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Volume 14 Issue 1 • Winter 2018

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

Dr. Tamieka Howell 2017-2018 NCAFP President


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 Winter 2018

Mount Olive’s Dr. Kevin Talton Named 2017 NC Family Physician of the Year P. 12

PRESIDENT’S MESSAGE

MEETINGS & CONFERENCES

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The 2017-2018 Inaugural Address

HEALTH POLICY & ADVOCACY

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Hints for Family Physicians as NC Moves to Medicaid Managed-Care

Lucky Finds … and CME Learning Opportunities in 2018

MEDICAL STUDENTS

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Learning to Step Out of Your Comfort Zone

PRACTICE MANAGEMENT

CHAPTER AFFAIRS

16 Oh Baby! Oh No! But, Let Us Know

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North Carolina a National Leader in Fighting Rogue Internet Pharmacies

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DEPARTMENTS

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President’s Message 4 Policy & Advocacy 8 Membership 12 Chapter Affairs 16 Meetings & Conferences 20

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919.833.1801 • ncafp.com

Managing Editor & Production Peter Graber, NCAFP Communications

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. Tamieka M.L. Howell 2017–2018 NCAFP President

The 2018 NCAFP Inaugural Address I know I’m one of the last things keeping us from more libations and a great night of music and dancing. I tried to get out of this and just say, ‘Thanks for allowing me to be your President, lets dance!’ Even saying thanks in as many languages as I could think of couldn’t get me to the 12-15 min that Greg has requested. So I’m going for 10 minutes. I want to talk to you about 3 things this evening. I want to talk about deficit, unity and upstanders. I didn’t realize that was a word until a few weeks ago when I saw it on a Starbucks table tent while I was writing this speech and thought is was so fitting. So I stole it, or creatively borrowed it. Not the table tent, just the use of the word. But more on that later. I think our former President Barack Obama said it correctly when he said we suffer from a deficit in this country, a deficit of understanding. A deficit of empathy, a deficit of unity. A deficit of seeing ourselves in others, of being part of a village that looks after the greater good of those around us and speaks up when something isn’t right. We have a deficit when our young people are sent off to war to serve our ‘Great America’, that thanks and appreciates thousands of our NC Veterans with homelessness, and lack of mental and physical support fol-

lowing the atrocities they have endured. These are my patients, our patients. We have a deficit when my children, your children, our patients, the children in our metaphorical village see nooses hung in their schools, the schools that are supposed to be a safe place to be educated. In 2017, nooses are being hung in our schools. These are your patients. We have a deficit when a boy is killed by his own parent, because of his sexual orientation. A child murdered, by the same hands that created his life, because he loved another boy, another human being. These are our patients. We have a deficit when our CEO’s are making more in a day than some of our hardest working Americans are making in an entire year. When a mother, our patients, must choose between a $3 copay for one of their sick children to be seen or using that $3 to feed her family of 4 their only meal of the day. Or your Grandmother has to decide whether to purchase her insulin or pay her heating bill. Or your newly-diagnosed, yet curable cancer patient says, “We can’t take on any more bills, I don’t want to be treated.” But its curable! WHY??? Because we have a deficit. Dr. Martin Luther King Jr spoke words that still are relevant for today. He spoke of an urgency, of an extreme urgency. Not the kind of urgency we typically think of in medicine, the kind of urgency that can be the difference between life and death, but the kind of urgency that can be the difference between justice and injustice, equality and inequality. “Unity,’ he said, “is the great need of the hour.” I want you to listen to these words again. Continues on next page

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The North Carolina Family Physician


2017-2018

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

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

District Directors District 1 - Mackenzie Smith, MD District 2 - Gilbert Palmer, MD District 3 - Garett R. Franklin, MD District 4 - Shauna L. Guthrie, MD, MPH District 5 - Dimitrios “Taki” P. Hondros, MD District 6 - Ying Vang, MD District 7 - Jennifer Mullendore, MD At-Large Jason T. Cook, MD At-Large Talia M. Aron, MD IMG Physicians Brian McCullough, MD Minority Physicians Jewell P. Carr, MD Osteopathic Family Physicians Slade A. Suchecki, DO New Physicians Elizabeth B. Baltaro, MD Family Medicine Residency Directors Mark L. Higdon, MD (Novant FMR) Resident Director Courtland Winborne, MD, MPH (Cabarrus) Resident Director-Elect David S. Baker, MD (MAHEC-A) Student Director Allyson Mentock (BSOM) Student Director-Elect Cameron G. Smith (Campbell) Medical School Representatives & Alternates Chair (ECU) Chelley K. Alexander, MD Alternate (Campbell) Nicholas Pennings, DO Alternate (Duke) Anthony J. Viera, MD, MPH Alternate (UNC) Cristen P. Page, 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

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

Winter 2018

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From Left: Dr. Howell’s family - son Myles, husband Dwayne Tesseneer, and daughters Corinne and Chrisette. At Far Right: Dr. Howell with her Mother, Lynda Howell.

‘Unity… is the great need of the hour’. At a time, in 1961, when people were unsure of change and the black community was doubting of themselves and often doubtful of each other, on the eve of the bus boycotts in Montgomery, Dr. King understood the need for people to believe in the reason they were assembling and speaking-up for the inequalities of their everyday lives. That if people would join Rosa Parks and boycott the bus, that the message would be clear. The same way that 4 years later, the American people -- 25,000 people -- while not directly affected by injustices, would not tolerate the injustices thrust upon those that looked different, yet were their equals. A unified people, not just black southerners, but black and white, people from the north and south, rich and poor, Jew and gentiles, young and old participated in the march from Selma to Montgomery so that everyone could have the right to vote. UNITY…They believed in unity for the greater good of those around

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them. The need to build bridges and not walls. Bridges of commonality. Whether you support gun control or the right to bear arms, both groups agree that no more children in Sandy Hook should die, no more worshipers at the church in Texas or Charleston, SC, or the Sikh temple in Wisconsin should die, no more concert goers in Las Vegas should be fatally injured because of the misuse of a gun, and, in some cases, many guns. Both sides must find a way to unify in order to produce a solution. Most people agree that it is in the best interest of everyone to have access to

The North Carolina Family Physician


necessary and quality healthcare, but we cannot agree on how to get there. The concrete foundation of that bridge of unity is built, (everyone should have healthcare) but we need to agree on whether it’s going to be wood or steel or somewhere in between. On whether the individual will be solely responsible for being able to afford their own healthcare, or whether we as a nation will foot that bill for all or if we will come to a compromise and find the best of both so that no one has to be without. I came across a quote from the Bible that I felt applied whether you believe in the Bible or the Koran, the Book of Mormon, the teachings of Buddha, or some other higher power, or none at all. The quote says, “Every kingdom divided against itself is brought to desolation; and every city or house divided against itself shall not stand.” Divided…brought to desolation… and shall not stand. We must no longer divide our kingdom of the USA so that we shall remain standing. We must no longer divide the cities in which we practice. We must no

Winter 2018

longer divide our house of medicine. Unity. Unity is the great need of the hour. Unity for our profession. Unity for our Country… But most importantly, unity for our patients. What do I hope this means for you? It is against these deficits, these atrocities, these moral deficits, we must find unity. None of you are exempt from taking action in all of this. By sitting on the sidelines and just saying, ‘oh, thats so wrong,’ but not taking actions, or witnessing firsthand these injustices and not speaking up, you are bystander, and not the innocent type. Don’t just be a bystander, be an upstander. This word was added to the English Oxford dictionary about a year ago. Now let me define this for you. Upstander- a person who has chosen to make a Continued on Back Cover

