Michigan Family Physician Magazine Fall 2021

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FALL 2021

REENVISIONING

FAMILY MEDICINE RESIDENCY EDUCATION

Plus Meet new Michigan Academy of Family Physicians President Dr. Srikar Reddy and the 2021-2022 MAFP Board of Directors

Recruiting and Retaining Medical Assistants Clinical Tropical Medicine


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TABLE OF CONTENTS MAFP BOARD OF DIRECTORS Chair Mustafa “Mark” Hamed, MD, MBA, MPH, FAAFP President Srikar Reddy, MD, FAAFP President-elect Glenn Dregansky, DO, FAAFP Vice President Beena Nagappala, MD, MPH Speaker Rachel Klamo, DO Treasurer Bashar Yalldo, MD 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 Pamela Rockwell, DO, FAAFP Kristi VanDerKolk, MD, FAAFP Teniesha Wright-Jones, DO, FACOFP Resident Member Himanshi Chopra, MD Student Member Adjoa Kusi-Appiah Ex Officio, Chief Executive Officer Karlene Ketola, MSA, CAE

FMFM BOARD OF TRUSTEES

President Mary Marshall, MD, RN, FAAFP Vice President Mustafa “Mark” Hamed, MD, MBA, MPH, FAAFP Secretary/Treasurer Robert Jackson, MD, MMM, FAAFP Executive Vice President Karlene Ketola, MSA, CAE Trustees-at-Large Jennifer Aloff, MD, FAAFP David Kazanowski, MD Amy McKenzie, MD, MBA Elizabeth Pionk, DO, FAAFP

Jeanette Wilson, MD Bradford Woelke, MD Thomas Wolff, JD

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. ©2021 MAFP. All rights reserved.

Editor: Dana Lawrence

Michigan Academy of Family Physicians 2164 Commons Parkway, Okemos, MI 48864 517.347.0098 | mafp.com

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Reenvisioning Family Medicine Residency Education Cover Story

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8

When The Plane Takes Off, What Do You Value?

Community Comes from Connection

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President’s Message

CEO Insight

Scope of Practice, Telemedicine, Electronic Prescribing on Radar Screen

Practicing Globally: Clinical Tropical Medicine

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19

Focus on Students & Residents

Advocacy Update

How to Keep Your Current MAs While Trying to Hire New Ones Business Sense

Plus

Student Extern Strengthens Commitment to Detroit’s Homeless Family Medicine Foundation of Michigan News

Academy News p. 20 | Meet the Legislators p. 22 Members in the News p. 24 | Events p. 30


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When The Plane Takes Off, What Do You Value? By Srikar Reddy, MD, FAAFP A few years ago, my wife and I were taking a weekend trip to visit family and friends in South Carolina. After we boarded the plane and were about to depart, the pilot, in usual fashion, announced, “Cabin crew, prepare for takeoff.” I am not a novice when it comes to commercial flights, but I closed my eyes and for the 30-35 seconds between the plane picking up speed and lifting off the tarmac, it seemed as though everything important to me was simplified 6

FALL 2021 | MAFP.COM

and clear. You need not be on a plane to ponder what you value most in your life. In fact, before you continue reading, I ask you to close your eyes for 30-35 seconds to consider what you find most valuable in terms of your profession.

identify our core values. We wear multiple hats as family physicians, and our specialty is unique in that it allows us to care for patients of all ages, demographics, disease presentations, and socioeconomic backgrounds.

Shining in the Spotlight

We were the first to quickly adapt and implement alternative methods of care delivery when it was needed most at the outset of the pandemic. Whether through

It appears the COVID-19 pandemic over the past year-plus has made many of us stratify our priorities and dig deep to


PRESIDENT’S MESSAGE

Our future is on the runway ready for takeoff. Close your eyes for 30-35 seconds and answer the question, ‘What do you value most in your professional life?’

virtual care, remote patient monitoring, or vaccination clinics, family physicians were front and center—and our value has never been more evident. By nature, family docs tend to be quite selfless, without overt desire for recognition. Our goal: patients receiving the care they need. But, make no mistake, the time has come when our value and contributions to the medical field are on full display and beginning to be distinguished. We must not lose this spotlight. I am eager and excited, as your 2021-2022 MAFP president, to build on the current momentum at this critical time in history. I vow to continue leading our upward trend to raise awareness of the value of family medicine among our legislators, partners, patients, and neighbors over the next year.

Using Our Voice for Good

In the spring, I had the privilege of representing our Academy at Gov. Gretchen Whitmer’s press conference on COVID-19 vaccination in 12-15 year-olds. A family physician was chosen to address this public health topic because studies clearly show that patients and parents of patients trust the immunization advice of their primary care physician more than any other source. Continuing to elevate our collective voice and increasing visibility of the

importance of our specialty—not only for the healthcare system but in the lives of mothers, fathers, daughters, sons, grandparents, as well as employees—is essential to preserving and advancing the practice of family medicine. That’s why grassroots advocacy is so critically important. The old saying, “The squeaky wheel gets the grease,” holds true today. We must be the squeaky wheel that calls for greater investments in the primary care workforce and initiatives for reducing the income disparity between primary care and other specialties—this is essential for making family medicine more attractive to the aspiring physicians of tomorrow, as we face a growing shortage of family docs. And who is better than us to stand up for reducing administrative burden that takes us away from patient care? Prior authorization reform legislation that was reintroduced in the Michigan Legislature earlier this year is working its way through the legislative process, and your and your patients’ stories are needed to raise awareness of the urgency for change—visit HealthCantWait.org. Equally important is using our unified family medicine voice to support innovations that increase access to healthcare for all, such as authorization of and appropriate payment for telehealth

visits and the establishment of a permanent Medicaid primary care provider payment uplift to 100% of Medicare levels. These are just a few of the advocacy issues your Academy is working toward on your behalf. MAFP and our specialty need you to join us to protect the physicianpatient relationship and our scope of practice, as well as to ensure all Michigan residents have access to quality, affordable healthcare within a family physician-led medical home. It is time that we elevate recognition for family physicians like never before, and we work to strengthen the legislative and regulatory climate that is the foundation for Michigan’s primary care community. Our future is on the runway ready for takeoff. Close your eyes for 30-35 seconds and answer the question, “What do you value most in your professional life?”

Srikar Reddy, MD, FAAFP is president of Michigan Academy of Family Physicians. He practices family medicine at Ascension Medical Group in South Lyon. He also serves as Ministry Market regional medical director of virtual care for Ascension Medical Group Southeast Michigan and as a national Ascension virtual care lead and subject matter expert. FALL 2021 | MAFP.COM

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Community Comes from Connection By Karlene Ketola, MSA, CAE Well known author Brené Brown once shared, “Connection is the energy that is created between people when they feel seen, heard, and valued.” This is even more applicable today, as the past 18 months have taught us valuable lessons about the necessity of connection. As the dust settles post-pandemic, many of us are ready to get back to “normal,” whether at home or work. I know I’ve come to appreciate the importance of connection and being fully vaccinated, 8

FALL 2021 | MAFP.COM

as it provided the opportunity to visit with family and MAFP members this summer.

continuing their work to support our family medicine community.

With sincere appreciation, I thank our Michigan Academy of Family Physicians 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

As you know, Michigan Academy of Family Physicians 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 high-quality, cost-effective healthcare for patients of all ages.


CEO INSIGHT

I encourage you to mark your calendar to join your colleagues at the 2022 Michigan Family Medicine Conference & Expo, July 7-10, where we hope to once again convene in person at the historic Grand Hotel on one-of-a-kind Mackinac Island. 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, resident, or student, I hope you consider MAFP as your profession’s community. Here are two ways to stay connected as a valued member of our family medicine community:

Advocacy

Among the Academy’s many benefits is its professional and grassroots advocacy. Advocacy, in fact, is frequently rated No. 1 among members in terms of what the Academy does for them. Combined with the work of our advocacy team, the Academy leads members in sharing their bootson-the-ground perspectives with elected officials. Together, the Academy and our members have successfully advocated for: •

• •

• •

Protecting the scope of family medicine by stopping the advancement of legislation that would extend medical licensure to other groups of clinicians, such as naturopaths Reforming the prior authorization process to reduce administration burden and protect patients’ health Investing in primary care to ensure patients can access quality, costeffective, comprehensive primary and preventive care from a family physician-led team, when and where they need it Preserving the physician-patient relationship by opposing legislative interference in the practice of medicine Coordinating efforts with the federal and state government and local health departments to get vaccine doses into family physicians’ practices for administration among some of the hardest to reach patients Increasing the visibility of family physicians and the specialty via media roundtables; plus, current MAFP President Dr. Srikar Reddy stood

alongside Gov. Gretchen Whitmer and Michigan Department of Health and Human Services Chief Medical Officer Dr. Joneigh Khaldun to encourage parents to get their children ages 12 years and older vaccinated against COVID-19

Networking

Another key benefit of Academy membership is networking. Membership opens doors to building strategic connections with: •

Legislators, payers, partnering organizations, and families across the state, which increases awareness of the role, expertise, and value of family physicians The media, by—during two media roundtables this spring and summer— spreading news of the role of family physicians as trusted experts on issues such as childhood immunizations and the COVID-19 vaccine

Plus, now that COVID-19 restrictions have been lifted, plans are underway for mentor/ mentee relationship building among practicing family physicians and medical students in Michigan through MAFP’s facilitation. We also are eager to, once again in the near future, host in-person events for earning continuing medical education credits necessary for medical licensure in Michigan, American Board of Family Medicine certification, and Academy membership. In this issue, you will learn more about your Academy’s advocacy efforts and member initiatives, as well as other critical issues, including workforce development and the future of family medicine residency programs.

