Michigan Family Physician Magazine March 2020

Marijuana & CBD: Primary Care Considerations Celebrating Women in Family Medicine Residency Curriculum Generates New Family Medicine Advocates Prior Authorization Bill Moving Through the Legislature

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Hindsight

2020

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TABLE OF CONTENTS MAFP BOARD OF DIRECTORS Chair Mary Marshall, MD, RN, FAAFP President Keerthy Krishnamani, MD, MBA President-elect Mustafa ‘Mark’ Hamed, MD, MBA, MPH, FAAFP Vice President Srikar Reddy, MD, FAAFP Speaker Glenn Dregansky, DO, FAAFP

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Marijuana & CBD Cover Story

Treasurer Beena Nagappala, MD, MPH AAFP Delegates David Walsworth, MD, FAAFP Robert Jackson, MD, MMM, FAAFP AAFP Alternate Delegates Tina Tanner, MD, FAAFP Loretta Leja, MD Members-at-Large Harshini Jayasuriya, MD, FAAFP

Brandon Karmo, DO Amy Keenum, DO, PharmD, FAAFP

Rachel Klamo, DO Sadeer Peter, MD Pamela Rockwell, DO, FAAFP Kristi VanDerKolk, MD Bashar Yalldo, MD

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Viruses, Advocacy & Mentorship

2020 & Beyond: Let’s Take the Leap Together

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President’s Message

CEO Insight

Resident Member Julie Ngoc Thai, MD

Student Member Shelby Owens Ex Officio, Chief Executive Officer Karlene Ketola, MSA, CAE

Prior Authorization, MIDOCS, Scope of Practice

FMFM BOARD OF TRUSTEES

Celebrating Women in Family Medicine

Advocacy Update

Women’s History Month

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President Robert Jackson, MD, MMM, FAAFP Vice President Mary Marshall, MD, RN, FAAFP Secretary / Treasurer David Walsworth, MD, FAAFP Executive Vice President Karlene Ketola, MSA, CAE

Trustees-at-Large Jennifer Aloff, MD, FAAFP Amy McKenzie, MD, MBA Lynn Gray, MD, MPH, FAAFP Angelo Patsalis, MD, FAAFP Adam Jablonowski, MPA Elizabeth Pionk, DO David Kazanowski, MD Jeanette Wilson, 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

Michigan Academy of Family Physicians

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Residency Curriculum Generates New Family Medicine Advocates

Members in the News

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Professional Development, CME & Networking Events

MAFP Annual Meeting

Academy News

NEW FROM CDC

HIV Nexus is a new comprehensive website from

the Centers for Disease Control and Prevention that provides the latest scientific evidence, guidelines, and resources on: • Screening for HIV. • Preventing new HIV infections by prescribing PrEP and PEP. • Providing treatment to people with HIV to help improve health outcomes and stop HIV transmission.

To access CDC tools for your practice and patients, visit:

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PRESIDENT’S MESSAGE

Viruses, Advocacy & Mentorship

(and not in that order)

by Keerthy Krishnamani, MD, MBA While the world focuses on the mysterious coronavirus, it’s important that family physicians stay attuned to what remains a far greater danger to their patients–the flu and insufficient hand hygiene. That is the recommendation from the Centers for Disease Control and Prevention (CDC) and American Academy of Family Physicians.

treatment. These patients may also say they “don’t believe in flu vaccination.”

Continuing to educate our patients about vaccination for common illnesses such as influenza, while dispelling misconceptions spread by those who oppose vaccinations, has become part of the everyday practice of medicine.

At the end of February, the CDC’s key indicators that track influenza activity remained high. The agency estimates there have been at least 32 million illnesses, 310,000 hospitalizations, and 18,000 deaths from the flu to date this season.

So, it’s critical that you continue to ask patients during each visit whether they’ve received their flu shot. If they haven’t, make a strong recommendation they get immunized that day.

Now onto a brighter topic—Michigan Family Medicine Advocacy Day (page 10). Held in downtown Lansing on Feb. 25, more than 100 advocates talked with legislators and their staff about key family medicine advocacy priorities during this important annual event co-hosted by Michigan Academy of Family Physicians (MAFP) and Michigan Association of Osteopathic Family Physicians.

Regarding coronavirus, the CDC has taken a lead in the United States’ response, testing systems, and quarantine methods, which have been improved based on recent experiences with other pandemiccausing viruses. The CDC also released a toolkit (cdc.gov) that includes resources for healthcare professionals, such as a flowchart for identifying and assessing COVID-19 and preparedness checklists for readying clinical facilities for patients with potential or confirmed cases.

I have, and you most likely have, patients asking about coronavirus activity and

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Participating in Advocacy Day is a great way to get involved in your Academy and speak on issues important to your day-to-day practice. You also get to meet colleagues who are as excited as you about advocating for patients and our profession.

I met with my legislators, alongside other family medicine residents and physicians.

We talked about the need to address student loan debt and urged our legislators to support the “Health Can’t Wait” prior authorization reform bill moving its way through the Legislature. MAFP supports Senate Bill 612 because it protects patients

and reduces administrative burden (page 10). These conversations were powerful.

Advocacy Day was one of the main reasons I became actively involved with the Academy eight years ago and continue to do so today. If you weren’t able to attend Advocacy Day this year, I strongly encourage you join us in February 2021.

The more advocates we have, the louder the voice of family medicine becomes.

