NC Family Physician - Fall 2017

Volume 13 Issue 4 / Autumn 2017

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

NCAFP Family Physicians at the Forefront of Leadership

Mark your calendars now for NCAFP’s 2018 CME opportunities NCAFP offers creative and out-ofthe-box learning opportunities at every CME event. You’ll take advantage of audience response technology, case-based study workshops, interactive learning workshops, hands-on practice sessions, timely panel discussions, innovative product theaters, and more.

Enjoy creative, interactive learning opportunities at every CME event we offer.

Exceptional care calls for exceptional CME

2018 Spring Symposium

Presenting 63+ AAFP Prescribed Credits in 2018 Expert Speakers | Timely Topics | Terrific Locations | Flexible Schedules

What our attendees are saying: “This was by far one of the most beneficial/valuable conferences I have attended as far as relevant content that I can actually use in my daily practice.”

“Always a great experience… that’s why even though I no longer live in NC, I keep coming back.”

“This is the best organized conference I have attended. The app functionality was incredible. I already can’t wait to come next year.”

-A Saturday CME EventSaturday, April 14, 2018 Approx. 8+ AAFP Prescribed Credits CHARLOTTE MARRIOTT SOUTHPARK HOTEL CHARLOTTE, NC

2018 Mid-Summer Family Medicine Digest Sunday, July 8– Thursday, July 12, 2018 Approx. 30+ AAFP Prescribed Credits KINGSTON PLANTATION/EMBASSY SUITES MYRTLE BEACH, SC

“There were clinical pearls in all lectures.”

2018 Winter Family Physicians Weekend

“I feel more confident to deliver high quality care!”

Thursday, November 29– Sunday, December 2, 2018 Approx. 25+ AAFP Prescribed Credits

Have questions? Please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events, at 919.214.9058 or at katkinson@ncafp.com.

Pre-Conference Afternoon Workshop Opportunities on Wednesday, Nov. 28, 2018 OMNI GROVE PARK INN, ASHEVILLE, NC

www.ncafp.com 

The North Carolina Family Physician

Inside Autumn 2017

NCAFP SUCCESSFUL IN SUIT OVER VACCINE ADMINISTRATION FEES

P. 8

PRESIDENT’S MESSAGE

RESIDENTS & NEW FPs

4

24 Over 68% of 2017 State Residency Graduates to

Reminders of Why I Became a Family Physician

HEALTH POLICY & ADVOCACY

6

Fighting for Family Medicine Never Stops

MEMBERSHIP

10 NC Family Physicians at the Forefront of Leadership

Practice In-State

MEDICAL STUDENTS

26 A Student’s Perspective on the AAFP Congress of Delegates PRACTICE MANAGEMENT

30 Download Your Free Flouride Toothpaste App to

DEPARTMENTS

PUBLISHED BY

t 919.833.2110 •

Help Improve Oral Health in Children

fax

919.833.1801 • ncafp.com

Managing Editor & Production Peter Graber, NCAFP Communications

President’s Message 4 Policy & Advocacy 6 Membership 10 Chapter Affairs 20

Residents & New FPs 24 Student Interest 26 NCAFP Foundation 28 Practice Management 30

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 Members

By Dr. Charles Rhodes 2016–2017 NCAFP President

- MUSINGS FROM THE MOUNT -

Reminders of Why I Became a Family Physician God reminded me this week why I became a Family Physician.

Nancy and I have just returned from the Dominican Republic after a week of mission work in the San Juan region, along the border with Haiti. I am exhausted, overwhelmed, and humbled at what others deal with on a day-to-day basis.

Charles W. Rhodes, MD It is sometimes easy 2016-2017 NCAFP President to put our American hats on and tell others how they should live; but truthfully, I would not survive three days if I was in their shoes. No grocery stores, no electricity, what food you have cooked over a wood fire. And very little chance of ever getting out of this situation. It broke my heart to hear a father tell me his daughter deserved to be sick because they were poor.

Monday we worked in Batey 7, which is about an hour south of San Juan. A Batey is a labor camp for Haitian

4

sugar cane workers and their families. The men make roughly $12 a day for back breaking manual labor, but are happy to have the work as there is none in Haiti.

The conditions are unbelievably primitive, the resources are minimal, and the sense of desperation is palpable. The camps are rudimentary at best, and it can be a hand-to-mouth existence. The only health care is at the public hospital miles away, and there is no transportation other than on foot. They are what the Bible describes as “the least of these.”

Being Haitian in the Dominican Republic is a very real social determinant of health. Imagine a people group who look different, speak a different language, and can only get the most menial of jobs. We have those here in North Carolina as well. We were overwhelmed with an abundance of children, many of whom had never seen a doctor and couldn’t understand why I was looking in their ears or wanted to listen to their heart.

Several of us had the opportunity to make a house call on a 92 year-old lady who had fallen 10-months earlier and was now confined to a wheelchair. No husband, no family, all she had was a small room which housed her bed and cook stove. Along with her wheelchair, these were her sole possessions. Humbling, as I know her prognosis is not good, and there was little we could do to help other than give her some supplies and Ibuprofen for her discomfort, and to pray with her.

We have had the opportunity over the past 15 years to provide medical care to hundreds of communities and villages in this area. And literally thousands of patients, both Dominican and Haitian. One of my greatest joys is to take students and residents with us. We had three of our residents from Cabarrus this year as part of the team. To place young doctors in

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

a setting where their only concern is the patient in front of them, which sometimes may be a family of 6 all at once, allows them to see what true Family Medicine has always been about. It is not about computers or insurance coverage or an overbooked schedule.

It is about the patient in front of you, and the relationship that you develop with that patient and their family. Even if they speak Spanish or Creole, and you do not. Smiles are universal.

We hear a great deal these days about population management. My observation is that most of the discussion revolves around insurance and reimbursement. We spend a great deal of energy meeting indirect measures of health, such as hemoglobin A1C and PHQ9 scores, which may or may not reflect the actual health of the patient involved. I had the chance several years ago to visit a remote Continued on back cover

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) Medical School Representatives & Alternates Chair (UNC) Warren P. Newton, MD, MPH Alternate (Campbell) Nicholas Pennings, 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 Garett Franklin, MD, Vice-Chair CME Council Membership & Workforce

Benjamin Simmons, MD, Chair Shauna Guthrie, MD, MPH, Vice-Chair

Practice Management Council Public Relations & Marketing

Autumn 2017

Alisa C. Nance, MD, RPh, Chair Jewell P. Carr, MD, Vice-Chair

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

5

HEALTH POLICY & ADVOCACY

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

Advocacy for Family Medicine Never Stops NCAFP’s Work on Your Behalf

So what issues are most important currently for the NCAFP? We’re working on a tremendous number, but a few we have been addressing this fall include:

Vaccine Administration: There’s a more detailed article on page 8, but recently, the NCAFP, along with the NC Pediatric Society and eight pediatric practices, sued the state Medicaid Program over vaccine administrative fees paid in 2013-14 under the ACA Medicaid to Medicare Parity bump. The two associations believe that members could be owed between $12 and $15 million in back vaccine administrative fees. While most of the time the relationship with NC Medicaid is positive, this was an instance of tough love. We won the lawsuit, but as this magazine goes to print, we are still waiting to see if Medicaid will appeal. Again, for more information, see page 8.

Transparency in Medicaid Graduate Medical Education Funding: The NCAFP is always looking for ways to help improve the pipeline of future family physicians in North Carolina. Recently, the NC General Assembly formed a subcommittee to develop better transparency and accountability for taxpayer dollars spent on medical education and graduate medical education. Currently, academic hospitals receive an

6

enhancement to their daily inpatient Medicaid rate to compensate them for their graduate medical education function. But there has been little accountability. The Legislature is seeking to find ways to ensure that residency dollars go to programs that produce physicians who ultimately go into needed specialties and serve Medicaid patients in needed areas. That’s music to our ears, as Family Medicine is clearly a needed specialty that has the greatest spread across our state. Whether it’s residency education dollars, state loan repayment dollars, or other incentives, we believe this is an opportunity to advocate to help family physicians across North Carolina.

Better Integration of Behavioral Health in Primary Care: A third area of focus has been better integration of behavioral health into primary care, par-

The North Carolina Family Physician

ticularly in Medicaid. We have been talking with legislative leaders about the sheer number of behavioral health issues that are treated in primary care, and how Medicaid transformation can assist in your effort to better care for these patients. While this is not an easy fix, stay tuned as Medicaid reform proceeds, because we do think progress can be made in this area.