Giving Voice to Members

On July 24, MAFP held its virtual annual business meeting, where members elected the 2021-2022 MAFP Board of Directors and heard the vision of the

future of family medicine from Board Chair Dr. Mark Hamed, President Dr. Srikar Reddy, and AAFP Chair Dr. Gary LeRoy, who also conferred MAFP’s newest Fellows of the American Academy of Family Physicians. Nearly 60 members attended the business meeting and deliberated on six resolutions, several of which were forwarded to AAFP for consideration (page 21). Additionally, we recognized our 2021 “Academy” Awards honorees, whose accomplishments and dedication to family medicine were recognized during a virtual celebration following the Annual Meeting on July 24. I invite you to read about them on pages 24-28 and congratulate them on MAFP’s Facebook page. 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 2022 Michigan Family Medicine Conference & Expo, July 7-10, where we hope to once again convene in person at the historic Grand Hotel on one-of-akind Mackinac Island. As always, I encourage you to reach out and share your point of view and know you are seen, heard, and valued. We are stronger together and learning lessons each day as we continue evolving and innovating through the COVID-19 public health crisis, building connections, 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. FALL 2021 | MAFP.COM

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Scope of Practice, Telemedicine, Electronic Prescribing on Radar Screen By Matt Black

Spring 2021 saw a return to in-person legislative committee hearings, sessions, and votes at the state Capitol. With recission of the mask mandate in early May, those fully vaccinated against COVID-19 are no longer required to wear face coverings. Individuals giving testimony before House and Senate panels may choose to participate in the legislative process virtually or by coming to Lansing. While this (somewhat) return to normalcy was welcomed by most legislators and their staffs, it is still unknown what the fall will bring, as variants, most notably the Delta variant, continue to emerge and the flu season gets underway. Currently, virtual meetings remain the preferred meeting method for many advocacy groups, but most indicate their desire to resume faceto-face gatherings.

State Budget

The first week of July marked the beginning of the summer legislative recess, with state senators and representatives returning to their home districts to meet with constituents locally. Prior to their departure, both chambers focused on finalizing their respective policy and budget priorities. However, as of the writing of this article, the Fiscal Year 20212022 state budget is yet to be completed, with just the K-12 School aid funding earning 10 FALL 2021 | MAFP.COM

a stamp of approval. In the final week before leaving Lansing for the summer, the House sent its final omnibus budget bill to the Senate, but the Senate declined to act. The good news is that MAFP priorities have been included in the individual budgets passed by the House and Senate. The House budget includes: • •

Increased funding for MIDOCs, aimed at adding new community-based primary care residency positions Investment in the Michigan State Loan Repayment Program, which offers student loan repayment assistance for primary care physicians and nonphysician providers committed to serving in underserved areas State funding needed for continuation of the Healthy Michigan Plan, the state’s Medicaid expansion program that currently provides healthcare coverage for nearly 900,000 Michigan residents

Telehealth Bill

Regarding policy initiatives, MAFP has been monitoring several different bills that are moving through the Legislature. Among them is House Bill 4355, which MAFP strongly opposes. If passed, this bill would allow out-of-state physicians to provide telehealth services to Michigan residents without being

licensed to practice medicine in our state. Should this bill pass, it raises the potential of eroding continuity of care, infringing on the patient-physician relationship, and increasing healthcare costs. HB 4355, included in the House of Representatives’ bipartisan healthcare package, swiftly passed out of the House Health Policy Committee followed by the full House. It now awaits consideration by the Senate Health Policy and Human Services Committee. MAFP encourages members to contact legislators on the Senate panel as well as their own senator to urge opposition when HB 4355 comes up for a vote. Talking points are available at https://p2a.co/ snEjDhe.

CRNA Scope of Practice

Another bill of the House bipartisan package, HB 4359, expands the scope of practice for certified registered nurse anesthetists (CRNA) by allowing them to administer anesthesia to patients without physician supervision. MAFP joined most of the physician groups in opposing this bill. After passing the House in March, HB 4359 passed the Senate, with significant changes, in June. Under the substitute version of the bill, qualifications were established that CRNAs must meet


ADVOCACY UPDATE

before being granted autonomy, such as completing at least three years in practice. Gov. Gretchen Whitmer signed the bill, now Public Act 53 of 2021, into law July 13. Ever on the horizon is the potential for additional scope-of-practice expansion bills, and MAFP remains diligently opposed to efforts to expand or establish scope of practice for non-physician providers.

Electronic Prescribing Mandate Exemption

A third bill on our radar screen is House Bill 4659. MAFP helped craft this bill and supports its passage. HB 4659 would offer dispensing prescribers an exemption from the recently passed electronic prescribing mandate. It passed the House Health Policy Committee and then the full House in the final session days before summer recess. It now awaits consideration in the Senate, where discussions with the Senate Health Policy and Human Services Committee chair have already started. Michigan’s electronic prescribing mandate was approved by the Legislature at the end of 2020. It is modeled after the Centers for Medicare and Medicaid Services’ (CMS) guidelines that soon will require electronic prescribing for all controlled substances. Michigan’s bill went a step further to require all prescriptions, not only controlled substances, be prescribed electronically. Physicians who dispense out of their office would be left in a gray area, as Michigan’s definition for

dispensing prescribers does not match the federal definition. The MAFP advocacy team is also working with the Michigan Department of Licensing and Regulatory Affairs to establish financial hardship exemptions similar to those included in CMS exemptions.

Investment in Primary Care

The federal government granted states additional funding to help them rebound from the COVID-19 pandemic. In many cases, if the funding is not spent, it will be lost. MAFP is pushing for some of the funding to be invested in primary care—some ideas could include increasing reimbursement for certain services or adding dollars to loan repayment assistance options. Proposals are being explored in collaboration with state budget partners in the Legislature, the governor’s office, and the Michigan Department of Health and Human Services.

Aside from meeting with legislators in Lansing and sending emails to offer them your expertise, in-district work periods, such as in the summer and around holidays, offer opportunities to connect with your senator and representative at local fairs, festivals, townhall meetings, fundraisers, and coffee hours. Family physicians are the bedrock of healthy communities and sharing your perspective will help advance family medicine and the vision of MAFP to ensure all Michigan residents have access to quality, affordable healthcare within a family physician-led medical home. I encourage you to visit MAFP’s online Advocacy Center at mafp.com/advocacy and connect with me if you have any questions or would like to engage in the legislative process by offering testimony in support of or opposition to legislation in the future.

Grassroot Advocacy

While professional advocacy is an important tool for educating legislators, equally important is grassroots advocacy. Time and time again we hear from legislators how important it is that family physicians continue to raise concerns, share their experiences, and offer suggestions when it comes to legislation impacting patients, the practice of environment, and delivery of care. Constituents speaking directly with their elected officials is powerful.

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.

Join the Academy’s Key Contacts Advocacy Network to Ensure the Future of Family Medicine Legislators and policymakers need to hear from family physicians, whose unique perspectives and expertise are invaluable resources in the fight for family medicine. The American Academy of Family Physicians’ Key Contacts Program provides everything needed to create and leverage opportunities to educate elected officials on the issues that most affect family physicians’ practices, patients, and communities. More specifically, key contacts: • Build, maintain, and enhance relationships with members of Congress and their staffs while communicating AAFP legislative and policy priorities • Help amplify AAFP Speak Out campaigns and other calls to action • Contribute to the Academy’s political action committee, FamMedPAC Visit bit.ly/AAFP-key-contacts to learn more by watching a short video and sign up for AAFP’s Key Contacts Program for more information. Have questions or already have an established relationship with a member of Congress? Contact AAFP’s senior manager of political affairs and member engagement, Heather Cutler, at hcutler@aafp.org.

FALL 2021 | MAFP.COM

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Dr. Eli Eisman and Dr. Jaclyn Israel at Mt. Mulanje in Malawi.

Practicing Globally: Clinical Tropical Medicine By Eli Benchell Eisman, DO, PhD and Jaclyn Israel, DO As final-year students at Michigan State University College of Osteopathic Medicine, we had the chance to enroll in the program’s Clinical Tropical Medicine rotation. This opportunity is facilitated by University Distinguished Professor Dr. Terrie Taylor and operates in partnership with the Kamuzu University of Health Sciences. We enrolled as visiting students at the university and fully integrated with medical teams at Queen Elizabeth Central Hospital in Blantyre, Malawi. We worked alongside medical students, interns (recent medical school graduates distributed nationally by the Ministry of Health), registrars (residents), and consultants (attendings). Central hospitals are publicly funded by the Ministry of Health, offer primary care and specialist services, and are referral hubs for patients requiring escalated levels of care. Medical services are offered to patients free of charge, which is separate from the parallel “private practice,” or feefor-service available. 12 FALL 2021 | MAFP.COM

As incoming family medicine residents focused on primary care in underserved areas, we chose services that align with our interests—obstetrics and gynecology, and internal medicine.

