Winter 2017

Volume 13 Issue 1 / Winter 2017

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

Dr. Charles Rhodes 2016-2017 NCAFP President

Dr. Lee A. Beatty – The Champion of Mount Holly Looking at the New Year from Multiple Health Care Angles

Get a jump-start on your CME credits for 2017!

56th Annual Post-Graduate Symposium Co-hosted by The Mecklenburg County Chapter of the NC Academy of Family Physicians Program Chair: Jewell Carr, MD

This year’s convenient one-day format means less time away from the office. Mark your calendars now and make plans to join us Friday, March 31st for this opportunity to earn 8+ AAFP Prescribed Credits.

FRIDAY, MARCH 31ST, 2017 • 8:00 AM TO 6:00 PM Renaissance Charlotte SouthPark Hotel, Charlotte, NC

CME | Camaraderie | Networking www.ncafp.com/symposium

Inside Winter 2017

4 The 2016 -17 Presidential

Inaugural Address

Dr. Charles Rhodes of Mount Pleasant, NC, shared remarks during his installation as the 2016-2017 NCAFP President.

PRESIDENT’S MESSAGE

MEMBERSHIP & MEMBER SERVICES

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15 The Champion of Mount Holly– Dr. Lee Beatty

The 2016-2017 Presidential Inaugural Address

HEALTH POLICY & ADVOCACY

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Your Academy in Action

CHAPTER AFFAIRS

10 Looking at the New Year from Multiple

Healthcare Angles

Named 2016 NC Family Physician of the Year

RESIDENTS & NEW PHYSICIANS

22 What I Want Family Medicine to Look Like in 2026 PRACTICE MANAGEMENT

28 AAFP Remains Vigilant to Details of Medicare’s New Payment Models

PUBLISHED BY

DEPARTMENTS

t919.833.2110 •

President’s Message 4 Policy & Advocacy 8 Chapter Affairs 10 Membership 15 CME Meetings & Education 20

fax

919.833.1801 • ncafp.com

Managing Editor & Production Peter Graber, NCAFP Communications

Residents & New FPs 22 Student Interest 26 Practice Management 28

Have a news item we missed? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please email items to pgraber@ncafp.com

PRESIDENT’S MESSAGE to NCAFP Members

By Dr. Charles Rhodes 2016–2017 NCAFP President

The 2016-17 Presidential Inaugural Address

Thank you for allowing me to represent the North Carolina Academy of Family Physicians in the coming year. I look forward to working with you and for you.

For those of you who don’t know me, my name is Charlie Rhodes. I’m a Family Physician. It is what I have wanted to be for as long as I can remember. And it is what I have done for the past 36-years.

I practice in the small town of Mount Pleasant, North Carolina. When I introduce myself at meetings, people always tell me how much they like our bridge, and how beautiful Charleston is. No, that Mount Pleasant is in South Carolina, and yes, I agree Charleston is beautiful.

My Mount Pleasant is a town of 1,600 people in the northeastern corner of Cabarrus County, about 35 miles north of Charlotte. It is a very Mayberry-esque town where everyone is related to everyone. Where you are defined by which church you go to, whether you pull for Carolina or State (Sorry Dr. White, Duke is not in the equation anywhere), and whether you prefer your tractors green or red (I’m a John Deere man myself ). Almost the entire town is in the historic district. Our version of fine dining is What-A-Burger #13, home of the Witch Doctor, which is everything on the drink machine plus a handful of pickles thrown in.

Mount Pleasant was settled by German Lutherans in the 1700’s, and was historically known for its textiles, agriculture, and education. Mount Pleasant is the home of the Mount Pleasant Collegiate Institute, founded in 1853,

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which at different times was a women’s boarding school, Lutheran seminary, and men’s college. It closed during the Great Depression and is now a museum. There is a heritage room where you can trace the dozen or so family names in town back to the Rhineland in the 1600’s. There is also a medical room – there has been a doctor in Mount Pleasant since the 1850’s, and it is interesting to look through the old ledgers and books to see how much the practice of medicine has changed.

More recently, Mount Pleasant has become known as the home of the Avett Brothers. Too Much Sylvia, our musical entertainment tonight, is from just down the road in Concord.

Like the rest of the Metrolina region, Mount Pleasant is growing. We just got our third stoplight. We now have a Subway and a Domino’s. The textile mills have closed and moved overseas. The farms are disappearing as more and more of our people are driving into Charlotte each day for work.

But some things have not changed. The church parking lots are full on Sunday mornings. The Farmer’s Market is on Friday afternoons, in-season. We still have our Christmas Parade, and a 4th of July festival with a Miss Mount Pleasant pageant. Small towns have their own rhythm and pace.

Dr. Allen Dobson founded our practice, now called Cabarrus Family Medicine, in 1983. Allen and I were classmates at Bowman Gray, and trained together at East Carolina under Dr. Jim Jones. Allen came to Mount Pleasant after residency. I served in the Air Force for four years, and joined Mount Pleasant Family Physicians in 1987.

If Family Medicine has a niche, it is in the small town. We practiced full scope family medicine, went to the hospital twice a day for rounds, took care of the local prison and nursing homes, and delivered a lot of babies, many of whom I still see and take care of. Our practice grew from a partnership to a small group. In the mid 1990’s, along with Dr. Mark Robinson, Dr. Reb Snyder, and others, we founded the Cabarrus Family Medicine Residency Program, with the goal of training young family physicians to do what we had done in Mount Pleasant. We recently graduated our 136th resident. 71% of our graduates are in North Carolina. 38% are in small towns or rural practice, 10% provide maternity care.

We were bought by the local hospital. It wasn’t working, so we went to the bank and bought ourselves back. (Yes – you can do that). We grew to twelve offices in four counties.

The North Carolina Family Physician

2016-2017

NCAFP Board of Directors Executive Officers President President-Elect Vice President Secretary/Treasurer Board Chair Past President (w/voting privileges) Executive Vice President

Charles W. Rhodes, MD Tamieka M.L. Howell, MD Alisa C. Nance, MD, RPh David R. Rinehart, MD Rhett L. Brown, MD Thomas R. White, MD Gregory K. Griggs, MPA, CAE

District Directors District 1 - Mackenzie Smith, MD District 2 - Gilbert Palmer, MD District 3 - Eugenie M. Komives, MD District 4 - Shauna L. Guthrie, MD, MPH District 5 - Dimitrios “Taki” P. Hondros, MD District 6 - Cody A. Wingler, MD District 7 - Jennifer L. Mullendore, MD At-Large Jason T. Cook, MD At-Large Benjamin F. Simmons, MD IMG Physicians Christopher Z. Rayala, MD

2016-2017 NCAFP Executive Committee (L-to-R from top) Charles Rhodes, MD, President; Tamieka M.L. Howell, MD, President-Elect; Alisa C. Nance, MD, RPh., Vice President; David Rinehart, MD, Secretary/Treasurer; Jessica Triche, MD; and Rhett L. Brown, MD, Board Chair.

Minority Physicians Jewell P. Carr, MD Osteopathic Family Physicians Slade A. Suchecki, DO New Physicians Jessica Triche, MD

Six years ago we were purchased by a large hospital system and I joined the ranks of the employed physician. So these days I spend about half of my time dealing with administrative issues, and less time seeing patients. Still important work, but meetings are not my happy place.

I tell you all of this not because I find our practice history that remarkable or interesting. But, I think the transition my practice has gone through reflects the change all of us have experienced over the past few years, and the challenges we face in the future.

Medical School Representatives Chair Warren P. Newton, MD, MPH (UNC) Family Medicine Residency Directors Viviana Martinez-Bianchi, MD (Duke University FMR) Resident Director Alyssa M. Shell, MD, PhD (MAHEC-A) Resident Director-Elect Courtland Winborne, MD, MPH (Cabarrus) Student Director Angie Maharaj (Campbell) Student Director-Elect Allyson Mentock (BSOM)

It has been a wild ride.

When I finished my residency in 1983, most residents were male. Almost everyone planned to go into private practice, and almost everyone did hospital work. Many of us planned to do obstetrics in our practice.

Residents these days are more diverse. Over half are women. Most graduates plan to work for a hospital system. A few want to do full scope family medicine. A smaller number plan to do obstetrics.