Developing Better Relationships with Payers: Finally, both your Executive Committee leadership and staff have been working to meet with numerous payers around the state over the past year. If nothing else, our goal is to have contacts to reach-out to when our members face obstacles with one of their payers.

While in the past we have had contacts with Blue Cross and Blue Shield of North Carolina, our contacts with other payers have not been as strong.

That’s something we are working to change. Over the past six to eight months, Academy leaders have met with representatives of Humana, United, and Aetna, to name a few.

In every meeting, your leadership has stressed reducing administrative burdens, from changes to preferred drug lists to onerous prior authorizations. Similar to your complicated patients, progress may be slow. However, we believe we are opening new doors to potential changes more than the NCAFP has ever done before.

Look for updates on all these issues in our bi-weekly e-newsletter, NCAFPNotes, and in future editions of this magazine. And start building those relationships today.

Autumn 2017

Aetna is proud to support Community Care of North Carolina and the North Carolina Academy of Family Physicians.

Š2017 Aetna Inc. 2017509

aetna.com

PRACTICE ADVOCACY

NCAFP, NC Pediatric Society Successful in Suit Over Medicaid Vaccine Administration Fees For more than three years the NC Academy of Family Physicians and the North Carolina Pediatric Society have advocated for the state Division of Medical Assistance (DMA) to correct an underpayment of administration fees for immunizations provided to Medicaid patients under the Vaccines For Children (VFC) program. In mid-October, the Academy received final word that legal action taken on behalf of our members has proven successful.

The action sought to rectify a significant underpayment on approximately half of vaccine administration payments paid by Medicaid to attested providers under the Affordable Care Act during 2013 and 2014.

Superior Court Judge Beecher R. Gray ruled that the NC Division of Medical Assistance (DMA/Medicaid) shall reprocess those payments to attested primary care physicians for an extra $6.74 per affected vaccine.

He initially ruled the payments must be made within 120 days, but the state had 30 days to file an appeal.

All vaccines given under the VFC Program during 2013 and 2014 should have received the higher administration fee. However, approximately half the administration fees were paid at a lower rate. The amount any one practice is due will be based on how many vaccines were administered and paid at the lower level during the two years impacted by this case. Both associations had advocated directly to Medicaid to correct the error and continued to partner on the legal case to force the issue. Additional background information is included below.

We would like to thank a few people for their assistance in obtaining this tremendous victory for primary care.

as a spectacular advocate on behalf of the North Carolina’s family physicians and pediatricians. Medicaid argued that the parties lacked “standing” to bring the case, but Ponzi was able keep both associations and some specific practices as parties to the lawsuit. He did a masterful job handling strategic and tactical court navigation, as well as the complex world of Medicaid, coding, the VFC Program, and the ACA. We are very lucky to have connected with such a strong advocate. In addition, he is the son of a Goldsboro pediatrician.

Thanks also to the NC Pediatric Society for their partnership and leadership in this suit. By partnering together, our two associations provided a unified voice for primary care physicians that care for children and adolescents. The combined effort represented more than 6,000 combined members, providing significant clout throughout the process.

We would also like to thank several specific pediatric practices that also signed on as plaintiffs and helped fund the lawsuit, along with the two associations.

First, our attorney, Joey Ponzi at Brooks Pierce, served 8

The North Carolina Family Physician

These included: Blue Sky Pediatrics, Burlington Pediatrics, Cary Pediatric Center, Coastal Children’s Clinic, Goldsboro Pediatrics, Haywood Pediatric and Adolescent Medicine Group, KidzCare Pediatrics PC, and Sandhills Pediatrics. In addition, pediatricians Dr. Graham Barden, III, and Dr. Christoph Diasio researched the issue and served as technical support throughout the process.

Background The Affordable Care Act (ACA) increased Medicaid rates for two classes of service: E&M codes and vaccine administrations during 2013 and 2014.

The law was very specific that the vaccine rates be raised to the Regional Maximum which changed from $13.71 to $20.45 on January 1, 2013. Only about half of the administrations were paid at the correct higher rate. This affected approximately 2.5 million vaccinations in the state performed by health departments, FQHC’s, pediatricians, and family physicians. (Health Departments, non-attested physicians, and FQHC’s are not likely to be affected by this decision, because of the way they are paid.)

Beginning in August of 2014, the NC Pediatric Society and NCAFP had informal conversations with DMA regarding these vaccine administration issues, among many other ACA-related concerns. In fact, the two organizations typically meet with Medicaid leaders at least bi-monthly now, and did so as often as once a week during the payment crisis around NCTracks.

After lengthy discussions urging NC Medicaid to correct these underpayments proved unsuccessful, the NC Pediatric Society and the NC Academy of Family Physicians joined eight private pediatric practices to retain a lawyer and request a formal ruling from DMA in hopes our members could finally be paid as required by state and federal law. DMA’s ruling was adverse to providers, which was subsequently appealed to Superior Court Judge Beecher Gray. Judge Gray, who spent 30 years as an administrative law judge before being appointed to the Superior Court, ultimately ruled in favor of the associations.

UPDATE: DMA has decided not to appeal, but now has 365 days to reprocess claims.

For questions or additional information, please contact NCAFP Executive Vice President Greg Griggs at ggriggs@ncafp.com or 919-833-2110.

Autumn 2017

Let’s make NCAFP’s voice even in Raleigh

Contribute

Today!

FAMPAC Empowering Family Medicine

ncafp.com/fampac

MEMBERSHIP

By Peter Graber NCAFP Communications

- NATIONAL LEADERSHIP-

NC Family Physicians at the Forefront of Leadership NCAFP members have a long history of national leadership within Family Medicine. Beginning when the specialty began to formally organize in the late 1940s through the 1960s, family physicians from North Carolina have developed a reputation as being key contributors and leaders on the national level. Chapter members have held a range of major roles within the AAFP and its affiliated organizations. This legacy continues today with several NCAFP members helping drive progress on the national and international stages.

Highlighted below are five current Family Medicine leaders. Each shares their personal perspectives on leadership, the key motivations for contributing, and their perspectives on the future.

Elizabeth E. Baxley, MD Greenville, NC 2017-2018 Chair, American Board of Family Medicine NCFP: Describe your involvement with the ABFM. Where and when did it start, what motivates you to serve?

I was nominated for a position on the Board of the

10

ABFM by the Society of Teachers of Family Medicine in 2013, and eagerly accepted the offer of service because of my belief that medicine, and family medicine, were at a unique point in history with respect to the evolution of healthcare and the transformation in how we approached continuous professional education of physicians and other health professionals. As someone whose career has been dedicated to medical education across the spectrum of student, resident, faculty member and practicing physician, I was extremely interested in the potential to evolve the means by which family physicians could grow and learn over a lifetime of practice, and through which their current and continuous competence could be demonstrated to the public.

Prior to 2013, my experience with the ABFM was the same as that of any family physician diplomate. I knew of the steps I needed to take to maintain my own board certification. As a former residency director, I also had some experience with the ABFM in relation to standard-setting for trainees to be eligible to sit for their certification boards. I quickly learned that the ABFM is much, much more than this – including having a very robust research program that utilizes datasets to closely track what is happening to the discipline over time (scope of practice, practice location, relationship between training environment and practice, etc.), as well as a meaningful commitment to upholding standards of professionalism.

NCFP: Continuous improvement is the cornerstone of the ABFM. How is this process evolving within today’s primary care environment?

What people may not appreciate is the degree to which the ABFM holds itself, as an organization, to the same standards of continuous improvement as we expect from diplomates. Today’s family physicians face substantial burdens in practice that are contributing to burnout at a time when our fragmented healthcare system needs what we offer the most. Reports of 2:1 ratio of computer time to face-to-face time with patients and families, the constraints of poorly designed EHRs, mindless data entry to prove meaningful use and the accomplishment of quality measures that don’t really describe what we do, adjusting to ICD-10, and responding to virtual office visits when there is not time to do what was already in front of us in our bricks and mortar

The North Carolina Family Physician

~ ADVERTORIAL ~

$17.6 MILLION VERDICT IN MISSOURI DRIVES HOME MEDICAL LIABILITY IMPLICATIONS DISASTER PLANNING FOR MEDICAL PRACTICES OF OPIOID EPIDEMIC

By Tamara R. Johnson, BSN, RN, CPHRM, RHIA

By Jason Newton, Senior Vice President, Claims and Risk Management, and Associate General

With multiple major hurricanes causing significant damage this year, medical practices should be making sure they have a disaster Counsel plan in place, and reviewing and updating that plan if they do.