OB-GYN Reflections of Dr. Jaclyn Israel

My first delivery on the labor ward was an earth-shattering experience. There was indication for an emergency cesarean section; however, the mother was on the “free” side of the labor ward and low on the priority list. The team pressed on with a vaginal delivery, failing both forceps- and vacuum-assisted deliveries. With much effort of all involved, a lifeless baby was finally brought into this world. In the immediate moments that followed, delivery of the placenta was attempted, but it became immediately clear that there was more going on than we were prepared for. The mother was bleeding more than any obstetrical patient I had ever seen. I cannot speak Chichewa (one of nine recognized languages in Malawi), but I spoke more urgently, and clinicians began to move more quickly.

To be honest, this part was a blur. There were no methods to measure how much blood the mother had lost, and there didn’t seem to be a standardized protocol when it comes to postpartum hemorrhage. The mother was declared dead in less than 15 minutes and, just like that, people dissipated. The ward was quiet again as the cleaning staff came to take care of the mess. In complete shock, I walked on to offer assistance elsewhere.

Internal Medicine Reflections of Dr. Eli Benchell Eisman

The internal medicine wards at Queen Elizabeth Central Hospital are sensational in the truest sense of the word. When I first walked into Bay 3, the male ward, I was overwhelmed by the cacophony of beckoning in Chichewa and English, coupled with the familiar clamoring of rounding teams and hospital staff as they moved about their duties. All this was audible from the hallway between the sister’s (nurse’s) and clerk’s (ward registrar) offices just beyond the ward threshold.


FOCUS ON STUDENTS & RESIDENTS

As I moved further down the corridor toward the ward, the dissonant chorus was matched by distinct smells hovering in the stale air seeping from behind closed doors. Passing by the high-demand unit, I was astounded to see how the open-air bays were brimming with patients and their guardians—family members who stay in the hospital to provide the individualized care and feeding that is impossible with a nurseto-patient ratio of 1 to 50. The severity of the diseases I saw during my time with the Bay 3 team was often the most extreme versions of each disease: disseminated tuberculosis and TB meningitis, HIV/AIDS with cryptococcal meningitis overlying PML or PCP, and severe malaria. These are pathologies that inexorably play out to their most devastating outcomes when interventions are limited or simply unavailable.

Perspectives on Malawian Medicine Resources

One of the starkest differences compared to U.S. medicine we experienced in Malawi was the transition to operating in a resourcelimited environment—notably, the absence of consistent access to labs, imaging, and medications. Overcoming these barriers to care required adjusting our expectations. In some instances, there is a reliance on older technology, such as a fetoscope for the auscultation of fetal heart tones in the absence of doppler ultrasound. Another instance would be using physical exam findings to determine stroke type with the Siriraj Stroke Score when computed tomography is unavailable. The level of ingenuity in Malawian medicine is equally impressive, as evidenced by the fact that hospital items are

repurposed depending on the setting and need. A single-use latex glove, for example, is worn not only as personal protective equipment but also operates as a sterile field agent, a tourniquet, an ice pack, and a sample collection container. Thankfully, through international partnerships, some technologies are increasingly available for integration within the healthcare system.

Organization

The expediency with which patient care occurs in the U.S. is striking by comparison to how care is provided to patients at Queen Elizabeth Central Hospital. In the U.S., personnel and protocols govern systems to maximize productivity and minimize risk. By contrast, systems in Malawi can be inelegantly cumbersome and, at worst, chaotically burdensome. Routine hospital tasks can take days, delaying clinical decisionmaking and impacting patient outcomes. Moreover, conveying health information is also a tremendous challenge in Malawi. Over the course of the hospital stay, progress notes are recorded in paper charts that are kept in a rudimentary file. On discharge, hospital summaries are entered into health passports (an index card-sized paper notebook), which act as traveling health records of past medical histories, including hospital admissions and outpatient encounters at health centers. While these notebooks can be easily lost or damaged, poorly legible, or contain incomplete information, they represent a simple solution to ensuring continuity of care in a country without access to electronic health records. Disordered patient handoffs also result in errors. A young woman admitted for acute kidney injury and anemia secondary to malaria developed pyelonephritis after her

Eli Benchell Eisman, DO, PhD graduated from the Michigan State University College of Osteopathic Medicine in May 2021 and is now in his intern year at Henry Ford Hospital Family Medicine Residency in Detroit. He received Family Medicine Foundation of Michigan’s student externship award in 2020 and currently serves on MAFP’s Member Engagement Committee.

chart was lost. She was not seen by a single clinician for six days. In another example, an elderly male admitted for hypertensive emergency went 48 hours after admission without a single blood-pressure check. For many of us who choose to pursue a career in medicine, we arrive at the care decision driven by a commitment to service. Unique amongst the medical specialties, family medicine offers an exceptionally broad scope of practice and inherent flexibility. This appeals to the prospect of customizing our practice to attend to the needs of the communities in which we live and work. The expansiveness of the family medicine training model offers a prime opportunity to participate in global health initiatives. Our time in Malawi reaffirmed the importance of building the interpersonal relationships that are critical throughout medicine but especially in family medicine. Despite the language barrier we experienced in Malawi, saying “Zikomo” (a catch-all phrase in Chichewa that covers everything from “thank you” to “excuse me”) and offering a smile, even from behind a mask, was enough to begin building connections. By the end of a broken Chichewa and English conversation, an acquaintance becomes a friend and a family member. We are eminently grateful to our colleagues at Kamuzu University of Health Sciences, who were incredibly welcoming and generous. The people we met were excited and eager to share their culture, food, homes, and hearts, and we tried to be open and willing to accept all they had to offer. We now have lifelong friends, and we hope one day we will be able to return the favor and share our homes as well.

Jaclyn Israel, DO graduated from the Michigan State University College of Osteopathic Medicine in May 2021 and is now in residency at the Central Maine Family Medicine Residency program. She was the 2020-2021 student member on MAFP’s Board of Directors and also served on Family Medicine Foundation of Michigan’s Student and Resident Education Committee before relocating to Lewiston, Maine, for residency training. FALL 2021 | MAFP.COM

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Reenvisioning Family Medicine Residency Education By Warren P. Newton MD, MPH and Karen Mitchell, MD, FAAFP Eighteen months ago, family medicine set out to re-envision its residency education. The seven academic and clinical organizations defined key questions and then used these questions to frame focus groups, surveys, and commissioned papers leading to a national summit Dec. 6-7, 2020. All in all, over 3,500 people participated in the process and a permanent website curates the products.1 These writings are the products of the process. They are diverse and passionate, like the specialty and the people who created them, but what are the big messages going forward?

The Time Is Now

The increasing gap in health outcomes between the United States and comparable countries2 is a wake-up call, as are reduction in life expectancy3 and rediscovery4 of shameful disparities of health outcomes across race, ethnicity, and class. More broadly, these trends represent the coming of the end of an age in which technical advances from antibiotics through the first steps of genomics have led to dramatic improvement in health but now are increasingly limited by a healthcare system that provides poor access; is deeply disintegrated; and unable to address cost, quality, or many aspects of patient experience. The COVID-19 pandemic has taught us this again. Reform is needed. 14 FALL 2021 | MAFP.COM

The recently published National Academies of Science, Engineering and Medicine report Implementing High Value Primary Care5 lights the way. The first National Academies study on primary care in 25 years, the report underscores that primary care is a public good and the foundation of healthcare. The report argues for access to primary care for everyone, training primary care teams where people live and work, and establishing governmental and financial accountability for the largest healthcare platform in the United States. Reform is needed.

Of AAFP’s 133,500 members, nearly 17,000 are family medicine residents A good place to start is residency education, and the Accreditation Council for Graduate Medical Education (ACGME) major revision of residency standards in family medicine provides an opportunity. A distinguishing feature of the U.S. healthcare system is the close relationship between residency accreditation and board certification. We have been the envy of the

world, and the development of residency education has been a major driver of the progress we have made since the passage of Medicare and governmental funding of residencies. But the ongoing development of that system, with its bias toward subspecialization and incomplete response to the needs of society, has become part of the problem. Family medicine can play an important role in achieving the needed reforms. The specialty is a child of the social protest of the 1960s. It developed the largest and most widely distributed group of community-based personal physicians; insisted on recertification throughout a career and ongoing chart audits; brought residency education out of the hospital; and included educational objectives, behavioral health, and practice management. Family medicine made a difference in the 1960s. We have an opportunity to do so again.

