Infants and Toddlers: Findings from the Feeding Infants and Toddlers Study (FITS) 2016. J Nutr.

2018;148:1525S-1535S. 4. Tang M and Krebs NF. High protein intake from meat as complementary food increases growth but not adiposity in breastfed infants: a randomized trial. American Journal of Clinical Nutrition. 2014;100:1322-8.

5. U.S. Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference Legacy. 2018.

6. Prado EL and Dewey KG. Nutrition and brain development in early life. Nutr Rev. 2014;72:267-84.

7. Lozoff B, Beard J, Connor J, Barbara F, Georgieff M and Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006;64:S34-43; discussion S72-91.

8. USDA, Food and Nutrition Service. Infant Nutrition and Feeding Guide: A Guide for Use in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). 2019.

9. Krebs NF, Sherlock LG, Westcott J, Culbertson D, Hambidge KM, Feazel LM, Robertson CE and Frank DN. Effects of different complementary feeding regimens on iron status and enteric microbiota in breastfed infants. J Pediatr. 2013;163:416-23.

10. Palmer C, Bik EM, DiGiulio DB, Relman DA and Brown PO. Development of the human infant intestinal microbiota. PLoS Biol. 2007;5:e177.

11. Usama U, Khan MJ and Fatima S. Role of Zinc in Shaping the Gut Microbiome; Proposed Mechanisms and Evidence from the Literature. Journal of Gastrointestinal & Digestive System. 2018;8:548.

30 FALL 2020 | MAFP.COM ©2019 Cattlemen’s Beef Board and National Cattlemen’s Beef Association, #080819-06

CHOOSING BEEF: NEW DIABETES AND HEART HEALTH RESEARCH A new randomized, controlled trial, the gold-standard in nutrition evidence, shows that individuals have more choice in how much of their healthy diet can be from lean, unprocessed beef without increasing risk factors for heart disease or diabetes. It adds to the growing body of scientific evidence demonstrating that lean beef can be part of a diabetic friendly diet that supports metabolic and cardiovascular health.

WHAT DID THE RESEARCHERS DO? 7

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The 33 study participants (26 women and 7 men) were at risk for type 2 diabetes. Cardiometabolic risk factors were measured at the end of each feeding phase and compared within the same individual throughout the trial.

About half of participants started a a similar pattern that contained an additional 5.3 ounces of lean, unprocessed beef per day in place of refined starches.

(USDA-LB)

About half of participants started the USDA Healthy eating pattern with up to 1.2 ounces of red meat per day.

(USDA-CON)

STUDY TAKEAWAY Individuals have flexibility to include up to about 6 ounces of lean, unprocessed beef in daily healthy diets without increasing risk factors for heart disease or diabetes.

Measured cardiometabolic risk factors after 28 days

Participants were allowed to eat freely for 14 days or more as a “washout”

RESULTS Most indicators of cardiometabolic health, such as insulin sensitivity and LDL cholesterol, did not differ between the two diets.

Fed the opposite diet for 28 days

Measured cardiometabolic risk factors after 28 days A

Person A, Diet 1

vs.

A

Person A, Diet 2

The same individual’s risk factors were compared between the two diets

The only significant difference observed was a shift toward a greater percentage of cholesterol carried in larger, more buoyant LDL particles during the higher beef diet. More buoyant LDL particles are considered a favorable finding as they may be less likely to promote atherosclerosis.

To learn more about this research and how beef can play a role in healthy eating, visit BeefItsWhatsForDinner.com.

Maki et al. Substituting Lean Beef for Carbohydrate in a Healthy Dietary Pattern Does Not Adversely Affect the Cardiometabolic Risk Factor Profile in Men and Women at Risk for Type 2 Diabetes. J Nutr 2020; nxaa116, https://doi.org/10.1093/jn/nxaa116.

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Behavioral Health Services Available in Michigan Via Telehealth Services During COVID-19 Immediate Openings for Teletherapy and Telepsychiatry Our 300+ licensed, outpatient clinicians are providing care for all ages. Additional services include intensive outpatient therapy and some groups.

866.852.4001 | pinerest.org/telehealth

Virtual Walk-In Psychiatry for Adults The Psychiatric Urgent Care Center is open daily for immediate psychiatric triage and now offers virtual “walk-in� service.

800.678.5500 (answered 24/7) | pinerest.org/urgent

32 FALL 2020 | MAFP.COM