NC Family Physician: Fall 2019

Volume 15 Issue 4 • Autumn 2019

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

DRIVING MEMBER SATISFACTION PRACTICE IMPROVEMENT

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CM E | C AMR ADER IE | N ET WOR K ING | F UN

2020 NCAFP MEETINGS AT A G L A N C E

Spring Symposium – A Saturday CME Event

Late Summer Half-Day Saturday CME

Saturday, April 4, 2020 Charlotte Marriott SouthPark Hotel Charlotte, NC

Saturday, August 8, 2020 Venue to be announced Greensboro, NC

Evening CME Dinner Meeting

Evening CME Dinner Meeting

Tuesday, June 2, 2020 UNC Family Medicine Center Chapel Hill, NC

Tuesday, September 29, 2020 ECU Family Medicine Center Greenville, NC

Winter Family Physicians Weekend Thursday, December 3 – Sunday, December 6, 2020 The Omni Grove Park Inn Asheville, NC

You will always find creative and out-of-the-box learning opportunities at NCAFP CME events • Audience-response technology • Case-based study workshops • Interactive-learning workshops

• Timely panel discussions • Innovative product theaters • Convenient mobile conference app

• Hands-on practice sessions • Great social and networking events

Have questions or need more information about our CME opportunities?

Contact Kathryn Atkinson, CMP | Manager of Meetings & Events, at 919-214-9058 or via katkinson@ncafp.com.

Inside Autumn 2019

2019 Foundation Raffle Supports Key Student Family Medicine Programs

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PRESIDENT’S MESSAGE

PROFESSIONAL DEVELOPMENT

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HEALTH POLICY & ADVOCACY

RESIDENTS & NEW PHYSICIANS

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Driving Member Satisfaction and Practice Improvement

NCAFP Reiterates AAFP Position on Administration’s Executive Order of Medicare

Reach New Heights and Energize Your Passion for Family Medicine at 2019 Winter Meeting

Family Medicine Foundations: Great Preceptors Can Make All the Difference

CHAPTER AFFAIRS

PRACTICE MANAGEMENT

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NCAFP Representing FM in Multiple Ways at Multiple Meetings

Duke’s CIPHERS Project Studying Epigenetic Sperm Changes in Male Cannabis Users

DEPARTMENTS

PUBLISHED BY

President’s Message 4 Health Policy & Advocacy 8 Chapter Affairs 10 Membership 12 t 919.833.2110 •

fax

NCAFP Foundation 16 Professional Development 18 Residents & New Physicians 24 Practice Management 28

919.833.1801 • ncafp.com

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 pgraber@ncafp.com.

PRESIDENT’S MESSAGE to Members

By Dr. Alisa Nance, RPh 2018–2019 NCAFP President

~ THE NCAFP COMMITTEES ~

Driving Member Satisfaction and Practice Improvement As my year as President of the NCAFP ends, I look back to all I have learned. I have learned so much more about Family Medicine, the AAFP, the NCAFP, my fellow physicians, but mostly about myself. I have always loved being a family physician. What has been the most revealing is how passionate one becomes when representing so many talented and gifted people!

These are exciting times: times where the value of Family Medicine is being understood, where the longterm relationship with a patient is not only rewarding but improves care and lowers cost. We are on the cusp of payment reform, as we shift to value. Thank goodness, we, as family physicians, GET IT! We must remain poised to be the change agents for this shift.

To complete my committee introduction series, I would like to highlight NCAFP’s Member Satisfaction and Practice Environment Committee. With a mission to rebuild the excitement of Family Medicine across all practice settings, this committee’s goals are as follows:

for NCAFP members.

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

• Engage patients as advocates for Family Medicine.

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

• Improve the practice environment by providing education on different practice styles and opportunities to enhance practice efficiencies/effectiveness.

• Encourage mentoring, teaching and community engagement.

• Increase networking opportunities and support

• Provide quality education that impacts patient care

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The North Carolina Family Physician

2018-2019

NCAFP Board of Directors Executive Officers President President-Elect Secretary/Treasurer Immediate Past President Executive Vice President

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

At-Large Directors Talia M. Aron, MD Jewell P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Dimitrios “Takie” P. Hondros, MD Jennifer Mullendore, MD Mackenzie Smith, MD Ying Vang, MD Slade A. Suchecki, DO Brian McCollough, MD Elizabeth B. Baltaro, MD Family Medicine Residency Directors Mark L. Higdon, DO (Novant FMR) Resident Director David S. Baker, MD (MAHEC-A) Resident Director-Elect Elizabeth Ferruzzi, MD (Novant) Student Director Cameron G. Smith (Campbell) Student Director-Elect Katelyn Turlington (WFSOM)

Medical School Representatives & Alternates

and the practice of Family Medicine.

The committee’s members include: Dr. Shauna Guthrie, Chair; Dr. Talia Aaron, NCAFP Board Liaison; Dr. Nichole Johnson, New Physician; Dr. Sarita Lavani, Resident Physician; Dr. Charlie Rhodes, Past President; Scott Macbeth, Student; Dr. Takie Hondros, NCAFP Executive Board Liaison; and Dr. Dalia Brahmi, Dr. Lisa Cassidy-Vu, Dr. Sonia Duggal, Dr. Vickie Fowler, Dr. Mark McNeill, and Dr. Nadine Skinner as members-at-large.

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

Chelley K. Alexander, MD Nicholas Pennings, DO Anthony J. Viera, MD, MPH Cristen P. Page, MD Richard W. Lord, Jr., MD, MA

AAFP Delegates & Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

Michelle F. Jones, MD Karen L. Smith, MD Richard W. Lord, Jr., MD, MA Robert L. Rich, Jr., MD

The committee is actively working with the following strategic initiatives: • Providing opportunities for group chat sessions for medical students and residents (which took place with students at the Continues on next page

Autumn 2019

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

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~ Committee Member Highlight ~

Dr. Mark McNeill is our member spotlight for this issue. He is the epitome of living out the member satisfaction and work environment goals - being raised in Raeford, NC, and receiving all his education in North Carolina, including his undergraduate degree in Biology from Appalachian State University, medical school training at East Carolina University and residency training in Family Medicine at the Mountain Area Health Education Center Program (MAHEC).

He found his first inspiration of efficiencies and low overhead practices from his locums tenens year in New Zealand.

After New Zealand, Dr. McNeill moved back to Clyde, NC, to pursue his interest in rural Family Medicine. There he practiced full scope Family Medicine with Midway Medical Center for over three years while leading the practice from paper

to electronic health records. He was able to see how the, “successful use of an EHR is about workflow; looking at who touches what and why contributes to whether your technology increases or interferes with your efficiency.”

From there, Mark moved to Asheville to become the EHR champion at Community Family Practice. This is where he was able to see the value of patient portals in EHR technology. It was there at the start of the Centers for Medicare and Medicaid Services (CMS) Meaningful Use, and he then realized that patient portals were the key to moving to simplification. “Wow! [Portals] could really streamline things like patient phone calls and scheduling.”

Mark also learned from Ideal Medical Practices, a non-profit organization that educates and supports small, independent practices to understand how to achieve low overhead, high efficiency, high technology practices. In addition, he was inspired by a portal-heavy practice focused on Medic-

Family Medicine Day residency recruiting event).

and residency programs.

• Providing education to members on leadership development and personal growth during NCAFP’s upcoming annual meeting.

The Committee also supported practice environment sessions held at the 2018 Winter Family Physicians Weekend: Practice Management 301, DPC Discussion, MAT Training, and Value-Based Healthcare. It also promoted an educational session on collaborative care codes and models of care at the 2019 Spring Symposium.