In closing, I would like to plug our MAFP Mentorship Program, which started as a pilot in January with 11 mentormentee pairings. We are excited about this program, as it is another benefit for our members. The program provides an opportunity for established physicians to give guidance and be a sounding board for students, residents, and new physicians.

As physician burnout is reaching epidemic proportions, mentorship is an effective way to combat burnout and give back to our Academy members.

Keerthy Krishnamani, MD, MBA is the 2019-2020 president of MAFP. He oversees three Henry Ford Health System primary care clinics in southeast Michigan.

He is also an associate clinical professor at the Wayne State University School of Medicine.

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CEO INSIGHT

2020 & Beyond

Let’s Take The Leap Together

by Karlene Ketola, MSA, CAE

Sometimes your only available transportation is a leap of faith.

These words from author Margaret Shepard could not be truer as we start off the new leap year, new decade and new program cycle at Michigan Academy of Family Physicians (MAFP).

MAFP remains the state’s largest specialty physician association, representing more than 4,200 members statewide. The Academy is dedicated to assisting family physicians and their practices as they work to ensure high-quality, cost-effective healthcare for patients of all ages.

However, MAFP cannot rest on its history alone. Your Academy needs you. At the state level, it is an unpredictable time, as bills on prior authorization, naturopath scope of practice, and Gov. Gretchen Whitmer’s budget recommendations are moving.

Uncertain also summarizes the climate at the national level. There is new attention on Medicaid block grants; public health issues such as vaping, CBD, and coronavirus; and the upcoming general election this fall. Your voice is needed to protect your patients, practice and profession (page 10).

In January, the MAFP Board of Directors met with Dr. Joneigh S. Khaldun,

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Michigan Department of Health and Human Services’ chief executive and chief deputy director for health. Dr. Khaldun outlined the department’s priorities as they relate to systems-change, specifically in the areas of behavioral health, opioids, and health equity.

At that meeting, the board passed MAFP’s 2020 budget, funding new initiatives to enrich member value. Among the enhancements for this year are newly designed member-hosted Member Mixers (page 22), a text messaging service for communicating more efficiently with members (page 10) and MAFP’s third Advocacy & Leadership Development Program in December (page 19).

Thank you to our volunteer leaders who serve on boards and committees and in leadership roles at AAFP’s National Conference of Constituency Leaders, National Conference of Family Medicine Residents & Medical Students and Congress of Delegates.

If you are considering getting more involved in your Academy, MAFP is now accepting applications from physician, resident, and student members for a variety of leadership positions and event scholarships. I invite you to visit mafp.com/get-involved to explore the best fit for you.

If you want to earn continuing medical education while networking and having fun, I encourage you to register for the 2020 Michigan Family Medicine Conference & Expo, Aug. 6-9, in Troy.

The Professional Development Committee is excited to welcome an all-star lineup of state and national experts to lead our CME programming. Sessions focus on a variety of clinical, practice management, and advocacy topics, as well as pain and symptom management, human trafficking, and medical ethics sessions to help you meet state licensure requirements. We’ve added a few exciting new features to the conference agenda that you won’t want to miss. See the insert between pages 12 and 13 for details and register at mafp.com/events.

Whether you’re a life member, practicing physician, resident, or student, I hope you consider MAFP as your profession’s resource. The Academy’s mission is to support family physicians in Michigan through leadership, collaboration, and innovation to achieve the best patient outcomes. As always, I encourage you to reach out and share your point of view. We are stronger collectively, and I look forward to taking the leap together.

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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Jennifer Aloff, MD, FAAFP (bottom right) and Central Michigan University College of Medicine students.

More than 120 family medicine advocates convened in downtown Lansing on Feb. 25 to talk with their state legislators about issues impacting patients and the practice of medicine.

This annual event is an important forum for family physicians, family medicine residents, and medical students to share problems they experience in their everyday practices that could be solved through healthcare policy or legislation.

Tops on the list of Michigan Family Medicine Advocacy Day talking points

Prior Authorization, MIDOCS, Scope of Practice Advocacy Day Discussions

by Matt Black was asking legislators to support prior authorization reform legislation (Senate Bill 612) and the governor’s five-year MIDOCS budget recommendation of $21.6 billion (page 11), as well as to oppose legislation that would expand scope of practice for individuals, such as naturopathic providers, whose care is not based on scientific evidence and whose education has not prepared them to independently practice medicine.

To learn more about your Academy’s advocacy priorities, visit mafp.com/ advocacy/advocacy-priorities.

Text MIFMCONNECT to 52886 to subscribe to MAFP’s text messaging service.

Be among the first to receive: • Advocacy action alerts • Urgent news impacting family medicine • information about CME, professional development and networking events Message rates apply. Text STOP to stop receiving text messages. Text HELP to get help.

On average, each physician employs 1.7 FTEs to exclusively process prior authorization requests. That equates to 40-50 hours of prior authorization work per week per physician.

#FixPriorAuth Bill Moving Through the Legislature During January and February, the Michigan Senate Health Policy and Human Services Committee held three standing-room-only hearings on Senate Bill 612, legislation to reform the state’s prior authorization process.

Introduced by the committee’s chair, Sen. Curt VanderWall (R-Ludington), the bill calls for adding transparency, clinical validity, and timeliness to the current process.

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Hearings on Senate Bill 612 have concluded in the Senate.

Testifying in support of the bill were patients and physicians from across the specialties.

