Cardiovascular Health

FP Heart WINTER 2024

MISSOURI FAMILY PHYSICIAN

LEADING WITH THE

VOLUME 43, ISSUE 1

CARDIOVASCULAR HEALTH ISSUE

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FP MISSOURI FAMILY PHYSICIAN

EXECUTIVE COMMISSION BOARD CHAIR Kara Mayes, MD, FAAFP (St. Louis)​ PRESIDENT Afsheen Patel, MD (Kansas City) PRESIDENT-ELECT Natalie Long, MD (Columbia) VICE-PRESIDENT Beth Rosemergey, DO, FAAFP (Kansas City) SECRETARY/TREASURER Lisa Mayes, DO (Macon)

BOARD OF DIRECTORS DISTRICT 1

DIRECTOR Arihant Jain, MD, FAAFP (Cameron) ALTERNATE Brad Garstang, MD (Liberty)​ DISTRICT 2 DIRECTOR Eric Lesh, DO (Kirksville) ALTERNATE Katherine Holbrook, DO (Kirksville) DISTRICT 3 DIRECTOR Dawn Davis, MD, FAAFP (St. Louis) DIRECTOR Lauren Wilfling, DO, FAAFP (St. Louis) ALTERNATE Christian Verry, MD (St. Louis) DISTRICT 4 DIRECTOR Jennifer Allen, MD (Hermann) ALTERNATE Jennifer Scheer, MD, FAAFP (Gerald) DISTRICT 5 DIRECTOR Amanda Shipp, MD (Versailles) ALTERNATE Vacant DISTRICT 6 DIRECTOR David Pulliam, DO, FAAFP (Higginsville) ALTERNATE Misty Todd, MD (Sedalia) DISTRICT 7 DIRECTOR Chad Byle, MD, FAAFP (Kansas City) DIRECTOR Jacob Shepherd, MD, FAAFP (Lee’s Summit) ALTERNATE Rachel Hailey, MD, FAAFP (Lees Summit) DISTRICT 8 DIRECTOR Andi Selby, DO, FAAFP (Branson) ALTERNATE Barbara Miller, MD, FAAFP (La Russell) DISTRICT 9 DIRECTOR Douglas Crase, MD (Licking) ALTERNATE Vacant DISTRICT 10 DIRECTOR Gordon Jones, MD, FAAFP (Sikeston) ALTERNATE Jenny Eichhorn, MD (Jackson) DIRECTOR AT LARGE Stacy Jefferson, MD (St. Louis) Krishna Syamala, MD, FAAFP (St. Louis) Kento Sonoda, MD (St. Louis)

RESIDENT DIRECTORS Kelly Dougherty, MD, Mercy Noah Brown, MD, Mercy (Alternate)

STUDENT DIRECTORS Abby Crede, UMKC Mikala Cessac, UMC (Alternate)

AAFP DELEGATES Peter Koopman, MD, FAAFP Kate Lichtenberg, DO, FAAFP Sarah Cole, DO, FAAFP Alternate Delegate Jamie Ulbrich, MD, FAAFP Alternate Delegate

MAFP STAFF EXECUTIVE DIRECTOR Kathy Pabst, MBA, CAE ASSISTANT EXECUTIVE DIRECTOR Bill Plank, CAE MEMBER COMMUNICATIONS AND ENGAGEMENT Brittany Bussey The information contained in Missouri Family Physician is for informational purposes only. The Missouri Academy of Family Physicians assumes no liability or responsibility for any inaccurate, delayed, or incomplete information, nor for any actions taken in reliance thereon. The information contained has been provided by the individual/organization stated. The opinions expressed in each article are the opinions of its author(s) and do not necessarily reflect the opinion of MAFP. Therefore, Missouri Family Physician carries no respsonsibility for the opinion expressed thereon.

Missouri Academy of Family Physicians, 722 West High Street Jefferson City, MO 65101 • p. 573.635.0830 • f. 573.635.0148 Website: mo-afp.org • Email: office@mo-afp.org

CONTENTS 4 Family Physicians Lead with the Heart 5 Advocacy Day Flyer 6 Self-Measurement of Blood Pressure: A Necessary Componenet of Blood Pressure Control 13 Alcohol & Heart Health 15 Sodium Intake Significantly Lowered Blood Pressure in as Little as One Week 17 2022-2023 Officer Annual Reports 23 2023 Congress of Delegates Report 24 Meet the 2023-2024 MAFP Board of Directors 26 31st Annual Fall conference 28 75th Annual Meeting Celebrates Family Physicians 29 Family Physician Champions Honored with Recognition 30 MAFP Member Anniversaries 31 Nominate a Family Physician 32 Missouri Academy Installs New Officers 34 Griffith Named MAFP Family Physician of the Year 35 Lohsandt Named MAFP Outstanding Resident of the Year 37 Nurse Practitioner Geographic Proximity Waiver Interpretation 38 MAFP Joins Missouri All Copays Count Coalition 38 Statewide PDMP Implemented 39 Missouri Preceptor Tax Credits Now Available 41 Members in the News 47 References

MARK YOUR CALENDAR January 18, 2024 Virtual CME Series: Harm Reduction Strategies for Patients with Opioid Use Disorder www.mo-afp.org/cme-events/virtual-cme February 15, 2024 Virtual CME Series: Coronary CT in Chest Pain; A Paradigm Shift www.mo-afp.org/cme-events/virtual-cme February 26-27, 2024 MAFP Advocacy Day Courtyard Marriott, Jefferson City https://www.mo-afp.org/advocacy/advocacy-day/ February 27, 2024 MAFP Board of Directors Meeting Courtyard Marriott, Jefferson City (in-person & virtual) March 21, 2024 Virtual CME Series: Sexually Transmitted Infections www.mo-afp.org/cme-events/virtual-cme MO-AFP.ORG 3

Family Physicians Lead with the Heart

W Kara Mayes, MD, FAAFP Board Chair St. Louis, MO

medicine and lifestyle that helps them reach their elcome to 2024 MAFP members! I’m healthiest possible state. How many times have looking forward to a year serving as you told a patient that improving their health will your MAFP Board Chair and would require them to incorporate more movement or love for you to get to know me a bit. improved food choices in their daily routine? It I’m currently practicing obesity medicine after seems like a frequent conversation for all of us, in 9+ years of family medicine practice, including addition to prescribing appropriate medications for inpatient care and obstetrics, with a residency each patient. program. Helping patients with obesity improve The one constant in the care we provide for our their health is truly a passion, and I’ve been lucky patients’ heart conditions is the heart we put into to get to transition my practice to doing that fullour conversations with them. We must know how time. I live in the St. Louis area with my husband to speak to certain patients, what to say to cause Matt, kids Sophie and Cooper, and our wild golden positive change, and how to show retriever/labrador mix, Skye. that we care about our patients.

Matt is a pilot for Southwest THE ONE Isn’t that why we got into this Airlines and spends a lot of time crazy business of family medicine? with his 3D printer when he’s at CONSTANT IN Cardiologists are fantastic home. Sophie is an incredible subspecialists we refer to for artist and is usually found acting THE CARE WE more complex medical states. in her middle-school plays PROVIDE FOR OUR Their specialized training in and musicals. Cooper loves conditions of the heart video games, taekwondo, and PATIENTS’ HEART medical no doubt saves lives. However, chess – he recently was able can you think of any specialty to participate in his first chess CONDITIONS IS besides family medicine that tournament and loved it! When THE HEART WE has more heart for our patient I’m not at work, I enjoy running, panels? That’s why the focus of trying new restaurants, and PUT INTO OUR this magazine is “Leading with traveling as often as I can. Let the Heart.” As family physicians, me know how MAFP can help CONVERSATIONS we are leaders of our patients’ you this year.

WITH THEM. healthcare team. We are leaders Arrhythmias. Coronary in our community. The articles artery disease. Hypertension. submitted in this magazine are Angina. Congenital heart from leaders in family medicine. disease. Aortic stenosis. These are all issues we Whether you gain knowledge from the clinical see frequently with our patients. They come to us articles, read about our 2023 Family Physician to help manage these chronic conditions, and we of the Year and his heartfelt speech, or gain have several treatment options depending on the condition (and other comorbidities they may have). inspiration from our members in the news, I think you’ll see there is a lot to love about being a family We often counsel the patient on pharmacological physician! plans. Many times, we discuss lifestyle changes with them. Usually, it’s some combination of

Mission Statement:

The Missouri Academy of Family Physicians is dedicated to optimizing the health of the patients, families and communities of Missouri by supporting family physicians in providing patient care, advocacy, education and research.

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MISSOURI FAMILY PHYSICIAN January - March 2024

ADVOCACY DAY FEBRUARY 26 - 27, 2024

JOIN US AT THE COURTYARD MARRIOTT & THE MISSOURI STATE CAPITOL, JEFFERSON CITY, MO MONDAY, FEBRUARY 26

2:00-3:00 pm – Private tour of the Capitol Whispering Gallery.

6:00 – 8:30 p.m. – Legislative Briefing and Dinner Buffet at Courtyard Marriott (In-person/Virtual Legislative Briefing)

TUESDAY, FEBRUARY 27

8:00 – 9:00 am – Breakfast Buffet at Courtyard Marriott 9:00 am – 1:00 pm – Legislator Appointments 11:30 am – 1:00 pm – Luncheon Buffet at Courtyard Marriott 1:00 – 4:00 pm – MAFP Board of Directors Meeting (In-person/Virtual)

REGISTER ONLINE: WWW.MO-AFP.ORG/ADVOCACY/ADVOCACY-DAY/ We encourage you to invite a colleague, medical student, or resident to join you to promote the importance of family medicine and primary care. This is your opportunity to educate your State Senator and State Representative on issues that affect you, your profession, and your patients.

Make your lodging reservation at the Courtyard Marriott, 610 Bolivar Street, Jefferson City, MO 65101, (573) 761-1400. Be sure to reference the Missouri Academy of Family Physicians to receive the discounted rate of $134 per night. The last day to make a reservation in our block is January 26, 2024. Any reservations made after that date are subject to availability.

Limited complimentary lodging is available with preference to residents and students.

To request a complimentary room, email Kathy Pabst at kpabst@mo-afp.org.

Questions? Contact MAFP by calling (573) 635-0830 or emailing office@mo-afp.org.

YOU ARE THE VOICE OF MISSOURI FAMILY PHYSICIANS! MO-AFP.ORG 5

SELF-MEASUREMENT OF BLOOD PRESSURE: A NECESSARY COMPONENT OF BLOOD PRESSURE CONTROL

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ABSTRACT

David A. Voran, MD

Professor, Community and Family Medicine Department University Health Kansas City – Lakewood Medical Center

Three-year results of two Community and Family Medicine clinics’ participation in the Missouri Department of Health and Senior Services’ SelfMeasurement of Blood Pressure program.

Keywords: SMBP, Self-Measurement of Blood Pressure, MoDHSS, hypertension, quality measures, Community and Family Medicine

BACKGROUND

The State of Missouri’s Department of Health and Human Services approached University Health Kansas City (UHKC) Lakewood campus’ Family Medicine clinics in late 2019 wanting to know if we would participate along with 20 other clinics in a Self-Measurement of Blood Pressure (SMBP) project. This SMBP project was funded and managed by the Michigan Peer Review Organization (MPRO), now iMPROve Health, a designated Quality Improvement Organization (QIO). The program followed the protocols developed by the American Heart Association’s Target BP protocol. This program involved training staff on proper blood pressure measurement competency, patient education in how to take their own blood pressures, which we did during the device validation process, and how to complete logs of two same-setting blood pressures in the morning and evening.

When done, the patients received an FDA approved loaner cuff to use for a minimum of a week and then return.

Our staff completed the training provided by iMPROe Health and began enrolling patients in January of 2020. Each enrolled patient received on loan one of the 60 Upper Arm Blood Pressure Monitors (Homedics BPA-0200) after validating each against our standard office devices using a validation sheet provided to us by AHA’s Target BP program (Figure 1). This process was used to train the patient on proper

techniques.Finally, they were given a paper log, patterned after the American Heart Association’s Blood pressure log (Figure 2) and scheduled for a follow-up visit in 1-2 weeks where they were to return the loaned device and completed logs. Completed logs were then entered into a spreadsheet for averaging and analysis which was patterned after Target:BP’s worksheet (Figure 3) downloaded from https://targetbp.org/tools_downloads/ smbp-average-calculator/. The primary modifications made to this worksheet included changing the form to include each measurement in lieu of having patients enter the average of two same-setting numbers. We made this change because a number of our early participants were not able to calculate average blood pressures. After analysis, both the patient and providers received a summary containing graphs and tables (Figure 4) and entered into the chart. Finally, total daily averages were entered into the medical record in the system’s Remote Patient Monitoring (RPM) section so all providers could follow daily trends (Figure 5).

The COVID pandemic halted the program in March 2020, after only 48 enrolled patients. We resumed it in May of that year

Figure 1 SMBP Device Accuracy and Validation Form

MO-AFP.ORG 7

Figure 2 AHA Blood Pressure Log Form

after modifying the protocol to give, instead of loan, the patients the blood pressure cuffs because the refurbishing costs exceeded the initial purchase costs.

We redirected grant funds from a companion Million Hearts grant to purchase additional cuffs. Additionally, we were able to recoup some of the expenses by submitting billing codes for education, validation, and training (99473), and monthly analysis and recording of blood pressure logs (99474).

RESULTS AND FINDINGS

Over the next 3 years, 497 patients enrolled in the program (321 from the Bess Truman Family Medicine Center, a Resident Clinic, and 176 from the Lakewood

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Medical Pavilion, a faculty clinic). Sixty-three percent (63%) of the participants were female and 37% male distributed across age groups and consistent gender percentages in each age group with our clinic population (Figure 6). Over 70% of the participants were covered by Medicaid (31%), Medicare (22%), or had no insurance (20%). Only 28% of the participants had commercial insurance coverage. (Figure 7) According to UHKC’s current registry data, 34% of our 86,705 active patients have a diagnosis of hypertension. Thirty-seven (37%) of the 27,354 active patients in the two clinics participating in the SMBP program were diagnosed with hypertension. At the

Figure 3 SMBP Average Calculator

OVER THE NEXT 3 YEARS, 497 PATIENTS ENROLLED IN THE PROGRAM

beginning of the program only 46% of patients with hypertension were controlled (<140/90). There was significant improvement by June of 2023 with 53% of the two clinics’ hypertensive patients controlled. Sixtysix percent (66%) of SMBP patients who returned logs were controlled suggesting all patients with this diagnosis should be encouraged to monitor their blood pressure at home and return blood pressure logs periodically.

Other interesting findings were notable. First, there was a significant variation between two same-setting blood pressures that averaged about 7 mmHg, systolic, and nearly 5 mmHg, diastolic. (Figure 8) The difference, in a number of instances, could be quite dramatic and could exceed 20 mmHg with one as large as 48 mmHg, systolic, and over 33, diastolic. (Figure 9) We observed similar differences anecdotally in the clinic with our clinic blood pressure cuffs (Welch Allyn Spot Vital Signs).

