NC Family Physician, Spring 2018

Volume 14 Issue 2 • Spring 2018

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

Listening Leads to

Change

Who’s ready for summertime fun?

Join us at the beach for a week of top-quality CME ending at 1 pm each day Final Mid-Summer Family Medicine Digest CONFERENCE & EXHIBITION 30+ AAFP Prescribed Credits Program Chair: Lisa Cassidy-Vu, MD • Program Vice-Chair: Slade Suchecki, DO

TENTATIVE TOPICS INCLUDE: HIV Oral Health Atrial Fibrillation Asthma

Diabetes Adolescent Depression Eating Disorders Pediatric Rashes

Lipids Opioid Crisis in Teens Hypertension Obesity

PRACTICE MANAGEMENT TRACK Telemedicine • CPT Coding • Patient Attribution • Alternative Practice Models • Wealth Management

OPTIONAL SESSIONS Women’s Health Symposium (CME), KSA Study Working Group Opportunity on Heart Failure (CME), & Treatment Options for Osteoarthritis of the Knee (Non-CME) NEW DATES THIS YEAR!

SUNDAY, JULY 8 – THURSDAY, JULY 12, 2018 Kingston Plantation/Embassy Suites • Myrtle Beach, SC

CME | Camaraderie | Networking | Family Fun www.ncafp.com/msfmd

Inside Spring 2018

The 2017 NCAFP Annual Report P. 11

PRESIDENT’S MESSAGE

RESIDENTS & NEW FPS

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24

Listening Leads to Change

Family Medicine: We Do More Than Most Realize

CHAPTER AFFAIRS

STUDENT INTEREST & INITIATIVES

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26

Leading The Way for Our Members

Record MATCH Year for North Carolina!

MEETINGS & CONFERENCES

PRACTICE MANAGEMENT

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Last Chance for Summertime By The Sea

Tax Law Changes for 2018: Prepare Now for Big Changes in Taxes

PUBLISHED BY

DEPARTMENTS

t 919.833.2110 •

fax

919.833.1801 • ncafp.com

Managing Editor & Production Peter Graber, NCAFP Communications

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President’s Message 4 Chapter Affairs 8 Membership 9 Meetings & Conferences 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. Tamieka M.L. Howell 2017–2018 NCAFP President

Listening Leads to Change In the ever evolving world of medicine, the NCAFP makes every effort to keep its operations current based on issues that can affect physicians’ licenses, practices, knowledge, and reimbursement. Recently, we surveyed you, the members, to find out how the Academy can best support YOU. You Talked, We Listened In December 2017, a member survey was conducted to find out what physicians felt we were doing well and how we could improve. We also wanted to know which activities, supported by the Academy, are important to the members and in what areas of knowledge and engagement do members want access to additional resources. Additionally, through individual interviews, we sought input from members and non-members, both experienced and recently-graduated. We spoke with physicians from varying practice settings, including direct primary care, academic, employed, and independent. We also included surveys of our resident members.

Here are the major highlights that resulted from the survey and interviews: • There is a continued shift away from group practices toward hospitals / health systems with fewer physicians having equity in practices.

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• Potential changes in payment are a major area of concern, although many are participating in ACOs or value-based payment arrangements.

• The administrative burden from payers is a top area of frustration for family physicians.

• NCAFP is well-regarded but there are areas for improvement in the future. There are opportunities to:

- Improve information flow about NCAFP advocacy efforts beyond legislative/regulatory affairs.

The North Carolina Family Physician

2017-2018

NCAFP Board of Directors

- Build a stronger bond with our members by focusing on

ways the NCAFP can uniquely address the needs of family physicians.

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

- Communicate to our members in ways that are more relevant and convenient.

With help from the consulting firm of Walk West, we were able to conduct a SWOT analysis, review our avenues for communication, and see how we compare to similarly-run academies and compare and contrast what has been working well.

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

From this analysis, three general themes emerged: 1) The need to rebuild the excitement of family medicine across all practice settings by: • Improving the practice environment by providing education on different practice styles, as well as opportunities to enhance practice efficiencies and effectiveness.

• Increasing networking opportunities and support for NCAFP members.

At-Large Talia M. Aron, MD IMG Physicians Brian McCollough, 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)

• Help family physicians thrive (not simply survive) by promoting physician health and wellness and preventing burnout

Resident Director-Elect David S. Baker, MD (MAHEC-A)

• Engaging patients as advocates for family medicine.

Student Director Allyson Mentock (BSOM)

• Celebrating successes and accomplishments of family physicians by telling the stories of our members.

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

• Encouraging mentorship, teaching and community engagement.

• Providing quality education that impacts patient care and the practice of family medicine.

2) The need to strengthen the influence of Family Physicians with payors and health systems • Decrease the administrative burden faced by family physicians in their day-to-day practice lives.

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

• Improve access to ancillary staffing for family physicians, such as scribes, medical assistants, behavioral health Continues on next page

Spring 2018

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2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607 www.ncafp.com

professionals, and other team members.

• Advocate for a broad scope of practice for family physicians.

• Increase the number and influence of practicing family physicians in administrative roles within health systems and payers.

2 Payer and System Advocacy - To focus on payer outreach and advocacy, advocacy and outreach in hospital and other health care systems, and legislative affairs along with general public relations.

3 Workforce Pipeline - This includes the work of our Foundation, our current work with students and residents, and additional activities to encourage students at all levels to consider careers in family medicine.

• Empower family physicians to be voices for themselves and their patients.

• Build opportunities for regional networking among physicians employed by various systems in that region, as well as independent practicing physicians.

PARTICIPATE IN NCAFP’S REVISED COMMITTEE STRUCTURE Submit by June 8th, 2018

3) The need to bolster the family physician pipeline • Encourage systems, payers and others in NC to incentivize teaching and mentoring.

• Develop opportunities for members to provide education to school-age children, college students and medical students about family medicine, with particular emphasis on underserved areas.

• Highlight existing family physician mentoring and teaching efforts.

• Provide opportunities for residents and younger physicians to learn about job opportunities in family medicine.

• Modify existing student programs based on evaluation data and workforce needs.

• Increase resident engagement.

Once all of this was compiled, the leadership has reorganized our family medicine councils into 3 new categories: 1 Members Satisfaction and Practice Environment Designed to address issues related to membership, education and practice management.

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With the revised committee structure, the NCAFP is now seeking nominations for committee members. All committee members will be selected on a rotating term basis by the NCAFP Nominating Committee. Each committee will consist of 8 to 12 NCAFP members, including at least one student, one resident, one past president, one new physician (out of residency fewer than seven years), one current board member, and 5 to 7 at-large members. Committees will meet in-person at least twice annually and by conference call/web conference at least once annually.

Individuals interested in serving on one of these three key committees, should submit a short statement of interest and your CV to NCAFP EVP Greg Griggs at ggriggs@ncafp.com no later than June 8th, 2018

None of these commissions can be successful without you, the members. We encourage you to apply to serve with one these groups to allow input from a wide variety of those that the NCAFP serves. Most groups generally meet in person 2-3 times a year, with 1-2 phone conferences per year. Students and residents are also encouraged to apply. Additional information can be obtained by calling the Academy Executive Vice President Greg Griggs at 919-833-2110 or on the NCAFP website at www.ncafp.com.