Dr. Mark McNeill

• Continuing practice management education partnerships with the NC Medical Society and providing education on a wide range of topics (coding, workflow efficiency, value-based healthcare, population health, how to use EHRs effectively, and basic standards for what to expect in a practice setting) that improve patient care and the practice of Family Medicine.

• Working with NCAFP’s Student and Resident sections to identify burnout education opportunities and resources that might be included in future student and resident programs. This also includes sharing best practices from current efforts by medical schools

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At next month’s Winter Family Physicians Weekend (December 5-8, 2019), Practice Management 301 will feature Leadership, Coding, Accountable Care, and Population Health. In addition, Dr. Kim Yu will be delivering an optional two-hour workshop on physician wellness as a part of the “Physician Health First” initiative. A “Practice Models Summit” will present a range of practice models available in Family Medicine. Dr. Jan Beste will be present-

The North Carolina Family Physician

aid run by MAHEC in Flat Rock.

Combining his portal and Ideal Medical Practice concepts, Mark was able to strike out on his own in Asheville, NC. He opened Trillium Family Medicine as a full-service, high-tech, portal-based practice accepting traditional insurances. His practice recently celebrated its seventh year this fall! Dr. McNeill has been able to educate patients to use the portal for scheduling, questions, refills, and to incorporate an interview with the patient as a portion of their medical record note. This patient-centered data prepares Dr. McNeill and the patient for the visit and eliminates additional documentation, since it is completed prior to the appointment. With such efficiency, he can work with only 2 full-time employees - an office manager and a medical office assistant. He just recently hired a part-time physician-assistant. Dr. McNeill does not need a scheduler or large staff, and he has found himself more available with more access, and can see fewer patients per day.

Dr. McNeill says what he’s learned the most about himself in this process is “how important autonomy is”, and how “better workflow leads to more happiness

and less burnout.” He learned from a wise mentor that the success of a physician is not just about “availability, affability, and ability…. it’s about availability, availability and availability!” He also believes, “availability builds better relationships and less anxiety with and in the patients, which in turn leads to better satisfaction.”

Dr. McNeill has lectured for six years about his practice model, trying to be a change agent for the nay-sayers who believe the hamster wheel productivity model, is “just my life now,” and “I just can’t do anything about it.” I heard Dr. McNeill explain his idea of solving workflow problems with portals in 2016.

I was amazed and initially felt, like most physicians, that I had no autonomy. Yet, I’m living proof, like Dr. McNeill, that you have more power than you think!

Utilizing the portal will shrink your inbox of patient calls and questions. Retraining patients to ask for appointments via the portal or having open scheduling also frees up your front office staff. Replying to very frequently calling patients in writing via the portal once a day reduces staff and patient frustration.

The benefits go on and on... just ask Dr. McNeill!

ing on the main stage on, “Managing Up—Influencing the Hierarchy.”

in lieu of our Myrtle Beach summer conference.

Attendance has been excellent and touched more North Carolina members than out-of-state guests.

We look forward to continuing this effort in 2020 as we change the regional locations to engage new and returning attendees!

The NCAFP had many networking and CME opportunities in 2019, including: • The Spring Symposium in Charlotte.

• An update on Street Drugs in Winston-Salem in June.

• Thirty Minute Exchanges - Exploring Hot Topics in Wilmington in September.

• And the Essential Elements of Managing Common Chronic Diseases in Family Medicine held in Raleigh just last month.

This was the first year we tried to meet physician learners in their backyards throughout the year

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Finally, I was also able to attend and contribute to a regional Direct Primary Care (DPC) Summit panel discussion on the value of primary care and its role in reducing cost and increasing value. Attendees were prospective DPC physicians and local employers looking to offer this model as a benefit for employees.

Future endeavors of the Member Satisfaction and Practice Environment Committee are to continue to provide brief comments or Member Spotlights in this magazine and work toward achieving high membership benchmarks, as well as, promoting full scope of practice for family physicians. Stay tuned!

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POLICY & ADVOCACY

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

~ ADVOCACY IN ACTION ~

NCAFP Reiterates AAFP Position on Administration’s Executive Order on Medicare

The NCAFP supports AAFP’s strong statement on the Trump Administration’s Executive Order: “Protecting and Improving Medicare for our Nation’s Seniors,” praising three positive aspects of the order but opposing those areas that are contrary to AAFP policy. In the letter to the Administration on behalf of Family Medicine, AAFP Board Chair John S. Cullen, MD, FAAFP, writes:

• The AAFP Shares the Administration’s desire to take accelerated steps to reduce administrative burden placed on family physicians.

• The AAFP applauds the Administration’s continued commitment to creating site-neutral parity in payments for health care services.

• The AAFP welcomes an opportunity to work with the Administration on ensuring appropriate access to family physicians through network adequacy.

• While viewing the Medicare Advantage program positively, the AAFP urges caution against prioritizing the program over traditional Medicare coverage.

• While supporting patient choice and freedom to select their primary care team through private contracting, the AAFP wishes to raise concerns about creating the ability of patients to forgo all Medicare coverage outright.

• And finally, the AAFP strongly opposes recommendations to eliminate supervision requirements for non-physician providers and payment equity that would disincentivize team-based care.

STATE

Spectrum News Debates Key Healthcare Issues in InFocus Hometown Debate Series Spectrum News’ Loretta Boniti moderated a four-part series on state health care issues that aired on Spectrum cable and are available for viewing online. The series was sponsored by North Carolina’s Institute of Political Leadership (iopl. org), a non-partisan organization that educates future political and community leaders. Across four segments, the series discussed topics such as state Medicaid transformation, health insurance, rural healthcare access, and healthcare delivery.

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Family Medicine played a key role.

In the rural access segment, ECU Department of Family Medicine Chair Dr. Chelley Alexander served as one of four panelists. Additionally, NCAFP’s Executive Vice President Greg Griggs, MPA, was a panelist discussing healthcare delivery, including issues such as telemedicine, Certificate of Need and healthcare consolidation.

To view the series, visit www.ncafp.com/hometown.

The North Carolina Family Physician

PROGRESS WITH EVERY STEP Invest In Family Medicine

FAMPAC NORTH CAROLINA

Empowering Family Medicine in North Carolina

Contribute @ www.ncafp.com/fampac

CHAPTER AFFAIRS

• State Child and Maternal Health Summit sponsored by the NC Medical Society and co-sponsored by the NCAFP: Alisa Nance, MD, RPh, NCAFP President; Janalynn Beste, MD, Residency Director, New Hanover Regional Family Medicine Residency program and member, NCAFP Workforce Pipeline Committee; and Griggs.

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

~ ACADEMY IN ACTION ~

Rather than write a traditional column for this quarter’s magazine, I thought it would be good to provide our members with a list of just a few of the events where the NCAFP leadership and staff have represented the profession of Family Medicine in the last two months. As part of our efforts to advocate on behalf of you and your patients, we attend as many meetings that impact Family Medicine and primary care as possible. Here’s just a sampling of some of these events and at least a few of the individuals representing Family Medicine during each of these activities: OCTOBER • NC Medical Society LEAD Conference: David Rinehart, MD, NCAFP President-Elect; Shauna Guthrie, MD, and Garett Franklin, MD, NCAFP Board Members; and Greg Griggs, MPA, CAE, NCAFP EVP. • NCMS Foundation Community Practitioner Program 30th Anniversary Luncheon and Advisory Committee Meeting: Brent Hazelett, MPA, CAE, NCAFP Vice President and COO.