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HEALTH POLICY & ADVOCACY By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President

The Experts The NCAFP asked these experts for insight into Medicaid Managed-Care:

Anita Hughes Bachmann

- STATE MEDICAID REFORM -

Hints for Family Physicians as NC Moves to Medicaid Managed-Care IN JUST OVER A YEAR, North Carolina’s Medicaid program will move to a managed-care system. Rather than Medicaid paying physicians directly, the state will contract with several managed-care companies, or provider-led entities, to manage the care for a distinct group of Medicaid recipients. The state will pay these organizations a capitated payment per-covered-life. In turn, physicians and other healthcare providers will have to contract with various managed-care companies and/or provider-led entities to continue caring for Medicaid recipients. While the Academy vehemently opposed the state’s move to Medicaid Managed-care, the General Assembly ultimately dictated this direction. The Department of Health and Human Services (NC DHHS) will likely issue Request for Proposals for managed-care in late February or early March of this year, select contractors by late fall, and implement the changes in July of 2019. NCAFP is working with NC DHHS to minimize the negative impact to primary care practices and to Medicaid recipients.

To help prepare our members for this transition, the NCAFP has been contacting experts inside and outside of the managed-care industry. These efforts included a workshop at the NCAFP Annual Meeting last December. In addition, we have asked an expert panel to answer a few questions to help our members prepare for managed-care. Their answers are presented here. NOTE: Some answers have been edited for space and/or clarity.

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Chief Executive Officer North Carolina Health Plan UnitedHealthcare Community & State

Tom Banning

Executive Vice President and CEO Texas Academy of Family Physicians

Dr. Richard Buzard

Deputy Chief Medical Officer National Medicaid Management Aetna

Stephen W. Keene

General Counsel and Chief Operating Officer North Carolina Medical Society

Mardy Peal

Director, Business Development WellCare Health Plans

1) What are two specific items a family physician should look for and evaluate before signing a contract with a managed-care company? Banning: Number 1 – Look for how they are paying family physicians, but more on that later (see question 4). You should also look carefully at the plans’ referral networks. One tried and true strategy to save money is to narrow the plan’s network. One of the biggest headaches I hear about is the inability of a family physician to refer a patient for specialty care in a timely manner. You need to know what specialists and hospitals are part of the Medicaid MCO network. Next, find out what their prior authorization policies are. This can be a big headache. Finally, find out their payment policies -- how

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quickly will they pay -- and continue to advocate that Medicaid plans be held to the same standard as the commercial market. NOTE: Texas has had Medicaid managed-care for some time. Buzard: First, look for your appeal rights and processes. Second, look for opportunities to enhance your reimbursement based upon performance or other value-based payment mechanisms. Keene: I would offer three items. First, what degree of commitment has the MCO demonstrated to the Medicaid population? The importance of Medicaid patients to the MCO will give you some idea how much attention you will receive when problems arise. Second, how transparent and flexible is the MCO in working with providers and practices? And finally, is there physician leadership/governance at the health plan level?

2) What specifically will your company do to help ease the administrative burden of going from one Medicaid payment system to multiple plans? Keene: We know that Secretary Cohen (NC DHHS) is focused on this issue, and will push the plans hard to find ways to cooperate to further diminish administrative costs for doctors. We welcome that challenge. Carolina Complete Health will work with DHHS, providers, and other awarded health plans to streamline administrative processes such as provider credentialing. As a provider-led health plan, Carolina Complete Health will establish policies that eliminate barriers to allowing physicians to do their jobs - provide high-quality healthcare to their Medicaid patients.

1) Obtain clarity around how the value-based program will work and what supports the managed-care company can provide. For example: what metrics will be measured; how will data be collected and evaluated; what are payment terms and timeframes.

Bachmann: Most providers in NC have worked with our company (UnitedHealthcare) through our Commercial and Medicare products for 30 years, and are familiar with the people and processes within UHC. As part of these relationships, physicians have been instrumental in providing feedback on ways to simplify administrative processes (e.g., through provider associations). In response, we have improved and reduced prior authorization processes, deployed practice management tools that drive administrative efficiencies and clinical tools to provide physicians with deeper understanding of their patients’ care needs, and developed a provider relations model designed to expedite administrative issues resolution. In addition to these simplification changes, we are committed to continued engagement with physicians to understand and address their needs/concerns. 

2) Be confident that the contractual party can deliver on the terms of the agreement. Family physicians should consider the managed-care organization’s experience with value-based programs and whether the organization can provide supports and meet providers where they are in their practice readiness to participate.

Peal: We commit to working with other health plans and physician associations to identify processes and procedures that are common among all health plans, and we will seek to standardize those where we are able. WellCare’s overall approach to ease administrative burden is to have:

Peal: The first specific item is mission alignment. Ask yourself if the mission of the managed-care organization reflects the mission of your practice. Secondly, note the MCO’s operational support for practices, its local presence, flexibility in payment arrangements, and their general commitment to partnership rather than just a payer–physician contractual relationship. It’s also worth considering what supports they have in place to help a family physician achieve PCMH or AMH (Advanced Medical Home) status.

• Transparency related to billing and payment policies.

Bachmann: Managed-care organizations can serve as a reliable partner to family physicians by providing tools such as clinical data and quality payment incentives. Much of this will occur through the ongoing relationship between managed-care organizations and family physicians. Anticipating that most contracts eventually will be value-based, family physicians should:

• Robust training programs with local staff, conducted in-person when possible. • And ample local staffing to allow responsive turnaround and to assist when issues arise. Buzard: First, over the past year, Aetna has systematically Continues on next page

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reviewed our prior authorization requirements and reduced by 20% the codes requiring authorization. Second, Aetna provides access to criteria sets and clinical decision support tools for all clinicians and support staff. We will continue to do that with Medicaid.

3) Please provide the one best piece of specific advice to help North Carolina’s family physicians prepare to transition to Medicaid Managed-care. Banning: First and foremost, understand that the Medicaid MCO (managed-care organization) will enter into a competitively-bid contract with the state to provide comprehensive health care services to a patient population that is tough to manage. Conflict between parties will naturally arise, but the plans are legally obligated to fulfill their contractual requirements with the state. Use your collective advocacy efforts/tools to make sure the state is holding the plans accountable to the terms of their contract. Bachmann: With the transition to Medicaid managed-care, there is significant opportunity for family physicians to continue advocating for their patients’ needs and the needs of their practice. Family physicians should identify what is needed to best serve this complex and vulnerable population and to manage their practice, and communicate those needs to managed-care organizations and DHHS so they can be addressed. For example, physicians may need supports related to patient outreach, the clinical model - including data analytics and risk stratification, or other practice resource needs. The transition to managed-care is an opportunity to get additional supports that family physicians may need.  Peal: We would advise primary care physicians to continue working with existing entities in the state, such as your local CCNC network and your local AHEC program, to prepare your practice for the shift to a value-based system. Additionally, family doctors should engage with the health plans who are interested in doing business in NC to learn the health plans, their mission and approach to working with providers, their reimbursement strategies, and operational support they have available for providers in their network. Family Physicians should keep in mind that it is not necessary to work with all MCOs – it is fine to work only with those that seem like good partners. Buzard: Managed-care organizations are required by Medicaid to approve or deny a specific request as 10

submitted. We cannot, as an example, approve seven patient visits if 10 were requested.    Aetna recommends providers develop an understanding of the principles of managed-care.  Managed-care should not be about denying healthcare, it is about optimal utilization of resources. Utilization limitations are based on evidenced-based medicine. If there are instances in which you feel evidence is not being properly applied, every managed-care company has a forum for discussion. Keene: I’d recommend that family physicians consider the following in preparation for the transition: • Be ready to tell your story about how to achieve better care, better patient health outcomes, and lower cost-of-care. • Ask questions to learn how the health plan in question will make decisions that influence patient care. • Be ready to ask for changes that will serve your patients’ interests first. • Get and stay connected to your professional associations; ensure their advocacy teams are focused on the right issues. If plans do not pay primary care differently and give family physicians the time and resources to care for their patients, this won’t succeed.