The North Carolina Family Physician

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7 12/2/14 3:02 PM

CHAPTER AFFAIRS

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

- YOUR ACADEMY IN ACTION -

Leading the Way for Our Members Recently I received an e-mail from one of our members that reminded me just how often the NCAFP is taking leadership on behalf of our state’s family physicians.

Dr. Tom Koinis, one of our past presidents, sent me an update from the NC Immunization Advisory Board, on which he serves. His summary of the meeting talked about both state and federal updates.

For example, in his notes from the meeting, Dr. Koinis talked about Shingrix, a relatively new shingles vaccine that has been approved by FDA and recommended by ACIP for individuals age 50 and up. His notes also talked about how 653 practices covering 2,731 individual providers now use the NC Immunization Registry, something the NCAFP highly recommends.

While it was great to get the update from Dr. Koinis, it also reminded me of the reach of your Academy in action. Dr. Koinis is just one example of how NCAFP’s involvement keeps family physicians at the forefront of public health, public policy and more. He got involved at the state level during his years of leadership with NCAFP, and he has stayed involved, even serving on a few national committees. Other past and current family medicine leaders are involved at the state level in areas such as Stroke Prevention and Treatment, Cancer Control,

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Tobacco Cessation and more.

In recent years, the NCAFP has tried to take a significant leadership role in Medicaid Reform, trying to shape the policies that will ultimately impact how Medicaid managed care is implemented in our state. While we had opposed managed care altogether, once the Legislature decided to move in that direction, our job became to shape the new policies to benefit you and your patients as much as possible. So, what are some of the ways we are doing that?

First and foremost, there are family physician leaders throughout a series of work groups that were appointed by the Medical Care Advisory Committee, a federally-mandated committee that advises the state Medicaid program. For example, family medicine leaders on various subcommittees charged with providing input on implementation of managed care include: • Network Adequacy Subcommittee: Robert L. (Chuck) Rich, Jr, MD • Managed Care Quality Subcommittee: Jason Foltz, MD; Michelle F. Jones, MD; Eugenie Komives, MD; J. Thomas Newton, MD; Robert L. (Chuck) Rich, Jr., MD; • Beneficiary Engagement and Outreach Subcommittee: Marilyn Pearson, MD • Credentialing Subcommittee: Myself, Gregory K. Griggs, MPA, CAE This is not the only way that the NCAFP has remained engaged with Medicaid Reform either.

Your Executive Committee has submitted comments on numerous concept papers that the state Medicaid Program has released over the past several months, including: • Care Management and Advanced Medical Home Strategy for Under-Managed Care

The North Carolina Family Physician

• Network Adequacy and Accessibility Standards • Behavioral Health and I/DD Tailored Plans • And more.

As we inch closer to Medicaid Managed Care, look for ongoing updates on how these changes could impact your practice and tools for moving forward.

Every day, your staff and volunteer leaders are working hard to make the voice of family medicine strong and loud. We don’t win every battle, but we are there in the trenches fighting for you and your patients every step of the way.

Most recently, we’ve undertaken an effort to meet with a number of our private-sector healthcare payers, particularly about the administrative burdens faced by our members on a daily basis.

These have included conversations with Blue Cross and Blue Shield of North Carolina, Humana, and United to name a few. Our unified message: payers must value primary care/family medicine more in their payment structures and remove the administrative roadblocks to providing high quality care.

Some of these areas will likely receive even more attention in the future, as the NCAFP implements a new strategic plan. As I write this column, we are analyzing additional data from the Member Needs Assessment and Environmental Scan to present to our Board in mid-April. But know one thing – we are listening and trying to address your concerns.

Spring 2018

MEMBER BRIEFS

Two Family Physicians Receive State’s Prestigious Order of the Long Leaf Pine Award NCAFP Past President Dr. Robert Shackelford NCAFP Past President Dr. Robert Shackelford (‘65), was presented with the Order of the Long Leaf Pine in early April in Mount Olive. Dr. Shackelford practiced family medicine in Mount Olive from 1949 until 2013 and was heavily involved in both state and national affairs during his lengthy career. Pictured above from the presentation ceremony are Drs. Kevin Talton, Shackelford, and Opey Jeanes who spearheaded his nomination. Also pictured is Ms. Carol Dilda who worked with Dr. Shackelford for many years at Mount Olive Family Medicine Center. Congratulations!

NCSU Team Physician Dr. Mary Bengtson Dr. Mary Bengtson, a family physician with North Carolina State University since 1984, was presented with the Order of the Long Leaf Pine Award in late January. Dr. Bengtson earned her Doctor of Medicine from Southern Illinois University School of Medicine and completed her Family Medicine residency at Deaconess Hospital in Evansville, Indiana. She is Board-certified by the ABFM and holds a Certificate of Added Qualifications in Sports Medicine. Dr. Bengtson has served as team physician for Wolfpack Women’s Basketball for the past 34 years. Congratulations!

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NCAFP

Sights & Scenes

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The North Carolina Family Physician

THE

2017 Annual Report

The State of the Academy It gives me great pleasure to report that our Academy is strong and continues improving with each passing year. Showcased here are our many accomplishments in 2017. From a major legal ruling that helped family physicians statewide, to our members’ leadership in advancing family medicine at almost every level, 2017 brought many positive developments.

Charles W. Rhodes, MD 2016-2017 NCAFP President

Throughout 2017, our Academy was a ferocious advocate for family medicine. We fought and debated in the courtroom, the board room, at the state Legislature, and across countless other venues. Family medicine’s input on key legislation and policy had a direct impact on issues like concussion screening, the opioid epidemic, how Medicaid managed-care may be implemented in North Carolina, and practical matters like the administrative burdens you face every day. I’m proud to report we made progress.

The Academy’s #1 goal is to be the very best advocate for family physicians and strive to improve the practice of family medicine for all members. We waged this fight on multiple fronts in 2017, and I’m proud to have helped lead our efforts. Our members responded like never before, and it’s an experience with which I am truly grateful.

This report outlines a number of our victories for family medicine in 2017.