A an Missouri last response month awarded million to a the man whoofclaimed physician Having effectivejury disaster plan is the$17.6 first step in limiting impact a naturalhis disaster.

As partoverprescribed of any plan, the American Health Management recommends instituting procedures for protecting patient safety, opioids forInformation him, confirming whatAssociation (AHIMA) we at Medical Mutual have been telling our members for more than a securing health from ensuring stability in continuity of carries care activities, and providing orderlyfor and timely year: thatinformation in addition to damage, its human toll, the opioid epidemic significant implications recovery of information. physicians’ medical liability.

Providers should perform a thorough review of their organization’s disaster response plan and identify opportunities for In the case, a 45-year-old man alleged that he became addicted to three different opioids his primary incorporating these basic responses into their facility’s emergency preparedness plan:

care physician (unaffiliated with Medical Mutual) prescribed to him for back pain—a total of 40,000 over four years, according to the plaintiff. plaintiff alleged thata the volume of command, painkillersemployee • pillsDevelop a staff communication plan that includesThe communication protocols, written chain of prescribed byand hisemergency physiciancontact led him to become addicted to them, requiring him to enter a drug contact list, information rehabilitation program and damaging personal relationships, including his marriage.

•

Keep lines of communication open with patients. Utilize several methods (e.g., cell phone, social media, email, notice

•

Designate staff responsible for off-site management of patients if necessary

office door)the to communicate with patients Theonjury found physician liable, awarding $1.4 million in compensatory damages to the man and $1.2 million to his wife, as well as $15 million in punitive damages.

Until this opioid epidemic ebbs, doctors will need to stay mindful of its potential impact on their

• liability.

Advise patients to drives keep personal medical information with them at timesimportance (including medication list with The verdict home for physicians and practices theallvital of ensuring thatdoses, allergy information,practices other special opioid prescribing areneeds) consistent with CDC and state medical board guidelines. That’s not just good patient care—it’s also prudent risk management.

AHIMA also recommends that each facility closely monitor the maintenance of patient information.webinars, Practices should Medical Mutual members can visit www.medicalmutualgroup.com toidentifiable view CME-eligible consider implementing the following recommendations as part of any disaster plan:

three of which can help doctors meet North Carolina pain management CME requirements.

•

Protect computer/network equipment from water, fire, or extreme temperatures

•

Create a data back-up plan that includes performing critical data back up at the close of each business day

•

Implement a plan to reconstruct information when applicable

•

Engage in post-disaster management that includes documenting a detailed record of the event to include affected patient records, recovery efforts, and outcomes

About the Author • Jason Store data back-up files andChapel documentation off-site for process graduated from UNC Hill and obtainedthe hisrecovery law degree from Wake Forest. After a 14year career in private law practice defending doctors, APPs, and hospitals, in 2013, Jason came on • board Develop recovery plan/process for destroyedclient—in or damaged with aMedical Mutual—a longstanding andocuments in-house capacity. At Medical Mutual, Jason oversees the Risk Management, Healthcare Compliance, and Claims departments.

After reviewing their disaster plan, knowledge base, and capabilities to respond to a disaster— and putting a final plan in place — practices must educate their staff on the plan’s content and individuals’ specific responsibilities for implementing the plan.

Visit www.medicalmutualgroup.com to view resources offering guidance for preparing for and responding to a natural disaster, as well as details relevant to this year’s hurricanes.

Autumn 2017

11

offices. With all of this, it is not a surprise that continuous certification -- which used to be a more accepted part of personal mastery and self-regulation of the discipline -- is now viewed by some as a last straw.

ABFM has continually evaluated ways in which board certification should improve and evolve, with a desire to reduce burden and cost always at the forefront of our minds.

It is with this in mind the board reduced diplomates’ annual fees for ongoing board certification in 2012 to something less than my monthly cable bill. We invested substantial resources into creating the PRIME registry after studying ways to seamlessly extract data from electronic health records to produce meaningful, actionable information for family physicians about their practice. With permission from the physician, PRIME is already submitting PQRS data in the background, with no additional effort required by clinical staff. PRIME will also meet future reporting needs for MACRA, and currently provides documentation that meets the practice improvement requirements for continuous certification. That is what I meant by ABFM’s commitment to burden reduction for family physicians as part of the evolution of its processes.

Another component of our evolution was the roll-out of the Continuous Knowledge Self-Assessment (CKSA), which allows anyone who chooses to participate to receive 25 questions that are representative of family medicine practice every quarter, and provides immediate feedback with supplemental information as you go! This is a great example of continuous learning, rather than the episodic learning and one-sitting demonstration of knowledge that former methods of certification offered. The uptake of CKSA has been phenomenal, as have the evaluations from those who have participated.

NCFP: The ABFM continues to refine and adapt Continuing Certification and its family of assessment tools. What’s the best way for physicians to keep abreast of the changes?

Determining the best way to regularly and effectively communicate with nearly 90,000 family physicians in all stages of life, practice, geography, etc., is quite a challenge.

These updates are regularly provided in the Phoenix newsletter, as well as in short burst emails and in publications like the JABFM. Nevertheless, we recognize that this is not getting nearly as far a reach as needed. Another part of our commitment to continuous improvement is reflected

12

in our current work around communication. We are revamping our website to be more user-friendly and information-rich.

We would really love to be working more closely with the state chapters, such as NCAFP, as this is really where the most, and the best, communication with frontline family physicians occurs. Family physicians identify with our chapters as much as any other aspect of organized family medicine. This is where relationships exist that are built on trust.

Finally, the staff at ABFM are among the most committed and impressive group of people I have ever worked with – if a diplomate has a question about anything at all related to family medicine certification, they can get a call with a live voice that knows the most about the specific content area they are asking about and get answers.

NCFP: What do you see as ABFM’s most significant challenge relative to supporting/equipping family physicians as they transition to value-based care?

The discipline, and in fact, healthcare in general, is plagued by an explosion of quality metrics and reporting programs. There has to be sense-making about what really defines quality – and it cannot be 5,000 different metrics – in order to enter that into the value equation.

One of the things I am most excited about is that the PRIME Registry has been certified at the federal level as a Qualified Clinical Data Registry, which means that participating physicians can establish what quality measurements are most rational for our specialty.

The challenges in seeing this through? Certainly, working with some of the larger EHR companies to move PRIME’s advantages beyond the smaller, more independent physician practices to include those of us practicing in larger networks is a heavy lift, but we are making steady forward progress. Getting to a point where enough family physicians are using PRIME to hit an “emotional tipping point” in which there is sufficient broad-based trust in the system to reduce fears about what it might mean with respect to perceived added burden or over-sharing of information – that is a day that I am anxious to see happen!

The anxiety and even helplessness that family phy-

The North Carolina Family Physician

sicians feel today is real – ABFM is often viewed as adding to that – but I truly believe that the steps we are taking today can be a bridge to restoration of family physicians’ feelings of control over the practice environment. The information that PRIME gives a practice team about the patients for whom they care is very powerful. If it takes care of a series of requirements for reporting and adds value to practice, then we will have made a major contribution.

NCFP: In an ideal world, what lasting contribution would you like to achieve as this year’s ABFM Chair?

I would love to be able to close the gap between the fears and misperceptions that people have about Family Medicine certification and the things that I know we are doing to improve the situation for individuals and the discipline. So, communicating more, and in and different ways, and demonstrating our commitment in realized experiences for diplomates, would be a real achievement and will leave a legacy to build upon.

As I look at other certifying boards and how they relate with their specialty societies, I see some that have really come together in significant and visible ways to support, advocate for, and build up the physicians they represent. I think there are great opportunities for AAFP and ABFM to follow suit, partnering and working together to help each organization be more effective, and in return, provide greater support to the discipline. Working with state chapter leadership and members is a great way to achieve several of these goals that I have described and I welcome that opportunity with NCAFP. Benjamin ‘Frankie’ Simmons, MD Charlotte, NC 2017-2018 New Physician Representative, AAFP Board of Directors NCFP: Describe your background in contributing to Family Medicine?

Is this your first national leadership role? What are you doing?