Their overarching message: Insurers’ current prior authorization requirements cause harm to patients by delaying and denying care and medications they need, raise healthcare costs, and contribute to physician burnout.

Health plans testified in opposition to the bill, stating their customers expect them to keep costs low and root out unnecessary spending. Insurers contend the prior

authorization process is a tool that helps ensure patients receive the right treatment at the right time.

Now that the Senate hearings have concluded, it is critical that you contact your state lawmakers to urge them to #FixPriorAuth by supporting SB 612, because health can’t wait—visit healthcantwait.org/take-action.

Sending a message only takes seconds, and your voice really does have an impact.

ADVOCACY UPDATE

Friend of Family Medicine Award Presented to Sen. VanderWall On behalf of family physicians across the state, Michigan Academy of Family Physicians and Michigan Association of Osteopathic Family Physicians presented the 2020 Friend of Family Medicine Award to Sen. Curt VanderWall (R-Ludington) during Michigan Family Medicine Advocacy Day on Feb. 25.

Primary care and family physicians are foundational to a healthy society, and we must do all we can to strengthen this important part of healthcare in Michigan. - Sen. Curt VanderWall

This annual award recognizes an individual for outstanding contributions to improving the health and safety of Michigan’s citizens.

In fall 2019, Sen. VanderWall introduced Senate Bill 612 to reform Michigan’s prior authorization process (page 10).

“The current process fails patients because it is inefficient, bureaucratic, and, most critically, delays or denies care and treatment determined medically necessary by physicians.

The result—poor health outcomes, needless suffering, and exacerbated conditions that drive up healthcare costs,” said MAFP President Keerthy Krishnamani, MD, MBA. “Family physicians across the state commend Sen. VanderWall for sponsoring Senate Bill 612, because health can’t wait. We urge all lawmakers to support its passage for the health and well-being of their constituents.”

MAOFP Advocacy Committee Chair Rachel Young, DO; Sen. Curt VanderWall (R-Ludington); MAFP Director of Government Relations Matt Black; and MAFP Advocacy Committee Chair Glenn Dregansky, DO, FAAFP.

Governor’s 2021 Budget Proposal Invests in MIDOCS On Feb. 6, State Budget Director Chris Kolb presented Gov. Gretchen Whitmer’s Fiscal Year 2021 budget recommendation before a joint meeting of the House and Senate Appropriations Committees.

pediatrics, psychiatry, and general surgery.

The goal is to recruit and retain primary care physicians in underserved areas of the state. Currently, 90% of Michigan’s 83 counties have at least a partial shortage of primary care physicians.

Included in the governor’s proposal is $21.6 million general fund dollars over the next five years to support 48 resident positions within MIDOCS. This one-time funding would be combined with base funding to bring the program total to $85.6 million.

Now in its second year, MIDOCS currently supports eight residency positions spread across programs administered

by Central Michigan University College of Medicine, Wayne State University School of Medicine, Michigan State University College of Human Medicine, and Western Michigan University Homer Stryker M.D. School of Medicine.

Authorized by Michigan legislation in 2017, MIDOCS is designed to expand primary care residency positions in the specialties of family medicine, internal medicine, obstetrics and gynecology,

MAFP supports the governor’s recommendation.

Currently, 90% of Michigan’s 83 counties have at least a partial shortage of primary care physicians.

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

Marijuana & CBD Primary Care Considerations

by Dana Lawrence

Changes in state and federal laws in recent years have altered the landscape of marijuana use. What was once illicit is now becoming more socially acceptable. Sixty-one percent of Americans favor legalization,1 more than 12% of Michiganders use marijuana,2 and one in seven U.S. residents report they use some form of cannabidiol (CBD).3 The proliferation of marijuana and cannabis-derived products is due in large part to the legalization of medical marijuana in Michigan in 2008 and adult recreational use in 2018, as well as the 2018 federal Farm Bill allowing farmers to grow hemp.

This means that family physicians are likely to encounter a growing number of patients seeking information on the indications, contra-indications, efficacy, and safety of these products.

This proves difficult, however, due to lack of scientific evidence.

“A body of preclinical research—using cell lines and animal models—exists to understand the health effects of marijuana. Studies in humans are mostly observational in nature and we cannot draw causal conclusions from them. We need controlled trials to understand casual effects of marijuana, but these can be ethically questionable; for example, exposing participants to a psychoactive chemical such as THC,” said Omayma Alshaarawy, MBBS, PhD, assistant professor and researcher in the Department of Family Medicine at Michigan State University College of Human Medicine.

Currently Dr. Alshaarawy’s federallyfunded research combines epidemiological methods and laboratory experiments to study cannabis use and cardiometabolic health.

Here is what we do know about marijuana and CBD.

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Marijuana is considered a Schedule I drug at the federal level.

Based on Federal Drug Administration (FDA) findings, marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the U.S., and lacks accepted safety for use under medical supervision.4

Purchasing medical marijuana in Michigan requires a physiciancompleted certification form.

This entails having a bona-fide patientphysician relationship. The physician must perform a complete assessment of the patient’s medical history and current medical condition via an in-person medical evaluation, and the patient must be diagnosed with at least one qualifying debilitating medical condition. Learn more at bit.ly/LARA_MMMP.

There are potential health benefits.

“There is a strong evidence for marijuana effectiveness in managing chemotherapyinduced nausea and vomiting. Synthetic forms of THC have been approved by the FDA for some time now as antiemetics.