We are now DO’s as well as MD’s. A growing number of family physicians train overseas. We hold Certificates of Added Qualification (CAQ’s) in various areas such as Sports Medicine, Geriatrics, or Hospital Medicine.

But the basic philosophy of our specialty, lifelong care of a patient regardless of sex, age, or disease process, has not changed. We are special-

Medical School Representatives & Alternates Chair (UNC) Warren P. Newton, MD, MPH Alternate (Campbell) Charlotte Paolini, DO Alternate (Duke) J. Lloyd Michener, MD Alternate (ECU) Chelley Kaye Alexander, MD Alternate (Wake) Richard W. Lord, Jr., MD, MA AAFP Delegates & Alternates AAFP Delegate Michelle F. Jones, MD AAFP Delegate Karen L. Smith, MD AAFP Alternate Richard W. Lord, Jr., MD, MA AAFP Alternate Robert L. Rich, Jr., MD The NCAFP Family Medicine Councils Advocacy Council Thomas R. White, MD, Chair Garrett Franklin, MD, Vice-Chair CME Council Membership & Workforce

Alisa C. Nance, MD, RPh, Chair Benjamin Simmons, MD, Chair Shauna Guthrie, MD, MPH, Vice-Chair

Practice Management Council

Winter 2017

Public Relations & Marketing

Thomas Wroth, MD, Chair Slade Suchecki, DO, Vice-Chair William A. Dennis,5MD, Chair

ists in relationships. The relationship we have with our patients, with the patient’s family, and by extension the communities we all live and practice in.

Population management is not a new concept to family physicians. We have always taken care of communities, and have a unique perspective on what to expect in family members as they get older. We are the only specialty that offers trans-generational care.

The doctor-patient relationship is a bond forged in many cases over the span of decades. It is an extremely valuable and powerful tool, stronger than any medication or diagnostic test that I can order, and is actively sought out by our patients. It is not unusual for me to refer a patient to one of my subspecialty colleagues in Charlotte, only to have the patient ask the specialist to call me for my opinion. It is an incredibly strong bond. Which is why family physicians are successful in downtown Charlotte, as well as in small towns all across North Carolina and across the United States.

Dr. Bill Dennis spoke eloquently in his inaugural address three years ago of the transformation of the newspaper industry, and how to persevere and thrive in a changing economy.

Medicine is undergoing a similar transformation. Changes in the payment system have forced some of us into larger organizations or health care systems. This has meant a loss of control as we now work for someone else. And many of us are not comfortable with that. That’s not how doctors are trained. We are in most cases detail-oriented control freaks.

We are hearing more and more about physician burn out. I have to admit I feel a little scorched around the edges these days. Some of my colleagues, however, are extra crispy. There are multiple reasons for this, many of them with acronyms such as MACRA, PCMH, ACA, and the ever popular EMR. And despite my best efforts to ignore it, EMR has not gone away and seems to be a permanent part of the future state.

I feel sorry for our younger doctors who have never experienced the joy, speed, and efficiency of a paper chart. Instead, we are shackled with a flawed electronic tool that has become a barrier to communication, both with our patients and with our colleagues.

And even worse, the EMR’s are not even good at communicating with each other.

It has turned us all into transcriptionists and coders, which somehow has become “top of license”. I am not sure which class in medical school this was part of, because I must have slept through it. The amount of work after clinic -- now known by the

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The North Carolina Family Physician

acronym WAC -- is increasing and interfering with family time and other pursuits.

Physician burnout is a growing problem. I have been to multiple lectures on the topic to see if I could pick up any tips. I find it interesting that most of the speakers no longer see patients on a regular basis, which has cured their burnout. But, this doesn’t seem like a practical strategy for most of us, as we generally get paid per patient encounter. Perhaps this will change as we shift to a value-based system. But I believe that most of the things that burn us out have very little to do with patients anyway.

This is my doctor’s bag. I bought it in 1977 as a second year medical student at Bowman Gray. I paid $28 for it. Like me, it has some miles and a few scuff marks on it. Before doctors wore their stethoscopes around their neck, this is where you kept your stethoscope. Or maybe you carried it in your lab coat pocket.

As an intern, I bought the resident white jackets, short so that I would not be confused with an attending. It came with extra inside pockets so that I could carry my Washington Manual, Harriet Lane, and all of the other reference texts I needed to practice state of the art medicine. Scientific American Medicine was considered the gold standard at that time, which came as three very large volumes, updated monthly. Too large to carry. We still have a copy of it in our library in Mount Pleasant.

These days books have pretty much been replaced by iPhones and apps. I actually welcome anything electronic that helps me work more efficiently. I happily use Up to Date, which has replaced all of my other reference texts. And I don’t have the headaches I did as a resident from carrying all of the extra weight around with me all day.

Many of us don’t even wear white coats anymore. Patients heard about ‘White Coat Syndrome’ and started blaming everything on it. “No Mrs. Jones, your blood glucose of 380 has nothing to do with my white coat.”

Most of us these days wear our stethoscopes around our neck, because that is what the TV doctors do, and we want to look like real doctors. I don’t know if it is an early sign of memory loss, but I have to admit there are times I can’t find my stethoscope only to have my patient point it out around my neck. Rather than dementia, I blame this on CBS – “cluttered brain syndrome”, which is not to be confused with CRS, which is “can’t remember stuff”. More acronyms.

I had to have my bag repaired a couple of years ago. The handle strap had dry rotted from age. I could not find anyone at the Continues on p. 30

Winter 2017

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HEALTH POLICY & ADVOCACY

By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President

Let’s make NCAFP’s voice even in Raleigh

Contribute

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FAMPAC Empowering Family Medicine

ncafp.com/fampac

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The Academy in Action NCAFP’s Work on Your Behalf

“The Academy in Action” features the work that NCAFP leaders and staff are doing to advocate for and advance family medicine in North Carolina. Each quarter we highlight a few of the ways we have helped members over the past few months.

NCAFP, NC Pediatric Society Take Formal Action on Retroactive Immunization Payments For more than two years, the NC Academy of Family Physicians and the NC Pediatric Society have been advocating for the NC Division of Medical Assistance (DMA) to correct an underpayment of vaccine administrative fees for immunizations provided to Medicaid and NC Health Choice recipients during 2013-2014.

After lengthy discussions with DMA proved unsuccessful, the Academy, the NC Pediatric Society and several large pediatric practices have retained a lawyer and undertaken formal administrative action.

The group submitted a Request for Declaratory Ruling in late December that requires NC DMA to issue a formal ruling as to its position on the appropriate payment level. Second, the group also filed a Contested Case Petition with the Office of Administrative Hearings, that directly challenges NC DMA’s refusal to reprocess the vaccine administration claims in question.

The ultimate goal of the action is to have NC DMA to agree to reprocess all affected claims appropriately. It is estimated that

The North Carolina Family Physician

family physicians and pediatricians are due about $10 million in unpaid administrative fees. The Academy will keep all members informed on ongoing developments in this matter.

Members seeking additional information should contact Greg Griggs at the NCAFP at 919-833-2110 or via email at ggriggs@ncafp.com.

CMS Rural Health Tour NCAFP’s Greg Griggs attended a meeting with the Centers for Medicare & Medicaid Services’ (CMS) Regional Administrator on the topic of rural healthcare. CMS is working to update their strategic plan on improving rural health and held a series of listening sessions around the country, including one in North Carolina this past January. In addition to the NCAFP, representatives also included Federally-Qualified Health Centers, rural hospitals, the North Carolina Office of Rural Health, and others. During the discussions, the NCAFP advocated for several improvments, including payment reform and incentives to attract family physicians to rural areas.

NCAFP Leaders Attend Annual State Health Directors Family medicine was well-represented at NC’s State Health Directors’ meeting in January, the largest annual meeting of local and state public health officials. A number of NCAFP members who are involved in local public health agencies attended, including two NCAFP board members: Drs. Jenni Mullendore (Buncombe) and Shauna Guthrie (Granville-Vance Health Dept.).

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Winter 2017

CHAPTER AFFAIRS

By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President

Looking at the New Year from Multiple Healthcare Angles

physicians of this state. As a result, I’m trying to make an effort that I’ve never made before.