2016-2017 NCAFP Board of Directors Executive Officers

Medical School Representatives

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

Directors District 1 District 2 District 3 District 4 District 5 District 6 District 7

Mackenzie Smith, MD Gilbert Palmer, MD Eugenie M. Komives, MD Shauna L. Guthrie, MD, MPH Dimitrios “Taki” P. Hondros, MD Cody A. Wingler, MD 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 FM 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)

Chair (UNC) Representative (Campbell) Representative (Duke) Representative (ECU) Representative (Wake)

Cristen P. Page, MD Nicholas Pennings, DO J. Lloyd Michener, MD Chelley Kaye Alexander, MD 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 NCAFP Family Medicine Councils Advocacy Council

Thomas R. White, MD, Chair Garett Franklin, MD, Vice-Chair

CME Council

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

Membership & Workforce Practice Management Council Public Relations & Marketing

Benjamin Simmons, MD, Chair Shauna Guthrie, MD, MPH, Vice-Chair Thomas Wroth, MD, Chair Slade Suchecki, DO, Vice-Chair William A. Dennis, MD, Chair

National & International Family Medicine Leadership

Benjamin F. Simmons, III, MD Charlotte, NC Elected 2017-2018 New Physician Member, AAFP Board of Directors

Alexa Mieses, MD, MPH Durham, NC

Elected 2017-2018 Resident Member, AAFP Board of Directors

Karen L. Smith, MD, FAAFP Raeford, NC

2017 AAFP National Family Physician of the Year; Appointed as Chair, AAFP Commission on Governmental Advocacy

Elizabeth F. Baxley, MD Greenville, NC

Viviana Martinez-Bianchi, MD, MPH Durham, NC

2017-2018 Chair, American Board of Family Medicine

2016-2018 WONCA Executive Committee Member-at-Large and World Health Organization Liaison

Warren P. Newton, MD, MPH Chapel Hill, NC

Beat Steiner, MD, MPH Chapel Hill, NC

Named Incoming Chief Executive Officer, American Board of Family Medicine

Elected 2017-2018 President-Elect, Society of Teachers of Family Medicine

Membership Growth Two-Year Comparison

Resident Members

Dec. 31, 2016

Student Members Active Members

Life Members

Dec. 31, 2017

Active 2464 Supporting 9 Life 271 Inactive 25 Students 910 Residents 304

2503 10 294 28 959 318

Total

4,112

3,983

NCAFP Membership Recognitions 2017 Top AAFP XL Chapter for Retention of Active Members

(NCAFP 96.6% vs AAFP 93.8%)

2017 Top AAFP XL Chapter for Market Share (NCAFP 87.5% vs AAFP 76.9%) 2017 Top AAFP XL Chapter for Highest Percent Increase in Student Members 2017 Runner-Up AAFP XL Chapter for Retention of New Physicians

(NCAFP 93.3% vs AAFP 87.3%)

2017 Runner-Up AAFP XL Chapter Resident-to-Active Member Conversion 100% Resident Membership Recognition

(NCAFP 84.3% vs AAFP 72.3%)

Continuing Medical Education Meetings & Conferences 56th Annual Post-Graduate Symposium Jewell P. Carr, MD – Program Chair 8.25 AAFP Prescribed Credits 58 Registered Attendees

79+ AAFP Prescribed Credits Presented Total NCAFP CME 1,073 Conference

attendees

2017 Mid-Summer Family Medicine Digest Jewell P. Carr, MD – Program Chair 33.00 AAFP Prescribed Credits 186 Registered Attendees 26 Exhibitor Displays

$1,103,255

2017 Winter Family Physicians Weekend Dimitrios “Takie” Hondros, MD – Program Chair Lisa Cassidy-Vu, MD – Program Vice-Chair 37.75 AAFP Prescribed Credits 829 Registered CME Attendees 76 Exhibitor Displays

in grant funding that enabled the NCAFP to educate over 6,747 AAFP members across the country

2017 NC Family Physician of the Year R. Kevin Talton, MD, Mount Olive, NC Dr. R. Kevin Talton was recognized for demonstrating excellence in how a family physician compassionately serves both patients and families, yet also their entire community and beyond. Born and raised in the same town he practices, Dr. Talton was lauded for combining compassionate and adept clinical skills with community leadership and service. Dr. Talton earned his medical degree at the Brody School of Medicine at East Carolina University and went on to complete residency training through a joint program of Pitt County Memorial Hospital in Greenville and Sampson Regional Medical Center in Clinton.

Fighting for Family Medicine Practice Advocacy • Successsful in legal action that awarded state’s family physicians and pediatricians $6.74 per affected vaccine as administered to Medicaid patients during 2013-2014.

• NCAFP leaders engaged multiple insurance plans to advocate for better payment and less administrative burden for family physicians.

Regulatory & Legislative • Significant Input on legislation surrounding concussion screening and return-to-play protocols • Provided significant input into Strengthen Opioid Misuse Prevention Act of 2017.

Health of The Public • Successful in advocating for funding increases for statewide youth tobacco prevention and North Carolina’s Healthy Corner Store Initiative designed to address food deserts.

• Promoted NC Secretary of State’s Verify Before You Buy consumer safety campaign fighting rogue, web-based pharmacies

Financial Summary Our Academy continues to be financially sound.

Net Assets:

$3,166,857

2017 Revenues and Support:

$2,282,098

2017 Direct Financial Support to Residents and Students:

$118,953

Investing in Medical Students The NCAFP Foundation continues to work hard to promote family medicine through direct student experiences. In 2017, student experiences included early clinical exposure to rural family medicine, mentoring experiences, travel stipends to attend state and national conferences, implementation of the research poster contest, support to Family Medicine Interest Groups for on-campus activities and opportunities to develop leadership skills by serving on one of our two boards or completing a policy and leadership rotation with the NCAFP. The NCAFP Foundation’s financial investment is also made evident through the Foundation’s Family Medicine Scholarship program. Together, these initiatives reach hundreds of students in North Carolina.

2017 by the Numbers •

$1,207,245 balance of the Medical Student Endowment, effective 12/31/17

•

$118,000+ in direct financial support provided to students and residents

•

Over $28,000 raised for the Foundation via the raffle fundraiser and individual contributions made by NCAFP members, family and friends

•

13.15% record Match rate with 81 North Carolina medical students choosing to enter family medicine. This rate compared to the 2017 national average of 8.8% entering family medicine

•

959 NCAFP Student members at the end of 2017 (compared to 910 year-end 2016)

2017 NCAFP Foundation Leadership President Vice-President Secretary-Treasurer Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Physician Trustee Academy President Academy President-Elect Corporate Trustee Corporate Trustee Resident Trustee Resident Trustee Student Trustee Student Trustee Trustee Emeritus

L. Allen Dobson, Jr., MD, FAAFP Shannon B. Dowler, MD, FAAFP William A. Dennis, MD Lisa A. Cassidy-Vu, MD Garett R. Franklin, MD Cherrie C. Hart, MD R. Aaron Lambert, MD, FAAFP David E. Lee, MD Holly L. Stegall, MD Tom Wroth, MD Charles W. Rhodes, MD, FAAFP Tamieka M.L. Howell, MD Steve Parker John R. Smith, MD D. Landon Allen, MD, MPH, MBA Brian Antono, MD, MPH Erin E. Clark M. Elizabeth Ferruzzi Maureen E. Murphy, MD, FAAFP

Dr. Talia Aaron Dr. Chelley Alexander Dr. Landon Allen Dr. Brian Antono Mr. Carl Baker Dr. Elizabeth Baltaro Dr. Andrea Barkley Dr. Elizabeth Baxley Dr. Mary Bengtson Dr. Holly Biola Mr. Gary Bossert Ms. Shastra Brantley Dr. Rhett Brown Ms. Amanda Burton Dr. William Byars Ms. Marianne Campbell Dr. Jewell Carr Dr. Lisa Cassidy-Vu Dr. Stephen Causey Dr. Eric Chen Dr. C. Franklin Church Ms. Elizabeth Clark Ms. Erin Clark Ms. Julia Clark Dobel Dr. Randy Clinch Dr. Wendy Coin Ms. Andie Cozzarelli Ms. Alyssa D’Addezio Ms. Sheri Dailey Dr. Christopher Danford Mr. David Davidson Mr. Richard Davies Dr. Linda Davis Ms. Priscilla Davis Dr. Stephen Davis Dr. William Dennis Dr. Andrea DeSantis Dr. Ben Dieter Ms. Amy Dillon Dr. Allen Dobson Dr. Shannon Dowler Ms. Carolyn Dunn Dr. Kawanta Durham Dr. Howard Eisenson Dr. Thomas Ellis Dr. Erin Ennis Dr. Kelly Fedoriw Ms. Elizabeth Ferruzzi Dr. David Fieseler

Foundation Contributors NCAFP members and supporters of the Academy are encouraged to make gifts of on-going significance or annual contributions to the NCAFP Foundation. The following individuals contributed to the Foundation in 2017. Thank you for your continued support.