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• 14th Annual Jim Bernstein Health Leadership Dinner: NCAFP President-Elect Dave Rinehart, MD; Board Member Slade Suchecki, DO; as well as three medical students, a resident, Griggs and Hazelett.

REPRESENTATION

NCAFP Representing You in Multiple Ways at Multiple Meetings

• NC Medical Society Opioid Task Force: Brent Hazelett.

• NC DHHS Meeting with the Secretary on Advanced Medical Homes: Dr. Rinehart, Griggs and several other NCAFP members.

• North Carolina Institute on Political Leadership Hometown Debates broadcast by Spectrum News: Both Griggs and NCAFP Board Member and Family Medicine Chair at the Brody School of Medicine, Chelley Alexander, MD, served as panelists on two of the four debates.

• Presentation to Wake Forest University Family Medicine Interest Group and Health Policy Interest Group: Griggs and Tracie Hazelett, NCAFP Manager of Student and Resident Initiatives.

• Meeting with Residents at Cabarrus Family Medicine Residency Program: Tracie Hazelett, along with Clint Cresawn of the NC Office of Rural Health Placement Services Program.

SEPTEMBER • AAFP Congress of Delegates: The

The North Carolina Family Physician

official delegation from NC included Dr. Nance and Dr. Rinehart; our two delegates, Dr. Michelle Jones and Dr. Karen Smith; and our two alternate delegates, Dr. Rich Lord and Dr. Chuck Rich; although a number of other individuals from the state chapter attended, including Immediate Past President Dr. Tamieka Howell, and Secretary-Treasurer Dr. Jessica Triche.

C H A P T E R

B R I E F S

• Closing the Coverage Gap Meetings: Griggs.

• Monthly Meeting with NC DHHS Deputy Secretary in charge of Medicaid, Dave Richard: Griggs.

• Presentation by Dr. Karen Issacs to community members in Wilmington at the New Hanover Regional Medical Center on Navigating the Social Determinants of Health: Dr. Nance and Griggs.

• Practice visits to Wilmington Health Associates: Dr. Nance and Griggs.

• NCCare360 Advisory Council Meeting: Griggs.

• NC Opioid and Prescription Drug Abuse Advisory Committee: Griggs.

NCAFP Hosts Southeast Family Medicine Forum with AAFP Chapter Leaders Leaders and chapter executives from twelve AAFP chapters across the southeast converged in Asheville in mid-August for two days of policy, advocacy and issues conversations. More than 75 attendees heard presentations on topics such as private equity in Family Medicine, addressing the social determinants, the move to value-based care, as well as health policy and programming updates from the ABFM and the AAFP. This rotating two-day conference brings together chapter and physician leaders from all southeast chapters and is always a privilege for the hosting chapter. For additional sights and scenes from the event, see the NCAFP’s Facebook page at www.facebook.com/ncafp.

• NC Institute of Medicine Annual Meeting: Dr. Rinehart, Dr. Nance and Griggs.

NY Times Discusses North Carolina’s Move to Value-Based Care

• Advanced Medical Home Subcommittee of the Medical Care Advisory Committee: Dr. Rinehart.

Ardmore Family Practice in Winston Salem provided the backdrop for recent coverage in the New York Times about North Carolina’s move towards value-based care. Times reporter Steve Lohr visited the state in early summer to gather background and interview several people quoted in the article. Ardmore Family Practice physicians Drs. Robert Rosen and Amy Sapp provided an in-practice interview with Lohr; he also interviewed DHHS Secretary Dr. Mandy Cohen, and Dr. Mark McClellan of Duke University. Read the article at nytimes.com/2019/08/26/business/north-carolina-health-care-outcomes.html.

• The NC Institute of Medicine Task Force on Health Services for Individuals Who are Deaf and Hard of Hearing: Griggs.

These are just a sampling of the meetings where NCAFP has an official attendee to make sure that family medicine’s voice is heard. Remember, the old saying, if you don’t have a seat at the table, you are probably on the menu. Every month we strive to make sure that family medicine is at the table and not on the menu. But we couldn’t do it without you, our members.

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NCAFP Past President Dr. Shannon Dowler Named Medicaid’s New Chief Medical Officer Academy Past President Shannon Dowler, MD, (’13) is the new Chief Medical Officer for the North Carolina Division of Health Benefits/North Carolina Medicaid. Dr. Dowler has a long history of service in leadership roles in North Carolina. Professionally, she most recently served as the Chief of Community Medicine and Ambulatory Population Health for Mission Health Medical Associates in Asheville where she helped lead primary care, including quality, safety and ambulatory population health strategy for Mission’s primary care practices across an 18-county region. In her volunteer pursuits, Dr. Dowler previously served as chair of the North Carolina Physicians Advisory Group and as a member of the AAFP’s Commission on Health of the Public and Science. She currently serves as President of the NCAFP Foundation.

Dr. Dowler received her medical degree from East Carolina University and completed her residency training at MAHEC in Asheville.

NCAFP’s Dr. Rhett Brown Receives 2019 Equity of Care Award by Charlotte Healthcare Executives Past President Dr. Rhett Brown (‘17) was recently awarded the 2019 Equity of Care Award by the Greater Charlotte Healthcare Executives Group. The award recognizes physician leaders who are pioneering equity-of-care within their healthcare practice and whose actions, example, and efforts contribute to the advancement and promotion of diversity and inclusion. Dr. Brown is a leading healthcare advocate for the LGBTQ community in greater Charlotte who currently practices at Novant Health Midtown Family Medicine. Congratulations!

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MEMBERSHIP

By Tara Hinkle NCAFP Manager, Member Services

The NCAFP would like to thank all of our members for an outstanding 2019. We appreciate your participation, your voice, and your commitment to Family Medicine. Most of all, we appreciate your membership. If you have any questions, please use the contact information in each section or reach out to Tara Hinkle, NCAFP Manager, Member Services, at thinkle@ncafp.com or 919-980-5381.

2019 CME Re-Election Candidates If you are a candidate for 2019 CME Re-Election, you have until 12/31/19 to earn your 150 credits. Please note that the AAFP does not offer extensions on the earning deadline. Please visit www.aafp.org/cme to determine your re-election cycle (every three years), report CME, and view CME options if you are short of your required hours. You may also report and find quizzes on AAFP’s free mobile app. If you are attending our annual meeting in December, we will report your credits earned to the AAFP and they will add them to your transcript after processing.

2020 Membership Dues The deadline for 2020 dues payment is January 1st, 2020, for all Active, Inactive, Supporting, Transitional and first time Life members. Membership is on a January – December calendar year. Hard copy invoices were mailed to primary addresses last month.

You may access your invoice anytime online at www. aafp.org/quickpay or www.aafp.org/checkmydues.

You may also click on the “My Account” button on AAFP’s free mobile app. Installments are available. To pay dues by phone, please call the AAFP between 9:00 a.m. – 6:30 p.m. EST at 1-800-274-2237 x 0. If you have interrupted practice, retired, or moved out of NC, please call the AAFP as soon as possible to transfer your membership type or relocate your state chapter membership.

The North Carolina Family Physician

~ ADVERTISEMENT ~

Handling Immunization Refusal in the Anti-Vaccination Era

By Anita Linton, Senior Risk Manager, Curi A growing of parents are refusing to have their children Dealing number with Disruptive Patients and Building a Positive Practice vaccinated Environmentagainst preventable diseases, Vice making it more important thanCuri ever for practices to clearly outline

By Donna Nicholson, President, Risk Management, policies and procedures related to immunization. Physicians, particularly pediatricians, must If you’ve noticed a rising number of patient complaints disruptive incidents in your and tread carefully when faced with vaccine refusal, usingand a combination of education practice in recent years, you’re not alone.