Education Matters

It is important to underscore the importance of education. In an age in which information technology has become both ubiquitous and a dominant financial driver of our economy, it is perhaps understandable that education is often likened to downloading a file. But true education in clinical care is much more


COVER STORY

Transformation of healthcare in the United States will not happen unless there are more family physicians—but that expansion does not happen unless the best and brightest in every medical school class go into family medicine.

than information transfer. It is about variety and volume of the right kinds of clinical experience and assessments, the development of clinical judgement, and continuity of teachers and teaching. It requires skilled faculty and coproduction by learners and patients. It also takes time. Residency is the right initial target for medical education reform. Residency is when MDs and DOs become doctors. Residency matters. Residents learn by doing; and what they learn by doing, they continue to do for at least 20 years. The evidence is mounting that rates of operations and complications, use of medications, and the cost-effectiveness of care and location of practice are imprinted in residency practice.6 If we are serious about improving the healthcare system, if we want to address the quadruple aim, we must begin with changes in residency education. A corollary is that the residency practice is the curriculum. A traditional view of education lays out curricular objectives and goals. These are important but not sufficient in the residencies we hope to develop. Part of the challenge is we need to focus on what is learned rather than what is taught. More importantly, however, we need to understand that residency is much more than knowledge transfer and technical skills. Most important are decision-making, judgment, and the professionalism to lean into and respond over time to patient and community needs. And it is in the practice—taking care of patients over time in continuity practice, in hospitals, and in many other settings—that critical attitudes and habits are developed. High standards for processes and outcomes in all resident practice settings are, therefore, foundational.

Should we train new kinds of doctors who can help lead change in healthcare, or change healthcare to nurture the development of the right kind of doctors? Our answer is yes; we need to do both. Like many, the authors represented in this special issue have worked hard and with many partners to both ends. Now the need for change is urgent and will take a long time to fulfill. So, we must work on both fronts. This is both the challenge and the opportunity for all residency faculty and program directors.

Evolution or Revolution?

Do the ideas for changes in residency education in this issue constitute evolution or revolution? Of course, the papers are diverse and passionate; it will take further dialogue, innovation, and time to implement change. Asserting first-contact care, continuity, comprehensiveness, and coordination of care as the foundation of family medicine education7 and maintaining a broad scope

curricular foci will be augmented by implementation of competency-based assessment,13-16 needed reform of didactic curriculum,17 and reforms in our national system of graduate medical education.18,19 Taken together, and with the changes in payment and regulation called for by 400,000 physicians,20 they can help usher in a new direction for healthcare. We seek a new paradigm of care—and residency education.21 How medical students respond will also be important. In recent months, there has again been dialogue about the tension between quantity and quality of medical students going into family medicine. The goal set by Family Medicine for America’s Health—that 25% of American medical students will go into family medicine—is aspirational, and others have questioned both the feasibility and the wisdom of setting such a goal,22 emphasizing instead the quality of people going into family medicine.23 We believe both are important. Transformation of healthcare in the United States will not happen unless there are more family physicians (as well as other members of the primary care team)—but that expansion, as well as change in healthcare, does not happen unless the best and brightest in every medical school class go into family medicine. Best and brightest means looking like our patients, in terms of diversity of race and gender, but also ability, organization, work ethic, and above all the commitment to service to patients and communities. We seek medical students who can go into any residency they choose. We also believe that innovations and outreach to communities by residencies will increase

Residents account for 20% of MAFP’s membership of practice harken of our roots in general practice. Taken seriously, they suggest a strategy of evolution. On the other hand, making the practice the curriculum,8 putting patients at the center of the residency,9 making residencies more accountable to their communities,10,11 and asking sponsoring institutions to support more robust residency education12 and care constitute a dramatic change in the directions and intent of family medicine residency education. We hope that these

FALL 2021 | MAFP.COM

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COVER STORY interest in family medicine. The role our residency directors and faculty play will be critical. The spotlight now turns to the ACGME Review Committee for Family Medicine which writes the residency standards. The major recommendations in these papers— the foundational role of the four Cs, a broad scope of care, the practice is the curriculum, competency-based medical education, and the need for a residency educational system more capable of both innovation and standardization, and more social accountability—are clear. By the time you read this, the ACGME Writing Committee will have identified the major themes of the changes and will have begun to draft the new residency standards. We encourage all readers to participate in the feedback about the new standards, and we thank you for your significant participation so far. Beyond the immediate process of drafting new residency standards, we hope for debate and discussion within our discipline. The National Academies report5 calls for a recommitment to primary care as a public good and as the foundation of medicine and recommends sweeping changes in payment, access, community-based education, health information technology, and governmental accountability. As with all major changes, it starts with us, individually, and as a specialty. Now is the future of family medicine.

Source: Newton WP, Mitchell K. Reenvisioning Family Medicine Residency Education. Fam Med. 2021;53(7):487489. https://doi.org/10.22454/ FamMed.2021.459102. Used by permission from the Society of Teachers of Family Medicine.

References 1. Starfield Summit Re-Envisioning Family Medicine Residency Education. https://residency.starfieldsummit.com/. Published 2020. Accessed September 12, 2020. 2. National Research Council; Institute of Medicine. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Woolf SH, Aron L, editors. Washington, DC: National Academies Press; 2013. https://www.ncbi.nlm.nih. gov/books/NBK115854. Accessed May 27, 2021. 3. Woolf SH, Schoomaker H. Life expectancy and mortality rates in the United States, 1959-2017. JAMA. 2019;322(20):1996-2016. doi:10.1001/ jama.2019.16932 4. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003. https://www.ncbi.nlm.nih. gov/books/NBK220358/. Accessed May 28, 2021. 5. National Academies of Sciences, Engineering, and Medicine. 2021. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press; 2021. doi:10.17226/25983. 6. Phillips RL Jr, Holmboe ES, Bazemore AW, George BC. Purposeful imprinting in graduate medical education: opportunities for partnership. Fam Med. In press. 7. Bazemore A. Sailing the 7Cs: starfield revisited as a foundation of family medicine residency redesign. Fam Med. In press. 8. Neutze D, Hodge B, Steinbacher E, Carter C, Donahue KE, Carek PJ. The Practice is the curriculum. [published online ahead of print May 10, 2021]. [published online ahead of print May 10, 2021]. Fam Med. 2021. doi:10.22454/ FamMed.2021.154874 9. Lehmann C, Liao W. The patient voice: participation and engagement in family medicine practice and residency education. [published online ahead of print May 10, 2021]. Fam Med. 2021. doi:10.22454/FamMed.2021.327569 10. Carek P. Ongoing self-review and continuous quality improvement among

Warren P. Newton, MD, MPH is president and chief executive officer of the American Board of Family Medicine, and he oversees the ABFM Foundation and Pisacano Leadership Foundation. Dr. Newton previously served as executive director of the North Carolina Area Health Education Center, a national leader in practice redesign, continuing professional development, health careers programming, and innovation in graduate medical education; and vice dean of education at the University of North Carolina School of Medicine. From 1999–2016 he served as the William B. Aycock professor and chair of Family Medicine at UNC. Dr. Newton has served as a personal physician for 34 years. 16 FALL 2021 | MAFP.COM

11. 12. 13.

14.

15.

16.

17.

18.

19.

20.

21.

family medicine residencies. Fam Med. 2021;53 (In press). Wheat SJG. Community: the heart of family medicine. Fam Med. 2021;53 (In press). Kaufman A. Social accountability and graduate medical education. Fam Med. 2021;53 (In press). Holmboe ES. The transformational path ahead: competency-based medical education in family medicine. [published online ahead of print May 17, 2021]. Fam Med. 2021;•••. doi:10.22454/ FamMed.2021.296914 Saultz J. Competency-based education in family medicine residency education. [published online ahead of print May 17, 2021]. Fam Med. 2021. doi:10.22454/ FamMed.2021.816448 Fowler N, Lemire F, Oandasan I, Wyman R. The evolution of residency training in family medicine: a canadian perspective. [published online ahead of print May 17, 2021]. Fam Med. 2021. doi:10.22454/ FamMed.2021.718541 Newton WP, Magill MK. What family medicine can learn from other specialties. [published online ahead of print May 26, 2021]. Fam Med. 2021. doi:10.22454/ FamMed.2021.976389 Zakrajsek T, Newton WP. Promoting active learning in residency didactic sessions. [published online ahead of print May 26, 2021]. Fam Med. 2021. doi:10.22454/FamMed.2021.894932 Carney PA, Ericson A, Conry CM, et al. Financial considerations associated with a fourth year of residency training in family medicine: findings from the Length of Training Pilot Study. Fam Med. 2021;53(4):256-266. doi:10.22454/ FamMed.2021.406778 Douglass AB, Barr WB, Skariah JM, et al. Financing the fourth year: experiences of required 4-year family medicine residency programs. Fam Med. 2021;53(3):195-199. doi:10.22454/ FamMed.2021.249809 Stewart AD, Martin S, Goza SH, et al. Unified Voice, Unified Vision, Changing Primary Care Finance. https://static1.squarespace.com/ static/5fb2d43b0297530c833714e1/t/5fe3 5a5f0c3b8c5933aa7122/1608735327908/ Unified+Voice+Unified+Vision++Open+Letter.pdf. Accessed April 14, 2021. Saultz JW. Revolutionary leadership and family medicine education. Fam Med. 2008;40(4):277-280.

Karen Mitchell, MD, FAAFP is vice president of Medical Education at American Academy of Family Physicians. With over 30 years of family medicine teaching experience, she served as program director of Ascension Providence Family Medicine Residency in Southfield, Michigan, in 2008-2018, then joined the AAFP staff. She is a past president of the Association of Family Medicine Residency Directors and Michigan Academy of Family Physicians, and past chair of the American Board of Family Medicine. She was recognized by MAFP with the 2018 Volunteer Leadership Award, the 2017 Michigan Family Medicine Educator of the Year Award, and the 2008 “Archie” Award of Excellence.