Many factors influence Oscillometric blood pressure devices including cuff size, positioning, and extraneous movements caused by speaking and hand movements strongly suggests we should be taking multiple measurements each time, and record the average.

Secondly, we started noticing cyclical, sinusoidal variation in both systolic and diastolic blood pressures that rose and fell over a 3-5 day span. (Figure 10) We observed this in nearly every submitted log containing measurements over 7 days. The average systolic BP difference was 33mmHg, a large enough variation to have an impact on treatment decisions. (Figure 11) What would be the treatment decisions if the MO-AFP.ORG 9

Figure 5 SMBP Daily Averages in Remote Patient Monitoring Flow Sheet

Figure 4 Example of Blood Pressure Log Summary 10

MISSOURI FAMILY PHYSICIAN January - March 2024

Figure 6 SMBP Gender and Age Groups patient’s clinic visit occurred during a peak or trough cycle? We are beginning an investigation to determine whether these cyclical variations are random or have some other explanation. This finding also strongly suggests the few clinical blood pressures taken during any given year need inclusion of frequent home measurements in order to adequately manage hypertension.

Thirdly, we provided education and encouragement as well as a free blood pressure cuff to almost 500 patients. However, only 200 returned at least a week’s worth of logs despite scheduling for quick (1-2 week) follow-up visits. Admittedly, we did not have the staff to reach out and pursue patients who did not return nor complete logs. In retrospect, our SMBP project would be more complete had we been able to fund and dedicate staff for frequent, if not weekly, outreach and virtual follow-up. This also highlights the importance of patient engagement. We did survey over 100 patients using the Patient Activation Measures (PAM©) tool to compare Patient Activation Scores

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between those who returned and those who had not returned logs and we were not able to measure significant score differences between the two groups.

SUMMARY

SMBP programs are an important part of good hypertension management. They provide important information about patient’s blood pressures away from the office where the patient lives.

However, they do require funding, diligence, and training to implement and be self-sustaining. We are learning through this experience that adequate management of blood pressure requires SMBP or a similar method of documenting frequent home-based blood pressures.

Figure 9 Same-Setting Blood Pressure Differences - Whisker Chart

Figure 7 SMBP Participant Insurance Coverage

Figure 10 Cycling BP Oscillation Example

Figure 8 Absolute Same-Setting Blood Pressure Variances Figure 11 Cyclic SysBP Peak/Trough Differences 12

MISSOURI FAMILY PHYSICIAN January - March 2024

ALCOHOL & HEART HEALTH Jacob Scheer, MD Saint Louis University, Department of Family and Community Medicine

Kento Sonoda, MD, FASAM, AAHIVS Saint Louis University, Department of Family and Community Medicine

I

n the United States, most adults consume alcohol during their lifetime, and nearly 7% of them will develop an alcohol use disorder (AUD).1 In fact, more than 140 thousand people die from alcohol-related conditions every year in the United States.2 The toxic effects of alcohol on the heart are estimated to account for nearly ten percent of these deaths.1 Deleterious effects of alcohol on the cardiovascular system include hypertension, coronary artery disease (CAD), cardiomyopathy, heart failure, and arrhythmia.

In the United States, a standard drink is defined as 14g of pure alcohol. This corresponds to one glass of wine, one 12 oz beer, or one 1.5 ounce shot of distilled spirits. National Institute on Alcohol Abuse and Alcoholism (NIAAA) and Substance Abuse and Mental Health Services Administration (SAMHA) define binge drinking and heavy alcohol differently (Table 1).

Table 1 Definitions of heavy and binge drinking by NIAAA* and SAMHA Binge drinking (number of drinks)

Heavy drinking (number of drinks)

NIAAA

SAMHA

NIAAA

SAMHA

Men

5 or more within two hours

5 or more on the same occasion

5 or more drinks on any day 15 or more drinks per week

Binge drinking on 5 or more days in the past month

Women

4 or more within two hours

4 or more on the same occasion

4 or more drinks on any day 8 or more drinks per week

*NIAAA defines binge drinking based on blood alcohol concentration to 0.08 % or 0.08 gm/dl or higher, corresponding to the number of drinks described in the above table for a typical adult.3 MO-AFP.ORG 13

The proposed mechanisms of alcohol on health are complex.

While several studies have shown cardiovascular benefits with a J-shaped or biphasic relationship, there is growing evidence of dosedependent risk in cardiovascular diseases.4-9 More recent studies have posited that factors such as socioeconomic, favorable lifestyle, and behavioral factors may be confounding in individuals who drink light to moderate drinks (one-to-two drinks per day or less), which can skew the results of these favorable findings.10-12 A recent large cohort study showed a non-linear, consistently increasing risk of hypertension and coronary artery disease for all amounts of alcohol consumption with exponentially higher risk at higher consumption levels.13 Previous observational studies might have overestimated the benefits of alcohol on cardiovascular disease.

One-third of all atrial fibrillation patients identified alcohol as an essential trigger for their arrhythmia.21 Alcohol is associated with a higher risk of atrial fibrillation in part due to its association with other known risk factors, including hypertension, obesity, and sleep apnea.22 Furthermore, chronic alcohol users commonly have hypokalemia and hypomagnesemia, which predispose the heart to atrial fibrillation through increased excitability of electrical pathways. Additionally, alcohol has significant autonomic effects, including sympathetic activation through increased beta-receptor density, vagal inhibition, and reduced heart rate variability, leading to increased frequency of atrial fibrillation.23 Atrial fibrillation is the most common arrhythmia associated with chronic high-volume alcohol intake. At levels greater than 14g of

HYPERTENSION

alcohol per day, the relative risk increased by 10% for every standard drink of alcohol.24 However, it seems that there is no statistically significant increase in risk for atrial fibrillation in otherwise healthy individuals who consume less than 6-7 drinks per week on average.25 Decreasing alcohol consumption lowers the risk of recurrent atrial fibrillation.26

A large meta-analysis showed that any amount of alcohol consumption increased the risk of hypertension.13 One additional drink per day increased the odds of hypertension in both light and moderate drinkers. A dose-response relationship appears to exist between the reduction in alcohol consumption and the subsequent decrease in blood pressure.14 Of note, black individuals seem to have a higher risk of developing hypertension with alcohol consumption than Asian and White counterparts.15

CARDIOVASCULAR DISEASE (CVD)

Although some prior studies have reported protective benefits on cardiovascular disease from light-alcohol consumption, more recent analyses have questioned the strength of these associations.13,16 A recent meta-analysis has found a causal relationship between alcohol use and CVD in even small amounts after adjusting confounding factors such as lifestyle and socioeconomic status.11 This risk consistently rises with increased consumption, reaching exponentially higher levels at greater amounts of consumption.

Individuals with AUD, who sometimes drink heavily, have the highest mortality risks for ischemic heart disease, with a relative risk of 1.62 for men and 2.09 for women.9 A systematic meta-analysis has shown that moderate alcohol consumption has an immediately higher risk of cardiovascular events such myocardial infarction and arrhythmia.18 The dose-response analysis showed that individuals may have a slightly lower risk 24 hours after moderate drinking compared to other times, but heavy drinking was associated with increased risk even after 24 hours. Heavy/binge drinking is, therefore, associated with higher cardiac risk, even if the amount of alcohol consumed is similar to light or moderate alcohol drinking in a week.

ARRYTHMIA “HOLIDAY HEART SYNDROME”

In 1978, Ettinger coined the term “Holiday Heart syndrome” to describe hospitalized patients with atrial fibrillation following a weekend of binge drinking.19 Since that time, another study has shown that not only regular drinkers but also infrequent and nondrinkers may develop atrial fibrillation after alcohol consumption.20 Although some occurrences may manifest while a person is intoxicated, others may not present until 12 to 36 hours later.

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CARDIOMYOPATHY/HEART FAILURE

Alcohol and its toxic metabolites account for a third of all cases of non-ischemic cardiomyopathy.24 This occurs through multiple mechanisms of excess free-radical generation and oxidative stress.

Ethanol induces cardiomyopathy in a dose-dependent manner, independent of nutrition and vitamin status.27 Moreover, it exhibits synergistic effects with other CVD risk factors.27 Alcoholic cardiomyopathy leads to reduced cardiac contractility and enlargement of the heart chamber, ultimately resulting in heart failure and an increased susceptibility to arrhythmias. It is noteworthy that heavy drinking is associated with this condition; however, even moderate drinking, over time, can contribute to cardiomyopathy.28 Individuals with QRS interval >120 msec, atrial fibrillation, and absence of a beta-blocker had a worse prognosis.29

COCAETHYLENE

Alcohol is frequently consumed together with cocaine because the concurrent use increases the euphoria and creates a longer-lasting, more intense effect.30 When cocaine and ethanol are ingested together, the liver produces a psychoactive metabolite with similar properties to cocaine-cocaethylene. This product has a longer plasma half-life than cocaine, but has also been shown to be more toxic to the cardiovascular and hepatic systems. Cocaethylene, like cocaine, binds to dopamine transport in the nucleus accumbens and then blocks dopamine uptake.31 Cocaethylene increases heart rate and blood pressure more than cocaine, and may be over ten times more cardiotoxic. This highlighted toxicity of this metabolite can lead to increased morbidity and mortality associated with cocaine use, as it raises the risk of multiple life-threatening conditions, including myocardial infarction, stroke, and arrhythmias. When a patient discloses cocaine use but does not mention alcohol use, it can lead to unexpectedly prolonged psychoactive effects beyond what a clinician may anticipate.

References can be found on page 47.

REDUCING SODIUM INTAKE SIGNIFICANTLY LOWERED BLOOD PRESSURE IN AS LITTLE AS ONE WEEK -AMERICAN HEART ASSOCIATION

R

educing daily sodium intake by around 4,000 mg/day significantly lowered systolic blood pressure in more than 70% of adults, ages 50 to 75, in as little as one week compared to their usual diet, according to late-breaking science presented today at the American Heart Association’s Scientific Sessions 2023.1 The meeting, Nov. 11-13, in Philadelphia, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science. The full manuscript is also simultaneously published today in The Journal of the American Medical Association.

“High blood pressure is the most common chronic disease condition in the world, and for the majority of adults, dietary sodium intake influences blood pressure,” said Deepak K. Gupta, M.D., M.S.C.I., FAHA, associate professor of medicine and director of the Vanderbilt Translational and Clinical Cardiovascular Research Center in the division of cardiovascular medicine at Vanderbilt University Medical Center, in Nashville, Tennessee.

“However, dietary sodium recommendations are debated in part due to the variability in blood pressure response to sodium consumption from food.”

Researchers measured participants’ blood pressure while on their usual diets, then conducted a randomized trial in these same participants to understand how variation in dietary sodium between higher- and lower-sodium intake may relate to changes in blood pressure.

The study included more than 200 adults, ages 50-75 years, from the Coronary Artery Risk Development in Young Adults (CARDIA) study as well as other individuals. Participants were randomized to either a high-sodium diet with 2,200 mg of sodium added to their usual daily diet, or a low-sodium diet with a total of 500 mg sodium daily for one week. Participants then switched to the opposite diet for one week. Participants’ blood pressure was measured over a 24-hour period on the last day of each diet.

The results found that one week of the low-sodium diet significantly lowered systolic blood pressure in nearly 75% of adults. Additional results: • The median systolic blood pressure measurements were 125-, 126- and 119-mm Hg for the usual, high- and lowsodium diets, respectively.

• Systolic blood pressure was significantly lowered by 7-8 mm Hg for participants while following the low-sodium diet compared with participants in the high-sodium group and by 6 mm Hg compared with participants following their usual diet. These reductions in systolic blood pressure are comparable to the reductions attained with a common, firstline medication for hypertension.

• The usual diet for most individuals was already very high in sodium at approximately 4,500 mg/day. Participants’ systolic blood pressure was not significantly greater with the highsodium diet compared with usual diet.

• In contrast, returning to a high-sodium diet did raise blood pressure when starting from the low-sodium reference point.

“These results indicate that lowering blood pressure through dietary sodium reduction can be achieved safely and rapidly within one week,” Gupta said. “Our study also supports the American Heart Association’s position that consuming excess sodium beyond recommended levels is associated with increasing blood pressure.”

Additionally, the effect of reduction in dietary sodium on blood pressure was consistent across individuals with normal blood pressure, treated high blood pressure, and untreated high blood pressure.

“This reinforces the importance of reductions in dietary sodium intake to help control blood pressure, even among individuals already taking medications for hypertension,” Gupta said. “Just as any physical activity is better than none for most people, any sodium reduction from the current usual diet is likely better than none.”

Trial background and details: • In contrast to several of the largest prior studies examining the effect of dietary sodium on blood pressure, the trial included individuals taking medications for high-blood pressure as well as people with diabetes (Type 1 or Type 2 not collected), the researchers noted.

• At the start of the study, about one-quarter of the 213 participants had normal blood pressure, 20% had controlled high blood pressure, 31% had uncontrolled high blood pressure and the remaining 25% had untreated high blood pressure. Approximately 1 in 5 participants had diabetes.

• 73% of participants were from the CARDIA study. Other MO-AFP.ORG 15

participants were adults in Birmingham, Alabama, and Chicago, Illinois. Participants were ages 50 to 75 years, 65% were women, and 64% were Black adults.

• The low-salt diet included food and drinks provided by the researchers and daily meal plans. Sample breakfasts included oatmeal, Greek yogurt and grapes; sample lunches included fruit, a bag of chips and either a chicken salad, lentil soup or peanut butter and jelly sandwich; and sample dinners included fruit, a bottle of 1% low-fat milk and either a lowsodium frozen burrito, low-sodium frozen vegetable lasagna or a low-sodium rice and vegetable entree.

• Participants on the high-sodium diet added 2,200 mg of sodium to their regular daily diet — by consuming two chicken bouillon packets daily, with 1,100 mg of sodium each, as provided by the researchers.

• The median estimated total daily sodium intake for people on the high-sodium diet was 5,000 mg/day.

• People on the low-sodium diet had a median, 24-hour urine sodium level of approximately 1,300 mg, suggesting that some individuals consumed sodium outside of the food and drink provided.

The United States Department of Agriculture’s Dietary Guidelines for Americans 2020-20252 recommends adults should consume less than 2,300 mg of sodium daily, however, it’s estimated that adults in the U.S. typically consume about 50% more sodium, or about 3,400 mg/day. The American Heart Association recommends3 no more than 2,300 mg of sodium/day and moving toward an ideal limit of no more than 1,500 mg/day for most adults.

According to Gupta, all the items on the low-sodium diet menu were commercially available in grocery stores and online retailers, therefore, it is possible for people to achieve a similar diet low in sodium without participating in a clinical trial.