Understanding how to handle disruptive documentation to both encourage healthy immunization practices and protectpatients themselves and family members claims. while addressing complaints and concerns is necessary to create a against abandonment positive environment where providers are able to deliver high-quality healthcare.

Setting Policies Techniques De-escalation All When practices, regardless specialization, develop a clear policything statement presented with a of threatening patient should encounter, the most important that a regarding patient immunization.

Whether this policy permits or refuses to treat unvaccinated provider can do is to try to de-escalate the situation. When physicians and staff recognize individuals, the availability of suchthreatened, a statement will help patients understand the current sudden tension or feel physically we recommend the following: • Speak in will a calm, soft voice responding toongoing angry or care. threatening assertions environment and provide clearwhen expectations for •

Apologize when appropriate, acknowledging specific grievances (e.g., extensive wait

times) Practice staff must then be educated on the details regarding this policy so that they can • Avoid blaming others effectively communicate information to patients and their families. This policy should be • Call a “time to provide the time and space they need to gather their thoughts clearly displayed for out” incoming patients on practice websites and also be available in the form of a handout.

Why So Many Complaints?

According to a study by the Stanford University Department of Psychiatry, physicians with Education is Best high burnout scores had a strong association with the number of patient complaints. When It’s physicians physicians’ responsibility only provide healthcare forare patients, but to to make help them feel overwhelmed to or not dissatisfied with their work, they more prone make educated about their health children’s health. When faced with errors or their decisions interpersonal relationship skills and may their suffer.

vaccine hesitancy, physicians have a number of resources available to help educate Furthermore, in anon erathe characterized by safety, high-deductible healthcare plans, patients have concerned parents importance, and efficacy of vaccines. grown to expect more from their physicians and from practice staff.

The Center for Disease Control provides comprehensive conversation materials to help By takingduring a proactive approach to managing qualityimmunization and patient expectations well as physicians encounters with parents care exhibiting hesitancy.asPhysicians providing physicians with the optimal environment for practicing medicine, it’s possible to should document this interaction for future reference, noting specific handouts and decrease the likelihood of disruptive incidents. education materials discussed.

What Patients Want

Informed Refusal According to an interactive poll from the Wall Street Journal, the top five things that patients Education is often not enough to convince that vaccines are the healthiest choice for want from healthcare team members are theparents following: 1. ToSome be treated with dignity and choose respect to terminate the physician-patient relationship. their child. practices may then have their healthcare concerns and questions This is 2.an To individual decision that should heard be evenly enforcedanswered as stated in the practice’s 3.

To work with providers that are easy to talk to patient immunization policy.

4. To have their concerns taken seriously 5. To work with providers who are willing to spend time with them

If a practice chooses to continue to treat children whose parents have refused immunizations, we strongly recommend that parents are asked tothe complete an informed Interestingly enough, none of these top concerns actually addresses medical services refusal document.

Documentation in of this case should indicate that the parent was told why themselves, but rather the behaviors physicians and other providers. the vaccine is recommended, informed of the risks and benefits, and informed of the possible consequences ofthat immunization refusal, as well ascan thedrive specific education materials provided.

Understanding these are the core factors that patient complaints, we that physicians and practice leaders encourage the following behavior among Therecommend American Academy of Pediatrics (AAP) has created a sample informed refusal document thatstaff: providers can implement in their practice. Additionally, the AAP created a document • Be self-aware of behavior when interacting patients and family members discussing how to minimize liability with vaccine with hesitant parents.

• Take accountability and express concern when patients are frustrated • Recognize professionalism action and encourage continued Curi members can reach out to ourinRisk Management team at for further guidance on this • Be willing to give and receive constructive collegial feedback issue by calling 800-662-7917.

Curi members can reach out to our Risk Management team at 800-662-7917 for further guidance on this issue.

Autumn 2019

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NCAFP

Sights & Scenes

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The North Carolina Family Physician

Autumn 2019

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NCAFP FOUNDATION

2019 Foundation’s Raffle Raises Funds for Key Student Family Medicine Programs ~TRUSTEE PERSPECTIVE~ DR. MAUREEN MURPHY HEY DOCS!!! Remember when you were a med student? Hundreds of years ago for me, not so much for the rest of you. Remember how many times you were told you were “too smart” for this field? Remember how great it was when you were able to find your “peeps”, the FM folks, and how it made such a difference when you got validation from them?

Medical students today still need validation and the NCAFP Foundation has programs to help with this. The Foundation provides scholarships, clinical experiences, financial support to send students to FM conferences - like our Asheville meeting and the national one in Kansas City - and funds FMIGs on each school’s campus.

We need YOU to step up and support the Foundation to help keep the pipeline going and there is an easy way for you to help and have a chance for a prize. The NCAFP Foundation’s raffle fundraiser helps support all student programs. For $50/chance you not only have a chance to win a FABULOUS adventure (see details at right), but also give

much needed financial support and encouragement to medical students that might be ‘lost’ in the tertiary centers.

Do this NOW on the NCAFP site: www.ncafp.com/raffle and you will be honoring all those who helped lead you to Family Medicine. Get out those credit cards and PAY IT FORWARD to support our medical students.

The NCAFP Foundati experiences, Family Med on Sat., December 7th, w Weekend. You do

And if games of c

~STUDENT PERSPECTIVE~ HANNAH SMITH I sought opportunities to learn more about Family Medicine prior to medical school and have had some wonderful mentors in my life, but the opportunities available to students through the NCAFP Foundation have been instrumental in keeping me energized and excited about my training. As a first year

- T H E 2 0 1 9 N C A F P F O U N DAT I O N R A F F L E -

Win One of

5 Fabulous Vacations in the

Become a Sonoma Valley Winemaker: Intimate Blending Seminar, Winery Tours & Tastings, Fairmont Sonoma Mission Inn & Spa 3-Night Stay with Airfare for two.

Classic Wrigley Field Rooftop Experience: Rooftop Bleachers

& Dining Package at Regular Season Chicago Cubs Game, 3-Night Stay at Hyatt, Hilton, Marriott or comparable hotel with Airfare for two.

Tennessee Whiskey Adventure: Jack Daniels and George Dickel Distillery Tours and Tastings, Lunch, Transportation, 3-Night Stay at Renaissance Nashville with Airfare for two.

New York Long Weekend: Choice of Broadway Show, Dinner,

3-Night Weekend Stay at Hyatt, Hilton, Marriott or comparable hotel with Airfare for two.

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

US!

ion supports hundreds of medical students each year. All proceeds from the 2019 Raffle Fundraiser will be used to provide clinical dicine scholarships and travel awards directly to students, and on-going support to FMIGs on campus. Sales will continue until Noon with the drawing for the winner taking place at the Presidential Gala that evening in Asheville at the annual Winter Family Physicians not need to be present to win, but we hope you join us that weekend for some great CME and good times with your colleagues!

chance aren’t for you, feel free to donate generously to the Foundation or Endowment at www.ncafp.com/contribute.

at Brody, I had the chance to attend the annual Winter Family Physicians Weekend in Asheville, followed by the Western Rural Health Program during that first summer. By the end of the two-week summer immersion program, I had formed many new friendships with students from other schools and

a network of family physicians in Hendersonville and Asheville, each practicing in their own unique ways; and, endless relationships with patients who continue to shape my future every day.

Like me, so many students are impacted each year in North Carolina by the programming and involvement of the NCAFP in our medical schools.

