NC Family Physician - Fall 2024

Volume 20 Issue 4 • Autumn 2024

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

Methodist University Cape Fear Valley Health Medical School Holds Ground-Breaking Ceremony PG. 16

CME Opportunities Dynamic. Engaging. Innovative. Accessible. www.ncafp.com/cme

Family Medicine Academic Summit

Friday, Feb. 21, 2025 www.ncafp.com/summit E. Harvey Estes Conference Center | Durham NC Approx. 5 CME Credits Family Medicine Day follows the next day!

Virtual Alcohol Use Disorder Webinar

Wednesday, April 2, or Saturday, April 5, 2025 www.ncafp.com/audwebinar Two Opportunities to Participate Approx. 2.50 CME Credits (Tentative!)

Two-Part Saturday Summer CME Symposium

Saturday, June 7, 2025 www.ncafp.com/summercme Greensboro, NC | Location TBA Chronic Disease & Sports Medicine Approx. 6 CME Credits Pre-Conf KSA on Fri. June 6, 2025

2025 Winter Family Physicians Weekend

Thursday, Dec. 4, through Sunday, Dec. 7, 2025 www.ncafp.com/wfpw Omni Grove Park Inn, Asheville, NC Approx. 30+ CME Credits Pre-Conf. KSA on Wed. December 3, 2025

Inside Autumn 2024

s The NCAFP Strategic Plan Revised to Reflect Results of Needs Assessment PG. 8

PRESIDENT'S MESSAGE

MEMBERSHIP SERVICES

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18 Member Spotlight: Katie Haga, DO

Joy of Practice

ADVOCACY

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UnitedHealthcare Gold Card Program Began Oct. 1

CHAPTER AFFAIRS

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The NCAFP Strategic Plan Revised to Reflect Results of Needs Assessment

PROFESSIONAL DEVELOPMENT

STUDENT INTEREST & INITIATIVES

22 The Medical Student’s Guide to Getting Involved in North Carolina Family Medicine

PRACTICE MANAGEMENT

24 Navigating a Negligence Lawsuit Should Never Be a Solo Trip

11 The 2024 Winter Family Physicians Weekend

Approved for 48.50 AAFP Prescribed Credits!

PUBLISHED BY

DEPARTMENTS President's Message 4 Advocacy 6 Chapter Affairs 8

Membership Services 18 Student Interest & Initiatives 22 Practice Management 24

t 919.833.2110 • fax 919.833.1801 • ncafp.com Editor Kevin LaTorre, NCAFP Communications Managing Editor, Design & Production Peter T. Graber, NCAFP Communications

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

Material in articles and advertisements does not necessarily express the opinion of the NCAFP. Official policy is formulated by the NCAFP Board of Directors.

PRESIDENT'S MESSAGE

By Garett Franklin, MD, FAAFP NCAFP 2023-2024 President

Joy of Practice Fall is my favorite time of the year. The leaves are changing into beautiful colors, the oppressive heat of summer is finally abating, pumpkin-flavored everything is in the stores, and football is in full gear. Like most of you, I remember the fall as marking the start of a new academic year. My children directly remind me of the excitement, joy, and sometimes reluctance of returning to school all too well at this point. But, as I reflect on those days of being a student, I remember the time leading up to the start of medical school. This year, I have the bonus of giving advice to a new firstyear medical student in my family. My (not-so) little cousin is starting medical school. The summation of these events led me to: Why did I go into medicine to begin with?

As I reflected more, I wondered if we all should be asking that question more pointedly. In this current environment of struggles with prior authorizations, electronic medical records, portal messages, costs, increasing patient demands, and general burnout, empathy can be running low at times. Compounded with sociopolitical issues, post-COVID realities, and general mistrust of our profession, it poses the question, ‘Why do we do this?’ But the heart of that question is, “What brings joy to the practice of medicine?”

Personally, one of the greatest things that drove me into medicine was the high-level academics. I cannot remember a time I didn’t love science and math. The curiosity about the world around me and the desire to know it drove this love. I was able to pursue this love in undergraduate and graduate studies. And I was ultimately blessed with the opportunity to pursue this love in medical school. Thinking about today, this love 4

has not ended. Learning from colleagues, patients, students, challenging cases, literature, and my own life experiences can lead to challenges in my daily life, but it also brings lots of joy in the end. I suspect if I asked you the same question, you would give me a similar answer.

In addition, like a lot of you, I had a few different jobs before going into medicine. But what makes the profession of medicine different? As noted above, expertise and a high level of education is part of it. And The North Carolina Family Physician

2023-2024

NCAFP Board of Directors

naturally, accountability by licensing and “self-policing” complements this expertise. Our profession also comes with a degree of autonomy and the responsibility that is intimately tied with it. Some of the joy of medicine is being able to think and act independently and to wander down paths that have maybe not been trodden well in the past. There can be some well-laden treasures on these paths. However, there’s a responsibility to stay on the beaten path most of the time, and to make sure we keep our patients, communities, and fellow physicians as safe as possible in the process. Knowing when to deviate paths is dictated by professional experience. Again, autonomy comes with a great level of responsibility, but joy can be found when it’s done well.

Executive Officers President

Garett R. Franklin, MD, FAAFP

President-Elect

S. Mark McNeill, MD, FAAFP

Secretary/Treasurer

Benjamin F. Simmons, MD, FAAFP

Immediate Past President Shauna Guthrie, MD, MPH, FAAFP Executive Vice President

Gregory K. Griggs, MPA, CAE

At-Large Directors Josh T. Carpenter, MD Lisa A. Cassidy-Vu, MD, FAAFP Deanna M. Didiano, DO Nichole L. Johnson, MD, MPH, FAAFP

In addition, our profession demands a level of commitment. As noted above, times can be tough in medicine. The physician is an easy target and is often the brunt of criticism. However, we have a level of professional valor when we commit to patients, communities, colleagues, students, and ourselves. By continually providing great service and personal edification, we provide something that cannot be obtained in any other arena. Our profession is one of long-suffering and sacrifice, but it is worth the tribulations in the long run.

People are at the heart of the joy of practicing medicine. We have the ultimate joy of taking care of people throughout all stages of their lives.

We also have the distinct pleasure of taking care of them in sickness and health and at all the moments in between. Even within the house of medicine, who else can say that other than a family doctor? We should strive to find joy in these moments. Especially in the exam room, we see more of the low moments rather than the high moments. However, we should take heart in knowing patients have trusted us, and no one else, with these low moments. Therefore, we should be reminded that family physicians are trustworthy and invaluable to the patient.

We should never forget our duty to patients, because that is why we entered the medical profession.

Finally, I would remind everyone that it is truly a joy to practice medicine. We have been given the honor to practice a high level of academics, be part of a wonderful profession, and to help people even with their toughest problems. When your empathy tank is running low, remember where this journey has taken us in the past. Think about that medical school entrance essay, the formative days in medical school or training, or some of the past clinical wins. But also remember that being a family doctor is a labor of love. Finding joy in the good and bad times will sustain us as family physicians and as a specialty.