Marijuana-based medications such as nabiximols (THC + CBD oral spray approved in the United Kingdom) have been used to manage spasticity in patients with multiple sclerosis. In addition, there is some evidence to support marijuana use for the management of chronic pain in adults. Research regarding other therapeutic effects of marijuana is growing but have not yielded definitive results. CBD is also not well researched and there is not enough evidence to confirm or refute any therapeutic effects of CBD except in two rare severe forms of epilepsy,” said Dr. Alshaarawy.

There are potential health risks.

“Marijuana use can affect some domains of cognitive functions such as memory.

Marijuana use is also linked to poor educational outcomes as well as mental health disorders such as psychosis.

Cannabis use among vulnerable populations such as pregnant women and children/adolescence is associated with a number of adverse outcomes,” said Dr. Alshaarawy.

She went on to explain that the mechanisms of action of CBD are far less understood and thus the risks associated with CBD use are unknown.

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Marijuana & CBD: Practice Recommendations9 • Screen all patients for all potentially addicting substances • Counsel patients that evidence does not support safe recreational use • Use a validated screener to screen cannabis users for problematic use

The FDA reports it has seen only limited data about CBD safety and these data point to real risks that need to be considered before taking CBD for any reason.5 Just this past January, however, legislation was introduced in the U.S. House that calls for giving the FDA authority to regulate CBD as a supplement.

• Diagnose the presence/lack of cannabis addiction • If cannabis addiction is present, collaborate with an addiction therapy team • Continue to monitor and respond to cannabis use

Using unregulated products can have unpredictable and unintended consequences.

In a 2017 test on 84 CBD products, researchers found that labels on just 26 of them accurately reflected the contents, according to a research letter published

COVER STORY in the Journal of the American Medical Association.6 Some CBD products have actually little to no CBD in them; others contain more than 0.3% THC—the threshold for what is considered non-high producing.

Some incorporate pesticides or heavy metals known to be carcinogenic.

Those who use CBD are encouraged to read the product’s Certificate of Analysis—a document from an accredited thirdparty laboratory verifying the type and quantity of cannabinoids in the product.

August. See the conference insert between pages 12 and 13 for more information on this and other CME sessions.

1. Pew Research Center survey. 2017.

2. cbsnews.com/pictures/17-stoner-states-wheresmarijuana-use-highest/4/ 3. news.gallup.com/poll/263147/americans-say-cbdproducts.aspx 4. dea.gov/drug-scheduling

5. fda.gov/consumers/consumer-updates/what-youneed-know-and-what-were-working-find-outabout-products-containing-cannabis-or-cannabis 6. jamanetwork.com/journals/jama/ fullarticle/2661569 7. aafp.org/about/policies/all/marijuanacannabinoids.html 8. issuu.com/lbernskoetter/docs/jan-mar_2019_ missouri_family_physic 9. slideshare.net/slideshow/embed_code/key/ bI8C9xy9qjp7pO

When we are obliged to our patients, we are obliged to understand the scope and limitations of the evidence.

Show me.

- Steven Wright, MD

More scientific evidence is needed.

How do marijuana and CBD affect the metabolism of other medications? What happens if they are used for sustained periods of time? How do they affect a developing fetus, breastfed newborn, or the brain of a child? These are just a few of the outstanding questions for which limited research has yet to provide answers.

In a position paper released in 2019,7 AAFP acknowledges that preliminary evidence indicates marijuana and cannabinoids may have potential therapeutic benefits, while also recognizing subsequent negative public health and health outcomes associated with cannabis use. Thus, the Academy advocates for further research into the overall safety and health effects of recreational use, as well as the effects of laws on patient and societal health.

“When we are obliged to our patients, we are obliged to understand the scope and limitations of the evidence. Show me,” wrote Steven Wright, MD (Littleton, CO) in a 2019 Missouri Family Physician article.8 Dr. Wright is a family physician and a consultant in addiction medicine and medical pain management, with particular interest in cannabis, opioids, and benzodiazepines. He is presenting a session on cannabis considerations in primary care at the 2020 Michigan Family Medicine Conference & Expo in

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Celebrating Women in Family Medicine

by Dana Lawrence

Tina Tanner, MD, FAAFP With no family members attending college before her, becoming a doctor wasn’t in the cards, thought Dr. Tina Tanner (Montague, MI).

Srikala Yedavally-Yellayi, DO, FAAFP Dr. Srikala YedavallyYellayi (Rochester, MI) entered healthcare as a medical technologist, working in a cellular immunology lab before HIV was identified as the causative agent of AIDS.

“Just getting [to college] was the first step,” she said of her acceptance to Western Michigan University. Her intent was to study occupational therapy or social work but instead listened to her calling to practice medicine.

Realizing she was more curious about the people to whom the blood samples belonged than their disease, she applied and was accepted to Michigan State University College of Osteopathic Medicine.

Dr. Tanner began her quest for a medical degree from Michigan State University College of Human Medicine in 1992. It was there that she got involved with the Family Medicine Interest Group, which inspired her to choose family medicine and become active in American Academy of Family Physicians (AAFP) and the Michigan chapter.

With plans to become an infectious disease specialist, she matched into internal medicine residency. Through experiences in urgent care centers and as the medical director of a methadone clinic, Dr. Yedavally-Yellayi said she recognized how complete care is when you care for a person, not a disease. That’s when she knew family medicine was for her.