I’m not vowing to eat perfectly or lose a certain number of pounds, or even to exercise a minimum number of minutes each week. I’m simply pledging to do a bit better and hold myself more accountable, which includes working with a personal trainer (it always helps when a big guy named Giovanni holds you accountable too). Like each and every one of us, I know I can’t be healthier by myself. It’s a team sport. So, I’m working to put some accountability in place, including Giovanni, and maybe even each of you.

Like most people, I can come up with every excuse in the world to NOT take better care of myself – I don’t have time; I’m in the car too much; it’s not conWith each new year, the whole concept of New Year’s venient. Well, as we’ve moved offices, at least part of resolutions always comes up. For some reason, this those “excuses” have been taken away. There’s a gym in year I appear to be looking at these resolutions in an the basement of our building, and Giovanni and I will entirely different light; at least hopefully I am. I’m be there together at also looking at them least once a week from several differ(although I plan to ent angles. I hope be there more freyou will indulge me quently). When I briefly and read how met with Gio, he I think my personal reminded me of and professional rescomments I have olutions connect in heard from several 2017, and how each of our family physiof you can join me NCAFP Holding Open House on Friday, February 24th cian members. He along this journey. talked about attainThe NCAFP is holding an open house for all members and friends interested able goals, making First, from a perin touring the Academy’s new offices, getting to know Academy staff, and meeting your family medicine colleagues.

The open house is scheduled true lifestyle changsonal standpoint, from 4:30 pm – 6:30 pm EST on Friday, February 24th. es, and not trying I’ve had an ongoto deprive myself of ing goal of taking For planning and event logistics, please be sure to RSVP by visiting everything. So, I’m better care of mywww.ncafp.com/openhouse on a quest to get self, but haven’t more exercise, eat at really achieved it. least a little bit better, and begin making small changes Now that I’m in my 50s, it’s more important than to improve my personal health. ever for me to make progress in this area. It also seems that every year during my performance All this reminded me of the need for our physician review, the officers of the NCAFP encourage me to members to take a bit better care of yourselves as well. take better care of myself because they say they like Physician burnout and physician wellness are certainly having me around. And I like being around – for topics we are trying to address in our publications and my family first and foremost, but also for the family

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The North Carolina Family Physician

~ ADVERTORIAL ~

DO PHYSICIANS COMPARE?

By D. Scott Jones, CHC The CMS Internet Site Physician Compare was promulgated under Section 10331 (a)(1) of PPACA, mandating development of an Internet site that can be used by the public to identify and compare physicians. All physicians who are enrolled in the Medicare program, or who report measures under the Physician Quality Reporting System (PQRS), are identified on the site.

Physician Compare provides significant information to the public on individual and group physician performance. This includes: •

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Before data is posted to the site, a preview period is allowed, as with QRUR reports, allowing physicians to review and comment on the reports in Physician Compare before they are published.

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The easy access of comparative data also provides concerns with regard to medical negligence, or medical malpractice, actions brought against healthcare providers. The growing and wide range of quality data on the Internet is expected to be mined by plaintiff counsel, who may seek to introduce information as part of claims against physicians. Monitoring accuracy in the Physician Compare site data is an essential part of professional reputation management.

Currently, patients may search for Medicare physicians and other providers on Physician Compare, finding name, education, specialties, locations, hospital and medical group affiliations, Medicare assignment status, languages spoken, board certifications, and other data. Doctors who report in the PQRS system, the EHR incentive program, and those who use Electronic Prescribing (eRx) are so noted.

Be sure to check your Physician Compare reports!

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1

The Centers for Medicare and Medicaid Services (CMS), www.medicare.gov/physiciancompare (Accessed January 30, 2016)

at our meetings. Hopefully, many of you saw the excellent presentation on personal well-being from Dr. Kim Yu at our annual meeting in December. It’s simple: we need you to be healthy in order to take care of the people of North Carolina.

So I’m asking each of you to go on this journey with me; a journey of small changes -- a little bit at a time -- to take better care of each other.

The old saying goes that Rome wasn’t built in a day, and I certainly won’t be rebuilt in a day either, but we all need to take those small steps to improve our physical and emotional health. And some of it may be at times simply taking a day off to stop and smell the roses.

Which brings me back to the Academy. Over the past year, we’ve made some significant changes at the NCAFP. We feel like we are a leaner and meaner organization to fight for your needs. But our evolution isn’t over. We’re still working to make small change after small change to serve you better. From our communications, to our advocacy, to our member services and our education, we are constantly trying to evolve to serve you better.

In conclusion, I would like to give all of our members two charges for 2017: First, take the journey with me for a healthier you and a healthier me.

As I said above, improving ourselves is a team sport. I encourage you to send me your own personal tips or even share your failures. If you are so inclined, we can share suggestions with our entire membership, because we all need to work for healthier lifestyles. I don’t know what my personal outcome will be, but I want to make the effort to try; to just begin making those incremental changes.

Second, let us know how the Academy can better assist you, our members. You never know what suggestion may lead to that next incremental change here that can pay great dividends for all our members. One thing is for sure, we won’t know unless you ask us. Your entire staff and Board are committed to making our chapter the best it can be; serving the family physicians and future family physicians of North Carolina.

Please feel free to reach out to me at the office at 919-833-2110, via e-mail at ggriggs@ncafp.com, or even via my cell phone at 919-4176692. Just remember, if I don’t answer right away, it may be that I’m taking that time to improve my own health – both physically and mentally. But rest assured, I’ll get back to you.

Here’s to good health in 2017 and beyond!

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NCAFP Members Representing Family Medicine: NCAFP family medicine leaders have participated in several events recently, including Governor Roy Cooper’s Inaugural Ball, the 2017 North Carolina State Health Directors Conference and the Association Executives of North Carolina’s annual Legislative Reception held in later January.

Winter 2017

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The North Carolina Family Physician

Photos Š mtholly.us and Map Data Š 2016 Google

MEMBERSHIP & MEMBER SERVICES

The Champion of Mount Holly Dr. Lee A. Beatty Named 2016 North Carolina Family Physician of the Year

By Peter Graber NCAFP Communications

O

n South Main Street in downtown Mount Holly, just past a corner service station that’s been there forever, an A&P grocery once did a brisk business.

Like many small town markets, the old A&P was not only a grocery store, but also the de facto city center in many ways.

Neighbors and old friends bumped into each other, new acquaintances were made and the latest local scuttlebutt flowed.

In yesterday’s simpler times -- absent modern conveniences like email, texting and FaceBook -- the town grocery was one of the places the community connected.

When A&P shuttered, its closing signaled changing times for Mount Holly, a small Piedmont mill town adjacent to the Catawba River. Replacing an important community hub like the A&P would be a big challenge.

But where many saw an obstacle, Dr. Lee A. Beatty, the 2016 North Carolina Family Physician of the Year, saw opportunity. Dr. Beatty envisioned building another kind of asset to replace the A&P, but one just as vital in serving the community’s people and helping drive connections: an accessible, friendly and well-equipped family medicine clinic.

Dr. Beatty jumped headlong into the challenge, establishing Riverbend Family Practice in 1997. His work and effort have since made a profound difference in Mount Holly and have helped spark a major revitalization in the city’s downtown business district that continues today.

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The Road to Medicine Dr. Lee Beatty has deep roots in Mount Holly. The son of a local service station owner, Beatty grew up on South Main Street and graduated as an Eagle Scout from Mt. Holly High School. Although he largely credits his father for his interest in medicine, two of the town’s former family doctors also had a major influence. Both practiced in downtown, a stone’s throw away from his current clinic.

“Dr. Richard Rankin and Dr. B.D. Moore were really nice guys and good people who knew everyone in town,” Beatty said. “I knew I wanted to be a hometown doc like them.”

Beatty’s father had always encouraged him to pursue a field that provided ample opportunity and would make a difference in people’s lives. Doctoring fit the bill perfectly. With medicine on his mind, Beatty attended Duke University and became the first in his family to earn an undergraduate degree.

After Duke, he attended Wake Forest School of Medicine, earning his medical degree and subsequently completing his residency training in family medicine at Carolinas Medical Center - Charlotte in 1981. After graduation, Beatty co-founded South Point Family Practice in neighboring Belmont with Dr. David Locklear.

Dr. Beatty practiced in Belmont for the next decade but felt the desire to try his hand at academic medicine. Beginning in 1991, he served as a faculty member at Carolinas Medical Center where he helped teach residents and medical students.