Kelley V. Lawrence, MD, IBCLC, FABM, FAAFP Amanda R. Steventon, MD, FAAFP Patrick S. Williams, MD Courtland D. Winborne, MD Academic Position R. Aaron Lambert, MD, FAAFP Resident Director Morgan Parker, DO Resident Director-Elect Stephanie P. Wilcher, MD, MPH Student Director S. Evan Morgan Student Director-Elect Nicholas Wells

AAFP Delegates & Alternates AAFP Delegate

Richard W. Lord, Jr., MD, MA, FAAFP

AAFP Delegate

Robert L. Rich, Jr., MD, FAAFP

AAFP Alternate

Tamieka Howell, MD, FAAFP

AAFP Alternate

Thomas R. White, MD, FAAFP

NCAFP Committee Chairs Workforce Committee

Jay Patel, MD, MPH

Advocacy Committee

Deanna M. Didiano, DO

Practice Environment and Profesional Development Committe Nichole Johnson MD, MPH, FAAFP Academic Departments Chair

Margaret Helton, MD, FAAFP

NCAFP Foundation President

Maureen Murphy, MD

Happy Fall, y’all. Long live the Pumpkin Spice Latte!

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

Autumn 2024

www.ncafp.com

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ADVOCACY

By Kevin LaTorre

NCAFP Comunications and Membership Manager

program? For one thing, the program assigns eligibility by tax identification number (TIN) for provider care groups, including a hospital system, a group of practices under one tax ID (like a CIN), or an individual practice. Eligible TINs won’t need to apply. Instead, they are eligible by:

UnitedHealthcare Gold Card Program Began Oct. 1

• Being in network for at least one UnitedHealthcare health plan such as UnitedHealthcare commercial, UnitedHealthcare Individual Exchange, UnitedHealthcare® Medicare Advantage, and UnitedHealthcare Community plans

The UnitedHealthcare (UHC) Gold Card program to reduce prior authorization requests began on Oct. 1, an effort that could significantly reduce administrative burden for family physicians who qualify. Both the NCAFP and the American Academy of Family Physicians have long advocated for reduction programs like this one at the state and federal levels.

• Have a prior authorization approval rate of 92% or more across all Gold Card-eligible codes for each of those two review years

This new UHC program completes the plan which was announced in Fall 2023: “To help reduce the administrative burden on health care professionals and their staff, starting Sept. 1, 2023, we’ll begin a two-phased approach to eliminate the prior authorization requirement for many procedure codes.” Through this “Project Promise” program, UHC eliminated prior authorization on 200 codes between September and November 2023, including the UnitedHealthcare® Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford, UnitedHealthcare Individual Exchange plans, and UnitedHealthcare Community Plan.

The newest Gold Card program covers nearly 500 different codes for eligible practices. In total, UHC estimates that these reforms have removed 20% of the plan’s overall prior authorization volume.

Considering these previous reductions, we count the newest Gold Card program as a significant second step in reducing the unnecessary administrative constraints that keep North Carolina family physicians from spending valuable time with their patients.

But what should family physicians know about the Oct. 1

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• Meeting a minimum annual volume of at least 10 eligible prior authorizations each year for two consecutive years across Gold Card-eligible codes

Practices and systems should have been notified directly

by UHC if they qualified for the Gold Card program. To review the eligibility of your TIN, you should visit the UnitedHealthcare Provider Portal (at https://identity.onehealthcareid.com/oneapp/ index.html). In the right-hand “Quick Links & Tools” menu, you can select the “Gold Card Status Lookup.” From there, you can search using your specific TIN. If your practice is selected for the program, it will need to complete advance notification for all services. Without this advance notification, no claims with Gold Card-eligible CPT codes will be paid.

The vast majority of NCAFP members reported that administrative burden is one of their key concerns in our member needs assessment, and in conversations with members we regularly hear about the delayed care and clinical headaches which prior authorizations cause. That’s why we are excited to see UHC become the only national health insurer to make these broad improvements for prior authorizations as a result of our advocacy. We are thrilled that many of you have already begun to receive these benefits!

If you have any questions or concerns about the UHC Gold Card Program, we recommend that you review the overview and chat page at https://www.uhcprovider.com/en/ prior-auth-advance-notification/gold-card.html.

The North Carolina Family Physician

FIGHTING FOR YOU!

NCAFP Leaders Meet with Health Plans to Advance Primary Care Investment On Aug. 2, leaders from the NCAFP met with several representatives of health plans serving North Carolina to discuss issues of importance to Family Medicine, including greater investment in primary care. NCAFP representatives included President Dr. Garett Franklin, President-Elect Dr. Mark McNeill, Advocacy Chair Dr. Deanna Didiano, EVP and CEO Greg Griggs, Senior VP and General Counsel Shawn Parker, and Government Affairs Consultant Sue Ann Swift.

The meeting is part of our continued effort to improve the primary care practice environment in the state, and to

address recommendations of the Primary Care Payment Reform Task Force created by the legislature last year.

NCAFP leaders outlined the value of primary care and how family physicians and insurance plans can work together to improve health care in our state. In addition to representatives of the NC Association of Health Plans, specific health insurers represented at the meeting included Blue Cross and Blue Shield of NC, United Healthcare Community Plan of NC, WellCare, and Carolina Complete Health. The attendees committed to working together across multiple meetings still to come.

Three Ways to Advocate for Your Patients and Your Profession

By Sue Ann Swift Government Relations Advisor at Manning Fulton

Advocacy. It is a word that can sometimes feel a little intimidating, but the NCAFP, with its lobbying team at Manning Fulton, is here to help you navigate this complex landscape. We get it: the bombardment of political advertisements this time of year can be excessive even to seasoned politicos. However, you should know, as proven by the financial investment in these ads, that YOUR vote makes a difference in the outcome of the election!

As we gear up for the election and upcoming legislative session, we wanted to provide three action items that can help you be a stronger advocate for your patients and your profession:

1. Vote a. Review your sample ballot before you vote on Election Day at ncsbe.gov b. This is the best way for you to ensure you can do research on all the races on your ballot before you cast your vote (yes, even the race for Soil and Water Commissioner!)

Autumn 2024

2. Get to Know Your Legislators a. Now is a great time to meet with legislators or candidates in their district (your community!) b. Ask them to grab a cup of coffee, or ask when they are having a local event you can attend

3. Reserve March 19, 2025, to Attend NCAFP’s White Coat Wednesday a. We know you plan your schedule months in advance, so now is a great time to block off the annual NCAFP White Coat Wednesday If you need help with any of these items, or if you have any questions, please do not hesitate to reach out to your NCAFP staff contact, Shawn Parker, at shawn@ncafp. com, or to contact me at swift@manningfulton.com.

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CHAPTER AFFAIRS

By Greg Griggs, MPA, CAE

NCAFP Executive Vice President and CEO

You Spoke, We’re Listening!

The NCAFP Strategic Plan Revised to Reflect Results of Needs Assessment After closely examining the results of our Member Needs Assessment survey from earlier this year, the NCAFP Board of Directors recently updated the organization’s Strategic Plan. While the direction of the plan did not change greatly, your feedback allowed even greater focus and precision for our activities going forward. Approximately 20% of our Active practicing members responded to the extensive survey, with additional feedback from residents.

We also asked a lot of questions about your pain points in practice. When asked which market factors you think will impact Family Medicine over the next three years, you were most concerned over the increased use of NPs and PAs in clinical care (50% named it as a top-three concern), practice and health system consolidation (38%), and adjusting to value-based payments (35%).

When asked about what would impact the Family Medicine workforce over the next three years, you consistently reported two items: • Physicians leaving the practice of medicine due to increasing administrative burden (mentioned in the top three issues by 85% of respondents).

• Maintaining work-life balance (mentioned by 77% of respondents).

When asked about your top causes of frustration, you repeatedly pointed out three issues: • Administrative burdens caused by payers (49%).

• Undervaluing Family Medicine (34%).