THE NCAFP FOUNDATION’S EFFORTS TO SUPPORT STUDENT INTEREST INITIATIVES CONTINUES. NCAFP MEMBERS CAN SUPPORT THIS IMPORTANT WORK AND HAVE A CHANCE TO WIN YOUR CHOICE OF ONE OF FIVE FANTASTIC TRIPS!

Partipcating couldn’t be easier...

$50 per entry

1)

Simply visit www.ncafp.com/raffle.

2)

Make your purchase by Noon on Saturday, December 7th, 2019, and your name is automatically entered in the drawing. Each entry is $50.00.

3)

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

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

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

Questions? Contact Tracie Hazelett at thazelett@ncafp.com or 919-980-5357.

~2017 RAFFLE WINNER~ DR. LISA CASSIDY-VU First, I can’t thank the NCAFP enough for putting together such a great fundraiser! From the planning, to our return flights home, the entire process was seamless. My husband and I experienced Sonoma as an adult-only vacation, a rare treat in the Vu household!

We stayed at the Fairmont Sonoma Mission Inn which is a gorgeous hotel in the middle of Sonoma. The breakfasts were delicious and there was a wine tasting every evening. Everything was very accessible — we were able to walk to the historic area of Sonoma and had very short drives (we had a rental car) to the vineyards.

We enjoyed three, completely carefree, relaxing days. It was phenomenal!

I have already bought more tickets for this year’s raffle to try to win another trip AND support the critical student interest initiatives the Foundation implements. It is worth every dollar I put toward a chance to win a trip while supporting crucial pipeline programs.

PROFESSIONAL DEVELOPMENT

By Kathryn Atkinson, CMP NCAFP Meetings & Events Manager

The 2019 Winter Family Physicians Weekend

Reach New Heights & Energize Your Passion for Family Medicine Dec. 5-8th, 2019 • Asheville www.ncafp.com/wfpw

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The North Carolina Family Physician

G

uess what? The best time of the year is almost here!

The NCAFP Meetings Department is excited to welcome you to the 2019 Winter Family Physicians Weekend this December 5th - 8th at the Omni Grove Park Inn in Asheville, NC. Attended yearly by over 800 family physicians and other primary health care providers, this fantastic fourday event (also known as the largest specialty meeting in the state) will definitely be another fantastic weekend of camaraderie, networking, education, and fun.

With Program Chair Nichole Johnson, MD, and Program Vice-Chair, Victoria Kaprielian, MD, guiding the way, this year’s schedule includes CME opportunities at every turn.

Attend as much education as you can pack in for one day or be selective and drop-in on the topics that interest you the most. Timely and requested general session topics, along with several complimentary CME workshops and innovative satellite seminars, mean approximately 25+ AAFP Prescribed Credits are up for grabs.

Beginning Thursday morning, the main lecture hall will feature over 20 lively clinical and informative sessions with take-home pearls you can start using right away.

Get updates from the experts on Alzheimer’s, hemophilia, eczema, hypertension, cancer, STDs, influenza, pelvic pain, osteoporosis, diabetes, skin rashes, depression, and many more. The main stage will also include several enriching lectures paired with free complementary workshops. These lectures have been designed to further increase your knowledge of physician health, obesity management, insulin therapy, and pain management and opioids.

Other optional workshops to consider with your registration include Wednesday’s pre-conference, KSA Study Working Group on Heart Failure, a unique practice models summit designed to explore today’s various practice settings, a preceptor workshop with emphasis on adding value to your practice with medical students, an osteopathic manipulations workshop for MDs, and a practice management seminar centered on value-based healthcare and leadership.

Round out your educational opportunities with optional non-CME satellite breakfast and lunch programs on obesity, diabetes and cardiovascular disease, and Hep C. Autumn 2019

Saturday will include several networking opportunities to Continues on next page

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keep in mind. Drop by to get answers and updates from the AHEC Medicaid Transformation Support Team that morning. Later that afternoon, make your voice heard during two American Board of Family Medicine focus group opportunities with ABFM President Dr. Warren Newton. Residents should consider participating in this year’s inaugural Resident Workshop and Career Fair designed to showcase potential future employers and family physician opportunities right here in North Carolina. Last, the bustling exhibit hall will feature over 70 vendors eager to meet with you and discuss their valuable products and services.

For those who have attended this event in the past, you know that special guests often play a significant role in this fantastic weekend, and this year is no different. We are delighted to welcome Dr. Doug Henley, Executive Vice President of the American Academy of Family Physicians, back to North Carolina.

Dr. Henley served as NCAFP President from 1987 to 1989 and recently announced his planned retirement for 2020, marking 20 years at the AAFP. Join him when he takes the stage on Thursday morning to deliver his important AAFP update, Family Medicine: A Specialty Moving Forward. Don’t miss his in-depth discussion on the current practice environment, challenges impacting Family Medicine, how technology is impacting Family Medicine, and ways to transform Family Medicine to overcome these challenges.

After attending the lectures, consider filling your downtime with some of these great suggestions.

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Unwind with family and friends and gourmet hot chocolate next to one of the giant stone fireplaces in the historic Great Hall. Grab a glass of wine and a rocking chair and watch the dazzling sunset over the Blue Ridge Mountains. Schedule a well-deserved spa treatment in the GPI’s world-famous underground grotto spa. Rev up your holiday spirit and stroll the wings of the hotel to admire the award-winning gingerbread houses and the dozens of lavishly decorated Christmas trees. Or, head over to the Biltmore Estate for a self-guided candlelight tour of the Biltmore House, complete with 55 decorated trees, a thousand poinsettias, and miles and miles of garland!

On Saturday night, join the merriment during the Presidential Dinner and Gala when your new NCAFP Board of Directors is installed, and Dr. David Rinehart is sworn in as the 2019 – 2020 NCAFP President. The night includes a delicious dinner prepared by the Grove Park Inn chef and a fun night of dancing and laughs with DJ Mike Brooks. Taking your requests and spinning his playlist of today’s Top 40s, Motown, and R&B, Mike is sure to have you and your friends out on the dance floor all night long. This evening is the pinnacle of fun for the Winter Weekend, so be sure to wear your holiday-best and your dancing shoes!

As you can see, the best time of the year is almost here! Our unique combination of top-notch CME presented by expert speakers, networking opportunities and camaraderie, and just plain old fun makes the Winter Family Physicians Weekend an excellent opportunity to fulfill your year-end CME requirements while energizing your passion for Family Medicine. Access the latest schedule of events and complete your online registration today by visiting the conference site at www.ncafp.com/wfpw. Online registration ends on Sunday, December 1, at 11:59 pm. Only onsite registrations will be accepted after this cut-off, and rates will increase by $50 for all registration types. If you have questions or need more details, please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events via Katkinson@ncafp.com or 919-214-9058. We look forward to seeing you soon!

The North Carolina Family Physician

2020 NCAFP

Spring Symposium Saturday April 4, 2020 Charlotte Marriott SouthPark

Program Chair – Dimitrios “Takie” Hondros, MD • • • • •

Autumn 2019

Anticipated 8.00 credits Convenient Saturday schedule No lost office time Regional educational and networking opportunity More details coming soon

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ONLINE TRAINING

Into the Mouths of Babes Fluoride Varnish Program Now Offers an Online Training Option Five times more common than asthma, 36 percent of all North Carolina children have had tooth decay by the time they enter kindergarten…15 percent of it, untreated. Tooth decay hurts, and affects a child’s ability to eat, grow, talk, learn, sleep, play, and reach important developmental milestones. Poor dental health affects overall health. If left untreated, tooth decay can lead to tooth loss, infection and even death.