The investigators noted limitations of their study. Researchers did not observe patients eating the foods on each prescribed menu, in an effort to reflect “real-life” conditions, therefore, there may have been variability in sodium intake; and the dietary interventions were of one-week duration, meaning the study design did not address the long-term sustainability of the lowsodium diet or its effect on blood pressure. In addition, the

results may not be generalizable to populations with different demographics than the study group, Gupta noted.

Co-authors, disclosures and funding sources are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability.

Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting.

The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available at https://www.heart.org/en/about-us/aha-financial-information.

Additional Resources: • AHA health information: Get the Scoop on Sodium and Salt • AHA health information: How to Reduce Sodium • About Scientific Sessions 2023 • About the American Heart Association The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

References can be found on page 47.

RESEARCH HIGHLIGHTS

A randomized trial comparing the effects of high-sodium and low-sodium diets on blood pressure in adults with normal blood pressure and high blood pressure found that following a low-sodium diet significantly lowered blood pressure in 70%-75% of participants in as little as one week, including people currently taking blood pressure medications.

Systolic blood pressure was significantly lowered by 7-8 mm Hg for participants following a low-sodium diet in comparison to those following a high-sodium diet, and by 6 mm Hg for the low-sodium group compared with their usual diet.

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MISSOURI FAMILY PHYSICIAN January - March 2024

2022-23 Officer Annual Reports John Burroughs, MD, FAAFP Board Chair

As outgoing Chairman of the Board of Directors of the Missouri Academy of Family Physicians, I offer my final annual report with immense gratitude. This has been an amazing time of learning and growth since receiving a call from my friend and colleague, Dana Granberg, asking if I would be interested in filling her position as District 1 Director in 2015. I had no idea at that time the experiences that taking that position would offer me. I cannot thank the Academy enough for bringing me out of my small family practice in Liberty and showing me additional paths to helping my patients, my colleagues, my community, and my profession.

These 8 years have given me the opportunity to watch and learn from fellow Board members and the amazing past leaders of the Academy. They have taken me to meeting legislators in Jefferson City (even testifying before committees!), walking the halls of the U.S. Capitol, newspaper interviews in Columbia and TV interviews in Springfield, and meeting and exchanging ideas and experiences with other Board leaders from across the country. All the time feeling the support from our wonderful administrative staff. I know that I’ll be showing my age with this, but that’s OK: This experience has been really cool.

I am proud to report that your Board has had a very productive year. After our Strategic Planning retreat in the summer of 2022, our committees dedicated to membership, education, and advocacy immediately incorporated the vision and goals for the next 3 years. A major thrust has been increasing the presence of students and residents within the Academy by increasing our presence in medical schools and residencies. This has included an expansion in internship opportunities as well as developing an advocacy component to the education of our residencies and students spearheaded by our amazing Executive Director, Kathy Pabst, that has drawn the attention of the American Academy of Family Physicians. With the help of our lobbyists, we were able to have another bill pass in Jefferson City, this time increasing family medicine residency slots in Missouri. And we have academy members (and Kathy) participating in committees within the AAFP. We have responded to the ever-changing landscape of information and education exchange with an increased presence on social media, the inception of virtual CME, and a new trial of regional in-person CME meetings. And with the wonderful slate of executive committee members offered for 2023-2024 under the tutelage of our administrative staff, I have nothing but excitement in anticipation of the growth that is to come. I hope that many of you will take some time to consider how you can broaden your impact on healthcare past the walls of your offices and hospitals.

There are so many opportunities available through your academy to participate in CME education, advocacy locally and

nationally, and support (organizationally and monetarily) for community activities. There is so much more that we can do and need to do legislatively on the state level to protect our patients and our profession. That takes voices and (as always) money. We desperately need a stronger presence in Jefferson City. Ask how you can help.

Once again, thank you so much for the opportunity to serve your Academy of the past 8 years. Thank you to my fellow Executive Committee members over the past 4 years for your dedication, your inspiration, and your friendship. Thank you to all of the Board Directors that I have had the privilege to sit with and work with from throughout Missouri. Thank you to my colleagues working in this amazing profession of family medicine.

Your patients and communities appreciate that tireless (and tiring) work that you do every day, and so do I. And a million thanks to Brittany Bussey, Bill Plank, and the remarkable Kathy Pabst for all that you have done for me and our Academy.

Enjoy the conference and have a safe and wonderful holiday season. And as always, take care of yourselves. We need you.

Kara Mayes, MD, FAAFP President

I began my year of serving as your Missouri Academy of Family Physicians president on my 40th birthday. It has been an excellent way to lead into the fifth decade of my life. Our board is made up of a group of physicians with a wide variety of practice types and settings, and we are all working together to make our specialty as strong as possible in the state. I have always loved the variety available to family physicians and love that we all have similar goals in caring for our patients regardless of setting and scope.

I recently ran my second marathon, and I see many similarities of marathon training and leading an organization like MAFP. Both require assistance from people around me. At MAFP I am lucky to have incredible staff in our chapter office, who can take care of the daily operations of an organization of this size. I also have an excellent team of physicians on the Executive Commission that will continue to lead the Academy in the future. Marathon training also requires a team – my coach to guide training, my family to take on more household responsibilities, and my healthcare providers to keep me from getting sidelined during training. While my marathon training is over, I am fortunate to get to continue with the MAFP Executive Commission for another year as Board Chair.

During my year as President, I have been able to represent the MAFP in many settings. I installed a colleague and friend as President of the St. Louis Academy of Family Physicians in January. I participated in advocacy at the state and national MO-AFP.ORG 17

2022-23 OFFICER ANNUAL REPORTS level with MAFP’s Advocacy Day and AAFP’s Family Medicine Advocacy Summit. I was able to interact with high school students interested in family medicine as a career through HOSA’s family medicine competitive event at their state competition this spring. I enjoyed my first-time attendance at AAFP’s Congress of Delegates last month and getting to observe the policy decisions on such a large scale.

Once again, I want to encourage you to take a more active role in your Academy. Plan to attend one of our regional meetings in December, come to Advocacy Day in Jefferson City in February, or attend our Annual Fall Conference in 2024. Contribute to our MAFP PAC or the Missouri Family Health Foundation. Author an article for the Missouri Family Physician magazine or share your knowledge with a talk at our CME conference or virtual CME sessions.

Thank you to everyone who supported the MAFP this year, it has been an honor to serve as your president and I plan to continue my involvement as much as possible in the future.

Afsheen Patel, MD President-Elect

As we have all moved back to our normal routines and schedules, it seems to be busier than ever for the MAFP. As your president-elect, I have been preparing for my service by learning about our priority issues and how we can use our influence to advance family medicine.

I have always been involved with the MAFP’s Advocacy Day to educate our state legislators about the importance of family medicine in improving the health of Missourians. We passed important legislation this year to expand primary care residency slots with $2.3 million in state funding.

This impactful legislation was passed the first time it was introduced, which is unusual for most legislation.

This year I took it a step further and joined family physicians from across the country and met with our US Senators and Representatives at the AAFP Family Medicine Advocacy Summit in Washington, DC. This year’s conference promoted “Change Starts Here” and was an amazing opportunity to educate Congress and their staff for improved Medicare reimbursement, relief from administrative burden, and an enhanced primary care workforce. We learned in medical school and residency that it takes a team to provide the best health care possible. This same concept is true for addressing change in the health care system.

The MAFP physicians and staff worked together to make efficient use of our limited time in Washington, DC, as well as emphasize our critical message of “Change Starts Here.”

When I look back on my practice and career, I did not imagine I would be preparing to lead a statewide organization of colleagues. Yet, here I am and we are working as a team to lead MAFP in unison so that we leave it better than it was when we started. By attending the AAFP Multi-State Forum and the Annual Chapter Leadership Form, I have listened to other family physicians, chapter executives, member constituencies, and experts talk about what keeps them up at night, how they 18

MISSOURI FAMILY PHYSICIAN January - March 2024

manage programs and services, governance issues, and basically, how to lead a chapter. As I listen to my patients to diagnose their illness, I also listen to a myriad of speakers talk about best practices for chapter management. As I was listening, I was so relieved to learn that your state chapter has implemented many best practices, operating efficiently, and always has you, our members, in mind.

We are wrapping up our 75th anniversary with the Annual Fall Conference, November 10-11. We care for 75-year-old patients about their heart health, bones, joints, muscles, social activities, memory, and so many more other parts that may not be working the way they used to. When I think about the MAFP and applying this analogy, we are in good hands with our chapter team, Kathy, Bill, and Brittany. They are the heart that keeps beating and moves the Academy forward in our advocacy efforts, education, and membership programs. You are our muscle – the strength to advocate for your patients, community, and other family physicians. Our conferences and upcoming regional meetings are social opportunities to network with other Missouri family physicians and learn from each other. We have all the right parts in place to be a healthy organization and to continue to support family medicine.

I would like to personally ask you to join us in December at one of the regional meetings held around the state. Members should have received an email with more details, but you can also go to our website for details and registration information.

I am humbled by the trust that you have placed in me to serve as your President. I will always be member-centered in our advocacy efforts, education programs, and member services.

Natalie Long, MD Vice President

Serving as the Vice President of the Missouri Academy of Family Physicians has been an honor and a privilege. As part of the Executive Commission, I have garnered a deeper understanding of the extensive behind-the-scenes work that happens on a daily basis on behalf of our membership. While we may only feel connected every few months when the next installment of the Missouri Family Physician journal arrives in our mailbox or when we gather together for our conferences, I can assure you that efforts are constantly being made to ensure that the needs, concerns and voice of Missouri’s Family Physicians is being heard.

Advocacy Day in February was an opportunity for Family Physicians across the state to meet and discuss healthcare related concerns with our local lawmakers, prioritizing the preceptor tax credit and expanding primary care residency positions were two positive outcomes.

I also had the opportunity to travel to Texas in February to attend the Multi-State Conference and connect with state leaders from our region. After hearing the struggles and challenges that many other state chapters face, I am certain that our board is well structured with strong leadership strategies and plans for future growth. By focusing on our strategic plan, we can direct our

2022-23 OFFICER ANNUAL REPORTS efforts on priority measures, like encouraging the next generation of family physicians through outreach and pathway programs. I love talking to medical students at Mizzou about life as a family doc, nominating students for family medicine programs and commissions, and writing letters of recommendation!

The AAFP’s Annual Chapter Leadership Forum held annually in Kansas City each spring is another opportunity to bring together family medicine thought leaders and members to collaborate and energize efforts to promote family medicine on a national level.

It is such an incredible experience to be surrounded by so many fellow family doctors with similar missions and goals. At times the future of medicine can seem bleak, but I’m confident that with so many passionate and brilliant family medicine advocates working together, creative solutions will be found to improve payment models, practice effectiveness, and work life balance while continuing to provide top tier family and patient centered care.

I’m looking forward to connecting with many of you at future MAFP meetings and outreach events to bring members together throughout the year.

Lisa Mayes, DO

Secretary/Treasurer

The Missouri Academy of Family Physicians’ (MAFP) strategic plan guides the organization’s programs and services for our members. The mission statement provides the direction for our strategic plan: The Missouri Academy of Family Physicians is dedicated to optimizing the health of the patients, families and communities of Missouri by supporting family physicians in providing patient care, advocacy, education and research.

With this being our compass for our programs and services, we have begun the implementation of the 2023-2025 strategic plan which focuses on advocacy initiatives, resident and student support, education and CME opportunities, communications and more. The efforts are funded by member dues, fees for member activities, and support from vendors and sponsors. The MAFP continues to be financially sound as membership, programs, and services are meeting budgeted expectations. The investments have turned around and are showing gains this year. The interest earned is reinvested into the reserves and not utilized in daily operations of the MAFP. The membership dues collections continue to meet projections. Income from the Academy’s CME offerings and advertising are on target. Dues and event income support resident and student leadership development throughout the year, along with Family Health Foundation of Missouri support.

Next year’s annual budget is year two of the 2023-2025 Strategic Plan with several new initiatives continuing to expand CME sessions, residents and student leadership development, and advocacy efforts. The board reviews the plan at each board meeting along with our progress toward accomplishing the goals.

Fiduciary responsibility is provided by the MAFP Board of Directors with direct oversight of the financial operations of the Academy. Reporting and processes ensure our funds are used and focused on member-centered services.

RESIDENT BOARD REPORT

Kelly Dougherty, MD Resident Director

Noah Brown, MD

Alternate Resident Director

CAPITAL REGION MEDICAL CENTER FAMILY MEDICINE RESIDENCY

Program Director: Daniel Gibson, DO APDs: Dr. Morgan Schiermeier, MD; Dr. Jared James, MD Per Class: Three (3), Four (4), Three (3); 10 total, Will graduate 4 this year Chief Resident: Ishvara Om, DO Social Presence: www.crmc.org; Instagram: @ crmcfamilymedicine, Facebook: Capital Region Medical Center Updates: We have a complete point-of-care ultrasound (POCUS) curriculum, available integrative medicine curriculum with both online and in-person components, BOTOX training, dermal filler training, and international medicine rotation to Ghana.

COXHEALTH FAMILY MEDICINE RESIDENCY

Program Director: Shelby Hahn, MD APD: Kristin Crymes, DO Per Class: Ten (10), Ten (10), Ten (10); 30 total Chief Residents: Jackson Bagby, DO, MS, and Kayla Hufham, MD Social Presence: www.coxhealth.com/fmr; Instagram: @coxhealthfmr; Facebook: CoxHealth Family Medicine Residency Updates: We now have six residents in our Jordan Valley (FQHC) track. 2023 graduates and plans listed below: Brittany Dahlager, DO: Jordan Valley Community Health Center (Springfield, MO) Joshua K. Etcheson, DO: Cox Barton County-Medical One Clinic (Lamar, MO) Alexandra Jones, DO: Olathe Health Family Medicine – College Point (Olathe, KS) Hannah McCarthy, MD: Siloam Springs Regional Hospital (Siloam Springs, AR) Jordan Moore, MD: CoxHealth Family Medicine & Obstetrics (Branson, MO) MO-AFP.ORG 19

2022-23 OFFICER ANNUAL REPORTS Sara Neibauer, DO: Avera Family Health Center (Sioux Falls, SD) Nichole Norgard, DO: CoxHealth Inpatient Psychiatry (Springfield, MO) Grant Ralston, MD: University of Arkansas Sports Medicine Fellowship (Fayetteville, AR) Duncan Tillack, DO: CoxHealth Branson Hospitalist (Branson, MO)

STILL OPTI-NORTHEAST REGIONAL MEDICAL CENTER FAMILY MEDICINE RESIDENCY

Program Director: Eric Lesh, DO, CHSE Per Class: Four (4), Four (4), Four (4); 12 total Chief Residents: Molly Thompson, DO and Kade Kinney, DO Social Presence: www.atsuresidency.com Updates: 2023 graduates and plans listed below: Katherine Holbrook, DO: ATSU Kirksville Family Medicine (Kirksville, MO) Jennifer MacSwords, DO: Milford Family Health (Milford, OH) Sydney Priest, DO: Mercy Clinic Springfield Communities (Rolla, MO) Dominick Wright, DO: Northeast Regional Medical Center ER (Kirksville, MO)

MERCY FAMILY MEDICINE RESIDENCY

Program Director: Sarah Cole, DO APD: Stefanie White, MD Per Class: Six (6), 18 total Chief Residents: Jason Maddox, DO and Rikki Koebler, DO Social Presence: www.mercy.net/healthcare-education/ graduate/st-louis/family-medicine/; Facebook: www.facebook.com/groups/mercystlfamilymedresidency/; Instagram: @mercy_stl_fm Updates: Mercy Family Medicine has created a new opportunity to complete an additional year of training in the management of obesity for children, adolescents, and adults to pursue dual certification from the American Board of Obesity Medicine. This innovation in residency education has garnered press attention and is envisioned to continue in future years.