4) Comment on how managed-care plans can reward family physicians differently than the traditional fee-for-service model, and what strategies your company may use. Banning: The Medicaid managed-care plans are actually employing some pretty innovative, progressive payment models, more so than the commercial plans. Much like Medicare Advantage, the Medicaid plans assume full risk for the Medicaid population which gives them significant flexibility to provide Medicaid patients value-added services and pay physicians differently for providing high quality, cost effective care. Don’t get hung up on traditional fee-for-service payment. There is a lot of opportunity in shared-savings and care management/care coordination fees or other payment methodologies. Peal: Our preferred method of paying primary care physicians is through value-based models that offer incentive compensation to the physician based upon their performance related to quality and efficiency. We recognize that a physician’s ability to render the highest qualThe North Carolina Family Physician


ity care is aided by many factors, including data provided by a health plan, support and tools made available, and creative payment models that provide a physician the ability to invest in and improve their practice. WellCare offers a vast continuum of payment models that provide incentive compensation, from a basic pay-for-performance program, all the way up to full global risk. We recognize that primary care physicians rendering quality care to our members is an essential component to the success of our health plan and more importantly, having the best outcomes for the patient. Buzard: We’ve (Aetna) partnered with Community Care of North Carolina and Community Care Physicians Network because we understand and value the work that family physicians have already done in North Carolina. Our partnership will build on that foundation.  We’re working with CCNC/CCPN to evaluate practices and develop a variety of payment models using value-based contracting, and that focus reimbursement on quality patient care resulting in optimal clinical outcomes. Keene: Medicaid is headed toward significant payment reform. This change does create some uncertainty, but the news is good for primary care in general, and Family Medicine in particular. This is because the elevation of population health and clinical outcomes as primary definers of success creates opportunities for family physicians to be at the forefront of making improvements to care for Medicaid beneficiaries, and being paid fairly for delivering those improvements. If selected to serve North Carolina’s Medicaid program, we will establish payment models to reward those who are contributing to increasing access to quality care, and to enable doctors to improve health wherever they see an opportunity.

Winter 2018

Bachmann: With the 1.3 million individuals we serve today in NC, there are value-based contracting (VBC) arrangements already in place with more than 50 provider groups across the state. Additionally, more than 20 percent of our national Medicaid members receive care from a physician participating in a value-based program. These VBC arrangements can generate provider payments over and above existing fee-for-service reimbursement. For example, in 2016 our Florida Medicaid health plan awarded more than $2.1 million in bonus payments to physician practices in the state for improving quality of care. Value-based programs also can facilitate clinical/practice transformation support by providing practices with specific performance data that can improve care management strategies and patient health outcomes. To be successful, it will be critical that VBC arrangements are geared toward the provider and supporting their ability to drive improved quality and performance.

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MEMBERSHIP By Peter T. Graber NCAFP Communications

Mount Olive’s Dr. Kevin Talton Named 2017 NC Family Physician of the Year One of the mainstays of exceptional Family Medicine are relationships, built over time, nurtured by trust and compassion, and drawing upon a unique sense of family and community that few specialties can match. It’s central to the core of what makes Family Medicine so effective and many of its family physicians so revered in cities, towns, and communities everywhere. North Carolina’s 2017 Family Physician of the Year, Dr. Robert Talton, FAAFP, of Mount Olive, is a textbook example of these tenets in action. Born and raised in the town he now practices, Dr. Talton draws on his special sense of community, compassion, and commitment to deliver exceptional care. Dr. Talton was drawn into Family Medicine almost by chance. After graduating Mount Olive High School, he entered the Engineering program at North Carolina State University with every attention of completing the program. Soon after starting, he realized he had curiosity for other paths. And as fate would have it and right around the same time, the Mout Olive’s volunteer rescue squad put out a call for volunteers. This sparked Talton’s interest and in the ensuing months, lead him to complete a basic EMT certification course at his local community college. After serving on the front lines with the squad that next summer, medicine became his passion, with family doctors front and center.

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The North Carolina Family Physician


“My experience with the rescue squad exposed me to family doctors in my community,” related Dr. Talton in describing his path. Talton described the rescue squad as operating as a basic level service at the time, without paramedics or even advanced life-saving equipment. This meant it had to rely on local physicians when responding to serious, life-threatening calls like cardiac arrests, severe traumas, and motor vehicle accidents. When the squad issued an “all call for doctors,” it was typically the area’s family physicians who would leave their practice, home, or family to meet at the scene to provide support. It was profoundly inspiring. “Day or night, these family physicians would respond to this call. They often would ride in the ambulance with us to the hospital to take care of the patient. They never charged the patient, just did it because it was the right thing to do. These family physicians were my inspiration,” reflected Dr. Talton. After that first summer and with a newfound inspiration, Dr. Talton went on to graduate from North Carolina State University in 1993, earning a Bachelor of Science in Zoology and immediately entered medical school at East Carolina University. And as timing and luck would have it, Mount Olive leaders began recognizing the community’s pressing need to recruit new physicians, as many around town and the area were aging and edging closer to retirement. The pipeline needed to be filled. The town formed a small foundation to raise money to fund the medical education of local area medical students in exchange for their future service. Talton jumped at this chance when it presented itself and wound up completing medical school debt free! After medical school, Dr. Talton entered residency training as part of a joint program of Pitt County Memorial Hospital in Greenville and Sampson Regional Medical Center in Clinton. This brought him into direct contact with both the Clinton Medical Clinic, as well as the Mount Olive Family Medicine Center. Both practices had a major impact on him. NCAFP Board Chair Dr. Charles Rhodes with Dr. Kevin Talton

“I did an extensive amount of residency training at Clinton Medical Clinic and have been employed Continues on next page

Winter 2018

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with Mount Olive Family Medicine Center for 17 years,” noted Dr. Talton. Both practices are steeped in the Family Medicine tradition of delivering compassionate and comprehensive care while also serving the community. “All of the physicians at these practices have been instrumental in making me into the physician I am today,” said Talton. After residency, Talton returned to Mount Olive and started practice in 2001. By following this path, Dr. Talton joins a long line of distinguished physicians from that practice, including two previous NC Family Physicians of the Year — Dr. Robert Shackleford (1993) and Dr. Hervy Kornegay (1998). Dr. Talton’s practice of Family Medicine combines compassion and adept clinical skill with longstanding relationships that span decades. It’s one advantage of practicing medicine at a clinic directly across the street from his childhood home. “The most rewarding part of returning to practice medicine in my hometown has been the opportunity to take care of lifelong friends and neighbors within the community,” Dr. Talton described. “I am now caring for the kids of my childhood friends, as well as caring for those adults who were influential to me growing up in my hometown. Like many family physicians, the relationships you have with your patients are the most rewarding aspect of practicing medicine.” Outside of practice, Dr. Talton has followed the path of community service in the same spirit as other leading family physicians from his practice and across the region. Drawing on their service as inspiration, Talton currently serves in a range of volunteer roles, including serving as Team Physician for the University of Mount Olive’s 400 athletes, sitting on his local bank’s board of directors, assisting his church, and even helping lead his local Boy Scout troop. Even with this service, a couple of Dr. Talton’s recent efforts stand out.