Success followed him at CMC and in 1996, Dr. Beatty was awarded the prestigious David Citron, MD, Lectureship for Distinguished Scholarship and Teaching by the UNC-Chapel Hill family medicine faculty. Dr. Citron was the founding chair of the Department of Family Medicine at Carolinas Medical Center and one of Dr. Beatty’s most important professional mentors. The award represented one of his greatest professional accomplishments.

Citron had had a profound impact on Dr. Beatty during his time as a resident at CMC. “Dr. Citron’s combination of wisdom, humility, perseverance, inquisitiveness, and good heartedness was a mentoring example for many residents and medical students,” said Beatty.

Fresh off his accomplishment the next year, Dr. Beatty saw the closed A&P in downtown Mount Holly, and decided to establish a practice in the place that’s been dear to him his whole life. It’s been a whirlwind ever since.

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Located about a hundred yards away from his childhood home, it’s almost impossible to tell that Riverbend Family Practice (now part of Carolinas HealthCare System) was once a grocery store. Dr. Beatty’s vision and investment have established Riverbend as a key community asset, serving patients from in and around the area with high quality, team-based and patient-centered family medicine. His work and passion have also provided the impetus to a major revitalization movement in Mount Holly’s downtown business district. In so many ways, Riverbend has built a community unto itself, just like the A&P it replaced.

True Community Champion Instilled in Dr. Beatty since childhood is the desire to serve people and make a difference. This goal influences how he practices medicine and the activities he pursues throughout the community. Dr. Beatty believes everyone can contribute to the common good, especially family physicians. His work and efforts have led him to become one of Mount Holly’s most respected and influential people.

Outside of clinical practice, Dr. Beatty has a long list of community contributions to his credit. While many connect to his efforts in helping revitalize the city’s business district,

The North Carolina Family Physician

Photo © Carolina Thread Trail

The Catawba Riverfront Greenway: Dr. Beatty led a citizen-driven process that resulted in a $5M bond referendum which funded construction of a new greenway connecting downtown Mt. Holly to the nearby Catawba River. The greenway is part of the Carolina Thread Trail. many others exemplify his belief in the power of prevention, teamwork, and healthy lifestyles. For instance, in 2001 Dr. Beatty served as Founding Chairman of the volunteer citizen committee The Heart of Mount Holly that was responsible for raising awareness of the challenges and opportunities facing the city’s central business district. The momentum created by this effort eventually led Beatty to lead a 6-month citizen-review process in 2003 that looked at other improvements. The review ultimately resulted in a $5 million bond referendum that funded improvements in downtown streetscapes and built the Catawba Riverfront Greenway, a greenway connecting downtown Mount Holly to the Catawba River.

Dr. Beatty also played an instrumental role in establishing the Mount Holly Community Development Foundation (www. mounthollyfoundation.org) that now helps guide the city’s economic development and image enhancement efforts. He’s also served as team physician to two local high schools for over 25-years, co-authored a history book about Mt. Holly, and even established a community 5K that’s in its 20th year.

Both are working to foster healthier activities and lifestyles in the community.

“Family docs can be patients’ cheerleaders certainly, in the exam room. But more importantly, we need to be involved

Winter 2017

outside of the clinic, within the community, making opportunities for physical activity more available,” says Dr. Beatty.

Dr. Beatty firmly believes that the most important thing patients can do for their health is to expect more of themselves.

That means not only in their personal life, but in their community as well. He is convinced that when people become invested in their community -- and invested in the future of their children and children’s children -- they develop ownership in their own health.

For family physicians (especially new ones), Beatty stresses the importance of embracing the role of interpreter and guide for patients. “As family physicians, we cannot just turn over certain aspects of our patients health to someone else, such as a subspecialist. Our patients trust us and frequently trust us alone. We need to help them understand and navigate the healthcare system,” notes Dr. Beatty.

All this points to why Dr. Beatty does what he does, dayin and day-out for his patients and his community. He’s a champion in every way. And that’s why he was chosen the North Carolina Family Physician of the Year.

Dr. Beatty and his wife Kristen have been married 41-years.

They have two grown children, Dr. Allison Beatty, a pharmacist, and Mark Beatty, an exercise science instructor at NC State.

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MEMBER NEWS & HIGHLIGHTS Duke’s Viviana Martinez-Bianchi Elected to WONCA Executive Committee The NCAFP now has an international family medicine leader within its ranks! NCAFP’s current Residency Directors Constituency Chair, Dr. Viviana Martinez-Bianchi, of the Duke Family Medicine Residency Program, was elected late last year to be one of three At-Large members of the WONCA Executive Committee, the World Organization of Family Doctors. Executive Committee members meet up to twice yearly and act for and on behalf of the WONCA World Council. Dr. Martinez-Bianchi has been active in WONCA for several years, including most recently serving as a member of the organization’s Organizational Equity Committee.

Remember to share your practice news, milestones, awards/recognitions, appointments, publishing notes, etc., with your NCAFP family! The NCAFP has a convenient online form where you can share such information to be considered for inclusion in the “Member News” section of a future member magazine issue. To access the form anytime, simply visit www.ncafp.com/submit-a-note. If you are unable to use the form, you may email your news to Tara Hinkle, NCAFP Manager, Member Services, at thinkle@ncafp.com.

2017 Membership Dues--

Wilmington’s Janalynn Beste Awarded UNC’s 17th Annual Peter M. Curtis Award

What to Do if The January 1st Payment Deadline was Missed

New Hanover Regional Medical Center Residency in Family Medicine Program Director Dr. Janalynn Beste has been awarded UNC’s Peter M. Curtis Award.

Dr. Beste was honored for her presentation, “Marathon Medicine Mom,” and for her contributions and leadership in family medicine during a recent statewide retreat. The Peter M. Curtis Award was established in 2000 honoring senior faculty who have made a substantial contribution to the mentoring of junior faculty and to the development of the statewide department.

Active, Inactive, Supporting, and First-Time Life Members: The 2017 dues payment deadline was January 1st, 2017. To check if you have paid or have a balance, please visit www.aafp.org/quickpay.

Payments may be made on that webpage, in addition to printing invoices and setting-up installment and/or auto renewal plans. (Installments are taken monthly through August 2017). Please pay your balance or set up an installment plan as soon as possible to maintain your membership.

Family Physicians Playing Key Role in New Carolinas-Novant Community Health Effort Family physicians are playing a central role in a new community health partnership recently launched

by Charlotte’s two largest health systems, Carolinas HealthCare and Novant Health. Carolinas HealthCare’s Dr. Alisahah Cole, was recently featured in an excellent article published in the Charlotte Observer In discussing Dr. Cole’s efforts establishing the new partnership, two additional NCAFP members were also mentioned: Dr. Marcus Plescia, and Dr. Ophelia Garmon-Brown. Just another example of family physicians at the forefront in Charlotte.

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We Want to Hear From You: Send in Your Member News!

~How to Pay Dues~

• By the AAFP Mobile App: Tap ‘My Account’ button.

• By Phone at (800) 274-2237 from 9:00 A.M. - 6:30 P.M. EST • By Mail: Make checks payable to AAFP and mail to AAFP, P.O. Box 419662, Kansas City, MO 64141 • Pay Online at www.aafp.org/quickpay. Your seven-digit AAFP ID # serves as your username. For login issues or dues questions, please contact AAFP at (800) 274-2237.

The North Carolina Family Physician

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EDUCATION & PROFESSIONAL DEVELOPMENT

By Kathryn Atkinson NCAFP Meetings & Events Manager

Upcoming Events & Conferences

Convenient, Timely & Fun: 2017 CME That Fits

Archtype to Supply 2017 Meetings Advert

Presenting 63+ AAFP Prescribed Credits in 2017

Expert Speakers | Timely Topics Terrific Locations | Flexible Schedules 56th Annual Post-Graduate Symposium Friday, March 31st, 2017

RENAISSANCE CHARLOTTE SOUTHPARK HOTEL, CHARLOTTE, NC

The NCAFP Meetings & Education Department strives to design robust educational programs to fit your CME needs. We listened to your feedback in 2016 and we paid special attention to the topics you’ve requested, along with the formats your busy schedules require.

We hit the ground running shortly after the holidays and we are very excited to announce several great CME events this year. We happen to think you will find our conferences to be the perfect fit for your 2017 CME needs.