2023 graduates and plans listed below: Catherine Baker, MD: Blessing Health Systems (Quincy, IL) Viola Hoxha, MD: Baptist Primary Care (Jacksonville, FL) Megan Landis, DO: Mercy Family Medicine (Washington, MO) Michele Sun, MD: Mercy Family Medicine (Kirkwood, MO) Raphael Yang, MD: ArchWell Health (St. Louis, MO) Ellie Hoover Osterman, DO: Fellowship, Obesity Management, Mercy Family Medicine (St. Louis, MO)

RESEARCH FAMILY MEDICINE RESIDENCY

Program Director: Kavitha Arabindoo, MD, FAAFP, MPH APD: Ashley Cefalu, DO Per Class: Eight (8) residents, total of 24

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MISSOURI FAMILY PHYSICIAN January - March 2024

Chief Residents: Emily Rogers, DO. Emily Vahrenberg, MD. Alex Ondracek, DO Social Presence: http://researchresidency.com; Instagram: @researchfamilymedicine

LEE’S SUMMIT FAMILY MEDICINE RESIDENCY

Program Director: Lawrence M. Gibbs, MD Associate Program Director: Karen Foote, MD Per Class: Approved for 18 ACGME slots Social Presence: https://hcahealthcaregme.com/locations/ lees-summit-medical-center/family-medicine-residency/ Updates: The HCA Healthcare Kansas City/Lee’s Summit Medical Center Family Medicine Program is a newly accredited residency entering its third academic year in the summer of 2024. We will be a 6-6-6 program in the summer of 2024.

Our mission is to develop the next generation of competent and compassionate physicians as well as physician leaders.

Our mission is accomplished through excellence and innovation in education, clinical practice, scholarship and service, while expanding residents’ perspectives to be inclusive of cultures, values, and ideals. Driven by a ‘Clinic First’ mentality, our program provides the best opportunities for education from the wealth of resources we have in our area, and couples them with an outstanding, energetic faculty. Residents and faculty work as a team, but also care for their own patient panels, in our outpatient office, Lee’s Summit Family Medicine. We are the only residency in our region to offer the American College of Lifestyle Medicine’s Lifestyle Medicine in Residency Curriculum and have resident wellness integrated into our didactic schedule. Though focused on our immediate Lee’s Summit community, our residents work in different locations throughout the metropolitan area to get exposure to a wide variety of patients with different factors which impact their healthcare. Each resident is provided a laptop, an iPhone for their work as well as M-Modal dictation software. STEP/ COMLEX 3 reimbursement is also provided. There is an orientation stipend of $1,000 and an annual meal stipend of $950.

SSM HEALTH/SAINT LOUIS UNIVERSITY FAMILY MEDICINE RESIDENCY Program Director: Elizabeth Keegan-Garrett, MD Associate Program Director: Jay Brieler, MD Per Class: Six (6) residents, total of 18 Chief Residents: Meghan Hernandez, DO and Victoria Phillips, MD Social Presence: Instagram: @slumedfam Updates: 2023 graduates and plans listed below: Ryan Allen, MD: Sports Medicine Fellow - SSM Health/Saint Louis University Sports Medicine Fellowship Jessica Auld, MD: Private Practice with Mercy Medical Group in St. Louis Anthony Hang, DO: Private Practice with SSM Health Medical Group in St. Louis

2022-23 OFFICER ANNUAL REPORTS Kenneth Alston Lee, DO: Private Practice with Mercy Medical Group in St. Louis Dymon Morgan, MD: Addiction Medicine Fellow - University of California (San Francisco, CA) Carmen Purvis, MD: Maternal Child Health Fellow - University of Rochester (Rochester, NY)

ST. LUKE’S DES PERES FAMILY MEDICINE RESIDENCY

Program Director: Joseph Eickmeyer, DO Assistant Program Director: Brittany Herrin, DO Per class: Four (4) PGY1, Four (4) PGY2, Five (5) PGY3 Chief Residents: Max Hesse, MD Social Presence: https://www.stlukes-stl.com/DesPeres/healthprofessionals/medical-residency.html Updates: Matched 4-interns; Graduated 4 residents Nicholas Faron, DO: Private Practice with Cedar Hill Family Practice, St. Luke’s Medical Group Dina Helina Fleming, DO: Private Practice with Mercy Medical Group in St. Louis Shawn Khosla, DO: Private Practice with Mercy Medical Group in St. Louis Kayla Thomason, DO: Private Practice with Mercy Medical Group in St. Louis

UNIVERSITY OF MISSOURI – COLUMBIA FAMILY MEDICINE RESIDENCY

Program Director: Erika Ringdahl, MD Per Class: Fourteen (14) (plus 2 Sedalia R1s) Chief Residents: John Bocinsky, Jane Salutz, Tori Applegren, Allyson Sanders Social Presence: https://medicine.missouri.edu/departments/ family-and-community-medicine/residency; Instagram: @ Mizzoufamilymed; Facebook: University of Missouri Family Medicine Updates: Matched 14 R1s. 2023 Graduates and plans listed below: Sarah Bohnert: Bloomsdale Medical Center (Bloomsdale, MO) Maggie Brennan: Mercy St. Louis Family Medicine Residency Faculty (St. Louis, MO) Brooke Dean: Pana, Illinois Family Medicine (Pana, IL) Hannah Goodwin: NE Missouri Health Council (FQHC) (Edina, MO) Dalton Lohsandt: Sports Medicine Fellowship, University of Alabama (Tuscaloosa, AL) Dan Lyon: Locum Hospitalist (St. Louis, MO) Seth Mobley: Mercy-Springdale Clinic (Springdale, AR) Colbert Nelson: Sports Medicine Fellowship, University of Missouri (Columbia, MO) Melanie Oler: University of Missouri faculty (Fayette, MO) Danielle Poive: Mercy Family Medicine (Lebanon, MO) Nicole Seddon: SSM Medical Group (St. Charles, MO)

Conner Sutton: University of Missouri faculty (Boonville, MO) Christine White: Family Medical Care Associates (Blue Springs, MO) Andrew Wright: Complete Family Medicine (Moberly, MO)

UNIVERSITY OF MISSOURI – BOTHWELL FAMILY MEDICINE RESIDENCY

Program Director: Misty Todd, MD Per class: Two (2) Social Presence: www.brhc.org/residency; Instagram: @bothwellruralfmr Updates: Approached by other specialties to replicate our program

KCU-GME CONSORTIUM/FREEMAN FAMILY MEDICINE RESIDENCY

Program Director: Barbara H. Miller, MD, FAAFP, and APD Mariam Akhtar, MD Per class: Five (5) per class, 15 total Chief Residents: None Social Presence: www.freemanhealth.com/graduate-medicaleducation Updates: We have two excellent classes of residents, currently recruiting our third class.

We are leaning into our areas of focus, including community health and behavioral health. We have successfully won a $2.5 million grant from HRSA to enhance our residents’ training in behavioral health. Our current second year class is tentatively planning to go into hospitalist medicine, outpatient medicine in a local FQHC, OB fellowship, and sports medicine fellowship.

UNIVERSITY OF MISSOURI KANSAS CITY FAMILY MEDICINE RESIDENCY

Program Director: J. Lane Wilson, MD APDS: Kevin Gray, MD, CAQSM, FAAFP; Jennifer Livingston, MD; Carlie Nikel, PsyD Per class: Twelve (12) per class, 36 total Chief Residents: Miki Andrus-Bearden, DO ; Mallory Dameron, DO; Chris Moyer, DO Social Presence: https://med.umkc.edu/fm/; Facebook: https://www.facebook.com/UMKCFM/ Updates: Graduates and plans listed below: Tasfia Ahmed: Manet Community Health Center – Outpatient (Boston, MA) Annette Anwander: Maternity Care Fellowship- Family Medicine- UMKC/UHLW Kathryn Estes: Allina Health Blaine Clinic – Outpatient (Blaine, MN) Logan Hemme: St. Luke’s Primary Care – Outpatient (Blue Springs, MO) Desztini Howard: Pending (graduates in December) MO-AFP.ORG 21

2022-23 OFFICER ANNUAL REPORTS Haley Kertz: Barry Pointe Family Care – Outpatient (Kansas City, MO) Hai Song Kim: Kaiser – Outpatient (Fontana, CA) Morgan Murray: Direct Primary Care and Locum Tenems Matthew Myrick: PRN hospitalist in Kansas City, MO, eventually practice in Kenya Eddy Ndichie: St Luke’s Health System – Hospitalist (Kansas City, MO) Caroline Ward: Derry Medical Center – Outpatient (Hampton, NH)

STUDENT BOARD REPORT

Abby Crede

Student Director UMKC

Mikala Cessac

Alternate Student Director

University of Missouri—Columbia

KANSAS CITY UNIVERSITY OF MEDICINE AND BIOSCIENCES – KANSAS CITY CAMPUS AND JOPLIN CAMPUS

Goal: To show how multifaceted family medicine is Activity since last board meeting: Coordinated two youth sports physical volunteer events, ultrasound workshop FMIG Leadership (FMIG is part of Primary Care Club/ACOFP at KCU): Joplin Leadership: Allayna Scheumann (Allayna.Scheumann@ kansascity.edu), Kansas City Leadership: President: Shalom Lee (shalom.lee@ kansascity.edu), VP: Chris DeSpain, Treasurer: Ella Fischer, Secretary: Kylie FischerFaculty Advisor: Dr. Guatam Desai

ST. LOUIS UNIVERSITY SCHOOL OF MEDICINE

Goal: Hosting events to increase knowledge of the application and interview process to family medicine, including an M4 practice interview night and residency fair. Also planning to host annual scrubs sale and Primary Care Interest Week Panel Activity since last board meeting: HIV/Prep workshop, Addiction Medicine workshop FMIG Leadership: Co-presidents: Danielle Thistle (Danielle. thistle@health.slu.edu), Divya Patel (divya.patel@health.slu. edu) Faculty Advisor: Matthew Breeden, MD (matthew. breeden@health.slu.edu)

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MISSOURI FAMILY PHYSICIAN January - March 2024

UNIVERSITY OF MISSOURI-COLUMBIA SCHOOL OF MEDICINE Activity since last board meeting: Fall dinner forum, many residency visits FMIG Leadership: Katelyn Weith (kcwrmd@health.missouri. edu); Abigail Beach (beachab@health.missouri.edu), Evadne Rodriguez (ecrtgd@health.missouri.edu), Andruw Wittels (amwyb5@health.missouri.edu)

UNIVERSITY OF MISSOURI-KANSAS CITY SCHOOL OF MEDICINE

Goal: Increase awareness and involvement in the specialty amongst young medical students Activity since last board meeting: Intro to Docent Event, Primary Care Week Events (resident panel, suture workshop, MAFP lecture, POCUS workshop) FMIG Leadership: Co-Presidents: Abby Crede (amc4ck@ umsystem.edu) and Mitchell Mahan (mwm4gq@umsystem. edu), Vice President: Rachel Tran (rntyrt@umsystem.edu), Secretary: Lauren Vaughn (levgvz@umsystem.edu), PR Chair: Samena Talib (stgm8@umsystem.edu), St. Joseph Representative: Will Obert (willobert@umsystem.edu) Advisor: Dr. Chelsie Cain (Chelsie.cain@uhkc.org)

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

Goal: Recruit incoming M1s interested in FM and use approved budget to host events and connect members with information and local opportunities in the field Activity since last board meeting: Participated in a residency fair hosted by SLU FMIG Needs/Requests/Discussion Items: Would like connections with more FM physicians in the STL area who are interested in speaking/meeting with students, as Barnes-Jewish does not have an FM department.

FMIG Leadership: Michael Youssef (m.youssef@wustl.edu)

A. T. STILL UNIVERSITY OF HEALTH SCIENCES: OSTEOPATHIC MEDICAL SCHOOL

Activity since last board meeting: Events hosted: My Route to FM (Dr. Margaret Wilson), Black bag event (learning to use medical equipment), Mock SP, acupuncture clinic (Dr. Stull), Mayo Clinic FMR w/ OMM Track Talk, Aphasia event, Pap smear lecture/demo, Trunk or Treat Event Upcoming events: IDD health fair, FM physician panel FMIG Leadership: President: Levi Stacken (sa208698@atsu. edu)Faculty Advisors: Dr. Margaret Wilson and Dr. Joseph Novinger

2023 CONGRESS OF DELEGATES REPORT

P

reparation for the 2023 AAFP Congress of Delegates began well ahead of the meeting dates of October 25-27 in Chicago. We worked with Dr. Todd Schaeffer to get him ready for his run for President-Elect and we reviewed potential resolutions to submit on behalf of our members. As we drew closer to Congress, Dr. Kate Lichtenberg served as chair of the Bylaws Committee, Dr. Peter Koopman served on the reference committee for Advocacy, and Dr. Sarah Cole served as a teller at the Congress.

Two Bylaws changes were considered. The first was to establish a nominating committee to establish a slate of candidates for the board positions, Speaker, Vice-Speaker, and officers. The second was to award additional delegates to chapters over 1500 members with the largest chapters getting the most delegates.

Establishing the nominating committee passed and was followed by a long discussion of the rules that would then govern. In the end, rules were agreed to and Dr. Reid Blackwater, former AAFP President, was named as the first chair. Work continues to collect names of those that will serve on the committee and he will eventually appoint them. The second change was not adopted and all chapters will continue to have 2 delegates to represent them at the Congress.

Missouri submitted a resolution asking AAFP to collect Chapter PAC donations with annual dues. There was much discussion in the reference committee and in the end the recommendation was to not adopt. We did not extract it for discussion on the floor and have instead decided to do additional research and work with AAFP staff to find other ways of facilitating PAC dollar collection. This could include bringing back a new resolution for 2024.

There were resolutions that were adopted, those that were reaffirmed as current policy, some that were amended, and some that were not adopted.

HIGHLIGHTS ARE AS FOLLOWS:

Resolution 202 introduced by the Missouri Chapter (NOT ADOPTED): RESOLVED, That the American Academy of Family Physicians create an option for opt-in contributions to state chapter Political Action Committees at the time of the membership renewal/invoice.