I graduated from residency in 2012 from Elizabeth Family Medicine at Carolinas Healthcare Center in Charlotte NC. I began my journey to my new leadership role while I was in residency. My clinic medical director, Dr. Rhett Brown, and I had spoken about my interest in advocacy, and he invited me to the North Carolina AFP Advocacy Day in Raleigh. At the time, healthcare systems were beginning to discuss and organize accountable care organizations, and as a state chapter, we were discussing how that would affect our state. I remember how inspired and motivated I felt after visiting the North Carolina General Assembly and sharing my story with our state representatives. I realized that family physicians could help to influence and shape how healthcare is provided to our patients on a state level. This experience left me with the desire to learn more about the advocacy work in North Carolina, and I began attending more NCAFP meetings.

After finishing residency, I was asked to be North Carolina’s LGBT delegate for the AAFP National Conference of Constituency Leaders (at that time it was called National Conference of Special Constituencies).

This conference gives the opportunity for AAFP members (chapter leaders and underrepresented constituencies – Minority, Women, IMG, LGBT, and New Physician) to develop leadership skills and to write policies for the Academy. Through my attendance to NCCL I was able to serve as the co-convener to the LGBT Constituency, as well as serve as 2016-2017 Member Constituencies Delegate at the AAFP Congress of Delegates.

At NCCL this year I was elected New Physician Member to the Board of the Directors. This will be my first time serving the AAFP on the Board of Directors. I am honored and grateful to be serving in this capacity. I have served as a board member to the NCAFP for four years (two years as Minority Constituences Director and two years as Member-at-Large Director).

NCFP: What motivated you to seek a leadership role?

I have had an interest in advocacy work and have had great mentors who have kept me motivated and inspired. I have received motivation and support from Drs. Rhett Brown, Mott Blair, Karen Smith, Viviana Martinez-Bianchi, Alisa Nance, Mary Hall, and Continues on next page

Autumn 2017

13

Alisahah Cole. However, my biggest motivation comes from my patients. If it weren’t for them, I would not have a reason to advocate on their behalf. Their experiences, challenges and success keep me motivated.

Board deliberations. I am also responsible for orienting other resident officers to AAFP governance and policy, as well as serving as the resident point-person for AAFP commissions and the Congress of Delegates.

NCFP: For any New Physician considering getting involved at the state level, what insight can you share?

Passionate, outspoken, as well as a good listener and mediator, I really enjoy working with my peers for a larger cause.

Since college, I have naturally taken on leadership roles that allow me to advocate for my peers as well. These sorts of experiences have prepared me well to participate in organized medicine -- only recently did I learn there was such an official term for what I love to do. Organized medicine is not just an opportunity to advocate for my peers and profession, but most importantly, for my patients. I know the Board position will be transformative, and allow me to grow to better serve others.

The first step in getting involved is showing-up and expressing interest. There are many physicians within the NCAFP who are willing and ready to mentor medical students, residents, and young physicians. Another great avenue is by attending the AAFP NCCL (National Conference of Constituency Leaders). Please contact the state chapter if you have an interest in this opportunity NCFP: How has your involvement made you a better family physician for your patients?

What I have learned so far is the importance of getting involved. NCCL is an excellent training ground which has allowed me to give voice to my patients and my colleagues. Since getting involved with NCAFP and attending NCCL, I have become more aware of the issues facing my colleagues and patients nationwide. I have engaged my city and state-level representatives on various health related issues affecting the community. In my practice, I am able to pull from various community resources to better help provide care to my patients.

Alexa Mieses, MD, MPH Durham, North Carolina 2017-2018 Resident Representative, AAFP Board of Directors

NCFP: How do you juggle the time commitment of serving with the demands of your training?

Juggling this major commitment with the rigor of residency training is no easy feat. I am fortunate to be part of an immensely supportive residency program.

My program director, co-residents, and staff, understand why it is important for physicians to be involved in this sort of work. As a result, my program and I have worked closely together to adjust my rotation schedule. We tried to accommodate my Board meetings and events as much as possible. The scheduling logistics were the hardest part to work out. My passion to develop as a leader and serve others provides me with the motivation to dedicate my personal time to this endeavor. It does not feel like a sacrifice, but an essential part of training.

NCFP: What have you learned as a leader that has made you a better family physician?

NCFP: Describe your role as Resident Representative to the AAFP Board of Directors?

What motivated you to seek this role?

The best thing a leader can do is listen. It is important to relate to whatever cause you lead, and to listen to those you are lucky to have been chosen to represent. This has no doubt made me a better family physician, as most of what I do to care for my patients stems from the information and connection garnered by listening to them.

As the Resident Representative to the AAFP Board of Directors, I function as a full member and bring the residents’ perspective to all

NCFP: What words of encouragement would you offer other residents seeking to develop their leadership skills?

14

The North Carolina Family Physician

Go full steam ahead for anything and everything you are passionate about! Leadership opportunities will find you.

All too often people become concerned with the idea of taking on a formal leadership role, with a title, recognized by others. If you love and are good at what you do, you are already a leader.

Viviana Martinez-Bianchi, MD, FAAFP Durham, North Carolina 2016-2018 WONCA Executive Member-atLarge and World Health Organization Liaison NCFP: Describe your background and history in serving in WONCA? Let me begin first be describing WONCA. WONCA is an acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. WONCA’s short name is World Organization of Family Doctors. The Mission of WONCA is to improve the quality of life of the peoples of the world through defining and promoting its values, including respect for universal human rights and including gender equity, and by fostering high standards of care in general practice/family medicine.

In 2011, I represented Argentina and WONCA at the United Nations High Level Summit on Chronic Non-Communicable Diseases, and again at its follow-up meeting in 2014. In 2013, I was nominated by the AAFP and elected by the Council to become a member of the WONCA Organizational Equity Committee (OEC) during the WONCA Council meeting in Prague. I have also been a member of the Working Party on Education and the Special Interest Group on Migrant Health Care.

In 2016, the AAFP Board supported my nomination to run for Member-At-Large of the WONCA Executive board, and was elected to the Council during speeches

Autumn 2017

and elections at the WONCA Council Meeting in Rio de Janeiro in November 2016. I will serve in this role until Seoul, 2018. WONCA President Dr. Amanda Howe, then asked that I serve as WONCA Liaison to the World Health Organization and attend the World Health Assembly and WHO Executive Board on behalf of the Executive and the 500,000 members of the World Organization of Family Doctors.

Every year the World Health Organization (WHO) hosts the World Health Assembly (WHA) in the United Nations’ Palais des Nations in Geneva, Switzerland.

WHA is the decision-making body of WHO and is attended by delegations from 193 Member States and almost 200 non-governmental organizations from across the world. WHA focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General (Dr Tedros was just appointed in May 2017), supervise financial policies, and review and approve the proposed program budget. In my role as WONCA-WHO Liaison, I represent WONCA to the WHA together with President Amanda Howe, MD; President-Elect Donald Li, MD; and Executive Garth Manning, MD. I also engage WONCA member groups and interest group members on the writing of expert opinions for WHO consultations.

NCFP: What motivated you to seek a leadership role within WONCA? I was motivated by the desire to serve Family Medicine on the global stage. In 2011, during my time at the United Nations High Level meeting on Non-Communicable Diseases (NCD), I was surprised to see the amount of discussion taking place in silos of NCD care and Infectious disease care.

I realized multiple organizations were spending millions of dollars in a vacuum, in silos of care for single conditions, and I became determined to work on the recognition of Family Medicine as the specialty that should be adopted by countries working on health workforce development. There is a need for a global recognition of the strength of Family Medicine as a specialty that can resolve 80% of presenting conditions, a specialty that can work holistically, integrating knowledge and clinical expertise across the lifespan and in multiple settings.

Continues on next page

15

NCFP: What do you see as the major parallels between WONCA and the AAFP? What can we learn?

WONCA is an organization of organizations, we are all members of WONCA through our membership in the AAFP. WONCA advocates for Family Medicine at the global stage at the World Health Organization (WHO) and in each WHO region, much as AAFP and chapters advocate for Family Medicine at the federal and state level. WONCA also advocates in relation to other key players and stakeholders in other specialties. We communicate through consultations, remotely, and through in-person meetings with different departments of WHO, the International Labour Organization (ILO), the Organization for Economic Co-operation and Development (OECD), IFMSA (International Federation of Medical Students Associations), World Heart Federation, and International Council of Nurses, among many others.

We can learn that we will need to continue to support the global development of family doctors, understanding how Family Medicine is practiced in different places with different types of resources. Walking with each other, empowering and creating communities of learning, advocacy, and development of primary care with a backbone of Family Medicine.