Dr. Conrad Flick Dr. Garett Franklin Mr. Connor Fredrickson Dr. David Fredrickson Dr. Ashleigh Freeman Dr. Cammie Fulp Dr. Donald Goodman Mr. Gregory Griggs Dr. Shauna Guthrie Ms. Nancy Guy Dr. Wayne Hale Dr. David Hall Dr. Mazen Hamad Ms. Bertha Hambridge Dr. Scott Harper Dr. Michael Harris Dr. Cherrie Hart Dr. Jessica Hart Mr. Brent Hazelett Ms. Tracie Hazelett Dr. Lori Heim Ms. Sherri Henderson Dr. Mark Hester Dr. Mark Higdon Dr. Courtney Hinton Dr. Dimitrios Hondros Mr. Mike Hou Dr. Tamieka Howell Dr. Laura Hubbard Dr. Ronald Hughes Dr. Matt Jaeger Dr. Nichole Johnson Dr. Michelle Jones Ms. Shawna Jones Dr. Matt Kanaan Dr. Jarrod Kanady Dr. William Kane Dr. Victoria Kaprielian Dr. Christina Keiger Dr. Richard Kennedy

Dr. Thomas Kirtley Dr. Thomas Koinis Dr. Eugenie Komives Dr. Hervy Kornegay Dr. Robert Lambert Dr. Thomas Lareau Dr. Kelley Lawrence Dr. David Lee Ms. Gail Leppla Dr. Susan Lester Ms. Sara Lincoln Dr. Yvonne Lowne-Chase Ms. Kimberly Mallin Dr. John Mangum Dr. Shannon Masneri Dr. Alfred May Dr. Brian McCollough Dr. James McNabb Dr. Darlyne Menscer Ms. Ally Mentock Dr. Paul Meyer Dr. John Mitchell Dr. Jennifer Mullendore Dr. Maureen Murphy Dr. Alisa Nance Dr. Laura Neece-Baltaro Dr. Tommy Newton Dr. Katie Notaro Dr. Gilbert Palmer Mr. Stephen Parker Dr. Nicholas Pennings Dr. Myron Petruska Dr. Robert Poetta Dr. Lara Pons Ms. Amber Popham Dr. Catherine Rainbow Dr. Charles Rhodes Dr. Robert Rich Dr. Kendra Richardson Dr. David Rinehart

Ms. Sandy Robertson Ms. Amber Rowe Dr. Lloyd Runser Mr. Jason Sandner Mr. James Schindler Mr. Robert Schmid Mr. Shawn Scott Dr. Elizabeth Sergile Dr. Alyssa Shell Dr. Jim Shepherd Dr. Benjamin Simmons Dr. Nadine Skinner Dr. David Slawson Dr. H. Lee Smith Dr. John Smith Dr. Karen Smith Dr. Mackenzie Smith Dr. Richard Smits Dr. Christopher Snyder Mr. David Sousa Dr. Jessica Staton Dr. Holly Stegall Dr. Erika Steinbacher Mr. John Still Dr. Chris Street Dr. John Stringfield Dr. Slade Suchecki Dr. Lara Surles Dr. David Swayne Dr. William Taylor Dr. James Thompson Dr. Rebecca Thomson Dr. Miranda Turner Dr. Eugene Wade Dr. Erin Wagner Ms. Annette Wallwork Dr. Ricky Watson Dr. Jana Watts Dr. Martha Welch Dr. Alexandra Werner Dr. Thomas White Dr. Gustov Wilde Dr. Patrick Williams Dr. Courtland Winborne Dr. Glenn Womack Dr. Tom Wroth Dr. Brian Wysong Dr. Cynthia Young Dr. Christopher Zagar

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PROFESSIONAL DEVELOPMENT

By Kathryn Atkinson, CMP NCAFP Manager of Meetings & Events

Last Chance for

Summertime CME by the Sea

W

hile he won’t physically be there … Geoffrey Chaucer just might be at this year’s Mid-Summer Family Medicine Digest … in spirit.

You may be wondering why I would reference the Father of English Literature in an article about this year’s Mid-Summer Family Medicine Digest. Well, like the famous poet once said, “All good things must come to an end.” And, after 30+ fantastic years of CME by the sea, this year’s 2018 Mid-Summer Family Medicine Digest will be the last regularly scheduled annual summer conference for the NCAFP. While it is indeed a bit sad to see a summertime tradition fade away, we are extremely excited about the possibilities the change will bring to our members.

Why the change? Based on feedback and discovery from a recent Membership Survey, the NCAFP Meetings Department has decided to focus energy and resources towards hosting more regional CME 20

opportunities beginning in 2019. By changing when, where, and how we offer first-rate CME, your Academy will be able to reach more members with more accessible and schedule-friendly learning opportunities throughout North Carolina. Stay tuned to the NCAFP Meetings Department for updates and information on convenient CME opportunities coming soon to a city near you! (It is important to note, this change in annual CME scheduling does not affect the always popular and extra-fantastic annual Winter Family Physicians Weekend in The North Carolina Family Physician

NCAFP Says Farewell to a Tradition in Myrtle Beach!!!

Asheville. See www.ncafp.com/wfpw.)

So, before we bid adieu to the Annual Mid-Summer Family Medicine Digest, make your plans for one last hurrah in Myrtle Beach! With Program Chair Lisa Cassidy-Vu, MD and Program Vice-Chair, Slade Suchecki, DO leading the way, our week of sun, sand, and CME will be a terrific time for you, and your family and friends. Mark your calendars for Sunday, July 8 – Thursday, July 12, 2018, and load up on the sunscreen. Be sure to pack your swimsuit, your sunglassSpring 2018

es and that book you’ve been meaning to read because this summertime conference finale with 30+ AAFP Prescribed Credits and sessions that end by 1:00 pm each day is sure to be a fantastic week of learning and relaxation for everyone.

The afternoon of Sunday, July 8th includes a complimentary Pre-Conference Women’s Health Symposium from 1 pm to 6 pm. Those arriving in Myrtle Beach early on Sunday should plan on grabbing up to 5 free AAFP Prescribed credits that afterContinues on next page 21

noon with clinical sessions on pelvic pain in women, menopause, contraception medicine, STIs, and more.