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First, beginning in 2014, Dr. Talton took quick action to address sports concussions in his community by establishing the grant-supported Mount Olive Family Medicine Concussion Clinic. This program now provides concussion screening and comprehensive concussion management to area middle and high school student athletes and has already touched approximately 1,200 students across 3 neighboring counties. And just last fall, with the specter of flooding from an unpredictable hurricane looming, Talton jumped into action again. He reached out to his community’s leaders and emergency services team knowing that Mount Olive had the potential to be cut off from the local hospital due to flooding from Hurricane Matthew. He setup his clinic as a 24/7 emergency medical center and when the floods came, Dr. Talton manned the center around the clock for four days, operating under generator power and working with emergency services until the crisis had passed. He treated anyone who showed-up. Talton also finds the time to serve his country. He is a Lieutenant Colonel in the US Air Force Reserves, serving as the Commander of the 916th Air Refueling Wing’s Aerospace Medical Squadron at Seymour Johnson Air Force Base. In this role, he cares for members of the Air Refueling Wing to make sure all are medically “mission ready.” He has participated in numerous volunteer endeavors related to this service, including in marquee community events like the Wings Over Wayne Air Show. His work helps ensure that the medical community was ready for an event attended by over 100,000 people. Dr. Talton has already had an exceptional career in Family Medicine, and in many ways, he’s only just getting started. He’s built his practice on the foundation of longterm relationships, continues to grow it through trust, and is steadfast in improving his community one project at a time. Dr. Talton resides in Mount Olive with his spouse of 23 years, Lynnette, and three sons: Tyler (22), Brandon (16), and Mitchell (14).

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CHAPTER AFFAIRS

Member Briefs

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

By Tara Hinkle NCAFP Member Services Manager Join the Conversation! If you’re like me, you have plenty of social media accounts. With that comes notifications, alerts, and having to remember passwords. For me, the latter is a lost cause. But most of you probably already have Facebook and Twitter. Make sure you are following us because fun things are happening! No extra password to remember. You’ll find relevant articles; videos; short but fun quizzes; members in the news; updates from events we may be attending on your behalf; information to share with your patients; and you may even find a nutritious recipe! Lots more planned! Follow us and stay in the know: On Facebook at: www.facebook.com/ncafp On Twitter: www.twitter.com/#myncafp

MEMBERSHIP REMINDERS

2018 Membership Dues Payment Extension If you missed the January 1st 2018 dues payment deadline, AAFP offers an extension. Installment plan enrollment is still available online or via phone. To pay dues or access your invoice, please visit www.aafp.org/checkmydues or the member portal at www.aafp.org/welcomecenter. You may also pay via AAFP’s free mobile app by selecting “My Account.” If paying by check, please make checks payable to AAFP and submit to P.O. Box 419662, Kansas City, MO  64141.  For credit card phone payments, please call AAFP at 1-800-274-2237 x 0 between 9:00 a.m. – 6:30 p.m. EST.  If you have moved, retired, or interrupted practice, please contact the AAFP immediately.  The drop date for 2018 dues non-payment is scheduled for May 2, 2018. Thank you to our members who have already paid or enrolled in the installment plan. Your receipt may be accessed online anytime. 2017 CME Re-Election Reporting Deadline Candidates for 2017 CME Re-Election should have earned their 150 credits by the 12/31/17 deadline.  Please report credits to the AAFP by 3/31/18 to avoid final notice communications. Thank you to our members who have successfully been re-elected. Your transcript may be accessed online at www.aafp.org/ mycme or through the member portal at www.aafp. org/welcomecenter. 16

Oh Baby! Oh No! But, Let Us Know Oh Baby!

When you get an e-mail about a publication targeting expectant moms called, “Oh Baby!”, you probably don’t think about having an immediate visceral response. But that’s exactly what happened to me the week before Christmas. And it all started because good communication from one of our family physician members. On the Thursday before Christmas, an NCAFP member from the western part of the state e-mailed me excerpts from a GateHouse Media publication. Now, you may ask why anyone cares about GateHouse Media? Well, GateHouse owns nearly 800 publications around the country, including 14 daily and community newspapers right here in North Carolina. In many of these communities, they publish supplements, including “Oh Baby,” billed as “the everything planner for expectant mothers,” including a discussion of how to select an obstetrician and a pediatrician. Yes, you read that right, the selection of obstetricians and pediatricians. Not only did they leave family medicine out of the equation, but they also openly disparaged your profession. Here’s a quote from one of their previously published supplements: “If you already have a family doctor, you may not think you need a pediatrician. Although a general physician is licensed to care for children, they lack the training of a pediatrician….” This segment of the publication was entitled “Choosing Your Pediatrician,” and went on to tell why a “pediatrician” was so important. The publication also failed to give any credence to a family physician delivering babies.

Oh No!

Fortunately, the member who contacted us, Dr. Diana Curran, is Medical Director of the Henderson County

The North Carolina Family Physician


Department of Public Health and on faculty at the Hendersonville Family Medicine Residency Program. GateHouse Media happens to own the Hendersonville newspaper, and they hoped to publish a supplement in the community and use the Health Department to help distribute it. That’s where the first “Oh No” came into play. Dr. Curran said, “Oh No” to GateHouse and suggested changes, but they didn’t seem real receptive. That’s when Dr. Curran e-mailed the NCAFP. I must say my reaction wasn’t simply “Oh No,” but I do consider this a family publication, so I won’t write what I said out loud when I read Dr. Curran’s e-mail. I spent all that Thursday researching GateHouse Media and contacting everyone I could find related to the publication. This included an e-mail to one paper in North Carolina that had already published the supplement, e-mails to the publisher and/or editor of all 14 Gatehouse publications in our state, an e-mail to the President of Gatehouse, an e-mail to the company’s Senior Vice President for their news division, contacting AAFP to bring them into the loop, a quick update to the NCAFP Executive Committee, and finally contact with at least a few other Chapters where GateHouse has a significant presence. My message to GateHouse: in North Carolina, you (the members of the NCAFP) are 4,000 strong, and you take care of thousands upon thousands of our state’s children. In addition, many of you either deliver babies or share care for mothers and newborns with OBs. We immediately asked the company to cease publishing the supplement in its current form and to take action to rectify any harm that may have been done to the reputation of family physicians in the state by their erroneous information. Here’s one paragraph from the e-mail I sent to various GateHouse representatives. “Even more objectionable are the comments the publication makes about taking children to a pediatrician versus a family physician. Family physicians also have four years of medical school (the same as a pediatrician) and three years of residency.  Depending on a community’s need, many family physicians have gone on for additional training and receive certificates of added qualification.  Almost all family physicians care for children, and in many areas of our state, they are the only physicians available to care for children.  Family Medicine residency programs are specifically designed to teach family physicians to provide care for the entire family at all stages of life in a wholistic manner.  While we certainly do not object to our pediatric and obstetric colleagues, we find it offensive that the “Oh Baby!” publication belittles the years of training, certification and continuing education that family physicians have.”