Resolution 205 introduced by the Oregon Chapter (Substitute Resolution ADOPTED): RESOLVED, That the American Academy of Family Physicians support and advocate for an evidence-based, standardized, universal training program in suicide prevention for clinicians and healthcare practitioners in the United States.

Resolution 305 introduced by the Michigan Chapter (ADOPTED): RESOLVED, That the American Academy of Family Physicians encourage multi-state and national electronic health record vendors to include screening tools to document individual patient Adverse Childhood Events and Positive Childhood Events in a manner that may be used for individual or population assessment and to inform intervention strategies by members of the interdisciplinary care team, and, be it further RESOLVED, That the American Academy of Family Physicians encourage multi-state and national payors to pay for the administration of screening tools under Current Procedural Terminology code 96160 to document individual patient Adverse Childhood Events and Positive Childhood Events.

Resolution 309 introduced by the Hawaii Chapter (REFERRED to the Board of Directors): RESOLVED, That the American Academy of Family Physicians develop recommendations for sustainable models of after-hours access to primary

care physicians, especially for small independent practices that lack the sustainability for 24-hour solo coverage, and be it further RESOLVED, That the American Academy of Family Physicians endorses expansion of research on the various models of after-hours care, to compare quantifiable outcomes such as emergency department visits, health care utilization, patient satisfaction, and physician wellness.

Resolution 407 introduced by the New Mexico Chapter (REAFFIRMED as current policy): RESOLVED, That the American Academy of Family Physician advocate that Centers for Medicare and Medicaid Services rules be changed to recognize a hemoglobin A1C greater than or equal to 6.5 as solo diagnostic criteria to be allowed to refer to diabetes education services.

Resolution 410 introduced by the Rhode Island Chapter (REFERRED to the Board of Directors): RESOLVED, That the American Academy of Family Physicians investigate the management of pediatric obesity and overweight, and develop a guideline on this topic, with meaningful consideration for the harmful impacts of weight stigma and overreliance on Body Mass Index.

Resolution 503 introduced by the California Chapter (ADOPTED): RESOLVED, That the American Academy of Family Physicians support elimination of mandatory reporting to law enforcement for adult intimate partner violence victims, and be it further RESOLVED, That the American Academy of Family Physicians support requirements for referrals to local and/or national domestic and sexual violence advocacy services for adult intimate partner violence victims.

Resolution 508 introduced by the Indiana Chapter (Substitute Resolution ADOPTED): RESOLVED, That the American Academy of Family Physicians explore viable processes by which a physician may be compensated for participation in the peer-to-peer and prior authorization processes.

Resolution 514 introduced by the Washington Chapter (Substitute Resolution ADOPTED): RESOLVED, That the American Academy of Family Physicians support the Modernizing Opioid Treatment Access Act to expand access to methadone for treatment of opioid use disorder, and be it further RESOLVED, That the American Academy of Family Physicians work with government agencies and other relevant stakeholders to implement a viable plan for the United States to expand access to methadone for opioid use disorder.

A complete list of all of the actions of the Reference Committees can be found at https://www.aafp.org/about/congress-delegates/2023/2023refcom-reports.mem.html.

On the final day of Congress, the election for President-Elect took place.

Our candidate had a strong showing in his speech and answering questions posed by the Congress. He answered countless questions from members over the days ahead of the vote. In the end, Dr. Jennifer Brull of Fort Collins, CO was elected as AAFP’s next President-Elect. The entire Missouri Delegation was honored to be a part of Dr. Schaeffer’s campaign and are so very proud of him. Special thanks to the MAFP staff, Kathy Pabst and Bill Plank, for all of their work on the campaign.

Respectfully Submitted, Kate Lichtenberg, DO, MPH, Delegate Peter Koopman, MD, Delegate Sarah Cole, DO, Alternate Delegate Jamie Ulbrich, MD, Alternate Delegate MO-AFP.ORG 23

MEET THE 2023-2024 MAFP BOARD OF DIRECTORS

Kara Mayes, MD, FAAFP (St. Louis)​ Board Chair

Afsheen Patel, MD (Kansas City) President

Natalie Long, MD (Columbia) President-Elect

To connect with your district director or for any questions, please email district.director@mo-afp.org.

Beth Rosemergey, DO, FAAFP (Kansas City) Vice-President

24

Lisa Mayes, DO (Macon) Secretary/Treasurer

Arihant Jain, MD, FAAFP (Cameron) District 1 Director

Brad Garstang, MD (Kansas City)​ District 1 Alternate

Eric Lesh, DO (Kirksville) District 2 Director

Katherine Holbrook, DO (Kirksville) District 2 Alternate

Dawn Davis, MD, FAAFP (St. Louis) District 3 Director

Lauren Wilfling, DO, FAAFP (St. Louis) District 3 Director

Christian Verry, MD (St. Louis) District 3 Alternate

Jennifer Allen, MD (Hermann) District 4 Director

Jennifer Scheer, MD, FAAFP (Gerald) District 4 Alternate

Amanda Shipp, MD (Versailles) District 5 Director

David Pulliam, DO, FAAFP (Higginsville) District 6 Director

Misty Todd, MD (Sedalia) District 6 Alternate

MISSOURI FAMILY PHYSICIAN January - March 2024

Chad Byle, MD, FAAFP (Kansas City) District 7 Director

Jacob Shepherd, MD, FAAFP (Lees Summit) District 7 Director

Rachel Hailey, MD, FAAFP (Lees Summit) District 7 Alternate

Andi Selby, DO, FAAFP (Branson) District 8 Director

Barbara Miller, MD, FAAFP (La Russell) District 8 Alternate

Douglas Crase, MD (Licking) District 9 Director

Gordon Jones, MD, FAAFP (Sikeston) District 10 Director

Jenny Eichhorn, MD (Jackson) District 10 Alternate

Stacy Jefferson, MD (St. Louis) At Large Director

Krishna Syamala, MD, FAAFP (St. Louis) At Large Director

Kento Sonoda, MD (St. Louis) At Large Director

Kelly Dougherty, MD, Mercy Resident Director

Noah Brown, MD, Mercy Resident Alternate

Abby Crede, UMKC Student Director

Mikala Cessac, UMC Student Alternate

Peter Koopman, MD, FAAFP AAFP Delegate

Kate Lichtenberg, DO, FAAFP AAFP Delegate

Sarah Cole, DO, FAAFP AAFP Alternate

Jamie Ulbrich, MD, FAAFP AAFP Alternate

District 5 and 9 Alternate Director positions are vacant.

MO-AFP.ORG 25

31 Annual Conference st

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Fall

he Missouri Academy of Family Physicians held the 31st Annual Fall Conference November 10-11, 2023, at Big Cedar Lodge in Ridgedale, MO. This conference was special as it marked the 75th anniversary of the Missouri Academy of Family Physicians.

Family physicians from all corners of Missouri and surrounding states attended this conference. A total of 176 family physicians, residents, students, and other health care professionals participated in this annual CME conference. Moreover, our industry partners play a powerful role in making this conference possible, and their support was strong with 33 exhibitors and sponsors.

This year’s conference festivities started a few weeks early as the Family Health Foundation of Missouri held a silent auction which started virtually and converted to live at a Friday evening cocktail hour. Many great items were available to win including a Super Bowl football signed by Kansas City Chiefs player Creed Humphrey, Tory Burch Purse, Rocky Mountain Lodge trip with luggage, socks with mystery gift cards, regional specialty goods and art, homemade treats, and much more. Members, attendees, and exhibitors enjoyed shopping to support medical students and residents in their journey to becoming family physicians and the Tar Wars program. Our annual 50/50 drawing was held for those that didn’t find an item in the silent auction or who just wanted to support monetarily. Over $10,000 was raised through these events for the Family Health Foundation of Missouri, a substantial increase from previous years! Our physicians were also very motivated to donate to the MAFP Political Action Committee. Our members stepped up their giving to the PAC this year and donated over $10,500 at this conference. Thank you to all who donated!

Attendees were able to earn up to 13.5 CME credits. Many thanks to the speakers who presented. Based on evaluation responses, attendees were very satisfied overall with the speakers and topics.

In addition to the expert lineup of speakers, MAFP held its annual meeting and installation ceremony at this event. Several family medicine leaders were recognized including recognition of Steve Griffith, MD, FAAFP as Family Physician of the Year. John Burroughs, MD was presented the Soaring Eagle Award in recognition of his year as MAFP Board Chair. Kara Mayes, MD, FAAFP was presented with a commemorative gavel in recognition of her year as MAFP Board President. Afsheen Patel, MD was installed as our president and received a framed print of the presidential oath. Dalton Lohsandt, MD, was awarded Resident of the Year. More information on the Annual Meeting including details on these award recipients can be found on pages 28-29.

Members interested in presenting CME at the Annual Fall Conference are encouraged to reach out to MAFP Assistant Executive Director, Bill Plank, CAE, at bplank@ mo-afp.org or (573) 635-0830 for further details.

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MISSOURI FAMILY PHYSICIAN January - March 2024

Save the Date

The 32nd MAFP Annual Fall Conference will be held November 8-9, 2024. After many years at Big Cedar, we are moving to InterContinental on the Plaza in Kansas City. The MAFP annual meeting will be held in conjunction with this conference. Watch for more details as the conference schedule takes shape throughout the year.

Heidi Miller, MD

Synergizing Public Health, Policy, and Healthcare Delivery in Missouri

Charlie Rasmussen, DO, FAAFP

Urgent and Emergency Care Clinical Pearls

Michael Selby, MD, FASN Andi Selby, DO, FAAFP

Nephrology for the Primary Care Physician

Caroline Rudnick, MD

Understanding Disordered Eating: Recognition and Management Strategies

John Paulson, DO, PhD

Treating the Most Difficult Patient - Ourselves: Physician Wellness and SelfCare Interactive Session

Abraham Chyung, MD, PhD

Facilitating Cognitive Assessment in Primary Care for the Timely Detection of Alzheimer’s Disease: Leveraging Medicare Reimbursement Mechanisms to Improve Clinical Care

Kevin Gray, MD, CAQ SM

Keep a Clear Head: Concussion Diagnosis, Treatment, and Prevention

Dawn Davis, MD, MPH, FAAFP, CCHP, CHCQM Care of Justice-Involved Patients: Considerations and Resources for Individuals Who Have Experienced Incarceration Kento Sonoda, MD, AAHIVS, FASAM

How to Address the Stigma of Addiction Medicine

Maya Moody, DO, FAAP

Depression, Anxiety, and Suicidal Ideation in Adolescents

Anna Larson, DO

Gender Affirming Care 101

Kara Mayes, MD, FAAFP

Obesity Treatment: 2023 and Beyond

MO-AFP.ORG 27

75th Annual Meeting Celebrates Family Physicians

A

s we commemorated our 75th anniversary on November 11, 2023 at Big Cedar Lodge we reflected on our past, but looked forward to our future as family physicians.

The annual meeting elected new officers, affirmed board appointments, reviewed annual reports, and took a moment of silence for our fellow family physicians who passed away during the last year. The annual meeting was followed by our awards and installation ceremony where recognized family medicine champions.

Reflecting on the last 75 years, we are working on issues that were important to us then and now, including workforce issues, physician reimbursement, scope of practice, and so much more.

Ultimately, we are still working together to improve our patient’s health, reduce healthcare costs, and ensure physician satisfaction continues to improve.

A brief history of our beginning started 75 years ago, in February 1948, our first president, Dr. Robert Myers, organized a group of 25 family physicians in St. Louis to sign our first state charter of the American Academy of General Practice. Missouri’s first family practice residency program was accredited at Research Hospital in 1968. Family medicine became the 20th specialty board in 1970 at which time we also changed our name to the Missouri Academy of Family Physicians. Membership in the MAFP has grown from 950 in the 1980s to over 1,300 today. Our Family Physician of the Year award began in 1991 and continues to this day.

We have had several members elected to the AAFP board over the years including Dr. Jack Stelmach in 1974, and then he served as president in 1979; Dr. Pat Harr served on the AAFP board in 1992 and as president in 1997; Dr. Julie Wood served on the board for one year before joining the AAFP team; and most recently, Dr. Todd Shaffer, served on the board from 2020-2023.

Governor Mike Parson offered a Certificate of Recognition to the MAFP to commemorate our founding 75 years ago. It reads: 28

MISSOURI FAMILY PHYSICIAN January - March 2024

Whereas, the Missouri Academy of Family Physicians (MAFP) was founded in 1947 and is the largest Missouri medical society devoted solely to the practice of Family Medicine representing more than 2,400 members including family physicians, family medicine residents and medical students; and Whereas, the MAFP was the first state chapter of the American Academy of Family Physicians; and Whereas, MAFP members provide acute, chronic, and preventive primary care services necessary to restrain everincreasing health care costs and improve public and community health; and Whereas, family physicians have studied for a minimum of seven years from medical school through residency and have completed rigorous, specialized training in adult medicine, pediatrics, obstetrics-gynecology, general surgery, geriatric medicine, psychiatry/behavioral healthcare, and musculoskeletal care; and, Whereas, Missouri family physicians conduct over 4 million patient visits per year, contributes $3.2 billion in direct and indirect economic output and employ over 21,000 direct and indirect employees; and, Whereas, Missouri is home to seven medical schools and twelve family medicine residency programs; and Whereas, MAFP will celebrate its 75th Anniversary during the 31st Annual Fall Conference at Big Cedar Lodge in Ridgedale, Missouri from November 10-11, 2023; and Now, therefore, I, Michael L. Parson, Governor of the State of Missouri do hereby recognize and thank the Missouri Academy of Family Physicians for their many contributions to the state of Missouri and extend to them our best wishes on their 75th anniversary.

Kara Mayes, MD, FAAFP, presented the slate of officers that were duly elected during this annual meeting. Read more on page 32.

The membership also ratified the following representatives for the AAFP Congress of Delegates: Delegates Kate Lichtenberg, DO, FAAFP (Kirkwood) Peter Koopman, MD, FAAFP (Columbia) Alternate Delegates Sarah Cole, DO, FAAFP (St. Louis) Jamie Ulbrich, MD, FAAFP (Marshall) Throughout the year, there is turnover in the district director positions. The MAFP Executive Commission selected the following members to renew their current position or fill vacant positions on the board: District 1 Alternate Director - Brad Garstang, MD, Liberty District 2 Director - Eric Lesh, DO, Kirksville Alternate Director - Katherine Holbrook, DO, Kirksville District 4 Director - Jennifer Allen, MD, Hermann Alternate Director - Jennifer Scheer, MD, Gerald

District 6 Director David Pulliam, MD District 7 Director - Chad Byle, MD, Lee’s Summit Alternate Director - Rachel Hailey, MD, Kansas City Directors at Large Krishna Syamala, MD, St. Louis Stacy Jefferson, MD, St. Louis Kento Senoda, MD, St. Louis The following family physicians who have gone before us this past year were recognized and remembered: Robert E Mason, DO, Saint Louis William P Hamilton, MD, Verona Lee B Heutel, MD, Saint Louis L Mitchell Magruder, MD, Nevada William G Marshall, MD, Fayette Gene Alan McFadden, MD, Waverly William D Soper, MD, Kansas City James P Brillhart, MD, Columbia

Family Physician Champions Honored with Recognition

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he Missouri Academy of Family Physicians recognizes family physicians who are exemplary individuals who go above and beyond to support and promote family medicine in Missouri. This year was no exception and we had the honor of installing your new president, awarding the Outstanding Resident of the Year Award, and announcing the Family Physician of the Year. In addition, we conferred seven family physicians to receive the Degree of Fellow from the American Academy of Family Physicians (AAFP) and recognized family physicians who have reached membership anniversary milestones.