• Recruiting and retaining staff (31%).

So, what did you tell us? The survey first provided more insight on who you are, where you practice, and how you practice. For example:

Finally, when we asked you what you thought our state-level advocacy priorities should be, you most often identified the following (all priorities listed in Figure 2):

• The membership of the NCAFP is almost evenly split between male and female family physicians.

• Over half our members (54%) now work for a health system or academic institution, while only 26% work in private practices.

• The large majority of our members participate in some type of value-based payment model.

• Roughly one in three predicted a change in their practice setting within the next three years, up 10% since our last survey in 2021.

• Your scope of practice seems to be — at least somewhat — defined by your practice setting. Our academic physicians generally reported the broadest scope, while our other health system-employed physicians reported a narrower scope, with fewer providing child and maternal health, adolescent health, and procedures.

• 68% of our members precept some type of health care professional, from residents to medical students to nurse practitioner (NP) or physician assistant (PA) students. But of those who precept, 75% receive no dedicated time or reduced responsibilities when teaching.

• Increasing payment or greater investment in primary care (78% selected it in the top three issues).

• Reducing administrative burden (76%).

• Physician burnout (57%), which is most likely related to the first two issues.

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We were pleased to see that overall satisfaction with membership in the NCAFP is continuing to increase, with 92% of members reporting they were satisfied with their membership and 25% saying they were extremely satisfied, an increase from previous surveys. We were also glad to see that 87% of respondents said they were extremely likely or very likely to retain their membership, and another 9% said they were somewhat likely.

But what does all this mean?

While these results did not mean completely throwing out our previous strategic plan, they did result in greater focus and a tightened set of goals based on your feedback.

The North Carolina Family Physician

Figure 1

Goals: • Provide education on different practice models and enhanced practice efficiencies.

• Provide high-quality education and increase networking opportunities.

Workforce Committee: Grow the future family physician workforce in North Carolina.

Goals: • Encourage policymakers, systems leaders, and practices to incentivize precepting, teaching, and mentoring.

• Nurture medical student interest, resident engagement, and new physician retention.

So here are our updated areas of focus based on the results of the needs assessment and additional work to revise our strategic plan: Advocacy Committee: Strengthen the influence of Family Medicine with health systems, government agencies, and payers.

Goals: • Decrease the administrative burden faced by family physicians in their day-to-day practice lives.

• Increase investment in Family Medicine to reflect our value and scope.

While the structure remained mostly the same, the NCAFP Board voted to reduce the number of goals to focus on the items you deemed most important, primarily administrative burden and increased investment in Family Medicine, while at the same time providing you with high-quality continuing education to improve your clinical and practice skills, and nurturing the future Family Medicine workforce.

While the new plan does not limit us to these few areas, it provides a clear map of where we should be spending the time and resources you entrust to the NCAFP. As we embark on this new structure, please look for additional information as we work to address these specific challenges, and please respond to any call for action we may need as we work to change statewide policies to better serve you and your patients.

Practice Environment and Professional Development Committee: Support family physicians in their personal and professional development and satisfaction.

Autumn 2024

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NC Continues Leadership at AAFP Congress of Delegates, New Policies Adopted

By Greg Griggs, MPA, CAE NCAFP Executive Vice President and CEO

In September, family physician leaders from all over the country gathered in Phoenix, AZ, to develop policy and elect new leaders at the American Academy of Family Physicians (AAFP) Congress of Delegates. North Carolina once again had a large contingency at the Congress, including our delegates, Dr. Rich Lord and Dr. Robert “Chuck” Rich; our alternate delegates, Dr. Tamieka Howell and Dr. Thomas White; NCAFP President Dr. Garett Franklin; NCAFP President-Elect Dr. Mark McNeill; NCAFP Treasurer Dr. Benjamin “Frankie” Simmons; and numerous other past and current leaders, as well as four staff members. I will provide a brief overview of the most important activities and results below.

NORTH CAROLINA WELL-REPRESENTED IN AAFP ELECTIONS NCAFP Past President Dr. Shannon Dowler (2012-13) won election as one of three physicians in the latest class

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of AAFP Board Members in a strong field of six candidates. Dr. Elisabeth Fowlie Mock of Bangor, ME, and Dr. Kathleen Mueller of Winsor, CT, joined Dr. Dowler on the Board of Directors for a three-year term.

In her campaign speech before the Congress, Dr. Dowler discussed several milestone events from her professional career, including her work with NC Medicaid to implement Medicaid expansion after a 10-year effort to expand coverage for the working poor in North Carolina. She also discussed various waypoints in her career, noting that Family Medicine offers so many different journeys.

Unfortunately, Dr. Karen L. Smith, NCAFP Past President (2005-06), was unsuccessful in her bid for AAFP President-Elect, after her successful three-year term on the AAFP Board. Dr. Smith lost a hard-fought race to Dr. Sarah Nosal of New York City, NY. Dr. Nosal, a past president of the New York chapter, is chief medical information officer and vice president for innovation and optimization at the Institute for Family Health, a network of 27 New York federally qualified health centers in Mid-Hudson, Bronx, Manhattan, and Brooklyn.

Dr. Jen Brull of Fort Collins, CO, was installed as president of the Academy after winning election as President-Elect during the 2023 Congress of Delegate in Chicago. Dr. Brull practiced in rural Kansas for two decades and is now vice

The North Carolina Family Physician

president of clinical engagement for Aledade. Dr. Steven Furr, the most recent president of AAFP, moved into the role of Board Chair. Dr. Furr is a rural practice owner from Jackson, AL. Joining Drs. Nosal, Brull and Furr as officers, both Dr. Russell Kohl (Stilwell, KS) and Dr. Daron Gersch (Avon, ME) won their re-elections as Speaker and Vice Speaker of the Congress of Delegates, respectively.

In her speech, Dr. Brull said, “I am thrilled to introduce the AAFP’s new strategic plan, launching right around the corner in 2025. This plan was built with YOU at the center. It’s ambitious, it’s innovative, and over the next three years, the AAFP is going to make big things happen for family physicians.” Brull later highlighted each section of the plan’s four-prong approach:

Three individuals were installed for one-year AAFP Board Terms: Dr. Cynthia Chen-Joea, MPH, of Lakemont, CA, as New Physician Board Member; Dr. Aerial Petty, of New York, NY, as Resident Board Member, and finally, Mikala Cessac of Columbia, MO, as student board member.

1) Make family physicians an essential voice in all health care decisions

PRESIDENT BRULL CHARTED AAFP’S COURSE IN HER FMX PRESENTATION

3) Improve systems that support Family Medicine, ensuring that payment, investment, and operating models evolve to meet the needs of today’s family physicians

After the end of the Congress of Delegates, Dr. Brull addressed thousands of family physicians in a mainstage event at the Family Medicine Experience (FMX), outlining a sneak peek at the AAFP’s new strategic plan. The new AAFP plan — which shares similarities with our chapter’s new Strategic Plan (see our entire overview on pg. 8) — focuses on efforts related to advocacy, physician well-being, payment, and workforce development.

2) Enhance the well-being of family physicians, prioritizing challenges of burnout and improving work-life balance

4) Strengthen our future by attracting, retaining, and guiding a diverse and inclusive community of family physicians POLICY DEVELOPMENTS AT THE CONGRESS OF DELEGATES While in Phoenix, the Congress of Delegates developed continues as "Congress of Delegates" on pg. 26

! d i r b Hy www.ncafp.com/wfpw

Approved for 48.50 AAFP Prescribed Credits!