Winter 2018

GateHouse heard us and reacted. Before the clock struck midnight, the Director of Business Development for GateHouse had responded and indicated she would make changes. A quote from her response: “Please know that our intent has never been to insult or diminish the importance of trained and certified family physicians. I know how important they are to NC.” On Friday morning, the Regional Vice President for GateHouse Media in North Carolina had also responded, saying she was aware of our concern and wanted to resolve this as quickly as possible. Both offered to allow the Academy to help adjust the publication. I reached back out to the publication in early January to make sure the changes would be made. They noted that they had received some additional input from other Chapters and will be incorporating family physicians into the publication. Their final comment, “we will not publish the NC book until we have Family Medicine covered.” A few days later, GateHouse e-mailed me (and AAFP’s communication team) a draft article on family physicians for inclusion in their magazine. While it’s not perfect, it’s much better than before and we are still providing feedback.

Let Us Know

Not every complaint we receive at the Academy has such a happy ending, but rest assured we try. When you or your profession is harmed, we act – and act swiftly – on your behalf. One of the morals of this story is simple: Let us know. Had it not been for an e-mail from one solitary member, I may have never known that the “Oh Baby” publication even existed. GateHouse media is not in the Raleigh market. But they are in Hendersonville, Shelby, Gastonia, Lexington, Fayetteville, Asheboro, Burlington, New Bern, Jacksonville, Wilmington, and more. Who knows how many supplements could have been printed around the state totally ignoring and even disparaging the profession of Family Medicine. So, I’ll simply ask: let us know. Whether it’s an issue with a payer, a legislative initiative, or a publication disparaging your profession; if you have a concern, contact us. If I don’t know, I can’t help. And you’re likely not the only family physician in the state facing the same issue. Like I said, we don’t always win, but we always try. It’s our mission – to serve you, our members, in hopes of giving you the resources and time to care for your patients, their families and your community. Let us know. We’ll do our best.

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NCAFP

Sights & Scenes

Winter 2018

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PROFESSIONAL DEVELOPMENT By Kathryn Atkinson, CMP NCAFP Manager of Meetings & Events

- 2018 LEARNING -

Lucky Finds … and CME Learning Opportunities in 2018

D

id the beginning of the New Year bring artful posts of colorful, uplifting and inspirational words to your Instagram and Facebook pages, too? Since January, I’ve added a few fantastic words to my vocabulary, and I even had to make a new Pinterest page to keep up with them all! Some of my recent favorites include flawsome, coddiwomple, hygge, and eunoia. If they aren’t in your regular lexicon already, you may want to check them out.

2018. So, grab your calendars and save the dates for our terrific CME opportunities scheduled for April, July, and December. With valuable AAFP Prescribed Credits, timely topics, expert speakers, and interactive-learning sessions slated for each event, you’ll want to attend all three!

One especially fancy word, carefully typed in pretty, swirly lettering alongside a pencil sketch of a hummingbird and some wildflowers, recently caught my attention. The word is trouvaille. And, this all-Southern girl got the pronunciation right on the very first try ... “troo-vale.” While trouvaille is pretty to look at and fun to say, its meaning is the best part of all: “a lucky find; a valuable discovery.” How sweet is that? Like finding a penny heads-up on the sidewalk!

Join us Saturday, April 14, 2018, from 8:30 am to 5:45 pm in Charlotte at the Marriott SouthPark Hotel for our 2018 Spring Symposium – A Saturday CME Event. Held in collaboration with the Mecklenburg County Chapter of the NCAFP, and hosted by program chair, Nichole Johnson, MD, this convenient one-day-Saturday conference means no lost office time and a great way to earn 8 AAFP Prescribed Credits. Attendees can count on a variety of 30 minute, 60 minute and 2-hour lectures combined with panel discussions and interactive-learning on several pertinent topics. Catch-up on schedule information, invited speakers and online registration options by visiting our conference website at www.ncafp. com/symposium.

Speaking of lucky finds, the NCAFP Meetings Department has several trouvailles in store for you in

If you’ve never attended our annual Mid-Summer Family Medicine Digest in Myrtle Beach, I can only

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The North Carolina Family Physician


Top-quality CME supports your commitment to providing compassionate, comprehensive care every day.

2018 Spring Symposium A Saturday CME Event Program Chair: Nichole Johnson, MD Held in collaboration with the Mecklenburg Chapter of the NCAFP

This year’s convenient Saturday CME opportunity equals no lost office time. Mark your calendars now & make plans to join us for this opportunity to earn approximately 8 AAFP Prescribed Credits. Topics include Chronic Pain, Depression, Women’s Health, Diabetes, Hypertension, Lipids, Direct Pay Models, Managed Care Contracting, & more.

SATURDAY, APRIL 14, 2018 8:30 AM TO 5:45 PM Charlotte Marriott SouthPark, Charlotte, NC

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

YOU’RE INVITED TO DINNER ~ APRIL 14 Immediately following the Symposium on April 14, the Carolinas HealthCare System Department of Family Medicine will honor Dr. Darlyne Menscer in recognition of her 30+ years of service. The dinner celebration will be held in the Terrace Ballroom of the Marriott SouthPark Hotel. A separate RSVP is required; contact Jennifer Robb at Jennifer.A.Robb@carolinashealthcare.org or 704.304.7125.

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ask, “What have you been waiting for?” This summertime CME favorite, with 30+ AAFP Prescribed Credits, is popular for several reasons. While excellent CME, relaxation, and fun are probably the top three; I’ve got another great reason: Half-day sessions that end by 1 pm each day! Or, in other words, spending sunny afternoons on the beach with family and friends! So, if splashing in the ocean, soaking up the sun and satisfying your CME requirements sound like your kind of conference, we invite you and your family to join us Sunday, July 8 – Thursday, July 12 at the Kingston Plantation and Embassy Suites in Myrtle Beach, SC. Program Chair, Lisa Cassidy-Vu, MD, and Program Vice-Chair, Slade Suchecki, DO, are planning a fantastic schedule of timely topics that everyone will enjoy. Visit our conference site at www.ncafp.com/msfmd for updates, hotel reservations, and online registration. Please note: This year’s Mid-Summer Family Medicine Digest conference dates are Sunday, July 8 – Thursday, July 12, 2018, and will not be held over the Fourth of July holiday.

Lastly, December includes a CME weekend like no other! Our annual Winter Family Physicians Weekend, scheduled for Thursday, November 29 – Sunday, December 2, 2018, in Asheville, NC, is the perfect kick-off to your holidays and a first-rate solution for your end-of-year CME needs. As the largest state-based meeting of its kind, it’s no wonder our attendee numbers continue to climb each year. Over 825 family physicians and primary care providers gathered in 2017 at the Omni Grove Park Inn for this spectacular combination of CME and camaraderie. Attendee comments below highlight a few great reasons as to why this annual meeting is a must for so many. “An excellent conference. Well-run, great mobile app. The variety of topics and quality of speakers make this a favorite CME opportunity.” “I think the event gets bigger and better every year. Nice tweaks to the check-in process with the kiosk. The mobile app is excellent, intuitive and time-saving. Has everything you need. Academy staff is without parallel. Great conference!”