Sterling Ransone, MD, Past President of AAFP, was given the honor of conferring family physicians with the Degree of Fellow. The Degree of Fellow recognizes AAFP members who have distinguished themselves among their colleagues, as well as in their communities, by their service to family medicine, by

their advancement of health care to the American people, and by their professional development through medical education and research. The Degree of Fellow signifies not only ‘tenure’ but additional work in your community, within organized medicine, within teaching, and a greater commitment to continuing professional development and/or research. The following family physicians were conferred: Kelly Bain, MD, FAAFP, Washington John Burroughs, MD, FAAFP, Kearney Chadwick Byle MD, FAAFP, Kansas City Katie Davenport-Kabonic DO, FAAFP, Springfield Todd Fristo MD, FAAFP, Greenwood Bridget Gruender MD, FAAFP, Columbia Kathryn Huggins Rampon, MD, FAAFP, Kansas City

MO-AFP.ORG 29

Congratulations on Your Membership Milestone

25

Years

Karl Grant, DO, Ottawa, KS Danny Bartlett, MD, Cameron Jay Brieler, MD, FAAFP, St. Louis Damon Broyles MD, FAAFP, Eureka Richard Burke, MD, Rock Port Pearl Carrillo, DO, Marshall Mary Chitwood, MD, Eureka Betsy Clemens, MD, Creve Coeur Brian Clonts, MD, Branson Bridgett Cooper, MD, Parkville Kevin Craig, MD, MSPH, FAAFP, Columbia Justin Cramer, MD, MBA, FAAFP, Marshall Elizabeth, Dexter-Manade, MD, Blue Springs Chad, Fowler, MD, Lake St Louis David Gayle, MD, Piedmont Tracy Godfrey, MD, FAAFP, Carl junction Bryan Green, MD, Maryville Kieth Groh, MD, Columbia Megan Groves, MD, Liberty Jamie Honeycutt, MD, Richmond Kurt Jaeger, MD, Hillsboro Jamie Jones, MD, Springfield Timothy Jones, DO, FAAFP, Springfield Raghu Kanumuri, MD, Frontenac Kenneth Kilian, MD, Festus Beryl Kime, MD, Cassville Louis Krenn, MD, Battlefield Mary Anne Kurek, DO, Camdenton Kate Lichtenberg, FACPM, DO, MPH, FAAFP, Kirkwood Rachelene Middleton, MD, Springfield Sandra Minchow-Proffitt, MD, Kirkwood Audrey Montooth, MD, Saint Louis Jennifer Moretina, MD, Kansas City Serin Phruttitum, MD, Saint Louis Ann Riggs, DO, Platte City Amy Roberts, MD, Saint Louis Aaron Sapp, MD, MBA, Columbia Diane Scheuer, DO, Lees Summit Sharon Scott, MD, Liberty Jennifer Sewing, DO, Saint Louis Chad Smith, DO, Wright City Jessica Smith, MD, Florissant Matthew Stinson, MD, Springfield Joy Stowell, MD, Troy Clint Strong, MD, FAAFP, Springfield Madhuri Subbaiah, MD, Saint Louis Dorothy Swingle, MD, FAAFP, Louisiana Margaret Taylor, MD, Nixa Marsha Taylor, MD, Ozark Jason VanGundy, MD, Wentzville Chad Wagoner, MD, Carthage Raymond Weick, MD, Eurekma Rick Williams, MD, Springfield Brice Windsor, DO, Fulton Erica Scheffer, MD, Dyersburg, TN

30

Years

Jennifer Livingston, MD, Leawood, KS Tammy Albrecht, MD, Elk Creek Lynn Allison, MD, Branson Kelvin Bailey, MD, Tuscumbia Grace Beaumont, MD, Saint James Brian Bellamy, MD, Clinton Nishua Bendt, DO, Republic Christopher Best, MD, FAAFP, Kansas City 30

MISSOURI FAMILY PHYSICIAN January - March 2024

Michelle Britton-Mehlisch, MD, Lees Summit John Burroughs, MD, FAAFP, Independence Rodger Campbell, MD, Stockton Caroline Day, MD, MPH, Saint Louis Kendall De Selms, DO, Cameron Kenneth DeCoursey, MD, Jackson Stephen Dennis, DO, Monett Michael Di Bernardo, MD, Kansas City Akinrinola Fatoki, MD, Saint Louis Kristen Glover, MD, Springfield M Griswold, MD, Eldon Marcel Haulard, MD, Wright City Robert Herting, MD, Columbia Leonard Hoffmann, MD, O Fallon Mark Howard, MD, Wentzville Kevin Kane, MD, Columbia Debra Keith, DO, Weston Hee Sun Kim, MD, Ozark Candise Kroutil, MD, Strafford Erik Lindbloom, MD, MSPH, FAAFP, Columbia Tonya Little, MD, Fenton Brian Mahaffey, MD, FAAFP, Saint Louis David Melchior, DO, FAAFP, Wentzville V Messmore Arn, MD, Belton Philip Mitchell, MD, Lebanon Robin Morris, MD, Liberty Patrick O’Hara, MD, Fredericktown Fred Rottnek, MD, FAAFP, Creve Coeur Kevin Schrunk, DO, Warrensburg Todd Shaffer, MD, MBA, FAAFP, Lees Summit Deanna Siemer, MD, Jackson Patrick Smith, MD, Washington Lori Snook, DO, FAAFP, Maryville Gregory Terpstra, DO, Potosi Richard Tipton, DO, Gordonville Jamie Ulbrich, MD, FAAFP, Marshall Patricia Williams, MD, Fenton James Wirkkula, DO, Butler

35

Years

Julie Wood, MD, MPH, FAAFP, Leawood, KS David Afshar, DO, Hollister William Bednar, MD, FAAFP, Kansas City Kenneth Braton, DO, Kansas City Thomas Dahlberg, MD, FAAFP, Blue Eye Todd Fristo, MD, FAAFP, Greenwood James Hall, MD, Kansas City Robert Heath, MD, FAAFP, Rogersville Grant Hoekzema, MD, FAAFP, Creve Coeur Thomas Hopkins, MD, Lamar Brent Hrabik, MD, FAAFP, Kansas City William Kessler, Jr, MD, FAAFP, Joplin Rosa Kincaid, MD, FAAFP, Saint Louis Edwin Kraemer, MD, Lees Summit Thomas Landholt, MD, Saint Louis Brian Lenz, MD, MBA, Wildwood Ziana Liese, MD, Independence Robert Mason, DO, FAAFP, Saint Louis Roderick Matticks, MD, Cottleville David McCormick, MD, FAAFP, Kansas City James McDowell, MD, FAAFP, Macon Linda Myers, MD, Joplin Stephen Nester, MD, Saint Louis Bernie Parrish, MD, Springfield Daniel Roney, MD, Kansas City Paul Schoephoerster, MD, Fayette Jeffrey Scott, MD, Raymore Douglas Smith, MD, FAAFP, Odessa George Solomon, MD, Clayton

Jeffrey Tedrow, MD, FAAFP, Bolivar Ronald Vance, MD, FAAFP, Bolivar Elizabeth Wuebbels-Jones, MD, High Ridge Cynthia Croy, MD, Anderson, SC John Tabb, DO, Georgetown, TX

40

Years

Richard Schamp, MD, FAAFP, Rockford, MI Anne Arey MD, FAAFP, Nixa David Barbe, MD, FAAFP, Mountain Grove Donald Binz II, MD, FAAFP, Saint Louis Jonathon Bird, MD, FAAFP, Farmington Dennis Breed, DO, FAAFP, Kansas City Rama Devabhaktuni, MD, Chesterfield Henry Domke, MD, New Bloomfield William Donnell, MD, Bolivar Sidney Griffith, MD, Cape Girardeau Dennis Hughes, DO, FAAFP, Shell Knob Robert Kleinigger, MD, FAAFP, Leslie Timothy Little, MD, Kansas City Layne Lovell, MD, FAAFP, Fenton Michael Pennington, MD, Springfield David Pulliam, DO, FAAFP, Higginsville David Showers, DO, FAAFP, Springfield Debra Smithson, MD, FAAFP, Lees Summit Scott Soerries, MD, FAAFP, Saint Louis Kenton Stringer, MD, Republic Austin Tinsley, MD, FAAFP, Poplar Bluff Ted Vargas, MD, Eureka James Weiss, MD, Jefferson City Rodney McFarland, MD, FAAFP, Grove, OK Michael O’Dell, MD, MHA, FAAFP, Memphis, TN

45

Years

Polly Galbraith, MD, Naples, FL Richard Honderick, DO, FAAFP, Solon, IA Larry Rues, MD, FAAFP, Leawood, KS Thomas Alderson, MD, FAAFP, Saint Joseph Edwin Breshears, MD, FAAFP, Fulton R Collison, MD, FAAFP, Springfield Max Goodwin, MD, FAAFP, Liberty Lonnie Kennington, MD, FAAFP, Chesterfield Peter Marcellus, MD, FAAFP, Branson F L Thompson, MD, FAAFP, Nevada

50

Years

Fred Caldwell, MD, Poplar Bluff Jack Colwill, MD, Columbia Malcolm Dickerson, MD, FAAFP, Barnett

60 65

Years

T W Garrison Jr, MD, Springfield William Hamilton, MD, Verona

Years

Marvin Fowler, MD, West Plains Robert McAfee, MD, FAAFP, Springfield

MO-AFP.ORG 31

Afsheen Patel MD, Lisa Mayes DO, Kara Mayes MD, Natalie Long MD, and Beth Rosemergey DO.

Missouri Academy Installs New Officers

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he Missouri Academy of Family Physicians (MAFP) installed new officers at the Academy’s 75th Annual Meeting on November 11, 2023, at Big Cedar Lodge in Ridgedale, Missouri. Serving as President last year, Kara Mayes, MD, FAAFP, became Board Chair of the family medicine group. Other officers include President Afsheen Patel, MD; President-Elect Natalie Long, MD; Vice President Beth Rosemergey, DO, FAAFP; and Lisa Mayes, DO, who completed year one of her three-year term as Secretary/Treasurer.

K. MAYES (CHAIR)

Kara Mayes, MD, FAAFP, of St. Louis, Missouri, practices at Mercy Clinic Weight and Wellness in Ballwin, Missouri. She completed medical school at Saint Louis University and residency at the Mercy Hospital Saint Louis Family Medicine Residency program. She is board certified in family medicine and obesity medicine. Dr. Mayes is married and has two children.

PATEL (PRESIDENT)

Afsheen Patel, MD, of Lee’s Summit, Missouri, practices at the St. Luke’s Primary Care Clinic in Lee’s Summit with a special interest in women’s health care, sports medicine, geriatric care, and primary and preventative care. She completed her medical school training at the Royal College of Surgeons United Kingdom and her residency at the University of Missouri Columbia Family Medicine Residency 32

MISSOURI FAMILY PHYSICIAN January - March 2024

program. She is board certified by the American Board of Family Medicine. Dr. Patel is married and has four children.

LONG (PRESIDENT-ELECT)

Natalie Long, MD, of Columbia, Missouri, completed her medical school and family medicine residency at University of Missouri Columbia (UMC). She practices full-spectrum Family Medicine and has a special interest in maternal mental health, opioid dependence management, and pregnancy care. She holds the rank of Associate Professor of Clinical Family and Community Medicine at the UMC School of Medicine. She resides in Columbia, MO with her husband and four children.

ROSEMERGEY (VICE PRESIDENT)

Beth Rosemergey, DO, FAAFP of Kansas City, Missouri, is Chair of the Department of Community and Family Medicine at University of Missouri Kansas City School of Medicine and serves as the Associate Chief Medical Officer at University Health Lakewood Medical Center.

She completed medical school at the University of Health Sciences – Kansas City and residency at University of Missouri - Kansas City. Dr. Rosemergey lives in Lee’s Summit, MO.

L. MAYES (SECRETARY/TREASURER)

Lisa Mayes, DO, of Macon, Missouri, completed year two as Secretary/Treasurer of the Missouri Academy of Family Physicians

(MAFP) and confirmed continuation of her 3-year term. Dr. Mayes is employed by the Samaritan Hospital in Macon, Missouri, and has been practicing for 14 years. She is board certified in family medicine. She graduated from AT Still University in Kirksville and completed her residency at Northeast Regional Medical Center in Kirksville, Missouri. Dr. Mayes has three daughters.

MAFP INSTALLS 75TH PRESIDENT

When Afsheen Patel, MD, chose family medicine as her specialty, she didn’t expect to be elected and installed as the Missouri Academy of Family Physician’s 75th president. Kathy Pabst, MAFP Executive Director, had the privilege to install Dr. Patel as your 20232024 President. As Kathy introduced her, she emphasized Dr. Patel’s qualities that make her a strong President such as committed, dedicated, experienced, advocate, and warrior. Afsheen loves being a family physician which has led her to where she is today, your next president. She continually gives her heart to her family, her patients, and her profession. Kathy presented Dr. Patel with the President’s Oath and Pin to commemorate this honorable occasion.

AFSHEEN PATEL, MD, MAFP 75TH PRESIDENTIAL SPEECH

Thank you, Kathy [Pabst], for those kind words and for your friendship over the past 10 years. One of the wonderful benefits of being involved in this organization is developing professional and personal relationships with good people like you. I would like to thank those who have served on our executive committee during my 8 years on the Academy’s Board and over the past 2 years in the Executive Committee. You have shown wonderful leadership and generosity with your time outside of your busy practice lives to help further our profession throughout Missouri. Special thanks to Sarah Cole, John Paulsen, John Burroughs, and Kara Mayes for being such excellent role models to follow.

The only way we can all lead this organization while also continuing our full-time practices as physicians is with the help of an amazing staff. Kathy, Bill, and Brittanie go above and beyond their

job descriptions on a regular basis, and they really make it easy for us to continue to grow the impact of MAFP. I would like to talk about some of the things the Academy has been working on.

We co-sponsored the Missouri Wellness Conference in October with the Missouri State Medical Association and the Missouri Association of Osteopathic Physicians and Surgeons. It was highly successful with 21 physicians and their families. Two MAFP members presented at the conference and several family physicians attended.

Here is a comment from one attendee: “I mentioned this in the review, but I just wanted to specifically say how much I enjoyed this conference. My wife and I feel actually altered in our approach to our life and my career going forward in ways that will be good for our family.”