Virtual Attendees can anticipate earning up to 37.50 CME Credits!

In-Person Attendees can anticipate earning up to 48.50 CME Credits!

The AAFP has reviewed 2024 Winter Family Physicians Weekend, and deemed it acceptable for AAFP credit.

Term of approval is from 12/04/2024 to 12/08/2024. Following this CME activity, participants will have the opportunity to earn an additional two Prescribed credits for participation in each Translation to Practice® exercise.

Information on Translation to Practice® will be shared within the activity.

@ HEADQUARTERS

How My Summer Internship at the NCAFP Served You

By Iman Abdi

This summer, I had the privilege of completing an internship with the NC Academy of Family Physicians. I dove into several projects under the guidance of Communications and Membership Manager Kevin LaTorre. Whether I was organizing event data or fine-tuning editorial pieces, the common thread of my work was ensuring that the Academy’s members had access to the key resources they needed to stay informed and supported. I had quite a fulfilling summer, and I would love to share a few highlights from my work with your NCAFP staff.

One of my key projects was developing a database to track CME events. Your Director of CME & Events, Kathryn Atkinson, needed a place to easily look up past CME topics, speakers, and ratings. I integrated data going back to 2017, and I was able to learn about the kind of lectures given at these events. Members depend on these CME opportunities to stay up to date on the latest advancements in Family Medicine, and part of my job was to make the planning process smoother.

While keeping things organized was a priority, the larger goal of the resource was to make sure the Academy could plan future events more efficiently and offer a better experience for members. By having accessible records of past events and feedback all in one place, Kathryn and the Academy staff can better understand what members find valuable and continue to meet their needs. It is gratifying to know that this tool will continue to be useful after this past summer.

Another major part of my internship involved writing weekly entries for the NCAFP Notes newsletter. These brief entries were a great way to connect with members more regularly. Each week, I was given two or three stories to write. I got to share state agency updates related to Family Medicine, upcoming events, member highlights, and more updates that help members stay in the loop. I enjoyed writing for Notes because I stayed informed on a range of topics, from what was happening at the NC Dept. of Health and Human Services (NCDHHS) to which NCAFP members were retiring. I got to deepen my understanding of the health

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policies from NCDHHS, especially when I wrote about Medicaid expansion. This experience has prepared me to contribute to North Carolina’s health care landscape by advocating for and implementing policies that support vulnerable populations, particularly mothers and children. Writing for NCAFP Notes also made me think about how to communicate clearly and concisely, something that’s always important when trying to reach busy professionals like our hard-working physician members. I also enjoyed creating these updates while knowing that thousands of members were counting on receiving them to stay informed.

Lastly, I had the opportunity to contribute to producing the summer 2024 issue of The North Carolina Family Physician.

This work involved reviewing proofs, editing articles, and learning about the printing process for magazines. While we primarily edited to catch grammatical mistakes, I learned how to ensure that the tone and clarity of the content resonates with the readers. From small spelling changes to larger structural edits, every tweak the NCAFP team made aimed to improve your experience as readers and physicians. It was great to play a part in delivering this high-quality magazine to members. I felt proud of everyone’s work when I finally got to hold the summer edition in my hands.

As I reflect on my summer internship, I see how everything I worked on, from event planning tools to member-facing communications, was focused on the same thing: making sure NCAFP members were supported, informed, and valued. It’s been a rewarding experience, and I’m excited to see how the work I did with the NCAFP will continue to benefit the members and support Family Medicine in North Carolina.

Iman Abdi is a senior at UNC at Chapel Hill, studying Public Policy and Medical Anthropology, with a particular interest in maternal and pediatric health. She plans to earn a master’s in public health and aspires to reduce health care disparities in the U.S.

The North Carolina Family Physician

A D V E R T O R I A L

The Importance of Peer Support

By Kristi Wright, Senior Vice President, Claims, Curi Insurance For physicians, the idea of facing a malpractice lawsuit is one of the most terrifying experiences imaginable. It’s understandable why medical providers wouldn’t want to ever discuss such a topic, even when the provider knows they have done nothing wrong. However, being named in a lawsuit is not nearly as uncommon as many might assume. In fact, according to Medical Economics, nearly one-third of U.S. physicians have been sued at some point in their careers1. So, if you ever find yourself in this position, know that you are not alone.

When named in a suit, a physician’s first call is often to their medical malpractice insurance carrier. At Curi, we recognize the emotional and mental toll this experience can take on our members and do our best to provide holistic support as their trusted partner. We take a three-pronged approach to supporting our members. First, we have dedicated, experienced claims consultants who are here for you to guide you through the process. They attend first-suit meetings, mediations, depositions, and are by your side at trial, answering questions you may have along the way. Second, we provide an experienced medical malpractice defense lawyer, who will vigorously defend your care and work towards the best possible resolution. And finally, what I would like to discuss more with you today, is our Clinician Peer Support Program.

It's important that providers don’t internalize the negative emotions that may come up during a lawsuit.

By speaking with peers who have faced similar circumstances, our members can feel better understood and more prepared to face difficult situations head-on.

I recently sat down with Curi member and Chief Medical Advisor, Dr. Carolyn Anctil, to discuss her perspective on the importance of peer support, and here is what she shared: Physician egos are often deeply entwined with their profession. They attend medical school with the goal of helping others. They take an oath promising to do no harm. So, when something goes wrong and a patient is harmed, physicians take the news to heart. Errors are inevitable, physicians are not superhumans; but they often feel personally responsible for patient outcomes. The pain and guilt of causing or being part of a medical error is significant. Being named as a defendant in a lawsuit causes additional shame, anxiety, and embarrassment for the most caring of physicians.

Research demonstrates that talking to a peer about a significantly stressful event speeds recovery.

Fortunately, Curi has a dedicated team of experienced physicians who have been involved in harm events or litigation themselves to provide support for doctors facing an active suit. Being involved in an adverse medical event doesn’t mean you’re a bad doctor, and Curi Peer Support helps to make the burdensome load of a lawsuit feel a little lighter.

The power of connection cannot be understated in difficult situations, and I’m proud to be able to offer members the opportunity to connect with one another in meaningful ways when support is needed most.

For more ideas and observations from Curi’s in-house experts, visit blog.curi.com.

1

“See you in court: 31% of physicians get sued during their careers,” Medical Economics, May 2023

The opinions and views expressed in this post belong to and are solely those of the individual author, and do not necessarily reflect those of Curi Insurance or Curi Insurance’s parent or affiliated companies or their members, insureds, clients, customers, or partners. The information and services provided in the Peer Support Program are intended for informational purposes only. They do not serve as a substitute for legal or medical advice or medical assessments or treatment. The program offerings do not constitute medical care, and no patient-provider relationship is established. If medical or legal services are needed, please seek out a professional.

© Curi 2024

800-662-7917 | curi.com

Dr. Conrad Flick, Dr. Vickie Fowler, and Dr. Warren Newton.

Dr. Viviana Martinez-Bianchi speaks as the WONCA President-elect at the AAFP Congress of Delegates.

The student members and faculty advisor of the UNC FMIG who received the AAFP Award for Excellence.

Dr. Karen Smith receives the Order of the Lo

Dr. Michelle Jones, Dr. Maureen Murphy, Dr Smith, and Dr. Tamieka Howell.

Dr. Roddy Drake receives the Order of the Long Leaf Pine.

Medical students hiking during their summer program in Boone.