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BUSINESS SENSE

How to Keep Your Current MAs While Trying to Hire New Ones By Jodi Schafer, SPHR, SHRM-SCP

QUESTION: I am trying to fill a medical assistant position and am not having a lot of luck. When I talk to my colleagues, it seems I am not alone in my recruiting struggle. There are several factors at play—inadequate training to meet current practice demands, inflated unemployment payments due to the federal subsidy, and ongoing fears and/or family demands due to COVID-19. While I’m trying to work every angle, the clock is ticking. My team is doing more with less, and I can see the signs of burnout all around me. The worst thing that could happen is for me to lose one of my existing staff at this stressful point in time. What can I do to retain my current team in this challenging environment, and do you have any ideas for growing my MA talent pool? ANSWER: As you know from talking

with other practices, hiring for certain positions has become incredibly difficult and expensive. The drop in qualified applicant numbers has led to a supply/ demand dilemma, and starting wages are rising drastically as a result. Some practices have grown so desperate they have started poaching employees from colleagues in the community. You are right to worry about hanging on to the staff you have. Losing them to burnout or the practice down the street is a real threat. To ward off unwanted departures, you need to find out how your staff perceive their job responsibilities, their workload, your management style, the practice policies and protocols, their wages and benefits, etc. before it’s too late. Talking to your current MA team members, one at a time, for the purposes of retaining them is referred to as a “stay interview.” These conversations provide insight into why an employee chooses to stay with your practice and what might cause them to leave. While pay may be one factor that needs adjusting because of the current job market, it probably is not the only change, nor the most meaningful change, you could make to improve overall job satisfaction. If you’ve never conducted a stay interview before, it can be a little nerve-wracking. You may be anxious to hear what employees will say, and employees may be hesitant to tell you the truth. It’s best to set the stage 18 FALL 2021 | MAFP.COM

for a stay interview in advance of the actual meeting. Let your staff know that you recognize the stress and added demands that have been placed upon them over the last 16-plus months and you want to do what you can to support them and make your practice a great place to work. Then, let them know you’ll be having an informal talk with each of them to find out how they are doing, what they like about their job and the work environment, and what you could do to make things even better. When the time comes to speak with your employees, follow the 80/20 rule. Spend 80% of the time listening and 20% of the time probing further and taking notes. This is about them and their perspectives, so let them do most of the talking. Use these five classic stay interview questions to get you started, but feel free to dive deeper based on the responses provided: • • • • •

What do you look forward to each day when you come to work? What are you learning here, and what do you want to learn? Why do you stay here? When is the last time you thought about leaving us, and what prompted it? What can I do to make your job better for you?

As for how to grow your MA talent pool, I have several creative suggestions to help you in the short term. One of my clients has experienced a lot of success connecting

with recent graduates who aspire to apply to physician assistant, nurse practitioner, or nursing school. These programs are competitive, and applicants have a desire (or in some cases a requirement) to have practical experience on their resume. Patient contact hours can be hard to come by, so applicants in this boat are not price shopping. They are typically looking for part-time or per-diem work during this transitional period, so you won’t have the added cost of benefits either. The trade-off is you will need to provide them with training, but I have found these candidates to be bright, motivated, and invested in making a good impression. Remember, they need a positive recommendation, along with the experience, to meet their career goals, so it’s a win-win during this challenging time. Jodi Schafer is a certified senior professional in human resources (SPHR, SHRM-SCP) and the owner of Human Resource Management Services (HRM). She has a bachelor’s degree in psychology and education from Kalamazoo College and over 20 years of experience in human resources management. She was recognized as one of the “10 Over the Next Ten” in the next generation of business leaders by the Lansing Regional Chamber of Commerce and accepted the MSAE Association Choice Award on behalf of HRM for the consulting services category.


FAMILY MEDICINE FOUNDATION OF MICHIGAN NEWS

Student Extern Strengthens Commitment to Detroit’s Homeless During May, Anneliese Petersen—now a fourth-year student at Wayne State University School of Medicine—took part in Family Medicine Foundation of Michigan’s (FMFM) 2021 clinical externship funded jointly by the American Academy of Family Physicians Foundation. “Year after year, we get to watch a student explore the specialty and, as a result, develop an even deeper commitment to pursuing a family medicine career than they had had prior to the externship,” said Karlene Ketola, MSA, CAE, chief executive officer of MAFP and executive vice president of its philanthropic arm, FMFM. Anneliese dedicated her externship time to Street Medicine Detroit, a nonprofit organization affiliated with

WSU that provides medical care and supportive services to those experiencing homelessness in Detroit. “I find that Street Medicine embodies the core of family medicine, as we bring medical care out to meet our patients where they are, eliminating barriers and bridging the gap that exists between the medical and homeless communities,” she said. Anneliese serves as president of the organization, working under the mentorship of faculty advisor and medical director, Richard Bryce, DO. During her externship, Anneliese helped implement many needed changes within the Street Medicine Detroit structure as it bounced back from a COVID-induced pause, trained the new board members to lead their medical student peers in care alongside a preceptor, and got the inpatient consult up and running with the new third-year students.

“The consult service is a unique part of Street Medicine, allowing us to increase our continuity of care as we see our patients in the hospital and can then provide followup care on the street after discharge. It has impacted the care that I provide, and I hope that I will be a physician who can work to ensure my patients have access to the medications, supportive services, and follow-up care they need after a serious illness,” she said. Anneliese is a rising star in family medicine, shared Dr. Bryce, who went on the say that, “Her dedication and compassion are second to none. Her exceptional care given to those facing homelessness inspires me to remember the most important aspects of practicing family medicine.” Student members of MAFP are eligible to apply for the annual externship. Applications for the 2022 program are due by April 1 at mafp.com/membership/ medical-students/externships. n

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Meet Your New Academy President and Board

On Saturday, July 24, during Michigan Academy of Family Physicians’ virtual annual membership meeting, Srikar Reddy, MD, FAAFP was installed as the 2021-2022 board president. His oneyear term began immediately following the installation ceremony led via livestream by American Academy of Family Physicians Chair Gary LeRoy, MD, FAAFP. Dr. Reddy is a family physician affiliated with Ascension Medical Group in South Lyon, where he specializes in preventive medicine, adolescent and behavioral medicine, sports injury care, and virtual care visits.

He also serves as the ministry market regional medical director of virtual care at Ascension. In this role he was responsible for the implementation of a virtual care platform in ambulatory and urgent care settings for Ascension Medical Group Southeast Michigan. He also is a national Ascension virtual care lead and subject matter expert involved with establishing clinical care guidelines and maintaining quality control across all markets, as well as a physician lead for Ascension Michigan’s remote patient monitoring. Dr. Reddy earned his Doctor of Medicine from the Saba University School of Medicine, an accredited university in the Dutch West Indies, and completed family medicine residency at Mount Carmel Graduate Medical Education in Columbus, Ohio, where he served as the 2009-2010 chief resident. He achieved the Degree of Fellow from the American Academy of Family Physicians (FAAFP) in 2014 . Prior to being elected president of MAFP, Dr. Reddy served as president-elect, vice president, speaker, and a director on the board.

As MAFP president, Dr. Reddy will work with the Board of Directors (opposite page) to help set the agenda for the upcoming year. In addition, he will be one of the leading voices representing Michigan family physicians on local, state, and national issues. Among his issues of focus are investing in expanding broadband internet access across the state and increasing access to/making permanent telemedicine visits. From his experience as a telehealth expert, Dr. Reddy is committed to advocating for: • •

Removing obsolete restrictions on the location of the patient and the physician Maintaining and enhancing the U.S. Department of Health and Human Services’ authority to determine appropriate providers, services, and modalities for telemedicine Ensuring clinicians at federally qualified health centers, critical access hospitals, and rural health clinics can provide telehealth services outside of the COVID-19 public health emergency Removing restrictions on Medicare beneficiaries’ access to mental and behavioral health services offered through telemedicine

AAFP Degree of Fellow Conferred During Annual Meeting During the Michigan Academy of Family Physicians Annual Meeting on July 24, American Academy of Family Physicians Chair Gary LeRoy, MD, FAAFP conferred the Degree of Fellow to 11 family physicians. AAFP represents 133,500 family physicians, family medicine resident physicians, and medical students. Its Degree of Fellow—denoted by the post-nominal initials FAAFP—was established in 1971 by the Congress of Delegates as an avenue for special recognition of AAFP members who have distinguished themselves among 20 FALL 2021 | MAFP.COM

their colleagues and in their communities, by their service to family medicine, the advancement of healthcare to the American people, and their professional development through medical education and research. This year’s fellowship class brings the total number of AAFP Fellows to more than 17,500 nationwide and 2,375 in Michigan. To learn more

about the requirements of applying for the Degree of Fellow, visit aafp.org/ membership/welcome-center/ involve/fellow.html.