I’m not sure if I could give a conference review that means more than that.

We’re developing guidelines to award a $2,500 scholarship to a Missouri family physician to participate in the AAFP wellness program. Scope of practice for APRNs is always an important issue.

We will continue to advocate for a collaborative practice. We did pass the increased primary care residency slots legislation with $2.3 million in 2023. Preceptor tax credit rules have not been finalized yet. They have been published for comments, but the final rule isn’t available. We are hopeful it will happen soon.

Last and most importantly, I want to thank all my family for their support. My husband has been amazing at encouraging me throughout the years. My children have come to know the academy as their home. You might have seen pictures of them advocating with us in Jefferson City. Personally, I love this. Family medicine is about personal relationships. What better way than to make our family and children feel that they are a part of our every effort and accomplishment.

I thank you all again for being here and being the best of family medicine and best of all practicing medicine has to offer.

MO-AFP.ORG 33

Griffith Named MAFP Family Physician of the Year

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he Missouri Academy of Family Physicians presented R. Stephen Griffith, MD, FAAFP, of Kansas City, Missouri, with the 2023 Family Physician of the Year Award at the Academy’s 75th Annual Meeting. A committee of family physicians selected Dr. Griffith from nominations made by patients, community members, and fellow physicians.

Dr. Griffith has practiced family medicine in Missouri, including obstetrics, inpatient, pediatric, and adult medicine for over 40 years.

As a rural family physician, then a residency program director, and then Chair of the family medicine department, Steve used every opportunity to teach and share his compassion with patients, medical students, residents, and colleagues.

Dr. Griffith was born in rural Northeast Missouri and raised on a farm where hard work wasn’t optional. He earned his medical degree at the University of Missouri - Columbia and completed his family medicine residency at the University of Arizona in Tucson. He has given back to his profession by providing dedicated service to the American Academy of Family Physicians, Missouri Academy of Family Physicians, Society of Teachers of Family Medicine, Association of Family Medicine Residency Directors, the Association of Departments of Family Medicine, and other national and statewide organizations.

Dr. Griffith attributes the impact he made to those around him – particularly his colleagues, parents, wife, and children. He reflects fondly on his career in family medicine saying, “The relationships that a family doc develops with the patients over multiple generations is unique among the specialties and is what I believe most patients still desire.”

He also looks forward to the next generation of family physicians saying, “I also spent most of my career teaching medical students and residents. The fulfillment one gets from that is great. We should all share the responsibility to teach the next generations of family physicians.

Dr. Steve Griffith is a Family Physician at University Health, Lakewood Medical Center in Lee’s Summit. He is married with four children and four grandchildren.

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MISSOURI FAMILY PHYSICIAN January - March 2024

2023 FAMILY PHYSICIAN OF THE YEAR SPEECH R. STEPHEN GRIFFITH, MD, FAAFP

Thank you. What an honor. I would like to thank the MAFP, the committee that chose me, the person who wrote the eloquent letter of nomination, the other folks who were willing to write supporting letters, listing the good things and leaving out the bad bits. As we all know, medicine is a team sport and in order to be considered an excellent physician one must also be associated with wonderful, capable co-workers, staff, and partners and I owe a debt to all of them as well. One’s life improves so much if you’re lucky enough to work with people who make you feel good to be around them, and I have been fortunate to have been around people like that my entire career.

You have heard of the “impostor syndrome” which probably most of us experience in our early years of practice, when we feel we are not really up to the task expected of us and others will eventually figure that out and we will be disgraced. Well, I have been a practicing family physician since 1980 and I’m over 70, so I got over that a long time ago. However, I would propose a corollary syndrome, maybe called why not you syndrome, that indicates while I am very proud to be named the physician of the year, I know there are plenty of other family physicians in this room and across the state that are just as deserving of the award as am I. I salute you all.

I believe any success I have achieved came from three wise life decisions I made. The first one was I chose the right parents. My mother was a nurse, and I heard her stories from the hospital about the patients and their conditions and the doctors who attended them. Those stories about how doctors acted--both positively and negatively--undoubtedly influenced my decision to go into medicine and the kind of doctor I wanted to be. My mom suffered a lot of tragedy in her life, and was a model of perseverance and resilience, keeping her faith, defending her family, keeping her sense of humor. She was a great role model. So was my dad--a farmer, hardworking, honest, dependable. He had a great sense of humor, liked to tell jokes, and could take a joke. The characteristic of his that I believe made the most difference in my career was his willingness to put himself in other people’s shoes before making judgment. If

someone said something negative or “gossipy” about someone else, he would suggest that since we hadn’t walked a mile in that person’s moccasins, we don’t know what our actions would have been. In medicine, we are often working with patients who are dealing with health conditions brought about by poor decisions and actions on their part. I try to remember that if I had been raised in their environment or had some of their experiences, my decisions may have been as bad as theirs or worse. So, I remind myself that they need my care not my judgment. For instance, there may be people in this very room who root for the Kansas Jayhawks.

I don’t know what sort of childhood traumas they experienced that would lead them to make a decision like that, so I try not to judge them too harshly.

The second decision was I picked the right spouse. My wife, Nora, is here. If she puts up with me for another 6 months, we will celebrate our 50th anniversary. When we met, she was working as a psychiatric nurse. I know what you are thinking, but we did not meet when I was a patient in her unit. I was in college working at a bank part time and she was a customer. Today, if someone meets someone in whom they are interested they check out social media.

We didn’t have those tools then, but I was able to check out the balance of her checking account and get her phone number, so that worked. They say a male’s frontal lobe isn’t mature until the early 20’s. So, my parents get credit for the first 18 years, but the finishing touches were influenced by Nora. I would not have experienced the same success I have enjoyed without her influence. She has always helped me stay grounded, reminding me of the right priorities when I needed reminding. And she did the lion share of raising our 4 children. Let me introduce them as well. It is said that no one is perfect, but whoever made that up never met our four grandchildren.

The third wise decision I made was to be a family physician.

Not to get all Star Wars on you, but I believe it was my destiny. I cannot imagine a career that could be more fulfilling. In previous decades talking to family docs nearing their retirement, they often suggest that they were lucky to practice in a “golden age” of family medicine. Since the creation of the specialty in the late 60’s, it has been evolving to meet the needs of our patients. I feel lucky to have practiced during the time when I could do what is now called “full spectrum” family medicine--then it was just called family medicine.

The relationships that a family doc develops with the patients over multiple generations is unique among the specialties and is what I believe most patients still desire. The current shortage of family physicians which is predicted to get worse will be detrimental to the health care of our country, but I am preaching to the choir here.

I also spent most of my career teaching medical students and residents. The fulfillment one gets from that is great. I know there are several hundred family physicians providing care in Missouri and surrounding states that I have had some part in making that happen.

When medical students whom I have worked with suggest the experience was important in their decision to go into family medicine, or say they gained new understanding and respect for what we do, I believe I have achieved something important. We should all share the responsibility to teach the next generations of family physicians.

Finally, let me tell you of a struggle. I was raised on a farm in northeast Missouri and one of the values that was emphasized to us often was to avoid excessive pride. After all, vainglory or excessive pride is one of the seven cardinal sins--often the first one listed. To be honest, I was never sure why that cardinal sin was so important; after all, we went pretty easy on gluttony, and it is also on the list. At any rate, it was okay to be proud of your family, and to be proud of being a farmer, but feeling too much pride because of an individual achievement was greatly discouraged. This is not the first honor I have received. Not to brag, but in third grade I got a perfect attendance award, so I have tasted celebrity. And since then, I have been fortunate enough to receive some very meaningful awards. But receiving this award, which I feel like is a lifetime achievement award, creates so much vainglory in me that I will have to seek abundant forgiveness.

Thanks so much for this great honor. To all you family physicians, continue to be worthy to serve our patients.

Lohsandt Named MAFP Outstanding Resident of the Year

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he Missouri Academy of Family Physicians (MAFP) presented Dalton Lohsandt, MD of Tuscaloosa, Alabama, with the 2023 Outstanding Resident of the Year Award at the Academy’s 75th Annual Meeting. Dr. Lohsandt was chosen as the award recipient by a committee of family physicians from nominations made

by Missouri family medicine residency programs.

The MAFP Outstanding Resident of the Year award is presented to a graduating Missouri resident who exhibits exemplary patient care, demonstrates leadership, displays a commitment to the community, contributes to scholarly activity and is dedicated to the specialty of Family Medicine. The recipient of this award, Dr. Dalton Lohsandt, was Chief Resident at the University of Missouri Columbia Family Medicine Residency, has served as a physician volunteer at MedZou Community Health Clinic and the MSHSAA State Football, Wrestling, and Track Championships. He also served on the Rural Longitudinal Integrated Clerkship Committee, and Rural Scholars Advisory Board. Dr. Lohsandt completed medical school and residency at University of Missouri Columbia and is now pursuing a sports medicine fellowship at University of Alabama in Tuscaloosa, Alabama.

MO-AFP.ORG 35

A Scoliosis Surgery with

Flexibility Helping Kids Avoid Spinal Fusion

As a leader in vertebral body tethering (VBT), we’re proud to offer an FDA-approved fusionless spine surgery that allows kids to maintain their spinal anatomy and range of motion. For kids whose idiopathic scoliosis can’t be managed with bracing, VBT offers: • An early treatment option for scoliosis • A less invasive, less limiting alternative to spinal fusion • For most, a one-time surgery that naturally adjusts as kids grow • The ability to avoid any sort of fusion in the spine

MEET THE DOCTOR Daniel G. Hoernschemeyer, MD, is a board-certified pediatric orthopaedic specialist, chief of pediatric orthopaedic surgery and member of the Pediatric Orthopaedic Society of North America. As a pioneer in VBT procedures, Dr. Hoernschemeyer has been performing VBT surgeries for the past 10 years and is actively teaching the next generation of pediatric spine physicians.

To learn more or to refer a patient, call (573) 884-6132 or visit muhealth.org/vbt-for-docs.

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MISSOURI FAMILY PHYSICIAN January - March 2024

Nurse Practitioner Geographic Proximity Waiver Interpretation

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egislation (HB 115) was passed during the 2023 session which included creating a waiver process for APRNs and physicians to collaborate outside the current 75 mile radius. The Board of Healing Arts discussed the interpretation and implementation of this legislation on collaborative practice arrangements between physicians and advanced practice registered nurses during their October 20 meeting.

This law went into effect August 28th which was 54 days prior to the date of this BOHA meeting. This is significant since as stated below, the board has 45 days to consider a request for a waiver. We identified several concerns with the current interpretation: • Rules have not been drafted but the statute only gives them 45 days to consider a request for a waiver. If the request for a waiver is not acted upon, its stands approved per the statute. At the time of the meeting, there were 4 pending applications.

• An application for a waiver needs to be developed so consistent information is submitted for justification and evaluation.

The waivers that were requested didn’t include similar information and, in some instances, there was clearly not enough evidence presented as to why the waivers were necessary.

• Procedures need to be developed to administratively process waiver requests.

Such procedures could include whether the review of requests should occur in open or closed session, whether the review can be performed by Board of Healing Arts staff, and if the whole board needs to review requests in a manner similar to how current cases are addressed.

• Who can submit the waiver request?

Some waiver requests came from many “entities” and not ARPNs or physicians.

Physicians bear the legal responsibility of the collaborative practice arrangement.

The board was unclear if they could legally process a request from an entity since they wouldn’t bear the legal responsibility.

• Collaboration between the Board of Healing Arts and the Board of Nursing on processing waiver requests needs to be formulated. The waiver process statutory change also included the removal of the joint rule promulgation on collaborative practice between the boards. The statute does require both entities to approve the waivers. Either board’s process of determination for the need and the outcome of the application can be different.

• After much discussion, the Board of Healing Arts determined that they will handle the pending applications for waivers in closed session.

The Board appeared to make the determination that since the action taken by the statute change presents as an amendment to a

contract between a physician and an APRN that only the physician can seek the waiver since they are ultimately legally responsible for the APRN under the collaborative practice arrangement. Reading this requirement into the statute could legally be the correct move but will likely spur other parties interested in these waivers to need find new legislative means to hem in the authority of BOHA. Stay tuned during the next five months as scope of practice bills are introduced and make it through the legislative process. We will be sure to include an update in the weekly legislative reports that are sent on each Friday during session. Questions, contact Kathy Pabst at kpabst@mo-afp.org or call her at (573) 635-0830.

MO-AFP.ORG 37

MAFP Joins Missouri All Copays Count Coalition to Support Legislation to Ensure All Copays Count Toward Patient Deductibles

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atients from across Missouri, and Missouri’s leading patient advocacy organizations today thanked Representative Wright and Senators Bernskoetter, Fitzwater, and Eslinger for introducing legislation that would require more health insurance plans to count all prescription drug copayments made by or on behalf of Missourians.

The important health policy reform would prevent an increasingly common practice used by insurance companies and pharmacy benefit managers called “copay accumulator adjuster programs” that prevent prescription drug copay assistance from counting towards a patient’s deductible or out-of-pocket maximum.

Accumulator programs subvert assistance meant to support patients. Increasingly, insurers no longer count assistance that patients use to help afford their prescriptions toward the patient’s deductible and out of pocket costs. When those costs don’t count, patients pay more out of their own pockets.

In Missouri, 80% of health plans on the marketplace feature language preventing patients from accessing copay assistance that counts. For individuals living with rare and chronic conditions, like cancer, hemophilia, arthritis and many more, access to effective treatment is often made possible through copay assistance.

Under copay accumulator adjuster programs, out-of-pocket costs are paid twice, first from copay assistance and then from the patient. The legislation pre-filed for the 2024 legislative session would stop that discriminatory practice and protect patients.

Four bills that are currently pre-filed: House Bill 1628 (Rep. Wright) Senate Bill 844 (Senator Bernskoetter) Senate Bill 1106 (Senator Fitzwater) Senate Bill 1190 (Senator Eslinger)

Statewide PDMP Implemented

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he Missouri Department of Commerce and Insurance announced that the Missouri PDMP was implemented on December 13 and the St. Louis County PDMP has ceased operation. For those of you who utilized the St. Louis PDMP, there are numerous changes from the St. Louis County PDMP for you to be aware of: Interstate sharing through PMP Interconnect (PMPi) will no longer be allowed. Missouri licensed providers will only be able to access Missouri data.

Out-of-state entities will no longer have access to Missouri data when querying the PDMP through Gateway or PMP AWARxE. Dispensers that were participating in the St. Louis County PDMP do not need to re-register with PMP Clearinghouse. You will be able to continue to use your existing data submitter account to comply with the Missouri PDMP mandates.

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MISSOURI FAMILY PHYSICIAN January - March 2024

To ensure compliance for Missouri PDMP dispensation reporting, please follow ASAP 4.2 guidelines and Missouri reporting requirements in the linked Missouri Data Submission Dispenser Guide.