Participation in the symposium is free to all registered conference attendees.

coding, alternative practice models, and wealth management.

For those who need to fulfill their ABFM KSA reThe conference week forquirement, we’ve got you mally kicks off on Monday, covered. Join us on TuesBy changing when, where, and how we July 9th at 6:45 am with day, July 10th for our KSA offer first-rate CME, your Academy will breakfast in the exhibit hall.

Study Working Group on be able to reach more members with more General sessions will begin Heart Failure from 1:15 accessible and schedule-friendly learning each day at 7:15 am and pm to 5:15 pm. Course adjourn every afternoon at 1 fees are $180 for registered opportunities throughout North Carolina. pm; leaving you lots of time conference attendees and for lazy summer afternoons $200 for non-conference with family and friends. attendees. A completed Clinical topics for the week KSA will provide 10 certiwill include HIV, atrial fibrillation, oral health, asthfication points and 8 CME credits for your participama, colon cancer, pediatric rashes, adolescent deprestion. A light lunch is included. sion, opioids, diabetes, obesity, hypertension, lipids and more. Our Practice Management track will inYou can begin making your plans to participate in our clude discussions on telemedicine, patient attribution, last annual week of CME by the sea by visiting our

About AAFP

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Download the AAFP’s mobile app and get enhanced access to AAFP services and benefits.

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CORE CONTENT Discounts About AAFP

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AFP Journal Speak Out

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CareerLink News & Blogs

Board Review

Events Social Media Practice Qu..

Assess your News medical knowledge and get CME credit with more than 1,000 Board prep questions.

My Account & Blogs Patient Info Events

FPE/FPA CME Social Media

CME Reporting

Use your mobile device toCareerLink report your CME, when and wherever you choose.

Immunizatio..

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Access to up-to-date information on adolescent and adult immunizations including interactive and more.

FPM Journal charts, PatientFAQs, Info FPE/FPA CME For Students

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Make evidence-based decisions about the treatment and prevention of disease with AAFP clinical recommendations, sortable by topic or title.

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Apple, the Apple logo and iPad are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play is a trademark of Google Inc. MKT15021025

22

The North Carolina Family Physician

conference site at www.ncafp.com/ msmfd. There you will find additional conference details including registration rates, a tentative schedule of events, hotel reservation links, family fun activities (discount tickets to Pirates Voyage!) and convenient online registration. Make your reservations soon via the Kingston Plantation and Embassy Suites hotel link on the conference website or by calling 800-8760010 and request the NCAFP room rate. Accommodations include hotel rooms and 2-3 bedroom condos and villas ranging from $254 to $448 per night. While the cut-off date for reservations is June 8, 2018, make your reservations early as the block will sell out before the cut-off date.

In closing, while the Irish poet, Henry James came along almost 400 years after Chaucer, he also had a way with words.

Believe it or not, I remember studying James’ poetry in an English Lit class at UNCW many years ago. One of his famous lines is now also one of my favorites. “Summer afternoon – summer afternoon; to me those have always been the two most beautiful words in the English language.” I’m willing to bet that you will agree with Mr. James when you join us in Myrtle Beach for a conference that includes plenty of family time and well-deserved downtime in the summer afternoons … every single day beginning at 1 pm.

If you have questions or need any assistance in planning your time in Myrtle Beach this year, please contact me at 919-214-9058 or via email at katkinson@ncafp.com. I hope to see you there!

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

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

Spring 2018

23

RESIDENTS & NEW FPs

By Courtland Winborne, MD, MPH, PGY-2 Cabarrus Family Medicine NCAFP Resident Director

Family Medicine: We Do More Than Most Realize In 1969, Family Medicine was first recognized as a specialty in the US. However, in 2018, there are still few people, even our own patients, who know all the capabilities of our specialty. Many know us as the specialty that sees patients from “the Cradle to the Grave,” but the specifics of what we do as a specialty is often unknown or under-recognized by our patients and our colleagues in other fields. Residency is a time that family physicians first experience the possibilities of their scope of practice and see the skills and procedures they will be able to perform when their training is complete. The scope of practice we choose as family physicians depends on the desire of each of us individually.

These interests will shape the population of patients we serve. During residency, we begin to master the skills in which we want to become proficient. Not every family physician offers the same skillset, but within the specialty, patients can find complete care.

As I complete my second year of training in family medicine, I have reflected on numerous experiences with patients. I am continuously grateful for the wonderful specialty I have chosen. Through interactions with patients, I continue to develop my own skills and scope of practice that I plan to take with me into my career.

I am surprised on a daily basis at how few patients are aware of the abilities and depth of practice their family doctor possesses. I use my time with patients to educate them and to further develop the skills I see necessary to best take care of them, now and in the future.

24

During my encounters with patients, there are many personal experiences that stand out to me that have helped shape the vision I have for my future practice. I remember a new patient who came to esDr. Winborne is a resident physician at tablish care to have Cabarrus Family Medicine Residency his first physical in Program in Concord, NC. A native many years. He was North Carolinian, she graduated married with chilfrom UNC-Chapel Hill with a Bachdren, one of whom elor of Science in Biological Sciences had autism. He before attending the Brody School of Medicine at East Carolina for her complained that Masters of Public Health and Doche had difficulty tor of Medicine degrees. In addition finding a physician to her involvement with the NCAFP who understood throughout medical school and now his child and took residency, Dr. Winborne has been the time to examactive with the American Medical Asine and commusociation, the American Public Health Association and the North Carolina nicate with him in Medical Society. Dr. Winborne’s exa way that made periences as a student member of the him feel safe and NCAFP laid the foundation for her to comfortable. He assume a leadership role in the Acaddid not know that emy as a resident. She looks forward family doctors saw to serving her peers and representmore than adults. ing resident interests as the resident physician voice on the NCAFP Board.

When he noticed kids in the office that day, he wondered if this was a place he could bring his whole family. He was overjoyed to learn I had other patients with similar needs to his child. He found comfort in the fact that his family could come to one clinic for everyone’s healthcare.

In our residency, we get the experience of having specialty clinic within our continuity clinic. There are half days of clinic set aside where specialists from the community come to our clinics to see patients for specialty care, including dermatology, OBGYN, and

The North Carolina Family Physician

travel medicine. These clinics allow our patients extra opportunities for care, and allow residents to further develop our skills to take with us into practice.

Women’s health in family medicine is a passion of mine and an often-underutilized skillset that many family physicians have and enjoy. It is this area of family medicine I find most rewarding. There are few, if any, female patients who like to have a pap smear.

Thinking about having to make another appointment, see another doctor and pay another co-pay for a gynecologic procedure or pap smear is often a very daunting and time-consuming experience. I am currently on the OB track in my residency and I enjoy doing gynecologic and OB procedures. It is rewarding for me to see the relief and surprise on my patient’s faces when I tell them we can deliver their baby or provide the gynecologic procedure they need right in my office. I hope to carry these skills with me into practice when I graduate.