ACADEMY NEWS

2021-2022 MAFP BOARD OF DIRECTORS Chair: Mustafa “Mark” Hamed, MD, MBA, MPH, FAAFP President: Srikar Reddy, MD, FAAFP President-elect: Glenn Dregansky, DO, FAAFP Vice President: Beena Nagappala, MD, MPH Speaker: Rachel Klamo, DO Treasurer: Bashar Yalldo, MD AAFP Delegates: Robert Jackson, MD, MMM, FAAFP, and Loretta Leja, MD AAFP Alternate Delegates: Tina Tanner, MD, FAAFP, and 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 Pamela Rockwell, DO, FAAFP Kristi VanDerKolk, MD Teniesha Wright-Jones, DO, FACOFP Resident Member: Himanshi Chopra, MD Student Member: Adjoa Kusi-Appiah Ex-officio: Karlene Ketola, MSA, CAE, chief executive officer

Membership-passed Resolutions Headed to AAFP for Consideration Members in attendance at MAFP’s 2021 Annual Meeting considered the following six member-proposed resolutions: • • • • •

21-01: Advocate for Evidence-based Treatment of Obesity as a Chronic Disease 21-02: Support Medication Assisted Treatment for Opioid Use Disorders 21-03: Advocate for Nursing Home Healthcare Reform 21-04: Advocate for Jail and Prison Healthcare Reform 21-05: Eliminate Socioeconomic and Racial Disparities in Reproductive Health

21-06: Utilization of Comprehensive Sex Education Resources Beyond Abstinence

Following approval of resolutions 1, 3, 4, and 5, they were sent to American Academy of Family Physicians. The resolutions will either be discussed by the Congress of Delegates, or forwarded to an AAFP commission or staff for additional work. Resolution 2 was referred to the MAFP Board of Directors for further consideration. Resolution 6 will be acted upon by MAFP. MAFP’s online resolution submission form (mafp.com/get-involved/

resolutions) is always open. If you have an idea, concern, or issue to be solved, you are encouraged to submit it to MAFP in the form of a resolution to be discussed at the next Annual Meeting. All members in good standing, whether a practicing physician, resident, or medical student, are eligible to submit and vote on resolutions. To learn more about the six resolutions passed at this year’s Annual Meeting, visit mafp. com/get-involved/annualmeeting. FALL 2021 | MAFP.COM

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Making Michigan a Better Place for All By Matt Black

On either side of the aisle within the Michigan House of Representatives, Rep. Graham Filler (R-DeWitt) and Rep. Lori Stone (D-Warren) are equally invested in bettering the health and well-being of Michiganders.

Rep. Graham Filler for Michigan residents,” he said. When it comes to healthcare, Rep. Filler’s top priority is for Michiganders to have access to reliable care, especially now during the pandemic. He also is focused on ensuring COVID-19 vaccines are available to everyone and the vaccines are being used. Prior to serving in the Michigan Legislature, Rep. Filler was an assistant attorney general, where he worked on physician licensing and compliance. This role and his marriage to a board-certified OB-GYN, Dr. Alicia Filler, have given him a greater understanding and perspective of the ongoing training and education required for medical licensure of physicians and non-physician providers.

this open communication and dialogue, he said he gains a greater understanding of the potential impact of legislation. Of great concern to the representative is the potential erosion of physician oversight. It is common, he said, for several scopeof-practice bills to be introduced every legislative session. One example is the recently passed House Bill 4359, which allows certified registered nurse anesthetists to administer anesthesia without physician supervision. Rep. Filler voted against this bill twice—when it was before him as a member of the House Health Policy Committee, and then when it came to the House floor for a vote.

Serving his second term in the state House, Rep. Graham Filler represents residents of Clinton County and the southern part of Gratiot County. He is as a member of the House Health Policy Committee and chair of the House Judiciary Committee.

“Michigan Academy of Family Physicians and the doctors it represents, as well as other professional associations, advocacy groups, and stakeholders, are always valuable resources of input regarding policy initiatives,” he said.

Rep. Filler was born and raised in Michigan and graduated from Ovid-Elsie High School in Clinton County. He attended and graduated law school at Detroit Mercy. Today, he remains active in his community by volunteering with the Kiwanis Club and as a member of Farm Bureau advocating for farmers.

“The medical field has been a big part of both my professional and personal life, and I’m absolutely thrilled to be serving on the committee on Health Policy. I look forward to continuing to try to improve healthcare

This holds true for topics of concern as well as issues that MAFP supports. Rep. Filler encourages input from MAFP members on any policy that impacts their patients and/or practice. Through

Filler and his wife have a 3-year-old daughter, Claire, and a loving family cat, Mango. They often spend time hiking and playing golf within the district or across Michigan, and they remain active within their church.

22 FALL 2021 | MAFP.COM


MEET THE LEGISLATORS

Rep. Lori Stone Of particular concern to Rep. Stone is healthcare employee protections. The assault of healthcare personnel happens much too often, she said, and she has been collaborating with her House colleagues to put more protections into place. Rep. Stone also is focused on initiatives aimed at addressing opioid use disorder and the state’s opioid epidemic. In this arena, she has been crafting legislation to increase access to drug use treatment, behavioral health services, and diversion court programs. She is committed to increasing student access to healthcare, which she understands can help students improve in the classroom.

Rep. Lori Stone was first elected representative of the 28th District (comprised of Warren and Center Line) in 2018. She serves as a member of the House Health Policy Committee, where she is serving her second term, as well as the Education and Insurance committees. Her work centers around the intersection of health and education. “From providing a quality education for every child, to ensuring access to affordable healthcare, to auto insurance reform, I will fight for everyone in Michigan to have the opportunity to learn, live, and drive without worry,” she said. As a representative serving in the minority within the Michigan Legislature, it often takes more work to get good policy passed, she said. This work is frequently under the radar of most the public and involves partnering with stakeholder groups, gathering input from constituents, and drafting bill packages. Legislation typically moves faster when standalone bills are included in a bipartisan package, she said.

Rep. Stone is a strong supporter of behavioral healthcare services for Michiganders. She believes all residents should have reliable access to all services they might need, and that addressing behavioral healthcare needs will continue to improve many aspects of the state, including physical health for some. Prior to joining the Legislature, Rep. Stone worked as an educator for 14 years. She most recently taught fourth grade at Mound Park Elementary in Warren. A graduate of Michigan State University for her undergraduate and master’s degrees, Rep. Stone studied political theory, constitutional democracy, and education. She went on to achieve Fellow of the Michigan Political Leadership Program, which Michigan Academy of Family Physicians has co-sponsored in the past.

E S I T R E V D A

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A life-long resident of Warren, Stone remains engaged in local programs such as the YMCA, Warren Civics Theater, and the American Cancer Society’s Relay for Life. Community engagement helps give her a better understanding of the needs of her constituents, she said, so she can work to make the 28th District and the state of Michigan a better place for all. FALL 2021 | MAFP.COM

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‘Academy’ Awards Shine the Spotlight on Family Medicine By Dana Lawrence It was a packed virtual “room” when the Michigan Academy of Family Physicians membership, leadership, and staff celebrated the 2021 “Academy” awards honorees July 24. As is the tradition of this esteemed awards program, this year’s “Archie” Award of Excellence winner and Family Physician, Family Medicine Educator, Family Medicine Resident, and Outstanding Medical Student of Year exemplify the tradition of the family medicine specialty and a commitment to quality, comprehensive, patient-centered care. Do you know an exemplary individual deserving of an MAFP “Academy” Award? Nominations for the 2022 awards are being accepted until March 1, 2022, at mafp.com/get-involved/awards.

The ‘Archie’ Award of Excellence Established in honor of the late Dr. Archie Bedell, this award recognizes individuals who, similar to Dr. Bedell, have distinguished themselves by their service to the Academy, the specialty, their patients, and their community. One such member is Keerthy Krishnamani, MD, MBA, a dedicated family physician committed to and passionate about his patients. They, in turn, are committed to and passionate about him, shared his colleague in practice and on the MAFP Board of Directors, Mark Hamed, MD, MBA, MPH, FAAFP. A 2003 graduate of Madras Medical College in India, Dr. Krishnamani completed residency at Sparrow/Michigan State University Family Medicine Residency in East Lansing in 2008. He then practiced at a federally qualified health center in rural New Hampshire before relocating to Michigan in 2011. Here, he served in a variety of family medicine roles, including at outpatient primary care clinics, a rehabilitation 24 FALL 2021 | MAFP.COM

facility, on inpatient hospital service, and in urgent care. He also was a physician leader at Henry Ford Health System, overseeing three primary care clinics, and he was an associate clinical professor and family medicine preceptor at Wayne State University School of Medicine. To prepare for his administrative duties, Dr. Krishnamani earned his executive master’s degree in business administration from the University of Michigan Ross School of Business, and he completed Henry Ford Health System’s Physician Leadership Institute and MD Content Leadership Course. He is certified by the American Board of Family Medicine and maintains interest in chronic disease management, sports medicine, geriatrics, and mental health disorders. The latter part of Dr. Krishnamani’s 20192020 MAFP presidential term coincided with the onset of the COVID-19 pandemic. During this unprecedented time, he provided exemplary leadership amid the uncertainty and ever-changing family practice and nonprofit management environments. Throughout the pandemic, Dr. Krishnamani was a staunch supporter of his primary care colleagues, advocating for

initiatives that protected their personal, physical, and financial health, and of telemedicine as a practice model for overcoming barriers to accessing care. Under his leadership, MAFP was vigilant in sharing up-to-date pandemic information with members, providing educational resources, facilitating connections in new ways, and working with partners across the state and country to preserve the practice of family medicine. MAFP commends and agrees with Dr. Krishnamani’s philosophy that was the driving force of his COVID-19 presidency: “Family physicians are strong, and with our training, compassion, and personal relationships, we will work together to revive our practices so we can continue to be here for our patients. Family medicine will emerge stronger and more respected.” During his MAFP membership, Dr. Krishnamani took on the roles of president-elect, vice president, and speaker of the MAFP Board of Directors, and vice president of Family Medicine Foundation of Michigan. He also was an active volunteer leader as chair of the Professional Development, Member Engagement, and Nominations


