10 minute read
NCAFP’s Student Programs Helped Cement My Interest in Family Medicine
By Cameron Smith (MS4) Campbell University School of Osteopathic Medicine
NCAFP Student Programs Help Cement My Interest in Family Medicine
I was thrilled when asked to write an article for this magazine and I decided to use the opportunity to show my gratitude for what this association of family physicians has done for me during my medical school career. June in eastern NC. During the first week of this experience, we networked with current Family Medicine residents, practiced procedures, and attended didactics and workshops in Greenville, NC. The week culminated in a kayaking trip along the Pamlico River.
During my second week, I was fortunate to stay at the home of Dr. Aaron Lambert, meet his welcoming family, and shadow him and other physicians in a rural Mt. Pleasant practice. I consider this experience one of the key factors in my journey to Family Medicine because it was my first exposure to the scope, breadth, and possibilities available to family physicians.
I came into medical school interested in Family Medicine, among other fields. Since then, Family Medicine has become cemented in my mind as not only the best specialty overall, but the best specialty for me. All along the way, the NCAFP has been there to encourage, guide, and provide invaluable opportunities.
My first meeting with Chapter staff was at the annual Family Medicine Day held in Durham. This meeting is jam-packed with a motivational keynote address, hands-on workshops, and opportunities to engage with dynamic training programs all interspersed with the occasional joke from Dr. Higdon, the current Academic Representative on the NCAFP board. NCAFP staff were as energetic as ever, welcoming and excited to meet budding physicians struggling to find the right path. Like most NC medical students, Tracie Hazelett was my first point of contact with the Academy and the robust community of family physicians throughout the state. Her continual support has taken me much farther than I could have gone on my own.
I was encouraged to apply for the summer rural internship experience, in which I was privileged to participate during two weeks in
Mr. Smith is a 4th year medical student at Campbell University School of Osteopathic Medicine (CUSOM). He received his Bachelor of Science degree in Neuroscience from Brigham Young University in Provo, UT, prior to moving to NC. Once in medical school, he quickly became involved in the NCAFP through the Eastern Rural Health Program. After that experience, he sought other ways to get involved, which led to serving for two years on the Academy Board of Directors. In December 2019, he completed his term as the Student Director. During his first two years of medical school, Cameron served as President of the CUSOM Family Medicine Club and volunteered with Campbell’s Community Care Clinic. Cameron has completed his third and fourth-year clinical rotations in Fayetteville, NC. My first trip to Asheville for the Winter Family Physicians Weekend was also a career highlight for me. I was impressed with the sheer number of people in attendance, so many of whom shared the same values and goals for the future of health care. The quality of the lectures was remarkable and the networking I was able to do with other students, residents, and practicing family physicians during the conference continued to impact me throughout my remaining time in medical school. During this event, I also had the honor of meeting other physician leaders and Academy staff, including the NCAFP’s EVP, Greg Griggs. Each time I have the pleasure of interacting with him and the entire Academy team, I am blown away. From the facilitation of high-level board meetings, explanation of intimate legislative policies, and later rallying the crowd (mostly you, the Academy’s membership) to donate thousands of dollars for student programming, their commitment is unmatched.
Those generous donations have helped me and countless other students enjoy the benefits of conferences, clinical experiences, lectures, workshops, and net
Family Medicine Day Saturday, March 7th, 2020
working. All these experiences made me want to do more, so I pursued a position on the NCAFP board of directors, which I had the privilege to serve on for two years. I learned at the feet of great leaders such as Dr. Charlie Rhodes, Dr. Tamieka Howell, and Dr. Alisa Nance. Other board, committee, and Academy members -- too many to name -- have also been instrumental in encouraging and guiding me towards my bright future, and I cannot thank them enough.
To current medical students, I encourage you to investigate and apply for everything the NCAFP has to offer. The experiences are truly one of a kind and will leave you excited for Family Medicine.
To current physicians, on behalf of all students, I thank you for your generous gifts of time, money, encouragement, and mentoring along the way. Students are always looking for strong role models. If you feel able, consider becoming a community preceptor and take students in your clinic. We need more of you!
To the NCAFP physician leaders and staff: thank you, thank you, and thank you! I attribute all of my success thus far in my Family Medicine journey to you, and I will be forever grateful.
The future of Family Medicine is bright!
Registration Now Open!
The NCAFP and the North Carolina Area Health Education Centers (AHEC) program are excited to present North Carolina’s 13th Annual Family Medicine Day.
This fantastic one-day event is North Carolina’s premier family medicine residency recruitment conference. The day will begin with lunch with keynote speaker, Dr. Shannon Dowler, Chief Medical Officer for North Carolina Medicaid at NCDHHS, followed by 5-hours of clinical skills workshops led by North Carolina Family Medicine residency programs. Students will enhance clinical skills while getting to know the residents and faculty of the very diverse residency programs available in North Carolina. During the evening residency recruitment fair, you will learn even more about North Carolina and other regional Family Medicine residency programs.
Don’t miss this incredibly fun, educational and hands-on day! Registration is currently open for exhibitors and medical students.
For complete information and online registration, visit www.ncafp.com/students/fmd.