56th Annual Post-Graduate Symposium Planning for the 56th Annual Post-Graduate Symposium, slated for Friday, March 31st and co-hosted by the Mecklenburg County Chapter of the NCAFP, is in fullswing, with Program Chair Dr. Jewell P. Carr leading the way. Dr. Carr’s streamlined schedule gives way to a fantastic opportunity to earn 8+ AAFP Prescribed Credits in a terrific one-day format. This convenient and affordable symposium at the Renaissance Charlotte SouthPark Hotel will feature timely and important CME lectures on HPV, Antibiotics, Pre-Conception Health, Post-Partum Depression, Stress Testing and more. The program will also showcase a two-hour session titled “Addressing Chronic Pain: Safe Practice, Changing Lives.” This feature session will discuss the CDC guidelines for prescribing opioids, immediate-release opioids, and

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Approx. 8+ AAFP Prescribed Credits Mid-Summer Family Medicine Digest Sunday, July 2nd – Thursday, July 6th, 2017 KINGSTON PLANTATION/EMBASSY SUITES MYRTLE BEACH, SC Approx. 30+ AAFP Prescribed Credits Winter Family Physicians Weekend Thursday, Nov. 30th – Sunday, Dec. 3rd, 2017 Pre-Conference Afternoon Workshop Opportunities on Wednesday, Nov. 29th OMNI GROVE PARK INN, ASHEVILLE, NC Approx. 25+ AAFP Prescribed Credits

Register today: www.ncafp.com

also review state-specific information and non-pharmacological options for treating pain. Participants can expect this two-hour session to also highlight useful tools being applied within case vignettes and helpful faculty-learner interaction.

Important to note, NCAFP Business Sessions will also be held over the weekend. The NCAFP’s Foundation Board of Trustees will gather for a lunch meeting on Friday the 31st and the NCAFP Board

The North Carolina Family Physician

of Directors, along with the NCAFP’s various councils, will meet on Saturday, April 1st. Visit our conference website at www.ncafp.com/symposium for a full schedule of events along with complete registration and hotel reservation information.

2017 Mid-Summer Family Medicine Digest If sunny beaches, warm ocean waves and Fourth of July celebrations with friends and family are a few of your favorite things, then you are in luck! Join us this July 2nd – July 6th in Myrtle Beach, SC, for our annual Mid-Summer Family Medicine Digest at the Kingston Plantation and Embassy Suites. This fun week of half-day sessions, featuring Hot Topics, Sports Medicine, Adult & Women’s Health, Chronic Disease, Pediatrics, and Practice Management, along with optional afternoon hands-on workshops and study working group opportunities, is sure to suit your summertime CME needs. Visit www.ncafp.com/msfmd for complete schedule, hotel and registration information.

2017 Winter Family Physicians Weekend Finally, a sincere ‘Thank You’ to all 809 of you who participated in our recent Winter Family Physicians Weekend in Asheville this past December! It was a remarkable four days in the Blue Ridge Mountains, complete with fantastic speakers, engaging workshops and lots of fun for everyone. I hope that you will go ahead and mark your shiny new 2017 calendars now for Nov. 30th – Dec. 3, 2017 at the Omni Grove Park Inn in Asheville when we’ll do it all over again! Watch your email and our website for additional details and information on what is the largest (and in our opinion, the best) state specialty meeting of its kind in the U.S. If you have any questions or need more details about fitting these terrific CME opportunities into your 2017 calendar, please contact Kathryn Atkinson, Manager of NCAFP Meetings & Events at 919-214-9058 or via email at Katkinson@ncafp.com. Best wishes for a terrific 2017 and I hope to see you soon!

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RESIDENTS & NEW PHYSICIANS

By Dr. Stephen Carek (PGY-3) Carolinas Medical Center Charlotte Family Medicine Residency Program

What I Want Family Medicine to Look Like in 2026 It is the year 2026, “Triple Aim Hits the Bullseye: Health Care System Rises in Access and Quality While Lowering Costs” flashes across the screen of a daily new show. In this moment of reflection, I take the time to remember where the American healthcare system was 10-years prior and view the current landscape of healthcare with optimism. It had been a long, arduous battle, but after years of reform, cooperation, and evolution, the United States healthcare mega-complex had undergone such tremendous reform that the world no longer viewed the US as a model of big spending and inefficiencies, but as a model of reform and innovation.

But why? What had become of the system fraught with inequities, corruption, overspending, and compromised patient care? It was no more, thanks to an established network of primary care physicians who took a corrupt model of healthcare, flipped it upside down and created a system that no longer served the interests of insurance companies, hospital systems, pharmaceutical companies, and bureaucracies.

Family medicine changed everything. The collective momentum of insightful minds who put the system in a new perspective and created a model of healthcare where patients’ interests and well-being were prioritized through a system of primary care physicians and preventive care models that promoted well-being.

Why Family medicine? Why was this the specialty that pushed itself to the forefront in a sea of confusion and uncertainty?

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Because we offer a perspective unlike any other, caring for all patients, regardless of age, gender, ethnicity, income, or education.

Because our relationships with patients are like no other.

Just as much as we may impact our patient’s lives, they impact ours.

Because we introduced the model of shared decision making, allowing patients a vested interest in their own care, simplifying communication and tailoring decisions on the wants and needs of our patients.

Because we created quality metrics that were meaningful and improved outcomes, allowing for a greater understanding of our community at an individual level and in the frame of an entire population.

Because we expanded the concept of the ‘end of life’ discussion with our patients and their families in our clinical environment, building on a relationship of trust and care to prevent pain and uncertainty for the patient and their family, creating peace and closure when the time comes.

Because we continued to improve medical education, training world-class students and residents to pursue the challenge of healthcare reform to serve as advocates for our patients and the needs of all physicians.

Because we built a system that utilized novel technologies through virtual care, Internet-based communications and social media to connect with patients in ways that had never been seen. Increasing access and strengthening relationships.

Because we provided clarity and leadership in the age of ‘alphabet soup’ of healthcare reform, the age of the ACA, ACO, HMO, and MACRA, and created modern models for delivery of care that put the patient first.

Because we reached out to those who needed care the most, giving everyone in this country a chance to pursue their American dream and live a happy, healthy life.

Family medicine became the foundation for healthcare innovation and improvement in the 21st century. Not only did we revolutionize healthcare, but together, we saved it.

The North Carolina Family Physician

Life’s too short to live with limits

SEIZE YOUR OPTIONS Norfolk

Raleigh

Greenville

Charlotte

If you’re looking for more from the practice of family medicine, consider a place that feels right, right from the start. Where you’ll sense immediately that you’ve found colleagues who’ll be your friends for a lifetime.

Vidant Health and The Brody School of Medicine at East Carolina University are creating the national model for rural health and wellness, led by dynamic physicians like you. You’ll have the infrastructure you need to manage a modern medical practice — EHR, financial and human resources — and a built-in referral network. Explore practice opportunities near beautiful beaches and in charming waterfront towns. Learn why family-oriented professionals, intrigued by the coastal lifestyle, find eastern North Carolina a perfect match.

Wilmington

Benefits: Monthly residency stipend • Outpatient only (inpatient optional) • No call (various locations) • Student loan repayment • Annual stipend • Malpractice with tail • Relocation assistance Seize your options in family medicine at VidantHealth.com/PhysicianJobs or apply directly to Karen.Gliarmis@VidantHealth.com.

2016-2017 Resident Leaders (l-to-r): Courtland Winborne, MD; Alyssa Shell, MD; Latonya Beatty, MD; Landon Allen, MD; Anna Afonso, MD; Jason Fishel, MD; Brian Antono, MD; and Sam Fam, DO.

RESIDENT SECTION UPDATE

By Tracie Hazelett, Manager, Medical Student & Residency Relations

Asheville Winter Meeting Draws 85 Residents At the NCAFP Winter Family Physicians Weekend & Annual Meeting in Asheville last December, 85 family medicine resident members gathered, representing 13 family medicine residency programs across North Carolina.