“Without my experiences with the Academy, I would not be the family physician I am today,” she said.

Over the past two decades, Dr. Yedavally-Yellayi has practiced family medicine and mentored the family physicians of tomorrow. She is an assistant professor in the Oakland University William Beaumont Department of Family Medicine and Community Health, a global health director, and clerkship director for family medicine undergraduate medical education.

Elected in 2014 as the fifth female president of Michigan Academy of Family Physicians (MAFP), Dr. Tanner was at the helm when the Academy supported then-Gov. Rick Snyder’s innovative, bipartisan Healthy Michigan Plan.

She also went toe-to-toe with several legislators as the Academy protected family medicine scope of practice when nurse practitioners lobbied for autonomy.

Throughout the legislative process, initial adversaries soon became friends as mutual respect and a focus on the common goal of increasing access to family physician-led, team-based, affordable, comprehensive, quality healthcare was realized. Dr. Tanner identifies her work with MAFP, particularly in helping to achieve these advocacy wins for her patients and her fellow and future physicians, as her greatest professional accomplishments.

“I have been able to use these same advocacy skills in my practice, coaching and mentoring patients and colleagues through difficult times,” she said, also crediting the Academy for bringing some of her closest friends, whom she now considers family, into her life.

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In 2019, Michigan Academy of Family Physicians (MAFP) named her Michigan Family Medicine Educator of the Year.

“We have the unique ability to care for populations undifferentiated by gender, age or disease process. It is every family physician’s responsibility to educate the public and our other specialty colleagues that value-based care can only be achieved in a healthcare system centered around family medicine. This is my sincere belief and passion and something I try to impart in some way to every learner, patient, and colleague I encounter,” she said.

Today, nearly 41% of Michigan Academy of Family Physician’s 4,200-plus members are women, 36% of the state’s active physician workforce are female and, as of 2019, women outnumber men in medical schools (50.5% women, 49.4% men).

Holli Neiman-Hart, MD, FAAFP As a nurse in a hospital with an active family medicine residency program, Dr. Holli Neiman-Hart (Battle Creek, MI) felt the tug to go back to school to pursue her medical degree. Since then, learning and teaching has been at the core of her career.

“I have worked in solo and group private practice, employed hospital-based residency practice, as faculty in a university and tertiary care hospital, and as a hospitalist and at a federally qualified health center,” she said.

Today, Dr. Neiman-Hart offers a wide variety of services to her patients, including outpatient, inpatient, procedures, obstetrics, and home visits. She serves as director of Michigan’s newest family medicine residency program in Battle Creek–a program she helped found and develop in collaboration with Western Michigan University Homer Stryker M.D. School of Medicine, Bronson Battle Creek Hospital, and Grace Health (an FQHC).

She said getting the residency approved and ready to start its first class of six residents in July 2019 is her greatest professional accomplishment to date–that and having met the criteria for promotion to associate professor.

“Working with residents and students keeps me on my toes, and I enjoy learning about new things as well as teaching. I thoroughly enjoy the variety of things that I can do as a program director. I can still provide broad spectrum clinical care, teach, and participate in leadership activities. This keeps me from getting stagnant.”

This helped her combat burnout, as has combining the professional and personal aspects of her life.

Dr. Neiman-Hart said she learned early on in her career to share some of her job with her children.

“They came with me to labor and delivery to check on a patient in labor. They came to nursing homes and thought it was pretty cool when I came to their classrooms with my white coat and some medical equipment to talk about being a doctor. We often sat at the dining room table together doing our ‘homework.’”

WOMEN’S HISTORY MONTH

Beena Nagappala, MD, MPH Dr. Beena Nagappala (Troy, MI), a family physician of 18 years, said she cannot imagine anything other than the practice of family medicine as her career choice.

“I feel medicine is my calling, and I love what this specialty encompasses—the variety of care and taking care of the entire family.”

She presently works part-time in a busy family medicine group practice, where she is involved with quality and compliance initiatives for the group and her practice. She is also the medical director for community health for Ascension Southeast Michigan and oversees the medical care provided through its 24 school-based clinics in and around Metro Detroit.

With a commitment to giving back to her community, Dr. Nagappala volunteers at HUDA Clinic and MAPI Charitable Clinic, where she is clinic director. Both are free clinics, providing care to the underinsured and uninsured patients of metro Detroit.

Equally fulfilling for Dr. Nagappala is advocating for her profession and patients and having a say in the policies that impact them. That’s why she was compelled to join the Academy 16 years ago, and why she serves on the MAFP Board of Directors—currently as treasurer—and on its Advocacy Committee.

“I feel that the Academy advocates for me and my patients,” she said.

Her personal vision for the future of family medicine aligns with that of the Academy: achieving the best patient outcomes. This, she said, requires increasing physicians’ time spent with patients, which means decreasing administrative burden.

Reducing administrative tasks that take away from patient care is among MAFP’s advocacy priorities.

To aspiring, new, and seasoned family physicians alike, Dr. Nagappala said, “Be encouraged by the small day-to-day interactions you have with your patients and know that even minor changes will make a significant difference in their lives.”

Tsveti Markova, MD, FAAFP Growing up as a voracious reader who was always doing science projects and getting involved in community organizations working to help people, Dr. Tsveti Markova (Detroit, MI) felt led to medicine.

Next to medicine, Dr. Markova said she is passionate about education.

