Unicorns — that Actually exist”

Address of NCAFP President Dr. Shauna Guthrie

Executive Officers President Shauna Guthrie, MD, MPH

President-Elect Garett R. Franklin, MD

Secretary/Treasurer Mark McNeill, MD

Immediate Past President Dimitrios P. Hondros, MD

Executive Vice President Gregory K. Griggs, MPA, CAE

At-Large Directors

Joshua Carpenter, MD Lisa Cassidy-Vu, MD

Deanna Didiano, DO Nicole Johnson, MD, MPH Kelley Lawrence, MD, IBCLC, FABM Benjamin F. Simmons, MD

Patrick Williams, MD Courtland Winborne, MD

Academic Position

Margaret Helton, MD (UNC)

Resident Director Matthew Drake, MD (ECU)

Resident Director-Elect Morgan Parker, DO ()

Student Director Morgan Beamon (ECU)

Student Director-Elect

Akhila Boyina (Wake Forest)

Although we shared a love of medicine, I was not blessed with an amazing memory or the confidence to ski down double Black Diamonds with wild abandon like my grandfather, but I did inherit two other things from him. First, his loud, boisterous, old-man-style, often painful, sneezes. Every single sneeze seems to become a spectacle and there’s little I can do about it. Maybe don’t put away those Kleenexes just yet…on the upside, since COVID I have a little more control because who wants to be sneezing in their mask??

What I also inherited is his propensity to see the bright side of things, and learn from our trials and tribulations while turning them into entertaining stories to share with others. You would think one of the best things to ever happen to him was getting stranded without power on a cruise ship in the middle of the ocean on his way home from a trip to Antarctica.

I grew up on a farm, a scrawny tomboy, and my absolute least favorite

AAFP Delegates & Alternates chore was carrying 50-pound prickly bales in the Midwest’s humid 102-plus-degree heat. I knew growing up that this was not the life for me. Thanks to the help of others, resilience, persistence, and frankly a significant amount of privilege, I live a very different life from that now. I did purposefully land in a rural area because that is where I can best utilize my training and skills, but I can live by my own schedule, have my own dog, raise chickens in town (I guess you can’t completely take the country out of the girl)…and students…this can be you some day…I can even buy namebrand cheese now!

Living in the country, it can be easy to be disconnected from politics, put my head down, and focus on caring for my patients. Whether we practice in a city or out in the sticks, a lack of advocacy for our patients and our profession can affect the lives of many. Food is health, housing is health, social support IS health. Working with legislators is sometimes icky business, but it’s necessary. And I’m proud that our elected officials know that when there is a question about how something affects the health of our communities, the NCAFP is one of the trusted groups they call. For issues of gun safety, abortion bans, or scope of practice, they can come to us to provide an evidence-based, patient-centered perspective while representing all our members across the state. The NCAFP will continue to fight these fights on your behalf — sometimes publicly and sometimes more privately. They will always protect evidence-based medical decision-making, informed patient autonomy, and the right of physicians to practice without fear of unnecessary legal ramifications. You can absolutely put your head down and see patients, that’s okay! But if there are issues that are important to you, get involved! It can be very refreshing to affect your community in a different way. Email Greg Griggs if you want to participate in a White Coat Wednesday, join a board committee, or if you aren’t sure how you can get involved, just tell him you would like to know more. He’ll get you involved, and you could be in my shoes before you know it.

Talking to our legislators can be intimidating, but I was once told that the scary feeling you get when doing something new (like getting involved with the NCAFP Board within your first year of practice in a new state) is called growth.

A neighbor used to say, “I learned something new, so it’s already a good day,” and I now also say this often. In the middle of 2020, I worked a weekend hospitalist shift. Since I left private practice for public health, I often did this for a weekend every couple months to keep up my skills, but hadn’t for several months because for some reason after March 2020, no one was taking vacations anymore. I was already a little intimidated – having spent the majority of my time understanding outpatient management, contact tracing, the latest on masking, and constantly changing quarantine and isolation guidelines…I definitely felt like a resident again, going to my fellow hospitalists with my plan to get confirmation I wasn’t doing anything totally off the grid. I will always remember when I went to visit my first inpatient with COVID, ever, I walked confidently into the negative pressure anteroom, saw the PAPPR and associated equipment, and turned right back around. I hadn’t realized until that moment I didn’t have a clue how to properly put this thing on. I put one on once before COVID had even reached the U.S. It sure seemed easy with the rest of the nursing staff in our conference room!