NCFP: In working with WONCA and family doctors from around the globe, how has this experience inspired you as a family physician, educator, and leader?

WONCA has provided me with amazing friends in every corner of the world. I learn from them, I am inspired by their knowledge, their commitment to working with those most vulnerable -- often in difficult conditions -and by their quest for making a difference in improving health for all. This past August, I ran an 8-hour leadership development pre-conference workshop in Peru during the WONCA Regional meeting, together with Duke Family Medicine Chief Resident Dr. Samuel Fam and Minnesota Family Medicine colleague Dr. Shailey Prasad. We were expecting about 80 attendees but had over 250! During this workshop we heard stories of amazing courage, resilience and dedication. Some of our colleagues are working for a pay of $20 a month, some are working where Family Medicine is not understood, or where health systems do not provide all the needed resources, yet where

16

universal access to healthcare is guaranteed, and family doctors are making a difference providing great quality of care to whole populations. The more I meet family physicians in other corners of the world, the more inspired I am. I carry them in my heart, their abilities and their struggles, their power and their resilience are with me everywhere I go.

Beat Steiner, MD, MPH Chapel Hill, North Carolina 2017-2018 President-Elect, Society of Teachers of Family Medicine (STFM) NCFP: Describe your role as President-Elect of the STFM? What motivated you to seek this role?

I was motivated to seek this role because I have witnessed STFM’s power to inspire and teach. Being President of STFM will give me the opportunity to help lead STFM’s effort to expand our community of learning so that more teachers of Family Medicine feel the support and inspiration that STFM can provide. In particular, I hope to engage more community preceptors. Engaging more family physicians in teaching our students is a critical component to increasing the number of students choosing Family Medicine as a career.

NCFP: How do you juggle the time commitment of serving with your faculty demands at UNC? My role in STFM will directly help me in my role as Assistant Dean for Clinical Education at UNC. The two roles are really synergistic. I will be able to bring back important lessons from our national partner while at the same time, highlighting the innovations happening at UNC. NCFP: What have you learned as a leader that has made you a better family physician?

I really like the definition of servant leadership.

It

The North Carolina Family Physician

begins with the idea that service comes first and leadership is the means to that end. I chose Family Medicine as a career because I wanted to play a role in narrowing the inequities in health care. My leadership roles have helped me better understand how to change systems and influence people. These are essential roles of a family physician in my view.

NCFP: What do you see as the most significant challenge facing STFM and/or academic Family Medicine in general?

We face a critical shortage of family physicians who can practice broad scope primary care. This shortage is particularly acute in rural and underserved areas. We need 40% of our workforce in primary care and are less than half way there. STFM clearly can’t solve this problem alone. But helping to ensure a welltrained workforce is fundamental to the work of STFM. Community preceptors who teach learners in their practices are a vital part of that work, role-modeling the future of our profession. Yet community preceptors have less time to teach because of clinical productivity pressures and paradoxically are being asked to teach more because of a rising number of learners. I believe that STFM can lead national efforts to recruit, retain (and support) community preceptors. We need to find innovative ways where family physicians who demonstrate a passion for patient care show our learners the future of Family Medicine.

Pluryso.n.th.e ABFM * See sto e! on next pag

We Listen. We Respond.

We Protect.

More than 220 Risk Management educational resources available!

RM TOOLKITS

RISK ASSESSMENTS

Professional Liability

WEBINARS

Employee Benefits

A.M. Best has awarded Medical Mutual’s professional liability coverage the highest rating of “A” (Excellent) for thirteen consecutive years.

Find out more by calling 800.662.7917 or visiting

www.medicalmutualgroup.com Corporate Sponsor of the North Carolina Academy of Family Physicians

ADVERTISE! Reach many types of Family Medicine professionals in North Carolina.

Contact Peter Graber with the NCAFP at pgraber@ncafp.com

Autumn 2017

17

APPOINTMENTS

UNC’s Dr. Warren Newton Named New Incoming CEO of the ABFM The American Board of Family Medicine (ABFM) announced in early October that Warren Newton, MD, MPH, has been selected to become its next President and Chief Executive Officer. Dr. Newton will succeed Dr. James C. Puffer and will assume full executive duties on January 1st, 2019, that includes overseeing the ABFM, the ABFM Foundation, and the Pisacano Leadership Foundation. Dr. Newton will officially join ABFM on July 1st, 2018, and will work alongside Dr. Puffer for a six-month transition period.

Dr. Newton is currently Executive Director of the North Carolina Area Health Education Center (NC AHEC), and Vice Dean of the School of Medicine at the University of North Carolina (UNC). From 1999 until last year, Newton served as the William B. Aycock Professor and Chair of Family Medicine at UNC. “For nearly 50 years, the American Board of Family Medicine has served family physicians and the public with great distinction. I am delighted to serve the Board and family physicians across the country and honored to follow the outstanding leadership of Jim Puffer,” said Dr. Newton.

18

Member Briefs

By Tara Hinkle NCAFP Member Services Manager

New Live Chat Feature at AAFP.org The AAFP now has a live chat feature on their website at www. aafp.org. Look for the “Live Chat” orange icon on the right side of all pages. Clicking that icon will prompt you to enter your name, AAFP ID, and email address. Once that information is entered, you are connected in real time with an AAFP representative. Once you choose to end the active conversation, a quick survey will appear with an option to email the chat transcript directly to you. In addition, a chat pop up box will appear while navigating certain areas of the website. You have the option to decline the invitation. The AAFP may continue to be reached via email at aafp@aafp.org and via phone at 1-800-274-2237 between 9:00 a.m. – 6:30 p.m. EST. 2018 Dues Payment Deadline is 1/1/18 2018 dues invoices for all Active, Inactive, Supporting, and first-time Life members are available for payment online at www.aafp.org/checkmydues. The AAFP also mailed paper invoices to primary addresses in October. The payment deadline for 2018 dues is January 1, 2018. You may also enroll in the installment plan to extend payments monthly through August 2018. If you are moving out of NC or if you have interrupted practice for a retirement or other extenuating circumstances, you will need to contact the AAFP at 1-800-274-2237 to either relocate your membership to the appropriate state chapter (AAFP and state chapter membership is unified) or transfer your membership to another category to avoid membership interruption. Any questions regarding dues invoicing, payments, or receipts, may be directed to the AAFP at 1-800-274-2237.

2017 CME Re-Election Deadline is 12/31/17 If you are a candidate for 2017 CME Re-Election, you have until 12/31/17 to earn your required 150 credits.

Not sure of your re-election cycle or want to view/update your transcript? Please visit the Member Welcome Center at www.aafp.org/welcomecenter or www.aafp.org/cme.

CME FAQs may be found on the AAFP’s website or you may call the AAFP at 1-800-274-2237.

The North Carolina Family Physician

5

- - T H E 2 0 1 7 N C A F P F O U N DAT I O N R A F F L E - -

Win One of

5

Fabulous Vacations in the US!!!

Become a Sonoma Valley Winemaker:

Package includes an Intimate Blending Seminar, Winery Tours & Tastings, 3-Night stay at the Fairmont Sonoma Mission Inn, with airfare for two.

Classic Wrigley Field Rooftop Experience:

Rooftop Bleachers & Dining Package at a regular season Chicago Cubs Game, 3-Night Stay at Hyatt, Hilton, Marriott or comparable hotel, with airfare for two.

New Orleans Jazz & Dining:

Preservation Hall of Jazz, Commander’s Palace Jazz Brunch or Dinner with Wine Pairing, 3-Night Stay at Hyatt, Hilton, Marriott or comparable hotel with airfare for two.

New York Long Weekend:

Choice of Broadway Show, Dinner, 3-Night Weekend Stay at Hyatt, Hilton, Marriott or comparable hotel with airfare for two.

America’s Cup Yacht Sailing in San Diego:

Sailing Experience on America’s Cup Yacht, 3-Night Stay in San Diego at Estancia La Jolla Hotel & Spa with airfare for two.

For full details and to purchase your chance to win, please visit:

www.ncafp.com/raffle

$50

per entry

CHAPTER AFFAIRS

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

Much Like a Complicated Patient, Advocacy is a Marathon Not a Sprint I recently had the opportunity to talk about advocacy at UNC’s statewide Department of Family Medicine Retreat at Wildacres. It was a bit of a humbling experience. It once again reminded me how impressive North Carolina’s family physicians are; this time in the realm of medical student and residency education.

housing or food insecurity.