Her practice has always been in an academic setting, fully integrated in residency programs and medical student educational sites.

Today, she is chair of the family medicine and public health sciences department at Wayne State University (WSU) School of Medicine, where she also serves as associate dean of graduate medical education and lead principal investigator for the Michigan Area Health Education Center.

“I feel very fortunate to have the opportunity to blend medicine and education into my professional career as a medical educator. This experience has provided incredible opportunities for impact, for gaining exceptional mentors, and for developing lasting relationships,” she said.

Under Dr. Markova’s leadership, WSU’s Department of Family Medicine and Public Health Sciences has risen to seventh nationally in the Blue Ridge report for National Institutes of Health Funding and has grown in the areas of public health, behavioral sciences, and health disparities. She also has championed innovative initiatives for residents to acquire skills needed to provide high-quality, safe, effective, and equitable care in the new healthcare environment.

“Family medicine is at the heart of prevention, chronic disease management, and population health with large impact on healthier communities. As a physician, there is no greater honor than to be trusted with the most intimate issues of someone’s personal health, their family, living conditions, and working environment,” said Dr. Markova.

Anne Kittendorf, MD, FAAFP As the mother of two teenage girls, Dr. Anne Kittendorf (Dexter, MI) understands the challenges of juggling family needs and work demands. An academic family physician who cares for newborns through geriatric patients, and a teacher of medical students and residents at the University of Michigan, Dr. Kittendorf has found family medicine to be a fantastic career for women because of its various practice locations and flexibility in meeting ever-evolving personal needs and interests.

“There are so many opportunities to pursue whatever your passions—including research, teaching, full-spectrum or even narrow scope practice—within family medicine,” Dr. Kittendorf said. “Seeking mentors who can help guide you in making your own work-life balance choices is important.”

Dr. Kittendorf feels fortunate to have likeminded mentors who have coached her through academic and professional accomplishments.

She noted that the opportunities she has pursued have nearly always come because someone approached her and supported her forward.

A 2001 and 2004 graduate of the University of Michigan Medical School and Family Medicine Residency, respectively, Dr. Kittendorf admitted she did not always know she wanted to be a doctor. When it came down to it, she was most intrigued by a career in science where she could work directly with people she could help.

“There is no other career in medicine that matched my desire to develop long-term relationships with patients and their families and help them face all sorts of challenges as they walk through the various stages in their lives. It is so rewarding for me to take care of multiple generations based on a foundation of trust and understanding that comes only from building long-term relationships,” she said.

Dana Lawrence is director of communications and member services at Michigan Academy of Family Physicians. She directs the organization’s communications strategy, including media relations, public relations, and social media presence; works to increase family medicine awareness and member engagement; and is the lead on medical student and family medicine resident initiatives.

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Residency Curriculum Generates New Family Medicine Advocates When Julie Thai, MD, MPH applied for MAFP’s Advocacy & Leadership Development Program in 2018, little did she know it would lead to igniting innovation within McLaren Flint Family Medicine Residency program’s curriculum.

Dr. Thai—who obtained her medical degree from Michigan State University and also holds a master’s degree in public health from Columbia University—said she was drawn to MAFP’s program in her intern year because she wanted to learn skills that would help her make positive changes in the Flint community.

“We must protect our patients, the practice of medicine, and the patient-physician relationship,” she said.

I want to make important changes to improve our practice which will, in turn, better our communities throughout Michigan.

- Julie Thai, MD, MPH Now embarking on its third cohort, MAFP’s biannual Advocacy & Leadership Development Program aims to equip family physicians, residents, and medical students for growing into family medicine advocacy leaders in their practices, programs, and communities.

Advocacy in Action A key component of MAFP’s program is developing and implementing an advocacy action plan in the months following the one-day immersion training in Lansing.

Past program scholars have held legislative meetings in their communities to provide forums for physicians, residents, and students to talk with their state lawmakers about issues of interest. Others have written articles for publication in Michigan Family Physician and helped craft advocacy priorities. Dr. Thai decided to do something completely different.

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“I designed an advocacy and health policy curriculum to educate residents about how healthcare policies are made at the state level, and to help them better understand the healthcare system infrastructure and how they can advocate within the structure,” she said.

The idea for the curriculum came to Dr. Thai last June, when she was selected to represent McLaren Flint Family Medicine Residency at Graduate Medical Education Advocacy Day. “Talking with state legislators about the need for funding resident training programs in the Greater Flint area inspired me to connect residents to policymakers through the curriculum so they can make shared decisions about policies that affect healthcare accessibility and delivery in Michigan,” she said.

Hands-on Elective The four-week elective is designed to teach residents how to advance the Academy’s advocacy priorities. Included are experiential activities, from discussing healthcare administration with the hospital’s chief executive officer and chief medical officer, to shadowing a legislator/ legislative aide at the state Capitol, to attending Michigan Family Medicine Advocacy Day. The curriculum was introduced to McLaren Flint Family Medicine faculty, residents, and medical students through two courses to gauge interest in the topics covered by the curriculum. Participants identified healthcare access, healthcare delivery, and prevention and public health as the top three areas of interest.

Based on the evaluations, 100% of attendees indicated their understanding of advocacy improved after the first course, Introduction to Advocacy, and the rate of interest in advocacy and health policy nearly doubled, explained Dr. Thai.