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The North Carolina Family Physician


“This is a consistently excellent conference to go to and, I will continue to come here annually.” Consider this as your personal invitation to experience the Winter Weekend firsthand and for many of you, yet again! Save the dates and visit our conference site at www.ncafp.com/wpfw for updates, hotel reservations, and online registration information. When it comes to your CME needs in 2018, the NCAFP has you covered. Whether you require a convenient regional location, sand between your toes, mountain views in the mornings, or all the above, you can count on us. Our programs always include flexible schedules, timely topics by expert speakers, fun social activities, and clinical pearls (lucky finds!) for the perfect conference experience. Discover for yourself and make plans soon to join us for one (or all!) of this year’s terrific learning opportunities. If you have questions or need additional details, please contact me at Katkinson@ ncafp.com or via my direct office line (919) 214-9058. In closing, I have one last trouvaille from my Pinterest page to share. Meraki is a Greek word meaning “to do something with soul, creativity or love; to put something of yourself into your work; to do something with heart.” From someone who embraces her flawsomeness (just ask anyone in this office), I find Meraki to be a perfectly fitting description of what you as Family Physicians do every day within your communities. On behalf of the NCAFP, Thank You for what you do and best wishes for a terrific 2018. I hope to see you soon!

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Winter 2018


RESIDENTS & NEW FPs By Tracie Hazelett NCAFP Manager of Medical Student & Residency Relations

Asheville Winter Meeting Draws 82 Resident Members At the NCAFP Winter Family Physicians Weekend & Annual Meeting in Asheville last December, 82 family medicine resident members gathered, representing 13 North Carolina programs, and 3 out-of-state residency programs. During the Resident Section Business Meeting, the resident constituency received updates from the previously-elected 2017 resident board and council representatives. Updates included discussions from the Academy Board of Directors, the Foundation Board of Trustees, and the Academy’s council meetings structured to address the current strategic plan. Attendees engaged in open discussions regarding issues important to residents in North Carolina, including ways to be engaged in the advocacy process at local and state levels. As a result of these discussions, the NCAFP Board of Directors approved the following resident recommendation: The NCAFP will explore ways to increase opportunities and the ease with which residents can be engaged in the advocacy process. Examples of this might be to take legislators to residency programs; or, publishing navigation tools to help residents identify or develop advocacy opportunities in all parts of the state. Informational items provided to residents during the meeting included a review of grants and awards

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Left to Right: Seated: Dominique Sanchez, Megan Campbell, Sarah Barker. Standing: Landon Allen, Courtland Winborne, David Baker, Demetria Rawlinson, and Cara Hall

available through the AAFP Foundation and an update on NCAFP visits to residency program sites. During their meeting, the resident constituency elected new leadership to represent North Carolina’s Family Medicine residents and the NCAFP. A new Resident Director-Elect, two Foundation Board Trustees, and four council representatives were elected. Dr. Courtland Winborne, MPH (Cabarrus), rotated into the Resident Director role. Congratulations to the other newly-elected leaders: David Baker, MD (MAHEC-Asheville), Resident Director-Elect; Resident Trustees on the Foundation Board of Trustees are Sarah Barker, DO (Novant Health) and Megan Campbell, MD (Cabarrus). The four newly-elected Council Representatives are: Landon Allen, MD, MBA, MPH (MAHEC-Hendersonville), Practice Management; Cara Hall, MD (Duke), Medical Education; Demetria Rawlinson,

The North Carolina Family Physician


MD (CMC), Membership & Workforce; and, Dominique Sanchez, MD (UNC), Public Relations and Marketing. Congratulations and thank you in advance for your service! Awards Also taking place during the Winter Family Physicians Weekend each year is the recognition of Outstanding Resident Award winners. Each North Carolina Family Medicine residency program is given the opportunity to select a third-year resident for this annual award. Any third-year resident in a North Carolina program, civilian or military, is eligible for selection; however, recipients must be a member of the AAFP/NCAFP. Outstanding Resident Award recipients were invited to represent their program and were recognized during t h e St a t e - o f - t h e Academy Awards Luncheon held Friday, December 1st, 2017. The Academy requested programs reward mature, Family Medicine residents who demonstrate exceptional interest and involvement in Family Medicine and exemplify a balance of the

Winter 2018

qualities of a family physician. These qualities include: community service and social awareness, evidence of scholarly inquiry, caring and compassionate patient care, involvement in Academy affairs locally or nationally, balance between personal and professional activities and mature interpersonal and collegial skills. Although candidates might not exhibit strengths in every one of these identified areas, the resident is expected to recognize the qualities of compassionate patient care and peer relationships. The 2017 award winners include: Kelly Aguilar, MD (MAHEC-Hendersonville), Samuel Fam, DO (Duke), Jason Fishel, MD (CMC), Holly Hoey, MD (Wake Forest), Janelle Lindow, DO (Womack), Brittany Lloyd, MD (New Hanover), Juliana Oliveira, DO (ECU), Emily Peacock, MD (Cabarrus), Jazma Phelps, MD (Cone Health), Sterling Riddley, MD (Southern Regional AHEC), Rebecca Thomson, MD (MAHEC-Asheville) and Serena Zhou-Talbert, MD, MPH (UNC). Congratulations to these residents as they pursue excellence in the specialty of Family Medicine!

Left to Right: Front: Emily Peacock, Juliana Oliveira, Kelly Aguilar, Janelle Lindow, Brittany Lloyd, Dr. Tamieka Howell (NCAFP President). Back: Jason Fishel, Samuel Fam, Sterling Riddley, Rebecca Thomson. Not pictured: Holly Hoey, Jazma Phelps and Serena Zhou-Talbert

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STUDENT INTEREST & INITIATIVES By Erin Clark (OMS-III) Jerry M. Wallace School of Osteopathic Medicine at Campbell University

Learning to Step Out of Your Comfort Zone Health equity, implicit bias, and social determinants have been capturing attention in healthcare. We care about these issues in Family Medicine. In some ways, we are asking everyone else why they’re late to the party. Regardless of our historical success in addressing barriers to health in our communities, we need to continue making progress. We have a unique responsibility in Family Medicine to care for our patients as individuals and in the context of their family and environment. Family physicians are most likely to care for underserved populations, minority groups, and patients affected by health inequities -- we need to be equipped to do this well.

are well-intentioned, especially in medical students and family doctors who are stretched thin already and who might actually be experts in other areas where changes are needed. But a practice that we need to intentionally pursue in medicine is allowing ourselves to enter situations that will make us uncomfortable. I am a participant in the AAFP’s Emerging Leader Institute, a year-long leadership development program in which I have been equipped to effect change in my community. I chose to partner with Healing Transitions, a homeless shelter and residential addiction recovery program in Raleigh. Although I have not dealt with a substance use disorder, I felt a tug toward this organization. Actually, the tug I felt was away -- thinking to myself, “this could be messy.” I knew nothing about the organization, my comfort zone has been in health education and exercise interventions, and the idea of working with the stereotypical homeless drug addict intimidated me. I’ve been working with Healing Transitions for almost six months and making good progress. I have been volunteering at their onsite, outpatient clinic monthly, joining their weekly run club, and developing a program analysis to quantify the benefit of their organization to the Raleigh com-

Ms. Clark is a 3rd year medical student at Campbell University School of Osteopathic Medicine. At Campbell, she has been involved in her Family Medicine Interest Group (FMIG), has been a sports medicine volunteer at University athletic events, and volunteers at their student-run Community Care Clinic. Ms. Clark participated in the NCAFP’s Western Rural Health experience, has served as a student trustee on the NCAFP’s Foundation Board of Trustees, and during the 2017 AAFP National Conference, served as an Alternate Delegate for our chapter and as a reference committee member. In addition to her selection for the AAFP Foundation’s Emerging Leaders Institute, she has been appointed to serve as an AAFP FMIG Regional Coordinator. Ms. Clark received her Bachelor of Science degree in Kinesiology-Exercise with honors from the California Polytechnic State University in San Luis Obispo.