The topic of the retreat was, Advocacy: Think, Plan, Do. I had the opportunity to share just a little about the NCAFP’s advocacy activities and help teach a session on writing letters to the editor. As I worked on my comments, it hit me that advocacy truly is like your complicated, multiple chronic disease patient. Let me take just a few minutes to explain.

At some point, your patient finally decided to quit smoking. Then suddenly, they started taking their medication just like you prescribed it. Eventually, they may be exercising, eating better and even cutting down on their alcohol content.

Over time, their blood pressure is better, and you’ve even successfully got their A1C down, almost within this month’s recommended range.

Take one of your most complicated patients. It may be someone who has high blood pressure, diabetes and congestive heart failure all in one. On top of it, they probably have a co-morbid behavioral health issue, potentially depression, anxiety or even substance abuse. In all likelihood, there’s multiple social determinants of health that you may have no control over, such as poor

None of it happened overnight. It took time. It took effort. It took a lot of little victories, and probably some setbacks along the way. It took the patient making some decisions on their own. It took the trusting relationship you have with that patient.

20

You’re certainly not able to “heal” that patient overnight. It takes time.

It takes building a trusting relationship. On occasion, it may take some tough love. Other times it takes a listening ear. But over time, something starts to happen.

Advocacy is much the same. Most of the problems we deal with or things

we want to change aren’t easy. There are few quick fixes. Typically, it takes building a longterm trusting relationship with an elected official. Usually it means moving a couple steps forward and potentially one step backward.

At times, it may take a little tough love. But you never publicly embarrass an elected official or policy maker, just as you would never publicly embarrass your patient.

It’s hard work. At times, wins seem few and far between. You seem to always be in the trenches. But suddenly, something good happens, and you move the ball just a few yards down the proverbial football field.

But it seldom happens overnight.

Just like there are small steps you can take along the way with your patients and small victories to gain over time, building the relationship with an elected official for policy change is much the same way.

First, establish a relationship. Isn’t

The North Carolina Family Physician

it easier to work with a patient when you have the relationship even before they develop a complicated issue? It’s the same with elected officials. It’s much better to develop the relationship even before you need them to impact policy. Here are some ways to consider taking this first step: • Invite them to your office when they are at home in district.

• Go to a town hall meeting they are holding.

• Go to one of their fundraisers or other campaign events.

• Come to Raleigh and visit with them when the Legislature is in session.

Autumn 2017

Wherever you meet with them, take a picture with them and post it on social media thanking them for meeting with you and for supporting family medicine.

When you see that they’ve done something you agree with, send them a quick note or e-mail thanking them for their effort.

Or even consider writing a letter to the editor to publicly praise them for something they have done. But remember, just as you don’t publicly embarrass your patient, don’t publicly embarrass an elected official either. It’s not good for building a relationship.

It doesn’t take long to do one of these.

I would encourage you to start now.

Pick just one of these that you can do, and make a commitment to do it during the next quarter. It’s been said that it takes seven interactions with a person for them to know who you are. So, start now. If you want our advice or assistance, just let me know. We’re here to help you establish those relationships. It may not pay dividends today, but it probably will tomorrow. The ultimate goal is for them to trust you so much, that they call you first when thinking about healthcare policy. And start building those relationships today.

21

Sights and Scenes from NCAFP Events

22

The North Carolina Family Physician

NC Opioid Resources www.ncafp.com/opioids

Autumn 2017

RESIDENTS & NEW FPS

By Tracie Hazelett NCAFP Manager of Medical Student & Residency Relations

Over 68% of 2017 State Residency Graduates Entering Practice in NC Each year the Academy seeks information from North Carolina family medicine residents as they graduate. This year, 100 Family Medicine residents from our chapter completed their training right here in North Carolina. The NCAFP, in partnership with the residents and their programs, compiled information regarding where each new physician is making their next career stop.

Graduates this year will be providing care in very diverse ways. As is the hallmark characteristic of Family Medicine, there is a wide array of options available.

This graduating class is demonstrating the ability to be creative as they design their first job. For some, it may be a short-term situation, while for others it will be their practice situation for years to come.

In addition to “typical� full scope family medicine (from children to the elderly), these new physicians are taking on roles that focus on outpatient, inpatient, palliative care, sports medicine, maternal and child health, obstetrics, hospitalist work, academic appointments, integrative medicine, urgent care, geriatrics, aerospace medicine, and more! All this is happening in a variety of settings, including community-based private practices, Federally-Qualified Health Centers/Community Health Centers, academic programs, direct primary care practices, the military, the National Health Service Corps, and Indian Health Services sites.

24

2017 Resident Graduates by the Numbers

Completing Fellowships Sports Medicine Maternal Child Health Geriatrics Chief Year/Faculty/Career Dev Rural Medicine Other: 1 each in Adolescent Med, Epidemic Intelligence Service of the CDC, HEAL (UCSF) Neuromusculoskeletal, Palliative Care

Entering Practice*

In-State

Out of State

62%

38%

19% 9.5% 9.5% 19% 4.8% -

14.3% 24%

68.4%

31.6%

18.5% 61% 13% 7.4%

12% 64% 0% 24%

71.2% 17.3% 11.5%

73.9% 17.4% 8.7%

25% 37.5% 35.4% 14.6% 23% 10.4% -

22.7% 45.5% 41% 18% 18% 9% 4.6%

18.75% 58.3% 2.0% 6.25% 8.3% 2% 4%

34.8% 39.0% 4.4% 4.4% 4.4% 8.7% 4.4%

Practice Setting

Academic Community-Outpatient Hospitalist Other Practice Type

Employed Physician Private Practice Other Location

Urban Suburban Rural FQHC/CHC Teaching Hospital NHSC / HIS VA Primary Focus of Care

Full Scope w / OB Full Scope No OB Geriatrics Hospitalist Palliative Care Sports Medicine Teaching / Academics Urgent Care Other

*71% of surveys were completed directly by Residents. For those completed on behalf of Residents, not all categories could be reliably addressed. Therefore, some categories (setting, primary focus of care) do not reflect 100% of resident graduates.

The North Carolina Family Physician

For some graduating residents, it was a final wrap on the threeyear curriculum at their respective residency program. For others it marks the start, or completion, of a fellowship program. Overall, this year’s results appear to bode well for North Carolina citizens, with more than 68% of the 79 physicians entering practice remaining in state. And of those who are leaving, 72% have chosen to do so to practice near loved ones. A total of twenty-one graduates are entering fellowship programs, of which 62% will remain in North Carolina to pursue them.

A deeper dive shows that 68% of the resident graduates entering practice are doing so within 100 miles of their residency program. You might be thinking, ‘well, of course 68% are staying in-state to practice.’

However, there is a bit of variability in that some residents are practicing across the border in South Carolina, and a few residents are staying in NC, but moved 150-250 miles from their program site.

This statistic of 68% compares to 56% of residents nationwide according to data from the 2009 American Medical Association Physician Masterfile. Is this a positive thing? Absolutely! But we are not done.

Our goal is to grow the North Carolina primary care workforce and we are honored so many graduates chose to remain here. While we celebrate that, the Academy will also continue to assess needs for family physicians from east to west.

We would like to congratulate these outstanding new physicians. No matter the road you chose, a journey of at least 11 years has you squarely positioned for success.

We are certain the patients in your path will be better for it; they will be the beneficiaries of your service for years to come. Thank you and congratulations!

Autumn 2017

MAHEC Asheville’s Dr. Rebecca Thomson Receives Prestigious AAFP Excellence in Graduate Medical Education Award MAHEC Asheville Family Medicine Chief Resident, Rebecca Thomson, MD (PGY3) was honored in September at the AAFP FMX Conference in San Antonio, TX. Dr. Thomson is one of twelve family medicine residents selected nationwide to receive AAFP’s prestigious Excellence in Graduate Medical Education Award for exemplary patient care, interpersonal relationships with patients, physicians and faculty, and demonstrated leadership and community involvement. Dr. Thomson helped start a consult clinic for adults who have intellectual and developmental disabilities. The clinic helps a large underserved population in the area, and she hopes it will serve as a model for other residency programs. Following residency, Dr. Thomson plans to pursue her passion for rural health by working at a clinic in a community or Federally-qualified health center that provides care for the indigent populations of Western NC. Dr. Thomson also plans to continue to mentor and work with residents and medical students. Congratulations!