McLaren Flint Family Medicine Residency also hosted a resolution-writing workshop

Dr. Julie Thai attended the Jan. 30 Senate committee meeting on state legislation to reform the prior authorization process.

“I know my patients are largely dependent on me to help them navigate the complexities of our healthcare system, and the last thing we need is yet another barrier to delivering efficient and effective care. I support Senate Bill 612 to place more oversight and restrictions on insurance companies when it comes to prior authorizations and hope that change will be made to benefit those who are most affected by this—our patients.”

MEMBERS IN THE NEWS

for residents and found their knowledge of resolution writing increased by 50%.

Additionally, it learned that half were likely to write a resolution, compared to none at the beginning of the course.

“We are using this data to help us further develop the curriculum to meet the residents’ learning needs and interests,” said Dr. Thai.

Applications for the Dec. 2020 Advocacy & Leadership Development Program are being accepted at mafp.com/events.

Replicating Success Lauded as a success by McLaren Flint Family Medicine Residency leadership, the curriculum will gain national exposure when Dr. Thai presents at AAFP’s PDW (Program Directors Workshop) and RPS (Residency Program Solutions) Residency Education Symposium in Kansas City, MO, in April.

“This is the first time in the history of the program that a resident has had an innovation accepted for presentation at this symposium,” said program director Prabhat Pokhrel, MD, MS, PhD.

Do you have news to share about yourself, your practice, or a colleague? Email info@mafp.com and include Member News in the subject field.

Dr. Thai believes she was in the right place at the right time to take on this important endeavor and credits her program leadership for their support in creating the curriculum.

She also recognizes that working in an urban underserved area such as Flint has made this curriculum even more critical.

This curriculum has even inspired Hussein Saghir, DO, associate director of the McLaren Flint Family Medicine Residency program, to seek further training by completing a fellowship in Minority Health Policy at Harvard University.

Dr. Thai and Dr. Saghir are currently working on building a toolkit, which will be available on MAFP’s website at mafp.com, to help other residency programs develop and implement a similar health policy curriculum. Questions about the curriculum can be directed to Dr. Thai at Julie.thai@mclaren.org.

“Business of Medicine” sessions: • Create a Rewarding Family Medicine Career Path • Prep Like a Pro: Acing the Interview • Financial Well-being During Residency & Beyond • Understanding Your Employment Contract

PLUS networking with employers and recruiters

SPRING 2020 | MAFP.COM

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ACADEMY NEWS

MAFP Annual Meeting Members discuss and vote on resolutions at the MAFP Annual Meeting.

All MAFP members are invited to the 2020 MAFP Annual Meeting on Saturday, Aug. 8, 12:10-2:10 pm.

Held during the Michigan Family Medicine Conference & Expo at Detroit Marriott Troy in Troy, MI, the Annual Meeting serves as the platform for MAFP members to help shape the Academy, reflect on successes of the past year, and identify challenges that lie ahead.

Lunch will be served while members in good standing discuss and vote on resolutions, elect officers and directors, and hear presentations on the state of the Academy. President Ada Stewart, MD, FAAFP (Columbia, SC) will install MAFP’s incoming leaders and confer the Degree of Fellow.

There is no cost to attend the Annual Meeting, but advance registration is required (mafp.com/events).

Resolutions Any MAFP member in good standing is invited to submit a resolution for consideration at the Annual Meeting.

A resolution is a recommendation for establishing MAFP policy, addressing issues of concern, eliminating nonessential activities, or requesting that MAFP investigate or implement a program. Resolution proposals are due by June 24. Visit mafp.com/ get-involved/annual-meeting for instructions on how to write and submit a resolution. All resolution submissions will be reviewed and edited by the

Aug. 8, Troy, MI

Resolution Review Committee before being presented to the full membership prior to the meeting.

Resolution Review Committee MAFP is seeking members with experience writing and reviewing resolutions to join the newly formed Resolution Review Committee. The review process will include evaluating resolution drafts for clarity, formatting, and editing prior to the Annual Meeting so more time during the meeting can be spent discussing the merits of resolutions. The Resolution Review Committee application is available at mafp.com/get-involved/mafpcommittees.

AAFP Fellow Convocation Members elected to receive the AAFP Fellow designation (FAAFP) but who have not participated in an official convocation ceremony are invited to be conferred at MAFP’s ceremony taking place during the Annual Meeting. Email info@mafp.com or call 517.664.9086 to reserve your spot.

Active, life, and inactive members who have been active members for at least six years or have held a combination of resident and active membership for at least six years are eligible to apply for FAAFP status. Learn more about Degree of Fellow eligibility at aafp.org/ membership/involve/fellow.html.

MAFP Team Member Appointed to AAFP Commission Dana Lawrence, director of communications and member services at MAFP, was appointed to serve on AAFP’s Commission on Membership and Member Services for a three-year term that began Dec. 15. This commission—one of eight commissions that direct AAFP policies and programs—guides the AAFP’s membership efforts and assists constituent chapters in their membership endeavors.

“I am honored to be appointed to this commission and very excited to serve with family physicians and chapter staff from across the country in helping shape the Academy’s membership initiatives,” said Ms. Lawrence.

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EVENTS

Professional Development, CME & Networking January 2020 MAFP Member Mixer hosted by Rachel Klamo, DO in Rochester, MI.