Dr. Shannon Dowler and Dr. Tamieka Howell with a group of their fellow physicians at the AAFP Congress of Delegates.

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Dr. Rich Lord and Dr. Garett Franklin.

The North Carolina Family Physician

the Long Leaf Pine.

Dr. Karen Smith with a few of her colleagues at the AAFP Congress of Delegates.

Dr. Chuck Rich and Dr. Hershey Bell.

Andrea Augustine, Evan Morgan, Dr. Karen Smith, and Dr. Morgan Parker.

Dr. Chuck Rich with a colleague at the ground breaking of the new Methodist University Cape Fear Valley Health School of Medicine.

hy, Dr. Shannon Dowler, Dr. Karen

Dr. Hershey Bell speaks at the Methodist University Cape Fear Valley Medical School ceremony.

Dr. Chuck Rich and Dr. Rich Lord serving as delegates at the AAFP Congress of Delegates.

Medical students help treat a patient in their Concord summer program.

Dr. Karen Smith speaks at the Southeast Family Medicine Forum.

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Dr. Allen Dobson, Dr. Maureen Murphy, Dr. Michelle Jones, and Greg Griggs.

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New Methodist University Cape Fear Valley Health Medical School Holds Ground-Breaking Ceremony

By Kevin LaTorre Communications and Membership Manager

On Sept. 10, NCAFP Exec. Vice President and CEO Greg Griggs joined two NCAFP members, Dr. Hershey Bell and past NCAFP president Dr. Chuck Rich, at the ground-breaking ceremony for the Methodist University Cape Fear Valley Health School of Medicine in Fayetteville.

The ceremony gathered the leadership of Methodist University, Cape Fear Valley Health, and the future medical school to begin the construction, which will be completed in time for the school to welcome the first class of medical students in July 2026.

According to its leaders, one of the key objectives for creating the medical school is to increase the number of health care professionals in Bladen and Cumberland counties. In

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Cumberland county, County Health Rankings reported that there was one primary care physician for 1,420 people in 2021. Dr. Rich, who began working in the area in 1989, says, “There are no more primary care physicians or providers than there were when I first started.”

When Dr. Bell, founding dean of the medical school, spoke at the ceremony, he emphasized the community benefit of these future physicians: “Today, we’re celebrating the groundbreaking of not just any medical school – it’s our medical school, Fayetteville’s medical school, Cumberland County’s medical school, and the entire Southeast North Carolina region’s medical school,” he said during his speech at the ceremony. “It will be the greatest honor of my career to introduce the first class when they arrive. They won’t be just any medical school students; they will be our future neighbors and physicians.”

Dr. Rich will serve as the school’s founding head of the Family Medicine division, and he shares Dr. Bell’s excitement for what these future physicians will do. “I’m excited about the school,” he says. “When I look at the need for

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ADVISORY CAPITAL INSURANCE

Can understanding deliver outstanding?

Dr. Chuck Rich and Dr. Hershey Bell at the ceremony.

more health care access in the southeastern part of North Carolina, this is part of the solution.”

Historically, patients in these areas had to travel to Raleigh, Durham, and even Charlotte to receive medical care. But once the medical school begins embedding physicians in their own neighborhoods, Dr. Rich says that patients should face this obstacle less often: “Patients ultimately won’t have to travel as far. They’ll be able to get more primary care and more specialty care.”

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Improving all communities’ access to affordable, comprehensive medical care is one key reason the NCAFP focuses on the future workforce of North Carolina family physicians. Our work in this area includes funding medical students interested in Family Medicine through scholarships; providing immersive training for them through both in-clinic summer programs and our Family Medicine Day event; supporting the physicians who precept for those students; and other objectives, all of which increase the number, expertise, and commitment of future North Carolina family physicians.

And so, we at the NCAFP are glad that both Dr. Bell and Dr. Rich will help lead this new medical school and train the future family physicians who will come through its doors, so that they can serve the communities where they eventually practice.

Congratulations to Dr. Bell, Dr. Rich, and all the rest of the leaders who have worked to bring the new medical school to this part of North Carolina. *A version of this article appeared at ncafp.com in September 2024.

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

MEMBERSHIP SERVICES

By Kevin LaTorre

NCAFP Communications & Membership Manager

~ MEMBER SPOTLIGHT ~

Katie Haga, DO Dr. Haga works as a family physician in Cornelius and serves as the Clinic Director and Director of Advocacy and Health Systems Education at the Novant Health Family Medicine Residency Program.

She first came to medicine after studying the financial shortcomings of the medical system.

“I got my undergraduate degree in business management,” Dr. Haga says. “My mom and grandfather both owned their own businesses, so doing something in business was a natural choice. In the process of doing that, I started doing a lot of reading about health care and its structure from a financial and consumer standpoint. It was wild to me how difficult obtaining care as a consumer was, and also that we could have so much money and revenue in health care but not have outcomes that matched or surpassed other industrialized countries.”

During this time, she started working on projects on the health system during her business courses. “I heard from many how health systems were run by businesspeople but how health care was run by clinicians, and how these two groups didn’t run in conjunction with each other,” Dr. Haga says. “So with that in mind, I thought, ‘I need to become a physician, because I already understand some business, and then I’m going to start helping this system improve.” She continued studying health systems after she graduated from

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Arizona State University. For four years, Dr. Haga worked in business development at a small company, working with researchers and medical device manufacturers, where she also improved her real-world business acumen.

When she began medical school at the Campbell University School of Osteopathic Medicine, eager to make changes, Dr. Haga found that she had plenty to learn about medicine first. “It was embarrassing how little I knew about medicine at the start,” she says. “I didn’t understand any of the med school process. I was just there because I was so excited to make a difference in the health care system.” But by her third-year rotations, she had gotten her feet under her and knew how she was going to continue her work: Family Medicine.

“When I was learning more about health care from the clinician’s standpoint,” Dr. Haga says, “I saw how essential a primary care physician was to all the moving parts.

Patients’ health outcomes are better when they have a family physician, and the cost to the health systems becomes more contained when family physicians truly quarterback patients’ care. Everything pointed back to me being a family physician.”

Today, her work to improve Family Medicine for patients and physicians includes teaching at the Novant Health Family Medicine Residency and leading its clinic.

Dr. Haga addresses the larger factors affecting medicine in her role as the Assistant Program Director and Clinic Director at the residency, where she teaches residents about the concerns that first brought her into Family Medicine. “I really try to educate our residents on nuts-and-bolts things like correctly billing for their work, appropriate charge captures, and all the payer changes,” she says.

She also oversees the residency’s health system management curriculum, which gives her the chance to explain health systems to second-year residents for four-week rotations.

“It’s one of my favorite parts of the job,” Dr. Haga says.

“We talk about the different systems, the patient experience

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in receiving health care, and the overall American health system. We also discuss the importance of advocacy. What I try to teach these residents is that they can make an impact.”

Her interest in medical management reform also guides her work in leading the residency’s clinic, which has 25 physicians. “I work side-by-side with our clinic administrator,” Dr. Haga says. “I learn something new every day, and I feel like I’m still trying to wrap my mind around running an individual practice, much less a group or a health system.

But I do think my background gave me an opportunity to understand these roles and this work.”

And throughout all her responsibilities, Dr. Haga has still managed to become a leader in the NCAFP. She first became a NCAFP member as a resident and almost immediately joined the Member Satisfaction and Practice Environment Committee. “I absolutely wanted to be involved because the NCAFP’s work tied into my mission,” Dr. Haga says. “The

MEMBERS IN THE NEWS

NCAFP Member Andrea Augustine Elected as AAFP Foundation Board of Trustees Student Member During the AAFP National Conference in August, NCAFP student member Andrea Augustine won election as the new student trustee of the AAFP Foundation!