Life After Residency You’ve been getting job offers practically since you started residency, but do they reflect the type of job you are interested in? Do you feel prepared for the next step? The AAFP and NCAFP Career Centers each have resources available to help in your search.

From tools and resources for updating your CV, negotiating employment contracts, information on salaries, statistics and trends, to searching through current physician job openings. Also, don’t forget to consider Loan Repayment and Placement options available. Take advantage of all the tools and resources available to you as a resident member. Visit www.aafp.org/careers and www.ncafp.com/jobs

STUDENT INTEREST & INITIATIVES

By Alyssa D’Addezio (MS4) ECU Brody School of Medicine

A Student’s Perspective on the AAFP Congress of Delegates

Ms. D’Addezio is a 4th-year medical student at ECU Brody and is one of three students in the Class of 2018 chosen for the Brody Scholar Award. A Cabarrus County native, she attended NC State University on a Park Scholarship and while an undergraduate, conducted novel research on the role of endocrine-disrupting compounds during human development. She also participated in the Fulbright Summer Institute Educational Exchange program at Newcastle University in the United Kingdom.

26

In September, I had the opportunity to attend the AAFP Congress of Delegates in San Antonio, Texas, as part of a Healthcare Leadership and Policy elective rotation with the NCAFP. This was an immersive introduction to healthcare policy and organized leadership within Family Medicine on a national level, and I want to share a few of my observations from my experience as a medical student at the Congress of Delegates.

I witnessed first-hand the importance of representation and the collective power of voting. The Congress of Delegates is a meeting place for delegates of the fifty states, territories, special constitutencies, and students and residents. There are

resolutions, caucuses, reference committees, consent calendars, campaigns for national leadership positions, and an abundance of parliamentary procedure. Seeing each of the pieces of the Congress of Delegates at work bridged my understanding of how the AAFP guides its day-to-day affairs and advocacy.

First, resolutions were presented from various state chapters that asked the AAFP to address a specific issue and, if passed, take action on the proposed issue. The various resolutions were discussed within smaller caucuses where we debated our position for or against the resolutions. Among the resolutions, we were tasked to discuss some controversial topics— single payer, ABFM maintenance of certification, physician assisted suicide, the Hyde Amendment, and even physician burnout. I worked within the Student and Resident Caucus and had the opportunity to meet our elected student and resident delegates and leaders from across the country. Throughout our multiple caucus meetings, it was evident that our student and resident leaders possessed a great depth of knowledge and were well-equipped to represent the voices of our student and resident members.

There was healthy debate surrounding some of the more controversial resolutions, requiring the elected delegates from the caucus to balance opinions and best represent the majority opinion of medical students and residents. In some cases, the personal views of some of the leaders dissented from the majority views of the caucus. This sparked an interesting conversation with another medical student asking, “How can one delegate best represent the views of an entire constituency?” We tried to understand the difficulty in possibly having a personal opinion that differs from the majority opinion of the group of people you represent. But, as an elected representative, one is asked to represent the majority and not just his/her own personal views. We concluded that being an elected representative may mean that you have to vote in a way that differs from your personal views.

In the current political climate of our country, it was humbling to be reminded of what it means to represent a large group of people and not just one’s own personal

The North Carolina Family Physician

views. Fortunately, we have information and resolutions passed directly from the National Conference of Family Medicine Residents and Medical Students that we were able to use as evidence to help guide our discussions and, eventually, our votes. All of this is to say, making your voice heard to your elected representatives is vital to ensuring that you are represented well.

After the resolutions were discussed in the caucuses, they were sent to one of five Reference committees: Advocacy, Education, Health of the Public & Science, Organization and Finance, and Practice Enhancement. These committees listened to testimony from AAFP members, including students and residents, and then made recommendations on each resolution to the Congress of Delegates for debate and further action. The recommendations from the five Reference committees were formulated into consent calendars which were to be voted and potentially adopted by the Congress. While this is a simplification of the entire process and the lengthy debates regarding resolutions, there is much to gain from the overall process. This process, occurring once each year, allows for input from each delegation to propose resolutions, debate resolutions, and vote on resolutions that will guide the actions of the AAFP and its resources.

Amidst all of the parliamentary procedure, it was obvious that the leadership of the AAFP through the Congress of Delegates and the Board of Directors is dedicated to serving its mission “to improve the health of patients, families, and communities by serving the needs of members with professionalism and

~ First-Year Medical Students ~

Apply for 2018 Summer Family Medicine Interest Programs Application deadline is January 15, 2018.

creativity.� Throughout the meeting, key Family Medicine leaders focused on making primary care and Family Medicine the center of the future of healthcare, and I was reminded of the power that our more than 129,000 AAFP members together can have on the future of healthcare in the United States.

As a medical student, this experience solidifed the importance of being an informed member of my specialty and the impact that students can have on the future of healthcare policy and primary care. Along each step in the process at the Congress of Delegates, people were listening closely when students and residents were speaking about resolutions and asking questions.

Family Medicine is a unique specialty because Family physicians invest in medical students as the future of primary care in our country.

We have the unique opportunity to have our concerns voiced directly to state and national leadership of our specialty, and we should not take this lightly. I encourage any medical student who is interested in Family Medicine to get involved by joining a Family Medicine Interest Group, the NCAFP, and the AAFP. Family Medicine is poised to be a strong leader in the future of healthcare, and I hope that medical students will get connected and be active participants in the many opportunities including student programs, conferences, and student leadership in our state and national levels.

It was a privilege to be able to observe the workings of the national leadership for Family Medicine, and I am looking forward to continuing to be involved in building a strong future for our specialty.

The NCAFP Foundation offers a variety of programs and opportunities to medical students. Some are clinical experiences only available to 1st year medical students. These opportunities take place the summer between your first and second year of medical school.

There are multiple programs available, ranging from two to four weeks in length.

To learn more about the options and the exciting specialty of Family Medicine please visit: www.ncafp.com/students

NCAFP FOUNDATION

By Tracie Hazelett NCAFP Manager, Medical Student & Residency Relations

Medical Students Awarded NCAFP Foundation Family Medicine Scholarships The NCAFP is pleased to announce seven medical students have been selected to receive the Family Medicine Scholarships offered by the NCAFP Foundation. This scholarship program received a record number of applications for the 2017 cycle.

Monetary awards are scholarships, unless a recipient does not complete family medicine residency training. In those circumstances, the awarded money is converted to a loan and is paid

back to the Foundation with interest.

This year, all recipients are fourth-year medical students. As of press date, they are actively interviewing at family medicine residency programs. In addition to sincere interest in Family Medicine, they articulated a commitment to community and service, and have demonstrated leaderships skills and financial need.

The NCAFP extends best wishes and heartfelt congratulations to the following student winners: Kate Abraham, UNC; Paige Driver, ECU; Colin Good, Campbell; Nikki Hadley, ECU; Rebecca Laurine, Campbell; Brett Prestia, Campbell; and Erin Saner, Wake Forest.

The NCAFP would like to recognize that all applicants were deserving women and men with impressive experiences. We understand every medical student has financial need, and decisions were difficult. We are grateful for each student’s commitment to Family Medicine. The future is in great hands with any of these outstanding individuals.

Family Medicine Day is Saturday, March 10th, 2018 Registration is Now Open The NCAFP and the North Carolina Area Health Education Centers (AHEC) program are excited to present North Carolina’s 11th-annual Family Medicine Day! This fantastic one-day event is North Carolina’s premier family medicine residency recruitment conference.

The day will begin with a keynote lunch speaker sure to inspire, followed by 4-hours of clinical skills workshops.

During the afternoon workshops, students will network with faculty from North Carolina family medicine residency programs as they teach and refine skills, and share their experiences as family physicians. This is followed by a residency recruitment fair in the evening, where students can learn even more about North Carolina and 28

other regional family medicine residency programs.

This wonderful professional networking opportunity will introduce students to residents, faculty and students from across the state. You do not want to miss this incredibly fun, educational and hands-on day!

Registration is now open for the medical student classes of 2019 and 2020; Class of 2021 students may register beginning on 2/10/18. For complete information and online registration, visit www.ncafp.com/fmd. Questions may be directed to Tracie Hazelett at thazelett@ncafp.com

The North Carolina Family Physician

- UP C OMING -

STUDENT INTEREST

Win an Amazing Adventure AND Support Student Interest Initiatives The NCAFP Foundation continues efforts to raise funds for student interest initiatives. You can support the Foundation’s important work and have a chance to win your choice of one of five fantastic trips!