I am not underprivileged and do not identify as a minority, so I automatically have less credibility in this conversation. But I care, and so do others like me. The trap we fall into is thinking, “I don’t want to step on toes or offend anyone, so I’ll just stay out of it and let the experts handle it.” Most of the time those thoughts

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munity. I’ve been pleased with the tangible outcomes, but significant change is occurring in less obvious places. I’m learning to be more compassionate and better at listening. I am more careful with my words. My awareness of barriers to health in my community is increasing exponentially. Most signifi-

The North Carolina Family Physician


cantly, my perspective on caring for patients is changing.

2017-2018

“Patient-centered” is a phrase we often use in medicine, but its meaning is vague and dull from overuse. “Patient” is a generic person who will appreciate the inclusive language in our practice’s intake form. A patient in our practice is one who can’t afford glasses or maybe never learned to read. Thanks to my time with Healing Transitions, my instinct is to think of people as individuals rather than an entity of the group where they might identify. Generalizations and stereotypes don’t help us treat patients, personal relationships do. It’s a good thing that’s what we’re best at in Family Medicine. We can better serve our patients and communities by intentionally pursuing relationships with people or groups that might make us uncomfortable. These relationships can expose disparities and barriers, create opportunities for partnership, and give us real feedback on how to best communicate with people different than us. These relationships can help us address our own implicit bias in real time, often more effectively than any workshop we attend. Utilizing resources like the AAFP’s EveryONE Project and Duke’s REACH Equity Center, family physicians in North Carolina are in the perfect position to improve the health of our state. Equipped by these programs and in partnership with community organizations, we can use our relationships as ultimate vehicles for change.

Winter 2018

NCAFP STUDENT LEADERS: (Left to Right) Cameron Smith, Ally Mentock, Courtney Brooks, and Olivia Johnson

NCAFP Student Section Elects New Leaders At the NCAFP Annual Meeting last December, 155 medical students converged on Asheville. Students participated in educational sessions, business meetings and took advantage of several social and networking opportunities with other students, residents and physicians. A packed student section discussed opportunities available to students enrolled in NC medical schools, shared information about activities at each respective institution and elected new student leaders. Ally Mentock (Brody) will rotate to Student Director on the Academy Board of Directors; others elected to represent the medical student body of North Carolina are Cameron Smith (Campbell) Student Director-Elect; and, Student Trustees on the Foundation Board of Trustees are Courtney Brooks (Wake Forest) and Olivia Johnson (Brody). Congratulations!

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PROMOTING FAMILY MEDICINE

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 2nd/3rd year students at Duke, were 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 be selected to participate in these programs. Although the deadline for students to apply has passed, the NCAFP can use member help. We rely

FOUNDATION

Celebrate the End of Summer at the Foundation’s Family Medicine Gala! This fabulous evening at the Raleigh Convention Center will be filled with fun and laughter, food and spirits, and is sure to honor and inspire. Join the Academy to recognize, toast – and roast - AAFP’s 2017 National Family Physician of the Year, Dr. Karen Smith, for her remarkable contributions to her community and the specialty of Family Medicine. This will be the Foundation’s only fundraising event of the year and you won’t want to miss this highly anticipated night! Supporting the advancement of Family Medicine in North Carolina remains the mission of the Foundation. It fosters medical student interest in Family Medicine through valuable, first-hand clinical experiences and opportunities to help them experience and fully embrace the specialty. This is a key component to helping ensure the future of Family Medicine in North Carolina. Your participation helps. 100% of Gala proceeds will be used for NCAFP student interest initiatives.

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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 r esident 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: 919-980-5357. • June 3rd – 9th: Host homes only. Greenville, NC area • June 10th – 15th: Physician preceptors and host homes in any rural / underserved area but particularly central and eastern NC area • July 15th – 22nd: Host homes only. Hendersonville area • July 22nd – 28th: Physician Preceptors and host homes in rural /underserved Western NC area

Tickets and sponsorships for this glamorous, black-tie-optional event are available now, don’t delay! Individual tickets are $150.00 and sponsorships begin at $1000.00. We know schedules are busy at this time of year, if you can’t make it but want to show your support, send a medical student instead! Or, simply make a contribution instead to show your support of the Foundation’s student interest initiatives. There is truly a way for everyone to show their support and contribute to this crucial cause, no matter the amount. For more details please visit www.ncafp.com/fmgala. Or contact Tracie Hazelett @ the NCAFP via telephone at (919) 980-5357 or by e-mail at thazelett@ncafp.com

Saturday, August 25, 2018 6:30 pm to 10:00 pm Raleigh Convention Center 500 S. Salisbury Street – Raleigh, NC 27601 Want to make it a weekend-getaway? Stay in our discounted room block at the Raleigh Marriott Center (conveniently connected to the Convention Center). Visit www.ncafp.com/gala for hotel information and to make your reservation in the NC Family Medicine Gala room block no later than July 27th.

The North Carolina Family Physician


- UPCOMING -

May 1st Deadline for NCAFP Foundation Family Medicine Scholarship Program The North Carolina Academy of Family Physicians Foundation has established a program to provide medical students considering careers as family physicians up to $5,000.00. All applications will be reviewed

Noteworthy AAFP Deadlines for Medical Students and Residents • March 1st: Emerging Leaders Institute. This year-long leadership development program is for students and residents. More details, requirements, and the application can be found on the AAFP Foundation’s website at: www.aafpfoundation.org If you would like to be connected to a student or resident already participating in this program, please contact Tracie Hazelett at thazelett@ncafp.com.

by a scholarship committee. Awardees will be selected based on sincere interest in the specialty of Family Medicine, leadership and community service characteristics, and some consideration given to financial need. Medical students in their 3rd or 4th year of medical school effective 8/1/2018 are eligible to apply. Notifications to scholarship recipients and disbursements will be made in the fall. For full details, or to apply, please visit: www.ncafp.com/students. • April 1st: 2018 National Conference Poster Competition. Medical students and Family Medicine residents are invited to share their innovative and effective educational programs and unique community projects. Submit your research and network with medical students and residents with similar interests in Kansas City this summer! Full details can be found at: www.aafp.org/nc • May 1st: Travel scholarships to the 2018 National Conference. Multiple categories. Full info and application at www.aafp.org/nc/scholarships.

About the Guest of Honor Sponsorship The Foundation is seeking Gala sponsors. If you would like to commit vital sponsorship support for this event to build student interest in Family Medicine please visit: www. ncafp.com/fmgala or contact Tracie Hazelett at NCAFP offices, at thazelett@ncafp.com or 919-980-5357.