One of the best -- but now mostly forgotten -- experiences for family doctors is the home visit. I have had this wonderful opportunity in residency. One such experience found me visiting an elderly patient who still lived at home with early stages of Alzheimer’s dementia. I enjoyed ringing the doorbell and having her and her daughter-in-law answer the door. She was so excited to have visitors. She invited us in and gave us a tour of each room in her house and showed us all her pictures. We not only went over her medications and did an exam, but we got to know her more personally.

For her to have a doctor visit her in her home was very meaningful to her. She asked us to stay for lunch and told us over and over how much she loved visitors and how she had never had a doctor come to visit her.

Through all these experiences, we develop our skills as family physicians, and through our interactions with our patient, we continue to show people that family doctors are capable of doing traditional office visits and so much more. If your current scope of medicine isn’t as broad as you would like, seek out opportunities and challenge yourself. It will be good for you and good for your patients too.

Remarkable people providing remarkable healthcare Physician opportunities Novant Health primary care and specialty North Carolina and Virginia Novant Health is a not-for-profit integrated health system of 15 medical centers, 1,558 physicians in 539 locations, as well as numerous outpatient surgery centers, medical plazas, rehabilitation programs, diagnostic imaging centers and community health outreach programs. Our 26,000 team members care for patients in communities across North Carolina, South Carolina, Virginia and Georgia.

Novant Health offers physicians a fair market value salary package, a relocation allowance, support annually for continued medical education, and a comprehensive benefits package.

As a member of our medical group, you will be supported by highly-trained professionals who provide assistance at every level. We will provide you with all the assistance necessary to ensure your success.

Support services include: • Managed care • Electronic health record • Human resources • Legal services • Coding and compliance • Financial services • Information systems

To learn more about the health system, visit NovantHealth.org or contact one of the recruiters below.

Emily Slagle Manager, provider recruitment for Novant Health eclslagle@NovantHealth.org Physician recruitment Samantha Brown - samantha.brown@NovantHealth.org Cher Chambers - cldelaney@NovantHealth.org Stephanie Floyd - skuykendall@NovantHealth.org

EOE

Spring 2018

25

• Self-insured malpractice coverage • Operational and practice management • Marketing and communications • Group purchasing • Centralized billing

STUDENT INTEREST & INITIATIVES

By Tracie Hazelett NCAFP Medical Student & Residency Relations Manager

Record Match Year for North Carolina!

Information available at press time indicates 597 North Carolina Medical students participated in one of the three matching systems: the Military Match in December, the National Matching Service’s Match for the American Osteopathic Association in February, or the National Resident Matching Program (NRMP) Match in March. Of those 597 students, 92 chose to enter the specialty of Family Medicine. The Brody SOM had another incredible year, while UNC and Campbell experienced their highest matches on record. Although Wake Forest dropped this year, following their record year in 2017 (15%), Duke doubled their contribution this year.

This year’s 15.4% marks the highest number and Friday, March 16, 2018, resulted in a new record for percentage of North Carolina medical students to the percentage of North Carolina medical students entering family medicine! Although some “North Carolina is truly outpacing students participatthe country by any measure. We’ve ed in earlier matchmade some right steps and our state’s es, March 16th was medical schools are headed in the the day most mediright direction.” cal students learned NCAFP President Dr. Tamieka Howell where they will go next. With excitement in the air, and surrounded by family, friends and mentors, students eagerly opened their envelope – or even their e-mail – to learn where they will spend the next three to seven years training.

26

The North Carolina Family Physician

Medical School

2018 NC Student Match at a Glance* • 597 NC Medical students representing five medical schools participated in the Match • 92 students selected the specialty of Family Medicine (15.4%) • 38 will remain in NC for training (41.3%)

enter this specialty, this rate compares to just 9.3% nationally.

Although this rise is encouraging, our work is not done. According to a 2015 report by the Robert Graham Center, in order to meet the growing needs of NC citizens, the state needs to add 1,885 primary care physicians by 2030.

This year’s graduating class has represented family medicine well. To the medical students on their

Brody Campbell Duke UNC Wake Forest

FM Match Rate

In-State Match

21.13% 53.3% 23.18% 25.7% 3.92% 50% 19.05% 46.88% 5.7% 66.66%

*Data based on information made publicly available.

North Carolina Family Medicine Residency Programs filled 121 intern positions this year, including allopathic, osteopathic and dually-accredited residency programs. This total does not include interns at the two Armed Services Family Medicine Residency Programs in our state.

“We have to do all we can to encourage today’s medical school students to explore and consider primary care. In all areas of our state, access to primary care is repeatedly proven to lower medical costs while improving patients’ health, and their communities.”

- NCAFP President Dr. Tamieka Howell heels, North Carolina and family medicine needs you too. Congratulations to the Class of 2018!

From Left: Ashley Dougherty, Wake Forest, matched at Duke; Kevin Courts, UNC, matched at CMC; Elizabeth Ferruzzi, ECU, matched at Novant Health; Emma Ciborowski, Campbell, matched at New Hanover; and Priscille Schettini, Duke, matched at UNC.

Spring 2018

27

FOUNDATION

~ The 2018 Family Medicine Gala ~ NCAFP Foundation’s Largest Fundraiser of 2018!

This fabulous evening at the Raleigh Convention Center will be an enjoyable, fun-filled night with a wonderful dinner followed by a time to honor and become inspired. Join the Academy to recognize and offer a toast to 2017 AAFP 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!

Saturday, August 25th, 2018 Raleigh Convention Center -- 6:30 to 10:00 pm Register at www.ncafp.com/fmgala

The 2018 Family Medicine Gala will be held at the Raleigh Convention Center on Saturday evening, August 25th, 2018 – 6:30pm to 10:00pm. 100% of proceeds from this elegant event will be used to fund the Foundation’s student interest programs.

Registration is now open, and members can purchase individual reservations or serve as a vital sponsor. If you can’t make it but still want to show your support, send a medical student or simply make a valuable contribution to the Foundation. Please visit our website at www.ncafp.com/fmgala for more details and to view all of these options. Or, feel free to contact Tracie Hazelett at the Academy offices if you have questions or would like to discuss vital sponsorship support to help build student interest in family medicine. Tracie can be reached at thazelett@ncafp.com or 919-980-5357.

Guest of Honor Dr. Karen L. Smith, FAAFP 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.

28

The North Carolina Family Physician

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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 Spring 2018

29

KEY FINANCIAL DATA PRACTICE MANAGEMENT

By Brent Hazelett, MPA, CAE NCAFP Deputy Executive Vice President

Base amount of tax ($)

0 to 9,525

-- Tax Law Changes for 2018 --

952.50

+

10.0

+

12.0

Of the amount over ($)

9,525.00

4,453.50

+

22.0

38,700.00

82,501 to 157,500

14,089.50

+

24.0

82,500.00

157,501 to 200,000

32,089.50

+

32.0

157,500.00

200,001 to 500,000

Prepare Now for Big Changes in Taxes

45,689.50

+

35.0

200,000.00

150,689.50

+

37.0

500,000.00

Married filing jointly and surviving spouses 0 to 19,050

To help you plan for 2018, Triangle Securities Wealth Management has provided current information on the new income tax rates, gift tax, and estate tax exclusions, retirement plan contribution limits as well as information on Social Security and Medicare.