Enter the Foundation’s raffle at www.ncafp.com/raffle by Noon on Saturday, December 2nd, 2017 and your name is automatically entered in the drawing. Each entry is $50.00.

Winner will be drawn that evening at the Presidential Gala in Asheville. Winners do not need to be present to win so spread the word and support the cause!

Available trips include experiences in New York City, New Orleans, Chicago, San Diego and Sonoma County, CA. Yes, we are aware of the tragic fires in the area and have been monitoring the situation closely. We will substitute this experience with another wine experience in a different location as needed.

Winners will be fully informed of options prior to making their selection.

Full details about available trips can be found at www.ncafp.com/raffle.

Autumn 2017

Mark Your Calendar for the NCAFP Foundation’s Largest Fundraiser of 2018!

The 2018 Family Medicine Gala will be held at the Raleigh Convention Center on Saturday evening, August 25th, 2018. Join us in honoring Dr. Karen L. Smith, NC’s rural primary care rock star, during this elegant event to raise funds for the Academy’s student interest programs. Dr. Smith is well-known for her commitment to improving patient lives and her instrumental efforts in making Hoke County a healthier place to live.

She is Past President of the NC Academy of Family Physicians, and the 2017 National Family Physician of the Year.

The Foundation is currently seeking sponsors.

Opportunities start at $1000.00. Please contact Tracie Hazelett at the Academy offices if you have questions or would like to commit vital sponsorship support for this event to build student interest in Family Medicine. She can be reached at thazelett@ncafp.com or 919-980-5357.

29

PRACTICE MANAGEMENT

By Kelly Close NC DHHS - Oral Health Section

~ Improve Young Children’s Oral Health ~

Download Your Free Fluoride Toothpaste App from www.Toothtalk.org Brushing Is Fun, Start by Age 1!

Over the last two decades, North Carolina has pioneered innovative ways to address the oral health needs of young children at high risk for tooth decay.

As a result, NC medical professionals lead the nation in providing oral preventive care to infants and toddlers through the ‘Into the Mouths of Babes’ Fluoride Varnish Program (IMB). The tradition of leadership in preventing and reducing early childhood caries continues with the debut of a new, free phone app for medical providers to share with parents on the appropriate amount of protective fluoride toothpaste for children ages birth to six.

The colorful new app, found at www.toothtalk.org, is a project of The Duke Endowment’s ‘Brushing is Fun, Start by Age 1!’ program which combats early childhood caries by disseminating national recommendations for early fluoride toothpaste use via its

30

website (toothtalk.org), short streamed videos, and brief informative eblasts. Beginning fluoride toothpaste use when the first tooth erupts, along with fluoride varnish applications at regular intervals, are strong evidence-based practices for preventing and reducing early childhood caries.

The American Academy of Pediatrics, American Academy of Pediatric Dentistry, and American Dental Association, recognize early fluoride toothpaste use as an underutilized yet highly effective intervention. All three have policies recommending parents begin brushing children’s teeth when the first primary tooth erupts using a smear (rice-sized amount) of fluoridated toothpaste twice daily. In children ages three to six, a pea-sized amount of fluoridated toothpaste should be used.

In today’s fast-paced, digital world, the Brushing is Fun, Start by Age 1! project team realizes a picture is worth a thousand words! This user-friendly tool will assist you in getting important oral health information to the parents of your young patients.

Easy to download on your phone, computer, or tablet, this effective app enables you to quickly and easily show parents what a smear or pea-sized amount of toothpaste looks like. Parents can even download their own free version of the app as a reminder!

To get your free app, visit www.Toothtalk.org, an engaging and informative website where you can also learn more about Brushing is Fun,Start by Age 1!, a collaboration of UNC-CH School of Dentistry and the NC Division of Public Health Oral Health Section. Want to know more about ‘Into

The North Carolina Family Physician

the Mouths of Babes’ Fluoride Varnish Program (IMB)? Check out https://www2.ncdhhs.gov/dph/oralhealth/partners/IMB.htm or call/ email Kelly Close, NC Oral Health Section at 919-707-5485, Kelly.

Close@dhhs.nc.gov.

References: American Academy of Pediatrics Section on Oral Health (Dec 2014). Maintaining and improving the oral health of young children. Pediatrics, 134(6), 124-1229. DOI: 10.1542/ peds.2014-2984 http://pediatrics.aappublications.org/content/134/6/1224.

American Academy of Pediatric Dentistry Council on Clinical Affairs (2016). Policy on Early Childhood Caries (EEC): Classifications, consequences, and preventive strategies. AAPD Reference Manual 38(6), 52-54. Retrieved from URL http://www.aapd.org/assets/1/7/P_ECCClassifications1.PDF American Dental Association Council on Scientific Affairs (Feb 2014). Fluoride toothpaste use in young children. The Journal of the American Dental Association, 145(2),190-191.

DOI: http://dx.doi.org/10.14219/jada.2013.47

You can’t imagine doing anything else…

Let us handle your marketing while you focus on patient care. We help you obtain patients who are a good match for your practice. Then we keep them coming back, so you can keep them well.

ARCH ETYPE

graphic design & writing services, inc.

Archetype-usa.com

DESIGN & CONTENT for PRINT & WEB

Including WordPress, Social Media, & E-mail Marketing

BRAND DEVELOPMENT Including Logo Creation

ACCESS TO DISCOUNTED PRINTING SERVICES MARKETING CONSULTING

CLASSIFIEDS WANTED: Collaborating physician for Georgetown graduate Family Nurse Practitioner. Requirements: Active MD/DO North Carolina license, Board Certified in Family Medicine. No onsite supervision required, minimal time investment, only 2 meetings per year. 1099 annual contract. Monthly $$ REWARD $$ - Call 913-223-1113.

Current clients include Avance Care, Aetna, and NCAFP. We are committed to making every project hassle-free and cost-effective for you.

Contact us today for a free phone consult and an estimate on helping you build your practice: Elizabeth@archetype-usa.com

919.835.0450 Owners: Tom Forsythe, Designer Elizabeth Forsythe, Writer/Consultant Autumn 2017

31

Mission, from pg. 5

It reminded me of the role that family physicians have always played in their communities. Small town family physicians tend to live where they practice. They interact with their patients outside of the office, and know the needs of their communities. Family physicians have traditionally been advocates for both the patient and the communities they serve.

At CFM, we have teamed with the Cabarrus County Sheriff’s Department for a series of town hall presentations, to help educate our population and to offer resources to those who are struggling with addiction. We are working on a drug takeback program for our offices, realizing this is our responsibility and not someone else’s. We are educating our providers and residents as to proper prescribing habits, and have embraced the STOP Act.

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

This particular clinic had minimal resources, basically a bottle of Amoxicillin and some acetaminophen which the physician had purchased himself. We brought our team and a Dominican dentist (who had no anesthesia and borrowed Ibuprofen from us for extractions), and at the end of the day left medical supplies for the community, which the physician was happy to receive.

What I remember most was a hand-drawn map on the wall of the physician’s office, which showed the houses in the community he served. Each house had a notation as to how many people lived in the house, their rough demographics and a series of colored pins – green for diabetes, red for hypertension, purple for anemia, etc. True population management.

ita basis. Not something I am proud of.

But something we as a practice have taken head-on.

www.ncafp.com

clinic in the outback of San Juan. Newly graduated physicians in the Dominican Republic are required to spend a year in an underserved area as repayment for their education. And the more remote the assignment, the greater the physician’s chance of getting a specialty residency. Not a bad idea.

My time in the Dominican Republic grounds me. It is a time of renewal. It allows me to teach young physicians about caring for others. It reminds me why I went into medicine in the first place. It also gives me time to think about how I can improve things back home.

I would encourage all of you to find something similar in your own life and practice. It doesn’t have to be overseas.

There is plenty to do here as well. Take a step back, outside of your comfort zone, and remind yourself why you do what you do.

My goal when I chose Family Medicine was to help people and make a difference.

This week at least, I believe I did.

At least in the Charlotte area, this may no longer be true.

Non-Profit Org. US Postage

PAID

Pontiac, Illinois Permit No. 592

Physicians increasingly tend to live where other physicians live, they look for set schedules, and the tie to their community is lessened. Which makes me question whether we are still the community advocates that we need to be? The current opioid epidemic should be a call to action for all of us. I am unhappy to report that my county, Cabarrus, leads the state in both opioid and heroin overdoses on a per cap-