During the Resident Section Business Meeting, the resident constituency received updates from the 2016 resident representatives previously-elected to serve on each NCAFP council and also elected new leadership to represent residents and the NCAFP. Attendees engaged in open discussions regarding issues important to residents, including ways the NCAFP can best support and be involved with residents, as well as concerns regarding finding jobs in North Carolina with the desired scope-of-practice. As a result of resident feedback, the NCAFP Board of Directors approved the following:

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• Investigate piloting a community-centered ‘town hall’ or focus group through a collaboration between the NCAFP and a specific residency program. The town hall will be designed to: a) engage community members about their healthcare needs, and b) provide clarification on the role of family physicians and the NCAFP’s advocacy agenda.

• Provide new residents with orientation materials such as an introductory email with links to resources and/or a podcast or video that would summarize the North Carolina healthcare environment.

• Investigate developing an ongoing podcast/digest with brief episodes that summarize NCAFP actions and legislative updates.

• Work to have a more ongoing presence with residents, including better website resources.

Residents also elected a new Resident Director-Elect, two NCAFP Foundation Resident Trustees, and four council representatives. Dr. Alyssa Shell, PhD (MAHEC-A), rotated into the Resident Director role. Congratulations to these newly-elected resident leaders: Courtland Winborne, MD, MPH (Cabarrus), Resident Director-Elect; Resident Trustees on the Foundation Board of Trustees are D. Landon Allen, MD, MPH, MBA, (MAHEC-H) and Brian Antono,

The North Carolina Family Physician

MD, MPH (MAHEC-A).

The four newly-elected council representatives are: Anna Afonso, MD, MPH (Duke), Practice Management; Latonya Beatty, MD (CMC), Membership & Workforce; Sam Fam, DO (Duke) PR & Marketing; and Jason Fishel, MD (CMC), Continuing Medical Education. Congratulations and thank you in advance for your service!

Advocacy

Resident Opportunities for Advocacy Many residents have been eager to get involved with advocacy. The NCAFP has two great opportunities that will take place at the North Carolina General Assembly in Raleigh this Spring.

-- TODAY IS --

High Blood Pressure

In an effort to bring more attention to hypertension in North Carolina, the NCAFP will partner with the American Heart Association (3/14) and the Justus-Warren Heart Disease and Stroke Prevention Task Force (5/17) for blood pressure Inquire Here screenings over the next few months. On Tuesday, March 14th and Wednesday, May 17th, we need resident volunteers to staff short shifts scheduled between 9am – 3pm at the NC General Assembly. Volunteers will be responsible for taking the blood pressure of legislators, their staffers, lobbyists, or anyone who happens to be at the General Assembly that day. Shifts will likely be 2-hours in length, and you do not need not to volunteer the entire day. This is an educational, yet casual, opportunity to connect with policy makers. Although these screenings will not be a typical ‘White Coat Wednesday’, the NCAFP will set-up meetings with residents and their respective legislator for anyone who plans to attend. This is a great opportunity to share the message of the importance of family medicine -- particularly around prevention and high blood pressure.

Awareness Day Free Pressure Checks!

AT T h e G e n e r A l A S S e m b lY

Upcoming Deadlines March 1st: Family Medicine Leads Emerging Leaders Institute — The Emerging Leaders Institute is a

year-long leadership development program that focuses on ensuring the future of the Family Medicine specialty by increasing the number of future Family Medicine leaders and providing training for this important role. Residents in their 1st, 2nd or 3rd year when this leadership institute kicks off at National Conference in Kansas City in July are eligible to apply. More details, requirements and the application can be found on the AAFP Foundation’s website at: www.aafpfoundation.org.

March 15th: AAFP Foundation Family Medicine Cares Resident Service Award — The $16,500 Fam-

ily Medicine Cares Resident Service Award creates an opportunity for first-year and second-year FM residents to fulfill a desire to address health disparities by tackling the health needs of the underserved in their local communities. Complete details, requirements and application on this 12-month service project can be found at AAFP Foundation’s website: www.aafpfoundation.org.

Brand Architecture Identity System

~ S P O N S O R E D

B Y

~

Food Certification will remain its own identity.

¨

Corporate Signature Stationery, Buildings, Presentations, Corporate Functions, Stroke-Only Materials, All Internal Documents.

Cause programs grandfathered in AHA logo first to focus on parent brand.

Program Name

Stroke branding

Program Name

Masterbrand All external communications with the exception of “Stroke ONLY.”

Future programs text only. No new icons or logo treatments.

Program Name

All logos have a stacked vertical version when needed for space requirements.

American Heart Association/American Stroke Association Branding Guide Mini: Signature System

dents and students to share your research by entering the National Conference poster competition. Categories for posters include: Research, Clinical Inquiry, Community Project and Educational Program. Submission requirements and full details can be found at www.aafp.org/nc.

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Please contact Tracie Hazelett (thazelett@ncafp.com) if you are interested in participating via email or at 919-9805357. Triangle-area Residents: even if your schedule doesn’t allow for participation, if you have space in your home and are willing to open it to traveling residents, please contact Tracie. Traveling residents should inform Tracie if you would like a place to stay the night before, or the night of, either event.

Winter 2017

April 1st: 2017 National Conference Poster Presentation Competition — The AAFP invites resi-

May 1st: Travel Scholarships to 2017 National Conference — The AAFP Foundation offers two

scholarships to attend the 2017 National Conference. For eligibility requirements, submission deadlines and writing tips, please visit: www.aafp.org/events/national-conference/about/scholarships.html.

Please Note: Elections for national resident positions take place during this conference. If you are interested in a national leadership position, the deadline to notify the NCAFP of your intention to seek election or appointment is May 1st, 2017. This deadline is for all elected and some appointed positions. Other appointed positions have a deadline of August 15, 2017. Residents should contact Tracie Hazelett (thazelett@ncafp.com) for questions or more information.

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STUDENT INTEREST & INITIATIVES

By Tracie Hazelett, Manager, Medical Student and Residency Relations

NCAFP Student Section Elects New Leaders At the NCAFP annual meeting last December, approximately 125 medical students converged on Asheville to represent all five North Carolina medical schools. Students participated in educational sessions and business meetings and took advantage of several social and networking opportunities with other students, residents and physicians. A packed Student Section meeting discussed opportunities available to students enrolled in NC medical schools, shared information about activities at each respective institution and elected new student leaders. Angie Maharaj (Campbell) rotated to Student Director on the Academy Board of Directors; others elected to represent the medical student body of North Carolina are Ally Mentock (Brody), Student Director-Elect; and, Student Trustees on the NCAFP Foundation Board of Trustees are Erin Clark (Campbell) and Elizabeth Ferruzzi (Brody).

Pictured at right are (L-to-R): Ally Mentock, Erin Clark, Elizabeth Ferruzzi and Angie Maharaj. Congratulations!

The Academy and its Partners Prepare to Provide Summer Programs The NCAFP Foundation is once again providing opportunities for medical students to be immersed in family medicine this summer. Rising 2nd year medical students at each medical school, along with 3rd year students at Duke, have been invited to apply for incredible educational and clinical experiences this coming summer. There will be two Rural / Underserved Health Programs offered, one in Eastern NC and one in Western NC, as well as multiple 4-week Clinical Externships. Up to 26 medical students will participate with stipends to off-set travel and related costs.

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The NCAFP can use member help. We rely heavily on our residency partners in rural eastern and western North Carolina, as well as physicians and residents to teach, host and mentor students. If you are a physician or resident interested in hosting a medical student in your practice or in your home during any of the times noted below please contact Tracie Hazelett at thazelett@ncafp.com or via phone at NCAFP Offices at 919-980-5357.

• •

• •

June 4th - 9th: Host homes only. Greenville, NC area June 11th -16th: Physician preceptors and host homes in any rural / underserved area but particularly central and eastern NC July 9th -17th: Host homes only: Hendersonville area July 17th -22nd: Physician Preceptors and host homes in rural / underserved Western NC.

March 1st is the Deadline to Apply to AAFP Foundation’s Emerging Leaders Institute The Emerging Leaders institute is a year-long leadership development program that focuses on ensuring the future of the family medicine specialty by increasing the number of future family medicine leaders and providing training

The North Carolina Family Physician

well-known for her commitment to improving patient lives and her instrumental efforts in making Hoke County a healthier place to live. Dr. Smith will speak on “The Role of Novice Healthcare Providers in the Race for Reform.” Following Dr. Smith’s keynote, attendees will enjoy 4-hours of clinical skills workshops and wonderful professional networking opportunities with North Carolina and other regional family medicine residency programs and students from across the state. Registration is currently open for the medical student Class of 2018 and 2019.