Lessons Learned from a Year-Long Journey as the CDC Foundation Clinical Consultant for the Opioid Crisis
By Blake Fagan, MD Mountain Area Health Education Centers Program
I was fortunate to be selected to be the CDC Foundation North Carolina Clinical Consultant for the Opioid Crisis for 2019. I have a passion for this work as I have had patients die of opioid overdose. First, I want to acknowledge that for several years many people and organizations have been working diligently on prevention, treatment and recovery of persons with opioid use disorder (the new term for opioid addiction). And, they will be working on this problem for years to come. They are the true heroes in this struggle. Thus, pardon my naïveté as some of the following lessons that I learned are most likely, “of course, we have known that for years” moments for the folks working in the addiction space.
1) We need to prescribe opioids appropriately … which means a lot less or maybe none at all. For acute pain we need to follow the NC STOP Act, which states: if we are going to prescribe opioids for acute pain, prescribe 5 days or less and after surgery 7 days or less. North Carolina physicians are doing a great job at prescribing more appropriately. But we could do better. For example, the patient with a kidney stone. For years, I would prescribe oxycodone/acetaminophen until the patient could see the urologist. Substituting ibuprofen and acetaminophen given at the same time instead of an opioid, provides equivalent or better pain control without the risk of addiction. 2) Children should not get opioids unless absolutely necessary. I believe this is true for all types of pain, but the only randomized controlled trial in adolescents is with third molar extraction. A study of 15-16 year olds who had their wisdom teeth out and were given oxycodone/acetaminophen show 6% entered into an opioid use disorder within the year. If instead they were given ibuprofen and acetaminophen (which the dental literature says is superior pain control after tooth extraction) then only 0.4% entered into an opioid use disorder within the year. You cannot tell which kids will fall within that 6%.
3) We should not start opioids for patients with chronic pain unless all other modalities have been exhausted. The 2018 SPACE trial states, “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee OA pain.” A 2007 Annals of Internal Medicine meta-analysis concluded that if a patient has chronic back pain and is on chronic opioid therapy, their lifetime risk of having a substance use disorder is 36 to 56%.
4) Encourage everyone to get unused opioids out of their homes. There are millions of unused opioids in unlocked cabinets in people’s homes. This is one of the ways that kids, grandkids, friends and other relatives start misusing opioids.
5) Bottom line: Opioids can cause brain changes… not in everyone, but in some people. We do not know how an individual will react to opioids. 75% of daily heroin users started with opioid pills. Approximately 40% started with a legitimate prescription from their provider. 6) Access a. Expanding Medicaid would instantly allow about 400,000 North Carolinians to access medical care through insurance. Many patients with Opioid Use Disorder could get their chronic disease treated if they had health insurance. b. We need more providers waiver trained to prescribe buprenorphine. Only 11% of people in North Carolina who had an opioid use disorder and tried to find treatment in 2016 were able to find a prescriber of medication assisted treatment like buprenorphine. The great thing about family physicians is that we can take care of their primary care needs as well!
7) Stigma kills people Patients, patients’ families, providers, law enforcement, and citizens in general continue to think of people with opioid use disorder (OUD) as having failed morally. However, OUD is a chronic relapsing disease just like asthma, diabetes, hypertension, or COPD. The stigma is a huge barrier to starting the medications like buprenorphine; and frankly, is a reason that patients stop taking their medications too early, often times inciting a return to use.
Academy Partners with NC Dental Society and NC Pediatric Society to Promote Children’s Dental Health Month in February
MEMBERS: State Dental Varnish Project is an Excellent Way to Improve Care
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. Poor dental health affects overall health, and if left untreated, tooth decay can lead to tooth loss, infection and even death.
The NCAFP has partnered with the NC Dental Society and the NC Pediatric Society to promote the importance of dental health in young children and to raise awareness of North Carolina’s highly successful dental fluoride varnish program, Into the Mouths of Babes, that helps prevent tooth decay in young children. The NCAFP and Family Medicine was instrumental in launching this program in 2001.
Get Trained Online to Provide Dental Varnish
North Carolina’s Into the Mouths of Babes Fluoride Varnish Program (IMB) is a successful medical model of providing oral health services for very young children. The IMB program has teamed with WAKE AHEC to offer a convenient online training option to physicians and other providers interested in offering the service. The training features an interactive e-learning course that teaches physicians and providers all the basics, including how to conduct an oral evaluation and risk assessment for children ages infant to 3 ½ years; how to refer young children to a dental home using risk-based guidelines; how to apply fluoride varnish to the teeth of young children; and file a Medicaid claim for the oral evaluation, counseling, and fluoride varnish procedure. Training is now available online!
The e-learning course is available to physicians and providers statewide at www.ncafp.com/imb-training.
Get to Know Value-Based Care with Videos
Interested in learning more about value-based care and how it might be changing the way you get paid? The NCAFP partnered with Humana to produce an educational video providing an overview on this evolving topic. To watch the two-minute trailer, which was introduced at the recent NCAFP Winter Meeting, visit www.ncafp.com/vbc2020.
To view the entire video, simply visit www.ncafp.com/ value-based-care. Please remember to complete the very brief survey about the video, which helps us determine the value of these educational opportunities.