MEMBERS IN THE NEWS

committees. Serving on a committee is one of the best ways to get involved in the Academy, he said. Dr. Krishnamani also has always been a steadfast advocate for his profession and his patients. In fact, attending MAFP’s Advocacy Day was one of the main reasons he became actively involved with the Academy beginning in 2012. Fast forward to 2018: Dr. Krishnamani was a key player in protecting family

physicians’ scope of practice when there was a push by naturopathic providers to gain licensure in Michigan. Dr Krishnamani, who was MAFP vice president at the time, worked closely with 2018-19 MAFP President Mary Marshall to educate legislators about the licensure’s risk to patients. Their advocacy actions were instrumental to thwarting the naturopathic licensing bill from passing, preserving the family physician-patient relationship, and

prohibiting naturopaths from obtaining licensure in Michigan. Earlier this year, Dr. Krishnamani moved to Georgia to take on the role of executive medical director of a primary care network that is part of a large healthcare system serving families of northwest Georgia and northeast Alabama. He is already missed here at the Academy, at the institutions, and in the communities where his leadership made an impact.

Michigan Family Physician of the Year Throughout her career, Pamela Rockwell, DO, FAAFP has been the consummate family physician, exemplifying extraordinary service to her patients. Her clinical outpatient practice encompasses the full spectrum of family medicine, including pediatric and adult care, prenatal care, women’s health, and osteopathic manipulation. She also attends to family medicine patients admitted to general medicine floors of the University of Michigan Hospital in Ann Arbor. Sincere, reliable, tireless, dedicated, warm, humorous, respectful, consistently excellent, and a cultivator of relationships are just a few words her patients use to describe her. Patients also greatly appreciate Dr. Rockwell’s breadth of clinical experience and medical knowledge that underly her approach to treating the whole person rather than simply managing a disease. When nominating Dr. Rockwell for the Physician of the Year Award, one patient shared that never in his first 50 years did he have a doctor he considered his doctor — until he met Dr. Rockwell. “Now I will never have another (doctor),” he said. Since joining the family medicine faculty at University of Michigan in 1994, Dr. Rockwell has built a loyal and sought-after family medicine practice. Beginning in 1993, she has served as medical director

of the Domino’s Farms Family Medicine Clinic, which consistently ranks near the top of all UofM’s ambulatory sites for quality performance and patient satisfaction. As a clinical leader, Dr. Rockwell has earned a reputation for independence and innovation, raising the bar of excellence in primary care delivery within UofM’s academic health system. Among her peers and UofM leaders she is known as an extraordinary clinician, educator, and leader; systematic, loyal, caring, compassionate, and superb; a master at teaching patients about their conditions; and tenacious when advocating for her patients and overcoming bureaucratic barriers. She also is recognized for selflessly giving her time and energy to help the residents of Michigan understand the necessity for and safety of vaccines—including the COVID vaccine. She has spent countless hours studying, teaching, presenting, and advocating for the importance of vaccines for our public health, and she has published many articles and scholarly works, including a textbook on vaccine science for primary care. In 2013, Dr. Rockwell completed a fellowship in vaccine science through the American Academy of Family Physicians, after which she was appointed as the Academy’s liaison to the Centers for Disease Control and Prevention’s national Advisory Committee on Immunization Practices (ACIP). She also serves as MAFP’s liaison to the Michigan Advisory Committee on Immunizations in the

Michigan Department of Health and Human Services (MDHHS). In these roles, Dr. Rockwell speaks as the voice of family physicians to ensure immunization recommendations align with the experience of primary care physicians. Dr. Rockwell’s vaccine expertise and leadership were exceptionally important during the COVID-19 pandemic. Starting in fall 2020, as COVID-vaccine clinical trial data began to be released, she was called upon in her ACIP role to evaluate safety and efficacy data for purposes of providing expert panel advice to inform vaccination policy, strategy, and dissemination. She also worked in several key roles within MDHHS, advocating for sound science and efficient, just vaccine distribution. She was a strong voice for the practice of community-based family medicine. Earlier this year, Dr. Rockwell was appointed to Gov. Gretchen Whitmer’s Protect Michigan Commission to help clinicians and Michiganders navigate the COVID-19 pandemic. Known as an enthusiastic teacher, Dr. Rockwell regularly mentors residents and students in the clinic and on inpatient service. She often brings them to MAFP events and meetings to help them cast a wider net for cultivating mentor relationships. Her teaching style, based on expert medical knowledge and that of a well-rounded physician, consistently earns high ratings from her mentees. For her excellence in teaching, Dr. Rockwell was recently selected as a member of the University of Michigan’s prestigious Academy of Educational FALL 2021 | MAFP.COM

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Excellence—an honor bestowed upon just 3% of all faculty members across all specialties at the university.

to be involved in social justice initiatives and supporting those who are eager to advocate at the local and state level.

Lastly, as an advocate for her specialty, Dr. Rockwell is concise, direct, and confident when speaking with legislators at the state Capitol and members of Congress on the Hill. She has been active in MAFP’s Advocacy Committee since 2015 and has served on the MAFP Board of Directors as a member-at-large since 2016. In these roles, she is not only a strong voice for family physicians to organized medicine and policymakers, but she also is a role model for her colleagues and learners by living her professional values and working tirelessly to advance comprehensive person-, family-, and community-centered care throughout Michigan and beyond.

He also was a source of leadership and comfort throughout the COVID-19 pandemic, helping to rapidly implement telemedicine visits at the medical center and residency program and serving as a sounding board for residents’ concerns and a shoulder they could lean on.

Michigan Family Medicine Educator of the Year

Students often comment on Dr. Paschall’s calm demeaner, engaging attitude, and encouraging conversations. These are qualities the residency program’s new director, Dr. Jenese Reynolds-Gibbs, can attest to, as she first trained under Dr. Paschall during year one of medical school.

No one is more deserving of the Michigan Family Medicine Educator of the Year Award than Mark Paschall, MD, a lifelong academic physician who has made outstanding contributions to family medicine education in Michigan. From 2004 until July 2021, Dr. Paschall served as program director of Ascension St. John Hospital Family Medicine Residency. During this time, he remained active in his own clinical practice, while also teaching at Ascension St. John Family Medical Center in St. Clair Shores and on inpatient service at Ascension St. John Hospital. Over the past few years, Dr. Paschall notably challenged his residents to explore their own implicit biases, even before it was suggested as a necessity by Gov. Gretchen Whitmer, pushing them 26 FALL 2021 | MAFP.COM

In addition to his influential role as an educator and mentor of resident physicians, Dr. Paschall also is a role model of academic excellence for thirdand fourth-year students—both in the clinic and at the hospital—encouraging them to look beyond medical issues to pay attention to social determinants of health.

She said, “Dr. Paschall is a quiet force, a humble person who leads by example.” With the mantra, “It is a human’s job to go forth and give of yourself and your time to the community,” Dr. Paschall extends his community service globally. With a background in tropical medicine training, he takes several residents to Kenya each year, where they work in a medical clinic, seeing thousands of patients over a two-week period. And, he has repeatedly raised funds for the Hope Water Project to place wells in the same Kenyan community where he volunteers. All who have been impacted by Dr. Paschall’s training and guidance thank him for his years of service to the education of residents, students, and patients, and wish him well as he continues a family medicine residency faculty member at Ascension St. John Hospital.