Class of 2020 students may register beginning on 2/11/17.

For complete information and online registration, visit www.ncafp.com/fmd today.

May 1st is Deadline for AAFP Foundation Scholarships to the 2017 National Conference in Kansas City

for this important role. Students in their 2nd, 3rd or 4th year when this leadership institute kicks-off at the National Conference in Kansas City in July are eligible to apply. Enhance your leadership skills and earn a full scholarship to attend this energizing conference! More details, requirements and the application can be found on the AAFP Foundation’s website at www.aafpfoundation.org.

Register Now for NC Family Medicine Day Scheduled for Sat., March 11th, 2017 The NCAFP and the North Carolina Area Health Education Centers Program (AHEC) are excited to present North Carolina’s 10th annual Family Medicine Day, the state’s premier family medicine residency recruitment conference! This fantastic one-day event will feature a keynote presentation by 2017 National Family Physician of the Year -- Dr. Karen L. Smith, FAAFP, of Raeford, North Carolina. Dr. Smith is a rural primary care rockstar,

Winter 2017

The American Academy of Family Physicians Foundation supports Family Medicine Leads (FML), a program focusing on filling the workforce pipeline with the best and the brightest and supporting the development of future family medicine leaders. FML scholarships to the National Conference are provided by the AAFP Foundation and are made possible by the donations of family physicians from across the country. There are multiple scholarship categories, with the number within each category varying from year-to-year depending on the funding level and the number of applicants. However, the AAFP anticipates awarding up to 250 scholarships in 2017! For eligibility requirements, submission deadlines and writing tips, please visit: www.aafp.org/events/national-conference/ about/scholarships.html.

This conference has something for all students -- MS1 to MS4s -- offering interesting educational workshops, informative and inspiring leadership forums, and the opportunity to meet and network with residency programs from North Carolina and across the country.

Please Note: Many national student positions are elected during this conference. If you are interested in a national leadership position, the deadline to notify the NCAFP of your intention to seek election or appointment is May 1, 2017. This deadline is for all elected and some appointed positions. Other appointed positions have a deadline of August 15, 2017. Medical students should contact Tracie Hazelett for questions or more information.

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PRACTICE MANAGEMENT

By Peter Graber NCAFP Communications

AAFP Remains Vigilant to Details of Medicare’s New Payment Models The AAFP continues to advocate for family physicians as Medicare’s new Quality Payment Program begins to be implemented. The AAFP has stayed engaged in the federal rule-making process and recently forwarded CMS a lengthy response to the agency’s final MACRA rule it published last November, as well as its recent draft proposal of new patient relationship codes and categories. The final MACRA rule outlined how CMS will imple-

Medical Society Announces Plan for New Medicaid Managed Care Plan The North Carolina Medical Society (NCMS) recently announced its intent to create a new Medicaid managed care plan to offer “…a model of care that is patient-focused, physician-led, value-based and home grown..” Known as Carolina Complete Health, NCMS is collaborating with the North Carolina Community Health Center Association and the Centene Corporation to establish, organize and operate the plan. NCMS and its partners

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ment the program’s two new payment pathways for physicians beginning this year: the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs) pathway.

In a letter addressing how the payment models would be implemented, the AAFP recommended the simplification of both pathways and stressed that simplification would encourage physician participation and preserve valuable clinical time.

Late last month, also AAFP shared its thoughts on CMS’s new patient relationship codes and categories.

These are mandated by MACRA and are designed to determine incentive payments by identifying and tracking attributed resource use. The AAFP communicated a rather blunt assessment of CMS’s draft plan and urged it to “thoroughly pilot test” the proposed categories before committing to using them. Easing administrative burdens was again the central theme.

“CMS must minimize the reporting burden for physicians ... through pilot-testing to address logistical issues and possible unintended consequences, especially for small practices,” wrote AAFP Board Chair Wanda Filer, MD, MBA.

will also create the Carolina Complete Health Network that will be jointly-owned and governed by NCMS, physicians, physician assistants, nurse practitioners and Federally-Qualified Health Centers and will provide medical management services for the plan. The new plan will submit a proposal when North Carolina issues its Request for Proposal for Medicaid managed care plans later this year.

The North Carolina Family Physician

State Health Plan Looks to Partner with Physicians on Diabetes Prevention One in three Americans have prediabetes and 90 percent of those individuals are unaware of it. The Centers for Disease Control and Prevention (CDC) reports that in the average primary care practice, it is likely that one-third of patients over age 18 – and half over age 65 – have prediabetes. “Prediabetes” is the term used for individuals with impaired fasting glucose or impaired glucose tolerance and indicates an increased risk for developing diabetes. If left untreated, up to one-third of patients with prediabetes will progress to diabetes within five years. Screening at-risk patients is important since early identification and treatment has the potential to reduce or delay the progression to diabetes and its related complications.

The Diabetes Prevention Program (DPP) is a CDC-approved, evidence-based strategy proven to prevent or delay diabetes in at-risk individuals by 58 percent. It provides a comprehensive, non-pharmacological approach to implement lasting lifestyle changes. Since April 2016, the North Carolina State Health Plan (Plan) has been offering DPP as a covered benefit for at-risk active employees, non-Medicare retirees, and Medicare retirees enrolled in the Traditional 70/30 Plan, as well as dependents over 18. For coverage of DPP, “at-risk” is defined as those individuals who have a history of gestational diabetes, an A1c between 5.7 and 6.4, or a score 9 or above on the CDC-Prediabetes Screening Test.

Plan members pay only $25 for the program. The Plan covers the remaining $400 cost of the program.

Over the course of 12 months, experienced and engaging instructors lead participants into a journey of healthy living. Members can participate online or through statewide onsite classes by registering at www.DiabetesFreeNC.com.

Here’s where the Plan needs your help to keep our members – and your patients – as healthy as possible.

The Plan is eager to partner with you, our members’ trusted family physicians, to not only help save lives, but promote long and healthy lives. As a partner in

Winter 2017

preventing diabetes, please assess your patients for prediabetes, refer at-risk patients to the DPP initiative, and encourage them with their lifestyle changes. As our partner, you will also receive notification of Plan members who participate in DPP. To request a DPP promotional poster for your exam and waiting room, or for more information, please contact nchealthsmart@nctreasurer.com. ~ Patient Care ~

American Academy of Pediatrics– Do Not Prescribe Codeine to Children Codeine has been prescribed to pediatric patients for many decades as both an analgesic and an antitussive agent. However, in recent years, various public health organizations and regulatory bodies, including the American Academy of Pediatrics, the World Health Organization, the US Food and Drug Administration, have issued pointed warnings regarding the potential occurrence of adverse effects with codeine in children.

These and other groups have or are considering issuing a contraindication notice for the use of codeine for children as either an analgesic or an antitussive. Adverse drug event surveillance has documented the occurrence of unanticipated respiratory depression and death in children after receiving codeine, many of whom have been shown to be ultra-rapid metabolizers. If codeine is prescribed, parents and caregivers should be warned about the risks associated with codeine use in children.

Bringing these concerns to our attention, the American Academy of Pediatrics recently issued a clinical report which states that “Codeine should no longer be prescribed to children due to its poor analgesic effect and risk of opioid toxicity and oversedation.”

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INAUGURAL ADDRESS CONTINUED

mall who knew how to fix it. They wanted to sell me a new one, but the only thing I could find was made by Gucci and cost around $300. I finally found an 87-year-old gentleman in Albemarle named Mr. Yarborough. Mount Pleasant is one of those places that if you want something done or need something fixed, you ask your patients and they will tell you who to go see. Mr. Yarborough put a new handle strap on it for a few dollars. Good for another 50,000 miles.

I used to carry my bag with me to the hospital. To me it was a toolbox, but my patients often found it comforting. There is power in symbols – the white coat, the stethoscope, the doctor’s bag, the family doctor they have known for years. I still carry my bag in my car. You never know when someone will have an emergency at church or at the Food Lion.

when they married. He was long deceased, and she lived by herself. Her son was out of state, but visited on weekends.

Mrs. Walker developed congestive heart failure, and we put her on home oxygen. She could no longer drive, so she asked if we could come see her. I remember pulling up to her house the first time and seeing two watermelons busted open on the front porch. There were a half dozen or so chickens picking the seeds out. A little unusual, but hey, this is Mount Pleasant.