Andrea is a third-year student at the Duke University School of Medicine who also holds a master’s in public health from the University of Texas Health Science Center. How did she come to pursue Family Medicine? “My deep-rooted desire to build long-term relationships with my patients and engage actively with their communities guided me to the specialty,” she said in a statement.

“My passions include the interface of primary care and behavioral health, innovating community-engaged public health initiatives, and leadership and advocacy for my patients, our communities, and the field of Family Medicine.”

most rewarding part was getting to meet so many incredible physicians who are all passionate about Family Medicine and all get excited about making things better for patients.”

Dr. Haga has also learned the importance of physician advocacy by attending several past White Coat Wednesday events, attending the Family Medicine Advocacy Summit, and serving on the NCAFP Advocacy Committee.

Her largest contribution to NCAFP leadership so far will come this December: Dr. Haga is the program vice chair for the 2024 Winter Family Physicians Weekend, after attending the last six versions of the event. “It’s been so much fun to work on the meeting with [Program Chair] Dr. Tom White and [Events and CME Director] Kathryn Atkinson,” she says. “It’s going great. Like everything else, it ties into my passions for patient care and equipping physicians.” *A previous version of this article appeared online at ncafp.com in September 2024.

In addition to founding and leading the Student Primary Care Alliance at Duke, Andrea also serves as the student trustee on the NCAFP Foundation Board. Accordingly, we’re happy to offer high praise for her: “Andrea has been an excellent student member of our chapter from early in her medical school career,” said NCAFP Workforce Initiatives Manager Perry Price. “She has a true passion for primary care. Andrea takes full advantage of every opportunity she is offered and strives to not just participate but make an impact. She is a joyful human with a servant’s heart.” Congratulations, Andrea!

Dr. Bradley Christoph Named VP of Physician Services at UNC Health Caldwell NCAFP member Dr. Bradley Christoph will become the new Vice President of Physician Services at UNC Health Caldwell! Dr. Christoph has served the Caldwell community as a trusted family physician while also serving as the medical director at Helping Hands Clinic in Lenoir. And since 2017, he has managed to deliver this patient care and physician leadership while remaining a loyal, engaged member of the NCAFP. continues on next page

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Four Resident Members to Remain in Community When They Finish Residency at Campbell University It’s the best news we can hear about our resident members: according to the Campbell University School of Osteopathic Medicine, Drs. Shelby Rhyne, Sarah Lassiter, Morgan Hawkins, and Bonnie Page have all signed on to stay with Harnett Health after completing their residency in June 2025. All four are NCAFP members. “I decided to stay at Harnett Health so that I could continue to care for the patients who are part of that community,” said Lassiter. “The patient population and the patients I currently see bring me so much joy, I couldn’t imagine leaving.”

According to NCAFP member Dr. Regina Bray Brown, Director of Medical Education at Harnett Health and program director of the Harnett Health Family Medicine Residency Program, this outcome is the objective of training family physicians: “The mission of both Campbell and Harnett health residency is to train excellent physicians who want to stay and serve our community," she said. "We’re very excited.”

Congratulations to all four of these physicians, and thank you so much for continuing your commitment to the patients of Harnett County!

and what we are trying to do for primary care,” Dr. Aiken said. “There is significant momentum, and as a constituent in NC hoping to help my fellow primary care physicians, this feels like meaningful work.”

We are glad to see Dr. Aiken joining with his fellow physicians at the DPC Coalition to support the Access to DPC for People in Medicaid Act and the Primary Care Enhancement Act. For one thing, we hope that those bills can better help patients access their must-have primary care options.

But for another thing, we are glad to see Dr. Aiken practice the physician advocacy that we value. It’s important for family physicians to know and speak with their elected representatives, both at the state level and at the federal level.

Dr. Zachary Morehouse Selected for AAFP Annals of Family Medicine NCAFP member Dr. Zachary Morehouse recently learned that he was selected as the resident member of the Annals of Family Medicine Editorial Advisory Board. Alongside the other board members, Dr. Morehouse will help guide the scholarly research of the Annals of Family Medicine until September 2025. He joined fellow NCAFP member Dr. Karen Scherr on the board.

“It is through the hard work of dedicated members like you who accept leadership roles that we are able to accomplish our goals,” AAFP Board Chair Dr. Tochi Iroku-Malize wrote to Dr. Morehouse in a statement. “We at the AAFP look forward to working with you over the next year.” Congratulations, Dr. Morehouse!

Dr. Ben Aiken Advocates with Fellow Physicians in Washington, DC On Sept. 12, NCAFP member Dr. Ben Aiken (far left in the above picture) joined other physicians to advocate for federal efforts that would better support direct primary care (DPC) nationwide. “We’ve met with health care staff leads for the Senate Finance Committee and representatives and senators on both sides of the aisle who believe in the model

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The North Carolina Family Physician

STUDENT INTEREST & INITIATIVES

The Medical Student’s Guide to Getting Involved in North Carolina Family Medicine

By Samuel Evan Morgan MS-4 at Wake Forest School of Medicine

Family Medicine is a vast specialty that offers preventative, acute, and chronic care for extremely diverse arrays of patients by fostering comprehensive, coordinated, compassionate, and continuous health care. I am in my fourth year at Wake Forest School of Medicine, and each year has progressively highlighted my passion for Family Medicine.

During this time, I have served as the Treasurer, President, and M4 Class Representative of the Wake Forest Family Medicine Interest Group; the Outreach Coordinator and Vice President for a Health Insurance Certificate Program; the NCAFP Workforce Pipeline Committee Student Representative; and NCAFP Student Director, where I served as a

voting member on the NCAFP Board of Directors and was sent as the NC Delegate to Student Congress at the American Academy of Family Physicians National Conference. Throughout this immensely fulfilling adventure, I have come to learn several things which I would like to share with future medical students interested in Family Medicine, so that they may both learn from my mistakes and experience as fulfilling of a journey as I have in their pursuit of the specialty.

1. Get involved early, and don’t be shy to take on responsibility: My first introduction to the NCAFP was during my M1 year at Family Medicine Day in Durham. Trust me, I had no clue what I was doing and was quite nervous to put myself out there as a freshly minted medical student. Not only were the students and staff incredibly welcoming, but they also introduced me to student leadership that very day, and the connections I made sparked my journey to becoming NCAFP Student Director. I have developed strong relationships within the NCAFP since that nerve-wracking day in 2021, and I have made lifelong friends throughout the process. Do NOT let your age or year in medical school dictate your willingness to get involved with leadership. Everybody wants to enhance continues as "Involvment" on pg. 27

FOUNDATION PROGRAMS

Medical Students Enjoy Time with Family Physicians During NCAFP Foundation Summer Programs

By Kevin LaTorre Communications and Membership Manager

Through June and July 2024, 11 students from North Carolina medical schools completed their NCAFP summer programs in western North Carolina, Concord, and other places around the state. These programs paired the medical students directly with family physicians practicing in rural and underserved areas, so that students could learn about Family Medicine in those practice settings and larger communities. “Participants get to spend time learning from faculty and practicing physicians, learning with Family Medicine residents, and shadowing in various clinic settings,” said NCAFP Manager of Workforce Initiatives Perry Price.

“They are fully immersed into life as a family physician and gain great insight into a rewarding career path!”