Triangle Securities is a Raleigh-based independent investment advisor dedicated to serving the financial needs of families. A neighbor and advocate to the NC Academy of Physicians for over 10 years, they are a respected resource not only for investment management, asset allocations strategies, and retirement planning, but for any need that has an impact on your financial future. For printable version and additional tax information, visit ncafp.com/2018tax.

12.0

19,050.00

77,401 to 165,000

8,907.00

+

22.0

77,400.00

165,001 to 315,000

28,179.00

+

24.0

165,000.00

315,001 to 400,000

64,179.00

+

32.0

315,000.00

Of the amount over ($)

38,700.00

Filing status

200,000.0030

Standard deduction

Married, filing jointly and qualifying widow(er)s

$24,000

Single or married, filing separately

$12,000

Head of household

$18,000

Phaseouts begin at AGI of:

Eliminated for 2018 but expected to return after December 31, 2025.

Single or marri

Dependent filin

Additional ded

Blind or over 6

Blind or over 6

35.0

400,000.00

Tax Rates on

37.0

600,000.00

If taxable incom $77,200 (joint)

+

10.0

Head of household 0 to 13,600

If taxable incom $77,200 (joint)

13,601 to 51,800

1,360.00

+

12.0

13,600.00

51,801 to 82,500

5,944.00

+

22.0

51,800.00

If income falls rately), $479,00

82,501 to 157,500

12,698.00

+

24.0

82,500.00

3.8% Tax on

157,501 to 200,000

30,698.00

+

32.0

157,500.00

Married, filing

200,001 to 500,000

44,298.00

+

35.0

200,000.00

149,298.00

+

37.0

500,000.00

+

10.0

952.50

+

12.0

9,525.00

38,701 to 82,500

4,453.50

+

22.0

38,700.00

82,501 to 157,500

14,089.50

+

24.0

82,500.00

157,501 to 200,000

32,089.50

+

32.0

157,500.00

200,001 to 300,000

45,689.50

+

35.0

200,000.00

28% tax rate a

Over 300,000

80,689.50

+

37.0

300,000.00

Married, filing

+

10.0

255.00

+

24.0

2,550.00

Married, filing

9,151 to 12,500

1,839.00

+

35.0

9,150.00

Single and ma

Over 12,500

3,011.50

+

37.0

12,500.00

Estates and tru

Over 500,000

Married filing separately 0 to 9,525

Single Married, filing

Exemption A Married, filing Single Married, filing

Estates and tru

All others

Estates and trusts 0 to 2,550 2,551 to 9,150

Exemption am

Copyright © 2018 Horsesmouth, LLC. All Rights Reserved. Sources: Tax Cuts and Jobs Act, IRS-Rev. Pro License #: 4679701 Reprint Licensee: Triangle Securities Wealth Management Horsesmouth is an independent organization providing unique, unbiased insight into the critical issue Horsesmouth, LLC is not affiliated with the reprint licensee or any of its affiliates.

Gift and Estate Tax Exclusions and Credits Personal exemption

Married, filing j widow(er)s

+

1301 Annapolis Drive Raleigh, NC 27608

Standard Deductions & Personal Exemption

Filing status

+

www.trianglesecurities.com

82,500.00

Standard De

91,379.00

919-838-3221

9,525.00

www.trian

161,379.00

Triangle Securities Wealth Management Independence * Integrity * Care & Concern

†

919-838-

Head of house

+

9,526 to 38,700

Download Print version at www.ncafp.com/2018tax

10.0

1,905.00

400,001 to 600,000

Big changes are going into effect in 2018 due to the Tax Cuts and Jobs Act of 2017.

+

19,051 to 77,400

Over 600,000

500,000.00

Marginal tax rate

38,701 to 82,500

Over 500,000

157,500.00

Plus

1301 Ann Raleigh, N

Single 9,526 to 38,700

018

al e

2018 Tax Rate Schedule Taxable income ($)

DATA

2018†

Triangle Independ

Maximum estate, gift & GST rates Estate, gift & GST exclusions Gift tax annual exclusion

40% $11,210,000

The North Carolina Family Physician

Exclusion on gifts to non-citizen spouse

Education Credits, Deductions, and Distributions

$15,000

$152,000

e amount Of the amount919-838-3221 er ($) 919-838-3221 over ($)

,525.00 9,525.00

38,700.00 ,700.00

82,500.00 ,500.00

157,500.00 ,500.00

www.trianglesecurities.com www.trianglesecurities.com Standard Deductions PersonalExemption Exemption Standard Deductions & &Personal Filing status Filing status

Married, filing jointly and qualifying 200,000.00 Married, filing jointly and qualifying widow(er)s 500,000.00 widow(er)s ,000.00 Single or married, filing separately

,000.00

19,050.00

,400.00 165,000.00

,000.00 315,000.00

$24,000

$24,000 $12,000

Single or married, filing separately

$12,000

Head of household

$18,000

Dependent filing own tax return Additional deductions for non-itemizers

$1,050*

Head of household

,050.00 77,400.00

Standard Standard deduction deduction

Dependent filing own tax return

Gift and Tax Exclusions and Credits Gift Estate and Estate Tax Exclusions and Credits Personal Personal exemption exemption

Phaseouts Phaseouts begin at AGI of: of: begin at AGI

to return after December 31, 2025.

Additional for non-itemizers Blind ordeductions over 65

Add $1,300

BlindBlind or over 65 65 and unmarried and not a surviving spouse or over

$1,300 AddAdd $1,600 Add $1,600 0% 15%

falls at or above $425,800 (single), $239,500 (married-filing sepa82,500.00 If income 3.8% Tax on Lesser of Net Investment Income or Excess of MAGI Over Married, filing jointly

20%

$250,000

,500.00 200,000.00 3.8% Tax on Lesser of Net Investment Income or Excess of MAGI Over Single $200,000 ,500.00 500,000.00 Married, filing jointly $250,000

,000.00

Married, filing separately

$125,000

Single Exemption Amounts for Alternative Minimum Tax** Married, filing separately Married, filing jointly or surviving spouses

$125,000 $109,400

Single Exemption Amounts for Alternative Minimum Tax**

$70,300

Married, filing separately Married, filing jointly or surviving spouses

$54,700 $109,400

157,500.00

Estates and trusts Single

$24,600 $70,300

200,000.00

Married, filing separately

,000.00 9,525.00 38,700.00 82,500.00

,525.00

,700.00

,500.00

300,000.00

,500.00

28% tax rate applies to income over: Married, filing separately

Estates and trusts All others

28% tax rate applies to income over:

,000.00 Exemption amounts phase out at: Married, filing separately Married, filing jointly or surviving spouses ,000.00 2,550.00 9,150.00

Single and married, filing separately All others

12,500.00

Exemption amounts Estates and trusts phase out at:

$15,000

Gift tax annual exclusion

Exclusion on gifts to non-citizen spouse

$152,000

$15,000 $152,000

Credit/Deduction/ Maximum credit/ Income phaseouts Account deduction/ AGI of: phaseouts Credit/Deduction/ Maximum credit/begin at Income distribution Account deduction/ begin at AGI of:

distribution $160,000 joint American Opportunity $2,500 credit Tax Credit/Hope American Opportunity $2,500 credit $80,000 all others $160,000 joint Lifetime credit $2,000 credit $114,000$80,000 joint Taxlearning Credit/Hope all others $57,000 all others Lifetime learning credit