Details and registration at mafp.com/events

April 1

May 20

October 14

Member Mixer–Hillsdale County

Member Mixer–Kalamazoo County

Michigan Reception @AAFP’s FMX

April 3

June 4

October 24

Member Mixer–Cheboygan County

Michigan Future of Family Medicine Student Conference

Hosted by Glenn Dregansky, DO FAAFP. Network, enjoy food and beverages. All membership levels are invited. ǀ 6:30-8:30 pm, Jonesville, MI

Member Mixer–Genesee County

Hosted by Mary Marshall, MD, RN, FAAFP. Network, enjoy food and beverages. All membership levels are invited. ǀ 6-8 pm, Grand Blanc, MI

May 1 Beyond Clinical & Curriculum Resident Conference

“Business of Medicine” sessions will help residents understand and negotiate the employment contract, ace their first job interview, and make sound financial planning decisions. Employers and recruiters are invited to exhibit to connect with soon-to-be new physicians. ǀ Okemos, MI

Hosted by Kristi VanDerKolk, MD. Network, enjoy food and beverages. All membership levels are invited. ǀ 6:30-8:30 pm, Kalamazoo, MI

Hosted by Loretta Leja, MD. Network, enjoy food and beverages. All membership levels are invited. ǀ 7:30-9 am, Mackinaw City, MI

July 17 Member Mixer–Oakland County

Hosted by Srikar Reddy, MD, FAAFP. Network, enjoy food and beverages. All membership levels are invited. ǀ 7-9 am, South Lyon, MI

Join Michigan colleagues for an informal gathering and complimentary hor d’oeuvres and beverages. ǀ 5-7 pm, Chicago, IL

Explore the breadth and depth of the family medicine specialty through panel discussions, handson clinical workshops, and residency fair. Exhibitor opportunities available. ǀ Detroit, MI

July 31

November 13-15 Family Medicine Midwest Conference

Member Mixer–Wayne County

Michigan Reception @ AAFP’s National Conference of Family Medicine Residents & Medical Students

May 14

August 6-9

November 14

Michigan Family Medicine Research Day

Michigan Family Medicine Conference & Expo

Women in Family Medicine Conference

Hosted by Chris Bush, MD FAAFP. Network, enjoy food and beverages. All membership levels are invited. ǀ 6:30-8:30 pm, Grosse Ile, MI

Educates physicians, residents, and medical students on the latest family medicine research in Michigan. Poster presentation abstracts accepted. ǀ Howell, MI

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Enjoy hors d’oevres and beverages while networking with residents, Michigan residency program directors and faculty, and medical students. ǀ 5:30-7 pm, Kansas City, MO

Premier annual gathering of family physicians in Michigan. Continuing medical education, networking, and fun! Sponsorship and exhibitor opportunities available. ǀ Troy, MI

Faculty, residents, and medical students from Midwest states convene to share innovative ideas and best practices, build a regional network dedicated to improve the health of all patients, and inspire student choice of Midwest family medicine residency programs. Oral and poster presentation abstracts accepted. ǀ Minneapolis, MN

Evidence-based strategies, education, and skill development to help women family physicians advance at various stages of their careers. ǀ Frankenmuth, MI

GETTING TO THE MEAT OF THE MEDITERRANEAN DIET Mediterranean-Style Eating with Lean Beef Supports a Healthy Heart The Mediterranean diet is one of the most popular eating patterns. It is often described as being rich in fruits, vegetables, whole grains, nuts/seeds and olive oil, and lower in sweets, sodium and red meat. Interestingly, many Mediterranean countries eat about the same amount of red meat or more as the United States, but those countries pair red meat with more fresh vegetables and fruits, whole grains and healthy oils.1 Recent research shows that a Mediterranean-style eating pattern that includes fresh* lean red meat can support heart health. The study demonstrates that following a Mediterranean-style eating pattern that includes up to 18 ounces of cooked, fresh lean beef and pork per week – along with poultry and fish – is just as effective at improving certain heart disease risk factors (such as blood pressure and total and LDL cholesterol) as a Mediterranean-style eating pattern that limits red meat.2

Why Include Lean Beef in a Mediterranean Diet?

You can rest easy knowing that along with being delicious, lean beef contains important nutrients, like protein, iron, zinc and B-vitamins that your body needs.3

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The eating pattern allows a wide variety of proteins (including fresh lean beef, pork, poultry, and fish) that support heart health, and can help keep you satisfied throughout the day.2,4

Beef is a delicious tasting, high-quality protein that can be enjoyed at any meal throughout the day. It’s easier to start and stick to a healthy eating plan when it is satisfying and enjoyable – and includes different foods and flavors.5

Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2015. Available at https://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf O’Connor LE, et al. A Mediterranean-style eating pattern with lean, unprocessed red meat has cardiometabolic benefits for adults who are overweight or obese in a randomized, crossover, controlled feeding trial. Am J Clin Nutr 2018, nqy075. https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqy075/5036105 U.S. Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference Legacy Release, April 2018. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl Leidy HJ,et al. The role of protein in weight loss and maintenance. Am J Clin Nutr 2015;101:1320S-9S. Wycherley TP, et al. Self-reported facilitators of, and impediments to maintenance of healthy lifestyle behaviours following a supervised research-based lifestyle intervention programme in patients with type 2 diabetes. Diabet Med 2012;29:632-9.

* Fresh meats were defined in the study as requiring no further preservation or processing beyond refrigeration or freezing; they are not cured, salted or smoked or include chemical preservatives.

SPRING 2020 | MAFP.COM

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