According to their feedback through a post-program survey, all 11 students reported that they’re now more likely to consider Family Medicine as their future specialty of choice, thanks to completing the programs. “This gave me a view of what Family Medicine is really like day to day,” said one student. “I can see myself being a family physician.”

These medical students had the chance to understand family physicians and their patients.

Their programs included meeting with patients, learning from Family Medicine residents, and even living with local family physicians. If they had expected any of the medical care to be monotonous or predictable, they received a pleasant surprise: “I saw patients across the age spectrum,” said one student from the western program. “I think the youngest I saw was about seven years old, and the oldest patients were in their 80s.”

“Patients ranged in age from babies to elderly patients,” said one student. “Since we were at a federally qualified health center, most of them did not have insurance or had either Medicaid or Medicare. About one-third of our patients spoke Spanish.”

The students also found plenty of differences in the patients’ medical needs. “I loved doing true full-spectrum care: all kinds of acute and chronic concerns like diabetes, hypertension, opioid use disorder, obesity, and other needs,” said one student. “Overall, I just enjoyed the variety of conditions and needs that people came in for. It is a nice change of pace from cities and suburban areas.”

The learning they received came right from their preceptors: “Dr. Erika Steinbacher was really kind and personable during my stay,” said one student, “she made me feel comfortable and welcome.”

“The way that Dr. Shawn Hamm really listened to his patients and let them be active participants in their health care really inspired me to do the same when I practice one day,” said another student.

Many of the students say they want to pursue Family Medicine, courtesy of the NCAFP. Seeing family physicians at work proved that Family Medicine has what they want, said many of the participants: continues as "Summer Programs" on pg. 27

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PRACTICE MANAGEMENT

Navigating a Negligence Lawsuit Should Never Be a Solo Trip

By Kristen Janicek, RN, JD, and Damian McHugh MD, FACEP

The sheriff shows up at your home or office reciting those dreaded words: “You’ve been served.” Alternately, you sign for certified mail on your porch and find it is from a plaintiff`s attorney. The day you get served with a medical negligence lawsuit is likely one of your very worst days as a physician.

After you dedicate many years to intense study since high school, delay your gratification through residency, and spend numerous holidays and weekend nights caring for humanity, the suit papers you might receive are anything but “just business.” Being named in a suit rocks your very foundations of a physician. Immediately, as a named defendant in a medical negligence lawsuit, you are in deeply unfamiliar territory and likely feel scared, vulnerable, and very much alone. Although challenging, please remember you are not alone.

According to a robust American Medical Association benchmark report from 2016-2022, almost half of all physicians aged 54 or over have been sued. Medscape previously reported that more than half of physicians will be named in a lawsuit at some point in their careers. Although it’s common, being named in a medical negligence lawsuit is still a highly stressful experience.

Should you ever find yourself a named defendant in a medical negligence lawsuit, your first move should be to call

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your medical professional liability (MPL) insurance carrier.

Lawsuit responses must be filed with the court, and these are time sensitive. It is important to get your medical professional liability carrier on notice as soon as possible.

A claims professional from your carrier should be available to discuss the matter with you promptly. They will provide you with guidance and instruction. Be prepared to provide your claims professional with copies of everything you have received to date related to the claim. Your claims professional will need to first confirm your coverage and then retain an attorney to represent you against the claims of medical negligence. Be prepared to wait, as this process may take several business days.

After you are served with a complaint, there are a couple of things you should abstain from until you receive guidance from your attorney. Curiosity will undoubtedly lead you to wonder about the medical care at issue. You will want to log on to your facility’s electronic medical record system and review the patient’s chart.

This is inadvisable, not only due to privacy concerns but also because audit trails are created each time you log in. Audit trail data is typically requested and received by plaintiff’s attorneys during the pendency of litigation. If a plaintiff’s attorney can skew data to make it look like you were nervous or concerned about the care you provided, they undoubtedly will. Do not give them ammunition. Rest assured that your attorney will be able to obtain the medical records and provide you with a copy for review.

Another instinct is to discuss the care you provided with a colleague or friend. It is important to remember that such conversations with colleagues or friends are discoverable in the litigation journey. What if your colleague thought you should have run a different test or sought additional consultation? Suddenly, your colleague may have unwittingly become the plaintiff’s star witness! Certain conversations during the pendency of a lawsuit are privileged and not subject to discovery. Please ask your attorney’s guidance before discussing the merits of the lawsuit with anyone.

The North Carolina Family Physician

The time between notifying your professional liability carrier and speaking with an attorney can be particularly stressful (especially because you know you should not access the record or speak with colleagues). This is a great time to practice self-care. Remember that just because you have been named in a lawsuit, it does not mean you have done anything wrong. While you wait, try to do something you love, like spending time with loved ones, getting out into nature for exercise, or meditation. Your suit means you join a cadre of diligent professionals whose care has been called into question by our tort system. The unexpected clinical outcome is much more likely to have arisen simply due to the underlying disease process. It is not a reflection of your value as a physician.

As promptly as is feasible, the attorney your carrier assigned to your case will contact you. This attorney will be skilled in representing physicians in medical negligence claims.

They will go over initial instructions and provide you with a broad overview of the litigation process. They and their experienced team will handle the bulk of the lawsuit to let you return to the daily business of practicing medicine.

Please understand though that litigation is an arduous marathon and surely not a sprint. Lawsuits can last for years and often do. Please be prepared to let your attorney and claims professional know the frequency and type of updates you would like to receive during the pendency of the lawsuit.

Everyone is different in this regard. Some physicians want to be updated frequently, and others want to be updated only when necessary. There is no right or wrong. The key is to communicate your wishes to those representing you.

During the lawsuit, you can expect certain flurries of activity, followed by months and months of little to no activity.

At the outset, your attorney will need you to teach them about medicine. On your behalf, they will retain expert reviews to assess whether your care complies with the applicable standards of care. If you know of experts who might be able to support you, share that information with your counsel. Counsel may also retain causation experts to opine whether your care was a proximate cause of the plaintiff’s harm.

At some point, you will have to give a deposition. This is one of the most important days during the lawsuit process. It is important that your attorney thoroughly prepares you for your deposition. Physicians, by nature, are teachers. A deposition is not your time to teach the plaintiff’s attorney about your care. To that end, the entire process is

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antithetical to what most physicians are used to doing day in and day out. Depositions demand abundant preparation and at least a couple of real-life trial runs.

Lawsuits usually end in one of three ways: settlement, dismissal, or trial. Many physicians are dismissed from lawsuits for one reason or another. Other times, cases get settled. A settlement is not an admission of liability. It is a risk avoidance measure and may require your consent. There are reporting requirements to both state licensing boards and the National Practitioner Data Bank in the event of settlement.

Your professional liability carrier will advise you should settlement become recommended.

Lastly, a small number of cases end in trial. Trials are time-consuming and stressful. Should your case proceed to trial, know the numbers remain strongly in your favor. 65% of claims closed between 2016-18 were dropped, dismissed, or withdrawn. Of the 6% of claims that were decided by a trial verdict, 89% were won by the defendant (Medical Liability Claim Frequency Among U.S. Physicians, José R. Guardado, PhD, AMA Economic and Health Policy Research, April 2023).

Once the first few waves of the lawsuit tsunami have passed, and your team has taken shape, it may be worth trying to compartmentalize feelings and actions throughout this challenging time. Your primary goal is to look after yourself and your family each day, as you proceed through this often difficult legal process. Remaining grounded and aiming to live and work soundly each day may be seemingly unattainable goals, but with expert help from your attorney and carrier, they are possible. With cooperative partnership and expert support, you will come through this process even stronger.