Did you know you can do something about it? North Carolina’s Into the Mouths of Babes Fluoride Varnish Program is a successful medical model of providing oral health services for very young children. Training is now available online! This engaging, interactive e-learning course teaches physicians and medical providers how to conduct an oral evaluation and risk assessment for

children ages infant to 3 ½ years, refer young children to a dental home using risk-based guidelines, apply fluoride varnish to the teeth of young children, share with parents the appropriate amount of fluoride toothpaste for their child based on age, and file a Medicaid claim for the oral evaluation, counseling, and fluoride varnish procedure.

Into the Mouths of Babes has partnered with Wake AHEC to offer this online educational activity for 1.0 AMA PRA Category 1 Credit to the first 200 participants FREE. The e-learning course is available to physicians and providers statewide at www.wakeahec.org/courses-and-events/60304/webinar-recorded---into-the-mouths-of-babes-preventiveoral-health-training-for-medical-providers.

NATIONAL

Politico Discusses Healthcare Transformation in North Carolina An in-depth article discussing North Carolina’s healthcare transformation efforts was published in late October by Politico. The article highlights the close collaborations taking place between DHHS and Blue Cross NC, and also touches on several related statewide initiatives helping to address the common social drivers in healthcare.

NCAFP member and Johnston County Health Director Dr. Marilyn Pearson (picured) is directly quoted in the article, as is Dr. Karen Smith of Raeford who shares some excellent information on how her practice -- Karen L. Smith Family Medicine -- is working with Alledale and BCBSNC to better serve

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Hoke County patients in a sidebar that accompanies the piece.

Read it as ncafp.com/politico-1019.

The North Carolina Family Physician

jobs.ncafp.com The NCAFP CME & Meetings Department continues to explore new ways of bringing you the best possible educational and networking opportunities. With our promise of always providing top-notch CME on timely requested topics presented by first-rate speakers, to an advanced yet user-friendly mobile app and time-saving registration kiosks; we pride ourselves on providing members with a fantastic and rewarding experience at every event.

Discovery and feedback gathered in the 2018 Membership Survey inspired NCAFP leadership and staff to do a little brainstorming on ways to further enhance 2019 CME events. Armed with a fresh perspective of what members need and want, we began refocusing energy and resources towards providing elevated education and networking experiences to

Employers:

Family Physicians:

• PLACE your job in front of our highly qualified members • SEARCH our resume database of qualified candidates • MANAGE jobs and applicant activity right on our site • LIMIT applicants only to those who are qualified • FILL your jobs more quickly with great talent

• POST multiple resumes and cover letters or choose an anonymous career profile that leads employers to you • SEARCH and apply to hundreds of fresh jobs on the spot with robust filters • SET UP efficient job alerts to deliver the latest jobs right to your inbox • ASK the experts advice, get resume writing tips, utilize career assessment test services, and more

powered by

jobs.ncafp.com Autumn 2019

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RESIDENTS & NEW PHYSICIANS

served for the last six years as a reminder of why I am training in Family Medicine!

Family Medicine Foundations

How do any of us choose our career path? Likely because it was modeled for us. Children of physicians are more likely to practice medicine. So I set out on a track to blend my brain for science with caring relationships. Because I’d apprenticed with my dad in reproductive veterinary medicine, I thought I wanted to be a reproductive endocrinologist. I considered public health after working with my undergraduate mentor and being enthralled by the way data can inform policy and guidelines. An engaging biology professor taught me that education is about creating analogies to simple examples, and I use this daily to explain physiology to patients.

Great Preceptors Can Make All The Difference

By Kate Timberlake, MD PGY 3 Cone Family Medicine Residency

Do you recall the person who steered your medical career toward Family Medicine? For me, this was Dr. Geoff Jones.

Neither a miraculous patient care story (although I’m sure he has many) nor a new experience doing a procedure changed my path. Rather, I simply saw Dr. Jones living my career dream: he was engaged with the community, innovating new ways to deliver care, passionate about his work, making a difference, and pursuing his family with the same enthusiasm he brought to his work. My horizons were broadened as he explained setting up temporary clinics in tents in the nearby fields to care for migrant workers, while I rode with him to pick up his kids from soccer. I observed him encouraging residents to ask patients about which life experiences led them to their belief systems or fears about medicine. I was a part of the NCAFP Rural Health Immersion Experience, which inspired me to practice Family Medicine. The coffee cup he gifted me at the end of our week together (pictured) has

24

But Dr. Jones showed me how this all fits together.

We set limits on our dreams until someone shows us that we can dream bigger. There’s room in Family Medicine for everyone’s career aspirations. Mamas, show a future lady doc that she can be both a great mother and outstanding Family Medicine doctor.

Docs of color, tell a younger version of yourself that you are waiting for them at the top of that mountain of social struggles. Someone told you back in the day that you were too smart for Family Medicine? Tell your students that their intelligence is necessary and welcomed.

Caring is contagious! Thank you Dr. Jones and the NCAFP Foundation for creating this formational experience for my career. What more do we want than to make a difference while having fun, stretching our intellect, and being part of a community of medicine that exemplifies our values? Would you like to share your passion for Family Medicine with students? Consider speaking in your local schools to guide students into Family Medicine careers— we have a toolkit in the works for you!

The North Carolina Family Physician

NATIONAL

MAHEC Resident Receives AAFP’s Prestigious GME Award MAHEC Asheville Family Medicine third-year, Rivers Woodward, MD is one of twelve Family Medicine residents selected nationwide to receive AAFP’s Excellence in GME Award for exemplary patient care, interpersonal relationships with patients, physicians and faculty, and demonstrated leadership and community involvement. Dr. Woodward has designed and implemented a rural health careers pipeline program for high school students in two rural counties in Western North Carolina. Following residency, Dr. Woodward plans to practice full-spectrum family medicine in rural Western North Carolina. He also hopes to build capital and experience to create an innovative low-overhead clinical community center that can provide health care to multigenerational rural families and address food insecurity and loneliness.

Medical Mutual is now Curi Helping physicians in medicine, business, and life.

Three NCAFP Residents and Students Appointed to Leadership Roles

Curious to know more? Visit curi.com

The NCAFP is pleased to announce that three resident and student members have been appointed by the AAFP to fill key leadership positions. Erin Clark, a 4th-year Campbell student, was named as the student member to the AAFP Commission on Health of the Public and Science. Hannah Smith, a third-year Brody/ECU student, was selected to serve as one of AAFP’s FMIG Regional coordinators. Finally, Dr. Clay Cooper, a second-year resident at Duke, was named as the resident member of the Commission on Membership and Member Services. Congratulations!

CORPORATE SPONSOR OF THE NORTH CAROLINA ACADEMY OF FAMILY PHYSICIANS

Autumn 2019

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

Contact Peter Graber with the NCAFP at pgraber@ncafp.com 25

MEDICAL STUDENT PROGRAMS

By Tracie Hazelett NCAFP Medical Student & Residency Relations Manager

Five Medical Students Awarded NCAFP Foundation Family Medicine Scholarships The NCAFP is pleased to announce that five medical students have been selected to receive the Family Medicine Scholarship offered by the NCAFP Foundation. Each year, the Foundation provides scholarships to North Carolina medical students considering careers as family physicians. Medical students in their 3rd or 4th year of medical school are eligible to apply. The awards received by students are financial scholarships, unless the recipient does not complete their Family Medicine residency training. In that circumstance, the awarded money is converted to a loan and is paid back to the Foundation with interest.

This year, each of the recipients are fourth-year medical students who are all currently interviewing at Family Medicine residency programs. Alongside a sincere

interest in Family Medicine, these medical students exhibited a commitment to community and service, have demonstrated leaderships skills, as well as financial need.