I walked into the living room, and there sat Mrs. Walker on her couch, holding a chicken. A picture of her grandfather in his civil war uniform hung over the mantelpiece. She was having a good day. I finished the doctoring part of the visit, and she asked me if I wanted to look at her picture album with her. Grandkids, I thought, which is fine. No, pictures

I also use my doctor’s bag for home visits. I have done house calls my entire career, even when I was in the military. This has always confounded the administrators, who feel you are much more productive in the office environment within a structured schedule. Where you can be watched and measured, put on a spreadsheet and compared to other providers.

But I would argue that seeing a patient every 15-minutes in the artificial construct of a 10-by-14 foot examination room, is not the best way of understanding your patients. There are things about our patients we will never know until we see them in their home environment.

When you go to their house, you see the obstacles they deal with on a day-to-day basis. What kind of support they have.

Which medicines they can afford and are really taking, what they have in the refrigerator. Older people can’t drive in many cases, and when you live in the country, it is not that easy to get someone to take you to the grocery store or the doctor’s office. Usually a family member or neighbor has to take the day off to drive them.

There is sometimes a reason that our older diabetics can’t get their glucose and blood pressure under control. Twinkies and prepared foods are much cheaper than fresh fruits and vegetables, can be bought in bulk at Sam’s, and have a longer shelf live. (I’m not sure what the shelf life of a Twinkie is these days – I read up to 20-years on Google.) It is also difficult to cook for one person, and sometimes even to use the stove or microwave if you have arthritis or limited vision.

I learn so much from home visits.

Let me tell you about Mrs. Walker, who was in her 80’s and still lived in the house her husband had built for them

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of her pet chickens. The watermelons were their treat. And we went through the photo album as she pointed out her favorites by name. She has since passed away, but I have not forgotten her, and every time I drive past her house I still look for the chickens.

The pictures are what teach me the most. When you enter someone’s home, the family portraits usually line the entrance way and spill into the living room. People are proud of their family, and the older we get the more family we have to be proud of. The pictures help me learn family relationships, who is related to whom, and help explain the dynamics I sometimes see in the office. There is invariably a picture of the patient as a beaming young bride in a wedding

The North Carolina Family Physician

dress, her husband, now deceased, on her arm. There will also be a picture of the young mother, her children dressed up and looking distracted, as she looks confidently into the camera, certain of what the future brings.

And then you look down at your patient in the bed in front of you and see the toll that time and disease have taken.

The child, now a mother herself, stands beside your patient holding her hand, looking to you for words of comfort and encouragement.

“Yes, you’re doing everything you can.”

Your words have power and meaning. “Call me if you need me”. And they know I mean it.

I was the adult caretaker for my parents. Both are now de-

There is a movement afoot in corporate medicine to redefine family medicine. We are being lumped together with other types of providers and other specialties, and re-labelled as generic “PCP’s”. This shows a complete indifference, or perhaps ignorance, of what makes family medicine different. Under the mantra of consumerism, the doctor-patient relationship is being de-valued, and words like access, convenience, and cost are dominating the conversation. We are being told that patients no longer value a relationship with a trusted physician. They prefer to receive their care on-line, or through a quick care type of venue.

I agree that there will always be a segment of our population for whom convenience is king, and who will only be happy when they get the Z-Pack that they are convinced they need.

But there is a larger majority who value and seek out care from a trusted physician, who they have known for years, who in some cases took care of their parents, and perhaps their grandparents. And who will be there every time they get sick. And who they can trust with their lives, and the lives of their children. Anything that interferes with the doctor-patient relationship is bad and needs to be actively resisted.

We face some significant challenges in the next year. Independent practice will be a major issue as relates to our nurse practitioner colleagues. The discussion is just starting to heat up in the Legislature. I believe there is room for compromise as long as we agree that the ultimate goal is what is best for our patients.

ceased. It was interesting to experience the doctor-patient relationship from the other side. A doctor who knows your family, is available to them, and who will be there for as long as it takes. Priceless.

As a young newly-minted family physician who did OB, my practice was mainly young families and children. As I have aged, my patients have aged with me and most of what I see these days is geriatrics. But that is OK, my patients and I have been friends for a long time. Our office is across the street from the cemetery in Mount Pleasant. I have a lot of friends buried there as well, and I look for their names as I drive to work in the morning. It is good to be reminded of your limits. Medicine keeps you humble.

Winter 2017

There continues to be scope-of-practice issues for our new graduates. This is particularly true for those joining the large hospital systems. Our residencies spend a great deal of time and effort in training our residents to do hospital work, procedures, and obstetrics. But that is not the vision of family medicine that some of the systems have. We as an academy need to advocate for our graduates, so that they can practice the full breadth and scope of family medicine, if that is what they chose to do.

As an academy, we need to demand an electronic Health Information Exchange (HIE). It is unacceptable the EMR’s cannot communicate with each other. We need to push for the expansion of Medicaid, and for a payment system that truly values what we do, including working to increase Medicaid payments. Family physicians have always been the safety net for the poor and disadvantaged. We take care of the patients no one else wants to. We can proudly point to Community Care of North Carolina (CCNC) as a success.

We need to support CCNC. Continues on next page.

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INAUGURAL ADDRESS CONTINUED

I started out talking about burnout. My cure for burnout:

I want to introduce you to my niece, Dr. Abby Lancaster Gardner, who is a first year resident at the Moses Cone Family Medicine Residency Program. Abby gets it, and will be a great family doctor.

All of us will eventually need a physician to

What we do is special. What we do is right.

No other specialty allows you to do as much good for as many people as family medicine.

I love being a family physician. There is nothing else I would rather be. And for you medical students out there, if I had the opportunity to choose over again, I would make the same choice today. In a heartbeat. No question.

Dr. Pons read my life verse earlier, which is Matthew 25:40. Mother Teresa, now Saint Teresa, put this in a similar light: “At the end of life we will not be judged by how many diplomas we have received, how much money we have made, how many great things we have done.

We will be judged by ‘I was hungry, and you gave me something to eat, I was naked and you clothed me. I was homeless, and you took me in.’”

Again, thank you for this great honor. I look forward to working with you in the next year.

Non-Profit Org. US Postage

#3: Teach. I am here because someone else took time out of their busy practice to inspire me and to instill their love of family medicine in me. Inspire the next generation of doctors.

Family medicine is not a job. It is a calling.

Just like He would a minister, God reaches out and touches your heart and asks you to take care of His children. And that is where family doctors come from.

PAID

#2: Get outside of your box. Make house calls. Become engaged in your community.

Get to know your patients on their own turf.

Here’s a picture of the 46,000 square foot hospital we are building in San Juan de la Maguana. Come help. Our next trip is in October.

Pontiac, Illinois Permit No. 592

#1, Get to know your patients. They are not the problem. Spend some time with them, particularly the older ones. Sit down, put your computer away and listen. They have had experiences you never will, and are happy to have someone listen to their story.

2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607

We have some heavy lifting ahead of us in the coming year. I would ask that you continue to be active in lobbying for what your patients need. I would ask that each of you establish a relationship with your local legislator, so they know to call you for advice when they vote on issues involving your patients. I would also ask that you financially support FAMPAC. It’s important. We need funds to fight for those things that are important to Family Medicine.

#4: Find something outside of work that inspires you, and makes medicine fun again.

Practice at the real top of your license. For me that has been medical mission work. Nancy, Lara and I have been leading mission groups to the Dominican Republic for the past 15-years.

Many of you here tonight have gone with us.

What do these doctors have in common? Do you see the smiles? When was the last time you felt that good about practicing medicine?

www.ncafp.com

We will also need to help our members get ready for MACRA and MIPS and APMs. And we must be ready for whatever changes the new administrations, both federal and state, have in mind. We stand on the shoulders of giants in this academy. Our specialty is strong, our academy is effective, our legislative voice is loud. The current AAFP Family Physician of the year, Dr. Karen Smith, as well as last year’s winner, Dr. Maureen Murphy, are both incredible physicians who have given North Carolina family medicine a spotlight on the national stage.

take care of us. Be a mentor. Even if the medical student working with you chooses a different specialty, would you not prefer they were well trained. Who better to teach them how to take care of you, than you?