The information provided in this article is intended for informational purposes only. It is not intended as, and does not serve as a substitute for, legal advice.

Kristen Janicek is Curi’s Director of Operations, Claims. In her previous life, she practiced as a registered nurse and as an attorney defending physicians. Her current role with Curi allows her to utilize her skill set to assist in the defense of health care providers.

Damian McHugh is Curi’s Senior Director of Physician Engagement. In this role, he advises Curi leadership on how the company can best meet the needs of physicians and health care teams.

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"Congress of Delegates" continued from pg. 11 key new policy positions and updated existing policies based on members’ input and testimony. For example, the Congress adopted a resolution directing AAFP to “explore opportunities to evaluate the impact of private equity on the practice of Family Medicine, including the effects on family physicians’ practices and the resulting potential changes in outcomes for patients,” and to ultimately develop a “policy statement on the short and long-term impact of private equity of family physicians and their patients.”

The Congress also: • Adopted a resolution on standardizing FMLA paperwork • Adopted a resolution supporting removing the designation of fentanyl test strips as drug paraphernalia • Adopted a resolution calling for increased harm reduction education and resources • Adopted a resolution calling on the AAFP to investigate

the main drivers of family physicians leaving the workforce and ultimately make recommendations for addressing those specific issues • Adopted a resolution asking AAFP to advocate for a national tax credit or tax deduction for physicians serving as community preceptors for medical students and residents who otherwise do not receive payment from an educational institution • Adopted a resolution that AAFP advocate for “standardized guidelines and requirements for health plans to improve the accuracy, transparency, timeliness, and fairness of patient attribution processes and methodologies that emphasize voluntary agreements between patients and physicians…and advocate for formal mechanisms to allow physicians to verify and correct attribution data as necessary” These adopted resolutions are just a sampling of the work that the AAFP Congress of Delegates completes each year.

NORTH CAROLINA CHAPTER ATTENDEES Here is a complete list of the North Carolina Chapter members who joined me in attending the Congress of Delegates: Delegate: Dr. Rich Lord (Past President – 2010-11) Delegate: Dr. Robert “Chuck” Rich (Past President – 2008-09) Alternate Delegate: Dr. Tamieka Howell (Past President – 2017-18) Alternate Delegate: Dr. Thomas White (Past President – 2014-15) President: Dr. Garett Franklin President-Elect: Dr. Mark McNeill Treasurer: Dr. Benjamin “Frankie” Simmons AAFP Board Candidate (now Board Member): Dr. Shannon Dowler (Past President – 2012-13) AAFP Pres.-Elect Candidate (former AAFP Board Member): Dr. Karen Smith (Past President 2004-05) NCAFP Foundation President: Dr. Maureen Murphy (Past President – 2000-01) Past President: Dr. Allen Dobson (1998-99) Past President: Dr. Conrad Flick (2003-04) Past President: Dr. Doug Henley (1987-89), also Past AAFP President and Past AAFP Exec. VP and CEO Past President: Dr. Michelle Jones (2006-07) AAFP Commission Member: Dr. Andrea DeSantis NCAFP Foundation Board Member: Dr. Vickie Fowler President of American College of Osteopathic Family Physicians: Dr. Brian Kessler President of the American Board of Family Medicine: Dr. Warren Newton President-Elect of WONCA (World Organization of Family Physicians): Dr. Viviana Martinez-Bianchi NCAFP Senior VP and General Counsel: Shawn Parker, JD, MPA NCAFP Director of CME and Events: Kathryn Atkinson, CMP NCAFP Manager of Communications & Membership: Kevin LaTorre, MA

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The North Carolina Family Physician

"Involvement" continued from pg. 22 your journey along the way, if you simply ask.

2. Explain your thought process and diagnosis to your patients: Too many times, I have been involved in clinic visits where patients had no idea what medications they were on or the purpose of their visit. There is nothing quite as humbling as asking a patient what brings them to clinic and having them reply, “I have no clue.” Taking a few seconds to explain a diagnosis to a patient and give them your thought process goes a long way. I have seen some family physicians even go the extra mile by drawing diagrams for patients on the exam table during a visit. Patients are much more likely to take advice and follow health care plans when they feel their physician cares about their understanding. I have heard the phrase “We sure do need more good Family Doctors like that” no less than 20 times during medical school, and this almost always comes after simply explaining a patient’s diagnosis to them.

3. Do not let other specialties dissuade you from pursuing primary care: I specifically remember one instance on my surgery rotation where a surgeon asked what I was interested in, to which I replied, “Family Medicine.” He promptly replied, “Ah, so you like writing notes and not being listened to.” There will almost certainly be instances in your medical school journey where other specialists will not lend Family Medicine the credit it deserves. I advise students not to let this dissuade them, as there will be some point in this specialist’s very near future where they will recommend their patient follow up with their primary

"Summer Programs" continued from pg. 23

care physician (PCP). Studies show that 10 extra PCPs per 100,000 people increases life expectancy by 51.5 days [1].

Primary care is literally life-saving.

4. Experience rural medicine at some point in your medical education: This is a must. Rural medicine combines patients with the most minimalistic health care with some of the most comprehensive practices I have ever seen.

I rotated through a clinic in West Jefferson where the family physician performed clinic vasectomies. There is nothing quite as exhilarating as a full-scope rural clinic where family doctors might deliver babies, do c-sections, perform vasectomies, do colonoscopies, dispense their own medicine, run inpatient services, and so much more.

5. You will use SOMETHING from every rotation you go through in your future practice: No matter the rotation, you will use something that you learned in Family Medicine. Whether it’s describing the process of EMG to your carpal tunnel patient, suturing a skin laceration in an acute care visit, or talking a female patient through pregnancy concerns, you will need knowledge from every rotation to make you a comprehensive Family Physician.

The breadth of Family Medicine is astounding, and its future is extremely bright. I hope my words can help future students carve their pathway towards the broadest and arguably most-rewarding specialty in medicine.

1. Vogel L. Life expectancy grows with supply of primary care doctors.

CMAJ. 2019 Mar 25;191(12):E347. doi: 10.1503/cmaj.109-5729.

PMID: 30910887; PMCID: PMC6435370.

“Watching three or four generations of patients be treated by one physician is amazing and exactly what I want to do,” said one student. “Seeing that same provider provide psychiatric support, childhood vaccines, and suboxone is quite frankly amazing.”

the whole reason we organize these summer programs. One student said, “I am super thankful that the NCAFP made it possible for me to participate. Initiatives like this show that the NCAFP is dedicated to exposing more people to Family Medicine, so that we can have more primary care doctors who bring healing to our communities.”

The goal of continued, comprehensive care, combined with the variety of patients and care needs, clicked perfectly for one student from the Concord program, who said, “At times, I had the fear that I may get bored over the course of my career if I become a family physician. But this program has most definitely changed my mind on that note.”

In turn, we are very thankful for the medical students and physician preceptors who helped us organize these crucial programs! A special thank you to the MAHEC – Boone Family Medicine Residency and to the Cabarrus Family Medicine Residency for their partnership with the Foundation programs this summer.

Pointing talented medical students who want to serve the underserved toward Family Medicine in North Carolina is

*A previous version of this article appeared on ncafp.com in July 2024.

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Connecting Family Physicians and Family Medicine Employers in North Carolina

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