Beginning January 1, 2024, all controlled substance dispensing MUST be reported within real time of delivery to the patient using the PMP Clearinghouse system, which is provided by Bamboo, Inc. Data Submitters may use ANY available submission method, as long as they are made within real time of the dispensation of the medication.

For more insight on the actions needed please review Data Submission Supplemental Guidance. The documents referenced above and more information can be found on the Missouri PDMP website at: https://pdmp.mo.gov/.

Missouri Preceptor Tax Credits Now Available

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s you know the MAFP worked to successfully pass the Community-Based Faculty Preceptor Tax Credit program in 2022. This program is administered by the Department of Health and Senior Services’ (DHSS) Office of Rural Health and Primary Care (ORHPC), and provides an income tax credit for qualified community-based faculty preceptors for primary care physicians and physician assistants.

The program is now active and open for applications. Applicants must meet the following criteria: • Serve as a community-based faculty preceptor (physician or physician assistant) providing the preceptorship • Hold a current and active license issued by the Division of Professional Registration of the Department of Commerce and Insurance • Provide a medical or physician assistant student core preceptorship to 1 or more medical student(s) or physician assistant student(s) • Complete a minimum of 1 preceptorship rotation (120 hours of community-based instruction in family medicine, internal medicine, pediatrics, psychiatry, or obstetrics and gynecology) to 1 or more medical student(s) or physician assistant student(s), up to 3 preceptorship rotations during the tax year in which the preceptorship is claimed; and • Have not received any direct compensation for the preceptorship(s).

documentation is January 31 of each calendar year following the tax year in which the tax credit application is being submitted. For example: For tax credit year 2023, the application documentation deadline is January 31, 2024.

Questions? Contact the Office of Rural Health and Primary Care at ORHPCinfo@health.mo.gov.

Submit your application today

You can submit your application electronically through the online CommunityBased Faculty Preceptor Tax Credit Program Application which can be accessed online at https://health.mo.gov/living/families/ primarycare/precept/index.php.

Applications will be accepted on a first come first serve basis and can be submitted at any point during the calendar year, after completion of preceptorship(s).

Final deadline to submit application MO-AFP.ORG 39

40

MISSOURI FAMILY PHYSICIAN January - March 2024

DO YOU HAVE NEWS TO SHARE? Email it to office@mo-afp.org for review.

We love to hear from our members!

MEMBERS IN THE NEWS

Paulson Announced as New Interim Chief Medical Officer for Access Family Care

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ccess Family Care recently announced John Paulson, DO, PhD (Joplin, MO), as the new interim chief medical officer.

Dr. Paulson is a Fellow of the American Academy of Family Physicians (AAFP).

Currently, he serves as the Department Chair of Primary Care at Kansas City University (KCU) Farber-McIntire Campus in Joplin. He is a core faculty member at the Freeman/ KCU Family Medicine Residency. He is a past-president of the Missouri Academy of Family Physicians and the Community Clinic of Southwest Missouri’s board of directors in Joplin, MO. Dr. Paulson has completed the American Association of Colleges of Osteopathic Medicine (AACOM) Osteopathic Health Policy Fellowship and the AAFP Leading Physician Wellness certificate program.

“I am honored to serve the community in this capacity. I believe strongly in the mission that defines Access Family Care—a commitment to improve the health of the medically underserved of greater southwest Missouri through direct services and collaborative efforts,” said Paulson.

Lincoln Receives Two New Certifications

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andy Lincoln, MD (Columbia, MO), is among the inaugural cohort of only 103 physicians in the US and Canada to be board-certified by the North American Board of Breastfeeding and Lactation Medicine (NABBLM-C).

She also obtained certification in perinatal mental health (PMH-C) from Postpartum Support International.

Dr. Lincoln is excited to continue learning and incorporating new knowledge to provide compassionate comprehensive care to perinatal families, especially in matters of breast-feeding, lactation, and mental health.

Bothwell Resident Published in Sedalia Democrat

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rittany Pendergraft, MD, a resident family physician in the Bothwell-University of Missouri Family Medicine Residency program, recently published an article in The Sedalia Democrat.

The article “From the Expert: Do you need the shingles vaccine?” discusses recommendations for the shingles vaccine. You can read the full article online by visiting https://www.sedaliademocrat.com/stories/from-theexpert-do-you-need-the-shingles-vaccine,41294.

MO-AFP.ORG 41

Peter Koopman Appointed to AMA Delegation

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eter Koopman, MD (Columbia, MO), was recently appointed to represent the American Academy of Family Physicians (AAFP) as the American Medical Association (AMA) Delegate. Members of the AMA House of Delegates serve as an important communication, policy, and membership link between the AMA and grassroots physicians. His term of service will run from December 15, 2023, until December 14, 2025.

Dr. Koopman serves as an AAFP Delegate for the MAFP and is Co-Chair of the Advocacy Commission.

AAFP Features Cole in #FamilyDocFocus

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arah Cole, DO, FAAFP (St. Louis, MO), was featured in a December AAFP #FamilyDocFocus.

AAFP News’ #FamilyDocFocus spotlights practicing family physicians, FPs in academic or administrative roles, family medicine residents, and medical students committed to the specialty who have dedicated themselves to improving the lives of their patients and communities. In the article, Dr. Cole discusses leadership and her time on the AFMRD Board. You can read the article by visiting https://www. aafp.org/news/family-doc-focus/sarah-cole.html.

St. Luke’s Des Peres Names New Chief Resident

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ax Hesse, MD, was named Chief Resident at St. Luke’s Des Peres Hospital Family Medicine Residency Program. Dr. Hesse said he chose to be a family physician because it allows him to form close and meaningful relationships with patients. “Every patient brings something unique,” Hesse said. “I enjoy the adaptive, essential and diverse nature of primary care.”

Caption: Left to right: Dr. Allison Politsch, Dr. Kayla Beashore, Dr. Max Hesse, and Dr. Alex Downey complete community project at the continuity clinic to the Peace Pantry.

Todd Named “Top 20 under 40” Recipient by Sedalia Democrat

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isty Todd, MD (Sedalia, MO), was selected as a recipient of the “Top 20 under 40” by The Sedalia Democrat. This achievement spotlights area men and women aged 40 and under who are contributing to the West Central Missouri community. You can read the article online by visiting https:// www.sedaliademocrat.com/stories/20-under-40-todd-is-cole-camps-small-communityphysician,41024? (subscription required).

Dr. Todd is the program director for the Bothwell-University of Missouri Family Medicine Residency program. She serves on the MAFP Board of Directors and Co-Chairs the Member Services Commission.

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MISSOURI FAMILY PHYSICIAN January - March 2024

Richelle Koopman to Chair MU Family and Community Medicine Department

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ichelle Koopman, MD, MS, FAAFP (Columbia MO), was recently named the 5th Chair of the Family and Community Medicine Department at the University of Missouri. She began her term in January 2024.

Dr. Koopman is succeeding Dr. Michael Lefevere as the first female chair of the department. She also recently became President of the North American Primary Care Research Group (NAPCRG)-the premier international primary care research organization.

Members Appointed to AAFP Commissions

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ikala Cessac, MAFP Alternate Student Director and student at University of Missouri-Columbia School of Medicine, was recently appointed to serve on the American Academy of Family Physicians (AAFP) Commission on Membership and Member Services (CMMS).

Mikala will serve a one year term that began in December.

Karstan Luchini, DO, former MAFP Student Director and resident at University of Missouri-Kansas City Family Medicine was recently appointed to serve on the AAFP Commission on Quality and Practice (CQP). Dr. Luchini will serve a one year term that began in December.

Missouri Physicians Conferred at Congress of Delegates

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hree MAFP Members recently achieved the Degree of Fellow of the American Academy of Family Physicians (AAFP), the national medical association representing nearly 127,600 family physicians, residents, and medical students. The degree was conferred on more than 250 family physicians during a convocation on Saturday, October 28th, in conjunction with the AAFP’s annual meeting in Chicago, IL. Congratulations to: Margaret “Meg” Gibson MD, FAAFP (Kansas City, MO) Joseph “Lane” Wilson MD, FAAFP (Lees Summit, MO) Jayne Bumgarner MD, FAAFP (Independence, MO) Criteria for receiving the AAFP Degree of Fellow consist of a minimum of six years of membership in the organization, extensive continuing medical education, participation in public service programs outside medical practice, conducting original research and serving as a teacher in family medicine.

MO-AFP.ORG 43

In Memoriam: Donald Albert Potts, MD March 25, 1930 — January 3, 2024

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r. Donald Potts strongly supported the MAFP and was one of Independence, Missouri’s most admired family physicians. Dr. Potts was in private practice in Independence for more than 20 years. He graduated from the Kansas University School of Medicine in 1962, working his way through college as a bricklayer and entering the profession at a time when doctors still made house calls.

If patients couldn’t afford to pay, he sometimes accepted a dozen eggs from their family’s farm or a walnut cake at Christmas time. Eventually, Dr. Potts became one of the area’s first board-certified family physicians, recognizing the growing need for doctors to treat the whole patient, not just the disease or injury.

In 1986, he moved his practice to Truman Medical Center (now known as University Health Center) and joined UMKC School of Medicine as Medical Director of the Family Medicine Residency Program. Many of his former students still practice in the metropolitan area. Dr. Potts also took on a secondary role with the Jackson County Detention Service, treating prison inmates. In his retirement, he volunteered as a physician for the Jackson County Free Health Clinic. In 2020, then 90-year-old Dr. Donald Potts received the Kansas City Medical Society’s “Lifetime Achievement Award” for his commitment to the health of the community.

Dr. Potts was a longtime member of the Rotary Club International and served on several city and nonprofit boards, including the Independence Advisory Board of Health, the Independence Board of Ethics, and the American Correctional Health Services Advisory Board. As a Kansas City Health Commission’s Tobacco Prevention and Control Committee member, Dr. Potts worked tirelessly to decrease tobacco use in the region. He advocated for local legislation to ban smoking in public places and was a leading voice in the community for raising awareness about the dangers of e-cigarettes and vaping.

A veteran of the Korean War, Donald Potts served stateside as a special agent in the Army’s Central Intelligence Corp (CIC) from 1953-1955. He especially enjoyed his work in the CIC and often mentioned that if he hadn’t been accepted to med school, he might have joined the FBI. It was during his time in the service that he married Barbara Joyce Elledge, who grew up in Independence, Missouri, in 1953.

Building on his devotion to God, country, and community, Dr. Potts served as Church Elder for more than 40 years. He completed seven medical missions to Haiti and returned again in 2010 when he volunteered with Heart to Heart International after Haiti was devastated by a powerful earthquake. Dr. Potts also traveled with Heart to Heart to New Orleans in 2005 on a medical mission to treat the victims of Hurricane Katrina.

He remained a member of the Missouri Medical Reserve Corp throughout his retirement.

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MISSOURI FAMILY PHYSICIAN January - March 2024

The family and friends of Dr. Potts knew him as a man of many passions. He loved to travel. In their early retirement years, Donald and Barbara traveled internationally. They spent summers in Lake of the Ozarks with friends, where he enjoyed his two favorite outdoor activities: fishing and golfing. His many hobbies included large collections of recorded music and fine wines. As a member of the KC Jazz Ambassadors organization, Donald was an enthusiastic supporter of the area’s many jazz musicians, programs, and establishments. An avid collector of fine wines, he became a Chevalier with Le Confrerie de la Chaine des Rotisseurs, the oldest and largest food and wine society in the world. He was a violinist, accomplished photographer, and had lifelong interests in audio electronics and trains.

Donald Potts was born in 1930 and grew up in Brooklyn, New York. He graduated from Brooklyn Technical High School and earned undergraduate degrees at Graceland College and Kansas University. In addition to his wife Barbara, Donald leaves behind his four children and their spouses, including Tedd Potts, Dwight Potts, Douglas and Sally Potts, and Laura (née Potts) and Scott Shelton. He also leaves behind nine grandchildren and their spouses, including Claudia (née Potts) and James Alford, Matt and Ashlea Ahrenholtz, Brian Potts, Sarah Potts, Ryan Potts, Alex and Bailey Potts, Lindsey (née Ahrenholtz) and Jake Wade, Nika Potts, and Sean Potts; and eight great-grandchildren including Lily and Hudson Ahrenholtz, Charlie and Beau Alford, Beau and Hayes Wade, and Isla and Maggie Potts.

Source: www.speakschapel.com/obituaries/donald-potts

MU Family Medicine Announces 2023 School of Medicine Curriculum Board Award Winners OUTSTANDING COMMUNITY FACULTY PRECEPTOR

BJ Schultz, MD

Family Physician/Preceptor at Compass Health

OUTSTANDING CLINICAL FACULTY EDUCATOR

Ben Crenshaw, MD, FAAFP MU Family Medicine Assistant Professor

OUTSTANDING CURRICULUM INNOVATION: RURAL LINC PROGRAM

Laura Morris, MD, MSPH MU Family Medicine Professor

OUTSTANDING CURRICULUM INNOVATION: RURAL LINC PROGRAM

Mercy Clinic Family Medicine Residency Shares Successes from Program Leadership and Residents

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arah Cole, DO, is serving as President-Elect of the Association of Family Medicine Residency Directors.

Dr. Cole is the program director at Mercy Family Medicine.

Fresh off his term as the Chair of the Accreditation Council of Graduate Medical Education Review Committee for Family Medicine, Grant Hoekzema, MD, was named to the American Board of Family Medicine Board of Directors.

His term will run from 2023-2028. Dr. Hoekzema is the Department Chair at Mercy Family Medicine.

Kelly Dougherty, MD, is a current scholar with the AAFP Family Medicine Leads Emerging Leader Institute.

Her project centers on pregnancy care in rural Missouri.

Dr. Dougherty is a second-year resident at Mercy Family Medicine.

Lauren Malinowski, DO, authored a review article on the role of lifestyle medicine in autoimmune disease with her mother, Susan Hull, DO, in the Journal of Family Practice.

Dr. Malinowski is a third-year resident at Mercy Family Medicine and Dr. Hull is a family physician with Mercy in Wildwood, MO.

Kevin Frazer, MD, MSAM MU Family Medicine Associate Professor

OUTSTANDING CURRICULUM INNOVATION: RURAL LINC PROGRAM

Whitney LeFevre, MD

MU Family Medicine Assistant Professor

MO-AFP.ORG 45

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MISSOURI FAMILY PHYSICIAN January - March 2024

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References Alcohol and Heart Health

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Reducing Sodium Intake Significantly Lowered Blood Pressure in as Little as One Week — pages 15-16 1. https://www.abstractsonline.com/pp8/?_ ga=2.252499981.569559676.16934299471069604919.1693247687#!/10871/presentation/16562 2. https://www.dietaryguidelines.gov/sites/ default/files/2020-12/Dietary_Guidelines_for_ Americans_2020-2025.pdf 3. https://www.heart.org/en/healthy-living/healthy-eating/ eat-smart/sodium/how-much-sodium-should-i-eat-perday

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