I could have TOLD someone how to do it. I probably could’ve figured it out, but I also could’ve done it wrong but in that point in the pandemic the repercussions felt especially scary for myself and anyone I came in “close contact” with. So, instead of being a tough gal I opted for vulnerability. I snuck over to the nursing area where of course a whole group of nurses were chatting, and asked for help. Like any great nurse, my patient’s nurse didn’t bat an eye (or laugh at me), helped me get suited up, and sent me on my way. It was very humbling – some growth definitely happened that weekend. It didn’t hurt that the rest of the shift was not very memorable.

As family physicians, we are lifelong learners. And we have certainly had our fair share of learning in the past few years. Trying to decipher guidance about and then actually obtain proper PPE, reading scientific articles to be sure our advice to get the vaccine is the right choice for our patients – or just so we can argue with someone spreading misinformation online. As someone with no children of my own I spent an inordinate amount of time attending school board meetings with my boss and always had to come prepared with data, the latest community and school-based guidance, and ready to answer any questions someone asked with a straight face because they saw a Facebook post that they deemed reputable.

Physicians do not like to be vulnerable and ask for help, but that is one thing that helps us learn. We are willing to watch five YouTubes on how to inject an elbow rather than just ask our practice partner for a quick refresher. Before COVID stopped us in our tracks for a sniffle, we would work long shifts despite feeling like death because we didn’t want to let our team down. As an only child and a strong, independent woman and especially as a physician asking for help personally or professionally can be hard. But it can also keep you safe, and bring you closer to those around you, and make the day a better one, because you learned something.

All of us share the trauma of the past three years and I don’t want to discount that. But something we also share and can be proud of is the incredible amount of learning we did during this time, especially at the beginning. Information was changing faster than we could take it in, but we did it! And the NCAFP really stepped up during that time to provide frequent newsletter updates to keep us all on top of the changes. They knew that primary care medical providers, especially family physicians, are the key to having meaningful discussions with patients about getting vaccinated because we are their trusted medical advisors. And the NCAFP staff pushed – HARD – to remind state officials of the important role family physicians play in their patients’ care, and helped us get vaccines into our offices and into the continues on next page arms of our patients.

Before my training, I had no idea of the importance of family physicians in healthcare and in their local communities. Despite my initial intentions, I’m not only a family physician but now have the honor of representing all of you.

The only thing I thought I was sure of when I started medical school was that I did not want to be a family physician. I had no great local role models in my small town like you often hear about. Honestly, I had very limited medical care at all growing up. What I did have was a part-time job in college as a medical assistant swabbing throats and drawing eyes because my feedback usually revolved around wanting to know what happened to someone’s dog, did they ever get pregnant, were they able to go back to work, are they living with their uncle again? It became clear very early on that I needed a specialty with continuity. I really liked mental health, and I knew I liked working with people of all ages. And my hands are not the steady hands of a surgeon (plus my chlorhexidine allergy seemed like a sign). Meanwhile, I remember the moment I found this program called the New Hampshire Dartmouth Leadership Preventive Medicine Residency. It was a complete mouthful, but a real lightbulb went on for me. I was sitting in our small group computer lab and what drew my attention was not their blood. From that perspective, Family Medicine looked so boring. Luckily, I was obviously wrong.

After undergrad at the University of Kansas, I went to Drexel University College of Medicine in Philadelphia and participated in a problem-based curriculum. Most of our learning was done using patient cases. When we finished the case, we would give feedback to improve the case for the next group, and the other members of my small group would roll their unnecessarily-long name, but their master’s in public health focused on quality improvement. Now, keep in mind, this was 2005 – when quality improvement wasn’t a widely-used term, nor had it become a dirty word.

I have always been someone who liked seeing problems (often that others didn’t even see, or at the least didn’t want to deal with) and finding a solution. I have been told more than once that I don’t always have to rock the boat. To which I respond: If I don’t, then nobody will. When I saw this program, I knew that this way I could learn to rock the boat but the right way – the more effective way. And, as a bonus, I got to use data and spreadsheets (those that know me understand my excitement). I still wanted to be a “real doctor,” and they had this cool program – the Paul Ambrose Fellowship – where you could combine it with your fourthyear medical school curriculum if you did Family Medicine. So, I thought, why not?! Fast forward a year, and I’m having a romantic Valentine’s dinner in a snowstorm with my future program director and his wife – because they wanted me to feel welcome the night before my interview. And I did. It was still kind of awkward though.