0%

20%15%

,600.00

rately), $479,000 (joint), $452,400 (head of household), $12,700 (estates)

40%

Education Credits, Deductions, and Distributions

$1,050*

$77,200 (joint), $51,700 (head of household), $2,600 (estates) income or above $38,600 (single/married-filing separately), 13,600.00 If taxable If income fallsfalls at oratabove $425,800 (single), $239,500 (married-filing sepa$77,200 (joint), $51,700 (head of household), $2,600 (estates) rately), $479,000 (joint), $452,400 (head of household), $12,700 (estates) 51,800.00

40%

$11,210,000$11,210,000

Exclusion on gifts to non-citizen spouse Education Credits, Deductions, and Distributions

$18,000

taxableon income falls belowCapital $38,600 (single/married-filing separately), Long-Term Gains and Qualified Dividends 600,000.00 TaxIfRates ,000.00 $77,200 (joint), $51,700 (head of household), $2,600 (estates) If taxable income falls below $38,600 (single/married-filing separately), ,000.00 If taxable income falls at or above $38,600 (single/married-filing separately), $77,200 (joint), $51,700 (head of household), $2,600 (estates)

157,500.00

Estate, gift & GST exclusions Estate, gift & GST exclusions

Eliminated for 2018 but expected Eliminated for 2018 but expected Gift tax annual exclusion to return after December 31, 2025.

BlindTax or over 65on and unmarriedCapital and notGains a surviving spouse Dividends Rates Long-Term and Qualified 400,000.00 ,000.00

,800.00

Maximum estate,estate, gift & GST Maximum giftrates & GST rates

$200,000

$54,700 $95,750

$24,600

$191,500

$95,750 $1,000,000 $500,000 $191,500 $82,050

Savings bond interest tax-free if bond used Savings for education

$2,000 credit

$114,000 joint

Deduction limited to $119,550 joint $57,000 all others amount of qualified $79,700 all others Deduction limited to $119,550 joint expenses

interest tax-free if $2,000 maximum; amount not of qualified$190,000$79,700 all others joint Coverdell used for education expenses $95,000 all others deductible

Coverdell 529 plan (K-12) 529 plan (Higher Ed.)

529 plan (K-12)

maximum; not $10,000$2,000 distribution

deductible Distribution limited to amount$10,000 of qualified distribution expenses

529 plan (Higher Ed.) Tax Deadlines

None $190,000 joint

None$95,000 all others

Distribution limited to amount of qualified expenses

None

None

January 16 – 4th installment of the previous year’s estimated taxes due April 17 – Tax filing deadline, or request extension to Oct. 15. 1st installment Tax Deadlines of 2018 taxes due. Last day to file amended return for 2014. Last day to January 16 – or 4th installment of the previous year’sKeogh estimated contribute to: Roth traditional IRA for 2017; HSA for 2017; or SEPtaxes for due 2017 April (unless filing deadline has been extended).

17tax – Tax filing deadline, or request extension to Oct. 15. 1st installment

due. Last day to file amended return for 2014. Last day to June of 15 2018 – 2ndtaxes installment of estimated taxes due

contribute to:installment Roth or traditional IRAtaxes for 2017; September 17 – 3rd of estimated due HSA for 2017; Keogh or SEP for 2017 (unless tax filing deadline has been extended).

October 15 – Tax returns due for those who requested an extension. Last day to contribute Keogh for 2017 if extension was due filed.

June 15to– SEP 2nd or installment of estimated taxes December 31 – Last to: installment 1) pay expenses for itemizedtaxes deductions; September 17day – 3rd of estimated due 2) complete transactions for capital gains or losses; 3) establish a Keogh October 15establish – Tax returns duea for requested an extension. Last day plan for 2018; 4) and fund solothose 401(k)who for 2018; 5) complete contributetotoemployer-sponsored SEP or Keogh for 2017 if extension was filed.

2018 to contributions 401(k) plans; 6) correct excess contributions to IRAs avoid penalty.

December 31 –and Lastqualified day to: plans 1) paytoexpenses for itemized deductions; 2)

† Tax Cut and Jobs transactions Act (based on current understanding law, Jan. 2018) complete for capital gains oroflosses; 3) 1, establish a Keogh * Greater of $1,050 or $350 plus the individual’s plan for 2018; 4) establish and fundearned a soloincome.

401(k) for 2018; 5) complete ** Indexed for inflation and scheduled to sunset at the end of 2025.

2018 contributions to employer-sponsored 401(k) plans; 6) correct excess Married, filing jointly or surviving spouses $1,000,000 ,550.00 Tax Cuts and Jobs Act, IRS-Rev. Proc. 2017-58, IRS Notice 2017-64, Affordable Care Act, Social Security Administration, Centerscontributions for Medicare &to Medicaid Services, Miscplans IRS documents.

IRAs and qualified to avoid penalty.

Single and married, filing separately $500,000 alth Management ,150.00

biased insight into the critical issues facing financial advisors and their clients. of its affiliates. Estates and trusts ,500.00

$82,050

† Tax Cut and Jobs Act (based on current understanding of law, Jan. 1, 2018) * Greater of $1,050 or $350 plus the earned income.

Check withindividual’s your financial advisor for updates. ** Indexed for inflation and scheduled to sunset at the end of 2025.

uts and Jobs Act, IRS-Rev. Proc. 2017-58, IRS Notice 2017-64, Affordable Care Act, Social Security Administration, Centers for Medicare & Medicaid Services, Misc IRS documents. anagement d insight into the critical issues facing financial advisors and their clients. ffiliates.

Check with your financial advisor for updates.

State Health Exchange Connection Deadline is this June 1st

State law (NCSL 2017-57) mandates all health care providers who receive any state funds for the provision of health care services (e.g.

Medicaid, NC Health Choice, State Health Plan, etc.) to connect to and submit patient demographic and clinical data by certain dates in 2018 and 2019.

Hospitals, physicians, physician assistants, and nurse practitioners who provide Medicaid services and who have an electronic health record system must be connected by this June.

Spring 2018

Physicians and providers who will not be able to connect by the mandated deadline may be granted an extension if certain criteria are met. Extensions are not an exemption from the state’s connection requirements but provide additional time. See HealthConnex’s Extension Process page for additional information.

The sooner you connect, the better. For more information, and to begin your connection process, visit NCHealthConnex.gov, send email to hiea@nc.gov, or call 919-754-6912.

31

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

www.ncafp.com

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AAFP’s award-winning, consumer website, familydoctor.org offers your patients physician-reviewed education materials focused on supporting the physical, mental, and emotional health of the whole family. FamilyDoctor.org is a trusted source for medical answers and advice used by both physicians and consumers, and here to help you help your patients.

Non-Profit Org. US Postage

PAID

Pontiac, Illinois Permit No. 592

To help practices promote FamilyDoctor.org, a convenient downloadable full color flyer that can be distributed to patients can be downloaded at www.ncafp.com.