The NCAFP offers best wishes and congratulations to the following outstanding 2019 Family Medicine Scholarship recipients (from top): Erin Clark, Campbell; Matthew Drake, Brody; Sharon Olang, Campbell; Cameron Smith, Campbell; and, Travis Williams, UNC. The NCAFP would also like to extend a special thank you to the Foundation’s Scholarship Review Committee and acknowledge that all applicants were extremely deserving medical students with impressive experiences. It is understood that every medical student has financial need, decisions were difficult. We are grateful for each student’s dedication to Family Medicine and anticipate North Carolina will be the recipient of these outstanding individuals’ commitment and healthcare services to our communities in the future.

First-Year Medical Students

2020 Summer Family Medicine Interest Programs The NCAFP Foundation offers a variety of programs and opportunities to medical students. Some consist of clinical experiences only available to 1st year medical students. These opportunities take place the summer between the first and second year of medical school. There are multiple programs available, ranging from two- to four-weeks in length. To learn more about these options and the exciting specialty of Family Medicine, please visit: www.ncafp.com/summer.

The application deadline is January 15, 2020. For questions and/or additional information, contact Tracie Hazelett at thazelett@ncafp.com.

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The North Carolina Family Physician

Family Medicine Day Saturday, March 7th, 2020 The North Carolina Academy of Family Physicians (NCAFP) and the North Carolina Area Health Education Centers (AHEC) Program are excited to present North Carolina's 13th Annual Family Medicine Residency Recruitment Conference.

This fantastic one-day event is North Carolina’s premier Family Medicine residency recruitment conference. The day will begin with a keynote lunch speaker, followed by 5-hours of clinical skills workshops. During the afternoon workshops, students will network with North Carolina’s Family Medicine residency programs as they teach and refine skills and share their experiences as a family physician. During the evening Residency Recruitment Fair, participants will learn even more about North Carolina’s state-of-the-art training programs. This is a tremendous networking opportunity with residents, faculty and other NC medical students.

You do not want to miss this incredibly fun, educational and hands-on day!

Registration will open in early 2020 for medical students in the classes of 2021 and 2022. Class of 2023 students can register beginning February 7th 2020.

For updated information and links to the registration, please visit www.ncafp.com/students/fmd.

Contact Tracie Hazelett with questions at thazelett@ncafp.com Autumn 2019

SKILL BUILDING • RECRUITING NETWORKING • FUN

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PRACTICE MANAGEMENT

- RESEARCH IN ACTION-

Duke’s CIPHERS Project Studying Epigenetic Sperm Changes in Male Cannabis Users

By Bryan Luukinen and Samuel Cohen Nicholas School of the Environment at Duke University

The landscape of marijuana legalization and public opinion on marijuana use in the U.S. are shifting rapidly. An increasing number of states have legalized recreational marijuana use, with 11 states plus Washington D.C. currently allowing recreational use. Today, more Americans perceive marijuana to be safe, and an increasing percentage of adults now use marijuana.

Over the past few decades, the concentration of THC in marijuana has significantly increased, making it more potent. Modern use methods such as vaping, dabbing, and the use of high-THC resins can offer THC concentrations upwards of 75%.

Criminal justice reform and increased tax revenues are touted benefits of the regulatory shifts, but public health and medical practitioners still need to address the potential consequences of use by at-risk groups including adolescents and pregnant women.

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Around pregnancy, efforts to study the potential effects of marijuana have focused almost exclusively on women. Although the available science has some limitations and uncertainties, groups like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists advise women not use marijuana during pregnancy or while breastfeeding. Few resources have been devoted to studying potential preconception use among men. In the future, family physicians should expect questions about marijuana use around family planning and pregnancy to come up more and more often.

The Cannabis-Induced Potential Heritability of Epigenetic Revisions in Sperm (CIPHERS) Project at Duke University seeks to understand the impact of male marijuana use on the epigenetic profile of sperm, and male fertility and preconception health. Through research in humans and animals, our team works to understand how marijuana effects sperm, whether these effects are passed on to offspring, and whether abstaining from use might reverse these effects.

Nearly all of our cells carry the same genes, but cells in different parts of the body look different and do different things, in part because of epigenetics Our findings are preliminary, but do seem to indicate that marijuana use may alter certain epigenetic marks in the sperm of those exposed. Our pilot study also found an association between marijuana use and lower sperm counts. Our most recent study identified a specific gene linked with autism that appears to undergo changes

The North Carolina Family Physician

in the sperm of men who use marijuana (the study does not draw a definitive link between autism and marijuana use, but does warrant further research).

In addition to the research, the CIPHERS outreach and education team works to share the findings and broader impacts with several key stakeholders, including medical providers, public health organizations, and community groups. We started this effort locally, and have heard from family physicians and OB GYNs that maternal marijuana use around pregnancy is a growing concern.

For some women, marijuana is seen as an effective treatment for symptoms around pregnancy such as nausea.

Some do not believe that the practice is harmful for their baby’s health, while others may simply be unsure of where to look for advice. One study interviewed pregnant women who used marijuana and found that

few reported receiving helpful information on the topic from their health care provider or social worker, and instead relied mainly on internet searches and anecdotal experience or advice from family or friends.

So what does all this mean for medical practitioners?

Patients are looking for more information about marijuana use before, during, and after pregnancy, and family physicians can help.

We have created outreach materials for clinical settings that summarize our research findings and highlight considerations for parents who may be planning to start a family. You can find those materials, along with a whiteboard illustration video that describes our research, links to our research articles, and informative blog posts on our website: https://sites.duke.edu/ ciphers.

STATE PROGRAMS

Upstream USA Partnering with North Carolina to Reduce Unplanned Pregnancy Upstream USA is a national nonprofit working to expand opportunity by reducing unplanned pregnancy in the U.S. Upstream partners with states to provide training and technical assistance to health centers to ensure all patients have equitable access to the birth control method of their choice.

Upstream provides patient-centered, evidence-based training and technical assistance to hospital systems, state and local health departments, Federally Qualified Health Centers (FQHCs), community agencies and more. The program works with the entire center, from administrative staff to nurses to physicians, to ensure a tailored and cohesive experience for the whole team. Its CME/CEU-eligible training is delivered in-person by experts in reproductive health

and is designed to equip staff and providers to provide best-in-class contraceptive care. After training ends, Upstream’s quality improvement team works on-site and at the elbow with health center staff to ensure they have the best practices, guidance, resources, and tools necessary to provide same-day access to all methods of birth control for all patients.

Results from its early work and first statewide initiative in Delaware gives program leaders confidence in the strength of the model. Pre- and post-surveys show that knowledge of LARC methods and other indicators See ‘Upstream’ on next page

Autumn 2019

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1. Sexual misconduct involving a patient by a licensee.

2. Fraudulent prescribing, drug diversion, or theft of any controlled substances by a licensee.

Medical professionals need not have definitive evidence of misconduct to make a report. The law specifies that licensed medical professionals should submit a report if they “reasonably believe” that misconduct has occurred. Licensees who report suspected misconduct in good faith are granted civil immunity. NCMB has created a new online form to receive reports from healthcare professionals or institutions. The form may be used to report information required by statute, or to report any other concern the reporting individual believes NCMB should investigate. The online form can be accessed at www.ncmedboard.org/report.

This page also includes FAQs and other information to help licensees understand their reporting obligations under the law.

PRACTICE TRANSFORMATION

Need an AHEC Practice Support Contact?