Winter 2018

Dr. Karen Smith lives and practices in Hoke County. She operates a solo private practice in a small town called Raeford, where she has made it her life’s work to improve patient lives and make this small, rural, North Carolina town a healthier place to live, work and play. Dr. Smith’s efforts were recognized when she was named the 2017 AAFP National Family Physician of the Year. At that time, everyone else learned what we already had the privilege to know, that she is a rural family doc rock star who relentlessly pursues the use of technology and innovation to operate her private practice. In addition to her varied professional and community roles, Dr. Smith is a wife and mother to four children. Dr. Smith, received her Bachelor of Science degree from Duke University, her medical degree at Hahnemann University School of Medicine in Pennsylvania, then returned to Duke University, where she completed her residency at the Duke SRAHEC program in Fayetteville, NC. Dr. Smith is a Past President of the NC Academy of Family Physicians and has also served on the NCAFP Board of Directors. She currently serves as the Chapter delegate to the AAFP Congress of Delegates.

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PRACTICE MANAGEMENT By George Jeter, Public Information Officer Department of the NC Secretary of State

NC a National Leader in Fighting Rogue Internet Pharmacies You Can Help Educate Your Patients

“This is a major problem,” Secretary Marshall said. “Prescription counterfeiters put people’s health at risk by not delivering the promised dosage of medicine or by adding who knows what to make that pill look right. They also collect personal and credit card information that opens the door to identity theft.” To focus energy on this problem, Secretary Marshall created the Secretary of State’s Advisory Council to Combat Counterfeit Medication, composed of national partners, such as the Center for Safe Internet Pharmacies, and state partners including the NC Academy of Family Physicians, the NC Medical Board, the NC Association of Pharmacists, and the NC Board of Pharmacy, among others.

NCAFP member Dr. Garett Franklin still remembers his “Aha! moment” when a patient asked him to send a prescription to a pharmacy he had never heard of.

The Council promotes the VerifyBeforeYouBuy.org website. It gives physicians and patients a tool to test online pharmacy sites to make sure they are legitimate. The site’s key feature is a search engine where consumers can copy and then paste in the URL or internet address of an online pharmacy site to find out if it is real and legally selling prescription medicine to customers in the United States.

“Fortunately, it happened right as NCAFP was asking me to get involved with the NC Secretary of State’s campaign to alert doctors and patients to the dangers of fake online pharmacies,” Dr. Franklin recalls. “I put in that pharmacy name and bingo—it came back as a rogue one. My patient had found it online and liked the advertised prices.”

For free patient information cards for display in your office, please contact the NCAFP offices at (919) 833-2110. You are encouraged to remind patients to ask for prescription assistance programs if they are looking for lower prices and, above all, to make sure they are buying from a legal, legitimate pharmacy.

Every year, more people turn to the internet in hopes of finding a good deal on prescription medicines. But in the vast majority of cases, they are looking at “rogue” pharmacy sites selling questionable substitutes and outright fake medicines. “The sad truth is that most online pharmacy sites are to one degree or another, scams,” North Carolina Secretary of State Elaine F. Marshall explains. The U.S. Food and Drug Administration has estimated that about 97 percent of them are illegitimate.

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The North Carolina Family Physician


PRACTICE BRIEFS Adolescent MCV Vaccination Requirements will Change in 2020 to Require Booster Dose Beginning August 1st of the 2020 school year, North Carolina high school seniors will be required to have a second booster dose of Meningococcal Conjugate vaccine (MCV.) This change was made in 2014 to more closely align North Carolina’s requirements with the current Advisory Committee on Immunization Practices (ACIP) recommendations. Physicians and practices should note that if their 16-17 year old patients had originally received their first MCV dose on or after the 16th birthday, the booster dose is not required. Look for additional information on this requirement in the coming months; it’s never too early to start to prepare.

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Avoid MIPS-Understandings Do not get stuck with a 4% reduction in Medicare payments in 2019. North Carolina Area Health Education Centers (NC AHEC) across the state are working together to help small practices understand and enroll in the Quality Payment Program (QPP). The NC AHEC’s practice support team understands the challenges in navigating the requirements of the new CMS Quality Payment Program. Their experienced practice transformation coaches are located near you to provide answers and guidance in being successful in the QPP Merit Based Incentive Program (MIPs). Visit ncahec. net/practice-support/what-we-do/ to apply for on-site services from your local NC AHEC practice support team, or you can call 919445-3508, or e-mail QPPsupport@ncahec.net for more options.

Medicaid to Pay Vaccine Underpayments by End of June North Carolina Medicaid Director Dave Richard reported in the General Assembly’s Joint Legislative Oversight Committee for Health and Human Services this January that the agency plans to pay vaccine underpayments by the end of June 2018. The payments are the result of last year’s successful lawsuit by the NCAFP, the NC Pediatric Society, and several pediatric practices that sought to recoup approximately $10-12 million of underpaid vaccine administration fees from 2013-14. Family Medicine practices and physicians who may be owed payments do not need to act. DHHS is identifying all codes that were underpaid and will remit the difference directly to each effected practice.

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Winter 2018


Inaugural Address, from pg. 7

Be an upstander like Dr. Chuck Rich, from Bladen County, who has dedicated many thankless hours locally and nationally to advocate for us, for you as family physicians, as Medicaid providers and for our Medicaid populations. Or an upstander like Dr. Jessica Triche in the community of Bath, NC, who helped to organize a vigil against hate and racism, and to be a voice for the victims of Charlottesville. And is modeling that for the future, for her sons. Don’t be a bystander. Be an upstander. Be an upstander like Dr. Rhett Brown, from Charlotte, who works to make sure that transgender patients get the treatment, both socially and medically, that they need to live a full life. Or like my 3 kids who advocate for a later bedtime. They believe it is a positive change. But sometimes you live in a dictatorship. Chrisette, Myles, Corinne…Keep trying, you never know what persistence will bring. Or be an upstander like Dr. Shannon Dowler, from here in the mountains of NC, who has spent time on Capitol Hill advocating for community health center funding to create more residency slots in teaching heath centers.

Commit to being an upstander like Dr. Jim Jones in Hampstead, NC, a career-long advocate for Family Medicine, who has worked for the improvement of health in our rural and underserved communities since some of you were in medical school, high school, diapers or even a twinkle in your Mother’s eye. It doesn’t matter how far in your career you have come. You can be an upstander at any stage.

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In many ways, doesn’t being an upstander sound a lot like us? Like family physicians?

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difference in the world by speaking out against injustice and creating positive change.

it too, like Dr. Alexa Mieses, who as a student served on the New York State AFP Public Health Commission and now as a Resident at Duke, has authored a resolution at the AAFP’s leadership conference to help strengthen the pipeline for minorities in medicine.

In closing, let’s work to rid our communities of the social and moral deficit. Unite and build bridges with those that have differing ideas, but a common goal. And be an upstander for your practice, your patients, your community. For Family Medicine. Take action in your office, take action in your neighborhood, take action in your city, take action right here in the North Carolina Academy of Family Physicians. Let us unite. No matter who you are. No matter with which side of party lines you identify. No matter the color of your skin. Let us unite. No matter your sexual orientation, no matter with which religion you identify or the size of your paycheck. We can all unite and be upstanding. We can be upstanders for ourselves, our profession and for our patients. We must choose to be united and upstanding and create positive change for Family Medicine.

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