Obviously, I have come a long way from mediocre acceptance to a full-on passion for Family Medicine. When people ask what kind of doctor I am, I proudly tell them I am a family physician. And when they say, “Is that like, some kind of generalist?”, I tell them that we have specialized training to take care of the whole person, the whole family, and the whole community – cradle to grave. What they don’t stick around to hear about is one thing I love about Family Medicine - that our scope can change with the seasons of our lives. I started in a private practice, working harder than I ever have doing outpatient, inpatient and obstetrics at two hospitals, and nursing home (with one day a week doing quality improvement before it was cool). When I got the opportunity to move to public health about 20 years sooner than I planned and start a new primary care practice there, I went with it because I was ready for a change and growing tired of the lack of continuity and fast pace in my current location. I wanted to spend time with patients. I wanted to have more meaningful interactions. And I loved the opportunity to have a greater community focus. I still sprinkled in some side-gigs with the hospital, hospice, and a local detention center because I love variety and wanted to keep up all my skills. Except delivering babies. I stopped in 2018 and I don’t have any interest in delivering any more babies. Ever. Those of you that do, thank you! Around that same time I realized that to make any difference in our very significant local opioid epidemic, I needed to start providing treatment for people with opioid use disorder. With the support of my health department colleagues, we started the first office-based opioid treatment program in a health department in NC. This started a journey that I say changes the shape of my brain and stretched all of our public health/harm reduction hearts, and it has been immensely rewarding. I had no idea at the time that this would lead to a renewed passion in my professional and personal life.

And now – with our primary care program at the health department reaching maturity - I’m not leaving, but I am stepping back and I have opened Sunflower Direct Primary Care (a nod to my Kansas roots) – where I can really practice the way I have always wanted to…while also serving part-time as the CMO at our local hospital. I just really love being a family physician, and there are so many roles we can play, scopes we can practice, and places we can go (literally and figuratively). Family Medicine is not at all what I envisioned when I went to medical school, and yet, I’m exactly where I’m supposed to be. If you aren’t happy where you are, you can make a change! Ask Talia Aaron or Tom White or many others in this room who have drastically changed directions in their careers. Think big! Define your passion! You are infinitely employable and deserve to be happy. Your patients deserve a doctor who is happy.

We are family physicians. We are smart enough to manage complicated patients (but can still explain concepts in a way non-doctors can understand), we look at the whole picture, and we’re nimble enough to change entire workflows when global pandemics happen so that we can still care for our patients. We are unique unicorns that actually exist and we get to do the coolest stuff! And for the medical students here worried about paying off their loans, YOU WILL -- all physicians are paid well and if family medicine feels right for you, why not pay them off doing something you love?

In my role as President of the NCAFP, and with their support, I will do everything in my power to protect and support our ability to practice freely, up to our scope, with as few administrative burdens as possible so we can do what we’re good at – not just TREATING our patients – but CARING for them, generations of their families, and our community. Because, in the wise words of the great Dr. Maureen Murphy, (a fellow Jayhawk):

“We are Family Physicians, because freakin’ awesome is not a job title.”

Chapter Affairs

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

April 9, 1948

The Birthdate of the North Carolina Academy of Family Physicians

It may have been an innocuous date in 1948 for most individuals: April 9. But it wasn’t in the life of Family Medicine in North Carolina. That was the date that the NC Chapter of the American Academy of General Practice was officially chartered, and some 75 years later the NCAFP is still going strong.

As we begin to celebrate the 75th Anniversary of our Chapter, we have been poring over some of our archives. Included in those archives is our official charter, which was verified by five of the original members of our chapter: Drs. John R. Bender, Roscoe D. McMillan, G. Grady Dixon, Vernon W. Taylor, and W.E. Selby.

Just as a refresher on the formation of what was then the AAGP and now the AAFP: In June of 1947, a group of generalists gathered at the AMA Meeting to organize the American Academy of General Practice. After World War II, specialization was becoming more of a norm in medicine, and generalist physicians wanted to make sure their voices remained strong, which led to the formation of the AAGP.

On Feb. 21, 1948, Missouri became the first state to constitute a chapter, followed by 32 other states that same year, including North Carolina. In March of 1948, AAGP established its headquarters in Kansas City. Later that summer, on June 21, the AAGP held the first meeting of the Congress of Delegates just prior to the Annual Meeting of the AMA at the Sheraton Hotel in Chicago. Delegates from 26 chapters attended.

It didn’t take long for CME to become a mainstay of the AAGP, holding the first Scientific Assembly in Cincinnati in early March of 1948 with 3,500 family physicians in attendance. Thus, many of the tenets of the specialty were established very early in the