Regional Contact Listing Helps Practices Engage Any Family Medicine practice across North Carolina can engage with the NC AHEC program to access its practice support services. AHEC’s quality improvement coaches (QICs) are trained to work with practices to transform the way in which care is delivered and help them prepare for new payment models and incentive programs while focusing on patient-centered care– from electronic health records to Medicaid transformation. For complete contact information on each part of the state, download AHEC’s Practice Support contact listing at www.ncafp.com/ahec-support.

NORTH CAROLINA AHEC REGIONAL PRACTICE SUPPORT CONTACTS Northwest AHEC

Greensboro AHEC

CHRIS JONES (336) 713-7039

er

nd

Ale xa

MONIQUE MACKEY QI Manager (919) 445-3501

chris_weathington@ncahec.net

deborah_grammer@ncahec.net

monique.mackey@arealahec.org

carol_stanley@ncahec.net

ton

Tyrrell

Dare

Pitt

Hyde

Beaufort

Wayne

Craven

Lenoir

Pamlico

Cumberland

Hoke

Jones

Sampson

Sc otl

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d

Duplin

Cartaret

Onslow

Robeson

Southern Regional AHEC

DONNA BOWEN (910) 678-0119

donna.bowen@sr-ahec.org

DEBBIE GRAMMER Deputy Director (919) 966-0801

Chowan

Harnett

Moore

Richmond

Anson

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Stanly

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NC AHEC PROGRAM OFFICE PRACTICE SUPPORT TEAM

CAROL STANLEY Medicaid Transformarmation Manager (919) 966-0815

Wilson

Rowan

CHRIS WEATHINGTON Director-Practice Support (919) 966-2401

mary_mccaskill@ncahec.net

Gates

Bertie

Martin

Edgecombe

Chatham

Lincoln

Cleveland

Charlotte AHEC

MARY MCCASKILL HIT Manager (910) 818-4371

Nash

Pe

Catawba

Gaston

Polk

Franklin

Wake

Randolph

Rutherford

Henderson

Jackson

Macon

Clay

Orange

Hertford

Halifax

nk uota s sq an uim

Guilford

Davidson

Haywood

Swain

Graham

Forsyth

Davie

Burke

Warren

Pa

Yadkin

Iredell

Durham

Caldwell

Granville

Wilkes

Avery

McDowell

Person

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Buncombe

Caswell

Alaman

Yancey

ll

Madison

Rockingham

Stokes

Vance

Watauga

leslie.mcdowell@mahec.net

ERIN CLOUTIER (704) 512-6052

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SHANNON CAMBRA (252) 972-6958

shannon.cambra@arealahec.org

Northampton

Surry

erin.cloutier@carolinashealthcare.org

The program is excited to get started in North Carolina! To learn more about Upstream or schedule a meeting to talk about a potential partnership visit: https://upstream.org.

Area L AHEC

LORA WRIGHT (919) 350-0472

lowright@wakeahec.org

Alleghany

Ashe

Cherokee

Wake AHEC

SUZANNE LINEBERRY (336) 662-5810

suzannelineberry@conehealth.com

cjones@wakehealth.edu

Mountain AHEC

LESLIE MCDOWELL (828) 771-4227

che Mit

The NC Academy of Family Physicians has endorsed Upstream’s efforts in North Carolina and has a representative on Upstream’s State Advisory Committee: Dr. Jennifer Mullendore, Medical Director at Buncombe County Health and Human Services.

The N.C. General Assembly recently passed House Bill 228, an Act to Modernize the N.C. Medical Board (NCMB). The Act includes several provisions that affect licensed medical professionals, including a new legal obligation to report certain misconduct by any individual licensed by NCMB. This new “duty to report” provision (N.C. Gen. Stat. §90-5.4) went into effect Oct. 1st, 2019, and obligates any individual licensed by NCMB to report:

ia

The project is working to achieve impact at scale across the United States.

By 2024, its goal is to work with healthcare centers across four states, including North Carolina, that serve over one million women each year.

New State Law Requires Licensed Physicians to Report Certain Misconduct

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increases after training, and providers report that they feel confident in their ability to talk with their patients about their options. Patient surveys conducted at Upstream-trained healthcare centers affirm that patients are in charge of choosing their own method, feel listened to by their healthcare providers, and don’t feel pressured to choose a specific method of birth control.

NC MEDICAL BOARD

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UPSTREAM from p. 29

Bladen

Pender

New Hanover

Columbus

Brunswick

Eastern AHEC

ANGEL MOORE (252) 744-5221 moorean@ecu.edu

South East AHEC

JESSICA WILLIAMS (910) 667-9350

jessica.williams@seahec.net

The North Carolina Family Physician

HELP NORTH CAROLINIANS PREVENT TYPE 2 DIABETES—

DPP Navigators Help Patients Locate Diabetes Prevention Programs The NC Division of Public Health, Community and Clinical Connections for Prevention and Health Branch hosts diabetesfreenc.com, a portal for CDC-recognized Diabetes Prevention Programs (DPPs) throughout North Carolina. DPPs are evidence-based year-long programs led by a trained lifestyle coach and provide a group learning environment. The lifestyle coach helps participants develop strategies for healthy eating and physical activity and connects participants with others working on similar goals to prevent type 2 diabetes. DPPs are offered to North Carolinians in both in-person and online formats with various start dates and times.

In conjunction with this, a new service is now being offered by the NC Division of Public Health called the DPP Navigator. DPP Navigators are available to locate DPPs and coordinate enrollment for participants throughout the state.

DPP Navigators also receive and coordinate referrals from health care providers, practice referral coordinators and community-based organizations. DPP Navigators provide bi-directional feedback to referring providers and organizations to include participant enrollment and program completion status.

DPP Navigators are available to assist and receive referrals Monday through Friday from 7am to 7pm via phone 1.844.328.0021; Fax 1.866.336.2329; email dppreferral@dhhs.nc.gov; and NCCARE360.org.

Autumn 2019

P R A C T I C E

T R A C K S

Keep Updated on Recommendations on Lead Poisoning in Children The July issue of the American Family Physician journal has a nice review article titled, Lead Poisoning in Children, by Dr. Laura Mayans. The NC Division of Public Health’s recommendations for follow-up testing for children with elevated blood lead levels differ, however, from those listed in the article. NCDP’s recommendations can be viewed online at https://nchealthyhomes.com/files/2018/06/2018-06RevisedFollowupScheduleforLead.pdf.

Also at nchealthyhomes.com/lead-poisoning are links to lead risk assessment questionnaires for children and pregnant women (high risk zip codes are listed on the back), educational materials, a list of lead-certified painters and contractors in North Carolina and more. Remember: test at age 2, as well as, at age 1! -- the risk of lead poisoning is highest at age 2. Physicians or practices with questions may contact Ann Chelminski, MD, MPH at ann.chelminski@dhhs. nc.gov or at 919-707-5861.

North Carolina’s Early Check Program Screens for Fragile X Syndrome All babies born in North Carolina are screened for a set of 37 health conditions shortly after birth as part of the state’s standard testing protocol. North Carolina’s Early Check (http://earlycheck.org) program provides two additional tests for babies whose parents sign up for the complimentary service: spinal muscular atrophy and fragile X syndrome (FXS). Although FXS is a rare condition, it is the most common inherited intellectual and developmental disability. Children with FXS may have problems with attention, impulsive actions, and anxiety, but also have moderate to severe intellectual challenges and language problems. While there is no cure for FXS, early intervention, support services, and connecting with physicians who serve this population has shown promise. Learn more at Early Check and its optional, free testing at the program website earlycheck.org/what-isearly-check/conditions-tested.

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