Michigan Family Medicine Resident of the Year With 600-plus resident members of MAFP, our state boasts many stellar family medicine resident physicians. This year we were honored to present the 2021 Michigan Family Medicine Resident of the Year Award to Srvanai Alluri, MBBS, a physician in training who exhibits exemplary patient care, effective leadership, commitment to the community, contributions to scholarly activity, and dedication to the specialty of family medicine. In June, Dr. Alluri completed residency at Western Michigan University Homer Stryker MD School of Medicine’s Family Medicine Residency program in Kalamazoo. There, she was recognized by her program director, Dr. Kristi VanDerKolk, as demonstrating a commitment to family medicine, research, and empathy for the underserved. Dr. Alluri has always had a humanitarian vision at heart, seeking to work in areas of the world in critical need of medical services. With this goal, she completed a pre-residency fellowship in disaster medicine at Beth Israel Deaconess Medical Center in Boston, Massachusetts. At the start of the COVID-19 pandemic, Dr. Alluri volunteered extra time on the toughest assignments, not only to be on the front line but also to spare her colleagues as she was able. She currently is working on starting Disaster Docs, a physician-run organization that provides emergency preparedness services and deploys medical personnel to disasters. Within WMed’s residency program, Dr. Alluri has been a strong proponent of using home visits in service to


MEMBERS IN THE NEWS

patients of the local federally qualified health center. She has been relentless in spearheading a street medicine program for the homeless in the “Tent City” of Kalamazoo, partnering with local outreach organizations to provide healthcare services and coordinate care to the unsheltered homeless. Dr. Alluri currently is working on setting up a street medicine clinic, as well as making treatment for substance use and hepatitis C more accessible to the homeless population. Dr. Alluri embodies the patient-centered model of care during every patient interaction. She stands out amongst her residency peers in her drive to understand and address health equity and social determinants of health. Based on experience from her research fellowship at Harvard Medical School, she uses a data-driven approach to develop research studies to answer questions where literature is absent. This, said WMed’s program chair, Dr. Lisa Graves, makes Dr. Alluri unique among her fellow residents. In the words of Dr. Graves and Dr. VanDerKolk, “Dr. Alluri is an example of excellence in family medicine residency, and we have no doubt that she will do great things in this world.”

Outstanding Medical Student of the Year MAFP’s newest award recognizes a student member for academic excellence, leadership, community service, and dedication to pursuing a career as a family physician. This year’s award winner is Anthony Seely, a rising fourth year student at the Wayne State University School of Medicine. Anthony has a strong desire to pursue a career in family medicine and is recognized as one who goes

above and beyond in his clinical skills, effective patient-centered care-team collaboration, and relationships with patients. Dr. Leah Vandenbussche—one of Anthony’s mentors—shared, “It is obvious that Anthony’s approach is centered around the perspective of the patient and not just the singular reason for the visit.” Aside from being a medical student, Anthony also is an engaged volunteer dedicated to improving the wellness of his community. Beginning when he was in high school in Detroit and continuing for nearly a decade, Anthony was involved with the local Manna Community Meal, Gleaners Food Bank, and Neighborhood Service Organization. Upon entering medical school, Anthony joined Detroit Street Medicine, whose mission is to ensure access to quality medical care for Detroit’s unreached and service-resistant homeless population. During his first two years of medical school, he spent hundreds of hours leading street runs to provide local outreach and host patient seminars to educate the community on common medical problems. Anthony then served as director of patient care for Street Medicine Detroit, identifying high-risk patients and coordinating specialized care plans with multiple organizations. He also invited the street care teams at the Michigan State University College of Osteopathic Medicine and the University of Michigan to collaborate with Street Medicine Detroit on developing an interactive patient chart that ultimately improved patient follow-up and expanded the programs’ collective pool of resources. At the height of the pandemic in spring 2020, Anthony volunteered daily at the state fairgrounds to help administer COVID-19 testing and he raised funding for local personal protective equipment drives.

Dr. Sheth Named a 2021 Crain’s Health Care Hero Avani Sheth, MD, a family physician and chief medical officer at Neighborhood Service Organization (NSO) in Detroit, was named a Crain’s Detroit Business 2021 Health Care Hero. During the pandemic, Dr. Sheth took on the role of safety officer at NSO, leading its COVID-19 taskforce and vaccination initiative. NSO serves people experiencing homelessness and mental illness. Learn more at crainsdetroit. com/awards/avani-sheth-md2021-health-care-heroes.

Dr. McKenzie Appointed to Certificate of Need Commission Gov. Gretchen Whitmer appointed Amy McKenzie, MD, MBA to serve on the state’s Certificate of Need Commission (CON). This commission is responsible for developing, approving/disapproving, and revising CON review standards used by the CON Program Section to issue decisions on CON applications and make recommendations to revise the list of covered clinical services. Dr. McKenzie is a Michigan Family Medicine Foundation of Michigan trustee and served as president in 20172018. FALL 2021 | MAFP.COM

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MEMBERS IN THE NEWS

Welcome New Members More than half way into 2021, MAFP has welcomed more than 340 new physician, family medicine resident, and medical student members. Visit mafp. com/membership/newmembers, and if you see a name you know or the name of a member who practices in your community, reach out and say “hi” to welcome them to our Michigan chapter of AAFP.

Dr. Edwards-Johnson Publishes Article on Growth of Family Medicine Resident Debt Jennifer EdwardsJohnson, DO, MPH, assistant professor and community assistant dean at Michigan State University College of Human Medicine’s Department of Family Medicine, authored an article in the May issue of the Journal of the American Board of Family Medicine on resident debt. She writes about her own experience and the experiences of her colleagues as the backdrop to the rising medicine resident debt, which impacts residents’ choice of specialty and practice type. The article is available at jabfm.org/content/34/3/665.

NCCL Delegate Co-authors Successful IMG Resolution In her role as MAFP’s International Medical Graduate (IMG) Delegate to AAFP’s 2021 National Conference of Constituency Leaders (NCCL), Fatin Sahhar, MD, FAAFP co-authored a resolution that calls on the Academy to encourage other entities and agencies to offer grants for incentivizing IMGs to practice primary care in underserved communities. Dr. Sahhar, an international medical graduate herself, serves as associate director of Detroit Medical Centers’ Sinai Grace-Michigan State University College of Osteopathic Medicine Family Medicine Residency program. MAFP was one of 25 chapters that sent full delegations to NCCL in spring 2021, meaning all five member constituencies were represented. Thank you to the Michigan delegation for representing MAFP:

• • • •

IMG Delegate: Fatin Sahhar, DO, FAAFP Minority Delegate: Srikala Yedavally-Yellayi, DO, MMEd, FAAFP Woman Delegate: Emily Smith, MD New Physician Delegate: Razel Remen, MD

LGBT/LGBT Physician Ally Delegate: Harshini Jayasuriya, MD, FAAFP MAFP is currently accepting applications from active members interested in serving as a Michigan delegate to the 2022 NCCL. Applications are due Nov. 26 at mafp. com/get-involved/nccl.

U-M Program Director Recognized for Excellence Jean Wong, MD, assistant professor of family medicine and program director of the University of Michigan Family Medicine Residency, was recognized with the Program Director of Excellence Award by the school’s Office of Graduate Medical Education during a virtual reception May 3. Dr. Wong was selected for this award based on her strong vision, commitment to diversity, and advocacy for resident education and wellness.

Southeast FPs Receive AMG Excellence in Medicine Award Congratulations to the six Ascension Medical Group Excellence in Medicine awardees who are family physician members of MAFP: Kwame Francis, MD; Mark Paschall, MD; Sean Coyle, MD; Beena Nagappala, MD; Veena Panthangi, MD; and Robert Camara, DO.

Do you have news to share about yourself, your practice, or a colleague? Email dlawrence@mafp.com. 28 FALL 2021 | MAFP.COM


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EVENTS

Earn Up to 21 CME Credits Attending Fall Events Information and registration at mafp.com/events Stay on Course: Your Ticket to Family Medicine CME

Watch all 12 webinars before July 17, 2022, and earn 13 CME credits. Thank you, sponsors!

MAFP Reports Members’ CME Credits Earned with Us Michigan Academy of Family Physicians/ Family Medicine Foundation of Michigan continues to offer a variety of continuing medical education (CME) on-demand webinars, including single sessions and those that are part of our “Stay on Course” yearlong package. Several of the webinars also count toward/ meet the state of Michigan’s training requirements for medical licensure on the topics of clinical ethics, human trafficking, and pain and symptom management. The Michigan Department of Licensing and Regulatory Affairs (LARA) requires every physician licensed to practice medicine in Michigan complete: • • •

Building an Integrated Behavioral Health Program in Primary Care Live webinar | Oct. 4 | 7-8 pm ET Approved for 1 CME credit.

2021 Michigan Future of Family Medicine Student Conference Live Zoom conference | Oct. 9 | 8 am-12:15 pm ET

2021 Michigan Family Medicine Residency Connection Live Zoom webinars | Various times Oct. 13-20

Women in Family Medicine Conference

Live Zoom conference | Nov. 13 | 9 am-1:15 pm ET

Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending

Knowledge Self-Assessment (KSA): Health Counseling and Preventive Care Virtual via Zoom | Dec. 4 | 8 am-12 pm ET Approved for 8 CME credits.

30 FALL 2021 | MAFP.COM

3 hours of training on pain and symptom management every three years 1 hour of medical ethics training every three years 1 hour of one-time training on human trafficking

Effective June 1, 2022, LARA will also require implicit bias training for medical licensure and renewal in Michigan. MAFP will be hosting webinar/in-person CME events to help members meet this new training requirement. Once you complete a CME webinar and corresponding post-webinar survey, MAFP staff will report your CME credit(s) earned to AAFP and email you a CME certificate for your records. Active members must report to AAFP at least 150 credits of approved CME every three calendar years. Visit aafp.org/ about/policies/all/cme-requirements. html for more information about CME requirements for AAFP membership. Questions? Contact MAFP Director of Communications and Member Services Dana Lawrence at dlawrence@mafp.com.


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